On another note, AmericanLolo and I will be leaving for a year in the States at the end of this month! We are bustling around getting things ready to go, and things ready to stay. For us, whenever we ‘go home,’ we leave home. We very much look forward to seeing all our kids (7) and grandkids (14) and my parents and sisters and all our friends! We will be living out of suitcases from the time we leave this month until the beginning of October! Good thing we are still young! We look forward to keeping in touch with all of you through LiP!

First of all, let me explain a little bit about the system. There are two kinds of hospitals in the Philippines, public (government: city or provincial) and private. In government hospitals the costs of the room, Operating Room and doctor’s professional fees are underwritten by the governing agency (the fees are less). Medicines may be offered at a discounted price, but the patient must buy them and give them to the nursing station for the patient’s use. If blood is needed, the family has to come up with it, usually at P1,200.00 per unit, and this covers the testing of the blood. All fees not covered by PhilHealth must be paid before a patient can be discharged. Often, a poor patient can appeal to the hospital administration for a further discount, or to the mayor or some other dignitary for help in paying the bill. When someone is sick and in the hospital, families pull together all their resources to meet the need.

Private hospitals usually require the patient to show their PhilHealth insurance card upon admission. Usually there is no down payment, but the expenses at admission are for medicine, IVs and oxygen. People need money for medicine, as private hospitals also just give the family a prescription and the family goes out to find it and buy it. Patients have to pay all fees (room, OR and professional fees) before they can be discharged, just like in a public hospital, so it is at the time of discharge that people really scramble to get money together.

If someone is asking you for money to help with a medical emergency, it is fair to ask for the name of the patient, the name of the hospital and the landline phone number of that hospital before committing any money. If this brings cries of, “You don’t trust me!” just say that you are sorry but this is the “American’ (British, Australian, Japanese, etc.) way of doing things. If she cannot give you that information, don’t send any money. I would also advise rethinking your romantic situation at this point. If she does give you this information, figure out the time difference and call the hospital during business hours. Remember that the people answering the hospital phones are not expecting to speak to a foreigner and may be flustered. Speak slowly and politely, using ‘Maam’ and ‘Sir’ to address people. Do not tell your story. Stick to business.

Ask for the billing desk and begin by asking if (name of patient) has been admitted, if yes, then explain that you are calling to check on the status of that patient’s bill. Say that you are a friend of the family and have been asked for help. Speak slowly and just stick to what you want to know: Has the patient been admitted there? How much has already been paid on the bill? What is the balance as of today? Does the patient have PhilHealth? Can I send money directly to the hospital to help with this bill? Which money service do you recommend? The best time to help is when the patient is ready to be discharged and there is a clear total on the bill, but there will be costs for medicines before that.

A request for medical help can come at any point in a relationship. Have you been here to meet the family? Do you know what they are like? Questions to ask yourself are, are these people truly poor, or do they have other resources they can draw upon in this situation? I would say that if you know they are very poor (Pick any two: live out of town, or in a squatter area, 1-2 room house/shack, keep a pig and chickens, kids go to public schools, small TV, no cable, one cell phone in the family) then go ahead and help as much as you can, if you want. But if they are middle class (Pick any two: home made of cement, have an air con unit, own a motorcycle or other vehicle, large TV with cable, kids attend private school, all have cell phones, own fighting cocks) then don’t pay the whole bill, just pay part and let them work out the rest. This establishes some limits to what you will do in the future as well. If they are using a private hospital, that indicates they have some money (or know you do). If they are in a government hospital, then they probably have some genuine needs.

Culturally, there is a lot of pressure on a girl who has a foreign boyfriend/fiance when the family has a need. She is one of the resources that the family will draw upon. If the need is genuine, she should not hesitate to give you more information about the medical situation, the hospital etc. How much you give is up to you.

