Eighty percent of the Philippine population, or about 69 million Filipinos, struggle to survive on P96.00 or less (about US$2). The US$2 benchmark is based on World Bank’s defi nition of poverty threshold. The threshold for the Millennium Development Goal is lower at less than US$1. Of the fi gure, 46 million Filipinos go
hungry everyday.
Based on the projection of the National Wages and Productivity Commission, a family of six living in the National Capital Region needs a living wage of P911.00, but the daily minimum wage is only P382.00. The low wage is a part of the conditions of the International Monetary Fund to ensure that the Philippines would be able to pay its debts.
The gap between the rich and the poor is getting wider, with the net worth of the ten richest Filipinos (US$12.4 billion in 2006) equivalent to the combined annual income of poorest 9.6 million families.
Monday, May 25, 2009
Wednesday, April 15, 2009
Crash and Burn
Humanitarian aid workers and staff of non-government organizations (NGO) are often praised for their selfless devotion in making the world a better place to live in. But put the accolades aside, and the question begging to be asked will surface: who takes care of this sector’s mental health needs?
NGO staff and aid workers are often at the forefront of humanitarian work. It is inevitable that in the course of their work, they are exposed to a dreadful environment where death and suffering are common occurrences. In some instances, they themselves are threatened with bodily harm. In his paper, “Mental Health and Aid Workers: The Case for Collaborative Questioning,” Thomas Ditzler of the Center of Excellence in Disaster Management and Humanitarian Assistance, asserts that “the nature of humanitarian assistance puts workers in contact with the local environment in ways that can erode the normal personal / professional boundaries which provide some measure of psychological protection.”
A 2001 study published in the Journal of Traumatic Stress showed that 30 percent of returning aid workers reported being stressed, while ten percent could be suffering from PTSD.
NGO staff and aid workers are often at the forefront of humanitarian work. It is inevitable that in the course of their work, they are exposed to a dreadful environment where death and suffering are common occurrences. In some instances, they themselves are threatened with bodily harm. In his paper, “Mental Health and Aid Workers: The Case for Collaborative Questioning,” Thomas Ditzler of the Center of Excellence in Disaster Management and Humanitarian Assistance, asserts that “the nature of humanitarian assistance puts workers in contact with the local environment in ways that can erode the normal personal / professional boundaries which provide some measure of psychological protection.”
A 2001 study published in the Journal of Traumatic Stress showed that 30 percent of returning aid workers reported being stressed, while ten percent could be suffering from PTSD.
Sunday, March 08, 2009
Community-based Mental Health Programs: Back to Basics
In the report ”Integrating mental health into primary care : a global perspective,” the World Health Organization and the World Organization of Family Doctors bat for the integration of mental health care program with primary health care since it results in greater access to much needed services.
The report resonates with truth, considering that confinement in mental asylums or rehabilitation centers is a common treatment modality for mental disorders. For poor countries dealing with fund scarcity and the lack of specialists, a psychiatric hospital-based approach alone may not work. However, there are cost-effective models of community- and home-based programs that work well.
Community-based mental health program
A community-based mental health program is not meant to replace the treatment and services offered in hospitals; it rather complements these services by making these more accessible to the people.
Such a program is also more culturally appropriate and capitalizes on the tightly-woven social fabrics of most Asia-Pacifi c countries. The involvement of the
community and family members in caring for a patient helps ease stigma and provide a more healing and nurturing environment for a patient.
The report resonates with truth, considering that confinement in mental asylums or rehabilitation centers is a common treatment modality for mental disorders. For poor countries dealing with fund scarcity and the lack of specialists, a psychiatric hospital-based approach alone may not work. However, there are cost-effective models of community- and home-based programs that work well.
Community-based mental health program
A community-based mental health program is not meant to replace the treatment and services offered in hospitals; it rather complements these services by making these more accessible to the people.
Such a program is also more culturally appropriate and capitalizes on the tightly-woven social fabrics of most Asia-Pacifi c countries. The involvement of the
community and family members in caring for a patient helps ease stigma and provide a more healing and nurturing environment for a patient.
