Philippines Solidarity & Justice

Doctors' Statement on Medical Findings on the 43 Health Workers

2010-02-26T09:31:00.000-08:00

Reference:

Julie P. Caguiat, MD

We, volunteer medical doctors, strongly condemn the continuing psychological torture inflicted upon the 43 health workers illegally detained by the Armed Forces of the Philippine at Camp Capinpin. We also deplore the military’s disrespect for the basic human rights of the detained health workers, including their right to medical services.

Despite repeated requests from lawyers and family members, we have been denied entry by the camp authorities nine times. We were only allowed to see the detainees on February 11 (six days since their illegal arrest) and only upon the intervention by the Chairperson of the Commission on Human Rights, and on February 24, when only one of the 3 physicians was allowed to enter. Under severely restricted conditions, the check-ups merely lasted for 10-15 minutes and under the scrutiny of 2-3 guards standing in close proximity, which made our patients feel uneasy. Such is the violation of their right to health and their right to privacy.

After the medical check-ups, we still endorsed our patients and their particular medical needs to their custodians. However, to date, no medical intervention has been made accordingly.

According to reports from the families, our colleagues who are now our patients continue to suffer from various physical and mental conditions. Two of them asked their custodians for emergency medical help but no medical attention was provided.

Under Republic Act 7438 Sec. 2(f), “Any person arrested or detained or under custodial investigation shall be allowed visits by or conferences with any member of his immediate family, or any medical doctor or priest or religious minister chosen by him or by any member of his immediate family or by his counsel... The person's "immediate family" shall include his or her spouse, fiancé or fiancée, parent or child, brother or sister, grandparent or grandchild, uncle or aunt, nephew or niece, and guardian or ward.”

These provisions, meant to recognize both the needs and the rights of the detained health workers, are being violated on a daily basis.

Hence, we demand that the rights of the 43 detained health workers be recognized. We demand an immediate end to torture.

Free the 43 health workers now!

Community Health Worker shot in Negros

2010-02-26T09:27:00.001-08:00

Ronald Capitania, 24 years old, single, a habal habal (motorcycle) driver and a resident of Brgy. Manlocahoc, Sipalay City, Negros Occidental was shot February 23, 6:45 am in Brgy Manlocahoc, Sipalay City, Negros Occidental. He was one of the 30 Community Health Workers (CHW) who graduated in a 1 year ladderized health training of Community Based Health Program sponsored by Council for Health and Development (CHD) and Negros Island Health Integrated Program (NIHIP) on November 22, 2009. He is also the Public Information Officer of Camindangan Small Farmers Association (CASFA), a partner organization of NIHIP in southern Negros.

While on his way to Brgy Cambugiot, Sipalay to fetch a regular passenger, he noticed 2 bonnet-wearing men riding a motorcycle following him. Sensing danger, he fled with his motorcycle but was shot thrice and hit on the shoulder and abdomen. The gunmen continued to chase and shoot him. Despite the pain, he still remembered the Basic Health Skills Training 1 given to him by volunteer nurses of NIHIP. Hence, he applied pressure on his wound to minimize the bleeding.

Capitania is now confined at the Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH) in Bacolod City. His colleagues suspect that the military is behind the shooting because their organization was active in the campaign calling for the withdrawal of the military detachment inside the barangay hall.

Dr. Merry Mia-Clamor, one of the 43 health workers illegally detained at Camp Capinpin, Tanay, Rizal together with NIHIP representative and Brgy. Capt Elijer Borris of Camindangan distributed diplomas for the graduates of the South CHW Association where Capitania served.

Still Detained... but Pressure Mounting! Your support is of great help!

2010-02-13T04:36:00.000-08:00

We've had a reply from Ambassador Brillantes, which was not much more than a reassurance that the Philippine government will have to present their evidence to the trumped-up charges in court, but this can take months. In the mean time, we are still extremely concerned for the safety of our friends.

Letters of concern and solidarity are still very important at this time, so please consider writing.

Here are some photos I received today from a protest on Negros Island.

CHD to AFP: Educational attainment not a hindrance to learn health skills

2010-02-12T17:19:00.000-08:00

Media Release
Reference: Dr. Eleanor A. Jara

February 13, 2010

CHD to AFP: Educational attainment not a hindrance to learn health skills

Health groups today slammed the military’s malicious statement regarding some of the health worker-trainees’ capacity to learn health skills with regard to their educational attainment. Lt. Col. Noel Detoyato, spokesperson of the Armed Forces’ 2nd Infantry Division said in an interview that the trainees’ profiles revealed that some of them reached only elementary and high school levels while only a very few were college levels and graduates. Thus, why give them health training?

“For 37 years, community-based health program practitioners have been training volunteers who would like to become Community Health Workers (CHWs) regardless of their educational attainment. We do not discriminate against a person’s educational background as long as he or she has the heart to serve other people in the villages. In fact, we have CHWs who are illiterate but are efficient and respected healers in their communities,” Dr. Eleanor A. Jara, Council for Health and Development’s Executive Director said.

In a country where 7 out of 10 Filipinos die without ever seeing a doctor and where public health services lack or are inaccessible, Dr. Jara said that it is CHD’s and COMMED’s mandate to bring health into the people’s hands. “This means, our health professionals and health workers go out of their way to reach underserved communities and organize health committees and train Community Health Workers. That way, the people themselves can prevent and cure common illnesses and practice first-aid even with the absence of government services in their communities,” Dr. Jara explained.

She added that health skills should not be an exclusive property of a few who can afford to buy it -- it should be learned by as many people as possible as long as they have the passion to use that knowledge to serve their fellowmen especially the poor and the oppressed.

Tuition fee in Metro Manila medical schools ranges from P55,000 to P85,000 per semester.

“It is a shame that the AFP discriminates the capacity of our people to learn health skills just because they only reached elementary or high school levels. The AFP should be the ones ashamed of themselves for persecuting health workers that genuinely serve the people. If the Armed Forces is questioning and suspicious as to why we train these people without high educational attainment, the answer is there is not enough health workers and health services in the country and the blame is on the government’s incapacity and skewed priorities,” Dr. Jara ended.

Open Letter to Ambassador Brilliantes

2010-02-10T11:16:00.001-08:00

February 8, 2010

Ambassador Brilliantes
130 Albert Street, Suite 606
Ottawa, Ontario, Canada
K1P 5G4

Dear Ambassador Brillantes,

We are writing you to express our strong concern over the recent abduction of 43 health workers by the Philippine Army and Philippine National Police on the 6th of February in Rizal, Philippines. These workers were illegally abducted while attending a health training put on by the Council for Health and Development (CHD).

One of the abducted health workers, Dr. Merry Mia, is a personal friend, one of the hosts to me and my family when we spent seven months in the Philippines in 2008 as volunteer community health workers. Dr. Merry is a committed health professional who works with the poor and marginalized of Philippine society. The idea that Dr. Merry is involved in violent or criminal actions is absolutely ridiculous to anyone who knows her, as we do. She is committed to social justice and human rights and works with legal, popular movements of Philippine society.

As concerned Canadians we are watching the actions of the Philippine government very carefully. Please convey our concerns to the appropriate authorities in the Philippines. We look forward to hearing of the speedy release of Dr. Merry the other 42 health workers currently being illegally detained.

Sincerely,

Ormond-Roberts Family

Martha Roberts, R.M.
Aiyanas Ormond
Sophia Roberts, age 13
Billy Grayer, age 8

URGENT ACTION by KARAPATAN (Alliance for the Advancement of People’s Rights)

2010-02-10T11:13:00.000-08:00

Health workers, including the wife of Karapatan Deputy Secretary General, illegally arrested in military raid in Rizal province, Philippines

Case: Violation of Domicile; Destruction of property; Abduction, Divestment of Property; Illegal Search and Seizure; Illegal Arrest; Illegal Detention; Torture; Threat, Harassment and Intimidation, Fear for Safety

Victim/s :
Abducted, Illegally Arrested and illegally detained(partial list)
1. Dr. Merry Mia, Health Education and Training Services coordinator for Council for Health and Development (CHD), wife of Mr. Roneo Clamor (KARAPATAN Deputy Secretary General)
2. Dr. Alexis Montes
3. Gary Liberal, Registered Nurse (Jose Reyes Medical Memorial Center)
4. Teresa Quinawayan, Midwife
5. Lydia Obera, community health worker
6. Reynaldo Macabenta, community health worker
7. Angela Doloricon, community health worker
8. Delia Ocasia, community health worker
9. Jane Balleta, community health worker
10. Janice Javier, community health worker
11. Franco Remoroso, community health worker
12. Ailene Monasteryo, community health worker
13. Pearl Irene Martinez, community health worker
14. Elen Carandang, community health worker
15. Dany Panero, community health worker
16. Rayom Among, community health worker
17. Emily Marquez, community health worker
18. Emelia Marquez, community health worker
19. Glenda Murillo, community health worker
20. Ace Millena, community health worker
21. Ely Castillo, community health worker
22. Lalyn Saligumba, community health worker
23. Jovy Ortiz, community health worker
24. Samsung Castillo, community health worker
25. Mark Estrellado, community health worker
26. Miann Oseo, community health worker
27. Selvia Pajanosta, community health worker
28. Lolibeth Donasco, community health worker
29. Jenelyn Pizaro, community health worker
30. Ramon de la Cruz, community health worker
31. Jacqueline Gonzales, community health worker
32. Maria Elena Serato, community health worker
33. Mercy Castro, community health worker
34. Lea de Luna, community health worker
35. Judilyn Oliveros, community health worker
36. Valentino Paulino, community health worker
37. Yolanda Yaun, community health worker
38. Edwin Dematera, community health worker
39. Sherilyn Riocasa Tawagon, community health worker
40. Gerry Sustinto, community health worker
41. Jenmark Barrientos, community health worker
42. Mark Escartin, community health worker

Place of Incident: Residential compound of Dr. Melecia Velmonte in Bgy. Maybangcal,
Morong, Rizal

Date of Incident: 06 February 2010

Alleged Perpetrator(s): Joint elements of the 202nd Infantry Brigade of the Philippine Army (202nd IBPA), and Rizal Philippine National Police (PNP) headed by Colonel Aurelio Baladad, commander of the 202nd Infantry Brigade of the Philippine Army based in Tanay, Rizal and Police Superintendent Marion Balonglong of the Rizal PNP.

Account of the Incident: On February 1, around 40 medical practitioners and health workers participated in a one week First Responders Training, sponsored by the Community Medicine Foundation, Inc. (COMMED) and Council for Health and Development (CHD) at Dr. Melecia Velmonte’s Farm, a conference and training facility in Morong, Rizal.

Dr. Velmonte is a renowned and respected infectious disease specialist and a consultant at the Philippine General Hospital. Her farm is a regular venue of health trainings, with participants coming from both the communities and the academe.

At around 6:15 am on February 6, 2010, around 300 heavily armed elements of the military and police forced their way into the farm of Dr. Melecia Velmonte in Bgy. Maybangcal, Morong, Rizal. At gunpoint, the military forced the caretaker to open the gates. Inside, the soldiers fanned out to different directions. They also kicked the main door to get into the building.

When Dr. Velmonte and her son, Bob demanded for a search warrant, they were merely brushed aside by the military. All medical practitioners and health workers, were ordered to line up at the garage, frisked, and handcuffed. The victims were also questioned and photographed by the military, while another took a video recording of the interrogation. The male victims were then blindfolded with old shirts brought in by the soldiers and secured with packaging tape. All of the personal belongings of the victims were also taken by the military.

When the participants were already handcuffed, it was only then that Police Superintendent Marion P. Balonglong showed Bob a search warrant for a certain Mario Condes of Bgy. Maybangcal, Morong, Rizal, charged with illegal possession of firearms. The search warrant dated February 5, 2010 and issued by Judge Cesar A. Mangrobang of Branch 22 of the Imus, Cavite Regional Trial Court, did not indicate the exact address of the Velmonte compound.

Bob asserted that the warrant did not specify their address, and that Mario Condes, who is subject of the warrant, is not even the owner of the house, but he was ignored by the authorities.

Outside the compound, were eight (8) vehicles. Along with the four (4) 6 x 6 military trucks were two (2) Armored Personnel Carriers (APC), a KIA Pride car, and an ambulance. Some of the vehicles had no plate numbers while the rest of the license plates were either covered, or smeared with mud.

The male health workers were loaded into the military trucks while female health workers were forced into the cars and vans. They were brought to Camp Capinpin in Tanay, Rizal, headquarters of the 202nd Infantry Brigade of Philippine Army.

The military declared that the victims were members of the New People’s Army because of the explosives allegedly found inside the compound. However, according to witnesses, the military conducted the search of the compound’s premises only after all of the victims, as well as the residents, were already outside the buildings. Witnesses also said that the military have brought in with them plastic bags with the GMA Kapuso logo printed on it.

Allegedly found were C4 explosives, a pistol with seven bullets, 3 grenades (one allegedly found under a pillow); beside the grenade were some improvised landmines. However, Bob said that they were not issued a receipt of the inventory of the said firearms and explosives.

The military and police arresting team were led by Col. Aurelio Baladad and Police Superintendent Marion Balonglong.

The illegal search of the Velmonte compound ended at past 9:00 in the morning of Saturday, February 6, 2010.

Prior to the incident, one of the participants related that on February 4, the grassy portion outside of the Velmonte compound caught fire at around 8:00 in the evening. Everyone panicked and went out of their sleeping quarters fearing the fire will cross over to the compound. Fortunately it did not and the fire died on its own.

On February 5, at around 11:00 pm, the dog tied near the male sleeping quarters and the geese nearby made a raucous. Then at around 12 midnight, the chickens in a coop nearby were also disturbed and cackled furiously. One of the male participants went out twice to check but did not see anybody.

In the afternoon of the February 6, Karapatan Deputy Secretary General Roneo Clamor, husband of Dr. Merry Mia, Olive Bernardo, Karapatan Services Head, along with Karapatan counsel, Atty. Ephraim Cortez, Dr. Geneve Rivera and Dr. Edelina De La Paz, chairperson of Health Action for Human Rights (HAHR), went to Camp Capinpin to inquire about the victims. They were not allowed to enter the camp premises.

