Tuesday, October 21, 2008
Masskara: Masking the Many Faces of Urban Poverty
Martha, October 21, 2008
It was ironic that our Bacolod urban poor integration fell on the final weekend of the Bacolod Masskara festival; ‘Masskara’ meaning ‘many faces’ referring to the positive outlook of the Bacolod residents, smiling in the face of adversity; the festival where revellers don smiling masks and dance in the streets, ignoring the cares and the woes of daily life; a festival whose budget exceeds P 5 million while thousands face demolition and homelessness.
During these past few days I witnessed how the city of Bacolod throws a grand festival to distract the attention of tourists and locals alike from the true plight of the majority of residents of Bacolod. The 41 of 61 Barangays that live in poverty; the residents of the approximately 40,000 homes targeted for demolition by the year 2010. The thousands of youth whose lives are a daily struggle for survival, without education, without livelihood, without a place in society.
Struggles for Land and Housing
Many urban slum residents fled to Bacolod from the countryside due to O’plan Thunderbolt, the counterinsurgency operations that cleared the countryside of the ‘water’ (the people) to force out the ‘fish’ (the New People’s Army or NPA). While O’plan Thunderbolt was not successful in squashing the NPA, it was successful in forcing thousands of farmers away from their lands and into the squalor of urban poverty, with no option but to squat public lands in an attempt to survive. While the farmers were displaced from their lands, mining corporations moved in and claimed the land for extraction of minerals, including copper and gold. The end result? The poor are displaced and the corporations are lining their pockets from the misery of the people.
To add insult to injury, the very project that will see many homes demolished is a P 52 million international sea port in Bacolod funded by GMA to facilitate the export of raw mineral resources and agricultural products from the plunder of the countryside. The remainder of the homes to be demolished are making way for real estate and tourist resort expansion. It seems particularly unjust that the Bacolod 2010 Comprehensive Land Use Development Plan has earmarked thousands of squatter homes for demolition with no feasible relocation plan for those who will lose their homes.
The Myth of Relocation
It is law in the Philippines that in order to gain a writ of demolition for squatters, whether on public or private lands, the government must provide a site for relocation. Yet, it is explained to me that many judges are corrupt, friendly with the land owners, or simply are not up to date about the law, and so demolition orders are given without adequate relocation plans.
In the case of some squatter communities, particularly those on the future port site, their relocation lands are inland, far from the seashore and the source of their livelihood in fishing or in working the ports. In the case of other squatter communities, the plan of the landlord is to abandon development and garner a profit selling the land to the tenants through the government-mediated ‘Community Mortgage Program’ or CMP. The CMP is not a feasible plan for the urban poor, who struggle just to cover the basics of food, clothes, and transportation to work; if enough remains it goes to the education of their children. If someone gets sick, it is a major financial crisis that puts the family on the brink of starvation, and often the sick die from lack of health care. These families simply cannot afford to pay a 25-year mortgage for housing.
The condition of the slums is appalling, with few government services for the poor: no potable water, no sanitation, no waste disposal, open pit latrines flowing into the ocean where children bathe and play, sewage running in the ditches, garbage littering the ground, stagnant water providing dengue-carrying mosquitoes ample breeding ground. In many communities, residents have struggled and won some services, such as a public school for elementary students, and wells to provide clean water for washing and bathing (but not safe for drinking since the wells are below sea level). But these few services come as the result of a consolidated effort of the local squatter organizations.
How to Earn a Living?
The residents of the urban poor communities struggle daily to earn an income for their families. Vending, driving tricycles or jeepneys, working on the ports as haulers or day labourers, fishing and collecting shellfish, washing clothes in middle class suburbs, working construction, running small sari sari stores, and even working for the government in low level positions. Every family member must work to contribute, even the children, who help prepare the shellfish for market, wash clothes, assist in sari sari stores, and a myriad of jobs for the income of the family.
Without access to social services and government health insurance there is simple not enough to go around; what is earned is not enough to make ends meet. Many youth turn to prostitution and the drug trade to survive – a product of economic exclusion and a sad testimony of injustice.
In Sickness until Death
The natural outcome of such living and working conditions is ill-health, a physical, a financial, and an emotional crisis for entire families.
