Author Archive

Misspelling “Embarrassed” in Korea

by on Thursday, August 20th, 2015

King Sejong statue in Seoul with the Gwanghwamun behind

King Sejong statue in Seoul with the Gwanghwamun behind

Ana’s experience teaching in the language school reminded me of the first time my supervisor observed me when I was teaching elementary German in the US as a PhD student in German literature. I was very nervous. At the end of the class she pointed to the blackboard where I’d made a mistake in elementary grammar—in subject-verb agreement or something like that. I blushed, and we laughed it off. At the same institution I took a linguistics class from an instructor whose illustrations of linguistic phenomena on the board always contained English spelling errors. That was a bit much, because she could have checked the spelling in advance, but we pointed the errors out, and she corrected them.

Confucian cultures, however, are “shame cultures” with little tolerance for mistakes or disabilities. Many people also don’t seem to distinguish between “professional” and “personal.” This story illustrates what can happen when Western employees work under Korean management—but also how the employee can eventually excel. Tip: Don’t provide any information the boss doesn’t need to know.

This interview took place over Skype while Ana was in South Korea and I was in the Philippines.

Ana’s story

Before I came to Korea I was living in the United States. I’d just finished a master’s degree, which meant I could teach at a Korean university although my degree was not in language teaching or a related field. When I contacted a friend who’s teaching here, she told me I could check out jobs online or I could come over and find a job, since they were plentiful. I was skeptical because my only teaching experience was a year in South America. But I did come over, and I got an interview at a language school connected with a top university in Seoul. The woman who interviewed me was absolutely delighted with me. She became my boss. Her English name is June.

Nowadays to get a work visa as a foreigner in Korea you need a criminal background check and an apostilled diploma. I’d had some of the paperwork done before I left, but the police station where I had my fingerprints taken did it incorrectly, and the FBI couldn’t read the prints. I had to get them done again here. That meant waiting a month and a half. However, the school was willing to hold the job for me. Then I was sent to a Korean consulate in Japan for my work visa. I couldn’t start working until I had my visa in hand. Before I left, I stopped in at the office to say hello, and June said, “There’s something about you. You bring sunlight into the room.” It was the nicest thing anybody had ever said to me.

I was originally supposed to start in May, but my first day was in mid-July. June came in to observe. During the lesson I misspelled a word on the board. Ironically, that word was “embarrassed.” Afterwards June asked, “Why did you spell it wrong? Why can’t you spell?”

There was another teacher in the room, so I said, “Can I talk to you privately?” We went into another room and I explained that I’m slightly dyslexic.

She said, “I feel deceived.” She dismissed me. Her behavior turned very cold, like I was a horrible teacher. I couldn’t spell, and therefore I couldn’t teach. After that she kept repeating that I’d deceived her by not telling her about my dyslexia. She was talking down to me as if I’d been convicted of grand larceny.

Eventually, I said, “Deception is what you do when your intention is to hurt someone, but I wasn’t trying to hurt anybody. I feel ‘deceived’ is not the right word to use in this situation.” I tried to let it go.

This was still within the first three days of my job. I was waiting for her to tell me the school wasn’t going to keep me on. At that point I was so disheartened I said, “I don’t know if this is for me.”

It was weird because she was so unhappy with me and she so disliked me, but she wasn’t firing me. She was also hammering away at another message: I needed to make it up to her. I’d wronged her, so now I needed to be perfect. I needed to prove to her that I could teach. I’d come to the school without a teaching degree, and she’d thought I could do it anyway. I realized she was telling me to make sure she saved face in front of her boss.

I became so sensitive that I believed everything anyone said was about me, whether it was directed at me or not. For example, the school had special classes where students could get extra help, but none were assigned to me. I thought it was because people had no confidence in me. It didn’t occur to me that I should be happy I didn’t have to take an extra class or that my assignments weren’t made to fit in with other people’s teaching schedules.

So there was this huge hubbub about my having misspelled a word, and then one of my coworkers confided that he was on thin ice. A few days later, between lunch and the first afternoon class, there was an emergency meeting. Someone took our orders for coffee from a nearby gourmet coffee shop. I heard, “It must be really bad if they’re buying us gifts.” At the meeting they told us they’d had to let somebody go. They wanted us to pick up his classes. So I got another class.

In the meantime, June had taken a leave of absence for a month because she wasn’t feeling well—a nervous condition or something. Within the second week of her absence, I was waking up in the middle of the night panicking that I was going to sleep through my alarm. Every day I hated it. I was going to work with a big fricking smile on my face, but I felt trapped. I felt ill all the time. On top of that I had a full course load. I had four classes a day. That’s seven hours of teaching, every day, Monday through Friday—and the extra pressure. But when I took the job I’d made a vow to myself that I would give it 110%, and I did. I never was never late for a class, and I was never unprepared.

Maybe two months into my five-months’ contract, my boss called me into a meeting and said, “We’re not going to rehire you.” I hadn’t planned to sign up again anyway, but it was still a blow to my ego, and my feelings were hurt. Then I started feeling jealous of my co-workers because they were enjoying their jobs while I was in my own private hell. Fortunately, I had friends outside of work I would see on the weekends.

Things started changing when a friend said, “You need to get a thicker skin.” Other people told me to stop fighting and let it go. “Stop trying to make it right. Stop trying to read meaning into everything. As soon as you stop fighting it will be different.” And it was.

When I stopped internalizing everything, it all shifted. I’d find myself in a negative thought, and I’d tell myself, “Stop. Don’t go there.” I realized I was bringing in stuff from the past that had nothing to do with the current situation. I told myself I needed to have a different attitude. I needed to pick out the things I liked about the job and say to hell with everything else.

I got along fine with all my coworkers, all the other foreigners. One day when June snapped at me in front of other people—which was embarrassing and unprofessional—they said, “What was that all about?”

“I don’t know, she just really doesn’t like me, I guess.”

They said, “Why?”

The head teacher of the Korean staff, a woman named Young-ah, was nice and supportive and kind. I have a lot of respect for her. Even in the thick of things, when she saw me in the hall, she’d always stop me and say things like, “How are you doing? How are your classes? You look really nice. All I’m hearing are good things from your students.”

I had the most wonderful group of students. They were amazing people. At first I’d been nervous because my students are business people, and I’d heard how chauvinist Korean businessmen can be. Ninety percent of them were so nice. Drinking is very big in this culture, but when we went out after class and I said, “I don’t drink,” they didn’t make a big deal of it. They just bought me a soda. They were really genuine people.

It made all the difference to focus on the good things. In the future when I get to something that’s difficult, I can remember being in Korea and feeling trapped. After a while I had started enjoying myself, not only because the end of my contract was near but because I was having a good time with my students. I thought, “Wait a minute, I really like my job. Maybe I have to see my boss twice a week, once at a meeting and once in passing. I can do that.”

Fast forward now three and a half months, and my coworkers were having problems with the boss. For example, there was going to be a North American-style Thanksgiving dinner. June made a big deal about including the wife and two kids of one of the teachers. Then the day before the dinner she called him into the office and said his family couldn’t come. Another teacher, someone who had problems with the boss, wrote her an email expressing her feelings. That didn’t go over well. Since I had already worked through all that negativity, I found it interesting to sit back and watch other people act like babies, responding in a very reactive way.

Then there was the episode of the skiing trip which was supposed to be for the staff and the students. [In Korea and Japan attendance at supposedly solidarity-building work functions is mandatory.] The boss was talking about how we could rent a bus, we could start drinking after skiing and then go bowling at night. I really didn’t want to go, so I told them I had family coming to Korea. Other people were saying they wouldn’t go because they didn’t like the boss, like the guy who couldn’t bring his family to the Thanksgiving dinner.

So in response to your original question, “Would you see something like this in America?” I say no. I think an American boss would have asked me what she could do to help. In the States I’ve made mistakes on the job without getting talked down to. When I ran into another foreigner who used to work with June, he was surprised. “Why is she so close-minded? I’m not a good speller. People make mistakes. That’s why we have spell-check.”

This is a shame culture. Your exterior has to look spotless. My students are in class from 8:30 to 5:30, Monday through Friday, for ten weeks. During the week they live here. On the weekends they go home to their wives and their husbands. Then they come back here and do another week. They told me they feel like robots. It’s almost sad. Here if you screw up, you don’t apologize, you don’t show your face. You’d better just fix it. People around you will remember.

One day the office manager, who was always on someone’s butt for something, realized she’d forgotten to tell the students their pictures were going to be taken. It was time, and nobody had showed up. She didn’t say, “I made a mistake,” she just crumbled. She said, “Oh my God, I can’t believe I did that.” She was in a real panic, and then she squatted down and covered her head like someone was about to beat her. One of my coworkers made a sarcastic remark about her not running a tight ship. People were saying, “God forbid anyone should make a mistake.”

I’ve heard so many horror stories about teaching here that I honestly don’t think my situation is any different. I was never told straight-out what they wanted. I had to read between the lines. One of my first experiences had to do with textbooks. My boss held up a book and said, “This is what we usually use, but I want you to go to the bookshelf and pick out one you’d rather use instead.” I picked out two I liked. When I showed them to her, she said, “Oh, no, I want you to use this one.” Another time she asked, “Do you have time in your schedule to take another class?” I said, “No, I only have a small amount of free time, and I need some time to myself.” She said, “But we really need you to do this.” It’s like they give you the illusion of choice, but there’s only one right answer.

June came up to me last weekend and asked how many weeks I had left. I told her two weeks. She said, “I’d like to take you out to dinner.” At the staff meeting beforehand, I said I really enjoyed working there, people had helped me a lot and given me guidance, and I appreciated the head teacher, who had always been nice to me.

I get uneasy around June, but at dinner I told her how I felt, that I had vowed to do a good job and after everything happened there were times when I wanted to give up, but I was really glad I’d stuck it out. I thanked her for the opportunity, and I meant it.

She listened. Then she talked about holding the position open for me during the long wait for the paperwork. She said in Korea dyslexia was looked upon as a disease, there was such a stigma attached to it. She said, “I refused to look at it that way.” She told me she’d had to meet with the dean. Other teachers hadn’t wanted me to stay, because the school was run like a business and they were afraid their clients wouldn’t like it. Even though her head was telling her it wasn’t a good idea, she’d wanted to give me a chance. She said, “You worked so hard, you’re genuine, you’re honest.” She went on and on.

I thanked her. I reminded her of when I’d walked into her office and she’d said I brought sunshine into the room.

She said, “I still think that. I’m not taking any of the other teachers to dinner, and I don’t care whether they like it or not. You’re probably among the top ten most amazing people I’ve ever met. If I ever meet someone else with dyslexia I’d like to share this experience. Can I use your name?”

It blew my mind. I told her I was flattered. I felt she was being genuine. Dinner was a really nice gesture.

Readers write:

Many of the readers of this story on Facebook made positive comments. The majority were English teachers working in Korea.



Benefit for a Filipino Musician

by on Wednesday, August 5th, 2015

Lilybeth Garcia, Skarlet Brown, Nyng Pinion, Nickie Mossman and Joel Galang

Lilybeth Garcia, Skarlet Brown, Nyng Pinion, Nickie Mossman and Joel Galang

Recently I sat on the porch outside Tago Jazz Café with Nickie Mossman, and she supplied the words to go with the photos I’d taken at a benefit a few nights before at Cafe Astana in Makati. (Click on photos to enlarge.)

Nickie’s story

Joel Galang & Nickie Mossman

Joel Galang & Nickie Mossman

The benefit we had was for Joel Galang, who was my pianist from 1987 until I went to Hong Kong in 2007. We were like siblings. His parents loved me, and I was really like a member of the family. I came back in 2011 when my mother got cancer because I needed to look after her. I didn’t have time to look him up. When I did go to his old address in Cubao, I was really
surprised that his house had been demolished. There was just a vacant lot. Then a few weeks ago I heard that he’d had a stroke and his brother had abandoned him. He was living on the streets. The news was very painful.

Was there a story behind why he was abandoned?

John Balmonte

John Balmonte

His brother is a jerk. He’s been spending all the family money without giving any to Joel. I hated him for that. But I knew Joel had a son, Jovy, so I went looking for him. Fortunately, last Saturday I got his number and I called and insisted on seeing him. He came over around midnight. We talked, and I said, “All right, what are we going to do about your father?” We agreed to go through Skarlet and the Heart of Music, which is the official non-governmental organization for helping musicians with severe medical conditions. Jovy doesn’t have much money, but as his son he has an obligation to care of his father. I promised him to help him. He said he has always seen me as his aunt, which I really appreciated.

House pianist, Lando Opon

House pianist, Lando Opon

The benefit happened because a group of friends—the owners of the bar where we performed, the regular customers and other singers—found out about Joel. They got in touch with me and asked if it would be all right to have benefit to raise money for his physical therapy and his medicine. He can raise the affected arm, which is a good sign. After a stroke some people can’t raise the arm at all. So when they asked me about the benefit, I said, “Why not?”

MC, Nickie Mossman

MC, Nickie Mossman

Then I called Skarlet to tell her, since she’s the one looking after Joel. We also wanted her to be in charge of the money we raised. That’s why we were at the table going over the figures. She wants it to be clear that what she does with the money—to avoid suspicion and all that. Everything was written down. That’s why I love her. She’s very transparent. What you see is what you get.

So it really was a spontaneous thing, which was why I happened to see your invitation on Facebook at the last minute.

Floraine Lacson

Floraine Lacson

Yes. I was inviting everyone. The songs we played were mostly the jazz standards we were singing when Joel was still playing the piano. We wanted to inspire him, to tell him, “Look, you have to do something. You have to get well so you can get back to paying for us.” Heart of Music will help him, and I heard there’s another group as well.

