THE ICEBERG OF LEADERSHIP IN THE PHILIPPINES

“We have struck iceberg … sinking fast … come to our assistance,” They called for help but it was late. On that excessively cold Sunday, shortly before midnight, 14th day of April 1912, White Star Liner Titanic struck an iceberg in the North Atlantic Ocean. Less than three hours later, the ship sank to the bottom of the cold ocean and only 706 survived out of 2,223 people on board, (Davis, J.R., 2012).

What is an iceberg? An iceberg is ice that broke off from glaciers or shelf ice and is floating in open water. To be classified as an iceberg, the height of the ice must be greater than 16 feet above sea level and the thickness must be 98-164 feet and the ice must cover an area of at least 5,382 square feet, (National Ocean Service, 2014).

The tragedy of Titanic was not the fault of that iceberg but a failure in leadership (Davis, J.R., 2012; Smith, G.P., 2014).

President Duterte is in an outraged war against drugs. He said that this is the primary problem of our country. According to the PNP, more than 6,200 people were killed from July 1, 2016 to January 10, 2017. Two thousand two hundred seventeen (2,217) of these were suspected drug personalities killed in police operations, as of January 10, 2017; and 4,049 were victims of extrajudicial or vigilante-style killings, as of December 15, 2016 (Rappler.com, 2017, 44th Update). Deaths due to drug war happen almost every day. Killings, vigilante or not, are always connected to drugs by the witnesses or the killers themselves.

The current underlying educational philosophies of the Philippines are geared towards nation building by developing Filipinos who are Maka-Diyos, Maka-tao, Makakalikasan and Makabansa. Aren’t these suspected drug personalities Filipinos and the men in uniform trying to suppress them? And every leader of the home, the community, every organization and all the appointed and duly elected leaders of this country, including teachers, aren’t they Filipinos? Did they not learn the core values of Maka-Diyos, Maka-tao, Makakalikasan and Makabansa from the classroom? How could we have such enormous problem on drugs and such terrifying death toll of more than 6,200 for about seven months? Drugs is not the primary problem of this country and killing is not the solution.

The root cause of every problem in any organization is always leadership. Ants follow the track of their team’s goal without going astray while people cannot do the same all the way. Drugs have been proliferating because many leaders in the government, local and national, tolerate the same in exchange of money and power. This means that killing a drug pusher or an addict does not solve the problem because the root cause remains— corruption in leadership.

There is corruption in leadership in the government which is as big as an iceberg. However, what President Duterte sees is just the tip of that iceberg, the part that is not submerged into the waters and a portion of which is drugs; the rest of it are destruction of Nature and climate change, poverty, sleeping laws, ineffective justice system, etc. This makes the root cause even deeper and more difficult to solve. It only proves that leadership is the rarest commodity of all.

Teachers are called builders of the future leaders of this nation. With this scarcity of good leaders, there is a big question about the implementation of Philippine education system. Every public officer, including their accessories and accomplices, who cuddles drug lords or permits the occurrence of any crime and/or immorality within his or her knowledge and/or presence, has undergone schooling because a degree is required to acquire government positions.

The moving spirit of DepEd core values are hardly felt in the classroom. Teachers are pushed away from them on the job, especially those in the Basic Education Curriculum, where the critical period of a child’s personality development surges. School leaders tell them to observe numbers like proficiency and national achievement levels, number of failing students, dropouts, and winnings. Thus, teachers became competitive with numbers. Like students, they will do everything for their ratings, to pass and be promoted, sometimes, regardless of the means. This is not happening today, neither last year. This has been for decades.

The most fundamental patriotic behavior in all government agencies, including public schools, is the singing of the Lupang Hinirang, the Philippine National Anthem. This is observed on Mondays only. How many filipinos sing the Lupang Hinirang with all their hearts and how many among those who come late during the ceremony, stop, and sing as expected? During the Panumumpa Sa Watawat, the Maka-Diyos, Maka-tao, Makakalikasan and Makabansa core values are mentioned as qualities of the Filipinos. Does everyone recite the Panumumpa Sa Watawat with sincerity as the right hand is raised with pride and excitement since this is done only on Mondays? Even now that there is an existing law governing the singing of the national anthem, gone are the days when government and public school leaders reprimand or even discipline the members of their organizations due to non-observance of the proper behavior during flag ceremony.

