Not Simply Mamita

Last week I wrote about Dr. Mita Pardo de Tavera, former secretary of social welfare and pioneer in community-based tuberculosis control, who passed away two weeks ago. Mamita, as friends called her, was a second mother to me. I do not think she would have wanted me to write in a spirit of mourning so instead, I will share some of the lessons she left me, not just about public health but about life in our times, in our country.

Simplicity was important for Mamita, from the way she insisted on the use of “Mamita” rather than the grander “Doktora Tavera” to every aspect of her lifestyle. She was known for her simple meals. She didn’t like big meetings and preferred to meet one on one, often over lunch in her homes, usually with fish and vegetables, or a torta (omelet). Even after she became social welfare secretary during the Corazon Aquino presidency, she insisted on wearing very simple clothes: a plain blouse with locally made accessories. No designer labels for her; in fact, she would promote products -- foods and crafts -- from the communities she visited by using them.

Mamita was simple, but would spare no expense for what she felt were the truly fine aspects of life. She loved her ancestral home, which used to be in Manila, so when she had to move to Makati City, she had much of that older home transported -- for example, grand old wooden planks and doors and fine grilled windows -- to build the new house.

Article by Michael L. Tan for Pinoy Kasi Column at the Philippine Daily Inquirer, November 7, 2007

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Simply, Mamita

I was waiting for a flight when I got the news that Dr. Mita Pardo de Tavera had passed away last week. I thought of writing an obituary, but postponed it, not wanting to write while I was still overwhelmed by grief. Mamita was a second mother to me; my parents referred to her in Chinese as my “hua lang bu” [Spanish mother] and said that with great pride. I still mourn her passing, but write now, hoping to capture the way she lived, vibrantly and so full of celebration.

I had graduated from college just a year earlier and was working with the Catholic Church’s community-based health programs, when a Maryknoll sister suggested that I apply for work with a new non-government organization. It was called AKAP, an abbreviation of the kilometric name Alay Kapwa Kilusang Pangkalusugan [Caring for Others Health Movement], specializing in tuberculosis control and headed by Dr. Mita Pardo de Tavera.

Dr. Tavera? The name of an old wealthy Spanish family alone was intimidating, yet I can’t remember the job interview to have been grueling in any sense. What I recall is how she introduced herself, and she insisted that she be called, simply, Mamita.

Article by Michael L. Tan. Pinoy Kasi column, Philippine Daily Inquirer, November 2, 2007

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Bayaning Doktor

One after another they came, each delivering a brief eulogy for their Doc Louie. It was the final night of the wake for Dr. Glorioso Saturay, held in the covered court of Barangay Pag-asa in Quezon City. The venue was appropriate since Doc Louie had served once as captain of the "barangay" [neighborhood district], one of the many civic engagements he had in his life.

I sat through some of the eulogies, reflecting quietly. All through the week, I had been getting text messages from friends who had known Doc Louie. The texts that came in sometimes described him as “napakabait,” and other times as “napakabuti,” a rare combination. Both words mean “good” but in different senses. “Mabait” means someone who maintains good interpersonal relations and is kind and caring. “Mabuti” on the other hand, and when combined with “doctor,” refers to someone who excels in his or her profession or work. At the same time, it can refer to someone perceived to have a strong ethical sense, a morally upright person.

Most physicians I know do only medicine, shuttling from home to one clinic to another. Doc Louie was different, a man with many lives, and I mean that in the sense of wearing many hats, of moving in different social networks. It was not until his wake that I learned that he had been a barangay captain -- or more specifically, “mabuting alagad ng barangay.”

by Michael L. Tan, Pinoy Kasi column, Philippine Daily Inquirer, August 31, 2007

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Mangyans of Mindoro: Fighting the Odds

Mangyan is the general term for the indigenous people of Oriental and Occidental Mindoro, 140 kilometers south of Metro Manila. A Mangyan alliance, Samahang Pangtribo ng mga Mangyan sa Mindoro (SPMM) or Association of Mangyan Tribes , estimated the Mangyan population in Mindoro at 260,000 as of 2006, a 34 percent reduction from the 1989 estimate of the Office of Northern Cultural Communities.
Mangyans largely depend on swidden agriculture (slash and burn) for subsistence, with hunting, fishing and gathering of forest products as major supplements.

Difficult existence
Asked to describe the current situation of Mangyans, Antonio Calbayog, an Iraya and chairman of SPMM shook his head saying, “Our life is hard, miserable.” Mangyans suffer extreme poverty largely because they are losing their lands.

Like other IPs, Mangyans believe that land is not merely a piece of property to be owned or disposed of by anyone, but is part of the ancestral domain. For decades now, however, they have been driven from their ancestral lands as landlords, corporations, and even government projects take these lands away from them.
Calbayog cited government forestry projects and the 9,720-hectare Mindoro Nickel Project of Crew Minerals Philippines that constricted their areas and limited their communities’ access to natural resources they depend on. The mining company’s Mineral Production Sharing Agreement (MPSA) was cancelled by the Department of Environment and Natural Resources in 2001 due to overwhelming public protests but was reinstated by the Office of the President in March 2004. Calbayog said crew is set to start operations this year, which they plan to protest against.