The Hidden Battlefield
The destruction brought about by war and armed confl icts transcends the structure of cities and communities and encompasses the mortality and overall well-being of those who engage in it and those who are dragged into it. The victims, the perpetrators, and defenders may not share the same goals in war but they all share the trauma and suffering surfacing from such violent events.
The effects of war, according to a study by R. Srinivasa Murthy and Rashmi Lakshminarayana of the Regional Offi ce for the Eastern Mediterranean of the World
Health Organization (WHO), are varied and some are not even included in most available literature.
The known effects, the study said, included endemic poverty, malnutrition, disability, economic/social decline and psychosocial illness, among others. The
authors said that only when confl icts and mental health problems are fully understood can effective strategies be developed to deal with the effects of war.
"The effects of war include long-term physical and psychological harm to children and adults, as well as reduction in material and human capital. Death as a result of wars is simply the 'tip of the iceberg,'" the authors said.
The effects of war, according to a study by R. Srinivasa Murthy and Rashmi Lakshminarayana of the Regional Offi ce for the Eastern Mediterranean of the World
Health Organization (WHO), are varied and some are not even included in most available literature.
The known effects, the study said, included endemic poverty, malnutrition, disability, economic/social decline and psychosocial illness, among others. The
authors said that only when confl icts and mental health problems are fully understood can effective strategies be developed to deal with the effects of war.
"The effects of war include long-term physical and psychological harm to children and adults, as well as reduction in material and human capital. Death as a result of wars is simply the 'tip of the iceberg,'" the authors said.
Thursday, March 05, 2009
Intended Death: A look at suicidal behavior
The World Health Organization (WHO) noted that suicide is taking the lives of more and more people worldwide. In the year 2000, the WHO revealed that approximately one million people died from suicide, representing a mortality rate of 16 per 100,000 or one death every 40 seconds.
In the last 45 years, it also noted that suicide rates have increased 60 percent worldwide; suicide is now among the three leading causes of death among those aged 15-44 (both sexes). These fi gures, however, do not include suicide attempts that are up to 20 times more frequent than completed suicide.
Further, suicide worldwide is estimated to represent 1.8 percent of the total global burden of disease in 1998, and 2.4 percent in countries with market and former socialist economies in 2002. Although suicide rates have been traditionally highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of both developed and developing countries.
In the last 45 years, it also noted that suicide rates have increased 60 percent worldwide; suicide is now among the three leading causes of death among those aged 15-44 (both sexes). These fi gures, however, do not include suicide attempts that are up to 20 times more frequent than completed suicide.
Further, suicide worldwide is estimated to represent 1.8 percent of the total global burden of disease in 1998, and 2.4 percent in countries with market and former socialist economies in 2002. Although suicide rates have been traditionally highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of both developed and developing countries.
Sunday, March 01, 2009
Untangling the Mental Haywire
Globally, an estimated 450 million are suffering from mental and neurological disorders such as epilepsy, dementias (e.g. Alzheimer’s disease, vascular
dementia), and bipolar affective disorder. According to the 2001 World Health Report entitled “Mental Health: New Understanding, New Hope,” depression ranked fourth in the global disease burden; it is projected to jump to second place by 2020.
In the Asia-Pacific region, an estimated 13.7 million have dementia; as the region’s population ages, the number of those with dementia is expected to hit 64.6
million by 2050.
Substance addiction, whether alcohol, drugs, or tobacco, is also considered a mental health issue. Asia accounts for close to 55 percent of amphetamine-type stimulants (ATS) abuse worldwide, and majority of ATS addicts are youth. Alcohol abuse, on the other hand, account for 5.5. percent of the Asia-Pacifi c region’s burden of disease. In some Pacifi c countries, the percentage of alcohol-related abuse and violence is staggering: in Papua New Guinea, close to 90 percent of emergency room trauma are due to alcohol; while in Guam, 62 percent of murders are also alcohol-related.
dementia), and bipolar affective disorder. According to the 2001 World Health Report entitled “Mental Health: New Understanding, New Hope,” depression ranked fourth in the global disease burden; it is projected to jump to second place by 2020.