Many suffer and some die from malnutrition and perpetual hunger, ulcers, skin infections, diarrhea, respiratory infections including tuberculosis, hepatitis A and B, undiagnosed and untreated diabetes and hypertension, liver cirrhosis, and kidney failure – just to name a few.
I heard many stories of families who struggled and saved to gain title for their small plot of land and their meagre house, and then a family member fell ill with the result of all savings lost, and all family members working to pay health care debts.
The ultimate price of urban poverty is the life of the poor.
Urban Uprising
While the picture I painted in this blog entry is one of a loss of hope, the strength, vitality and resolve of the urban poor is astounding. I took such great inspiration and drew many lessons from the many Bacolod affiliate member organizations of Kadamay, the national umbrella organization of the urban poor.
Do not think that the urban poor are meek victims of capitalism and imperialism; do not be fooled by their poverty, for it is a spark against the tinderbox of injustice! Eventually the smouldering social volcano that is Negros will erupt.
I am invigorated by the organizing that I witnessed in these past few days. Now I am almost ready to go home to Canada and take up my work with the Alliance for People’s Health and the Organizing Centre for Social and Economic Justice.
One last stop for us: the urban poor in Manila and the situation for urban poor home deliveries.
Stay posted for upcoming entries on the organizing lessons I have learned and the struggles for reproductive health in the Philippines!
It was ironic that our Bacolod urban poor integration fell on the final weekend of the Bacolod Masskara festival; ‘Masskara’ meaning ‘many faces’ referring to the positive outlook of the Bacolod residents, smiling in the face of adversity; the festival where revellers don smiling masks and dance in the streets, ignoring the cares and the woes of daily life; a festival whose budget exceeds P 5 million while thousands face demolition and homelessness.
During these past few days I witnessed how the city of Bacolod throws a grand festival to distract the attention of tourists and locals alike from the true plight of the majority of residents of Bacolod. The 41 of 61 Barangays that live in poverty; the residents of the approximately 40,000 homes targeted for demolition by the year 2010. The thousands of youth whose lives are a daily struggle for survival, without education, without livelihood, without a place in society.
Struggles for Land and Housing
Many urban slum residents fled to Bacolod from the countryside due to O’plan Thunderbolt, the counterinsurgency operations that cleared the countryside of the ‘water’ (the people) to force out the ‘fish’ (the New People’s Army or NPA). While O’plan Thunderbolt was not successful in squashing the NPA, it was successful in forcing thousands of farmers away from their lands and into the squalor of urban poverty, with no option but to squat public lands in an attempt to survive. While the farmers were displaced from their lands, mining corporations moved in and claimed the land for extraction of minerals, including copper and gold. The end result? The poor are displaced and the corporations are lining their pockets from the misery of the people.
To add insult to injury, the very project that will see many homes demolished is a P 52 million international sea port in Bacolod funded by GMA to facilitate the export of raw mineral resources and agricultural products from the plunder of the countryside. The remainder of the homes to be demolished are making way for real estate and tourist resort expansion. It seems particularly unjust that the Bacolod 2010 Comprehensive Land Use Development Plan has earmarked thousands of squatter homes for demolition with no feasible relocation plan for those who will lose their homes.
The Myth of Relocation
It is law in the Philippines that in order to gain a writ of demolition for squatters, whether on public or private lands, the government must provide a site for relocation. Yet, it is explained to me that many judges are corrupt, friendly with the land owners, or simply are not up to date about the law, and so demolition orders are given without adequate relocation plans.
In the case of some squatter communities, particularly those on the future port site, their relocation lands are inland, far from the seashore and the source of their livelihood in fishing or in working the ports. In the case of other squatter communities, the plan of the landlord is to abandon development and garner a profit selling the land to the tenants through the government-mediated ‘Community Mortgage Program’ or CMP. The CMP is not a feasible plan for the urban poor, who struggle just to cover the basics of food, clothes, and transportation to work; if enough remains it goes to the education of their children. If someone gets sick, it is a major financial crisis that puts the family on the brink of starvation, and often the sick die from lack of health care. These families simply cannot afford to pay a 25-year mortgage for housing.
