Not sure if you’ve come across the latest outrage du jour. Apparently, Teri Hatcher’s character in ”Desperate Housewives” thinks her gynecologist is a quack because he just diagnosed her with being perimenopausal, and she demands to know whether or not he graduated from a medical school in the Philippines.

(All this while hundreds more American soldiers die needlessly in Iraq, probably because Blackwater mercenaries continue to recklessly provoke the Iraqi population. And W kills SCHIP, pulling the rug out from under a couple of million of kids whose parents make just enough money to pull them above the poverty line, but no where near enough money to take their kid to the doctor’s office when they get sick. Where’s the outrage there, I ask?)

Now as a person-of-color, and as a Filipino American specifically, you don’t have to preach to me about racism. It’s a given that the average white man or woman is ignorant about what life is like for someone with that little extra melanin that God gave you (and I’m not talking about going to the tanning salon, either.) White writers are bound to write stupid things about people-of-color. There’s just no way around that.

But whatever happened to observing Heinlein’s Razor? Never attribute to malice that which can be adequately explained by stupidity.. C’mon now. Elevating this faux pas to a level of outrage far exceeding that which was mustered against, oh, I don’t know, the continued operation of the illegal prison at Guantanamo Bay, or the continued shredding of the Constitution by the extension of the Patriot Act, or maybe even the continued abuse of undocumented workers in the U.S. is, frankly, worse than stupidity. It’s insanity. Now I’m beginning to understand why white people can’t take Jesse Jackson and Al Sharpton seriously.

(Now, Don Imus now, he had what he got coming to him. That was just plain mean. Why the hell are you going to call a championship college basketball team a bunch of nappy headed hos? White, black, polka-dotted, or striped, that’s just uncalled for. I mean, it’s like me calling your mom a cheap $2 hooker who specializes in teethless fellatio, because she all her teeth have rotted and fallen out. It has nothing to do with race. It’s just plain disrespectful.)

But since the Pandora’s Box has been opened, I think it needs to be deconstructed. This isn’t some simple “they’re wrong, we’re right” scenario here. I mean, this touches upon a lot of little interesting details in the client/patronage relationship between the United States and the Philippines. It also actually touches upon what a disaster the health care system in the United States is evolving into. And lays bare the depraved legacy of colonialism.

I’m serious!

But, in no particular order:

Unus

Correct me if I’m wrong, but the doc was a white guy, wasn’t he? Meaning, here was (putatively) a white guy who couldn’t get into an American medical school or even a foreign medical school affiliated with an American medical school, so he had to pony up a few hundred thousand dollars to pay for the privilege of learning medicine as practiced in a developing country.

Now don’t get me wrong. I had a hard time getting into medical school myself. I had to take a few detours before I finally got in. I ended up paying for a questionable master’s degree of no apparent use except as a way to grease the rails. Me and my classmates used to joke that we got into the one school that was probably only a hair’s breadth away from ending up in the Caribbean.

And it’s no fun to be a foreign medical graduate. Just ask my dad. In the throes of my dark despair, I would bring up the idea of going to medical school in the Philippines and he would just laugh his ass off. He would tell me I’d be better off going into computer science or something.

Now here’s the big, dirty secret. Much like most of education, medical school is just another hoop you have to jump through to get to where you actually want to go. Ask me just exactly what it was that I learned in medical school that I still find useful in actual clinical practice, and the first thing that will jump into my mind is: Why exactly did I spent a quarter of a million dollars? Oh right. That piece of paper.

I’m still a big time believer that it’s your residency program that determines how good of a doctor you’ll be. You could’ve graduated from Harvard for all I care, and you could still have crappy bedside manner, and you could still make fatal mistakes by misdiagnosing and mismanaging your patients. The pedigree of your M.D. or D.O. says little about what kind of physician you are going to be. What matters—what has always mattered, and what will continue to matter—is how much time, energy, passion, and dedication you put into your chosen field of study. Oh yeah. That and brains. You’ve got to have a big brain. Otherwise your head will explode. I kid you not. All that information has to go somewhere, and if you just don’t have the capacity, POW! Grey matter all over the walls. But I digress.

So yeah. Big deal if you had to go to Southwest University in Cebu because you couldn’t get into Rosalind Franklin University of Medicine and Science in the hinterlands of Illinois. If you manage to grab a residency spot at UCSF (and yeah, even UCSF will take FMGs sometimes) that’s all that matters. You’ll be just as well trained and just as board-eligible as the guy who graduated from Yale and did his residency at Duke. No one would be the wiser, unless you happen to have an accent, but anyone who discriminates against you because of your accent deserves to referred to die at the hands of an incompetent surgeon anyway.

