Payatas Exposure Trip

May 31, 2008

Today was our exposure at Payatas; the community built on the cusp of the Quezon City dump site, ironically also adjoining the water reservoir!

Kuya Rod picked us up and we met Mel and Teresa on the way to meet Ate Anna and Ate Nanay, two Payatas Community Health Workers. When we arrived we made our way to Ate Anna’s house, and shortly Ate Nanay arrived with her granddaughter and another CHW named Ariel (also Anna’s son). After we briefly shared about the reasons for our trip, we had a good discussion about the experience of organizing on the health concerns in Payatas and on many other issues, including working as scavengers in the dump.

There is so much to recount that it is difficult to put it all down, but we think it is important to document and share. I have tried to categorize to make sense of it all and write the bulk, and Aiyanas will go through and edit and add, so this is really a joint venture!

Context and Housing Conditions:

Ate Nanay moved to the Payatas dump area in 1981; many people come to this area from the provinces, either permanently from displacement, or temporarily due to the seasonal nature of the peasant income. It is a long-standing squat, and there is a struggle over the title to the land. The government is in negotiation for the land, but they want to sell the community members the land title, which is expensive – the land was cleared and the homes built by the labour of the people! One of the CHWs we met, Ariel, pays ‘rent’ of p1,000/month to live in the one-room house ‘owned’ by another Payatas resident while he and his family await surgery for their daughter Mariel before return to the provinces.

There are 300 houses in Payatas Area B, with overcrowded houses. The population was hard to clarify, but I did manage to learn that there are 9 babies born every week in Payatas Area B. The CHWs joked with me that they don’t have family planning, but rather family ‘planting’ – which got laughs from all of the CHWs. But more on the health issues as we go.

Another major issue is water; there is no water in Payatas, rather people pay to have drums of water trucked in at a dear price. Yet, this is the only option unless the community becomes a member of a private water company and pays a p500 monthly fee for piping in water.

Work Issues:

Now put these prices in context. When asked how much she earns per day, Ate Nanay answered that, after paying scavenging all week, at the end of the week she will have about p100. The scavengers must pay an annual access fee and have an ID card to work in the dump. Then weekly, after gathering the boxes, cartons, bottles, plastic, metal, etc, they must pay p15 to have the dump truck drive them to the junk shop to trade in their goods. This is a monthly income of about 10 Canadian dollars, or p400, per working adult / child (13 is the legal age to start being a scavenger) – so how could these families pay p500 for water supply?

In 2001, 200 houses built too close to the edge of the dump were buried in a sudden landslide during a downpour. People were buried alive. It was declared an emergency and many NGOs and the government came in to assist with a rescue effort, but still hundreds died. It was the media attention that brought the rescue effort, and it is ironic that the neglect and corruption of the government caused the landslide, and then they come in to the ‘rescue’ to look good for the media. The memorial for the landslide victims is the loveliest, most peaceful place in the area; what about the living? What about all those kids playing in the garbage?

Following the landslide there was a brief ban on scavenging on the dumpsite and building houses in close to the mountain of garbage. However, with time things returned to ‘normal’ and now the possibility for a repeat of the disaster is certainly there. However the area residents, and especially the workers don’t want to bring attention to the conditions for fear that the dump will be shut down and they will lose their livelihood.

Scavenger work is very dangerous work. Ate Nanay says she would rather die from working than from hunger. With housing inaccessible, and even rice prices up to p32-40 per kilo, the scavengers are really backed into a corner. When we first met Nanay she had just come from one of the sites where the government distributes subsidized rice. Although she lined up for hours she was not able to buy any, they ran out. She informed us that even when she is able to buy the reduced price (p18 per kilo) rice, she is limited to 3 kilos. Ate Nanay told us she could get 2 meals per kilo of rice – how many meals of plain rice does one weeks work provide?

Ate Nanay has a remarkable ability to laugh and crack jokes about the struggles she faces; she informs us the dump is her ‘great big office’ and her scavengers hook is her ‘great long ball pen’!

Health Issues:

Remember that the major cause of death in children is still preventable communicable diseases and accidents. Imaging living in such cramped quarters, with no sanitation or running water, not being able to wash your hands or have a running shower. Not enough proper food leads to malnutrition, unsanitary conditions lead to diarrhea, which can be life threatening, especially among malnourished children. Malnutrition – diarrhea – severe malnutrition – chronic diarrhea – death.

