For all following my blog, I am behind in my writing since we have been so busy this last little while. I am working on a couple more entries, so even though we are flying back to Canada today, please stay posted!
Coming soon:
Struggle for Reproductive Rights in the Philippines: Contradicitons and Clashes
How a National Liberation Struggle Raised the Peasants of a Nation: Reflections on the contrast between Vietnam and the Philippines
Making Sense of It All: The final assessments of 7 months of Solidarity!
Saturday, November 22, 2008
Tuesday, October 21, 2008
Masskara: Masking the Many Faces of Urban Poverty
Martha, October 21, 2008
It was ironic that our Bacolod urban poor integration fell on the final weekend of the Bacolod Masskara festival; ‘Masskara’ meaning ‘many faces’ referring to the positive outlook of the Bacolod residents, smiling in the face of adversity; the festival where revellers don smiling masks and dance in the streets, ignoring the cares and the woes of daily life; a festival whose budget exceeds P 5 million while thousands face demolition and homelessness.
During these past few days I witnessed how the city of Bacolod throws a grand festival to distract the attention of tourists and locals alike from the true plight of the majority of residents of Bacolod. The 41 of 61 Barangays that live in poverty; the residents of the approximately 40,000 homes targeted for demolition by the year 2010. The thousands of youth whose lives are a daily struggle for survival, without education, without livelihood, without a place in society.
Struggles for Land and Housing
Many urban slum residents fled to Bacolod from the countryside due to O’plan Thunderbolt, the counterinsurgency operations that cleared the countryside of the ‘water’ (the people) to force out the ‘fish’ (the New People’s Army or NPA). While O’plan Thunderbolt was not successful in squashing the NPA, it was successful in forcing thousands of farmers away from their lands and into the squalor of urban poverty, with no option but to squat public lands in an attempt to survive. While the farmers were displaced from their lands, mining corporations moved in and claimed the land for extraction of minerals, including copper and gold. The end result? The poor are displaced and the corporations are lining their pockets from the misery of the people.
To add insult to injury, the very project that will see many homes demolished is a P 52 million international sea port in Bacolod funded by GMA to facilitate the export of raw mineral resources and agricultural products from the plunder of the countryside. The remainder of the homes to be demolished are making way for real estate and tourist resort expansion. It seems particularly unjust that the Bacolod 2010 Comprehensive Land Use Development Plan has earmarked thousands of squatter homes for demolition with no feasible relocation plan for those who will lose their homes.
The Myth of Relocation
It is law in the Philippines that in order to gain a writ of demolition for squatters, whether on public or private lands, the government must provide a site for relocation. Yet, it is explained to me that many judges are corrupt, friendly with the land owners, or simply are not up to date about the law, and so demolition orders are given without adequate relocation plans.
In the case of some squatter communities, particularly those on the future port site, their relocation lands are inland, far from the seashore and the source of their livelihood in fishing or in working the ports. In the case of other squatter communities, the plan of the landlord is to abandon development and garner a profit selling the land to the tenants through the government-mediated ‘Community Mortgage Program’ or CMP. The CMP is not a feasible plan for the urban poor, who struggle just to cover the basics of food, clothes, and transportation to work; if enough remains it goes to the education of their children. If someone gets sick, it is a major financial crisis that puts the family on the brink of starvation, and often the sick die from lack of health care. These families simply cannot afford to pay a 25-year mortgage for housing.
The condition of the slums is appalling, with few government services for the poor: no potable water, no sanitation, no waste disposal, open pit latrines flowing into the ocean where children bathe and play, sewage running in the ditches, garbage littering the ground, stagnant water providing dengue-carrying mosquitoes ample breeding ground. In many communities, residents have struggled and won some services, such as a public school for elementary students, and wells to provide clean water for washing and bathing (but not safe for drinking since the wells are below sea level). But these few services come as the result of a consolidated effort of the local squatter organizations.
How to Earn a Living?
The residents of the urban poor communities struggle daily to earn an income for their families. Vending, driving tricycles or jeepneys, working on the ports as haulers or day labourers, fishing and collecting shellfish, washing clothes in middle class suburbs, working construction, running small sari sari stores, and even working for the government in low level positions. Every family member must work to contribute, even the children, who help prepare the shellfish for market, wash clothes, assist in sari sari stores, and a myriad of jobs for the income of the family.
Without access to social services and government health insurance there is simple not enough to go around; what is earned is not enough to make ends meet. Many youth turn to prostitution and the drug trade to survive – a product of economic exclusion and a sad testimony of injustice.
In Sickness until Death
The natural outcome of such living and working conditions is ill-health, a physical, a financial, and an emotional crisis for entire families.
Many suffer and some die from malnutrition and perpetual hunger, ulcers, skin infections, diarrhea, respiratory infections including tuberculosis, hepatitis A and B, undiagnosed and untreated diabetes and hypertension, liver cirrhosis, and kidney failure – just to name a few.
I heard many stories of families who struggled and saved to gain title for their small plot of land and their meagre house, and then a family member fell ill with the result of all savings lost, and all family members working to pay health care debts.
The ultimate price of urban poverty is the life of the poor.
Urban Uprising
While the picture I painted in this blog entry is one of a loss of hope, the strength, vitality and resolve of the urban poor is astounding. I took such great inspiration and drew many lessons from the many Bacolod affiliate member organizations of Kadamay, the national umbrella organization of the urban poor.
Do not think that the urban poor are meek victims of capitalism and imperialism; do not be fooled by their poverty, for it is a spark against the tinderbox of injustice! Eventually the smouldering social volcano that is Negros will erupt.
I am invigorated by the organizing that I witnessed in these past few days. Now I am almost ready to go home to Canada and take up my work with the Alliance for People’s Health and the Organizing Centre for Social and Economic Justice.
One last stop for us: the urban poor in Manila and the situation for urban poor home deliveries.
Stay posted for upcoming entries on the organizing lessons I have learned and the struggles for reproductive health in the Philippines!
It was ironic that our Bacolod urban poor integration fell on the final weekend of the Bacolod Masskara festival; ‘Masskara’ meaning ‘many faces’ referring to the positive outlook of the Bacolod residents, smiling in the face of adversity; the festival where revellers don smiling masks and dance in the streets, ignoring the cares and the woes of daily life; a festival whose budget exceeds P 5 million while thousands face demolition and homelessness.
During these past few days I witnessed how the city of Bacolod throws a grand festival to distract the attention of tourists and locals alike from the true plight of the majority of residents of Bacolod. The 41 of 61 Barangays that live in poverty; the residents of the approximately 40,000 homes targeted for demolition by the year 2010. The thousands of youth whose lives are a daily struggle for survival, without education, without livelihood, without a place in society.
Struggles for Land and Housing
Many urban slum residents fled to Bacolod from the countryside due to O’plan Thunderbolt, the counterinsurgency operations that cleared the countryside of the ‘water’ (the people) to force out the ‘fish’ (the New People’s Army or NPA). While O’plan Thunderbolt was not successful in squashing the NPA, it was successful in forcing thousands of farmers away from their lands and into the squalor of urban poverty, with no option but to squat public lands in an attempt to survive. While the farmers were displaced from their lands, mining corporations moved in and claimed the land for extraction of minerals, including copper and gold. The end result? The poor are displaced and the corporations are lining their pockets from the misery of the people.
To add insult to injury, the very project that will see many homes demolished is a P 52 million international sea port in Bacolod funded by GMA to facilitate the export of raw mineral resources and agricultural products from the plunder of the countryside. The remainder of the homes to be demolished are making way for real estate and tourist resort expansion. It seems particularly unjust that the Bacolod 2010 Comprehensive Land Use Development Plan has earmarked thousands of squatter homes for demolition with no feasible relocation plan for those who will lose their homes.
The Myth of Relocation
It is law in the Philippines that in order to gain a writ of demolition for squatters, whether on public or private lands, the government must provide a site for relocation. Yet, it is explained to me that many judges are corrupt, friendly with the land owners, or simply are not up to date about the law, and so demolition orders are given without adequate relocation plans.
In the case of some squatter communities, particularly those on the future port site, their relocation lands are inland, far from the seashore and the source of their livelihood in fishing or in working the ports. In the case of other squatter communities, the plan of the landlord is to abandon development and garner a profit selling the land to the tenants through the government-mediated ‘Community Mortgage Program’ or CMP. The CMP is not a feasible plan for the urban poor, who struggle just to cover the basics of food, clothes, and transportation to work; if enough remains it goes to the education of their children. If someone gets sick, it is a major financial crisis that puts the family on the brink of starvation, and often the sick die from lack of health care. These families simply cannot afford to pay a 25-year mortgage for housing.
The condition of the slums is appalling, with few government services for the poor: no potable water, no sanitation, no waste disposal, open pit latrines flowing into the ocean where children bathe and play, sewage running in the ditches, garbage littering the ground, stagnant water providing dengue-carrying mosquitoes ample breeding ground. In many communities, residents have struggled and won some services, such as a public school for elementary students, and wells to provide clean water for washing and bathing (but not safe for drinking since the wells are below sea level). But these few services come as the result of a consolidated effort of the local squatter organizations.
How to Earn a Living?
The residents of the urban poor communities struggle daily to earn an income for their families. Vending, driving tricycles or jeepneys, working on the ports as haulers or day labourers, fishing and collecting shellfish, washing clothes in middle class suburbs, working construction, running small sari sari stores, and even working for the government in low level positions. Every family member must work to contribute, even the children, who help prepare the shellfish for market, wash clothes, assist in sari sari stores, and a myriad of jobs for the income of the family.
Without access to social services and government health insurance there is simple not enough to go around; what is earned is not enough to make ends meet. Many youth turn to prostitution and the drug trade to survive – a product of economic exclusion and a sad testimony of injustice.
In Sickness until Death
The natural outcome of such living and working conditions is ill-health, a physical, a financial, and an emotional crisis for entire families.
Many suffer and some die from malnutrition and perpetual hunger, ulcers, skin infections, diarrhea, respiratory infections including tuberculosis, hepatitis A and B, undiagnosed and untreated diabetes and hypertension, liver cirrhosis, and kidney failure – just to name a few.
I heard many stories of families who struggled and saved to gain title for their small plot of land and their meagre house, and then a family member fell ill with the result of all savings lost, and all family members working to pay health care debts.
The ultimate price of urban poverty is the life of the poor.
Urban Uprising
While the picture I painted in this blog entry is one of a loss of hope, the strength, vitality and resolve of the urban poor is astounding. I took such great inspiration and drew many lessons from the many Bacolod affiliate member organizations of Kadamay, the national umbrella organization of the urban poor.
Do not think that the urban poor are meek victims of capitalism and imperialism; do not be fooled by their poverty, for it is a spark against the tinderbox of injustice! Eventually the smouldering social volcano that is Negros will erupt.
I am invigorated by the organizing that I witnessed in these past few days. Now I am almost ready to go home to Canada and take up my work with the Alliance for People’s Health and the Organizing Centre for Social and Economic Justice.
One last stop for us: the urban poor in Manila and the situation for urban poor home deliveries.
Stay posted for upcoming entries on the organizing lessons I have learned and the struggles for reproductive health in the Philippines!
Mining is Murder: Mining, Militarization and Corporate Plunder in the Philippines
Aiyanas Ormond: October 18, 2008
Standing at the seashore looking out over the blue expanse towards the distant islands of Palawan, Tatay Putot scoops a handful of fine brown earth from the shallows. This is evidence, he says, of an environmental disaster that has already begun with the latest Philex Gold exploration here in south-western Negros. The Canadian mining company is only in the very beginning stages of its operations here, having sunk only 20 of up to 96 exploratory holes, but already the Bacuyangan river runs brown into the sea bearing silt from the mines and the earth stripped away from the mountaintops. The potential impact on the local people is concerning – the rice farmers of the fertile valley rely on the river water to irrigate their crops while the coastal communities rely on the sea for their livelihood.
We have accompanied Tatay Putot, an organic farmer and leader with the local farmer’s organization, to see first hand the impacts of the mining exploration on the coastal fisherfolk communities. A group of fisherfolk gather to meet with us outside a small house, just meters from the sea. They tell us that the catch is very bad this year, and point to the brown beach, clogged with fine silt as the cause. Joking with one of the mangingisda (fishermen) that last year he borrowed money from him but this year it will be the other way around. Everyone laughs in the usual Filipino way, but the fisherfolk are no longer laughing as they explain that their children are going hungry now because the catch is so little.
Across the highway and a little inland we visit with members of the irrigators association, small scale rice farmers who irrigate their fields from the Bacuyangan river. The association, representing all of the 100 or so households in the community has taken a clear position against the Philex mine. Based on previous experience in the region, they are certain that the chemicals and heavy metals involved in the mining process will end up in the river, and as farmers they know that what is in the water ends up in the rice.
Mountain Journey
At some point between fording the river, climbing a 15 foot shear rock face and trudging through bamboo thickets which cut at the our bare arms and faces, Martha turns to me, her face red and shirt soaked in sweat, and says “I can’t make it”. We are approaching the Philex mine by the ‘back door’ in an attempt to avoid the military and security. They have stopped previous fact-finding missions from reaching the mine site.
Martha does make it, and even little Billy survives the three hour hike with only a few tears and a short stint on my back. As we approach the drilling site we begin to see evidence of the erosion – areas where the mountain is stripped bare of its plentiful vegetation and the mud runs down into the lowland streams and creeks. The company has taken mandatory measures to try to mitigate the erosion, but from what we can see the sand-bagging and planted grasses are ineffectual against the combined force of gravity and the torrential rains that are almost daily at this time of year.