On February 7, families and relatives of the illegally arrested went to Camp Capinpin to try to visit and see the conditions of the victims. They waited at the gate and held a short program but the 2nd Infantry Division played very loud music trying to drown the speeches of the family members and their supporters. Two groups of fierce-looking dispersal units (with firearms and shields) were dispatched and blocked the gate of the camp. Later, Mr. Clamor and Dr. Caguiat were allowed to enter the camp premises but once again were not allowed to see the victims because allegedly they will be presented for inquest. They waited until very late in the afternoon no inquest took place.

On February 8, the team remained in Camp Capinpin. It was heard over the radio that the 2nd IDPA issued a statement that an inquest took place at past 9:00 in the evening of the previous day. The Commission on Human Rights (CHR) issued a statement condemning the act of the arresting team. A team was dispatched by the CHR to Camp Capinpin. It was allowed to enter camp and Chairperson Leila De Lima was to follow later.

Suddenly, the 2nd IDPA provided a tent, chairs, breads and juices for the people at the gate. The loud music was turned off.

When Chairperson De Lima arrived, the relatives requested her to intercede to allow them to see the victims. She agreed. However, only Chairperson De Lima with Dr. Rivera and two relatives were allowed to enter the camp. The other victims were denied entrance despite the agreement that all the relatives would be allowed to.

At around 3:00 pm, Chairperson De Lima went out of the camp and briefed the waiting families and relatives. She told the soldiers to allow the relatives to see their loved ones. They were finally allowed to enter. They entered by batches of seven. There were three batches.

They were only allowed 30 minutes each to speak to their loved ones. They could not freely talk because they were closely guarded by soldiers. But despite this, the horrors of what the victims suffered under their captors were revealed. It was learned that they were blindfolded and their hands bound behind with a plastic cuff since they were arrested until a few hours before Chairperson De Lima arrived. They slept sitting down but when the CHR team arrived, they were already placed in quarters with beds. All females were put together in one big room while the males were either given their own room or sharing a room with another with toilets. Their meals were fed to them and their guards pull down their underwears for them everytime they go to the comfort rooms. The female guards even washed the private parts of women detainee. They were deprived of sleep because they were repeatedly interrogated. Others related that the interrogation was done in unholy hours with the clear intention to deprive them of sleep.

Others related that they were physically tortured.

Dr. Alexis Montes complained to his son that his shoulders are sore from being pulled back due to the prolonged binding of his hands behind his back. He also told his son that during interrogation, he was told that he was standing at the edge of a ravine and everytime he answered a question, he was poked with a pair of stick forcing him backward. He also said that he was electrocuted. He did not lose
consciousness but was paralyzed for a time.

Ely Castillo softly whispered to his sister to avoid being overheard by the soldier accompanying her that he was tortured. He was not able to elaborate because of the presence of the soldier.

Dr. Merry Mia related to her husband that she was alternately interrogated by “kind” and harsh men. The “kind” interrogators only asked about personal details, the harsh ones threatened her by saying “You know what we are capable of doing to you and your family.” “We will soon know who your husband is.” She was also asked over and over again where she lives, where she studied, and what her task was in the training, etc. There was an instance that three men interrogated her simultaneously. Threatening to harm her family. One of whom told her, “We’re not done with you yet. I will come back for you and will not let you sleep tonight.” Although she was not physically tortured, she was worried that the others were hurt because she heard screams of both men and women in pain.

Dr. Rivera saw Dr. Mia first before her husband. Dr. Rivera told the team that she found Dr. Mia in a fetal position. When she softly called her name, she raised her eyes but it took her a long time to recognize the very familiar face of her friend.

Recommended Action:

Send letters, emails or fax messages calling for:
1. The immediate release of the health workers who are tortured, illegally arrested and illegally detained at Camp Capinpin, Tanay, Rizal.
2. The government to ensure the safety of the victims and that they are not harmed; their belongings be returned immediately to them.
3. The immediate formation of an independent fact-finding and investigation team composed of representatives from human rights groups, the Church, local government, and the Commission on Human Rights that will look into raid and illegal arrest of the health workers conducting health skills training in Morong, Rizal.
4. The military to stop the labeling and targeting of human rights defenders as “members of front organizations of the communists” and “enemies of the state.”
5. The Philippine Government to be reminded that it is a signatory to the Universal Declaration of Human Rights and that it is also a party to all the major Human Rights instruments, thus it is bound to observe all of these instruments’ provisions.

You may send your communications
to:

H.E. Gloria Macapagal-Arroyo
President of the Republic
MalacañangPalace,
JP Laurel St., San
Miguel
Manila Philippines
Voice: (+632) 564 1451 to 80
Fax: (+632) 742-1641 / 929-3968
Cell#:
(+ 63) 919 898 4622 / (+63) 917 839 8462
E-mail: corres@op.gov.ph / opnet@ops.gov.ph

Sec. Annabelle T. Abaya
Presidential Adviser on the Peace
Process
Office of the Presidential
Adviser on the Peace Process (OPAPP)
7th Floor Agustin Building I
Emerald Avenue
PasigCity1605
Voice:+63 (2) 636 0701 to 066
Fax:+63 (2) 638 2216
osec@opapp.gov.ph

Norberto Gonzales
Secretary, Department of National
Defense
Room 301 DND
Building, Camp Emilio
Aguinaldo,
E. de
los Santos Avenue, Quezon City
Voice:+63(2)
911-9281 / 911-0488
Fax:+63(2)
911 6213
Email: osnd@philonline.com

Atty. Agnes Devanadera
Secretary, Department of Justice
Padre Faura St., Manila
Direct Line 521-8344; 5213721
Trunkline 523-84-81 loc.214
Fax: (+632) 521-1614
Email: soj@doj.gov.ph

Atty. Leila De Lima
Chairperson, Commission on Human
Rights
SAAC Bldg., UP Complex
Commonwealth Avenue
Diliman, Quezon City, Philippines
Voice: (+632) 928-5655, 926-6188
Fax: (+632) 929 0102
Email: chr.delima@yahoo.com

Please send us a copy of your
email/mail/fax to the above-named government officials, to our address below.

URGENT ACTION Prepared by:

KARAPATAN (Alliance for the Advancement of People’s Rights)
National Office
2/F Erythrina Bldg., #1 Maaralin
cor Matatag Sts., Brgy. Central, Diliman, Quezon City
1100 PHILIPPINES
Voice/Fax: (+632) 435 4146
Email: urgentaction@karapatan.org
Website: www.karapatan.org

CHD to AFP and PNP -- release abducted doctors, nurses, and Community Health Workers in Tanay, Rizal

2010-02-10T10:54:00.001-08:00

MEDIA RELEASE

CHD to AFP and PNP -- release abducted doctors, nurses, and Community Health Workers in Tanay, Rizal

As thousands of Filipino health professionals are driven away from the country because of lack of enough opportunities, the government terrorizes the very few who chose to stay and serve their fellow citizens, Council for Health and Development revealed in a press conference held in Quezon City.

In a statement, Eleanor A. Jara, medical doctor and Executive Director of Council for Health and Development said that at 6:15 am yesterday, February 6, 2010, medical doctors, nurses, and Community Health Workers (CHWs) were frisked, blindfolded and forcibly taken by combined heavily armed elements of the 2nd Infantry Division of the Philippine Army and the Rizal Philippine National Police. The troop numbered to about 300, reports said.

Council for Health and Development is the National Secretariat of more than 50 community-based health programs in the entire Philippines.

"The raiding team showed a bogus search warrant and herded our doctors, nurses, and Community Health Workers conducting health skills training-seminar in the house of Dr. Melecia Velmonte," Jara said.

"CHD denies the claim of Col. Aurelio Baladad of the Philippine Army's 202nd Infantry Brigade to the media that the participants were undergoing a bomb-making training. We further condemn the AFP and PNP’s action of planting evidences such as guns and ammunitions in the training venue. In truth, the participants were holding a first responders’ health skills training-seminar aimed to facilitate the exchange of knowledge and skills of health professionals and Community Health Workers to develop their capacities in providing health care services to the poorest of the poor,” Jara added.

Dr. Julie Caguiat of the Community Medicine Foundation further explained that such brazen act was clearly a state effort to terrorize health professionals and health workers that work among the people.

Dr. Jara lamented that the abducted health professionals and CHWs are among those that serve far-flung villages where government personnel and services are lacking or are nonexistent. Because of their passion and dedication to serve their fellow Filipinos, these health professionals and CHWs brave difficult work environments and meager salaries just so they could be of service where they are most needed, Jara added.

"Instead of supporting and lauding their efforts and sacrifices, what does Mrs. Arroyo's government do? Her military and police abduct these health professionals and CHWs and violate their rights. In effect, the delivery of health services in the poorest communities is derailed," Jara said.

The ratio of doctor to patient in the Philippines is pegged by the Department of Health at 1:30,000.

As of press time, the military has denied the relatives and co-workers of the victims to see or speak to them.

"The military has done it again, this condemnable incident adds up to the long list of human rights violation against health workers and community-based health practitioners.

We call on all health professional organizations, entire Filipino people, and the international community to denounce state terrorism in the strongest possible terms. We enjoin our colleagues in the health profession as well as the entire Filipino nation to stand united and demand for the release of the abducted health personnel," Jara concluded.

Behind the times...

2008-11-22T23:15:00.000-08:00

For all following my blog, I am behind in my writing since we have been so busy this last little while. I am working on a couple more entries, so even though we are flying back to Canada today, please stay posted!

Coming soon:
Struggle for Reproductive Rights in the Philippines: Contradicitons and Clashes
How a National Liberation Struggle Raised the Peasants of a Nation: Reflections on the contrast between Vietnam and the Philippines
Making Sense of It All: The final assessments of 7 months of Solidarity!

Masking the Faces of Urban Poverty Slideshow

2008-10-21T02:03:00.001-07:00

Masskara: Masking the Many Faces of Urban Poverty

2008-10-21T01:47:00.000-07:00

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!

Mining is Murder: Mining, Militarization and Corporate Plunder in the Philippines

2008-10-21T01:42:00.000-07:00

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.

Mining is Murder Slideshow

2008-10-21T01:41:00.000-07:00

View from the Mountains: Final Kalabaklabakan Entry

2008-10-01T02:51:00.000-07:00

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

The Five Ts of Transformative Midwifery

2008-10-01T02:47:00.000-07:00

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.

DOH: Department of Hoodwinking

2008-09-30T23:48:00.000-07:00

August 30, 2008

It has happened; I have fallen in love with the Philippines. I know this to be true because at the CHD health sector picket to demand access to cheaper essential medicines outside the Department of Health I feel such a passionate anger that I have to pace around to burn off the energy. What I see painted on the walls of the DOH is in such stark contrast with the reality I witness in the community that I rename the DOH the ‘Department of Hoodwinking’.

Why hoodwink? The government propaganda is everywhere in Manila, convincing the middle class and the upper echelons of the working class that the government responds to the needs to the people and provides adequate health services. Check this out!

First I see a mural lauding the DOH clinics in the community. OK, I am confused. No community I have visited has had a clinic, but rather the odd Barangay health centre, which, when it exists, is far too often little more than a room with a very few supplies, occasionally staffed by an over-worked, under-paid midwife (cum doctor, cum nurse). Patients often have to walk very far for the few services, such as vaccinations, which are offered. Although in government propaganda TB medicines are provided for free for all infected, in reality even if there are TB meds, they are very expensive. Most do not complete the multi-drug formula for the necessary 6 months. What else can the Community Health Workers do but teach about preventing communication! In San Isidro, there is actually an ambulance, which looks terrific; in practice the fee is 1,500P paid in advance for the trip to the hospital! The average daily wage, when sugar work is available, is less than 100P per day, so that explains why the ambulance still looks so shiny and new – people can’t afford to use it!

Next I pass a beautiful mural lauding the provision of safe drinking water. It’s a joke, right? What community is that? Any place I have visited that has safe drinking water, it has been the People’s Organization, and NOT the government, which has ensured clean water to drink and bathe by piping water down from upland springs, or building enclosed cisterns over deep wells to prevent contamination from shallow ground water. Most rural communities I have visited have few toilets so people use the fields as their toilet and then use ground water or stream water to drink and to bathe. Given the incidence and death toll from diarrhea, the 3rd leading cause of death in children, this isn’t merely about good health, but a matter of basic survival.

Now, my personal favourite! The DOH Superman delivering iodized salt to the people. This really is a joke – the irony is sadly hilarious. I can’t even keep track of the number of women I have seen in the mountain provinces with goiter. Keep in mind, women of childbearing age, having many babies, with such a terrible risk to a diet inadequate in iodine; as the mural explains: still birth, cretinism, dwarfism, poor cognitive development to name a few. Women struggle to use iodized salt, as there is little incentive for sari-sari store owners to sell it as they make less profit from it.

Another beauty, the smiling kids with lovely white teeth, visiting the what? The dental clinic? I never saw one, personally, in my many months of travels to rural communities. I did, however, see countless children with poor dentition and many carries, in terrible need of dental care. I saw children who were refusing to eat due to pain from rotting teeth. It was heartbreaking. I can think of several great programs that would increase prevention and provide basic dental care at the community level – but alas, despite the lovely propaganda, the DOH does not really care for children’s dental health.

There were many lovely murals to describe, but in the interest of brevity, I will conclude with the mural lauding environmental protection. Can anyone say “PhilEx”? Let our coming testimonials on the impacts of multinational mining operations attest to the GMA position on ‘environmental protection’ in the Philippines.

Called to Deliver a Baby ‘Half-Born’: the Struggle to Survive in Rural Philippines

2008-09-20T20:55:00.000-07:00

*Warning -- this blog entry is graphic*

After lunch Aiyanas and I were playing chess when there was a commotion in the clinic, and I heard “Martha” and “bata” (baby) and a bunch of excited talking, so I poked my head out front to see what was going on. The ‘ice candy lady’ from the elementary school was in the clinic with Josephine and Erwin, saying that Grace had delivered, but the baby was breech and only half-born; the Lola was there delivering the baby and now they need help. What is going on? I am full of disbelief; the baby is half-born? Why are we standing here talking? Josephine calls to Nanay, who comes running back to the clinic, I grab my backpack with my birth equipment, Aiyanas grabs me some pesos to pay for a hubble-hubble (motorcycle) and Nanay and I are off at a run up to the road to catch a ride to Grace’s house. It must have taken us 20 minutes to get there from the time I first heard the news of the baby half-born; we arrived just after 3:40 pm.

