Bakungan

On September 9, 2009 (090909!) Marcus, Lyn-Lyn and I accompanied a group of Palawan State University second year nursing students on one of their outreach trips to a Barangay called Bakungan. Bakungan is about a 40 minute drive from the center of Puerto Princesa, and is a somewhat rural location. The nursing students have been conducting survey work in this Barangay all semester and have been going from house to house interviewing residents and carrying out basic health checks (like checking blood pressure). We wanted to get an idea of what some of these rural households look like so we shadowed some of the students as they carried out their work.

Palawan’s National Highway is a pretty good road and is paved most of the way to Sabang – location of the underground river, Palawan’s number 1 tourist attraction. Bakungan is about halfway to Sabang, so the roads were great up until the turnoff for the Barangay. Once we got off the National Highway, we were on unpaved, muddy dirt roads. We drove to a community center hut within the Barangay and watched as the students prepared their survey materials and got ready to begin their work. Many of the students rolled up their pants, took off their shoes and changed into flip flops, as some of them had to wade through a stream in order to get to some of the households.

The Barangay church

Every Barangay in the Philippines has a basketball court! Loved this makeshift one...

In the first household our group went to, the students interviewed a woman caring for an 8 year old boy who is her youngest child as well as a 4 year old girl who is her granddaughter. The woman looked older than her 42 years and seemed tired, though happy to speak with the students.

Her husband supports their family of 9 on P8,000 pesos a month – the equivalent of about $165. The woman said she practiced family planning and used birth control pills, though right after reporting this, said that she had 6 children. I wished that the nursing students asked a follow up question of whether those 6 pregnancies were planned but unfortunately this question wasn’t part of their survey tool. Many Filipinas I’ve met use the pill, but don’t use it regularly. If money is tight, it is understandably spent on food rather than on contraception.

In another household we visited, a 38 year old woman was caring for her 6 year old son and her 10-month old daughter. Again, this woman reported practicing family planning, and said that she had 5 children. Her husband is the household breadwinner and supports the family on P7,000 pesos a month.

I came away from this trip with a feeling of guilt at how much I have and how little many of the people in this community have. I cannot imagine a family of 9 living off P8,000 a month, but these families do it, and hard as it is to imagine, these families are better off than many others. I really wished I could have asked the women more questions about their desired family size and their contraceptive use and any education they had and about any desires to work. When we do our own data collection in the community we are going to work in, I will definitely speak with women about these things.

One thing from this trip that really made an impression on me and Marcus was the effort that people in the community put into taking care of their homes. All the homes we saw were very simple and sparse, but they were clean and tidy and a lot of thought had been put into decorating the spaces with whatever materials could be found. Also, the homes all had lovely gardens with lots of flowers and pretty plants. I know this sounds terribly cliché but it really reminded us to be thankful for all that we have, and it left us with a desire to try to simplify our lives and do more with less stuff. As my mom always liked to tell me as I was growing up, “Live simply that others may simply live.”

Trip to Bagong Silang

Last week Susan, Lyn Lyn and I went to Barangay Bagong Silang so I could have a look around, learn more about the barangay, meet some of the people within the community, and learn more about the health services available.

The community has around 5,000 people and about a third of them are Badjao. The Badjao are a Filipino tribe of sea gypsies. They are a traditionally nomadic group of people whose origins are within the Sulu archiapelago. They are a Muslim group and were displaced by the conflicts in Sulu and other Muslim areas. They are a marginalized group, looked down upon by non-Badjaos even in Islamic areas. Badjaos tend to be very poor and uneducated and are frequently beggars. These factors all contribute to the discrimination that many non-Badjao’s have against this group.

The majority of the non-Badjao men are fishermen, and women either sell fish at the market, work at the local department store, NCCC, or stay at home. Some children go to school but many do not, particularly among the Badjaos. Badjao children are frequently seen selling plastic bags at the market, or begging. Bagong Silang received funding from Puerto Princesa Mayor Hagedorn to fund a preschool/day care center in the community which some children do attend. The day care center serves 57 students - children aged 3 and 4 in the mornings, and children aged 5 in the afternoons.

