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Dean's Inaugural Message (2012)

OUR SHARED JOURNEY OF ENRICHMENT
The Dean’s First Formal Address
to the Community
UP College of Medicine
14 August 2012

Agnes D. Mejia, M.D.


It is often said that life is a journey. Yet, oftentimes, we fail to appreciate that this is so—caught as we all are in the web of day-to-day concerns at home, in school, at work…or on Facebook. We need to be alert to—and grateful for—those rare opportunities when we can pause to look back and cherish the people and circumstances that enabled us to get to where we are.

For me, this is one such moment.

Today, as I formally address the UP College of Medicine (UPCM) community for the first time as Dean, I’d like to briefly trace my journey to this point. And, from there, I would like to offer a glimpse of what lies ahead in that journey—not just for me, but for all of us.


My uncertain path to Deanship

The curious thing about life journeys is that we can never be absolutely sure of our destination. We may aspire for certain things that, in the end, do not turn out to be meant for us. Was the Deanship meant for me? It would be presumptuous of me to make such a claim. By the same token, it would be false modesty on my part to deny that I am prepared for this job.

That preparation began—without my knowing it—40 years ago right on this campus. I was an ordinary student during my 1st and 2nd years in Med School. I found my wings, so to speak, on my 3rd year when the clinics exposed me to the varied faces of humanity. That’s when I first internalized the value of compassion and how this infused meaning to our chosen vocation.

Much of those times were spent with my group mates: Joy Dizon, Menmen del Carmen, Ching Demeterio, Eva Edroza, Joel Elises, Dick Esguerra and Willie Escober. We didn’t talk about grades or class ranking in those days. We worked together, shared notes and provided each other relief from the stress that comes with aspiring to be a doctor. From them I learned the value of teamwork.

My residency nearly did not transpire at PGH. There were only seven slots, and I was No. 8. Fortuitously, Enya Aguila, the 7th on the list, decided to leave for the US. That stroke of luck thrust me into the illustrious company of Camilo Roa, Raffy Castillo, Vangie Luna, Cory Juan, Jane Baylon, and Marge Jimenez. We taught each other without finding faults. From them, I picked up the value of accountability.

As a Fellow at the University of Michigan, I came under the wing of the “three wise men” in hypertension.

Sitting beside me in a plane to Glasgow, Stevo Julius, one of the most brilliant internists and physiologists in the world, would pull a table napkin and scribble the neurophysiology of hypertension. Through him, I came to treasure the value of humility. This eminent mentor taught me that learning need not always be inspired by the sublime; to him, even Fellows like me were sources of wisdom.

Andrew Zweifler, an equally esteemed mentor, infected me with the contagiousness of candor and confidence. One day, after I had delivered a presentation, he walked into the Fellows’ room and told me that he enjoyed my presentation; he called me a pro and asked if I would consider writing a paper with him. We eventually did co-author a paper.

The oldest of the three, David Basset, impressed me with his detailed flowsheets. From him, I learned to harvest the fruits of meticulousness.

Upon my return to the Philippines in 1990, I was welcomed back with open arms and tight hugs by my Filipino mentors—among them, Dr. Ramon Abarquez, Dr. Greg Patacsil, and Dr. Ernie Domingo. They showered me with roles to choose from and a career to pursue. With their guidance, I learned to nurture equanimity. Rather than feel threatened or intimidated by brilliant or precocious minds, harness their talent. There will always be a place for everyone and, ultimately, you will all be peers.

These past eight and a half years as Chair of the Department of Medicine constitute an extremely fulfilling period in my academic career. Working with my Execom (Tangco, Jorge, Fernandez, Punzalan, Tranquilino, Tan, Reyes and Alejandria) opened my mind to fresh perspectives from younger colleagues and to the diversity of ways to achieve our goals. The residents, fellows and students filled gaps in my knowledge—be it in Medicine, in the stash items they needed, or in the desire to jump over financial constraints to get those patients home. The Department was a world of its own, but we all managed to sneak out often enough to see the other side of life. The experience rekindled in my consciousness the power of passion: my own as a teacher at heart and that of all the other committed members of the Department, who invested long hours of service for so little by way of material returns.

