 We have with us Dr. Carmen Sita David Padilla, Professor of Pediatrics at the College of Medicine and currently Chancellor of the University of the Philippines, Manila. Dr. Padilla is a pioneer in genetics in the Philippines and the Asia-Pacific region. Chancellor Padilla is also a distinguished academician of the National Academy of Science and Technology. She is a multi-awarded and her well-known awards include the Robert Guthier Award by the International Society of Neonatal Screening, the Outstanding Professional of the Year Award in the Field of Medicine by the Professional Regulation Commission, including the Eric Nubla Award, the most distinguished alumnus of the UP College of Medicine in 2016, and the Outstanding Young Men Award for Medicine in 1994. Chancellor Padilla, tell us your story. Why did you go into medicine? When I was young, I frequented the office of my aunt who was a pediatrician and she was actually the director at White Cross, an orphanage close to Pinaglabanan. I actually enjoyed the children and somehow I saw the connection and maybe I could be somebody like her in the future. But maybe more important than that, my parents felt and they believed that my personality was for a physician. Was genetics your first choice as a subspecialty in pediatrics? When I got into medicine, I was clear that I wanted to become a pediatrician. When I entered the residence in pediatrics, I wanted to become a neonatologist and for four years I prepared myself to become a specialist for very sick babies. But after my chief residency, four mentors actually approached me and told me that they needed a geneticist and I was actually coerced to move into the field of genetics. It was not an easy decision. I asked for a few weeks to think about it and with some soul searching, I felt that maybe going through a new field probably wasn't so bad. So I said yes. But I think I belonged to a generation we're in. We followed what the old people told us and I did it with a very heavy heart at that time. So can you tell us how you started genetic services in the country? When I was in training, I realized that there were so many services that we needed. I needed a clinic, I needed a laboratory and there were many things that were not present in the Philippines. So when I came back home, I actually informed the Dean of the College of Medicine that I needed a following. And the only thing they could offer me at that time was actually one person and I had to start from scratch. I started really with just a table in a chair. I had 40 boxes of old equipment from my mentor in Australia and that was the beginning. I set up a clinic at PGH. I got referrals from all over the country. Being the only geneticists at that time, I practically saw patients from the different hospitals within Metro Manila. So starting genetics in the College of Medicine in UP, UP Manila, was not really that easy at that time. That was the time when genetics was not so popular. Genetics was looked at a very academic field and it was not really for the ordinary person at that particular time. Newborn screening is considered to be one of the most successful population-based genetic screening program in the country. It's a story that's all of you, I think. So can you share with us the triumphs, the failures of this program, how you dealt with the challenges of institutionalizing a huge program for the country? When I was in training, newborn screening was just a very small rotation in my training and right after my training, my mentor in Australia actually requested me to join a conference. Everybody in the audience were running already a program newborn screening whereas I was the only one. The father of newborn screening, Dr. Guthrie, upon knowing that I was the only one in the audience who had no newborn screening program, requested me to stay next to him. And he told me that when he was trying to set it up 40 years earlier, nobody wanted it, nobody believed him and there was not even a single journal who wanted to actually publish his paper. But he actually told me that it is good for the babies, it's good for the country, it's good for the world, but we should not give up. And because of that when I came back to the Philippines, I started discussing this with my mentor who wanted to set up newborn screening 17 years earlier and this is actually Dr. Carmelita Domingo. Dr. Carmelita Domingo came home to the Philippines 17 years earlier and she never succeeded in setting it up in the country. So together we set it up. Newborn screening is really started out as a research. My goal at the beginning was just to offer the data to government because I knew that without the data, they could not adopt it. So actually newborn screening started out as a simple research, getting the data in the Philippines to show that it was important for the babies. But when we finished the research, the government was not ready. And despite many visits to the Department of Health, they told me that the problems were too difficult to solve. It was too difficult to implement and that I needed legislation. And because of that, I decided at one point in my life I had to enroll and take a master of arts in health policy studies so that I could learn the skill of writing the law. Well of course by this time the program was expanding without legislation but not enough to reach every baby in the country. And of course I learned the skill. Writing the law is easy actually if you know what you want. By the time I had the law passed in less than a year which is a miracle even at that point, the harder part was implementing it. So because now it's actually found and being implemented in every hospital, each of the 7,000 hospitals in the country and birthing center in the country is offering newborn screening and I think that is the reason why they say that I