ACT continues support for Bohol project

The VPHCS project with the Asian Community Trust (ACT) of Japan, “Sustaining community-based health programs to promote health and prevent disease in Bohol” is on its third year.

The project is implemented in Barangay Sto. Nino, San Miguel and Barangay Caluasan, Dagohoy, in partnership with the people’s organizations, Hugpong Mag-uuma sa San Miguel (HUMASA) or the Farmers Association in San Miguel and the Mga Mag-uuma sa Lakalsanda Apektado sa Land Levelling (Farmers in Lakalsanda affected by Land Levelling) in Caluasan.

There are 125 households (679 population) in Sto. Nino and 402 households (2,132 population) in Caluasan.

Since the project started in April 2010, it has greatly benefitted the residents who are mostly poor farmers in dire need of health services in their rural areas. Through various programs developed and sustained by the people’s organizations through their trained CHWs and health committees, the project has reaped increased health awareness and improved health practices and rendered basic health services to the people.

A community health worker weighs a child as part of the growth monitoring and nutrition program in Sto. Nino and Caluasan. 

 

A community health worker renders ventusa or cupping therapy, a form of traditional Chinese medicine.

The project witnessed widespread health information dissemination on disease prevention and health promotion, covering topics including home remedies for common ailments, nutrition, basic first aid, family planning and contraception, control of acute respiratory tract infections, and control of diarrheal diseases, among others.

Health services by trained CHWs addressed common illnesses such as upper respiratory tract infections or common colds, diarrhea, fever, gastritis, muscle and joint pains, tension headaches, and skin diseases with the use of herbal medicines, water therapy, ventusa, and over-the-counter medications such as paracetamol, antacids, oral rehydration salts, and common antibiotics. Cases that they cannot handle were quickly referred to the project health services officer and to the health centers or government hospitals for more specialized care. 

A community health worker takes blood pressure. Hypertensive patients are advised on healthy lifestyle and referred to health professionals for proper treatment.

Hypertensive patients were screened by trained CHWs in the series of operation blood pressuring monitoring and were referred to the project health services officer and to the health centers for further work-up for possible complications and associated illnesses such as heart diseases and diabetes mellitus.

A nutrition program was started in the second year in both barangays which did not only have mass feeding of malnourished children identified in operation weighing and growth monitoring but also maintenance of proper nutrition through health information on nutrition, proper food preparation, cheap and easily available food sources and feeding practices to the mothers provided by trained CHWs.

Nutrition program in Sto. Nino and Caluasan fed malnourished children, monitored their growth and taught mothers regarding good nutritional practices.

A family planning program was launched in Caluasan, Dagohoy which included community education classes on reproductive health and contraception and referral by the CHWs of women desiring birth control to the health centers to avail of contraceptives such as pills and condoms.

The third year that started in April 2012 shall sustain the gains of the two years in terms of making the CHWs more capable of addressing the health problems in the communities. Advanced health skills trainings shall be conducted to enable them to manage more difficult medical cases. Special skills trainings shall enable them to effectively launch and sustain their ongoing health campaigns, the nutritional rehabilitation of malnourished children, promotion of proper nutrition, family planning, control of hypertension, and provision of essential herbal and rational Western medicines.

Furthermore, a small community health center shall be constructed in each of the two barangays, which shall serve as venues for the meetings of the CHWs, health education classes, clinics for regular check-ups and services, and the botica sa barangay (village pharmacy). Herbal medicines to be processed by the residents, medical supplies and materials, leaflets on common health problems and essential Western medicines aside from the patients’ medical records will be stocked safely in the health centers.

To strengthen the sustainability of their health programs, the leaders of the people’s organizations shall continue to network with their barangay councils, municipal governments, health centers and civic organizations in order to generate financial and material resources.

These prospects have been planned together with the leaders of the two people’s organizations.

“Health for all”: The staying power of community-based health programs

By Aurora Fernandez, R.N.

Rosario was quiet and subdued as she slowly walked towards us. Coming closer, it was plain to see how pale and weak she was. Three weeks earlier, she had agonized through 14 hours of breech childbirth, soaking five blankets with blood and without a midwife, delivered a stillborn baby. Shortly afterwards, the midwife showed up to assess the afterbirth and without any compunction, asked for P100.00.

The 33-year-old mother of four, complacent that her previous deliveries had been problem-free, had no prenatal care, even though her husband had urged her several times to see the doctor at the nearby Barangay Health Unit.

Now she was bleeding again, with blood clots the size of fists. She urgently needed hospitalization for a blood transfusion and dilatation and curettage (D & C).

