Roots of Health

Our Blog Has Moved!

2010-01-13T14:08:00.003+08:00

The Roots of Health blog has a new home!
Please visit http://www.rootsofhealth.org/blog.htm to see our new and improved blog.

Ugat ng Kalusugan in December

2009-12-22T16:17:00.006+08:00

As with every month since we started working in the Philippines, December was another very busy month for Ugat ng Kalusugan!

I started off the month with 3 days of back to back to back meetings in Manila with other organizations focused on maternal and child health and reproductive health. The people I met with were incredibly helpful and I am so thankful for their generosity in sharing their time and best approaches and practices with me. I really learned a lot and left the meetings eager to return to Palawan and use some of the wise advice I’d been given. Reflecting on the meetings made me feel so thankful for how supportive the nonprofit and NGO community has been here in the Philippines. Everyone we have met with has been so happy to help us and Roots of Health / Ugat ng Kalusugan is benefiting and will continue to benefit greatly from all of these relationships.

Back in Palawan, Susan, Marcus and Lyn Lyn were busy preparing for our end of year Christmas party in Pulang Lupa and when I returned I helped organize our activities as well. Christmas is a very big deal in the Philippines, and we had decided in late November that though we wouldn’t be able to begin our educational outreach activities before January 2010, that we could at least have one session to formally launch our activities in the community before we closed for the Christmas holidays. We decided to have a short program for the women and children in Pulang Lupa. We planned to gather all the women in one area and introduce ourselves and our work more formally and give them an update on what we would begin doing in January. We decided to have a few games related to our work, serve a simple merienda (snack) and give each woman a small gift of food/groceries for her household. We decided to have a brief program for the kids as well and planned to have games and stories with the little ones in a nearby area, serve them a merienda, and give each child a toy that we had purchased. We tried to guesstimate how many people would attend and decided that probably around 50 women and 130 children would attend. We planned for that many number of gifts and rounded up a bit for food. We knew that the party was probably going to be a bit chaotic but we also believed that it would be fun and we hoped to have a good number of women in attendance.

The Christmas Party

On December 11, party day, we showed up in Pulang Lupa 40 minutes before our start time, fully expecting that we would need time to start rounding up some of the women and children. We had planned to start our activities when we had about 40 kids and about 20 moms in attendance. We were surprised upon arriving to see that a small group of children had already gathered. Within 15 minutes, there were about 50 kids waiting and a few minutes before our scheduled start time, there were more than 100 participants patiently waiting. Some of the moms and kids did come a bit late, but we had nearly all our participants ready and waiting at our scheduled start time. There were so many people! We estimate that there were about 150 kids and about 60 women all together. In addition, there were about 10 men from the community - fathers and husbands - who came to join in our programming as well. The extra numbers made things a little bit more hectic, but we were so pleased that we had such a high turnout, and we were happy that everyone, including the men, had decided to come out. We were thankful for the extra food we had brought because it allowed us to also give the men a small merienda. Not all of the women got a bag of groceries, but all households did get a bag of food (some households had more than one woman in attendance.) And we had candy that we gifted the extra kids with. So in terms of supplies, it all went fine.

Susan and Lyn Lyn and I handled the program for the women, and it all went better than we could have hoped for. All the women in our group were cheerful and excited to participate and were interested to learn more about our planned programming for January. Before we began we asked the women to write their names on nametags, and we called on each individual by name. We think they really appreciated this, and it was helpful to us to place more faces with names as we hope to know every member of the community on a first name basis before too long. The games and activities we’d planned all had something to do with reproductive health and we were pleasantly surprised to see the women really engage and really get into the games and discussions. We don’t think that they have very many chances to talk about their lives and their thoughts and ideas, and it was fantastic to see how much they enjoyed participating in our activities. The men were mostly on the periphery, just listening, but I think they are also happy to know more about our plans, and they enjoyed listening to the women and watching them engage. My dad, Oscar, also came to the party and he stood with the menfolk and chatted with them quite a bit. We don’t yet have programming for the men in the community but we are very glad that they came and now know more about what we are doing as we think this will make it easier for the women to come to our sessions without eliciting any suspicion from their husbands about what we might be teaching them.

We knew going into the Christmas party that the kids would be a bigger and wilder group so we recruited some extra help for Marcus and were so thankful for the help that Jane, Evetha, Gonie, Jennie, Jong and Jen lent us. Marcus and his team entertained the kids with games and songs and Evetha, who is an amazing story teller, told the children a few stories. It was a huge group but they managed to keep everyone engaged and entertained. Distributing the toys was the only portion of the afternoon that did not go as smoothly as other parts because of the extreme enthusiasm and excitement from the kids, but even that didn’t go too badly. In the end all the kids went home happy and were all very appreciative of their new friends and new toys.

After we cleaned up we piled into our cars and went home exhausted, but really thrilled with how well the afternoon went, and really excited about starting our programs there in January.

Other Activities

On December 14th Susan and I held a Board Meeting with our New York and Vermont based Board of Directors. Unfortunately Susan and I could not attend in person, but technology allowed us to participate in the meeting via phone. Our Board of Directors is comprised of intelligent and enthusiastic women and we had some great discussions about the work we’ve already done and our work ahead. One Board member, Suneeta, has already visited us in Palawan and we hope that in 2010 the rest of the members of the Board will be able to come to Palawan to see our work firsthand as well.

