After spending the next week investigating Marco’s death and the events surrounding it, and the crime in general, they were aghast at what they discovered. While the Philippines is an apparent paradise when you look at it from the outside, when you start digging deep, you find that it is a virtual cesspool, where crime is present on just about every street corner, and life has little, if any, meaning. I have included an article from National Geographic below. “In Philippine Drug War, Death Rituals Substitute for Justice” By Aurora Almendral.

As soon as Rick Medina saw the body slumped onto the curb on the evening news last November, he knew it was his 24-year-old son, Ericardo. The corpse — dumped on a quiet avenue in the Philippine capital of Manila, with his back to the TV cameras — could have been anyone. But a father knows.

The next morning his daughter Jhoy, 26, went to the morgue. Eight bodies were lined up on the floor, covered in sheets or in body bags. They all died the same way: their heads bound in packing tape, then stabbed multiple times with an ice pick to pierce their lungs. She refused to believe one of them was her brother until she unzipped the final body bag. Jhoy wanted to scream. Instead, she froze.

Ericardo’s body was dumped with a cardboard sign labeling him a drug user. According to his father, Ericardo never touched drugs; Jhoy says he’s dabbled in it. Either way, his killers meted out a final punishment without due process.

The plight of the Medina family has been repeated thousands of times in the Philippines, where Rodrigo Duterte rode a tide of populist frustration to the presidency last year by promising to end drug-related crime within six months. Since his inauguration on June 30, according to police data, at least 2,200 people have been killed by police, and another 4,000 by unknown assailants, perhaps mercenaries. The national murder rate spiked more than 51 percent between July and November. Duterte has extended his bloody anti-drug crusade indefinitely, vowing not to stop “until the last [drug] pusher on the streets is fully exterminated.”

As a growing number of families are left mourning the victims, death rituals are becoming an ever-more common part of life in Manila’s slums, where most of the deaths occur. The rituals are meant to console the family and deepen community ties, but as the death tolls mount, they have come to serve another purpose: They substitute for justice at a time when the killings are committed with staggering impunity.

Steeped in Death Rituals

For hundreds of years, Philippine culture has been steeped in death rituals, which outnumber ceremonies performed for births or marriages, says anthropologist Nestor Castro of the University of the Philippines, Diliman. They’re vestiges of pre-Hispanic Philippine culture combined with Catholicism spread by Spanish colonialists some 500 years ago.

Filipinos perform any number of rituals around death. A pot is thrown on the ground to break the cycle of death, and prevent more from following. The dead person’s favorite personal items — perhaps a snapback cap or pack of cigarettes — are tucked into the casket so he or she can have them in the afterlife. When it leaves the home, the casket is spun three times to confuse the spirit and stop him from returning. Coins are thrown along the path of the funeral procession to help pay for travels to the next life. Children are carried over the casket before burial to keep the ghost from haunting the living. Three days after a death, the spirit is supposed to visit a member of the family. The visit, called pakiramdam, lets the family know the state of the spirit, and takes on particular urgency when the death is sudden and violent.

A Family’s Grief

Rick Medina lives in a shack propped up among the tombs of the Pasay public cemetery. His daughter lives a few feet away over a stack of crypts. They make a modest living keeping graves clean and selling snacks to people visiting the dead. Most nights Ericardo slept sprawled out on a tomb under a coconut tree outside Jhoy’s home.

Before her brother died, Jhoy watched as a row of tombs filled up with the victims of the anti-drug campaign. “I saw the people crying, saying there was no justice,” she said. “I didn’t realize we would know that feeling, too.”

The day after Ericardo’s death, Rick, who is frail and still struggles to talk about what happened to his son, took a copy of his death certificate and stood at a busy avenue begging passing motorists for money. From the other cemetery-dwellers, Jhoy heard of a recent cremation, and she got permission to reuse the casket. They dressed Ericardo in a traditional Filipino garment, wrapped a rosary in his hands, and laid him out for the seven-day wake of Filipino folk Catholicism. Day and night Jhoy and their other siblings didn’t leave his side. Friends and family came to whisper their final goodbyes to Ericardo’s embalmed remains.

During his wake, Jhoy waited for the feeling that Ericardo’s ghost was with them. She posted on Facebook asking if anyone had had contact with Ericardo. No one had. “I was so annoyed with him,” she said, “it had been six days and he still hadn’t made himself felt.”

It wasn’t until the day before his funeral that she felt him at the convenience store near the intersection where he worked, the last place he was seen alive, climbing onto the back of someone’s motorcycle. That night, Ericardo visited Jhoy in a dream.

“He was smiling,” she said. When she consulted the local spiritista, an old woman who communes with the dead, the woman told her that Ericardo did not want the family to suffer, he wanted them to feel that he was still alive. It gave her comfort to know that Ericardo was not an angry spirit, lingering in this world, unable to accept his own death and demanding vengeance. “It was just like him,” Jhoy said, “He was always so easy-going.”

Still there’s one more dream Jhoy craves. “I want to dream about the night he was killed,” she said. “I want to stab the person who stabbed him. So I can finally defend him,” even if just in her dreams.

War on Drugs

A dream of vengeance may be the nearest thing to justice Jhoy and others can hope for. Few of the killers are ever caught.

Many of the people in slum areas heavily targeted by unknown assailants suspect that the police are involved and turn a blind eye to the killings. Investigations into individual murders are cursory, with the police collecting little more than the basic facts before the cases go cold. There are no visible efforts by the police to stop motorcycle-riding gunmen from sweeping through a neighborhood. In Manila, killings in one night regularly reach the double digits.

In remarks during the Philippine National Police Christmas party, Police Chief Ronald dela Rosa, accepts the police’s role in initiating the rising death toll, but denies police involvement in the thousands of murders committed by unknown assailants. Instead, he says vigilantes may be responsible.

“Indeed there have been killings, so forgive us,” dela Rosa said, in a mixture of Filipino and English. “We’re not saying we’re behind the [extrajudicial killings] you’re talking about. Many have joined the bandwagon of the war on drugs, but still they become victims because of our war on drugs. The blame is still on us because we initiated this war on drugs.”

Dela Rosa, however, continued to defend the more than 2000 people who have been killed in police anti-drug operations. Police claim the suspects were killed in self-defense, an assertion witnesses regularly dispute. For his part, Duterte has encouraged the police force to act aggressively. He promised to pardon policemen convicted of killing suspects while carrying out his anti-drug campaign, a statement human rights advocates argue encourages impunity in the police force. Duterte underscored his position when the Philippine National Bureau of Investigation accused policemen of killing a drug suspect as he lay defenseless inside a jail cell. “I will not allow these guys to go to prison, even if the NBI says it was murder,” Duterte said in December. “Whatever the police say, that’s the truth for me.”

A Child’s Death

Not far from Pasay cemetery, five-year-old Francis Mañosca lay in a white casket. A pair of chicks clucked on the Plexiglas fitted over his embalmed corpse. Chicks are an old Filipino tradition, meant to peck away at the conscience of his murderer, who shot Francis between the eyes as he slept. The intended target, his father, Domingo, 44, was also killed. His mother Elizabeth Navarro, 29, sat silently crumpled on the floor between their two caskets, nine months pregnant and cradling her toddler.

Maila Tumazaro, Domingo Mañosca’s sister-in-law, hopes that guilt will keep Francis’s killer up at night, but when asked if the family planned to pursue a case, she was resigned. “There’s no one for us to file a case against,” she said.

The boy’s death did not garner a public outcry; it received fleeting local media coverage. A recent survey found that while 94 percent of Filipinos disagree with the killings and believe drug suspects should remain alive, support for Duterte remains high, with 77 percent of Filipinos saying they were satisfied with his job performance.

The killings are focused in poor neighborhoods, among people who have the least clout.

In Caloocan, another slum district in northern Manila, the family of 35-year-old Rommel Silva Aquino brought his casket to Manila North Cemetery. Aquino was killed in a police operation twenty days earlier. The family dragged out the wake in order to gather the money to pay for his funeral. They raised 30,000 pesos, or about $600, by keeping part of the profits of gambling card games at his wake. By the time they buried him, his body had already begun to decompose, his left eye socket was stuffed with cotton to keep the rot from spreading. Still the money fell short. After an extended negotiation at the graveside, the gravediggers agreed to seal the crypt and attach the tombstone for free.

“We’ve buried so many people who are victims of Tokhang,” Barok Manahan, the gravedigger said, referring to the police’s most high-profile operation for the anti-drug campaign. “They have absolutely no money.”

In Navotas, a slum district around Manila’s port, the family of Joaquin Garbo, killed in an alleged case of mistaken identity, wept as they prepared to bury him. The children circled the casket. Coins were thrown to ease his path to the afterlife. However, less than a kilometer from Garbo’s wake, was a harsh reminder that the rituals bring more comfort than action: Another man splayed out on the asphalt in a pool of blood, the milling policemen casting long shadows in the morning light.

Back at the Pasay cemetery, Jhoy Medina whispers a greeting and presses her hand against the still-fresh cement of her brother’s grave.

“If all the families who have suffered a death speak out about everything that they’ve felt,” she said, “maybe it will reach Duterte.” She hopes that if he understands their pain, he might stop the killings. But in her heart she believes that the killings won’t stop until Duterte is no longer president.

