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!