Vox Meditantis

In 1911, Fe Villanueva del Mundo was born into a Manila household where death arrived with cruel regularity – three of her seven siblings would perish in infancy. That grief, particularly the loss of her eleven-year-old sister to appendicitis, transformed young Fe into one of the twentieth century’s most influential yet overlooked medical innovators. Over eight decades, she pioneered community-based paediatric care, invented a bamboo incubator that saved countless premature infants in electricity-starved villages, and founded the Philippines’ first children’s hospital – selling her home to finance the dream. Today, through historical records, personal testimonies, and her own published reflections, we reconstruct what that conversation might have sounded like.

We meet Dr del Mundo not in a gleaming conference room, but on the second floor of the Children’s Medical Center in Quezon City, where she chose to live after selling her home to fund the hospital’s construction in 1957. At ninety-nine, she still makes morning rounds in her wheelchair. Her hands, weathered by decades of examining fevered children and improvising solutions from whatever materials presented themselves, rest gently on the armrests. When she speaks, her voice carries the cadence of someone who has spent a lifetime translating complex medical concepts for frightened mothers in remote barrios.

Thank you for speaking with us today, Dr del Mundo. Your life spans nearly a century of extraordinary change. I’d like to begin where you did – with loss. Three of your siblings died in infancy, and your older sister, who dreamed of becoming a doctor, died of appendicitis at eleven. How did those deaths shape your path into medicine?

It’s peculiar how grief can become a sort of compass, isn’t it? When my sister died, I was quite young – still learning to read properly – but I remember the helplessness in the house. She had spoken of wanting to be a doctor for the poor, and when she was gone, it felt as though someone needed to carry that forward. Not out of duty exactly, but because the possibility she’d imagined couldn’t simply evaporate.

In those days, infant mortality was staggering. Families expected to lose children the way one expects the rainy season. But expectation doesn’t soften the blow, does it? My parents bore their losses with a kind of stoic grace I’ve always admired, yet I could sense the weight of it. I thought: if there are answers to why babies die of fevers and diarrhoea, if there are methods to prevent such waste of potential, then finding them is worth dedicating a life to. It wasn’t romantic. It was practical necessity made personal.

You entered the University of the Philippines at fifteen to study medicine, graduating as valedictorian in 1933. President Quezon then offered you a scholarship to any medical school in the United States. You chose Harvard. Did you know at the time that Harvard didn’t admit women?

I had absolutely no idea. Can you imagine? I was twenty-two, terribly earnest, and thought Harvard represented the pinnacle of paediatric training – which it did, mind you. President Quezon’s offer was extraordinarily generous: study anywhere, any field. I chose paediatrics because of the provinces. During medical school, I’d travelled to Marinduque and other rural areas and witnessed children suffering from entirely preventable conditions. Measles, dehydration from diarrhoea, malnutrition – all treatable, all killing children by the dozens.

So I applied to Harvard and was accepted. It wasn’t until I arrived in Boston in 1936 and reported to my assigned dormitory that anyone realised the error. The housing officer looked rather startled when I appeared at the men’s residence hall. There was a moment of confusion, some hurried consultations. I gather they’d assumed “Fe” was a man’s name – perhaps they thought Ferdinand or Felix.

The head of paediatrics reviewed my academic record and, to his credit, decided the mistake wasn’t sufficient grounds to turn me away. He said something to the effect of, “Well, you’re here now, and your qualifications are excellent.” So I stayed. I was the only woman in the programme, which made for some awkward moments, but the medicine itself was fascinating enough that I focused on that rather than the oddity of my situation.

Let’s talk about that medicine – specifically, the bamboo incubator you invented in 1941. Can you walk us through the design process as though explaining it to another paediatrician? What were the technical specifications, the heat retention characteristics, the temperature regulation mechanisms?

Ah, the incubator. That particular invention arose from sheer necessity, not laboratory experimentation. I’d returned to the Philippines just before the Japanese invasion, and by 1941, rural communities – already resource-poor – had even less access to medical equipment. Premature infants, especially those with low birth weight, require stable thermal environments. Their thermoregulatory systems are immature; they can’t maintain body temperature independently. In a hospital with electricity, you’d use a closed incubator with controlled temperature, humidity, and sometimes supplemental oxygen.

But what do you do in a village with no electricity? With families whose nearest health centre is hours away by foot? You improvise.

The design I settled on used two bamboo laundry baskets – the kind every household had for washing clothes. I selected baskets of different diameters so one nested inside the other with a gap of about five to eight centimetres between them. Bamboo was ideal: it’s locally available, inexpensive, lightweight, and has natural insulating properties due to its cellular structure. The air pockets within bamboo fibres reduce heat transfer.

I placed hot water bottles – typically four to six, depending on the baskets’ size – in the space between the inner and outer baskets. The water bottles acted as thermal reservoirs. By using water heated to approximately 40 to 45 degrees Celsius, and replacing the bottles every two to three hours, we could maintain the inner basket’s temperature at around 32 to 34 degrees Celsius, which is suitable for most premature infants.

The baby lay on soft cloth in the inner basket. Over the top, I fashioned a hood – sometimes from additional fabric, sometimes from a smaller inverted basket – and attached tubing to deliver supplemental oxygen if the infant required it. The hood served two purposes: it retained warmth and created a microenvironment where oxygen concentration could be modestly elevated without requiring sophisticated delivery systems.

Temperature monitoring was the trickiest part. We couldn’t afford thermometers for every family, so I taught midwives and mothers to assess warmth by touch – the infant’s skin should feel comfortably warm, not hot, not cool. It’s imperfect, certainly, but human skin is surprisingly sensitive to temperature differentials. We trained extensively on recognising signs of overheating – flushed skin, restlessness – and hypothermia – lethargy, cool extremities.

The entire apparatus could be assembled for less than the cost of a chicken. Families could reproduce it themselves. That was the point: not to create something that required me or my hospital, but to empower communities to care for their own vulnerable infants.

How does that compare to the electric incubators of the time – say, the Tarnier or Lion models being used in European hospitals?

Functionally, for straightforward thermal support, the bamboo incubator performed adequately. A Tarnier incubator, which had been standard since the 1880s, maintained temperature through heated water reservoirs and later electric elements, achieving precise control – typically within half a degree. It was enclosed, reducing infection risk from airborne pathogens, and some models included humidity control.

The bamboo version couldn’t match that precision. Temperature fluctuated more, perhaps by two to three degrees depending on how diligently the water bottles were refreshed. Humidity was uncontrolled – it depended on ambient conditions. The open or semi-open design meant greater exposure to environmental contaminants.

But here’s what the cost-benefit analysis looked like: a Tarnier incubator cost roughly two hundred to five hundred U.S. dollars in the 1940s – an unimaginable sum for rural Filipino families, even if one could transport such a device to a remote barrio. It required reliable electricity, which didn’t exist in most areas. Maintenance required trained technicians.

The bamboo incubator cost perhaps two pesos – less than fifty cents – if the family didn’t already own suitable baskets. It required no electricity, no specialised parts, no technicians. Maintenance meant refilling hot water bottles, which any family member could do. The trade-off was precision for accessibility. In settings where the alternative was no thermal support whatsoever – where premature infants simply died of cold stress within hours – “adequate” temperature control that saved, say, sixty per cent of those infants rather than ninety-five per cent was still worth doing.

