Have we really gone heartless?

Some members of the Sigma Rho fraternity are on hot seats nowadays for the alleged hazing of UP Public Administration student, Cris Mendez, that resulted to his untimely death.

This is not the first time that we hear of senseless deaths involving campus fraternities.

And to think that these fraternities are composed of supposedly educated individuals!

The truth is, I am now reminded of someone who had written, "I am a survivor of a concentration camp. My eyes saw what no person should witness. Gas chambers built by learned engineers. Children poisoned by educated physicians. Infants killed by trained nurses. Women and babies shot and killed by high school and college graduates. So I'm suspicious of education. My request is: help your students to be human. Your efforts must never produce learned monsters, skilled psychopaths, or educated Eichmanns. Reading and writing and spelling and history and arithmetic are only important if they serve to make our students human."

What about the pharmacist who irresponsibly dispenses prescription drugs nowadays like candies in sari-sari stores?

Or the one who is not bothered by the illegal selling of misoprostol which is used as abortifacient?

Or our inaction to the unethical practice of our profession?

Have we really gone heartless?

Surely, I want to hear more of Michael Jackson singing:

"Heal The World

Make It A Better Place

For You And For Me

And The Entire Human Race

There Are People Dying

If You Care Enough

For The Living

Make A Better Place

For You And For Me"

I really hope that would help...

More on "look-alike" and "sound-alike" dispensing errors

I'm beginning to notice that dispensing errors that have caught media attention or have landed in courtrooms were due to failure to observe dispensing rules and regulations under the Generics Act of 1988.

If, for example, "the lady at the counter" paid more attention to generics, she might have refused to fill the prescription for Methergin if the generic name was not written on it. Or, if the generic name was written, she might have thought it as an "impossible prescription" if she have interpreted the brand name as Melleril. [1]

A.O. 63 s. 1989 specifically states that "[v]iolative and impossible prescriptions as defined in A.O. 62 (Generic Prescribing) shall not be filled. The pharmacist shall advise the prescriber of the problem and/or instruct the customer to get the proper prescription..." (Section 4, 4.1)

The dermatologist who prescribed Thiamine had observed generic prescribing but the pharmacist's failure to practice what was required under the law had led to a dispensing error by filling the prescription with Thorazine. [2] (Oral doses of thiamine is being used as an mosquito repellant.) [3]

References:

1. "Wow mali" by Joy Gonzalez at http://www.manilastandardtoday.com/?page=goodLife02_sept_2003 [cited Aug.16, 2007]

2. http://ca.supremecourt.go/cardis/CV83632.pdf [cited Aug. 16, 2007]

3. "Avoiding Mosquito Bites" at http://www.infomediko.com.ph/past_episodes.html#061107avoiding [cited Aug. 26, 2007]

"Look-alike" and "sound-alike" dispensing error

Today, while browsing the internet, I came across an article in the May 29, 2007 issue of the Sunstar Manila* entitled “High court upholds damage suit v. drugstore chain”.

Here is part of that news article:

“… on Nov. 25, 1993, [Sebastian] Baking went to the clinic of Dr. Cesar Sy for a medical checkup. After undergoing an ECG, blood and hematology examinations, the doctor found that Baking's blood sugar and triglycerides were above normal levels, for which he gave two medical prescriptions -- Benalize tablets for his triglycerides and Diamicron for his blood sugar.

"Baking proceeded to Mercury Drug-Alabang branch to buy the prescribed medicines.

"However, the saleslady misread the prescription for Diamicron as a prescription for Dormicum, a potent sleeping tablet, and sold it to Baking, unaware that it was the wrong medicine.

"On the third day of taking Dormicum, Baking figured in a vehicular accident when he fell asleep while driving his car and it collided with another car. He said that he could not remember anything about the collision or felt its impact.

"Suspecting that the tablet he took may have a bearing on his physical and mental state at the time of the collision, Baking returned to Dr. Sy's clinic.”Upon being shown the medicine, the physician was shocked to find that what was sold to him was Dormicum, instead of Diamicron, prompting Baking to file a complaint for damages before the Quezon City RTC.”

Finally, this year, the Supreme Court has ordered Mercury to pay damages to Mr. Baking for the dispensing error “that caused him to fall asleep and figure in a vehicular accident.”

