Most Affected. Poor families in the rural areas, such as this father and his two children, are most affected by the lack of resources for health. (davaotoday.com photo)

DAVAO CITY – The conventional wisdom is that, poverty being so widespread in the Philippines, the state of health of poor Filipinos leaves much to be desired. In Mindanao, where most of the countryâ€s poorest provinces are located, the problem is particularly more acute.A recent survey conducted by the nongovernment health group Community Based Health Services Association (CBHSA) affirmed many of the sad realities of the Philippine health care system, particularly in Mindanao. Many of the afflictions Mindanaoans suffer were preventable, the study found out, but these diseases became chronic and incurable because of the widespread poverty and lack of health services.

According to the groupâ€s “Community Diagnosis” or “Mindanao CDx,” the lack of resources for health has resulted in dire situations for Filipinos in these poor communities.

To be sure, there had been similar studies conducted in the past, according to Dr. Ma. Lourdes Alisasis, a volunteer physician of the CBHSAMindanao Project Management Desk, but none were as organized and as extensive as the CBHSAâ€s “Community Diagnosis.”

The Mindanao CDx surveyed 3, 579 respondents in 38 barangays in these Mindanao provinces: Agusan del Norte, Agusan del Sur, Bukidnon, Camiguin, Compostela Valley, Davao del Norte, Davao del Sur, Lanao del Norte, Landao del Sur, Misamis Occidental, Misamis Oriental, Saranggani Province, South Cotabato, Surigao del Norte, Surigao del Sur and Zamboanga del Norte.

The survey was supported by the AID-Uprooted Program (Philippines) of the European Union- Delegation of the European Commission to the Philippines.


Findings. Dr. Ivy Boyose-Nolasco of the Urban Integrated Health Services Foundation Inc. gives her reaction to the findings of the Mindanao Community Diagnosis presnted by CBHS. (davaotoday.com photo by)

What makes this survey unique, according to CBHS project director Dani Beltran, is that it used the principle of “concrete analysis on concrete condition” – a method that goes beyond determining the symptoms and the superficial causes of diseases and illness and looks instead at the many other factors that, at first glance, may have nothing to do with medicine.For instance, it used to be that Mindanaoans considered tuberculosis as the top illness. Today, however, they are more worried about hypertension. The CDx teams found out that hypertension was the number one illness among respondents, which is curious in itself if only for the fact that hypertension is usually thought of as a condition that afflicts the rich and the middle class.

But the CDx established that many of the food that the poor respondents could afford are top causes of hypertension, among them salted fish and fish paste (ginamos), probably the cheapest alternative to viand that is also very salty.

“If we want to have a comprehensive health care delivery system at the community level, we must be able to systematically learn and analyze as well the different structures and relations in the community: the economic, political, socio-cultural and historical background of the people and their community,” Beltran said.

“Just like the rich, the poor, too, can get hypertensive due to the food they set on the table,” Beltran said. “But it is important to note that they get hypertensive, because they do not have much choice.”

Poverty

Beltran pointed that six out of 10, or 52 percent, of the respondents received only a measly income of below 50 pesos a day. Twenty-eight percent earned a family income of more than 100 pesos a day and 20 percent got not less than 51 pesos but not more than 100 pesos a day.

These were usually farmers, fisherfolk, workers, employees, drivers, laundrywomen, and sari-sari (variety) store owners, in both rural and urban communities.

Among the CDx findings:

• Mothers could hardly nurse their children anymore as they had to find work in order to augment the family income
• Four out of 10 mothers stopped breastfeeding their child before the childâ€s first birthday
• Five out of 10 infants were given formula milk instead
• Some mothers used condensed milk, instead of formula, because the former is cheaper

But apart from the inability to provide proper and adequate food on the table, health facilities in the communities were sorely lacking.

In many cases, the CDx determined, health centers were mere structures with no usable facilities inside. A health center with a blood pressure apparatus was considered lucky. One mother said she had to walk three hours just to have her blood pressure checked.

Even ultrasound diagnosis for pregnant women was seen as a privilege — only 19 of the total 539 respondents were able to undergo ultrasound in their pregnancy.

No Medicine


Not Enough of Everything. Poor families often have to make do with their meager incomes, sacrificing the health of their children. (davaotoday.com photo)

Medicine was not available in eight out of 10 barangays surveyed, in spite of the governmentâ€s program called “Botika sa Barangay.” In fact, the CDx found out that 30 out of 38 barangays had no pharmacies. Residents had to buy their medicines from sari-sari stores and town centers. This presented problems for those who were on prescription drugs.There were no doctors in the barrios regardless of the abundance of health professional graduates in the country. Only one out of 10 barangays was visited by a doctor, and only once a week at that. Only one of the 10 barangays was visited by a doctor, once a month. Five of the 10 barangays had never seen a nurse.

These findings, Beltran pointed out, are consistent with how the director of the World Health Organization in the Western Pacific, Dr. Shiegeru Omi, described the condition in the Philippines: “The Philippines loses more than 15,000 nurses annually, more than any country. Many of them are among the countryâ€s best-educated and most experienced nurses, leaving a critical shortage of qualified specialty nurses. Some doctors in the Philippines are training for higher paying nursing jobs in the United States. More than 5,000 children under the age of 28 days die everyday. Many of those infants would have survived if skilled attendants were on hand during childbirth.”

