HOUSE TO HOUSE SURVEY
One of the first step in
community assessment is doing a house-to-house survey among the households of
Luop, Diplahan Zamboanga Sibugay. We arrived at our community on March 29,
2014, Saturday and on Monday we prepared our survey questionnaires. Immediately
on Tuesday we started to survey the households, we need to survey at least 75%
of the households in the barangay. Our questionnaire comprises queries that
would assess the living condition holistically of each household in the
barangay. It focuses on the different facets
of life such as Environmental, Economic, Social and most specially Health.
Our Barangay is composed of
162 households divided into 6 puroks. Each household is surveyed at an average time
of 30 minutes, since everybody in the group can speak and understand bisaya we managed to cover an average of
30 households per day. We just divided ourselves into 4 groups assigned to
different puroks. Initially we surveyed the farthest purok which is the purok 6
and 5 and followed by the the last 4 puroks. We have complexity in covering
100% of the households because at that time its harvest season in the barangay
and the majority of the populace spend their day time at the farm harvesting
and at the same time they are celebrating the anniversary of their barangay so
almost all the people are very busy and hard to find at their house.
At the end of the week on Friday April 4 we hit the 132nd
household and that is 80% of the entire households in the barangay. Since this
number of households already represents the entire Barangay, we use the
weekends collating the data for us to analyze the results of our 4-day survey.
We appreciate every little bit of the time that the community people has
offered us, despite of their busy schedule they still gave us a warm welcome in
their humble home. And this made as reached our goal.
LAOM LUOP: AN INTRODUCTION
Simple living, breath taking view, fresh air, and where people will welcome you warmly; there’s no other place to be but in our lovely community where we call our second home. Zamboanga Sibugay is subdivided into 16 municipalities and one of the municipalities is Diplahan.
As a medical student of the Ateneo de Zamboanga University, we are being exposed and assigned to a particular community. We are to bring change as well as do health education. We also in turn learn a lot from our exposure.
Our community is
more or less sixteen kilometres away from the highway. We are assigned at
Barangay Luop, Diplahan, Zamboanga Sibugay. The main source of livelihood is
farming since its land area is surrounded by a large area of rice fields. Our
community is not as remote as what we expected. Actually, they are quite
progressive and capable on their own if it’s not for the flood that they often
experience every now and then. They have mini grocery stores, vendors of fresh
fish coming in from nearby barangay, the residents have many fruit trees and
they also have gardens of vegetables such as eggplants and string beans. The
houses are built not far from each other; they are mostly made up of mixed
materials while some houses are made up of light materials. They have 1
elementary school, a Health Center and a day care center. The roads going to
our barangay is paved and concrete except for some areas prior to reaching our
barangay.
Barangay Luop is
made up of six puroks. Barangay Luop is situated 40 kilometers away
from the provincial capitol. It has 6 puroks and bounded by Barangay Pilar at
the North; Barangay Minsulao at the East; Barangay Boyugan at the West and
Barangay Baligasan at the South boundary.The people
of our community are peace loving, hospitable and hardworking. To sum it all
up, out community is a wonderful place.
Warning: Cliche - Everything Happens for a Reason
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| Credits to Olivia's blog for this photo |
Just a few months back, the pressure of having to study such a lot and the actual challenge to pass each and every exam given to us began to take their toll on me. I was losing my cool and I couldn't help but think about that day I could just lay down, watch a good movie and not worry about what else I have not or still need to read. Eventually, the community exposure became that light at the end of a very long, winding and dark tunnel and the thought of going to community sparked up a fire that kept me going. Aside from the fact that we would again be seeing the people we already learned how to love, the idea that I could think less about the academic side of a medical student excited me. It actually felt, for a moment, like I was living such a sedentary lifestyle that I could no longer manage to give time for myself to even just breathe. But the thought of the community drawing close made me actually realize that there could be a break from such a monotonous routine.
