Sunday, May 25, 2008

Slideshow of Manila Photos

A Mission of Solidarity: A Canadian’s Experience in Manila

May 16, 2008, 11:00, the National Centre for Mental Health
The patients, in their burgundy gowns, clamber to the bars of the locked-down ward for mentally ill young women, asking my name and nationality, reaching through the bars to shake my hand, telling me bits of their personal stories, asking me if I have seen their relatives. This ward is grossly overcrowded, without enough beds for the patients, who are forced to share beds or sleep on the floor, as many young women are doing, without mattresses or pillows, no blankets in sight, no personal comforts. The noise and the smells are overwhelming. The census shows there are 117 patients in this ward, with only one nurse!

This nurse cares deeply for her patients. She expresses to me, “as the only nurse in this ward, how can I provide even basic care to so many patients, let alone the type of care that would truly improve the lives of these mental patients?”

This nurse is performing socially necessary and productive work, but is forced to work in dangerous conditions, risking her own personal safety in an overcrowded and sadly under-funded hospital. Without back up, she cannot take a single break on her 8 hour shift; meals are taken at her station. If her replacement nurse is ill or delayed, she will work up to 16 hours unable to leave her station. And for what pay? A take home pay of less than p 8,000/month, or about 6 Canadian dollars per day.

As a Canadian, I ask myself, “why is this happening to the nurses and to the patients?” “Where is the health budget and what are the priorities of the Gloria Macapagal Arroyo (GMA) government that such deplorable conditions for both patients and health care workers could be allowed to continue?”

In a demonstration of solidarity for the struggles of the Filipino people for national and social liberation, my family and I are spending 7 months in the Philippines. As a midwife from Vancouver, Canada, naturally my alliance lies strongest with the health sector. On May 16, 2008, I had the privilege of an orientation with the Alliance of Health Workers and to tour 3 hospital facilities with AHW organizers: the National Mental Health Centre (NMHC), San Lazaro (SL), and Philippine General Hospital (PGH). This article recounts my experiences and the lessons I drew from that inspiring day.

Debt Servicing Over People’s Health: Mistaken Priorities of the GMA Government

All across the Philippines, the conditions that Filipinos face in their workplaces, in factories or fields, in their communities, and in their homes do not support health. Filipinos continue to get sick and die from preventable and often easily curable infectious diseases. Poverty, low wages, unsafe working conditions, and an absence of government social programs in housing, sanitation, basic nutrition, and health prevention lay the foundation for the ill health of the people. While 80% of the population of the Philippines lives on less than $2 US dollars per day, multinational pharmaceutical corporations are reaping billion dollar profits and benefiting from GMA tax-break schemes.

1:00, San Lazaro Hospital for Infectious and Communicable Diseases
A patient at San Lazaro hospital arrives at the admission ward, sick with an infectious disease, such as typhoid, dengue, malaria, tetanus, or cholera. It was the poverty of their families and communities, a lack of adequate housing and sanitation, and enforced hunger and malnutrition that led these patients to contract the disease in the first place. Yet, to obtain a diagnosis, this patient must pay a fee to use the laboratory diagnostic equipment, which is now owned by a multinational corporation and ‘leased’ to the hospital for a fee. If the patient can afford to pay for their diagnosis and is admitted for treatment, a myriad of other user-fees must be paid, including a daily bed fee. Even the poorest of patients must pay at least 10% of their total hospital bill. At San Lazaro, a hospital bill can amount to 3 months of salary for a patient! Every day at San Lazaro, patients sick with highly infectious diseases are turned away and sent back to their communities due to lack of funds. In fact, half of the population of the Philippines will die without the benefit of medical attention!

In the context of this gross unequal distribution of wealth, I learned there are multiple issues facing the health care system of the Philippines: a lack of affordable medicines; rising user fees in hospitals; contracting out of health services and medical and diagnostic equipment; income generation programs in the hospitals, such as private pay wards that divert essential resources to those able to pay; dilapidated hospital buildings, and non-functional and outdated equipment; and most significantly, the mass exodus of skilled health care workers, especially nurses and doctors. During my tour I learned from one union organizer that the union is assisting nurses to take up other skills such as tailoring to earn additional pisos to supplement their income as nurses!