We need to clamber up another slippery steep incline to reach one of the actual drilling sites, but we manage to get there and the workers, reticent at first, become helpful and friendly as the local organizers begin talking with them. Billy gets right in there to have a look at the machinery.
The operation is impressive, especially since we have seen almost no real industrial equipment aside from the rare tractor since leaving the city. Yet here in the middle of the country side, where farmers still plough by carabao and the major means of mass transportation is the hable-hable (motorbike), we find this multi-million dollar piece of equipment. Martha and I talk about the implications of this. Like all the communities we’ve visited there is real need for capital here. Farmers need tractors and threshers and mills for their rice production, fisherfolk need access to refrigeration and both groups need roads and transportation to get their products to market. But there is virtually no money available from the government, corporations or mainstream NGOs for this kind of grassroots development. But if there is gold to be had... The history of mining in the Philippines indicates that the mining companies will come in for a few years with lots of capital, employ a few local people, and then disappear, leaving nothing but displacement, militarization and environmental destruction.
The workers here at the drilling site show us the 240 meter hole they have drilled into the side of the mountain, and a handsome young engineer makes Billy’s week by giving him a piece of volcanic stone. They also show us their safety equipment, which to us looks inadequate for this kind of heavy industrial operation. Local men are happy just to have a job in the prevailing context of poverty, where millions of Filipinos have to travel overseas for work. Unfortunately the lifespan of these mines is short. The nearby Philex Vista Allegre gold and copper mine operated for only about 5 years. It closed in 1997, just as the workers began to unionize (though this was only one factor in the closure of the mine). Retrenched workers from the previous mine are still in the courts trying to get compensation for a wage structure which paid locals significantly less than workers doing the same jobs who were brought in from other areas of the Philippines or abroad.
The Military and the Monetary
We were able to get the mining site without any interference from the military, however militarization in the community was evident. In addition to the Armed Forces of the Philippines detachment at the mine site, we also observed elements of the Philippine National Police’s Regional Mobile Group, an assault rifle carrying quasi-military group, in the community. And like in the other areas we’ve visited, organizers with the farmers organization, including our host Tatay Putot, have been branded as ‘communists’ and ‘rebels’ and face harassment and intimidation from the military.
This is a pattern in the Philippines where, as part of the policy of extrajudicial killings under the GMA regime, 21 environmental activists have been murdered in the last 7 years - 15 of them having been directly involved in anti-mining activist. The assassinations of activists is an just the most reprehensible aspect of a generalized campaign of fear waged against communities that resist the corporate profit-centred ‘development’ model being imposed by GMA and her political masters – the IMF, U.S. and big business in Canada, the U.S. and other rich countries.
Rather than asking why there is so much resistance to the large foreign owned mining operations in the country, the GMA regime is actively encouraging the mining companies to set up their own paramilitary groups saying, “the security of mining operations should be a common responsibility of mining firms, the government and local communities”.
In this region of Sipalay where the Philex exploration is happening the link between mining and militarization of the countryside is longstanding. From 1988 to 1992 under the Aquino regime a massive military and counter-insurgency program was mounted in the area as Operation Thunderbolt. The mountainous areas were virtually cleared of people under the conception that if you want to catch the fish (the guerrillas) you need to drain the pond (the communities that support them). The military, paramilitaries and anti-communist fanatic groups like the ‘greenan’ (known by their green uniforms) were mobilized in the area. At that time the military paid a bounty for the ears of supposed rebels, and groups like the greenan did not distinguish between real guerrillas and those who might sympathize with them or share common ideals.
The clearance of the population from the mountainous areas made possible the first large scale mining which had been impossible previously due to strength of people’s organization and the presence of the New People’s Army. Thus the military operation fulfilled the dual (and connected) purpose of suppressing people’s organized movement for meaningful social change, and creating conditions for profit for large multi-national mining corporations and their local “partners”, including the government.
The current situation looks very much like history repeating, with militarization, human rights abuses and a general climate of fear accompanying large scale open pit mining. And this is just the tip of the iceberg. The Philex claim itself is more than 4,000 hectares, but fully ¾ of Sipalay and a large part of the entire land-mass of Negros is covered by mining claims. If significant gold is found, the mining corporations are poised to strip this island bare.
Development or Plunder
Like so much of the ‘development’ under capitalist globalization, mining only seems to develop the bank accounts of the rich and leaves very little for the people. On our way back to Bacolod we stopped at the now closed Mercalor mine in San Jose. The huge open pit mine and the bare hillsides are still there but with no indication of any kind of sustained prosperity. Quite the opposite, there is strong sense of industrial depression here. Rusting buildings and shut gates, a good road with very not much traffic, poor farms and a town with little in the way of productive activity. This model of ‘development’, pushed by the international capitalist establishment, offers no way out from the poverty which is the legacy of more than 400 years of colonization, feudalism and foreign domination.
But this is after all, a very rich country. Aside from the fertility of the soil, the plentiful fish in the sea and the wealth of human capacity and creativity, there are vast mineral resources. If all these resources and capacities were to be harnessed for a program of development that put the welfare of the people first, that broke the cycle of foreign debt payments that suck up 70% of the national budget, and that shrugged off U.S. economic and military domination – so much would be possible. This is the hope of the national democratic struggle – an end the exploitation and plunder which has persisted under more than 400 years of colonization and foreign domination.
Standing at the seashore looking out over the blue expanse towards the distant islands of Palawan, Tatay Putot scoops a handful of fine brown earth from the shallows. This is evidence, he says, of an environmental disaster that has already begun with the latest Philex Gold exploration here in south-western Negros. The Canadian mining company is only in the very beginning stages of its operations here, having sunk only 20 of up to 96 exploratory holes, but already the Bacuyangan river runs brown into the sea bearing silt from the mines and the earth stripped away from the mountaintops. The potential impact on the local people is concerning – the rice farmers of the fertile valley rely on the river water to irrigate their crops while the coastal communities rely on the sea for their livelihood.
We have accompanied Tatay Putot, an organic farmer and leader with the local farmer’s organization, to see first hand the impacts of the mining exploration on the coastal fisherfolk communities. A group of fisherfolk gather to meet with us outside a small house, just meters from the sea. They tell us that the catch is very bad this year, and point to the brown beach, clogged with fine silt as the cause. Joking with one of the mangingisda (fishermen) that last year he borrowed money from him but this year it will be the other way around. Everyone laughs in the usual Filipino way, but the fisherfolk are no longer laughing as they explain that their children are going hungry now because the catch is so little.
Across the highway and a little inland we visit with members of the irrigators association, small scale rice farmers who irrigate their fields from the Bacuyangan river. The association, representing all of the 100 or so households in the community has taken a clear position against the Philex mine. Based on previous experience in the region, they are certain that the chemicals and heavy metals involved in the mining process will end up in the river, and as farmers they know that what is in the water ends up in the rice.
Mountain Journey
At some point between fording the river, climbing a 15 foot shear rock face and trudging through bamboo thickets which cut at the our bare arms and faces, Martha turns to me, her face red and shirt soaked in sweat, and says “I can’t make it”. We are approaching the Philex mine by the ‘back door’ in an attempt to avoid the military and security. They have stopped previous fact-finding missions from reaching the mine site.
Martha does make it, and even little Billy survives the three hour hike with only a few tears and a short stint on my back. As we approach the drilling site we begin to see evidence of the erosion – areas where the mountain is stripped bare of its plentiful vegetation and the mud runs down into the lowland streams and creeks. The company has taken mandatory measures to try to mitigate the erosion, but from what we can see the sand-bagging and planted grasses are ineffectual against the combined force of gravity and the torrential rains that are almost daily at this time of year.
We need to clamber up another slippery steep incline to reach one of the actual drilling sites, but we manage to get there and the workers, reticent at first, become helpful and friendly as the local organizers begin talking with them. Billy gets right in there to have a look at the machinery.
The operation is impressive, especially since we have seen almost no real industrial equipment aside from the rare tractor since leaving the city. Yet here in the middle of the country side, where farmers still plough by carabao and the major means of mass transportation is the hable-hable (motorbike), we find this multi-million dollar piece of equipment. Martha and I talk about the implications of this. Like all the communities we’ve visited there is real need for capital here. Farmers need tractors and threshers and mills for their rice production, fisherfolk need access to refrigeration and both groups need roads and transportation to get their products to market. But there is virtually no money available from the government, corporations or mainstream NGOs for this kind of grassroots development. But if there is gold to be had... The history of mining in the Philippines indicates that the mining companies will come in for a few years with lots of capital, employ a few local people, and then disappear, leaving nothing but displacement, militarization and environmental destruction.
The workers here at the drilling site show us the 240 meter hole they have drilled into the side of the mountain, and a handsome young engineer makes Billy’s week by giving him a piece of volcanic stone. They also show us their safety equipment, which to us looks inadequate for this kind of heavy industrial operation. Local men are happy just to have a job in the prevailing context of poverty, where millions of Filipinos have to travel overseas for work. Unfortunately the lifespan of these mines is short. The nearby Philex Vista Allegre gold and copper mine operated for only about 5 years. It closed in 1997, just as the workers began to unionize (though this was only one factor in the closure of the mine). Retrenched workers from the previous mine are still in the courts trying to get compensation for a wage structure which paid locals significantly less than workers doing the same jobs who were brought in from other areas of the Philippines or abroad.
The Military and the Monetary
We were able to get the mining site without any interference from the military, however militarization in the community was evident. In addition to the Armed Forces of the Philippines detachment at the mine site, we also observed elements of the Philippine National Police’s Regional Mobile Group, an assault rifle carrying quasi-military group, in the community. And like in the other areas we’ve visited, organizers with the farmers organization, including our host Tatay Putot, have been branded as ‘communists’ and ‘rebels’ and face harassment and intimidation from the military.
This is a pattern in the Philippines where, as part of the policy of extrajudicial killings under the GMA regime, 21 environmental activists have been murdered in the last 7 years - 15 of them having been directly involved in anti-mining activist. The assassinations of activists is an just the most reprehensible aspect of a generalized campaign of fear waged against communities that resist the corporate profit-centred ‘development’ model being imposed by GMA and her political masters – the IMF, U.S. and big business in Canada, the U.S. and other rich countries.
Rather than asking why there is so much resistance to the large foreign owned mining operations in the country, the GMA regime is actively encouraging the mining companies to set up their own paramilitary groups saying, “the security of mining operations should be a common responsibility of mining firms, the government and local communities”.
In this region of Sipalay where the Philex exploration is happening the link between mining and militarization of the countryside is longstanding. From 1988 to 1992 under the Aquino regime a massive military and counter-insurgency program was mounted in the area as Operation Thunderbolt. The mountainous areas were virtually cleared of people under the conception that if you want to catch the fish (the guerrillas) you need to drain the pond (the communities that support them). The military, paramilitaries and anti-communist fanatic groups like the ‘greenan’ (known by their green uniforms) were mobilized in the area. At that time the military paid a bounty for the ears of supposed rebels, and groups like the greenan did not distinguish between real guerrillas and those who might sympathize with them or share common ideals.
The clearance of the population from the mountainous areas made possible the first large scale mining which had been impossible previously due to strength of people’s organization and the presence of the New People’s Army. Thus the military operation fulfilled the dual (and connected) purpose of suppressing people’s organized movement for meaningful social change, and creating conditions for profit for large multi-national mining corporations and their local “partners”, including the government.
The current situation looks very much like history repeating, with militarization, human rights abuses and a general climate of fear accompanying large scale open pit mining. And this is just the tip of the iceberg. The Philex claim itself is more than 4,000 hectares, but fully ¾ of Sipalay and a large part of the entire land-mass of Negros is covered by mining claims. If significant gold is found, the mining corporations are poised to strip this island bare.
Development or Plunder
Like so much of the ‘development’ under capitalist globalization, mining only seems to develop the bank accounts of the rich and leaves very little for the people. On our way back to Bacolod we stopped at the now closed Mercalor mine in San Jose. The huge open pit mine and the bare hillsides are still there but with no indication of any kind of sustained prosperity. Quite the opposite, there is strong sense of industrial depression here. Rusting buildings and shut gates, a good road with very not much traffic, poor farms and a town with little in the way of productive activity. This model of ‘development’, pushed by the international capitalist establishment, offers no way out from the poverty which is the legacy of more than 400 years of colonization, feudalism and foreign domination.
But this is after all, a very rich country. Aside from the fertility of the soil, the plentiful fish in the sea and the wealth of human capacity and creativity, there are vast mineral resources. If all these resources and capacities were to be harnessed for a program of development that put the welfare of the people first, that broke the cycle of foreign debt payments that suck up 70% of the national budget, and that shrugged off U.S. economic and military domination – so much would be possible. This is the hope of the national democratic struggle – an end the exploitation and plunder which has persisted under more than 400 years of colonization and foreign domination.
Wednesday, October 1, 2008
View from the Mountains: Final Kalabaklabakan Entry
September 30, 2008
As I sit and write this final Kalabaklabakan blog entry the rain pours down again, I wonder if this is the start of number 4 in a series of 12 active typhoons. I hope that it rains today and is sunny tomorrow, since we head down the mountain tomorrow; I hope that the power holds steady at least until after bedtime! Travel is so difficult in the mountains to begin with, but after days of storm, the mud is ridiculous – I had no choice but to ditch my useless shoes and go barefoot, or land on my butt deep in the palay!