Tuberculosis is a major health concern in Payatas, as in all poor communities in the Philippines. It is difficult to treat here, as medications are very expensive, and even if the public health unit has enough stock to treat their current caseload, the patients must miss work and travel to the health unit EVERY DAY for their medication. Hence people are taking their medications for only one or two months, until they feel better, rather than their full six month course required to completely cure. This mistreatment leads to antibiotic resistant tuberculosis, which would be disastrous and heart breaking. In order to have proper treatment, these families need not only access to the proper medications, but also compensation for missed work time and adequate housing and nutrition!!

Skin infections are also another major source of morbidity. In the CHD clinic I saw a young baby who had multiple infected carbuncles on his scalp from scratching insect bites with dirty hands. This baby was very ill with the number of large skin infections. It is living in poverty that leads to these disorders. Mariel, the daughter of Ariel, has a cyst on her leg that has steadily worsened over a year, and now requires surgery to remove. It is so frustrating to hear this story! If they had had proper treatment in the province, this family would not have had to leave their work, move into Manila, and live in a dump while awaiting an overpriced surgery for their daughter. Already they have been waiting a month, hoping each day for a text message from the hospital that Mariel can receive her treatment. It is shocking and saddening that people are forced to such ends.

I already mentioned that in Payatas there are 9 babies born every week in Area B. Most of these babies are born at home, primarily with a Hilot, or traditional healer. There are midwives in Payatas, but they charge from p1,500 up to p5,000 for a delivery, and so only those families lucky enough to afford it can have the benefit of formal training and most importantly, western medicine when needed. A Hilot will often deliver for a small fee, and sometimes for a T-Y (Thank You). Recently a mother delivered with a Hilot, and had a postpartum hemorrhage (PPH). The Hilots do not have access to oxytocin or other medications for PPH, and so this young woman bled to death while her husband desperately rushed to the pharmacy for medications. By the time he returned, she was dead. Knowing how quickly a woman can bleed out after a delivery, it is maddening that the DOH does not give Hilots the basic training necessary to administer medications and a birth kit to carry with them!! My brain was turning with ideas for a future project to do some basic emergency birth training with the Hilots and garner some donated medications and small equipments for deliveries!

We were admiring Ariel’s baby son, when he explained that they had 3 children, but his middle baby died when she was 18 months due to a malformed heart / congenital heart defect. They did not have timely diagnosis and no surgery was performed. It was very moving to hear him explain how they were in the province and came into the hospital in Manila, but it was not enough, and she died. We discussed the genetics of heart defects, and I know this is a huge worry for Ariel, as he holds his baby son, wondering what the future holds. I didn’t bring my stethoscope that day, but I sure wished I had it. How could this family raise the money for the diagnostics, let alone any open heart surgery? Mel told me that at the Philippine Heart Centre they only accept 2 charity patients per month, and many are dead by the time their turn arrives. Last year we had a baby in our practice in Vancouver with transposition of the great arteries detected shortly after delivery; within days of birth, the neonatal cardiologists at Children’s Hospital had a detailed complex care plan in place and were discussing how to best approach surgery. While he will have lifelong limitations, this baby had a very high probability of survival.

Back to Payatas! Another health concern I witnessed is that animals are kept in the houses, as there is no other place to keep them. We met one young CHW in training who is also a student nurse. Her family is raising pigs in the house to pay her tuition of p7000 per 6 month semester. The current pig lives in a pen in the rear of the house, next to the sleeping area. Unfortunately, one pig is not enough to pay this tuition, so the money has to be garnered from other sources. Animals are a source of livelihood and food, but also of disease. When children touch the animals and then eat or put their hands in their mouths, this can cause diarrhea and worms. There is just no other option until the plunder of the Philippines by transnational corporations is stopped and the wealth of this rich nation is divided according to need.

The Peoples Response: Training CHWs and Getting Organized

Naturally, there is a response of the people to this situation. There is the KBK, KilosBayan para sa Kalasugan (People’s Movement for Health), a chapter of the Council for Health and Development and the local coalition of community based health programs. They provide basic health services, herbal medicines, and ongoing community health worker training (CHWs). They also participate in the broader campaigns of the health sector, such as the campaign for cheaper medicines, as well as the broader movement activities. If you check out my slide show, you will see the KBK banner flying in the Ka Bel memorial and protest march!

Our time in Payatas was a wonderful experience. We are very thankful to Ate Nanay, Ate Anna, Ariel and all of the Payatas members who were generous with their time and sharing their lives and struggles with us!

Tuloy ang Laban!