With their source of subsistence shrinking, many are forced to leave their communities. Calbayog estimates that about 20 percent of the Mangyan population have become farm workers who are often deceived and exploited.

Military operations in the island also force Mangyan communities to flee. Aside from being caught in the midst of armed conflicts between government troops and rebels, they have become targets of harassment as the military accuse them of supporting the New People’s Army. According to Calbayog, Mangyan leaders have also become victims of extrajudicial killings, with at least four Mangyans killed in 2003-2004.

Poor, insecure, and discriminated against, it is no longer surprising that Mangyans do not have access to basic services such as education, housing and health. Lack of adequate health and sanitation services for Mangyan communities has resulted in malnutrition, illnesses, and death among adults and especially children.

Health-poor
The Oriental Mindoro Health Investment Plan (OMHIP) 2006-2010 admits that “public health facilities which cater to the poor are mostly ill-equipped, with inadequate supply of drugs and medical supplies. Private hospitals that provide better health care are beyond the reach of the poor.” It also acknowledges the limited access of Mangyans to health services.

In this province, respiratory diseases still rank as the leading causes of mortality and morbidity. The most common causes of morbidity are upper respiratory tract infection, bronchitis, pneumonia, diarrhea and pulmonary tuberculosis (TB). In Occidental Mindoro, acute respiratory infection has also been the leading cause of morbidity, followed by diarrhea and gastroenteritis.

Barangay Health Stations (BHS), run by rural health midwives and volunteer health workers, provide primary health care at the barangay level. In Oriental Mindoro, only 91 out of 426 barangays or 21 percent have BHS. Meanwhile, nearly 25 percent of the 162 barangays in Occidental Mindoro do not have BHS.

Oriental Mindoro has 22 hospitals, 13 of which are privately owned and nine are government-operated. Occidental Mindoro has eight government hospitals and three private hospitals.

The OMHIP contains a specialized health care program for the Mangyans with the goal of making health care services more accessible for Mangyan communities. Among the plans are special Mangyan wards in all government hospitals and provision of free medical services to Mangyan patients in all government facilities; construction of additional 25 BHS in different Mangyan barangays; and training of Mangyan volunteer health workers.

Calbayog acknowledged that training for barangay health workers (BHW) are given, but he laments that no medicines are provided. He said the common illnesses are tuberculosis, pneumonia, measles, and gastro-intestinal diseases, all of which are curable but many Mangyans still die of these. Since there are no doctors in the barangays, they have to go to the municipal health units and usually all they get is a prescription. In hospitals, even public ones, they are still confronted with biases and are often not attended to.

Moreover, even if there are BHW trainings and medicines provided, if they still go hungry, are sleepless and terrorized by military presence, then they can never be healthy, Calbayog said. A widower with six children, Calbayog cited his own experience, “I believe my wife died because of the constant stress brought by military operations.”

Due to poverty, hunger and the effects of militarization of their communities, many Mangyans are malnourished and thus have low resistance and are easily infected by diseases. With government projects and mining operations encroaching into their domains, they are not only losing their freedom of mobility but also their source of food and medicinal plants.

Health and beyond
It is not enough that local governments recognize the Mangyans’ lack of access to health services and plan special programs for them. Strategies such as those contained in the OMHIP, if at all implemented, are like mere drizzle in a parched field. As expressed by Calbayog, his people’s problems are very basic – land to till, food to eat, right to live in peace. Without securing these, social services will not reach them or make a dent on their hard life.

The overall approach to addressing IPs’ issues must change. Government policy regarding IPs has been directed at their assimilation or integration into mainstream Philippine society and at the expropriation of their land and resources for the “national interest.” Oppression has already forced the IPs to retreat deeper into the mountains where they have a much harder existence. But they are still being pursued because mountains are rich in mineral deposits and diverse forest products.
Although laws have been passed ostensibly to protect the rights of IPs, the government has supported the intrusion of commercial activities into ancestral domains. The struggle of the Mangyans against Crew Minerals Philippines is a case in point. This only shows that state policies recognizing IPs’ rights are mere lip service as IPs continue to be marginalized, dispossessed and live in abject poverty. IPs like the Mangyans of Mindoro still face a long journey towards genuine socio-economic advancement and self-determination.

By Jennie Malonzo

Sources:
1. Interview with Antonio Calbayog, 14 March 2007.
2. Oriental Mindoro Health Investment Plan 2006-2010
3. “Occidental Mindoro.” NSCB Fact Sheet Special Edition, April 2005.
4. Malonzo, Jennifer del Rosario. “Indigenous Peoples.” IBON Facts & Figures, 15 April 2001.

The original article of this appeared in Health Alert Asia Pacific Issue No. 10, 2007 (Supplementary issue). For copies of the newsletter, please email hain1985@gmail.com. Jennifer R. Malonzo is the publications head of IBON Foundation. Contact Ms. Malonzo at jenndelrosario@yahoo.com

Indigenous people’s survival: Our Environment, Our Lives

Among the indigenous communities, health is not just conceived as an absence of disease, but is closely bound up with relationships to community and the environment – both physically and spiritually.