The weather leaves me feeling really exhausted so this blog entry will be scattered. Yet there are a few things I want to document.
Pregnancy and Hypertension in the Mountains!
First, this month was one of challenging management of pregnancy and birth. Hypertension and pre-ecclampsia/ecclampsia is a major cause of maternal mortality in the Philippines. In September Nanay and I had two very different cases: one patient admitted to hospital and delivered prematurely due to unmanageable and severe hypertension with baby number 12; one woman relatively mildly hypertensive (I suspect chronic) managed by me and Nanay at home on daily rest periods and frequent BP and urine monitoring. Good outcomes in both cases, after a great deal of worry on my part! In the mountains, hypertension in pregnancy is no easy matter; there is no such thing as ‘outpatient’ management – either you’re ‘severe’ and in-hospital (if you’re lucky enough to have your BP monitored) or you’re at home in the mountains. Being at home in the mountains essentially means no care at all, while being in hospital usually means selling your animals to pay the bills, pulling your older kids out of school to care for the younger kids; making tremendous financial sacrifices, bearing a lot of emotional stress and strain.
I was glad to be there for our mildly hypertensive patient, and Nanay and I hiked to her home every few days to check her BP, dip her urine, discuss warning signs, listen to baby, and encourage resting left lateral, which really did bring her BP down nicely. She was open to my stretch and sweeps, and was very happy when her baby was delivered, a strapping boy weighing in at 3.4 kg! (No IUGR in this case). And yet she remains hypertensive – chronic. Our severely hypertensive patient is back home with her daughter who weighs in at 1.5 kg (growth restricted and premature) and a handful of 5mg bite-and-swallow nifidipine capsules she was instructed to take once per day; the meds are not controlling her hypertension – last reading I took at home was, once again, 190/110. I read and re-read the BCRCP, SOGC, and WHO guidelines I brought with me, and wrote out a couple of medication suggestions, but now Nanay has the challenge of finding the appropriate medicines for management and monitoring the effectiveness and dosage, and the families have the burden of affording such medicines.
Struggle for Health = Struggle for Justice
It is true what Mammy tells us, that the struggle for health in Kalabaklabakan is not just a struggle for physical and mental health, but for social equality, for equitable land distribution, for economic justice. Families can’t achieve physical and mental health when they can’t afford to eat regular meals, their children go hungry, their clothing is inadequate, their homes lack water, electricity and sanitation, their farming techniques suffer from forced underdevelopment, the landlords demand a share of the products of the peasant labour, the multinationals and agricultural cartels fix product prices, and the government provides not a single iota of respite from the toil and travails of rural life.
The tragedy of Grace and Randy’s twins plays out over and over again in the mountains of Guihulgnan, in different form. Like with little 6-month Jonmark, who I tentatively diagnosed as Down’s syndrome, suffering chronic lung infections from what I believed was a congenital heart malformation. His parents willingly took him to the Guihulgnan hospital, where they spent over P 5,000 in consultations and diagnostic tests to be told that he has Down’s and a malformed heart. Then they were referred to San Carlos, to a bigger hospital, for more and expensive diagnostics, such as an echocardiogram, spending another P 10,000. Now they are referred to Cebu City on Cebu Island, for specialist care and a surgery when Jonmark is old enough for open heart surgery. This will cost hundreds of thousands of pisos; where will the money come from? The doctor in San Carlos suggested the parents travel to Dumaguete City to request some funds from the Congresswoman there. What little public health care that exists is completely undermined by rapidly expanding IMF-WB-WTO dictated privatization and gross government corruption. Can you imaging having to beg a politician for health care for your infant son? Even if they get the funds, it will not be enough to pay for the surgery.
In any case, I am working on a small book about health and the struggle for liberation in the Philippines, so I will save some of my thoughts for that work!
To Learn Is To Change
This is the final theme of my final Kalabaklabakan blog entry; to learn is truly to change. In some ways I know I have changed: I am tougher, my eyes are further opened to the realities of the majority of the world’s people, I am further convinced of the need to refuse neutrality and actively participate in the struggle for social justice. Aiyanas and Billy are also changed. It is very touching to hear Billy talk about the hardships he has witnessed. Aiyanas has recommitted himself to writing, and his book on imperialism in the Philippines will be an important resource for organizers and students of social justice.
Yet, we won’t really know how much we have really changed until we are home in Vancouver once again. How will what we have gained by our time in the mountains push us forward in our local organizing work? We have plenty of ideas, but putting action into our words is a challenge that awaits us. And how will we feel when we are back in the lap of imperialism? Only time will tell.
* Graphic - David Werner from “Health Care and Human Dignity: A Subjective Look at Community-Based Rural Health Programs in Latin America” published in the Council for Primary Health Care Reader’s Series, May-June, 1981
As I sit and write this final Kalabaklabakan blog entry the rain pours down again, I wonder if this is the start of number 4 in a series of 12 active typhoons. I hope that it rains today and is sunny tomorrow, since we head down the mountain tomorrow; I hope that the power holds steady at least until after bedtime! Travel is so difficult in the mountains to begin with, but after days of storm, the mud is ridiculous – I had no choice but to ditch my useless shoes and go barefoot, or land on my butt deep in the palay!
The weather leaves me feeling really exhausted so this blog entry will be scattered. Yet there are a few things I want to document.
Pregnancy and Hypertension in the Mountains!
First, this month was one of challenging management of pregnancy and birth. Hypertension and pre-ecclampsia/ecclampsia is a major cause of maternal mortality in the Philippines. In September Nanay and I had two very different cases: one patient admitted to hospital and delivered prematurely due to unmanageable and severe hypertension with baby number 12; one woman relatively mildly hypertensive (I suspect chronic) managed by me and Nanay at home on daily rest periods and frequent BP and urine monitoring. Good outcomes in both cases, after a great deal of worry on my part! In the mountains, hypertension in pregnancy is no easy matter; there is no such thing as ‘outpatient’ management – either you’re ‘severe’ and in-hospital (if you’re lucky enough to have your BP monitored) or you’re at home in the mountains. Being at home in the mountains essentially means no care at all, while being in hospital usually means selling your animals to pay the bills, pulling your older kids out of school to care for the younger kids; making tremendous financial sacrifices, bearing a lot of emotional stress and strain.
I was glad to be there for our mildly hypertensive patient, and Nanay and I hiked to her home every few days to check her BP, dip her urine, discuss warning signs, listen to baby, and encourage resting left lateral, which really did bring her BP down nicely. She was open to my stretch and sweeps, and was very happy when her baby was delivered, a strapping boy weighing in at 3.4 kg! (No IUGR in this case). And yet she remains hypertensive – chronic. Our severely hypertensive patient is back home with her daughter who weighs in at 1.5 kg (growth restricted and premature) and a handful of 5mg bite-and-swallow nifidipine capsules she was instructed to take once per day; the meds are not controlling her hypertension – last reading I took at home was, once again, 190/110. I read and re-read the BCRCP, SOGC, and WHO guidelines I brought with me, and wrote out a couple of medication suggestions, but now Nanay has the challenge of finding the appropriate medicines for management and monitoring the effectiveness and dosage, and the families have the burden of affording such medicines.
Struggle for Health = Struggle for Justice
It is true what Mammy tells us, that the struggle for health in Kalabaklabakan is not just a struggle for physical and mental health, but for social equality, for equitable land distribution, for economic justice. Families can’t achieve physical and mental health when they can’t afford to eat regular meals, their children go hungry, their clothing is inadequate, their homes lack water, electricity and sanitation, their farming techniques suffer from forced underdevelopment, the landlords demand a share of the products of the peasant labour, the multinationals and agricultural cartels fix product prices, and the government provides not a single iota of respite from the toil and travails of rural life.
The tragedy of Grace and Randy’s twins plays out over and over again in the mountains of Guihulgnan, in different form. Like with little 6-month Jonmark, who I tentatively diagnosed as Down’s syndrome, suffering chronic lung infections from what I believed was a congenital heart malformation. His parents willingly took him to the Guihulgnan hospital, where they spent over P 5,000 in consultations and diagnostic tests to be told that he has Down’s and a malformed heart. Then they were referred to San Carlos, to a bigger hospital, for more and expensive diagnostics, such as an echocardiogram, spending another P 10,000. Now they are referred to Cebu City on Cebu Island, for specialist care and a surgery when Jonmark is old enough for open heart surgery. This will cost hundreds of thousands of pisos; where will the money come from? The doctor in San Carlos suggested the parents travel to Dumaguete City to request some funds from the Congresswoman there. What little public health care that exists is completely undermined by rapidly expanding IMF-WB-WTO dictated privatization and gross government corruption. Can you imaging having to beg a politician for health care for your infant son? Even if they get the funds, it will not be enough to pay for the surgery.
In any case, I am working on a small book about health and the struggle for liberation in the Philippines, so I will save some of my thoughts for that work!
To Learn Is To Change
This is the final theme of my final Kalabaklabakan blog entry; to learn is truly to change. In some ways I know I have changed: I am tougher, my eyes are further opened to the realities of the majority of the world’s people, I am further convinced of the need to refuse neutrality and actively participate in the struggle for social justice. Aiyanas and Billy are also changed. It is very touching to hear Billy talk about the hardships he has witnessed. Aiyanas has recommitted himself to writing, and his book on imperialism in the Philippines will be an important resource for organizers and students of social justice.
Yet, we won’t really know how much we have really changed until we are home in Vancouver once again. How will what we have gained by our time in the mountains push us forward in our local organizing work? We have plenty of ideas, but putting action into our words is a challenge that awaits us. And how will we feel when we are back in the lap of imperialism? Only time will tell.
* Graphic - David Werner from “Health Care and Human Dignity: A Subjective Look at Community-Based Rural Health Programs in Latin America” published in the Council for Primary Health Care Reader’s Series, May-June, 1981
The Five Ts of Transformative Midwifery
Thursday September 25, 2008: 15:40 Kalabaklabakan Mountain Clinic
I type this on 50% computer power, and once that 50% is gone, it may be another 5 days of brown out before I can charge up again! There was a typhoon over the weekend and since Saturday we have only had power for 3 hours.
Now that I have more birth experience under my belt, I can truly consider myself a ‘barefoot midwife’. It is good to have some time to sit and reflect upon my experiences, and on the general situation here in Barangay Trinidad. With two very different cases of gestational hypertension and a tragic case of undiagnosed twins who didn’t survive, my recent experience has been more indicative of local maternal and infant health statistics. It is one thing to read that a community has a maternal mortality rate of 1/100 and an infant mortality rate of 0.8/100, but to directly experience the conditions, political, economic, cultural, geographic, that contribute to these shocking statistics is a life-altering experience.
It is simply not enough to practice as I was trained. Not to deny that at the University of British Columbia I had one of the best midwifery educations in the world, that is a privilege of which I am keenly aware; rather it is not enough to simply practice. A midwife in the Third World context must go beyond her calling, to be one with the women in all aspects of their lives, to be changed by their experiences, and to struggle as they struggle for systemic changes. It is only through mutual support and encouragement that we, as women, can tackle at the roots the conditions that give rise to so much hardship and suffering.
As a response to my recent experiences, I have brainstormed what I call the ‘5 T’s of Transformative Midwifery’.
The first T is Track. Track refers to the provision of typical midwifery care, in particular, antenatal care. It is essential for the prevention of crises to track all of the pregnant women in the community, whether or not they present for midwifery care. Through word of mouth it is possible to learn of who is pregnant and where they live. To track I am envisioning a large wall map for a visual aid and reminder of all current cases.
The visual wall map works in tandem with the second principle of track, which is to have regular rounds of home visits for all pregnant women. Home visits are imperative for a number of reasons: a) women will actually get the care if you go to see them at home – if left to attend at clinic visits this is far less likely as work often takes precedence over personal care, b) at home visits you can see the conditions of the home and judge the poverty of the family and how they will deal with a need for expensive hospital or doctor visits, c) walking the distance to the home allows you to assess the emergency transport situation and make an informed recommendation on transport and safest birth location.
Finally, tracking includes a third step, the documentation, compilation and interpretation of local maternal and infant health statistics. From the patient record, a central database can be created to monitor the common health problems and health outcomes of the community. An example for Trinidad is the incidence of goiter and the success of implementing educational programs on the consistent use of iodized salt. As a mountainous area, iodine is lacking in the diet, and many women suffer from goiter.
The second T is Treat. As midwives we are valued for the care we can provide childbearing women and their families. In a rural, Third World setting the preventative care we provide can save women from extremely costly and difficult doctor or hospital visits. Early and effective treatment of common illnesses can save women from serious illness or even death.
The focus on prevention goes hand in hand with the use of locally available herbal remedies. Encouraging each woman to have an herbal garden is a great way to boost her self-care and make effective use of local and free resources.
The production of locally-relevant patient care guides is the third aspect of treat. The liberal use of images helps in a context where the vast majority of the population stops their schooling between grade 3 and grade 6. Disseminating correct information is important, so the production of patient education materials works in concert with the training of the Community Health Workers, who can engage in door-to-door outreach and oral education.
The third T is Transport. This is perhaps the most challenging of the five Ts. Planning emergency transport in a rural, mountainous setting is extremely taxing and yet of vital, lifesaving importance for childbearing women and their infants. Each woman needs to have a transport plan in place from the first weeks of pregnancy until after delivery. This plan needs to be shared with family and neighbours.