Can you tell me something about Heart of Music?

Girlie Benedicto

Girlie Benedicto

Well, HOM has been really, really good to musicians. I think it’s growing slowly. I hope it will be really successful very soon because, as I see it, there are lots of musicians who need help, even people out in the provinces. It’s the only NGO I’ve seen that helps. What HOM does is try to find sponsors for musicians who need dialysis or medications for high blood pressure or some other on-going condition. My mom was a recipient. She was a singer. When she needed blood I contacted Skarlet, and she helped me with two bags of blood. As long as I’m a singer, I qualify for help, and so does my family. I like the people with HOM because they really care. Skarlet is such a beautiful woman with a very big heart.

Nyng Pinion

Nyng Pinion

I think they are going to have another free dental mission or something. I heard that somewhere. And once again it’s Skarlet’s HOM doing this for the musicians.

Now, for my readers who don’t know about music in the Philippines, could you tell me more about Skarlet?

Skarlet Brown (Myra Ruaro)

Skarlet Brown (Myra Ruaro)

She was the lead singer with a ska band called Put3ska [a word play based on the Tagalog phrase, putres ka—damn you] and another called the Brownbeat All Stars. They had cut records. For a while Skarlet owned a bar called Ten02, renamed Skarlet’s Jazz Kitchen. When I first heard her sing, I was so amazed that I said, “Who’s she?” I met her that night. Then when I came back from Hong Kong a few years later she’d already formed Heart of Music. It was a great idea to set up an NGO for musicians. The government certainly wasn’t helping. We’re not earning enough—sometimes as little as 500 pesos [$11.36] a night or even less—and we’re so tired. We entertain people, but nobody entertains us. I’d been telling people that we should do something. We should help each other. But at that time I guess people were scared. That’s why I admire Skarlet so much.

Butch Miraflor & Joey San Andres

Butch Miraflor & Joey San Andres

What would people be scared of?

I don’t know—probably the government. With the system here you’re not going to get protection unless you hand over a certain amount.

There was also that NGO scandal.

Mark Mabasa

Mark Mabasa

Yeah. That’s why during the 1990s musicians weren’t into putting up unions or NGOs. I hope this HOM grows bigger and bigger and gets a lot of sponsors to help musicians like me. To be honest, I’m not getting any younger. One day I’ll have to call Skarlet and ask for help. When I saw how she really helped Joel—I call him my brother—the way she helped my brother, I don’t know how to thank her. She pulled him off the streets, and she asked Nelson if Joel could stay at Tago for a couple of days. That was fine by Nelson, but Joel couldn’t sleep. He needed rest. He’d had a stroke. He’s also really stubborn. He’d go around asking people for cigarettes and beer. Well, he’s in a bar. What do you expect? The temptations are there.

Lilybeth Garcia

Lilybeth Garcia

So scarlet had to pull him out of Tago. After that I heard he was with his brother, and then back on the streets, which was really terrible. But I think everything’s going to be all right. I heard they’re going to put Joel in a hospice. His son and I will provide moral support.

Yes, the hospices are cheaper than the national hospitals [which charge about a third or less than the private hospitals]. The hospices here are run by nuns, and they only ask for a small donation, like 50 pesos [$1.13]. So I think that would be better for him. It’s better than his staying on the streets.

Lando Opon, Anna Tanquintic, John Balmonte

Lando Opon, Anna Tanquintic, John Balmonte

I  know someone who lived on the streets here for quite a while. She looked like she was dying. Very, very thin. Skin that had turned an unhealthy shade of brown from a skin disease. People had tried to get her into a treatment center, but she wouldn’t go. One Sunday afternoon I rode around with some friends who were trying to find an emergency room at a national hospital which would treat an infected cut on her foot. They eventually found one. I’ve seen other people who have no teeth because of methamphetamine poisoning but who keep having babies because reproductive health isn’t available. There’s a nice, gray-haired woman who comes to my friend’s soup kitchen and who showed up once with a knife wound all down one side of her face. So I know what somebody who lives on the streets can look like.

Sammy Sancuan

Sammy Sancuan

I saw the pictures of Joel when he was found. He also had a skin disease from living on the streets. He’d made a bed outside a barangay [district] hall. Skarlet said he’d tried to talk the barangay people into letting him come inside when it rained, but they said no. It did rain when Skarlet went to visit him, and they both got soaked. That’s when Lilybeth offered him a room.

Lando Opon & Dra.Gissele

Lando Opon & Dra.Gissele

URLs to copy and paste on your navigator bar:

Skarlet and friends spearhead advocacy to help ailing musicians.

Facebook Heart of Music page.


A reader writes:

I cannot wait to see your BLOG in print.The interviews are excellent.Contact the New Yorker to publish some of these or National Geographic.
Another reader writes:
This is beautiful, Carol. I hope some of your reader would also send donations for Joel. Thank you very much, my dear friend!

Making Donations in Rural Zambales

by on Saturday, July 18th, 2015

iVolunteer members who help at Mang Urot's soup kitchen arranging school supplies.

iVolunteer members who help at Mang Urot’s soup kitchen arranging school supplies.

The man who calls himself “Mang Urot” has been a friend of mine for several years. The links below connect with previous posts I did about his work. Recently I recorded his trip to a tiny village in rural Zambales.

Mang Urot’s story

Mang Urot (n yellow teeshirt) and volunteers

Mang Urot (n yellow teeshirt) and volunteers

View on the way to the village.

View on the way to the village.

I’ve had a Facebook friend from Saudi Arabia for three years. We’d debate various points about religion. About a month ago he visited my home, he made a donation for my work and told me he was an ordained pastor of Day by Day Ministries, a born-again Christian church. In the Philippines their main venue for services is at the Folk Arts Theater. Once in a while I go there to hear the sermons, but I’m not a formal member.

Typical house made of concrete block and bamboo with a sheet metal roof.

Typical house made of concrete block and bamboo with a sheet metal roof.

The first time I went to the village we visited in Zambales, I was with the three pastors of the congregation, but they’ve already returned to Saudi Arabia. That’s when I met the local pastor.

Village church with sign saying, "Everyone says Jesus is God."

Village church with sign saying, “Everyone says Jesus is God.”

The trip we made together was purely spontaneous. I just had some ideas springing about helping the school and the church. Tibag is in the barrio of Naugsol in the hinterlands of Zambales in Luzon, northern part of the Philippines, about 180 kilometers from Manila and four or five kilometers uphill from Subic, the nearest town.

School children

School children

We went to make donations to Tibag Elementary School and individual school children and to bring electric fans, lighting fixtures, a television and a DVD player to the chapel. It amounted to about 30,000 to 35,000 pesos [$682-795] for the school and about 10,000 pesos [$228] for the chapel. The donation was also a way of giving back to the Saudi pastor.

Teeshirts with church logo

Teeshirts with church logo

Each of the little kids got four or five notebooks, three ballpoint pens, three pencils, erasers, a pair of slippers [flip-flops], vitamins, snacks, toys and some other stuff that they can use for their studies. For the school I also brought books, folders, chalk, blackboard erasers, sports equipment and school equipment. Some of it was left over from a previous trip to another location.

The villagers made a good lunch for us served right outside the church.

The villagers made a good lunch for us served right outside the church–grilled tilapia, grilled eggplant, greens and rice.

The income of the villagers is very low and seasonal. When they’re harvesting some of their crops the median is probably $3 a day, but at other times a lot less. There are no school buses there. High school students going to school in Subic have to walk downhill for an hour or an hour or two, depending on where the residents are located or if the residents are from the school. When it rains the dirt roads get very muddy. If they took a tricycle, the price would be 100-200 pesos [a day’s income or more].

Tibag Elementary School with four classrooms and 42 students.

Tibag Elementary School with four classrooms and 42 students.

The front of a classroom holding maybe 42 chairs.

The front of a classroom holding maybe 42 chairs.

I think there were about twenty volunteers who went with us, people who’d previously volunteered for the soup kitchen. We took two vans. Some of them contributed for the school and the church, so I didn’t ask them for any money, but I asked the others for 500 pesos each for the transportation, because the funds were running low. It was really not in my plan to bring them along, but they wanted to go, so I wanted them to share my experience with them.

Children waiting in school doorway to get school supplies.

Children waiting in school doorway to get school supplies.

The volunteers seemed to enjoy it. There’s a Catholic, a born-again Christian, there’s even an atheist. What we do is just a work of love, there’s no religion really. Even though I donated to a church, it wasn’t because it was a church. I donated because I saw the people’s need for a more comfortable place to worship and because some of some of the pastors are my friends.

"Mang Urot," the pseudonym assumed by the soup kitchen guy.

“Mang Urot,” the soup kitchen guy.

I told the people, “If you become rich, don’t prioritize the church, prioritize people.”

From the volunteers:

Hi, my name is Jeanette, and I’m the wife of Mang Urot. We’re here to go to the Zambales Outreach Program. We’re very excited about giving these things to the school children.

Jeanette gives supplies to the head teacher.

Jeanette gives supplies to the head teacher.

Hi, I’m Malou del Rosario. I’m joining this outreach for the school in Zambales to experience this outreach.

Hi, I’m Estella Aubres. I came back from the Philippines but migrated to Australia a few years back. I’m here in the Philippines because I was assigned by my company to work on a project. Since I’ll be here long-term. I searched for a something to work on during my free time, and I found Karinderia ni Mang Urot online. I’ve been active with it because I want to serve my countrymen in any way I can.

Preparing for distribution of notebooks, pens, books, toys, snacks and flip-flops.

Preparing for distribution of notebooks, pens, books, toys, snacks and flip-flops.

Little boy gets stuff.

Little boy gets stuff.

My name is Sophie, and I come from China. I’ve been volunteering for the soup kitchen, and Mang Urot invited me for this trip. So I am excited about helping children.

Hi, I’m Rommel Gusto. I’m from the Philippines. I just wanted to help.

I am JR from the Philippines. I’m a volunteer because want to help.

A thank you from the kids.

A thank you from the kids.

The local pastor and her child

The local pastor and her child

Links to previous posts on Mang Urot’s mission:

A Personal Crusade.

At a Filipino Soup Kitchen.

The Man behind the Soup Kitchen, Parts 1 and 2 and

Mang Urot also brought me along to meet his friends for this post, Filipino Squatters’ Tales, Part 1.


Seize the Moment!

by on Thursday, July 2nd, 2015


Philippines/andrew/AGCPhotography/CarolDussereWhile talking with Andrew G. Contreras I was reminded of a beginning sculpture class I took years ago. During the first class students had to walk slowly around someone’s piece and observe it from this place and that place, from above and below. Part of what I got from the exercise was seeing the countless number of two-dimensional views we could get of a three-dimensional object, some definitely more interesting than others.

Andrew and I talked at my home in Quezon City. Please check out his page at  Many thanks to Andrew for the photographs. (Click on photos to enlarge image–they’re all well worth enjoying for a while.)

Andrew’s story

Philippines/traveleast21/AGCPhotography/CarolDussereWhy don’t you tell me about your experience with photography from your first camera to the present day?

When I was a kid with an Instamatic, I’d take vacation pictures or pictures with friends. I was always disappointed because the results weren’t what I’d had in mind. At the time I made no effort to do anything about it because I wanted to be a comic book artist. For years I was just shooting randomly.

Philippines/traveleast01/AGCPhotography/CarolDussereMy family is a family of artists, so I figured eventually I’d end up in the arts. I started college in Fine Arts at the University of Santo Tomas, but the program focused on drawing for advertising with a lot of technical stuff done by hand. I realized that that was not my calling. I went from there to Mass Communications at Philippine Women’s University, which at first I saw as a stepping stone for the University of the Philippines. I majored in Public Relations thinking that I would eventually take over my dad’s business. He was in PR as a consultant for big companies like Pepsi and the Lopez Group, which owns ABS-CBN. Later I found the communications background useful because of its emphasis on getting the message across in whatever medium you manipulate, rather than snobby, high-end abstract photography. It taught me to think, “If you have something to say, how do you communicate it and make it understandable?”

Philippines/traveleast 00a/AGCPhotography/CarolDussereSo after mass communications, what changed?

Getting into photography was an accident. After my third year in college, I came home late, got into an argument with my dad and got booted out of the house—actually, it was a mutual decision. I didn’t want to live there anymore. Still, it felt like my whole world was crumbling. It turned out to be one of the best things that happened to me. I went to see my aunt and ask whether she had any connections which would help me get a part-time job. During dinner, my cousin walked in and said, “Hey, I don’t have an apprentice right now. Try it out.”

Philippines/traveleast17/AGCPhotography/CarolDussereI guess the trick is not to get fixated on keeping the end in sight and not to fear the unknown. Just because you can’t do something doesn’t mean that you can’t eventually learn to love it. I had the same experience with cooking. I got into it as a practical matter just to feed myself, but after I put my heart into it I came up with things I was happy with, like a damned good kare-kare.

Philippines/traveleast23/AGCPhotography/CarolDusseretraveleast 23My cousin Toto Labador was a well-established fashion photographer, doing covers for magazines like Preview, Cosmopolitan and FHM. He’s a graduate of the Art Center School of Design in Pasadena.  apprenticed for him and his older brother, Albert, who was doing weddings and architecture for hotels. They saved me. I was just blown away by my cousin’s slides of Nepal, from his climb of the Himalayas. He had books of Richard Avedon’s work and Joel Peter Witkin. and videos of National Geographic photographers. He introduced me to Annie Leibovitz. I said, “Wow, there’s so much you can do!” That was probably when I started making a conscious decision to come up with good pictures of my own. I got an SLR [single lens reflex], a Yashica with a 35mm lens. I loved that camera.

