Hate to End the Year on a Rant, But...

I was going to post a list of new year's resolutions. One of the things that was almost on my list was to try not to be so peevish.

Then some of my pet peeves started crawling into my mind, and before long I was making a list of pet peeves. Somebody please smack me.

Fear not, I won't foist either my so-called resolutions or my list of pet peeves on anyone today, but I do need to vent about something on the pet peeve list. Let's call it Pet Peeve #5: being told what to do as a physician by an insurance company.

Because there is already a brilliant post about this topic on the well-written blog Counting Sheep, I will try to be as concise as possible on this particular subject.

You have two choices.

See that long, black thing I'm holding in the picture on the side bar at right?

Behind Door #1, someone is going to snake a device similar to that, but longer and larger in caliber, up into your rectum and all the way through your colon after giving you a dose or two of unpredictable, unreliable sedatives with unpleasant side effects such as grogginess, uneasiness, nausea, vomiting, and itching. The person operating the black scoping thing is trying to make sure you don't have an ugly polyp (see above) or anything life-threatening in your colon, but because you're half awake, you sometimes tense and buck, making it hard for him or her to pass the scope through, hard to find lesions in all the recesses, and hard to watch over any ill effects the sedatives might be wreaking on your system. When you come to, you feel groggy and perhaps queasy, and you might have vague recollections of a big tube being snaked up through you, causing some abdominal cramping...

Behind Door #2, someone is going to snake a device similar to the scope at right, but longer and larger in caliber, up into your rectum and all the way through your colon after someone gives you a small, calculated dose of a drug that removes any awareness of the discomfort associated with the procedure. This drug can actually make it easier for the person operating the scope to pass it (and detect those life-threatening problems) because you are totally relaxed. Someone highly trained to protect you from this drug's possible side effects is giving it to you and watching over your breathing and your vital signs. You wake up quickly, feeling refreshed and nausea-free, probably surprised that it's all over, and you will probably be ready to go home soon.

Let me guess - you'd rather take Door #2, right?

Oh, oops, I lied. You don't have two choices, actually. That is, if your health insurance is covered by Aetna, Humana, or WellPoint. Sorry. You get Door #1.

Call me uncharitable, but right now I think any insurance carrier who's making these medical judgments without anesthesia training, or any medical training at all, should first be required by law to undergo the prize behind Door #1 before imposing such regulations on doctors and patients. Happy New Year to you too.

Filipino Food II: Merienda (or, Pinoy Pood dat I mees)

"Hey, I remember that smell," my son commented at the airport. I interpreted his comment to mean that aromatic medley of pandan leaves, fried dough, bamboo, and jasmine that I associate with being in the Philippines. It's an aroma that leaves a pleasant taste in your mouth and makes you hungry, so I said without thinking, "How very Proustian of you," though in fact it was I who was being transported to the past.

My Filipino sensory memories are centered around food. Filipinos love to eat and eat as much as possible. To leave food out of any kind of occasion, large or small, is unthinkable. We are all foodies, and we are obsessed.

Let me explain about meriyenda, from the Spanish merienda, "la comida que se toma antes de la cena."

Filipinos can eat up to four or five meals a day. Breakfast (almusal), morning merienda (kind of like the hobbits' second breakfast), lunch (tanghalian), merienda, and dinner (hapunan).

Merienda is no mere afternoon tea or pre-dinner snack. Merienda - the word itself is delicious to say - is a meal that celebrates the pleasure of eating, a time when the rest of life stops and the savoring of yummy treats takes priority - including treats that one might have enjoyed at breakfast earlier in the day. Merienda can be as simple as a piece of buttered pan de sal with hot chocolate (made from dark cocoa tablets from Spain, of course), or it can be a huge buffet of appetizers, main courses (like kaldereta, or goat stew), snacks, and sweets, blurring the lines between merienda and early dinner, in fact morphing into "merienda-cena."

Let me start there, with pan de sal. Historically I think pan de sal was a lean bread, like the French baguette, with the simplest of ingredients - flour, water, yeast, and salt. Over time it became richer, with the addition of sugar and eggs. The current version is the most delicious bread I know - soft and doughy on the inside, my favorite part, with lots of little places for melted butter to seep into, and crusty on the outside with a tasty dusting of dry breadcrumbs that is its signature feature. The dough is rolled into a log, then cut, coated with dry breadcrumbs, and baked, so the final shape of each roll of pan de sal is round or slightly elliptical.