Encouraging the People’s Organization (PO) to have a centralized transport plan will assist all women in the PO and allow for faster and more coordinated emergency transport. Encouraging the PO leadership to meet and discuss the particular needs of childbearing women and their infants could be a positive step in breaking the silence that seems to exist when it comes to the particulars of women’s health. I have noticed that this is even a weakness within the Community Based Health Programs that women’s health concerns and training in women’s health care seems to take a back seat.
Knowing when to transport is a challenge, especially when travel takes over 2 hours and the hospital fees are very expensive for the family to bear. The decision over whether to transport is truly a cost-benefit analysis; when a family has to sell animals and order their older children to leave their schooling or paid employment to mind the younger children and perform the household duties, it is not just a matter of dialling 911. The role of the midwife is to provide leadership and skilled knowledge in the decision to transport, judging the seriousness of the situation to the best of her ability; however, the role of the midwife must also be to respect the family when they decide not to transport and take risks that as a privileged midwife from a First World country, it can be difficult to accept.
The fourth T is Train. All community members benefit from the principle of a ‘Health Worker in Every Home’; hence training one woman from each family to provide care for common discomforts of pregnancy, how to support a woman in labour, and how to care for common newborn concerns would be a boost to the health of all.
More intensive training for the community health workers (CHWs) on the common illnesses and health issues of pregnancy, on childbirth emergencies such as breech and shoulder dystocia, and warning signs of pregnancy and labour and when to transport would be of major assistance to the midwife and to the women of the community.
Providing targeted community training and public education on how to prevent and treat the most common health issues identified through the first T, Track, would help to improve the incidence and outcomes of these health problems.
Finally, working in cooperation with local Hilots (traditional birth attendants) and inviting them to all educational events and opportunities will raise the level of care for all women in the community. Respectfully asking the Hilot to send someone to fetch you when she attends deliveries gives the midwife the opportunity to observe practice. Watching the Hilots work gives midwives insight into local traditions and allows the midwife to make small and achievable suggestions for improvement and change while learning about the rich culture of childbirth among the women in the community.
The fifth and final T is Transform. The last T, but perhaps the most important! Ultimately the roots of the health crisis lie in economic exploitation and political and social oppression. Midwives have a history of taking action on behalf of the women we care for; now more than ever we need to take that action in an organized and coordinated fashion, to address the economic and political roots of women’s ill health.
Joining the activities of the PO, using the contact made with women during the course of midwifery care to encourage women to join the PO, and increasing the participation in mass organization at the community level is a good first step.
Attending rallies, carrying placards, making speeches, writing press releases and statements on the conditions of women in the community are some positive ways to raise the consciousness of the community. Making it known that, as a midwives, we deplore the lack of public health care services, decry militarization in the community, and are outraged by backward and corrupt land ownership and grossly inadequate wages and unsafe working conditions allows community members to understand, through our actions, the link between poverty, oppression and the health crisis in their communities.
We must, as health care workers, take sides; we cannot remain neutral, for in this struggle for life there can be no neutrality. To be silent is to give consent to those who steal life from the poor. To take action is to say I stand with the poor; I am on the side of justice.
Tuesday, September 30, 2008
DOH: Department of Hoodwinking
August 30, 2008
It has happened; I have fallen in love with the Philippines. I know this to be true because at the CHD health sector picket to demand access to cheaper essential medicines outside the Department of Health I feel such a passionate anger that I have to pace around to burn off the energy. What I see painted on the walls of the DOH is in such stark contrast with the reality I witness in the community that I rename the DOH the ‘Department of Hoodwinking’.
Why hoodwink? The government propaganda is everywhere in Manila, convincing the middle class and the upper echelons of the working class that the government responds to the needs to the people and provides adequate health services. Check this out!
First I see a mural lauding the DOH clinics in the community. OK, I am confused. No community I have visited has had a clinic, but rather the odd Barangay health centre, which, when it exists, is far too often little more than a room with a very few supplies, occasionally staffed by an over-worked, under-paid midwife (cum doctor, cum nurse). Patients often have to walk very far for the few services, such as vaccinations, which are offered. Although in government propaganda TB medicines are provided for free for all infected, in reality even if there are TB meds, they are very expensive. Most do not complete the multi-drug formula for the necessary 6 months. What else can the Community Health Workers do but teach about preventing communication! In San Isidro, there is actually an ambulance, which looks terrific; in practice the fee is 1,500P paid in advance for the trip to the hospital! The average daily wage, when sugar work is available, is less than 100P per day, so that explains why the ambulance still looks so shiny and new – people can’t afford to use it!
Next I pass a beautiful mural lauding the provision of safe drinking water. It’s a joke, right? What community is that? Any place I have visited that has safe drinking water, it has been the People’s Organization, and NOT the government, which has ensured clean water to drink and bathe by piping water down from upland springs, or building enclosed cisterns over deep wells to prevent contamination from shallow ground water. Most rural communities I have visited have few toilets so people use the fields as their toilet and then use ground water or stream water to drink and to bathe. Given the incidence and death toll from diarrhea, the 3rd leading cause of death in children, this isn’t merely about good health, but a matter of basic survival.
Now, my personal favourite! The DOH Superman delivering iodized salt to the people. This really is a joke – the irony is sadly hilarious. I can’t even keep track of the number of women I have seen in the mountain provinces with goiter. Keep in mind, women of childbearing age, having many babies, with such a terrible risk to a diet inadequate in iodine; as the mural explains: still birth, cretinism, dwarfism, poor cognitive development to name a few. Women struggle to use iodized salt, as there is little incentive for sari-sari store owners to sell it as they make less profit from it.
Another beauty, the smiling kids with lovely white teeth, visiting the what? The dental clinic? I never saw one, personally, in my many months of travels to rural communities. I did, however, see countless children with poor dentition and many carries, in terrible need of dental care. I saw children who were refusing to eat due to pain from rotting teeth. It was heartbreaking. I can think of several great programs that would increase prevention and provide basic dental care at the community level – but alas, despite the lovely propaganda, the DOH does not really care for children’s dental health.
There were many lovely murals to describe, but in the interest of brevity, I will conclude with the mural lauding environmental protection. Can anyone say “PhilEx”? Let our coming testimonials on the impacts of multinational mining operations attest to the GMA position on ‘environmental protection’ in the Philippines.
It has happened; I have fallen in love with the Philippines. I know this to be true because at the CHD health sector picket to demand access to cheaper essential medicines outside the Department of Health I feel such a passionate anger that I have to pace around to burn off the energy. What I see painted on the walls of the DOH is in such stark contrast with the reality I witness in the community that I rename the DOH the ‘Department of Hoodwinking’.
Why hoodwink? The government propaganda is everywhere in Manila, convincing the middle class and the upper echelons of the working class that the government responds to the needs to the people and provides adequate health services. Check this out!
First I see a mural lauding the DOH clinics in the community. OK, I am confused. No community I have visited has had a clinic, but rather the odd Barangay health centre, which, when it exists, is far too often little more than a room with a very few supplies, occasionally staffed by an over-worked, under-paid midwife (cum doctor, cum nurse). Patients often have to walk very far for the few services, such as vaccinations, which are offered. Although in government propaganda TB medicines are provided for free for all infected, in reality even if there are TB meds, they are very expensive. Most do not complete the multi-drug formula for the necessary 6 months. What else can the Community Health Workers do but teach about preventing communication! In San Isidro, there is actually an ambulance, which looks terrific; in practice the fee is 1,500P paid in advance for the trip to the hospital! The average daily wage, when sugar work is available, is less than 100P per day, so that explains why the ambulance still looks so shiny and new – people can’t afford to use it!
Next I pass a beautiful mural lauding the provision of safe drinking water. It’s a joke, right? What community is that? Any place I have visited that has safe drinking water, it has been the People’s Organization, and NOT the government, which has ensured clean water to drink and bathe by piping water down from upland springs, or building enclosed cisterns over deep wells to prevent contamination from shallow ground water. Most rural communities I have visited have few toilets so people use the fields as their toilet and then use ground water or stream water to drink and to bathe. Given the incidence and death toll from diarrhea, the 3rd leading cause of death in children, this isn’t merely about good health, but a matter of basic survival.
Now, my personal favourite! The DOH Superman delivering iodized salt to the people. This really is a joke – the irony is sadly hilarious. I can’t even keep track of the number of women I have seen in the mountain provinces with goiter. Keep in mind, women of childbearing age, having many babies, with such a terrible risk to a diet inadequate in iodine; as the mural explains: still birth, cretinism, dwarfism, poor cognitive development to name a few. Women struggle to use iodized salt, as there is little incentive for sari-sari store owners to sell it as they make less profit from it.
Another beauty, the smiling kids with lovely white teeth, visiting the what? The dental clinic? I never saw one, personally, in my many months of travels to rural communities. I did, however, see countless children with poor dentition and many carries, in terrible need of dental care. I saw children who were refusing to eat due to pain from rotting teeth. It was heartbreaking. I can think of several great programs that would increase prevention and provide basic dental care at the community level – but alas, despite the lovely propaganda, the DOH does not really care for children’s dental health.
There were many lovely murals to describe, but in the interest of brevity, I will conclude with the mural lauding environmental protection. Can anyone say “PhilEx”? Let our coming testimonials on the impacts of multinational mining operations attest to the GMA position on ‘environmental protection’ in the Philippines.
Saturday, September 20, 2008
Called to Deliver a Baby ‘Half-Born’: the Struggle to Survive in Rural Philippines
*Warning -- this blog entry is graphic*
After lunch Aiyanas and I were playing chess when there was a commotion in the clinic, and I heard “Martha” and “bata” (baby) and a bunch of excited talking, so I poked my head out front to see what was going on. The ‘ice candy lady’ from the elementary school was in the clinic with Josephine and Erwin, saying that Grace had delivered, but the baby was breech and only half-born; the Lola was there delivering the baby and now they need help. What is going on? I am full of disbelief; the baby is half-born? Why are we standing here talking? Josephine calls to Nanay, who comes running back to the clinic, I grab my backpack with my birth equipment, Aiyanas grabs me some pesos to pay for a hubble-hubble (motorcycle) and Nanay and I are off at a run up to the road to catch a ride to Grace’s house. It must have taken us 20 minutes to get there from the time I first heard the news of the baby half-born; we arrived just after 3:40 pm.
Why didn't they come get us sooner? I learned that Grace was afraid because the military detachment is across the road, and last night they were firing at random.
Entering the house I am struck by Grace’s position; Grace is up on the sleeping platform lying supine, knees bent, legs covered with a blanket, and Lola has her hands under the blanket. It is dark in the house though it is still light outside. Is there a baby I ask? Yes, they say, half-born up to the neck. Without thinking I am pulling off the blanket and calling for Grace to turn so the breech hangs; somehow I have gloves on, but I barely remember getting them and my kit out as we entered the house. I put my hand inside Grace’s vagina to feel what is going on. I feel the baby’s face anterior, his little body is so blue and cold and his back is anterior, his neck is twisted, he is obviously dead. He is so small I am suspicious, since it doesn’t fit with how pregnant we thought Grace was.
I feel another head following - twins. Gently I push the second head back up the vagina; Nanay gives me some suprapubic pressure and the first twin disimpacts and is delivered onto Grace. Then directly the second twin is delivered up onto Grace. I feel the cords of the babies and the second twin has a pulse, so I grab my clamps from my kit and clamp the cords, free the second twin first, and start to ventilate him. I check his heart rate, but it is so chaotic in the house I can barely hear, I think I get about 60 beats per minute. I show Nanay how to do chest compressions while I ventilate, but we can’t get coordinated, so after perhaps 15 seconds I listen with my Doppler and count 100 bpm! We clear the small table and place the second twin onto a pair of soft track pants I grab from the clothes pile nearby. I instruct Nanay how to ventilate, make sure his little chest is rising and he is getting at least 40 breaths per minute.
Time to switch my attention to Grace, who is lying supine with her eyes closed. Is she conscious? Is she bleeding? Is she in shock? I cut the cord of the still born twin, bundle him, and set him next to his brother. I coax Grace awake and up into a squat to get the placenta out, intact, great, just to be safe I quickly draw up one of my precious vials of oxytocin and give it to her. Her BP is good, 120/80. Nanay checks Grace’s perineum, and there is only a very small tear, which is good because there is no time to suture. I am very worried about Grace and her emotional state, so Lola comes to sit with her and hold her hand. Time to switch back to second baby boy and make sure he is doing OK.
Before I take over ventilations again, I listen with the Doppler one more time so I can hear his heart rate clearly in the noisy, crowded hut. Why are there so many people here? We shoo some people outside, and listen, getting a heart rate of 140, with my stethoscope I can hear air entry with ventilations, his lips and face are pink. Why isn’t this little guy breathing? I quickly examine him and can see he is quite premature: smooth foot soles, smooth scrotum, soft ear cartilage, testicles undescended. Grace wasn’t 8 months pregnant, as I thought; I realize she was likely only 7 months but big due to the twins. The lack of adequate prenatal care in the communities is outrageous. This little guy needs intensive care; we need to transfer him as soon as possible. I take over ventilating again, and Nanay is freed to help with the transfer.