On January 30, 2017, following a series of corruption scandals involving the police — the most egregious being the murder of a Korean businessman by policemen in national police headquarters under the guise of an anti-drug operation — General dela Rosa ordered the suspension of all anti-drug operations while the police go through what he called an “internal cleansing.”

While this is an admission of police wrongdoing, Duterte indicated that this will likely be a short reprieve. The same day, he reiterated his vow that the drug war would continue until his last day in office.

Transnational organised crime syndicates based in Southeast Asia are fueling the trafficking of people for both forced criminality and sexual exploitation in “scam farms” that have spread across the region.

There are estimated to be some 400 of these criminal enterprises in the Philippines alone. They are almost always operated clandestinely and illegally alongside licensed and legal online gaming operations.

The proliferation of online scam farms targeting victims across the world is a relatively new phenomenon that exploded during the COVID-19 pandemic.

The Philippines Presidential Anti-Organized Crime Commission (PAOCC) has raided and shut down dozens of the operations in recent years and is collaborating with the UN Office on Drugs and Crime (UNODC) to look at ways of working with other countries to disrupt and dismantle the scam farms in Southeast Asian countries, including Cambodia, Laos and Myanmar.

UNODC’s engagement in this area complements the work of the International Organization for Migration (IOM), whose analysis on trafficking in persons for forced criminality in Southeast Asia’s online scamming centres provides practitioners, policymakers and donors with actionable recommendations. IOM, in collaboration with government counterparts and other stakeholders, supports the implementation of rights-based victim identification and protection. In the Philippines, IOM provides protection and repatriation support to victims and promotes inter-agency and international cooperation to tackle this emerging trend.

UN News visited raided locations in, Manila and Bamban. We spoke to two people: Susan, a Filipina and Dylan* from Malaysia. Both were coerced into carrying out scams. UN News also met PAOCC’s Winston Casio.

Susan: My half-sister tricked me into leaving home and travelling to Myanmar where I was promised a marketing job in her company. It turned out to be a scam farm, and I was forced to work to pay off my sister’s debts as she had fled.

I developed a fake character, a rich young woman based in Brooklyn, New York, who owned property and businesses. The managers gave me images from an Instagram account to build the character and told me to contact divorced or lonely men in the US and get them to transfer money to me. This is what is called a “love scam”. In the pictures, my character is always shopping. But I could not even go outside. I was trapped inside the building.

We are given scripts to use in text conversations, and when they told me to improvise, I used a grammar app to check my English. If the client wants to meet you on a video call, they have models who play the role. The models are also trafficked.

Dylan: Most people do not choose to be there. You have to work up to 16 hours a day, especially as you have to contact clients across time zones. The managers told me to get them to invest in a fictitious oil deal in Dubai and then steal their money.

There are quotas for the amount of money you must scam. They set the target for me of $100,000 a month, and when I did not make that, I was beaten.

Winston Casio: We rescued around 680 people in the Bamban scam farm, but we think that a number of managers escaped after they were tipped off.

These are huge operations. People are not allowed to leave. They are held against their will and forced to commit scams and fraud. Women are trafficked as sex slaves, and the managers in one farm had what they called “the aquarium” where women were forcibly put on display and then chosen by the men to perform sex.

Every location is self-contained, and everything is provided. Of course, there are dormitories and cafeterias, but also a barber shop, medical clinic, massage spa, gambling room as well as a VIP karaoke bar for senior managers, where they could drink, sing and socialise in private rooms. 

Just a few metres down the hallway, we also found a torture room with handcuffs and bloodstains on the walls, where people were taken for brutal punishment when they did not meet their quotas.

Susan: I got close to scamming some clients, but felt bad about it so secretly warned them whilst telling my manager that they had blocked me. He got angry and beat me with a metal pipe. My injuries were too serious to be treated at the scam farm, so I was taken to a hospital by three guards but was unable to tell the doctors what had really happened to me. I still suffer the physical and emotional trauma.

Dylan: I didn’t make any salary, but started building up debt as I had to pay for food, which cost two to three times more at the scam farm than outside. I was freed after one month when the facility was raided.

Winston Casio: It’s sometimes difficult to know the difference between victims and complicit scammers. There are cases where people are taken against their will, but who after four to five days training, embrace the illegal activity and thrive and actually make money. The law wants to see this situation in black and white, but there are many grey areas.

It is an understatement to say that this situation is challenging, as the transnational organised criminal networks that run these facilities are always three or four steps ahead of us.

This is a regional problem which no one country can solve. This is organised crime. Susan will confirm the furniture and computer equipment is the same in facilities in Myanmar and the Philippines.

Law enforcement agencies across Southeast Asia need to collaborate and coordinate, and this is why UNODC is important. It can bring countries together and provide expertise, for example, in digital forensic investigations.

Susan: Towards the end, I was beaten 13 times in one day. I just prayed and prayed while they beat me. I was forced to call my parents and ask them to pay $7000 for my ransom, which was the cost of the hospital bill. They didn’t have the money, and I told them not to try to pay it. I said to my managers “just kill me.” They don’t care about people. They only care about money. However, in the end they realised I had no money and that I was of no use to them, so they just let me go. I made my way back through Thailand to the Philippines.

***

Susan now works for PAOCC in Manila, and Dylan has agreed to be a witness in possible forthcoming legal action and hopes eventually to return to his home in Malaysia.

*Not their real names

Secretive and ruthless, the traffickers controlling the kidney trade thrive on the desperation of the poor and the sick. Nancy Scheper-Hughes lays bare the ‘collateral damage’.

Men from Baseco, a slum in the port area of Manila, the Philippines, show their scars from kidney sales in a photograph from 1999.

The slide on the screen showed several skinny, dark Filipino men lined up, displaying their sacred wound, the kidney scar, long as a sabre slice across their convex torsos. More than 150 representatives of scientific and medical bodies from 78 countries stared solemnly at the photo during the Istanbul Summit of 2008, the defining moment in the global recognition of human trafficking for ‘fresh’ kidneys. ‘Is this why we began as transplant surgeons?’ one of the convenors, US surgeon Francis Delmonico, asked. ‘Are we comfortable with this? Is this fair? Do we want to participate in this?’

The man sitting next to me, a Hindu surgeon in white robes, reminiscent of Hippocrates, was moved. When I asked what he was thinking, he replied: ‘This is too late. Kidney selling is no longer a strange or exotic act. It is normal, everyday, and entrenched. We in the South can agree that it is a tragic turn of events, but the demand comes from outside.’

In the early 1980s a new form of human trafficking, a global trade in kidneys from living persons to supply the needs and demands of ‘transplant tourists’, emerged in the Middle East, Latin America and Asia. The first scientific report on the phenomenon, published in The Lancet in 1990, documented the transplant odysseys of 131 renal patients from three dialysis units in the United Arab Emirates and Oman. They travelled with their private doctors to Bombay (now Mumbai), India, where they were transplanted with kidneys from living ‘suppliers’ organized by local brokers trolling slums and shantytowns. The sellers were paid between $2,000 and $3,000 for a ‘spare’ organ. On return, these transplant tourists suffered an alarming rate of post-operative complications and mortalities resulting from mismatched organs, and infections including HIV and Hepatitis C. There was no data on, or discussion of, the possible adverse effects on the kidney sellers, who were still an invisible population of anonymous supplier bodies, similar to deceased donors.

In 1997, I co-founded Organs Watch, specifically to draw attention to the then invisible population of kidney ‘suppliers’. Today human trafficking for organs is a small, vibrant and extremely lucrative business that involves some 50 nations.

No cadavers wanted

In the summer of 2009 I received a phone call that unnerved me.

‘Are you the Organs Lady?’ a young man I’ll call Jim Deal* asked me with a slight tremor in his voice.

‘Perhaps,’ I replied. ‘How can I help you?’

‘I just found out that my kidneys are failing and my doctor wants me to start dialysis immediately.’

‘Yes?’

‘Well, I can’t attach myself to a machine three days a week. I’ve just started a new company and I can’t lose a minute. I need a kidney now. Where can I go to get one? I have the resources. Money is not an object.’

My suggestions to ask his relatives (which included several siblings) were rejected – they were all busy with their careers and families. Would he be willing to take the ‘Steve Jobs option’, registering in multiple transplant centres in different regions of the US, increasing the possibility that his number would be called – Bingo!

‘No cadavers,’ Jim said. It would have to be a kidney purchased from a living stranger. Could I recommend a surgeon or a broker who could help? Given his family genealogy, which included a grandparent from Iran, I told Jim that he might be in luck. Iran had the only legalized and regulated kidney selling programme, but it was reserved for Iranian citizens and diaspora.

‘I’m not going to go to Iran, if that’s what you are saying,’ Jim countered. ‘I want First World medicine.’

There was no use trying to convince Jim that Iran had ‘First World’ surgeons. Some weeks later he called to tell me that his family had found several local, willing kidney providers online through Craigslist. He chose the least expensive ‘option’: a kidney from 19-year-old community college student Ji-Hun*, an immigrant from South Korea who could not afford his tuition, books, room and board, and who feared deportation if he dropped out.

The deal was secured for $20,000. The night before the transplant, two very nervous Korean brothers met with Jim’s relatives in an upscale suburb of Los Angeles to count the kidney loot in crisp one hundred dollar bills. An armed guard oversaw the encounter. The seller requested half in advance. The family refused, but they agreed to hand over the money to the seller’s older brother as soon as both parties were under anaesthesia but before they knew the outcome of the organ transfer.