will be remembered for newborn screening. Yes, you are called the mother of newborn screening in the Philippines and can you share with us how you're also helping the other Asian countries set up their newborn screening programs? Well it has its own challenges. It didn't happen overnight and actually it's not yet over because when you talk about the newborn screening program you're not just talking about setting up the lab for the babies. You have to work on the financing part. We got field help to pay for the fee. We had to look to the follow up and then now we're setting up genetic centers in the country. But I think the model of starting from nothing became attractive to a lot of the lower and middle income countries that it is actually possible to set up a program with no support at all from the very beginning. I tell all of my colleagues in the region so I have about 12 countries now who are actually trying to find out just exactly how we did it. I tell them at the beginning they need first a leader to put it forward because I think you need a national leader. It doesn't have to be a national leader but you need a person who believes in the program who is going to go through all of the problems regardless of what happens. Can you tell us more about the challenges that you encountered setting up newborn screening for the whole country as well as pushing it to become a law? Well, in the first place I never expected that I will be doing it for the whole country. I wanted to do the data and I wanted to give it to the Department of Health but by the time we had the data they were not ready to adopt it. The implementation on a national scale was too complex for them and most of the problems that I presented could not be answered by the rules that they had at the Department of Health. After three years of meetings with them one Assistant Secretary told me I needed legislation. That was a time when I went back to school. I decided that I couldn't afford the consultants at that time and it was cheaper for me to just go back to school and I did a match of arts and health policy studies and I learned the skills of what should be said and what should not be done. When I was writing the bill it's not a long bill but it addressed each of my problems in the implementation of the program. Number one, how do you make hospitals follow you? I am just an ordinary faculty member of the College of Medicine. Well, we solved it. It's a requirement for licensing. A hospital or a birthing center will not be licensed to operate unless they have newborn screening as a service in their hospital. How do you get paid? That was my problem. Even if the parents paid the hospitals did not pay us. So that was another thing we put in the law that I wrote there that was going to be part of the newborn care package. So in other words, if you look at the law now it's really very short but it addresses each of the problems I encountered in the seven years that I was setting up the program. But I'm not alone. I had 24 hospitals to set it up and I have to give credit to the 24 hospitals who told me that they will join me in this crusade and these were very senior people until we get it done at the national scale. Now that I had the bill I had a conversation with the health secretary and this is an interesting story because he said, why are you pushing for legislation? And I told him, if you can get it to become a program in the country before I get it passed as a bill, I'll be happy. But the mystery there and the miracle there is that it all got passed in less than a year and I think that's providential at this point. I cannot take full credit for that. I think it was time. There was nothing wrong with the bill. It meant saving babies and I had enough publications to show to government that if this became a program of the country it could save the government actually hundreds of millions because these children who were saved will be taxpayers of the future. So that was just at the beginning but when finally it was passed as a law there were still hospitals who did not participate. So I had to work very closely with the department of health on how I was going to get these hospitals to follow the law. So I think my lesson there is that if you believe in something and you've reached the point that you moved it from a project to a policy you have to hold hands with your implementing agency and this particular one my partner really is a department of health. I really take a back seat. The lead agency is a department of health but they know that we will be there. We at UPE will be technical consultants but at the end of the day it's going to be a hospital. I think the biggest challenge is looking at the coverage in the country and it's not at 100% up to now but there was something that the law had that I think helped me a lot and this is something I'd like to share. When I gave my first, when I gave my working draft to the Senate they told me that it is such a good project but you need to create an office in UPE and I said, I don't think I want to do this for life but they said it's going to die. You have to create an office within the university that will serve as a technical support for the project. When I went to the lower house I had exactly the same comment. They said this is such a good bill and if it's passed without an office in the university to help the government it's not going to work. So I had to sit back and ask myself how far am I willing to go with this project. It was just a project. I had many other projects. People think it's a full-time job. It's not even my full-time job. It reached a point it was really an advocacy at that point. But I had to ask myself will I take on the challenge or not because I knew that if I created an office in the university then I will be stuck with the program until I retire