“Weather and water affect health and wellbeing,” said Deuane, 80 years of age. “In the past, I slept well in the mountains where the weather was cooler and we didn’t have to worry about where to get water as it was available all year round”. Deuane and his family are one of the many families who belong to the Alak ethnic group that were relocated from the mountains to the lowlands by the Lao government as part of the program ostensibly aimed at improving access to health, education and other services. The name of his village, Ban Dak Kiat, goes with them wherever this community of about 30 families go. Many years ago, they were initially resettled in the lowlands of Sansai District, Attapeu, Lao PDR but after settling there, nine villagers died so the people consulted a spiritual healer who said that this location was the market place of the spirits, so they moved again to a ‘safer’ place in the same district.

Many indigenous communities now have access to health services, but they still apply many of their traditional knowledge.

“When my family and I get sick, we immediately go to the health center with trained health staff, which is in a neighboring village. Before the change of government in the 1970s, we used to go to spiritual healers...we started to change our belief in spirits but I still use some traditional treatments like steam baths with herbs to treat backache and body pains” , said Nang Daen, a 53-year old grandmother who belong to the Oye tribe.

Chansamay, a 19-year old mother from the Taleang ethnic group, prefers to use a traditional medicine for birth spacing. “The spiritual healer told me to take a mixture of leaves of a bitter vine and herbs for two days in a month, two weeks after my menstrual period to prevent pregnancy. I prefer the traditional medicine than western medicine because I heard a lot of stories about the side effects of pills and my mother experienced it herself. Besides, we don’t have money to pay for western medicine. Anyway, traditional medicine can be found in the forest and is easier to use.”

It must be pointed out that there is a need to systematically document the communities’ intensive knowledge. But the documentation of their traditional knowledge must be for the improvement of the entire community and not for individual material gains.

The importance of the environment in the indigenous communities’ survival cannot be underscored enough. But development approaches are frequently unhelpful to the indigenous peoples. In her appeal during the third session of the Economic and Social Council, Permanent Forum on Indigenous Issues in New York, a Health Unlimited-trained Tampoen Community Educator said, “After years of relative isolation, the region has recently opened up to so called development where logging, cash cropping and industrial farming were introduced. Traditionally, we have depended on the forest for our livelihoods and now we are threatened by diminishing forested areas, migration, land loss due to confiscation of ancestral lands and border insecurity. These are affecting our ability to survive.”

For example, commercial pressures and environmental degradation result in the continued loss of land and water resources upon which the livelihood and traditional ways of life of indigenous people depend. At the extreme, indigenous peoples suffer systematic repression and deprivation, to the extent that their survival is threatened. For most, life is a constant struggle in the face of poverty, ill-health and social disintegration.

Different organizations have taken up the cause of indigenous peoples, but they sometimes take on paternalistic and patronizing attitudes towards the IPs. In the long run, such attitudes defeat their noble purpose.

By Susan Claro, Jerry Clewett & Alison Sizer
Health Unlimited, Laos PDR

About Health Unlimited:
Health Unlimited, a development organization working with the indigenous peoples of Laos and Cambodia, is careful not to fall into this trap. The core of its program is the empowerment of the indigenous peoples. At all times, Health Unlimited seeks to understand that for indigenous people, their worldview, their health and their wellbeing are rooted in traditional belief systems that must be recognized if the communities are to develop.Health Unlimited works directly with indigenous peoples. It seeks to 1. improve their access to effective and culturally appropriate health care, 2. support them in articulating their own health needs while challenging inequity and discrimination and, 4. tackling obstacles that impede access to health services and achieving the health Millenium Development Goals. Health Unlimited has supported, financially and technically, the Provincial Traditional Medicine Station and the Traditional Healers of Attapeu Province with the aim at integrating the tradional health and western health modalities. Village women are also trained as volunteer educators in each village. They are active partners in conducting health information and education activities in their own ethnic languages. To facilitate the activities, culturally-appropriate interactive communications methodologies like role play, puppet shows, radio programming and story telling are adopted.

Note:
1 Tampoun is an ethnic community in Ratanakiri Cambodia.
2 Utz’ Wachil, Health and Well-being among Indigenous Peoples, Health Unlimited and London School of Hygiene and Tropical Medicine, 2003.

The authors are connected with Health Unlimited. Ms. Susan Claro may be contacted at susanclaro@laopdr.com. For more details about Health Unlimited, visit its website at www.healthunlimited.org

The original article of this appeared in Health Alert Asia Pacific Issue No. 10, 2007 (Supplementary issue). For copies of the newsletter, please email hain1985@gmail.com

Health care for the Orang Asli: Consequences of Paternalism and Non-recognition

The Orang Asli are the indigenous minority peoples of Peninsular Malaysia. In 2004, they numbered 149,512, representing a mere 0.6 percent of the national population.

