6th Philippine Conference on Community Health
College of Pharmacy auditorium, University of the Philippines-Manila (UPM), Ermita, Manila
Thank you very much. Kindly take your seats.
Dean Charlotte Chiong of the UP College of Medicine; Dr. Abdel Abulla; Dr. Edelina dela Paz; Dr. Tilde Hao; members of the faculty present; my dear students and members of the medical and allied professionals; honored guests; ladies and gentlemen; magandang umaga po sa inyong lahat. [applause] Pagsasabayin ko na lang. [laughs] You know when I was on my way here, I was telling your advisers that when I was looking at the speech prepared, sinabi ko sa sarili ko na hindi ko na babasahin iyong speech because I think, you will benefit more from stories and the realities that I have come across with on the ground. Sobrang dami kasi. I would not want to venture on lecturing you about anything… about anything medical dahil mas mahusay kayo doon. Pero ikuwe-kuwento ko lang sa inyo, abogado ako. Maybe I’m the only lawyer in this hall and it is both an honor and a daunting task to be among doctors and medical students. Sinasabi ko sa mga estudyante na kaharap ko kanina na I have so much for doctors kasi my second daughter is also a medical student. Clerk na siya ngayon. Hindi na namin nakakausap. [laughter] Nasa bahay siya every other night pero kapag nasa bahay siya, hindi na siya nakakarating ng kuwarto, hanggang sala lang siya. Doon lang siya. Iyon na iyong bahay niya, doon na siya natutulog, doon na lahat, dahil sa pagod. So when I see medical students, when I see doctors, parang na-i-imagine ko how much hardwork and sacrifice ang kailangan niyong pagdaanan because of that.
Gaya ng sabi ko, ako, abogado, and siguro, alam ng mga kasama natin dito na doctors because we all come from the same region—lahat sila mga Bicolano pareho ko. In all the years that my husband was a politician, I was just a practicing lawyer. Pero when I was a practicing lawyer, hindi ako iyong abogado na naghihintay sa law office. I belong to SALIGAN. It’s an NGO of lawyers. Instead of waiting in our offices, nasa communities kami. Ang ginagawa namin, hindi lang kami nag-a-abogado kapag may kaso na, pero ang ginagawa namin ine-educate namin iyong mga sektor. In fact, we translate laws into the dialect para alam nila iyong mga karapatan nila. Para sa amin mas preventive iyon kasi kung alam nila iyong karapatan nila, they will be in a better position to fight for their rights. Kung alam nila iyong kanilang mga obligasyon, mas maiiwasan nila iyong mga violations na hindi dapat nila ginagawa. So that was what I was doing for a long time for about 10 years. Talagang babad doon sa communities and ang ginagawa namin, tinuturuan iyong mga tao. And we think, the medical profession should also be like that. Hindi na naghihintay sa clinics para gumaling ng mga may sakit, pero sinisiguro na hindi magkakasakit. And I think that is also the aspiration of many doctors—to ensure that Filipino families are healthy, ‘di ba? Iyon naman iyong pinaka-obligasyon.
Pero iyong realities on the ground, iba talaga. Iyong realities ng kahirapan, iba talaga. And I want to share with you iyong mga kuwento na I come across with. Halimbawa, when I was—when my husband died in 2012, I became an instant candidate. I was not ready, I became an instant candidate, and in a few months’ time, I was already a member of Congress. And one of the first things I did when I became a member of Congress [was] to find out kumusta iyong kalusugan sa aming mga barangay. So tiningnan ko, I checked our stats, alin iyong mga barangay na napakataas ang malnutrition rate kasi most probably, iyong mga sakit doon din naguumpisa. So hinanap ko anong mga bayan, anong mga barangay na napakataas ang malnutrition rate, and I decided to launch a malnutrition—a nutrition program in a town na pinakamataas iyong malnutrition rate. So I went. Pagpunta ko, mayroon silang feeding programs. Iyong feeding program nila, the municipality was spending a lot of money on it. Pero noong hiningi ko na iyong kanilang baseline, wala. Tinanong ko sila, “Saan ba galing iyong numbers? Bakit sinasabi na kayo iyong may pinakamataas na malnutrition rate?” Ang sabi nila, “Ma’am, iyong pinakalast”—I became a congresswoman in 2013—ang sabi nila, “Ma’am, iyong pinakalast na baseline namin 2009 pa.” So sabi ko, “Ano iyong basis noong pagtala kung sino iyong mga malnourished?” Iyong mga bata raw kasi, payat. Nakikita kasi payat.