But how to pay for it? Her husband was a gravedigger at the Liloan cemetery, and when there were no funerals, he cut down and pounded buli (a palm tree) trunks all day long to produce enough landang (palm flour) for binignit (a dessert with coconut milk). Lack of money meant their 12-year-old eldest son didn’t start school until last year.

Despite her protests, Rosario was persuaded to go to Vicente Sotto Memorial Medical Center by volunteers and staff of the Visayas Primary Health Care Services (VPHCS). Dr. Erlinda Posadas of VPHCS admitted her and coordinated her treatment, even obtaining the medications and supplies on credit from an outside pharmacy. Working with the radiologist and OB-GYN physician, Dr. Posadas made sure the patient was promptly seen and a successful D & C performed at 11:00 PM the same day, following an ultrasound which showed placental fragments. Since Rosario’s husband had a fever, a friend, Julie, stayed with her overnight at the hospital.

Julie described the chaos at the emergency room that night as a scene straight out of Dante’s Inferno: nightmarish, frightening, and harrowing, with bloody patients moaning and screaming in pain while others waited desperately for medical attention. Two other postpartum patients lay on cots in the ER hallway while their families tried to find the money for a D&C. It was the kind of moral dilemma that drove doctors to despair. But Julie was also left with the unforgettable image of a no-nonsense doctor – Dr. Erlinda Posadas – whose compassion for a patient far exceeded ordinary expectations.

---0---

Trying to make sense of the Philippines’ health care system where “those with the greatest need have the least access” is an exercise in futility. Barely propped up by Philhealth, the government health insurance system only covers 15 percent of hospitalization, medications and selected outpatient procedures, but NOT regular preventive medical check-ups – and the patient still gets slapped with a huge bill on discharge from the hospital.

Rosario’s designation as a charity case meant no doctors’ fees, but other services had to be paid for. Julie helped her obtain reimbursement for the loaned medications from the municipal government, but bureaucratic red tape at the local DSWD (Department of Social and Welfare Services) forced her to return three times before finally getting financial aid.

With the support of VPHCS, Rosario did not have to pay anything, but the whole episode was sobering. It pointed to the need for a rational health care system accessible to those without the means to pay, throwing into sharp relief the necessity for systematic reproductive health education and outreach not just to women of childbearing age and adolescents, but to entire barangays and local government units (LGUs). At the very least, it showed the need for easier access to financial assistance in LGUs -- services paid for by tax monies.

If not for timely intervention from VPHCS, Rosario would now be another statistic in the unrelenting maternal mortality data of this country, where eleven women die from maternal causes every single day, a tragic loss which not only has a profound personal and societal impact but also has economic consequences for years to come. Rosario’s stillborn infant did become a statistic: Philippine infant mortality rate remains at 34/1000 (Thailand’s is 18.23/1000).

--- o ---

What is Visayas Primary Health Care Services and what does it do? As a community-based health program (CBHP), VPHCS, which has been in existence for 30 years, provides free or low-cost health care services to indigents in urban and remote rural areas in Cebu and Bohol. It is a limited safety net for those who fall through the cracks of government health care, but its proven ability to network with other health care practitioners – the specialists in tertiary care, for example – tremendously facilitates provision of services. One of its strong points is its ability to navigate the bureaucratic hospital maze and coordinate essential services. Another is its holistic orientation which includes the promotion of integrative medicine and appropriate technology, specifically acupuncture, homeopathy, reflexology and herbal meds.

In July 2006, VPHCS initiated a reproductive health program called YO! Lead or Youth on the Lead. Funded by Planned Parenthood Federation of America, YO! works with youth organizations in schools and local communities, developing leadership and life skills and providing information and access to reproductive health care services in office clinics and mobile medical missions.

CBHPS embody the principles of primary health care declared at the 1978 Alma Ata International Conference on Primary Health Care: fair, equitable and efficient health care services; community participation in decision-making; and an emphasis on education and preventive health. These principles are evident in the medical missions requested by various barangays and the annual training and skills update of community health workers.

CBHPs work without fanfare and with modest remuneration, their vision carried out by dedicated and selfless staff and volunteers in numerous communities throughout the Philippines - and in the United States. Seminal and groundbreaking, CBHPs deserve a place in the country’s Bantayog ng mga Bayani (Monument to Heroes) for their proven record of public service which has saved – and continues to save – the lives of countless Filipinos.

Aurora Fernandez, R.N. is a retired public health nurse based in California who believes that health care is a human right that should be accessible to everyone regardless of ability to pay. For her, a healthy, productive population strengthens and contributes to nation-building.