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.