The Philippines: The Making of a Feminist Physician

Delia D. Aguilar interviews Dr. de la Paz

IN SEPTEMBER 1992 a federal court in Hawaii found the late Ferdinand Marcos, Philippine President and dictator for twenty years, guilty of human rights violations in his country. Interpreted by justice-minded people as a warning to all potential despots, the verdict constituted moral victory for the 10,000 Filipino victims in whose behalf the suit was filed. Among the testimonies presented during the trial was that of Dr. Sylvia de La Paz, former Executive Director of Medical Action Group (MAG) for the victims of human rights abuses and widow of Dr. Roberto de La Paz, an activist physician who lost his life to military gunman’s bullet in 1982. Delia D. Aguilar attended the trial, where she interviewed Dr. de La Paz.

Delia D. Aguilar: Perhaps you can begin by talking about the recent hearings in Honolulu pertaining to the human rights violations of the Marcos administration in the Philippines, its significance and your participation in it.

Dr. de la Paz: The hearing was part of a process in which victims and survivors of the Marcos regime sought to 1) pin responsibility for human rights violations on Ferdinand Marcos himself by virtue of command responsibility, and 2) get compensation for the victims/survivors; from the Marcos estate.

Fifteen Filipinos testified and fifteen more sent videotaped testimony. There were those who had family members who were killed, were victims of salvaging [a military term for summary execution], or who disappeared, and some were themselves torture victims. It was a moving experience for us—some testified in Tagalog—as well as for the jury.

For me, it meant raking up painful personal memories because I was in the trial in two roles: as plaintiff, widow of Dr. Bobby de la Paz, and as former Executive Director of MAG, an organization that served torture survivors.

DA: Can you explain your role as plaintiff? Dr. de la Paz: As plaintiff, I was asked why Bobby and I were serving as physicians in a province like Samar and why we pinned responsibility on the military.

We went to Samar in 1978. We were new graduates, just finished with our internships in 1977. People were suffering from ill health not because it is God’s will, not because it is natural, but because of the social conditions, specifically poverty. It’s ironic because Samar is rich in natural resources, it’s an island surrounded by water, so you have lots of fish, mines, fertile soil, and yet so many are poor.

Our work was largely focused on Community-Based Health Programs (CBHP), with special emphasis on TB. It was sad to see that people there had not been visited by any manner of health personnel, be it doctor, nurse, or midwife.

We felt that our role as doctors was not merely to render curative services because, for example, even if you treat TB with the best anti-TB drugs, if you return the person to the same poverty that she came from she will eventually develop a reactivation of the disease. Curative medicine is not the answer. You have to move on to preventive medicine, and preventive medicine has to be community-managed, so community organizing is an essential aspect of health-care delivery.

We trained people to answer their own health needs. We taught them how to do sputum smears for TB themselves, in order to empower them. But we did not stop at that because we believed that the government also has a responsibility to the people; the government signed a decree for the observance of human rights, and among human rights are health rights. So we had to demand what is due the people—for example, adequate facilities and health-care personnel.

It was in this process that we came to be viewed as anti-Marcos.

DA: And did you learn preventive medicine in medical school?

Dr. de Ia Paz: Certainly not! (Laughs) We learned hands-on the job from hilots [healers], from community organizations, from people actively involved in social action, some who were church-based, some not.

By the time we were taking our internship more than fifty percent of our class were in the United States already. That’s still the trend today. At the time, we were already going against the current There were NGOs [nongovernmental organizations] developing CBHP, and at this time we were also discussing the structural analysis of society, represented by an inverted triangle wherein the bulk of the resources are used by the few who are on top, while the majority at the bottom have to make do with minimal resources.

We went to Samar for our internship because that was one of the areas where there was an integrated school, the U.P. Integrated School of Health Sciences, which trained barefoot doctors who could later be trained as nurses, midwives, or doctors. It was a government program, but it had people already active in CBHP, like Jimmy Tan, now the Undersecretary of Health. There was a program there that supervised the six-month rural health practice of graduates.

Bobby and I were attracted to that since it would expose us both to work with CBHP and also see the innovative government approach With five other classmates, we spent our six-month requirement there. After that was completed to get our license, we simply stayed on.

At that time there was a very strong resistance movement in Samar. There were times when truckloads of dead soldiers would be brought to the hospital, sometimes the wounded ones helicoptered to Manila. We were caught in the turmoil, but we felt that was where we were needed.

DA: Do you mind telling me what the immediate circumstances were? I’ve never asked you this directly. What exactly happened? Was it in your clinic?

Dr. de la Paz: It was in his clinic, in 1982. I was on duty in the hospital. All of a sudden people brought him in a jeep to the hospital at 5p.m., and we battled for his life until midnight. There were many donating blood for him. We heard later that there were many fisherfolks in the island who also wished to offer blood, but could not because they didn’t have the means to get to the hospital. The team of doctors really worked hard to save his life. DA: What happened? Someone just walked into his clinic and shot him?

