 Welcome to Kalosugan Ay Karapatan. The One Health Concept is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of healthcare for humans, animals, and the environment. The synergism achieve will advance healthcare for the 21st century and beyond by accelerating biomedical research discoveries, enhancing public health efficacy, expeditiously expanding the scientific knowledge base, and improving medical education and clinical care. When properly implemented, it will help protect and save untold millions of lives in our present and future generations. One Health recognizes the health of humans, animals, and the environment is interconnected. Holistic, coordinated, cross-sectoral approaches are required for understanding, protecting and improving human, animal, and environmental health. Good day, ladies and gentlemen. Welcome to Kalosugan Ay Karapatan. Have you heard about One Health? What does it mean to the ordinary Filipino? I am Dr. Menchit Padilya, and your host today. And my partner is Atoni Abdel. Thank you, Dr. Menchit. Before we start, may I greet all of you a good day. I hope you will like our episode today, a topic which is not known to many, but hopefully at the end of the day we'll be able to be fully ascertained about what it is. Through our invited guests, we will take a closer look at the One Health and the programs related to it to address problems at the interface of human, animal, and environmental health. That is true, Dr. Atoni Abdel. Globalization, natural calamities, and man-made disasters forces to explore further programs on how we can work together and use the One Health strategy, which is also a means to achieve our targets faster for the health related to millennium development goals while developing a culture of public health security. So without further ado, let us introduce our guests. To my right here we have Dr. Michael T. He is an internist with subspecialization in rheomatology. He is also the vice chancellor for planning and development of UP Manila and can surely provide us insights on One Health. Welcome, sir. We're also happy to have Dr. Loinda Baldrias, a professor from UP Lisbanyos with specialization in veterinary public health and food safety. She is also the former dean of the college of UP, UP College of Veterinary Medicine. Welcome. Okay, so let's start the ball rolling by asking the question. Anyone of our guests can begin. What is One Health all about? Itay napakalagang tanong. One Health is about interdisciplinary collaboration, working together of various disciplines, starting with human, animal, and those concerned with environmental science. It also includes other disciplines which may not be health related, like engineers can be part of this health, One Health concept. So para nyo One Health it's really everybody involved in health. That is the concept. Pwede abogado jyan ma. Pwede, kasi we really need good laws that would really promote helping together. Doc, you were saying? Yeah, it's about finding intersection in how the disease or the health of one area or one aspect of our environment, let's say the animals can affect the humans. How the environment changes in the environment, climate change, resiliency will affect food production and therefore will also affect our animals and down the line humans. How what you see as clues in the environment like the increasing algae, harmful algae bloom for instance or the density of mosquito in one area as a result of changing temperature, humidity, rainfall can also affect human health. And what's important about human health is that it provides a clue. It provides you with actionable information. Now as to how we can do that will depend on how these people will interact and right now there's minimal if not absent interactions because veterinarians work with animals, human doctors work with humans, agriculturists will work with their plants but they do not talk to each other. So what you're saying is that in health you need all sectors helping so that we can improve the health of the human being of the person. That's why you mentioned the vet med and then you mentioned agriculture as part of the whole team. So is that something new in the Philippines? Is this the concept of one health? Is it something new in the Philippine setting? I believe it's not new. What we started with long before wala patay is the Bayanihan spirit wherein we have the community working together to be able to address problems that affects the community tulad ng paglilipat ng bahay. So they work together to be able to achieve that goal. In the same way when we work on this one health, we can be able to address problems that has long been there. Naisabi nga mga intractable problems, mga wicked problems were in if only one sector works towards it, hindi masusolve. So we have to work together to be able to address it. Like for example, we have a goal to be rabies-free Philippines by 2020. But to achieve that it cannot be the work, sole work of veterinarians. We have the Department of Health coming together, coming alongside the Department of Agriculture. We have the local government units to work together to be able to facilitate and support the program so