Then there's the queen of breakfast breads in the Philippines: the ensaymada. We took what Spain originated and made it 100 times better. Ensaymada is a bright yellow or golden brioche type of bread, soft and airy, topped with a melt-in-your-mouth mixture of finely grated cheese, sugar, and butter. This is the kind of thing whose last bite instills a little melancholy, because you know you can only savor the tastes and textures a moment longer, then the magic is over. My Tita (aunt) M, who is of Pampanga stock - and this is a Pampanga delicacy - makes THE BEST ensaymadas IN THE WORLD. Lots of people make this wondrous bread from scratch, and we've tried their versions, and they're good, even superbly yummy, but still no match for Tita M's, and once you've tried hers, you can't eat any other version and enjoy it as much. Hers are simply a culinary treasure. The 5 dozen she sent to our house on Christmas Eve are GONE. When my 7-year-old son got on the phone to ask her for more, and she asked how many she should make, he answered, "Hmm...maybe, a hundred?" She laughed her head off but said ok.


I could go on about other foods I miss when we're back in the States. Champorado, a chocolate rice porridge. Our version of chorizo, the sweet, garlicky longganisa, served with rice and eggs (above, middle). Green mangoes and bagoong, of course (above, top), and ripe mangoes which I've already waxed rhapsodic about before. Rice-flour sweets such as sticky, brown-sugar infused bibingka (above, left), the coconut-covered palitaw, and the tricolor sapin-sapin (above, right). Cylindrical wafers called barquillos. Savory treats like pancit palabok (above, middle), a noodle dish served on a large bilao, or woven basket tray, and salsa monja, an olive-and-shallot relish unknown outside the Philippines, it seems, but apparently served by Spanish nuns to Spanish friars back in the day, as a condiment to flavor their food. Yum! We also inherited merienda items from China: siomai (shrimp dumplings), siopao (steamed pork buns, below), and hopia (bean paste filled pastries, also below).

And I have to drool over two last favorites, the soothing taste and smooth textures of buko pandan (below), and our native masterpiece dessert, the cake known as Sans Rival. Tiers of almond or cashew merengue layered with a sweet, rum-tinged buttercream and covered with toasted almonds:

There are better pictures on flickr here, here, and here. I know I'm going to have to undergo a massive detox when I leave, but for now, I'm taking pleasure in every dish and savoring every bite of merienda, enjoying with those bites the very Proustian flashbacks to my happy childhood.

Stepping Back in Time

I guess it's normal after being away from a childhood home for years to do a lot of walking down Memory Lane upon returning. Here are some stops I've made so far during this visit.

I was born 8 weeks early and spent my first several weeks of life in an incubator. Here I am at the "feeder-&-grower" stage, somewhat bigger than the 3 lbs 14 oz at which I started out.

I've mentioned before that I did a lot of ballet in my youth. I peaked in my early-to-mid teens, then went downhill. But I enjoy looking back on those more graceful moments...

I like to step back in time by hundreds of years, too. Today the hubby and I revisited Intramuros, the old walled city of Manila, and speculated on what it must have been like during colonial times. Our conclusion: sweltering! How did they survive those swishy skirts and dark suits without AC? 400 years of Spanish rule - that's a longer time under Spain than a lot of Central and South American countries had! While I'm sure the more tyrannical features of Imperial Spain stank to high heaven, I do think the disappearance of the Spanish language here is a loss...almost as bad as the deterioration of the English language today...