Philippines/traveleast05/AGCPhotography/CarolDussereFrom 1999 on was the apprenticeship. I loved it, even if some of the models treated me like the help. I didn’t mind making coffee, I didn’t mind running errands, taking film to the lab and waiting for it. The part-time job became a full-time job when I graduated. During the apprenticeship I decided to make photography a career. At first I wasn’t ready for the responsibility of making decisions, like what angles to choose. For an editor you’re supposed to come up with eight solid set-ups—that’s what they call them—or layouts. Making the decisions can really squeeze your brain. But I was really glad that my cousins were empowering. They didn’t train me in order to have a dependable assistant-apprentice for life. They wanted me to make it on my own. So during the latter part of my apprenticeship, they’d encourage me to get jobs of my own, and they passed on to me some jobs they thought I could handle—and also some that they knew I couldn’t. They threw me into the fire anyway.

Philippines/traveleast06/AGCPhotography/CarolDussereBecause I had the liberty to get my own clients, eventually I realized it was time to go out on my own, and trained somebody else to take my place as an apprentice. In the meantime, I’d moved back in with my parents, but then my dad started losing a lot of money, and I braced myself for the inevitable moment when I wouldn’t be able to live at home and save whatever I earned. So I moved out and set up AGC Photography around 2001 or 2002.

Philippines/traveleast18/AGCPhotography/CarolDussereThere was a time around 2009 when the business nearly folded because no money was coming in. The quality of my work was not what it is now. Sometimes it happens that you get obsessed with earning a lot of money. You spend more time running after clients than trying to take the best pictures—at least I did. I got so burned out. But eventually I had to accept a new perspective on it and remind myself why I got into photography. From that point on, no matter what the client was paying I still put the same amount of heart into my work. My mindset needs to be that, even if I’m paid a lot for a picture and the client is happy with it, I can’t kid myself that I’m also happy with it when I’m not. That’s why I push myself constantly and continuously to do better.

Philippines/traveleast08/AGCPhotography/CarolDussereBasically it’s just being honest, telling it like it is. The trick is that there may be a better way to approach the subject. That’s the challenge that motivates me to try to do something different. But again, the mass communications background reminds me that I’m just a messenger, I’m just a vessel for whatever talent I was given. The ego cannot be bigger than the art itself. Basically, there has to be a balance. Figure out how to take that picture that’s not too artsy. Sometimes the simplest picture speaks volumes.

Philippines/traveleast19/AGCPhotography/CarolDussereWhat I really love about taking pictures is that there’s so much room for mid-air adjustments, there’s room to just go with the flow. Steve McCurry from National Geographic is one of the people whose work I most admire. He’s the photographer who’s famous for the Afghan Girl image. He said the journey is the destination. You might be fixated on going to a place where you expect to find a great picture, but while you’re crossing the street something terrific happens. If you’re not ready to adjust you’ll miss it.

You mentioned teaching. Where are you teaching now? What advice do you give your students?

Philippines/traveleast09/AGCPhotography/CarolDussereI don’t have time to teach anymore, but two or three years ago, I taught at Abba’s Orchard Montessori School, and every now and then I was invited by certain corporations to do lectures for employees who were interested. I found it ironic that a lot of the amateur photographers had more passion than the greater percentage of the people who have apprenticed for me. I told my students to start with just the basics. First and foremost, move around. Don’t just sit in one place with your legs crossed and use your zoom lens. Don’t just shoot from the same place as everybody else—unless of course it’s a sporting event like tennis where you have to stay in a designated area. Get off your chair and move around.

Philippines/traveleast04/AGCPhotography/CarolDussereI tell them, “First, really love what you do.” A lot of people get into stuff like music and photography because it’s “in,” it’s considered cool. If your heart is not 100% into your work, it will never be as great as it could be. The work you put into the craft will be reflected in whatever rewards may come—which for me are just a bonus. The real prize is the picture itself. If photography is your profession and you love it enough, the money will come in eventually.

Philippines/traveleast10/AGCPhotography/CarolDusseretraveleast 10We talked about your sending me some pictures. Could you talk about the specific ones you’d like to send?

A lot of the stuff I’ve come up with recently will probably be in an exhibit to be called “Down Time.” It comes from in-between moments when I’m shooting for a corporate client but then suddenly I see something else. Probably I’ll share a photo I took during Christmastime. I was working for Coca-Cola following a truck made up to look like a vending machine. People stood in line, and out of the door came gifts, like lechon [roast pig] or a flat-screen TV or cups. We went from barangay [local district] to barangay and covered the people’s reactions when they got their goodies. In one of these locations I saw a guy who had dressed his dogs up with Christmas hats and shades. Two had toy guitars around their necks, and another one was sitting in front of a toy piano. So I excused myself to go to the restroom, and I ran to the corner to take a picture of the dogs. The owner didn’t want to be in the picture, but if you look closely you see him reflected as a tiny image in the shades of one of the dogs.

Philippines/traveleast11/AGCPhotography/CarolDussereIt’s those quirky things on the side I find really fulfilling. Basketball is really big in the Philippines. Recently, I went to a lot of rural areas. While I was waiting for the client to get set up, I took a picture of kids playing basketball. I focused on the ball and the kids’ very, very dirty feet mid-air.

Another time we were in Bulacan, already packed up to go back to Manila. There was a beautiful sunset and a father holding three-year-old son. They were standing in front of and orange house. Fiesta banners were casting perfect shadows on the wall. It was just beautiful.

Philippines/traveleast22/AGCPhotography/CarolDussereI went to Thailand recently, and I made sure to wait until after the busy hours go to the floating market. When the market closes down, the hustle and bustle of trading is gone, so you can walk around without being hounded to buy something at five times the normal price. You see people washing their dishes in the river, and you can have a boat all to yourself. You can tell the boatman where to go because nobody else is in the way. I love those moments of peace.

Philippines/traveleast12a/AGCPhotography/CarolDussereWhen you capture a moment, it’s yours. But that’s not to say I wouldn’t go back. Even shooting an event, I’ve found that if I wait a bit longer there’s always the possibility that I’ll get something better. I like to go back. The lighting conditions would be different, and there would always be a different perspective. So that drives me, the nagging feeling that maybe I could get something better. It’s also humbling to say it’s not so perfect that I couldn’t go back. Every unique place has a unique moment—we’d like to think only for us, right? For example, in London the morning before my flight back to Manila, the sun was coming up. The light was perfect. At one end of a long bench there was a guy in a suit and tie, on his phone. He looked very ready to mix it up. At the other end was a homeless guy asleep. I’d like to think that a moment like that it mine. It won’t happen again. Or if it did there wouldn’t be someone there to photograph it, right?

Philippines/traveleast14/AGCPhotography/CarolDussereI was in a vegetable market with perfect defused light creeping onto one of the stalls. A vendor wearing green was selling greens. The background was a gray wall with speckles of light on it. I took a photo, and I was really happy with it because the moment was unique. Three minutes later the guy is no longer there. The moment was a gift of nature or whatever, the powers that be. As a photographer I feel fortunate to be able to shoot it the best I can.

Philippines/traveleast12b/AGCPhotography/CarolDussereWhat cameras are you using now?

Right now I use a Canon 70D and 60D. I usually carry two bodies around, especially for work. I move around a lot, and I don’t want to worry about changing lenses. One nice thing about digital is you don’t have to change film after every 36 shots. I encourage people to learn as if they were using film and didn’t have memory to burn although I might be saying that because of my loyalty to film, because that’s how I was trained and how my skills were honed. Film is a very harsh teacher. You wait for your contact prints, sometimes you look at your contact prints and you think it looks good. But then it turns out to be out of focus or too shaky. What you did wrong really sticks in your memory. My purpose even with digital is to get everything right initially. Of course with digital a certain amount of editing does have to be involved with every photo, but my practice is to not edit it to a point beyond what could have been done on film or in the darkroom. It has to look real.

I still love film.

Philippines/traveleast07/AGCPhotography/CarolDussereYeah, with digital people can take pictures that are technically really good but have no soul. Not many people understand that. A lot of the new school photographers are obsessed with what the gear can do for them. There’s a saying that it’s not the bow and arrow but the archer. Nowadays some photographers will convince clients that the gear they have is a requirement for taking good pictures. They think it will do everything. But that’s not going to happen until cameras have auto-compose, auto-frame and auto-anticipate. I know some people who have the eye and who take good pictures with cell phone cameras. For me it’s the soul and the composition and the recognition of that unique moment, not huge lenses. There are “professional photographers” who shoot a whole event from one spot. I’d get bored just sitting glued to my seat, especially during sporting events or concerts when there’s so much movement, so much happening. Apart from the wrong reasons for getting into photography, all this hi-tech brouhaha has made everyone lazy.

Philippines/traveleast02/AGCPhotography/CarolDussereHow you practice your art or your craft is parallel with what you’re going through personally. With the clarity I’ve found, I assume I can sniff out those who are just doing it for the money versus people who are purely passionate about their respective craft. I can smell the posers from a mile away, maybe because I’ve had so much experience with dishonest artists.

How do you get digital to look a little more like film?

Philippines/traveleast15/AGCPhotography/CarolDusserePersonally, I really love shooting at higher ISOs to get more grain. When digital started out, the challenge was to equal the quality of film because film looked so much cleaner. Then digital caught up and overtook film as far as clarity was concerned, and digital looked too clean. When a shot looks too sharp, I use a blur tool on Photoshop like you would focus in a darkroom. I don’t like it when the lines are too sharp and the skin tone is too smooth. I still like that old film texture that’s not too perfect.


In Search of a Father’s House

by on Thursday, June 18th, 2015

Marita's father, Enrique Lopez-Mena, in Europe

Marita’s father, Enrique Lopez-Mena, in Europe

Marita and I met in the summer of 2008 at a writer’s conference in the South of France, and we became friends. We often talked about her visiting me in the Philippines, the country where her father was born and raised. This finally happened in early 2015, when she came over with her daughter, Paloma. This interview took place at my home in Quezon City. Thanks to Marita for the family photographs. (Click on to enlarge.)

Marita’s story

I’ve wanted to come to the Philippines since I was a little kid wondering what Manila was like because my father talked about it all the time. He described his home and family life as a kind of paradise, a happy, beautiful place. Manila was “the Pearl of the Orient,” a phrase I’ve heard here as well. It hasn’t looked much like a pearl on our short visit. It is a huge city re-built from nearly scratch after massive bombing during WWII when the US liberated it from the Japanese.

Grandfather, Enrique Lopez y Mena

Grandfather, Enrique Lopez y Mena

My father grew up in 1883 in Vigan, an old Spanish colonial military settlement [previously Chinese]. I think his father was assigned there as the head of military forces. The family moved to Manila, maybe when he was nine or ten, because he talked very fondly of the house from what seemed a kid’s perspective. He also talked about a young boy his own age who slept by his bed at night. His mother was a very busy businesswoman. My father got to see her by appointment —with his mother’s European style of parenting, that is, checking on the kids maybe every two or three weeks to be sure his education was going well. He had to sit in a straight-backed chair, without crossing his legs, and answer questions about what he was learning in school and in life in general.

My dad told stories about how his mother—my grandmother—gave big parties. There were a lot of servants in this house, and they would wrap their feet in cloth and dance in the ballrooms to polish the floors. He remembered dancing on the floors with them and laughing and playing. It sounded like an idyllic early childhood. After his father died of consumption at about the age of thirty, I don’t know what their lives were like. His mother was left alone with three kids. I know she owned an indigo plantation and shipped the product all over the world on square riggers. She also was social and was one of the founders of La Cruz Roja (the Red Cross) in the Philippines.

I imagine my father lived in Manila into his early twenties, so approaching 1910. He traveled a lot, circling the globe four times in his life and having adventures. He was sixteen the first time he sailed away. My grandmother gave him money to travel first-class on steamships, and he had a whole set of monogrammed trunks and suitcases including a round leather box for his collars, and a flask with nesting stainless cups for travel. He never mentioned whether anyone was traveling with him. He might well have been sent out alone. I do know that he got halfway around the world and was on his way back when he ran out of money. He wired is mother, who said, basically,“Too bad.” So he went over first class and had to return on the same ships as a stevedore working below decks.

Grandmother, Felicitas Ortiz y de Leon

Grandmother, Felicitas Ortiz y de Leon

Oddly, he didn’t resent this. Particularly when he was older, he felt that it was a turning point in his life. He hadn’t known how people outside his social class lived, and he found out. He was an independent, gregarious man, perfectly cheerful working down in the kitchen and doing chores he was not used to. He made lots of new friends. He learned from that experience that there was more to the world than his narrow social class. My mother said she never knew who he was going to bring home for dinner — the electrician, the plumber – just anyone he took a liking to. He also entertained counts, a Russian princess, and dignitaries.

I know little about my grandfather, but everybody knew my grandmother as a strong woman. When my father was working for the government in the Philippines, his first wife and their daughter Nina—my half-sister—lived some of the time in Malacañang Palace, the presidential residence and offices. My grandmother would come to visit with her family, and she would stroll the halls of the palace in her gown, which had a little pair of scissors tucked in the deep pockets. Every so often she’d jump out at Nina from out of the darkness and cut off a piece of her bangs. The women in the family had a tendency toward thinning hair in front, and she was convinced that if she cut Nina’s hair back like grass she would have thicker hair. Nina shrank away from her because of that and because she was not a warm person.

My father spent at least part of his childhood on the indigo plantation which was said to have been the largest one in the world at that time—but that might have been an exaggeration passed down through the generations. I think they had sixty employees in the house and on the plantation. I hope they paid them. Who knows what working conditions were like? I’ve heard that when one of her ships went down laden with indigo she would wade into the sea and threaten to kill herself. The servants would “rescue” her from herself. I don’t imagine my grandmother was easy to work for.