Through all the stops in this journey, my family has remained my magnetic north, grounding me constantly in the value of simplicity.

The sum of all these values has come to define my character as a person, as a physician, as a leader. And, in the estimation of the panel which evaluated my credentials, it must have amounted to a bunch of traits and capabilities worthy of the Deanship. I would like to thank all those who supported me. I extend my gratitude also to the other candidates, Dr Joey Lapena and Dr Arlene Samaniego, who were among the first to text me their congratulatory messages.

I do not know—nor do I wish to presume—that I will be influencing the personal journeys of some of the younger members of the UPCM community. What I do know is that, for the next three years, we will be in this journey together. To underscore this point, I wish to acknowledge the substantive input of my team to the roadmap that I shall be outlining shortly.

I have entitled this address, “Our Shared Journey of Enrichment”. The choice of the word, “enrichment”, is meant to remind us of a critical fork in the road during our formative years as aspiring doctors. This is when we must discern whether what drives us to excel is the lure of financial rewards and social stature or a burning desire to serve and heal our community. I submit that only a journey that can enrich us in mind, heart and spirit is worth embarking on; all other rewards would flow as a matter of course. That is the premise upon which I invite all of you to this shared journey as stakeholders of the UP College of Medicine.


The challenge ahead

In an incisive article written a few years ago, Dr. K. Srinath Reddy, president of the Public Health Foundation of India, sheds light on what he calls “the missing ‘E”s of medical education. He points out the downside of the heavily science-based model of medical education that took root in the 20th century: “(I)t limits the understanding of a complex interplay of multiple systems that operate within the human body, as well as in its physical and social environments, to define the balance between health and disease. There is now a growing recognition of the need to infuse a greater degree of inter-disciplinary learning into medical education...”

He sees the need for the curriculum and teaching methods to be reconfigured “to increase the emphasis on epidemiology, economics, ethics, empathy and engagement with the health system.”

Looking at our College, it is perhaps fair to say that we are culturally predisposed toward adapting to Dr. Reddy’s paradigm. The University of the Philippines has nurtured us in a tradition that goes beyond embedding notions of academic excellence, upon which any respectable university must be founded. As the state university, the most prominent learning institution subsidized by the Filipino people, UP carries a mandate to serve those sectors of our society which are most in need.

This mandate is reflected in the mission of the UP College of Medicine, which reads in part: “we commit ourselves to excellence and leadership in community-oriented medical education, research and service, using the primary health care approach, intended especially for the underserved.”

The same theme is reinforced in the UPCM vision of a “community of scholars highly competent in the field of medicine with a heightened social consciousness;… committed to the development of Philippine society…”

This bias for the poor is not meant to adorn a fiery slogan or to assuage our collective conscience. It simply serves as a gentle reminder that the UPCM portals are an entry point not just to a career in medicine but to a lifelong commitment to serve our people and to help build our nation. This mindset lies at the core of our strengths as a College.

Like all other topnotch medical training institutions, UPCM recruits the best and the brightest students into our program and molds them into consummate professionals and leaders in their fields. We take pride in the quality and volume of our research work, but so too do the other medical colleges which can rightfully claim to be in our league. The same parity can perhaps be observed in terms of the depth and breadth of clinical services across these institutions.

How then does UPCM distinguish itself in this sea of academic excellence, real or imagined? To an insider who has spent 22 years of her life in the system, the difference lies in the culture spawned by our College’s unique mandate and circumstances. As an institution supported by taxpayers, we are conscious of our duty to give back to society. This we do by attending to the endless streams of patients trapped in the vicious cycle of poverty and disease and by immersing our students in community work.

This orientation has bred graduates with perhaps greater empathy, patience, resourcefulness and depth of insight than their peers. Our clerks’ and interns’ intensive experience in our wards imbues them with the foundation for enviable clinical expertise and generates primary data for research with rich potential impact on public health.