‘Kidney selling is no longer a strange or exotic act. It is normal, everyday, and entrenched’

By the time I arrived at the famous ‘hospital for the Hollywood stars’ in Beverly Hills, the surgery was over and Jim was out of the recovery room and surrounded by well-wishers. His private room was festive with flowers, gifts, smiles and prayers for Jim’s recovery. Nurses popped their heads in and out to see if everything was going well.

Nicolae, a father of three children, suffers from chronic hypertension. He fears he will not see them grow up.

Nancy Scheper-Hughes

It took some sleuthing to locate Ji-Hun, who was tucked away in a corner room several flights above the regular post-op recovery rooms. He was a delicate young man, weighing no more than 55 kilos. He was doubled over with pain, and blushed with shame when I introduced myself to him as an informal ‘kidney donor’ advocate. The nurses tittered anxiously when I presented my calling card with its Organs Watch logo. They told me that Ji-Hun would be released that same day, although he had not yet seen a doctor following his kidney removal. He was worried about returning to his one-room bedsitter apartment in a dodgy section of Los Angeles. Before leaving the hospital Ji-Hun gave me his cell-phone number.

A few days later Ji-Hun reported that he was still in bed, immobilized with pain, and unable to eat, urinate or defecate. His older brother, a surly young man who worked as a dish washer in a fast-food restaurant, was angry with him. He had no medical insurance, and the $20,000, which had been handed over to his brother in a public toilet on the surgical ward, was already all but gone after settling unpaid bills along with student tuition and remittances for their parents in Korea. After a few brief calls, Ji-Hun’s phone went dead.

Vladiumir, recruited at 18, died from post-surgical infection and kidney failure on return from botched surgery in Turkey.

Nancy Scheper-Hughes

Jim, anxious about disclosure, emigrated to another country and on last report was married and able to work. The head of the surgical staff of the complicit hospital refused to discuss the case, citing patient confidentiality. The consulting nephrologist who worked shifts at the private hospital contacted me to say that he had seen many other instances of bartered kidneys, but was loath to be a ‘whistleblower’.

While most illicit kidney transplants take place in the so-called developing world – India, Pakistan, Bangladesh, Egypt, the Philippines, and more recently Central Asia and Central America – future transactions are likely to resemble the above story. Facilitated by the internet, organ ‘suppliers’ will be drawn locally from the large pool of new immigrants, refugees and undocumented workers. The transplants will be arranged in private hospitals where the transactions are reported as altruistic, emotionally related donations.

Organized crime

That is the future. For now, transplant tours are more usual. They can bring together actors from as many as four or five different countries, with a buyer from one place, the brokers from two other countries, the mobile surgeons travelling from one nation to another where the kidney operations actually take place. In these instances, and the case of a private clinic in Kosovo is perhaps the best example (see ‘The Medicus affair’), the participants appear and disappear quickly, with the guilty parties, including the surgeons, taking with them any incriminating data. When the police finally arrive at the scene, they discover the bloody remains of a black-market clinic, with traces of forensic evidence, but the key players long since disappeared.

Viorel is furious because his kidney was removed under duress. Both he and Vladiumir were operated upon by the prolific Turkish outlaw surgeon Yusuf Sonmez.

Nancy Scheper-Hughes

Over the course of more than 17 years of dogged field research, my Organs Watch colleagues and I had realized that we were not dealing with a question of medical ethics. Rather, we had gained entry into the world of international organized crime. Following fieldwork in Turkey, Moldova, the US, Israel, Brazil, Argentina, the Philippines and South Africa, it became apparent that organ brokers were human traffickers involved in cut-throat deals that were enforced with violence, if needed. Many of the ‘kidney hunters’ who seek out new candidates in poor localities are former sellers, recruited by crime bosses.

The transplant and organ procurement traffic is far-flung, sophisticated and extremely lucrative. Although trafficking in human organs is illegal in almost every nation, the specifics of the laws differ, making prosecutions that can involve three or more nations a judicial nightmare. In some countries it is illegal to sell a kidney but not to purchase one. In others it is illegal to buy and sell within the country but not to buy and/or sell abroad.

Organ trafficking made its début as a much-contested add-on to the 2000 United Nations Palermo Protocol on Human Trafficking, which recognizes that even willing participants in underworld illicit kidney schemes can be counted as victims. Indeed, most are coerced by need, not physical threats or force. Some even pay significant amounts of money to be trafficked.

As it is covert behaviour, it is difficult to know with any degree of certainty how many people are actually trafficked for their kidneys, but a conservative estimate, based on original research by Organs Watch, is that at least 10,000 kidneys are sold each year. Human trafficking for organs is a relatively small and contained problem, one that could be dealt with efficiently with the political will to do so.

Complex co-ordination

Unlike other forms of trafficking that unite people from shady backgrounds, the organ trade involves those at the highest – or at least middle-class – levels of society: surgeons, doctors, laboratory technicians, travel agents, as well as criminals and outcasts from the lowest.

Unlike other forms of trafficking that unite people from shady backgrounds, the organ trade involves those at the highest levels of society, like surgeons.

Transplant professionals are reluctant to ‘name and shame’ those of their colleagues involved in the trade, thereby creating a screen that conceals and even protects the human traffickers who supply the surgeons. And because trafficking living donors for organs is a traffic in ‘goods’ (life-saving ‘fresh kidneys’) not traffic in ‘bads’ (drugs or guns) there is reluctance, even on the part of the justice system, to recognize the ‘collateral damage’ it inflicts on vulnerable bodies – and the harm to society and the profession of medicine itself.

Organ brokers are the linchpins of these criminal networks, which handle an onerous feat of logistics. They co-ordinate three key populations: (1) kidney patients willing to travel great distances and face considerable risk and insecurity; (2) kidney sellers recruited and trafficked from the urban slums and collapsed villages of the poor world; (3) outlaw surgeons willing to break the law and violate professional codes of ethics. Well-connected brokers have access to the necessary infrastructure such as hospitals, transplant centres and medical insurance companies, as well as to local kidney hunters, and brutal enforcers who make sure that ‘willing’ sellers actually get up on the operating table once they realize what the operation actually entails. They can count on both government indifference and police protection.

The complicit medical professionals perform expert teamwork – technicians in the blood and tissue laboratories, dual surgical teams working in tandem, nephrologists and post-operative nurses.

There are ‘transplant tour agencies’ that can organize travel, passports and visas.

In the Middle East and in the US, religious organizations, charitable trusts and patient advocacy groups are often fronts for such international networks.

Tactics of persuasion

Some brokers in Moldova used underhand tactics that had already been honed in recruiting naïve Moldovan women into sex work. They offered the opportunity of work abroad to unemployed youth, or household heads in debt or in need of cash to support sick spouses or children.

On arrival, the young men were kept in safe houses, had their passports confiscated, and were reduced to total dependency on the brokers (women were exceptions, see ‘My heart weeps inside me’). A few days later, the brokers would break the news that it was not painting or ironing trousers that was needed from the illegal ‘guest workers’ but their kidneys. Those who refused outright were threatened or beaten. One young man, Vladimir*, explained the stark ‘choice’ that faced him in Istanbul: ‘If I hadn’t given up my kidney to that dog of a surgeon, my body would be floating somewhere in the Bosphorus Strait.’

Nancy Scheper-Hughes with Alberty Alfonso da Silva, who was recruited from a Brazilian slum to provide an organ to an American woman from New York City.

Nancy Scheper-Hughes

Most brokers, however, offer themselves as altruistic intermediaries promising a better life to donors and recipients. The commonest scenario is of vulnerable individuals easily recruited and convinced to participate in the trade. The pressures are subtle; the coercion hidden.

In Baseco, a dockside slum and notorious ‘kidney-ville’ in Manila, brokers recruit young men (and a small number of women) who are distant kin, related by blood or marriage or informal fosterage.

Ray Arcella, a famous broker from the area, could often be seen with his arm slung loosely around the shoulders of his young recruits, some of whom referred to Ray as their uncle or their godfather. Ray’s less than avuncular advice to his many ‘cousins’ and ‘nephews’ was that kidney selling was the best way of helping out one’s family – since mechanized containers had rendered dock work, once Baseco’s main source of employment, obsolete.

Brokers will hire local kidney hunters – often former sellers – to do the dirty work of recruiting their neighbours and extended family members. In these seemingly consensual transactions, controlling behaviour, fraud and manipulation are well hidden.

The sellers

Kidney sellers are predictably poor and vulnerable: the displaced, the disgraced or the dispossessed. They are the debtors, ex-prisoners or mental patients, the stranded Eastern European peasants, the Turkish junk dealers, Palestinian refugees, runaway soldiers from Iraq and Afghanistan, Afro-Brazilians from the favelas and slums of northeast Brazil, and Andean Indians.

Most enter willingly into a ‘transaction’ in which they agree to the terms, which are verbal, but only realize later how they have been deceived, defrauded or cheated. Few are informed enough to give consent. They do not under­stand the seriousness of the surgery, the conditions under which they will be detained before and after the operation, or what they are likely to face with respect to the discomfort or immediate inability to resume their normally physically demanding jobs.