During the last week of work in 2009, we focused on organizing our materials and workshops so that we can hit the ground running in January 2010. Within the first few weeks of January we plan to test some of our workshops and activities with students at Palawan State University, start the programming for women in Pulang Lupa, and begin the nutritional support program for undernourished children in the community. We are so excited to begin our programming and for all that lies ahead in 2010.

All of us at Roots of Health / Ugat ng Kalusugan would like to thank you for your support and enthusiasm for our work since we started in August, and we look forward to your continued support and interest in 2010. We wish you all a wonderful holiday season, and send our best wishes for a peaceful and prosperous New Year.

Starting our activities with women

Evetha and Jong with some of the kids

Some of the men with Oscar

Distributing gifts

With the women

A little boy enjoying his new toy car

To view more photos from the Christmas Party, please click here.

Pulang Lupa

2009-11-30T15:30:00.000+08:00

November has been a busy and important month for Roots of Health. Since my last blog update, we completed our needs assessment. In analyzing the data as well as our general observations from being in the communities, we have decided to begin our programs and service delivery in a community in Santa Lourdes called “Pulang Lupa” (meaning “red earth”) which is a part of Purok Matahimik. It is the community that I mentioned before that is also referred to simply as “Dumpsite”. Based on the income and size of the local families as well as health and nutrition patterns, education levels and knowledge on reproductive health, Pulang Lupa is clearly the most underserved community and we believe they will benefit greatly from our programs.

Upon selecting Pulang Lupa as our first program site, we mapped all the households within the location and spent 4 days conducting in-depth surveys within every household in the community.

Photos of the community are available here.

The following are some of the data from the surveys:

Number of households - 59

Number of people living within the 59 households - 315 (average of 5.3 individuals per household)

Percentage of households with access to their own toilet facility - 61%

Percentage of households with access to their own electricity - 44%

Percentage of households with connection to their own supply of water - 5% (95% of the people in the community do not have their own connection to a water supply and have to walk down a steep hill to collect water from a well for bathing and cleaning and they buy water directly from a water company for drinking and cooking).

100% of the respondents live in homes made of nipa or thatch, and 95% of the houses have only one room for all of the inhabitants to share.

42% of the respondents do not have a job

The average salary in the community is around P3,330 ($66). However, this figure is skewed because of outliers-- two households have a monthly income of around P10,000 ($200) and many more have a monthly income between P500 ($10) and P1000 ($20).

Less than 30% of the respondents practice some form of family planning.

62% of respondents said that the ideal number of children is either 2 or 3.

Only 54% of respondents have been pregnant 3 times or less

Of the remaining women, 8 (13.5%) have been pregnant 4 times. 3 women (5%) have been pregnant 5 times. 6 women (10%) have been pregnant 6 times. 3 respondents (5%) have been pregnant 7 times. 2 women (3%) have been pregnant 8 times. 3 respondents (5%) have been pregnant 9 times. 2 women (3%) of respondents have been pregnant 10 times and 1 woman has been pregnant 12 times.

Nearly all births are at home with a traditional healer as a birth attendant

10 women have had no formal schooling in their lives. 17 women went to anywhere from 1st to 5th grade in elementary school. 14 women went up to the 6th grade and completed elementary school. 9 women had some high school education but only 5 women actually graduated from high school. 1 woman went up to her second year in college, and 3 women completed vocational or secretarial school.

All of the women have experienced difficulty in feeding their families, and very few can afford to buy meat or fish. Most women reported eating rice with either eggplant, kangkong (a type of spinach), plantains or casava when we asked them to tell us everything they had eaten the day before we interviewed them.

Support Roots of Health - Gifts with Meaning

2009-11-13T15:06:00.000+08:00

I wanted to let you all know about a unique opportunity to help raise funds for Roots of Health.

A friend of mine who lives in Australia, Frank Mathisen, has started an online store selling Christmas cards to benefit select charities. Roots of Health is one of the featured organizations.

Each packet of 10 cards is AU$20 (or about US$18.50) and for each packet sold, AU$10 is donated to Roots of Health. Shipping to the US/UK is AU$5 and the cards are mailed within 24 hours of receiving the order and payment. The postal service estimates that it takes 4-6 working days to ship the cards from Australia to North America/UK.

I would really appreciate it if you would consider purchasing your holiday cards this year from Gifts with Meaning to benefit Roots of Health. The website address is http://www.giftswithmeaning.com.au/.

We're trying to spread the word and reach as many people as possible, so if you feel comfortable forwarding the Gifts with Meaning information on to your family and friends, that would be fantastic.

Thanks so much for your continued support!

Honday Bay Photos

2009-11-12T06:23:00.000+08:00

We conducted surveys at Honda Bay - the last of the four sites we were considering for our programs. I'm not posting the survey results as I feel the answers have reached a saturation point - most of the results and comments were similar to previous surveys we conducted. But the photos that Marcus took of the site are gorgeous so I am sharing those here. You can also see the photos and comment on them on our fan page on facebook.

“I’d like to give birth in a hospital but I don’t have the money to pay for it. So I give birth at home.”

2009-11-05T14:09:00.000+08:00

Surveys in Purok Matahimik

Earlier this week we returned to an area in Santa Lourdes called Purok Matahimik which means “quiet place”, also known as “Pulang Lupa” or red earth because of the color of the soil, and is also simply known as “Dumpsite” because of the community’s proximity to the Puerto Princesa landfill. This community is a top runner for where we might begin our services as it is quite isolated and very poor and has high numbers of malnourished children.