My last bit of advise is, don’t loan the money, give it. If you must make a loan, never loan more than you can afford to never see again. If you are asked for a loan, you can compromise by giving what you can afford instead. Loaning money will just give you an ulcer and make you mad at the family because even between Filipinos, people do not tend repay loans unless the loaner can prove he now needs the money more than the loan-ee, and no one will think a foreigner needs money more than they do, as a rule. Of course there are exceptions, but until you know that the situation you are in is clearly one of those exceptions, give and don’t loan, or only loan what you can afford to give.

I hope this is helpful!

CORRECTION: Just this week I had a patient admitted to a local private hospital, so I am now up close and personal with this process. Yes, a down payment is required, the amount depending on the procedure. Having PhilHealth lowers the amount of down payment. It was P2,500.00 down for a normal birth, but they added an additional P10,000.00 when it became apparent that a c section would be needed.

The next time I needed to renew I had moved to another town and also needed to change the address. This was a little more involved, and they had added a ‘medical certificate’ to the process. For the medical certificate, I was sent to the Provincial Hospital where I paid 10 pesos and was given a number. When my number was called, I went to the desk and my blood pressure was taken, a form was signed, and that was it. Evidently, blood pressure was the only essential, medically speaking, for driving a motor vehicle. Nearly blind? Ok. No legs? Ok. No blood pressure? No deal.

That time time I had to keep renewing my ‘official receipt’ for three years because my plastic license never came. It turns out the LTO in Manila, where the plastic cards were made, burned down, and my card with it. I finally re-applied and got my card in four months.

The last time I had to renew my driver’s license I was in a new city again. There were a lot of people the day I went to the LTO, but in only an hour and a half, I had my freshly minted plastic card in hand! Wow, I was impressed!

Which brings us to this last week. My husband discovered his card had expired the end of February. Mine will expire in June, when we will be in the States, so we both went to renew our driver’s licenses. The first item of business was the medical certificate, but now it is the real deal! Businesses offering medical certification cluster near the LTO, along with the smog test places. Paying customers have their blood pressure checked, are weighed, measured, checked for color blindness and myopia. (If someone couldn’t see the number on the color-blindness test, they just told him the numbers, I noticed) The next stop is the drug test, so don’t stop at the CR before you go for a renewal. After the results were found and my picture taken, it was back to the LTO to sit in line for quite some time. When my name was called, I found out I was renewing my license too early. When I explained I would be out of the country, I was told to bring a Xerox of my plane ticket… Okay, I’m out for this round and will have to come back another day. In the meantime, my husband was waiting for the cashier to call his name. At 11:49 the whole place closed for lunch, so we went home. We had been there for about three hours.

My husband went back after lunch and after waiting a while, and after needing the card to be redone since it said he was Filipino, he came back with the much awaited license. Whew!

My friends all told me I should have gone to the LTO at the mall which is very fast, so I went there the next day with my half-done paperwork and a Xerox of my plane ticket. No deal. Since it was an early renewal, it was a special case and this office did not do any special cases, so I had to go back to the other place.

I went the next morning, arriving at 7:30 am. They open at 8 and I was one of the first in. No LTO staff came to my window until 8:45, and then a woman with what must have been a fixer slipped up to that window and the guy gave the window lady P20, and she went first. But I was not far behind. I got my picture taken again, waited for the cashier and the final call for the plastic card, and walked away with my license at 9:15 am.

I am so glad it is good until 2011!

[Disclamer: I know all families are not like the ones I am telling you about, but my observation is that the arrival of a foreigner into the family nest brings out the worst in many families. It is a Filipino cultural value that all must benefit from the good fortune of one; that there is limited good in the universe, so those who have more must share with those who have less or be considered stingy and a bad person.]

I have two friends who have foreign suitors. These are girls I have known since they were in high school. I know their families. Let me tell you some of the problems they have, on this end, when they have a foreign boyfriend. I will change the names to protect all parties.