and be in. After some soul searching again I said okay I'll do it. So in the law it says that there will be a newborn screening reference center that will be created in the university that will serve as a technical arm of the project. But people thought it will take me 10 years to get it passed. Nobody expected me to get it passed in less than a year. Well I thought it will take 10 years because that was what told me. It takes me 10 years to make a law. And I told him I will wait. And of course when it got passed in less than a year it was big news at the department of health because there was one health bill that got passed in less than a year. So I have to give credit to a lot of people now because it's not just me. I think I'm just the face. I may be the leader of the group but I could not have done this with all the people who were supporting me at that time. The midwives, the nurses, the doctors, the society who said we will support this because we believe that it's a good project for the Philippines. So because of the law and it's now 24 years old do I still have challenges? Oh many. I don't think the challenges will ever stop. So since I have the office now which I work very closely with every year we evaluate the program. Every year we look at the project. It's really a program. I don't call it a project anymore but what are our challenges beyond now? So I have a long list of things to do actually for the next couple of years that all pertains to newborn screening. What is your vision for newborn screening 10, 20 years from now? Well I'm hoping it's it will happen before I live this world. We're not at 100%. We're just about 80%. I'm still losing some babies who are not being offered screening. Right now we have an office which is about 20 that oversees the whole program. I have seven labs in the country that's offering the service. We have 2 million babies a year. So I had this formula on how can we bring down the cost and still make it accessible. So that was something that I really studied before I got into this. It's really affordable at this point. We have 14 clinics now around the country and we've got all regional offices with the coordinator and something that's going to happen in the next couple of months is that because of the number of babies we are saving and by the way newborn screening is about saving babies. If we put this in place then we will be saving thousands of babies down the line. Just what conditions we're talking about. We're talking about conditions if they're tested at birth. If they are screened at birth we know whether they will die or will have a certain condition or disease that can be treated from birth. So far we have saved more than 100,000 babies right now. So it's really for me to continue what I'm doing right now is making sure that I have a group who will continue this work beyond my term and beyond my life. If I look at the story of the successful countries the people who started it like Dr. Guthrie is still alive even way past his way past his life. So looking down the line and really looking at being implemented throughout the country beyond the lives of everybody who's supporting it right now. The newborn screening law has a twin legislation and that's the Rare Disease Act. Can you tell us how you actually pushed for this act as well? When I was eventually implementing the newborn screening law the gaps in that law and newborn screening law talks about screening the baby I had a lot of problems finding treatment for the babies we were picking up it was a struggle. The problem with geneticist is that when you find the patient you have to find the treatment not all treatment is really cheap some are more expensive so following the model again in other countries I prepared legislation that I prepared the bill that will respond to all my problems which covers from treatment to education and to employment. That law took me eight years that was difficult because each time and I don't understand why it took so long I think it's because treatment was expensive I think that's one because in the other one the treatment was cheaper I had a different set of struggles with my second legislation but when I reached the point when I told myself that I had to change my my you know you need to get somebody at the Senate who will fight for you. I had to change my strategy and of course I have to give credit to Senator Pia Cayetano who really helped me push that law to the very end because that was a difficult bill to pass but of course you know it has been passed and we're also implementing it right now Chancellor you have more than 120 publications in the form of textbooks original articles monographs you definitely are one person who recognizes the role of research in an academic institution How significant is research for an institution's sustainability and development as well as knowledge driven innovations I'll just want to focus on UP and I believe that as a university and we claim to be a research university it really is the source of new ideas so I think the primary responsibility of a university is to generate new knowledge because the new knowledge is important so if you want to help in the problem solving in the country then we have to come up with new ideas that's actually solving old problems so these ideas will have to be cultivated these ideas will have to be put in the right environment so that faculty will feel good about generating new ideas and that ideas will not end which means that if an idea is not even published at a certain point government other faculty members other universities will not benefit from the value of that new knowledge so early on one thing I learned from my mentor and in particular I'll give a site former chancellor Parilas Santos Ocampo she was probably also had quite a huge number of publications and she was