Furthermore, considering the power of music, it is not a good practice to sing Lupang Hinirang and recite the Panunumpa Sa Watawat during Mondays only. To keep the spirit of patriotism alive, such practice must be done before the first hour of every working day in all government agencies. Once this is done, all public officers and employees will recite also their Panunumpa Ng Kawani Ng Gobyerno which will specifically remind them of their accountability and responsibilities to every Filipino within their communities.

It is stupid to do such daily patriotic rites? Such rites are not everything but they shape the foundation of leadership in any organization. God has given the human race the power of speech and music that is why the power of reasoning and social interaction are there. Imagine life without speech and music, how can the human race express their emotions and thoughts? The human race is created to profess and share emotions and ideas to survive and make this world a better place. Words and music maintain the spirit of humanities and keep them a lot worthwhile. Besides, human brains are designed for repetitive sounds and sights for retention and execution.

Humans need leaders to survive and keep this Earth a home. For as long as leaders are chosen and/or voted based on ‘benefits’, the rich will become richer and the poor will become poorer. The iceberg remains then and will even become bigger as the winter of Philippine education system freezes with numbers. It is time to revisit the cl assr oom . Ref er ences Davis, J.R. (2012). Leadership failure sinks unsinkable ship. Business lessons from the Titanic. The Forum Corporation. Retrieved from http://www.forum.com/_assets/ download/ 01c7cb9e-ea66-4d2c-93b9-413ed595b140.pdf

National Ocean Service (2014). What is an iceberg? NOAA. United States Department of Commerce. Retrieved from http://oceanservice.noaa.gov/facts/iceberg.html

Smith, G.P. (2007). The Sinking of the Titanic: An Analogy of Failed Leadership. Retrieved from http://www.chartcourse.com/the-sinking-of-the-titanic-an-analogy-offailed-leadership/

Rappler.com (2017). IN NUMBERS: The Philippines’‘war on drugs’. Retrieved from http:/ / www.rappler.com/ newsbreak/ iq/ 145814-numbers-statistics-philippines-war-drugs

— oOo— The author is Master Teacher I at Madapdap Resettlement High School

A good living environment is essential for an individual to maintain homeostasis. Access to clean water, air, medical services and having a good nutrition are some of the basic contributing factors for a favourable living environment.

Global statistics shows that there are 15.6-9 million affected with rheumatic heart disease, 1.9 million of them has history of acute rheumatic fever (ARF) (Carapetis et al. 2012). Approximately 470,00 new cases of acute rheumatic fever each year has been recorded and an estimated of 230,000 deaths annually is associated to rheumatic heart fever (Rheumatic heart Disease Australia, 2012), (Marijon, Mirabel, Celermajer, & Jouven, 2012). Ralph et al. (2013) found out that Rheumatic heart disease is one of the leading cause of illness and death among aged group 5-10 residing in unsanitary environment. Aetiology and pathogenesis * Causes of the disease

Rheumatic heart disease (RHD) is the chronic complication of rheumatic fever (RF) (RHD Australia, 2012). The causative agent is the Group A Streptococcus (GAS) bacteria, it starts from throat infection and if left untreated it will result to permanent damage to heart valves and muscles mainly the mitral and aortic valve (AIHW, 2013). * Risk factors