The condition of the slums is appalling, with few government services for the poor: no potable water, no sanitation, no waste disposal, open pit latrines flowing into the ocean where children bathe and play, sewage running in the ditches, garbage littering the ground, stagnant water providing dengue-carrying mosquitoes ample breeding ground. In many communities, residents have struggled and won some services, such as a public school for elementary students, and wells to provide clean water for washing and bathing (but not safe for drinking since the wells are below sea level). But these few services come as the result of a consolidated effort of the local squatter organizations.
How to Earn a Living?
The residents of the urban poor communities struggle daily to earn an income for their families. Vending, driving tricycles or jeepneys, working on the ports as haulers or day labourers, fishing and collecting shellfish, washing clothes in middle class suburbs, working construction, running small sari sari stores, and even working for the government in low level positions. Every family member must work to contribute, even the children, who help prepare the shellfish for market, wash clothes, assist in sari sari stores, and a myriad of jobs for the income of the family.
Without access to social services and government health insurance there is simple not enough to go around; what is earned is not enough to make ends meet. Many youth turn to prostitution and the drug trade to survive – a product of economic exclusion and a sad testimony of injustice.
In Sickness until Death
The natural outcome of such living and working conditions is ill-health, a physical, a financial, and an emotional crisis for entire families.
Many suffer and some die from malnutrition and perpetual hunger, ulcers, skin infections, diarrhea, respiratory infections including tuberculosis, hepatitis A and B, undiagnosed and untreated diabetes and hypertension, liver cirrhosis, and kidney failure – just to name a few.
I heard many stories of families who struggled and saved to gain title for their small plot of land and their meagre house, and then a family member fell ill with the result of all savings lost, and all family members working to pay health care debts.
The ultimate price of urban poverty is the life of the poor.
Urban Uprising
While the picture I painted in this blog entry is one of a loss of hope, the strength, vitality and resolve of the urban poor is astounding. I took such great inspiration and drew many lessons from the many Bacolod affiliate member organizations of Kadamay, the national umbrella organization of the urban poor.
Do not think that the urban poor are meek victims of capitalism and imperialism; do not be fooled by their poverty, for it is a spark against the tinderbox of injustice! Eventually the smouldering social volcano that is Negros will erupt.
I am invigorated by the organizing that I witnessed in these past few days. Now I am almost ready to go home to Canada and take up my work with the Alliance for People’s Health and the Organizing Centre for Social and Economic Justice.
One last stop for us: the urban poor in Manila and the situation for urban poor home deliveries.
Stay posted for upcoming entries on the organizing lessons I have learned and the struggles for reproductive health in the Philippines!
Mining is Murder: Mining, Militarization and Corporate Plunder in the Philippines
Aiyanas Ormond: October 18, 2008
Standing at the seashore looking out over the blue expanse towards the distant islands of Palawan, Tatay Putot scoops a handful of fine brown earth from the shallows. This is evidence, he says, of an environmental disaster that has already begun with the latest Philex Gold exploration here in south-western Negros. The Canadian mining company is only in the very beginning stages of its operations here, having sunk only 20 of up to 96 exploratory holes, but already the Bacuyangan river runs brown into the sea bearing silt from the mines and the earth stripped away from the mountaintops. The potential impact on the local people is concerning – the rice farmers of the fertile valley rely on the river water to irrigate their crops while the coastal communities rely on the sea for their livelihood.
We have accompanied Tatay Putot, an organic farmer and leader with the local farmer’s organization, to see first hand the impacts of the mining exploration on the coastal fisherfolk communities. A group of fisherfolk gather to meet with us outside a small house, just meters from the sea. They tell us that the catch is very bad this year, and point to the brown beach, clogged with fine silt as the cause. Joking with one of the mangingisda (fishermen) that last year he borrowed money from him but this year it will be the other way around. Everyone laughs in the usual Filipino way, but the fisherfolk are no longer laughing as they explain that their children are going hungry now because the catch is so little.
Across the highway and a little inland we visit with members of the irrigators association, small scale rice farmers who irrigate their fields from the Bacuyangan river. The association, representing all of the 100 or so households in the community has taken a clear position against the Philex mine. Based on previous experience in the region, they are certain that the chemicals and heavy metals involved in the mining process will end up in the river, and as farmers they know that what is in the water ends up in the rice.