Dr. de la Paz: There was a man who came into his clinic and shot him. I was able to get this information from Bobby because he was conscious when he was brought into the hospital. He was able to describe this man to me. Later, another man came looking for me at the hospital; luckily, a fellow physician told him I was someplace else.

DA: They were also after you?

Dr. de la Paz: Yes. Later we found out that there were others on the list along with my husband whom the military also wanted to liquidate.

His death had a great impact on me. It’s one thing to declare that you are prepared for something like this, but you’re never prepared when it actually happens. He was thirty, I was thirty-two.

When I came back to Manila with his body the day after his murder, I saw how the organized health sector responded not only locally but internationally. Because of the pressure generated by widespread protest, the military was forced to admit its culpability.

Eventually it became clear that the circumstances surrounding my husband’s death followed a pattern similar to those who were salvaged. Initially, the military would spread rumors that you are part of the NPA [New People’s Army, guerrilla contingent of the Communist Party of the Philippines], that there’s an order of battle for you to be “liquidated.”

The military did this so that when the event takes place, people are inured to it and they will say it’s because you’re subversives. Enrile himself who was Defense Minister at the time admitted that it was the military who killed Bobby, but only after a lot of pressure from cause-oriented organizations and the media.

From then on l was involved in the health and human rights movement. A few months later, we formally organized MAG [Medical Action Group], which had been in the making for two years. It was former Senator Jose Diokno of FLAG [Free Legal Assistance Group, a lawyers’ organization taking up the defense of political prisoners] who felt the need for physicians to be organized so that health needs of political detainees could be met I was made MAG’s first Executive Director.

DA: How did the murder of Bobby affect your own thinking about the work you were then about to do?

Dr. de Ia Paz It fired me up. There was a time in our lives when Bobby was a lot more politically advanced than I was.

DA: What makes you say that?

Dr. de la Paz: We were both looking in the same direction, both exploring another system, socialism. But he had more experience and more theory. He started out with the student movement earlier than I did. His family was more liberal compared to mine, which protected me.

Fortunately, a few weeks before his death, I already made my political commitment internally. I say “fortunately’ because I’d seen that among our politically active friends, those who had not reached that point had a more difficult time coping when their partners disappeared or were killed or tortured. They went through all sorts of sell-blame.

I also went through periods of thinking what if? Then you discover that you’re just wasting your time, because for every minute lost blaming yourself, it is time lost doing something about the situation, especially because I could see that he wasn’t alone. That also helped me to see that the problem was systemic. In fact my awakening to torture took place only after Bobby’s death.

Prior to this, I remember meeting a torture survivor. I remember thinking “How terrible for him, not realizing fully the impact of torture. This knowledge came only after I learned about the phenomenon of political detention. So somehow Bobby’s death speeded up the process that was only just beginning, and somehow my fears simply flew away.

There was a release—maybe it was the anger, the realization that it happened to him and that it’s continuing to happen until now. So much really needs to be done by those who are still around to bring about a situation where people will no longer have cause or inclination to perpetrate brutalities upon each other.

What is sad is that repression is continuing to this day. For as long as we live in a society where a few amass their wealth and power at the expense of the majority, then we are sitting on top of a social volcano. We can expect that torture, disappearances, and salvagings will continue.

DA: Even with Cory, and now, with Ramos?

Dr. de la Paz: This has been borne out by statistics. My husband was only one of many murdered by the military.

I had occasion to serve some who were tortured because this is one of the programs of MAG. I’ve also had occasion to observe how family members have to cope with their day-to-day lives while they continue to hope that someday their disappeared partners will appear. They can’t even go through the grieving process and move on.

DA: What was your work in MAG?

Dr. de la Paz: I never before had experience in administering a program. Initially there were just myself and a clerk/typist. I had to write project proposals, a task with which I had no experience, but somehow the ideas came. For example, there was a need to attend to the health requirements of political detainees, workers on strike, wounded demonstrators, etc. Somehow proposals got off the ground, especially with the help of others.

We grew from a staff of two in 1982 to ten or twelve in 1988 when we were running three different programs: education and organizing health services, and services for torture survivors.

DA: How did you overcome your anxiety about your lack of administrative experience?

Dr. de la Paz: Well, I discovered that things can be learned hands-on. Then after four to six years of work with MAG, I began to feel that was getting into a rut. That was the time I discovered feminism. I was asked to speak in the Davao Medical Women’s Association as MAG Director and as the widow of Bobby.

I was asked what the role of female physicians was in the health-care system. I asked, “is there a difference between a female physician and one who’s male?” Fortunately, there already were people around me who’d answer, “Of course. Think back. You and Bobby were both physicians. But when you got home, who was responsible for home management?”