In the Asia-Pacific region, an estimated 13.7 million have dementia; as the region’s population ages, the number of those with dementia is expected to hit 64.6
million by 2050.
Substance addiction, whether alcohol, drugs, or tobacco, is also considered a mental health issue. Asia accounts for close to 55 percent of amphetamine-type stimulants (ATS) abuse worldwide, and majority of ATS addicts are youth. Alcohol abuse, on the other hand, account for 5.5. percent of the Asia-Pacifi c region’s burden of disease. In some Pacifi c countries, the percentage of alcohol-related abuse and violence is staggering: in Papua New Guinea, close to 90 percent of emergency room trauma are due to alcohol; while in Guam, 62 percent of murders are also alcohol-related.
Sunday, January 18, 2009
First Aid for Panganganak
*What will you do if you happen to be with a pregnant woman who, all of the sudden, goes into labour?
In emergencies such as this, it is important that we equip ourselves with pieces of information on initial steps to aiding parturients.
I am to share an article, which was published in Reader’s Digest (November 2008), entitled Call 999! by Leo Hickman. This tells the writer’s experience of attending to his wife’s delivery. Because this was their third child and Jane Hickman’s previous labour had only lasted 45 minutes, they were advised to have a home birth. Unfortunately, the midwives were stuck in traffic so he made an emergency phone call.
Here is the recorded call that details the whole procedure.
17:28:12 (Call answered)
Operator: Emergency ambulance. What’s the problem? Tell me exactly what’s happened.
Leo: Hello, my wife is in labour and is having the baby at home, but she’s really feeling the urge to push. (Leo gives her his address, postcode and telephone number and answers her questions about Jane’s medical history, condition and contractions.)
Operator: OK, I’m organising help for you now. Just stay on the line and I will tell you what to do next. Allow her to sit in the most comfortable position and have her take deep breaths between contractions. Have you got clean towels and blankets?
Leo: Yep.
Operator: Right, I want you to look at her vagina very closely to see how close the baby is being born. (Pause.) OK, do you see any part of the baby now?
Leo: Yeah, I think I can see a head. Yes, I think the top of the head. I think.
Operator: With each contraction, place the palm of your hand against the vagina and apply firm but gentle pressure to keep the baby’s head from delivering too fast and tearing. (She asks who else is in the house and says someone should open the front door for the ambulance crew.)
Jane: (Screaming.) Ohhh, I need to push! I NEED TO PUSH!
Leo: Hang on.
(Long pause while Leo does an examination.)
Operator: How are you doing?
Leo: OK. You know, I don’t think it is the head actually.
(Leo is very scared now: instead of a smooth baby’s head, what he is looking at has become rippled and ridged in appearance and blotchy in colour. He realises that telling the operator he has doubts that it is a head will frighten Jane, but he knows he has to tell the operator everything.)
Leo: Something’s coming out, but I don’t know what it is.
(Jane moaning in the background.)
Operator: You don’t know what it is?
(Jane experiencing another contraction in the background.)
Leo: I think . . . I think it’s part of the sac that hasn’t burst yet. It’s got liquid in it.
Operator: Liquid in it? You need to get a safety pin in case the baby is born in the sac. You need to burst the sac. You need to do that now.
Leo: OK. (To Jane.) OK, wait there, Jane.
(While Jane moans and screams, Leo leaves the bedroom. He runs out on to the landing and freezes, trying desperately to think where he might find a safety pin. After 30 seconds of panic and incoherence, he returns to the bedroom to see that the waters have now started to break.)
Leo: There’s a lot of meconium.
(Meconium - the baby’s first poo - can cause complications, especially in a home birth.)
Operator: There is? (Pause.) OK, you’re still going to need to support the baby. Is it the sac coming out? The baby must be in the sac.