Mountain Journey
At some point between fording the river, climbing a 15 foot shear rock face and trudging through bamboo thickets which cut at the our bare arms and faces, Martha turns to me, her face red and shirt soaked in sweat, and says “I can’t make it”. We are approaching the Philex mine by the ‘back door’ in an attempt to avoid the military and security. They have stopped previous fact-finding missions from reaching the mine site.
Martha does make it, and even little Billy survives the three hour hike with only a few tears and a short stint on my back. As we approach the drilling site we begin to see evidence of the erosion – areas where the mountain is stripped bare of its plentiful vegetation and the mud runs down into the lowland streams and creeks. The company has taken mandatory measures to try to mitigate the erosion, but from what we can see the sand-bagging and planted grasses are ineffectual against the combined force of gravity and the torrential rains that are almost daily at this time of year.
We need to clamber up another slippery steep incline to reach one of the actual drilling sites, but we manage to get there and the workers, reticent at first, become helpful and friendly as the local organizers begin talking with them. Billy gets right in there to have a look at the machinery.
The operation is impressive, especially since we have seen almost no real industrial equipment aside from the rare tractor since leaving the city. Yet here in the middle of the country side, where farmers still plough by carabao and the major means of mass transportation is the hable-hable (motorbike), we find this multi-million dollar piece of equipment. Martha and I talk about the implications of this. Like all the communities we’ve visited there is real need for capital here. Farmers need tractors and threshers and mills for their rice production, fisherfolk need access to refrigeration and both groups need roads and transportation to get their products to market. But there is virtually no money available from the government, corporations or mainstream NGOs for this kind of grassroots development. But if there is gold to be had... The history of mining in the Philippines indicates that the mining companies will come in for a few years with lots of capital, employ a few local people, and then disappear, leaving nothing but displacement, militarization and environmental destruction.
The workers here at the drilling site show us the 240 meter hole they have drilled into the side of the mountain, and a handsome young engineer makes Billy’s week by giving him a piece of volcanic stone. They also show us their safety equipment, which to us looks inadequate for this kind of heavy industrial operation. Local men are happy just to have a job in the prevailing context of poverty, where millions of Filipinos have to travel overseas for work. Unfortunately the lifespan of these mines is short. The nearby Philex Vista Allegre gold and copper mine operated for only about 5 years. It closed in 1997, just as the workers began to unionize (though this was only one factor in the closure of the mine). Retrenched workers from the previous mine are still in the courts trying to get compensation for a wage structure which paid locals significantly less than workers doing the same jobs who were brought in from other areas of the Philippines or abroad.
The Military and the Monetary
We were able to get the mining site without any interference from the military, however militarization in the community was evident. In addition to the Armed Forces of the Philippines detachment at the mine site, we also observed elements of the Philippine National Police’s Regional Mobile Group, an assault rifle carrying quasi-military group, in the community. And like in the other areas we’ve visited, organizers with the farmers organization, including our host Tatay Putot, have been branded as ‘communists’ and ‘rebels’ and face harassment and intimidation from the military.
This is a pattern in the Philippines where, as part of the policy of extrajudicial killings under the GMA regime, 21 environmental activists have been murdered in the last 7 years - 15 of them having been directly involved in anti-mining activist. The assassinations of activists is an just the most reprehensible aspect of a generalized campaign of fear waged against communities that resist the corporate profit-centred ‘development’ model being imposed by GMA and her political masters – the IMF, U.S. and big business in Canada, the U.S. and other rich countries.
Rather than asking why there is so much resistance to the large foreign owned mining operations in the country, the GMA regime is actively encouraging the mining companies to set up their own paramilitary groups saying, “the security of mining operations should be a common responsibility of mining firms, the government and local communities”.
In this region of Sipalay where the Philex exploration is happening the link between mining and militarization of the countryside is longstanding. From 1988 to 1992 under the Aquino regime a massive military and counter-insurgency program was mounted in the area as Operation Thunderbolt. The mountainous areas were virtually cleared of people under the conception that if you want to catch the fish (the guerrillas) you need to drain the pond (the communities that support them). The military, paramilitaries and anti-communist fanatic groups like the ‘greenan’ (known by their green uniforms) were mobilized in the area. At that time the military paid a bounty for the ears of supposed rebels, and groups like the greenan did not distinguish between real guerrillas and those who might sympathize with them or share common ideals.