A Very Worthy Welcome
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| Picture taken from Google |
At last, the long wait was over. We took a trip down memory lane and reminisced the first time we had that long bus ride going to our community. During the trip, my classmates were quite noisy this time and I could feel that they also feel as ecstatic as I am that they could now have a break from having to read lectures and notes daily. We had the usual pit stops at Ipil, Sindangan and other municipalities, and after 8 long hours arrived safely at our community's Rural Health Unit where we were met by our Community Preceptor (Dr. Leigh Arouet Lluisma) and the other members of the RHU Team with a "Butung" Party. The smiles they had on their faces when they saw us and the hug they shared with us made us feel very welcome and at home - like they were sending a silent message of "We've waited for you for so long. Welcome Back!"
What Really Happened
I woke up, after 10 long hours of sleep, to the sound of my mother shouting at me, telling me to get up. I was rattled because it was only 6 AM and my class was not due until 9 in the morning which irked me a lot. But the sound of our radio made my stomach drop and I got quiet for a moment. It had been 2 years since my family last tuned in to the radio and usually if we did so, a horrible news was up front - and it was no different this time around.
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| Aerial Shot of one of the affected Barangays |
What me and a very good friend had been talking about and dreading for the past few months has happened. It was something I have never seen or gone through (as I really have no memories of the Cabatangan Siege) and it's definitely not a good sight to watch. There were rumors of hostage-takings, videos of men covered and bathed in their own blood, and a group of people who seemed to be tied to one another. The reporters from the news mentioned a few barangays and my mind shot several different questions at once - Are my friends safe? Have they been caught in the gunfire? How long was the situation gonna last before resolution? Is everything gonna be okay after everything is over? Will we still have class even with the situation at hand? My mind could not find all the answers it sought so I decided to break into prayer and asked God to bless and guide all the innocent. When my mind was cleared, I messaged my classmates who I knew were directly affected by the ongoing crossfire and got relieved when I found out they were all okay.
Even though when everything was building up and getting blown out of proportion, I couldn't help but still trust that the government could put an end to whatever misunderstandings, arguments or clash they had with the opposing team - that everything would be back to normal when I wake up the next day. I was deeply wrong. Instead of the resolution I so wanted to see happen, the "war" dragged on for quite a while, causing damages along the way. Innocent lives taken, houses burnt down to the ground, several properties and belongings stolen or ransacked. The big question on my mind was "Who did what?". I could not really answer it so I settled with the fact that TIME might tell me soon.
A Pause for a Cause
Not surprisingly, classes were suspended until further notice and curfews were imposed. A sports complex and a few schools too served as shelter for more than 120,000 people from 5 to 6 barangays. What I think the "war" did to most of us was just instill fear and apprehension. For that matter, I stayed most of the 28 days at home doing my part of guarding our house (mostly just staying up until the early hours of the morning surfing the net) for fear that our barangay will be affected as well. The challenge too of the exam that was yet to come never left me so that the mental warfare that I have been struggling with intentsified.
What I liked though was that amidst the chaos and heavy emotions, people found time to offer the little things that they have to those affected and that gave Zamboanga the ray of hope that at the end of what seemed like years of famine and danger, a new beginning awaits. In our little way too, the Potentia Domus (ADZU SOM Batch 2016) class offered what we had by giving out several family hygiene kits that we felt the evacuees needed to avoid certain diseases brought about by poor hygiene practices. We could not have our community exposure too so we were most welcome to render our voluntary services to the ever growing population of the evacuees. Surprisingly, several of our batch offered their services even during the active phase of the crossfire. Most of us though were not allowed by our parents to leave our homes for fear that we could be victims of stray bullets and other forms of danger. But one thing was for sure - all of us were one in praying that the situation would be over soon and that no more innocent life be sacrificed or wasted.
Despite that desperation of not being able to go back to the community and have that 'mental' rest I have been wishing for so long, I was thankful that even with what had transpired, me and all of my classmates were safe. Many may have lost homes, properties and some have lost their loved ones along the way, but one thing I can be certain of is that every single one of us still has that HOPE inside of us.
Now it's been about a month since the end of the crisis, but the real challenge has just started - the challenge to start anew. We may not know or fully understand why these things happened, but we know that "Everything Happens for a Reason".