Why didn't they come get us sooner? I learned that Grace was afraid because the military detachment is across the road, and last night they were firing at random.

Entering the house I am struck by Grace’s position; Grace is up on the sleeping platform lying supine, knees bent, legs covered with a blanket, and Lola has her hands under the blanket. It is dark in the house though it is still light outside. Is there a baby I ask? Yes, they say, half-born up to the neck. Without thinking I am pulling off the blanket and calling for Grace to turn so the breech hangs; somehow I have gloves on, but I barely remember getting them and my kit out as we entered the house. I put my hand inside Grace’s vagina to feel what is going on. I feel the baby’s face anterior, his little body is so blue and cold and his back is anterior, his neck is twisted, he is obviously dead. He is so small I am suspicious, since it doesn’t fit with how pregnant we thought Grace was.

I feel another head following - twins. Gently I push the second head back up the vagina; Nanay gives me some suprapubic pressure and the first twin disimpacts and is delivered onto Grace. Then directly the second twin is delivered up onto Grace. I feel the cords of the babies and the second twin has a pulse, so I grab my clamps from my kit and clamp the cords, free the second twin first, and start to ventilate him. I check his heart rate, but it is so chaotic in the house I can barely hear, I think I get about 60 beats per minute. I show Nanay how to do chest compressions while I ventilate, but we can’t get coordinated, so after perhaps 15 seconds I listen with my Doppler and count 100 bpm! We clear the small table and place the second twin onto a pair of soft track pants I grab from the clothes pile nearby. I instruct Nanay how to ventilate, make sure his little chest is rising and he is getting at least 40 breaths per minute.

Time to switch my attention to Grace, who is lying supine with her eyes closed. Is she conscious? Is she bleeding? Is she in shock? I cut the cord of the still born twin, bundle him, and set him next to his brother. I coax Grace awake and up into a squat to get the placenta out, intact, great, just to be safe I quickly draw up one of my precious vials of oxytocin and give it to her. Her BP is good, 120/80. Nanay checks Grace’s perineum, and there is only a very small tear, which is good because there is no time to suture. I am very worried about Grace and her emotional state, so Lola comes to sit with her and hold her hand. Time to switch back to second baby boy and make sure he is doing OK.

Before I take over ventilations again, I listen with the Doppler one more time so I can hear his heart rate clearly in the noisy, crowded hut. Why are there so many people here? We shoo some people outside, and listen, getting a heart rate of 140, with my stethoscope I can hear air entry with ventilations, his lips and face are pink. Why isn’t this little guy breathing? I quickly examine him and can see he is quite premature: smooth foot soles, smooth scrotum, soft ear cartilage, testicles undescended. Grace wasn’t 8 months pregnant, as I thought; I realize she was likely only 7 months but big due to the twins. The lack of adequate prenatal care in the communities is outrageous. This little guy needs intensive care; we need to transfer him as soon as possible. I take over ventilating again, and Nanay is freed to help with the transfer.

This discussion takes a painfully long time. The babies were born at 3:45 and 3:46, and it is now after 4:15 and they are still talking about what to do. I explain, hoping that it will be understood, that they can decide to transfer to the hospital or they can stay home and the baby will die. It sounds crass, but I realized that they have to make the decision about what is right. Now that I write this, I wonder, did it sound judgemental? It is not the way I intended it to sound and I hope it wasn’t taken that way. But this persistent little boy is taking some breaths! The conclusion is they will go to the hospital; now we need to get the truck so we can ventilate the baby on the way. This will require permission and a driver from the Barangay Capitan. There is a problem, I still don’t know what, with the local Barangay Capitan, and so they have to ask in Hilaiton which is 45-60 minutes away.

Nanay and I hunker down to business, and develop a rhythm of adding 3 breaths between each one of little baby’s so that he is getting 40 breaths per minute. I balance my newborn stethoscope on his little chest so I can time my breaths to his heart rate, hear the air entry, and monitor his independent breaths. We request some hot water bottles which we tuck around his body. I place a nasogastric tube, but I do not carry an ET tube and laryngoscope, so we use a mask to ventilate. After an hour or so I am exhausted, and I want to examine the first twin and the placenta, so Nanay does an ambubag shift. I go to pee, and see the military watching from the detachment across the road. This just enrages me – 10 times the funding of the health care system and they sit and watch as babies die.

Very carefully I pick up the first little guy and take him to the adjoining Nipa hut so I can examine him thoroughly without so many observers. He is so tiny, weighing in at 1.5 kilos including the weight of his blanket. It feels like his neck is broken, and he has dark bruises on his abdomen over his palpable liver. I wrap him in a blanket, lay him on the pretty blue fabric of my scale sling, and quickly take his photo for Grace and Randy. My belief is that these are mono-chorionic, mono-amniotic twins, with the first twin transfusing blood, oxygen and nutrients to the larger and more robust second twin, but this is only a guess. There is only one placenta with two cords of close insertion, and for the life of me I can only see one sheer set of membranes, but it is impossible to tell and I am rushing; in any case we will bring the placenta with us.

Now back to business of ensuring the ventilation is going well and preparing for transport. We hear news that the truck from Hilaiton is on its way! Great, this little trooper is hanging in there, so we will make it! I take over ventilations again and Nanay gets a board and some blankets ready so we can ventilate in the back of the truck. Finally after 6:00 pm the truck arrives and we are off on the long trip to the hospital. Sometimes the road is so bumpy the board is bouncing, I try to protect his little head, and the little guy’s heart rate is always over 100. After what seemed like an endless journey of heart beats and breaths, heart beats and breaths, we arrive at the hospital.

As the truck pulls up, Nanay calls out ‘emergency, emergency’ and an orderly comes running. We get baby boy out of the truck and quickly onto the examination table in the ER operation room. I keep ventilating until the doctor comes and takes over care of the baby. The doctor quickly concludes that the baby is premature and needs CPAP (continuous positive airway pressure) and I completely agree! Great! Let’s get it going! But… there is no equipment for premature babies at this hospital, so we will have to go to Dumaguete. Why is the nurse not ventilating the baby? What is going on?

Randy, the father of the baby, shakes his head and sadly explains there is no money for going to a private hospital in Dumaguete. The doctor then asks Randy if he will admit the baby at this hospital, and Randy agrees. But what will they do here? They provide free-flow 100% oxygen through an ET tube, which it takes 20 minutes to place because they can’t find an ET tube small enough in their ancient crash cart; the baby is only breathing ten times per minute and there is no equipment to ventilate. They give him dextrose through an IV. I know that he will die, but my heart still hopes. Randy and I sit with him, and Randy asks me why the first twin died. I gently tell him I think he was born too early and his lungs were not ready, but I can’t bring myself to mention his injuries. Randy thinks his second son is a fighter, and I agree with heavy heart, knowing he isn’t getting the care he needs to give it a fighting chance.

Nanay and I are exhausted, it is now after 9:00 pm and I need to wash and lie down. We will spend the night at Nanay’s Auntie’s. After sleeping in fits and starts we return at 6:00 to learn that the baby boy died at 3:00 am and Randy has already taken him home. I am so angry! I am so sad! The pictures of Gloria Macapagal Arroyo smiling on the wall of the hospital are enraging! How can she justify a national budget where debt payments are 63 times the national health budget? How can the military, which harasses and intimidates the people, be a priority over equipment necessary to save newborn babies? How can the military sit and watch while Randy scrambles to find a ride to the hospital? It is so backward I feel like kicking over that stupid (and grossly under-stocked) crash cart that sits nearby. I cry on the hubble-hubble ride home, thinking how Grace and Randy must be suffering, and my beautiful little patient who didn’t make it.

Now we are home and the story is already widely known. Will anything change? Perhaps more people will join the rally in Guihulgnan Town on Sunday. Perhaps the People’s Organization will gain more members as the string of injustices that lead to the deaths of these boys is discussed in the community. I am moved by the strength of the optimism, even among those who suffer terrible injustices; hope that things will change if the people are united, committed and share a common vision of justice for all.

Hey Terrence and Pipay!

2008-09-20T20:54:00.001-07:00

We miss you!

Negros Medical Mission Slideshow

2008-09-20T20:53:00.000-07:00

The Negros Medical Mission: Service and Solidarity

2008-09-20T20:39:00.000-07:00

September 20, 2008

Kalabaklabakan Mountain Clinic

Last weekend, September 13 and 14, was the large and greatly anticipated Negros Mercy Mission: a Medical and Psycho-Social Mission which brought over a dozen doctors, community health workers, organizers and documenters to three rural communities of Guihulgnan, including Kalabaklabakan, in Barangay Trinidad.

The mission was spearheaded by the local People’s Organization (PO), Kaugma-on, literally ‘future of the small farmers’, and supported by several organizations from Cebu, Bacolod and Manila, including the Negros Island Health Integrated Program (NIHIP), the Council for Health and Development (CHD), and progressive party list Bayan Muna. The mission was one of service to the people, and solidarity with their struggle for justice and against the intensified militarization; Guihulgnan is now identified as a priority area for the AFP aggressive war of counter-insurgency, an operation which causes many human rights violations, physical harm and psychological trauma for the peasants.

Over 460 patients received treatment during the two day mission in Kalabaklabakan, including doctor consultations, essential medicines, prenatal care, psychological counselling and minor surgeries. Despite repeated attempts from the AFP Infantry Battalion (IB) 11 to enter the private clinic premises, and to intimidate and harass those patients entering the clinic compound, the mission was a resounding success, and many patients had their sufferings eased by the mission teams.

While the medical care provided through missions is only but a small band aid for the large wounds of the people, the demonstration of solidarity from the urban areas and the large organizations such as CHD and Bayan Muna is a tremendous boost to the local PO. Missions send a clear message to the military and the government that those struggling peasant farmers in the countryside are not forgotten, rather are of fundamental importance, to those who struggle in the urban areas.

Tuloy Ang Laban!

Back to the Mountains

2008-08-31T02:00:00.001-07:00

Heading back to Kalabaklabakan for more mountain integration. Stay posted and send us some comments.

San Isidro: A True People’s Health Committee

2008-08-28T19:07:00.000-07:00

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.

San Isidro Health Work

2008-08-28T19:06:00.001-07:00

Sugar Workers Struggle

2008-08-28T19:05:00.002-07:00

Joint and Back Health Training

2008-08-28T19:05:00.001-07:00

Reproductive Health Training

2008-08-28T19:04:00.000-07:00

Life in San Isidro

2008-08-28T19:01:00.000-07:00

Super Busy Times

2008-08-27T05:44:00.000-07:00

Hi Folks, I write this from Manila, where fellow APH organizer Dave sits next to me working on the blog entry we are co-authoring on our time in San Isidro.
See our website:
www.vcn.bc.ca/~aph

Aiyanas, Sophia, Billy and I traveled from Bacolod to Escalante, where we joined a training for National Federation of Sugar Workers Community Health Workers. I helped lead the first aid and the physical exams... pretty fun. Evy, a medical student from the Belgian organization INTAL (International Action for Liberation) joined us, and we had a blast together. After that short 3 days, our family, Evy, and our guides from NIHIP traveled to Cadiz, where we spent the night at a camp for the families of 13 men arrested for the 'crime' of trying to eek out a living burning charcoal during what is now 'tiempos muertos' or 'dead time' between planting and harvesting the sugar cane, when hunger is severe. The day we arrived, the families buried its youngest victim, 3 year old Jenny, who died from malnutrition and broncho-pneumonia. It was a very inspiring night of prison visit and check ups, more check ups at the camp and Aiyanas did a great radio interview which was aired the next morning to our delight. We learned recently that 11 of 13 men have been released, and have joined their wives and children in the camp until the remaining 2 men are freed.

After Cadiz, Aiyanas, Billy, Sophia and our guide Julius traveled to San Isidro, a community where the PO, NFSW, has initiated a strong health committee... but more on that when Dave and I finish our joint blog.

Now I am in Manila escorting Sophia and Dave to the airport. Aiyanas and Billy remain with Julius in Escalante for further integration with sugar workers and fishers, and research and documentation on the impacts of oil exploration and mining off the coast.

Send us some comments!

Escalante Sugar Workers CHW Training

2008-08-26T23:37:00.001-07:00

Cadiz Political Prisoners Family Camp

2008-08-26T23:27:00.001-07:00

Cadiz Political Prisoners Solidarity Visit

2008-08-26T23:19:00.000-07:00

Community Health Worker Training

2008-08-18T22:56:00.002-07:00

A simple thing.
Swollen glands,
In neck and under the jawbone.

Could be a sign of TB.
Could be a sign of upper respiratory infection,
Your best chance at detection,
To heal a brother, a mother, or a child.
Not a simple thing.

Lub-dub Lub-dub Lub-dub
Hands on the stethoscope,
Learning to listen for the sounds of disease
Listen to the heart…
Murmurs and faces focused,
Learning to listen,
For the echoes of imperialism.

Diagnosis is 80% history.
Spanish plunderers on the shores;
American soldiers with false aid
And a lecherous gaze;
Philex, Canadian mining giant
Developing nothing but their own profit.

Healing hands, working hands, fighting hands.
Palpitating,
Eyes open and assessing,
Trying to heal the body,
To mend the lives,
To strengthen the community,
To free the nation,
And change the world.

~ Aiyanas Ormond

Is Capitalism a Disease?

2008-08-18T22:56:00.001-07:00

Communities sick from hunger,
Sick from pollution,
Sick from dirty water,
Sick from overwork and stress,
Sick from junk food in shiny plastic packages.
And there are bill board advertisements,
And there are 25 choices of toothpaste,
And there are police to protect private property,
But no food, no doctor, no medicine.
Is capitalism a disease?

~ Aiyanas Ormond

Short Update

2008-08-10T00:44:00.000-07:00

We are in the 'city' for one night on our way to Escalante, a highly militarized area where I will be giving 2 trainings for the health workers, first aid and anatomy and physiology, and maternal-child health. Aiyanas will be documenting human rights violations.
Stay posted for our updates on this northern region. Thanks for the comments!

