Friday, August 31, 2007

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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Wednesday, August 29, 2007

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

Thursday, August 09, 2007

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.