Sinat as a Pinoy medical concept

mild-fever
By Dr. Michael L. Tan/GMANews.com – Last Wednesday at the Philippine Pediatric Society’s national convention, I delivered a paper on Filipino concepts of wellness in children. I started out noting how physicians and other health professionals focus mainly on quantitative measurements – blood pressure, blood chemistry, body temperature – to determine if a child is well, or sick.

Outside medical settings, people – parents especially – are more subjective, looking for example at how strong or weak a child’s appetite is, or how physically active they are. Body temperature does come into the evaluation, but this is not always measured with a temperature reading. A parent knows when a child has a fever and in the Philippines, we even have specific terms for a light fever – sinat in Tagalog, senat or sanat in Kapampangan, pudot in Ilokano, danggas in Cebuano. (I’m relying on Jose Panganiban’s Diksyunaryo Tesauro, published back in 1973, and would appreciate hearing from readers for similar terms in other Philippine languages.)

After the convention I began to think more about sinat and thought of how powerful an example it is of sense, and science. Sinat’s translation into “mild fever” can be mysterious. How mild is mild? Until a few years ago, my training in the sciences made me want to know, just what is it in centigrade or in Fahrenheit? But I never bothered to investigate because sinat wasn’t too relevant to me, it being something you hear more from mothers.

And then my own children came along. After almost nine years of parenting, I’ve realized sinat is more than just body temperature. You don’t measure sinat; you sense it.

Being a single father who does not believe in yayas, I’m very much hands-on with child-rearing, and that includes carrying them a lot and, in the process, discovering the enigmatic sinat. Sinat is biocultural, a real physical change that is detected only in some cultures.

You won’t find concepts of sinat in cultures where the norm is of parents maintaining physical and emotional distance. Thus, even in the Philippines, we find mothers talking more about sinat than fathers, Lolas more than Lolos. An Ate (elder sister) will tell her mother about sinat in a younger sibling, but Kuya (elder brother) almost never talks about sinat unless he himself has it.

Sinat is disappearing with upper-class Filipinos as close physical contact is reduced. Parents also don’t think of, or feel, sinat because the child gets his or her own room very early in life, sometimes even as an infant, to train them to be independent. That premium placed on independence might also mean less carrying: “No, you’re a big boy now” we tell them. If there’s carrying, well, that’s left to yaya.

If a child sleeps with the parents – a good family planning method, incidentally – sinat is more frequently detected, especially on top of the constant carrying. About two years back as I rushed into an elevator with my kids, I suddenly called out, “The baby, where’s the baby?”, referring to my youngest. My other kids laughed out, almost chanting in unison, “You’re carrying her, Dada.” Should it be surprising we have sinat, given the way children become second skin?

When you sense sinat, your brain goes into high gear, trying to figure out where the sinat comes from. We dismiss the sinat knowing the child has just returned from the playground, or a soccer game, a ballet class. I learned early, too, that all kinds of stresses can be bring about sinat. “There,” I tell my son, “I know you watched Walking Dead, right?” and he gives me a sheepish, sinat smile.

Then there’s folk wisdom about sinat coming from erupting teeth (nangingipin), so the sinat can actually be a welcome harbinger of another milestone in a child’s life, especially the first few teeth.

Sinat toward the end of the day, accompanied by the child becoming irritable, tells you they’ve had a long day, and it’s bedtime. The child usually protests, driving the sinat further up, but with firm coaxing, they’ll settle down, and the sinat disappears even before they fall asleep.

As the child grows older, sinat becomes an important signal to spend time with the child. How the child coddles up as you ask tells you how serious the problem is. There’s always a bit of performance here, but you learn to tell whether the whimpering is just to get your attention, or comes out of real physical distress.

mild-fever
By Dr. Miachael L. Tan/GMANews.com – Whether serious or not, the child calms down as you hug them more tightly, which can sometimes mean realizing, this isn’t just sinat, it’s lagnat, a “real” fever, and then you take a thermometer to get the numbers.

Even then, the thermometer isn’t as important as your subjective evaluations. Doctors say putting your hand to the forehead of the child is not an accurate way of determining temperature because your own hand temperature distorts the evaluation. I’d argue that sinat is different because it comes out of having carried the child constantly, so your evaluation comes out of a a comparison of what we know to be the regular temperature of the child… as well as our own.

When we say the child has sinat, we don’t reach out for the paracetamol drops or syrup and instead find ways to comfort the child, and to be extra vigilant in watching the child, including more carrying and hugging to be sure we can detect if the sinat becomes lagnat.

Often enough, deep into the night as I check on a child, this time just touching them on the forehead so I won’t wake them, I find sinat comforting. Sinat can tell us if a child is recovering, almost as if the child herself tells us, “It’s OK, I’m OK. Go back and sleep well.” — TJD, GMA News

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