This is what I find frustrating about how medical innovation is remembered. The emphasis falls on sophistication, on technological complexity, as though those are inherently superior. But sophistication is only valuable if it reaches the patient. A device that sits in a wealthy hospital while infants die in the countryside is less effective, in aggregate, than a crude device that reaches fifty villages. We ought to measure innovation not just by what it can do, but by whom it serves.

Did you document the outcomes – survival rates, complications – of infants treated with bamboo incubators compared to no intervention?

Not in the rigorous controlled trial sense that would satisfy modern research standards, no. The conditions didn’t permit it. During the war, I was running a makeshift children’s hospice within the Santo Tomas internment camp, caring for over four hundred children with minimal supplies whilst the Japanese authorities watched our every move. After the war, as director of North General Hospital and later when establishing my own medical centre, I was training physicians, treating patients, organising mobile health teams – there was scarcely time to sleep, much less conduct formal longitudinal studies.

What I did was observe. I spoke with midwives who’d used the incubators. I followed up with families when I could. The anecdotal evidence was clear: premature infants kept warm had markedly better survival than those who weren’t. Mothers reported fewer deaths from what we’d call cold stress or neonatal hypothermia. But precise figures? Controlled comparisons? Those luxuries belonged to institutions with funding, laboratory facilities, and research staff. I had none of those things.

This is part of the problem with how scientific knowledge is validated. Research conducted in well-resourced Northern institutions, with proper controls and publishable data, is deemed “rigorous.” Work done in resource-constrained settings, where the very act of collecting data competes with the imperative to save lives, is dismissed as “anecdotal” or “unscientific.” Yet the latter often addresses more urgent problems. I sometimes wonder if the Nobel committee has ever considered awarding a prize for an innovation that can’t be patented because it’s too simple, too reproducible, too… humble.

You mentioned sending blood samples abroad for analysis during your dengue research in the 1950s. What was that experience like – conducting research in a context where you depended on Northern laboratories for validation?

Profoundly frustrating. Dengue was – and remains – a major health threat in the Philippines. In the 1950s, very little was understood about how it affected children specifically. I had patients: fevered children with haemorrhagic symptoms, some recovering, some deteriorating rapidly. I could make clinical observations, note patterns, develop hypotheses. But confirming dengue serologically, identifying which serotypes were circulating, understanding immune responses – all that required laboratory capabilities we didn’t have.

So I collected samples – blood, sera – preserved them as best I could, and sent them to laboratories in the United States or Japan. Then I waited. Weeks, sometimes months, for results. By the time confirmation arrived, the patient had either recovered or died, and the clinical moment had passed. Yet those delayed results were necessary for publication, for my work to be taken seriously by the international medical community.

It created a strange dynamic. I was the one observing the disease, treating the patients, immersed in the epidemiological reality. But the laboratories abroad, which never saw a dengue patient, held the authority to validate my findings. When papers were published, they were often collaborations, with Northern scientists listed as co-authors because they’d performed the laboratory work. Sometimes my observations were credited; sometimes they weren’t.

I don’t blame individual scientists. Most were generous colleagues. But the structure itself is colonial, isn’t it? Knowledge produced in the Philippines requires Northern validation to be accepted as legitimate. The microscope, the serological assay, the institutional letterhead from Harvard or Johns Hopkins – these become gatekeepers determining whose knowledge counts. Meanwhile, thousands of Filipino children were suffering from dengue, and the most urgent questions – how to identify severe cases early, how to manage fluid resuscitation in resource-limited settings – those practical questions weren’t considered “important” research by international journals. They were dismissed as “clinical management” rather than “discovery.”

You developed the BRAT diet for childhood diarrhoea – bananas, rice, applesauce, toast. That intervention has saved millions of lives globally and is still recommended today. Yet many paediatricians worldwide don’t know it originated with you. How does that feel?

It’s bittersweet. On one hand, the fact that a simple dietary intervention spread globally and became standard practice is precisely what I hoped for. The point wasn’t to ensure my name attached to it; the point was to reduce mortality from diarrhoeal dehydration. If a mother in rural Indonesia or a clinic in Kenya uses the BRAT diet to help a child recover, the child benefits whether or not anyone knows a Filipina doctor developed it.

On the other hand, the erasure isn’t accidental. When Western paediatricians adopted the BRAT diet, it was often presented as “emerging best practice” without attribution to its origins. I published articles in Philippine medical journals – extensively, over a hundred papers – but those journals weren’t indexed in major databases, weren’t read in London or New York. So when the diet appeared in Western textbooks, it seemed to materialise without a source, as though it were folk wisdom rather than the result of clinical observation and systematic trial.

This is what I mean by the invisibility paradox of appropriate technology. Because the BRAT diet is simple – ordinary foods rather than pharmaceuticals – it doesn’t generate patents, doesn’t create intellectual property. There’s no corporate interest in promoting it because there’s no profit. And because it’s simple, it’s not considered “innovative” by the standards that award scientific prizes.

But consider what it achieves: rehydration and electrolyte balance using foods available in nearly any household, regardless of income. Bananas provide potassium, rice provides binding starch, applesauce is gentle on the gut, toast supplies easily digestible carbohydrates. It works for mild to moderate diarrhoea and prevents the progression to severe dehydration that would require hospitalisation. In resource-limited settings, preventing hospitalisation isn’t just cost-effective – it’s often the difference between life and death, because the hospital is three days’ travel away.

So when medical historians credit oral rehydration therapy – which is marvellous, don’t misunderstand me – but neglect to mention the BRAT diet, they’re privileging the intervention that came from WHO and Northern research institutions over the one that emerged from a Filipino clinician observing what worked in practice. Both interventions save lives. Only one gets remembered because only one fits the narrative of “scientific breakthrough.”

If I’m honest, what troubles me isn’t the lack of personal credit. It’s that the erasure perpetuates the fiction that medical knowledge flows only from North to South, from resource-rich to resource-poor, from sophisticated to simple. That fiction makes it harder for today’s Filipino or Kenyan or Bangladeshi researchers to have their work taken seriously. It tells them their context, their patients, their insights are peripheral. And that’s a lie that costs lives.

You were a devout Catholic, yet you championed family planning and population control – positions directly opposed by Church doctrine. How did you reconcile that tension?

It was never comfortable. I attended Mass regularly, prayed daily, considered my faith integral to who I was. The Church’s teaching on artificial contraception was clear, especially after Pope Paul VI’s 1968 encyclical Humanae Vitae. I understood the theological reasoning: that married love should remain open to procreation, that human life is sacred from conception.

But I was also a paediatrician working with families crushed by poverty, watching mothers bear eight, ten, twelve children they couldn’t feed. I treated infants with severe malnutrition – kwashiorkor, marasmus – because there simply wasn’t enough food to go round. I saw women’s bodies destroyed by endless pregnancies, maternal mortality from complications that could have been prevented if they’d been able to space births.

From a medical and public health standpoint, the evidence was overwhelming: family planning reduced maternal and infant mortality, improved child nutrition and health, gave women time to recover between pregnancies. When I established the Institute of Maternal and Child Health in 1966, we integrated family planning clinics because the women themselves were asking for it. They wanted information, wanted access to methods that would allow them to care adequately for the children they already had.