Some in the slums of Manila, as in the slums of Brazil, were underage teens who were counselled by brokers to fabricate names and add a few years to their age to make them ‘acceptable’ to the surgeons. Many of those trafficked deny the ‘sale’, saying that what they were paid was too small to constitute a sale for something as ‘priceless’ as a non-renewable body part. In these unconventional transactions, the boundaries between gift, commodity and theft are decidedly blurred.

‘If I hadn’t given up my kidney to that dog of a surgeon, my body would be floating some­where in the sea’

Male kidney sellers tend to minimize the trauma they experienced to protect their pride. But their reserve often crumbles under gentle but probing questioning of how their lives have been affected. Some male sellers in Moldova denied that they were ‘trafficked’ because the language of trafficking made them sound like female ‘prostitutes’, a stigma they could not live with. Others become obsessed with the kidney sale and attribute all the misfortunes that occurred before or since to that one act of ‘stupidity’.

Among a group of 40 Moldovan kidney sellers we followed from 2001 to 2009, there were deaths from suicide, failure of the remaining kidney, and even from battering by angry villagers who felt that the sellers had disgraced their village. Some were banished from their homes and disappeared.

The brokers

The brokers, who may be transplant surgeons, or organized crime figures, co-ordinate transplant tour junkets that bring together relatively affluent kidney patients from Japan, Italy, Israel, Canada, Taiwan, the United States and Saudi Arabia with the impoverished sellers of healthy organs.

Transplant brokers and organ traffickers are ever more sophisticated, changing their modus operandi, realizing that their engage­ments with public and private hospitals in foreign locations are severely time-limited. Israeli brokers, for example, recently confided that they either have to pay to gain access to deceased donor pools in Russia or Latin America (Colombia, Peru and Panama in particular), or they have to set up new temporary sites and locations (Cyprus, Azerbaijan and Costa Rica) for facilitating illicit transplants quickly and for a short period of time, already anticipating police, government and/or international interventions. They are always prepared to move quickly to new locations where they have established links to clandestine transplant units, some of them no more sophisticated than a walk-in medical clinic or a rented ward in a public hospital.

The buyers

Transplant tourists are a varied but determined and risk-taking population, willing to travel to ‘parts unknown’ to purchase a stranger’s kidney. They pay for a package deal; they do not know – nor do they want to know – the exact price that will be paid to the person who will deliver their fresh kidney. They do want to know whether the purchased organ will come from a healthy person, an educated person, a person of acceptable race and ethnicity. (Ethnicity matters to them because it might signify a ‘closer’ or a ‘better’ match.) They want a kidney that has not had to work hard for a living, and they want their surgeon to make sure they get access to the seller’s healthiest kidney.

There is a preference for male donors between the ages of 20-30 years. Transplant tourists are asked to pay a great deal of money – normally somewhere between $100,000 and $180,000 – of which the sellers receive a mere fraction.

Some buyers refuse kidneys from women, expressing a kind of old-fashioned chivalry, others an old-fashioned sexism. Men are by far the greatest purchasers.

In 2010, I was paid a visit by a sixty-something man from southern California who insisted on setting me straight on certain matters. David* wanted me to know what it felt like to be in his shoes. ‘Dialysis is like a living death,’ he said. ‘You get cataracts, problems in your gut, you can hardly eat. You lose your libido, you lose the ability to relieve yourself until finally you stop urinating altogether. You lose your energy, you become anaemic, and you are cold all the time. You get deeply depressed.’

He was put into contact with a surgeon and his broker in Tel Aviv, who required him to settle the entire package – $150,000 – in advance for a transplant at an undisclosed location. Putting his fate in their hands, David travelled to Israel, and following cursory medical exams, he flew with the Israeli surgeon and his broker on to Istanbul where they picked up a second surgeon. ‘One takes out and the other puts in,’ was the simple explanation. Only in Istanbul was David told that his transplant would take place in Kosovo, a country he knew nothing about. The day before flying there, the broker announced that police had broken into the Medicus Clinic in Pristina, and that the planned transplant there was now unavailable. However, he was willing to offer, at a cut-price rate, another option that had opened up in Baku, Azerbaijan. And that is where David finally received his kidney, from a seller from Central Asia.

The new generation

Following the Istanbul Summit in 2008, the Declaration of Istanbul Custodian Group was instituted. For the last eight years, it has been working closely with The Transplantation Society, the World Health Organization (WHO), and a vast network of transplant professionals to negotiate with public health and other government officials to create new laws to encourage deceased donor programmes, promote transplant self-sufficiency within nations, and discourage transplant tourism. It has also exerted pressure on hospitals to stop sheltering the outlier surgeons who perform transplants involving foreign patients and trafficked kidney suppliers.

But illicit transplant trafficking schemes remain robust, exceedingly mobile, resilient and generally one step ahead of the game.

The new generation of organ traffickers is also more ruthless. During the Beijing Olympics, brokers had their supply cut off after foreign access to organs harvested from executed Chinese prisoners was shut down. Undeterred, they began to pursue transplants from living donors, some of them trafficked Vietnamese, others naïve villagers in parts of China where blood-selling programmes had groomed people to accept kidney selling as another possibility.

The sites of illicit transplants have expanded within Asia, the Middle East, Central Asia, Eastern Europe, Central and Latin America, Europe and the United States. As for the recruitment of kidney sellers, they can be found in almost any nation. One crisis after another has supplied the market with countless political and economic refugees who fall like ripe, low-hanging fruit into the hands of the human traffickers.

Prosecutions are difficult. In most instances a few culprits, usually lower-ranking brokers and kidney sellers, are convicted. The surgeons, without whom no organ trafficking crimes can be facilitated, and the hospital administrators often escape, pleading ignorance.

The famous Netcare case in Durban, South Africa, is a case in point. A total of 109 illicit transplants were performed at Saint Augustine’s Hospital, including five in which the donors were minors. A police sting resulted in several plea bargains from various brokers and their accomplices. Netcare, the largest medical corporation in South Africa, pleaded guilty to having facilitated the transplants. The immediate result was the plummeting of Netcare stocks.

The four surgeons and two transplant co-ordinators who were indicted held fast to their not-guilty plea. Their defence was that they had been deceived by the company and its lawyers, who had stated these international surgeries were legal. In December 2012, they were given a permanent stay of prosecution and the state was ordered to pay their legal costs. It is fair to state that rogue transplant surgeons operate with considerable immunity. This is unfortunate because they constitute the primary link in the transplant-trafficking business.

A victimless crime?

Because human trafficking for organs is seen to benefit some very sick people at the expense of other, less visible or dispensable people, some prosecutors and judges have treated it as a victimless crime.

When New Jersey federal agents caught Levy Izhak Rosenbaum, a hyperactive inter­national kidney trafficker who had sold transplant packages for upwards of $180,000, the FBI had no idea what a ‘kidney salesman’ was. The prosecutors could not believe that prestigious US hospitals and surgeons had been complicit with the scheme, or that the trafficked sellers had been deceived and at times coerced. The federal case ended in a plea bargain in 2011 in which Rosenbaum admitted guilt for just three incidents of brokering kidneys for payment, although he acknowledged having been in the business for over a decade.

At the sentencing in July 2012, the judge was impressed by the powerful show of support from the transplant patients who arrived to praise the trafficker and beg that he be shown mercy. The one kidney-selling victim, Elhan Quick, presented as a surprise witness by the prosecution, was a young black Israeli, who had been recruited to travel to a hospital in Minnesota to sell his kidney to a 70-year-old man from Brooklyn. Although Mr Cohen had 11 adult children, not one was disposed to donate a life-saving organ to their father. They were, however, willing to pay $20,000 to a stranger.

Transplant tourists are a varied but determined and risk-taking population, willing to travel to ‘parts unknown’ to purchase a stranger’s kidney

Quick testified that he agreed to the donation because he was unemployed at the time, alienated from his community and hoped to do a meritorious act that would improve his social standing. On arrival at the transplant unit, however, he had misgivings and asked his ‘minder’, Ito, the Israeli enforcer for the trafficking network, if he could get out of the deal as he had changed his mind. These were the last words he uttered before going under anaesthesia.

His testimony had no impact. The judge concluded that it was a sorry case. She hated to send Rosenbaum to a low-security prison in New Jersey for two-and-a-half years as she was convinced that deep down he was a ‘good man’. She argued that Elhan Quick had not been defrauded; he was paid what he was promised. ‘Everyone,’ she said, ‘got something out of this deal.’

Convicted brokers and their kidney hunters are easily replaced by other criminals – the rewards of their crimes ensure that. Prosecuting transplant professionals, on the other hand, would definitely interrupt the networks. Professional sanctions – such as loss of licence to practice – could be very effective. Outlaw surgeons and their colleagues co-operate within a code of silence equal to that of the Vatican. International bodies like the UN and the EU need to take concerted action on the legal framework in order to prosecute these international crimes.

Prosecutors look kindly on kidney buyers because they are sick and looking to save their lives. But buyers have no qualms about taking a kidney from deprived persons without any medical insurance, any future, and sometimes no home. They have to be made accountable.

Until we can revolutionize the practice of transplantation, a case needs to be made for a more modest medicine that realizes our lives are not limitless. This is a difficult message to convey when transplant patient advocacy groups and religious organizations have sprung up demanding unobstructed access to transplants and to the life-saving ‘spare’ organs of ‘the other’, as if this were a moral crusade.