Paloma and Marita at a cathedral in Dumaquete

Paloma and Marita at a cathedral in Dumaquete

When I came to Manila I expected its size, but thought there would be more old neighborhoods. I was probably thinking of how most of Europe protects and preserves its old architecture. I didn’t know that during World War II the American bombing decimated Manila. Nothing I expected to see exists anymore. Our family homes were plowed under. I’ve heard the same thing from people I traveled with during our stay who come from the same kind of old families. Often their houses were destroyed after the Japanese appropriated and used them. On their way out, the Japanese burned them down and sacked them so there was nothing left. A man who was on this journey with us said that part of his family died and part of it survived, but everything was stolen from their house—their furniture, their silverware, all their possessions. After the war they would sometimes find their silverware for sale in stores or on little tables on the street. They’d have to buy back their own possessions. I don’t think my father had but a few things in the States that came from the Manila homes.

marita-mapPaloma and I spent nine or ten days in Manila and then went north for three days in Vigan. We went to the cathedral to find my father’s baptismal certificate and looked to see whether it included an address where the family might have lived and whether it was one of those houses that was spared. We toured around and got a much better sense of what the Spanish architecture was like—pretty houses with window panes made of shell, tiled floors and beautiful hardwood floors. Then we had three days on the seashore outside Dumaguete in Negros Oriental. It’s a very pretty place. The land is lush. The ocean was beautiful, but there were no sandy beaches. Where we were there were no sandy beaches, but there’s a lovely view across the water to distant islands.

Maria (Marita) Cerilia Lopez-Mena

Maria (Marita) Cerilia Lopez-Mena

I don’t really have any relatives in the Philippines. The person I visited with was my father’s second wife’s granddaughter. She remembered my dad fondly from when she was a small child. The other people we traveled around with knew my aunt, my father’s favorite sister, the woman I’m named after, who perished during World War II. She was caught one day and marched away like the family members of the people we were traveling with. I met a gentleman who remembered my Aunt Marita with particular clarity as he was twelve years old when he last saw her. The Japanese had been appropriating homes. It sounded as if they had taken most of the houses by the time they got to the house of friends where she was staying nearby. The friends were sleeping four and five to a bedroom. My Aunt Marita had been out shopping the day the Japanese came to the house where she was staying. They separated the families, taking some of them away and letting others go. When she came home she didn’t realize what was happening. The Japanese didn’t want to let her in, but she insisted that she lived there. She was marched away with her friend and never seen again. I think she was taken to the Masonic hall—a building they used—where a lot of people were kept alive for a few days and then shot and burned. The gentleman whose mother was her friend remembered her as very feisty, which people also refer to me. So maybe in addition to her name I inherited some of her personality.

This is my first time in Asia, and I’ve found the trip more confusing than anything else. Metro Manila is big and sprawling. The interactions with people have been hard to interpret. You can sense hostility or you can sense friendliness, but you don’t know how deep either one goes or why it’s there—if it actually is. In order to know that you need to work and live in a community and understand what people are really about. For example, in our little boutique hotel in Makati there was an awful lot of smiling and deferential behavior. No matter how often the hotel staff have seen you, it’s “hello, ma’am” and “goodbye, ma’am” and “can we give you something, ma’am” and “do you want bacon, ma’am?” It’s hard to know if that’s the culture of extremely effective guest relations training by the hotel. I understand that that’s part of hotel experience everywhere, but the extent of it was more than what I’m used to. [The ubiquitous “ma’am” or “sir” is a translation of the Tagalog honorific po which appears in every sentence spoken to a person of greater age or higher rank. Its use appears to be mostly automatic and not to be taken too seriously.]

Marita (far left) with Paloma (far right) with family friends at Casa Blanca in Intramuros the day before the 80th birthday party for Marita's father's second wife's granddaughter, Jess Huberty.

Marita (far left) with Paloma (far right) with family friends at Casa Blanca in Intramuros the day before the 80th birthday party for Marita’s father’s second wife’s granddaughter, Jess Huberty. Everyone’s wearing traditional Filipino blouses as requested by the birthday girl.

Almost everybody has been friendly, some just neutral. I went to a birthday party here attended by people from the same socio-economic class. Some were Americans, some Spanish-Americans, some Spanish-Filipinos or Filipino-Americans—any number of combinations. They were all very welcoming, pleasant and curious to know why I was here and what I was doing. They found it odd and amusing that I was here visiting my father’s second wife’s granddaughter. It is kind of an odd situation because he was divorced from her grandmother and then married my mother.

Paloma at a shop in B-Side, Makati

Paloma at a shop in B-Side, Makati

All three of my father’s wives were Americans women. I think the first one was from the South. He married his second wife in Hong Kong. As I said, he traveled a lot. He went to Cuba a good deal. I have a photo from a club in Havana with the men all in tuxedos. I can tell from some of the women’s dresses that it was probably the mid-to-late 1930s. I think he hung around with the “jet-setters” of their day, the people who traveled by ship to Cuba and trains or by air to Newport.

I haven’t met a lot of people since we’ve been here—your housekeeper, who’s friendly but a little hard to read also. I don’t think people make instant friends here, not like in the States, where you talk to someone on the bus or plane and the next thing you know you’re exchanging emails. Look at how you and I met. In pretty short order people figured out which conference participants they liked and wanted as friends. I don’t expect that here.

Your place in Quezon City is very different from Makati. The streets are broader, they’re less congested. There’s not as much pollution here. People seem to be more relaxed. In the financial district in Makati, there was a lot of wealth but also a lot of extreme poverty—people living on the streets, small children asleep under a tree. I didn’t know whether they’ were homeless or out in front of their house or waiting for a parent to get off work. You don’t see that here in your neighborhood. [The guards in this gated community would never let them in.] You see kids running around, but it’s different. It’s more relaxed here. More green.

St. Sabastian Church in Manila,

St. Sebastian Church in Manila,

Makati is suffocating because of the pollution. They tell me it’s so much better now, but I can’t imagine how it’s so much better. We went on a ferryboat to Corregidor [an island at the mouth of Manila Bay]. As we sat waiting on the ferryboat, the engine was running and kicking out diesel fuel for a good hour before we took off. There was a cloud of smoke. I was having asthma and wishing they’d turn off the engine until all the passengers were on board, and in the meantime it was polluting everything in sight. [Motorists also idle their cars unnecessarily for long periods of time.]

In Makati we felt safe. When we were walking on the street and asked for directions, everyone we asked was willing to help. People said we shouldn’t take taxis, but had no trouble. We’re used to taxis in New York City and a cab is a cab is a cab. I can’t imagine that all of the taxis in Manila are driven by psychopaths. The people who warned us had private cars and drivers or they hired a car through a company. [It’s common for people with cars and drivers to claim that taxis aren’t safe.] Taxis are an inexpensive way to get around, and we never had any trouble finding one. So we began to feel more independent.

The sanctuary at St. Sebastian Church

The sanctuary at St. Sebastian Church

One day my daughter and I walked over to The Collective, a dark, dank former warehouse which now houses stores and B-Side the art and performance space. It’s kind of a community project where counter-culture events take place. We walked through all manner of neighborhoods, including some where we were very much in the minority and people were suspicious of what were we doing there. I can’t say I felt overtly threatened, but I felt anxious. When we finally got there, we had a perfectly lovely time. At a little restaurant we split a sandwich, and at another I bought one of those gizmos that shreds melon into curly strips . I bought two of the best chocolate bars I’ve ever had in my life, handmade and beautifully wrapped. The collective was an interesting project. Paloma wanted to get out more to see the city, just as you and I would have when we were a lot younger. I’m a little more tentative than I used to be.

The crypt at St. Sabastian.

The crypt at St. Sebastian.

Our boutique hotel in Makati had an Italian restaurant inside—and a damned good one. I can’t say I fell in love with Filipino food, but it may just be that we didn’t go to good restaurants. We’ve had adobo, chicken and pork, we’ve had steamed fish and lots of shrimp. White rice, which It was eaten was good, inexpensive and filling. There wasn’t much in the way of salads. But plenty of fruit, which was divine. I ate all the pineapple I could get my hands on and mangoes and bananas. In a restaurant we had sinigang, the traditional sour soup flavored with tamarind. I didn’t miss American food. Enough of the Filipino food was similar. There were also so many Chinese restaurants where you can get hot and sour soup or barbecued pork in sauces.

In school I didn’t get a lot of history about the Philippines although I went to an excellent regional school in central New York. There was more about Europe and Latin America, of course. There was very little truth-telling in our history books, I expect — sanitized versions of the Civil War and what life was like for African-Americans. I’m glad that I understand better what happened here during the war here in the Philippines.

The Lopez-Mena family graves in the St, Sabastian crypt. The caretaker said someone had come recently and lit a candle.

The Lopez-Mena family graves in the St, Sabastian crypt. The caretaker said someone had come recently and lit a candle.

I wouldn’t have missed this trip for the world. It’s put to rest certain things that I’ve always been curious about, like what the Philippines looks like — a measure of the reality against the fantasy. I didn’t really expect to “find” my father or my roots. He died when I was six years old. I never met my namesake aunt. Under those circumstances, the best I could discover at this late time would be a glimpse of their personalities from a story somebody who knew them might tell me. And that’s a nice thing.


Puzzle Gourmet Store and Café, Serving a Special Need

by on Sunday, May 31st, 2015

The folks at Puzzle Cafe

The folks at Puzzle Cafe

Last November, Girlie Canoy set up the Puzzle Gourmet Store and Café in order to provide a future for her son Jose, who has autism. Her daughter, Ysabella Canoy is the general manager. After graduating from college, she wants to go to the States for a master’s in Applied Behavioral Analysis and then return to the Philippines to help people here. I spoke with both women in the next-door gallery, also owned by Girlie Canoy. The Puzzle Café project has evolved well beyond its original purpose.

Ysabella and Girlie Canoy’s story

Mother and daughter

Mother and daughter

Our son and brother Jose quit school after the fifth grade because it wasn’t doing any good anymore. He found it so boring, and it was exasperating for us when we had to tutor him for exams. Autism had greatly affected his ability to learn a first language, let alone a second, and since English is the language of our home, he didn’t speak Filipino. We couldn’t see a reason for him to keep going to school. He’d already learned as much as he was going to. It was more important to learn life skills like how to cross the street, how to talk on the phone, how to count money—things he wasn’t learning in a mainstream school. Since his education was limited, we were looking for a place for him to work which would still be open in five, ten years from now.

The café just happened. When I took Jose to the grocery store, I noticed he would straighten up the cans on the shelves, lining them up properly. He loves to fix everything. I told the children we should open a convenience store for him. The kids wanted to make it into a coffee shop. Then the interior designer made this place so beautiful that it became a café. One day I opened my eyes and said to myself, “I don’t know how to run a restaurant. What am I doing here?” I called up a niece and said, “You have to help me because we’re opening in two weeks and I don’t even know what to buy.” So she helped me, and now it’s there. Originally, it was planned for Jose, but other individuals with autism came here in the hope of landing real jobs in the future.

Jose Canoy

Jose Canoy

People with autism are all different. Jose happens to be one of those where it takes longer than most people for him to understand and it’s harder for him to talk, to communicate. Basically autism is a neurological disorder. There are various theories about it, but the causes and cures are still unknown. There is no correct answer for everyone. The early red flags are difficulty in communicating, hand clapping, lack of eye contact, great sensitivity to light, sound, smells and noise. Speech is in very repetitive language. People with autism don’t really learn from their environment, and they’re not stimulated by the things happening around them. They probably clap their hands to stimulate themselves. Jose talks to himself for stimulation the way we might talk to each other. They seem to have a hard time processing things around them, so they find comfort in things that happen again and again, such as watching the same video over and over because it seems normal and predictable. People sometimes think that individuals with autism live in their own world, which may be true, but I think it’s because they’re having a hard time processing what’s around them. It’s overwhelming—all the people, sights and sounds and smells—because all their senses are heightened. So they can hear things that we don’t necessarily hear, smell thing we don’t smell. They see things so much differently than we do.

A tabletop

A tabletop

It’s important to realize that autism has a very wide spectrum. Here we have high-functioning kids, but there are also low-functioning people who are thirty years old and in adult diapers because they’ve never been toilet trained. Maybe they haven’t received the proper care and education. Some people aren’t as blessed as the kids we have here. Of these ten people, no two the same, although there are some similarities among all of them. They’re all high-functioning, but at different tasks. You should be prepared to be surprised.

Coming here is a different kind of experience from just sitting in a café and drinking coffee with friends. Customers get to experience firsthand what autistic people are actually capable of. They see that the kids are happy and interacting with others. That’s more than just reading about autism. First and foremost, we’re focusing on awareness. We want people to see that people with autism can function, that they’re not so abnormal that they can’t do anything or communicate at all. We want them to show that given opportunities our kids can actually work. And it’s not just a matter of opportunity. It’s a matter of acceptance. Twenty years ago if we took Jose out in public and he acted a little strange people would look us over from head to foot, saying nonverbally, “You should have left him at home.” Over the years there’s been a definite change, but not everyone has come around.

Another tabletop

Another tabletop

The café gets the kids ready for employment. It’s part of their therapy. Here they get to interact with others. It’s not the same as being in school. They come through the Independent Living and Learning Center or through a therapist we’ve been working with for over ten years, Josephine de Jesus. Both the school and the therapist focus on teaching life skills. For us it’s crucial to work to work together with them because they know the individuals they’ve sent to us so much better than we do. We collaborate in deciding what the individual is interested in and what he or she is able to do. Out of all their students the teachers had to decide who was highly functional and not resistant to learning because, as we said, some autistic people just want to stick to what they already know, and it’s hard for them to get used to something new. Others want to work and meet new people. They’re interested in what we’re doing and they’re very good at following instructions.