My First Midwifery Training

2008-08-03T22:42:00.001-07:00

Emergency Transport - Mission Almost Impossible

2008-08-03T22:38:00.001-07:00

Guihulgnan Health Work

2008-08-03T22:35:00.001-07:00

Life in Guihulgnan

2008-08-03T22:32:00.001-07:00

The Kalabaklabakan School Experience

2008-08-03T22:22:00.001-07:00

Maternal and Child Health on Negros

2008-08-03T22:01:00.000-07:00

August 2, 2008

In the Philippines, 10 mothers die daily due to pregnancy and childbirth related causes. On Negros, 0.81% of pregnant women die in pregnancy or during childbirth. 13 of over 1,000 newborn babies die.

We understand that this is because the basic and chronic problems in health are not addressed and indeed are allowed to worsen as the majority of the population lives in dire poverty. It all boils down to the reality that the government priorities foreign debt and the military over the health of the people!
For the national situation, see my earlier blog entry 'National Situation'.

Trinidad is but one of 33 Barangays in the ‘city’ of Guihulgnan, Negros Oriental; Trinidad Barangay itself is composed of many small sitios, each with a population in the low thousands. This community is about as rural as it gets; very few of the extremely modest 1 or 2 room bamboo houses has direct access to the road, so reaching most homes involves a 20 minute to several hour hike.

This means that women and their families have very limited geographical access to health care services. But the problem goes much deeper, and encompasses not only the geographical, but includes the social, ideological, political and economic.

The social barriers include the burden placed on the family when the mother is absent from her childcare and household duties in order to access far-away and expensive health services. When it takes several hours a day to prepare meals over open fires, and either you cook or you don’t eat, there is no other option for many families except to try and farm out their children or bring them into the city. The usual 'choice' is to not go to the health centre or hospital at all.

The ideological barriers are difficult to express. There is an acceptance that women take a risk of dying for having a baby that would never be socially-acceptable in Canada. Children with deformities are prayed for and then left to find ways to compensate. My perception of risk is completely altered by this experience.

The political barriers run deep to the corruption of the Philippine national government and the patronage-focus of the provincial and local governments. If you are poor and have no money to pay for your kidney dialysis or blood pressure medication – go see the mayor and ask for a favour because you voted for her in the last election! No social services for the people as state responsibility, but rather stop-gap measures from the politicians looking for support and votes. In an emergency, in order to use the municipal truck for transportation, you first must see the Barangay Capitan! Meanwhile, the injured or sick person is already dead while their families scramble to find transport. This very situation happened last weekend and the teenager with the head trauma died.

The economic barriers are the most maddening, and yet provide an explanation for the geographical, social and ideological barriers. The political corruption and foreign-debt and military focus of the national expenditure leaves the people on the brink of disaster.

The Personal is the Political

We started the basic midwifery skills training for local CHWs and hilots that I led last week with each woman sharing a situation where she felt that she needed more support or knowledge to deal with a woman or baby in her care. Every participant shared a story of a woman or baby, or both, dying for lack of proper care, medicines, or treatment.

The stories were saddening, but it was also heart-warming to see how excited these women who all attend deliveries yet live in far-flung areas were to sit in one room together and share their experiences and their ideas. I really emphasized as much as possible the importance of continuing to share like this, but also to go to see the Barangay Capitan together and light a fire under his chair about the need for medicines, equipment and proper emergency transport!

The stories included women and their unborn babies dying from eclamptic seizures due to undiagnosed and untreated high blood pressure; one woman shared that a woman was brought to the clinic with a BP of 220/120, and died just outside the door of the clinic while they were trying to get her to the hospital. Many participants had the experience of prolonged labour or malposition where the baby was already dead by the time it was born. Nanay shared a story of a newborn that developed severe jaundice, the parents could not afford the hospital and would not transfer when Nanay insisted, shortly after the baby was dead.

The response from the government to the shockingly poor maternal-child health statistics and the hardships and dangers faced by pregnant and labouring women has been complete inaction and silence.

International UN organizations, such as UNICEF, have a response almost as lacking as the Philippine Government. Here in the Kalabaklabakan Mountain Clinic sit two large boxes of midwifery equipment and medications. There are no instructions on how to use the equipment and no manuals on managing delivery or emergencies! To top it off, the kits lack ANY postpartum hemorrhage medications! There is even magnesium sulphate to treat severe hypertension and eclamptic convulsions, but no oxytocin or ergot! I am shocked. The kits are great but where is the needed support to put them into use?

There Are No Personal Solutions to Political Problems

It was a goal of mine to attend deliveries in the Philippines, and I knew I would help out with some training along the way. It wasn’t until I was actually out here in Guihulgnan that it really hit me how fundamental health skills training is to the strength of the People’s Organization and the survival of the community as a whole.

Considering this, I cannot be disappointed that it is so hard to get out to the deliveries, but be happy with the deliveries I get. It is shocking how dangerous it is to give birth here, and if I could, I would stay here for a year and train everyone! So now I let go of the pleasure of delivering babies and focus on doing the best trainings that I possibly can while I am here – and in as many creative ways as I can, too! I have been asked to give 4 more formal trainings, plus to keep training with each prenatal visit, and any deliveries that occur during my stay.

It was incredibly inspiring to design and facilitate a two-day basic skills and emergency training with local Community Health Workers (CHWs – work for the People’s Organization), Barangay Health Workers (BHWs – work for the local health unit), and Hilots (traditional birth attendants). We covered what to do in a basic prenatal visit, what abnormal findings mean, when you can treat at home and when to go to hospital, doing a normal delivery, the midwifery kit, and then some emergencies such as hemorrhage (with no meds!), shoulder dystocia, breech, and prolonged labour. For the CHWs at Kalabaklabakan, I reviewed the uses of the essential medications for pregnancy and delivery, minus the PPH drugs (!), since UNICEF didn’t send those!

Training of health workers is the best and most lasting contribution I can make; knowledge and skills in the hands of the health workers leads to a better life for the whole community and is a significant contribution to the movement!

Congenital Abnormalities Undiagnosed and Untreated

2008-08-03T21:57:00.000-07:00

Walking the market or visiting the school, the health worker in Barangay Trinidad can witness many birth defects which have gone unrepaired and untreated; neglect of the corrupt Philippine government. My first experience of this was on my first day in the Barangay – it becomes a matter of fact once you digest that there is no treatment available. In some cases, I wonder, are there other potentially-debilitating defects associated which have been undiagnosed? What are the long-term health consequences of such defects? As a midwife who performs neonatal examinations, I know that where there is one defect, there very well may be others. In particular, when I see children with a mid-line defect, such as a cleft lip/palate, I wonder how extensive of a physical examination has the child had, if any at all?

Some of the more common-place ones I have witnessed:

Partial blindness from malformed eye: There is a boy with an abnormal eye in Billy’s basketball play group. He does not play basketball, but sits on the sidelines and observes the game with the younger kids. Vision impairment will have a major effect on his ability to earn a livelihood in a rural peasant community. I imagine, however, that the child learns to compensate with his good eye as much as possible; but with the common tool of the peasant being the machete, and knowing the regularity with which the health workers repair machete wounds, it must be a risky compensation.

Deafness & impaired speech: There are 3 children who are mostly deaf and who hence have impaired speech in a family of 6 children. The parents wonder why this is happening to them, but no medical professional has ever visited them and reviewed their medical history and pedigree; there are no services available to this family, and no funding for the children. Women in the community have no access to iodized salt, and goiter is fairly commonplace among women of childbearing age and this might be the root of the deafness. I have not seen anyone using signing with these children, and when I asked Nanay if his parents use sign language, she was unsure.

Cleft lip/palate: Although I have seen other unrepaired clefts, there is a girl in Sophia’s play group that must be about 10 who has a marked cleft, and for some reason, this strikes me as the most regretful neglect of the Philippine health care system. Perhaps it is because I am very knowledgeable about the available intrapartum diagnosis, neonatal nutritional monitoring and support, early structural and cosmetic repair, dental care, and counselling available in Canada for parents of and children with a cleft. It makes it hard to look the politicians in the eye when we meet when I know the suffering of these children.

Club foot: There is a young boy of perhaps 10 who walks on his ankle bone as his foot is markedly clubbed. The ankle appears to have a dense layer of scar tissue, but I do wonder about pressure wounds and circulation issues, not to mention, life-long pain.

Extra digits: A minor and virtually non-issue, but a large number I am seeing, and something that we would not even question repairing in Canada.

I know this entry is disjointed, but my time is so tight and I only have access to the internet very sporadically, and then only for an hour at a time. It might be another month before we have internet again, so take care everyone!

Birth of Baby Sophia -- Kalabaklabakan Mountains

2008-07-27T20:22:00.000-07:00

July 8, 2008

First delivery call!

Tuesday morning we had just gotten the kids settled into their new school classes when I had the opportunity to accompany Nanay Meralyn on a house call for a delivery. We rushed back to the mountain clinic and gathered up our supplies. I threw my charting documents, prenatal kit, delivery kit, newborn resuscitation kit into my backpack along with a bottle of water, my headlamp and a clean bandana; Nanay packed sterile cloths and a hanging scale into two basins, and grabbed her home visit kit. To help with translation and provide support, Josephine and Ping also came along.

To get to the simple home of this farmer and his labouring wife, we had to hike for over 45 minutes with Nanay leading our entourage at full tilt. After reaching the summit of the first slope I was so out of breath and dripping with sweat I thought I was going to collapse or at least throw up, but we had just started! Nothing to do but keep going and hope the feeling passed. After the second climb I started to get the hang of it; then, magically, we reached the summit of the hills and walked on the highlands with valley on either side. It was positively gorgeous landscape. In midwifery school I never imagined I would be hiking into a birth with my kit on my back. I had hoped that we would be able to discuss the situation on our way, but Nanay was leading the pack always at least 20 paces ahead and I was too hot and winded to have a conversation! As we passed each house Nanay would call out greetings and get directions. It was quite fun once I no longer needed to desperately gasp for air, though I was nervous about what was awaiting me on this first birth in rural Philippines.

Finally we start to descend into the valley on our left, all the while I am thinking, ‘what goes down must come back up’… imagine hiking home with your equipment after a birth! There below us lay the home of this newly-wed couple having their first baby. The mother-to-be was already 34, old age for a first baby in these parts. The house was very simple, a one-room bamboo hut on stilts, with a pen for their goats, and chickens and puppies roaming the grounds. On the north and west sides there lay lovely a corn field almost ready to be harvested, on the west cassava underground with their vibrant green leaves bursting through the thick brown soil, and to the south the most incredible avocado tree literally dripping with giant soft and delicious avocados which we were fed shortly after our arrival. The home was tiny but very clean; no toilet or running water, but the raised and slatted bamboo floor was spotless and the air smelled fresh and sweet.

There were about 12 relatives in the house, on the small porch, and in the yard cooking and chatting. At first the fire was built under the house so the heat was passing through the slatted floor into the house so it was literally a sauna, but thankfully that fire was put out as the sun rose higher in the sky and a new fire was started off to the side!

It was 10:15 when we arrived. The labouring mother, Conception, or Connie, was lying flat on her back, not looking much like a woman in labour to me! Nanay went about checking her vital signs, and then I followed with an abdominal exam, feeling the position of the baby and listened to the FHR, first with my fetoscope and then with my Doppler so the parents could hear the FHR. I palpated for contractions and felt mild contractions about once every 8 minutes. The story took almost one hour to unfold, all the while Connie lying on her back covered in a blanket. It seemed that her pains started the previous night, she didn’t sleep well, and that morning she was still having pains coming and going, no fluid or bloody show yet. This information was difficult to gather, let alone get a full history of the pregnancy! After this we continued to eat and socialize with the family as they churned out snack after snack, avocado with muscovado sugar, cassava roasted in banana leaves, fresh ripe bananas, and rice with sardines.

As we snacked, I started to make suggestions about the labour. Everything has a process to follow, believe me; this was very hard to do for a variety of reasons, the biggest one being a huge language and culture barrier. Luckily, the father of the baby was very happy to have me, so this helped immensely. Mainly I felt it imperative that we get Connie up off her back and walking and swaying and moving her body. Periodically I listened to the FHR, perhaps every 30 – 45 mins, not too worried with schedule since I felt she was still quite early in labour.

Finally, at 12:00 I was starting to think that all of this socializing was getting us nowhere and I wanted a more complete picture of what was going on here. I could see that Connie was acting more like a labouring woman. I asked if I could again palpate contractions, and perhaps do an internal exam to see if the cervix was at all dilated. This took some negotiating, since I gather now from discussing with a CHW, the local hilots do not do much in the way of physical examinations of mom or baby; but consent was gained. After explaining through patchy translation how the exam works, I discovered that she was 1 cm dilated, 2 cm long, soft, vertex -1, ROT to ROP with SROM for clear fluid! Although I had been assured a few times that nothing was coming from her vagina, I was most definitely touching hair and that was for sure clear fluid pooling on the blanket. After more complicated and raucous discussion among the many women in the room, I finally discerned that, indeed, fluid had started leaking in small amounts at 08:00 that morning. Now we have a 34 year old primip with PROM and a posterior baby, to boot.

Damn! In my quest to make my backpack lighter I ditched my castor oil at the mountain clinic. Of course, now I want it! On the bright side, I think the baby is a nice small peanut and judging by how low it is sitting, I think she can push it out. At this point I am thinking about how the sun sets at 18:00 and we have to hike an hour to get to the clinic and the road. I tell Nanay what I am worried about: PROM, infection, I think we should be headed to the hospital if labour isn’t starting by night time, and how to transport if a fever starts or augment/induction turns out to be necessary. We discuss the transport process again: hike for 45-60 minutes, ask the Barangay Captain to use the Barangay jeep, then drive 2-3 hours to the hospital in Guihulgnan City. OK. I tell Nanay that if she isn’t in good labour by 18:00 we should go to the clinic cottages, as the transport process is ridiculous and we can’t facilitate it from here. Vital signs are stable, fluid is clear; FHR is good, nice accels - all reassuring stuff so we should enjoy the native coffee and the view with a plan in place.

Thinking that I want the labour to get going, I ask Nanay if there is a local alternative to castor oil. A tiny little woman with a long grey braid and a big smile appeared from out of nowhere and started to perform some kind of a ritual – a faith healer! How exciting for me to have the chance to witness. The healer proceeded to massage Connie’s belly with oil (which I later learned is snake oil) and to chant prayers to the baby.