that we can be able to achieve this rabies-free Philippines. It's a long dream for me. What we're saying now is that the practice, the impact of one health has been felt long before. It's just that there is no label. We're not calling it one health. And therefore people are not consciously or conscientiously working towards a goal of getting the data from one sector and transmitting it to the other sector who may be able to use it better. Right now, the doctor will know what he knows. The vets will know what they know. But the interaction is something that we are all blind to. Pero matagal na pala siya. It's just a new name. Yeah, a new label. So ang question ko po, sir, kung matagal na po siya, what is the status of the implementation of one health in the Philippines? In the Department of Health, there is a one health program. There is an office now trying to put these things together. But as to the framework against which it will be measured, it is an ongoing process. We can say that it's something that our group, our Pikari group, is trying to contribute to. I think muna meron tayo sa Department of Health. So can you just elaborate on that because I'm not aware that this is a new office or a new program that's being implemented by the Department of Health? And Kailan po ba? Did it start? I believe, siguro just a few years back, nagsimula na itong one health. And among the things that we would like to address together is antimicrobial resistance. The other one is rabies which is concerned zoonotic disease natin sa Pilipinas. Was it called one health at the time a few years ago? Yes. That's nice to hear that this has been conceptualized already at the level of the Department of Health. And also the Department of Agriculture. And specifically, you wanted to address rabies and antimicrobial resistance. Those are the two main projects. Yes, I know. There's another one but I can't remember it right now. So can we talk about those two things? On going na pa leyan dito sa Pilipinas, can you talk about rabies first? In line with rabies, the funds of the Department of Agriculture is very limited because there are so many diseases that affects our animals and we have so many animals to deal with our livestock animals. So ang focus usually when it comes to the Department of Agriculture is livestock animals. So hindi masyadong tinututukan ang mga dogs which are of course considered to be pets natin. But we have of course a lot of stray animals. So ang nangayari ay the Department of Health shared so many with the Department of Agriculture to buy vaccines because we've been doing vaccinations at the Department of the Euro-Fundable Industry. Kaya lang very limited because we have very limited funds and we were encouraging the local government units to help. Kaya lang limited yung kanilang funds. But when the Department of Agriculture shared this fund, Department of Health shared these funds. Ito na nga yung nakabili din tayo nang maraming vaccines and we're hoping we can continue working on that so that we can be able to address a 70% level of protection to be able to protect the community against kumiyaramat tayong attack of a rabid animal. So ang vaccination pala is really part of the concept of one health. From Secretary of Health, we had a meeting with Secretary of Health and she was quite informative in the battle against rabies. She was saying, we've been vaccinating after dog bite. Dog bite after dog bite, the increasing number of vaccinations post exposure is so high. Now what we should do is, not because we are Department of Health, we will focus on vaccinating post bite. We are now shifting focus on the animals as you even mentioned some administrative hurdles that they had to overcome because vaccinating dogs is not vaccinating humans and therefore the mandate of Department of Health is somehow not aligned with it. But with the one health concept, she found a good alignment. She's now able to hurdle the administrative barrier of spending for vaccinating dogs because imagine you're Department of Health, your patients are humans and yet you are vaccinating dogs. This one health concept help her hurdle that. Doc, baka lang kasi makonfuse ang nanonood, baka kala nila, vaccination lang ang one health, vaccination of dogs. Baka pwede, ano pa ba ang mga other areas kung rabies pang pinagusapan since we're on that topic, ano po ba ang ginagawa pa or ina-addressed ng one health aside from vaccination? Kasi ang nakita ko po, prevention, akala ko prevention, pero yung pala, really involving the animal element in the environment. Basically yan mula ang si-simula natin, but I believe we can be able to involve other areas na gukos ng problem. Like for example, nakikita natin na halimbawa for we had several floods, undoy, habagat and it was found na ang increase ng ating number of cases was correlated to the increase in rainfall. So increase in leptospirosis pala. Increase number of cases of leptospirosis. Pwede natin ng adresyon kasi leptospirosis is ang pinaka number one source are rats, mice, which could be sick of leptospirosis. And also dogs can be sick of leptospirosis. So if we can control the disease in animals, then we can