Like other indigenous peoples the world over, the Orang Asli are among the most marginalized, faring very low in all the social indicators both in absolute terms and relative to the dominant population. For example, while the national poverty rate has been reduced to 6.5 percent, the rate for Orang Asli remains at 76.9 percent. The official statistics also classify 35.2 percent of Orang Asli as hardcore poor, compared to 1.4 percent nationally. (Zainal Abidin 2003)

Orang Asli concept of health and illness
Traditionally in Orang Asli settings, when a person suffered an illness that was serious enough to warrant some action, it became a concern of the whole community. Like most traditional communities, the Orang Asli have long perceived disease as being the result of a spirit attack, or of the patient’s soul being detached and lost somewhere in this world or in the supernatural world. The Orang Asli also believe that both their individual and communal health are linked to environmental and social health. If there is too much pollution, for example, or too much blood spilled, and taboos governing correct behavior have not been followed, then disease and even death will strike.

Healing is often a community effort. The shaman or healer (who may also be the midwife in some communities) is an important anchor in the traditional Orang Asli health system. As Wolff noted, the intimate ties created between patient and healer in a traditional framework reinforce a strong sense of socio-medical reciprocity that government officials or western-trained doctors are rarely able to replicate. It is not surprising therefore that the Orang Asli have an intense desire for healing to be integrated within their local socio-cultural context. Traditional healers and their methods are thus unlikely to disappear easily from Orang Asli culture.

Furthermore, the Orang Asli’s traditional medical system is an ordered and coherent body of ideas, values and practices embedded in a given cultural and ecological context. Health is viewed as a communal or kinship responsibility, that taboos and all other practices related to maintaining health and preventing illness are necessary, and that any breach by one individual will have repercussion on others. The Orang Asli are also very clear about the link between maintaining their environment and maintaining their health and sustenance.

Orang Asli health today
The most recent review of the Orang Asli’s health situation shows that the crude death rate for Orang Asli is twice that for all of West Malaysia. It is worth emphasizing here that most Orang Asli lack food security. With the majority of them living below the poverty line, their narrow margin of survival makes the Orang Asli’s health situation precarious. They are also vulnerable to natural hazards and the whims of ecosystem destruction by others.

Paternalism and Insensitivity
The Department of Orang Asli Affairs (DOAA) is tasked to manage and control the affairs of the community. Under the current set up, the Orang Asli are treated as wards of the state. The Orang Asli, therefore, are not recognized as a people, but rather as individual subjects requiring large doses of governmental support in order to assimilate them into mainstream society. This underlying attitude extends well beyond legal and land matters, and into the realm of health policy and healthcare for the Orang Asli as well.

The underlying assumption in state policies is that Orang Asli’s backwardness is a result of their way of life and remote location. Government policy therefore is to introduce strategies and programs to integrate them into the mainstream. Such an objective has ramifications for the Orang Asli, even in aspects of healthcare delivery and their general health situation.

Viewed as backward and ignorant, the Orang Asli are often blamed for any outbreak that happens within their communities. For example, in July 2004, when a university study found out that high levels of Escherichia coli in Tasik Chini lake caused rashes and diarrhea in some Orang Asli living in five lakeshore villages, the minister in charge of Orang Asli affairs immediately suggested that the Orang Asli be resettled into one place so that they can attain proper amenities. However, as the village batins there pointed out, the problem only started when the authorities dammed the Chini River to prevent the lake water from flowing into the Pahang River. Moreover, the university study plainly said the contamination was due to improper sewage disposal by a local resort and by the Tasik Chini national service camp at the lakeside.

Development planners and policymakers commonly assume that Orang Asli health will improve if the Orang Asli accept development programs designed for them or accede to resettlement elsewhere (usually with cash-crops as the main means of subsistence). The reality is far from this.

The poor nutritional status of Orang Asli children living in regroupment schemes shows that the scheme’s social objectives are not being met. For example, Orang Asli children living in resettlements still have a poor nutritional status.
In hospitals and medical institutions, Orang Aslis are often treated with ridicule and derision. Two studies conducted in 2001 and 2004 showed that Orang Aslis were adamant to go to hospitals because of the unfriendly and rude treatment they got from staff.

The Orang Asli have been treated as not-so-deserving beneficiaries of government assistance, rather than the other way round. This situation is further worsened by discrimination and the formal denial of Orang Asli inherent rights, such as their rights to their traditional lands and resources. Those responsible for Orang Asli health (or for that matter, their overall well-being and advancement) could not or did not want to see the link between Orang Asli wellbeing and good health on the one hand, and their need to be in control over their traditional lands and resources on the other.

With increasing pressures to privatize healthcare in Malaysia, and the unwillingness of the state to accord the political and social recognition that is due to the Orang Asli as the first peoples on this land, it is difficult to see how Orang Asli healthcare will improve through the initiative of the state and its functionaries. It remains a major project, therefore, for the Orang Asli to assert the recognition of their rights as a people, and with it, the delivery of a more sensitive and effective healthcare system.

