Esteemed guests, colleagues and friends, a pleasant day to you. With gladness and pride, I welcome you to this historic meeting in the beautiful city of Roxas, province of Capiz in the island of Panay in Western Visayas.

My warmest greetings to our president Dr Michelle Beluso Almeida, the EXECOM, the organizing committee headed by Dr Rhoel Dejano, the different chapters, represented by their respective presidents, Dr Alex Zander Bondoc of NCR, Dr Estelita Jacinto of North Luzon, Dr June Anne de Vera of STARS, Dr Jan Nathleen Dizon of Mindanao and our very own PARMVis president Dr. Elda Grace Anota.The Visayas is home to 48 strong physiatrists in the central part of the Philippine archipelago.

The Philippine Academy of Rehabilitation Medicine holds the distinction of being the mother organization that nurtures a unique group of physicians, the physiatrists of the Philippines.

I salute the first wave of physiatrists to leave Manila in the 70’s to practice on home ground: Dr Jose Soriano, Dr Vicente Villareal and Dr Atanasia Siva of Iloilo, Dr Primitivo Cammayo of Bacolod, Dr Malgapo and Dr Mary Jeanne Flordelis of Cebu, Dr Luchi Aportadera of Davao, Dr Romeo Abiog of Baguio, Dr Roy Lim of Pampanga, Dr Grace Cid of Cagayan de Oro, and Dr Greg Diaz of Naga. Those who stayed on in Metro Manila developed and strengthened the original four residency training institutions. They were our tireless mentors, they were the first to dare the path least taken and we continue to pay tribute to our courageous forebears. They are the tireless champions of the relevance of our position in the medical field. They paved the way to where we are now in the practice of physiatry.

On my first year residency as a physiatrist, one of my earliest assignments was to evaluate a 17-year old male whose hands were caught in a threshing machine. He had a short above-elbow stump on the right and a below-elbow stump on the left. He was a student, he helped his father with farm work on weekends. I began by asking him how he fed himself, how he did other basic activities of daily living. I asked him about other previous interests—I found out that he used to love drawing and playing the guitar. All this time, I tried to look calm and collected, measuring the stump length and testing for muscle strength and sensation, pondering to myself my rehab plans and goals, and my prosthetic prescription. Then the prosthetist came, took one look, and blurted. “Ay, wala kang kamay, kawawa ka naman.” Instantly, the boy replied, “Hindi naman po. Pag may sunog, nakakatakbo ako.” The quick reply humbled me. I became a changed person when I left the room.

Physicians often think that patients draw strength from them. In rehab, the physiatrist is uplifted by the power of optimism and human connection’ by his or her daily encounter with patients with disabilities, his tireless exercise of empathy as he or she helps them rise above their limitations. He strives to find creative solutions so that the patients can continue to live a life of meaning and substance, notwithstanding the broken limbs and shattered dreams. Hope and a better quality of life are a shared vision between patients and physiatrists, beyond impairment and disability. This sacred space, my dear friends, and the countless stories of triumph over disability that arises from it—this is what makes physiatrists unique among many other medical professionals.

The physiatrist is trained to address the full spectrum of disability through preventive and preemptive strategies in the pre morbid, acute as well as chronic stages. He or she helps patients regain optimum function, and eventually achieving community integration. This is the bigger picture that he or she envisions, but they know they must take care of the smallest detail in order to achieve. Anchored in the strong academic tradition of excellence and clinical skills fundamental in the training of the medical professional, the physiatrist leads various other allied professionals towards the full recovery of patients, and is indispensable in patient care throughout the lifespan.

We are confronted today with new challenges: on one hand, the advent of advanced and rapidly evolving technologies, robotics and AI, and on the other, the increase of aging populations. There are also other conditions, such as the rise of technology- related disorders, the increasing prevalence of mental health conditions, cancer and cardiopulmonary disorders, imminent disasters due to climate and environmental crisis. How do we use our expertise to meet these pressing demands?