hopefully address mag-impreventive tayo in controlling the disease from being transferred to humans. So parang ganun din sa rabies, kumakontrol natin yung rabies sa animals, then we can protect human health. Sir para kay Dr. T.K., Dr. Mike Don, siguro you can tell, share with us ano ba yung symptoms ng rabies in the human man and then is in science and symptoms in leptospirosis kasi dalawa natin nag-usapan ating sakit ngayon na, nakonectado, no? For leptospirosis, patients will have fever, decrease urine output, or T-colar urine, and in really bad cases, you'll find them jaundice, yellow eyes. They will not urinate at all, not just decrease urination. That's wild syndrome. And talking about the rainfall, one health is not just about preventing it in animals because how can you prevent the entry of leptospirosis in rats? They live underground. So what's important is that if you are able to harness the data from pagasa, harness the data from other government agencies, you'll know that there will be rain. And with rain, you need to prepare for what will happen. The people will wade in floodwaters. So now, you activate all available information system. Activate the media. Tell them to warn the people about don't wade in floodwater. Tell them to consult when they have fever. And more importantly, you deploy prophylactic antibiotics in areas where you have floods. This is not usually done before because you have no predictive power. But now you can predict, especially if our dream of providing this information to our resource mobilizers, the leaders in the local government unit, because we have developed health system. So who deploys the municipal health officer? Who deploys the budget for purchase of our tablets as prophylaxis for leptospirosis. If he has a dashboard saying that in barangay A, rainfall will be like this, barangay B like this. And previously, these areas with crops had poor yield because of previous rat attack. Then you know that the rat population there will increase. Kinain nila yung anay, yung dapat kinain ng tao. So da dami sila. Pag dumami sila, tapos hag bahak, silan ngayon yung magkakalat ng leptospirosis. Maraming concepts ng pumasok at Torny Abdel. So ang tanong ko lang ngayon, ay, so meron tayong rats na infested, tapos bumaha, tapos may lumusong sa bahak sa karon tayong ng paciente. Yun ng ating connection talaga sa from the infested rats to a person being affected. So ang role naman ngayon ng environment ngayon to make sure na hindi sila infested with leptospirosis, sa naman ang ginagawa ng ng inyong community, Dr. Loins? Inline with agriculture. So naman si Doc yung ating mangyarads na increasing population. Usually this would be related to harvest season. So ito ngayon natin, makikita natin yung, may mga relationships yung mga bagay-bagay. So if we can be able to see kung paano natin may address makontrol, for example, the infestation nakikita natin, harvest season. So ibig sabihin, dapat meron tayong implement biological pest control. So makontrol natin yung ating pest sa environment. So in that way, maminimize natin yung population ng rats. Minimize natin yung possible entry, transmission of leptospirosis sa tao. But I would like to add na hindi lang rats ang paring panggalingan leptospirosis. Kung ano yung symptoms sa nakikita natin sa tao, yung din yung nakikita natin sa animals. Kaya napakagandang alert. Pag makita natin yung symptoms sa animal. Ibig sabihin, inyat tayo, kasi in a little wild pwede lang magkarun tayo ng sakit sa humans. So alert level ang maganda dito. So Doc la yung din po ba ng one health nato? Ang yung mga animals na ito yung sa alertness na yan ay inform yung mga tao and extremely if I may take it further, la yung din po ba niya na i-eliminate itong mga animals na nagdadala ng mga sakit? I think it's more on education. Napakalaga yung joint education. Kasi may information nagalang sa human medicine. Meron din information coming from the veterinary side and agriculture meron din from the environment. So ito yung mga information na ito if we can put it down together to serve as a basis for more holistic information mas magkakarun tayo ng preventive aspect sa mga sakit. Pero susundan ko yung tanong niya Tonya Abdel kasi for the rabies nagbavaccinate sila ng dogs pero pa pa niyong mga rats? So far ito i-based dun sa supposedly lahat ng warm blooded animals is susceptible to rabies pero ang nakita nila sa Pilipinas 99.9% are due to dog bites ang ating rabies cases sa humans so kung saan yung problema dun natin i-address yung solution so vaccination of dogs at samadari natin yung cats and then yung sarat siguro siguro next level naman yan pag na-achieve natin yung unang priority natin. Pero panong how can we prevent the condition in the rats? Ano magiging lunas natin kasi at least for rabies nilang tayong solution what about for the rats? So I guess dito ngayon yung napakalaga ng hygiene nating if we provide food for the rats like for example garbage yan na magiging source ng katilang pagkain so da-damit sila so if we have a clean environment malinis yung ating mga baranggay then we can be able to decrease the population of these pets. Bang itin na po yung rats yung dogs pero nabasa