very particular about getting data into the print and I think as a faculty member it's something that I imbibe and that it became part of my life and I think that is something that young faculty have to remember that if it becomes part of your life then it will not be so difficult so even up to now I continue to publish and I still have some ideas that I want to share and if I don't write these ideas then nobody will ever find out that it's a possible solution to a future problem of the country so you've stayed in the university for how long now maybe 40 maybe 4 decades I've been in UP since 1973 as a student then going on to medicine and then I've stayed on so you know that being in the university is very fulfilling for the heart but not so much for the pocket if you're a doctor clinical practice can be more attractive because of the monetary gains but you chose to stay as a public servant in the university I think it's something that's that one is difficult to explain because of course I had options when I came back but I have to go back to my rearing were in we were made to believe that money is not everything it's hard to say exactly why I did it I still sometimes when my son asked me why and I tried to grope for answers and it's something you want and I hope that the younger generation will see that it's not all money that matters but UP has given me the environment for my ideas I think if I look at what UP has given me it allowed me to cultivate my ideas because my ideas were not the ordinary my ideas were different my ideas were new if I knew that if I wanted a private sector somebody else well in UP we all know that it provides you the leeway the elbow room to do what you want and I think I enjoy that so I think it's very important to enjoy what you're doing I enjoyed what I was doing I think that's what's important now because if you enjoy what you're doing then you start putting the balance on the balance in life why did you choose to become a chancellor of UP Manila you know this is interesting I don't think I've shared this with a lot of people more than a decade ago people kept telling me that I was going to be a chancellor of the future even 20 or 30 years ago and I said it's not even part of my plan I just wanted to be an ordinary faculty member but at a certain point when I started holding administrative positions because I've had so many positions already in administration I saw that there were I could still offer more may becoming a chancellor and I saw the gaps and I wanted to fill in those gaps and I wanted I wanted to help I think that's it I wanted to help the future generation of faculty members because if I had that kind of environment I think from a decade earlier what do you think are your concrete projects that help you accomplish your vision for UP Manila when you became a chancellor well I of course I had many dreams and I know that life is too short and I was trying to reflect on which of my which of my projects or which of my achievements would probably give value because actually of course all of them are important in the first place I wanted to be as inclusive as possible being a doctor I didn't want to favor only medicine I wanted to make sure that all of my colleges all the colleges were my children and they will feel that I am their mother but at the end of the day when I was trying to reflect there are two things number one is I saw there was a lot more we can do in the field of research I wanted to move forward to a time when research can be a career because that does not exist in the country in the US you can survive as a researcher not in the Philippines but I saw the difference that I cannot say that you can be only a researcher so my bargain now to the faculty is I want them a balanced life of academics and research but I have to create the environment so that they will not be threatened to become a researcher and that is tough because I being a researcher for decades I knew exactly where the problem was so before I go back to research before I forget the other one is I wanted the green campus I don't understand whereas Diliman had the greens Los Baños had the green so I told myself that in my term I will create an environment where in we will have the greenery in UP Manila and that's the reason why I started having the high rising buildings because the only way for UP Manila to expand is to start building the high rise and then open the spaces for the garden and I think we're going to have it before the end of the year we're in we will have a green campus and my goal is a walking campus and UP Manila is small enough to achieve that it may be difficult in other constituent universities but UP Manila I think it's possible that five years down the line we will have a walking campus so going back to research now these are the things if I were to come up with another generation of researchers number one yes we have the research ethics board and I take pride in our research ethics board because it has been just been awarded as the most outstanding ethics research board in the region and I think that really tells tells us that we're doing it right and we know that for health research ethics is very important that has been there for a while but I think we've been able to improve one big problem for researchers is the grants management grants management really means helping a researcher from the time that the grant is being when you're looking for money for the grant writing the grant implementing the grant doing the finances dealing with the the lawyers dealing with the funding agency that was one environment I felt that was needed so that I can attract more faculty members to do research and of course when it's one of my main agenda at the beginning was to reorganize and actually the way it was there but then I wanted to make sure that it was