Saturday, June 14, 2008
Boso Boso Health Work
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.
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!
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!
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!
Monday, June 2, 2008
Payatas Exposure Trip
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!
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!
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