This discussion takes a painfully long time. The babies were born at 3:45 and 3:46, and it is now after 4:15 and they are still talking about what to do. I explain, hoping that it will be understood, that they can decide to transfer to the hospital or they can stay home and the baby will die. It sounds crass, but I realized that they have to make the decision about what is right. Now that I write this, I wonder, did it sound judgemental? It is not the way I intended it to sound and I hope it wasn’t taken that way. But this persistent little boy is taking some breaths! The conclusion is they will go to the hospital; now we need to get the truck so we can ventilate the baby on the way. This will require permission and a driver from the Barangay Capitan. There is a problem, I still don’t know what, with the local Barangay Capitan, and so they have to ask in Hilaiton which is 45-60 minutes away.
Nanay and I hunker down to business, and develop a rhythm of adding 3 breaths between each one of little baby’s so that he is getting 40 breaths per minute. I balance my newborn stethoscope on his little chest so I can time my breaths to his heart rate, hear the air entry, and monitor his independent breaths. We request some hot water bottles which we tuck around his body. I place a nasogastric tube, but I do not carry an ET tube and laryngoscope, so we use a mask to ventilate. After an hour or so I am exhausted, and I want to examine the first twin and the placenta, so Nanay does an ambubag shift. I go to pee, and see the military watching from the detachment across the road. This just enrages me – 10 times the funding of the health care system and they sit and watch as babies die.
Very carefully I pick up the first little guy and take him to the adjoining Nipa hut so I can examine him thoroughly without so many observers. He is so tiny, weighing in at 1.5 kilos including the weight of his blanket. It feels like his neck is broken, and he has dark bruises on his abdomen over his palpable liver. I wrap him in a blanket, lay him on the pretty blue fabric of my scale sling, and quickly take his photo for Grace and Randy. My belief is that these are mono-chorionic, mono-amniotic twins, with the first twin transfusing blood, oxygen and nutrients to the larger and more robust second twin, but this is only a guess. There is only one placenta with two cords of close insertion, and for the life of me I can only see one sheer set of membranes, but it is impossible to tell and I am rushing; in any case we will bring the placenta with us.
Now back to business of ensuring the ventilation is going well and preparing for transport. We hear news that the truck from Hilaiton is on its way! Great, this little trooper is hanging in there, so we will make it! I take over ventilations again and Nanay gets a board and some blankets ready so we can ventilate in the back of the truck. Finally after 6:00 pm the truck arrives and we are off on the long trip to the hospital. Sometimes the road is so bumpy the board is bouncing, I try to protect his little head, and the little guy’s heart rate is always over 100. After what seemed like an endless journey of heart beats and breaths, heart beats and breaths, we arrive at the hospital.
As the truck pulls up, Nanay calls out ‘emergency, emergency’ and an orderly comes running. We get baby boy out of the truck and quickly onto the examination table in the ER operation room. I keep ventilating until the doctor comes and takes over care of the baby. The doctor quickly concludes that the baby is premature and needs CPAP (continuous positive airway pressure) and I completely agree! Great! Let’s get it going! But… there is no equipment for premature babies at this hospital, so we will have to go to Dumaguete. Why is the nurse not ventilating the baby? What is going on?
Randy, the father of the baby, shakes his head and sadly explains there is no money for going to a private hospital in Dumaguete. The doctor then asks Randy if he will admit the baby at this hospital, and Randy agrees. But what will they do here? They provide free-flow 100% oxygen through an ET tube, which it takes 20 minutes to place because they can’t find an ET tube small enough in their ancient crash cart; the baby is only breathing ten times per minute and there is no equipment to ventilate. They give him dextrose through an IV. I know that he will die, but my heart still hopes. Randy and I sit with him, and Randy asks me why the first twin died. I gently tell him I think he was born too early and his lungs were not ready, but I can’t bring myself to mention his injuries. Randy thinks his second son is a fighter, and I agree with heavy heart, knowing he isn’t getting the care he needs to give it a fighting chance.
Nanay and I are exhausted, it is now after 9:00 pm and I need to wash and lie down. We will spend the night at Nanay’s Auntie’s. After sleeping in fits and starts we return at 6:00 to learn that the baby boy died at 3:00 am and Randy has already taken him home. I am so angry! I am so sad! The pictures of Gloria Macapagal Arroyo smiling on the wall of the hospital are enraging! How can she justify a national budget where debt payments are 63 times the national health budget? How can the military, which harasses and intimidates the people, be a priority over equipment necessary to save newborn babies? How can the military sit and watch while Randy scrambles to find a ride to the hospital? It is so backward I feel like kicking over that stupid (and grossly under-stocked) crash cart that sits nearby. I cry on the hubble-hubble ride home, thinking how Grace and Randy must be suffering, and my beautiful little patient who didn’t make it.
Now we are home and the story is already widely known. Will anything change? Perhaps more people will join the rally in Guihulgnan Town on Sunday. Perhaps the People’s Organization will gain more members as the string of injustices that lead to the deaths of these boys is discussed in the community. I am moved by the strength of the optimism, even among those who suffer terrible injustices; hope that things will change if the people are united, committed and share a common vision of justice for all.
The Negros Medical Mission: Service and Solidarity
September 20, 2008
Kalabaklabakan Mountain Clinic
Last weekend, September 13 and 14, was the large and greatly anticipated Negros Mercy Mission: a Medical and Psycho-Social Mission which brought over a dozen doctors, community health workers, organizers and documenters to three rural communities of Guihulgnan, including Kalabaklabakan, in Barangay Trinidad.
The mission was spearheaded by the local People’s Organization (PO), Kaugma-on, literally ‘future of the small farmers’, and supported by several organizations from Cebu, Bacolod and Manila, including the Negros Island Health Integrated Program (NIHIP), the Council for Health and Development (CHD), and progressive party list Bayan Muna. The mission was one of service to the people, and solidarity with their struggle for justice and against the intensified militarization; Guihulgnan is now identified as a priority area for the AFP aggressive war of counter-insurgency, an operation which causes many human rights violations, physical harm and psychological trauma for the peasants.
Over 460 patients received treatment during the two day mission in Kalabaklabakan, including doctor consultations, essential medicines, prenatal care, psychological counselling and minor surgeries. Despite repeated attempts from the AFP Infantry Battalion (IB) 11 to enter the private clinic premises, and to intimidate and harass those patients entering the clinic compound, the mission was a resounding success, and many patients had their sufferings eased by the mission teams.
While the medical care provided through missions is only but a small band aid for the large wounds of the people, the demonstration of solidarity from the urban areas and the large organizations such as CHD and Bayan Muna is a tremendous boost to the local PO. Missions send a clear message to the military and the government that those struggling peasant farmers in the countryside are not forgotten, rather are of fundamental importance, to those who struggle in the urban areas.
Tuloy Ang Laban!
Kalabaklabakan Mountain Clinic
Last weekend, September 13 and 14, was the large and greatly anticipated Negros Mercy Mission: a Medical and Psycho-Social Mission which brought over a dozen doctors, community health workers, organizers and documenters to three rural communities of Guihulgnan, including Kalabaklabakan, in Barangay Trinidad.
The mission was spearheaded by the local People’s Organization (PO), Kaugma-on, literally ‘future of the small farmers’, and supported by several organizations from Cebu, Bacolod and Manila, including the Negros Island Health Integrated Program (NIHIP), the Council for Health and Development (CHD), and progressive party list Bayan Muna. The mission was one of service to the people, and solidarity with their struggle for justice and against the intensified militarization; Guihulgnan is now identified as a priority area for the AFP aggressive war of counter-insurgency, an operation which causes many human rights violations, physical harm and psychological trauma for the peasants.
Over 460 patients received treatment during the two day mission in Kalabaklabakan, including doctor consultations, essential medicines, prenatal care, psychological counselling and minor surgeries. Despite repeated attempts from the AFP Infantry Battalion (IB) 11 to enter the private clinic premises, and to intimidate and harass those patients entering the clinic compound, the mission was a resounding success, and many patients had their sufferings eased by the mission teams.
While the medical care provided through missions is only but a small band aid for the large wounds of the people, the demonstration of solidarity from the urban areas and the large organizations such as CHD and Bayan Muna is a tremendous boost to the local PO. Missions send a clear message to the military and the government that those struggling peasant farmers in the countryside are not forgotten, rather are of fundamental importance, to those who struggle in the urban areas.
Tuloy Ang Laban!
Sunday, August 31, 2008
Back to the Mountains
Heading back to Kalabaklabakan for more mountain integration. Stay posted and send us some comments.
Thursday, August 28, 2008
San Isidro: A True People’s Health Committee
Dave:
San Isidro, is a rural community near Toboso in the North East of Negros where sugarcane is virtually the only economy. Even in the remote areas such as San Isidro, the land is owned not by the families that live there but by vacant landowners. Under the “Pakyaw” system, sugarcane workers are given a certain acreage of land to plow, weed, or harvest for a set amount of money no matter how much time it takes to accomplish.
Aiyanas and I walked for about an hour to the field where the community members were working to see the conditions for ourselves. Twenty-nine people were working a 3 hectare plot of land, weeding and hacking away grass with machetes. It was incredibly hot and humid – I was having troubles keeping hydrated just walking to the worksite and within the sugarcane the temperature spiked even higher. Aiyanas tried out the machete for a few yards of weeding and felt his back start to ache in just a few minutes.
Over 4 days the workers earn about 90P a day or a little more than $2CAD, much below the average of 150P and far below the estimated 750P per day that is required to meet basic needs. As a result, most people skip breakfast while lunch and dinner consists of mostly rice and a very small portion of meat or fish. I spent a good two hours one night tromping through the river with two young guys hunting frogs which became our very small portion of meat for more than one meal.
As someone interested in physiotherapy I wanted to see how these working conditions played out in the bodies of the sugarcane workers. We did a workshop on muscle and joint pain to collectivize the experiences of the workers and try to make suggestions for changes. Lower back, neck, shoulder and knee pain were the norm. When it came to making suggestions we had to say that there was no alternative body positioning that could protect the workers from this gruelling labour. We had to say that the crippling of their bodies would really only lessen when the labour conditions were changed through prolonged struggle with the landlord and the government. During harvest season, men must pick a bundle of sugarcane about 5 ft long and weighing 60 kilos from the ground, onto their backs and then walk up a plank onto the awaiting truck for transport.
My first consultation was with a man who had a pretty severe scoliosis (bending to the side) of his spine most likely due to the loading of one shoulder with sugarcane. Women bore the double brunt of working in the fields and hand washing laundry, fetching water, cleaning and childminding – all of which is heavy manual labour and hard on their bodies. We finished the workshop with some stretches and exercises that might help to alleviate the common conditions but with the understanding that these will really only be one of the tools used to build their capacity for the struggle for justice.
Martha:
What immediately struck me about Toboso was the strong relationship between the People’s Organization, the National Federation of Sugar Workers (NFSW), and the Community Health Workers, who are all active NFSW members. The basis for the health work lies in the overall struggle to improve their lives and to struggle for land, livelihood and justice. Within the broader vision for social change lies the vision for a healthy community and health services provided by the people themselves.
During my seemingly never-ending stream of consultations which spanned 5 days, old and young, men and women, I witnessed the impacts of poverty, grinding labour, and forced underdevelopment on the bodies and the minds of the workers and their families. Through this process of interview, discussion, physical exam and care-plan formulation I learned a great deal about the particular physical and mental impacts of exploitation of sugar workers.
Dave has already mentioned the severe hunger in the community, and the tendency to skip meals. During my consultations I saw several men with stomach ulcers: abdominal pain, burning esophagus, bloody stools; the medications used to treat the ulcers and to help them heal are beyond the means of these men, so they suffer pain as their ulcers worsen. We discussed growing aloe vera in an herbal garden so that free treatment is readily available for heartburn and ulcers. Headaches are a common problem in both men and women; sometimes due to poor vision, but most commonly, worry about money, feeding their children, finding work.
Two patients were particularly striking, a boy of 2 and his 4 year-old sister, the one responsible for caring for the 2 year-old! The boy was severely malnourished, not able to walk or crawl, and not able to talk. The girl was also unable, or perhaps unwilling, to talk, and cried a steady stream of tears as I attempted to examine her brother. Even the neighbours agreed that they didn’t hear the girl speaking, but rather she simply looked at them when they asked her a question. Piecing together a history from the neighbours, I learned that there are 6 children in the family and that the mother ran away when the youngest son was only 5 months. In an attempt to care for his children, the father was making them rice to eat, but rice is inadequate for an infant that needs breastmilk! The father then had to work long hours every day, leaving his children unattended. The result is that the youngest two children are stunted in development and the older children absent from school while they wander freely. My diagnosis: poverty! My care plan? The two youngest children should go to a relative or neighbour who can help out while the father works. I thought that the youngest boy might need hospital attention, but that was far beyond the means of this farmer. In the long run? Address the issues that led to this poor young mother running away from her family in the first place!
Another patient that stands out in my mind a young mother breastfeeding a 7 month-old and caring for another child under 2 years old. Her problem? Nausea for 2 months. My diagnosis? Pregnancy, which the pregnancy test confirmed, and upon exam her uterus was a few fingers below the umbilicus and the heart rate loud and clear – I figured about 4 months. Her first response was to punch her husband and her second was to burst into tears and hide her face. I could have cried, too, and had to take a few moments to pull myself together. It was obvious that this was an unwelcome surprise, and heartbreaking that the control of childbearing is so difficult to achieve for a wide variety of reasons, including not only culture and religion, but also economics and politics.
