Sunday, September 18, 2011

Five Days Four Nights In the Land of Limbo

Sunday, September 18, 2011

     I have read and heard a lot of rhetoric and hyperbole about healthcare.  The very word, “healthcare,” invokes a response from my eyelids akin to sleep on the cusp of coma. If I hear one more expat pensioner living off the American tax payer, tell me endlessly that they, “damn well don’t want no ‘obamacare,’ cuz no one tells an American what to do,” (which I always found funny coming from guys whose patriotism rarely extended further than their wallets and spent their entire life, usually in the service, rarely in combat, being told what to do, by senior NCO’s), I will shoot myself; Which ironically, would really score the point of my story.   Healthcare, particularly in America, has been transformed from a real and civilized concern of society to a political tool of blunt force trauma, wielded not with surgical skill to dissect and cure, but as a rude instrument fashioned to define party and worse, social affiliation.  We’ve all heard it, complicated options reduced to childish slogans, “Obamacare,” and other stellar contributions to the think pool.  The simple fact is that people in virtually all civilized countries, (yes, even America), can, will, and do,  find capable doctors and nurses to attend their needs when they find themselves in the unfortunate predicament of  bleeding to death, or merely infirmed  and unable to help themselves.  This is the undiluted reality of healthcare; To be cared for when we are injured; To know we wont die or be abandoned when we are weak; To care for those suddenly taken ill; The most basic tenant of a civilized and humane society.  The plain truth is that in America one will find a medical response to a medical emergency and in Canada, Australia, most European nations, among many other civilized nations in this world, you can receive substantially more than immediate care, you can receive comprehensive health treatment. In the Philippine Republic you pay or you die.  This is the story of how the mother of my children almost died and how I cared for her health. Simple really, health and care; but nothing could be farther from that simple truth. 

     Marilyn seemed to be doing as well as expected following Maya’s delivery in a typhoon, in the hands of our midwife, who’d been up all night with her hands in someone else’s uterus.  I have often worried about the fatigue factor in matters of medicine, piloting, and sharp instruments; no one ever died from a bad photo, at least not physically.  On August 2, following nine days of bed rest, Marilyn’s reasoned, and not unexpected post partum bleeding, became serious as she began to hemorrhage that terrifying Tuesday, made all the more traumatizing because summoning an ambulance here is a lot like finding gentle currents in a riptide. It is difficult to describe the feeling when confronted by someone you love lying in a bed of blood, in obvious panic, losing all color and consciousness.   I managed to flag a trike a block from home and directed the driver immediately to the medical birthing home of our midwife, being the closest medical facility I knew.  It was raining, and Pinoy trike drivers generally act with the urgency of a lizard sunning itself; When the driver stopped to let a security guard wave out some vehicle from its parking space and into our traffic, I told him in loud and clear terms he could understand, that I would physically throw him off the bike and drive it myself if he didn’t get around the car and drive like his own life depended on it, (which at that point it did).  I used language a bit more colorful than my mother likes to hear, but life is not always an experience in gentility.   It seemed to have the desired effect, as the guy suddenly exhibited a proclivity reserved for race car drivers and road rage pursuits; apparently the sight of blood alone is not enough to motivate the Filipino.  Never underestimate the motivational power of well placed rage and vitriol, just choose your battles wisely, especially in the republic.

     Arriving at Grace’s, well guarded panic gave way to terror, and a kind of breathing best reserved for kidney punches, as blood and clumps of bloodied flesh, (what I latter learned where latent elements of the placenta – discharged with the hemorrhaging), marked Marilyn’s path to the examining table.   Clearly all that the midwife and her nurse could do was attempt to evacuate what were now toxic elements of placenta that had not been properly evacuated.  As I waited those rarely felt but decidedly surreal, “hour long minutes,”  for the ambulance to arrive, I remembered the horror of looking at Marilyn and thinking she could die and, with no humor to help wash down the idea,  my  worry regarding fatigue in matters of medicine, piloting, and sharp instruments stuck in my throat. 

     As Marilyn was placed into the ambulance I told her the lie people in such situations tell others, “Everything will be ok.” It’s at best a hope, it’s not a truth, and it tastes like a lie on the lips you hope will not prove fatal.  Traffic was expectantly terminal, with mongering jeepneys and darting trikes competing with a minority of private vehicles and an endless interruption of Filipinos on foot intersecting traffic without any care to corners, crosswalks, or their own life.  I’ve come to believe that many Filipinos, subconsciously accepting their fate, have a latent death wish, but that’s another story.  As we cut through the congestion and endless streets, lined with humanity, goods, and food stalls, I silently placed a call to god, but I never seem to get a confirmation, just a lot of hope that the line is clear and the signal strong.  Maybe today I’ll be the ninety eighth caller to GODX FM. I suppose, to paraphrase Woody Allen, that’s the paradox of faith; It’s a small hook to hang your hat on, but its all we get.  