So if there were no doctors, what about midwives?

There were, according to the study, government midwives but they seldom went to the barrios. “They would arrive so late and would leave so early because they had to catch the ride back home,” respondents told the CDx teams. These midwives visited 25 out of the 38 barangays once a month.

As a result, six out of 10 cases of childbirth took place in homes where there was not a single attending health professional. Only eight of the 100 pregnant women were seen by a doctor.

This scarcity of professional services was evident, too, in dental health. Many of those who complained of toothache had to resort to self-medication. In one case, a resident used a flea from a buffalo to cure a toothache.

Moreover, many residents died without getting medical attention during their illness. Only 44 percent of the 397 deaths recorded in the respondent barangays between June 2005 and January 2006 had received medical attention.

No Emergency Help

Meanwhile, people did not know whom to ask for help in times of emergencies such as floods, typhoons, drought, hunger, earthquake or war. And they did not count on government agencies for help, as shown in the data that a measly 2.8 percent of the respondents relied on local government help, 1.7 percent relied on the military and only 0.2 percent relied on the Department of Social Welfare and Development (DSWD).

Instead, people ran to health workers. Four of 10 respondents relied on the Barangay Health Workers or Community Health Workers (BHWs/CHWs), while 32 percent relied on midwives and only one percent on doctors.

Militarization Aggravates Situation
Already poor, sick and miserable, many villagers faced the threat of displacement brought on by intensified military operations, the CBHS study found.In some of the communities surveyed by CBHS, the militaryâ€s aerial bombings and ground operations hampered the delivery of health services.

Worst, there were cases where health workers themselves were victims of harassments and other forms of human rights violations perpetrated by elements of the Philippine military, according to the study.

One incident is the experience of the Mindanao CDx teams in Sibulan, Sta. Cruz, Davao del Sur, middle last year.

Carlos Atten, a Bagobo Tagabawa who heads the peasant organization Nagkahiusang Mamumuo sa Sibulan (United Farmers of Sibulan), said in an interview that the military prevented the CBHS health workers from conducting CDx in sitio Landing Dos. The reason: they were suspected as supporters of the New Peopleâ€s Army NPA. (Cheryll D. Fiel/davaotoday.com)

The traditional healers — hilots and albularyos — were the heroes in these communities. Sixty-two out of 178 respondents, or 34.8 percent, went to them for their ailments. Only 35 or 19.7 percent went to hospitals, and 18.5 percent or 33 went to Rural Health Units (RHUs). Meanwhile, 26 or 14.6 percent went to private clinics, and 22 or 12.4 percent consulted CHWs.The sick had to walk for miles and miles just to get to the nearest hospital. Some had to ride the habal-habal (single motorcycle). In the absence of this only means of transportation in the hinterland villages, the sick had to cross rivers and go over mountains just to get medical attention.

The Mindanao CDx shows that at least 50 percent, or 120 of the respondents, traveled from six to 10 kilometers just to reach the nearest hospital, 22 percent or 51 traveled 11 to 15 kilometers and 15 percent or 35 traveled 16 to 20 kilometers while 13 percent or 31 traveled 2 to 5 kilometers.

Health Education

Even awareness about their health was lacking among the respondents, according to the CBHS findings. Two out of 10 residents were clueless as to what caused their diseases.

The CDx teams also uncovered a case of a sitio (subvillage) where nearly every household had a leper.

Leprosy is supposed to be a treatable disease but Beltran lamented that the lepers could hardly come out of their houses because of the social stigma. In the case of the sitio, Beltran said they found out that even the Philippine military is culpable. According to the residents, soldiers had threatened to shoot lepers if they ventured out of the village.

Dr. Ivy Boyose-Nolasco, a volunteer physician of the Urban Integrated Health Services Foundation Incorporated (UIHSFI), a Davao-based health institution, explained that leprosy is a “very preventable” illness and that, after treatment, it is no longer infectious.

Family Planning

Lack of education extendsed to matters as basic as information on family planning in the communities.

The CDx revealed that there was a significant number of respondents – nearly 30 percent — who did not use family planning due to the alleged side effects.

Awareness on proper sanitation was no better. In fact, one of the findings cited that one out of 10 households threw its garbage in the stream or river where they also get their drinking water.

In terms of waste disposal, at least 50 percent of the household surveyed buried their waste, 14 percent wrapped it, while 10 percent disposed of it in an open pit.

Comprehensive View

The CBHSâ€s Beltran said they hoped that through the CDx findings, they would be able to provide stakeholders in the health sector “a comprehensive view of the current health situation of the people in Mindanao.”

Aside from distributing it to the communities, health institutions and community based health organizations, the Mindanao CDx will be submitted to the Department of Health (DOH) and international institutions, such as the World Health Organization.

The survey was conducted in communities where there were existing organizations and members who recognized the need to help in the undertaking. The Community Based Health Programs and the health committees of the organizations in the communities took charge of the actual conduct of the CDx.

Beltran said the survey used questionnaires, interviews, and focus-group discussion with the community leaders, health workers and traditional leaders. The results were given back to the community for feedback. davaotoday.com

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