As we gathered together with the NFSW members on the final night of our too-short week-long stay, I presented a list of the most common health concerns: malnutrition, cough, fever, poor dentition, anemia, goiter, high blood pressure, chest pain, arrhythmias, headaches, back pain, ulcers, urinary tract infections, constipation, diarrhea, dehydration, vision difficulties. No doctor, no dentist, no opthamologist, no cardiologist, no laboratory, no ultrasound, no x-ray, no medicines. No running water, no toilets, no bathtubs, no showers. Not enough food, not enough work, low wages, gruelling labour, no worker protection or compensation, no protective gear or equipment.
What does the community have on their side? Knowledgeable and eager Community Health Workers and a plentiful supply of herbal remedies; the passion and commitment to launch a health clinic, build a toilet, pipe-in spring water and rally the community to improve their health. A regional health organization, NIHIP, to provide training and ongoing support for the CHWs. A strong local People’s Organization with many active members and very skilled organizers, fighting the land owners and the local government for just wages and living conditions. And most importantly, a visionary national liberation movement fighting through both legal and underground means to demand control of the state and its resources, to serve the people, and create justice for all.
San Isidro, is a rural community near Toboso in the North East of Negros where sugarcane is virtually the only economy. Even in the remote areas such as San Isidro, the land is owned not by the families that live there but by vacant landowners. Under the “Pakyaw” system, sugarcane workers are given a certain acreage of land to plow, weed, or harvest for a set amount of money no matter how much time it takes to accomplish.
Aiyanas and I walked for about an hour to the field where the community members were working to see the conditions for ourselves. Twenty-nine people were working a 3 hectare plot of land, weeding and hacking away grass with machetes. It was incredibly hot and humid – I was having troubles keeping hydrated just walking to the worksite and within the sugarcane the temperature spiked even higher. Aiyanas tried out the machete for a few yards of weeding and felt his back start to ache in just a few minutes.
Over 4 days the workers earn about 90P a day or a little more than $2CAD, much below the average of 150P and far below the estimated 750P per day that is required to meet basic needs. As a result, most people skip breakfast while lunch and dinner consists of mostly rice and a very small portion of meat or fish. I spent a good two hours one night tromping through the river with two young guys hunting frogs which became our very small portion of meat for more than one meal.
As someone interested in physiotherapy I wanted to see how these working conditions played out in the bodies of the sugarcane workers. We did a workshop on muscle and joint pain to collectivize the experiences of the workers and try to make suggestions for changes. Lower back, neck, shoulder and knee pain were the norm. When it came to making suggestions we had to say that there was no alternative body positioning that could protect the workers from this gruelling labour. We had to say that the crippling of their bodies would really only lessen when the labour conditions were changed through prolonged struggle with the landlord and the government. During harvest season, men must pick a bundle of sugarcane about 5 ft long and weighing 60 kilos from the ground, onto their backs and then walk up a plank onto the awaiting truck for transport.
My first consultation was with a man who had a pretty severe scoliosis (bending to the side) of his spine most likely due to the loading of one shoulder with sugarcane. Women bore the double brunt of working in the fields and hand washing laundry, fetching water, cleaning and childminding – all of which is heavy manual labour and hard on their bodies. We finished the workshop with some stretches and exercises that might help to alleviate the common conditions but with the understanding that these will really only be one of the tools used to build their capacity for the struggle for justice.
Martha:
What immediately struck me about Toboso was the strong relationship between the People’s Organization, the National Federation of Sugar Workers (NFSW), and the Community Health Workers, who are all active NFSW members. The basis for the health work lies in the overall struggle to improve their lives and to struggle for land, livelihood and justice. Within the broader vision for social change lies the vision for a healthy community and health services provided by the people themselves.
During my seemingly never-ending stream of consultations which spanned 5 days, old and young, men and women, I witnessed the impacts of poverty, grinding labour, and forced underdevelopment on the bodies and the minds of the workers and their families. Through this process of interview, discussion, physical exam and care-plan formulation I learned a great deal about the particular physical and mental impacts of exploitation of sugar workers.
Dave has already mentioned the severe hunger in the community, and the tendency to skip meals. During my consultations I saw several men with stomach ulcers: abdominal pain, burning esophagus, bloody stools; the medications used to treat the ulcers and to help them heal are beyond the means of these men, so they suffer pain as their ulcers worsen. We discussed growing aloe vera in an herbal garden so that free treatment is readily available for heartburn and ulcers. Headaches are a common problem in both men and women; sometimes due to poor vision, but most commonly, worry about money, feeding their children, finding work.
Two patients were particularly striking, a boy of 2 and his 4 year-old sister, the one responsible for caring for the 2 year-old! The boy was severely malnourished, not able to walk or crawl, and not able to talk. The girl was also unable, or perhaps unwilling, to talk, and cried a steady stream of tears as I attempted to examine her brother. Even the neighbours agreed that they didn’t hear the girl speaking, but rather she simply looked at them when they asked her a question. Piecing together a history from the neighbours, I learned that there are 6 children in the family and that the mother ran away when the youngest son was only 5 months. In an attempt to care for his children, the father was making them rice to eat, but rice is inadequate for an infant that needs breastmilk! The father then had to work long hours every day, leaving his children unattended. The result is that the youngest two children are stunted in development and the older children absent from school while they wander freely. My diagnosis: poverty! My care plan? The two youngest children should go to a relative or neighbour who can help out while the father works. I thought that the youngest boy might need hospital attention, but that was far beyond the means of this farmer. In the long run? Address the issues that led to this poor young mother running away from her family in the first place!
Another patient that stands out in my mind a young mother breastfeeding a 7 month-old and caring for another child under 2 years old. Her problem? Nausea for 2 months. My diagnosis? Pregnancy, which the pregnancy test confirmed, and upon exam her uterus was a few fingers below the umbilicus and the heart rate loud and clear – I figured about 4 months. Her first response was to punch her husband and her second was to burst into tears and hide her face. I could have cried, too, and had to take a few moments to pull myself together. It was obvious that this was an unwelcome surprise, and heartbreaking that the control of childbearing is so difficult to achieve for a wide variety of reasons, including not only culture and religion, but also economics and politics.
As we gathered together with the NFSW members on the final night of our too-short week-long stay, I presented a list of the most common health concerns: malnutrition, cough, fever, poor dentition, anemia, goiter, high blood pressure, chest pain, arrhythmias, headaches, back pain, ulcers, urinary tract infections, constipation, diarrhea, dehydration, vision difficulties. No doctor, no dentist, no opthamologist, no cardiologist, no laboratory, no ultrasound, no x-ray, no medicines. No running water, no toilets, no bathtubs, no showers. Not enough food, not enough work, low wages, gruelling labour, no worker protection or compensation, no protective gear or equipment.
What does the community have on their side? Knowledgeable and eager Community Health Workers and a plentiful supply of herbal remedies; the passion and commitment to launch a health clinic, build a toilet, pipe-in spring water and rally the community to improve their health. A regional health organization, NIHIP, to provide training and ongoing support for the CHWs. A strong local People’s Organization with many active members and very skilled organizers, fighting the land owners and the local government for just wages and living conditions. And most importantly, a visionary national liberation movement fighting through both legal and underground means to demand control of the state and its resources, to serve the people, and create justice for all.
Wednesday, August 27, 2008
Super Busy Times
Hi Folks, I write this from Manila, where fellow APH organizer Dave sits next to me working on the blog entry we are co-authoring on our time in San Isidro.
See our website:
www.vcn.bc.ca/~aph
Aiyanas, Sophia, Billy and I traveled from Bacolod to Escalante, where we joined a training for National Federation of Sugar Workers Community Health Workers. I helped lead the first aid and the physical exams... pretty fun. Evy, a medical student from the Belgian organization INTAL (International Action for Liberation) joined us, and we had a blast together. After that short 3 days, our family, Evy, and our guides from NIHIP traveled to Cadiz, where we spent the night at a camp for the families of 13 men arrested for the 'crime' of trying to eek out a living burning charcoal during what is now 'tiempos muertos' or 'dead time' between planting and harvesting the sugar cane, when hunger is severe. The day we arrived, the families buried its youngest victim, 3 year old Jenny, who died from malnutrition and broncho-pneumonia. It was a very inspiring night of prison visit and check ups, more check ups at the camp and Aiyanas did a great radio interview which was aired the next morning to our delight. We learned recently that 11 of 13 men have been released, and have joined their wives and children in the camp until the remaining 2 men are freed.
After Cadiz, Aiyanas, Billy, Sophia and our guide Julius traveled to San Isidro, a community where the PO, NFSW, has initiated a strong health committee... but more on that when Dave and I finish our joint blog.
Now I am in Manila escorting Sophia and Dave to the airport. Aiyanas and Billy remain with Julius in Escalante for further integration with sugar workers and fishers, and research and documentation on the impacts of oil exploration and mining off the coast.
Send us some comments!
See our website:
www.vcn.bc.ca/~aph
Aiyanas, Sophia, Billy and I traveled from Bacolod to Escalante, where we joined a training for National Federation of Sugar Workers Community Health Workers. I helped lead the first aid and the physical exams... pretty fun. Evy, a medical student from the Belgian organization INTAL (International Action for Liberation) joined us, and we had a blast together. After that short 3 days, our family, Evy, and our guides from NIHIP traveled to Cadiz, where we spent the night at a camp for the families of 13 men arrested for the 'crime' of trying to eek out a living burning charcoal during what is now 'tiempos muertos' or 'dead time' between planting and harvesting the sugar cane, when hunger is severe. The day we arrived, the families buried its youngest victim, 3 year old Jenny, who died from malnutrition and broncho-pneumonia. It was a very inspiring night of prison visit and check ups, more check ups at the camp and Aiyanas did a great radio interview which was aired the next morning to our delight. We learned recently that 11 of 13 men have been released, and have joined their wives and children in the camp until the remaining 2 men are freed.
After Cadiz, Aiyanas, Billy, Sophia and our guide Julius traveled to San Isidro, a community where the PO, NFSW, has initiated a strong health committee... but more on that when Dave and I finish our joint blog.
Now I am in Manila escorting Sophia and Dave to the airport. Aiyanas and Billy remain with Julius in Escalante for further integration with sugar workers and fishers, and research and documentation on the impacts of oil exploration and mining off the coast.
Send us some comments!
Tuesday, August 26, 2008
Monday, August 18, 2008
Community Health Worker Training
A simple thing.
Swollen glands,
In neck and under the jawbone.
Could be a sign of TB.
Could be a sign of upper respiratory infection,
Your best chance at detection,
To heal a brother, a mother, or a child.
Not a simple thing.
Lub-dub Lub-dub Lub-dub
Hands on the stethoscope,
Learning to listen for the sounds of disease
Listen to the heart…
Murmurs and faces focused,
Learning to listen,
For the echoes of imperialism.
Diagnosis is 80% history.
Spanish plunderers on the shores;
American soldiers with false aid
And a lecherous gaze;
Philex, Canadian mining giant
Developing nothing but their own profit.
Healing hands, working hands, fighting hands.
Palpitating,
Eyes open and assessing,
Trying to heal the body,
To mend the lives,
To strengthen the community,
To free the nation,
And change the world.
~ Aiyanas Ormond
Swollen glands,
In neck and under the jawbone.
Could be a sign of TB.
Could be a sign of upper respiratory infection,
Your best chance at detection,
To heal a brother, a mother, or a child.
Not a simple thing.
Lub-dub Lub-dub Lub-dub
Hands on the stethoscope,
Learning to listen for the sounds of disease
Listen to the heart…
Murmurs and faces focused,
Learning to listen,
For the echoes of imperialism.
Diagnosis is 80% history.
Spanish plunderers on the shores;
American soldiers with false aid
And a lecherous gaze;
Philex, Canadian mining giant
Developing nothing but their own profit.
Healing hands, working hands, fighting hands.
Palpitating,
Eyes open and assessing,
Trying to heal the body,
To mend the lives,
To strengthen the community,
To free the nation,
And change the world.
~ Aiyanas Ormond
Is Capitalism a Disease?
Communities sick from hunger,
Sick from pollution,
Sick from dirty water,
Sick from overwork and stress,
Sick from junk food in shiny plastic packages.
And there are bill board advertisements,
And there are 25 choices of toothpaste,
And there are police to protect private property,
But no food, no doctor, no medicine.
Is capitalism a disease?
~ Aiyanas Ormond
Sick from pollution,
Sick from dirty water,
Sick from overwork and stress,
Sick from junk food in shiny plastic packages.
And there are bill board advertisements,
And there are 25 choices of toothpaste,
And there are police to protect private property,
But no food, no doctor, no medicine.
Is capitalism a disease?
~ Aiyanas Ormond
Sunday, August 10, 2008
Short Update
We are in the 'city' for one night on our way to Escalante, a highly militarized area where I will be giving 2 trainings for the health workers, first aid and anatomy and physiology, and maternal-child health. Aiyanas will be documenting human rights violations.
Stay posted for our updates on this northern region. Thanks for the comments!
Stay posted for our updates on this northern region. Thanks for the comments!
Sunday, August 3, 2008
Maternal and Child Health on Negros
August 2, 2008
In the Philippines, 10 mothers die daily due to pregnancy and childbirth related causes. On Negros, 0.81% of pregnant women die in pregnancy or during childbirth. 13 of over 1,000 newborn babies die.