     Amado Garcia Hospital is located on a stretch of Rizal Street that is actually home to three hospitals and medical centers, no less than ten birthing homes, peppered expectantly with pharmacies and topped off by a generous dash of carenderias, where a plate of adobo or a piece of fish can be had with some rice and a drink, on the cheap, and on the fly, for those ensnared in medical row.   Once we traversed one last river of trikes, screaming to fill a fare or disgorging one, our ambulance found safe harbor at the street side doors to the Amado Garcia ER.  Exit ambulance and enter the absurd dance that is the Garcia experience, a Grateful Dead concert paled in comparison to the carnival madness. Marilyn was immediately attended to - more to do with the familiar face of our midwife and a tall foreigner with a baritone bark.  Clearly, the site of a ghostlike woman covered in blood does little to rejoin much reaction as I was to learn, observing similar situations play out over the course of my week wandering about the ‘Hotel Garcia.’  We got Marilyn’s started on an IV of antibiotics and another of Dextrose, (no IV in the ambulance), and she was typed for her blood and a transfusion ordered.  That’s as far as the good news traveled.  Instead of immediately initiating said transfusion I was handed a prescription and directed to the cashier.  Words escape one at moments like this, “welcome to the Buko Republic.”   

     One minute you’re in shorts having breakfast, covered in milk and children, the next you’re in an ER, covered in blood, but in the republic you better not forget your wallet and don’t even think about American Express - it’s definitely not welcomed here.  Pay for your loved one’s blood or if solo pray you went down with a wallet containing cash or contact information because that’s the status quo.  Pay or die, I exaggerate not.  I presume that if one was brought in without any identity documentation, (or identity bracelet as I’ve come to consider), alone and dying, the authorities would attempt to make them comfortable, but little more. Choose your battles, and your alert methods, wisely.  I went forthwith to the cashier where I obtained the holy ‘OR’ official receipt which cleared me to make haste to the blood bank and initiate my first of three blood purchases.  Words simply elude one regarding the obscenity of clean and orderly insanity. 

     Marilyn was eventually transferred upstairs to a private room, which strangely, was only a few hundred pesos more than the public ward, which was as sanitary as the crew quarters of an eighteenth century sailing ship, and mercifully filled to capacity.  A friend remarked, days later, that if you ever want to contract an airborne contagion, hit the ward of any hospital in the republic and you’re as good as infected with some manner of airborne pot luck.  At this point I should mention that Garcia is a private hospital, and there exist something in the area of seven hospitals in Angeles, six of them private.  The one public hospital is named Ona, which should be named, “ano,” which is the tagalong word for, “what.”  Ona is where people go to die, whether they know it or not.  I was there once, for as long as it takes to walk in, walk about and walk out.  I had dengue fever, it was the start of the height of the rainy season in ’09 and even in my delirium I had the presence of mind to run.  Ona actually makes the crew quarters of said referenced eighteenth century ship look like heaven, and that would be after a six months at sea, in bad weather.  I don’t think they even have a blood bank on site, and only until this happened did I ever think of the word blood bank as anything other than a euphemism.  Welcome to the republic.

     Marilyn’s room was quiet and secure and she was as comfortable as a heavily sedated person can be, which is to say, she was resting peacefully. I on the other hand was consumed by fear, concern, and grief, least of which was how we were going to pay for all of this.  Oh, and the realization that the hospital had no cafeteria, and nothing resembling so much as a coffee machine.  I can find a coffee machine in the oldest mall in Luzon, so the rational behind this just flummoxed me, but hey, who am I to want coffee in a hospital at 4:00 a.m.  Fortunately, as mentioned, Rizal’s hospital row has a well justified assortment of eateries, but everything locks up by midnight, also astounding.  They had posted visiting hours, which I regarded with the dedication of a teenager to curfew.  I slept on the room’s bench and when she was more stable I shared the bed.  Apart from wandering Rizal Street, the intersecting side streets, and exploring the old churches and ghettos I lived in that little hospital room for the duration of Marilyn’s confinement.  I had arranged for the children and our nanny to stay at friends who also have small children, as well as familial and hired help to aid them.

     Four walls, a clean bathroom, that little bench, and a tank of oxygen; certainly not Cedar Sinai but I was grateful that she was stable and the room was clean.  She had a total of four intravenous bags delivered through two veins, including blood, antibiotics, dextrose, metrondazole, various injections of things I didn’t have a chance to inventory, and a steady flow of oxygen administered intranasally.  She would be monitored that first day, night, and into the following day, to see if she would respond to the antibiotics treating the infection and the blood transfusion. There is nothing quite so lonely or heartbreaking than sitting under a fluorescent light in a third world hospital at four in the morning, watching someone you love fight for their life while you face the totality of your predicament without the aid of sleep, where no one speaks your first tongue, hoping your infant children are safe.   I have often said it’s hard to calibrate misery but that’s got to be a personal watermark.