Photos from our visit are here.

We interviewed 13 women between the ages of 17 and 56.

Family Planning Usage

We asked the women about their family planning usage and just over 30% of the women we spoke with use artificial forms of contraception. Three use the injectable DMPA (Depo Provera) and one uses birth control pills. All four women pay for their contraception themselves. Three of the women we spoke with use natural family planning methods including the calendar/rhythm method and the withdrawal method. One woman just recently gave birth to a baby and isn’t on any contraception but plans to be when her period returns.

Five of the women we interviewed do not use any form of family planning. One of them gave no explanation for why she prefers not to use any contraception. One woman said that she had been living in an isolated and rural area and did not have any access to any healthcare or family planning methods. Another woman said that she isn’t using anything because she doesn’t have a husband any longer and is on her own. Another respondent said that she didn’t think she had to use anything because she’s already old (she is 56 and has a four year old daughter.)

37 year old Helen, who has three children, said, “I’m not practicing any family planning right now, but there were 5 years between my last two children so I think that’s a good thing - but I’m not using anything. I tried using pills before but I only lasted about 2 months. I got so dizzy from the medicine. I actually thought I was already done with kids but then I got pregnant again. I just gave birth two weeks ago. I’ll probably go on something now - maybe the injectable [DMPA]. It’s really hard when you think you’re done with kids but then you suddenly get pregnant again.”

How many is a good number of kids?

We asked the women we spoke with what their ideal number of children is. The two youngest respondents, aged 17 and 18 and each with one unplanned child, said they would like to have 3 children. Both of them are now using contraception. Other respondents with 3-4 children answered that their ideals are the same as the number of children they do have. One woman, Carolina, 36 years old, said her ideal is three kids but she has five because she didn’t know of any ways to control the number of her pregnancies. Merleta, who is 34, has four children, which she says is her ideal, but she has had eight pregnancies, and none of them were planned. Edita, 56 years old, says her ideal is three children. She has four living children but has had nine pregnancies in her life - none of which were planned. 39-year-old Marlyn said her ideal is three or four children, but she has nine children - none of them planned. She actually gave one of them up for adoption some years ago because she did not have the resources to feed and care for another child. 48-year-old Angelita’s ideal is four children but she has eight. She lived in an isolated, rural area and had no access to contraception. Marilyn, who is 25 years old, says her ideal is four or five children. She has seven and is not on any contraception. She told us, “I can’t do anything because my husband doesn’t want me on any contraception. I actually asked my sister to adopt one of my kids because I have malnourished children and I can’t handle all of them myself.”

Pre and Post Natal Care

10 of our 13 respondents did receive prenatal care with their last pregnancy, but most only had two to four appointments before they delivered. Of the three women who did not seek prenatal care, one went to a traditional healer and two said they just took care of themselves.

After giving birth, five of the women we spoke with saw a health professional for at least one postnatal check up. One woman saw a traditional healer. Another did not have any check up but her doctor sent her a bottle of postnatal pills which she took for one month. More than half of the women we spoke with did not have a postnatal check up and four of told me they didn’t even consider it because they just don’t have the money to spend on a check up.

Health Care

Nearly all of the women we spoke with said that when they or their children are sick, they prefer to see a doctor when they can afford it, or seek free care from Barangay Health Workers. Two women said they they just buy their own medicine when they are ill rather than spend money on a consultation. One woman with no experience or training in herbs or alternative medicine said, “When I have money I like to go to a doctor. But when I don’t have any money I just use herbs that I find around where I live.”

Birthing

All of the women we spoke with except for one said that their preferred birth attendant is a traditional healer or a midwife. One person prefers a doctor. Seven of the women prefer giving birth at home and actually did have their children at home. Three women said they gave birth at hospitals just to make sure they would have the help they needed had there been any problems with their deliveries. One woman had her last baby at a hospital but the rest were born at home. She’d had eight pregnancies and four live births. One woman who has had nine pregnancies and four live births said, “I’d like to give birth in a hospital but I don’t have the money to pay for it. So I give birth at home.”

Thoughts on Family Planning

We asked the interviewees what their thoughts on family planning are and some of their statements include:

“You’ll probably be more successful if you plan your pregnancies.”

“You really have to do family planning because otherwise, you can’t make a good future for your family.”

“When you have lots of children its hard to support all the children’s needs.”

“You should plan your family so that you can give them a good life.”

Food and Nutrition

Most of the respondents breast fed their babies. The majority of them breast fed until their children were two years old though some breast fed for shorter periods (one to six months or a year) and some breast fed for longer (until age three).

We asked if any of them receive supplemental food support and nearly all of them have children who are fed in the biweekly Aloha feeding. (To read about Aloha’s program, see my previous blog entry by clicking here.) One woman said that she does not receive any support and added, while pointing to her daughter, “I really need some help for her - she’s so skinny.”

Household Income

We asked the women we spoke with what their monthly household income is and whether they or their husbands have work. Most women reported very small amounts of income that have to support multiple people for a month. One woman with four children said their monthly income is P1,000 ($21). She doesn’t have any work but would like to do anything to make more for her family. Another woman whose 84-year old husband is paralyzed sells fish in homes around the neighborhood and makes about P500 ($10) for her family of six. Another woman is a single parent and makes about three straw mats a month that she sells in the market. She can make about P500 ($10) to support herself and her son. Another single parent makes about P1,500 ($31) making and selling mats and this supports her and her eight children.

