Halfway down the Danube

Cebu

Spent the day in Cebu City, which is on Cebu Island, about 500 km south of Manila.

Cebu is nice.  It's much smaller than Manila, just a million people or so, and it lacks the high-rises and the squalor.  There's less traffic, it's cleaner, people seem more relaxed.  I didn't get to play tourist for more than half an hour, and that was in the local shopping mall at lunchtime, but I liked it.

Also, I had two particularly good interviews.  One was with a private medical clinic located in that same shopping mall.  Like, between the sporting goods store and the NafNaf outlet, right across from the fresh-juice-frogurt place?  Walk-in diagnostics, complete with X-rays, sonograms and a well-stocked lab.  Three doctors, bunch of nurses.

But the clinic was just a pied-a-terre and a proof of concept.  These guys were innovative medical entrepreneurs: their real goal was to make a buttload of money outsourcing the management of other private medical clinics.  Businesses run by doctors are not always run well, right?  So the mall-clinic guys would provide better management, better IT, and a bunch of tricks like rationalizing procurement, and they'd run your clinic for you so much better that you'd both profit. 

Honestly, it was one of those interviews that makes me just smile thinking about it.  You know?  Like, maybe we can do some good here, but at the end of the day the Philippines might be just fine without us.  That's sort of paradoxical, but there it is.

Bohol

Spent most of Sunday on Bohol, a hilly, Delaware-sized about 2/3 of the way down the archipelago.

The trip was mostly a day off for our assessment, with a visit to a midwives' clinic thrown in just because.  We ended up wishing we'd had more time, because Bohol is pretty nice.  It's provincial, but in a good way.  Like, there's a huge cathedral, which we tourists were free to wander around just after the Sunday morning service, because there aren't all that many tourists.  (It's a cool cathedral.  Built in the 16th century, rebuilt in the 18th, all cool damp coral limestone with moss on it and swallows nesting up on the ceiling.)  Next to the cathedral is a museum, which is really more like an attic full of random stuff: 200-year-old hymnals, endless Virgins, priestly vestments in six different colors, a mimeograph machine from the days when the Church was quietly supporting samizdat against Ferdinand Marcos.  For about 40 cents you can wander around for an hour, then stand in the old balcony where the creole elites used to look down on everyone else for just as long as you care to.  It's... nice.

Other high points included a short cruise on a local river, the sort-of-famous Chocolate hills, some giant millipedes, and half an hour at the beach.  (Only half an hour, because time was running short.) 

And tarsiers!  Oh, man, are tarsiers great.  I felt kind of bad because these little guys were being shown in conditions that, while humane, were not too good from a conservation standpoint -- they don't breed in captivity -- and also kind of unpleasant, what with constantly being woken up (they're really nocturnal).  On the other hand, I may never have another chance to see a tarsier, and I'm really glad I did, because they're beautiful and wonderful.

And the midwife clinic, of which perhaps more anon. 

And then we came back to Manila and I got my cell phone stolen.  Tcha, stuff happens.

USAID has decided that the team should make a proper visit to an outer island, though, so two of us will go to Cebu City all day Thursday.  This will involve waking up at 4:30 am to catch a 6 am flight.  Imagine my enthusiasm.  Oh, well, it's another piece of the puzzle.

Some things I've learned about the Philippine pharmaceutical market

It's complicated.  Most things are,  right?  Some first thoughts.

Only a few drugs are produced locally, because the Philippines doesn't have much of a local chemical industry.  (Which is an interesting issue right there.  I'm not sure if the proper question is "well, why doesn't it?" or "well, why should it?" but anyway, it doesn't.  And while there is the technical know-how and human capacity to run a pharmaceuticals plant, there was never much investment money for capital-intensive greenfield projects wandering around the Philippines.  And there's even less today.  So. )  There isn't the capacity to produce a lot of APIs, Active Pharmaceutical indegredients.  Or at least not in an economically effective way.

There are exceptions, of course.  Apparently there are some APIs that don't require much underlying industry, and that you can more or less whip up in a basement.  These include some obvious ones like aspirin and antiseptics, and also paracetamol, drugs that end in "cillin", and -- who knew?  -- oxytocin. Those are made here from scratch.   But most other stuff, not.

That said, there is a pharmaceuticals industry!  They're just not producing stuff from scratch.  Instead, they're importing APIs and other raw materials -- salts, esters, binders and such -- doing some processing, turning them into pills and ampules, and then packaging and labelling them.  Turns out that pharmaceuticals is another one of those industries where different parts of the production chain can be sourced in different countries, and usually are.

Page break! 

You know you're in the Philippines when

...the cheese pastry has sugar sprinkled on top.

...you hear three Carpenters songs played in public, three different times, in the space of one afternoon.

...entering the shopping mall, as you walk through the metal detector, the security guards sing out, "Happy Valentine's Day, Sir!"

More in a bit.