At first the teachers and the therapist were very much present. In the beginning it’s important that the kids see that they’re being watched. They can’t be left alone. Now we’re doing that less and less. The teachers and the therapist showed us how to handle the kids. We didn’t know much about their individual personalities, and they were only with us for two hours at first. We didn’t know what they were like anywhere else. So that was very important, the transition from the therapist or the teachers to us.

We set the original session at two hours so as not to overwhelm anyone, but in that period of time we were able to identify who could work longer. Some now work every day—like Jose. Some work three times a week, some just once a week. We need to be careful in this setting where customers don’t necessarily know the extent of their condition. Two weeks ago we hired a cook, Carmelo San Diego, who was diagnosed with autism, but he had two years of culinary experience and had graduated from culinary school. He’s working and getting paid. We’re still not sure whether he can actually be left alone to work by himself. But we decided to give him a chance, and he’s doing well.

Customers read the menu and select what they want on this order sheet.

Customers read the menu and select what they want on this order sheet.

The food and drink on the menu consists of house favorites. You have to have good food so people will come back, but we say, “Remember we are not here to make money. We are here for the advocacy.” Of course, we have to make money also because we’re looking at Jose’s future. We don’t want to burden anybody, especially financially, even though he has five siblings who have all volunteered to take care of him. You don’t know whether a future spouse might not agree.

Yes, we have a sign saying “April is Autism Month.” It’s a worldwide celebration which has evolved. Before it was “autism awareness,” but now I think it’s becoming “autism acceptance.” People are aware that individuals with autism exist. So the next step is acceptance. What we’re striving for is a more inclusive community, inclusive in the sense that people are more sensitive to the special needs of these individuals and understand that they’re viable employees in the workplace. So this year we partnered up with a lot of companies who are also trying to educate their staff about possibly hiring an individual with autism.

Message on the front door

Message on the front door

This effort was spearheaded by the Unilab Foundation, which set up a meeting with several schools and companies such as McDonald’s, LBC, Jollibee and all the SM’s. It’s a step in the right direction. Hopefully in the future people won’t need a special Autism Month to learn about it because it’s already very much known in the community.

The companies involved in this effort are aware of how productive individuals with autism are because of their strong focus on the task they were asked to do. Ysabella was invited to join in with the Unilab Foundation’s efforts because of her firsthand experience in an establishment where people with autism interact directly with the public. We know a lot of companies who have autistic employees working in the background, doing this like drawing. But having people with autism who interact, we’re one of the very few. She’s been invited to help prepare a manual for companies who do want to do this. It’s still in the process.

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Following the Plan through Southeast Asia, Part 2

by on Sunday, May 17th, 2015



This is a 2014 interview with a man who went to Southeast Asia looking for something. In the first part he’s on the road in India, Thailand, Vietnam, Laos, the Philippines, Australia and New Zealand. Here he returns to the Philippines. Thanks to Joe for the photo.

Joe’s story

In 2003, having just completed my round-the-world trip, I was newly back back in the UK. I decided that rather than go back to work perhaps I should go back to the Philippines as I’d promised my girlfriend. She and I had been sending daily texts, but suddenly the contact just died. So whilst I was calling there was no answer. I started to worry that maybe something had happened to her. Sometimes it would ring and there would be no answer, and at other times it just wouldn’t ring. It never crossed my mind that for whatever reason she just didn’t want to talk to me. I’d been such a catch while I was there (or so I thought at the time), getting drunk every night, being an obnoxious SOB.

Not to be deterred, I thought, “Right. I’ll go anyway.”

On my first night in Manila I bought a new SIM card, giving me a new number, put it in my phone and called. She answered.

“It’s me, I’m back.” I didn’t quite get the happy reception I thought I might. “What’s going on?”

“I met somebody else after you left.”

At that point it would have been understating it to speak of my ego as a bursting balloon. So I did what any self-respecting man of the world would do, went out and got shit-faced. I went to probably one of the worst places in Malate, a joint infamous for foreigners and “hunting girls.”I sat at the bar. Whenever any girl came up to ask if I wanted some company, I’d tell my story, and she’d bugger off. Then I got this idea that rather than slink back to the UK with my tail between my legs, I’d stay and make a success of my trip (or at least try to). After a few months bumming around Manila and some other places, including Puerto Galera, I decided to fly down to a province in the south.

There I met another lady who seemed quite intelligent and had a job with a respectable organization for a regular salary. We got on, so I decided to open my own business down there. I’d get my own bar. My business plan was non-existent, my research on how to get a return on my investment was non-existent, and I hadn’t considered the fact, which is blindingly obvious now, that I really had quite a drink problem. I thought with my own place I could drink with friends and close when I wanted to. A recipe for disaster in the making!

I was still traveling back and forth to do the odd contract in Europe or wherever else and earn a bit of real money. Having decided to settle down in the Philippines, I demolished the bar on the inside and rebuilt it. Afterwards people said, “Wow, this is such a nice place. It’s something we’d expect to see in Greenbelt in Makati.”[Greenbelt is an affluent urban mall with trim, pristine greenery, while Makati is the urban financial center.] This I took as a compliment, but what they were actually saying was it didn’t fit the environment. I was about five years too early with my grandiose scheme.

Finally the bar opened. It was a nightmare. Everybody who came in wanted to have a drink with me (or so I thought at the time). Everyone expected me to be there (or so I thought at the time). I was there trying to be the disc jockey at night, staying open until three or four for the late drinkers and then opening back up at seven for breakfast. Sometimes people driving home would see me asleep on the porch where I’d not managed to finish locking up.

One night a quiet, self-assured guy came in. I went over to talk with him and found out he was an active-duty soldier, an Englishman named Fletcher who was stationed in Iraq. He was on leave, and he’d come to the Philippines to meet a girl he’d gotten to know online. If it worked out the way he believed it would, he was going to marry her.

So I said, “Don’t you think that’s a bit rash? You’ve not even met her yet.”

“But I know her heart. She’s the same faith as me, and we talked a lot. I asked God to show me if this is meant to be.”

Over the course of the next year or so, when he came back on leave to see his fiancée he’d always come to have a drink with me. I got to know him really well. Fletcher was by no means a saint, but he had a real working version of the faith I’d known when I was younger. When it was time for him to go back, I’d drive him to the airport with my girlfriend and his fiancée. Before he left we’d pray together. I told him I’d kind of been searching. He always said, “Jesus hasn’t turned his back on you. Just petition him for help.”

I wasn’t ready.

Then, finally after two and a half years, my bar business was gone, along with yet another relationship. Looking back I can see I wouldn’t have wanted to stay with me either. But at the time all I could see were the wrongs everybody else had done to me.

One day in August I packed my remaining personal possessions into my car, said goodbye to my few friends in the province and drove onto the super-ferry bound for Manila. It was raining and gray and horrible. The ferry sailed along the coast, past the bar I’d once owned that was now no more, the place where I used to live, the place where my ex-girlfriend worked. I told myself to start looking to where the ship is going, not where it was coming from. Try to be positive. I wasn’t. In Manila I met a housing agent through some friends of mine. For five days she took me to look at different apartments in Makati. I was in a trance, saying no, no, no. In the province I’d been able to get a three-bedroom villa with two bathrooms and a garden for about 7,000 pesos a month, yet in Makati they wanted upwards of 20,000 for a shoebox. I just couldn’t see it. Late Friday afternoon the agent said, “I’m sorry, but my patience is gone. I’ve spent five days showing you everything in my portfolio. If you can’t pick one of the places we’ve looked at, I’m finished with you.”

I just picked one of the last two we’d seen. For a few months I stayed in that apartment and didn’t want to do anything. In the province I’d been given a medication to help with my depression. Combined with the alcohol it took me on a roller coaster ride, up and down. Every time I went out and walked around Greenbelt, I only saw happy couples everywhere I looked.

Standing on my seventeenth-story balcony, I’d have very negative thoughts. Then at a quarter to ten on the morning of Friday, on September 1, 2006, I felt the overwhelming need to ask for help. I got on my knees and asked Jesus to help me. It wasn’t like suddenly something lifted, but I did feel able to go out, and that evening I went to get something to eat. On Sunday I went to the same church that I’d been to two weeks before, the same denomination Fletcher belonged to. He’d said, “If you want to go to church, choose carefully. Try to find one that really does teach from the Bible and practices what they teach.”

The first time I went, a loving, warm, engaging pastor greeted me, shook my hand and gave me his phone number and said to call if I had any questions and wanted to get together. That was Pastor J.

So on Sunday I went to evening service. Afterwards when Pastor J asked how I was I admitted to being a bit down. He took me home to have supper with him and his wife. I told him I’d really been struggling and that on Friday morning I’d gotten on my knees and prayed for help. He asked me to reiterate what I’d said, and when I told him a beaming smile came across his face.He said, “On Friday morning my wife and I were praying for you.” We worked it out, and he and his wife had been praying for me before I got on my knees. “I can promise you now that God will help you.” He told me about a loving God who cares about me and will always love me.

Within a few weeks I asked to be baptized. We went to a condominium belonging to some people in the church, and I was baptized in their swimming pool. That was September 17, 2006. With my new-found fire and passion, I went north in the Philippines, sharing the good news with as many people as I could. I found myself in kubos in the north, sharing passages of scripture that had given me hope. For a while I was alive and felt reborn.

I brought a friend down from the north to visit their friend in Hospital in Manila. That’s when I met Celina, a young lady I quite liked. She was helping to look after my friend’s friend in hospital. I left my phone number pretending it was for the patient, her uncle. She picked it up, we communicated a few times and even went out on a date, but it really didn’t work very well, partly because I was still an obnoxious, self-centered, selfish, very mixed-up person. We did get in touch occasionally.

It was wonderful for a few months. I stopped drinking. I stopped womanizing. But little by little I started struggling, and then started going back to bars that I’d been avoiding. Basically, over a period of four years, things declined. Sometimes I still tried to go to church, but the closeness I’d felt before with God was missing. I was spinning out of control again. At the time of the 2010 World Cup, I was at my lowest ever, just going from blackout to blackout, not knowing what day of the week it was or being able to distinguish one day from the next. Then one afternoon I was sitting on a bar stool outside my local bar, not knowing why I was taking another drink when it was the last thing I wanted.

A guy walked into the bar. The guys I was sitting with made a joke. “Oh, that’s Clem. He doesn’t drink.”

My ears pricked up.

Then one of them said, “Yeah, he’s something to do with AA.” They were joking and laughing.

I followed Clem into the bar, and I said, “Excuse me, are you with AA? I might have a bit of a problem.”

“Well, do you want to stop drinking?” When I said yes, he said, “That’s the only requirement if you want to give it a go.”

He gave me a phone number, but I think it was another two weeks before I called. I went to my first meeting on August 5, 2010. That morning I took my last drink. Since that day, I’ve been learning to live my life a different way. I now have what I believe is a real relationship with my higher power whom I chose to call God. I have a conscience now.

After I had been in my recovery program for a few years, Celina and I met for coffee and had a real heart-to-heart. I told her that I wasn’t really the godly person I had pretended to be when I was going around trying to share the Bible. I said that although I’d liked her when I met her in the hospital, I’d thought I could never have a relationship with someone like her. I’d thought she was better than me and that I wasn’t worthy of anybody decent. I told her that I was now in recovery and was different to what I was like before. Something changed in our friendship. She told me she struggled to live up to the image other people had of her as a pastor’s daughter.

I saw her again just before I had to leave the Philippines–my mom was really sick and I had to look after her. Then on the Christmas of 2012 I asked Celina if she’d be my girlfriend. For a year we had a long-distance relationship, communicating every day. In 2013, I came back, and before I left I asked her to marry me. We recently married and are expecting our first child together.

I can’t believe how blessed I am. Being able to love somebody I know loves me as well, that’s a gift of recovery. I know I would never have gotten into recovery had my higher power not heard me when I asked for help. This is a new beginning. So now I know, I went around the world trying to find the answer. The answer, that the whole time was hidden deep within me. I just had to ask God for it.

A reader writes:

What a beautiful story of Joe. Inspiration, trials, courage, inner strength, faith, success. Found his way to Celina.




Following the Plan through SE Asia, Part 1

by on Friday, May 1st, 2015

Cambodian Temple

Cambodian Temple

This is a 2014 interview with a man who went to Southeast Asia looking for something. In this first part he’s on the road in India, Thailand, Vietnam, Laos, the Philippines, Australia and New Zealand. In the second part he returns to the Philippines. Thanks to Joe for the photos.

Joe’s Story

Cambodian Temple

T Cambodian Temple

In 2001 I was living in an apartment in Amsterdam when friends told me about their traveling experiences, meditating in ashrams in India and wats in Thailand. At that point in my life I was earning good money as a contractor, I had a nice car, and my house in the UK was rented out. But I had a deep sense of wanting to get in touch with myself. Apart from a few typical package holidays in Europe and a three-week trip to Thailand, I hadn’t done any travel abroad. I was thinking about Southeast Asia.

I said, “I can’t travel because I have a contract and a job and a house.”

They said, “You can if you really want to, although it will take a bit of organizing.”

Cambodian Temple

Cambodian Temple

I started making preparations so I could put my important stuff in storage, sell my car, finish my contracts and go. Then my mum had a minor heart attack, so the trip was delayed for a year. When I set off I was in good shape, and I’d been gym training regularly. I’d been told to take as little as possible because I’d have to carry it. So in March 2002 I’d got my life down to one 35-liter backpack with an extra eight-liter pocket. I had a round-the-world ticket, a package deal with Virgin Airlines, Air New Zealand and Singapore Airlines—all really good airlines—so I could take as many flights as I wanted as long as I kept moving east and got back to my point of origin within a year.