The first is Suzy, my former neighbor. Suzy’s parents are poor. Her father is basically a lazy, arrogant fellow who has depended on his wife to support him all their married life. She is now out of work, but they rent out rooms in their small house and the mother raises pigs (Daddy won’t get his hands dirty). Her rich aunt has an internet café, so her parents told her, “Go to the internet café and find a foreign husband!” After a while, she found a nice fellow named Tommy in England. They met online and chatted and sent letters for several years. A friendship developed. Tommy is not rich. At last report, he had a job in a grocery store and some other side job. Last year Tommy came for a visit. He took Suzy and her family for one night in a very expensive hotel (probably because it was the only one in town to advertise online). When they got to her home, he gave her some money to help with food. Susy’s parents and family were very friendly and welcoming to Tommy, and were able to speak some English with him. But what Tommy did not know was that all the time, while the family was talking to Suzy in Cebuano, they were asking her to ask Tommy for money. Suzy replied with a smile on her face so that Tommy would not know what they were saying or how embarassed and frustrated she was. They were badgering her and shaming her and giving her a really hard time. Tommy left, none the wiser, and Suzy and her parents didn’t speak to each other for at least a month after he left.

This year Tommy came back for a longer stay. By this time, Suzy had moved out because she was sick of the pressure from her parents, especially her father, to get money from her boyfriend. When it came to light that her father was carrying on with a girl younger than Suzy, she brought her mother here to CDO to live with her in the apartment Tommy paid for. Her mother had gone back to her dad before Tommy came the second time. This time, she spent a lot less time with her family when Tommy was here. But still, they were constantly asking. Her father wanted a new cell phone with a camera, and was furious when Tommy gave Suzy one, and he only got her old one. Tommy is gone now, but there are constant calls from Suzy’s mother asking for money to buy rice and pay for the cable, etc. Suzy’s wedding in June will be pretty traumatic, I am sure, with her dad demanding an expensive wedding to show off to his friends, and the rest of the family hoping to get something before Suzy takes off for England as soon as possible to get away from the whole mess! Question: How do you think Suzy will feel if Tommy brings up the idea of moving to the Philippines, where it is cheaper to live, so she can be near her family?

The second is Tiza. She is a cousin of Suzy, but she has a lot nicer immediate family. She is from way up in the mountains and ‘met’ Don, an American from the South, by signing up for a pen-pal when she was still in high school. They have never used the computer to communicate, and it has only been in the last few years that they have been more than just letter-friends. In recent years they have talked on the phone along with the written letters. He sent her money to buy a camera, but other than that he has not sent money after she told him not to. Her family was pretty put out that she would ask him not to send money, because they wanted her to ask for money for them, especially when they had needs. Two years ago Don came to meet Tiza, but was scared to death to come to Mindanao, so he flew Tiza, her mom and sister and brother-in-law up to Manila. He was only here for a week, and Tiza was so shy she hardly talked. This year Don came back, this time for a month, and determined to come down to Mindanao and meet her family and see where she lived, and to decide whether to ask her to marry him. Since he does not speak the language, he does not know that just about as soon as they got into town, relatives were asking Tiza to ask him for money. She just kept smiling. Since he planned to go up to the mountains, to her very remote home place, we suggested that he take a pig and a sack of rice for the village. But in the end, it was decided they couldn’t do this, since they had other relatives who lived near town who would be jealous and demand the same. Believe me, things like this get complicated!

Don is actually still here in the Philippines. Before they left our house, I told Don to feel free to come back here if they felt he had seen all there was to see of the small town. To Tiza, in Cebuano, I said that if it got too difficult, with people making demands, just bring Don back here and spend some time seeing CDO. She was very grateful to have that option.

I will add here that in the mix is the fact that Suzy has compromised her moral standards, so she cannot tell her family, “He doesn’t owe me anything, so I’m not going to ask!” He does owe her, but the family is mad because she keeps it all for herself. Tiza has not compromised, nor does Don expect her to, so she can tell her family that he owes her nothing, and they know it is true because they are never alone. 