The health care system of the Philippines is starving for funds as health care workers are forced to leave the country in droves to work overseas in order to support their own families. It is estimated that more than 150,000 Filipino nurses are working overseas, with the Philippines as the number one exporter of nurses. Following closely behind is the export of doctors, with the Philippines as the number 2 exporter of doctors! During my health orientation and hospital tour, it is painfully obvious to me that the GMA government lacks the political will to provide employment for the health sector and simultaneously provide health care for the people.

Turning a blind eye to the health crisis, the government continues to borrow funds in the name of corporate profit and increase the national debt in order to remain a ‘junior partner’ of the US. The national health budget remains inadequate, with only 0.34% of GDP spent on health. It is shocking that, given the health situation of the people, the military budget is 6 times the health budget, while debt servicing is 63 times the health expenditure! With their hard-earned remittances, overseas Filipino workers are floating the corruption and corporate favouritism cum tax evasion and ‘business incentives’ of the government, which is committed to privatization, trade liberalization, and market deregulation; a commitment to the irrational economics of imperialist globalization over much-needed investments in the Filipino people themselves.

Since the government refuses to take responsibility for the health of the people, the burden falls on the health sector workers themselves to leave the country and support their families, to fill in the huge gaps left by the government. In 2005, the Philippines economy received USD 10B-12B in overseas cash remittances from the labour of the OFWs.

The Experience of Overseas Workers: The Live-in Caregiver Program of Canada

The experience of Filipino workers in Canada demonstrates that the Arroyo government is willing to sell Filipino nurses into what amounts to ‘modern day slavery’ rather than provide a viable economic plan for the health sector in the Philippines.

The Live-in Caregiver Program (LCP) of Canada recruits highly-skilled workers to come to Canada to provide 24-hour per day live-in domestic and care-giving work for often below the minimum wage. The program results in the de-skilling of the majority Filipino women who, living in the employers homes as domestic servants, are highly susceptible to exploitation, abuse, and forced prostitution.

On the flip side, the LCP allows the Canadian government to privatize essential childcare and home care nursing and programs, citing the availability of ‘economically viable’ private alternatives through the exploitation of imported cheap labour from abroad.

Canadian-based Filipino organizations, such as SIKLAB, call for the scrapping of the LCP as a racist and anti-woman government policy!

Hey GMA! The People Respond!

3:00, Philippine General Hospital
PGH workers crowd into the PGH All Up Workers Union office, preparing for a medical mission into a poor community. As health care workers, the All Up Union members take seriously their mission to serve the people. It takes dedication and perseverance to withstand the conditions they face daily in their work, let alone to add to their burdens the challenge of union organizing to fight for the rights of health care workers and all oppressed and exploited sectors of society. Despite the myriad of tasks to complete for the medical mission, an All Up Workers Union representative still makes time to tour the hospital with us, explaining the issues and conditions of the workers. This dedicated worker and organizer also shares how the union actively engages in campaigns for pay raises, better working conditions, and against the economic policies of the government.

Campaigns such as the one to raise health sector salaries p3000 across the board show that health sector workers are rising up to demand that their needs be met without being forced to separate from their families and endure the hardships of overseas work.

PGH workers and AHW organizers are active in the Health Sector Alliance Against JPEPA, exposing and opposing the government’s corrupt intentions to increase the export and exploitation of Filipino health care workers at the expense of the Filipino people.

Thank you to all of the workers and organizers who took their time and shared their struggles and their lessons with our family. Your struggles are a true inspiration to us, and we stand in solidarity with you.

Makibaka! Huwag Matakot!

Remembering a Working Class Hero

May 23, 2008

Hello again, everybody. Another hot and sunny day amidst the rainy season, though by the afternoon the downpour will likely start anew. Life here goes on, though slowly. The kids are well after a fever and sore throat passed through us; seems to be passing around organizers at CHD, too. We are enjoying the many fruity and savoury treats on our walks to and from CHD, as well as the myriad of opportunities that present throughout the day to learn about the struggles of the people. I am working on an article for the Alliance of Health Workers’ newsletter; I’ll post the article to our blog.