*****

Although the said article was way back in May 2007, I still decided to write the editor to comment:

Here’s what I wrote:

Dear Editor,

I just would like to comment on the article "High court upholds damage suit v. drugstore chain" (May 29, 2007 issue).

It is my opinion that the error in dispensing Dormicum instead of Diamicron is in the first place an error in prescribing the drug by its brand name.

Medication errors due to "sound-alike" and "look-alike drugs" happen and the article did not mention whether the doctor prescribed the drug by its generic name, because if he did, the drug will most likely be dispensed correctly.

This is because the generic name of Diamicron is gliclazide while midazolam is that of Dormicum. (Both generic names are not "sound-alike and "look-alike".)

Under the Generics Act of 1988, drugs prescribed by their brand names only should not be filled. So if, in this case, the drug was prescribed in its brand name (Diamicron) without the doctor writing the generic name (gliclazide), the drug store chain's employee indeed violated the law in the same manner that the doctor violated the same law.

Then I would say that if only the prescriber and drug store chain employee complied with the Generics Act, none of this thing would happen to the patient.

*****

I shared the above article to my colleagues and there were questions that came up in relation to the case:

1. How come the saleslady had access to a regulated drug, such as midazolam? (Pharmacists are the only ones authorized to have access to regulated and restricted drugs. These drugs are kept locked in their storage areas.)

2. Was there a pharmacist at that time? Should he/she be held liable?

3. Was there a dosage strength written on the prescription? If there was, how come she did not doubt the correctness of the drug that she dispensed? (Dormicum is available as 15 mg per tablet while Diamicron is available as 80 mg per tablet.; Diamicron MR is available as 30 mg per tablet)

*****

In the above case, the Supreme Court ruled that “ ’It is generally recognized that the drugstore business is imbued with public interest. The health and safety of the people will be put into jeopardy if drugstore employees will not exercise the highest degree of care and diligence in selling medicines’ ”.

I hope that every pharmacist who reads this learns that we have a social responsibility to guard the public health and by being negligent of our duty to properly dispense drugs, we certainly have a price to pay for our shortcomings. Pharmacy assistants or clerks should never be allowed to do the job that we are licensed to do. Let alone, to dispense a drug without regard to its classification as prescription or OTC drug.


*Source:
http://www.sunstar.com.ph/static/man/2007/05/29/news/high.court.upholds.damage.suit.v..drugstore.chain.html

Questionable promotional material

Section 6 (c) of the Generics Act of 1988 states that "Any organization or company involved in the manufacture, importation, repacking, marketing and/or distribution of drugs and medicines shall indicate prominently the generic name of the product. In any case of brand name products, the generic name shall appear prominently and immediately above the brand name in all product labels as well as in advertising and other promotional materials."

Last July 21, I wrote the Bureau of Food and Drugs inquiring whether drug companies are now allowed to advertise their drug products with the brand name above the boxed generic name.

My concern is regarding the 2 billboards of a popular cold preparation along the east service road of the South Super Highway. One is located near Sucat tollway and the other is located before the Skyway in Bicutan.

I was on my way today for work and while I was travelling the South Super Highway, I remember about this matter. So I checked and saw that the 2 billboards were already changed into a multivitamin product which complies with Section 6 (c) of the Generics Act of 1988.

I am not sure whether it was because of my inquiry that the 2 billboards were changed but if it was BFAD's action to my letter, I'm thankful that it was done accordingly.

Quote of the day

"We don’t want to be a critic of the Botica ng Bayan program but there are some unanswered questions about it. Firstly, why does the Philippine International Trading Corp. import generic medicines from India when we have a pharmaceutical industry which also manufactures generic drugs? Secondly, how come the drugstores of the Botica ng Bayan are not run by professional pharmacists? From a write-up on the Botica ng Bayan, it appears that even buy-and-sell entrepreneurs can get Botica franchises and sell medicine. Selling medicine like selling goods in a sari-sari store could be dangerous to the health of our medicine consumers."

- Jesus C. Sison in his article People's trust in courts boosted
Malaya (Opinion) , March 24, 2007

Source: http://www.malaya.com.ph/mar24/edjesus.htm

PPhA president promoting use of generics

I was watching Unang Hirit last Friday morning in a bus on my way to work. In one of the commercial breaks, a familiar face was shown on TV.

