Community health worker with herbal medicine. Photo: Blair Seitz

WHEN Maria noticed the open sores on the ear of a little boy who had just moved in next door, she bathed them with an antiseptic solution from boiled guava leaves. But she didn’t have any ointment A commercial preparation was too costly and there were no malunggay shoots in her backyard to boil with coconut oil to make a herbal variety.

Hoping that another clean oil would be helpful, Maria strained the only one she had — the remains from frying the evening fish. She applied it for several days, and the sores disappeared.

Maria’s knowledge and concern stem from the community-based health programme (CBHP) in her barrio (neighbourhood). Inspired by several foreign volunteers and agencies, villagers who were consistently cut out of medical services by their poverty and remoteness began to loosen the stranglehold of an unjust system. They made health a right instead of a commodity. Rather than think that the little boy should see a doctor, Maria considered what she could do.

The loosening is a process, a slow moving from a dependency mentality to a spirit that strives for self-reliance. Only after a lot of persuasion about herb medicines did Maria use them instead of the Western drugs.

When poor Filipinos — 70 percent of the population — are asked what medical facilities they enjoy, they frequently answer, ‘No-body ever comes to our barrio. Sixty-eight per cent of the country’s doctors are abroad.

Only ten per cent of the rural folk receive any doctor’s care. So alternatives have been found.
Community-based health begins with analysis. Residents work out what they need. Cough, fever and diarrhoea are common for the poor. The Ministry of Health puts influenza, bronchitis and gastroenteritis among the most common causes of death in the country. Rheumatic fever, which often results from untreated respiratory infections, is a leading contributor to heart disease, the second highest cause of mortality.

Professional health workers give intensive training on body functions, food values, traditional medicines, and so on to volunteers or elected residents. The newly trained health workers then ‘echo’ their learning to their neighbours. Taking in new information and sharing it is a perpetual process which increases not only knowledge but awareness. It is human and fluid — open both to creative enhancement and error.

‘During our study of the lungs, we discussed the role of steam inhalation in clearing congestion,’ said one nurse. ‘The people told me now they understand why the old folks told them to take a congested child down to the sea in the morning.’

Resistance to alternatives to Western medicine is because of the notion that pharmaceutical cures from abroad are better and safer. In the regular health system Filipinos line up to state their complaint and receive a prescription that they may not be able to afford. Dozens of mothers have told me that the health knowledge they got from the community-based health program has relieved them of taking their children to clinics. Now they can get stool examinations for worms in their own neighbourhoods and can receive fresh ipil-ipil seeds for de worming. They know how to reduce fever and relieve cough.

Examining for sign of T.B. Photo: Blair Seitz

Translating these ideas into tangibles saves lives. For tuberculosis victims in far-flung barrios, AKAP, which stands for Help Your Neighbour Movement for Health, has extended the community health approach to this major killer. Over 770 volunteer health workers have been trained to do sputum examination and give treatment to positive cases.

Nolasco Cahilig benefited from the concern of AKAP health workers. When he moved into Carmons, a resettlement area for squatters, Cahilig was approached by his area health worker Marita Munoz. She asks any coughing persons to spit phlegm in a cup she folded from shiny paper. With a fresh coconut midrib, she scrambles the phlegm throughout the saliva; puts it on a glass slide and dries it for ten seconds over an alcohol flame. Next, she stains the specimen. Trained to look for the ‘red dashes (TB bacilli) in a sea of blue’, she uses the microscope housed at the clinic and begins drug treatment on positive cases. There is no waiting for lab results, instead consistent treatment and follow-up.

Munoz invited the Cahilig family to a crash course in TB treatment. The father began spitting his phlegm in a can and burning it at the end of the day. He kept his glass separate. All three children got BCG vaccinations. It was all very different from his out-patient treatment in Manila at a clinic far from home where he learned nothing about how TB spreads.

Two years later Cahilig is cured — and stouter — and now an AKAP health worker himself.

Things turned out differently — and more typically — for Kardo Lopez. His sudden attack crumpled the fragile existence of his wife Manang and their nine children. It had seemed that he was keeping the TB in check; occasionally he even worked at the port. But this time the coughing wouldn’t stop, and there so much blood. Now he was in the hospital. The bed free but the medicines cost far more than Manang earned in a month as a laundry-woman. And how would she buy the nutritious foods they said he needed for strength?

At an exorbitant rate, a money-lender paid for Kardo’s treatment but the TB had taken too firm a hold. A week later he was dead.

‘When communities deal with the causes of disease, they invariably go beyond germs to the social and economic causes,’ noted one Community CBHP doctor. Behind them are factors that block the poor from health-promoting political power. Over crowdedness, poor sanitation and undernourishment set the stage for TB and other preventable diseases. Coughing was widespread in the crammed neighbourhood where the Lopezes put up their 12 square meter shelter. And before Kardo’ s own hacking began, he finished off many a workday with only rice. Breakfast was often hot water.

Poverty invites a recurrence of TB. With a cure rate of 98.6 per cent in five pilot areas, AKAP confirms that scientifically trained and motivated non-professionals can handle both TB diagnosis and treatment. But with 40 per cent of the population infected, the disease cannot be beaten unless social and economic conditions improve. ‘TB is the yardstick of social justice,’ says Dr. Mita
Pardo de Tavera, AKAP’s director and TB specialist.

In spite of visions of substantial change someday, the Community Based Health Programs move painfully slowly. But the failures are there: one community program’s anniversary featured a baby bottle-drinking contest — even though breast-feeding is encouraged. People borrow herbs from health workers instead of accepting seedlings to raise their own. Mothers who cook balanced meals give in to their children’s pre-dinner cravings for junk food. Doctors and nurses fail to live on the same level as the people they serve.

But very slowly people have become assertive about their needs and what they value has drastically reduced the catch of small fishermen.

Poor Filipinos may have loosened the rope that strangles their health, a small mercy, but the noose is not yet untied.

Ruth Seitz is a freelance journalist based in The Philippines.