But you should know that packages coming through the post office arrive on a ‘first in, last out’ basis. Once it gets to Manila (especially during Christmas) the packages stack up in their warehouse. My parents mailed this package on December 11th and it arrived January 10th. This is the first package we have gotten (in 20 years) that was this badly damaged, probably because no attempt was made to lessen the smell of that delectable Belgian, Dark Chocolate from Trader Joe’s. Rats ate through the package from both ends, but when it was discovered, the package was taped up and sent on its way. The photo, the chocolate and the mini video adaptor they sent were all present and accounted for. And of course, after breaking off the teeth marks, we are eating the chocolate!

We lived in Gingoog City for 12 years. Our work was primarily among the poor in that city. A friend of ours, Bert, needed to have surgery for a hernia. His livelihood was buying and carrying a couple buckets of fish up into the mountains everyday, and selling them there. The hernia had become a problem. At this time, the Committee of German Doctors was doing clinics and immunizations in our city, so we encouraged Bert to go to them for his surgery. All went well and he was admitted to the Provincial hospital.

Three days later we were contacted by Bert. He could not leave the hospital! There was a huge bill to pay, and until it was paid by the German Doctors, he could not leave! My husband went to the hospital to find out what was going on. When he talked to the lady in the billing department, she showed him the bill. Every cotton ball was listed and charged, and the cost was way over what it should have been! When he asked her why it was so high, she shook her head and said, “It is because of doctor Matilda. They will not let Bert out until the German Doctors pay all this bill. Doctor Matilda really came here and made a problem!”

Oh dear, who is this doctor Matilda, and what could she have done to upset the whole hospital? We pictured a large, Brunhilda, bossy and aggressive… American Lolo went to the place where the German doctors were staying. We knew the place because whenever we could, we invited the visiting doctors to go snorkeling and have breakfast with us during their stay. He explained our problem with getting Bert out of the hospital, and we met doctor Matilda.

Doctor Matilda turned out to be a petite, delightful, fun, friendly and wonderful person! We ended up becoming good friends, and she has visited us several times since, and we plan to be in her home in Germany this coming summer. She was horrified to find that she had caused a problem at the hospital, but here is what had happened.

She and her companions were doing immunizations and clinics way up in the mountains above Gingoog. In the course of the clinics, she saw a man with a very bad skin condition. She and her fellow German doctors had given a supply of medicines to the Provincial hospital (part of the good things they do) and so she knew that the medicine this man needed was there. She told him to go there and get the medicine. She wrote a note saying it should be given to him. Two weeks later, when she was back in the same place, here came the same man with no improvement of his skin condition. She asked if he had applied the medicine she had told him to get. He replied that he had paid to go down to Gingoog and had gone to the provincial hospital, only to be told there was no stock for that medicine. She couldn’t believe it! She KNEW the medicine was there! She felt terrible that this man was not only still suffering, but that he had wasted what little money he had to run a fools errand upon which she had sent him!

When she got back to town, she went to the Provincial hospital and told them what had happened, and how upset she was! She looked them all in the eye, especially the director and the head of the pharmacy. She pointed and shook her finger as she talked.  She caused the dignitaries of the local Provincial hospital to lose face. Now they would make the German Doctors pay for their humiliation, and would show them who had the upper hand! Bert was the only patient in the hospital under the German Doctors program, so he became the tool for their getting back at them.  “They said they would pay? Well! We will make them pay, alright!”

When my husband explained to Doctor Matilda what had happen, and the cultural implications of how she had handled the problems at the hospital and its consequences, she felt terrible! She had not been given any significant cultural orientation before coming, and had not realized how her lecture would be received. She and her director went to the heads of the Gingoog Provincial Hospital, and Doctor Matilda offered a very humble apology to all concerned. It was accepted, and Bert was released from the hospital with no further charges. Doctor Matilda continues to come to the Philippines with German doctors when she can.

