Wednesday, December 17, 2014

10 Life Lessons from Dr. Carmencita Padilla

The following is the transcript of the speech delivered by Dr. Carmencita David-Padilla, Professor and Chancellor of UP Manila, during the Commencement Exercises for Residents and Fellows of the Department of Pediatrics, UP-Philippine General Hospital last December 12, 2014.  

Dr. Carmencita David-Padilla
Professor, UP College of Medicine
Chancellor, UP Manila
National Program Adviser of  VYLH-Philippines
Our dear faculty led by our Department Chair Juliet Sio-Aguilar, parents and guests and our dear graduating residents and fellows, good morning.

The graduating residents were my first year residents in my last year as Chair of the Department. I am very proud of what you have become. My son Patrick, who is a clinical clerk has voted our Department as one of the best and has become his benchmark when he rotates in other departments. He does not really want to become a pediatrician but because of the faculty and the residents he worked with, he has considered Pediatrics as an option.

Your invitation today gave me the opportunity to reflect on my life. It is good to stop and reflect on one’s past.

I have many stories to tell but today, I would like to share 3 short stories with 10 life lessons.

The first story is on how I became a geneticist.

Early on, I wanted to become a doctor and to be specific, a pediatrician. Nursery was my first rotation and I fell in love with the field. I decided that I wanted to become a neonatologist. By my third year in residency, I had a collection of books in Neonatology. I was ready.

Everything was clear and set for my training in London when the lone geneticist in the Department unexpectedly died of cancer leaving a vacuum in our department.

One of my friends was supposed to pursue genetics but she fell in love with a native of Nueva Vizcaya and this also changed her plans. That friend of mine is Marilyn Cervantes Padre, the mother of Sarah Mae, a first year resident in our department.

On a bright sunny day in May 1987, I was summoned to the office of the Chair of the Department of Pediatrics where four senior professors (Amelia Fernandez, Luis Mabilangan, Carmelita Domingo, and the late Perla Santos Ocampo) were waiting for me. Since I was the youngest faculty member at that time, having just stepped down from chief residency, I was the target. They sweet-talked me to changing my field to Genetics and they wanted a decision in 48 hours. I asked for a month to think about it. I visited the house of Dr Tereret Briones, the geneticist who passed away. I looked at her collection of books and honestly, I was very unhappy. It was a very difficult time for me. I was upset and hurt. I was eventually convinced (maybe the correct word is coerced) by my mentors to change my course from neonatology to genetics. Although a very difficult decision, to pursue a road less travelled, I said 'yes'. I come from a generation when the young MUST follow the old. That was 28 years ago.


The College of Medicine had a ready scholarship for me for a fellowship in Clinical Genetics at the Royal Alexandra Hospital for Children, Sydney, Australia. Upon my return, I had the solo responsibility of setting up genetic clinical services and various genetic laboratories at the Philippine General Hospital that eventually moved to the National Institutes of Health. I first set up the Cytogenetics Laboratory in 1990. Then I set up the first newborn screening laboratory in 1997 in Manila, a Biochemical Genetics laboratory in 1999, and a Molecular Genetics laboratory in 2000. I then set up a series of newborn screening laboratories in the country because of the expansion of the newborn screening program – in Iloilo in 2005 to service the Visayas, in Davao in 2010 to service Mindanao, in Angeles City in 2011 to serve Northern Luzon, and recently in Batangas to serve Southern Luzon.

Regrets? I have none. I am happy I made that difficult decision in May 1987. It was a major turning point in my life.

If I pursued the path of a neonatologist, I will be working in 3 or 4 hospitals only. Because I made the difficult decision of becoming a geneticist, I have been able to set up all of these services and laboratories to serve patients from all over the country.

Here are my first 2 lessons.

Lesson No 1
Dream. You must dream. It is free.

Not all of our dreams will come true but it is an excellent exercise to aim for something. Life cannot be free willing. Just like any relationship, you have to invest time to even think of what you want to do in life. When you leave the halls of the Philippine General Hospital, you must have a plan and you have to work to achieve your plan.

Lesson No. 2
Life is made up of choices.

In every turning point in my life and your life, we have a choice.
The best choice is not always the easiest.
The right choice is not necessarily what you want.
Sometimes the choice is not what we want but somehow, there is a tiny voice in our heart that tells us that this is the right one.

Let me move on to my second story. 
How did I get involved with newborn screening?

Because of my special training in Genetics, I became instrumental in setting up the newborn screening pilot project in 24 hospitals in 1996. Of the many challenges in my career, this probably will be tagged as the most significant since data generated from our research was the basis for Republic Act 9288 or the Newborn Screening Act of 2004. It is now being offered in 5800+ hospitals and lying-ins with more than 90,000 babies saved from mental retardation and death. It continues to save babies every day.

Sounds simple but this journey taught me a lot of lessons. Allow me to share some with you.

Newborn screening was being offered in developed countries since 1960s – way before most of you were born. Starting a new program in a country beset with many problems was a challenge.