Looking at empathy from a fundamental standpoint, Dr. Reddy laments how conventional medical schooling tends to distort the student’s view of his/her role vis-à-vis the patient. “The first contact in a medical college is with a cadaver,” he points out. “The student is taught to acquire knowledge from the dead, in an impersonal manner, for self-advancement. On entering the clinical wards, he or she is directed by well-meaning teachers and senior students to examine patients with statements like “see that case — he has a nice heart murmur”…The driving force becomes ‘how can I learn from this patient,’ and the question of ‘how can we help this patient’ becomes secondary.” For those who still have doubts on the OSI curriculum, let me tell you that the curriculum was designed to overcome these handicaps. We, the faculty, must make it happen. The OSI curriculum is here to stay.

Being part of a state university that is highly dependent on miniscule government budgets has ingrained in us the discipline of economics: to be circumspect in the use and deployment of our limited resources. Far from being drawn into cynicism or despair by our perennially tight circumstances, we have learned to nurture a knack for independent thinking, resourcefulness and the initiative—the guts, in fact—to try something different.

Daily exposure to the poor has also made our students sensitive to the socio-economic circumstances of their patients. Nevertheless, we need to strengthen our students’ capacity for holistic treatment: to look beyond the patient and understand his/her family and circumstances. This requires an emphasis on ‘core needs’ of patients by discerning what is judicious and what is unnecessary to maximize limited resources. While we are not expected to relieve our patients from the grip of poverty, we should at least ensure that the recommended treatment would not push them to a more desperate situation. We would also need to infuse didactics and clinical wards with more public health issues to let students sense the reality of the health system and prepare them after graduation - especially with the return of service agreement.

Dr. Reddy goes beyond the traditional definition of epidemiology and looks toward employing it proactively for disease prevention, health promotion and risk management. He points out that risk assessment is key to decision-making both on a macro and micro scale: “Epidemiological orientation will prepare a doctor to be a better clinician, researcher and policymaker.”

In the area of ethics, a gap exists in discussing and modeling concepts like confidentiality, informed consent and patients’ rights in the clinical aspects of the medical curriculum.

In terms of engagement, the argument is for systematically instilling deeper familiarity with the workings of the public health system so that students would be able to function productively in rural and depressed urban health settings.

In June this year, The Economist came out with a briefing on “The future of medicine”, which describes other ways by which 20th-century medical practices are adapting to 21st-century realities. The main article highlights the consequences when demand for health care outpaces the supply of doctors. Empowered by technology, armies of paramedical personnel are filling the gap, taking on routine tasks ranging from low-level patient diagnostics to care for the chronically ill. Rather than view this development as a threat to the medical profession, the article sees it as an opportunity for doctors to focus on the higher-level work that they are best suited to do—aided as well by the tools of technology. The patient clearly winds up the winner on both ends of the spectrum. The future of medicine, in our college, will lie significantly on how well the RSA program will be implemented - the College of Medicine, Nursing and Public Health also have RSA. A multidiscipinary practice will be an entry point for our graduates while working in the local community.


Time for well-grounded strategic thinking

To our College, these global trends and adjustments in medical training and practice present no serious cause for strategic concern. We’ve always been known to be a fiercely adaptable and resilient lot.

In terms of financial and material resources, one might say the UPCM ‘box’ is so small that we are forced to think out of it. The question is: are we thinking smartly enough? An abundance of great but disparate ideas does not automatically translate to systemic and sustainable responses to the College’s persistent and emerging concerns. We need to put our heads together and think strategically, rather than expend individual brilliance on tactical solutions—which would be such a waste of our greatest collective resource.

Strategy does not stop at setting goals, however modest or grand. Conjuring up a dream destination is the easy part. Mapping out precisely how to get there—in objective and realistic terms—is the far bigger challenge. This entails, among others, coming to terms with our institutional weaknesses.

As is often the case, those weaknesses spring from our own strengths. Take the virtue of ‘resourcefulness’, for instance. Taken to the extreme, it has spawned a warped sense of pride in our being maabilidad and in our tenacity in the face of daunting odds. At one point, we should stop holding this up as a badge of honor.

There is little consolation in feeling that we have done the best ‘under the circumstances’, rather than envisioning and realizing what we can actually achieve. The point is that we need not resign ourselves to a condition of perpetual shortage of resources with which to meet our objectives. Often, this entails mustering the conviction that certain circumstances—which we too easily dismiss as ‘given’—can in fact be changed.

