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!
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