Today we are headed into downtown Manila to attend the Parangal (wake) of Ka Bel, congressman from the progressive party-list Anakpawis, a man who sought economic justice for the workers and the equal distribution of land to the peasants. The wake is divided into a schedule to give all the opportunity to attend, to hear about his life, and to share their experiences and heartfelt reflections of Ka Bel. I really appreciated what one of the CHD organizers shared yesterday, that Ka Bel was a true working class hero and a man of the people. At 75 years of age, despite his being a respected congressman, he was up at 6:30 AM fixing a leak in his roof! That even as a government official, his ‘assets’ were limited to p20,000, two barongs, and a pair of eye glasses. He certainly knew where his priorities lay, with his tireless efforts to bring over 300 alternative bills forward to the congress in defence of the workers and the peasants, the masses of poor in the Philippines.

In this context of reflections on a great leader, the future of the struggle in the Philippines is also on everyone’s lips. Coupled with grief are also sentiments of hope and dedication to continuing the struggle for justice. It is a sad time, and also a time to see right into the heart of the people, and the commitment and the love for each other that resides there, providing the impetus for the personal sacrifice that each and every organizer makes in order to struggle for a just and liberated society for all.

For the duration of this time of mourning and reflection, our plans have changed. Next week we will attend the procession from congress in recognition of Ka Bel. The loss will also be greatly felt at the ILPS in June; Ka Bel was preparing for our gathering at the time of his accident. The multi-sectoral organization of the movement in the Philippines comes clearly into view; it was described to me as an orchestra, with each instrument and section (organization & sector) providing their part, each part contributing to the score (strategic plan).

Unfortunately I can’t find a computer with the program necessary to load photos onto this blog, and loading photos onto my flicker site takes aeons of paid internet cafĂ© or CHD computer time. So, if you want to check out our photos, follow the link to our flicker site from the 2003 exposure trip slide show posted on this blog.

We will be posting some interviews on the life of Ka Bel in the days to come.

Tuloy Ang Laban! The Struggle Continues!

Tuesday, May 13, 2008

Today was our briefing on the national situation and the activities of CHD. In order to tackle the roots of the people’s ill health, a broad perspective must be taken. It is only within this context that a full understanding of the health crisis in the Philippines can be understood. Hence, this blog entry is long! However, I found it very interesting to learn the true situation as well as compare to what is happening to public health care in Canada.

The three key issues in the Philippines remain:
1. Foreign domination
2. Landlessness
3. Corruption

Within this overarching context millions of Filipinos get sick or die from preventable and curable diseases; the health gap grows rapidly while the public health care system is collapsing due to neoliberal policies, under-financing, and the exodus of health care professionals.

The health crisis highlights that the people’s health situation is an outcome of neoliberal policies of privatization, deregulation and liberalization.

What is the situation of people’s health?

The leading causes of morbidity are communicable infectious diseases which are preventable and have simple cures;
- Major causes of death are heart disease, cancer, and accidents, followed closely by TB (tuberculosis) and respiratory tract infections.
- TB incidence 4th highest in the world and 75 Filipinos die of TB daily
TB is a disease which follows the course of poverty, considered to be a poverty indicator (for those of you in Vancouver, compare to the rise of TB in the Downtown Eastside!). In 2003 TB accounted for 40% of the death rate per 100,000. WHO cites the Philippines as worst in the region with 36% of the population afflicted.
- Child mortality rate (1-4 yrs) is 12/1,000 – WHO cites the Philippines as one of the 42 countries that contributes to the over 90% of global child deaths; the top 5 leading causes of child death are: pneumonia, accidents, diarrhea, measles and congenital problems.
- Neonatal mortality rate (0-1 month) is 17/1,000
- Maternal mortality rate 70/100,000; 10 mothers die daily due to pregnancy and childbirth related causes.
For the midwives reading this blog, the leading cause of maternal mortality are:
Labour and delivery complications, hypertension, postpartum hemorrhage, and complications with abortion.
- The maternal mortality rate has not improved in this decade.
There is a massive DEATH GAP between the rich and the poor:
- Poorest 20% account for 66% of the under 5 mortality;
- Poor children are 3 times more likely to die than the child of a rich family.

Ill Health = the People’s Basic Needs Not Met

- 22% of the population undernourished
- 28% preschool children underweight and 27% stunted
- 27% of pregnant women are underweight
- Anemia in under one year olds is 66%
- 37% or 27 million Filipinos do not eat three times a day
- 16.5 million Filipinos go hungry daily and 15 million Filipinos eat only once a day

Of households in the Philippines
- 35% of households have no access to safe drinking water
- 48% have no electricity
- 60% have no concrete house
- 30% have no clean toilette

Going back to the introduction to this blog entry, we know that the roots of this ill-health crisis lie in the priority of the government to serve imperialism over the people!