Some time about 13:45 I needed to stretch my legs and pee in the corn fields. After a time I went back into the house and discovered Nanay starting to get Connie to push! Glancing at my watch I see it is 14:22. No way is this baby coming. I gently ask Nanay what is going on. She told me that ‘plenty of water’ was coming and the vagina was parting and was completely convinced it was time to push. OK, I tell Nanay that I am sure it is too early, but she has Connie down on the floor semi-sitting and is doing her thing; I have no other choice but to give this pushing business time to prove it useless. At least since Connie is now only contracting once every 15 mins for less than 45 seconds I am not worried about causing harm. Finally, after over 1 hour and only 4 pushes, I tell Nanay that I am certain that nothing is happening and we should stop this pushing in order to observe the labour – now Nanay is willing to have me step in. I sit quietly with my hand on Connie’s belly and feel contractions about every 8 minutes, mild to moderate; I gather that the contractions are still irregular and Connie was only pushing with the moderate and ignoring the mild.

Now it is close to 17:00. I tell Nanay that the labour is still very early and we should go to the clinic cottages now before it gets dark. To confirm this, against my better judgement I do another exam, sure enough, just as I expected, 2 cm dilated, 2 cm long, though there is some show on the glove now, fluid still nice and clear. I explain to the family that the womb is still mostly closed and the baby is not coming yet, but since the water is leaking we may need to be closer to help if it is needed. I also explain that the walk will likely get the labour going since the baby is so low it will help the cervix open. Finally, there is electric light, a cell phone, and intermittent cell signal at the clinic. At the clinic cottage we can wait until tomorrow morning to go to the hospital if needed, but at least we will be close if we have to go overnight.

OK, they agree! This is too easy. Everyone is bustling about packing up clothes, food, blankets, even a chicken tied by its feet and a long bamboo pole. But what is going on now? I peek back in the house and see Nanay has her pushing again!

It is hard to convey the scene that unfolded. There are now 13 people in the tiny steamy house, the faith healer is chanting and throwing flowers, men are saying prayers, women are all talking over each other shouting suggestions. I literally thought I was going to lose it – this was the most outside my comfort zone I had been the entire trip. I can laugh now, but at the time all I could do was do breathe deeply and remind myself that by tomorrow it would all be a memory – and a darn good one! Speaking loudly and clearly I stated again that the baby was not coming now and we should go before dark. I learned the day after from Mamay Amy that the father of the baby told everyone to listen to me and that we should leave – thank goodness because I think it was the right decision.

Now we set off. Connie is walking with her husband and a relative on either side to support her when she has pains. I show Connie how to slow dance with her husband when a pain comes. I am certain the walk will be a great help, and feel that we are doing the right thing as already the contractions are picking up. But what is happening now? Connie didn’t sleep last night and she is too tired to walk the rest of the way – the thunder is starting and the rains threaten. Like magic a man appears from the woods on a horse followed by a couple more men. They wrap blankets around Connie and tie her to the bamboo pole, and now we are off at great speed. I practically run with them the rest of the way to the clinic, leaving the family trailing behind with their iron pots and chickens. My adrenaline is now rushing and I barely notice the climbing.

As we descend the last decline we run into Mamay Amy who was on her way to look for us, worried we had been gone for so long and it was almost dark now. Nanay runs to the clinic cottage to turn on the lights and make a place for Connie while Mamay heads off to find Aiyanas and the kids and tell them I am back.

The trip was brilliant! At 18:00 Connie is looking like a woman in rocking labour. I joke with Nanay and Connie’s husband that this is what a woman in labour looks like! After a pee and a good drink, we get Connie side-lying and encourage her to rest between contractions, using massage to help her relax. I set out my delivery kit, my PPH meds, my newborn resuscitation kit and my suture kit, along with some extra gloves, cloths for the newborn and extra gauze. At about 19:00 she is starting to make grunty noises and I see perineal bulging! Time to set up our instruments and place a clean drape; I laugh as I look at my light blue tank top and jeans, so Mamay brings me a rubber apron. I tell Nanay about when to coach Connie to pant; I quickly coach Ping how to listen to the FHR with my Doppler between pushes. As the head starts to crown, the room fills with relatives all shouting encouragements. I am calling out “Pant! Pant!” and everyone else is chanting, “Sigue! Sigue!” Ah, well, what can I do but roll with it? So, in a dimly lit cottage in rural Philippines I perform my first-ever somersault manoeuvre as I feel the nuchal cord and yet Connie is pushing like a woman possessed and the family is all yelling for more! At 19:50, following a giant push, the baby is out, unravelled from the nuchal cord, and up onto Connie; with a good rub of the clean towel the baby cries! The cord is no longer pulsing, so I clamp and have the father do the honours with cutting the cord. It’s a baby girl!

Now the placenta; I am doing expectant management since my access to PPH medications is so limited. I have to say, I am a hard-core active management kind of gal, so this is the moment that makes me hold my breath. After a cuddle and a quick attempt at a breast-feed to get the oxytocin flowing, we get Connie up in a squat, and at 20:05 we have an intact placenta and about 300 cc of blood loss, which I suspect is now bleeding from her perineum. Uterus nice and firm; BP is great. Second degree laceration sutured beautifully, I must say, thanks to the Mountain Equipment Coop headlamp I brought for just this occasion.

Finally, my favourite part, the newborn exam. What a perfect little rosebud of a baby girl, weighing in at 2820 grams. Everyone is elated, and they name the baby girl Sophia! What a great tribute.

The family will spend a few days in one of the clinic cottages so we can do our postpartum care without hiking each direction – thank goodness! As it turned out, one of the relatives is the leader of the People’s Organization (hence the men appearing by magic) so even Aiyanas had a good experience talking with them while I did the birth.

My first home birth since graduation, a beautiful birth, a memorable story!

Barangay Trinidad, Guihulgnan, Negros Oriental

2008-07-27T20:18:00.000-07:00

July 26, 2008

20:00 in the Kalabaklabakan Mountain Clinic

So, Aiyanas and I sit down at the computer together already at the end of our third week here in Kalabaklabakan. Martha has already delivered a baby, which is the subject of another blog entry, and was a great way to gain the confidence of the local women – though they are still very shy; if only we could stay here for the duration! We have learned plenty about this community which is a site of intense militarization and human rights abuses by the military due to the history of this area as a stronghold of people’s organization.

Prior to the 1990s this community had a strong organization, and the connection between the legal and underground movement was cohesive; the NPA (New People’s Army) and the armed movement has a policy of 90% community service and only 10% military struggle. This balance has a great impact on communities. Leaders in this community remember the demonstration farm, the agricultural advances, the winning of lands converted from sugar plantations to food production, the vibrant health clinic which functioned as a people’s hospital. When we look outside the window the clinic, we gaze upon fields that were once sugar production, and now feed peasant families with rice, corn, bananas, cassava, and kamote. When the community was strongly organized the community was able to win a reduction in landlord tithe from 1/3rd to 1/5th of production. For families in a sitio where hunger is commonplace, this can mean less hungry bellies.

In discussions with leaders from the peasant organization Kaugmaon, we have gotten a better sense what feudalism actually means for the lives of those who live in the Philippines countryside. One child in the neighbourhood was complaining today that he has been eating kamote (a root crop like a potato) as his only food for 3 meals each day! Even families with land to till often experience hunger because of the landlord tithes and the fast-rising food and fuel prices. Aiyanas has noticed that every week in market the price of rice rises 5 pisos per granta (~2 kg).

Early this week Mamee and Nanay led us on a 6 hour walk through the Barangay to visit a pregnant woman, the home of Imelia (snatched from her home and now a political prisoner – more later), and to cross the bridge that Bayan Muna built. Bayan Muna, a progressive congress party list, responded to the dire need of the people, and built a suspension-bridge that connects two of the sitios. This basic necessity means that children can get to the primary school by simply crossing the river, where previously it was a 3 hour walk to cross by the nearest concrete bridge! In response, Bayan Muna, a legal political agency, is a target of intense military harassment and threats, and basically unable to operate openly in the Barangay Guihulgnan. Party-list organizers have been the victims of political killings in Guihulgnan.

Peppered throughout our community integration is the steady trickle of patients that come by the clinic or that we visit on our house calls. I am having great fun seeing patients in the clinic and at home. I have several pregnant ladies in my care now, hoping that I am actually here for one of their births! There is fair amount of training the clinic CHWs with each visit, which is an excellent chance to build their skills. I am also enjoying the reciprocal challenge of diagnosing, treating, or struggling to help with machete wounds, skin infections, infertility, respiratory infections, tooth abscesses, rashes, urinary tract infections, diarrhea, and a host of troubles and complaints. I am doing a fair amount of risk assessment with the local pregnant women, as the slideshow I am posting attests, advance emergency preparation is a major concern as transportation is severely limited. I even had a chance to talk up the Barangay Capitan about more liberal use of the municipal truck for childbirth emergencies, which hopefully will do some good. See our clinic and transport slide shows.

I am thrilled and quite nervous that next week I am leading a two day basic midwifery training for local hilots and community health workers. How exciting that I have this honour, and I hope I can teach well. I am terribly excited about the chance to really talk to the hilots and learn their experiences. Hopefully, if we return in September for a few weeks, I can attend a delivery with one of the hilots – this is a goal of mine.

I will be posting a whole entry on the people’s health clinic in the days to come, so health folks, stay posted!!

Aiyanas is a hero, spending 3 to 4 hours each day lighting the fire, stoking the fire, and preparing our very simple meals; given the few choices of ingredients, Aiyanas is making the best of a difficult situation! Last night we had the pleasure of eating lechon manok (roasted chicken), freshly shot out of the trees (true fact) with Zari’s rifle and spit-roasted with fresh tanglad (lemongrass) – yum! Most nights we eat rice and a variation on squash, string beans and a weird green veggie. I have lost 12 pounds of midwifery-school flab. See our Life in Guihulgnan slide show.

Thankfully the kids are enjoying their integration at the local primary school. Sophia has 50+ kids in her class, and 1 text book for every two kids, or for some subjects, no books at all. Sophia, as usual, has a huge posse of girlfriends that she plays with at recess and after school. Billy enjoys playing basketball with the B-ball posse, but finds school less exciting. The rote copying is a bit more trying on him. See our school slide show.

An organizer from Karapatan (the human rights organization) shared with us that the militarization is closely linked to economic developments here on Negros. The first is the large number of local and foreign-controlled mining developments; the second the local landowners desire to increase sugar production to meet the new demand for biofuel as a legislated biofuel quota kicks in. Under the prevalent conditions of high-level of people’s organization, especially the strong presence of the NPA, these kinds of anti-people developments can be resisted. Hence, the first actions of the military have been to attack the progressive political organizations, especially the peasant organization, to persecute and harass those thought to be sympathizers with the NPA.

We’ll keep you posted; we hope you keep reading and supporting the struggle!

Negros Island: The Struggle for Land, Wages and Social Benefits

2008-07-04T02:54:00.000-07:00

July 3, 2008

Geography, Economy and Social Situation

Negros has a long history of Spanish and then US colonial occupation and plunder. Yet, Negros also has a long and rich history of struggle for land, wages and social benefits.

Negros is the 4th largest island in the Philippine archipelago, with over 1,322,837 hectares of land, majority alienable and disposable agricultural land. 2/3 of the land of Negros is under private control by large landlords and local and national elites; in addition, irrigations systems necessary for productive farming are also under control of local elites.

In 2001, 56% of the land mass was given over to the sugar industry, dominant in Negros Occidental, and controlled largely through the semi-feudal ‘hacienda’ system stemming from Spanish colonialism. Semi-feudal in that most farms and haciendas are not corporate productions, or ‘capitalized farms’, but rather the hacienda system operates on a semi-feudal means of production, whereby workers and their families live on the hacienda, many owning their own tools and carabao, but yet inadequately compensated for their labour in Pesos, as opposed to pure feudalism with a crop-sharing arrangement. There is also a large pool of surplus labour, or the underemployed ‘sacadas’, who move from hacienda to hacienda selling their labour where work is available. During the ‘tiempo muerta’ or ‘dead time’ the majority of hacienda workers are forced to migrate to the urban areas or to eek out meagre livelihoods on small plots of land. The corruption and failure of the IMF/WB enforced, pro-landlord CARP program for land re-distribution is a major issue on Negros (see earlier blog posts for information on CARP).

Other products of Negros, primarily in Negros Oriental, include rice, corn, coconut, bananas, peanuts, vegetables, and fish in the coastal (as opposed to mountainous) regions. Monocrop culture enforced by the IMF/WB SAPs (structural adjustment programs) essentially eliminates a farmer’s ability to sustain their families on what they produce, and contributed to a crisis in displacement to the urban centres. In Bacolod, in Negros Occidental, there are 61 barangays, 41 are urban poor communities, with 15,000 families living in dire poverty and 4335 families living in shanties in “extreme danger zones” such as overhanging unpredictable and typhoon-frequent coastal waters. For fisher folk, environmental damage and off-shore oil exploration have had dire impacts on fishing yields, with yields dropping from 20 kg/5 hours to 3 kg/5 hours.

Mining claims currently cover 47% of the total land mass and 88% of agricultural land. In Negros Occidental Philex, a 90% Canadian owned gold mining corporation has contributed to displacement, environmental destruction, and the rapidly growing gap between the rich and the poor, the owners and the workers and peasants.

Per capita income is dropping, there is an annual 8.89% increase in hunger on Negros, and illiteracy is increasing. Many children stop schooling at grade 3 with a full 70% drop out rate by grade 6, in order to contribute to the family income through formal or informal work. It is estimated that there are 334,900 working children on Negros, 26% of these children working on haciendas.

Human Rights Situation

In these dire economic times of growing hunger, increasing poverty and massive land displacement the people’s struggle for national and social liberation strengthens, even in the face of heightened military repression.

