Basilan: The Fear to Tread

BASILAN ISLAND (Alexandra Garcia / 21 Mar) "Last summer, five children died of diarrhoea in our village. The mothers of the sick children had asked for my help but all I had were some condoms and contraceptive pills.

I approached the authorities for transportation fare to get material from the town's Rural Health Unit (RHU), but they said the barangay has no money. I had no money either, and a pump boat ride - the only way to reach the mainland - is expensive.

I watched helplessly as the children died one after the other."

This story was related by Soraya, a village health worker (BHW) on the island in Basilan, one of some 230 BHWs serving the 300,000-odd people of the province.

Basilan attained international notoriety in 2002-03 when the dissident Abu Sayyaf group carried out a spree of terrorist activities in the region. Now, an uneasy peace pervades but the health sector appears to be one of the conflict's casualties.

The Department of Health personnel is underscored by a comparison of its doctor to population ratio of 1:144,865 with the current ratio in the country (1: 20,000), and the ideal ratio prescribed by the World Health Organisation (1:10, 000).

Because of this, many sick people are forced to rely on sheer faith, traditional healers, and over-the-counter drugs.

The situation is now so bad that Lamitan District Hospital has a note permanently stuck on the front door; "Sorry, we have no doctor." Since the still unresolved killing in 2004 of Dr Julius Aguila, its chief, the hospital has remained doctorless.

Sumisip District Hospital, the other facility under the provincial government, is not functional. As in Lamitan, there are no takers for the hospital posts. This is where BHWs step in.

Ana Turabin, a public health nurse, enumerates the BHWs' tasks: assist in various Department of Health programmes like polio immunisation; counsel couples on methods of family planning; dispense pills and condoms when supplies are available; and assist midwives in pre and post-natal care.

They advise parents on child health and nutrition; perform minor health procedures like first aid; are tapped as treatment partners in crucial programmes; and conduct house-to-house surveys when required.

Turabin says the service rendered by BHWs is vital, especially in far-flung areas not regularly served by the health personnel. Despite the wide-ranging services expected of them, their work is considered "voluntary" and, therefore, not regularly compensated.

In some towns, BHWs receive meager allowances ranging from P 250 (US$1=Pesos 51.36) per quarter to P 150 a month. Most BHWs interviewed, however, claimed that aside from occasional donations from residents for services and medicines dispensed, they are not remunerated at all.

There are markers of their importance to the system, though. November 23, 2005 is officially recognised as Barangay Health Workers' Day. And there are laws that provide several incentives and benefits -- like hazard and subsistence allowance, continuing education, exposure tours, field immersion, scholarship, special training programmes, free legal services, preferential access to loan and Civil Service Eligibility -- to BHWs who have rendered five years continuous service.

For the Basilan BHWs, however, these laws are meaningless -- even frustrating --because they are not implemented. There is a glimmer of hope, though. A Bill that seeks to increase BHWs' salaries is due; another Bill seeks to set aside additional funds for their work; and a third seeks to grant a monthly travel allowance as an additional incentive for BHWs.

Minang, 37, does not avail of prenatal care and delivered all her babies at home with the help of a "panday" (traditional birth attendant). She said her husband forbids her to use any contraceptive, averring that it is prohibited in Islam. She complains of an aching back and perennial fatigue but says her husband knows what is best.

Ironically, Muslim-majority Basilan has a Fatwa (Islamic edict) on family planning citing Quranic authority and listing allowable methods. This injunction apparently has not reached Minang's husband. Mariam, the BHW in Minang's village, is also concerned about incidents of wife battering and the high rate of parasitic infection in the community.

She added that people diagnosed with tuberculosis do not take their medicines religiously even if they are provided with free medicines. Some children, she observes, have already been infected by their parents. Others are malnourished or have skin diseases.

Although several donor organisation and NGOs are implementing programmes to strengthen the capacity of local government to address the health needs of their constituents, unless the local executives cooperate, these efforts are bound to fail.

The critical health situation in Basilan is a signal for people to take their local governments to task for failing to respond to the issues and concerns in the health sector. The problems seem insurmountable but Mariam remains hopeful. Inshallah (God willing), she says, in due time, we will solve these problems. (Women's Feature Service)