There are *so* many children in this community.

In 20 minutes of walking around, I counted more than 80 kids who look to be around 13 years old or below. Most of the small children were in various states of nakedness, were dirty, malnourished, and looked visibly sick.

The community has some people who are better off than others: many people have actual houses made of concrete. But the poorest members of the community, a disproportionate number of whom are Badjaos, live in bamboo shacks built over the beach leading into the ocean. The shacks are stacked up on each other and have no sanitation facilities. People throw their trash and all their waste through the cracks into the water below. When the tide comes in, the waste is washed to the sea. It was low tide when we arrived and the stench was pretty awful. This community is a water and sanitation nightmare! Because the shacks are right up on the ocean, the homes are vulnerable to the elements. The week before we visited, a storm had destroyed a number of homes which had yet to be rebuilt. I’m not sure where the inhabitants of those homes are now.

Because of the extreme poverty of this community they have received some funding from the national Department of Social Services and from the local City Health agency to fund a small clinic to serve the local population. The funding is by no means adequate to support community needs, but the community health workers (CHWs) staffing the center make do with what little they have. The center provides immunization, prenatal care, and family planning services. Immunization services and prenatal activities are conducted every first week of every month. The CHWs provide information on family planning and can assist with IUDs and other injectable types of contraception, but these and birth control pills must be purchased by the clients, and most of them cannot afford the costs. There are many pregnancies in the community and most women give birth at home, sometimes with a midwife.

The CHWs also reported that through a special grant they obtained funds to run a feeding program for 2 months. They said that in the community there were only 50 cases of malnourished kids (my casual observations point to a far greater number!) and their program is feeding 25 of them. Of the 25 only 3 kids are Badjao.

The CHWs were extremely friendly and eager to speak to us about their activities. I was impressed with how organized their small center was, and they seem to have good records of the people availing of their services. We will return next week and they have promised to share their data with us -- an invaluable favor as we compile data for our needs assessments!

I think it would be very interesting to work in this community, not only because of the demonstrated needs, but also because of the presence of a marginalized group (the Badjao) among the already-marginalized poor. Part of me hesitates because the community already has some services being provided to them, but another part of me knows these services are nowhere near adequate or sustainable. It may also be more effective to work within a community that already has some services set up. It would make our service delivery more effective. In addition, in the future, the process this barangay went through could serve as a guide for us in establishing services in other communities without any . However, I wonder whether it would be more important to start providing services in communities where there are none. There is a lot to think about and no doubt we will have a lot of discussion when we conclude our needs assessments and decide which community to work in.

Roots of Health - the Adventure has Begun!

Now that Marcus and I are finally here in Palawan, the work of Roots of Health / Ugat ng Kalusugan has started in earnest.

In the next few months, Ugat ng Kalusugan will begin conducting reproductive health trainings with students and future partners at Palawan State University and will be completing more comprehensive needs assessments of various communities in Puerto Princesa in which we may conduct our activities. My mom, Susan, has conducted a needs assessment of Barangay Bagong Silang, and we may well do our work in this community as they very clearly need the support, but there may be other communities in which our activities would be more beneficial, so we will take the time to gather data on other communities before deciding exactly which community to work in.

We will gather data from the government City Health agency, through Palawan State University College of Nursing and Health Sciences (they do needs assessments for their students’ practicum programs) and by going into the various communities and speaking with the community leaders, health workers (if any) and local residents.

As we go through this process, we will also conduct reproductive health trainings with students within PSU’s school of nursing and midwifery and school of social work. While PSU students are elites in the sense that they have education, many of them come from the communities we are considering working in, and many of them lack the same knowledge regarding reproductive health (yes, even the nurses!)

We hope to complete our needs assessments by November, and begin working in the community we select in the same month. We will begin with our reproductive health outreach and our healthy pregnancy program, and will plan to introduce the nutrition program in late December or early January 2010.