We may not have an abundance of financial resources as a College, but we can certainly leverage our massive in-house talent and our extensive network to secure additional resources.

How often has it been said that our campus and faculty are magnets for some of our nation’s sharpest minds? Many of these highly intelligent men and women would forsake compensation for something intangible but far more precious. That is the opportunity to interact with each other and with our students to polish their skills and to keep up with advancements in the medical field. There is also that irrepressible passion to help mold new generations of independent thinkers with a strong social commitment.

Thousands of alumni, who owe a large part of their success to their UPCM training, would be more than willing to enhance the learning environment in their alma mater. In addition, there is the wider web of stakeholders in the health sector who can be tapped for grants, investments and donations.

We have long recognized these assets but have somehow fallen short of harnessing them continuously and systematically through a logical program that can span multiple College administrations. We need to convince our stakeholders that our goals are achievable over the short term and can be built upon in the long term. It is not enough to paint them a grand vision. It is equally important to mark milestones for celebrating small victories which would give us a collective sense that we are moving toward the attainment of a bigger goal many years down the road.


The Dean as enabler

In this regard, I see the Dean’s role as that of an enabler, more than a dream-weaver. The Dean is but part of a highly potent team and an extensive network of stakeholders. Everyone with a stake in the College must be mobilized and enabled toward achieving a singular goal.

Our ‘dream’ as a College is already spelled out in our mission and vision. I and my management team only need to outline the concrete steps to enhance our capacity to fulfill our mandate and then to enable the UPCM units to carry these out efficiently and cohesively.

In the view of someone like me, who is in essence a teacher, any program—particularly in an academic setting—has to be grounded on strong fundamentals. In the case of our College, these have to do with the basics of molding excellent physicians with character and with empathy for the less privileged among our people and a keen understanding of their plight.

Against this backdrop, allow me to outline in broad strokes what I and my management team see on the operations horizon.


1. Undergraduate program

The call of our times is to make medical education more relevant to the needs of the nation amidst a shifting—and currently unstable—global milieu. This is nothing new to our College, given our mission to give priority to the underserved in Philippine society. We just need to make sure that our science-based and problem-based learning systems continue to improve and be adaptive to the situation.

What I want to emphasize is that we shall proceed along this track without compromising the transfer of essential knowledge and skills to our students. In this regard, we are fortunate to have a good teaching hospital, where the sheer volume and variety of real patients preclude any need for us to resort to patient simulators. This underscores the importance of mastering time-tested methods of competent patient history-taking, physical examination, and the appropriate use of advances in science and technology; these would all constitute vital tools even in-flung areas.

To address the missing E’s in modern-day medical education, Associate Dean Coralie Dimacali (Medicine) and Dr Lani Nicodemus (DFCM) shall introduce innovations to our curriculum to permit the integration of themes and issues in public health services delivery, patient safety, lay health education and the like. These add-ons to the curriculum should help prepare our graduates for the return service agreement program that will begin in 2014.

We will strengthen our urban and rural community immersion programs to introduce mechanisms that would enhance our doctors’ ability to interface with local governments.

Let me emphasize that these curricular modifications will not call for more manhours from our faculty. Our intention is to simplify content and do more student and lay contacts.


2. Return service agreement (RSA)

When the members of Class 2014 enrolled three years ago, they signed a contract, with their parents’ concurrence, to serve the country for three years. They will therefore be the pioneer batch to carry out the RSA program. I fully support this long-overdue initiative, which is aligned with the mission of our College. I can think of no better way for our graduates to repay the Government for the massive subsidy that made it possible for them to acquire excellent medical training at an affordable cost.

There is an urgency to plan how the program will be implemented, because the batch is now on their fourth year as clerks. I have requested Dr Anthony Cordero, Department of Family and Community Medicine to head this program.

To start with, I would like to expand the range of options available to our graduating students\ to ensure an RSA experience that would be meaningful to our graduates, to our country, and, where applicable, to the communities they will serve.

Here are some ideas:

•      Allow residency training in private hospitals with good training curricula. This would be preferable to consigning our graduates to sub-par residency programs, simply because they cannot all be accommodated by PGH.

•      Encourage masteral programs in health economics, hospital administration, and public administration to produce people who know how to run hospitals.