Guess what? It was none other than Ms. Normita D. Leyesa, President of the PPhA, in a TV commercial with PITC chairman Roberto Pagdanganan promoting the use of generic drugs!

This was the first time that I've seen this kind of commercial since the Generics Act was enacted in 1988.

True enough to the PPhA preamble, President Leyesa has shown that "A pharmacist, in coordination with the government and other health professional helps in the formulation and implementation of health care policies, standards and programs designed for the benefit of society."

Let's all hope that the members of the PPhA feels the same way.

Urging pharmacists to back lowering prices of drugs

Today I sent a feedback addressed to the editor of Sunstar Manila (1) that reads:


Dear editor,

This is a reaction to the article "Pharmacists urged to back lowering prices of drugs" wherein it was stated that Senator Mar Roxas "called on the Pharmaceutical [and] HealthCare Association of the Philippines (Phap) to join hands with the Department of Health (DOH) in expanding public access to quality medicines at more affordable prices rather than block the passage of legislation to lower the cost of medicines."

I just would like to say that the Pharmaceutical and Healthcare Association of the Philippines is NOT an association of pharmacists but "a business association representing the providers of most of the country's medicines" whose "members include the country's leading research-based companies of pharmaceuticals and medical services." It claims to have a membership of at least "64 Filipino and international companies." (2)

Although the association says that it is a "non-profit, non-stock organization", (2) it is pretty obvious that it has to protect the business interests of its members.

It is true that the "cost of medicines in the country is too high" and I believe that as a pharmacist, I should support every move of the government to lower its prices for the benefit of the majority of our countrymen.

Senator Mar Roxas might as well call on the Philippine Pharmaceutical Association (PPhA), the Philippine Society of Hospital Pharmacists (PSHP), the Community Pharmacists Association of the Philippines (CPAP) as well as the Drugstores Association of the Philippines (DSAP) regarding this matter.
________
References:
1. http://www.sunstar.com.ph/static/man/2007/02/26/bus/pharmacists.urged.to.back.lowering.prices.of.drugs.html

2. http://www.phap.org.ph/home.aspx

Interview with an applicant

I am a member of a committee that interviews applicants for vacancies in our department.

Just recently, we interviewed a pharmacist who was previously employed in another hospital. As I went over her resume, I learned that she had finished a sponsored clinical pharmacy course.

Knowing that the sponsored course aimed at assisting other hospitals to get started with their clinical pharmacy service, I asked why she resigned from the hospital pharmacy and got herself a job in a non-government agency involved in iradicating tuberculosis in the country.

As we listened to what she was saying, we got the impression that her former colleagues were not as interested and eager as she was in pursuing a clinical pharmacy practice in their hospital. She said that was one of the reasons why she resigned.

As I write this post, I still wonder if her former colleagues are among the members of the PSHP who can say that they "have led in blazing new paths in hospital pharmacy management and originated clinical pharmacy programs that are recognized in Asia."*

_______________
*http://www.pshp.org.ph/static.aspx?categID=10

Quote of the day: On educating consumers on Generics Law

"There must be continuing education on Generics Law. Our consumers have yet to fully appreciate the value for money offered by generic substitutes. Our doctors and public health institutions must not negate the spirit of this law by failing to live up to their duty to inform their patients, particularly the poor, about generic substitutes."


- Senator Mar Roxas, on his sponsorship speech on Senate Bill No. 2263 to make the laws on patents, trade names and trade marks more responsive to the health needs of the Filipino people delivered at the Senate session hall on August 16, 2006.

_________________________
pinoypharmacist's comment:


Former BFAD Director, Quintin L. Kintanar, M.D., Ph.D., in recognizing the role of pharmacists, said that "Under the Generics Act of 1988, the pharmacist is not only a dispenser of drugs. He is also a teacher; he has been given the responsibility of informing the consumer what are the available generically-equivalent drug products and their prices."

He also said that "To discharge this responsibility properly the pharmacist himself must be professionally competent and must also be well-informed on the provisions of the Generics Act and the current developments in the pharmaceutical field."

Further, A.O. No. 63 series of 1989 requires drugstores, botica and other drug outlets "To inform the patient/buyer of all available drug products generically equivalent to the one prescribed with their corresponding prices. In so doing, the drug outlet shall not favor or suggest any particular product so that the patient/buyer may fully and adequately exercise his option to choose." (Section 3)

So, you see how confident and ready the government was about the role of pharmacists when they drafted the implementing rules of the Generics Act. It seems, however that WE WERE THE ONES WHO ARE NOT READY.