The clearance of the population from the mountainous areas made possible the first large scale mining which had been impossible previously due to strength of people’s organization and the presence of the New People’s Army. Thus the military operation fulfilled the dual (and connected) purpose of suppressing people’s organized movement for meaningful social change, and creating conditions for profit for large multi-national mining corporations and their local “partners”, including the government.
The current situation looks very much like history repeating, with militarization, human rights abuses and a general climate of fear accompanying large scale open pit mining. And this is just the tip of the iceberg. The Philex claim itself is more than 4,000 hectares, but fully ¾ of Sipalay and a large part of the entire land-mass of Negros is covered by mining claims. If significant gold is found, the mining corporations are poised to strip this island bare.
Development or Plunder
Like so much of the ‘development’ under capitalist globalization, mining only seems to develop the bank accounts of the rich and leaves very little for the people. On our way back to Bacolod we stopped at the now closed Mercalor mine in San Jose. The huge open pit mine and the bare hillsides are still there but with no indication of any kind of sustained prosperity. Quite the opposite, there is strong sense of industrial depression here. Rusting buildings and shut gates, a good road with very not much traffic, poor farms and a town with little in the way of productive activity. This model of ‘development’, pushed by the international capitalist establishment, offers no way out from the poverty which is the legacy of more than 400 years of colonization, feudalism and foreign domination.
But this is after all, a very rich country. Aside from the fertility of the soil, the plentiful fish in the sea and the wealth of human capacity and creativity, there are vast mineral resources. If all these resources and capacities were to be harnessed for a program of development that put the welfare of the people first, that broke the cycle of foreign debt payments that suck up 70% of the national budget, and that shrugged off U.S. economic and military domination – so much would be possible. This is the hope of the national democratic struggle – an end the exploitation and plunder which has persisted under more than 400 years of colonization and foreign domination.
Standing at the seashore looking out over the blue expanse towards the distant islands of Palawan, Tatay Putot scoops a handful of fine brown earth from the shallows. This is evidence, he says, of an environmental disaster that has already begun with the latest Philex Gold exploration here in south-western Negros. The Canadian mining company is only in the very beginning stages of its operations here, having sunk only 20 of up to 96 exploratory holes, but already the Bacuyangan river runs brown into the sea bearing silt from the mines and the earth stripped away from the mountaintops. The potential impact on the local people is concerning – the rice farmers of the fertile valley rely on the river water to irrigate their crops while the coastal communities rely on the sea for their livelihood.
We have accompanied Tatay Putot, an organic farmer and leader with the local farmer’s organization, to see first hand the impacts of the mining exploration on the coastal fisherfolk communities. A group of fisherfolk gather to meet with us outside a small house, just meters from the sea. They tell us that the catch is very bad this year, and point to the brown beach, clogged with fine silt as the cause. Joking with one of the mangingisda (fishermen) that last year he borrowed money from him but this year it will be the other way around. Everyone laughs in the usual Filipino way, but the fisherfolk are no longer laughing as they explain that their children are going hungry now because the catch is so little.
Across the highway and a little inland we visit with members of the irrigators association, small scale rice farmers who irrigate their fields from the Bacuyangan river. The association, representing all of the 100 or so households in the community has taken a clear position against the Philex mine. Based on previous experience in the region, they are certain that the chemicals and heavy metals involved in the mining process will end up in the river, and as farmers they know that what is in the water ends up in the rice.
Mountain Journey
At some point between fording the river, climbing a 15 foot shear rock face and trudging through bamboo thickets which cut at the our bare arms and faces, Martha turns to me, her face red and shirt soaked in sweat, and says “I can’t make it”. We are approaching the Philex mine by the ‘back door’ in an attempt to avoid the military and security. They have stopped previous fact-finding missions from reaching the mine site.