•      Tap opportunities in research assistantship in NIH or in the College itself.

•      Field more doctors to the barrios, but guide them on how to deal with the local government so as not to frustrate them at the outset. We also intend to open discussions with DOH on ways by which to make salary levels attractive to those who wish to serve in rural communities.

•      Look beyond meeting the health needs of underserved communities and the usual strategies like working in government hospitals and local health units. While these strategies address the present needs of Class “C” and “D” communities,, we also have to prepare for the future by finding ways to make the RSA program benefit the health care system over the long term. Health is for everyone.

The RSA program will be our best contribution to the Universal Health Care Program


3. Research

Research can mean exploring the individual faculty interest, the direction the department would want to pursue or what the college would like to be recognized for. We should be as flexible in our direction and always making the effort simple, enjoyable and practical.

Every department is encouraged to set its own research goals and to hold its own research direction-setting workshop. A word of advice to each department: institutionalize your research agenda; even the topics of residents and fellows should blend with what you want the department to be known for and what kind of knowledge is mission-critical in your field. In Medicine, for example, we realized that to move on, we badly needed basic data on “disease burden’—like prevalence/epidemiology of common illnesses.

Let’s be practical—and not overly ambitious—in selecting what we want our residents and fellows to research. The research needs must be clear; the methodology can be made simple.

The Dean’s office will concentrate on multi-disciplinary health policy research. We will prioritize what is important to start with—one that we can finish in less than three years.

Patient safety will be the College’s main research agenda. I have requested Associate Dean Armando Crisostomo (Surgery) and Dr. Ricardo Quintos (Physiology) to develop and write a proposal with the purpose of establishing high level expertise and state of the art facilities to develop the competences of medical and paramedical health professionals towards safer patient care and better health outcomes, thus making health care safer for Filipinos. For example:

•      For applied anatomy and pathology: promote the study of applied/clinical anatomy and pathology with the use of fresh cadaver technology, full-scale prosthetic models and audiovisual simulators. We will develop and evaluate teaching tools in applied anatomy and pathology using local technology materials.

•      For basic clinical skills: develop competences in the performance of basic clinical skills, including teamwork and professionalism using patient simulators, develop teaching tools and evaluate impact of basic skills on learning outcomes. For see one, do one should no longer be the norm.

•      For biomechanics and bioengineering: evaluate their safety

•      For infection control develop and evaluate low-cost, locally adaptable infection prevention and control methods and technology

•      For patient safety management and information: develop and evaluate innovations and dissemination of cognitive errors and their solutions.

Since this will entail huge grant funding, we envision this research program to serve as an educational master plan serving various departments in both the basic and clinical sciences.


4. Faculty and alumni

We have 741 faculty members; 289 of them have plantilla items. Through my Associate Dean for Faculty and Students, Dr. Madeleine Sumpaico (Pedia) and Dr Lyn Panganiban (Pharmacology), we will work on ranking our Clinical Associate Professors (WOC) as a means of giving credit and of evaluating them periodically for promotion. We will also explore new academic items and aggressively solicit faculty grants for them.

I also propose that we review/renew the qualification of faculty admission to the College. We have more than enough clinicians and` teachers to handle the OSI curriculum. It is time to be flexible and to track our faculty according to the demands of the university and set equivalences. It is time to diversify.

If we want to be known as a research university, we should recruit those enrolled in MS/PhD programs and set a research agenda for them. Their research interest or work should blend with the research agenda of their department. Even community work that needs a good amount of learning, social and economic outcomes should be included.. All departments should have at least one faculty member, with MS in NTTC, Bioethics & Medical Informatics. We have a good number of faculty with MS in Clinical Epidemiology. This group should be actively engaged in research development and be advisers.

Our academic items are limited by what is allotted by the DBM. The College recruited more and beyond the limits of DBM because the demand—as well as the need for new outlook and expertise—is obvious. We will explore how new academic items can be acquired.

For the set programs of the faculty, ie IPC, COME, MENTORING, IFDP, we will set the rotations for 2013, 2014 as early as this year so you can block off the time and not be harassed two weeks before the scheduled activity. These programs are already set, and we can be more efficient if the schedules are blocked off early enough.