But wait... Although Michael Tan (in his article, Generics again) observes that " drugstores don't always inform consumers about the possible choices", he admits that he "sees some hopeful signs around generics" based on his own experiences in buying medicines.

Reference:
http://news.inquirer.net/common/print.php?index=2&story-id=53269&site-id25&col=81

Labeling our patients' medications

In giving orientation to new interns, I always emphasize the importance of labeling "loose tablets and capsules" properly and in accordance with the requirements of A.O. 63 series of 1989 (Section 3, no. 3.2) not only for the sake of compliance but because it is the right thing to do to ensure the safety of medications for our patients.

My lecture on the subject matter includes powerpoint presentation of drug labels improperly (read unprofessionally) done that were collected from community drugstores and hospital pharmacies.

In one of this orientation lecture, an intern revealed to us that the pharmacist in a community drugstore where she had her internship reprimanded her for completing the information on the label simply because it took her longer to fill the prescription order.

What a disgusting way to train our interns!!!

For not filling a violative prescription

In one of our meetings, a senior pharmacist in-charge of the outpatients pharmacy outlet informed us about an incident regarding a doctor who prescribes by writing only the brand name of the drug on the prescription pad.

The pharmacist did not fill the prescription and asked the patient to get a correct one. The doctor was irritated and told the pharmacist that if his prescriptions were to be returned to him just to make him indicate the generic name of the drug, he might as well instruct the patient to buy the medicines outside the hospital.

What does this mean?

It means that while some of us do our best to follow the provisions of the Generics Act, violative prescriptions are still being filled in many drugstores and pharmacies instead of being rejected and/or reported to the Department of Health, as required by law.

When the Generics Act was enacted in 1988, then Secretary of Health, Alfredo R. A. Bengzon, M.D., issued Administrative Order No. 63 series of 1989 whereby "associations of affected professionals are enjoined to promote compliance in order to achieve a smooth transition to the next phase of full implementation" of the law. (Section 9)

After almost 19 years since the enactment of the said law, I think that the Philippine Pharmaceutical Association (PPhA) and its affiliate organizations and societies have a lot more to do.

The PPhA's Code of Ethics states that "A pharmacist, in coordination with the government and other health professionals helps in the formulation and implementation of health care policies, standards and programs designed for the benefit of society."

I wish that like in the Philippine Medical Association (PMA),* the Code of Ethics for Pharmacists has implementing provisions against unethical and unprofessional conduct as grounds for reprimand, suspension or expulsion from the PPhA.

________________________

Reference:

* http://www.pma.com.ph

A frontline pharmacist in action

One time I made a phone call to one of our outlets that serves the out-patients. I was put on hold for a while by the clerk who answered the call and while waiting for the pharmacist, I overheard her giving instructions to patients on the proper administration of their medicines.

As a trainer, I often wonder whether we are effective in giving encouragement and support to our frontline pharmacists so they may be able to provide drug information and patient counselling despite their heavy workload. So, you can just imagine my joy and excitement overhearing one of our frontline pharmacists counselling patients in action!

Surely, I made it a point that I let her know I am very pleased by what she does...

An inquiry for a dispensing doctor

One early morning just before office hours, a doctor inquired in our office about certain provisions in any law that prohibits doctors to sell medicines in their clinics, particularly vaccines. She told me this was an inquiry by a pediatrician friend of her.

I was the only pharmacist at that time and the only law I can think of is the Pharmacy Law (R.A. 5921) which states that "No medicine, pharmaceutical or drug of whatever nature and kind or device shall be compounded, dispensed, sold or resold, or otherwise be made available to the consuming public except through a prescription drug store or hospital pharmacy duly established in accordance with the provisions of this Act.

Pharmaceutical, drug or biological manufacturing establishments, importers and wholesalers of drugs, medicines, or biological products are authorized to sell their products only at wholesale to duly established retail drugstore or hospital pharmacies." (Section 25)

I also referred her to DOH Administrative Order No. 63 series of 1989 which states the "Rules and Regulations to Implement Dispensing Requirements under the Generics Act of 1988 (R.A. 6675)" (specifically, Section 1).