Martha does make it, and even little Billy survives the three hour hike with only a few tears and a short stint on my back. As we approach the drilling site we begin to see evidence of the erosion – areas where the mountain is stripped bare of its plentiful vegetation and the mud runs down into the lowland streams and creeks. The company has taken mandatory measures to try to mitigate the erosion, but from what we can see the sand-bagging and planted grasses are ineffectual against the combined force of gravity and the torrential rains that are almost daily at this time of year.
We need to clamber up another slippery steep incline to reach one of the actual drilling sites, but we manage to get there and the workers, reticent at first, become helpful and friendly as the local organizers begin talking with them. Billy gets right in there to have a look at the machinery.
The operation is impressive, especially since we have seen almost no real industrial equipment aside from the rare tractor since leaving the city. Yet here in the middle of the country side, where farmers still plough by carabao and the major means of mass transportation is the hable-hable (motorbike), we find this multi-million dollar piece of equipment. Martha and I talk about the implications of this. Like all the communities we’ve visited there is real need for capital here. Farmers need tractors and threshers and mills for their rice production, fisherfolk need access to refrigeration and both groups need roads and transportation to get their products to market. But there is virtually no money available from the government, corporations or mainstream NGOs for this kind of grassroots development. But if there is gold to be had... The history of mining in the Philippines indicates that the mining companies will come in for a few years with lots of capital, employ a few local people, and then disappear, leaving nothing but displacement, militarization and environmental destruction.
The workers here at the drilling site show us the 240 meter hole they have drilled into the side of the mountain, and a handsome young engineer makes Billy’s week by giving him a piece of volcanic stone. They also show us their safety equipment, which to us looks inadequate for this kind of heavy industrial operation. Local men are happy just to have a job in the prevailing context of poverty, where millions of Filipinos have to travel overseas for work. Unfortunately the lifespan of these mines is short. The nearby Philex Vista Allegre gold and copper mine operated for only about 5 years. It closed in 1997, just as the workers began to unionize (though this was only one factor in the closure of the mine). Retrenched workers from the previous mine are still in the courts trying to get compensation for a wage structure which paid locals significantly less than workers doing the same jobs who were brought in from other areas of the Philippines or abroad.
The Military and the Monetary
We were able to get the mining site without any interference from the military, however militarization in the community was evident. In addition to the Armed Forces of the Philippines detachment at the mine site, we also observed elements of the Philippine National Police’s Regional Mobile Group, an assault rifle carrying quasi-military group, in the community. And like in the other areas we’ve visited, organizers with the farmers organization, including our host Tatay Putot, have been branded as ‘communists’ and ‘rebels’ and face harassment and intimidation from the military.
This is a pattern in the Philippines where, as part of the policy of extrajudicial killings under the GMA regime, 21 environmental activists have been murdered in the last 7 years - 15 of them having been directly involved in anti-mining activist. The assassinations of activists is an just the most reprehensible aspect of a generalized campaign of fear waged against communities that resist the corporate profit-centred ‘development’ model being imposed by GMA and her political masters – the IMF, U.S. and big business in Canada, the U.S. and other rich countries.
Rather than asking why there is so much resistance to the large foreign owned mining operations in the country, the GMA regime is actively encouraging the mining companies to set up their own paramilitary groups saying, “the security of mining operations should be a common responsibility of mining firms, the government and local communities”.
In this region of Sipalay where the Philex exploration is happening the link between mining and militarization of the countryside is longstanding. From 1988 to 1992 under the Aquino regime a massive military and counter-insurgency program was mounted in the area as Operation Thunderbolt. The mountainous areas were virtually cleared of people under the conception that if you want to catch the fish (the guerrillas) you need to drain the pond (the communities that support them). The military, paramilitaries and anti-communist fanatic groups like the ‘greenan’ (known by their green uniforms) were mobilized in the area. At that time the military paid a bounty for the ears of supposed rebels, and groups like the greenan did not distinguish between real guerrillas and those who might sympathize with them or share common ideals.
The clearance of the population from the mountainous areas made possible the first large scale mining which had been impossible previously due to strength of people’s organization and the presence of the New People’s Army. Thus the military operation fulfilled the dual (and connected) purpose of suppressing people’s organized movement for meaningful social change, and creating conditions for profit for large multi-national mining corporations and their local “partners”, including the government.