Where in 1999 there were only two active battalions under the control of the Philippine National Police (PNP), in 2008 there are currently 2 full brigades of 4 battalions under the control of the Armed Forces of the Philippines, with additional military personnel providing assistance where necessary. The primary target of these military bases is the ‘neutralization’ of the liberation struggle of not only the New People’s Army (NPA), but also the legal struggle, including the workers and the peasants. Although these figures are currently being updated to correct 2008 numbers, since 2001 there have been 31 victims of extrajudicial killings, 4 forced disappearances, 11 political prisoners detained, 4 attempted assassinations, 5 cases of torture, 13 cases of physical assault, and over 2,000 evacuations due to military operations.

Community members report that the attempts of the community to implement co-operative farming operations, initiate health programs, increase community-controlled social programs, and to collectively raise the community from poverty and isolation, are determined by the AFP to be insurgent activities directly related to the armed liberation struggle of the NPA and result in the community having a strong military presence.

The result of this labelling is intense political harassment, death threats, false accusations, red-baiting local leaders, people’s organizations, unions, and mass organizations. But against these odds the people continue to struggle!

…More to come on the health situation and the organized people’s response in a month when we return from the rural area. For tonight, it is late, and we have a full day tomorrow!

PS: Data courtesy of our Negros hosts! Please see new links on this blog site.

Negros Island Integration

2008-07-02T20:09:00.000-07:00

We have now hit the two month mark, and still have so much left to accomplish! This afternoon is our formal Negros orientation and situation overview, however, we have already had such a wonderful experience in Bacolod.

For those of you who are following us on our journeys I am posting a map. Our first integration will be in Guihulngan, our second in Toboso, and our third in Sipalay, where Canadian mining firm PhilEx is active (even marked on the Sipalay tourist map, private air strip and all). Then back to Bacolod for one month, then Manila again for our final activities, pulling together our documentation, and reporting to the mass organizations in Manila.

We miss you all! Occasional pangs of homesickness that only mango-cheese icecream can allieviate!

Sahot, Trabajo At Karapatan!

2008-06-27T05:49:00.000-07:00

Multisec Mob Ng Sahod, Trabajo, at Karapatan!

2008-06-27T05:07:00.000-07:00

June 26, 2008

We participated in a 2,500 strong multisectoral mobilization. The march highlighted the immediate economic crisis: rising food, oil and electricity prices, as well as low wages, hunger and home demolitions. The rallying cry was for the ouster of GMA.

The cultural presentations and props at the rally were effective at re-creating the struggles of the masses.

Pahirap sa Masa! Patalsikin si Gloria!

Ilitaw at Palayain Karen at Sherlyn!

2008-06-27T04:47:00.000-07:00

June 25, 2008, the second anniversary of the forced disappearance of Karen and Sherlyn, two University of the Philippines students, accused of no more than standing on the side of the most oppressed sectors of Philippine society. Karen and Sherlyn were snatched in Bulacan, along with peasant Manuel Merino, from a rural farming community. To this day, Karen and Sherlyn have not been resurfaced, and their fate is unknown.

On this day Aiyanas and I attended a forum and protest rally at the UP, to call for the surfacing of Karen and Sherlyn, to educate the students and faculty of UP on the human rights situation in the Philippines, and to demonstrate to UP administrators and the government of the Philippines that political persecution and terrorizing of progressive forces must be stopped!

Context:

It is in the context of the daily human rights violations, of forced displacement due to military counterinsurgency and corporate plunder of natural resources, such as Canadian mining operations, that the struggle for genuine human rights, for land reform, and for national liberation arises.

Recent trends in poverty exacerbate a nation already pushed to the brink by political corruption, IMF/WB structural adjustment conditionality, WTO enforced trade liberalization, deregulation and privatization, and an intensified counter-insurgency program.

Annual average incomes have been dropping, from 145,000 Pesos in 2000 to 125,000 Pesos in 2006; this sum amounts to a National average daily income of Canadian $255 per month. 10%, or a full 1/5th of the workforce is working overseas in order to send home the vital remittances which keep the economy of the Philippines afloat.

It was in the context of the complete abdication of responsibility for the masses of Filipinos by the Gloria Macapagal Regime that UP students Karen Empeno and Sherlyn Cadapan decided to dedicate their talents and energies towards serving the people through legal means. Sherlyn, an award-winning athlete, was the Basic Masses Integration Officer of the UP Student Council, responsible for connecting students with the lived conditions and struggles of workers and peasants, joining in pickets and actions, as well as taking students out on exposure trips to the communities and the countryside. Karen was a generous-hearted social sciences student who actively supported the struggles of the workers and peasants, and who participated in a rural exposure trip. It was on such a trip to an impoverished community to integrate with peasants, that these two bright young women were snatched by military forces and ‘disappeared’.

Since Gloria Macapagal Arroyo took power in 2001 following the ouster of President Joseph Estrada, there have been more than 900 extrajudicial killings, including leaders and activists from the trade-union, peasant, women, health and student sectors as well as from progressive political party lists. As the rate of the killings has decreased (but not stopped) in response to international pressure generated by grassroots and establishment human rights groups, the rate of enforced disappearances has simultaneously increased with 193 victims to date, most of them in 2006 and 2007 when international attention was most focused on the human rights situation in the Philippines. Yet, already this year there have been 13 extrajudicial killings and 1 forced disappearance!

All sectors of progressive Filipinos have felt the impact of the red-baiting, intense harassment, and political terrorism of the GMA regime. Both students and teachers alike have been targeted. On January 10, 2007, Jose Maria Sui, a 53-year-old university professor, was shot dead in his classroom on the University of Eastern Philippines North Samar campus. There have been 9 documented killings of teachers, and one teacher forcibly disappeared, according to the Alliance of Concerned Teachers (ACT), a legal organization of progressive teachers. Two of those victims of extrajudicial killings were members of the ACT National Congress.

There is a direct relationship between the black propaganda of the Armed Forces of the Philippines and those victims of extrajudicial killings. Jose Maria Sui was directly named in a red-baiting flier distributed on campus, and the very next week became a victim of extrajudicial killings. On the website of the AFP, progressive activists and popular organizations will be directly named as a de-facto list of political targets.

After the forum and memorial performances dedicated to Karen and Sherlyn, we piled out of the auditorium and marched to the Student Union building with the rallying cry:
“Karen at Sherlyn! Palayain!”

ILPS Reflections

2008-06-23T08:42:00.000-07:00

Just returned to Manila after a fulfilling Third International Assembly of the International League of People’s Struggles in Hong Kong!

Naturally, it was a pleasure to connect again with comrades such as Wali from Pakistan, Raquel from Brazil, and Lyn and Richard from the USA, to deepen our understanding about their work and strengthen our connections. It was such a pleasure and a privilege to talk in depth with our US comrades about our organizing work, our successes, our challenges, and our vision; after such discussions I felt the lack of mentorship for me and Aiyanas in Vancouver. However, we are resolved to march forward, and to maintain our deepened connections in the USA.

It was lovely to share a cabin with our Indian comrades and to witness some very charming conversations between Billy and Saibaba from the Revolutionary Democratic Front of India, a highly respected revolutionary leader and esteemed speaker at the conference. It was heart-warming that even though this man was expected to present at numerous workshops, and has a leadership role nationally and internationally, he is still readily willing and able to connect with a 6 year old. Of course, it left me somewhat saddened at the lack of family culture in the Left in Vancouver, outside the Kalayaan Centre, that is. The Organizing Centre’s focus on building communities of resistance will ultimately address this.

The keynote addresses on Wednesday were invigorating.

Varavara Rao, the leader of the Revolutionary Democratic Front of India, denied a travel visa to HK, was the keynote speaker via G.N. Saibaba, who presented his paper. Varavara concretely explained the inter-imperialist rivalries as a major contradiction; rivalries to be found in the breakdown of WTO negotiations, conflicts over oil and gas, the Euro threatening the hegemony of the dollar, and the ascendancy of Chinese and Russian economic and military powers.

To quote Varavara: “While these are bleak days for the world wide imperialist economy singing the songs of its dark times there are definitely songs of possibilities, of revolutionary opportunities, songs of freedom, of revolution for the most oppressed and wretched of the earth in this whirlpool of deepening crisis of imperialism.”
Varavara overviewed the vast and growing economic independent zones in India which are organized by the revolutionary forces.
Varavara concluded: "everlasting peace is only possible with the struggles that establish genuine peace, by removing exploitation of man by man”.

Jose Maria Sison, the founder of the Communist Party of the Philippines and Chairman of the ILPS, labelled as a ‘terrorist’ by the Canadian government, gave the report from the Chair.
A highlight of Professor Sison’s presentation was his clear and concise direction to launch and strengthen mass organizations; to initiate and launch mass campaigns; to take up the major concerns and disseminate the analysis and action as widely as possible. Professor Sison really hyped the practice at this Assembly, calling for forces to arise where they did not exist and strengthen where they did exist.

There was representation from Kenya in Wahu Kaara of the Kenyan Debt Relief Network. To resounding applause, Wahu remarked that “a world with justice, a world with peace, a world with human dignity, and a world where none suffer from want is here with us today!”

The workshops were rewarding. The workshop on the cause of National and Social Liberation was filled with rich learning on global history, geo-politics, and current analysis. With presentations from 8 respected leaders, including Kali Williams form the Malcom X Grassroots Movement from the US, the global overview was rewarding. The workshop on the Health Concern was an excellent opportunity to update with comrades from the health sector, and to carry on the theme of Professor Sison on the launching of new mass organizations; to present the history and progression of the Alliance for People’s Health as a case study. The conference plenary accepted our resolutions to continue the Health Now! Campaign and to promote the Health Workers’ Call for Peace and Justice. A migrant health worker’s conference in 2009 should give additional impetus to this work!
http://vcn.bc.ca/~aph

Aiyanas wants me to add that a highlight was my performance with Sophia at the cultural night. Sophia was brave, and volunteered to sing for us! She did a beautiful job, and garnered great applause, even though she forgot the final verse. The resounding applause came after I announced that this was our children’s third ILPS hosted conference!

The cultural night all around was definitely a highlight. Aiyanas had the opportunity for a deep discussion on Indian politics with Amit from the Committee for Release of Indian Political Prisoners. The rousing performances, messages of solidarity, and warm feelings of camaraderie that permeated the evening were inspirational. Not to mention Wali’s pop-star performance of an Urdu human rights song – we hope at the next ILPS conference he will be able to bring his 4-year-old daughter to co-star with him!

We leave the Third International Assembly with new friends, a renewed commitment to struggle for unity, to build our mass anti-imperialist organizations, reach out to new member organizations, build the AI united front, and further the struggle for social and economic justice.

In memory of Ka Bel…
Tuloy Ang Laban!
Long Live International Solidarity!

Picassa Albums

2008-06-14T07:40:00.000-07:00

If you click on the slide show and link to Picassa, we have posted some photo albums.

Photos of Boso Boso Health Work

2008-06-14T07:24:00.001-07:00

Boso Boso Health Work

2008-06-14T06:51:00.000-07:00

Saturday June 15

Back from Boso Boso, where I finally got to experience some great hands on health work, as well as experience herbal hunting, and do my first popular education on women's health and childbirth! While this trip didn't provide much opportunity for Aiyanas, as we anticipate Negros will, he did get to spend some quality time playing basketball and gathered quite the local B-ball posse! The kids loved the rice fields, the beautiful forests, and the zillion friends they made.

Too tired to write much now. I write this from the CHD office, where we are sleeping tonight, exhausted from moving around, adjusting and re-adjusting. Today Aiyanas and I visited the provincial prison in Bulacan and accompanied a physican from Health Action for Human Rights on a medical visit to one of the political prisoners. So many activities to fill our time.

Back to Boso Boso. This particular community based health program was initiated in 1993 in reponse to the crisis in maternal mortality and morbidity due to the long travel to the nearest public hospital and the unpaved status of the road at that time. Now the program is 15 years old, and has hit a plateau. There are many skilled CHWs, but they have become clinic-focussed and too heavily geared towards their small Western-based pharmacy. My schedule of prenatal clinic, herbal gathering, and maternal-child health education was intended to help re-inspire the CHWs to get back out into the community, do home visits again, and refresh their tremendous herbal knowledge. It was exciting for me to a) be able to share my skills concretely, b) learn so much in such a short time about available herbal remedies, and c) use all of the knowledge and teaching skills I have practiced so much at South Commmunity over the last year and a half. While I saw many pitfalls of Community Based Health Programs, there were many successes gained through this program, and some leadership and direction could spark some innovative new practices for Boso Boso.

The highlight of this exposure / health integration was the prenatal visit I did in what I could best describe as a sweat shop where women were sewing children's clothing for some brand name I didn't recognize. The door-to-door prenatal afternoon was incredible, and I hope to do this more in Negros. The most challenging visit was the young woman having her second baby and suffering terrible pain from a large palpable symphysis pubis separation; I hope the PT pointers and mobility suggestions I passed on will help - but sleeping on the floor and doing physical work all day will not!

Sleeping is what I must do now. Good night, all.

Another Week, Another Rally!

2008-06-14T06:48:00.000-07:00

Saturday June 7, 2008

Well, today is a rest day for us, and we are heading out to the Mall of Asia for a movie, to pick up some popular education supplies like big paper and markers for teaching, and to eat Jamaican patties, which are masarap!

Thursday June 5 we had another urban poor exposure in Pasig, but this time we met with party list Bayan Muna organizers and discussed the process they followed in organizing their community. This was a great overview of their organizing work. It is similar to the process followed in other communities: starting with health sector work, medical missions, gaining contacts, starting committees, going deeper with the organizing. I now have a good sense of how things are initiated and followed through. Billy, in particular, enjoyed this day, as he made some friends and played pass the basketball – they couldn’t really play as the courtyard we were meeting in was far too small. The girls were having giggle fits as Billy is so much taller than the older boys. This was a special exposure for me as I met the 2 community midwives, one who does the home births and one who runs the birth centre. It was so much fun, and we had many laughs over birth stories and sharing the differences and similarities in our experiences. The birth centre was lovely! I will post some photos. It would be great to come back and spend some time with these midwives; they are very skilled and caring, with about 15 births each per month and each other as back up - they even do breeches! They have been working for 12 years, so much experience. What a chance it would be for me to learn, and to share my own knowledge!