     Dr. Theresa Belmonte, hospital staff OBGYN, and friend of our Midwife, was courteous, and articulate, but kept bankers hours and was frequently vague as to the true nature of the problem we were facing.  She usually visited late morning following Marilyn’s ‘scheduled’ breakfast, which like all three meals, continued to come, although she under strict instructions not to eat.  Should I say something? Choose your battles wisely, besides I was hungry! It’s strange how much faith and trust you place in relative strangers, like the good doctor, (and real estate agents – ouch), at times like these, add to that the incredible stress, hopelessness, and sleep deprivation, and your pretty much a child lost in the mall looking for a big hand to help you.  

     That second day brought only mild improvement in her Marilyn’s condition and she continued to run a high fever.  The antibiotics and intravenous fluids were helping but as feared she was not stabilizing and x-rays and ultrasounds were ordered.  In all,  three 450ml bags of  B Positive blood were transfused,  which is about 1.5 liters, factoring in that the average male has about ten pints/five liters of blood and the average woman has about eight pints/four liters of blood, she had lost more than 1/3 of her bodies blood supply.  I shudder to think what would have happened if we had gone to Ona AKA O-NO.  It’s only amusing now, and even now only mildly so.

     The bottom line, as best the bottom line was to be drawn that second day  by Dr. Belmonte, was attributed to various indefinite sources including,  but not limited to; The uterine wall not adequately healing where the placenta attached;  Also that previously undiagnosed anemia was a plausible cause of abundant bleeding, (which does not cure question of cause); and almost as an aside, the doctor mentioned, and I quote, “the existence of possible residual placenta,” I can promise you that the memory of Marilyn’s  blood and “possible,” placenta on the  both the floor of the birthing home and the hospital  made me begin to feel that I was talking to John Dean about Richard Nixon  before Dean cleared his desk.  The relationship between our midwife and our physician clearly served to cloak the definitive source of the problem, and the elephant in the room was actually pretty easy to obscure when your audience is a semi conscious woman and a sleep deprived man desperate for any kind of answers.  In time it would be revealed quite clearly that the placenta, insufficiently evacuated at birth had turned toxic and worse, had almost killed Marilyn.  Ultrasounds and X-rays bore this out and dictated immediate surgery that evening.  Thoughts of concern mix with fear, and exhaustion, along with the staggering realization of the increased costs associated with surgery, to say nothing of unscheduled surgeries; Costs,  which, as we were to learn, would be due in full before one was released from the hospital.  In fact I later learned that only owing to our doctor’s advocacy was the surgery even ordered without prior payment.  Why she did this I will never know with any finality or certainty.  Life in the republic is painfully cheap, a neighbor of ours, only seventeen, died a few months ago when a previously undiagnosed heart problem rendered his parents merciless before the hospital staff.  He was apparently sitting outside his house when he began clutching his chest.  He died in the trike on the second leg to Ona, having been refused admittance for lack of funds.  I hope I never again meet anyone whose fate comes to that crossroad, which is traversed in the republic daily. 

     I had about an hour to contemplate our predicament between the reading of the X-Rays, and ultrasound, which felt more like a reading of my own will, and tentatively slotted time for the surgery itself; In that intervening hour I tried desperately to get an answer as to even an approximate cost for the surgery; forget the cost of the anesthesiologist who was performing a spinal tap, and forget the perpetually administered drugs, procedures, room, technicians, doctors, and, dare I forget, the blood.  I attempted to ascertain cost from the Billing department with whom I felt like I was trapped somewhere between a bad Abott and Costello routine and the movie Brazil.  Eventually I cornered our surgeon in her staff office where she took the vague road with quintessential expertise as she reclined and mused, “I really don’t like to consider the cost of surgery as it impacts my ability to focus on the needs of the patient’s health and well being, which is my only concern.” I kid you not, it’s almost verbatim.  So maybe it was lack of sleep and maybe it was just my final surrender of patience among so many patients, but I simply leaned into her personal space and said, “Look, blood is not the only thing hemorrhaging from us this week. I’m exhausted, just tell me; it has to be a number bigger than a crumb and smaller than a mountain – take a shot.” Amazingly she ended up being within two thousand pesos, or forty dollars, from the line item of the surgery.   Amazing what a little candor and a lack of personal space can affect.  I had no idea how we were going to possibly pay for all this, but at that point you’re in the valley of death and you can fear no evil, or peso.  