My first flight was from Manchester to India. From there I was going to Thailand, Cambodia, Vietnam, Laos, Indonesia, Australia, New Zealand, Fiji, Los Angeles and back to the UK. The first night I took a train from London to Manchester, and I kept thinking, “This is it.”

The first two nights in India I was using the privilege card points I’d saved up from a hotel chain —so two nights in the Holiday Inn, a five-star hotel, in a resort area near the beach, where there were six and even seven-star hotels. From the airport in Mumbai to the hotel I saw people sleeping in the middle of the road and cows wandering around on the highway. I’d never seen anything like it, either the abject poverty or the luxurious, six and seven-star hotels.

The plan was to get over the jet lag and then go backpacking. Since I’d earned good money over the years, my idea was to keep a credit card in my back pocket so if it got too rough I could check into a nice hotel. But I did plan to hang out with backpackers and do what they were doing. I loved India, particularly not knowing what was around the corner. It was one surprise after another; people were always smiling and had a sense of playfulness about them, although things were not always good. After six weeks, I realized that my 35-liter backpack wasn’t big enough, so I asked my sister to DHL me my 70-liter backpack. I sent the little one back, even though I felt I was cheating a bit.

After Mumbai the next stop was Goa, where I knew there were ashrams, but also parties. I found all these western, modern-day hippies who were doing all the drugs that were available and having hill-top, full-moon parties. During my first week I washed the pair of really expensive trekking shoes I’d bought in Holland and put them outside my cottage to dry. I was so green that the next day I couldn’t understand why they were gone. I started to learn some valuable lessons.

I traveled all through Goa, down to Kerela, where I made friends with a local guy who owned a hotel and was planning to study in Europe. Then I came down with amebiasis—a parasite like dysentery, which I must have gotten from something in the water or in the food. In the space of two weeks I lost about ten kilos (twenty-two pounds). In photos I looked skinny. I was not eating properly, drinking a lot of alcohol and partying. I read the books I’d brought on the Dali Lama and all sorts of things that I thought were spiritual. Although I didn’t actually get into anything spiritual, I did spend quite a lot of the time out of my head, partying and waking up on beaches.

Angor Wat

Angor Wat



Then I flew to Thailand and met up with a contracting friend who was there for the 2002 World Cup. I put the backpacking on hold for two weeks, checked into a nice hotel and went out to clubs with my friend and pretended to watch some football. I got into all sorts of scrapes.

I got robbed one night. Actually, there was a real good Samaritan, an Australian guy who’d seen it all happening and who waited for the police to come and went with me to the station. He spoke Thai because he’d lived there a long time and had a Thai wife. He was translating. It didn’t help that I’d had quite a few drinks that night and didn’t really know what was going on. I was a bit wound up, but he told me to stay cool and calm. In the police station the police officer invited a camera crew to film me and the culprits who’d robbed me. I had cameras waved in my face, and I think the results were transmitted live on television. The police took one of the perpetrators into a back room and beat the crap out of him.



In Vietnam I met Louis, a really cool French guy and traveled for a while with him. We went to Cambodia together. I then left Louis and went on to Laos alone. In Laos I was backpacking, and for 50 cents a night I was staying in tiny, dimly-lit nipper huts on the side of the Mekong River. I went off on two three-or-four day treks up into the hills. On the first trek there were four of us: the local guide, a Uruguayan guy, a girl from Israel, and myself. After two days we came to a hill village where we saw a lad running around playing with his friends, but limping and wearing a really dirty, triangular neckerchief tied around his ankle. When we took it off we saw a huge gash which had obviously gone septic. Kio, his name was. I squeezed his toes, and he couldn’t feel anything. We concluded that if he didn’t get treatment for it soon, antibiotics or something, it was probably going to become gangrenous and maybe he would lose his foot or even worse. We asked the guide if we could take this lad back down to maybe the nearest field hospital, which he told us was about a day’s walking. The lad didn’t want to go, he said he was fine, but you could see he wasn’t. In the end he agreed. His parents let us take him, but they couldn’t come because they had to go harvest rice the next day. It took us about a day to get down to the valley, where there was a field hospital, which was staffed two or three days a week. They did have antibiotics. The three of us came up with about $20 to get this kid what he needed. Straightaway the nurse hooked up an IV. It felt like we’d done something worthwhile. The guide said the people in the village we talking about what we did. We stayed there for three days. Some of Kio’s cousins came down to fetch him, and last we knew he was making a good recovery. I kept his contact details. He’d be in his mid-20s now and probably has a family. It would be nice to go back one day and see him.



On the second hill trek, I was with the same Uruguayan guy and a different local guide who kept saying, “Yeah, this way, this way.” We were convinced he didn’t have a clue where we were. We walked for hours and hours through the jungle, and there were leeches attaching themselves to us. Seriously, we thought we were going to be lost in the jungle in Laos. The guide was showing us animal crap on the ground and telling us that it was tiger poop,that a tiger had passed through not long before! It felt like a real adventure. We stayed with locals in hill tribe villages and sampled the local Lao-Lao, which is rice whiskey.

When I went back to Thailand, I got the name of a wat that I was going to visit to practice Buddhist meditation, but I never quite got there. I thought I’d gone in search of myself, but I was really just running away from myself.

In October, my sister’s fortieth birthday was coming up, so I thought I’d just get a quick return flight back to the UK and surprise her! It just seemed like a good idea at the time. Without telling anyone in my family, I booked a return [round-trip] ticket from Bangkok to Holland, had a couple of days with my friends, caught up with some other stuff, took the boat to England and got a taxi from the ferry. I was two minutes from my mom and dad’s place when a car crashed into the back of the taxi and gave me a little whiplash. I got out, put my backpack on and went marching up the road and round the corner and just rang the doorbell. My mom nearly had another heart attack to see me standing at the door!

“What are you doing back? You’re not meant to be back until March!”



“Well, I just thought I’d come back for Sophie’s birthday. But you can’t tell her, it’s a surprise!”

A few days later I went down to the pub where Sophie was celebrating with her friends. She was absolutely gob-smacked.

Back in Thailand, I was emailing with Louis (the French guy I had traveled with in Cambodia and Vietnam), about my next stop, which was Indonesia. The first of the Bali bombs had gone off in Kuta, where all those tourists got blown up in a restaurant. I’d missed it by two weeks. I’d been planning on going to Kuta, so the news of the bombing was like an advisory not to go to Indonesia.

Louis said, “Well, maybe you should try the Philippines instead.”

“Really, why the Philippines?”

“It’s a really good place, like Indonesia but easier because they all speak English, and the girls are pretty, and everything’s cheap there as well.”

“Okay, why not? Something different, give it a go.”

So I arrived in the Philippines in November 2002, a week after my thirty-sixth birthday. I landed at NAIA Airport in Manila with my faithful Lonely Planet Guide in hand. I’d read everything it said about getting ripped off by taxi drivers and decided that wasn’t going to happen to me. I walked out of the airport, got in a jeepney, a conveyance of a type I’d never even seen before [inexpensive public transportation originally made from US military jeeps]. I rode to an LRT [Light Rail Transit] station—to this day I don’t know where it was. I’d never in my life seen so many people queuing up a stairwell, and there I am with my 70-liter backpack. I got to the security desk where they were checking bags and giving passengers the mandatory pat-down. They wanted to look inside my backpack. I argued that there was no way I could start taking it apart with my whole life inside and all these people around. I was sweating and tired and had probably had a heavy night in Bangkok the night before I left. In the end I allowed them to poke around in the outer pockets with their wooden stick. Then I got the LRT to probably Taft and walked from Taft to Ermita.

Laos, Mekong River

Laos, Mekong River

I thought, “What on earth is this place?” Guards were standing in every doorway, with pump-action shotguns. Nowadays Ermita and Malate are okay compared to twelve years ago when there wasn’t as much development. It was pretty grungy. I was walking up Mabini Street, looking for a place to stay. All of a sudden a head popped out of a window and said with an English accent, “Where you off to, mate?”

“Looking for somewhere to stay.”

“Aw, right.” He told me where to have a try.

I said I’d come back and have a drink with him later that night. So I did. He was peeling potatoes, chopping up chips up and doing the short-order food in a dingy bar in Malate. While I was there I met a “guest relations officer,” a girl who worked there. I got on quite well with her. I persuaded her to come on a trip with me. We spent Christmas and New Year’s in the Philippines, basically two months of partying. Then I realized that, shit, I’d only got two and a half months left to fit in Australia, new Zealand, Fiji and LA. The new plan I came up with was to spend maybe six weeks in Australia, six weeks in New Zealand, skip Fiji altogether and just get a transit through LA. I’d fallen for this girl even though we hadn’t met in the best of places. I was determined to make it work.

I said, “I have to go to Australia and new Zealand and finish my trip because I can only go one way. But I will be back, probably by April or May. So wait for me.”

Lao Hill Village

Lao Hill Village

Lao Temple

Lao Temple

In Australia I hired a camper van and drove all the way up to the coast to Byron Bay and Airlie Beach and did some scuba diving, because I’d taken two diving courses in the Philippines. But after the Philippines I found Australia a bit boring. You drive for hours, and hours and nothing changes. New Zealand I liked. It was so much more compact. I did all the really crazy, high-adrenaline stuff. Sky diving. Bungee jumping at what was then the world’s highest bungee jump.

On a bus tour they said, “Whoever wants to do the bungee jump, you need to let us know now because it’s got to be booked in advance.” So I signed up for it, then spent the next week not sleeping or having bad dreams and cold sweats. Actually, I don’t like heights. But if I get an idea in my head and then I start to question whether or not I can go through with it, then I’m screwed because I’ve already entered into a contract with myself. I can’t have the feeling that I’m afraid of something.

It was like 143 meters over a gorge, like the Road Runner cartoon where Wily E. Coyote goes over a cliff and he’s falling and getting smaller and smaller,and then there’s a crack where he hits the bottom. It was like looking down one of these gorges, sheer rock on either side and a little streak at the bottom. A massive gondola was suspended on a cable across the gorge. To get to it you had to cross on a little cable car. The gondola had a glass floor so you could see the bottom of the gorge. Between the time you stepped off it into space to when the cord started to stretch was nine seconds of free-falling. It was horrifying. But I did it. I was really ecstatic at having overcome my fear.

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Indonesian bombing,

Nevis Bungee Jump

A reader writes:

Loved it.

Another reader writes:

What a horror show he was at the time! I assume things get much better for him in part II.

A reader writes:

This blog is such an education – Paul Theroux, travel author, hasn’t got anything on you.

A reader writes:

Read it. You always make the story interesting, while keeping it true to the person’s narrative.



Having “Urgent” but not “Emergency” Surgery in the Philippines, Part 2

by on Wednesday, April 15th, 2015


Dr. Ramos with a nurse in Bob's room

Dr. Angliongto-Ramos, head of plastic surgery, with a nurse in Bob’s room

My friend Bob interrupted his one-year trip through Southeast Asia in order to have to have a large carcinoma removed at The Medical City in Manila. This interview took place at my home in Quezon City. The story of the decision-making and the successful outcome appears in Part 1. Part 2 deals with post-surgery care and the conflict with his US insurance company. In an email to me, Dr. Angliongto-Ramos writes,The blog has been making the rounds in the hospital and Bob’s concerns are being looked into. I am pleased with how Bob’s surgery turned out. I hope it was an overall good experience.”  Yes, indeed, Bob found his experience at Medical City overwhelmingly positive.

It will be interesting to see what effect cases like Bob’s have in the future as Americans choose to have surgery overseas. I’m predicting that US insurance, healthcare and malpractice industries will close ranks to protect themselves from foreign competition at one-tenth the cost–how bizarrely, I can only guess. A couple of years ago I attended meetings with Filipino-Americans campaigning to have Medicare available to US citizens living in the Philippines. But then someone speaking as an expert said, “Not only is this a long shot, but the doctors would have to have malpractice insurance.” That did it for me.

Bob’s story

Across the road to McDonald's

Across the road to McDonald’s

After the surgery I was very careful. When you’re 65 years old and paying for surgery yourself, you don’t want to screw it up. Dr. Angliongto-Ramos practices at three hospitals, so she’s got a lot of experience, and she’s very conscientious about avoiding infection. Because she’d done a flap operation and not a skin graft, I only had to stay in the hospital for four days. On the second day I was allowed to get up to go to the bathroom. On the third I could go across the open courtyard to Starbucks. Instead I broke the rules and crossed the road to McDonald’s because the WiFi was better.

My defection led to an international incident with the security guard who saw my hospital ID bracelet and tried to block my path. I was having none of it. He followed me. While I was inside McDonald’s on Facebook, the first guard and his boss were outside on their walkie-talkies. Another guard monitored me through the plate glass. They were trying to figure out a strategy because I was not going to be taken alive. All of these guys were impeccably dressed and ready for the most demanding of inspections. The supervisor was a big bruiser who assessed the situation and finally came in. We shook hands, and I invited him to sit down. He asked to see my ID, and I asked to see his, which he wasn’t prepared for.

He said, “Why are you here?”

Medical City tower as seen from a table outside McDonald's

Medical City tower as seen from a table outside McDonald’s

“Because the Internet at Starbucks sucks.”

“We have Internet at the hospital,”

“That’s even worse.”

He understood. “Are you going farther than this?’

“No, this is as far as I go. I promise you. I can see my room from here.” I pointed out the tower. “I will go no further. And I am coming right back. I am not trying to escape.”


We shook hands. He patted me on the shoulder and gave me a big smile. I apologized through the glass to the first guy. Everything was fine. I did worry a bit that Dr. Angliongto-Ramos was going to hear about it because she was responsible for injecting this foreigner into the system. So I did what I could–I apologized to the people of the Philippines on Facebook, and I tried to be a better person thereafter.