I came to believe that my obligation as a physician – to reduce suffering, to preserve life – sometimes required setting aside theological positions that, however well-intentioned, caused harm in practice. Not every family could rely on natural family planning methods, particularly in contexts where women lacked the education or agency to negotiate their use with husbands. Telling a woman she could only use the rhythm method, when she lacked the basic literacy to track her cycle or the power to refuse her husband, was effectively telling her to accept endless childbearing regardless of the consequences to her health or her existing children’s welfare.

I never reconciled the tension, truly. I simply chose, in each moment, to prioritise the living woman in front of me over abstract theological principle. Perhaps that makes me a poor Catholic. But I’d rather answer to God for compassion than for dogmatic rigidity.

Let’s discuss something you got wrong or would change if you could. What’s a decision or approach you regret?

I should have fought harder to document everything – the incubator designs, the clinical outcomes, the rural health programmes. I was so focused on doing the work, on treating the next patient, training the next cohort of physicians, reaching the next village, that I neglected to create the kind of record that would have made the work undeniable.

I knew, even then, that my publications in Philippine journals wouldn’t reach international audiences. I knew that without photographic documentation, without preserved prototypes, the bamboo incubator would fade from memory. But I told myself the work was more important than the documentation, that saving a child today mattered more than ensuring future historians remembered how it was done.

I was wrong about that. Documentation isn’t vanity; it’s stewardship. By failing to create a robust record, I made it easier for the contributions of Filipino medicine – and by extension, Global South innovation more broadly – to be erased. I allowed the narrative to remain one where medical progress flows from Harvard and Hopkins, where innovations that don’t generate patents or Nobel prizes don’t count as innovation at all.

If I could do it differently, I would have spent less time treating patients myself and more time training others to do so whilst I focused on writing, publishing in international journals, building institutional partnerships that would amplify the work’s visibility. That feels like a betrayal of my immediate patients, but perhaps it would have served future generations better. I don’t know. Even now, I’m not certain.

You lived on the second floor of your hospital from 1957 until your death in 2011, making rounds until you were ninety-nine, even from a wheelchair. Why did you continue working so long?

Where else would I go? I had no husband, no children of my own. The hospital was my family. The patients – well, they kept arriving, didn’t they? A child with pneumonia doesn’t care that I’m ninety-five. She needs treatment, and if I can provide it, why wouldn’t I?

There’s something else, though. I wanted to model a particular kind of medical practice: one where the doctor doesn’t disappear to a comfortable suburb, where the boundaries between professional and personal life blur in service of something larger. Living in the hospital meant I was available. It meant families knew I wasn’t simply collecting a salary; I was invested in their children’s welfare in the most literal sense. My home was their children’s ward.

In retrospect, perhaps that was unfair to the younger physicians I trained. How could they replicate that level of commitment? How could they not feel they were falling short if they wanted marriages, families, lives outside medicine? I may have inadvertently set an impossible standard, one that privileged a particular kind of self-sacrifice only possible for a single woman without other obligations.

But the truth is, I loved the work. Even in my nineties, wheeling myself down the corridor to check on a baby in the intensive care unit, I felt purposeful. Retirement seemed like a kind of death – why would I choose to stop doing what gave my life meaning? So I continued until my body simply couldn’t anymore.

You received the Ramon Magsaysay Award in 1977 and were named National Scientist of the Philippines in 1980 – the first woman to receive that honour. Yet internationally, you remain relatively unknown. Why do you think that is?

Geography is destiny, to some extent. If I’d spent my career at Children’s Hospital Boston or Great Ormond Street, the same work would have garnered far more recognition. But I chose to return to the Philippines, to work in a postcolonial nation rebuilding from war, and that choice consigned me to being “regionally significant” rather than “internationally important” in the eyes of medical history.

There’s also the gendered dimension. I was lauded as “The Angel of Santo Tomas,” praised for my compassion and dedication – which is lovely, don’t misunderstand me – but those accolades framed me as a caregiver rather than an innovator. Male physicians who founded hospitals were visionaries and entrepreneurs. I was selfless and maternal. The bamboo incubator was charming improvisation rather than engineering ingenuity. The BRAT diet was “common sense” rather than clinical insight.

This happens to women systematically: our intellectual contributions are reframed as extensions of feminine nurturing, which makes them seem less impressive somehow, less worthy of the kind of recognition reserved for “serious” science. If I’d been Eduardo or Ferdinand del Mundo, would I have been framed differently? Quite possibly.

And finally, there’s the issue of preventive medicine’s invisibility. The children who didn’t die of dehydration because their mothers used the BRAT diet – those children leave no dramatic stories, no miracle recoveries. They simply grow up healthy. The premature infants warmed in bamboo incubators – they don’t become statistics demonstrating “lives saved” because there was no formal data collection. The success of preventive and primary care is that it prevents crisis, and prevented crisis is, by definition, invisible.

Contrast that with a surgical breakthrough, where you can point to a patient who would have died without the procedure and now survives. That’s a compelling narrative. “Millions of children didn’t get severe diarrhoeal dehydration” is statistically significant but emotionally flat. So the work that actually saves the most lives – immunisation, nutrition education, improved sanitation, family planning – gets less recognition than dramatic interventions that save fewer lives in aggregate.

I don’t resent this, exactly. It’s simply how systems of knowledge and prestige function. But it means that people like me – working in public health, in resource-limited settings, on unglamorous problems – will always be marginal to the official history, no matter how many lives we save.

What advice would you give to young women scientists today, particularly those from the Global South, who face similar challenges?

Document everything. Publish internationally, even if it’s difficult, even if the journals are expensive to access and biased towards Northern institutions. Build networks – not just with colleagues in your own country, but across the Global South. Filipino researchers should know what their counterparts in Kenya and Peru are doing. Too often, we’re isolated, which makes it easier for Northern institutions to dominate the discourse.

Don’t wait for permission. I didn’t ask if it was appropriate for a woman to attend Harvard; I applied and dealt with the consequences when they arose. I didn’t seek approval before starting the family planning clinics; I saw a need and addressed it. Women, especially, are socialised to seek permission, to wait until they’re sufficiently qualified or experienced. You’re already qualified. The children dying of preventable diseases don’t care about your credentials; they need your help now.

At the same time, be strategic. I wish I’d been more strategic about building institutional partnerships, about ensuring my work was visible in the right venues. Being brilliant in obscurity doesn’t change systems. Find ways to make your work undeniable – document it, publish it, build coalitions that amplify it. This isn’t self-promotion; it’s ensuring the knowledge you generate serves future generations.

And please, for the love of all that’s good, don’t internalise the message that “appropriate technology” or “frugal innovation” is second-rate. A solution that costs ten dollars and saves a thousand lives is more innovative than one that costs ten thousand dollars and saves a hundred lives in wealthy settings. Context-appropriate design, community-based implementation, accessibility – these are sophisticated design constraints, not compromises. The bamboo incubator is every bit as clever as any device requiring electricity and specialised parts. Perhaps more so.

Finally, when you died in 2011, you were buried at Libingan ng mga Bayani – the Heroes’ Cemetery. What do you hope your legacy is?

I hope the Children’s Medical Centre continues serving families who couldn’t otherwise afford care. I hope the physicians I trained remember that medicine is a service, not a business. I hope the mothers in Marinduque and Palawan still know how to warm a premature baby if they haven’t a proper incubator, how to rehydrate a child with diarrhoea if they’re far from a clinic.