I learned from this experience that every pharmacist should maintain their familiarity and keep themselves updated with the laws, rules and regulations related to their profession.

The issue behind Senate Bill 1900

A few years ago, "An Act Regulating the Education and Licensure of Physicians and Their Practice of Medicine in the Philippines and for Other Purposes," otherwise known as Senate Bill 1900, caused a stir among pharmacists when an attempt to redefine the physician's roles was being "cooked" in the Senate.

If the bill passed the Senate, physicians will be allowed "to diagnose, treat, operate or prescribe and dispense any remedy for any human disease, injury, deformity, physical or mental condition."(1)

To air its position, the Philippine Society of Hospital Pharmacists issued an official statement for "A Call to Modify Senate Bill 1900." (2) The Drugstores Association of the Philippines also wrote the senate outlining its comments on the said bill. (3)

I suspect that maybe the reason why the word "dispense" found its way into Senate Bill 1900 is because of our failure to do properly what we are licensed to do.

For example, Dr. A.G. Romualdez, Jr. claimed that “here in the Philippines, until the advent of the Pharmacy Law…, most private Filipino patients obtained their medicines from the doctors who prescribed them. In most of the country, dispensing physicians were historically a big help in the distribution chain of drugs and they ensured that services were reasonably priced. Unfortunately, the practice has largely disappeared mainly because, under the Pharmacy Law, doctors were allowed to dispense only those medicines that they directly administered either by injection or inhalation or direct application to specific organs.” (4)

Now, this should be a wake up call to all of us...

________________________________

References:
1. http://www.inq7.net/globalnation/col_pik/2003/jul31.htm
2. http://www.pshp.org.ph/article.aspx?ID=5
3. http://www.dsap.org.ph/index1.php?fid=senate
4. Romualdez, A.G. Jr., MD. "Anti-poor conspiracies." Malaya 18 Aug. 2004.

Not a license to kill

"Lack of drugstore pharmacists kills patients." This is the title of an article written by David Dizon in 2002.*

It noted that "[p]harmacists play a crucial role in the process of dispensing safe and effective medicine to consumers" and that "they give valuable information that could mean life or death for patients."

Unfortunately, "some pharmacists actually 'rent out' their licenses and/or diplomas to drugstore owners while maintaining other jobs."

I don't know if we have improved already but I always tell my interns that their license is not a license to kill but a license to heal.

_____________________________

* http://uw2.abs-cbnnews.com/images/news/microsites/onddot/DavidDizon08132002.htm

Quote of the day

"I am a survivor of a concentration camp. My eyes saw what no person should witness. Gas chambers built by learned engineers. Children poisoned by educated physicians. Infants killed by trained nurses. Women and babies shot and killed by high school and college graduates. So I'm suspicious of education. My request is: help your students to be human. Your efforts must never produce learned monsters, skilled psychopaths, or educated Eichmanns. Reading and writing and spelling and history and arithmetic are only important if they serve to make our students human."

- Anonymous

An inquiry regarding PITC's legal mandate

Last November 24 I wrote the Philippine International Trading Corporation (PITC) through pitc@pitc.gov.ph asking for clarification regarding its legal mandate.* In my letter, I asked the following:

"Isn't it that under Section 10 of the Generics Act of 1988, only raw materials and not finished drug products are to be imported 'during periods of critical shortage and absolute necessity' and that the government agency authorized under that law 'to import raw materials of which there is a shortage for the use of Filipino-owned or controlled drug establishments to be marketed and sold exclusively under generic nomenclature' is the Department of Health?"

Today, when I opened my mailbox, I found out I got a reply from Mr. Steve Francis A. Roldan, PITC's Legal Officer V, and this was his response:

Thank you very much for your e-mail dated November 24, 2006 expressing your support for PITC’s efforts in bringing down the prices of medicines to benefit the majority of our countrymen. In your e-mail, you seek clarification on PITC’s legal mandate, vis-à-vis Section 10 of the Generics Act of 1988.

In response to your query, please be informed of the following:

1. Under Section 11, Article XIII of the Constitution, the government is mandated to “…adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all people at affordable cost …”

2. In order to “[r]educe by half the cost of medicines through increased and improved distribution importation through PITC and local sourcing, partnership with the pharmaceutical Industry, resolution of patent issues increased use of generic products, community based initiatives”[1] and consistent with the earlier quoted provision of the Constitution, the President issued Executive Order No. 442 on July 4, 2005, designating PITC as the lead coordinating agency to make quality medicines available, affordable and accessible to the greater masses of Filipinos.