I remember visiting the Department of Health (DOH) in 1992 - soon after I arrived from my training in Genetics. Upon the advice of the College of Medicine Dean Alfredo Ramirez, I met with DOH Assistant Secretary Alex de Leon, who happened to be my professor at the UP College of Medicine. I introduced the concept of newborn screening. He was very accommodating but at the end, he said: no data, no policy. And he said, newborn screening will be competing with existing programs of the country. Of course I went home disappointed. It was clear that I need another entry point.

Four years later in 1996, together with my mentor Dr Carmelita Domingo, we started a pilot project to generate data for the country. This story really started in November 1995 when Dr Domingo was worried because she was invited to give a talk on newborn screening and she had nothing to present. She shared with me that for the past 17 years since her return from her training in the US, she has been trying to convince funding agencies and the DOH to work on a pilot project in newborn screening but she was not successful. This time, we decided to work on this pilot together by inviting all 75 hospitals in Metro Manila. Only 28 responded to our letter and eventually only 24 hospitals joined the pilot project. Guidelines for the project were strict to give power to the data upon the advice of our epidemiologist, our Residency Training Program head Inday Dans. I still remember my meetings then with the hospital coordinators coming from the generation of Dr Domingo – at least 20 years older than me – and I was the youngest.

We had good data after 2 years and we gave it the Department of Health. Unfortunately although declared as good data, the DOH was not ready to take on the project. So the coordinators from the 24 hospitals decided to expand the program to other hospitals on their own. By 2003, newborn screening was in 323 hospitals but the DOH was still not ready to take it on as a national program.

When the newborn screening program was having difficulty in integration in the public health delivery system, I made the bold move of enrolling in a Master of Arts in Health Policy Studies at the College of Public Health, UP Manila. I considered this a step toward gaining the skills to write policies on newborn screening.

When I finally prepared the draft bill on newborn screening, I gave it to Senator Juan Flavier who was my lead supporter. I had to deal with legislators and their staff who were predominantly male. I personally lobbied at both Senate and Congress and never in my whole lobbying stint did I have to bribe anybody. It is possible. I patiently waited in their offices or outside the plenary halls that you see on television.

Being a student in 2003, lobbying for a bill was an experience.
Being a woman probably became my strength at the end.
Considered as one of the fastest bills to be passed, it was God after all who said, it is time!

I thought that with the law, I will be free from the program but I am still very much part of the national program as a technical partner. There are many caveats in this 18 year history of newborn screening. I do want to share some insights with the graduates.

Lesson No 3
You must have a high threshold for frustration.

Do not let frustrations get you down. For the past 18 years of the newborn screening program, I have a litany of disappointments and challenges that I can discuss in another session. The important thing is that you must learn to get up and move on. If I stopped in 1992 when I first met DOH Assistant Secretary Alex de Leon, then we will not have the national program today.
In 2003, just before I gave the bill to Senator Juan Flavier, then DOH Secretary Manolet Dayrit asked me why I needed a law. I said, it was a challenge convincing the DOH secretary everytime there is a change of administration.

Whatever your advocacy will be in the future, expect a lot of challenges. That is part of life.

Lesson No 4
The cliché ‘no man is an island’ is true for all generations.

Most of you will move on to management or leadership positions.
I may be the face for newborn screening but how to get 5800 hospitals to follow was a challenge.
Legislation was one strategy.
But getting it where it is right now needs a lot of good will. The people implementing the program must believe it is a good program. It cannot be lip service.

Lesson No 5
Leadership is a critical element of a successful program or advocacy. You will need this for your own advocacy.

The newborn screening program has a team of leaders. Each one of the 5800 hospitals implementing the program has a coordinator. He or she must implement the program in his or her hospital. Doctors, nurses and midwives must follow them. I need a team of leaders to implement a national program.

Can you be a leader? The answer is yes.
You can also be a leader.
I was not a leader in elementary or high school.
It was in College when I started holding key positions in student organizations. By the time I was a medical student, I was always a class officer. Then I became Treasurer of the Medical Student Council and I was in charge of managing the MSU canteen. By residency training in pediatrics, I emerged as a promising leader. I eventually become a chief resident.

At present, I hold several key positions. I am your Chancellor. I am still the Executive Director of the Philippine Genome Center, an office that cuts across all campuses of the University of the Philippines – UP Manila, UP Diliman, UP Los Banos, UP Mindanao. I still hold a Director position at the Commission on Higher Education until the end of December 2014.

I was chosen to lead. So what makes a good leader?

A leader is creative. A leader thinks outside the box……a thinker of new solutions for old problems.
Consistency in excellence is critical. You cannot be a performer today and be a lazy person next month.

It does not matter if your task is minor, do good at all times. Unfortunately, management will remember your failure…… your weakness. It is sad but that is reality. You have to project the image that you are responsible to take on a bigger role in the hierarchy of your organization.

Everybody starts at the bottom of the ladder.
Always put your best foot forward.
Nothing really comes on a silver platter.

Let me move on to my last story – the Birth Defects Surveillance Project.