And finally...a family nostalgia trip:

So many women in my family have remarkable gifts with food. One of my cousins, Suzette, has done something very special and unique with her talents. Her business, La Cocina de Tita Moning, houses a dining experience unparalleled in all of Manila. Suzette converted her grandparents' mansion into an intimate museum of family treasures from days gone by, with rooms showcasing her grandfather's medical clinic, antique photography equipment*, amateur radios, and library books, as well as a train room, a dressing room containing heirloom wedding clothes and ballet costumes, and a second-floor living room I remember well from our childhood, containing old photographs of our family and a couple of priceless paintings by Filipino masters. After offering guests a tour through the house and a look at its wonderful artifacts, she offers sumptuous, five-star, table d'hôte meals from family recipes passed down by her grandmother. This has been our most memorable meal in Manila, superbly prepared, served over an exquisitely beautiful table setting, in an historic home that holds many warm memories for me, including gatherings during which we kids - one of us would grow up to be a well-loved singer, actor, and songwriter - would put on "shows" for the older folks. Now WE are the older folks! Time to step forward again to present realities! :)

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*Photo of camera equipment is from www.lacocinadetitamoning.com

Quiapo and the Black Nazarene

"You want to go to Quiapo tomorrow?" my mother asked yesterday after lunch. I could hear the good-natured, "Are you out of your mind?!" contained in her question. She continued, "But Friday is Quiapo day."

"Exactly!" I said enthusiastically.

"It'll be packed with people."

By evening I was starting to get a little concerned that an expedition to the seedy Manila neighborhood during its busiest time of week would be sheer madness. The fact that it took us 2 hours and 45 minutes to drive home in bumper-to-bumper traffic from my aunt's farm yesterday, only 30 miles out of the city, also got me discouraged. But when I got up this morning I was still game to go, so off to Quiapo I went, with the woman who had watched over me during my childhood (my former yaya) and her sister, Nita.




Quiapo is a city district that not only lies geographically at the heart of Manila but also might be considered the spiritual beating heart of the city. On Fridays in particular, “Quiapo day,” it teems with crowds of devotees who flock to Quiapo church, some on their knees, to attend masses that go on all morning. Outside the church are hordes of vendors plying colorful candles, flower garlands, and religious prayer books as well as an odd assortment of goods such as rat poison, dog leashes, bundles of wheat to ward off bad spirits, and palm leaf fans to combat the heat.

Perhaps most fascinating are the vendors that set up their wares in the streets surrouding the church and its plaza. We maneuvered around clusters of people to get to these vendors, our nostrils frequently assailed by the pungent stench of rotting garbage in the streets, the sweet scent of sampaguita garlands, the aroma of various foods being roasted or baked nearby, an occasional irritating whiff of cigarette smoke, and the rancid bouquet of human perspiration that was never far away. Some stands displayed a variety of oils and herbs that were supposed to have efficacy against different ailments. Others sold magic objects, or “anting-anting”: amulets believed to have special powers, either to bring good fortune or to garner heavenly protection.

For fun I bought a talisman in the shape of a key, and the seller explained in rapid, barely intelligible Tagalog its use and the instructions I had to follow while it was in my possession. She whispered to it before placing it in a little bag for me and packaged it with a handwritten prayer that I was to open and say at midnight at the New Year, for prosperity. Or at least, I think that’s what her instructions were. Even Nita could barely understand her.

There is a long history of folk belief, “alternative medicine,” and superstitious ritual here, most of it entirely oral, with no source material for folklorists or historians who might have an interest in the cultural anthropology of the Philippines. The juxtaposition of established religion and folk tradition is apparent in the transactions with the amulet sellers and fortune-tellers in the square. Right across from the church door, in fact, sits a row of soothsayers who, though ordinarily forbidden by Catholicism, are tolerated here, at a crossroads where religion and magic travel hand-in-hand.

Just inside the entrance to Quiapo church sit a number of older women, the mandarasal, who offer to say prayers for people in exchange for a monetary donation. While this might seem utterly distasteful to many, it seems that some of these women regard their service as just that: a service to those who feel they don't know how to pray for themselves or feel they lack the fervor they would like to have as they say their prayers. Ted Lerner in a 2003 article for Asia Times quoted church administrator Gigi Camballa,

"We never get complaints from parishioners. The complaints come from religious people who think they know better. Sometimes nuns complain about the practice. But I tell them, 'Don't we all receive donations? They have to eat, they have to feed their families. It's their livelihood." But Camballa understands the feeling of outsiders. When she and her colleagues first took over running the church in 1999, they tried to drive the prayer ladies out of the sanctuary and into the busy square outside. "Our first impression was that this was 'pay for pray'," she said. "But they said, 'It's not payment. It's a donation for our food.' So we were forced to observe them. We discovered that they are helping people. There's value in that. People see the donation part and they think negatively. But they haven't taken the time to understand."