As Westerners, we do not know what this means. We use the words ‘embarrassed,’ ‘shy’ and even ‘ashamed,’ but none of these come close to the meaning behind the words in Filipino languages that are translated to the English words mentioned above. The Philippines, as well as other Asian countries, have a predominately ‘Shame/Honor’ culture.  This means that interactions at all levels are about people being treated with respect, and people being honored appropriately and preserving each others ‘face.’ It is also about avoiding dishonor, avoiding situations where one would look foolish, or have their ignorance exposed, or be made to look small, or be exposed as having no power, or being made the brunt of ridicule, etc. To have any of these things happen is to lose face. Losing face has driven people to leave a job, to move to another city, to drop out of school, to get into a big fight, to stab someone, to exact subtle revenge and to commit suicide. Honor and shame are serious business. Losing face is like a punch to the solar plexus, and can cause an entire family or clan to rise up in anger on behalf of the injured party.

When we Westerners get into an argument with a fellow Westerner, the issues are usually about who did what, who is right and who is wrong, guilt or innocence, winning or losing. Shouting or name calling is considered rude and poor form, but not equivalent to a stabbing. A Westerner who doesn’t like the way he is being treated by someone says, “He’s got a problem!” or “Who needs this?” or “I’m outta here!” We may get our feelings hurt, but for the most part, we can decide not to make it personal in one way or another by thinking, “He was having a bad day!” or “We won’t talk about that topic again.” or “He’s got an anger problem” etc. We like to win an argument, we like to be treated with respect, but these things to not determine ‘who we are’ in society. The things that really push our button are when people infringe on what we consider ‘OUR RIGHTS,’ or when we are falsely accused of committing some wrong. East meets west when the thing we have done wrong is a serious offense here, and not an offense at all in our home country, like causing someone to lose face. We don’t get it. We can’t believe that such a small thing as calling someone an idiot, or tapping a flight attendant on the head with a magazine, rebuking the lady who cuts in line, or telling the bank manager what you think of the system would even matter! We feel falsely accused and proceed to demand our rights…. And make things much worse.

This whole issue of losing face and our difficulty as Westerners in understanding it is complicated by the Filipino social rule that demands ‘smooth interpersonal relationships’ (SIR). The Westerner can be sailing along, offending people right and left, and not have a clue. Why? Because people keep smiling and acting like everything is just fine. All the Filipinos in the situation will know what is going on, because to them, the signs are obvious: smiles that are ‘plastic’ and never reach the eyes, tight body movements, short sentences, avoiding eye contact, avoiding social contact, eye-rolling behind the back, and often, increased requests or demands (to make you pay for what you did). Think about it. What if this is going on with several members of a family, and the wife is trying to help her husband understand by saying things like, “ I think you hurt my father’s feelings.” Or “Maybe my brother didn’t like what you said to him.” But the clueless foreign husband blows it off saying, “What? I didn’t say anything to him! We were just talking, for pity sake! Why is he so sensitive? He needs to get a grip!”  Things will go from bad to worse.

A learner’s attitude is in order here and a little humility. If you find yourself in this sort of situation, believe the person telling you there is a problem, and be grateful. Don’t defend yourself. Accept the fact that you are pretty clueless. Ask questions until you have an idea of who is offended and why. Realize that you will probably never understand how that person feels, or ever feel that way yourself, but if you value the relationship, you need to take responsibility for that person’s feelings and apologize for what you said or did (even if it doesn’t seem wrong). Lose a little face yourself. Pride and bluster will not win the day.

In the next couple posts I will tell some “East meets West” stories which you may find interesting and helpful.

Klaus had an article last week on this topic and I had what I thought was an interesting comment to post when a brown out lost it for me. So, here’s the pie, from my American perspective!

 I enjoy a good sense of humor, and what different cultures consider funny is a fascinating thing to think about. I do not claim to have a complete understanding of Filipino humor, but here are some things I have observed.