(Don’t piss me off, man! I know a lot of knife-happy monkeys out there who would be happy to needlessly open your abdomen and sloppily close it, leaving you to die an awful death in the throes of fulminant bacterial infection and septic shock.)

Duus

It’s one thing to go to a medical school in a developing country so you can learn how to practice medicine in a developing country so you can take care of sick people in a developing country. I think that that would be highly admirable, and it’s something that we clearly need a lot of. Even if that developing country happens to be the inner cities of the United States. The fact that we have the best medical technology in the world does you no good if your insurance refuses to pay for any of it. Not too many people I know can shell out the several hundred dollars required to pay for a CT scan out of pocket. But I digress.

It’s another thing entirely if you’re coming from a developed country and end up having to bribe some petty bureaucrat to let you into their school in a developing country, just so you can take the ECFMG and go back to your developed country to practice boutique medicine, administrating botox injections and writing for pain meds all day. And don’t tell me this doesn’t happen.

It’s also another thing, I think, if you’re going to med school because you’re in it for the prestige, or because you think it’ll improve your chances of leaving for greener pastures. One of the most mind boggling things is the pervasive brain drain from the Philippines.

Now I know that the semi-feudal economy rigged by the elites in Manila leaves little opportunity for the bourgeoisie to develop and possibly bring the Philippines into the 21st century global economy. (I’m not talking about the import/export of warm bodies here, which is apparently the lone pillar of the Philippine economy. Tax revenue from overseas contract workers is the only thing keeping the government solvent.) Ask my mom how many nursing jobs in Manila actually paid wages you could live on in the 1960’s, and watch her laugh for hours on end. If you think nurses here in the U.S. have got the short end of the stick (and, honestly, they sort of do, if you compare what an RN has to put up with with what any other professional has to deal with), you ain’t seen nothing until you see what RN’s in developing countries have to deal with.

I realize that without the brain drain, I would not exist.

But it still ain’t pretty. Just because we learned a lot from Nazi human experimentation doesn’t mean that it was a good thing, either.

The worst part about the brain drain is that bona-fide M.D.s from the Philippines are skipping the country and making their way to the U.S. to work as R.N.s! I mean, sure, we always need more nurses, but this has got to be a colossal waste of resources. Training M.D.’s in the art of medicine in the developing world, only to have them become R.N.’s in the developed world. There’s something awfully perverse about that.

Tertius

Which leads me to the sorry fact that the medical profession has nowhere near the level of prestige that it used to. Oh, don’t get me wrong. I’m happy that obnoxious, arrogant white guys who talk too much and think they know everything but who make you do all the work are an almost extinct species. The hierarchy is oh-so-slowly being dismantled. Residents and interns are now becoming recognized as having human rights. No one thinks working 60 hours in a row is a good idea any more.

Medical students no longer tremble in fear of the attending physicians. (OK maybe they still get cold sweats, but they don’t visibly tremble anymore.) Interns don’t have to kiss their resident’s ass. Surgeons aren’t allowed to throw things in the OR with impunity.

Despite my postmodern/postcolonial cynicism, sometimes there is such a thing as progress.

But at the same time, patients laugh at you when you give them recommendations. Aggrieved estranged illegitimate children will sue you for all you’re worth because their dad whom they haven’t seen in 25 years died under your watch, never mind the fact that he lived alone, and no relative could spare the time to take him to his doctor’s appointments, and he didn’t have any money to buy medication anyway.

And—oh yeah—honest assessments are met with insinuations of quackery.

Medicine has neither the respect nor the money of the bad old days. Oh yes, they were bad. You know that sinking feeling you get when you take your car into the mechanic, and they diagnose your car with some improbable condition, but you have to take their word for it, because you don’t know anything about cars, and that red blinky light is driving you crazy? That used to be the feeling people would get when they took themselves to the doctor’s office, and they would order some random blood test or imaging study in order to get their kickback, write you a prescription for some expensive proprietary medication that has never been shown to have more efficacy than a placebo, and then they would reel you in with some non-physiologic mumbo-jumbo that vaguely sounds like the threat of death if you fail to follow up. But you never studied endocrinology, so who are you to gainsay the good doctor. You get your tests done, you take your meds, you follow up obediently, all to the tune of several hundreds of dollars in cold hard cash. Flim-flammery. That was how you made money in the bad old days. (Come to think of it, that’s how you still make money in the bad new days.)

If the HMOs seem like a bad idea to you, just remember that they’re supposed to be a solution to a much bigger problem. (Seriously. Don’t try to convince me that the days of paternalism and cheating widows out of their fortunes with diagnoses of hysteria were better days. Sure you may be rich, but I have to be able to sleep at night without my conscience giving me B symptoms.)