Our alumni can be viewed as a massive untapped resource that can serve to reinforce our faculty in light of the upcoming RSA and regionalization programs.. In my view, we should recruit more alumni for the mentoring aspect rather than from our faculty roster, maybe at a ratio of 3:1. Dr Pipo Bondoc (Dept of Anatomy and Orthopedics), in charge of alumni affairs, will lead the conceptualization of programs that would give alumni mentors the recognition they deserve and the assistance they need in the provinces.

Recognizing the valuable role of UPMAS and UPMASA in facilitating plans to more actively engage our alumni, we will soon be institutionalizing activities designed to build and expand harmonious relationships between the College and the alumni societies. Already, plans are afoot for the Dean’s office to collaborate with UPMAS in organizing the Homecoming in 2013, a year with no silver jubilarians. Part of this effort on the part of the Dean’s office is to initiate yearlong activities to promote and pay tribute to our alumni. Conversely, we hope that these activities will help rekindle our alumni’s bond with their alma mater and make them more predisposed to lending support to programs of the College.


5. Postgraduate institute of medicine

I have transferred the MD/PHD to Academic Development under Dra Coralie Dimacali.This will allow Prof Rhodora Estacio (Biochemistry) and Dr Techie Gloria Cruz (ORL) to concentrate on promoting MS and PHD programs. This year, we will review the curriculum of the existing graduate programs. I would like to know how many of the graduate students have completed the program and how many have submitted their thesis. If the thesis output is not enough, let’s trace the core issues. Is it because advisers keep on changing the hypothesis and methodology? Or is it because of insufficient time and funding?

Two MS programs need support: Bioethics and Medical Informatics. The Bioethics program is on hold this year because only one student applied for the course that requires a minimum of five enrollees. This is a pity because Bioethics is now a must in any institution. Let's market this by requiring at least one faculty per department or section to enroll, let's gather enrollees from other colleges like nursing and offer this outside of UPM. The program also needs to augment its faculty and its roster of lecturers.

In contrast, Medical Informatics, our newest MS program, has enrollees but lacks faculty and item positions.

To qualify as faculty in an MS program, he/she should have an MS or PhD. We are looking at programs like PhD by research with Japan. We will explore the conversion of our training-residency with at least 1-2 years of fellowship with publication, leading to an MS or PhD degree with some additional courses. We will look at equivalence of courses. The medical degree, for all intents and purposes, is no longer an undergraduate degree, even if we refer it as such. Our residency program, coupled with two years of sub-specialization—in my case, six years—can be deemed the equivalent of a PhD, provided publication requirements are met.

Obviously, we cannot develop MS programs for lack of faculty, items, or even honoraria. For those departments contemplating the creation of an MS program, make sure that the financial foundations are clear from the very start.


6. Students

As the ultimate measure of the success of our programs, you, our students, will be treated legitimately as the College stakeholders that you are. The subtle and not-so-subtle changes that will be carried out in the curriculum will all be designed to make you more effective and fulfilled doctors of medicine. You can count on our full support inside and outside the classrooms and laboratories. We will track your progress as you go along until your very last day in the College. All we ask in return are your commitment and your intellectual honesty.

We are looking at collaborating with student organizations which can help defray the cost of extracurricular activities such as sports competitions and social events. I am not one to underestimate our youngest stakeholders’ passion and energy—least of all your capacity to harness the power of technology and social networking for noble and productive ends.

Along this line, we will institutionalize guidelines in social networking to be stewarded by a body composed of selected faculty, students, a lawyer and a social scientist. Rather than block or discourage the use of social networking sites like Facebook on campus, we will embrace it as a potential tool for learning and advocacy and find means of control, supervision, and collaboration.

We are also counting on your help as we seek to activate a parent-teacher association to create a new base of support for the College.

To the Greek and non Greek societies, I extend a hand of cooperation in the hope that we will constantly find common space by which to serve the interests of the College, our students, and our community. To be sure, we will run into sharp corners, and the door to my office will be open for you to discuss your concerns.

Let me be forthright: I am a MU, and will always be a MU. But my sisses and brods have always respected my position that affiliations have to be set aside if we are to achieve fairness and justice in the settlement of disputes. In the same vein, I appeal to your elders and advisers to promote sensitivity and objectivity.