I thought, Bobby was very keen on cooking. It wasn’t difficult to get him to cook. So I didn’t feel oppressed at the time. I wasn’t a victim of battering or anything like that. Little by little it dawned on me that when it comes to overall home management it’s really the woman who is responsible. I took the role as though it were natural. I got married, therefore I should do household work.-On birthdays, it was I who went out and got presents, wrapping them and adding notes that I signed “Bobby and Sylvia.” If that was not done, ! was the one who felt guilty, so I did it.

Then there was a friend who passed onto me this feminist book on witchcraft, midwives, healers. At that time I was getting into a rut with administrative work in MAC.-I don’t think it’s good for the soul to be an administrator for so long. You’re on top and have little contact with the grassroots.

DA: You missed the grassroots contact?

Dr. de Ia Paz: Yes I was dealing mostly with project partners It was fun for a while facilitating their visits here and taking them to Smoky Mountain [a huge garbage dump in Manila that is home to a few thousand families and other such places. They would get so shocked, and somehow I saw in them what I was like years ago when I was so shaken by the poverty of Samar. I felt that I would like to give to them what others gave to me. That was interesting for a while, waking others up, sharing a vision with them. But then there was this yearning for contact with the grassroots. Yet when I went back to the grassroots, because I am a doctor, people naturally dealt with me in that capacity, but I felt that I had no more skills to offer because all this time I’d been an administrator.

So little by little, the realization that I lacked skills, combined with a growing feminist awareness, eventually led me to involvement with the feminist movement It helped to have read books here and there and to get together with groups of women—that’s when I met you—to discuss these issues. It helped to jell these feminist concepts.

The health movement taught me about the linkage between health and imperialist and capitalist structures, but it didn’t seem to address individual needs, whereas the feminist movement really struck a chord inside. It makes one feel, “I have a personal stake in this.”

Eventually I asked to be transferred from the health sector to the women’s sector, specifically Gabriela [a coalition of women’s organizations], in 1988.

DA: But was that really so different, your involvement in the health sector? It seems to me that when you were in Samar, that was a personal stake, wasn’t it? You had cast your lot with the majority who were poor, that’s the reason why you decided to work there.

Dr. de Ia Paz: Yes.

DA: How different is that from the “personal” you’re talking about as a feminist? Is there a distinction? Because wasn’t the decision to stay in Samar a very personal decision?

Dr.de la Paz: Maybe at the time l thought of myself simply as a doctor, a genderless prison. At the time I wasn’t aware that there were such things as reproductive choices for women. I had some sense of the oppression of women even while in the College of Medicine, but it didn’t strike me the way it does now. For example, the concept of having children without marriage. I was totally shut off to that possibility because of my Catholic background, so I would look down on women in that situation.

When I went abroad, I met people who lived together without marriage, and they were just as normal as those who were married. My eyes were opened to the fact that indeed there are many ways in which people can arrange their lives, and that also includes the concept of reproductive rights—how many children, whether one wants children at all, whether to many or not, what sexual orientation.

When Bobby died, I had this anxiety that I’d be raising a boy by myself, without a father. I spent several sleepless nights worrying about that What if he became a homosexual? Then I met some Australian women —a lesbian couple, I believe—who had a boy and a girl whom they were bringing up. I realized it didn’t matter whether the parents are lesbian or heterosexual, but whether the child was brought up with love.

Even when I was politically involved, this anxiety was not being addressed. Also, there was this anxiety about being married. Now I ask is this what women are meant to do, reproduce? Should one’s self-esteem depend on whether or not one is married? Why? I have my profession, my commitment. If I meet someone with whom I want a relationship, should I have to get married? Somehow, my anxieties about these things have been assuaged by the feminist movement. That’s what I meant by the personal combining with the political.

DA: What you mean is that your personal concerns are now being talked about and addressed directly by feminism?

Dr. de la Paz: Yes. In fact, when these things were talked about in the past, they were talked about in stereotypical terms, further reinforcing what one is so anxious about.

Even with MAG, there are some who are very progressive, who are active in the nationalist movement, in the anti-nuclear movement, yet when it comes to feminist issues, they are very backward. So I felt that this is where I should be.

DA: So the women’s movement has really been of help to you?

Dr. de la Paz: Oh yes it helped a lot. So I felt that if this helped me, I wish that I could also help others. I also have an unmet need to express myself as a doctor, and I realized that I needed further training. My work with MAG was thirty percent clinical and seventy percent advocacy. That’s why I decided to go back to medical school, knowing that my skills were not adequate to give the best service.

DA: Can you talk about the decision to return to medical school?

