IN
1977, the World Health Organization (WHO) launched a worldwide movement called HFA 2000 or
Health for All by the New Millenium. Two decades and two years after, the Philippines, a
member-country, is far from the goal of ensuring equal health status for all Filipinos,
irrespective of socio-economic status and place of birth.
___Figures presented recently by the Community Medicine
Foundation (Commed), an NGO of community-based physicians and other health professionals
who advocate for community health, were sobering. Citing case studies during the National
Colloquium on Primary Health Care held in UP Manila early this week, Commed revealed that:
poverty and malnutrition are worsening
maternal mortality rate (MMR) and infant
mortality rate (IMR) remain high at 171 per 100,000 births and at 50 per 1,000 live
births, respectively
infectious diseases, such as tuberculosis and malaria, are re-emerging
around 15,000 persons get measles every
year despite the supposed 100-percent attainment of immunization targets
one out of five persons dies of
complications from pneumonia and diarrhea
most people still do not have access to
potable water
occupational diseases are on the rise
___For
all this, Commed says, the government is largely to be blamed, having failed to deliver
basic health services to the residents of far-flung areas. According to Commed, Section V
of the Declaration of Alma Alta, signed by WHO member-countries at the International
Conference on Primary Health Care in 1978, says: "Governments have a responsibility
for the health of their people which can be fulfilled only by the provision of adequate
health and social measures."
___Now,
Dr. Reynaldo Lesaca of the Health Alliance for Democracy suggests, it is time that the
sorry state of the Filipino’s health is examined in the context of the system that
has bred the debacle or, at the very least, the stagnation of such basic services in the
country.
___Judging
from the cases presented at the UP Manila conference, the Philippine government has a long
way to go to bringing every Filipino to "a state of complete physical, mental and
social well-being… without distinction of race, religion, political belief, economic
and social condition."
Malnutrition in Misamis
___In
1998, a deworming and nutritional assessment program of children aged 2-8 was conducted in
the barangays of Mamalad, Siloy and Singalat, Misamis Oriental in Northern Mindanao, under
the supervision of Dr. Jo-Anne Marie Salangsang, head of the services desk of the
Zamboanga Peninsula Health Extension Program. All these areas are mixed Visayan and
Subanen farming communities.
___The
program revealed several stories of malnutrition, hunger and general unhealth. For
instance, in all three barangays, most children were found to be underweight. In Mamalad,
only 7 per cent of children are of normal weight, while 47 per cent are malnourished to
the first-degree. In Siloy, only 13 per cent of the children have normal weights, while 62
per cent have first-degree malnutrition. In Singalat, only 9 per cent are of normal
weight, while 29 per cent are suffering from first-degree malnutrition, 41 per cent
second-degree, and 20 per cent third-degree malnutrition.
___Height
is also a problem in all three barangays. In Mamalad, 41 per cent of the total child
population have normal heights and 45 per cent suffer from mild stunting, and 14 per cent
have moderate stunting. In Siloy, 54 per cent of the children have normal heights, while
40 per cent have mild stunting and 16 per cent have moderate stunting. In Singalat, only
16 per cent are normal in height, 37 per cent are mildly stunted and another 37 per cent
are moderately stunted. Nine per cent are severely stunted.
___In
her conclusion, Dr. Salangsang said that the state of children in Barangay Singalat
"can be correlated with the fact that it is the farthest and most economically
deprived among the three."
The lepers of Tag-anghin
___Barangay
Tag-anghin is one of the 58 barangays in the municipality of Tapaz, Capiz. The community
is very isolated and is not accessible by modern transportation. There are roughly 90
families, each having five or more children. The residents live on slash-and-burn farming.
___The
fact-finding mission of COMMED to the place in 1997 found that the barangay is
"deprived of basic social services." A midwife, the report said, visits once
every two months, and only to provide immunization. The last time a doctor visited was in
1991. The nearest health center is located in Barangay Roxas, which is about a day’s
walk away.
___Out
of the 186 patients treated during the mission, six were found to be suffering from
leprosy, with active lesions. Some have never been treated while others were provided with
multi-drug therapy against leprosy, but treatment was not completed or was erratic. At
least nine more suspected cases of leprosy were reported by barrio folk but did not show
up during the mission.
___Discrimination
and ill treatment of leprosy patients is rampant in Tag-anghin because of lack of health
education among the people. Many leprosy patients are secluded in the forest, far away
from the barrio proper. An old woman with severe deformity, according to Fe Mamon,
executive director of HELP-Panay, (Health Education for the Less-Privileged-Panay), was
reportedly burned alive by the military with the
consent of her family.
