Community-based health care saves lives in the
Philippines
By Hillel Cohen
Mindanao, Philippines
There has never been a power outage because
there has never been electricity. Floods can't knock out the
sewage system because there isn't any. Water never gets turned
off because water has never been piped here.
The closest water is a stream that's at least a 20-minute
walk down a steep hill and another 20 minutes back up.
In this rural community on the Zam boanga Peninsula of
Mindanao, getting to town means an hour's "cab" ride down the
mountain. The "cab" is a moped, and as many as four passengers
might squeeze behind the driver. Mopeds--motor-bikes-- are the
only type of vehicle that can make it down and up the muddy
mountain road, provided it hasn't rained recently and the mud
isn't too deep.
If someone is ill, an ambulance is out of the question. None
could make it up the mountain, but none is available anyway.
Even if someone who is ill could get to town, she or he
wouldn't have enough cash for medication, let alone the fees of
a clinic or hospital.
Most families grow corn. Very few own their own land. Each
year the farmers have to give a big part of their crop to the
landlords for rent. Often, the corn left for food does not last
the year.
Caribou (oxen), used for plowing, are rare. Many households
do have a few chickens or even a pig that can be sold or
consumed on special occasions.
Very few in this community have ever seen a nurse, let alone
a doctor. Birth and death occur at home.
These conditions are common throughout the rural areas of
the Philippines. Crops and terrain may differ but the hardships
of daily life are similar for as many as 40 million to 50
million of the 80 million people of the Philippines.
I visited this rural community as part of an "exposure" trip
organized by the Council for Health and Development in
conjunction with the International Conference on Challenges in
Health Work Amidst Globalization and War. CHD is a national
organization of over 50 non-government community-based health
programs that work throughout the Philippines. One of these,
the Zamboanga Peninsula Health Extension Program, hosted my
visit in this part of Mindanao.
Community-based health programs started in the Philippines
about 30 years ago when the country was under the U.S.-backed
martial-law regime of Ferdinand Marcos. Doctors, nurses,
midwives and others with health skills volunteer to work with
rural communities.
Unlike "relief-style" health missions, the CBHP philosophy
does not emphasize providing health services that are not
sustainable and that would disappear when the volunteers can no
longer stay. Instead, the focus is on training community-based
health workers--community members who volunteer to take
training on condition that they will provide volunteer service
to their community.
Almost all of the community health workers are women. Most
have an elemen tary school education--six years--though some
have less. The communities cannot afford even basic medical
supplies so the training concentrates on basic sanitation,
first aid, tooth extractions, birth delivery, herbal medicines,
and techniques like acupuncture and acupressure that do not
require expensive equipment. Health workers also learn to
diagnose life-threatening diseases like typhoid fever that may
require a trip to a provincial hospital if one can be
arranged.
While not overtly political, the CBHP volunteers also
encourage community health workers to think about the economic
and social conditions that create such difficult conditions,
and how health requires basic needs like food, shelter,
sanitation and safe drinking water. They also discuss
international politics that affect them directly or
indirectly.
In a meeting with three community health workers here we
discussed the latest developments of the U.S. war on Iraq as
well as the impact of the World Trade Organization.
Deep concern over imperialist intervention
About a year ago U.S. troops were on Mindanao, not far from
here. Bush had sent them as part of the "war on terrorism."
Filipino activists believe the troops were an advance guard to
re-establish U.S. bases here.
A people's struggle had forced the Pentagon to close two
large bases in the Philip pines a decade earlier. The Pentagon
brass want to come back. Substantial oil reserves have been
found on Mindanao, and the Philippines is strategically located
near the major shipping routes of the Pacific.
Filipino farmers are also greatly concerned about the WTO
and the Inter na tional Monetary Fund. Debt service to the IMF
has led to big cutbacks in the national budget. The WTO has
made it harder for farmers to sell their crops in the local
markets because of competition from international
agribusiness.
In this remote rural community, with no TV, no newspapers
and only an occasional transistor radio, these community health
workers seemed more informed and concerned about international
affairs than many of my co-workers in New York.
Community health workers and CBHP volunteers are sometimes
arrested or haras sed by the military who claim that the health
workers are agents of local insurgencies that exist in many
rural areas. A couple of years before our visit at least two
community health workers in the area were killed by the
military or right-wing militia.
Although the CBHPs are legally recognized organizations, the
government often assumes that anyone who volunteers to help
their neighbors must be a dangerous threat to the status
quo.
Our host's mother, who lives a dozen yards away, came over
to chat. She told us that her daughter was one of 13 children
that she bore, but that 10 of the children died before the age
of 5.
Our host herself was pregnant with her sixth child, but so
far she had not lost any. She attributed the improvement to the
modest training that she and her neighbors had received through
the community-based health program.
Like her neighbors, she had a latrine (an out-house). Simple
as it was, it had been rare in that neighborhood when she was a
child, and the community organizers had to carry out a
substantial education campaign to explain why every household
should have a latrine to contain human waste, a potential
source of disease.
As night fell and we were about to go to sleep, I inquired
about the mosquitoes, as we had no nets. Our host proudly
exclaim ed, "I'm a community health worker. There are no
mosquitoes in my house." When I asked how she accomplished
this, she said that she made sure there was no standing water
in or around the house, and that every day she made a smokey
fire in the cooking area since mosquitoes flee from smoke.
These simple acts help protect her family's lives and
health.
Mosquitoes, of course, are not the only problem for these
landless farmers. The landlords and the globalizing capitalists
of the WTO are problems that cannot be overcome with simple
measures. How ever, I sensed that our host and her neighbors
were just as determined to liberate themselves from the legacy
of colonialism.
Their experiences with a community-based health program
reinforced the awareness that whatever they accomplish would
require their own efforts--and gave them more confidence that
they could find the ways to do it.
Reprinted from the Dec. 4, 2003, issue of
Workers World newspaper
This article is copyright under a Creative
Commons License.
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