Merleta, who has eight children, said, “My husband makes P1,000 ($21). I make straw mats and in a month I can make around 5. They sell for P200-300 ($4-6) each in the market. I make a little but I use it to buy rice or food for the children. So I never have anything left.”

One woman makes P4,000 ($84) a month buying and selling scraps (mostly recyclable plastic and glass) that she collects from the dumpsite. This supports her, her husband and their eight children.

The wealthiest of the women we spoke with has a husband who works as a painter and makes around P9,000 ($190) per month. She supplements this income with around P200 ($4) a week that she makes selling items at a small store in front of her home (these stores are called sari-sari stores and are usually stocked with some snacks and basic supplies like soap and cooking oil.) She only has one child so they have a much better situation than most of their neighbors do.

One family’s experiences confirmed an anecdote we had been told by a friend who works for the city’s Department of Social Welfare and Development. Our friend told us that the city government is frequently months late in paying salaries to city employees. Most people in Palawan have no credit, so late payment of salaries really puts people in a bind. People need cash and some resourceful (and cunning?) people have stepped in and lend city employees money until they receive their salaries, but they take a huge portion of the earnings as their fee. Some people think the city government is in on this lending scheme but this is not substantiated. One of the women we interviewed with three children said, “My husband is a driver for the city and should make around P6,500 ($136) a month. But the city doesn’t pay the workers right away so then we have no money. He borrows some from lenders who then take a cut. So what he brings home is just about P5,000 ($105). I just take care of things at home and watch over the kids. Once my baby is older, I’d love to work - maybe run a sari-sari store?”

Other Resources

We asked our interviewees if they receive any supplemental support from groups conducting outreach work in their community. The women we interviewed noted that they sometimes get free care from the Barangay Health Center and the Puerto Princesa City Health Center. A Korean church group also organized a medical mission to the community once last year. They gave away medicine and clothes and performed circumcisions. They haven’t been back since. One woman remembered an outreach program that the military once had but couldn’t recall when that was or what exactly they did. One woman answered that she and her friends don’t get any other support and added, “Contraception really should be free for us. The Health center is really far away and anyway when you don’t have money, you can’t buy anything so then you’ll just get pregnant again.”

A lot of young kids have to take care of their younger siblings

A young boy playing on some of the recyclable scraps that have been gathered for re-sale

Ideally interviews are carried out in the privacy of a home but sometimes we have to speak with women out in the open with other people around. This wasn't such a big deal for these surveys but when we do our in depth surveys to gather our baseline data, we will have to ensure that surveys are conducted in more private settings.

Some moms with their children:

“We go to the doctor when we have money. When we don’t have any money, we just pray and do what we can to take care of it.”

2009-10-29T17:20:00.001+08:00

Last week, Ugat ng Kalusugan returned to Barangay Bagong Silang to carry out a mini-survey among Badjao families. Like our first survey in Bagong Silang, our purposes for carrying out another survey were two-fold: we wanted to test out our community health survey, and we wanted to get more information on one purok (area) of Bagong Silang because it is a possible site for our work. Photos from our trip are here.

The results of our second survey are summarized below. As with our first survey, there are several caveats. These survey results are not representative of the whole Barangay. We only interviewed 11 women and one man from 12 different households, and only households in the Muslim, Badjao portion of the community. We employed convenience or accidental sampling - a type of nonprobability sampling wherein the sample (interviewees) are selected from the general population because they are readily available and convenient. There is an added bias to the group we interviewed: they were all mothers (or a father) whose children under five years of age were receiving their regular deworming and vitamin supplements distributed by the barangay health workers. We opted to accompany the barangay health workers as they went from home to home so they could provide an introduction for us to meet women within the community. Because our sample is comprised of women (and one man) whose children are being cared for by the health workers, it is important to remember that they and their children are likely much healthier and better off than their counterparts who do not access any health professionals or receive any free medicine.

While we cannot make any generalizations about the community based on our survey results, the results do offer some insights into this community, and we found some of the results interesting.

We interviewed 11 women ranging in age from 19 to 35, and one man who is 48. We generally plan to interview only women but in one household the woman we wished to speak to was sick and resting and her husband offered to answer our questions.

Family Planning

We asked the interviewees if they practice family planning. Two women answered that they do use contraception. One uses hormonal pills and the other uses the injectable DMPA (Depo Provera). Both women pay for the contraception themselves. One of the women is Catholic and the other belongs to the Iglesia ni Christo church.

The rest of the women in our sample do not use any form of family planning, artificial or natural. When asked why, every single person said that they do not use any form of contraception because it is forbidden as it is against Islam. Several of the women who do not use contraception because it goes against their religious beliefs are young (ages 19-21) and as yet each have only one child. Among the older respondents (ages 28-40) most women have had multiple pregnancies and children. Maida, who is 28, has 5 children. Sherwina is 29 and has four children but has had five pregnancies. Tina, who is 30, has three children. Her friend Adea, who is 32, has three children but has had eight pregnancies. Sandra is 35 and has had seven pregnancies and has six living children. 48 year old Cesar’s wife has had 13 pregnancies, and has nine living children.

