DOH chief Francisco Duque bears the 3 signs of incompetence
AS I WRECK THIS CHAIR By William M. Esposo
The Philippine Star 2008-05-04
Three signs mark the incompetent manager.

The first is inaction in the face of crisis, minor or major. The second is employing the wrong action, the result of poor judgment in deciding how to resolve a problem. And the third is the tendency to overreact, much like wanting to kill a fly with a bomb.

A good manager is defined by the ability to manage problems in a way that will result in the best positive results and the least possible damage.

From where I sit, wrecking another chair, Department of Health (DOH) Secretary Francisco Duque has all three signs of incompetence. Madame Gloria Macapagal Arroyo will do the nation a great service if she puts Duque on top of the list to be culled out of public service.

Duque’s overreaction to stories in local and foreign media about Filipinos selling their kidneys is a classic example. Duque, who also happens to be a medical doctor, quickly prescribed a ridiculous remedy: ban all donations of kidneys to foreigners and to Filipinos who are not related to the donor.

This drew immediate adverse reaction from the Philippine Society of Nephrologists (PSN) and a kidney donors association. Obviously, Duque panicked and wanted to show that he was in control. He could not admit the fact that the whole problem emanated from the failure of the DOH to implement its own administrative order governing kidney donation — this is inaction, the first sign of incompetence.

In 2002, the DOH issued AO 124 to govern organ donations. Among its features were:

1. Establishment of a Philippine organ donation program

2. Creation of a National Transplant Ethics Committee

3. Creation of a Kidney Donor Monitoring Unit

4. Assigning the Bureau of Health Facilities and Services (BHFS) to monitor the program

5. Prohibition of the sale of organs

6. Setting a 10 percent cap on organs than can be allocated for foreigners

We have no issue with prohibiting organ donation to foreigners. Up to 2005, data showed that around 10,000 Filipinos develop chronic kidneys (also referred to as end stage renal failure) every year. Doctors at the National Kidney Transplantation Institute told me that there could be more because a lot of those in poor communities with the affliction do not even seek medical help knowing that they cannot afford the cost of dialysis or a kidney transplant.

And yet, 2006 figures show that only 609 kidney transplants had been performed — not even 10 percent of the annual number of kidney failure cases. With so few organs available, it is only fair that Filipinos be given the first priority for these organs.

However, banning kidney donations to people who are not relatives is an idea one will never expect from a medical doctor. What was Duque thinking? This is the wrong solution to the problem (the second sign of incompetence).

The immorality lies not in whether the donor is a relative or not but whether the donation observed ethical conditions. It is the terms and conditions of the donation ‑ and not the kinship between patient and donor — that make it unethical. With Duque’s way of thinking, it will be justified to ban the birth of Italians in order to prevent the further existence of the Mafia.

This hysterical response (overreaction — the third sign of incompetence) will disqualify the majority of kidney donations in the country and effectively leave suffering patients to slowly die. In 2006, 78 percent or 473 out of 609 kidney transplants performed came from non-related donors. Only 22 percent or 181 were from relatives.

The reason why kidney donors do not tend to be related to the transplant patient is because kidney failures are mostly caused by diabetes, which is a hereditary ailment. Relatives of the patient are therefore also deemed as having the predisposition to diabetes, thus limiting the number of relatives who can be tapped as donors.

If the new DOH conditions were previously in effect, I would not even be able to benefit from a kidney transplant and neither can the present fellow Cabinet member of the health secretary — Justice Secretary Raul Gonzalez, unless of course his driver-donor is also his relative. Kidney transplant liberates one from debilitating hemodialysis treatments and allows the renal patient to live a normal life.

The PSN immediately took a position (posted on the ABS-CBN/Newsbreak online report) against the reckless DOH new guidelines. The PSN called the new DOH guideline “the wrong response to the problem.”

The PSN stated:

1. The failure stems from the absence of a mechanism to enforce the ethics committee created by AO 124 (again, lack of action).

2. Only 53 percent follow ups were noted from the Donor Monitoring Unit that was also created by AO 124 (more lack of action).

3. The BHFS does not have the capacity and the ability to monitor and thus could not effectively enforce its mandate under AO 124.

4. The 10 percent cap on organs allowed for foreigners was practically violated by all hospitals.

During the Cheaper Medicines Bill brouhaha over the attempt to impose a generics-only provision, Rep. Ferjenel Biron of Iloilo, the main author of the House version of the bill, blamed Secretary Duque for injecting the provision. Many of us thought that Rep. Biron may just be using Duque as a scapegoat after the provision drew a lot of flak.

However, with this new development about banning non-related kidney donors and other past Duque actions — we must just wonder if Rep. Biron was indeed being truthful.

In my December 11, 2007 column (Milking bulls: Only in the Philippines), I cited Duque for running a DOH television commercial that is falsely premised.

In an effort to promote mothers’ milk (which nobody will argue is best for humans), the DOH TV commercial claimed: “Ang gatas ng baboy ay para sa biik, ang gatas ng aso ay para sa tuta, e ang gatas ng baka, para sa anak mo? Hindi hayop ang anak ko (A pig’s milk is for its piglet, a dog’s milk is for its puppies, but is cow’s milk for your baby? My baby is not an animal.).”

It is one thing to promote breastfeeding and another to give mothers the false impression that an alternative nutrition (cows milk) is bad — effectively depriving them the option to feed cow’s milk to their infants. For the DOH to endanger mothers who can’t breastfeed is not only stupid but irresponsible.

With Francisco Duque in Health, Raul Gonzalez in Justice, Hermogenes Esperon in the AFP, Bert Gonzales in National Security and Herr Ronnie Puno on top of the PNP — we wonder how come we are still over populated.

  Previous Columns:

It had to happen on The Ides of March and Holy Week

Suggested guidelines for liability- free Internet posts

Election lawyer: PCOS critics should put up or shut up

All Excited by Pope Francis

A great disservice to P-Noy

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