By Colin Nicholas and Adela Baer
The original article of this appeared in Health Alert Asia Pacific Issue No. 10, 2007 (Supplementary issue). For copies of the newsletter, please email hain1985@gmail.com

Mangyans of Mindoro: Fighting the odds

Mangyan is the general term for the indigenous people of Oriental and Occidental Mindoro, 140 kilometers south of Metro Manila. A Mangyan alliance, Samahang Pangtribo ng mga Mangyan sa Mindoro (SPMM) or Association of Mangyan Tribes , estimated the Mangyan population in Mindoro at 260,000 as of 2006, a 34 percent reduction from the 1989 estimate of the Office of Northern Cultural Communities.
Mangyans largely depend on swidden agriculture (slash and burn) for subsistence, with hunting, fishing and gathering of forest products as major supplements.

Difficult existence
Asked to describe the current situation of Mangyans, Antonio Calbayog, an Iraya and chairman of SPMM shook his head saying, “Our life is hard, miserable.” Mangyans suffer extreme poverty largely because they are losing their lands.

Like other IPs, Mangyans believe that land is not merely a piece of property to be owned or disposed of by anyone, but is part of the ancestral domain. For decades now, however, they have been driven from their ancestral lands as landlords, corporations, and even government projects take these lands away from them.
Calbayog cited government forestry projects and the 9,720-hectare Mindoro Nickel Project of Crew Minerals Philippines that constricted their areas and limited their communities’ access to natural resources they depend on. The mining company’s Mineral Production Sharing Agreement (MPSA) was cancelled by the Department of Environment and Natural Resources in 2001 due to overwhelming public protests but was reinstated by the Office of the President in March 2004. Calbayog said crew is set to start operations this year, which they plan to protest against.

With their source of subsistence shrinking, many are forced to leave their communities. Calbayog estimates that about 20 percent of the Mangyan population have become farm workers who are often deceived and exploited.

Military operations in the island also force Mangyan communities to flee. Aside from being caught in the midst of armed conflicts between government troops and rebels, they have become targets of harassment as the military accuse them of supporting the New People’s Army. According to Calbayog, Mangyan leaders have also become victims of extrajudicial killings, with at least four Mangyans killed in 2003-2004.

Poor, insecure, and discriminated against, it is no longer surprising that Mangyans do not have access to basic services such as education, housing and health. Lack of adequate health and sanitation services for Mangyan communities has resulted in malnutrition, illnesses, and death among adults and especially children.

Health-poor
The Oriental Mindoro Health Investment Plan (OMHIP) 2006-2010 admits that “public health facilities which cater to the poor are mostly ill-equipped, with inadequate supply of drugs and medical supplies. Private hospitals that provide better health care are beyond the reach of the poor.” It also acknowledges the limited access of Mangyans to health services.

In this province, respiratory diseases still rank as the leading causes of mortality and morbidity. The most common causes of morbidity are upper respiratory tract infection, bronchitis, pneumonia, diarrhea and pulmonary tuberculosis (TB). In Occidental Mindoro, acute respiratory infection has also been the leading cause of morbidity, followed by diarrhea and gastroenteritis.

Barangay Health Stations (BHS), run by rural health midwives and volunteer health workers, provide primary health care at the barangay level. In Oriental Mindoro, only 91 out of 426 barangays or 21 percent have BHS. Meanwhile, nearly 25 percent of the 162 barangays in Occidental Mindoro do not have BHS.

Oriental Mindoro has 22 hospitals, 13 of which are privately owned and nine are government-operated. Occidental Mindoro has eight government hospitals and three private hospitals.

The OMHIP contains a specialized health care program for the Mangyans with the goal of making health care services more accessible for Mangyan communities. Among the plans are special Mangyan wards in all government hospitals and provision of free medical services to Mangyan patients in all government facilities; construction of additional 25 BHS in different Mangyan barangays; and training of Mangyan volunteer health workers.

Calbayog acknowledged that training for barangay health workers (BHW) are given, but he laments that no medicines are provided. He said the common illnesses are tuberculosis, pneumonia, measles, and gastro-intestinal diseases, all of which are curable but many Mangyans still die of these. Since there are no doctors in the barangays, they have to go to the municipal health units and usually all they get is a prescription. In hospitals, even public ones, they are still confronted with biases and are often not attended to.

Moreover, even if there are BHW trainings and medicines provided, if they still go hungry, are sleepless and terrorized by military presence, then they can never be healthy, Calbayog said. A widower with six children, Calbayog cited his own experience, “I believe my wife died because of the constant stress brought by military operations.”

Due to poverty, hunger and the effects of militarization of their communities, many Mangyans are malnourished and thus have low resistance and are easily infected by diseases. With government projects and mining operations encroaching into their domains, they are not only losing their freedom of mobility but also their source of food and medicinal plants.

Health and beyond
It is not enough that local governments recognize the Mangyans’ lack of access to health services and plan special programs for them. Strategies such as those contained in the OMHIP, if at all implemented, are like mere drizzle in a parched field. As expressed by Calbayog, his people’s problems are very basic – land to till, food to eat, right to live in peace. Without securing these, social services will not reach them or make a dent on their hard life.