Bob wearing bandages and drainage tube

Bob wearing bandages and drainage tube

The total bill was a shock. It was $5,700, still a huge bargain by comparison with the US, but it took me a bit of processing to get over the difference from the $4,300, the lower of the  initial estimates. Before I was discharged, I had a meeting with the surgeon and more testing. She signed my release and met with the desk staff who were preparing my bill. Then I met with the finance department and with the cashier. I paid and got a receipt to submit to the charge nurse on the floor,  who released me. That system is certainly efficient and keeps collection costs down. I was fortunate in having the money available on my Bank of America Travel Rewards Card, which contains an internationally recognized computer security chip.  To my relief the charge went through immediately.

The additional costs came from the many extra biopsies and tests which had to be done because squamos cancer cells–much more serious–were found among the basal cancer cells. Also, the operating room was used two or three hours longer than planned. Imagine all the surgeons and technicians in the operating theater standing around, the patient waiting in the anteroom and finally the anesthesiology team strolling in forty minutes late. When they finally wheeled me into the OR and the anesthesiologist entered, none of us looked at her. We were all silent but polite. I certainly didn’t want to piss off the person putting me to sleep. The extra charges included the longer use of the OR, the extra tests and I suspect the extra nursing care from the staff. Had I understood the Filipino system, I would have had a companion with me instead of making many demands for assistance. Once they understood my situation, the nurses and assistants really went out of their way to help me.

My conflict with Blue Cross Blue Shield HMO Blue was over a common sense issue, not a legal one.  BCBS’s bureaucracy is so entrenched that in order to satisfy their definitions of coverage–definitions which disagree both with my US doctor and within BCBS itself–it sacrificed huge savings both to the company and to me.  It was a word game: “emergency” versus “urgent.” Despite the enormous savings, urgently needed surgery was not covered if done overseas. They chose to focus not on my large, bleeding, bursting carcinoma but on what part of the hospital admitted me and where the biopsies and surgery recommendations were coming from.  When surgery became necessary, we’d lined up Dr. Angliongto-Ramos. Then I saw what a bargain the surgery would be and asked my wife, her company’s BCBS liaison, to contact BCBS HMO Blue to see if they would authorize overseas surgery at a leading hospital in the Philippines. Keep in mind that BCBS is a major insurer in the Philippines, so the local staff could easily have verified that the hospital was excellent and the surgeon very highly qualified. Instead BCBS looked at the computerized decision tree that insurance companies train their staff to use in order to pay the minimum number of claims at the lowest cost. Any variation from the standard falls on the patient. This network of prepared questions is designed to take claimants where the company wants them to go.

The insurance representatives had charts. They knew what the surgery would likely cost in the US and in the Philippines, they had the dimensions of the carcinoma, they had photos, they had all the information they needed to make an informed decision. Instead of factoring in the cost, they kept saying, “Come back to the US for the surgery, and we’ll cover it.” The ridiculous thing was that for me the BCBS deductibles and the cost of going back to the States far exceeded the total cost of the surgery in the Philippines. My family doctor, in a very long conversation with them, was also unable to persuade them to accept the surgery as an emergency and cover it. In order to satisfy a processing clerk in the US, I was advised to instruct this leading Filipino hospital to play silly, unprofessional games like writing “emergency” into every service order. My surgeon in Manila should conspire with the emergency department to admit me on an emergency basis, to have biopsies done in the ER and to have me checked into the hospital from the ER. At every turn it should be classified emergency, emergency, emergency. Even then coverage was not guaranteed. None of this smelled right from the beginning.

The scar and draining tube

The scar and draining tube

Dr. Angliongto-Ramos was so generous with her time. Her office hours don’t start until four p.m. because she’s done six to eight hours of surgery before that. She didn’t take a vacation last year. And BCBS said she should plan out this whole ruse? It was just absurd. I did run it by her. She listened, but I could tell she was going into a slow burn herself. She’s had previous experience with American insurance companies and with their attitudes, the ignorant assumption that everything in the Philippines is like jungle surgery, with doctors eating greasy pork with the fingers of one hand and operating with the other. It’s humiliating. She’s a leading plastic surgeon, practicing in three hospitals. Now she’s supposed to call a junior functionary at BCBS from from her home at night—there’s a thirteen-hour time difference—to create this artificial construct, then write up reports that only an idiot, certainly not a medical school graduate, would believe? So the insurance people in the US would have a good laugh over the stupidity of these people in the Philippines, writing something up as an emergency that doesn’t fit? I was embarrassed for having asked her. I’m really glad she took offense and absolutely refused.

I’ve heard estimates from the high $20,000′s to low $100,000′s for this surgery and hospitalization in the US. With all the tests I had done, I can see it’s far north of $29,000 and maybe not too far south of $100.000 that I saved BCBS. They’re getting excellent premiums for insuring my body, not the location at which I have something done. They can’t get out of their own way. If I don’t deal with them again in my life I’ll be only too happy—and that is what I feel about the entire medical system in the United States.  I would have all my surgeries for the rest of my life at Medical City if I could.

How to apply the bandages

How to apply the bandages

Someone who’s never lived overseas might be taken aback by the cultural differences in care and communication. Here there might be information you don’t get which the doctor doesn’t think it’s necessary to tell you and other information which seems far too technical for a patient to absorb.  There are also systems which are routine in the Philippines which are different from US routines that they don’t think to mention.   The systems of floor doctors and assigned doctors are different. I don’t think one is better or worse than the other.  I was surprised to learn that there are routine procedures, such as dealing with catheters or dispensing medication that only doctors are allowed to perform at Medical City, but I will tell you that my surgeon saw me three times before the surgery, every single day in the hospital, in the late afternoon or at seven at night. I don’t know where she got her energy. On the discharge day she spent quite a bit of time with me and with the staff getting me cleared for dismissal. And she saw me for times in the ensuing five weeks at no additional charge.

I’d thought in two weeks I’d be on my way, but she knew from the beginning that the first three weeks would be very delicate and require strict germ control and antiseptic procedures and that it would be a minimum of six weeks before I could resume full activities. I had very thorough visits with her. She did a lot of care herself, like inspecting, de-scabbing and re-sterilizing the area, reapplying the bandages and changing the types of bandages and elastic pressure bandages. She taught me how to apply them and Carol how to do the things I couldn’t see, mostly applying disinfectant and things like that. She didn’t charge me for follow-up visit or for medical supplies that aren’t cheap anywhere. Her whole share of the $5700 fee was $1000. The anesthesiology team’s fee was only $500.

As I said, the biopsies revealed a second type of cancer cell. The tests for those took fourteen days. Then I found out that on top of that one-millimeter basal cell carcinoma I had a squamous cell carcinoma–on top, but not reaching in. Squamos is a still treatable but much more serious form of cancer that does metastasize, although it’s far more treatable than a metastasized melanoma. Dr. Angliongto-Ramos was constantly testing my lymph system. Metastasizing cancers go first to the lymph nodes, then to the lungs, to the liver and kidneys and other vital organs and then to the bone. So if you have a squamous cell that’s metastasized, you’re likely to become a stage-four cancer patient. Fifteen percent of people diagnosed with stage four-cancer are still alive a year after diagnosis and one percent are still alive five years later. I’ve had two friends diagnosed with stage-four cancer, and they were both dead within months. So I’d been flirting with a possible death sentence and didn’t know it.

The pressure bandage

The pressure bandages

Fortunately, all the pre-screening and post-screening tests were exactly the right ones to rule out any metastasizing squamous cells in my body after the surgery. Migrated cells would have shown up on the chest x-rays. Anyway, it was enough to throw a scare into me. I’m not the doctor I think I am. I get too blasé about things. I have no patience with ill health. I really believe that staying mentally positive has given me a great quality of life. I don’t go running to the doctor for an antibiotic every time I sniffle or get a hacking cough.

If I were to have surgery again I would probably have it done in Korea. Nearly 100% of Korean doctors went to medical school in the US. Their reports use the same formats, so I can read the results of a blood test by looking at the US heading. Plus, Korea was my second home for over ten years. In order of preference I’d put Korea first and certainly the Philippines second. Singapore would be too expensive. Then probably India, where some modern hospitals are dedicated to medical tourism, which I would highly recommend. The savings are phenomenal.

I should add that Korean doctors hate to be questioned by anybody. Confucian society holds that you don’t question educated people at all. Everything they say is true and they possess profound knowledge that mere mortals don’t. Historically, doctors in the Confucian countries–China, Korea, Japan–were trained to protect you from yourself, not to tell you when you were dying of cancer, not to discuss what was wrong with you, only to tell you what treatment plan to follow, and sometimes not even to tell your family. The doctor knows best.

Once I stopped by a Korean hospital to get some antibiotic salve. The young, American-trained doctor asked how I knew what salve to request.  I said, “Well, it’s only pink eye. It’s not the end of the world.”

He snapped, “Where did you get your medical degree?”

I snapped right back, “Do you think that doctors own all the medical information in the world? Do you think that people should not be allowed to have the medical information they need and pay for? It’s out there. Live with it.”

He was furious. But things are changing. As Koreans travel and return to Korea, they have a different expectation of the doctor. As doctors are trained in the US, they understand that there’s a different way of doing things which involve making a patient a partner in their own recovery.  Many are starting do take that on board.

A big part of the savings in getting healthcare outside the US is that the doctors are not paying hundreds of thousands of dollars every year for medical malpractice insurance.  Dr. Angliongto-Ramos pays no malpractice insurance. She doesn’t need it. Even if a plaintiff won an award, the award wouldn’t be significant. Here people have to accept responsibility for their own decisions and behavior—spilling hot coffee on themselves at McDonald’s, for example. The medical malpractice industry in the US has become absurd and it places a huge cost burden on the healthcare industry. It’s layered and appears in every aspect. The Band-Aid you get in the hospital is $20 because the manufacturer is being covered against claims for failure to maintain an antiseptic environment. The hospital is being covered against claims of improper storage and handling. We need national health insurance. Then all this malpractice insurance scamming and greedy patients going for the malpractice lottery grand prize will disappear. It’s the golden rule: he who has the gold gets to make the rules. If you’ve got one entity, the US government, paying for healthcare, then the laws would quickly contour to fit. You can’t sue over a free lunch that you didn’t enjoy.

So that’s my ten cents worth on the subject!

Links to copy and paste on your navigation bar:

Here’s my (Carol’s) post on eye surgery after the first one or two. I’ve had sixteen in total, all at the expert and caring hands of Dr. Milagros Arroyo, who is also connected with Medical City.  “The Eye Thing,” Three-fourths of all cost connected with my macular degeneration was paid without argument by Pacific Cross, which is associated with Blue Cross Blue Shield. Years earlier I had a $2,000 gall-bladder operation in Seoul. Korean National Health Insurance paid half, and Pacific Cross paid the other half.

For a completely different surgery-in-Asia experience, check out “Robert’s Appendix,” which happened in a small town Chinese hospital thirty years ago.

A Medical City doctor writes:

Yes I read it and enjoyed it very much also. Had a funny moment when Bob, in response to the guard who followed him at McDonald’s said the internet in the hospital was even worse! Oh he speaks the truth. Anyway, what a folly the Health Insurance is indeed. I do hope it gets better so that it can also be availed off with less hassle here.
I doubt seriously that insurance private insurance will improve in the US. The companies have too many lawmakers in their pockets, and state control of the industry means only piecemeal reform. As I said in the intro to that piece, I suspect the insurance industry will put up more barriers against medical tourism when they get threatened. That’s why we need comprehensive reform in the US with a single-payers system of the type you find in Europe, Canada, Australia, New Zealand…
A reader writes:

I live in Taiwan. On April 16 I went to the emergency room at Xinwu Clinic and immediately saw a physician. I’d made two previous visits to the clinic and received 36 pills and four containers of cream for cellulitis. On this visit I was told I had an abscess. I was given super antibiotics and pain pills that proved too strong. Three days later I had a 30-minute incision and drainage procedure in the ER and was handed four bags of meds. Five hours after that, I had the bandage changed there. The total bill for the clinic visits and surgery was 600 Taiwan New Dollars or $18 US dollars. In contrast, in the ER at Desert Springs Hospital in Las Vegas, Nevada, I was wrongly diagnosed with cellulitis of the eye, treated and billed $2,000. This was later negotiated down to $800 after the county hospital UMC advised that the condition was in fact pink eye.

A reader writes:

Interesting, but I did think your friend Bob played a little fast and loose with his health.



Having “Urgent” but not “Emergency” Surgery in the Philippines, Part 1

by on Wednesday, April 1st, 2015

Open foyer between the towers at Medical City

Open foyer between the towers at Medical City

This year my friend Bob is making a one-year trip to Southeast Asia and cashing in the huge stockpile of Korean Air frequent flyer miles he built up over his decades as a merchant banker in Asia. The trip had to be interrupted for surgery. Based on my personal experience, I recommended The Medical City in Metro Manila, one of the leading hospitals in the Philippines. Although It is not the most expensive hospital in Manila, Medical City costs three times as much as the national hospitals. Excellent physicians also practice at public hospitals for humanitarian reasons, so the care is the same for the patients of equally qualified doctors, whether at private or national hospital. Of course any hospital is beyond the reach of many of the poor, who have no choice but to go back to the provinces and die.

For those of us with some knowledge of healthcare in Asia and health insurance in the US, the end of Bob’s story is highly predictable. I wonder what defensive tactics we’ll see from US insurance companies as they feel more and more threatened by medical tourism.

Bob and I spoke at my house in Quezon City. Thanks to Bob for some of the photos.