Maybe one day we’ll give up on the whole prestige angle. And actually organize and fight for our rights and the rights of patients. But I’m not going to hold my breath. And first I’ve got to pay back my loans. But that is neither here nor there.

Quartius

The only other Filipino American resident in my program brought up a good point. Despite the fact that the city we practice medicine in has probably the second largeset concentration of Filipino Americans in the United States (the first largest being L.A.), there aren’t exactly a plethora of us brown dudes wearing white coats and stethoscopes. Sure, at least 75% of all hospital wards are staffed by Filipino nurses. There are Filipino respiratory therapists. There are Filipino physical therapists and occupational therapists. Filipino social workers. Filipino nutritionists. With almost every position available in a hospital, there are a huge number of Filipinos.

Not so with physicians.

Maybe, like my dad warned me almost 15 years ago, it isn’t worth the pain and suffering of 28 years of formal education. (That’s right. 28 years. K-12. High school. Undergrad. Med school. Internship and residency. And that’s the minimum. God help you if you want to become a pediatric cardiothoracic surgeon or something.) Maybe most Filipinos are simply smart enough to realize that there are better ways to spend your life than paying off (on average) $150,000 in educational loans, or spending every fourth night awake and in constant fear of your pager going off.

Then there are the fools like me, who couldn’t figure out anything else they could possibly do with their lives.

But since I haven’t won the lottery, and I don’t have any dying rich relatives, if I have to work, I suppose I would rather be taking care of sick people than sitting in a cubicle all day.

Quintus

So, no, as a Filipino health care professional, it’s no skin off my back. After all, I’m not the one on the receiving end of an 18 gauge needle going into your spine or of the cold, stainless steel speculum going into your vagina while you lie there trussed up like a slab of meat. (Like they say, ‘tis better to give than to receive.) I’m allowed to write for controlled substances and know how to say things like “metastatic pilocytic astrocytoma.” I get to wear those stylin’ white coats. Maybe once in a while, I even get to make someone feel better. And the golden moments, the moments that make is seem almost, almost entirely worth it, when someone actually says thank you.

It’s even better when someone realizes that getting to leave the hospital alive and mostly in one piece is a miracle and not something they’re entitled to. I’m not saying that you have to pay necessarily. I just wish more people recognized that health is a gift. As far as I know, no other species of animal expends any effort to make their fellows get better. How lucky you are that there even is such a thing as health care.

I’m not asking for kudos for myself. I don’t care if you recognize that this is hard work, or that we health care professionals have spent years of our lives dedicated to this task of healing. I just want you to look around once in a while, and realize that it’s kind of a magical thing, this thing we call modern medicine. Ultimately, it’s a complicated system that needs maintenance to keep running. No single component is more important than all the others. We’re all in this together. And I just want everyone to recognize that we all have a stake in keeping it running.

Sextus

I mean, seriously, though. Just how pristine do we think medical degrees from the Philippines are? It’s not like former colonial possessions are immune from things like, oh, I don’t know. Corruption. Bribery. Graft.

Even the dean of my Catholic high school admits that everyone has a price.

How much do you think it would take to buy a medical school diploma?

And am I dissing the hard-working, dedicated physicians from the provinces back in the Phils? OK, maybe I am.

But ask my dad about what his classmates back in med school were like.

I’ve never heard of such venality, such wanton classism and elitism outside of a Charles Dickens novel. Such sloth and excess. Such disregard for the poor and unlucky. It’s interesting how sending me, my brother, and my sister to private schools taught us to hate the bourgeouisie (despite being part of it). In the same way, going to medical school taught my dad how to despise the rich (despite milking his associates for all their worth.)

Please. Let’s not pretend that everyone goes into medicine for purely altruistic reasons. (I mean, you can make hella bank as an RN. Especially if you cross those picket lines. Mmmm.)

Despite being people-of-color, despite having a legacy of colonialism, (or maybe precisely because of all these things) Filipinos are like some of the most racist, most elitist people I’ve ever met. I’ve never seen such high regard for material possessions, for brand names. I’ve never seen so much name dropping or connection pulling. Such exclusivity, such ostracization. For the longest time, it was hard for me to stand-up for our postcolonial culture, mostly because for a big chunk of my life, I never felt like I belonged. Maybe this is every person-of-color’s experience with their own culture. Maybe we suffer from the exact situation that Oscar Zeta Acosta describes: you learn to distrust your own. Crab mentality. Colonial thinking. Maybe I’m just hating on my own peeps.

If you think it’s a big deal, you’re entitled to your opinion.

But don’t think you can just foist yours on me, either.