Beyond that? I suppose I hope that someday, medical history expands to include people like me – not as curiosities or footnotes, but as central figures in the story of how twentieth-century medicine progressed. The innovations that spread from Manila and Accra and São Paulo are just as important as those from Boston and Stockholm. The physicians who work in communities without resources are just as brilliant as those with every advantage. We solve harder problems with less.

If my story can help shift the narrative even slightly, if it can help young scientists from the Philippines or Kenya or anywhere see themselves as central rather than peripheral, then perhaps being forgotten for decades whilst being remembered now serves a purpose.

But honestly, the individual legacy matters less than the systems it might change. I’d rather be completely forgotten if it meant every premature infant globally had access to thermal support, every child with diarrhoea received appropriate rehydration, every family had the resources to space births safely. The point was never to be remembered. The point was to save children. If we’ve done that – if the methods outlast the name – then we’ve succeeded.

Letters and emails

Since publishing our conversation with Dr del Mundo, our community has sent dozens of letters and emails – from rural health workers in the Andes to neonatologists in Warsaw, from biomedical engineers in Hanoi to researchers studying infectious disease across Africa. We’ve selected five particularly thoughtful questions that explore technical details she touched on briefly, probe the ethical tensions she navigated, and ask what she’d say to those continuing the work she began.

Juliana Ramos, 34, Rural Health Coordinator, Bolivia
Dr del Mundo, you mentioned training midwives to integrate into the formal medical system – something that remains contentious in many countries today. What specific clinical skills did you teach them beyond deliveries, and how did you convince sceptical physicians that midwives could be trusted partners rather than competitors? I work with traditional birth attendants who face similar resistance, and I’d love to understand your practical approach to building that bridge.

Ah, Juliana, you’ve touched on one of the most practical – and political – challenges I faced throughout my career. The midwife question wasn’t merely about clinical competence; it was about professional territory, class hierarchies, and frankly, whether male physicians could tolerate women who’d learned their craft through apprenticeship rather than university degrees holding authority in medical settings.

Let me be specific about the skills training, because that’s where I could build an unarguable case. I taught midwives to recognise danger signs that required immediate physician intervention: postpartum haemorrhage beyond normal blood loss, prolonged labour suggesting obstructed delivery, eclamptic seizures, neonatal respiratory distress. These weren’t midwifery techniques – these were triage skills. I showed them how to take accurate maternal vital signs, how to assess fundal height and position, how to recognise foetal distress through heart rate monitoring with a simple Pinard horn.

For neonatal care, I trained them in resuscitation basics – clearing airways, stimulating breathing, maintaining warmth – and taught them to identify jaundice severity using daylight assessment of skin and sclera. They learned to prepare oral rehydration solutions with precise salt and sugar ratios for infants with diarrhoea. I demonstrated how to examine a newborn for congenital abnormalities, assess feeding difficulties, recognise signs of infection – fever, lethargy, poor feeding, umbilical inflammation.

Crucially, I trained them to document. I created simple forms they could complete even with limited literacy: checkboxes for normal versus concerning findings, spaces to record temperatures and feeding patterns. This documentation became their credibility. When a midwife referred a patient to my hospital with a completed form showing progressive symptoms, physicians couldn’t dismiss her judgment as “women’s intuition” or folk knowledge – it was clinical observation, recorded and communicable.

The resistance from physicians was substantial, particularly the older generation trained to see medicine as a gentleman’s profession. They argued midwives lacked theoretical knowledge, couldn’t understand pathophysiology, would overstep their competence. Some of this was genuine concern about patient safety. Much of it was anxiety about status – if an uneducated village woman could perform medical assessments, what did that say about the value of a medical degree?

I addressed this through what I’d now call “collaborative protocols,” though we didn’t use that language then. I invited sceptical physicians to observe midwives at work in our rural health stations. I showed them the referral patterns: midwives were sending appropriate cases, not over-referring from paranoia or under-referring from false confidence. I presented data – informal, yes, but compelling – showing that villages with trained midwives had lower maternal and infant mortality than those without.

I also, quite deliberately, framed the midwives as extending physician reach rather than replacing physicians. I’d say to a resistant colleague: “You cannot possibly be in fifty barrios simultaneously. But fifty trained midwives, following protocols you’ve helped design, reporting to you regularly – they become your hands and eyes. They make you more effective, not less necessary.” This appealed to their professional identity whilst acknowledging the practical reality that the Philippines simply didn’t have enough physicians to provide rural care alone.

The Catholic Church’s support helped enormously. Many midwives were deeply religious women respected in their communities. When I positioned midwife training as Christian service – caring for mothers and babies, reducing suffering – parish priests became allies. They’d vouch for the midwives’ character, which mattered in conservative rural areas where trust in women’s authority was limited.

I won’t pretend I converted all the sceptics. Some physicians refused to work with midwives throughout their careers. But I built enough support that by the time I was organising mobile health teams in the 1960s, physician-midwife collaboration had become standard practice in many regions. The key was demonstrating competence through outcomes, documenting everything rigorously, and finding the physicians who were pragmatic enough to recognise that perfect medicine unavailable to most Filipinos was less valuable than good-enough medicine that reached them.

Your traditional birth attendants face the same resistance, Juliana. My advice: document relentlessly, train to clearly defined scopes of practice, create referral pathways that make physicians partners rather than rivals, and never stop demonstrating that your goal is better outcomes for patients, not professional turf battles. The medicine matters more than the credentials – though convincing credential-holders of that fact remains exhausting work.

Sipho Dlamini, 47, Paediatric Infectious Disease Researcher, South Africa
You conducted dengue research in the 1950s when viral serology was still quite primitive. Beyond sending samples abroad, what clinical markers did you use to distinguish dengue from other febrile illnesses like malaria or typhoid in real time? And did you observe patterns in disease severity – perhaps linked to prior infections or age groups – that might have hinted at what we now call antibody-dependent enhancement, even before the immunological mechanisms were understood?

Sipho, you’ve identified precisely the challenge that made dengue research so frustrating in the 1950s – we were working largely blind, relying on clinical acumen when the laboratory tools we needed simply didn’t exist yet, or existed only in a handful of institutions we couldn’t access.

The differential diagnosis problem you’ve mentioned was acute. Manila in the early 1950s saw regular outbreaks of dengue, but we also had endemic malaria in certain areas, typhoid fever, leptospirosis, and various other febrile illnesses that could present similarly. Without rapid serological confirmation, I had to distinguish them through careful clinical observation and pattern recognition.

For dengue, I looked for several characteristic features. The fever pattern was often biphasic – what we called “saddleback fever” – with high temperature for three to four days, a brief remission, then a second febrile period. Patients frequently complained of severe retroorbital pain, quite distinctive when you asked them to move their eyes laterally. The bone and joint pain was profound – “breakbone fever” is an apt description – far more severe than what I typically saw with malaria or typhoid.

The rash helped enormously when present. It usually appeared around days three to five, starting on the trunk and spreading to the extremities, often sparing the face initially. It had a particular appearance – maculopapular, sometimes with islands of normal skin creating what we called “white islands in a sea of red.” You didn’t see that pattern with typhoid or malaria.

Laboratory findings, even the basic ones we could perform locally, provided clues. Dengue typically showed leucopenia – low white blood cell counts – whereas typhoid might show normal or slightly low counts, and bacterial infections usually elevated them. Thrombocytopenia – low platelet counts – was particularly suggestive of dengue, especially when it appeared around day three or four of illness.