The kidney is the blood diamond of our times. The organ trade is one of the more egregious examples of late capitalism where poor bodies are on the market in the service of rich bodies.

Nancy Scheper-Hughes is Professor of Medical Anthropology at the University of California, Berkeley, and an activist in many social movements. Her classic 1993 study Death without Weeping: the Violence of Everyday Life in Brazil was the basis, 20 years ago, for an edition of New Internationalist.
* Names marked by an asterisk are pseudonyms.

PHILIPPINES: Harvesting the body parts of the poor is sinful exploitation

Subject: News – Reflections from PREDA and Fr. Shay Cullen, Philippines #

Harvesting the body parts of the poor is sinful exploitation (Fr. Shay’s columns are published in The Universe, The Voice, Local News and other magazines in the UK & Ireland, Sunday Examiner in HK, The Manila Times, Philnews USA and Worldwide on Internet and Web sites,
Archives: www.preda.org – Copy free with permission)

On almost every corner in a Philippine town and many developing countries you will see a shop of salvation, economic salvation for the poor – the pawnshop. Pawning their last precious possession for a pittance is a sign of hard times, grinding poverty and even utter desperation for the wretched of the earth, the dwellers of the slums.

When they have pawned everything and possess nothing and face another crisis there is, no way out, no hope, no handout. That’s when they are vulnerable to the ultimate exploitation – forced by hunger to sell their body organs. The trafficking of human organs is one of the fastest growing illicit trades in the Philippines.

A recent study made by the University of the Philippines (UP) revealed that an estimated 3,000 people in one slum area of Metro Manila alone sold their kidney for P 70,000 to P 120,000 (US$ 1,440 to $ 2,469). One poor man was cheated and was paid only a fraction of what was promised and went to the police. His complaint led to the arrest last December 2006 of a middleman that was arranging to buy the organs of the poor. Some major hospitals, the National Kidney Institute and doctors have agreed to co-operate in an investigation conducted by the National Bureau of Investigation (NBI).

President Gloria Macapagal-Arroyo ordered the Secretary of Health Waldo Duque to stop the illegal trade after The Manila Times ran a banner story on the scandal a few weeks ago. This came shortly after an Undersecretary of Health caused an avalanche of condemnation when he said that health tourism was the industry of the future and that foreigners ought to pay at least US$ 3000 to $ 5000 for a kidney.
Doctor Gene Alzona Nisperos Secretary General of the Philippine organization Health Alliance for Democracy was quoted as saying that the statement was “morally wrong and insensitive.”

Human organ trafficking is illegal in the Philippines. The anti-trafficking of persons act R.A. 9208 makes it crime to arrange the sale or removal of a person’s organ by abduction, deceit, fraud or force of any kind. This aspect of the law underlines the fears and allegations that children are being abducted and either trafficked into the sex industry as slaves or are being harvested for their body organs. Children’s rights advocates claim that foreign led gangs are behind the trafficking supplying children to the sex and health tourists flocking to the Philippines.

However the voluntary donation of an organ is legal and is considered an act of sacrifice. The medical profession has set up a fledgling Philippine Organ Donation Programme that encourages the selfless giving of organs to patients in danger of death.

Needy Filipinos, not foreigners ought to be the priority for available donated organs. The poor cannot afford the costly operation anyway. The availability and willingness of the poor to sell their organs is indicative of the depth of poverty. They sell them because they have nothing else to sell to survive. Many are so weak and malnourished can die within months of the removal unless they get continual medical care which devours any payment they get for the kidney. Critics say it is insidious that the rich, having 70% of the wealth of the nation now go so far as to harvest the bodies of poor to prolong their own pampered lives. This is even more objectionable when their diseases are brought on at times by sumptuous over eating or luxurious lifestyles. The death penalty is widely condemned in China and even more so the selling of body organs of executed criminals. Although authorities deny it critics say prisoners are even pre-screened and their blood type matched with a recipient of their organs. Their families get part of the payment. Their executions are scheduled to coincide with the operation of the patient.

The trafficking of human organs no matter where it happens must stop.

One thing is certain: the voluntary donation of organs must be allowed and encouraged yet with absolute control and screening.

Hospitals and doctors must be held responsible and a strict monitoring has to be in place. The rights and dignity of donor and recipient must be safeguarded at all costs.

What’s going on with the Philippines kidnapping and organ harvesting?

Today I saw this post (link below) about how young people are being kidnapped and/or raped and murdered for their organs in the Philippines. Is this something happening for real?

Answer: This started a week or so ago with the disappearance of 8 young men/women in Quezon City. Social media was apparently flooded with rumors of kidnappings and abductions.

QCPD states that there are no “confirmed” cases of kidnapping in Quezon (with one in Pasay city), ruling the disappearances mentioned above “not motivated by kidnapping”. While rumors and speculation say as many as 100 people have been kidnapped.

As for the organ harvesting bit, Philippines used to be a hot spot for global organ trafficking until they put out more stringent laws preventing it. The “used to be” bit has been contested of course; but official reports state that most kidnapping are related to forced labor and prostitution.

While there are kidnappings indeed happening, the number is exaggerated. Ever since the alleged disappearance of those people, rumors about more kidnappings spread very quickly in social media, especially in Facebook. However, most of these are fake. One example that is spreading on social media is a post that states to be wary of white vans, and to lookout for a white van with a license plate of XMM-507 and a green van with VXM-351. A simple search on Google confirms that this is fake and even dated last 2012. Another rumor is that there’s a kidnapping syndicate for internal organs and there are victims found with no internal organs and a large amount of money found inside the body. Obviously, this is fake. This rumor also started in 2015.

Answer: it’s easy for people to go missing in these areas, so people get their organs harvested/go missing.

If the same thing is happening in China (which it absolutely is) then you can get your ass it’s happening in Philippines as well.

Organ harvesting happens everywhere it’s scary. Even the US is involved with it if you look at DynCorp for example. There’s apparently a huge market for it.

A Suitable Donor: Harvesting Kidneys in the Philippines

1. Along the coast of Manila Bay in the Philippines, behind the grand Manila Hotel, there is a slum district called Baseco. Hidden by towering container yards and cargo ships, this shantytown had been virtually unknown until a few years ago when a television report broadcast nationwide put a red pin on the map of Manila.

Describing it as “a place where the people of damned souls (mga halang ang kaluluwa) sell their kidneys to survive,” Baseco brought to public attention the scandal of what is essentially a human organ farm.

This vote-rich village—where local and national politicians occasionally paid visits (and often made fantastic promises)—has been quietly providing fresh and healthy organs for moneyed foreign and local patients. Recipients have come from the Middle East, North America, Hong Kong, Japan, Korea, and most recently, Israel.

Originally the name of a shipping company where most of the men had worked as part-time stevedores, repairmen, and laborers, Baseco is a community of some twenty thousand people living literally on the margins of the sea and society.

2. There is no sign that leads to Baseco. Why should there be? Why would the Manila government waste its resources in drawing attention to a spot better hidden than seen? Nor is there any jeepney or bus on an officially sanctioned route to this place. Indeed, there is no single means of transport that says: “to Baseco” or “Baseco Express.” Baseco, it seems, simply does not exist. For the twenty years I have lived in Manila, I had not heard of Baseco. When I searched for it in December 2000, it took me two days to find it. It was only a thirty-minute drive from my parents’ residence!

3. He is walking on the narrow breakwater under the midday sun. Fire had just ravaged and reduced to coal and ashes a large part of the slums. Periodic fire often broke out here and many believe they had been deliberate and aimed at clearing the area of slum dwellers. Fire, occasionally, has been an absolute tool that the authorities employ when reason and force became inutile. The ruins are still smoldering and many residents are trying to salvage any piece of junk they could use to assemble a mosaic-like dwelling.

Leo is walking on the breakwater half-naked, wearing only a pair of loose basketball short pants. He has wrapped his head with a white towel. At a distance, he looks like just another skinny and undernourished young man living in the slums. But on closer look, after my guide had pointed it out, he bears the trademark of an operado—the foot-long, centipede-like scar on his left side. He had “donated” a healthy kidney! He wears his cut like a badge of honor or a brand of manhood. He was never ashamed of it nor even tried to make it less conspicuous. In fact, he is proud of it. He looks tough and confident.

4. He had “donated” his kidney on 8 June 1996. He was eighteen years old. His recipient was a Japanese man in his mid-twenties. His name, as far as he could remember, was Kusunori. And in gratitude for Leo’s heart of gold, Kusunori had handed him directly peso bills amounting to a hundred thousand pesos. The transplant operation had taken place at the world-class and elite St. Luke’s Hospital in Quezon City.

Leo’s education went as far as elementary school. He had no knowledge at all about organ transplant, organ donation, and much less about organ harvest. But of course, now that he has only one kidney, he knows a little better. Experience, after all, is the best teacher.

5. In addition, experience has taught him that if ever God would bless him with one more kidney, he would never ever part with it again. Not for any religious or ethical reasons, but for the simple and naked fact that to function as a normal human being, we need two kidneys. Now, he is only thirty-three but he already looks forty-three years old! He is toothless and his left eye is always red. He is skinny and every morning at dawn, especially when it is cold, he feels a stabbing pain in his abdomen. He is supposed to be in the prime of his life, but now he tires easily, just like an old castrated water buffalo. He used to work in the docks. Now, he can only do light errands for a sari-sari store.