3. PITC, as an agency under the Office of the President, is mandated under Section 1, EO 442, to “…establish retail outlets nationwide and supply these outlets with low priced quality medicines…”

As can be gleaned from the foregoing, while Section 10 of the Generics Act of 1988 authorizes the Department of Health to import raw materials for the use of Filipino-owned or controlled drug establishments to be marketed and sold exclusively under generic nomenclature during periods of critical shortage and absolute necessity, PITC’s mandate is distinct from, and is not precluded by, said Section 10.
We hope to have clarified matters.

_________________

* http://www.pitc.gov.ph/mandates.html

Dr. Kenneth speaks

Quote of the day
"Imagine a doctor who made a mistake, and then there are no pharmacists to countercheck or provide warnings to patients and consumers."
- Dr. Kenneth Y. Hartigan Go
As quoted in the article "Dispensing doctors? A controversy in the offing."Medical Observer vol. 6 no. 6 June 1997:29-31.

Doctors prescribing Cytotec

Misoprostol (Cytotec), an unregistered drug product was featured last Saturday in the television show Imbestigador (Channel 7). Although the Bureau of Food and Drugs had already issued BFAD Advisory No. 02-02, * warning against dispensing/selling and using this drug product, there are still doctors who prescribe it and, sad to say, the illegal market still proliferates (Quiapo was identified in Imbestigador).

The BFAD Advisory enjoins all concerned parties "to report to BFAD... or police authorities any information that may lead to the apprehension of persons dealing with the subject drug."

You may report through these e-mail addresses:

ntlanuza@bfad.gov.ph and tmgutierrez@bfad.gov.ph.

_____________________________

* To view the full text of this BFAD Advisory, visit the BFAD website at www.bfad.gov.ph (Click the heading "Advisory".)

MedExpress: changing the image of community drugstores

If there's one drugstore chain that is changing the image of community drugstores in the country, it is Med Express. This new retail drugstore chain "offers not only delivery and drive-thru pick-up but most importantly professional pharmacy services."*

"Medication safety issues [are] addressed by ensuring that only pharmacists will man all branches and call centers; strictly implementing a "No Rx, No Dispensing" policy; compliance packaging (patient's medication for a week is prepared in unit dose packaging); medication counselling; medication review; confidential medication profile system (a computer system that enables pharmacists to keep track of the patient's drug utilization and provide relevant pharmacist notes); and a patient compliance program (computer system that keeps track of the patient's supply of maintenance medications and enables pharmacists to monitor patient's adherence to medication regimen).

There are Med Express Drugstores in Ortigas Avenue, Mindanao Avenue and Filinvest Alabang.** Patronize this drugstore chain.

SAY NO TO DRUGSTORES WHO SELL PRESCRIPTION DRUGS LIKE CANDIES IN SARI-SARI STORES!

________________________

Source:

* "MedExpress: A New Concept in Community Pharmacy Practice." The Hygeian. December 2005.

** http://www.manilatimes.net/national/2005/jul/19/yehey/life/20050719lif1.html

http://www.mb.com.ph/issues/2005/05/16/TECH2005051634854.html

http://www.mb.com.ph/issues/2005/06/12/HLTH2005061236258.html

Second lecture on counterfeit drugs

The second lecture on "Counterfeit Drugs" for our CE last Wednesday was given by Mrs. Maria Theresa M. Gutierrez, Food-Drug Regulation Officer IV, of the Bureau of Food and Drugs.

During the lecture, she mentioned that pharmacists who want to attend conventions, seminars and similar events which require them to be physically absent in the drugstores where they are hired to work, should file a leave of absence and have it received by the owners to protect themselves just in case the owners decide to run the business without a pharmacist on duty.

She was also very accommodating in answering our questions and I was very happy that she gave me her contact number and e-mail address just in case I have something to report to their office.

To report any malpractice or violation of existing provisions of the Pharmacy Law, Mrs. Gutierrez may be reached at (0919) 430-96-49 or at her e-mail address, tmgutierrez@bfad.gov.ph