The overall approach to addressing IPs’ issues must change. Government policy regarding IPs has been directed at their assimilation or integration into mainstream Philippine society and at the expropriation of their land and resources for the “national interest.” Oppression has already forced the IPs to retreat deeper into the mountains where they have a much harder existence. But they are still being pursued because mountains are rich in mineral deposits and diverse forest products.
Although laws have been passed ostensibly to protect the rights of IPs, the government has supported the intrusion of commercial activities into ancestral domains. The struggle of the Mangyans against Crew Minerals Philippines is a case in point. This only shows that state policies recognizing IPs’ rights are mere lip service as IPs continue to be marginalized, dispossessed and live in abject poverty. IPs like the Mangyans of Mindoro still face a long journey towards genuine socio-economic advancement and self-determination.

Sources:
1. Interview with Antonio Calbayog, 14 March 2007.
2. Oriental Mindoro Health Investment Plan 2006-2010
3. “Occidental Mindoro.” NSCB Fact Sheet Special Edition, April 2005.
4. Malonzo, Jennifer del Rosario. “Indigenous Peoples.” IBON Facts & Figures, 15 April 2001.

By Jennie Malonzo, publications head of IBON Foundation. Contact Ms. Malonzo at jenndelrosario@yahoo.com

The original article of this appeared in Health Alert Asia Pacific Issue No. 10, 2007 (Supplementary issue). For copies of the newsletter, please email hain1985@gmail.com.

Creating Roads to Sexual & Reproductive Health

The explicit intertwining of the issues on infrastructure and health is what makes the town of Paracelis, said to be Mt. Province’s last frontier, among the four project areas of the 6th UNFPA (United Nations Population Fund) Country Programme. It has been said that the hierarchy of needs should always be the starting point of all programs seeking to adress the needs at a higher level. This is the case in Paracelis and even in most of the towns in Mt. Province, north of the Philippines, where reproductive health seems to be an abstract in the minds of its people.

Nestled in the interior triboundaries of Ifugao, Isabela and Kalinga is the remote town of Paracelis, Mountain Province. There are two difficult, almost impassable routes to get there – either through the steep and narrow mountainsides of Mount Polis, where boulders and rough mountain rocks combine to make the surface of a road; or by passing through Isabela and the dirt roads of Alfonso Lista, Ifugao. Both paths are characterized by rough, bumpy roads pockmarked with potholes. During the rainy season, the road turns sticky with mud and the two rivers become swollen, making travel next to impossible.

UNFPA’s initial project in the municipality targets four barangays that are equally challenging to reach. Barangays (village) Bantay and Bunot are easier to reach because vehicles can pass through and the routes are relatively passable. Reaching the other two barangays of Anonat and Buringal, however, will require tougher guts.
Anonat can only be reached after an hour-and-a-half motorboat ride in the Siffu River. From there, one has to hike for one-and half hour to reach the town proper. To reach Buringal, the farthest town, one has to pass through several towns in Isabela before reaching the mighty Mallig River in Dommon for an hour-and-a half motorboat ride. The rest of the journey is traveled by long hours of hiking.
During the community appraisal phase of the UNFPA project, the very condition of these roads was identified as central to the people’s quest for better and healthy lives.With the lack of key infrastructures in the area, any development intervention in the towns invariably fails.

Read full article here...

The original article of this appeared in Health Alert Asia Pacific Issue No. 10, 2007 (Supplementary issue). For copies of the newsletter, please email hain1985@gmail.com

Creating Roads to Sexual & Reproductive Health

The explicit intertwining of the issues on infrastructure and health is what makes the town of Paracelis, said to be Mt. Province’s last frontier, among the four project areas of the 6th UNFPA (United Nations Population Fund) Country Programme. It has been said that the hierarchy of needs should always be the starting point of all programs seeking to adress the needs at a higher level. This is the case in Paracelis and even in most of the towns in Mt. Province, north of the Philippines, where reproductive health seems to be an abstract in the minds of its people.

Read more »

Indigenous Peoples: Living on the Edge

In 2004, no less than the United Nations Economic and Social Committee noted that “indigenous peoples in many countries continue to be among the poorest and most marginalized.” The comment was made in light of the conclusion of the first International Decade of the World’s Indigenous Peoples, which commenced in 1994. Admitting that the the first Decade was a failure, a second International Decade was started in 2005.

Judging from the health situation of indigenous peoples, it seems that the second Decade is bound to be another failure unless concrete measures are taken to improve the lives of indigenous peoples.

This July, HAIN releases the latest issue of Health Alert (Issue No. 10) which delves into the health issues faced by indigenous peoples. The editorial provides a brief profile of indigenous peoples, as well as the importance of land to their well-being. It maintains that unless the indigenous peoples’ right to land and self-determination is respected, no amount of intervention can make a difference.

Two articles, “Health care for the Orang Asli: consequences of paternalism and non-recognition” and “Indigenous people’s survival: our environment, our lives,” give a brief explanation of the indigenous peoples’ concept of health and well-being. Also, the first article examines how paternalism and lack of sensitivity in handling indigenous peoples’ concerns further worsen the people’s health situation. The second article, meanwhile, shows the effect of environmental degradation in the lives of indigenous peoples.