For haemorrhagic manifestations, I used the tourniquet test religiously. You inflate a blood pressure cuff to midway between systolic and diastolic pressure, leave it for five minutes, then count petechiae in a defined area of the forearm. More than twenty petechiae per square inch suggested capillary fragility consistent with dengue haemorrhagic fever. It’s crude by modern standards, but it was reproducible and required only a sphygmomanometer we already had for measuring blood pressure.

Now, regarding disease severity patterns – this is where your question becomes particularly interesting, because yes, I absolutely observed patterns that troubled me deeply, though I couldn’t explain them at the time.

Children who’d had dengue previously seemed more likely to develop severe haemorrhagic presentations during subsequent infections. I documented this in my clinical notes: siblings where the first child had mild dengue, recovered completely, then contracted it again months or years later and developed haemorrhagic fever with shock. This seemed paradoxical. We assumed prior infection should confer immunity, as it does with measles or polio. Why would a second dengue infection be worse?

I also noticed age-related patterns. Infants under six months rarely developed severe dengue – they seemed protected, presumably by maternal antibodies. But children between six months and two years, particularly those I knew had dengue-positive mothers, sometimes developed fulminant haemorrhagic disease during their first documented dengue infection. Again, paradoxical and troubling.

I hypothesised – and wrote this in articles published in the Philippine Journal of Paediatrics – that there might be multiple dengue strains, and that infection with one strain might somehow predispose to severe disease when infected with a different strain. I speculated that perhaps maternal antibodies, rather than protecting infants, somehow enhanced disease severity under certain circumstances. But I had no mechanism to propose, no laboratory capacity to test these hypotheses rigorously.

It wasn’t until decades later, when immunologists described antibody-dependent enhancement – the phenomenon where non-neutralising antibodies from a prior dengue infection actually facilitate viral entry into cells during a subsequent infection with a different serotype – that my clinical observations made mechanistic sense. By then, I was quite elderly, but I remember reading those papers with a mixture of vindication and frustration. I’d seen it in 1952, described it as best I could, but lacked the tools to prove it.

This is what I mean about postcolonial science hierarchies, Sipho. Filipino children were experiencing antibody-dependent enhancement in the 1950s. I was observing it, documenting it, trying to warn colleagues. But without access to sophisticated virology labs, without the ability to culture virus and perform neutralisation assays, my observations remained “interesting clinical anecdotes” rather than “scientific discoveries.” The mechanism was eventually elucidated by well-funded laboratories abroad, using technologies I couldn’t access, and they received the credit for discovering a phenomenon that paediatricians in dengue-endemic regions had been witnessing for decades.

Your work in South Africa likely encounters similar challenges. I suspect you observe clinical patterns that hint at underlying mechanisms you can’t yet prove. Document everything. Write it down, even if you can’t fully explain it. Future researchers with better tools will need that clinical foundation – and you deserve credit for the observations, even if others eventually provide the mechanistic explanations.

Le Thi Hoa, 29, Biomedical Engineer, Vietnam
I’m fascinated by the thermal dynamics of your bamboo incubator. You mentioned hot water bottles maintained at 40-45°C, replaced every 2-3 hours – but how did you determine those specific parameters? Did you experiment with different replacement intervals or water temperatures, and what signs of thermal stress in infants guided your calibration? I’m wondering whether modern low-cost incubator designers could learn from your empirical testing methods, especially for contexts where formal laboratory validation isn’t feasible.

Le Thi Hoa, I’m delighted you’ve asked about the engineering process, because the bamboo incubator’s development was far more methodical than the “charming improvisation” narrative suggests. It wasn’t a sudden inspiration – it was iterative problem-solving constrained by available materials and informed by understanding neonatal thermoregulation.

Let me walk you through how I arrived at those specific parameters, because the process itself matters as much as the final design.

I began with the physiological requirements. Premature infants, particularly those under 1,500 grammes, cannot maintain core body temperature in typical ambient conditions. Their surface-area-to-volume ratio is unfavourable for heat retention, their subcutaneous fat layer is minimal, and their metabolic heat production is inadequate. The target range for a neutral thermal environment – where the infant expends minimal energy maintaining temperature – is roughly 32 to 34 degrees Celsius for most premature infants, slightly higher for very low birth weight babies.

So I knew what temperature I needed to maintain. The question was how to achieve it reliably using materials available in rural households.

I started with bamboo baskets because they were ubiquitous – every family had them. But I needed to understand bamboo’s thermal properties through direct testing. I placed a thermometer inside a single basket, covered it with cloth, and measured how quickly it lost heat when filled with warm water. Too quickly – within an hour, the temperature dropped significantly. A single basket wouldn’t maintain stable temperature.

The nested basket design came from observing how my mother stored warm rice. She’d wrap the pot in cloth and place it inside a larger basket, creating an insulating air gap. I wondered if the same principle might work for maintaining infant temperature.

I experimented with different basket size combinations. If the gap between inner and outer baskets was too narrow – less than three centimetres – I couldn’t fit enough hot water bottles, and heat dissipated too rapidly. If the gap was too wide – more than ten centimetres – the design became bulky and unstable. Five to eight centimetres proved optimal: enough space for four to six standard rubber hot water bottles, narrow enough that the outer basket’s bamboo provided meaningful insulation.

For the hot water temperature, I tested a range. Water at 60 degrees Celsius initially seemed promising – it held heat longer – but I discovered it created dangerous hot spots where bottles contacted the inner basket. An infant’s skin touching those areas could burn. Water at 35 degrees Celsius was safe but cooled too quickly, requiring replacement every sixty to ninety minutes, which placed an unrealistic burden on families.

Forty to forty-five degrees Celsius emerged as the sweet spot through trial and error. At this temperature, the bottles posed no burn risk even with direct contact, yet they maintained the inner basket environment at 32 to 34 degrees Celsius for approximately two to three hours. This replacement interval was manageable – family members could prepare fresh hot water bottles during their normal waking hours without exhausting themselves with hourly changes through the night.

I tested replacement intervals extensively using thermometers borrowed from the hospital. I’d set up the incubator, place a thermometer inside where an infant’s body would be, and record temperature at fifteen-minute intervals. With water bottles at 40 to 45 degrees Celsius, the inner basket temperature remained within the target range for roughly two and a half to three hours before dropping below 32 degrees. At three-hour replacement intervals, I could keep temperature fluctuations within about two degrees – not the precision of an electric incubator, but adequate for survival.

The challenge was teaching temperature assessment without thermometers, since rural families couldn’t afford them. I trained midwives using a calibration technique: I’d heat water to various temperatures, have them test it by dipping their wrist – as one tests milk for an infant – and memorise what 40 to 45 degrees felt like. It should feel quite warm but not uncomfortable to hold your wrist in it for five seconds. Then I taught them to assess infant temperature by placing the back of their hand against the baby’s chest. The infant should feel warm – about the temperature of one’s own cheek – not cool, not hot.

For signs of thermal stress, I taught them to watch for specific indicators. An overheated infant becomes flushed, particularly on the face and trunk, may breathe rapidly, becomes restless or irritable. A cold-stressed infant becomes lethargic, won’t feed well, feels cool to touch particularly on the extremities, and may develop a mottled appearance on the skin – we called it “cutis marmorata.” These signs don’t require instruments; they require careful, trained observation.