The current situation looks very much like history repeating, with militarization, human rights abuses and a general climate of fear accompanying large scale open pit mining. And this is just the tip of the iceberg. The Philex claim itself is more than 4,000 hectares, but fully ¾ of Sipalay and a large part of the entire land-mass of Negros is covered by mining claims. If significant gold is found, the mining corporations are poised to strip this island bare.
Development or Plunder
Like so much of the ‘development’ under capitalist globalization, mining only seems to develop the bank accounts of the rich and leaves very little for the people. On our way back to Bacolod we stopped at the now closed Mercalor mine in San Jose. The huge open pit mine and the bare hillsides are still there but with no indication of any kind of sustained prosperity. Quite the opposite, there is strong sense of industrial depression here. Rusting buildings and shut gates, a good road with very not much traffic, poor farms and a town with little in the way of productive activity. This model of ‘development’, pushed by the international capitalist establishment, offers no way out from the poverty which is the legacy of more than 400 years of colonization, feudalism and foreign domination.
But this is after all, a very rich country. Aside from the fertility of the soil, the plentiful fish in the sea and the wealth of human capacity and creativity, there are vast mineral resources. If all these resources and capacities were to be harnessed for a program of development that put the welfare of the people first, that broke the cycle of foreign debt payments that suck up 70% of the national budget, and that shrugged off U.S. economic and military domination – so much would be possible. This is the hope of the national democratic struggle – an end the exploitation and plunder which has persisted under more than 400 years of colonization and foreign domination.
Wednesday, October 1, 2008
View from the Mountains: Final Kalabaklabakan Entry
September 30, 2008
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
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
The Five Ts of Transformative Midwifery
Thursday September 25, 2008: 15:40 Kalabaklabakan Mountain Clinic
I type this on 50% computer power, and once that 50% is gone, it may be another 5 days of brown out before I can charge up again! There was a typhoon over the weekend and since Saturday we have only had power for 3 hours.
Now that I have more birth experience under my belt, I can truly consider myself a ‘barefoot midwife’. It is good to have some time to sit and reflect upon my experiences, and on the general situation here in Barangay Trinidad. With two very different cases of gestational hypertension and a tragic case of undiagnosed twins who didn’t survive, my recent experience has been more indicative of local maternal and infant health statistics. It is one thing to read that a community has a maternal mortality rate of 1/100 and an infant mortality rate of 0.8/100, but to directly experience the conditions, political, economic, cultural, geographic, that contribute to these shocking statistics is a life-altering experience.
It is simply not enough to practice as I was trained. Not to deny that at the University of British Columbia I had one of the best midwifery educations in the world, that is a privilege of which I am keenly aware; rather it is not enough to simply practice. A midwife in the Third World context must go beyond her calling, to be one with the women in all aspects of their lives, to be changed by their experiences, and to struggle as they struggle for systemic changes. It is only through mutual support and encouragement that we, as women, can tackle at the roots the conditions that give rise to so much hardship and suffering.
As a response to my recent experiences, I have brainstormed what I call the ‘5 T’s of Transformative Midwifery’.
The first T is Track. Track refers to the provision of typical midwifery care, in particular, antenatal care. It is essential for the prevention of crises to track all of the pregnant women in the community, whether or not they present for midwifery care. Through word of mouth it is possible to learn of who is pregnant and where they live. To track I am envisioning a large wall map for a visual aid and reminder of all current cases.
The visual wall map works in tandem with the second principle of track, which is to have regular rounds of home visits for all pregnant women. Home visits are imperative for a number of reasons: a) women will actually get the care if you go to see them at home – if left to attend at clinic visits this is far less likely as work often takes precedence over personal care, b) at home visits you can see the conditions of the home and judge the poverty of the family and how they will deal with a need for expensive hospital or doctor visits, c) walking the distance to the home allows you to assess the emergency transport situation and make an informed recommendation on transport and safest birth location.
Finally, tracking includes a third step, the documentation, compilation and interpretation of local maternal and infant health statistics. From the patient record, a central database can be created to monitor the common health problems and health outcomes of the community. An example for Trinidad is the incidence of goiter and the success of implementing educational programs on the consistent use of iodized salt. As a mountainous area, iodine is lacking in the diet, and many women suffer from goiter.