ko recently yung meron naman daw nagkaroon ng rabies kinagat ng bat up north so bat also is Very good source for rabies in South American countries and in other may iba mga bansa kung saan ang source ng kanang rabies ay bats so thankfully wala tayong vampire bats sa Pilipinas what we have are fruit bats and safe sila and safe sila against rabies kasi wala pa tayong na-identify sila ay nangangagat ng tao nangkinagat nila mga parutas So for attorney of the land examples natin kasi is animal and humanse we had a little discussion on environment pero meron pang examples na plants naman ang involved Concern din po ba yung plants pala dito may itay sa tanim kasi doke ang isang concern dito doke yung aspect ng food security natin na liba kung may sakit yung mga plants wala tayong pagkain mababawasan yung ating source sa food pero alam kung meron masi share pa dito si doc tungkol sa plant pero doc sabi nyo po mam yung plants na kakasakit? nang kakasakit ang mga plants ang madalas pag ma-pinesty yung ating mga plants na mamatay sila so hindi na natin sila ang pagkain pero that can have a consequence for example wala ng pagkain ngayon yung mga ibang animals tulad din na rats upon magahanap sila na ibang source ng pagkain so isang aspect yun na pwede natin makita na may mga interrelatedness ang mga bagay-bagay an example is the recent cocolizap that destroyed our plantation of coconuts so it resulted to low economic output resulted to increasing poverty and with poverty you'll have more illness among our young children we don't know the longer impact of this but it happened what we should know now is what resulted or what contributed to this increase cocolizap population what change in temperature what change in humidity what change in rainfall happened to trigger increase in cocolizap infestation it wiped out areas in San Pablo in south Philippines imagine the impact another thing is when you look at crops and crops are dying it's because of pests it can be because of insects well animal pest na animals or insects and the immediate reaction of farmers would be to prevent crop death through spray use of pesticides use of chemicals what is the impact of that chemical spraying to our people it can be systemic meaning it stays in your body for a long time another could be inhalational injury the young children of these farmers can inhale the chemicals resulting to increase respiratory problem can result to weakening of the immune system it may trigger autoimmune diseases because of deaths in their own cells so these are things that at this time really purely speculative because again the agriculturist is not talking to the human doctors one concrete example of how the interaction of these three players would be what happened in Monterey Bay that's why they now have the harmful algae bloom they noted that in California otters were dying they trace no, there's nothing there downstream so they look at upstream what is feeding the bay what river is feeding the bay and then they sample the water upstream and found out that the toxin found in otters were a result of increase algae and the algae are the ones producing the toxin a local example will be red tide saksa toxin right now we are fortunate because we already know what's happening so this is a concrete example of how one health the Bureau of animal BIFAR Bureau of Fish and Aquatic Resources the water monitoring system and our Department of Health are working together to issue periodic information don't eat shellfish from cavite don't eat shellfish from Samar or whatever as long as they know the pattern and one important environmental pattern here is the heat, the temperature of the water how it promotes the growth of algae and then we are warned right now you don't hear about paralytic shellfish poisoning as often as maybe as late as 5 years ago 5 years ago you hear about laguna with paralytic shellfish poisoning pamilya na hospital dahil kumainan tahong pamilya na kumainan ng halaan na na karoon ng pagsusuka, pagtatay maigalaw yung onaman yung mga sintomas na but right now you hear don't buy and in the market it is enforced your ass san galing yan apagaling yan hindi yan pa payagan ng market master na mapabenta we are looking at that kind of knowledge that will guide our policy makers yung pwede niyang sabihin umula ng ganto ay municipal health officer ni have doxycycline yes sir ilan 100 but i need 200 because he knows the the deployment of all his information and all of his resources he'll say municipal health officer 2 wala akang magiging ganyan padala mo kayo municipal health officer 1 lahat yan o 1, begay me yan sa lahat ng tao mo and then you'll have no leptospirosis that's the kind of powerful information we're trying to develop document sheet pero alam niyo ba kung bakit silang na impitan natin kasi si doc Mike rheumatologist yan ano anong ginagawa niya sa one health well siguro kay doctor loins kasi vet med siya but actually they're actually involved in a certain project one health they have teamed up to come up with a project one health i actually want them to describe ano ba itung one health project nila because we are looking forward to the outcome of this project so