We understand that this is because the basic and chronic problems in health are not addressed and indeed are allowed to worsen as the majority of the population lives in dire poverty. It all boils down to the reality that the government priorities foreign debt and the military over the health of the people!
For the national situation, see my earlier blog entry 'National Situation'.
Trinidad is but one of 33 Barangays in the ‘city’ of Guihulgnan, Negros Oriental; Trinidad Barangay itself is composed of many small sitios, each with a population in the low thousands. This community is about as rural as it gets; very few of the extremely modest 1 or 2 room bamboo houses has direct access to the road, so reaching most homes involves a 20 minute to several hour hike.
This means that women and their families have very limited geographical access to health care services. But the problem goes much deeper, and encompasses not only the geographical, but includes the social, ideological, political and economic.
The social barriers include the burden placed on the family when the mother is absent from her childcare and household duties in order to access far-away and expensive health services. When it takes several hours a day to prepare meals over open fires, and either you cook or you don’t eat, there is no other option for many families except to try and farm out their children or bring them into the city. The usual 'choice' is to not go to the health centre or hospital at all.
The ideological barriers are difficult to express. There is an acceptance that women take a risk of dying for having a baby that would never be socially-acceptable in Canada. Children with deformities are prayed for and then left to find ways to compensate. My perception of risk is completely altered by this experience.
The political barriers run deep to the corruption of the Philippine national government and the patronage-focus of the provincial and local governments. If you are poor and have no money to pay for your kidney dialysis or blood pressure medication – go see the mayor and ask for a favour because you voted for her in the last election! No social services for the people as state responsibility, but rather stop-gap measures from the politicians looking for support and votes. In an emergency, in order to use the municipal truck for transportation, you first must see the Barangay Capitan! Meanwhile, the injured or sick person is already dead while their families scramble to find transport. This very situation happened last weekend and the teenager with the head trauma died.
The economic barriers are the most maddening, and yet provide an explanation for the geographical, social and ideological barriers. The political corruption and foreign-debt and military focus of the national expenditure leaves the people on the brink of disaster.
The Personal is the Political
We started the basic midwifery skills training for local CHWs and hilots that I led last week with each woman sharing a situation where she felt that she needed more support or knowledge to deal with a woman or baby in her care. Every participant shared a story of a woman or baby, or both, dying for lack of proper care, medicines, or treatment.
The stories were saddening, but it was also heart-warming to see how excited these women who all attend deliveries yet live in far-flung areas were to sit in one room together and share their experiences and their ideas. I really emphasized as much as possible the importance of continuing to share like this, but also to go to see the Barangay Capitan together and light a fire under his chair about the need for medicines, equipment and proper emergency transport!
The stories included women and their unborn babies dying from eclamptic seizures due to undiagnosed and untreated high blood pressure; one woman shared that a woman was brought to the clinic with a BP of 220/120, and died just outside the door of the clinic while they were trying to get her to the hospital. Many participants had the experience of prolonged labour or malposition where the baby was already dead by the time it was born. Nanay shared a story of a newborn that developed severe jaundice, the parents could not afford the hospital and would not transfer when Nanay insisted, shortly after the baby was dead.
The response from the government to the shockingly poor maternal-child health statistics and the hardships and dangers faced by pregnant and labouring women has been complete inaction and silence.
International UN organizations, such as UNICEF, have a response almost as lacking as the Philippine Government. Here in the Kalabaklabakan Mountain Clinic sit two large boxes of midwifery equipment and medications. There are no instructions on how to use the equipment and no manuals on managing delivery or emergencies! To top it off, the kits lack ANY postpartum hemorrhage medications! There is even magnesium sulphate to treat severe hypertension and eclamptic convulsions, but no oxytocin or ergot! I am shocked. The kits are great but where is the needed support to put them into use?
There Are No Personal Solutions to Political Problems
It was a goal of mine to attend deliveries in the Philippines, and I knew I would help out with some training along the way. It wasn’t until I was actually out here in Guihulgnan that it really hit me how fundamental health skills training is to the strength of the People’s Organization and the survival of the community as a whole.
Considering this, I cannot be disappointed that it is so hard to get out to the deliveries, but be happy with the deliveries I get. It is shocking how dangerous it is to give birth here, and if I could, I would stay here for a year and train everyone! So now I let go of the pleasure of delivering babies and focus on doing the best trainings that I possibly can while I am here – and in as many creative ways as I can, too! I have been asked to give 4 more formal trainings, plus to keep training with each prenatal visit, and any deliveries that occur during my stay.
It was incredibly inspiring to design and facilitate a two-day basic skills and emergency training with local Community Health Workers (CHWs – work for the People’s Organization), Barangay Health Workers (BHWs – work for the local health unit), and Hilots (traditional birth attendants). We covered what to do in a basic prenatal visit, what abnormal findings mean, when you can treat at home and when to go to hospital, doing a normal delivery, the midwifery kit, and then some emergencies such as hemorrhage (with no meds!), shoulder dystocia, breech, and prolonged labour. For the CHWs at Kalabaklabakan, I reviewed the uses of the essential medications for pregnancy and delivery, minus the PPH drugs (!), since UNICEF didn’t send those!
Training of health workers is the best and most lasting contribution I can make; knowledge and skills in the hands of the health workers leads to a better life for the whole community and is a significant contribution to the movement!
In the Philippines, 10 mothers die daily due to pregnancy and childbirth related causes. On Negros, 0.81% of pregnant women die in pregnancy or during childbirth. 13 of over 1,000 newborn babies die.
We understand that this is because the basic and chronic problems in health are not addressed and indeed are allowed to worsen as the majority of the population lives in dire poverty. It all boils down to the reality that the government priorities foreign debt and the military over the health of the people!
For the national situation, see my earlier blog entry 'National Situation'.
Trinidad is but one of 33 Barangays in the ‘city’ of Guihulgnan, Negros Oriental; Trinidad Barangay itself is composed of many small sitios, each with a population in the low thousands. This community is about as rural as it gets; very few of the extremely modest 1 or 2 room bamboo houses has direct access to the road, so reaching most homes involves a 20 minute to several hour hike.
This means that women and their families have very limited geographical access to health care services. But the problem goes much deeper, and encompasses not only the geographical, but includes the social, ideological, political and economic.
The social barriers include the burden placed on the family when the mother is absent from her childcare and household duties in order to access far-away and expensive health services. When it takes several hours a day to prepare meals over open fires, and either you cook or you don’t eat, there is no other option for many families except to try and farm out their children or bring them into the city. The usual 'choice' is to not go to the health centre or hospital at all.
The ideological barriers are difficult to express. There is an acceptance that women take a risk of dying for having a baby that would never be socially-acceptable in Canada. Children with deformities are prayed for and then left to find ways to compensate. My perception of risk is completely altered by this experience.
The political barriers run deep to the corruption of the Philippine national government and the patronage-focus of the provincial and local governments. If you are poor and have no money to pay for your kidney dialysis or blood pressure medication – go see the mayor and ask for a favour because you voted for her in the last election! No social services for the people as state responsibility, but rather stop-gap measures from the politicians looking for support and votes. In an emergency, in order to use the municipal truck for transportation, you first must see the Barangay Capitan! Meanwhile, the injured or sick person is already dead while their families scramble to find transport. This very situation happened last weekend and the teenager with the head trauma died.
The economic barriers are the most maddening, and yet provide an explanation for the geographical, social and ideological barriers. The political corruption and foreign-debt and military focus of the national expenditure leaves the people on the brink of disaster.
The Personal is the Political
We started the basic midwifery skills training for local CHWs and hilots that I led last week with each woman sharing a situation where she felt that she needed more support or knowledge to deal with a woman or baby in her care. Every participant shared a story of a woman or baby, or both, dying for lack of proper care, medicines, or treatment.
The stories were saddening, but it was also heart-warming to see how excited these women who all attend deliveries yet live in far-flung areas were to sit in one room together and share their experiences and their ideas. I really emphasized as much as possible the importance of continuing to share like this, but also to go to see the Barangay Capitan together and light a fire under his chair about the need for medicines, equipment and proper emergency transport!
The stories included women and their unborn babies dying from eclamptic seizures due to undiagnosed and untreated high blood pressure; one woman shared that a woman was brought to the clinic with a BP of 220/120, and died just outside the door of the clinic while they were trying to get her to the hospital. Many participants had the experience of prolonged labour or malposition where the baby was already dead by the time it was born. Nanay shared a story of a newborn that developed severe jaundice, the parents could not afford the hospital and would not transfer when Nanay insisted, shortly after the baby was dead.
The response from the government to the shockingly poor maternal-child health statistics and the hardships and dangers faced by pregnant and labouring women has been complete inaction and silence.
International UN organizations, such as UNICEF, have a response almost as lacking as the Philippine Government. Here in the Kalabaklabakan Mountain Clinic sit two large boxes of midwifery equipment and medications. There are no instructions on how to use the equipment and no manuals on managing delivery or emergencies! To top it off, the kits lack ANY postpartum hemorrhage medications! There is even magnesium sulphate to treat severe hypertension and eclamptic convulsions, but no oxytocin or ergot! I am shocked. The kits are great but where is the needed support to put them into use?
There Are No Personal Solutions to Political Problems
It was a goal of mine to attend deliveries in the Philippines, and I knew I would help out with some training along the way. It wasn’t until I was actually out here in Guihulgnan that it really hit me how fundamental health skills training is to the strength of the People’s Organization and the survival of the community as a whole.
Considering this, I cannot be disappointed that it is so hard to get out to the deliveries, but be happy with the deliveries I get. It is shocking how dangerous it is to give birth here, and if I could, I would stay here for a year and train everyone! So now I let go of the pleasure of delivering babies and focus on doing the best trainings that I possibly can while I am here – and in as many creative ways as I can, too! I have been asked to give 4 more formal trainings, plus to keep training with each prenatal visit, and any deliveries that occur during my stay.
It was incredibly inspiring to design and facilitate a two-day basic skills and emergency training with local Community Health Workers (CHWs – work for the People’s Organization), Barangay Health Workers (BHWs – work for the local health unit), and Hilots (traditional birth attendants). We covered what to do in a basic prenatal visit, what abnormal findings mean, when you can treat at home and when to go to hospital, doing a normal delivery, the midwifery kit, and then some emergencies such as hemorrhage (with no meds!), shoulder dystocia, breech, and prolonged labour. For the CHWs at Kalabaklabakan, I reviewed the uses of the essential medications for pregnancy and delivery, minus the PPH drugs (!), since UNICEF didn’t send those!
Training of health workers is the best and most lasting contribution I can make; knowledge and skills in the hands of the health workers leads to a better life for the whole community and is a significant contribution to the movement!
Congenital Abnormalities Undiagnosed and Untreated
Walking the market or visiting the school, the health worker in Barangay Trinidad can witness many birth defects which have gone unrepaired and untreated; neglect of the corrupt Philippine government. My first experience of this was on my first day in the Barangay – it becomes a matter of fact once you digest that there is no treatment available. In some cases, I wonder, are there other potentially-debilitating defects associated which have been undiagnosed? What are the long-term health consequences of such defects? As a midwife who performs neonatal examinations, I know that where there is one defect, there very well may be others. In particular, when I see children with a mid-line defect, such as a cleft lip/palate, I wonder how extensive of a physical examination has the child had, if any at all?
Some of the more common-place ones I have witnessed:
Partial blindness from malformed eye: There is a boy with an abnormal eye in Billy’s basketball play group. He does not play basketball, but sits on the sidelines and observes the game with the younger kids. Vision impairment will have a major effect on his ability to earn a livelihood in a rural peasant community. I imagine, however, that the child learns to compensate with his good eye as much as possible; but with the common tool of the peasant being the machete, and knowing the regularity with which the health workers repair machete wounds, it must be a risky compensation.
Deafness & impaired speech: There are 3 children who are mostly deaf and who hence have impaired speech in a family of 6 children. The parents wonder why this is happening to them, but no medical professional has ever visited them and reviewed their medical history and pedigree; there are no services available to this family, and no funding for the children. Women in the community have no access to iodized salt, and goiter is fairly commonplace among women of childbearing age and this might be the root of the deafness. I have not seen anyone using signing with these children, and when I asked Nanay if his parents use sign language, she was unsure.
Cleft lip/palate: Although I have seen other unrepaired clefts, there is a girl in Sophia’s play group that must be about 10 who has a marked cleft, and for some reason, this strikes me as the most regretful neglect of the Philippine health care system. Perhaps it is because I am very knowledgeable about the available intrapartum diagnosis, neonatal nutritional monitoring and support, early structural and cosmetic repair, dental care, and counselling available in Canada for parents of and children with a cleft. It makes it hard to look the politicians in the eye when we meet when I know the suffering of these children.
Club foot: There is a young boy of perhaps 10 who walks on his ankle bone as his foot is markedly clubbed. The ankle appears to have a dense layer of scar tissue, but I do wonder about pressure wounds and circulation issues, not to mention, life-long pain.
Extra digits: A minor and virtually non-issue, but a large number I am seeing, and something that we would not even question repairing in Canada.
I know this entry is disjointed, but my time is so tight and I only have access to the internet very sporadically, and then only for an hour at a time. It might be another month before we have internet again, so take care everyone!