responsive to the needs of the researchers the third thing that I I felt that was important for the community was that was to have the research integrity so the research integrity this time is very new office is going to be opened up we want to make sure that our faculty come up with research that will test you know that are acceptable and not only by the local community but the foreign community but those are all offices and programs so my biggest challenge was where will I place the researchers if they wanted to do research and the national institutes of health which really is is not even my original idea this was the dream of the chancellor in the 1990s I felt I had the chance to implement it so although the money actually came in 2012 before my term I was the one in charge of preparing the building I felt that if there was a home for the researchers where they can do their work close to the hospital then I will be able to encourage more faculty members to research so that's just some of the things that I feel are important but having the building I think is really providing a home so that's how I felt when I started the college of medicine adapted me that was my home the hospital was my home so researchers without a home will find difficulty for continuity they will have difficulty sustaining their ideas and their programs so I feel that the NIH is going to be the home for the researchers of Manila but as we are building the 18 story building already I'm discussing where a second building will be constructed so I think as a chancellor we we have to know we have to get the pulse of the community what do we need and I'd like to believe that I am responding to every pulse that I feel if I don't have enough time to do it then hopefully my successors will continue then so I really look at what is needed by my community and my community is not just faculty members I have staff I have students I have researchers I have non-researchers I think as a chancellor we have to know what each group needs and then we will have to find the solutions for them but that's the way I look at the chancellor is looking at Did you make a lot of curricular changes during the time of your chancellor during this time to make the curriculum of the health science center nationally relevant as well as globally competitive? I believe that academic programs must be reviewed regularly and as a matter of fact I think every three to five years is relevant to the time so we've just finished overhauling reviewing all the undergraduate programs we're now working on the graduate programs so now we're working on the graduate programs and we're looking at new programs so if you look at the current academic the current graduate programs I think I finished last week I sat down and listened to the deans present their upgraded programs and they had to put in some new things the other thing is that there are many technologies now strategies for teaching technology that's important blended learning so I think we have to know what is important but I have another 25 programs in the pipeline and only a handful has been completed so when I asked the deans to tell me what is needed by the community that was after consultation with the stakeholders and we were able to identify another 25 new programs that will be implemented by UP Manila so I think as a chancellor that's also another thing that we have to do is they may be old programs but they have to be reviewed they have to make sure that our graduates are relevant to the employers my challenge actually to my deans is that to be able to say that 99.9% of our graduates are employed by the time they graduate because when I visit universities and we see special in Europe one thing they advertise is the employability of their students so of their graduates so yes, there are so much that's happening it's not only in the undergraduate but also in the graduate programs Chancellor so you've talked about teaching you've talked about research you've talked about services UP Manila has been doing has offered in terms of services what do you think will be the relevance of UP Manila to the country in the coming years well, health is always going to be a priority in the country and health is wealth so so long as there is a problem in the area of health UP Manila will be relevant I'd like to believe that UP Manila should continue looking at all the problems in health in the country and start generating knowledge so that we can contribute to the pool of solutions that we will give to government let me just give an example we should really start producing our own diagnostic kits to make a diagnosis I don't think we should be importing our diagnostic kits overseas but I have a problem in the Philippines because even if we have Filipino scientists who are developing the kits locally our government is not so open to adapt it immediately it's a big dialogue so I see academia as providing this knowledge and then eventually being adopted by government another example is our lagundi, lagundi is a very good example it's been around for a long time lagundi is a product of UP Manila sambong is a product of UP Manila but we have to support the researchers who are doing the research on plants we should support the ones doing the research on diagnostics and on treatment all the trials of new drugs so long as health is a concern and it will always be a concern then UP Manila is going to be relevant to the ordinary Filipino with the many lessons that you've learned in your life would you like to tell the youth one when I look back at my life yes I was sure about being a doctor yes I was sure about wanting to become a pediatrician but genetics was never part of my dream I was once young and I sort of like had my own set of dreams I wanted this and that and I thought it's one straight road but what I learned with