that it can be implemented by government si nabang magde describe loins what we what we would like to do with this project mag concretize namin yung application ng one health locally so mayro na kami mga target areas and what we will be doing is we are looking at the diseases being monitored by the department of health as well as the department of agriculture and we're also looking at possible sources of illnesses sa mga pesticides sa department of agriculture and if we look at all these things and we can be able to gather data and when we gather data ito ngayon ay gagawa ng application at ang one UP tayo college of medicine college of UP manila we have of course UP los baños and then UP dilliman will be developing the application together with our friends from UC Davis so gagawa ng up ngayon na ito ngayon ititrain natin yung ating one health worker na if you filled natin doon sa mga barangay so that they will be able to monitor kung ano yung mga sakit, ano ba may mga problema ba nangyari sa barangay and then ito ngayon ay lalagay nila doon sa UP and then ito UP ngayon yung information ibabato ngayon doon sa atong central server so that the data can immediately be analyzed so ngayon ating mga with that data pwede natin ma-advise natin mga local government officials kung ano dapat natin go in pwede agad natin ma-prevent we have a healthier community So ano ito minomonitor, ano yung hahanapi ng ating one health worker anong data ang kanilang kinokollect? Basically ang data na yan would be kung ano yung nakaka-affecto sa tao nakaka-affecto na sa ano yung mga nakikita nila ang mga sintomas nanandun sa tao, sa animal at yung yung ilalagay nilang data ang with this data i-input din natin yung data ating pag-asa our weather, ang ating mga rainfall, ilalagay natin nilatin yung mga data na yan so magakarun tayo ng algorithm makikita natin, may pattern mas marami nagkakarun ng clustering ng cases dito sa lugar na ito ano kayang naan doon so mga gano mga analysis lang ay lalabas na sagut yun and then hopefully that answer will lead to control of the disease we have an experience in Dengemaw at a self-learning machine we have already created a self-learning machine and were fortunate to have presented that in Greece last year the inputs included temperature, rainfall, humidity all coming from pag-asa and then we look at the incidents from the epidemiology bureau for the past 30 to 50 years we input at these things and then look at how it will predict Dengge incidents when certain certain environmental factors happen when a certain density of the population is predicted because it's not just what the weather it's also about how close the people are together because if there are a lot of people you have more incidents because the transmission is vector born I bite you, I bite her I bite him the three of you will have Dengge so this has been proven in Dengge now we want to prove it in other diseases there are 16 diseases for reportable for the epidemiology bureau they have been kind enough Dr. Irma Asanshon and Secretary of YAL have been very kind providing us with three books the PIDS manual it's a manual that directs how you should respond there are two ways of monitoring one is event if there is a diagnosis you record that the other is the usual monitoring and there are reportable cases that you report immediately upon diagnosis there are others that you wait for one week but the healthcare worker or the one health worker will be someone who is going to attend to the problem of the entity in front of him that's all I have a patient I am concerned with the patient if he is a human I love the checklist from our review of systems then the review of systems will direct me to a differential diagnosis but the application is not just in detection but also in providing immediate information if you have diarrhea or fever then the one health will inform the one health worker the barangay health worker and tell us I need to advise you about hydration I need to advise you about fever lysis and then I'll advise you to follow up with me or it will alert me to follow up with you within the algorithmic capacity of that app so ang nakukuha ko dito ngayon this one health project is developing a model such that our one health worker now who is not just for man and animal separately but one health worker will be able to get data to guide for the next steps on a bigger and a wider scale on a policy level kailan po masok din dito ang mga lawyers natin modeling is only one step if they're able to show that this system is going to work and this app is going to work and it's going to be a tool for the worker in the ground we definitely need a policy now at the level of government honga po parang very parang prevention ang ano nito of course yung holistic how far are we in finishing po yung app po na yan we are just starting with the app so the grant started April 1 our initial project report was submitted April 1 and we were allowed given the notice to proceed April 1 but when do you expect to get the data i think that's a more important one in 2 years time baka hindi kailangan din na umaputan ng 2 years kailangan natin ng panahon yan by the time it has