This also features articles on the health situation of Taiwanese and Australian Aborigines. “Saving Taiwan’s Aborigines” shows that Taiwanese Aborigines have shorter lifespan than non-Aborigines. It also highlights the growing concern for the alarming rise of diabetes cases among Aboriginals. “Australian Aborigines: a proud past; a checkered future” takes a look at the higher rate of mental and emotional distress among Australian Aborigines. It is emphasized that the skewed rate does not point to genetic aberrations; rather, it is the direct result of the social disintegration and neglect suffered by Australian Aborigines.

“The Mangyans of Mindoro: Tough life, ailing conditions” illustrates how apathy, government neglect, and militarization adversely affect the health and lives of indigenous peoples.

The last article, “The quest for the green gold,” focuses on biopiracy and how the act further marginalizes indigenous peoples.

The special issue, “Creating Roads to SRH,” provides a fresh angle in the discussion of delivery of health services in far-flung areas; detailing how the lack of roads and other vital infrastructures adversely affect a community.

To request copies of the Health Alert Asia Pacific, please email hain@hain.org or hain1985@gmail.com. We will also post in this blog some of the articles included in this issue.

Children’s Medicines

By Michael Tan
Philippinde Daily Inquirer, Pinoy Kasi column
July 25, 2007

View full article here...

The first bill filed in the new Congress was the proposed Cheap Medicines Act. More accurately, the bill was re-filed since it had been proposed in the last Congress but didn’t make it as a law. The bill went through rough sailing, facing tough opposition from multinational drug companies.

Among those lobbying heavily for passage of the bill are advocacy organizations working with the elderly. They’ve rightly pointed out that the country’s expensive medicines have been a terrible burden especially for the elderly, and the families that have to foot their medical bills. Because the elderly are more vulnerable to chronic ailments, they have much greater dependency on medicines, many of which have to be taken on a daily basis. Even with the 20-percent discount offered to senior citizens, the monthly bills for medicines easily run into the thousands, wiping out their savings. The elderly are literally held hostage by the drug industry with a grim message: Pay up, or suffer.

How costly is costly?

But sometimes we forget that there’s another large segment of the population that’s also held for ransom: the children. About 100,000 Filipino children die each year, many from diseases that are preventable and curable.

Let’s tackle the preventable deaths first. Vaccines play a key role in preventing many of these deaths. Fortunately, the government does provide free BCG (for tuberculosis), DPT (diphtheria, pertussis or whooping cough and tetanus), OPV (oral polio vaccine) and hepatitis B vaccines. Additional vaccines for flu, chickenpox, MMR (measles, mumps and rubella) have to be paid for with private physicians, and these can run into several thousand pesos. As far as I know, they’re not reimbursable with PhilHealth or with private health maintenance organizations.

There are many other diseases that are not preventable through vaccines. The leading cause of illness and death among children are acute respiratory infections. Children are also especially at risk for gastrointestinal infections that can cause life-threatening diarrheas.

Medherbal Pharmacy in Drug Retail

There is politics and economics in every pill. In the Philippines, branded medicines cost almost twice as generics. Media hype often dictates the drug consumption, no matter how unfounded some of the claims and portrayals in commercial ads.

Still with the exorbitant prices of drugs, it has become impossible for most patients to properly complete their medication. Medherbal Pharmacy (MHP) is trying to change that.

MHP is a community-oriented pharmacy promoting quality and affordable generic and herbal medicine. It also gives training on herbal medicine preparation.

The pharmacy was initially a project of the Council for Health and Development (CHD) with the mandate of providing generic medicines for the use of communitybased health programs (CBHP). It also provided affordable but effective medicines to members of organized communities.

When it started to achieve sustainability, the CHD Board of Trustees has decided to transform the project into an enterprise so it could reach more clients. Now it is slowly gaining ground into a wider market with its expansion around Metro Manila.

In line with its mission to provide affordable medicines to the poor, its three branches are located near urban poor communities.

A different business philosophy MHP may be a business entity, but its approach is different from commercial pharmacies.

Unlike other pharmacies that place as much as 30 percent profit of margin per item, MHP’s profit of margin is low; just enough to cover the operational expenses and post a small profit.

The pharmacy also carries generic medicines and herbal medicines. The herbal medicines are sourced from CBHPs to help them support community projects as well as their own programs. MHP buys its herbal soaps from CBHP-Isabela, herbal teas from San Benito SIPAG-KO in Bicol, and ampalaya (bitter gourd) capsules from the Tuazon Community Center Foundation. To ensure the products’ qualities, MHP regularly conducts trainings on syrup making and sterilization.

MHP also assists in the setting up of community-based pharmacies by conducting rainings on herbal medicine and pharmacy management. Organizations who have finished the trainings are then provided with initial stocks of medicines. So far, six community pharmacies have already been established: three in Paranaque, south of Manila; one in Tala; and two in the province of Nueva Ecija. MHP is planning to set up five more community pharmacies before the year ends.

Another thing that differentiates MHP from other pharmacies is its advocacy on Rational Drug Use. Since most of their customers have virtually zero knowledge on RDU, staff actually takes the time to educate them.

Advocacy at work
MHP often encounters some people who still think of amoxicilin as vitamins. “People need to know the right medicines to take, the right dosage, at the right time” says
Socoro Torres, Medherbal’s chief executive officer.