     Marilyn went into surgery, that evening, on schedule and I had to sit in a hallway and contemplated our life together in this place, in my own valley, which was becoming increasingly cold.  The overhead hallway speakers were piping really bad pop songs, somehow you’d think they could pump in some Handel or even a little Strauss, some choral music, even a waltz, or Jazz.  I’m not asking for Coltrane just some kind of auditory elixir that bore some resemblance to reasonable auditory mellow.  Sitting in the isolation of a surgical waiting area while its raining pop music is cruel and unusual, and prone to drive one already lost in existential reflection to a darker place where there is no light.  I ticked away the hours looking out over the city in its own waning light and wondering, as I often do, what all those little ants, I will never meet, were doing, and if they were happy, and if they were as worried and as scared as I was feeling

     I was allowed into the surgery room before she was moved to recovery; I had to wear top to bottom scrubs.  Everyone but one attendant and an orderly remained, the detritus of the surgery still being cleaned up. It was surreal.  I held her hand.  I didn’t speak and she could not talk.  It’s amazing how solemn certain simple actions can be. She was transferred to recovery and back in her room around midnight.  Dr. Belmonte told us that the decidedly toxic material was now a thing of history, and medical waste, (save for a medical grade sample I still have possession of), and that the infection and fever should now abate over the course of the evening.  I spent that night monitoring her.  Occasionally wondering the three floors and six nurses stations, where, on one of my rounds, I found every nursing personnel and the overhead lights dead to the world– I exaggerate not.  I also spent a few hours in the chapel on the third floor where I prayed silently and then contemplated the Stations of the Cross.

     The following day, early afternoon Thursday, Marilyn awoke and was able to eat for the first time in almost three days.  She was placed under continued observation by Dr. Belmonte and it was and hoped that she could be discharged the following day.  At 3:00 pm, as I had done everyday I went to the ever present billing office to get a daily print out of the expenses; it was an odious but almost endurable total sum.  I had been led to believe that the doctor’s surgery fee and anesthesiologist would bill separately and that those costs could be paid to their respective practices over time.  I continued to believe this and it appeared to be the case when I got the daily update of expenses on Thursday afternoon and found the surgery room on the list of billable but not the professional fees.  I spent that day and evening calculating, and by liquidating every single reserve we had managed to build, and call in debts owed, we’d be able to crawl out from under this calamity.  The thought of seeing our children and knowing there mother was safe was enough to make the repercussions of the financial disaster almost tolerable and I finally let lapsed into sleep around two in the morning.

     The sun failed to appear on Friday though word of its existence was promised to me.  As is the habit in Filipino hospitals various liturgy of catholic devotion echo the corridors of healing at differing times day and night, and as the sun made its alleged rounds that First Friday of the Catholic calendar, so too did the repetition of rosary prayers.  I’m a big fan of the holy mother but I find it hard to defend curative healing with pleas to pray for us now and in the hour of our death more than thrice, while body, mind and soul cry out for a quieter nature called sleep.   I understand the simplicity of form in making the liturgy accessible to all, just not delivered through that blasted overhead speaker system.  I confess, I was feeling a tad less Christian by the tenth Hail Mary and the lure of peaceful meditation had clearly eluded me.  I was risen and so I surrendered and sought out one of the numerous coffee carts plying their trade in the gentle, but unending rain of that week.  Marilyn was sleeping like a baby while I wondered off to think over the true nature of democracy in the republic, the existence of god, and the fiduciary apocalypse on the other side of this first Friday.

Late morning brought our neighbor and the Filipina insistence on the curative power of food; it is well known that the general solution in the republic to almost all matters of concern begin with the utterance, “lets eat,” or in this case, “let’s make her eat ‘til she rises from the bed!” I was dispatched in earnest to retrieve as many calories as possible in the form pork based soups and sweet breads.  The fever had abated, color returned to her complexion and Dr. Belmonte cleared us for departure when she stopped by for a few moments. In retrospect she seemed more interested in my take on the American debt ceiling fiasco, and, as the bill reflected, I did indeed pay for this thirty minute symposium.  In retrospect, I wonder if she’d have been receptive to a counter bill, for services rendered.  Following our doctors visit I made my daily pilgrimage to the sacred billing department and said hello to the cashier, with whom I was now on a first name basis.  The additional day rate had been tacked onto the bill, along with the doctor’s room visit.  I anticipated no surprises, which is always a mistake in the republic.  One hour later, bags packed, and Marilyn cleaned and dressed, I went to pick up the final bill and came face to face with the black heart and hypocrisy that is the Philippine Medical establishment.  The final bill had more than tripled with the now very apparent addition of all surgical fees.   Amazing how no one could tell me what the procedure would cost, and no one even bothered to include the most important disclosures until the eleventh hour.  It was then that I learned what I have previously alluded to; All fees are due and payable before patients are permitted to exit the premises.  I demanded explanation, received none, and was eventually told someone would come to the room and explain the policy.  As I walked upstairs to the room I thought of Edward Norton’s narration in Fight Club: [voice over] “Please return your seatbacks to their full, upright and locked position”.  This can’t be happening, it’s not a movie, and it’s not a prison. “We have just lost cabin pressure.”