___Mamon
shared data from the Western Visayas Regional Health Office for the year 1997 showing that
the incidence of leprosy is on the downward trend, but anecdotes gathered from rural
health workers and barrio folk tell of many undiagnosed and isolated cases in their areas.
Case-finding, Mamon continued, remains difficult due to the social stigma, and treatment
remains erratic due to inadequacy of supplies and "low compliance secondary to lack
of knowledge of what is actually happening in many rural remote areas."
___The
government set the goal of eliminating leprosy as a public health problem by the year
1998, and started to phasing out and converting its leprosariums nationwide. But it is
clear that the menace of leprosy has not left us.
Wanted: water in Nueva Ecija
___"The
municipal water systems were partially or totally destroyed or rendered ineffective due to
lack of maintenance. The barrios were, for the most part, without clean water in
sufficient quantities; there was lack of proper excreta and body waste disposal
facilities. In fact, all the necessities for a minimum state of physical, mental and
social well-being were lacking.
___"In
addition, poverty, lack of understanding of the causal relationship between disease and
insanitation, and the existing socio-economic conditions were largely responsible for the
high disease index in the Republic of the Philippines."
___This
was how the 1955 Annual Report of the Philippine-American Public Health Program described
in part the health situation of the country after World War II. COMMED asserts that it
remains true even today, as it does in Nueva Ecija.
___A
1998 survey by the Community-Based Halth Program-Nueva Ecija (CBHP-NE) covering four
barrios each in the towns of Guimba, Cuyapo, Nampicuan and Talugtog, shows that an average
of 180 persons (or 30 households with six family members each) share a single source of
water, usually a shallow well or poso of "questionable potability." The survey
says that "Many of them are positive for coliform organisms." Coliform is a
cancer-causing substance.
___Toilet
facilities are no better. Official 1991 statistics show that in Nueva Ecija, only 65 per
cent of households have sanitary toilets; 19 per cent have unsanitary toilets; and 15 per
cent have no toilets at all.
___But
then, who else is not in this pit? According to COMMED, only 68 per cent of the total
Philippine population have access to public potable water supply systems. Of the 42
million covered by water services, 57 per cent get their water from wells -- developed
springs of rainwater collectors; 28 per cent are serviced with communal faucets; and only
14 per cent get their water from distribution systems and communal faucets. The remaining
32 per cent of the population get their water from rivers, rain ponds, and open dug wells.
___In
1990, only 3.9 million out of the 11 million households had private, water-sealed,
septic-tank toilets. Some 942,000 households shared toilets with other households, one
million used closed pits and 1.6 million used open pits. Still, some 1.8 million
households had no toilets at all.
Dental decay in Tandag
___HFA
2000 set specific oral health goals for signatory countries. These are: 50 per cent
caries-free for ages five and six; less than three decayed, missing or filled teeth for
the age-12 group; 85 per cent retention of all their teeth at age 18. For ages 35 to 44,
the WHO envisioned a 50 per cent reduction in the number of persons with no teeth (in the
case of the Philippines, this means that 75 per cent of this age group should have at
least 20 teeth). And for the age group 65 and above, there should be a 25 per cent
reduction in number of persons with no teeth – that is, half of the age group should
have 20 teeth.
___Today,
however, the WHO cites the Philippines as one of the countries in Southeast Asia where
oral cancer is a common occurrence. Oral cancer is the 6th most frequent cancer in the
world but in developing countries, they rank third for males and fourth for females.
According to COMMED, 98 per cent of Filipinos suffer from dental caries and 50 per cent
suffer from various gum diseases. At the age of 12, most Filipino children have six
decayed, missing or filled teeth due to caries. COMMED remarked on the irony that like any
other diseases on top of the morbidity list of the country, oral diseases are enormously
preventable.
___What
contributed further to the problem, according to a COMMED paper, The People’s
Struggle for Dental Health Care in Tandag, is the inadequacy of the public dental health
system. As of 1997, the dentist-to-population ratio is 36,000 Filipinos for every
government dentist.
___The
paper pointed out that Tandag, capital of the Surigao del Sur in Northern Mindanao, has a
high incidence of dental patients in need of tooth extraction and dentures.
___"Like
the national government, the local government does not prioritize the health budget for
the province. Efforts in providing dental health education as a preventive measure of
dental problems are negligible. Dentists can hardly go farther than their health station
because of the lack of budget for transportation," the paper said.
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