6. Leo has lived in Baseco for over twenty years. His family came here when he was eleven. He is the eldest of three children. His father, from the province of Pampanga in central Luzon, was a junk collector and an itinerant vegetable and fruit vendor; his mother, Teresita, from Imelda Marcos’s city of Tacloban in the Visayas, was a laundrywoman. During their early years as squatters, Leo helped his mother do the laundry. His father eventually left them to live with another family. His two brothers sold newspapers and cigarettes in the streets of Divisoria in Manila.

Baseco was still an emerging squatter colony when Leo’s family decided to try their fate in this hidden edge of the city. He and his mother had struggled hard to erect the posts of a hut. Most of the materials were fashioned from bric-a-brac dregs from the city. They roamed the city and sifted garbage to collect materials. His two brothers were left in the streets of Tondo, selling tabloids and Marlboro. His father had the habit of appearing and disappearing like an urban guerilla. At a young age, Leo was already acting as the father to his younger brothers and partner to his mother. He never had a chance to give his affection to a girl; he was forced to take family responsibility at a young age.

7. One day in 1982, a tall, slim Japanese man in his forties known only as Fushimi came to Baseco with his teenage Filipino girlfriend. Fushimi’s young lover, who is from the Visayas like Teresita, had several relatives in Baseco. She introduced her cousins to Fushimi, who then asked her cousins if they would like to volunteer for blood tests. He promised three hundred pesos a day plus transportation expense for each volunteer. Several men instantly agreed. Three hundred pesos, after all, is not a bad idea for generally unemployed men. The blood tests remained blood tests. They did not lead to any further medical procedures.

In 1984, Fushimi came to Baseco again. This time, he was known as Dr. Fushimi, the Japanese doctor. He came with his girlfriend again. This time, a new person joined them. His nickname was Bakla, meaning “homosexual.” He was from the neighboring slum of Balut, Tondo. Fushimi gave Bakla the job of recruiting potential “kidney donors.” Bakla started to recruit in Baseco. Immediately, he found ten able-bodied men. One of them was James.

According to James who is forty-nine years old, Bakla brought the ten of them (now known locally as the Magic Ten) to a hospital in Pasay City. There, they met Fushimi and his girlfriend. The Magic Ten were subjected to thorough medical examinations: blood, urine, stool tests, ECG, CAT, and others. For a week, James and his fellow “hopefuls” were taken to different hospitals in Metro Manila for more tests. Each day, each of them was given a hundred pesos, exclusive of meals and transport expenses. Fushimi had paid all the medical fees.

“Nobody among us knew,” James said, “what the real objects of the tests were until the final day. Those who had passed all the tests satisfactorily were offered one hundred fifty thousand pesos (about US$7,000) for a kidney!”

James, who said he passed all the tests “with flying colors,” backed out at the last moment. A former soldier with a good build at 1.78 meters tall, he could have been an ideal specimen.

“I wanted the one hundred fifty thousand pesos,” he said, “but my mother refused it. ‘We are poor,’ my mother told me, ‘but I don’t want you to exchange for money what God has given you.’” James’s Christian belief prevented him from selling his kidney. At forty-nine, James, a carpenter, is still strong and fit and youthful. In fact, he looks a lot younger than many of the operados.

8. James introduced me to Dalmacio, now fifty years old, another member of The Magic Ten. Dalmacio, who once lived in Baseco, is now living in another slum district in Quezon City. James and Dalmacio used to be neighbors until a furious typhoon devastated their dwellings along the breakwater. Dalmacio now lives with his children, stepchildren, and grandchildren.

Dalmacio has had several mild strokes, now stammers, and speaks in a childlike manner. Unlike James, Dalmacio did not pass the medical examinations. Though he wanted very much to sell his kidney, he was not considered a suitable donor. Despite this failure as a “volunteer donor,” he had discovered a scheme to make money. Like Bakla, be became a recruiter, eventually becoming Fushimi’s right-hand man in Baseco. From 1989 to 1999, Dalmacio confessed, he had recruited more than a hundred kidney donors for Fushimi. Most of the recipients of these kidneys, Dalmacio told me, were Japanese, Arabians, Koreans, and rich Filipino-Chinese.

Dalmacio’s first recruits were members of his immediate family. He started with his sons-in-law. Next, his stepsons (children of his wife by her two earlier husbands). Later he expanded to his relatives, neighbors, and friends. It was a double-edged nepotism—immediate family members were the first to benefit and the first to suffer.

The first recipient, he remembered well, was a Japanese patient named Mr. Kubota. The organ came from his son-in-law. The operation in 1989 was conducted at the University of Santo Tomas (UST) Hospital. With his first client, Dalmacio had received twelve thousand pesos from Fushimi. “It was the biggest amount I had ever received in a single day,” he said.

And how did he spend his first “commission”?

“I love good clothes,” he said. “When I got the money, immediately I bought some clothes.”

Wearing his new clothes, Dalmacio and his family went to UST Hospital to monitor the progress of the transplantation. The operation was a success.

A day after Mr. Kubota received the new kidney; he raised his hands and said: “I’m already strong, I’m already strong.”

“We were all very happy,” Dalmacio said. “Mr. Kubota was like a member of our family.” They cheered him, told him stories, and cracked jokes with him.

But on the third day after the operation, Mr. Kubota suddenly became weak. And toward evening, he became unconscious. The following day, Mr. Kubota no longer opened his eyes, nor was he able to speak—he died. On the fifth day, Dalmacio and his family kept vigil at Mr. Kubota’s wake. They waited for his family to arrive from Japan.

The recipient of Dalmacio’s first recruit did not survive but his enthusiasm to find more “donors” did not die. For a decade, he scoured every small corner of Baseco and delivered more than a hundred “kidney donors” to Fushimi.

“Almost every month,” he said, “I have a donor. And after every transplant operation, we would have a good time. Fushimi loves young girls. I like brandy and Scotch. Now, I’m broke. No more good times.”

Penniless and partly paralyzed by strokes, he cannot work, nor does he have any savings. He depends on the mercy of his children and stepchildren.

“He is cursed,” James told me. “God had punished him for selling the organs of his fellow men.”

In 2007, he was laid to his final resting place in Bataan where he had moved with his own daughter.

9. Leo’s shanty stands by the sea. It is within spitting distance from the hut of Dalmacio who is better known as “Agent Baboy.” Baboy is always dressed like a politician, his hair heavily pomaded, and a Marlboro perpetually between his thumb and index finger. Every day he could be seen walking between the tiny gaps of houses in search of a potential “donor.” Moreover, there was never a dire shortage of more-than-willing and able-bodied young men wanting “to help” moneyed patients near death or with end-stage renal problems.

Baboy is a sweet talker. He wears his money on his sleeve; his look is money; he smells of money—and he displays it with outrageous flagrancy. He is always wearing brand-new shirts, double gold chains around his neck, and leather shoes. In the quicksand of squalor, shit, and filthy poverty in Baseco, Baboy stands out like a mushroom on cow dung.

Baboy promised Leo an amount if he agreed to “donate” his kidney. It is a figure that to Leo sounded like winning the lottery jackpot. Leo did not think twice. After all, he was not a newbie in selling parts of his body. He “donates” (i.e., sells) his blood.

During this time, Leo’s mother, Teresita, had been going in and out of the Philippine General Hospital—the biggest public hospital in Manila, if not in the country. Her face was bloated and her entire body was swollen. Her neighbors believed she was a victim of witchcraft and there was no use taking her to a hospital. But Leo loved his mother dearly. With the little cash he was earning as a dockworker, he was giving almost everything to her. But each visit to the hospital was a financial struggle. Although the basic consultation fee was free, Teresita could not afford the foreign-brand medicine prescribed. Each treatment was at most consultative in nature. She could not afford a continuous or comprehensive treatment. On her last confinement, her doctor advised her to be admitted lest it would be too late. Leo made the biggest decision in his life—to “donate” his kidney for his mother’s sake.

Nobody in the family knew about his decision. Not his brothers, not his mother. He did not want to aggravate his mother’s suffering. Only he and Baboy knew about the plan.

10. Leo had already “donated” blood several times before, more than a gallon in all. At a blood bank in Santa Cruz, Manila, he and his fellow stevedores had periodically made trips for “blood donation.” Every time he and his friends were out of cash, they would take a trip to a blood bank somewhere in the city. They were like occasional prostitutes; they would do this once every three months just for kicks. So when Baboy asked what his blood type was, he confidently replied: “O.” An “honorarium” of five hundred pesos (five hundred yen) would be given to him for every five hundred cubic centimeters (cc) of blood extracted from him. He had “donated” his blood ten times. After each session, he would always feel weak and dizzy. He would always eat lots of vegetable tops and balut (salted duck’s embryo) to expedite his recovery.

He was not a newbie to making a “blood donation” but he was shocked to know that a kidney too could be “donated.”

11. He wore his treasured pair of imitation Levi’s that he had custom-tailored in an underground shop in Quiapo, Manila. He topped it with an equally brand-new white T-shirt. He had his hair cut like a skinhead. He looked like a skinny high school kid just starting military training.

