What happened in Vegas

By Elizabeth E. Fildes | 04/01/2014

Director of Nevada quitlines program exports concept to her native Philippines.

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In February 2014, I, together with staff members from the Lung Center of the Philippines, met in Manila with Enrique T. Ona, MD, secretary of the Department of Health, Republic of the Philippines. Our agenda was simple: Establish a budget for the new Philippine Tobacco Users Helpline. This is an emerging international dimension of my nearly 20-year drive to make tobacco-use cessation services broadly available. The helpline, supported by revenue from a Philippine tobacco-alcohol tax enacted in 2012, is based on a successful program I implemented for the state of Nevada in the United States. Its purpose is to bring free, accessible, and immediately available treatment to the 17.3 million Filipino people dependent on tobacco.
 
This was not my first meeting with Secretary Ona. Two years prior, I had met with him in Manila to have a preliminary conversation about my idea. Throughout 2013, I briefed the secretary and other health officials on the advantages of quitlines and their implementation in the United States. In October 2013, after meeting with key personnel in the Lung Center of the Philippines Smoking Cessation Clinic, I began sharing detailed lessons learned from evidence-based practice as well as grant-application templates; minimum data set requirements; educational materials for counselors and patients; and protocols, implementation, and evaluation guidelines. The February 2014 meeting to produce budget guidelines was another milestone. However, the question remained: Would the Philippines go forward with a helpline inspired by the Nevada program?
 
My initiative was well-timed. First, in a political awakening to the unaddressed costs of tobacco use, the Philippine government recently hiked taxes on tobacco and alcohol. There was growing awareness that 17.3 million Filipinos ages 15 and older—nearly half of adult males and 9 percent of adult females—use tobacco. Indeed, 23 percent of Filipino adults smoke daily, with the average male smoker lighting up 11 cigarettes a day and the average female seven. Of adults recently surveyed, 48 percent had tried to quit, but only 5 percent had succeeded.
 
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Clinically and statistically, officials throughout the Philippine government knew what I knew: Tobacco use impacts every organ of the human body, causing cancer, lung disease, coronary artery disease, stroke, and other disorders. Now funds would be available to raise awareness among those who know the truth by their own suffering but lack the knowledge or support needed to escape deadly addiction.
 
Second, in a healthy coincidence, program evaluations and meta-analytic reviews had confirmed what I knew from my own observations in Nevada: Telephone-based tobacco cessation counseling is effective in helping tobacco users escape dependency. With adequate resources and rigorous implementation, it would work in the Philippines, too.
 
Third, I had expert knowledge of all the best tools. Nevada’s free quitline provided comprehensive dependence treatment—counseling, education, and medication—for all forms of tobacco use. As in Nevada, Filipino tobacco users would be able to access evidence-based nicotine-dependence treatment face to face and via phone, text, and the Web. They would have resources to educate themselves on tobacco’s effects and on strategies for quitting. The number of smoking cessation clinics in the country would increase.
 
Finally, a missing link was supplied. Those who determined the country’s health policy and budgetary priorities got it: The Philippines needed accessible nicotine-dependency treatment, because an individual who makes a personal decision to quit requires an immediate and sustained expert response.
 
Challenges remained. The list of deliverables was clear but daunting: nationwide integrated treatment by nicotine addiction-trained nurses and other health professionals; provider training on smoking-cessation strategies; marketing and outreach by specialists collaborating with the Department of Health, Philippine Medical Association, Philippine College of Chest Physicians, and other advocacy groups; a nicotine-addiction database; and nationwide awareness of the effects of smoking. And, of course, program evaluation!
 
Another consideration was the multicultural dimension. The original project in the United States had taken quite a few years to organize, test, and evaluate. Getting results across different cultures and languages with agencies oceans apart would demand new skill sets. The many activities undertaken to develop useful and relevant research questions; collaborate on research design, implementation, and analysis; and provide logistic and bureaucratic support would require two-way collaboration, which, in turn, would place a premium on relationships developed and sustained over the long term.
 
There would be challenges, but challenges aren’t new to me. A native of the Philippines, I attended nursing school at the University of Santo Tomas before emigrating to the United States in 1981. Graduate school came after marriage, three children, and two interstate moves, amid countless involvements of an extended multinational and multicultural family. I had come through in the past. I would meet this challenge. [Editor’s note: Click here to learn more about the author, who, in 2011, was presented the Healthcare Hero Award by Nevada Business Magazine.]
 
We overcame hurdles in setting up and implementing the Nevada Tobacco Users Helpline, and now, in the Philippines, the entire team—Secretary Ona and the Lung Center of the Philippines with its expert, dedicated staff—can be proud that, in Manila, hiring of key staff members for the Philippine Tobacco User Helpline has begun.
 
Elizabeth E. Fildes, EdD, RN, CNE, CARN-AP, APHN-BC, DACACD, a resident of Las Vegas, Nevada, USA, is professor, Chamberlain College of Nursing, and founder and senior director of the Nevada Tobacco Users Helpline.
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