Dr. de la Paz: My decision to go back came around 1990. Just prior to that I was in public health. I took my Master’s in Public Health, but it didn’t help very much because there remained a desire to do clinical work, which is different from public health work. Clinical work is an immediate response to the current concrete needs of women. Both public health and CBHP provided a fa reaching vision of transforming society in order to have a healthier environment. But what does one do for a woman who has concrete needs right now?

DA: What are your experiences now as a student?

Dr. de la Paz: Right now I’m working with students half my age. I can see myself in their shoes twenty years ago. In some ways it’s easier, and in other ways it’s more difficult being an older student. Catching up with fifteen years of academics is difficult There have been so many developments, like ultrasound.

It’s tough because one needs the physical stamina for twenty-four-hour duty during the first year. Now in my second year, I feel the need to catch up with academic study. I also wish to blend in my central concerns with my essential ones. My central concern is the women’s movement, but it’s not going to enable me to pay my rent Essential concerns will allow me to pay my rent, but if that’s all I’m going to do I won’t be happy either.

I have to seek a balance between these two. Right now they’re separate, but I wish that someday they can be blended into one. It would be good to be able to answer the needs of society as well as fulfill one’s own potential.

DA: What did you say in Hawaii as director of MAG?

Dr. de la Paz: As Medical Director of MAC from 1982-86, my testimony was specifically on torture. I presented six cases involving four women and two men. I presented how difficult it was for health personnel to go to detention camps. It was difficult to document torture after wounds had healed.

What strikes me is that state political torture is phenomenon that is foisted on those who oppose the system. Maybe there’s no such thing as a torture syndrome, because there are those who underwent torture but who’d built up such a steely opposition that they did not exhibit post-traumatic stress disorder. Therefore post-traumatic stress disorder can’t be equated with torture itself.

MAG sent us to Copenhagen where torture victims from different countries are being treated. I discovered that torture victims have similar experiences. Maybe the torturers learned techniques from the same school. Sure enough, Fort Bragg in Virginia was one that was commonly mentioned.

We need to work in solidarity with people from other countries to get rid of the situation that serves as the breeding ground for torture. You’ve got to educate— colleagues about torture; it can’t be medicalized and treated like a disease. It should bring you to the realm of politics, ot just medicine. You’ve got to make colleagues aware of the participation of doctors in torture, whether wittingly or unwittingly.

I also discussed political detention, how women were sexually harassed. The difficulty is that there is no concrete proof of this. I came to the realization only in the women’s movement that women have to put up with more while in political detention because they are targets of sexual harassment and rape, even though men also suffer homosexual rape.

One man was beaten on the chest with the butt of a rifle. Fortunately we saw him eight to ten days after this, so his injury was still fresh and we could document it That was a rare case. With the four women, they came to MAC a few months after release. Their symptoms were anxiety and depression, and it’s difficult the connection with detention and torture.

DA: How did the jury receive this testimony?

Dr. de la Paz: I was very nervous because this was the first time I’ve ever testified. While in court I could see that this was a male-dominated profession, from the lawyers to the judge. Although I was nervous, I felt that I had to be ready to do my best because it was not just for me but for the 10,000 members of the class suit.

The evidence was really overwhelming, the pattern of killings, torture, disappearances. The Marcos lawyers did not present their witnesses anymore—they were supposed to present Generals, but none of them appeared. The lawyers just said, “We rest our case.”

The jury pinned responsibility on Marcos. There was a consensus among the jurors. I’m happy about the verdict because it was a moral victory. It has impressed in the public consciousness that there were indeed killings, tortures, disappearances during the time of Marcos. This can set a precedent in the sense that if victims can file a charge against Marcos, so can victims against Cory Aquino, Fidel Ramos, whoever is president. Of course, this is no guarantee that human rights violations won’t occur.

Now about the compensation part, I’m not too hopeful. There has been no case in legal history where victims of human rights violations have received compensation. If it happens that we get compensation, it will be another breakthrough.

DA: And what is the current administration’s position on the matter?

Dr. de la Paz: it is claiming that the Marcos estate belongs to the government Now it will again be a struggle between individuals and the government.

DA: The Marcos party is appealing?

Dr. de la Paz: Yes. But I see this as only one arena of struggle. There are many arenas in which people can seek justice. Among them are the ongoing organized efforts by people to create genuine changes in their lives—the women’s movement, the nationalist movement, the health movement, etc.

DA: How about with recent changes—we had Marcos, followed by Aquino, and now Ramos. Have you felt any changes in your own sense of what you would want to do?

Dr. de la Paz: So much has remained the same in the Philippines. Cory’s policies were the same as Marcos,’ including the way the BNPP [Bataan Nuclear Power Plant, a Westinghouse-sponsored project that has met vehement popular protest] was handled. We continue to have an export-oriented economy, women’s oppression is virtually unaddressed. There’s still a need to make changes. With the changes in administration, all we’ve seen is a change in form, but not in essence.

March-April 1993, ATC 43