been approved we would have developed the app and then in one year in another year we would have tested it for its utility there's a different way of testing for developed applications but let's not wait for the app right now and dami na natin nakuhang possible lessons what we're saying now is that any health worker out in the field who finds a symptom in either animal or human should look for the connection because in dami natin example sa nakuhang sumang 40 diarrhea for instance the health worker will not just be concerned about you the next question will be do you have animals living around you the answer is yes have you observed similar nagtatairin ba ang mga baboy ninyo o kaya namamatay din ba yung mga manok nyo can't ayawang sinayang yes oh you observe namin yun tapos saang tubig ninyo saan nyo kinukua sa balun saan nang balun nyo? wala bang mga amuin ay hindi maganda wala naman ok, next punta ka sa kabila, balun din ang ginagamit walang hayok pero yung tao nagtatai now you find dalawang balun sa isang barang gay na meron nagtatai hindi naman sila nag party ng sabay pagdating sa pangatlo meron naman nag susuka, same, balun din ang ginagamit now you start thinking baka yung balun yung problema ayawang expert in person of din Romeo Kison so he has experience in looking at water cleanliness, water quality heavy metal in water hormones in water so that will be incorporated and we're coordinating with because it's Laguna, the Laguna Lake Development Authority so ano kawa ko ngayon daw sa inyo yan ang gustong pwedein magawa with the one health balik lang po tayo step back po concrete example so currently po are you saying na hindi to ginagawa or walang conscious effort na hindi to hindi to ang lens ng professional ginagawa natin, di nga lang ganun ka conscious or maybe we really have to create a platform kung saan we can get together and talk about common problems so coming from different disciplines and we can learn more this is not new because if you read the numbers numbers of the Old Testament will tell you kung humawa ka ng patay na na animal di ka pwedein sumama sa mga tao ihuala yung mga may ketong sa walang ketong kailangan yung maghugas if you are unclean you have to be separated even quarantine so curious bako tayo magtapos po bakit po one health ang pinili kayo po ba ang nag coin or did we adopt this from some global idea ang one health when we unang simula to one medicine so it's supposed to be human and animal medicine coming together pero later on nakita na there can be a bigger area pwede na nating may expand ito so yung one would mean in transdisciplinary so iba-ibang disciplines and then yung health is optimal health for humans and the ecosystem where in animals is also part of that ecosystem so yung parang the coin nila na one health so hindi kayo nag-invento hindi po kong invento hindi namin kayo nanawala lang kasi yung mga successful specialist so when you're specializing you tend to focus on what you're really very good at and forget everything else parang ako, i'm a specialist in rheumatology i know that but i'm now going back to the basic of health mga kailangan tayo mag-part 2 ato aneya Adele kasi kaka-start lang kanilang project ko but i've learned a lot about one health today the relationship between man, animal environment doc mentioned ko hindi ko nga na tanong nalene kasi hindi tingnan nila yung sa rainfall yung changes in the environment kasi ang buzzword ngayon yung climate change pang part 2 yan part 2 tayo yan but maybe we can ask them to give a message no? before we wrap up our show the concept of one health is something that can be developed a potential to change the course of disease development not because you know more about the disease but because you can now address even before the disease can happen the best general is the one that fights that wins without fighting if you can prevent the disease you don't need to fight in the arena of the human being fight it in public health so gusto nami i promote ang one health we can be able to work together to better improve community health the health of the environment and we're hoping na hindi lang health ng barangay but it would be the Philippine health and the global health so one health for synergism, collaboration integrative sharing of knowledge and information and according to our partners in UC Davis is the first in the world this is the first application development the first predictive capacity to be developed in the whole world aungo na naman ang Philippines well, wag tayo magpa-iwan but you know it say it's nice that we're proactive about it and definitely we need the part 2 maybe after a year meron na tayong kontin risul na pwede pagusapan at marami pa tayong pagusapan yung app dapat may example na tayong nyan okay so ladies and gentlemen, I hope this episode has given you new knowledge and insights on what is one health thanks to our guests today Dr. T and Dr. Baldrias for gracing our program again na babangitgani Dr. Menchit we will be very glad to have you again in our future programs for follow up and then thank you to everyone who joined us today and as always we hope to see you again in our next episodes thank you very much