Friday we had a 5 hour meeting and discussion with the Director of International Affairs for Bayan, the New Patriotic Alliance. It was a fabulous discussion. We covered all of the core issues: economics, low wages, hunger and poverty, political killings, political corruption, the struggle to oust GMA, the US military, mining, and Comprehensive Agreement on Agrarian Reform (CARP) and landlessness. We also had the privilege of discussing their organizing process, from which I drew many ideas and lessons; and the longer-term vision of social change, but that is all too much for this blog.

After our marathon meeting on Friday, I shared more with the two women who are CHD organizers as well as graduates of the Fabella School of Midwifery. They are fairly new grads, eager to start a clinic and do births and maternal-child care as a component of their organizing work. It is inspiring that midwives play such a central role in CHD organizing work. It was a fun discussion because we were sharing the differences in maternity care, such as the importance of tetanus vaccination in pregnancy and avoiding neonatal tetanus – something we are definitely not taught at UBC. I informed them that I brought some emergency skills text books and I think we will do some deeper skills sharing after I return from Boso Boso. I hope that their vision comes to reality and I can provide some assistance in the future; I would like to do the same thing in Vancouver – so we have great contacts in each other!!

Finally, to wrap up a busy and fruitful Friday, we attended a marathon march and rally. We started at the Lung Centre with a protest of the health workers against government plans to privatize several speciality hospitals, as well as a general rally to raise the wages and reduce the prices of rice and oil; basically to alleviate the economic hardship of the people that is leading to rising hunger, malnutrition and disease. Sophia enjoyed this rally as she met some friends and played clapping games. After a rousing rally, we marched to join the KMU and other unions in protesting the VAT (value added tax) which exacerbates hardship in such difficult times and ends up lining the pockets of corporations and corrupt politicians. Finally, we marched as a larger group to the DAR (Dept of Agriculture) to support the peasants in their demand to scrap CARP (Comprehensive Agreement on Agrarian Reform) and institute a just distribution of land. It was a 3 ½ hour marathon, and it was just getting going at the DAR when Aiyanas, the kids and I headed home for a late dinner and bed time!

After this lovely rest, clean, wash, grocery shop and pack weekend, we are heading out to Boso Boso on Monday. In this semi-rural community the Parish Priest has organized for women to come to the clinic to see me for 3 mornings! So my role as a midwife is finally coming to life. However, I am also to do some teaching. On top of that, I am bringing my compact birth kit just in case! One of the CHD midwives is joining us in case of a birth and to help with the popular education and training on mat-child health. This is good, as CHD has much experience with their style of teaching, and I would appreciate to at least see how someone does it here before I am solo on the content, just supported with translation!

Each experience teaches me (all of us, really) about the experiences, conditions and struggles of the Filipino people. It is also, however, very exciting to think of the possibilities to use my growing skill sets back in Canada; for Community Diagnosis, for organizing projects, for health work, and for building that community of resistance we were dreaming about at the OC. Finally, the possibilities for ongoing solidarity work are great. Now off this computer!

Payatas Exposure Slide Show

2008-06-02T21:36:00.001-07:00

Some Personal Shots

2008-06-02T21:34:00.000-07:00

Ka Bels Memorial Protest March

2008-06-02T21:29:00.000-07:00

Payatas Exposure Trip

2008-06-02T21:12:00.000-07:00

May 31, 2008

Today was our exposure at Payatas; the community built on the cusp of the Quezon City dump site, ironically also adjoining the water reservoir!

Kuya Rod picked us up and we met Mel and Teresa on the way to meet Ate Anna and Ate Nanay, two Payatas Community Health Workers. When we arrived we made our way to Ate Anna’s house, and shortly Ate Nanay arrived with her granddaughter and another CHW named Ariel (also Anna’s son). After we briefly shared about the reasons for our trip, we had a good discussion about the experience of organizing on the health concerns in Payatas and on many other issues, including working as scavengers in the dump.

There is so much to recount that it is difficult to put it all down, but we think it is important to document and share. I have tried to categorize to make sense of it all and write the bulk, and Aiyanas will go through and edit and add, so this is really a joint venture!

Context and Housing Conditions:

Ate Nanay moved to the Payatas dump area in 1981; many people come to this area from the provinces, either permanently from displacement, or temporarily due to the seasonal nature of the peasant income. It is a long-standing squat, and there is a struggle over the title to the land. The government is in negotiation for the land, but they want to sell the community members the land title, which is expensive – the land was cleared and the homes built by the labour of the people! One of the CHWs we met, Ariel, pays ‘rent’ of p1,000/month to live in the one-room house ‘owned’ by another Payatas resident while he and his family await surgery for their daughter Mariel before return to the provinces.

There are 300 houses in Payatas Area B, with overcrowded houses. The population was hard to clarify, but I did manage to learn that there are 9 babies born every week in Payatas Area B. The CHWs joked with me that they don’t have family planning, but rather family ‘planting’ – which got laughs from all of the CHWs. But more on the health issues as we go.

Another major issue is water; there is no water in Payatas, rather people pay to have drums of water trucked in at a dear price. Yet, this is the only option unless the community becomes a member of a private water company and pays a p500 monthly fee for piping in water.

Work Issues:

Now put these prices in context. When asked how much she earns per day, Ate Nanay answered that, after paying scavenging all week, at the end of the week she will have about p100. The scavengers must pay an annual access fee and have an ID card to work in the dump. Then weekly, after gathering the boxes, cartons, bottles, plastic, metal, etc, they must pay p15 to have the dump truck drive them to the junk shop to trade in their goods. This is a monthly income of about 10 Canadian dollars, or p400, per working adult / child (13 is the legal age to start being a scavenger) – so how could these families pay p500 for water supply?

In 2001, 200 houses built too close to the edge of the dump were buried in a sudden landslide during a downpour. People were buried alive. It was declared an emergency and many NGOs and the government came in to assist with a rescue effort, but still hundreds died. It was the media attention that brought the rescue effort, and it is ironic that the neglect and corruption of the government caused the landslide, and then they come in to the ‘rescue’ to look good for the media. The memorial for the landslide victims is the loveliest, most peaceful place in the area; what about the living? What about all those kids playing in the garbage?

Following the landslide there was a brief ban on scavenging on the dumpsite and building houses in close to the mountain of garbage. However, with time things returned to ‘normal’ and now the possibility for a repeat of the disaster is certainly there. However the area residents, and especially the workers don’t want to bring attention to the conditions for fear that the dump will be shut down and they will lose their livelihood.

Scavenger work is very dangerous work. Ate Nanay says she would rather die from working than from hunger. With housing inaccessible, and even rice prices up to p32-40 per kilo, the scavengers are really backed into a corner. When we first met Nanay she had just come from one of the sites where the government distributes subsidized rice. Although she lined up for hours she was not able to buy any, they ran out. She informed us that even when she is able to buy the reduced price (p18 per kilo) rice, she is limited to 3 kilos. Ate Nanay told us she could get 2 meals per kilo of rice – how many meals of plain rice does one weeks work provide?

Ate Nanay has a remarkable ability to laugh and crack jokes about the struggles she faces; she informs us the dump is her ‘great big office’ and her scavengers hook is her ‘great long ball pen’!

Health Issues:

Remember that the major cause of death in children is still preventable communicable diseases and accidents. Imaging living in such cramped quarters, with no sanitation or running water, not being able to wash your hands or have a running shower. Not enough proper food leads to malnutrition, unsanitary conditions lead to diarrhea, which can be life threatening, especially among malnourished children. Malnutrition – diarrhea – severe malnutrition – chronic diarrhea – death.

Tuberculosis is a major health concern in Payatas, as in all poor communities in the Philippines. It is difficult to treat here, as medications are very expensive, and even if the public health unit has enough stock to treat their current caseload, the patients must miss work and travel to the health unit EVERY DAY for their medication. Hence people are taking their medications for only one or two months, until they feel better, rather than their full six month course required to completely cure. This mistreatment leads to antibiotic resistant tuberculosis, which would be disastrous and heart breaking. In order to have proper treatment, these families need not only access to the proper medications, but also compensation for missed work time and adequate housing and nutrition!!

Skin infections are also another major source of morbidity. In the CHD clinic I saw a young baby who had multiple infected carbuncles on his scalp from scratching insect bites with dirty hands. This baby was very ill with the number of large skin infections. It is living in poverty that leads to these disorders. Mariel, the daughter of Ariel, has a cyst on her leg that has steadily worsened over a year, and now requires surgery to remove. It is so frustrating to hear this story! If they had had proper treatment in the province, this family would not have had to leave their work, move into Manila, and live in a dump while awaiting an overpriced surgery for their daughter. Already they have been waiting a month, hoping each day for a text message from the hospital that Mariel can receive her treatment. It is shocking and saddening that people are forced to such ends.

I already mentioned that in Payatas there are 9 babies born every week in Area B. Most of these babies are born at home, primarily with a Hilot, or traditional healer. There are midwives in Payatas, but they charge from p1,500 up to p5,000 for a delivery, and so only those families lucky enough to afford it can have the benefit of formal training and most importantly, western medicine when needed. A Hilot will often deliver for a small fee, and sometimes for a T-Y (Thank You). Recently a mother delivered with a Hilot, and had a postpartum hemorrhage (PPH). The Hilots do not have access to oxytocin or other medications for PPH, and so this young woman bled to death while her husband desperately rushed to the pharmacy for medications. By the time he returned, she was dead. Knowing how quickly a woman can bleed out after a delivery, it is maddening that the DOH does not give Hilots the basic training necessary to administer medications and a birth kit to carry with them!! My brain was turning with ideas for a future project to do some basic emergency birth training with the Hilots and garner some donated medications and small equipments for deliveries!

We were admiring Ariel’s baby son, when he explained that they had 3 children, but his middle baby died when she was 18 months due to a malformed heart / congenital heart defect. They did not have timely diagnosis and no surgery was performed. It was very moving to hear him explain how they were in the province and came into the hospital in Manila, but it was not enough, and she died. We discussed the genetics of heart defects, and I know this is a huge worry for Ariel, as he holds his baby son, wondering what the future holds. I didn’t bring my stethoscope that day, but I sure wished I had it. How could this family raise the money for the diagnostics, let alone any open heart surgery? Mel told me that at the Philippine Heart Centre they only accept 2 charity patients per month, and many are dead by the time their turn arrives. Last year we had a baby in our practice in Vancouver with transposition of the great arteries detected shortly after delivery; within days of birth, the neonatal cardiologists at Children’s Hospital had a detailed complex care plan in place and were discussing how to best approach surgery. While he will have lifelong limitations, this baby had a very high probability of survival.

Back to Payatas! Another health concern I witnessed is that animals are kept in the houses, as there is no other place to keep them. We met one young CHW in training who is also a student nurse. Her family is raising pigs in the house to pay her tuition of p7000 per 6 month semester. The current pig lives in a pen in the rear of the house, next to the sleeping area. Unfortunately, one pig is not enough to pay this tuition, so the money has to be garnered from other sources. Animals are a source of livelihood and food, but also of disease. When children touch the animals and then eat or put their hands in their mouths, this can cause diarrhea and worms. There is just no other option until the plunder of the Philippines by transnational corporations is stopped and the wealth of this rich nation is divided according to need.

The Peoples Response: Training CHWs and Getting Organized

Naturally, there is a response of the people to this situation. There is the KBK, KilosBayan para sa Kalasugan (People’s Movement for Health), a chapter of the Council for Health and Development and the local coalition of community based health programs. They provide basic health services, herbal medicines, and ongoing community health worker training (CHWs). They also participate in the broader campaigns of the health sector, such as the campaign for cheaper medicines, as well as the broader movement activities. If you check out my slide show, you will see the KBK banner flying in the Ka Bel memorial and protest march!

Our time in Payatas was a wonderful experience. We are very thankful to Ate Nanay, Ate Anna, Ariel and all of the Payatas members who were generous with their time and sharing their lives and struggles with us!

Tuloy ang Laban!

May 30 Manila Update!!

2008-06-01T22:08:00.000-07:00

Hello again! Our time in Manila is passing rapidly, and our lofty objectives are perhaps now more reasonable as the realities of life in a massive Third World city are now the realities of our daily lives! It is amazing that we are entering our fourth week here; we have 6 months left and so much to learn and do. I am really starting to feel settled in, knowing where to shop, what places we like to eat out, where to buy the best mangos and pineapples (though sadly Aiyanas has discovered, via whole-body rash, that he is allergic to pineapple), and how to get from place to place on jeepny, bus and train.

I mentioned in our last blog entry that we have been attending the Parangal of Ka Bel in Manila. On Wednesday, Sophia and I attended the funeral procession and protest march from the House of Representatives to the burial site for Ka Bel. It was a shame that Aiyanas was sick, and Billy was too much for me to manage on such a long protest. Sophia was very patient with all the waiting, and great with the marching! After congregating outside the gates of the HOR, enduring a very long wait as the ceremony and ‘necrological services’ dragged on in the HOR, we were finally marching with the massive vehicle caravan following behind us. There were many chants of, ‘Ka Crispin Beltran, Tuloy ang Laban’ (continue the struggle), chants for a minimum wage pay rise that Ka Bel was fighting for, and many other chants in support of workers and peasants.

The crowd was massive. It is difficult to compare with Vancouver geographically / spatially and in terms of numbers. I heard the next day that there were over 300 vehicles in the procession, and these are not cars, but buses, flat bed trucks, and jeepneys that can pack in the people. After an hour of marching, the crowds piled into the caravan and drove for another 5 hours through a winding route to the graveyard. Sophia and I did not join the caravan, but rather caught a jeepny home, as by this time we were on our 7th hour and Sophia was most definitely running out of steam and the sun was baking (my first sunburn, though a pretty minor one thanks to all the umbrellas). The caravan toured through many poor neighbourhoods to give the people a chance to respect this historical leader who was such a champion of their rights. Indeed, people poured out of their stores and homes to chant along with the passing crowd as we were marching; even the little kids raising their fists and chanting “Tuloy ang Laban!”

It was inspiring to participate in this historic event. And imagine, oh Vancouverites, that this massive mobilization happened with one week’s preparation!