The central object of devotion at Quiapo church is a 400-year-old statue of Jesus carrying his cross. This is Nuestro Padre Jesus Nazareno, the Black Nazarene. Carved by an Aztec woodworker in Mexico, it was procured by a priest and brought over to Manila on a Spanish galleon with the Augustinian Recollects in 1606. The ship went up in flames around it on arrival, but people kept the charred statue and put it in the Recollects’ church. It was moved to Quiapo in 1787. Quiapo church, the foundation of which was laid in 1582, went up in flames too, once in 1791 and again in 1929, but the Black Nazarene survived. The icon also survived two severe earthquakes, in 1645 and 1863, as well as the bombing of Manila in 1945. These survival stories increase the relic’s mystique and appeal among devotees, who today stood in a line which snaked around the block just to touch the statue.

Touching this image of Christ is believed to confer possible healing of diseases and sufferings, and perhaps other miracles. Belief in the power of this physical contact, this laying on of the faithful’s hands, is so strong that some believers rub the statue with cloths in the hope of carrying some of its power home. During the great fiesta of the Black Nazarene, on January 9, the statue is carried through the streets in procession and hundreds of thousands of people try to get close enough to toss their handkerchiefs or towels to the image-bearers (see video below - though I'd like to remind people that not all Catholics have the same understanding or express their faith in the same way; for many, devotional traditions such as these are quite alien). Many who walk in procession with the Nazarene do so barefoot, braving the hot asphalt, as an expression of humility.

"Does it really do anything for them?" I mumbled, half to myself, as I wandered with my two companions among the faithful queued up to see the Nazarene.

"When there's enough belief, then it becomes true," answered Nita, "and the power is experienced." We were quiet after she said this, taking in the sights and sounds of Quiapo.

Touch, faith, and healing. Magic and mystery. History and myth. Street noise and soulful silence. These are the colorful offerings of Quiapo, with its seething dance of human activity, its incomprehensible jumble of despair and hope.

For some terrific pictures of Quiapo, see here (laz'andre's pics on flickr) and here (pinoytravelblog).

Filipino Food I

Happy Feast of Stephen! (Of "Good King Wenceslas" fame...)

In the past couple of days I've been enjoying a cornucopia of culinary delights that I don't often get in the U.S. My thighs feel like blobs and my panniculus has doubled, and yesterday after Christmas lunch I was sure that my lower lungs were in a state of collapse from all the food piled up in my stomach squashing all the air out of my alveoli. We really need to get better Filipino food in the Boston area.

I'm sometimes asked what Filipino food is like, and I find it's a little difficult to describe well. Like the people, it's a mix of Asian and Spanish influences. Just before this trip I made arroz a la cubana, a dish of ground meat, tomatoes, and raisins, with a hint of soy sauce in the seasoning, topped with fried eggs and plantains. Yesterday and today I feasted on delicious calamares en su tinta - squid in its ink - made by my mom's best friend, a Caucasian Filipina whose family is of Basque origin. We have paella here (shown above), but we also have those Asian see-through noodles and our own versions of the spring roll, fried or fresh, which we call lumpia (shown above and below). Then there's adobo, our signature dish made of chicken or pork marinated in vinegar, soy sauce, and garlic, and bagoong, our deliciously stinky condiment about which I've written before - how to explain that? I've munched on green mangoes and bagoong here like a pregnant woman with cravings - but no, I'm not pregnant, so I don't even have an excuse for the cravings.

I'm sure I've mentioned before that ripe, golden Philippine mangoes are without equal in the world - sweet, succulent, with the consistency of custard rather than being stringy as the fruit is scooped out with a spoon, with no adulteration by that apple-like taste some other mangoes have. Hard to find mangoes like these in New England. I know, I sound like a mango elitist. But it's impossible not to be here.

Something most people find unusual is our purple yam, called ube. It is bright purple both raw and cooked, and as an ice cream looks as yummy as it tastes. Tonight I tried something new to me in world of ice cream: cheddar cheese ice cream. There was also a white sorbet laced with our citrus fruit, the calamansi, which produces a juice and flavor unlike that of any Western citrus fruit. I liked the purple ice cream best.