So sinasabi ko, kung wala tayong basis, so gawa tayo ng basis. Kunin natin iyong mga height at saka weight ng mga bata. So may mga barangay na isa-isa, pumupunta sa opisina namin, ang sino-solicit nila sa akin—nagsosolicit sila ng mga bathroom weighing scales at saka mga tape measure, iyong sa damit. So tinatanong ko, “Bakit niyo kailangan ng bathroom weighing scales at saka tape measure?” Sabi niya, “Kasi susukatin namin iyong”—ang term nila ikikilo eh—“kasi ikikilo namin iyong mga bata at saka susukatin namin iyong height.” Sabi ko, “Wala kayong salter weighing scales at saka wala ba kayong mga height board?” Sabi nila, “Ma’am, mayroon pero iisa. Iisa na pinaghihiramhaman ng mga barangay.” I think that particular municipality has 16 barangays. So sabi ko, tingan ko nga. Titingnan ko kung ano iyong available. Ayon, unfortunately iyong nag-iisa nilang salter weighing scale sira tapos iyong height board nila parang may nakalagay from Ministry of Human Settlements. Eh iyong Human Settlements, parang 70s pa iyon. So sabi ko, “Ito ba iyong nandiyan sa inyo?” Sabi niya, “Ma’am, oo. Iyan lang din iyong pinaghihiram-hiraman namin pero sobrang hirap manghiram kasi pinagaagawan.” So the following day, I went to the regional office of our DOH. Iyong nasa Legazpi na regional office. I talked to the regional director for the purpose of just asking her where we could find salter weighing scales and height board for all the barangays in that particular municipality. And then when I went, sabi noong regional director, “Ma’am, ang dami natin niyan. Isasama kita sa warehouse.” Sabi ko, “Puwede ko na bang kunin ngayon?” Sabi niya, “Puwede na, Ma’am.” Sabi ko, “Bakit iyong mga barangay namin wala?” Sabi niya, “Ma’am, ang tagal na niyan dito wala namang nagrerequest.” So alam niyo iyon, iyong disconnet? Parang the municipality was suffering without that—without those pala—for so long and yet DOH has. We didn’t—walang nagrerequest kasi ‘di ba devolved na kasi iyong… devolved na iyong health. So parang grabe iyong disconnect, na nandiyan naman iyong solusyon pero hindi… hindi napapa-meet halfway.
So okay na, tinitingnan ko, sabi ko, “When I looked at your… when I looked at your data all through the years”—kasi 2009, so i-update natin lahat. Pagbukas ko noong folder, there was a very thick folder ang nakalagay “Accomplishment Report.” So gusto kong tingnan iyong accomplishment report. Noong binuksan ko, parang all pages iyong nilagay nilang accomplishment, number of children fed. So I think the problem is with that kasi sabi ko, in the first place, the number of children fed should not be treated as an accomplishment because it is only a means to achieving an end. Kung nakuntento na iyong mga LGU—iyong ibang LGU kuntento na sila sa nagawa nila kasi iyong sukat nila kung ilan iyong mga nag-a-undergo ng feeding program, ‘di ba? Iyong nag-a-undergo ng feeding program, iyon na iyong accomplishment nila pero wala silang data kung iyong feeding program nila actually accomplishes, ‘di ba? Eh kung wala silang sukat, kung iyong mga dating malnourished, hindi na malnourished ngayon.
So we had to start from scratch. But it was really a sort of a risk. Parang lahat kailangang i-reset—reset of everything that was—that they were so used to doing. So I thought it was an isolated case. Pero apparently, it was not because of most of the LGUs with very high malnutrition rates, ganoon din ang ginagawa—na nandoon iyong feeding program, ang kino-consider na accomplishment report ay iyong pinapakain. Tapos kapag tinitingnan mo iyong pinapakain, all through the years, same families. Pero iyong mga severly malnourished, hindi kasali sa feeding program. Kapag tinanong mo kung bakit hindi kasali sa feeding program, kadalasan iyong sinasabi, “Kasi hindi naman dinadala sa center iyong bata.” Paminsan sasabihin parati iyong magulang hindi dinadala sa center. Hindi mo rin maaasahan na iyong mga BNS (Barangay Nutrition Scholar), magbabahay-bahay. Kasi ang ibang mga barangay, sobrang lalayo, tapos ang mga BNS sobrang underpaid. I was telling the doctors and some students I was talking with earlier, that I came across some barangays or some LGUs na iyong suweldo ng BNS at BHW (Barangay Health Workers) ay 500 pesos a year. So ‘di ba, these volunteers also came from very poor families. Ang trabaho nila, sobra. So talagang very underpaid. And that was the reason why noong nag-congressman ako, I filed a bill that insitutionalizes sana iyong mga barangay health workers and barangay nutrition scholars that they be considered regular government workers para well-compensated, mayroong mga benefits, etcetera, etcetera.