We asked the respondents what they think the ideal number of children is and most of them answered that the ideal is between two and four children. Some of the women with multiple children said that two or three is ideal, but that they couldn’t achieve their ideal because using contraception is against Islam. One women said the ideal is two or three but she has had seven pregnancies. She says she is too scared to use contraceptives. Cesar’s wife has had the greatest number of pregnancies and children (13 and 9 respectively) and in answer to what his ideal number of children is, he said, “Allah forbids planning. But in terms of what I think, this number [9] is enough. We’re already having a hard time and more children would be difficult. But if it is Allah’s will, then we will have more.”

Islam and Contraception

While we were carrying out our surveys, we asked the interviewees their beliefs and practices and we recorded their answers. We did not question people further about their religious beliefs but I was very confused as to why everyone was telling me that Islam forbids the use of contraception. I didn’t think Islam forbade family planning, but I wasn’t sure, and even if I was, I did not feel that it would have been appropriate to give an impromptu lesson on Islam and contraception. We completed the surveys and upon returning to our office, I conducted some internet research and found that Islam very clearly allows the use of contraception. I was stumped and continue to be. How is it possible that a large population of Muslims in this one particular community believe that Allah and the Koran prohibit something that in fact is allowed? These Muslim families are some of the poorest in the province, and most households are too large to support with one or two people’s meagre salaries. Yet families are large because men and women wrongly believe that their God prohibits planning their families. I have to assume that this group’s imam or their community elders have received incorrect information about Islam’s view of family planning and have successfully spread this misinformation among the population. I suppose that spreading the misinformation could be intentional, though I cannot comprehend why anyone would do that. This remains a mystery to me and I hope to have the opportunity to speak further with some of the people we interviewed to find out more about how they came to have this erroneous belief.

Care from Health Professionals

Eight of the women we interviewed had prenatal check ups with their last pregnancies. Among these eight women, none had regular checkups throughout her pregnancy. Most had only two or three check ups before delivering. The other four interviewees did not have any prenatal check ups and cited lack of money as the primary reason for not seeking care.

When asked what type of health professional they consult when they or their children are sick, six respondents answered that they seek care from Barangay Health Workers, four see doctors, and one goes to the City Health Center. One of the interviewees said, “We go to the doctor when we have money. When we don’t have any money, we just pray and do what we can to take care of it.”

When asked what type of birth attendant they prefer, eight stated manghihilot or traditional healer, two like doctors and one prefers a midwife. One respondent said she would really prefer to have a doctor, but her family cannot afford one so she uses a manghihilot or traditional healer.

Unlike their counterparts in other neighborhoods in Bagong Silang, the Badjao women we interviewed overwhelmingly prefer to give birth at home. When asked where their ideal birthing place would be, all but one of the interviewees said that they prefer to give birth at home. One women said she prefers the hospital. All the women who prefer home births did actually deliver their children at home, save for one woman whose parents took her to a birthing center because it was her first delivery. One interviewee noted that the home is best because their family does not have the money for a hospital birth, and another women said that she prefers the home because she is scared to give birth in a hospital.

Of the women we spoke with, only two had seen a health professional for a postnatal check up after their last pregnancy. These two women were the two women that gave birth outside the home - one at a birthing home and another at a hospital. None of the others had heard of the need for postnatal visits, and a few added that their health was fine after giving birth so there really was no need for a check up.

Beliefs about Family Planning

We asked the people we spoke with about their thoughts or beliefs relating to family planning. The following are some of their statements:

“It is forbidden by Islam to plan our families.”

“Islam forbids us to use contraception.”

“We don’t plan families because we are scared of Allah. We do not know more than Him so His will be done. Only God can let us survive.”

(-Cesar, whose wife has had 13 pregnancies and 9 living children)

You need to only have a few children so that you can

send them to school and feed them sufficiently.

(-Sonya, 19 years old with one child, not currently on any form of contraception)

“I’d like to give my children a good life -

have enough for them to go to school and to eat.”

(-Damesa, 21 years old with one child, not currently on any form of contraception)

“It’s better not to have too many children so that life isn’t too hard.”

(-Sherwina, 29 years old with four children, not currently on any form of contraception)

Beliefs about Pregnancy

We asked the interviewees about their beliefs regarding pregnancy. Most of the responses centered around a pregnant woman’s safety at night and included the beliefs that when you are pregnant you should cover your head if you go out of your home at night, that at night a pregnant woman should have garlic hanging in her house so that vampires will not be able to find her, and that generally pregnant women should not walk around at night. One woman said that pregnant women should not carry anything too heavy, and another said that when a pregnant woman reaches the month in which she will give birth, she should regularly drink ginger tea.

Immunizations

Like their counterparts whom we interviewed earlier in the week, all the children of the mothers we interviewed were up to date with their immunizations - or will complete them shortly (for babies under 1). These immunizations include BCG (Bacille Calmette-Guérin - a vaccine against tuberculosis), three doses of DPT (DPT refers to a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis [whooping cough] and tetanus), three Hepatitis shots, and three doses of the Polio vaccine. These results are probably not typical. It is important to remember that the women we interviewed were the mothers of children receiving medicine from the Barangay Health Workers. There is a bias here - these children are receiving care from the health center and thus are more likely to have completed all the requisite immunizations. If we were to randomly sample families within the community, we might not find 100% compliance with these immunizations.

Finances and Employment

Only two of the women we spoke with are currently employed. One delivers soap, and the other, who is the wealthiest of the women we surveyed, sells fish in the market. The man who we interviewed works as a street cleaner for the government. All of the other women have no work and expressed the desire to work in any kind of position that becomes available - especially being a saleslady or a maid.