Leo: Yep.
Operator: Is the head coming out?
Leo: OK, the head’s coming!
Operator: Right, you need to support the head and shoulders and hold the hips and legs, OK? It will be slippery so don’t drop him!
Leo: I can see the head. I can see the face!
(The baby’s eyes and mouth are closed and there is no movement in his face at all. Leo had expected the baby to breathe as soon as the head was born, so is feeling frightened now.)
Operator: OK, that’s fantastic. Just keep supporting the baby, OK?
Leo: OK. (Pause.) Jane, you’re doing really well.
Operator: Tell her she’s doing fantastic, OK?
Leo: There’s lots of waters breaking. Come on, little baby. (Jane screaming and moaning.) OK, one shoulder’s coming.
(One arm is now out – in the panic, Leo has said “shoulder” by mistake.)
Operator: OK.
Leo: Come on, little baby. OK, the baby’s out!
Operator: Is the whole baby out?
Leo: It’s quite messy. There’s a lot of meconium.
Operator: Right, what I want you to do is wipe the baby clean. (Pause.) Right, is the baby crying or breathing?
Leo: It’s not fully out yet.
(Perhaps it’s the sight of the thick umbilical cord that makes Leo say this. The baby has in fact been born; he is covered in meconium, including all over his face. The clean towel referred to earlier is now dirty and of no use. Leo is on his knees holding the baby up off the floor, unable to put him down to run for a towel. Jane is unable to turn round to hold him because she can’t get her leg over the cord. Both parents are worried because the baby is only making very small body and facial movements. He looks very blue.)
Operator: Is the baby crying or breathing?
Leo: Yes, it’s crying.
(The baby is making small crying noises.)
Operator: Right, what I want you to do is gently wipe off the baby’s mouth and nose. And dry the baby off with a clean towel. Then wrap the baby in a clean, dry towel, OK?
(Leo shouts t his mother-in-law to bring more towels.) . . .
. . . (Long pause as towels arrive and baby is cleaned and swaddled.)
Leo: Shall I give the baby to Mum?
Operator: Is he wrapped up in a towel?
Leo: Yes.
Operator: Don’t pull the cord too tight and put the baby in mother’s arms. Now make sure to keep the baby and the mother warm.
(Knocking heard downstairs.)
(Two midwives enter he room.)
17:39:28 (Recording ends.)
-Amanah Busran Lao
HAIN Research Associate
Citation:
• Leo Hickman “CALL 999!” Reader’s Digest, November 2008, page 121-125.
In emergencies such as this, it is important that we equip ourselves with pieces of information on initial steps to aiding parturients.
I am to share an article, which was published in Reader’s Digest (November 2008), entitled Call 999! by Leo Hickman. This tells the writer’s experience of attending to his wife’s delivery. Because this was their third child and Jane Hickman’s previous labour had only lasted 45 minutes, they were advised to have a home birth. Unfortunately, the midwives were stuck in traffic so he made an emergency phone call.
Here is the recorded call that details the whole procedure.
17:28:12 (Call answered)
Operator: Emergency ambulance. What’s the problem? Tell me exactly what’s happened.
Leo: Hello, my wife is in labour and is having the baby at home, but she’s really feeling the urge to push. (Leo gives her his address, postcode and telephone number and answers her questions about Jane’s medical history, condition and contractions.)
Operator: OK, I’m organising help for you now. Just stay on the line and I will tell you what to do next. Allow her to sit in the most comfortable position and have her take deep breaths between contractions. Have you got clean towels and blankets?
Leo: Yep.
Operator: Right, I want you to look at her vagina very closely to see how close the baby is being born. (Pause.) OK, do you see any part of the baby now?
Leo: Yeah, I think I can see a head. Yes, I think the top of the head. I think.
Operator: With each contraction, place the palm of your hand against the vagina and apply firm but gentle pressure to keep the baby’s head from delivering too fast and tearing. (She asks who else is in the house and says someone should open the front door for the ambulance crew.)