And speaking of white...while we were at the grocery this afternoon buying the ice cream, I had to take a picture of these signs for aisle 9, just in case people who read my post mentioning skin-whitening products thought I might have been exaggerating:

I could start ranting about the sociopolitical objections these products stir up in me...but I'm too stuffed from dinner and sleepy from jetlag to think lucidly (it's morning in the U.S., but dinner time here in the Philippines). So perhaps another day.

Christmas Star Light

The streets are lined with parols (from the Spanish word farol), lanterns shaped like stars to commemorate the Star of Bethlehem. According to Wikipedia, "In the Philippines, the parol has become an iconic symbol of a Filipino Christmas and is as important to Filipinos as the Christmas Tree is to other cultures. Its appearance on houses and streets, which usually starts in September along with other Christmas symbols, signals the coming of the season." Yes, we LOVE Christmas and have the longest season of the year - I would say, from October through January. Perhaps this explains my deep, extended enjoyment of it; it's partly cultural.

Growing up in the Philippines I remember watching the women in our household making parols. This has become a lost tradition from what I can tell now - all the parols hanging over the streets for the Christmas Eve barrio fiestas were electric. The colorful, home-made, crêpe paper and bamboo stars of my childhood are just memories of Christmases past. I feel wistful over this technologic sign of the times. There is something special about taking time to cut the crackly paper, feel its fronds between one's fingers, decide which colors to use and whether to create more elaborate designs. We're losing the capacity to linger over our crafts.

It's been a reminder to me of the tension between modern Christmas, with all its delightful but materialistic trappings, and true Christmas. I am not one of those who criticizes Christmas commercialism every year. I see it as a manifestation of our natural need for physical comforts. We are flesh and bone, sensation and movement. If we take pleasure in sparkling lights, wondrous music, freshly baked Christmas cookies, cheerful decorations, and delightful presents, it's because these comfort some very physical, real, tangible aspects of ourselves. I don't believe it's very generous or understanding to point fingers at these enjoyments, but that's because I subscribe to ideas expressed in this year's holiday episode of the TV show Bones: "As adults we're imbued by the pragmatic routines of life, which makes it difficult for us to regard anything with childlike wonder. But you know, it's all right for us to try. We put on silly hats and drape trees with sparkly lights, wrap gifts with garish paper, and that's good for us."

But I know, seeing it up close right now, that there is a sad side to our enjoyment of these little things, and that's the absence of these real pleasures in the lives of many and perhaps most people in our world. There are so many children in these streets who will have no Christmas today or tomorrow - not of this intensely material sort. I have to believe that by their plight they are closer to the Christ child than anyone else could be, and hope that they will have the "better portion," if not today, then someday - the true Christmas spirit, a peace and joy that surpass understanding.

Like the street kids that come up to our vehicle at every intersection, all the characters in the 2000-year old story were pushed to the fringes, homeless, tired, hungry, and far from friends and family. The shepherds: social outcasts living in poverty, doing a thankless night-shift like so many workers today - police officers, guards, health care workers, janitors, etc. The wise men, on a long trip in a foreign land. Mary and Joseph, who had to beg for lodging far from the center of town, far from home, and wind up where some stranger kept his animals. On the margins, far from the center: Jesus would start his life there, live it there, and die there, among people ignored and unloved by others (who would have the option to feast and enjoy the comforts of holiday trappings all their lives).

I know the things I enjoy about Christmas are not Christmas. It's not about baking cookies or wrapping presents - though I enjoy those. It's not about sparkling lights and wondrous music - though I love those. It's not even about spending time with friends and family - though I consider these among the most important parts of my life.

It's about one thing and one thing only: hope. Not the shallow hope of someone wishing for a particular Christmas present or a happy outcome. Not hope as defined by Michael Gerson in The Washington Post: "seeing present challenges in a positive light, living in the expectancy that the future will turn out well." This is mere optimism. What I mean by hope, rather, is the hope incarnate in a baby's birth or in the light of a guiding star, a light that doesn't waver even in the world's darkest corners: it is a kind of faith and rejoicing in the ultimate preciousness of our lives, a way of living in the world. It is a deep, inexpressible hope that comes from trusting that in our connections, in the presence of the sacred among us, in our very own worth as the stuff of this precious universe, we are never alone, and we have the power to transform sorrow into joy, darkness into light, destruction into new life.