The second T is Treat. As midwives we are valued for the care we can provide childbearing women and their families. In a rural, Third World setting the preventative care we provide can save women from extremely costly and difficult doctor or hospital visits. Early and effective treatment of common illnesses can save women from serious illness or even death.
The focus on prevention goes hand in hand with the use of locally available herbal remedies. Encouraging each woman to have an herbal garden is a great way to boost her self-care and make effective use of local and free resources.
The production of locally-relevant patient care guides is the third aspect of treat. The liberal use of images helps in a context where the vast majority of the population stops their schooling between grade 3 and grade 6. Disseminating correct information is important, so the production of patient education materials works in concert with the training of the Community Health Workers, who can engage in door-to-door outreach and oral education.
The third T is Transport. This is perhaps the most challenging of the five Ts. Planning emergency transport in a rural, mountainous setting is extremely taxing and yet of vital, lifesaving importance for childbearing women and their infants. Each woman needs to have a transport plan in place from the first weeks of pregnancy until after delivery. This plan needs to be shared with family and neighbours.
Encouraging the People’s Organization (PO) to have a centralized transport plan will assist all women in the PO and allow for faster and more coordinated emergency transport. Encouraging the PO leadership to meet and discuss the particular needs of childbearing women and their infants could be a positive step in breaking the silence that seems to exist when it comes to the particulars of women’s health. I have noticed that this is even a weakness within the Community Based Health Programs that women’s health concerns and training in women’s health care seems to take a back seat.
Knowing when to transport is a challenge, especially when travel takes over 2 hours and the hospital fees are very expensive for the family to bear. The decision over whether to transport is truly a cost-benefit analysis; when a family has to sell animals and order their older children to leave their schooling or paid employment to mind the younger children and perform the household duties, it is not just a matter of dialling 911. The role of the midwife is to provide leadership and skilled knowledge in the decision to transport, judging the seriousness of the situation to the best of her ability; however, the role of the midwife must also be to respect the family when they decide not to transport and take risks that as a privileged midwife from a First World country, it can be difficult to accept.
The fourth T is Train. All community members benefit from the principle of a ‘Health Worker in Every Home’; hence training one woman from each family to provide care for common discomforts of pregnancy, how to support a woman in labour, and how to care for common newborn concerns would be a boost to the health of all.
More intensive training for the community health workers (CHWs) on the common illnesses and health issues of pregnancy, on childbirth emergencies such as breech and shoulder dystocia, and warning signs of pregnancy and labour and when to transport would be of major assistance to the midwife and to the women of the community.
Providing targeted community training and public education on how to prevent and treat the most common health issues identified through the first T, Track, would help to improve the incidence and outcomes of these health problems.
Finally, working in cooperation with local Hilots (traditional birth attendants) and inviting them to all educational events and opportunities will raise the level of care for all women in the community. Respectfully asking the Hilot to send someone to fetch you when she attends deliveries gives the midwife the opportunity to observe practice. Watching the Hilots work gives midwives insight into local traditions and allows the midwife to make small and achievable suggestions for improvement and change while learning about the rich culture of childbirth among the women in the community.
The fifth and final T is Transform. The last T, but perhaps the most important! Ultimately the roots of the health crisis lie in economic exploitation and political and social oppression. Midwives have a history of taking action on behalf of the women we care for; now more than ever we need to take that action in an organized and coordinated fashion, to address the economic and political roots of women’s ill health.
Joining the activities of the PO, using the contact made with women during the course of midwifery care to encourage women to join the PO, and increasing the participation in mass organization at the community level is a good first step.
Attending rallies, carrying placards, making speeches, writing press releases and statements on the conditions of women in the community are some positive ways to raise the consciousness of the community. Making it known that, as a midwives, we deplore the lack of public health care services, decry militarization in the community, and are outraged by backward and corrupt land ownership and grossly inadequate wages and unsafe working conditions allows community members to understand, through our actions, the link between poverty, oppression and the health crisis in their communities.
We must, as health care workers, take sides; we cannot remain neutral, for in this struggle for life there can be no neutrality. To be silent is to give consent to those who steal life from the poor. To take action is to say I stand with the poor; I am on the side of justice.
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