Two of the people I spoke with have a monthly household income between P500-1,500 ($11-$32.) Three respondents have a monthly household income between P1,501-3,000 ($33-$64.) Two women reported a monthly household income between P3,001-4,500 ($64-$94.) Two of the families have a monthly household income between P4,501-6,000 ($94-$125.) One family’s monthly earnings totals P5,000 ($105). Another’s is P6,000-7,500 ($125-$161.) The wealthiest of the women represented had a monthly household income between P9,001-1o,500($188-$220.)

Supplemental Support

None of the children among the sample households we surveyed receives any regular supplemental feeding, despite the fact that Badjaos are referred to by city health officers as being some of the “poorest of the poor” and with some of the greatest number of children that are malnourished.

Most of the families do not receive any regular support from any outside groups but some families sometimes avail of services or food from the Department of Social Welfare and Development, Barangay Health Workers, from the city health center and from a nonprofit called Balikatan. One interviewee mentioned that her family sometimes receives free food when local officials celebrate their birthdays and feed the masses - an activity that is popular in Palawan and which Mayor Hagedorn and Governor Reyes both recently did for their birthdays.

“Life is very hard when you have too many children.”

2009-10-20T16:06:00.000+08:00

Yesterday Ugat ng Kalusugan carried out a mini-survey in Barangay Bagong Silang. Our purposes were two-fold: we wanted to test out our community health survey, and we wanted to get more information on one purok (area) of Bagong Silang because it is a possible site for our work.

Bagong Silang is a sea-front community with around 5,000 people - a third of whom are Cuyunon (a native group in Palawan), a third who are Bisaya (migrants from the Visayas) and a third Badjao. The Badjao are a traditionally marginalized group, looked down upon by non-Badjaos even in Islamic areas. Badjaos tend to be very poor and uneducated and are frequently beggars. 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. Average families in Bagong Silang have four or more children - a bit above the national average. The average age for a first child is 19 but there are also mothers as young as 14 or 15 - particularly among the Badjaos. To read more about Bagong Silang, click here.

The results of our survey are summarized below. Before sharing these, there are several caveats. These survey results are not representative of the whole Barangay. We only interviewed women from nine different households, and only households in the Catholic portion of the community. We employed convenience or accidental sampling - a type of nonprobability sampling wherein the sample (interviewees) are selected from the general population because they are readily available and convenient. There is an added bias to the group we interviewed: they were all mothers whose children under five years of age were receiving their regular deworming and vitamin supplements distributed by the barangay health workers. We opted to accompany the barangay health workers as they went from home to home so they could provide an introduction for us to meet women within the community. Because our sample is comprised of women whose children are being cared for by the health workers, it is important to remember that they and their children are likely much healthier and better off than their counterparts who do not access any health professionals or receive any free medicine. We do hope to accompany the health workers again when they do their medicine distributions among the Badjao population of Bagong Silang.

While we cannot make any generalizations about the community based on our survey results, the results do offer some insights into this community, and we found some of the results interesting.

We interviewed nine women ranging in age from 20 to 51.

Family Planning

We asked the women we interviewed if they practice family planning. Two women answered that they do not use any family planning. One did not explain why, and the other said she does not use anything because she doesn’t have a husband -- but she does have a two year old son.

The great majority of women do use some form of family planning. Two use natural methods (withdrawal and calendar method), three use pills, one uses an IUD and one used DMPA (Depo Provera). Of the women using artificial forms of family planning, only one pays for the medicine herself - the others rely on receiving them for free at the Barangay Health Center.

All of the women we spoke with think that the ideal number of children is between two and three. Just over half of the interviewees have the same number of children as this ideal, or one less child. Of the rest of the women, two reported having five children -- and they explained that they really wanted to have a baby girl, so they kept trying beyond the ideal number they desired. One woman with six children reported achieving her ideal of two or three children -- but did so with several different partners (!) One woman with five children said she had definitely wanted less children, but the five “had just happened”. She was one of the women who reported using contraception when it was given away for free.

All but one of the women we interviewed had prenatal check ups with their last pregnancy. Of those women who did get check ups, only one woman saw a doctor regularly from her first month of pregnancy until giving birth. The rest of the women saw a health professional between 2 and 4 times throughout their pregnancy.

When asked what type of health professional they consult when they or their children are sick, seven of the women answered that they consult doctors, three consult Barangay Health Workers, two consult a manghihilot (traditional healer), and one consults a nurse.

When asked what type of birth attendant they prefer, six stated doctors, two like nurses, and two women prefer midwives. One of the interviewees reported that for her last birth, she called a nurse to come but ended up having to give birth with a manghihilot (traditional healer) because the nurse got stuck in traffic and didn’t make it in time.

When asked where they prefer to give birth, two of the women listed their home and the local health center as places that would be ok, but 100% of the interviewees said that their first choice would be to give birth in a hospital. When asked why, most reasoned that a hospital setting is safest because there, they could have access to doctors and to any special equipment should there be any problems or complications with delivery. We did not ask the respondents where they did in fact give birth to their children, and will include this question in the next iteration of the survey.

Of the women we spoke with, only three had seen a health professional for a postnatal check up after their last pregnancy. None of the others had heard of the need for postnatal visits.