Jane: (Screaming.) Ohhh, I need to push! I NEED TO PUSH!
Leo: Hang on.
(Long pause while Leo does an examination.)
Operator: How are you doing?
Leo: OK. You know, I don’t think it is the head actually.
(Leo is very scared now: instead of a smooth baby’s head, what he is looking at has become rippled and ridged in appearance and blotchy in colour. He realises that telling the operator he has doubts that it is a head will frighten Jane, but he knows he has to tell the operator everything.)
Leo: Something’s coming out, but I don’t know what it is.
(Jane moaning in the background.)
Operator: You don’t know what it is?
(Jane experiencing another contraction in the background.)
Leo: I think . . . I think it’s part of the sac that hasn’t burst yet. It’s got liquid in it.
Operator: Liquid in it? You need to get a safety pin in case the baby is born in the sac. You need to burst the sac. You need to do that now.
Leo: OK. (To Jane.) OK, wait there, Jane.
(While Jane moans and screams, Leo leaves the bedroom. He runs out on to the landing and freezes, trying desperately to think where he might find a safety pin. After 30 seconds of panic and incoherence, he returns to the bedroom to see that the waters have now started to break.)
Leo: There’s a lot of meconium.
(Meconium - the baby’s first poo - can cause complications, especially in a home birth.)
Operator: There is? (Pause.) OK, you’re still going to need to support the baby. Is it the sac coming out? The baby must be in the sac.
Leo: Yep.
Operator: Is the head coming out?
Leo: OK, the head’s coming!
Operator: Right, you need to support the head and shoulders and hold the hips and legs, OK? It will be slippery so don’t drop him!
Leo: I can see the head. I can see the face!
(The baby’s eyes and mouth are closed and there is no movement in his face at all. Leo had expected the baby to breathe as soon as the head was born, so is feeling frightened now.)
Operator: OK, that’s fantastic. Just keep supporting the baby, OK?
Leo: OK. (Pause.) Jane, you’re doing really well.
Operator: Tell her she’s doing fantastic, OK?
Leo: There’s lots of waters breaking. Come on, little baby. (Jane screaming and moaning.) OK, one shoulder’s coming.
(One arm is now out – in the panic, Leo has said “shoulder” by mistake.)
Operator: OK.
Leo: Come on, little baby. OK, the baby’s out!
Operator: Is the whole baby out?
Leo: It’s quite messy. There’s a lot of meconium.
Operator: Right, what I want you to do is wipe the baby clean. (Pause.) Right, is the baby crying or breathing?
Leo: It’s not fully out yet.
(Perhaps it’s the sight of the thick umbilical cord that makes Leo say this. The baby has in fact been born; he is covered in meconium, including all over his face. The clean towel referred to earlier is now dirty and of no use. Leo is on his knees holding the baby up off the floor, unable to put him down to run for a towel. Jane is unable to turn round to hold him because she can’t get her leg over the cord. Both parents are worried because the baby is only making very small body and facial movements. He looks very blue.)
Operator: Is the baby crying or breathing?
Leo: Yes, it’s crying.
(The baby is making small crying noises.)
Operator: Right, what I want you to do is gently wipe off the baby’s mouth and nose. And dry the baby off with a clean towel. Then wrap the baby in a clean, dry towel, OK?
(Leo shouts t his mother-in-law to bring more towels.) . . .
. . . (Long pause as towels arrive and baby is cleaned and swaddled.)
Leo: Shall I give the baby to Mum?
Operator: Is he wrapped up in a towel?
Leo: Yes.
Operator: Don’t pull the cord too tight and put the baby in mother’s arms. Now make sure to keep the baby and the mother warm.
(Knocking heard downstairs.)
(Two midwives enter he room.)
17:39:28 (Recording ends.)
-Amanah Busran Lao
HAIN Research Associate
Citation:
• Leo Hickman “CALL 999!” Reader’s Digest, November 2008, page 121-125.