Instead of going to school, Baboy took him to St. Luke’s Hospital in Quezon City, Metro Manila to begin his medical philanthropy and missionary work. Agent Baboy delivered an O “donor” to the exclusive hospital. Leo was shocked at the grandness of the facility.

“Napakalaki!” he exclaimed, amazed at the size. “Ang ganda. Aircon lahat ng kuwarto.” He was all praises for the hospital’s air-conditioned rooms and impressive looks.

“Are you sure you really want to ‘donate’ your kidney?” Baboy confirmed one more time as they entered the hospital compound. “There’s no turning back, okay?”

“Lalaki akong kausap mo,” Leo invoked his masculinity as a guarantee of trust. “You are talking to a man.”

They entered through the main entrance of the hospital. Leo was a little a nervous. He had never been in a hospital of the rich and powerful before. Baboy led him to the basement and knocked at a door with a sign that read: Renal Unit. A tall, sensual lady in miniskirt opened it. She was Lady M, the transplant doctor’s secretary. Dr. R, the surgeon—described Leo—was a short, dark, elderly lady with short, black hair; she had a round face and she wore glasses. Upon seeing Leo with Baboy, she fired:“Ano’ng type ka?” She asked Leo’s blood type. “Are you O?”

She did not bother to greet or ask her “donor’s” name. Of course, she was more interested in blood type and kidney. Leo’s name was only incidental. A name, it seemed, was only something you used to distinguish a thing or person from another, a tool to aid the memory or a tool against forgetting.

Even before Leo could respond to the honorable doctor’s interrogation, she had fired another question: “You sometimes sell your blood, don’t you?”

“Opo,” was all he could meekly say to confirm the allegation.

He was surprised to hear the doctor use the word “sell” instead of “donate.” He had wanted to believe, despite the cash he was promised, that what he was doing was an act of altruism and a real help to someone very ill. But the old lady surgeon extinguished that illusion of philanthropy with one swish of her bladed tongue.

“How often do you sell?”

“Every three months, Doctor,” he said honestly.

Baboy must have filled her in about Leo’s visits to blood banks.

On the other hand, as a veteran doctor, she could tell a person’s state of health at a glance.

At the reception, about a dozen patients were waiting. Most of them, Leo thought, were Chinese-Filipinos. Most of them were very pale, their faces deprived of cheerfulness, and there was a lack of luster in their eyes.

Lady M took a sample of Leo’s blood. She extracted 5 cc. The sight of the syringe did not scare him at all. “It felt just like an ant’s bite,” he said. After the first test, Leo and Baboy had lunch at the cafeteria. Leo had a soup dish of vegetables and Baboy had pork adobo. Before they left, Lady M pulled Baboy to one side.

“Find me a Type B,” she whispered. “This is urgent.” Baboy nodded several times. Lady M pulled an envelope from her drawer and counted eight hundred pesos on Baboy’s palms. Baboy then gave Leo three hundred pesos.

12. Three days later, Baboy and Leo returned to St. Luke’s Hospital. Leo was subjected to more blood tests. He was examined for Hepatitis A and B. He had chest X-rays, ECGs (electrocardiography), and MRIs (Magnetic Resonance Imaging). After the check-up, Baboy gave him a share of three hundred pesos; again, he pocketed the five hundred pesos. Though his share was a pittance, Leo was content. It was much easier than going to Santa Cruz and “donating” blood. For every test he was subjected to, he would always ask himself: “Can I pass? Can I pass?” He was worried that if he did not pass, his mother would not be able to get medical treatment.

That night, after a battery of tests was administered to him, he wanted to test his strength. He wanted to prove he was healthy and strong. Therefore, he joined a gang of nightshift stevedores. From sunset to sunrise, they unloaded steel bars on the docks. He earned a thousand pesos. At noon, Leo and his fellow stevedores started drinking gin. Baboy joined in the “early celebration.” They drank to their last penny and to the last drop of their glasses until the last seconds of the day. They drank to their hearts’ content.

“If you pass all the tests,” Baboy reminded his recruit, “never forget my ten thousand pesos.”

Leo was promised one hundred thousand pesos. For him it was a fortune. He then promised to give the “first fruit” of his kidney to Baboy.

13. On his third visit to the hospital, Leo went through another series of intensive examinations. His lungs, heart, and kidneys were thoroughly checked.

The fourth time, he was tissue-typed. How compatible his tissues would be with his yet-unknown recipient was examined minutely. All this time, Baboy was always with him and they always went back home together. But after this check-up, he suddenly bade him goodbye.

“I have to go and find more money,” he said, grinning like a politician confident of winning the elections. “This one is already done.” He gave Leo a thumbs-up sign. Leo did not know what the gesture meant at that time. He followed Baboy to another room.

A young man in his mid-twenties was seated in a chair. He was short, fair-skinned, skinny, with his long hair swept back. He was wearing a white short-sleeved shirt. He looked so pale, and very yellow, Leo said. Standing beside him was a tall elderly man who looked just like him. He was the father. But he looked sad and deeply worried. Not far from the father was Lady M, smiling seductively and quite triumphantly.

Baboy gave the father and son a thumbs-up sign and another one to Lady M. Leo was bewildered. What were they thumbs-upping for, he thought. What were they agreeing about? Why couldn’t they say them in words? Why were they talking in gestures?

Lady M spoke in English.

“Kusunori-san, this is Leo, your donor.”

The young man stood up, shook hands with Leo, and gave Leo a friendly thumbs-up. His hand was so smooth and soft, Leo felt. Leo returned his thumbs-up gesture. Only then did he realize he had passed all the tests. He felt a surge of joy and fear. He took comfort in the thought that hundreds of Baseco men had already done the same and they had survived.

He thought he would be giving his kidney to a Filipino patient. Baboy never told him a single word about his would-be recipient. It never occurred to him he would be “donating” his young kidney to an equally young foreign man, to a Japanese.

It was already seven in the evening and Leo wanted to go home.

“Dito ka na lang,” Lady M said asking him to stay in the hospital and not to go home anymore.“Huwag ka nang umuwi.”

Lady M wanted to be absolutely certain Leo would not chicken out at the last minute. Leo could not resist the bewitching seduction of Lady M. He was admitted, to be precise, seduced to be admitted. In the past, some prospective “donors” had escaped at the last minute before the transplantation. But Leo was dead-set. His mother was the raison d’etre of everything and Leo was ready to give away his kidney.

14. Leo was given a room. It had a TV set with access to SkyCable, a refrigerator, a phone, a stereo set, and air conditioning. It had everything— the dream of a Filipino family. It was a dream room. However, it was a room with its walls painted in blinding white and did not have a single window for you to even get a glimpse of the gray sky. It felt like a prison, Leo said, a fancy prison. It was the first time ever in his life to stay in such a different and so alien a world and to taste such luxury.

He watched pro-wrestling all night on cable television. The stereo was also at full volume. There was so much food: fried chicken, fried fish, vegetables, bananas, sweets, and bread. Room service was also available.

On the third day, his younger brother and a cousin came to see him. Baboy had asked them to keep him company while he was being confined. These two men were also recruits of Baboy but Leo dissuaded both of them. “One among us is enough,” he said. Leo asked his younger brother especially not to proceed with his plans. At night, they would sneak out of the hospital and buy a few bottles of beer. “It was like staying in a hotel,” he said. “And everything was free. I was like a congressman!” But this sweet life lasted only four days.

Because on the fifth day, at six in the morning, a male doctor came to his room and ordered him to take a white tablet. He took it without asking whether it was poison or a miracle drug. He immediately felt sleepy. He got scared. He felt dizzy and his vision became hazy. He was laid on an operating table and his hands and feet were restrained as though he was going to be electrocuted. “I couldn’t move. I couldn’t shout. I couldn’t protest,” he said.

“Swallow your saliva,” the doctor ordered him and he made him turn on one side.

Leo saw a three-inch long syringe—the longest needle he had ever seen. The shot felt as though he was being nailed to the cross, he said. After the injection, complete darkness descended on him. He lost his entire consciousness.

“I died at that moment,” he said. He went under the knives, scalpels, forceps, scissors, and needles. A foot-long cut was carved on his right side. A huge window was surgically opened and his young bean-shaped organ was plucked or “harvested,” as transplant surgeons would say.

When they wheeled him to the operating room, Leo was already unconscious. He could not know if Kusunori, his recipient, was in the same “operating theater” as he was or if he was in a separate room. The operation took six hours.

Leo regained consciousness at noon the next day. Lights, blinding as the naked sun, surrounded him. He opened his eyes. He felt a distinct and excruciating pain in his back. He touched it—it was wrapped in bandage. He felt as though his body had been halved. He was surrounded by men and women in green robes wearing masks and caps.

“Akala mo pinaligiran ako ng mga aliens. Nakatingin sila lahat sa akin,” he said. It was a surreal scene, he said. It felt as though aliens had surrounded him and were staring at him in wonder.

“Para akong binangungot,” he said. It seemed he woke up from a nightmare.

Writhing in pain and minus a kidney, he was wheeled back to his room like a losing rooster in a cockfight. He was not applauded or congratulated for successfully “donating” an organ. Nobody said anything to him. Nobody said “thank you.” His value was already used up.

In his room, he started to contemplate what had become of his body. He could not turn his back to one side for the sheer agony of it.