Bob’s story

Bob at lunch

Bob at lunch

In 2006 I developed a basal cell carcinoma on my face. It looked like a pimple, but it wouldn’t heal, and it got larger and larger. When I had my executive physical in Korea, I was referred to a dermatologist who did a biopsy and told me it was a basal cell carcinoma. It would never metastasize, never enter my lymph system or my blood stream, never travel to my lungs, my vital organs or my bones. It wasn’t dangerous, but it wouldn’t heal. He told me he could remove it on my Korean National Health Insurance. It was getting pretty ugly. The removal was just a two-hour procedure done under local anesthetic. All during the surgery the doctor and I had a pleasant conversation about living and working in the US and Korea. I did notice that the carcinoma was a less than dime-sized lesion, but the doctor had to tunnel under the skin on my cheek almost over to my ear and almost up to my eye and almost down to my chin. He kept taking biopsies and sending them out for results in order to determine that there were no cancer cells left in my face. I had a four-inch scar on my face which within two years wasn’t even noticeable.

Probably about 2012, I got a spot on my back to the left of my right shoulder blade. It felt similar to the earlier one. Remembering how slow-growing that was I just told myself I’d get around to having it removed eventually. Two years later when I was getting ready for my one-year travel adventure throughout Southeast Asia, I decided I should probably have it removed. My primary care physician referred me to a dermatologist and surgeon, Dr. Patel, an ethnic Indian physician in his seventies who’d been practicing in Massachusetts for forty years.

He said, “It looks like a basal cell carcinoma to me, but it’s so large that it’s going to need a skin transplant. When are you going to Asia?”

The scar from the first carcinoma

The scar from the first carcinoma

“September 17. I’ve already got tickets.”

“We don’t have time now because a skin graft is a delicate operation. You have to have the area immobilized for some time after to make sure that it takes. You’re grafting your own skin, but it has to establish a connection with the nerves and blood vessels. Really, you have no time. You should probably reschedule your trip.”

“Well, I had great experience with surgery in Korea. Maybe I’ll get it done there, maybe in Thailand or the Philippines.” I was still thinking it would be a simple procedure.

That led to a discussion about overseas surgery. He seemed very enthusiastic and proud of India’s growing reputation for medical tourism.

I said, “Since these things are slow-growing and never fatal, I might come back a year from now.”

“It’s going to be about 30% bigger, but you do have that option,” he said.

When I left on my trip the carcinoma had gotten larger and more ugly, but it never bothered me. If I took a hot shower or I rubbed it against the sheets, the scab on top would occasionally come off, and it would bleed a little.

Three months into my trip, it suddenly started getting much bigger, bursting and bleeding every couple of days. I was staying in different hotels every day. I bought two bath towels to place over the hotel sheets so that I wouldn’t bleed on the sheets. Some Asian countries can get very fussy about stains or a cigarette burn on their linen. I had an argument with the Hotel Stella in Cebu, Philippines, which wanted to fine me $17 because I hadn’t had time to wash blood from a towel before I left.

About four or five months into the trip I was in the Chulalongkorn Hospital, the finest teaching hospital in Bangkok. I got in line and went through a screening, and the doctor told me I had to get it done right away, I should come back and he’d schedule surgery. In the hotel I was filling out the hospital forms when I came to the section which said, “You must have 60 days remaining on your entry visa or we will not perform any surgery.” Thai immigration regulations are very cumbersome and very rigid, giving you a fixed number of days you can be in Thailand over various periods of time. I’d already used up a lot of time. So I went to Vietnam for a couple of weeks and tracked the number of days I’d been in Thailand during the last ninety days, and I saw that surgery in Thailand was out of the question. In the meantime the carcinoma had become a bloody mess, seeping and weeping and smelling.

I contacted my friend Carol Dussere about coming to visit earlier than we’d planned. She’d had fantastic experience with surgery in the Philippines—and eye surgery at that. I arrived in Manila on February 19. Carol had made an appointment at a beautiful medical facility, The Medical City in Ortigas. There are twin towers surrounded by a couple of other medical buildings and a really fully equipped, state-of-the-art hospital, very well staffed, covering every discipline available in medicine. It’s one of the leading hospitals in the country.

Dr. Lourdes Ramos

Dr. Lourdes Angliongto-Ramos

I saw Dr. Lourdes Angliongto-Ramos, the head of plastic surgery. Like Dr. Patel in the US, she was concerned that the carcinoma was so big she might have to do a skin graft, but she also thought there was a 30% chance she could just do a flap operation. During the flap procedure they remove the carcinoma in concentric circles leading out from the lesion, and do lots and lots of biopsies, stopping only where there is no cancer in the entire circle. The surgeon moves live skin and fat cells, tunneling under the skin and leaving a large area detached from the flesh, then filling up the hole made after the carcinoma was removed, in this case about a four-inch by seven-inch section. After that the skin and flesh are dragged forward and up and over from the different sides and attached where the carcinoma was. The advantages are that there’s usually not a problem with skin rejection or infection, and the hole is filled to a great extent with your own fat, whereas if you take tissue from your thigh and transplant it to your back, you’re got two very different kinds and colors of tissue and textures with no fat tissue for filler. Dr. Angliongto-Ramos said it would be very noticeable on my back, and I’d have a rectangular scar on my thigh where the skin came from. That was why she strongly favored the flap operation, but wouldn’t know until the surgery whether it was possible. Off the top of her head, Dr.  Angliongto-Ramos listed everything I would need from the surgery and recovery and hospital stay and said the bill would be between $4300 and $4700. This included seven days in one of the best hospitals in the country, food, nursing and everything. The following week I’d have surgery.

The pre-surgical preparation and testing was impressive. Dr. Angliongto-Ramos wrote what looked like prescriptions for blood work, pulmonary and cardiological work and chest x-rays. Then she sent me downstairs to an outpatient clinic in the next tower, where I took a number. Filipinos are both very kind and respectful to senior citizens, and there were senior priority queues throughout the hospital, so I didn’t have to wait very long for any procedure. I’d get in line, take a number and check my number on the video screen to see what to do next. I’d go to the cashier to pay, wait until I was called and have the test. I did probably three or five tests the first afternoon, went home, returned and found I had an appointment wiFth the cardiologist who was in charge of my pre-surgery screening. He sent me out for a couple of other tests. After a couple of day’s break, I learned that I’d just screwed up the system because the electrocardiograph would take so long. But the technicians moved heaven and earth and finally gave the cardiologist an unsigned, unofficial reading which he used for my clearance, knowing that the final report would be in before the surgery.

Then I met with an anesthesiologist. We reviewed my allergies, my history with anesthesia and my family history with anesthesia. He explained what would likely be used and gave me a couple of skin-prick tests. That was very good because my aunt had nearly died from anesthesia thirty years before during a very simple procedure at the hospital in Berverly, Massachusetts. Every time my mother had surgery her blood pressure dropped dangerously low, and that had happened with me too. Not only was the preparation incredibly thorough, these tests—it was pay as you go—were so inexpensive. A series of chest x-rays, including the scans and reports in English, cost me 500 pesos or $12.50. Other tests were five dollars here, four dollars there. If I’d been buying candy, I’d have bought a truckload. The most expensive test was the very involved electrocardiography done on a very expensive machine and with well-trained technicians reading these results, and that whole procedure was only $100.

I’m not used to going to doctors. I went for thirty years without going to a doctor. The only surgery I’d had prior to the first carcinoma was an appendectomy in 1967. I stay healthy, which is so much a state of mind in my opinion. The strongest thing I’d taken in the last forty years was aspirin, which is an amazing painkiller. I insisted to the anesthesiologist that I be given the absolute minimum of pain medication and that I be able to stop getting it at any time. He agreed. Later I got into discussions with nurses and floor doctors who just couldn’t believe I wanted to avoid pain medication. I got it stopped as soon as I got out of the operating room. I figure pain is your body’s way of telling you something. If you move and it’s painful, don’t move. I healed very quickly and wasn’t constipated from the narcotics. It was a great experience.

The day before the surgery I checked in. The room looked just like Beverly Hospital where I’d brought my mother many times, truly a state-of-the-art facility, but there were subtle differences that I hadn’t really thought about and wasn’t prepared for. As in other Asian countries, in the Philippines a hospital patient has a “companion” staying with them twenty-four hours a day—a domestic helper, a relative or even someone who’s been hired for the occasion—so the nurses are not tied up doing things that a layperson can do, like emptying a bedpan or getting a glass of water or picking up something. They staff accordingly. There aren’t as many floor nurses or aides as there are in the States. I think there was little bristling on the part of the desk staff because in their opinion it was not their job to dump my urine bottle or get me a knife and fork from across the room. It wasn’t their job to do many of the things I couldn’t do for myself the first few days. But several of the staff went out of their way to help me and make me comfortable and make me not feel guilty about it. It was obvious that I hadn’t planned that part.

The nurses' desk

The nurses’ desk

When I was brought out of surgery and returned to my room, the urinary catheter came halfway out. As soon as I came to I was in agony. I was using my nurse call button, but the call didn’t get a quick response because everybody assumed my companion would come to the desk for anything important. The other thing I didn’t know was that the communication systems are different. Everything goes through your surgeon, who has doctors who are assigned to cover her patients when she’s in surgery or at home. With the slightest movement came intense pain. I kept pressing the button. Responses were mixed. A nurse would come in, and of course in the Philippines for most people English is not their first language, although it’s a strong second language. Between an American English speaker and a Filipino English speaker there can be communication problems regardless of education level.

So there was confusion. The surgeon had ordered the catheter to stay in for three days. No one was authorized to remove it. Only a doctor could touch it, not even a nurse. On my fourth call the nurse came in, and I explained that I was looking up on the internet how to remove a frigging catheter myself. That’s how bad the pain was. I knew I needed a ten-milliliter syringe to put in the tube and remove the sterile water in the balloon in order to pull the catheter out, but of course I didn’t have access to the syringe. Finally they contacted the doctor who was assigned to fill in for my surgeon. However, her primary purpose in life was to avoid disturbing the surgeon at home. She was playing pain chart games with the nurse. “Well, find out is the pain a four or a six or ten.”

So the nurse was going back and forth. At this point she was convinced that there was something wrong. “Yes, he’s in great pain, and he really needs to see you.”

Bob after surgery

Bob after surgery

She refused to come and look at it. Finally, I went on a bit of a rampage. With the nurse’s full support, we upped my pain estimate to eight. According to hospital guidelines, at seven or over the doctor had to come and see me. She came, but she obviously still didn’t want to disturb Dr. Angliongto-Ramos. I’m the last one to bother the doctor at home, but it was agony. Finally she was persuaded to call, and Dr. Angliongto-Ramos authorized removal of the catheter provided that I promise not to try to get out of bed. They removed the catheter and gave me a urine bottle, which was a great relief.

The care was fantastic overall, and the sanitation was great. The food was amazing. I didn’t get a choice of food, but it didn’t matter. Later I found out the dietician had decided I was overweight so I should be on a low-carbohydrate diet, but I hadn’t noticed. There were lots of great soups, pork soups or chicken soups that you spoon over rice, and lots of vegetables. They fed you five times a day, three meals plus a mid-morning snack and a mid-afternoon snack. I couldn’t get over it. I don’t like fish so there were a couple of dishes I didn’t eat, but it was not a problem. After a couple of days I learned you could order room service twenty-four hours a day.

A readers writes:

Hi. I happened to awaken early this morning and so had time to read Bob’s story. Also, of interest due to my medical past and the issues with healthcare. Fascinating the differences between the cultures.What remains the same in both, however, is the godlike status of the surgeon who cannot be disturbed post surgery for anything less than an 8 on the pain chart. At least his pain didn’t cost him thousands upon thousands of dollars! I hope that Bob is recovering nicely.


In my experience, the attitude of the junior doctor in question is very, very much in the minority, actually if you discount punctuality the only one I’ve heard of among lots of helpful, caring, humble people, whereas in my experience in the States the godlike attitude seems to affect even medical students, including one of my former roommates. Bob is doing well.

A reader writes:
Forwarding to my husband and a few others who work at Medical City. Thanks, Carol. Hope your friend is well.
Bob’s doing well and following doctor’s orders to the letter.
A Medical City doctor writes:
First of all, congratulations on that detailed experience by your friend Bob. Nice to read a story which absolutely hides nothing. Experience wonderful or not is always valuable more so medical as this provides help to others as they too in the future may need it, and don’t we all in one time or another? I do agree that there is a chain of command in the medical hierarchy and this will continue to do so with good reason, but one thing is certain and that is cultures do differ. Having written that I can say that the care given here usually is more compassionate. Nice to know that Bob is doing great.


Thank you. I agree. Yesterday I had a reaction to the sugar shock test at Megaclinic. The staff immediately had me in a wheelchair and on a bed, took my blood pressure, gave me a electrocardiogram and sent in a doctor . In a short time I went back to the lab for the second blood extraction. When I thanked the technician for her kindness, she said, “We love you.” The doctor saw me again. Then I had my badly needed coffee and breakfast. That’s the kind of treatment I’ve had here. At home on the Internet, I found that passing out–which I came close to–is a common reaction to the sugar shock test, which would be why the staff wouldn’t let me leave the lab area.

A reader writes:

Good to know local medical facilities and health care specialists and teams are appreciated One should realize, though that the cost of less than US$5k, including taking lab tests for the cost candy, is still outside the reach of the regular working man in Manila. That amount is still over 200k Philippine Peso, more than half of our annual wages. How I wish we all could just afford ‘urgent care’. May I share this post with my friends who work in TMC?


I understand. That’s why I inserted that bit into the introduction about national hospitals and people who can’t afford them either. If I need any long-term care myself it will be in a national hospital where one of my Medical City doctors practices. Please share the post with as many people as you like. Perhaps they might do a pamphlet for foreign patients who don’t understand the Filipino companion system or the doctor system.