Masuwerte iyong mga LGUs na medyo mayaman. Kasi iyong mga LGUs na medyo mayaman, they compensate better. Pero iyong mga LGUs na mahirap, ito din iyong mga mahihirap iyong constituents, ano din, iyon pa iyong hindi compensated iyong mga barangay health workers. Ayon, hanggang ngayon hindi pa… hanggang ngayon hindi pa napapasa iyong bill. But I will continue advocating for it.
Another kuwento, when there was still iyong mga medical missions, maraming mga grupo iyong mga nagmemedical mission. Pero ako, I am not a fan of it. I am not a fan of medical missions—[applause]—iyong medical missions na one time. Iyong mga one time na… So I did a program that naging partner namin iyong SEAOIL Foundation. Naging partner namin iyong SEAOIL Foundation. We launched a wellness program. Pero iyong ginawa namin, we invited specialists to do a medical [technical difficulty] in one municipality in my district. Pero the purpose of the medical mission was not just to treat ailments but also to do a health inventory of all the residents of a particular barangay. So we did a health inventory so maraming nakita. In a particular barangay, maraming nakitang hypertensive, mga may—maraming mga diabetes patients, maraming mga stroke patients na na-paralyze. So iyon iyong mga nakita. So iyong mga diabetics, mga hypertensive patients, most of them hindi nakaka-afford ng maintenance medicines. So tinanong ko iyong RHU, “Wala ba kayong supply ng medicines?” Sabi nila, “Mayroon naman, Ma’am, supply pero iyong pinapadala hindi siya appropriate for the illnesses that we have.” Parang karamihan yata ng mga gamot na pinapadala, iba naman doon sa mga sakit noong mga nandoon sa barangay.
So I went to DOH again. I asked whether there was budget for medicines. Ang sabi ng DOH, “Ma’am, mayroon po kaming budget. In fact, padala kami nang padala sa mga RHU ng mga—Pero malalaman namin na nag-e-expire lang iyong mga gamot. Tinatapon lang nila.” That was what DOH said. So again, the disconnect. Ang claim ng RHU, walang gamot; ang claim ng DOH, may gamot pero hindi ginagamit, tinatapon lang. And we are given this disconnect— Nandoon siya sa nagpapadala ng gamot pero iyong pinapadalang gamot, hindi naman nakakabase sa data, ano. Gastos ng gastos, nagpapadala ng gamot, ina-assume na common ailments, pero hindi siya sapat para doon sa sakit noong mga residents doon. So we talked as a group. Sabi natin sa DOH, “Kung kami iyong magpapadala kung ano iyong mga kailangan ipapadala niyo ba?” Sabi ng DOH, “Yes.” So from that night on, iyong mga residents nakakainom na noong mga gamot na dapat nilang inumin. Parang it doesn’t take rocket science to do that, ‘di ba? Kailangan lang naman mag-usap. Kailangan lang mag-usap noong local at saka ng DOH para ayusin iyong daloy ng medisina.
So it became a regular program of the office. Halimbawa, iyong, we also did a community health program and this was with the help of my sister-in-law, si Dra. Penny Bundoc. Tinulungan niya kami na idala sa community iyong rehab program kasi ang daming mga stroke patients, ang daming ibang ailments, na na-paralyze pero hindi kayang magpa-rehab sa ospital. At that time, around 100 pesos sa public hospital iyong rehab. Hindi kaya ng tao because they have to go there two or three times a week. So what we did was we had a… parang we had an agreement with the Bicol Medical Center, where iyong mga rehab doctors nila and the PTs will train the barangay health workers. So nagtrain sila ng mga health workers at iyong mga health workers, in turn, trained the caregivers. So iyong mga caregivers, sila na iyong gumagawa ng rehab noong kanilang mga pasyente.