 1. Filipinos love jokes involving a ‘play on words’ especially ones that involve English and another Filipino language, or about people making funny mistakes with English.

 Examples:

 What is this? (Holding your right hand out, wiggling your fingers to the left.) Answer: Pusit (octopus). And what is this? (Holding the left hand out, wiggling the fingers to the right) Answer: Opposite.

 A tourist was visiting the Philippines and his hosts were pleased to give him many of the local fruits, which he really enjoyed. At the end of his stay he told his friends, “Of all the bananas I have ever eaten, I like saging the best!”   This one is always good for a laugh!

 Erap, when he won the vice presidency was supposed to have declared, “I told you I would win by a landscape!” There are many jokes about politicians who mangle English in funny ways.

 Like the fellow in Agusan Sur, Manuel Dela Plaza, who didn’t have a lot of English, but was a well known politician. He had a speech writer who wrote his speeches in English. One day he was addressing an assembled group of educators and began his speech, “Good morning to you all, teachers, principals and administrators. Smile at the audience from time to time.”

 2. There are many, many jokes involving priests, nuns, prayer and all things Catholic. Here is a joke which my friends found hilarious every time they told it, and after several repeats, I still can’t find the humor in, at least not to warrant the kind of enjoyment it invoked in my friends!

 A man went to buy a parrot from a priest. (A lot of jokes also contain parrots) The priest told the man that it was a very religious parrot, and showed him that when you raise the right foot of the parrot, it would say the ‘Our Father’ and if you lifted the left foot, it would say a grace for the meal. The man was impressed and bought the parrot from the priest. When he took it home he tried it himself. Sure enough, when he lifted the right foot, the parrot recited the ‘Our Father,’ and when he lifted the left foot, it said a grace for a meal. Then he lifted both feet and the parrot shouted, “Animal! (bad insult) Put me down!” [uproarious laughter…]

 Here is another: A little boy went to church and prayed, asking God to give him a bicycle, within four days, by Friday. Everyday he prayed and reminded God how many days were left. Friday came and went, and he had no bicycle. Saturday he went to the church, to the statue of Mary, put his arm around the statue and held a knife to her throat and prayed, “Listen God, I’ve got your mother!”

 3. There are a lot of jokes about handicapped people which people think are really funny. In a culture that defines and describes people by their most prominent attribute (the fat one, the dark one, the short one, the bald one, the crippled one, the harelip, the ugly one, the one with pimples, etc. I guess this is understandable. In our culture we do our best to pretend that no one is in any way different from anyone else, to the point of denial. I never thought any of these jokes were funny. One I remember was also a play on words, using the word ‘bugtot’ which means hunchback and making it come out ‘book taught’ in a sentence.

 4. Filipinos do not use sarcasm or irony in their humor. Americans (and probably Brits) use a lot of sarcasm and irony, and it is not understood or well received here. When we make comments  like, “Oh, right! I’d love that!” when we mean the exact opposite, it doesn’t fly. Or when we say of a bad experience, “I’d love to do that every day of the week!” it makes no sense. Sarcastic remarks come across as negative and maybe even a little mean. Jokes that have ironic or sarcastic punch lines fall flat.

 5. Dirty jokes are called ‘green jokes.’ People find it very amusing to compare various body parts to fruits and vegetables.

 Bruce mentioned that most of the jokes he told to Elena’s family did not get the desired response, and gave an example of one such joke: “One cannibal says: I hate my mother-in-law. The other cannibal says: Never mind, just eat the vegetables.”

 I can think of a couple things that might have made this not seem funny. First, we use the word ‘hate’ very freely, but here, people would generally not say that they hated a food. If the first cannibal had said, ‘I don’t like my mother-in-law,” you might have gotten a laugh. The other thing is that people here do not tell ‘mother-in-law’ jokes. Mothers-in-law are serious business; called ‘Mama’ and respected, even if they cause problems. So, if you had changed it to the neighbor, or a member of a disrespected minority, you would probably have had a laugh.