Instead of picking up our packed bags, x-rays, and miscellaneous unwanted purchases, (forks, spoons, toilet paper, gauze, everything is sold at a retail premium),  and leaving the madness of Amando Garcia  we were now veritable prisoners of the hospital, pending full and complete payment of a bill that was now circling north of one hundred thousand pesos.  The per capita income in the Philippines, as borne out by the republics own senatorial statistics and the World Bank, is pegged at $1,463 US dollars.  This translates to a monthly income of only P6,475; Yes, that’s right, P6,475 and zero centavos!  Yes, the cost of living in any urban Filipino city is demonstrably higher than that, a fact, I am acutely aware of, as I now earn in pesos, and our rent alone is twice that number, (want to pay less don’t bother – if you don’t get dengue you’ll be taken care of by guaranteed robbery in the low rent area, as a Kanu or foreigner you simply don’t get that option in urban areas and in the provincial areas its fortress of flounder.  Our neighbors are generally good people and all but one are Filipino, that is to say, it’s a modest neighborhood and any more modest and we’d be incapable of the kind of traffic or ability to generate revenue in our store. This little economic observation on per capita income also explains the rampant theft, estafa, corruption, and the massive disparity between wealth and poverty in the republic. It fuels the terminally kleptocratic plutocracy that calls itself a democracy.  Yes, in straight from the hip terms our hospital bill was a year’s wages for a university certified teacher, and it was due in full.  If it sounds insane and absurd it is; don’t get me wrong, I still like a lot of things in my adopted homeland but this is not one of them; it’s quite potentially going to motivate my exodus because the future of my families body, mind, and spirit are immeasurable to me while clearly measured by the republic. 

     I believe the only reason we were not charged per procedure was because one, I am a Caucasian foreigner, and two, Dr. Belmonte was working in some degree of complicity with our midwife, who rather apparently been negligent; proving that point the republic is another story, but I digress. - I used to muse that I was like a phoenix rising, but this is more ash than I’ve ever had to lift before, a man can truly only take so much.  I demanded someone from accounting come to the room and defend this policy of full payment and I got Tweetle Dee and Tweetle Dum at four pm on a Friday.  I already knew what was going to transpire; if these two identically dressed bookends could dance enough double talk for an hour and skate we’d be someone else’s problem and they could snake out of the hospital lying to us that they’d send someone of higher authority to our room, which is exactly what they did; a supervisor was promised to be sent and  no one ever came.  When I went to billing an hour later it was dark and vacant.  Welcome to the republic – pass the buck, or peso, and run. I went through this in a prior email, but, in short, Garcia’s admittance agreement regarding fees, states no such full pay policy and is utterly ambiguous regarding payments, stating nothing more than, “payment be paid in a due and timely manner.” 

I am tired of learning about loss.  I remember pacing back and forth in front of my window overlooking the hills in Hollywood while Sue Silvers stewardship piloted my home into an ice burg and thinking how life had been filled with so much suffering; I used to muse that if the Anderson brothers had not more day of suffering that we had seen our quota of loss to last a lifetime.  How far from the threshold I, for one, was to find myself.  I have always considered myself a progressive realist, seeing the glass neither half full or empty; I see the glass as nothing more than a glass, and I will never be the one saying the end justifies the means but I am grateful when I see my son and my daughters faces smiling back at me, and frankly happy even when they are screaming, shitting, puking, pissing, vomiting, upon me and best of all when they hug me and laugh.  I love them and for that I have seen some sense in my suffering.

Make no mistake about it this experience was devastating to us, emotionally and financially.  We overspent our closely regulated monthly budget by about a year.  The path back is just that, a headlong battle that is far from won.  I have to deal with a back molar that cracked and I’ve decided that the pain is tolerable.  Dylan is late on his latest vaccinations and Maya still needs her first series of newborn vaccines.  I will cover Marilyn and the children with Phil Health, which offsets about fifty percent of any future medical emergencies.  I am not eligible.  In the days and weeks that mark Marilyn’s recovery I dedicated myself to the shop, for better and worse, and the care of my family.  I also, through research, learned what I had always believed but never clarified; that the infrastructure, of the archipelago, both private and public, simply does not provide the level of healthcare needed to sustain a civilized and healthy nation; Never mind the commercials endlessly selling things every family “needs,” all the formula, clean clothes, and food products in the world won’t cure you of your ills should you dare to face a medical crisis.   Because serious illness strikes without the impact of a tsunami, families devastated by a medical crisis suffer in silence and isolation amongst their fellow citizens.  There is nothing headline grabbing about one families devastating medical emergency, though it may leave in its wake more damage than the worst of fire or water or wind.  The ability to cure does indeed exist, but the will is absent to create or implement any coherent public or even private remedy to the crisis of medical care in the archipelago.  You fall seriously ill and you pay or you will be shut out! Period! People die everyday here because they can not procure the impossible sums mandated to live in the face of an emergency, and can not even take on the yoke of mortgaging their life to payoff the purchase of one’s very health. 