Drug consumption remains a big challenge because of the lack of knowledge about rational drug use as well as proper appreciation of generic drugs. Often people buy medicines inappropriate to their sickness. A majority of the Filipinos still buy drugs based on hearsay from what family members or neighbors say. Most of the time, they tend to buy drugs from what they hear or see on television or simply buy prescriptions given to them some years ago.

Often, lacking proper diagnosis from physicians, their illnesses take a turn for the worse.

Torres explains that cultural factors remain an issue, relating to how multinational drug companies have controlled or overwhelmed popular media with ads. Such example is that of the world boxing champion, Manny Pacquiao. In his endorsement of ibuprofen, he says that he has been using it for 11 years. However, a scientific finding concluded that prolonged use of ibrufropen can likely makes a person’s bones brittle, entirely belying the high profile ad.

Here still lies most of the challenges for MHP, but here is where it has also made significant gains. From an offshoot of CHD’s drug procurement unit then only serving orgnized communities, now it is reaching out to larger crowd that is mostly unfamiliar to the concepts of RDU. The MHP staff are proud to say that they have been somehow successful in slowly influencing some people to follow prescriptions, take a full course of medication or go for herbal or generic versions rather than known brands.

Torres admits that economic issues hinder the promotion of RDU. She says other patients could not afford to buy full dosage of medicines. “There are those who buy one or two tablets of amoxicillin. We tell them the minimum dosage for antibiotics is 15 tablets. We try to lower prices so they could buy the full dosage.” It is unfortunate however, that even if people know about the proper intake of medicines, they have not enough money to buy them.

Even with the enactment of the Generics Act of 1988, she underscores the failure of the government to support local drug manufacturers as well as its failure to regulate the production of medicines.

Due to monopoly pricing, the cost of drugs in the Philippines is one of the highest in the world, second in Asia next to Japan. Branded medicines still dominate the market, accounting for 97 percent of sales.

The Philippines now heavily imports drugs from India through the government’s parallel importation program. If indeed the government really wants to end monopoly and significantly reduce prices, Torres insists that it should instead promote local pharmaceutical companies by increasing subsidy and lowering taxes.

To demonstrate the ill-effects of such problematic trade, experts believe that the rise in number of cases of multi-drug resistant TB is a result of the failure to comply with prescribed medication.

The irony remains starkingly real. Great advances have been made regarding treatment and cure of many ailments, but who can afford them? All these gives MHP more reasons to continue its work.

By Philip Paraan Council for Health and Development (chdmancom@yahoo.com)
Published at Health Alert Asia Pacific (www.hain.org)

Tripping Over Trips

India, China, and other developing nations have made headway in producing generic versions of much-needed medicines, but the Trade-Related Intellectual Property Rights (TRIPS) is challenging this increasingly booming sub-industry. The effort to curb the further development of the generic drug industry stems from the fact that generic medicines, which is far more cheaper than branded ones – are eating into the profits of Big Pharma.

Big Pharma’s reaction was typical: all World Trade Organization (WTO) member-countries are required to fastrack the full implementation of the TRIPS agreement.

As the world’s leading manufacturer and exporter of generic medicines, India’s handling of the TRIPS issue had been a rallying point for health institutions and activists worldwide because of its possible ramifications in the global generic drug industry. No less than the World Health Organization and the UNAIDS urged India to take full advantage of the TRIPS flexibilities when it amended the act. India was forced to amend its Patents Act of 1970 in compliance with the TRIPS agreement.

The first sign that India might be caving in to pressures was a December 2004 ordinance it passed that would grant patents to products and not just to the process. The ordinance, which did not go through the Parliament, was passed because India had to beat the January 1, 2005 deadline set by the WTO. The revision would have an impact on the generic industry because Indian manufacturers utilized the original act’s differentiation between “process patents” and “product patents.” With the 1970 Act focusing on process patents, manufacturers were able to produce generic versions of branded medicines through reverse engineering.

The current ordinance has effectively watered down the 1970 Act, but health activists were able to score some points with the inclusion of several amendments, two of which address the most crucial issues. With regards to generic exports, the amendment would still allow foreign countries to export generic medicines from India without having to obtain a compulsary license from the patent holder. Another amendment guarantees existing Indian companies the right to market generic medicines (even those that are still under patent), as long as a royalty fee is paid.

The Indian chapter of the People’s Health Movement (PHM-I), however, cautions that the ambiguous wordings of the revised ordinance might be subjected to abuse. For example, manufacturers may still produce generic versions of new drugs, as long as the producer makes a “significant investment” and paid a “reasonable royalty” to the patent holder. The crucial questions are how significant the “significant investment” and reasonable the “reasonable royalty” are?

In its critique of the new bill, PHM-I admitted that the new ordinance is far from ideal and that certain provisions may have a negative impact on public health. The group pointed out the need for all stakeholders to continue monitoring the bill’s implementation. “This is possible only if both the political and the committed peoples movements mutually appreciate the positive roles being played by them without
trying to take up self righteous positions,” it said.

Sources: Health Alert Asia Pacific, Issue No. 9 (www.hain.org) www.phm-india.org ; www.ictsd.org

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