In IP communities, program seeks to change mindset on health, birth

By Frinston Lim, Inquirer.net

When then 14-year-old Mary Ann Mandesi gave birth to her eldest inside her house in Barangay New La Union here, she was in excruciating pain for 24 hours. It was the longest day of her life.
She thought she would not see her firstborn. “I labored for almost a day,” the T’boli woman, now 34, recalled. A hilot (traditional midwife) assisted the birth. Her child was born with Down syndrome.

The harrowing experience prompted Mandesi to decide against having another child for more than a decade.
Her second child came when Mandesi was 28, and again, in spite of her brush with death during the first, the young mother gave birth at home.

“I had no choice because there was no health center here,” Mandesi said.

Mandesi and other women in the T’boli-dominated village soon heaved a sigh of relief when the health center was built just a couple of years ago. There, they could receive prompt assistance during childbirth by well-trained health workers led by the village’s lone midwife.

Local and health officials acknowledged the difficulty in reaching far-flung, indigenous peoples’ (IP) communities and teaching them about health.

Cultural traditions

Skewed ideas about health, particularly on maternal and infant health care, brought about by cultural traditions used to prevail in IP communities in Maitum, such as New La Union, according to village midwife Merlie Sornito.
Officials said it was a welcome development when New La Union became one of 16 villages in Sarangani chosen for the IP-inclusive Barangay Leadership and Governance Program for Health.

“We felt a stronger resolve to improve the health of our constituents, particularly pregnant women,” said Bernie Pascua, village chief of New La Union (population: 1, 400).

Supported by the United Nations Population Fund, the Department of Health (DOH) and the Zuellig Family Foundation (ZFF), the program seeks to boost maternal, neonatal and child health and nutrition in IP communities.
Sixteen barangays from five of Sarangani’s seven municipalities (Maitum, Kiamba, Malapatan, Maasim and Glan) were chosen as pilot areas for the program.

It was pushed in an attempt to help improve health care services in IP communities by designing IP-sensitive health programs, said Julie Llavore, ZFF staffer.

Desired result

Under the program, village officials and tribal leaders went through a monthlong workshop on creating IP-inclusive village health boards to empower them in implementing culturally-sensitive local health initiatives.

Llavore said there have been many government initiatives on health in IP communities, but the desired result, the health of villagers, has yet to be attained.

“We want to convince them (IP communities) that they’re, in fact, included in this program,” said Llavore.
Provincial officials, led by Gov. Steve Solon, had taken part in the DOH-ZFF Health Leadership and Governance program ahead of the village and tribal leaders.

Llavore said program proponents want to expand its implementation to other areas in Mindanao using the Sarangani model.

Maternal deaths

Sarangani, she said, had been picked as pilot area because of the large number of IP communities (30 to 50 percent IP population per town). According to government data, majority of maternal deaths in IP communities in Sarangani in 2015 occurred during home deliveries.

Progress is being made in the village of New La Union. Pascua, the village chief, said the community is leading the way in introducing modern health practices to IP communities, resulting in drastic declines in maternal and infant mortality.

“We personally monitor and keep track of expectant women in New La Union, telling them to use our health center in giving birth,” said the village chief.

The village has set up “Bahay ni Nanay (Mama’s House),” a predelivery ward next to the health center where pregnant women could stay three days before the projected date of childbirth.

Food, cooking utensils and other provisions are available there.

From January to June this year, only three of 24 recorded childbirths in New La Union had been home deliveries, according to midwife Sornito. It was an improvement from last year when half of all childbirths are home deliveries, she said.

“We really have to go to their (IP) communities and knock on their doors to convince them to use our village birthing center,” said Sornito. She said IP beliefs often contribute to the hesitance among IP women to give birth in health facilities.

She recalled one case when health workers had to seek help from village officials to “forcibly bring a woman to a hospital” because she refused to seek medical attention.

“The T’boli woman was bleeding profusely and was fast losing blood after her placenta did not come out following a hilot-assisted home delivery,” recalled Sornito.

“She told us the placenta would come out on its own when her husband returns home from the farm. Hours had already passed and she was already sleepy and pale,” she said.

When the woman was overpowered and brought by motorcycle to the hospital in Maitum town center at least 10 kilometers away, the doctor said the woman could have died had she arrived minutes later, according to Sornito.
Officials said IP-sensitive health programs could further help convince tribal constituents to support these initiatives.

Change of attitude

Datu Fausto Soldavillo, IP representative in the village council, said many of his fellow tribes people now go to the health center.

“Before, they were ashamed to go to the health center even if they were sick, or if a pregnant woman was having a difficult time giving birth,” the chieftain said.

He said he has also been urging his young constituents to shun traditional early marriages.

Sornito said IP-sensitive health programs are vital in ensuring indigenous people’s support for government health initiatives.
“If an IP woman does not want to lie on the delivery table, we would let her lie on where she wants to,” the midwife said.

“If she wants to use herbs and traditional oils, we let her. What’s important is that we can observe and monitor that she’s OK,” the midwife said.

Officials said attitudes toward health care systems are now slowly changing in IP communities, like in New La Union.

Mary Jane Ugsal, 28, gave birth to her fifth child at the barangay health center.

“The health center here just came lately so I had my previous deliveries at home. It’s OK now because I did not labor for hours,” Ugsal told Inquirer, in her arms a baby boy.

Even husbands in the T’boli community are getting in on the act.

“My second baby was born at the barangay health center,” said Gina Mae Mondelo, 29.

“I felt safer because there was a midwife who assisted me. My blood pressure was monitored, the baby was vaccinated,” Mondelo said. “My husband was the one who prodded me to go to the center.”

Mandesi, the T’boli mother of three, gave birth to her youngest just recently at the barangay health center.
“I’m thankful. Now it was quicker,” said the mother, in tribal garb, stroking the head of her sleeping baby.
“At the center I was given vitamins, had an injection. When the midwife told me I would give birth at 4 p.m., the baby really did come out by 4 p.m.”

This can also be viewed at http://newsinfo.inquirer.net/793960/in-ip-communities-program-seeks-to-change-mindset-on-health-birth.