At the national level, The Philippine Health Insurance Corporation or PhilHealth was created in 1995.  A government owned corporation, PhilHealth attempted to achieve universal coverage for the archipelago.  However, PhilHealth has faced predictable corruption and is currently working with something in the area of a twenty billion peso debt and projected to go bankrupt by 2017, unless the government bails the program out.  It also has dramatically reduced coverage benefits and services in the face of increased subscriber claims.  It remains our only real option and I am hoping to get Marilyn and the children covered when we can afford to.  At the most basic level of medical remedy exists the barangy medical center which is little more than a band aid station where you can get an aspirin and have vital signs checked.  It feels daunting and depressing as I write and contemplate all this, I suppose because it is so, most emphatically disheartening.

To paraphrase Tony’s tribute to Wayne Gretsky, “I always miss 100% of the shots on goal I don’t take,” but Dorothy Hamill would have a better chance getting a hat trick, during the Stanley Cup finals, than we’d have getting any punitive settlement for our troubles.  Choose your battles wisely and know when to set your sights on another hill.  The rule of law is simply not an equitable solution to problems in the republic.  As my friend Jamie reminded me, never forget where you are.  The thing about the archipelago that you have to remember is that under the thin veneer of beauty and good natured joviality is the incontrovertible fact that the republic represents one of the worst examples of systemic corruption you can think of outside of Africa and the Middle East.  Its constitution is less than twenty years old and it only emerged from martial law under the Marcos Dictatorship in 1990.  Just consider,  if you will, the greatest personal experience of corruption you can recall, now imagine trying to remedy the wrong within a system of justice whose workings turn with the speed of cobweb covered gears on the slowest engine you’ve ever seen, whose very parts are being scavenged as they turn.  

I liquidated most of our remaining assets to repay the overnight loan from my buddy Charlie, stateside; his international monetary fund represented the lion’s share of two sources I had sew out of the night’s air; which in no uncertain terms, along with our savings, afforded  Marilyn’s escape  from the clutches of Amando Garcia in-hospitable hospital cum penitentiary.   Charlie is in no position to loan money, but he knows the predicament of one in the midst of medical malaise, Filipino style, having done a good bit of his residency in Angeles.  His righteous assist as a medical practitioner leans less on the crutch of irony and more likely stands as a pretty firm reason for helping us out; He knows medical emergencies loom with a special darkness in the land of sunshine, like a tsunami on a moonless night.  Needless to say it was a small victory to repay him and balance the scale he couldn’t well afford to tip.  We have one last loan to satisfy, which a cousin married to a geriatric pensioner proffered, likely under duress, and owing, (no pun intended) to the advocacy of his child bride.  The poor of this land and expat pensioners share a common life on the line, the poor living from peso to peso and the pensioners living from government check to government check, usually spent before its cashed by post adolescent concubines .   I’ve heard told that the pensioners are sympathetic to the plight of those facing calamity, but unless its in a dress speaking pigeon English, said sympathy lasts about as long as a bar room confession of love, which is to say, not much longer than the rising sun.  So that loan gets paid off this week and we go on the rice and soy diet.  We also can not face another medical emergency which makes me more grave and stoic than usual.  Its strange how much light and love children bring into your heart and how sobering life appears when they’re raised in the midst of so much peril.  I’m proud of myself, but its odd how doing my best and being a good person has bears fruits that can’t be shared.  I protect my children and love them and that is its own reward.  Their mother is safe again and cared for with all an endearing love born of suffering.  I pray her health, my own, and that our children will be in good care for a very long time to come.  It was two more months of barbarous trials peppered by the brilliance of Maya’s birth.  Here’s to tomorrow, may it shine with something resembling the promise of the North Star.  Sometimes I feel like we are the lost tribe, or maybe I just feel like I’m in a curious kind of exile, like Ulysses, trying to find my way home and keep my crew safe.  An old Irish fisherman’s prayer echoes in my head, “Oh God thy sea is so great and my boat is so small.” Amen.

Sunday, July 31, 2011

Maya Grace Anderson

Sunday July 31, 2011     

The week started out with a bang, or a blast, or a series of screams and into the void arrived Maya Grace Anderson, born Sunday morning July 24th.  She came into the world beautiful, and graceful, and with an appetite to fuel her eight pound six ounce frame.   I had just finished watching the Askals, (national football team),  play Kuwait in round two of the world cup live from Kuwait, (meaning it ended about 2:30am Sunday morning), proceeded by my quick lapse into sleep; proceeded by my  return to consciousness about twenty minutes later with an unmistakable plea for aid from the other side of the bed.  