So alam niyo iyon, parang kailangan lang mag-usap. Kailangan lang mag-collaborate. Marami nang mga ma-a-achieve na mga ends. So when I eventually became Vice President, we launched an anti-poverty program called Angat Buhay and Angat Buhay has six pillars and one of the pillars is really health. So we have been doing a lot of what I have been doing when I was still in Congress in many of the municipalities that were adopted by our office. We started with… we started with 50 communities. We’re now in 176 [communities] and the story is the same. Doon sa mga may matataas na malnutrition rates, may mga feeding programs pero hindi rin sila concerned sa data. Hindi rin nila nasusukat how effective the feeding programs are. Pero napansin natin where the malnutrition rate is high, poverty is also, parang worse.
So in—we had a community in Bulacan, iyong Pulong Elementary School nila. So what we did was we met with all the parents of the malnourished children and pinagusapan papaano sila matutulungan sa trabaho. Kasi para magiging sustainable iyong kanilang malnutrition program, dapat pagtulungan din iyong kabuhayan ng pamilya. Kasi when they remain very, very poor, parang you also do not capacitate them para lagyan sa nutrisyon iyong mga anak niya. So that’s one thing that we’re doing.
But we also came across very inspiring local government units. And one of them is San Remigio in Cebu. I don’t know if anyone here is from Cebu. Mayroon ba ditong taga-Cebu? Mayroong isang town sa Cebu called San Remigio. We went there to talk to a fisherfolk community. Ang kausap namin doon iyong mga mangingisda. Pero pagpunta namin, nakita namin na napakataas ng incidence ng mental health. Maraming mga mental health patients are being kept in cages at saka naka-kandado. Naka-kandado sila kasi some of them have already become violent and their family members cannot work kung hindi nila ikakandado kasi nakakadisturb sa iba. So parang marami doon iyong ganoon.
So we started a program and we learned that San Remigio was already doing a mental health program with an NGO called Americares. Mayroon na silang existing program. So kami, parang nag-supplement na lang kami. We partnered with the Philippine Mental Health Association in Cebu and the Philippine Mental Health Association were the ones who, parang capacitating the local health practitioners how to deal with it. Pero iyong kabutihan sa San Remigio was that the mayor was very proactive and the local, ano iyon, the local health officer? The rural health officer, who was a lady, was also very, very proactive. Ang ginawa nila, iyong programa, binaba na nila sa communities. So they already have a community health program and it has turned out to be very, ano ito, groundbreaking in the sense na marami pa silang na-discover na mental health patients na hindi pa nila nadidiscover before. So they have been capacitating not just the barangay health workers but also the family members of the mental health patients.
Last year, we went and we came up with the success stories and when you listen to them, may mga iba were chained to… parang chained to posts already and kept in cages na ngayon ay living a normal life already kasi natututukan na. Mayroong isa carpenter na siya, mayroong isa bumalik na sa pag-aaral. So it doesn’t—it didn’t take too much eh. It just needed a well-focused health program, [and] proactive local government officials to do that. And then we decided, our office funded a mental health facility and we inaugurated the mental health facility two weeks ago—that was last week? Last week yata. I was in Cebu last week to inaugurate the mental health facility.
Ano siya, it’s a very holistic program and the good thing about it is it’s really a product of the collaboration between the government and the private sector. Halimbawa, we found a partner. It’s a real estate company na wala namang projects sa San Remigio pero siya iyong nag-provide ng lahat na facilities doon sa mental health facility. They also found an organization, I don’t know if you’ve heard of Couples for Christ. Iyong Couples for Christ, mayroon silang foundation called ANCOP. Mga Filipinos in the US and they’re providing medicines for the mental health facility. They also provided an X-ray machine for the said facility.
So alam niyo iyon, parang… why I am I telling you all of these? Kasi tingin ko, to solve community health problems, wala lang sa doktor iyong… wala lang sa doktor iyong susi, wala sa doktor iyong solusyon, it also needs the government. It needs local officials who are dedicated, local officials who are focused. It takes a more proactive government agencies kasi to solve community problems, it’s not just solving the health problems, but it is also solving the poverty of the community kasi hindi talaga sustainable iyong mga health programs because of that.
I want to tell you another story and ito, tatapusin ko na kasi parang naggi-give up na iyong microphone sa akin.
Mayroon kaming isang… mayroon kaming isang area in northerm Palawan. I don’t know if you’ve heard of a town called Agutaya. Narinig niyo na ba iyong Agutaya? Hindi ko alam kung may nakakarating doon na doctors from the barrio. Pero ito, iyong Agutaya, you have to go to Coron first. I think you know Coron. Pero to go Agutaya, it will take you 10 to 16 hours by boat. Ganoon siya kalayo. Ten to 16 ours by boat, depende kung alin na barangay sa Agutaya ang pupuntahan niyo.