Our strength as specialists depends on the quality of diplomates and fellows produced each year. Given the breadth and diversity of the various fields that need to be studied, training institutions should strive to attain the highest standards of training. They should serve, not in competition with each other, but in collaboration, sharing resources and experiences.

The scope of rehabilitation medicine is huge, it is even bigger than Internal Medicine or any other specialty. In the three years of our residency training, we are required to master anatomy, physiology, kinesiology, sports and exercise, evaluation and management of pediatric, geriatric, cardiac, pulmonary, musculoskeletal, cancer, neurologic disability and rehabilitation on top of orthotics prosthetics, electrodiagnosis and diagnostic musculoskeletal ultrasound. In most training programs abroad, like in the US and Canada, residency takes four years. The fifth year is dedicated to sub-specialization.

Perhaps it would be worthwhile to consider another year of residency. The Philippine Academy of Rehabilitation Medicine Specialty Board is tasked to ensure the highest quality of training for future physiatrists according to the standard of ISPRM curriculum. It is true that our numbers have grown in recent years, but the population of persons with disability is also increasing.

To date, we now have 374 fellows and diplomates, 69 associates and 108 residents. With a population of 115 Million, what is 500 versus an estimated 13.8 M individuals with varying disabilities? From the original 4 training institutions we now have 11. With the exception of La Salle, these training institutions are all in Manila. We are eager to see more training institutions open in the major cities of the north and south in the coming years.

In her keynote speech last year Dr Flordelis pointed out: why do we rely in referrals, when we should be in the heart of primary care? Why do patients go to a hilot, a PT or an allied professional first rather than coming of to us? Why do we lack visibility, in the community and in social media? Why are we not recognized as leaders in stroke, pulmonary, arthritis, exercise and pain rehabilitation?

The importance of physiatry in medical practice remains a challenge to this day. We must pursue recognition aggressively as individual practitioners and relentlessly as a professional collective. How far have we gone so far? I say that we have made some strides. Gone are the days when patients were referred to us only on the day of discharge, or after recovering from a serious illness. We are now being consulted for preoperative rehabilitation, and we are taking part in the care of critically ill patients at the ICU.

The promulgation and annual celebration of the National Physiatry Day is a major triumph. Through the effort of our executive Board and key members of our organization we have attained some success with the inclusion of rehab benefits through Phil-health packages. What else can be done? Physiatrists are natural leaders and should try to take elective positions in the governing bodies of our PMA component societies. Run for office. Participate in outreach programs and continuing education activities. Initiate lay forums. Lay forums whether in person or on-line are strong drivers for community engagement.

We recognized the need for the development of sub-specialties more than a decade ago, when we initiated the formation of special interest groups. In the last few decades we have seen the emergence of individual and institutional forerunners of specialization. For instance, in sports medicine, we have Dr Tyrone Reyes, Dr Bee Giok Tan, and Dr Rhoel Dejano who became Olympic Sports Physicians, and Dr Raul Cembrano for Paralympics. They highlighted the importance of physiatrists in the area of sports. We still have to see a center dedicated for comprehensive rehabilitation for sports and training. In the field of musculoskeletal ultrasound we have Dr Jeimylo de Castro, an internationally recognized expert. Dr Josephine Bundoc established the first and only orthotics prosthetics school in the country, If neurologists have successfully required the tertiary hospitals to set up a stroke unit, then a neuro-rehabilitation center should also exist in tandem. Setting up specialty centers in key cities shall serve as training ground for sub-specialization and research. The training institutions perhaps should seek a collaboration and sharing of expertise with international societies to hasten this development. We can tap the DOH and PARM RARE for institutional research funding and development of CPGs. We must encourage and support members to attend and participate in international research presentations.

Rehabilitation medicine should be mandated as a subject in all medical schools. We could even go further by proposing to include it in the curriculum for Physical Education in the K-12 program at all levels to promote a culture of exercise and to introduce basic rehabilitation principles in the prevention of disability.