On September 27, 2012, we will have a Strategy Formulation Workshop for the details and then present he output in the next College Council (November) together with our other plans, ie, tracking for the regionalization and promoting immersion, infrastructure, admission criteria to UPCM and financial stability program.

For 2012-2013, the priority programs/agenda are RSA, grant for the educational masterplan, admission criteria, alumni brochures, MS Program and fiscal planning.


Mastering the art of the possible

After having outlined these plans, we must come to terms with an equally heavy burden of the job: to make sure that they are achievable. This points to twin operational thrusts:

•      Enhancement of internal organizational efficiency

•      Pursuit of financial stability programs.

Together with my college secretary, Dr Sally Vios (Dept of Physiology) and Special Assistant to us, Dr Francisco Tranquilino (Medicine), as a first step toward greater efficiency, we will streamline the structure of the organization. We will simplify processes and see how computerization of these procedures can be fast-tracked or enhanced. At the same time, we will upgrade the skills of administrative staff to enable them to take on more substantial tasks. We will also cut down on repetitious and non-sustainable projects. Along this line, our focus will be on evaluating and containing—not expanding—current programs. This harks back to the fundamental premise: why embark on something that cannot be sustained or done efficiently? We owe it to the Filipino people to use their money prudently.

Enhanced efficiency within the College will translate to reduced costs and consequently more funds for operations. We will also look into ways by which to increase UPCM’s share in the fiscal allotment of UP Manila. But, evidently, these will not be enough.

We would need to institute programs to raise funds systematically to stabilize the finances of the College. Toward this end, we will study the line item budget of the University of the Philippines Medical Alumni Foundation (UPMAF) that can be tapped in a programmatic fashion. We will also be more deliberate in mobilizing the UP Medical Alumni Society here and in the United States for scholarships and other forms of strategic support to their alma mater. For this, I have requested Dr Rody Sy (Dept of Medicine) and Melfred Hernandez (ORL) to head the resource generation office.

We also intend to set in motion projects that can generate enough resources to fund themselves and some of the College’s operational needs.

In the bigger scheme of things, the plan of action just outlined may not seem grand enough. That is because my intention is not to create an impression but to make sure that the UP College of Medicine will get to where it wants to go.

Perhaps, that is just the way my mind has been trained to work. Like many who aspire to help transform our College and our nation, I too harbor my share of that “impossible dream”. But my convictions dictate that I must first master the art of the possible. There is nothing more corrosive of a dream than the feeling of futility. That is why I have laid out a plan of action built on creating solid foundations for the College.

More than eight years of experience as Chair of the UP-PGH Department of Medicine have convinced me that it can be done. A deliberate program of institutional reforms has enabled the unit to win the Silver Cup as the ‘Most Outstanding Clinical Science Department of the UPCM’ eight times, while enlarging its output in research, lay medical education and other areas. Its resource mobilization partner, the Sagip Buhay Medical Foundation, has gone beyond mere patient subsidy to educational grants and support for infrastructure and research. Sagip now augments the Department’s budget by more than PhP3.5 million every year.

The vital lesson from this modest success story is simple: Pay attention to the little things that legions of stakeholders can deliver, and bigger dreams will fall into place.

It is equally important to me that, after I eventually leave this post, successive administrations can continue seamlessly and sustainably in the same general direction, animated by the UPCM mission and vision. After all, the true test of leadership, I have been taught, is not to make oneself indispensable but to inspire and empower others to carry on.

As I said at the outset, we are in this journey together. And I am counting on all of you to be by my side as we build the College that we all want to see.

Let me end with this short story. In December 2003, when I was nominated to be Chair of Medicine, I consulted my family - the 2 girls, Olia and Kittina, and my husband, Jimmy, all agreed. The last one was Jimboy - who was then 6 years old - "O, Jimboy, papayag ka bang maging chairman ang mama mo?" He replied, "Mama, pwede kang maging chairman pero hindi ka pwedeng maging BOSS."

So now, I am your Dean, but not your BOSS. My mind is clear, there is no fear in my heart, for together we can make this very good institution even better!

Thank you and Godspeed.

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