KEEF
In Action
To begin with, we were exposed to the birthing center where we went on duty during the night for 12 hours (7pm-7am) and were given the privilege to either manage or assist on a delivery, which was supervised by a trained Public Health Midwife. From the accounts of my classmates though, it was unfortunate that among the 10 rotations during the April 2013 exposure, there were only 2 instances that a laboring mother gave birth on our watch - it would either be that the expectant mother has a prolonged labor that by the time she gave birth we were already off duty, or the better possibility would be that we have fallen asleep and was so deep into it that the delivery took place without us.
Overall, the rotations to the Rural Health Unit was all worth it despite the fact that it would mean US (those going to duty) leaving the rest of our group members. This personally made me worry about what they might be eating, or would they be okay back home - a feeling only a FAMILY would feel for each other.
Ang Paglalakbay
Ang Paaralan ng Medisina ng Unibersidad ng Ateneo sa
Zamboanga ay isa sa mga natatanging paaralan ng Panggagamot sa bansa. Isa sa
mga dahilan kung bakit siya naiiba ay ang pagkakaroon ng tinatawag na
"Community-Oriented Medical Education (COME)" sa kanilang kurikulum.
Ang COME ay isang stratehiya ng paaralan kung saan inilalagay ang kanilang
mag-aaral sa isang mahirap na komunidad sa rehiyon upang makatulong na
masolusyunan ang mga problema ng naturang lugar. Dito nagagamit at naisasagawa
ng mga mag-aaral ang kanilang mga natututunan sa paaralan upang higit
Sa Ngalan ni Allah, Ang Pinakamahabagin, Ang Pinakamaunawain. Ang lahat ng kaluwalhatian at pagpupuri ay kay Allah lamang, ang Panginoon ng lahat ng mga nilalang. Pagpapala at kapayapaan sa lahat ng mga propeta kabilang na sina Adan, Moises, Noe, Hesus at sa huling Propeta na si Propeta Muhammad at sa kanilang mga kasambahay at mga kasamahan.
Ako'y lubos na nagpapasalamat sa Allah at nabigyan
ako ng pagkakataon na mapabilang sa Paaralan ng Medisina ng Unibersidad ng
Ateneo sa Zamboanga. Bilang baguhang mag-aaral ng naturang paaralan, ang daming
tanong ang sumagi sa aking isipan lalong-lalo na ukol sa COME. Makakayanan ko
ba ito? Magagawa ko ba ang aking tungkulin bilang isang sumasampalataya sa
kaisahan ng Allah (o tinatawag ding Muslim) habang nasa komunidad? at marami
pang iba.
Obligasyon ng bawat muslim ang magdasal ng limang
beses araw-araw sa nakatakdang oras at lumayo sa mga bagay na hindi kanais-nais
na makakapagpalayo sa kanya sa pag-alala sa kanyang Lumikha. Ayon sa Dakilang
Qur'an, ang librong naglalaman ng mga literal na Salita ng Allah na ipinahayag
Niya sa huling propeta na si Muhammad (sumakanya ang Kapayapaan at Pagpapala)
sa pamamagitan ng Anghel na si Gabriel,at sa pinakamalapit nitong kahulugan:
'At hindi Ko (ang Allah) nilikha ang mga jinn at mga tao maliban na lamang na sambahin nila Ako (ang Allah)' Qur'an 51:56
Kaya sinisikap ng bawat naniniwala sa kaisahan ng
Allah na sambahin Siya at huwag magtambal ng iba pa sa Kanya. Ito ang pundasyon
ng relihiyong Islam. Ito ang sinisikap kong gawin sa bawat araw ng aking buhay
at ito din ang pangunahing nasa isip ko sa pagpunta namin sa komunidad.