Let’s examine the situation in the Philippines from the perspective of the WHO.

According to the WHO, the causes of poor health care systems and delivery are:

1.Poor Health Care Financing
a.GDP spending on health ranks 174th out of 192 countries; 0.34% of GDP, less than the 5% prescribed by the WHO
b.The military budget is 6 times the health budget, while debt servicing is 63 times the health expenditure! (Thank you IMF/WB!)
c.Government expenditure on health as a percent of total health care expenditure ranks 156th and only 6.3 of the governments budget is allocated to health

2.Inappropriate Delivery (i.e. focus on tertiary care over primary care)
a.The number of hospitals is growing, but concentrated in urban centres
b.Barangay (neighbourhood) health stations limited to 2/10,000 population
c.Doctor to patient ratio (population)
i.Cuba 1:225
ii.USA 1:450
iii.Philippines 1:10,000-26,000
iv.Ideal (WHO) 1:600
d.Medical tourism is rapidly expanding, directly promoted by the GMA (Gloria Macapagal Arroyo) government. Rather than providing health care to the masses, the major tertiary care centres in the country are focussing on advanced medical care to tourists and private pay patients in order to generate profits.
e.At the same time:
i.5 out of 10 Filipinos die without getting any medical attention
ii.Only 60% of the population has full access to essential drugs
iii.The average hospital bill is three times the average monthly income

3.‘Brain Drain’ of Professionals
a.Health situation exacerbated by the diaspora of health workers due to the Philippine government’s Labour Export Program
b.Philippines is the biggest exporter of nurses; thus there are a mere 5 per 100,000 population
c.Many Filipino health workers end up de-skilled in their country of destination receiving lower pay than their counterparts (Canada is a prime example, more on the LCP later!)
d.Doctors are re-training as nurses for the purposes of working abroad

4.Excessive Pricing of Medications
a.Leads to massive out of pocket expense and inappropriate use (such as failure to complete TB medication regimens exacerbating resistant TB)
b.Medicines are vastly overpriced in the Philippines due to the monopoly of the Pharma giants facilitated by government patenting laws
c.Yet, the top 10 drug manufacturer’s profits were 4 times the national health budget!

5.Insufficient Efforts on Prevention and Control of Disease
a.Public health prevention programs are grossly inadequate
b.TB control and treatment is failing miserably at the expense of people’s lives
c.Control of diarrhea diseases covers only 14% of total cases and is limited to ORS

6.Inadequate Enforcement of Regulatory Mechanisms
a.HSRA (health systems reform act) was drafted in 1999 with financial and technical assistance of the US. Neoliberal policies are couched in terms which sound conducive to the expansion and strengthening of primary health care. One must read between the lines to grasp the implications of the HSRA:
i.“Provide fiscal autonomy to government hospitals” means that the budgets of government hospitals must be garnered from private sources, primarily through private-pay schemes.
ii.“Secure funding for priority public health programs” means foreign aid and loans which would demand implementation of projects implemented by TNCs (trans-national corporations) such as population control and food aid programs.
iii.“Strengthening of health regulatory agencies” really means promoting competition in the health market by providing information from competing private entities, ultimately resulting in government sponsored direct to consumer advertising of health services and products.

Compare those 6 key points of the WHO to the key priorities of the IMF/WB neoliberal prescription for health care delivery:
1.Reduction in public health expenditures
2.Promotion of private financing
3.User-fee health services
4.Competition in the delivery of clinical services

This neoliberal prescription for health care is at the root of the dire health situation in the Philippines!

With this situation in mind, we embark upon a life-changing learning experience to witness the community and sector organizing work of the CHD and allied organizations. I thought those of you who are following our trip might benefit from this information, so that you can read our blog entries with this context in mind.

Arrived and Settled In

May 12, 2008

Here we are sitting down together after a busy day to compose our first blog entry.
We arrived safe and sound in Manila on Thursday, and on Friday we had our orientation to the neighbourhood with M, one of the CHD health workers. M was a professor at the University of the Philippines, but after suffering a debilitating illness and benefiting from acupuncture, was one of those trained by CHD to become an acupuncturist. M now refers to herself as a ‘professor of the masses’ and dedicates her time to serving the people via CHD. So, after a short lesson in acupressure points for pain, we set off to the SM (super mall) to obtain some necessary home items such as a pot for boiling water and cooking.