“Wala na ang isang bato ko.” He rued his absent kidney. “Ano kaya ang mangyayari sa akin?” What might happen to me, he wondered.

He was very sleepy the whole day. He was amazed at the potency of the liquid injected in him.“Hayop sa tapang,” he said.

The following day, Lady M brought a new lady into his room. The equally voluptuous woman introduced herself as Joy and said she was a friend of Kusunori. She was tall, “very white,” adorned with rings, a watch, a gold bracelet, a thick gold chain around her neck, and she was wearing very, very tight-fit Levis jeans.

“Salamat,” she thanked him. “Binigyan mo ng buhay ang kaibigan ko.” She expressed gratitude for “giving life to her friend.”

From her shiny black bag, she took out a manila envelope. Before Leo’s unbelieving eyes, she took out its contents: two bundles of five hundred-peso notes. She handed them to him as though she was a First Lady distributing dole outs to her indigent constituents. Leo received them with joy.

“Gagaling na Nanay ko,” he whispered to himself. With this money, he thought, his mother would get well soon. He asked his brother to keep the brown envelope.

Joy came to see Leo not only once but almost every day during his post-surgical confinement. She was grateful and her gratitude was a little touching.

“Lagi siyang nagpapasalamat. Pasalamat nang pasalamat. Ako na nga ang nahihiya,” he said. She was always saying thank you. It was making him feel embarrassed.

A day after the transplant, Baboy came to visit. Entering the room he went straight to the refrigerator. He ransacked all the leftover food: oranges, apples, chicken, bread, ice cream, and beer.

“So,” Baboy finally asked him after satisfying his hunger, “how are you?”

“I am now one kidney less,” Leo replied. “Why are you here?”

“I just brought a Type B,” he replied matter-of-factly. “Give me my ten now.”

Over his still heavily sedated body, Leo’s brother counted twenty yellow Ninoy Aquino notes. Baboy collected them as though he was collecting takings from a poker game at a wake in Baseco. He then left abruptly.

Leo stayed seven days in the hospital after the operation. Each day, nurses and doctors took turns coming to check his condition. And each day seemed as long as a year. He was dying to escape from his air-conditioned room so he could immediately take his mother to the Philippine General Hospital for treatment.

On the third day after the operation, he asked his older brother and cousin to go out and buy some gin. Of course, he was forbidden to drink while his wound was still raw and fresh. But as with life in Baseco, everyday was an exercise of ingenuity and wit. Every day created by God was a struggle to outwit and outsmart the powerful and the privileged. So, each time his brother and cousin went out and came back to the hospital, the guard would always query and check what they were bringing in. And they would always show two bottles of clear mineral water. Two bottles of gin in bottles of eau de mineral—the poor shotgun-armed guard would never have imagined that touch of genius, not in his wildest dream.

Years later, each time Leo and his fellow “donors” would gather for a drink, this particular episode would be a great source of laughter, and endless variations would be created by each operado on the same theme. To live despite oppression, exploitation, and agony and still come out with a good story, it seemed, made life more bearable for many of the operados in Baseco.

Leo was a man of very few words. Unless spoken to, he would not initiate a conversation or approach and talk to you. Every time his group would gather and have a drink, he would always act as the tanggero—the toaster, the giver of drinks. He would offer each person seated in the circle a swig and would quietly keep the flow of gin and lime going on smoothly. He was also the youngest.

15. Three days after the transplantation, he was dying of thirst for gin. He, his brother, and a cousin decided to have an early celebration. They filled their glasses to the brim. They toasted the very “cooperative” security guard.

Although still very weak and in pain, he had pretended to his doctors that he was already well. Wearing only an undershirt and a pair of short pants and looking thin as a tingting (mid-ribs of coconut leaves), he requested a discharge. Though reluctant, the attending physicians granted his request. Together with his brother and a cousin, they took a taxi—a very rare thing for him. The cab driver was a little suspicious—they did not look like they could afford treatment at the most expensive hospital in the archipelago. Moreover, when they mentioned “Baseco” as their destination, the driver got scared. He said he could not take them there because he was headed the opposite way, bound for the garage. Leo’s brother then offered a bribe: five hundred pesos—four times the average fare. The once-terrified taxi driver became more courageous at the thought of becoming a few hundred pesos richer, so he stepped on the accelerator. He drove his “suspicious-looking” passengers to the shores of Manila Bay, just beside the derelict and stinking shipyard. From there, the three hired an outrigger ingeniously powered by a septuagenarian generator that had been salvaged from a junk shop.

16. They reached the end of the breakwater. Leo walked slowly on the narrow path like a survivor of a shipwreck. He appeared like a newly circumcised schoolboy treading carefully, avoiding contact with his own clothes and passersby lest they hit his fresh wound.

He arrived at their precarious hut. His mother was lying in bed. Her body was still swollen all over. Her face, arms, and legs were bloated and pale. His mother asked him where he had been. He said: “St. Luke’s.” The name was sufficient for her to know where her son had been and what had happened to him. In Baseco, the name is synonymous with “kidney donation.”

“You shouldn’t have done it,” she said with a tone of anger and sadness. “I won’t be here long.”

Putting on a brave face to avoid showing any hint of sadness, Leo asked an aunt to take his mother to PGH the next day. Teresita, for the first time after her long lingering illness, was given a thorough medical check-up. She was also able to buy all the medicine prescribed to her. She spent about two thousand pesos. But a week later, her situation did not improve. She went back to the government hospital again, was examined again, and some drug was prescribed again. She spent another two thousand pesos. She went for the third and fourth time. Nevertheless, her condition was fast deteriorating. The fifth time, Teresita refused to seek any further medical help. She refused to get up from bed. “My time is coming,” she said.

On a stormy roaring night, Teresita bade goodbye to Baseco and to her children. She was only thirty-eight years old. For her funeral, Leo spent twenty-five thousand pesos. The rest of his money he had used up to buy a television set, a karaoke set, battery for power generation, six pairs of Levi’s style tailor-made jeans, and four T-shirts. He had also bought materials for house repair. With the remaining twenty thousand pesos, he started a business—buying and selling fish. Stevedore that he was and not a vendor or fisherman, his maiden business venture ended up like driftwood on the shore after a typhoon. Furious winds blew away the newly roofed and walled hut. Raging fire the following summer finished off the remnants of it.

17. The slum village of Baseco faces west. On a clear day, the sunset in Manila Bay is one of the finest in the world. It seems the setting sun here is twice the size in diameter—its glow the most passionate on earth, its hue the most intense—the sky burning, the city of Manila the luckiest, and Baseco the most beautiful place on earth.

Baseco children at play

I’m having a drink with a group of operados. We are right along Baseco Beach—a long stretch of rubbish-strewn, industrial dregs-contaminated, dog and human waste-scattered along the shore. I’m watching Leo mix the last tall and fat pair of gin and lime that I had bought as a present for them. After taking the lids off, he let the Gilbey’s stand on a flat surface and secured it. In a fraction of a second, he fastens the lip of the lime to the lip of the Gilbey’s. The two bottles are welded together in a tight and amorous kiss. After several minutes, gin and lime—like natural lovers—blend and dissolve into one harmonious and potent drink. Leo hands me the first shot in a glass of Nescafe. It’s an honor to have the first swig. Careful not to disappoint them, I drink it bottoms up.

Fifteen years after he had “donated” his young kidney to a Japanese young man named Kusunori, Leo is still alive despite having only one kidney. But he now has long hair, eyes that are always red, a missing set of dentures, and a tattoo of a rose on his left arm (with black leaves and stalks and red petals). His ubiquitous trademark—a foot-long incision on his left side—is a lifetime reminder of that excruciating but memorable day. He remains single and always passes the night on a wooden bench in front of a sari-sari store.

“Kumusta na kaya ang bato ko?” he says as he hands me another shot when my turn comes. He wonders what became of the “stone” he had “donated.” Is it still functioning? And how is Kusunori? Is he still alive?

I have read, I say, that five years is the longest lifespan of a transplanted organ.

“So probably,” he says, “my kidney’s twin is gone.”

“Maybe. Maybe not.”

The sky is smoldering in orange and red. The Manila Bay sunset from Baseco beach is at its best. We all stand up as if it is a countdown.

Leo is standing beside me. His naked torso has become golden. Emboldened by the spirit of gin and lime, he waxes lyrical: “This is my life—always waiting for the sunset here every day. I pass the time watching the ships, fishermen, and stevedores. As for my living, I can’t be a dockworker anymore. I get tired easily. I must take care of my one remaining kidney. The setting sun is always pretty but it makes me lonely. My life is sunrise and sunset. It’s the same every day.”

Brave man, you are, I say. Good man.

This article is adapted from Rey Ventura, Cherry Blossoms in the Time of Earthquakes and Tsunami, published earlier this year by Ateneo de Manila Press.

After spending one solid week tracking down rumors and gleaning facts on the organ harvesting and other crimes, they had a firm grasp on the rampant crime that was taking place in the Philippines. Not only were innocent people being killed for their organs, but they were also being killed for ritualistic sacrifices. Devon, Thomas, and Andres came to the same conclusion that something had to be done. While they were all in agreement that the trash had to be cleaned up, they also knew that until the root cause was taken care of, the problem would never go away. Poverty and the lack of education were the breeding grounds for this epidemic of crime.