Some of the more common-place ones I have witnessed:
Partial blindness from malformed eye: There is a boy with an abnormal eye in Billy’s basketball play group. He does not play basketball, but sits on the sidelines and observes the game with the younger kids. Vision impairment will have a major effect on his ability to earn a livelihood in a rural peasant community. I imagine, however, that the child learns to compensate with his good eye as much as possible; but with the common tool of the peasant being the machete, and knowing the regularity with which the health workers repair machete wounds, it must be a risky compensation.
Deafness & impaired speech: There are 3 children who are mostly deaf and who hence have impaired speech in a family of 6 children. The parents wonder why this is happening to them, but no medical professional has ever visited them and reviewed their medical history and pedigree; there are no services available to this family, and no funding for the children. Women in the community have no access to iodized salt, and goiter is fairly commonplace among women of childbearing age and this might be the root of the deafness. I have not seen anyone using signing with these children, and when I asked Nanay if his parents use sign language, she was unsure.
Cleft lip/palate: Although I have seen other unrepaired clefts, there is a girl in Sophia’s play group that must be about 10 who has a marked cleft, and for some reason, this strikes me as the most regretful neglect of the Philippine health care system. Perhaps it is because I am very knowledgeable about the available intrapartum diagnosis, neonatal nutritional monitoring and support, early structural and cosmetic repair, dental care, and counselling available in Canada for parents of and children with a cleft. It makes it hard to look the politicians in the eye when we meet when I know the suffering of these children.
Club foot: There is a young boy of perhaps 10 who walks on his ankle bone as his foot is markedly clubbed. The ankle appears to have a dense layer of scar tissue, but I do wonder about pressure wounds and circulation issues, not to mention, life-long pain.
Extra digits: A minor and virtually non-issue, but a large number I am seeing, and something that we would not even question repairing in Canada.
I know this entry is disjointed, but my time is so tight and I only have access to the internet very sporadically, and then only for an hour at a time. It might be another month before we have internet again, so take care everyone!
Sunday, July 27, 2008
Birth of Baby Sophia -- Kalabaklabakan Mountains
July 8, 2008
First delivery call!
Tuesday morning we had just gotten the kids settled into their new school classes when I had the opportunity to accompany Nanay Meralyn on a house call for a delivery. We rushed back to the mountain clinic and gathered up our supplies. I threw my charting documents, prenatal kit, delivery kit, newborn resuscitation kit into my backpack along with a bottle of water, my headlamp and a clean bandana; Nanay packed sterile cloths and a hanging scale into two basins, and grabbed her home visit kit. To help with translation and provide support, Josephine and Ping also came along.
To get to the simple home of this farmer and his labouring wife, we had to hike for over 45 minutes with Nanay leading our entourage at full tilt. After reaching the summit of the first slope I was so out of breath and dripping with sweat I thought I was going to collapse or at least throw up, but we had just started! Nothing to do but keep going and hope the feeling passed. After the second climb I started to get the hang of it; then, magically, we reached the summit of the hills and walked on the highlands with valley on either side. It was positively gorgeous landscape. In midwifery school I never imagined I would be hiking into a birth with my kit on my back. I had hoped that we would be able to discuss the situation on our way, but Nanay was leading the pack always at least 20 paces ahead and I was too hot and winded to have a conversation! As we passed each house Nanay would call out greetings and get directions. It was quite fun once I no longer needed to desperately gasp for air, though I was nervous about what was awaiting me on this first birth in rural Philippines.
Finally we start to descend into the valley on our left, all the while I am thinking, ‘what goes down must come back up’… imagine hiking home with your equipment after a birth! There below us lay the home of this newly-wed couple having their first baby. The mother-to-be was already 34, old age for a first baby in these parts. The house was very simple, a one-room bamboo hut on stilts, with a pen for their goats, and chickens and puppies roaming the grounds. On the north and west sides there lay lovely a corn field almost ready to be harvested, on the west cassava underground with their vibrant green leaves bursting through the thick brown soil, and to the south the most incredible avocado tree literally dripping with giant soft and delicious avocados which we were fed shortly after our arrival. The home was tiny but very clean; no toilet or running water, but the raised and slatted bamboo floor was spotless and the air smelled fresh and sweet.
There were about 12 relatives in the house, on the small porch, and in the yard cooking and chatting. At first the fire was built under the house so the heat was passing through the slatted floor into the house so it was literally a sauna, but thankfully that fire was put out as the sun rose higher in the sky and a new fire was started off to the side!
It was 10:15 when we arrived. The labouring mother, Conception, or Connie, was lying flat on her back, not looking much like a woman in labour to me! Nanay went about checking her vital signs, and then I followed with an abdominal exam, feeling the position of the baby and listened to the FHR, first with my fetoscope and then with my Doppler so the parents could hear the FHR. I palpated for contractions and felt mild contractions about once every 8 minutes. The story took almost one hour to unfold, all the while Connie lying on her back covered in a blanket. It seemed that her pains started the previous night, she didn’t sleep well, and that morning she was still having pains coming and going, no fluid or bloody show yet. This information was difficult to gather, let alone get a full history of the pregnancy! After this we continued to eat and socialize with the family as they churned out snack after snack, avocado with muscovado sugar, cassava roasted in banana leaves, fresh ripe bananas, and rice with sardines.
As we snacked, I started to make suggestions about the labour. Everything has a process to follow, believe me; this was very hard to do for a variety of reasons, the biggest one being a huge language and culture barrier. Luckily, the father of the baby was very happy to have me, so this helped immensely. Mainly I felt it imperative that we get Connie up off her back and walking and swaying and moving her body. Periodically I listened to the FHR, perhaps every 30 – 45 mins, not too worried with schedule since I felt she was still quite early in labour.
Finally, at 12:00 I was starting to think that all of this socializing was getting us nowhere and I wanted a more complete picture of what was going on here. I could see that Connie was acting more like a labouring woman. I asked if I could again palpate contractions, and perhaps do an internal exam to see if the cervix was at all dilated. This took some negotiating, since I gather now from discussing with a CHW, the local hilots do not do much in the way of physical examinations of mom or baby; but consent was gained. After explaining through patchy translation how the exam works, I discovered that she was 1 cm dilated, 2 cm long, soft, vertex -1, ROT to ROP with SROM for clear fluid! Although I had been assured a few times that nothing was coming from her vagina, I was most definitely touching hair and that was for sure clear fluid pooling on the blanket. After more complicated and raucous discussion among the many women in the room, I finally discerned that, indeed, fluid had started leaking in small amounts at 08:00 that morning. Now we have a 34 year old primip with PROM and a posterior baby, to boot.
Damn! In my quest to make my backpack lighter I ditched my castor oil at the mountain clinic. Of course, now I want it! On the bright side, I think the baby is a nice small peanut and judging by how low it is sitting, I think she can push it out. At this point I am thinking about how the sun sets at 18:00 and we have to hike an hour to get to the clinic and the road. I tell Nanay what I am worried about: PROM, infection, I think we should be headed to the hospital if labour isn’t starting by night time, and how to transport if a fever starts or augment/induction turns out to be necessary. We discuss the transport process again: hike for 45-60 minutes, ask the Barangay Captain to use the Barangay jeep, then drive 2-3 hours to the hospital in Guihulgnan City. OK. I tell Nanay that if she isn’t in good labour by 18:00 we should go to the clinic cottages, as the transport process is ridiculous and we can’t facilitate it from here. Vital signs are stable, fluid is clear; FHR is good, nice accels - all reassuring stuff so we should enjoy the native coffee and the view with a plan in place.
Thinking that I want the labour to get going, I ask Nanay if there is a local alternative to castor oil. A tiny little woman with a long grey braid and a big smile appeared from out of nowhere and started to perform some kind of a ritual – a faith healer! How exciting for me to have the chance to witness. The healer proceeded to massage Connie’s belly with oil (which I later learned is snake oil) and to chant prayers to the baby.
Some time about 13:45 I needed to stretch my legs and pee in the corn fields. After a time I went back into the house and discovered Nanay starting to get Connie to push! Glancing at my watch I see it is 14:22. No way is this baby coming. I gently ask Nanay what is going on. She told me that ‘plenty of water’ was coming and the vagina was parting and was completely convinced it was time to push. OK, I tell Nanay that I am sure it is too early, but she has Connie down on the floor semi-sitting and is doing her thing; I have no other choice but to give this pushing business time to prove it useless. At least since Connie is now only contracting once every 15 mins for less than 45 seconds I am not worried about causing harm. Finally, after over 1 hour and only 4 pushes, I tell Nanay that I am certain that nothing is happening and we should stop this pushing in order to observe the labour – now Nanay is willing to have me step in. I sit quietly with my hand on Connie’s belly and feel contractions about every 8 minutes, mild to moderate; I gather that the contractions are still irregular and Connie was only pushing with the moderate and ignoring the mild.
Now it is close to 17:00. I tell Nanay that the labour is still very early and we should go to the clinic cottages now before it gets dark. To confirm this, against my better judgement I do another exam, sure enough, just as I expected, 2 cm dilated, 2 cm long, though there is some show on the glove now, fluid still nice and clear. I explain to the family that the womb is still mostly closed and the baby is not coming yet, but since the water is leaking we may need to be closer to help if it is needed. I also explain that the walk will likely get the labour going since the baby is so low it will help the cervix open. Finally, there is electric light, a cell phone, and intermittent cell signal at the clinic. At the clinic cottage we can wait until tomorrow morning to go to the hospital if needed, but at least we will be close if we have to go overnight.
OK, they agree! This is too easy. Everyone is bustling about packing up clothes, food, blankets, even a chicken tied by its feet and a long bamboo pole. But what is going on now? I peek back in the house and see Nanay has her pushing again!
It is hard to convey the scene that unfolded. There are now 13 people in the tiny steamy house, the faith healer is chanting and throwing flowers, men are saying prayers, women are all talking over each other shouting suggestions. I literally thought I was going to lose it – this was the most outside my comfort zone I had been the entire trip. I can laugh now, but at the time all I could do was do breathe deeply and remind myself that by tomorrow it would all be a memory – and a darn good one! Speaking loudly and clearly I stated again that the baby was not coming now and we should go before dark. I learned the day after from Mamay Amy that the father of the baby told everyone to listen to me and that we should leave – thank goodness because I think it was the right decision.
Now we set off. Connie is walking with her husband and a relative on either side to support her when she has pains. I show Connie how to slow dance with her husband when a pain comes. I am certain the walk will be a great help, and feel that we are doing the right thing as already the contractions are picking up. But what is happening now? Connie didn’t sleep last night and she is too tired to walk the rest of the way – the thunder is starting and the rains threaten. Like magic a man appears from the woods on a horse followed by a couple more men. They wrap blankets around Connie and tie her to the bamboo pole, and now we are off at great speed. I practically run with them the rest of the way to the clinic, leaving the family trailing behind with their iron pots and chickens. My adrenaline is now rushing and I barely notice the climbing.
As we descend the last decline we run into Mamay Amy who was on her way to look for us, worried we had been gone for so long and it was almost dark now. Nanay runs to the clinic cottage to turn on the lights and make a place for Connie while Mamay heads off to find Aiyanas and the kids and tell them I am back.
The trip was brilliant! At 18:00 Connie is looking like a woman in rocking labour. I joke with Nanay and Connie’s husband that this is what a woman in labour looks like! After a pee and a good drink, we get Connie side-lying and encourage her to rest between contractions, using massage to help her relax. I set out my delivery kit, my PPH meds, my newborn resuscitation kit and my suture kit, along with some extra gloves, cloths for the newborn and extra gauze. At about 19:00 she is starting to make grunty noises and I see perineal bulging! Time to set up our instruments and place a clean drape; I laugh as I look at my light blue tank top and jeans, so Mamay brings me a rubber apron. I tell Nanay about when to coach Connie to pant; I quickly coach Ping how to listen to the FHR with my Doppler between pushes. As the head starts to crown, the room fills with relatives all shouting encouragements. I am calling out “Pant! Pant!” and everyone else is chanting, “Sigue! Sigue!” Ah, well, what can I do but roll with it? So, in a dimly lit cottage in rural Philippines I perform my first-ever somersault manoeuvre as I feel the nuchal cord and yet Connie is pushing like a woman possessed and the family is all yelling for more! At 19:50, following a giant push, the baby is out, unravelled from the nuchal cord, and up onto Connie; with a good rub of the clean towel the baby cries! The cord is no longer pulsing, so I clamp and have the father do the honours with cutting the cord. It’s a baby girl!
Now the placenta; I am doing expectant management since my access to PPH medications is so limited. I have to say, I am a hard-core active management kind of gal, so this is the moment that makes me hold my breath. After a cuddle and a quick attempt at a breast-feed to get the oxytocin flowing, we get Connie up in a squat, and at 20:05 we have an intact placenta and about 300 cc of blood loss, which I suspect is now bleeding from her perineum. Uterus nice and firm; BP is great. Second degree laceration sutured beautifully, I must say, thanks to the Mountain Equipment Coop headlamp I brought for just this occasion.
Finally, my favourite part, the newborn exam. What a perfect little rosebud of a baby girl, weighing in at 2820 grams. Everyone is elated, and they name the baby girl Sophia! What a great tribute.
The family will spend a few days in one of the clinic cottages so we can do our postpartum care without hiking each direction – thank goodness! As it turned out, one of the relatives is the leader of the People’s Organization (hence the men appearing by magic) so even Aiyanas had a good experience talking with them while I did the birth.
My first home birth since graduation, a beautiful birth, a memorable story!
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