I never conducted formal thermal efficiency studies – I had neither the equipment nor the funding. What I did was observe outcomes. Midwives reported that premature infants kept in bamboo incubators survived at dramatically higher rates than those simply wrapped in blankets. Mothers told me their babies remained warm throughout the night, fed better, cried less. This wasn’t controlled trial data, but it was real-world effectiveness data, which matters enormously when the alternative is death.

Your question about whether modern designers could learn from empirical testing methods – absolutely, they should. The obsession with laboratory validation before field deployment delays life-saving interventions. I tested the bamboo incubator with actual infants in actual villages, iterating based on what mothers reported worked or didn’t work. That rapid feedback loop, that willingness to deploy and improve rather than perfect in isolation, saved lives immediately rather than waiting years for formal approval processes.

Design for your context, test in your context, iterate based on real use. The mothers using the device know whether it works better than any laboratory study can tell you. Trust them, listen to them, and build validation through demonstrated effectiveness, not just through controlled environments that don’t reflect how the device will actually be used.

Benjamin Cooper, 52, Medical Historian, United States
If you could rewrite one chapter of medical history to centre Global South contributions that have been erased, which specific innovation or discovery would you choose – and why that one over others? I’m curious whether you’d prioritise your own work, something from a contemporary you admired, or perhaps an even earlier figure whose obscurity troubles you most. What would including that chapter change about how we understand medicine’s development?

Benjamin, what a beautifully difficult question. If I could rewrite one chapter – just one – I think I’d choose the story of smallpox eradication, not to diminish what was achieved, but to tell it truthfully, acknowledging whose knowledge and labour made it possible.

The official narrative presents smallpox eradication as a triumph of Western scientific medicine and WHO coordination – Edward Jenner’s vaccine perfected by modern virology, deployed globally through Northern expertise and funding. That’s not false, exactly, but it’s profoundly incomplete, and the incompleteness does real harm to how we understand what effective global health requires.

Here’s what gets erased: smallpox was eliminated not primarily through sophisticated science, but through the grinding, dangerous, unglamorous work of tens of thousands of community health workers, vaccinators, and local physicians across Asia, Africa, and Latin America who went door-to-door, village-to-village, often facing suspicion, sometimes violence, working in brutal heat, navigating terrible roads, for wages that barely sustained their families.

In India alone – where some of the last endemic cases were found in the 1970s – hundreds of thousands of health workers conducted surveillance, traced contacts, vaccinated entire communities. They understood local languages, knew how to negotiate with village elders, recognised which households were hiding sick family members from government officials. They developed the “ring vaccination” strategy that ultimately proved decisive – not in a Geneva conference room, but in the field, responding pragmatically to the impossibility of vaccinating everyone simultaneously in regions with limited infrastructure.

Yet when the history is written, those workers are invisible. WHO gets credited. The international health authorities, the Northern epidemiologists who coordinated the campaign – they’re remembered. The actual humans who walked ten kilometres in monsoon rain to reach a village, who convinced frightened mothers to allow vaccination, who identified cases and traced their contacts – they’re reduced to “local health workers,” unnamed and unspecified.

Why does rewriting this chapter matter? Because it would fundamentally alter how we understand health interventions. It would show that the critical factor wasn’t vaccine technology – we’d had effective smallpox vaccine for decades – but community trust, local knowledge, culturally appropriate health education, and massive investment in primary health infrastructure staffed by people from the communities they served.

It would demonstrate that Global South health workers weren’t merely “implementing” Northern strategies – they were actively solving problems, adapting approaches, generating the practical knowledge that made eradication possible. They deserve recognition not as anonymous labour but as innovators and problem-solvers whose insights were as crucial as any laboratory discovery.

And crucially, rewriting this chapter would reveal that the conditions enabling success – sustained funding, political will, functional health systems reaching remote areas – are precisely what’s missing in our ongoing failures to eliminate other diseases. We haven’t eradicated measles not because we lack adequate vaccines, but because we lack the infrastructure and trust those smallpox workers built, often against considerable odds.

The absence of this honest history perpetuates several dangerous fictions. First, it suggests that medical breakthroughs emerge primarily from laboratories rather than from the interaction between technology and its deployment in complex social contexts. Second, it implies that Northern institutions are the natural leaders of global health, with Southern nations merely recipients of expertise, rather than recognising that effective health interventions require leadership and knowledge generation from the communities they serve. Third, it allows us to ignore the political economy questions: Who gets paid? Whose labour is valued? Whose knowledge counts as expertise?

I’d prioritise this chapter over my own story, honestly, because the smallpox eradication narrative affects how billions of dollars are allocated, how interventions are designed, who’s hired to lead health programmes. Getting that story right – centring the community health workers, acknowledging that successful global health requires massive investment in local capacity rather than importing Northern expertise – would change contemporary practice in ways that remembering my bamboo incubator, whilst personally gratifying, wouldn’t.

There’s a particular person I’d want included prominently: the unnamed Indian surveillance worker who, in 1975, identified what proved to be the last smallpox case in her district, traced all contacts, ensured they were vaccinated and monitored. She saved potentially thousands of lives through that meticulous work. I don’t know her name – it wasn’t recorded – and that’s exactly the problem. If the chapter were rewritten properly, we’d know her name. We’d know about the obstacles she faced, the strategies she employed, the decisions she made. She’d be recognised as a central figure in one of humanity’s greatest public health achievements, not a footnote.

What including that chapter would change is this: it would make visible the infrastructure required for health equity. It would show that technology alone never solved anything – it’s technology plus trained people, plus community trust, plus functional supply chains, plus political commitment, plus adequate compensation for health workers. That’s the lesson we desperately need contemporary health systems to learn, and it’s the lesson the current smallpox narrative obscures.

So yes, I’d rewrite that chapter, comprehensively, to tell the truth about whose work made eradication possible. Then perhaps we’d stop making the same mistakes – underfunding community health infrastructure, dismissing local knowledge, expecting imported solutions to work without deep community engagement – that prevent us from replicating that success with other preventable diseases.

Hanna Nowak, 41, Neonatologist, Poland
You practiced paediatrics for seventy years, witnessing the introduction of antibiotics, vaccines, neonatal intensive care technology, and eventually the internet. What single medical advance during your lifetime surprised you most – not because it was technically impressive, but because it fundamentally shifted what you thought was possible in saving children’s lives? And conversely, what problem did you expect would be solved by now that stubbornly persists?

Hanna, your question brings me both wonder and humility. Living through nearly a century of medicine means seeing miracles that would have seemed like magic at the start of my training. When I was a girl in prewar Manila, we lost infants to infections that now rarely make paediatricians lose sleep – a simple ear infection could become fatal. The sheer pace of progress, at times, took my breath away.

The single advance that most astonished me for what it allowed, rather than its technical sophistication alone, was the widespread use of antibiotics in children. I remember vividly the first time I witnessed a child with bacterial meningitis survive – when, a decade earlier, such a diagnosis was all but a death sentence. Penicillin arrived in the Philippines during the late stages of World War II, initially rationed for wounded soldiers, and only slowly found its way to our clinics. What a revelation! Previously, we relied on sulpha drugs, and before that, little more than prayer and skilled nursing. Watching a fever resolve and a delirious child return to themselves, eyes clearing, is a sight I never ceased to greet with gratitude.