Beliefs about Family Planning

We asked the women we spoke with about their thoughts or beliefs relating to family planning. The following are some of their statements:

“I wanted to get a ligation but my blood pressure was

too high. So we just use the withdrawal method.

I don’t want to do pills or get the injectable type of

contraception - I heard those can lead to tumors.”

“You really should just have the right number of kids -

otherwise life will be full of hardship.”

“If your family is small, you’ll be able to satisfy the

needs of your family and be true to your beliefs.”

“It’s really hard to feed your family when you have too many children.”

“It’s good to plan your pregnancies because it is too hard

when the children come one right after another!”

“Life is very hard when you have too many children.”

Beliefs about Pregnancy

We asked the interviewees about beliefs they have regarding pregnancy. A few women answered that one should not drink or smoke while pregnant, and that one should always go for check ups and get a lot of sleep. We also heard the beliefs that a pregnant woman should never eat eggplant (no explanation) or drink cold water because that might make the baby get too big. Several women also said that a pregnant woman should wear black panties at night so that monsters or evil spirits will not be able to find the baby and harm it.

Immunizations

All the children of the mothers we interviewed were up to date with their immunizations - or will complete them shortly (for babies under 1). These immunizations include BCG (Bacille Calmette-Guérin - a vaccine against tuberculosis), three doses of DPT (DPT refers to a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis [whooping cough] and tetanus), three Hepatitis shots, and three doses of the Polio vaccine. These results are probably not typical. It is important to remember that the women we interviewed were the mothers of children receiving medicine from the Barangay Health Workers. There is a bias here - these children are receiving care from the health center and thus are more likely to have completed all the requisite immunizations. If we were to randomly sample families within the community, we might not find 100% compliance with these immunizations.

Finances and Employment

One woman’s monthly household income is P500-1,500 ($11-$32.) Another’s is P1,501-3,000 ($33-64.) Three women reported a monthly household income of P3,001-4,500 ($64-$97.) Another’s is P6,000-7,500 ($129-$161.) The wealthiest of the women represented had a monthly household income of PhP10,500-12,000 ($226-$258.) One of the women has no income and is being supported by her parents. Another woman had a monthly income of PhP1,500-2,000 ($32-$43) when her husband was alive, but he passed away last month and she and her two children are now being supported by her sister.

Only three of the women we spoke with are currently employed. One is a Barangay Health Counselor (and is the woman with the highest monthly household income), another takes care of pigs and another sells fish at the local market. One woman does laundry for her neighbors but does not have regular clients and sometimes has no work. Of the rest of the women without work, two expressed the desire to work if it was something they could do at home so they could care for their young children. Another respondent would like to be a saleslady and two expressed the desire for any kind of work - becoming a maid, a laundry washer, participating in a buy and sell scheme (like Avon) or anything else.

Supplemental Support

None of the children were receiving regular supplemental feeding, but a few of the children occasionally get some extra food from special feeding programs that the Barangay Health Center sometimes has funding for.

None of the families receive any regular support from any groups, but some have sometimes been able to avail of medical services or food from medical mission trips carried out by both foreign and local groups.

Walking on unsteady wooden plank bridges over the ocean to get to the houses

Conducting surveys

Trash on the ground is a common sight

Out on the water, space is at a premium

One of the mothers we interviewed with her baby girl

Another mother with her son and nephew. Her son has a growth on his face -- we didn't really

understand what it is but we are hoping we can find a doctor who will be able to take a look at it.

More homes

Conducting a survey outside a home. Notice the beautiful orchids by the side of this house. People really put in a lot of effort to beautify their environment.

A lot of fishermen live in Bagong Silang - this is the kind of boat a lot of them use when they go out to the sea.

Myths and Misinformation at PSU

2009-10-08T10:38:00.000+08:00

One of the primary goals of Roots of Health is to provide educational outreach about reproductive health to women and girls. Once we begin our direct service, we will be working with underserved communities and with participants who have likely not had any formal education since grade school. We are currently still creating and tweaking our materials, so when we were invited to teach a two-day seminar at Palawan State University on reproductive health, we jumped at the chance to test our materials. The students were from the College of Nursing and were three years into their coursework. In the Philippines elementary school only goes up to 6^th grade and high school only up to 10^th grade, so students enter college at age 16. So despite being third year students, my seminar participants were only 18 or 19 years old. I assumed that, being nursing students, the participants would have already covered a lot of the material I was presenting. I was wrong!

I was shocked at the levels of knowledge, or lack thereof, that the students had about general reproductive health and HIV. Here are some of the highlights:

Nearly 20% of the students believe that you can not get pregnant the first time you have sex, and 70% of them believe that you can not get pregnant while breastfeeding a baby.

Only half the group believes that the condom is the only type of contraception that can prevent pregnancy and also prevent the transmission of sexually transmitted infections.

More than 50% of the participants incorrectly identified saliva and urine as modes of transmission of HIV.

Only 1/3 of the participants correctly identified breast milk as a possible mode of transmission of HIV for babies born to HIV+ mothers.

Less than half of the participants believe that someone can have a sexually transmitted infection without manifesting any symptoms.

When it comes to attitudes about sex, the Filipino “macho” culture and gender expectations really emerged.

One in three students do not believe that a girl can force her boyfriend to use a condom if they are having sex.

One in four students believe that there is nothing a girl can do to prevent pregnancy if her partner refuses to use a condom.

One in six students believe that a girl does not need to worry about sexually transmitted infections if her partner promises that he is being faithful.