M took us to an upscale grocery store in the SM mall; it seems like there was an assumption that as Canadians we would want to shop in the supermarket but the prices were very high. Since we are paying $610 for rent (!!), we are really trying to keep our food costs down. The next day we rode the MRT (light rail) to the large wet market which was both more interesting and affordable; we got mango and an incredible juicy amazing pineapple and a number of vegetables which were new to us, which Aiyanas made into a stew for dinner that night.

Sunday we wandered far and wide, through an urban poor neighbourhood and down to the Aquino Park and wildlife rehabilitation centre, which was fun for everyone, especially the kids. On our way home we passed through another market and ate some delicious barbequed fish and meat, and enjoyed looking about the stalls.

Today we had our orientation to the national situation and the activities of the Council for Health and Development (CHD) and the Community Based Health Programs (CHBP); we learned that there are now 60 CHBPs in 70 of the 78 provinces, and gained an overview of the organizational processes of building an effective CHBP. Aiyanas and I were struck by this concept in the CHD / CHBP orientation today, that CHD and the CHBPs struggle to attain the “opportunity to develop potential and creativity thru democratic and participatory processes” in the communities that they organize. It was inspiring how clear it is that communities stand to gain immediately and concretely through the work of the CHBP. The CHBP project is a crystal clear example of dual power: direct community engagement in the provision of an alternative health system completely integrated with political education and mass mobilization in the broader movement for social change. We have talked recently at the Organizing Centre about developing communities of resistance, and having this kind of an optimistic view of what our communities stand to gain by being organized is a good place to start.

We had the opportunity to learn more about our time in Negros and talk to one of the core CHBP leaders. It looks like I might have the chance to work for a short time ‘volunteering’ in midwifery in one of the local hospitals friendly to the CHBP and the People’s Organization (this is so great) and will most certainly be conducting trainings on maternity care with the CHWs (community health workers); boy am I glad I brought my equipment! Aiyanas has been asked to document the human rights situation regarding the growing militarization and resource extraction led by Canadian mining and gas corporations.

The political and economic situation in Negros is intense. There is currently at big push for mining in the area in keeping with President Arroyo’s economic policy of encouraging foreign direct investment and allowing unlimited repatriation of profits (in other words plunder of resources and communities in exchange for short term economic benefits). Canadian mining corporations are also playing a major role in Negros, an added reason for us to look into what is really happening on the ground. There is also major offshore oil exploration happening in the area, which has already impacted fish stocks and the livelihood of fisher folk, and again there is a Canadian corporate connection. The other big economic story in Negros also has to do with peak oil and rising energy prices. The GMA regime, like many other countries has mandated that 5% of total annual gasoline volume should be made up of bioethanol. The policy is justified in the name of fighting climate change and achieving energy independence. Here, bioethanol is derived from sugar so the policy is a boon to plantation owners in Negros, the most important sugar growing region in the Philippines. Not only will more land be turned over to producing this cash crop, it is actually undermining the extremely limited land reform measures of the CARP (Comprehensive Agrarian Reform Program) as the big landowners repossess farms which had been in the hands of small (and heavily indebted) farmers.

All these economic developments in Negros have made it a top priority in terms of militarization as the AFP seeks to quell any dissent. It looks like there will be lots of opportunities for us to learn from and support peoples struggles against development aggression and plunder, and we look forward to sharing more about the role of Canadian corporations.

In the mean time, we are all settling into Manila life. The kids are doing well considering the huge life style changes we have undergone. We like to think they are attending the school of life, as are we.

Tomorrow we have our orientation to the Health Alliance for Democracy (HEAD) and the current campaigns of the health sector, followed by an afternoon for me in the CHD acupuncture clinic. I am nervous about getting started, but am slowly digesting my handbook on acupuncture. At least for a while I observe, in any case.

Now we are so exhausted we can hardly keep our eyes open! Sophia commented that as soon as she lies down and closes her eyes she is out cold until the sun rises in the morning, and she loves it, because at home she has some difficulties falling asleep. Goodnight, everyone!