the decision in genetics is that these detours will happen in life so so long as you have the support from your family and your mentors we should consider taking these detours because you never know where the detour will lead you so this genetics was a detour for me but if not for that detour then the country will not have newborn screening the other detour in my life really is the genome center is not really planned to become an executive director but it fell on my lap but that one came at a time where maybe genetics was more mature but if I didn't take up the challenge then we don't have a genome center with two buildings right now that was one detour quite later in my life but now I realize there are too many detours in life what is important is that when you make that decision you have discussed it with your family you have discussed it with your colleagues it's not just mentors at this point I discussed it with my peers because there are so many factors that will contribute to the success each of the offices I have set up at this point because I have set up quite a number of offices starting from Ognay Nampahinungod Institute of Human Genetics the newborn screening reference center the genome center and so on there will always be many challenges but it's the way you will look at challenges the way I see it is that there will always be a solution but it's the way you will look at the solution is it a solution that you want or it may be a solution that you're not even interested in but then you have no choice so that has been my life I take in these challenges a spice in my life in my work because there's not a single project without these challenges and these frustrations and so on the other thing maybe this is one I usually tell my especially my son you've got to look beyond when you think of a decision it's not about me but it's really about whom it doesn't have to be the country it just so happened in my case in my department it can be my college it can be my university it can be my society it just so happened that I stumbled into a project that eventually reached the whole country but I did not plan it that way so I think one should not be scared about trying new things one should not be scared if things don't the way you planned it the important thing is that you've got to be focused until the very end so if you say that this is the end point my goal is fixed it may be changed a little but the goal is definite one thing I've learned in life is that when it's not about you when it's about other people it's really easy to work I find it so much comfortable for me when I talk about how it will serve the country because I think at the end of the day that's what we in UP are meant for so I really enjoyed my stay in the academy I if I had the choice I still want to work in the academy at this late age I've been offered many positions but if I had the choice I still want to stay in the academy because I think regardless of age I think the academy will have a place for new ideas it's not about being young or middle age or old age I see the value of people in post retirement having new ideas but the academy so long as it's open and willing to take you in then it will be a place to cultivate ideas the young has so much to offer and I think I see a bright future for the country and we in the university in administration should make sure that our next generation will feel good about staying in the Philippines and working in the university let's talk about Carmencita Padilla your persona who are you? what makes Chancellor Carmencita Padilla wake up energized every morning when I start the day and I know that I have a long list of problems and meetings beyond 8 hours I started with a very optimistic day I really say a little prayer to thank that I have a new day again and I ask for guidance I believe in spiritual guidance for me to hurdle the many challenges I have many problems as a Chancellor but I would like to believe that there is a solution for everything the solution is not always what I want but there is a solution to every case when people have asked me why I think that's the way I was really that's how I grew up and that's why when they gave me that gumamela in my name Hibiscus Chancellor Carmencita David Padilla that was the name of my gumamela and I was asking them why give me a red gumamela and they said because they saw a lot of optimism and that was the one that's being represented by the red color and but I think it's the optimism in me that helped me push forward every day and my days are long I practically when I go home if I don't have a meeting at night I start another day for my other advocacy because I have a long list of advocacy that I can only do after I finish my official work so I'm not easily broken down I think I've got enough personal issues in my life I've grown to be strong I've learned that you don't happen so you just have to accept what has been given to you because that's the best for you I believe in team team effort and whatever I've accomplished up to this point is really because of the very strong team effort within UP Manila I probably have that skill on how to deal with very difficult people because I have very difficult people that I have to face with somehow I know how to win them on my side and since they know that whatever I'm working for or fighting for has nothing to do with me has nothing to do at all with me but for the benefit of a bigger community then it's so easy to convince the people I work with I've enjoyed my life I've enjoyed my life as a researcher as a clinician now as a chancellor time is so fast I have not realized that my days are counted and that you never know when the day will end so as an ending I always tell my colleagues that if you want your ideas to continue beyond your life you better start working on succession