Lastly and most importantly, let us bring our service all the way to the grassroots -create Community Rehabilitation models specifically tailored to our respective communities, in collaboration with LGU’s and with PARM RARE, the NCDA and WHO. I am calling on the chapters to make this a priority. With the looming implementation of the Universal Healthcare Law, let us get on the ground and make our presence felt, as leaders, as primary doctors and as specialists providing expert care.

This era ushers a new breed of talented tech savvy physiatrists taking center stage. This generation is learning new skills on emerging therapeutic interventions in our field. One must never forget that the practice of rehabilitation medicine is deeply rooted in compassionate care. This is the tradition set by our first mentors. We do not sit, write a prescription and leave. In the words of Dr Grace Cid, while other specialists hold a patient’s hand, a physiatrist literally locks her arms around a patient to make sure he assumes the upright position, ever teaching and checking that the physical therapist is applying the right exercise and technique.

In the act of listening, tangible human connection and interaction, the long process of restoration of function and rehabilitation takes place. This is what patients will remember. This is how the community will know and recognize that physiatrists matter. All too often, patients who feel your genuine care will ask, Doc, pwede ba kitang yakapin?(Doctor, May I hug you?)

The science, expertise and recognition should be pursued, but we should never lose sight of the human side. Let me share a personal story. Many years ago, a young postpartum woman was referred to me because of dense right hemiplegia due to an intra-cerebral bleeding. She was a domestic helper in Singapore and came home after she became pregnant. History revealed that she had a seizure during labor. She underwent Cesarean Section and delivered a healthy baby boy, a love child with her foreigner boyfriend.

Needless to say she spent weeks and months undergoing physical rehabilitation. With training and encouragement from the rehab team, she gained independent ambulationthough she still needed partial assistance in some activities of daily living. Four months after she became my patient, her boyfriend arrived and saw her progress and functional abilities. That day, in my clinic I became a quiet witness to a promise fulfilled. Amid tears and sobs, the man informed me that he was going back with her and their child to Singapore and live there as a family. Last week, I received a message from her. They now are now living in Munich. “Doc, we are going to visit you in September. Our son now 14 years old,” she told me. It is stories like this, experiences like this that affirm us in our particular medical practice.

Postscript:

PARM VIsayas Chapter members headed by our very own Dr Michelle Beluso-Almeida wore with pride the traditional garments of the Panay Bukidnon. In this way we give duehonor and our respect to one of the two groups of the indigenous peoples of Panay. Vibrant red characterizes their clothing, adorned with elegant hand embroidery called “panubok.” The Panay Bukidnons who live in Central Panay have a great oral tradition, a living epic that is still part of tribal life. These stories which are part of the great epic have been handed down the generations through the “binukot,” the cloistered woman to whom tribal knowledge and wisdom is entrusted. The UNESCO recognizes the Panay Bukidnon epic cycle as a living heritage.

By bringing PARM to Roxas City in Capiz and immersing our participants in the local culture, we re-experience the origins of our rich cultural traditions and gain appreciation of the diversity of customs and ways of life of our brothers and sisters living in the many different islands of the Archipelago. We bring home with us memories of post-colonial heritage sites we have visited, indigenous ways of life which we glimpsed during the balsa ride down the river, the fantastic cultural show, and the surambaw ponsyon, all gifts from the Province of Capiz. The backdrop of our stage showed moving waves that provided a healing calmness while listening to our lectures. During our fellowship night, we were treated to an authentic rendition of a Panay song and dance, and a modern Panay Bukidnon fashion show. We viewed a presentation on the abaca fiber, featuring the mountains of Panay where it is sourced, how they are harvested, dried, and carefully hand-woven in looms. I hope you will bring home also this idea: the abaca fiber is known for its strength and durability. Each strand of abaca represents each one of us, our diversity, and strength which is our heritage as a people.