The moment the impending event switches from the abstract to the actual is indeed a surreal moment in what will be many surreal and sublime and anxiety inducing moments over the next few hours.  Dylan took thirty hours to arrive from the time it was apparent, “that it was time,” so I vacillated about going too soon but my gut, (and Marilyns), suggested it may not be thirty hours this time.  There are virtually no taxis in Angeles, and the closest taxi stand is kilometers away but the ever ubiquitous trike could be flagged as easily as swatting at a fly in the dark early morning heat of central Luzon.  Off we sailed, leaving Dylan in the care of Marilyn’s cousin, whom we took on a few weeks back as a nanny in anticipation of the big event.  There we were - tearing through the tropical night, me on the back of the motorcycle, hanging off the side, with one hand on the roof of the sidecar, while ducking my head inside to make certain Maya was not arriving in anything other than a delivery room.   The glorious absurdity of it all never ceases to leave me totally gobsmacked.

Our midwife runs a clean and well maintained birthing home and has delivered over eight thousand babies in her career, including Dylan, and I felt safer there than a large hospital.  Also, as is the habit of birthing homes in the republic I was allowed to be present and actually helped with the delivery, which is totally verboten in the hospitals.  It was great!  Hospitals are so institutional and often they can’t even compare in terms of sanitary standards.  But I digress.  We arrived about 5:30 a.m. to find Grace, (our midwife), already up and one look told me she had already been busy doing what she does best.  Marilyn was dilated but being only one centimeter we got her to bed and waited in the recovery / pre delivery area, which is a nice white tiled room with four private beds each separated by a series of optional hospital pull curtains for privacy and a facing wall of windows that looks onto a courtyard with an aviary and all manner of flora and a few renegade fauna.  It’s all very organic and simple but we really like it. 

At 10:00a.m. Marilyn was only two dilated two centimeters, (tens something of a goal, for the uninitiated).  Grace was not too concerned and suggested we ‘bed down’ as it could be six hours at the rate of dilation.  Every birth, as Grace is fond of saying, “is quite different,” and Maya proved the adage true.  Two good pushes, a lot of coaxing, and a mere thirty eight minutes later Maya entered the world!  One of the truly profound moments in a person’s life, for parties both within and without the womb.  The burden and blessings of her birth are great as will be the task to rise to the occasion.  Here’s to life! 

Monday, July 11, 2011

Reflections Amidst Raindrops

Reflections Amidst Raindrops

Sunday July 10, 2011
Three years, four months, eleven days, and twelve hours in country, (sans puddle jumps to Hong Kong and Malaysia for absurd visa satisfactions).   Has it really been that much time?  I remember Laurel, from another life at UCLA, admonishing me for being too cognizant of time.  I knew better! Her street infused intellect always tasted of the bittersweet optimism that so often appeals to youth.  I have felt old since I first learned that we don’t live forever.  Six years old, standing over the pink toilet at 5818 Kelvin, processing the information I had just gleaned from my mother with a mix of existential malaise and bulging bladder that only a six year old can know. It’s as if my mother told me that news this morning, I can still see the bathroom completely and those louvered windows that made up much of the door to the left; open, close, open, close.  My son affirms my preoccupation with time, and the anniversary of my birth this past Friday brought it all into sharp relief.  This curious Friday anniversary almost marked the birth of my daughter!  What a long strange trip it’s been! But I digress.

Life in the republic is harrowing, to say the least.  I manage to keep us living reasonably well.  In retrospect it utterly eludes me how, some days, we have not merely survived but done so without incident or harm, even flourishing from time to time.  The bottom could fall out tomorrow and while this is true everywhere in the world it is the rule, rather than the exception in the republic. We have endured a purse snatching, pick pockets, a massive and devastating typhoon, looters, and a noteworthy home invasion robbery, remaining, throughout them all, reasonably sound of mind, body, and spirit.  The rampant corruption is top to bottom in all facets of national, provincial, city, and barangay life both civil and government. It’s like a late stage cancer that somehow manages to keep the body looking authentic, even beautiful, but is a heartbeat away from complete and utter collapse.  Contrary to what one would perceive from this description, however, our familial life, in the midst of this, has never been more stable or commonplace.  In spite of the crushing poverty, deception, and criminality I have accepted the reality of the madness, sworn not to be consumed by it, and relish my family.  Ultimately I will either have to find some way to build a well defended home on a beach front province far from the urban insanity or leave the country all together.  I don’t fancy the notion of what is required to endure here.  I have witnessed sufficient deception for one life.  I’d take calm and placid any day.  To see my children grow strong and healthy and know the world from a position of security, compassion, strength and well fortified perspective.