And finally, almost all the students stated that premarital sex is bad, but one in three respondents thinks it is ok for an unmarried boy to have sex, compared to one in six believing the same thing for unmarried girls.

At the close of the workshop I administered the same survey I gave the students at the beginning of the two day seminar. Attitudes did not change a great deal but some knowledge did increase, and many of the misperceptions students had about basic reproductive health and HIV were corrected.

This experience was very positive in that the students were thoughtful in their discussions and appreciated the chance to speak freely about issues that are seen as taboo. And I think many of them really learned some new things that hopefully will help protect their health. The experience also reinforced the immense need for disseminating information about reproductive health. The students I met are not necessarily wealthy, but they are much more privileged and educated than the communities we will be targeting in our work. When future nurses know so little, it is likely that individuals without any formal training or education will know even less. We have a lot of work to do!

A Day at the Dump

2009-10-05T10:13:00.000+08:00

There is a nonprofit orphanage here in Palawan called Aloha House that conducts an outreach feeding program twice a month in a Barangay called Santa Lourdes. This past weekend Marcus, Susan and I joined Keith (Aloha’s founding director) Sheila (Aloha’s social worker) and their staff and observed their feeding outreach to get a feel for how we might want to run our programming.

The actual neighborhood that the feeding program takes place in is called “Dumpsite.” It is in fact the city dump and the residents there make a living by sorting and separating the trash, cleaning out the plastic and glass bottles, and salvaging anything that went into the trash that can still be used. Much of the actual waste then goes into a nearby "sanitary landfill" (more on this later!) Most of the people living in this location live in huts scattered around the hillside. Many of the residents keep pigs and we also saw some goats and a couple of turkeys.

Walking into the residential area

One of the many pigs in the area

When we arrived at Dumpsite we pulled up to the local church – a building with a cement floor and a nipa ceiling and walls (nipa is a type of straw commonly used here for structures.) The church was pretty dusty but as soon as we got there, a handful of mothers appeared and started sweeping the floor and setting out the plastic chairs stacked in one of the corners of the room. The Aloha staff unloaded the food they had brought – two cauldrons of food and two large jugs of fresh milk – and started setting up the bowls, cups and utensils. The food they serve is a very high nutrient porridge made of brown rice with mongo (mung) beans, malungay (moringa, a leafy green), and ground beef. The Aloha staff also brought a large container with boiled eggs cut in half, and each bowl of porridge was topped with half an egg.

The kids trickled into the church slowly at first but soon there were well over 50 kids ranging in age from under 1 to about 12 or 13. Because this population is so poor and underserved, Aloha doesn’t impose an age or weight cut-off. Once every couple of months they take down the children’s names and weigh them, but any child that comes to the feeding gets fed.

Keith noted that when they first got started, it was pretty chaotic but on the day that we went, we were impressed by how orderly and efficiently the feeding was carried out. Three Aloha staffers manned the table with the food and dished out the porridge and eggs and handed them to the kids, who by this point had lined up and were waiting patiently for their bowls. Once the kids got their bowls, they sat in chairs and waited for the go signal to start eating. The first child to finish eating is given a prize – that day it was a box of crayons. The contest to see who can finish eating first doesn’t seem like the best idea but I imagine they do this as a way to have all the kids wait and start eating at the same time, which makes it easier to ensure that everyone has had their first bowl of food before the Aloha staff start dishing out second helpings. Some of the kids were satiated by a single serving (the porridge is very heavy and looks quite filling) but many did ask, and were given, seconds. When the kids returned their empty bowls, they were given a glass of milk.

Sheila serving up the porridge

Some of the little ones

Eating in their little chairs

The little boy on the left was feeding the smaller boy on the right

More kids drifted in as the feeding was underway and by the time the feeding portion was through, Aloha staff had fed around 65 children, plus maybe 3 or 4 adults who were helping distribute the food. Once all the kids had been fed, the Aloha staff led them in some singing and some games before the staff packed up and left.

We interacted with some of the kids and they were all quite friendly. We were struck by how unhealthy they all looked though. They were pretty dirty and thin, and they looked much worse off than the kids that we’ve seen in Bagong Silang and in Bakungan. We had not been previously planning to consider this Barangay as a potential location in which to start our programs, but now we think it might be a really good place to work. The community is very poor and faces additional health issues due to their proximity to the trash and toxic waste. We don’t believe anyone has done any work with this community outside of the Aloha feeding so we will likely have to conduct our own surveys to get data on reproductive health needs and general community health. We didn’t have the chance to meet many of the mothers in the community but we’re hoping to meet more when we do return to start gathering data.

After the feeding program was over, we drove a short distance from the residential area to the actual landfill. The sanitary landfill claims to be the first of its kind in the Philippines. The funding for it was provided by a German organization and while the technology used at the landfill is appropriate for colder climates, it is apparently not terribly well suited to the trash and climate situation in the tropics. We’re not sure exactly how everything works and how many people are officially employed at the landfill but it looked pretty organized. We were amazed by the stunning views visible beyond all the trash. I’m looking forward to doing more research into this location and community and will keep you all posted on what I find!

The trash

This photo does it no justice but the view from the dumpsite is amazing!

Bakungan

2009-09-28T17:58:00.000+08:00

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

2009-09-01T14:51:00.000+08:00

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!

2009-09-01T14:43:00.000+08:00

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.