At noong buwan ng Oktubre 2012 una naming nasilayan
ang baranggay - Baranggay Pangulogon sa Roxas
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sa probinsya ng Zamboanga del
Norte- na aming tutuluyan sa susunod na apat na taon, kung hihintulutan ng
Allah. Naging mabuti naman sila sa pagtanggap sa amin at hindi naman kami
nahirapan makihalubilo sa kanila. Pangalawa naming bisita ay ito lamang
nakaraang buwan, ika-22 ng Marso hanggang ika-15 ng Abril 2013. Hindi mo
masasabing ilang buwan din kaming wala sa lugar sapagkat hindi pa rin nagbago
ang pagtanggap nila sa amin at ngayon ay masasabi kong mas napalapit na kami sa
kanila. Hindi naging madali para sa akin ang simula lalo na
ung mga oras na nagbabahay-bahay ang aming grupo upang makuha ang panimulang
datos na kelangan namin, pero sa awa at tulong ng Allah ay nalampasan ko at ng
aking mga kagrupo ang mga pagsubok na dumaan. Tunay nga ang sabi ng Allah sa
Kanyang Dakilang Qur'an at sa pinakamalapit nitong kahulugan:
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'Ang ‘Deen’ ng Allah ay madali at walang kahirap-hirap. Na kung kaya, hindi ipinag-utos ng Allah sa Kanyang mga alipin ang mga bagay na hindi nila makakayanan. Samakatuwid, sinuman ang gagawa ng mabuti ay magkakamit ng kabutihan; at sinuman ang gagawa ng masama, ay masama rin ang kanyang makakamit na kabayaran.' Qur'an 2:286.
Katotohanan na hindi lahat ng bagay ay matututunan mo
sa paaralan. Sa daang tinahak ko upang maging isang doctor, naniniwala ako na
ang komunidad ay may hindi matatawarang kontribusyon para hindi lamang maging
isang doctor na may alam sa panggagamot, pati na din ang maging makatao na may
responsibilidad tumulong sa iba at maging doctor na may takot sa kanyang
Tagapaglikha.
Naway patnubayan tayong lahat ng Allah sa matuwid na
daan at bigyan tayo ng sigla, lakas at kaalaman upang magawa natin ang mga
obligasyon natin dito sa mundong ibabaw, makagawa ng kabutihan at makatulong sa
kapwa para lamang sa Allah.
Thumbs Up for Bottoms Up
In diagnosing a
community one of the most crucial points along the process is the problem
identification and prioritization, as these will serve as a better room in
finding solutions and interventions that can contribute to help the community to
become self-reliant and determined.
Prior to conducting the community diagnosis, intensive planning was done by the
team Pangulogon as this will be the first major activity that would not only
diagnose the community but would also permit the community people to get to
know the medical students and as well as for the students to be more acquainted
with the people that they will be serving for 4 (four) years.
The Team Pangulogon
resolved to apply the “bottom’s up
method” using the Multi-Voting technique. In the said technique and method
the views of the community people were gathered first and followed by the
opinions of barangay officials. Subdividing the community people according to
their purok (1-4), we then requested them to come up with their own top 15
(ten) problems separately, while the medical students came up with their top 10
(ten) problems using the Maglaya
Prioritization Method among the problems identified that were taken from
primary data surveyed from the previous exposure. These problems were combined
to form a master list of 15 problems and from these, each community people were
asked to vote on paper their Top 10 perceived problems, which was immediately
tallied by some of the group members of Team Pangulogon. At the onset, we had
10 common problems, but the group felt that 2 of them were beyond our capacity
and was, in one way or another, not health related. The following are the TOP 8
problems as per the community people:
1.
Poor
access to a quality health care facility
Situated nearly 6 kilometers away from the main Poblacion and with the status quo revealing the absence of a health center in the barangay, access of the residents to a quality health care facility is deemed difficult by the team Pangulogon. With the wildly steep and rocky road, access to the Rural Health Unit situated at the Poblacion is also difficult. This has indeed been a concern for most of the residents in the community, as they find it either difficult or too bothersome to go to the health RHU, entailing them to spend for their fare. As a result, a lesser proportion of the community people seek for professional health care.
Proposed Solution: Putting up of a Health Center
2. 65%
of households falling within or below poverty line
Being immensely dense with hectares of coconut trees, corn and rice fields, Pangulogon is considered to be agricultural. There is no doubt therefore that most of the residents are farmers and depend on the yield of their crops for their day to day income. Unfortunately more than half of the households interviewed by the team seem to not have enough income to meet their daily expenses. Most of them too, according to the standards set by the Department of Social Welfare and Development fall on or under the poverty line.