We were hoping our daughter would be born on Friday, July 08, 2011, but she remains reluctant to vacate the womb. Marilyn’s birthday is Friday, July 15, 2011 so maybe she’ll come about mid course and split the difference.  I can assure you I was totally shocked when the ultrasound results came back with the gender.  The sex of the baby being that singular trait exclusively the domain of the father, I was awed and amazed at the notion of both a son and a daughter.  We’ve been vacillating on names as most parents do; wondering what she would prefer; We were reasonably committed to MAYA, but also really like CHLOE, which my friends can’t fathom but I think has such a groovy ‘40s feel to it, also in the running are SHANON, (which sounds too much like a playboy centerfold),  and Savannah.  Marilyn likes Savannah, but it occupies middle name status… and Maya Savannah is just wayyyyy to much onus of obligation for anyone to carry around for a lifetime.  Feel free to toss in suggestions.  The names only firm when the inks dry.

As we stand at the breach of our daughter's birth I read through the Manila paper this morning.  Three primary sources of domestic news exist; The Philippine Star, (too USA today), the Manila Bulletin, (pawn to the prelates), and my preference, the Philippine Daily Inquirer, "BALANCED NEWS, FEARLESS VIEWS" as the masthead declares.  The current administration under Ninoy Aquino came to power last year under a mandate to end corruption.  Aquino is heir to an assassinated father who inspired revolution and a mother who led the country out of martial law.  He appears to have a sincere appetite for confronting the unabated rape of his country,  from hands both internal and external, but it may be a task of such epoch proportions no mortal can possibly steward the sword to its desired end.  The previous administration under Gloria Arroyo is now indicted almost daily with a new charge of gross plunder and graft  involving everything from government contracts, price fixing on the domestic and export agricultural markets,  and literally hundreds of charges, directly attributed to her own hand or the result of her leadership.  Pick a con and Gloria was either writing the order or responsible for the hand that did the deed - bribery, racketeering, and extortion was occurring anywhere an opportunity to cop a peso existed.  

Far too many adorn themselves in the thin veneer of church and state, but sharing one’s ‘blessings,’ and ‘national pride,’ are so often just threadbare  raincoats covering egregiously selfish agendas and appropriation of others body, mind, and soul.  I can walk less than a kilometer from my home and see girls bought and sold like so many kilos of rice.  The girls either don’t know they are being bought for ten cents on the dollar, or learn to accept their predicament and work the angles to their advantage.  There are occasional delusions fueled regarding love but its just simple commodity exchange taking place at its most base and basic level.  That’s all it is; It’s an economy better than rural provincial poverty, (I’ll grant one that); in the booze saturated, frequently drug laced world they accept  to earn ipods, cell phones, and laptops, they become revered as veritable celebrities to far flung families grateful for the ‘remittance,’ or contributions to the coffers.  But for every jive story of a girls life improved, I’ve seen a thousand used up and spit out the other side, trampled on for a few years and left to decay, usually with just as little as when they started once everyone’s  plucked their feathers like so many chickens to the butchers block.   I’ve never subscribed to the notion that shiny shit is better than dull shit, a rational that fuels  the cyclic insanity of the sex trade here - shit is still shit, whether or not one knows they’ve stepped it… or how many times or even how much of it.  Never underestimate the power of denial.  

In spite of all this, or perhaps because of it, I have met some phenomenally resilient people that inspire me; they are a reminder that the soul does not have to be dispatched under  the weighted pressure of so much stone;  the authentically strong and caring shine with a brilliance from the weight almost mercifully impossible in the safety of the first world suburbs and I am reminded of Plato’s enduring words, "We can easily forgive a child who is afraid of the dark; the real tragedy of life is when men are afraid of the light."

I go forward, embracing and protecting my family and will endeavor to write more.  I think its time to emerge from  my self imposed exile.  I’m happy to answer any questions and all notions to the contrary I am living a most decidedly righteous life. Nothing could have prepared me for the buko republic… and perhaps that was ok too.  


Birthday Update

Friday July 15, 2011
Today is a milestone.  I am just not sure which milestones it will represent.  It will either be Marilyn’s birthday or it will be Birthday + 1.  There is a little girl that is most decidedly comfortable where she is and I have mused that if I was being well fed, well housed, and living in peace I too may be reluctant to rally forth into the madness of the seven billion…. Plus one!


Birthdate Update

Saturday July 16, 2011
Still on standby!  Sorta like watching paint dry but with a lot more anxiousness attached to the process.   This morning one of the kitchen pipes burst… it’s faster and easier to do it myself.  More on that later – gonna go for what will most certainly be our final pre-launch checkup.