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
2 comments:
where are you guys right now? will you be in Manila any soon or still on November?
We won't be in Manila until October 30, will you be there in November?
We are in Bacolod 26-30, will you be there?
Will we see you again?
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