The first time we went—we went November yata of 2016 nabalitaan kasi namin na sobrang hirap ng lugar—pagbaba namin sa Agutaya, people were waiting for us. Parang iyong buong island yata nandoon sa shore, naghihintay sa amin. And then they started crying. Hindi namin alam kung bakit umiiyak pero apparently, those were tears of joy kasi halos hindi sila nabibisita. Pagpunta namin, the entire island did not have electricity, did not have potable water. The only elementary school on the island, sira iyong bubong and sira four years before we went. Hindi pa rin ayos. Mahirap na mahirap iyong mga tao. We saw children na ang pinaglalaruan nila iyong mga live crabs—iyong mga crab na buhay—na nakatali. Iyon iyong ginagawa nilang parang kotse na nagre-racing.
Tapos what was most heartbreaking was iyong principal, pina-line up nila iyong mga bata to greet me. Mayroon silang mga flaglets. Pina-line up nila doon sa—wala naman doong strip—parang ano lang, pathwalk. Nag-umpisa sa Kindergarten hanggang Grade 6. So in-introduce ng teachers, “Ito iyong Kinder, ito iyong Grade 1…” Nasa Grade 5 na kami, pareho pa rin iyong size ng mga bata. So iyon ang tanong namin: “Bakit ganoon? Grade 5 na sobrang liliit pa.” So there was a doctor who was with us, sabi niya, “Most of the children there are stunted.” ‘Di ba you know what stunted is? Iyong iba, sinasabi nila—iyong mga bansot—nasa lahi kasi iyong mga taga-Agutaya raw mga bansot. Pero it’s not that eh. It was caused by malnutrition.
But the most—more hearbreaking thing about it is we all know that stunting is almost irreversible after the age of 5. So no amount of feeding programs can reverse that. And stunting, we all know, does not only affect the height but also the mental abilities of children. So iniisip namin papaano iyong future ng mga batang ito. So we started doing programs. Ngayon, more than 400 households there already have electricity because we found two partners na naglagay ng solar panels sa each household. So iyong—it was life-changing because suddenly, nagkaroon ng extra income iyong mga kababaihan. Ngayon, nagwe-weave na sila ng mga hats, ng mga mats, na binibili sa kanila ng Amanpulo kasi ang Amanpulo is nearby.
Mayroon kaming partner, St. Theresa’s, I don’t know if anyone here is from St. Theresa’s but St. Theresa’s Alumni Association is one of our partners. Iyong St. Theresa’s provided boats for the fishermen, motorized boats. Nalaman namin na noong Yolanda, so many fishermen there lost their boats. Iyong mga nawalan ng boats, nakikirent na lang o nakikihiram sa mga fishermen na mayroon pang boats. Naghihintay lang sila kung kailan hindi gamit iyong boats. Eh dahil sila ang nakikihiram, hati pa sila noong boat owner ng kita. So St. Theresa’s Alumni Association provided boats.
Andres Soriano foundation is now building a water supply so that they will have their own potable water already. We have another partner, the Philippine Toy Library, they put up a toy library so hindi na lang crabs iyong nilalaro. When the toy library was first set up, ayaw nang umuwi ng mga bata. So those things.
And why am I telling you these? Kasi it only takes collaboration. Our office has one of the smallest budgets in the bureaucracy so we almost do not have money for programs. Pero one of the things that we—was that there are just so many private groups [taps microphone] Ayaw na talaga—So many private groups that are willing to help but just don’t know how. Talagang sobrang daming gustong tumulong. And when you are doctors already and you will be immersing yourselves in the communities, you will also realize this—that you cannot solve the health programs of the communities by yourselves. You would need the collaboration from not just the local government unit, but also the private sector community in that particular locality. Kasi iyong kaya lang ng gobyerno is never enough. Kailangang pagtulung-tulungan lahat.
And I am just so happy that—kanina, I was asking the other students why “Aninag” and they told me, you have aninag to remind you that there are—the world is so much bigger than our problems and there is just so much that we can do. And I’m also happy that I was [inaudible] tomorrow, you will be helping barangay health workers who, I think, would be in the best position to, parang to share with you real stories on the ground and will make you understand how you can help them.
Kaya I hope some of my anecdotes today will more or less, or has given you already, a bird’s eye view of what is really happening and how to ga about some things. So thank very much for having me. Magandang umaga sa inyo. [applause]