The Birth Defects Surveillance Project is another favorite of mine. I worked on birth defects way before I worked on newborn screening. But it has not reached the same level of success. After several attempts to take this off the ground, I managed to do a pilot project just like the newborn screening program but really, not enough to push policy.

Lesson No 6
Believe in other people.

Last March, I was in Negros Occidental to deliver a message at the launch of the province - wide pilot on the Birth Defects Surveillance Project. The governor, mayors, municipal health officers, chiefs of hospitals, representatives from both private and government hospitals were in attendance.

Their task is to conduct the pilot project, generate the data and hopefully, their data will be the basis of future policies on the care of patients with birth defects. Governor Alfredo Maranon asked – why Negros Occidental?

My answer was very simple. I said, I believe in your people – they are passionate, dedicated, committed, outside the box thinkers, responsible. I just know that Negros Occidental is the right place. Negros Occidental is home to 11 exemplary awardees and 13 outstanding awardees in newborn screening. The leadership created new ordinances to ensure newborns in Negro Occidental are given the opportunity to live a normal life. They had to come up with creative strategies to capture as many babies in their province.

At the presidential table, Governor Maranon asked me – what else can I do? I asked him ‘do you have money for scholarships?’ He said yes. He said, how many? I said four. I saw his face grimace – I said 2 this year and 2 next year. Choose your pool of candidate students and we will choose the best. These 4 students will help move forward this project.
The next comment was very interesting. I want students who have a heart, the heart to help Negros.

Passion is important. The people around you will know if you are passionate about your work, your patient, or your advocacy. It will naturally show.

Allow me to finish my talk with a couple of lessons that cut across all of my projects.

Lesson No 7
Service to humanity is noble.
When I was interviewed for the UP College of Medicine, I was asked. Why be a doctor? I did say ‘I wanted to serve humanity’. Honestly, at that time, it was just an answer to an interview question.
Ask yourselves, why did you choose medicine? Why pediatrics? Why adolescent medicine?
Why endocrinology? Why cardiology?
Where will you serve? Who will you serve? Why and how?
There are no right or wrong answers. These are personal questions.
Ask yourself and reflect on your answers.

Lesson No 8
Time management is essential.

Despite technology, the day is never enough for the many things you have to do.

Lesson No 9
Enjoy life. Enjoy time with family.

I believe in balance in life.
In one magazine interview I was asked “What do you do to unwind given your very busy schedule”. I spend the very little time that I have with family. We just go to the mall, or the gym, watch a movie or simply stay at home. On Sundays, I still do the marketing and I cook lunch. My son and I love to see new places and experience new things together. I have done a lot of crazy things with Patrick and the craziest so far is jumping off a 35 foot bridge to go rafting. In a workshop in Cagayan de Oro one summer 10 years ago, Patrick and my staff asked me if it was alright to get wet – just a little, they said. I said yes. While I was meeting DOH officials, they went home to change to their swimming attire. After my meeting, they made me change too. We soon got off the jeepney. We were given life vests and we were soon standing at the edge of the bridge. After the crisp instructions from the tour guide, the young ones jumped. They loved it. I froze. I stood there holding on to my life vest. I asked the guide if I was the oldest to do this crazy thing. The guide said many tourists much older than me have done this and the youngest was a 6 year old. After 20 minutes, I jumped. The whole experience was just a few seconds. This is definitely in contrast to my concept of rafting as simply sitting in this big raft and floating in the river. At the end of the rafting experience, Patrick asked if it was ok to do caving since we had a half day to kill the following day before going to the airport. I said yes. What could be so stressful about visiting a cave. What they did not tell me is that to enter the cave, we had to rappel 120 feet down the side of the mountain. Inside the cave was pitch black and we had to wade through bodies of water from one cave to another until the exit of the cave.
Everyone should try adventures… stressful on that day but definitely lots of memories to remember.

Lesson No 10
Prayer is weapon.

In the many trials in my life, prayer has been my companion. I believe that God always
answers our prayers.
Sometimes, He readily says ‘yes’ because it is our destiny.
Sometimes, He gives something slightly different.
And sometimes, He says ‘no’ because He has something better for us.
In God's plan, there is a purpose for every person in this world. Men can help shape the future but only plans that are shaped with the guidance of God will reach perfection.

So my dear graduates, here are 10 life lessons to start with:

Lesson No 1 - Dream. You must dream. It is free.
Lesson No 2 - Life is made up of choices. In every turning point in your life, we have a choice.
Lesson No 3 - Have a high tolerance for frustration.
Lesson No 4 - No man is an island.
Lesson No 5 - Leadership is a critical element of a successful program or advocacy.
Lesson No 6 - Believe in other people.
Lesson No 7 - Service to humanity is noble.
Lesson No 8 - Time management is essential.
Lesson No 9 - Enjoy life.
Lesson No 10 - Prayer is a companion.

In God's plan, there is a purpose for every person in this world.
Life is a journey. Life is an adventure.

My dear graduates, look for your adventure.
Life is good to live.

Congratulations!
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