What surprised me most wasn’t the discovery itself, but the way antibiotics unlocked possibilities we couldn’t have dared imagine. Children who would have died survived to thrive, and our wards, once heavy with the expectation of mourning, filled instead with recovery. It changed how I thought about hope. The presence of a new medicine is more than the sum0 of its chemical parts – it transforms the entire stance of clinic and family, turning what was resignation into anticipation of healing.

And yet – your second question cuts right to the bone – some problems I believed would be solved by now have lingered with startling endurance. Chief among them: malnutrition. Decade after decade, I watched children arrive, bellies swollen yet bodies wasted, their development cut short by something so painfully preventable as hunger. I grew up believing, as many did after the war, that industrialisation and agricultural modernisation would render such suffering obsolete. Surely, we thought, within a generation or two, no Filipino child would die for want of rice, fish, or clean water.

But poverty endured, and malnutrition proved cruelly persistent. Even with vaccines, even with antibiotics, the basic requirement – nourishing food reliably on every family’s table – remained elusive. Structural injustice, landlessness, unemployment, rising food prices: medicine could cure pneumonia, but it could not fill empty bowls. Sometimes, I would stand at the cot of an infant on a feeding programme and wonder – what is it all for, if health and hunger cannot be separated by medicine alone?

You are a neonatologist, Hanna – you know the fragile window of newborn life, how small things become large in their consequences. The fight against neonatal sepsis, against jaundice, against congenital anomalies has seen astonishing gains. But infant malnutrition, along with preventable diarrhoeal deaths, stubbornly persists in every generation on this archipelago and beyond. I am reminded, again and again, that the greatest breakthroughs must be matched with justice: fair wages, education, women able to space births, clean water in every barrio.

I marvel at what we have achieved, I truly do – and I grieve what we let persist. For every miracle antibiotic, thousands of children remain unrescued by the simple, predictable lack of food or safe water or a mother’s milk undisturbed by exhaustion. I suppose, if I am honest, I am surprised by both the miracles and their limitations. Medicine advances; the causes of suffering change more slowly than the cures. It’s humbling, and at times, a heavy lesson to absorb. But perhaps it keeps us striving – a reminder that while science grants us tools, it cannot by itself level the whole terrain. That calls for the work of all.

Reflection

Dr Fe del Mundo died of cardiac arrest on the 6th of August, 2011, at the age of ninety-nine, just three months shy of her centenary. She was buried with full honours at Libingan ng mga Bayani – the Heroes’ Cemetery – a recognition that came late but arrived nonetheless. In the years since her death, the Philippines has slowly begun to reckon with what it means to have produced a scientist of her calibre, whilst the international medical community continues, largely, to overlook her.

Sitting across from Dr del Mundo – or rather, reconstructing what such a conversation might have revealed – illuminates themes that extend far beyond one woman’s remarkable life. Her story is about ingenuity born of necessity, about the quiet perseverance required to practice medicine in contexts where resources are scarce and recognition scarcer still. It is about the structural invisibility of women’s contributions to science, particularly women working in the Global South, whose innovations are dismissed as “making do” rather than celebrated as design brilliance.

Throughout our conversation, Dr del Mundo’s perspective diverged in subtle but significant ways from the official historical record. Where commemorative accounts emphasise her self-sacrifice – selling her home to build a hospital, working until ninety-nine – she redirected attention to the infrastructural and political dimensions of her work. She was less interested in being remembered as a saint than in having her technical innovations and clinical insights recognised as legitimate scientific contributions. Where biographies frame her as “The Angel of Santo Tomas,” she spoke with pragmatic precision about training protocols, thermal dynamics, and differential diagnosis. The humanitarian narrative, whilst not false, obscures the intellectual rigour and engineering creativity that defined her practice.

There are gaps and uncertainties in the historical record that our conversation could only gesture towards rather than resolve. The exact design specifications of the bamboo incubator remain incompletely documented – no photographs of the original device survive, no technical drawings exist in archives. Dr del Mundo’s claim that she observed patterns suggestive of antibody-dependent enhancement in dengue cases during the 1950s is plausible given her clinical acumen, but without her original case notes – presumed lost or never systematically archived – we cannot verify the specifics of what she documented. Her publications in Philippine medical journals are difficult to access; many have not been digitised, and institutional libraries in Manila suffered damage during war and natural disasters. This archival fragility means that reconstructing her contributions requires piecing together fragments from oral histories, secondary sources, and the memories of physicians she trained.

The contested interpretation that emerges most sharply concerns her relationship with the Catholic Church and family planning. Official biographies often gloss over this tension or frame it as unproblematic, suggesting she somehow reconciled her faith with her advocacy. In our conversation, she acknowledged the irreconcilability more honestly – she chose, repeatedly, to prioritise women’s health over theological consistency, and lived with that dissonance rather than resolving it. This complexity makes her more, not less, admirable. It reveals the ethical negotiations required of women scientists working within conservative social structures, negotiations that male colleagues rarely faced with the same intensity.

Drawing connections between Dr del Mundo’s work and contemporary challenges reveals both progress and persistent failures. Dengue remains a major public health threat in the Philippines and across Southeast Asia; the disease she studied in the 1950s now affects an estimated 390 million people annually worldwide. Her observations about disease severity patterns in children with prior infections presaged the discovery of antibody-dependent enhancement, yet dengue vaccine development has stumbled precisely because of this immunological complexity. The first licensed dengue vaccine, Dengvaxia, was found to increase severe disease risk in seronegative individuals – exactly the pattern Dr del Mundo observed decades earlier in infants and children.

Neonatal care has advanced dramatically since she invented the bamboo incubator, yet the core challenge she addressed persists: approximately 2.4 million newborns die each year, many from preventable causes including hypothermia. Modern “low-cost” incubators designed for resource-limited settings often cost hundreds of dollars and require electricity – improvements over traditional hospital incubators, certainly, but still inaccessible to the poorest families in the most remote areas. Dr del Mundo’s insistence that appropriate technology must be reproducible by communities themselves, using locally available materials, remains a challenge to contemporary global health, which still tends to privilege patented devices over community-empowered solutions.

Childhood diarrhoeal diseases, which Dr del Mundo addressed through the BRAT diet and nutrition education, remain the second leading cause of death in children under five globally. Oral rehydration therapy – celebrated as one of the twentieth century’s greatest medical advances – has reduced mortality significantly, yet approximately 525,000 children still die annually from diarrhoea. Dr del Mundo would likely note that the problem isn’t a lack of effective interventions but rather failures of infrastructure, health education, and political will. The BRAT diet she developed is still recommended by paediatricians worldwide, though often in modified forms that include continued breastfeeding and age-appropriate foods alongside the traditional components. Most physicians using it remain unaware of its Filipino origins.

The afterlife of Dr del Mundo’s work has been fragmented and incomplete. Her hospital, the Fe del Mundo Medical Center in Quezon City, continues operating as a major paediatric institution, training physicians and serving thousands of patients annually. Many of the doctors she trained went on to leadership positions in Philippine healthcare, creating ripples of influence that extended her impact far beyond her direct practice. Yet internationally, her contributions have been rediscovered fitfully, primarily through the work of historians of science focused on postcolonial knowledge production and gender in STEM.