Rheumatic heart disease (RHD) is associate to poverty, unhygienic living condition, overcrowding, inability to access medical care and previous episodes of acute rheumatic fever (ARF) (Arora, H. 2015), (Better Health Channel, 2016). Aboriginal and Torres Strait Islander (ATSI) has the uppermost incidence and prevalence rate because of overcrowded housing, poor education and nutrition, unemployment and access to quality health care (Parnaby & Carapetis, 2016). * Anatomy and Physiology As Marieb and Hoehn (2010) discussed in their book, the heart pumps blood throughout the body. It is made up of three layers namely the epicardium, the outermost layer; myocardium the middle layer; and endocardium the inner most layer. The heart is divided into four chambers the left atrium, left ventricle, right atrium and right ventricle. The left atrium and left ventricle is separated by the left atrioventricular valve or mitral valve. While the right atrium and right ventricle is divided by right atrioventricular valve or the tricuspid valve. Blood from the bod (deoxygenated) returns to the right side of the heart via venous circulation. From right atrium and right ventricle, the blood will be pumped to the lungs for oxygenation and travels back to the left atrium and left ventricle then pumped to the aorta to the body system. Implications for public health Ralph et al. (20130 suggested that a systematic ARF/RHD registration by the primary health care is an efficient way to control RHD. Primordial prevention has a great impact to help the Aboriginal and Torres Strait Islander in remote areas to prevent ARF and RHD. Carapetis and Zühlke (2011), recommended that a better understanding of the families, patients and health staff will also contribute for the prevention and treatment of the disease. The Australian Institute of Health and Welfare (2013), implies that individuals who are already infected with ARF and RHD are strongly recommended for long term antibiotic to prevent damage to the heart valves. Clinical Manifestations The better health channel (2013) and Arora, H. (2015) outlined the signs and symptoms of Rheumatic heart disease. Fever and chest pain will be present due to bacterial invasion in the heart. Heart palpitation and dyspnoea result from inadequate blood flow in left ventricle and narrowing of mitral valve. Syncope due to insufficient blood flow to the brain because of heart malfunction, and oedema from poor circulation. Diagnostic procedures Rheumatic heart disease (RHD) requires several test. Aside from series of blood test for infection and inflammation (John Hopkins Medicine, n.d) the doctor may require the following procedures (Mayoclinic, 2014).

Physical exam is done to check for body temperature, joint inflammation and skin nodules or rash (Mayoclinic, 2014). Auscultation of the heart. The most usual and inexpensive and rapid approach to detect abnormal heart rhythm and murmur (Robert, Colquhoun, Steer, Remenyi & Carapetis, 2013). Electrocardiogram (EKG/ECG). It records the electrical impulses of the heart by marking the patterns. The signals may show damage valve or poor heart function (Mayoclinic, 2014). Echocardiography. It detects damages to the heart through sound waves that displays the movement of the heart (Mayoclinic, 2014). Chest X-ray, may not be particular for RHD but it may show left atrial enlargement or ventricular strain. (Mayoclinic, 2014), (John Hopkins Medicine, n.d). Cardiac MRI. An imaging test that can examined the heart valves and muscles accurately (John Hopkins Medicine, n.d). Tr eat m en t The Rheumatic Heart Disease Australia (2012) and Medscape (2014) had the same pharmacological approach in treating rheumatic heart disease. The treatment includes antibiotic, anti-inflammatory and angiotensin converting enzyme (ACE) inhibitors.

The antibiotic treatment includes Benzathine penicillin G, 900 mg (1,200,000 U) for patient ? 20 kg or 450 mg (600,000 U) for patient < 20 kg, it is given 4 times weekly and 3 times weekly, intramuscular. Oral medication can also be given if intramuscular is not possible or allergic reaction to penicillin is note, phenoxymethylpenicillin (Penicillin V) 250 mg, or erythromycin 250 mg, twice a day (RHD Australia, 2012 & Medscape, 2014).

Angiotensin converting enzyme (ACE) inhibitors are prescribe to patient to reduce angiotensin II level and aldosterone secretion. Some of the recommended drugs are enalapril control blood pressure and proteinuria and captopril to reduce the afterload of left ventricle and potassium loss (Medscape, 2014).

Anti-inflammatory drugs that are commonly use are aspirin which is the drug of choice for prevention of platelet aggregation formation and prednisone to decrease inflammation (RHD Australia, 2012 & Medscape, 2014).

For pregnant women with history of rheumatic heart disease a multi-disciplinary management is necessary. It involves the obstetrician and cardiologist; comprehensive assessment is a must with echocardiography. Diuretics and vasodilators (ACE inhibitors and angiotensin II are prohibited). Beta-blockers or digoxin are prescribed for atrial fibrillation and anti-thrombotic regimes are also avoided (warfarin and aspirin). During labour antibiotic prophylaxis is use for prolonged labour with raptured membrane. For normal delivery forceps or vacuum may be use for extraction and caesarean section maybe not of vaginal delivery is unfit (RHD Australia, 2012). Prevention and Non- pharmacological treatment The possibility of preventing rheumatic heart disease is 100% if the community will accept the disease and comply with the preventive measures (James & Boardman, 2016).

— oOo— The author is Admin Aide VI, Department of Education, Division of Angeles City