On a more personal note, Wednesday night, I killed our first cockroach. Being on the 8th floor in a concrete building, we thought perhaps we were immune; 3 weeks of safety before the dreaded event. And then, arriving home with Sophia after dark on Wednesday, with Aiyanas and Billy in the bedroom and the light off in the kitchen/living room (2 room apartment) – the moment came – I flipped on the fluorescent over the sink and heard a clacking and scuttling and there the giant beast was! It was at least 2.5 inches long, and rustled as it moved. I tell you, the neighbours must have though an axe murderer was let loose in our apartment, because by this time Sophia, Billy and I were all screaming. I wasn’t sure how to kill it, and I was terrified! I grabbed a newspaper, but knew this wasn’t going to do the trick, so Sophia grabbed Aiyanas’ shoe; I knocked it to the flood, put the paper on the roach and then smashed it with the shoe. It made a sickening cracking noise! At least I had my wits about me to save Aiyanas’ shoe from the copious amounts of roach guts that were spread on the newspaper.

Carrying on with a busy schedule, Thursday I toured 5 public, semi-private, and completely private hospitals. It was painfully obvious how disparate the private is from the fully public. This truly warrants a blog entry all of its own, and will work on this in the days to come – perhaps an article, instead? I have been hoping to write for a few publications on the impacts of neoliberal economics on health and the people’s response.

I know Aiyanas has written a great entry on transportation in Manila, but I wanted to add my experience of commuting. On Thursday we travelled to the hospitals by walking, jeepneys and buses. We spent almost one hour travelling from the CHD office to the first hospital we toured; we took 2 jeepneys, which travelled winding and convoluted routes, and then finally one bus. We paid a total of p25 each for the trip. When I got home I looked at it on the map, and saw that I could have walked it in less time, except that with the sun, the humidity, and the pollution, walking is completely exhausting! Our family often walks to and from the CHD office, or grocery shopping, etc, though people are often surprised to hear this. With four of us, the costs for transportation add up quickly. If you read my ‘National Situation’ blog, perhaps you remember that accidents are the second leading cause of death in children. Certainly the high cost of transportation, or lack of transportation, greatly contributes. The family motorcycle is a common sight, with the entire family, even little babies, riding all piled on one motorcycle. Every time I see this I remember when I was a volunteer at McMaster Hospital, and worked with an 8 year old boy who fell off a motorcycle with his dad when he was just 18 months old, massive head trauma, very sad.

Today Aiyanas and I had our sharing with the staff of CHD. It was good to have the chance to outline our work in Vancouver, our struggles and successes, our plans for Vancouver organizing and what we hope to accomplish upon our return in terms of ongoing solidarity.

This is already very long! More soon.

Transportation in the Philippines

2008-06-01T22:07:00.000-07:00

The rising price of gas has created a crisis in transportation here in Manila. In some ways this crisis parallels the situation in Vancouver as the rising cost of transportation swallows even more of the income of working class people, tightening already tight budgets and pushing those at the margins towards poverty.

However there is an added dimension here in the Manila that arises from the reality of a very low rate of private car ownership, and thus reliance on various forms ‘mass’ transport. This mass transport system is almost entirely privately owned and operated, and even the light rail system, which is owned by the government, is run based on a market, user-pay logic.

Manila’s transportation system has been held up by some neoliberal transportation commentators as a model of free market transportation, with the “invisible hand” creating an amazing transportation network amid chaos. Indeed from a birds-eye view the network of jeepny, pedicabs (motorized and non-motorized tricycles), diesel buses, and taxis connecting to the several jam-packed light rail lines has a certain poetry to it.

The reality on the ground is anything but poetic. Take the romantic jeepny, the poster child of Manila transport. These transportation workhorses can pack in 12 – 18 passengers along two benches with two or more people sitting up front with the driver, all in a vehicle about the size of a small mini-van. Windows are open so that passengers and driver are exposed to all the pollution of the congested Manila streets. That means clouds of exhaust billow in as you sit and wait at a clogged and chaotic intersection.

While the fare is low (starting at 8.00 Philippine pisos) the short, convoluted routes mean frequent transfers, each one with a new fare. That’s because each jeepny is owner operated so there is no planning of the system, and each driver needs to choose a route where they can maximize the fares for each run.

The drivers’ work all day in the blazing sun, calculating fares and giving change as the fares are passed up hand along the row of passengers. And although the minimum fare is regulated the drivers are lucky if they make 150.00 – 200.00 pisos (about $5) per day once fuel and maintenance costs for vehicles are factored in.

Meanwhile, those who do not own a car and rely on these forms of transportation, basically the entire working class and a significant proportion of the middle class, end up paying a significant proportion of their income on transportation. One of the organizers at the NGO we are working with here in the Philippines, spends 100 pisos on her daily commute. In a context where about 30% of the population subsists on less than $1 (42 pisos) per day and the take home pay of a nurse is as little as 8,000 per month, that kind of expenditure for transportation is significant and prohibitive.

With the rapid increase in gas prices there has been a great debate on how best to deal with the rising costs for the tens of thousands of owner-operators in the transportation sector. The government, which regulates fares, has characterized this as a balance between the needs of transportation workers and the needs of the ‘transportation’ consumer.

This shell game is possible because of the privatized nature of the transportation sector, and the minimal role of role of the government in providing for this necessary public service. As one organizer put it to me, it’s really everyone (drivers and riders) against the oil companies, who have continued to post huge monopoly profits right through the ‘crisis’.

Recognizing this underlying class struggle, PISTON, a progressive union of jeepny drivers has called for the elimination of the Value Added Tax (VAT) on fuel and for the government to regulate oil prices instead of a fare increase. Last week PISTON staged a one day strike, with the support of BAYAN, the broad alliance of progressive forces, which stopped traffic at key intersections in Manila and other cities. Unfortunately the strike did not have the impact it might have because other transportation unions, which had originally intended to participate, pulled out at the last minute cowed by police intimidation and red-baiting.

Nonetheless more struggles can be expected in this area, unless gas prices spontaneously free fall, which seems highly unlikely. The government policy of small fare increases is unlikely to placate either drivers or passengers, neither of whom can afford this kind of squeeze on their income. Meanwhile, actions like the one taken by PISTON will continue to highlight that there is no neoliberal ‘market’ solution to the crisis and point the finger at the government’s priorities of pleasing foreign investors and financing a repressive counter-insurgency rather than meeting people’s basic needs.

The Rural Dimension

The impact of high fuel costs is also felt in the countryside, but here there is an added dimension. In the name of achieving energy self-sufficiency the Department of Energy is phasing in a 10% mandatory biofuel content. The requirement is a boon to the sugar industry which is the main source of biofuel here, but anything but a boon for poor farmers living in sugar producing regions.

With limited market for Philippine sugar in recent years sugar producing areas like the island of Negros had seen some limited land redistribution under the (misnamed) Comprehensive Agricultural Reform Program (CARP). While the CARP was vastly inadequate, it did allow for some small farmers to secure a piece of land, albeit with considerable debt. Now with the reinvigorated domestic market for sugar as biofuel, the big plantation owners are once again reconsolidating farms, using the leverage of debt, as well as an amenable military, to absorb the smaller farms. Meanwhile the farmers and their families are forced back into a long standing semi-feudal relationship of dependence on the local big landlords.

Slideshow of Manila Photos

2008-05-25T00:27:00.001-07:00

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

2008-05-25T00:13:00.001-07:00

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

2008-05-25T00:09:00.001-07:00

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 café 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!

2008-05-13T02:00:00.000-07:00

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

2008-05-13T01:55:00.000-07:00

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!

2008-04-01T19:15:00.001-07:00

In preparation for our departure

It has been a very busy time for us as we get ready to go on our 7-month journey to the Philippines to demonstrate our solidarity and lend our hands-on support.

There are a myriad of tasks, some minor, such as passports, plane tickets, vaccinations… some massive, like packing up our apartment and planning our various organizational strategies for the year at the Organizing Centre. But as the time grows increasingly closer, we also need to do our research and prepare our sharing’s on our local work and the situation in Canada!

History of the Canadian health care system

When I think about how I will present the Canadian health care system to my Filipino comrades, I am torn. Compare a delivery room in the Philippines to one in Canada:

Of course, there can be no comparison between our insured and medically advanced maternity care and the situation of extremely limited access, appalling underfunding, and ramped privatization in the Philippines.

The labour export program of the Philippines government has put so much pressure on families to send members to work overseas that Filipino doctors are retraining as nurses to work abroad! The ‘brain drain’ (AKA the plunder of Third World intellectual resources) has left countries, such as the Philippines, that carry huge debt loads and US-backed neo-colonial regimes, bereft of skilled health care professionals. Meanwhile WTO/WB/IMF imposed conditions leave the public health care system stripped of any potential for quality care while privatized hospitals and clinics grow at a steady rate. Medical tourism, anyone?

Comparisons aside, a critical examination of the Canadian health care system from a working class perspective is in order. Many believe that in Canada we are privileged with ‘socialized health care’!

Medicare was first introduced in Saskatchewan in 1962, and by 1971 was incorporated into the social safety net of all provinces. This health care plan, rather than a socialized health care system of public ownership of health care infrastructure, publicly salaried health care workers, and public provision of services, ended up (after a bitter struggle) as a public health insurance plan which covers a component of the health care costs of First Nations communities, Canadian citizens, landed immigrants, and refuges.

Private insurance companies and physicians with their powerful and persuasive profit-oriented lobbying undermined the creation of a social health care system by opposing socialized medicine, and imposing a system with clear paths to corporate ownership and profit making. In 1962, the pro-profit, free enterprise agenda of the medical professionals and insurance companies pressured the Canadian Commonwealth Federation (CCF) to accept fee-for-service billing and actively undermined the burgeoning collective model of community health centers which were rapidly springing up in response to workers demands for ‘health for all!’

What we have today is a public (for now…) health insurance system which covers the basic costs of ‘listed’ services for those who are eligible under each provinces health plan.

Creeping privatization

Privatization is nothing new to the Canadian health care system. De-listing of insured services, rising health care insurance premiums, the lack of a national pharmaceutical or dental program, physician/midwife fee-for-service remuneration, public-private partnerships (P3s), extra-billing, and a variety of other schemes and programs leave the Canadian health care system teetering on the edge of complete privatization.

As the profit motive increasingly impedes upon our ability as working class communities to access affordable, timely, and quality care, we are hit with a double edged sword.

We know that health requires much more than the provision of health care services. Health Canada identifies primary determinants of health as: income, social support, education, employment and working conditions, social environment such as housing and nutrition, and physical environment including particulate and noise pollution, while personal habits (smoking, drinking), exercise, and genetics appear as the last on the list.

Social class and annual income is the greatest indicator of health in the world today!

This leads us to ask “What about the working class?”

The global shift to neo-liberalism results in the slashing of the economic re-distributive measures, such as health care, which are highly regarded as a Canadian value, at the very same time the need for such economic re-distribution is on the rise.

Take a look at these statistics

In Canada:
The poorest 50% of the population own 6% of Canada’s wealth while the richest 10% own 53%
While the top 30% has ownership of 83% of the countries wealth, the remaining 70% have 17%
1 in 5 families have no net worth whatsoever
The lowest income Canadians has annual debts greater then their earnings

In British Columbia:
20% has an average net debt of $2,759, while the richest 20% has an average worth $1 million
Women are earning on average 20% less than men; Aboriginal women are earning even less still
The average annual income of a First Nations woman in BC is $13,000, far below the poverty level
Women comprise 60% of those living below the poverty level
25 % of First Nations people report having no source of income
The life expectancy of an Aboriginal person living in BC is 30 years less than a non-native counterpart!!!
More than one in five children in BC lives in poverty

The forever widening gap…

In clinic a few weeks ago, during a postpartum visit, a father of a family I helped care for broke down and started to cry because he was worried his wife would not be able to sustain breastfeeding their baby because her nutrient intake was so low. In short, they were starving.

Can you imagine how this man must feel? It is beyond comprehension to me that we live in a society with such gross displays of wealth, and a man is worried that his wife and children are starving; in BC, 2008.

This has a massive and almost unimaginable impact on the health of our communities.

Poor neighborhoods in urban Canada experience a much higher infant mortality rate (6.5/1000 as compared to an upper income rate of 4/1000). Poor Canadians are more likely to die from cancer, diabetes, infectious disease, and respiratory disease than their wealthy counterparts; these are examples of diseases of poverty, as extreme stress, poor housing, close quarters, inadequate nutrition, environmental hazards play a role in the contraction of these diseases.
In fact, low-income women and their families are more likely to fall ill or die of illness or injury at any stage in their life-cycle.

Infectious diseases such as AIDS and tuberculosis are epidemic in some working class neighborhoods in Canada, such as the Downtown Eastside of Vancouver. In fact, TB cases in Vancouver were 4 times more prevalent in low income neighborhoods. Immigrants to Ontario were at higher risk for contracting TB after immigrating to Ontario than prior to departure from a country where the disease was endemic; this example highlights the socio-economic roots of TB contraction.

So what can we do about it?

Borrowing a line from the Organizing Centre for Social and Economic Justice strategy document, “the word on the street is, “there is no alternative””.

As grassroots organizers, as leaders in the struggle for social transformation, we know there is an alternative! That alternative lies in our collective struggle for a new society.

That is what this trip to the Philippines is all about – taking part in that powerful transformation, the birth of a new world – and bringing the lessons back to Vancouver, to the Organizing Centre for Social and Economic Justice, to the Alliance for People’s Health, to the Bus Riders Union, and to all of our collective endeavors!

Makibaka! Huwag matakot!

Slide Show

2008-02-19T22:10:00.001-08:00

Philippines Solidarity Trip 2003

Getting Started

2008-02-19T20:36:00.000-08:00

Our first blog entry, getting closer each day to our departure for the Philippines; the long planned for, long anticipated 8-month journey of solidarity with the struggle for justice and liberation in the Philippines!

Collecting supplies and donations, reading, learning, planning our itinerary, preparing our kids for a whole new life experience... each day our list of things to do grows with each task we complete. I wanted to get this blog off the ground early, post some photos of my health exposure trip in 2003, and put out a call for donations to bring with us.

The organization I will be spending most of my time with:
http://chdphilippines.org/index.php

A publication with some great testimonials from others who have spent time working with CHD:
http://chdphilippines.org/pulication_data_files/anniversary%20issue.pdf

Now to figure out how to load up photos, files, and links. Please stay tuned for stories, experiences, and photos from me, Aiyanas and the kids.