In recent years, Google’s 2018 Doodle honouring her 107th birthday brought renewed attention, particularly among younger Filipinos who’d never learned about her in school. Academic publications examining appropriate technology in global health occasionally cite her bamboo incubator as an early example of frugal innovation, though often without detailed analysis of its design or acknowledgment of its inventor’s broader contributions. The Medical Women’s International Association, which she led as president from 1962 to 1964, continues to recognise her legacy, though her name is less familiar than it should be even within that organisation.

What remains most striking about Dr del Mundo’s legacy is its quiet persistence despite inadequate recognition. The BRAT diet saves lives daily without attribution. The principle of integrating midwives into formal health systems – which she championed and implemented – is now standard practice in community health programmes worldwide, though she’s rarely credited as an early advocate. Her insistence that medical innovation must serve those with least access, that complexity isn’t inherently superior to simplicity, that physicians have an obligation to work within communities rather than merely for them – these principles animate contemporary movements for health equity, often without explicit reference to her pioneering work.

For young women pursuing science today, Dr del Mundo’s life offers both inspiration and caution. The inspiration is evident: she broke barriers, invented solutions, saved countless lives, and did so with remarkable persistence despite facing gender discrimination, geographic marginalisation, and resource constraints that would have defeated lesser spirits. She demonstrated that brilliance emerges from all contexts, that women are fully capable of transformative scientific innovation, and that dedication to serving marginalised communities is compatible with – indeed, can enhance – scientific excellence.

The caution is equally important: even a woman of Dr del Mundo’s extraordinary achievements faced erasure. Her story reveals that individual excellence, whilst necessary, isn’t sufficient to overcome structural barriers that render women’s contributions, particularly those of women from the Global South, invisible. She published extensively, trained hundreds of physicians, founded institutions, received her nation’s highest scientific honour – and still, much of the world has never heard of her. This should trouble us. It should prompt questions about whose knowledge we preserve, whose innovations we celebrate, and whose names appear in textbooks.

Visibility matters. Mentorship matters. But so does changing the systems that determine what counts as “important” science, which journals are considered prestigious, which institutions are seen as producing legitimate knowledge. Dr del Mundo’s legacy challenges us to examine why appropriate technology generates no Nobel prizes, why preventive medicine is valued less than curative interventions, why work conducted in Manila or Nairobi is treated as “regional” whilst work from Boston or Stockholm is deemed “universal.”

For contemporary women in science, particularly those from underrepresented backgrounds, Dr del Mundo’s story offers a complex inheritance. On one hand, it demonstrates that barriers can be overcome, that meaningful work can be accomplished even in difficult circumstances, and that impact needn’t wait for perfect conditions or official permission. On the other hand, it reveals that even overcoming those barriers doesn’t guarantee recognition, that the work of documenting and preserving one’s contributions matters as much as the contributions themselves, and that individual achievement must be paired with collective efforts to transform the structures that perpetuate invisibility.

Perhaps the most powerful lesson from Dr del Mundo’s life is this: the worth of scientific work isn’t measured by how widely it’s celebrated, but by whom it serves. She chose, repeatedly, to prioritise accessible solutions over patentable inventions, to serve poor families over prestigious institutions, to work in Manila over staying in Boston. Those choices cost her international recognition but multiplied her impact on the lives that mattered most to her – Filipino children who might otherwise have died of preventable causes.

In an era when science is increasingly shaped by commercial interests, publication metrics, and competition for funding, Dr del Mundo’s commitment to service over recognition feels both antiquated and urgently necessary. We need scientists driven by her ethos: that the point isn’t personal fame but collective wellbeing, that innovations saving millions without generating patents are more valuable than breakthroughs benefiting thousands whilst generating profits, and that medicine’s highest calling is meeting people where they are with solutions they can use.

As I close this conversation – fictional though it is, grounded in historical truth – I’m left thinking about the thousands of women scientists whose stories we’ll never recover, whose innovations disappeared because no one thought to document them, whose names were omitted from papers they contributed to, whose ideas were attributed to male colleagues. Dr del Mundo’s partial visibility, fragile as it is, represents a kind of victory. But it shouldn’t. A woman of her brilliance, dedication, and impact should be as recognisable as Jonas Salk or Alexander Fleming. That she isn’t tells us more about the prejudices embedded in how we remember science than about the value of her contributions.

To young women considering careers in science: Dr del Mundo’s life demonstrates that the path is possible, that your perspective matters, that your contributions have value regardless of whether history remembers them. But it also demands that you work collectively to change the systems that made her invisible. Publish in accessible venues. Document your methods thoroughly. Build networks that amplify Global South voices. Demand that your institutions value community impact alongside academic prestige. Mentor younger women and ensure their contributions are credited. Make the bamboo incubators of your generation impossible to forget.

Dr del Mundo lived ninety-nine years, practised medicine for seven decades, and transformed countless lives with ingenuity born from observing what communities needed and determining how to meet those needs with materials at hand. Her legacy lives in every premature infant kept warm by improvised incubators, every child rehydrated through simple dietary intervention, every mother taught to space pregnancies safely, every physician trained to see medical practice as service rather than status. That legacy deserves to be shouted from every medical school, celebrated in every paediatrics textbook, and held up as exemplifying what science can achieve when brilliance meets compassion and humility.

She saved millions with bamboo and hot water. She proved genius doesn’t need a plug – only purpose, ingenuity, and the courage to trust that communities know what they need if we’re willing to listen. That lesson remains as vital today as it was in 1941 when she first placed hot water bottles between nested baskets and discovered that warmth, reliably maintained, could mean the difference between death and life. May we remember her name. May we honour her work. And may we build a world where the next Fe del Mundo isn’t forgotten.

Who have we missed?

This series is all about recovering the voices history left behind – and I’d love your help finding the next one. If there’s a woman in STEM you think deserves to be interviewed in this way – whether a forgotten inventor, unsung technician, or overlooked researcher – please share her story.

Email me at voxmeditantis@gmail.com or leave a comment below with your suggestion – even just a name is a great start. Let’s keep uncovering the women who shaped science and innovation, one conversation at a time.

Editorial Note: The conversation you have just read is a dramatised reconstruction, not a transcript of an actual interview. Dr Fe del Mundo died on the 6th of August, 2011, and this dialogue has been carefully constructed from historical sources including her published articles, biographical accounts, testimonies from colleagues and patients, archival materials from the Fe del Mundo Medical Center, and documentation of her awards and achievements. Whilst every effort has been made to ground her responses in documented facts about her work, beliefs, and historical context, the specific words, anecdotes, and reflections attributed to her here are interpretive – shaped by what the historical record suggests about her character, priorities, and perspective, but not direct quotations unless otherwise cited.

This approach allows us to present Fe del Mundo’s technical innovations, clinical insights, and philosophical positions in her own voice, making her contributions more immediate and accessible to contemporary readers. However, readers should understand that this is a work of informed imagination rather than strict historical documentation. Where possible, her responses reflect language patterns, medical terminology, and cultural references appropriate to her time and place, drawing on Philippine English usage and the speech rhythms evident in her recorded interviews and published writings. The supplementary questions and answers similarly represent plausible exchanges based on her documented expertise and the concerns she expressed throughout her career, but they are constructed rather than transcribed. We have chosen this format because Fe del Mundo’s story deserves to be heard in full dimension – not merely as a list of achievements, but as the voice of a brilliant, complex woman whose insights remain urgently relevant to global health today.

Bob Lynn | © 2025 Vox Meditantis. All rights reserved.