Fortunately, the barangay is endowed with so much resources that opportunities for economical growth is in all ways possible. There are also other ways in which we could exhaust the community's manpower, since most of the female counterpart of the farmers stay at home. Being one of the community's priority problems, the group saw it fit to include this in their list of Comprehensive Plan, and with the community people's eagerness to have this solved, sustenance of the project is indeed highly achievable.
Proposed Solution: Use of alternative sources of income such as maximization of the use of the plant Coconut.
3.
Poor
nutritional status among children under 6 years of age
Contrary to the belief of other people that children who are underweight are the only ones considered to be malnourished, it is also true that children who go beyond their expected weight are also malnourished (over nourished for that matter). It is quite alarming to note that one child is poorly nourished - as this will expose the child to countless diseases. Moreover, it is more alarming to note that not only one, but roughly 70 out of 75 children are undernourished in one aspect or another. 
On the survey made for the nutritional status of children under 6 years of age, it was found out that 95 percent of them were either stunted or wasted. Through the WHO Anthroplast, which automatically computed for the children's respective BMI and comparing their height and weight versus their age, it became apparent to the group what we really needed to do.
Nutrition is vital for a child's overall growth and development. This can be achieved by giving proper diet and nutrition. To say that a child is nutritionally stable or balanced, his height or weight should be appropriate for his age. The community people seem not too aware of the condition that their children are in, although some seemed to be bothered, but the group found it quite important to include it in the listed problems so as to be able to address and stabilize such condition through the participation and help of the parents.
Proposed Solution: Series of nutrition classes and lectures with return demonstrations.
4.
High
incidence of tuberculosis-related mortality and morbidity
In the advent of medical technology, prophylactic treatment and immunization, tuberculosis should have been a highly controllable disease. Moreover, it is a disease that is highly treatable.Unfortunately, knowledge deficit on treatment and isolation practices increase exposure of the afflicted with those who are TB free. Fortunately though, what was once considered a 'rich man's disease' have been conquered and drugs are given free at health centers.
Giving a hint to the residents that this disease may not be as benign as it seems (that is without treatment), due to them witnessing several deaths related to Tuberculosis, it prompted them to include this problem in their list. The team on the other hand, backed up with medical knowledge, sees that the death from disease is highly preventable and it is primarily this that they accepted the challenge to help the community in increasing their awareness of the disease.
It is a bit unfortunate though that a disease with similar manifestations as TB exists. Paragonomiasis - which is also rampant in the community will be discussed in the next problem.
Proposed Solution: Increasing of awareness and honing Health Team's skills on case detection and reporting.
5.
High incidence
of Parasitism
Home to some very aggressive parasites, Roxas has become a good study area for some UP Professor for the identification of some nematodes and filariaes. Capillariasis, Paragonomiasis and Filariasis are just some of the many parasites that infests the waters and food of the residents of Roxas.
Pangulogon of course is not an exemption to the case. According to the survey that the team conducted, several cases of Paragonomiasis either caused the disability or death of some Pangulogon residents in the past 2 years. Unfortunately, we cannot take the words of the residents as sole evidence to the cases since Paragonomiasis share similar manifestations as Tuberculosis.
Pangulogon of course is not an exemption to the case. According to the survey that the team conducted, several cases of Paragonomiasis either caused the disability or death of some Pangulogon residents in the past 2 years. Unfortunately, we cannot take the words of the residents as sole evidence to the cases since Paragonomiasis share similar manifestations as Tuberculosis.
Alarming though that residents (especially children) are seen bathing in the rivers which are proven to be infested with parasites. Most of the residents too (adults included) walk around barefooted in total disregard of the mode and transmission of the disease. Others also admit to have eaten fishes or crustaceans from the river, with a few eating them raw (what the call the Kinilaw)!
Methods to control incidence of the different types of parasitism is already running (such as the Operasyon Pampurga), but the team sees it essential that more steps should be undertaken to rouse the community's concern and increase their knowledge on the causes and effects of parasitism.
Proposed Solution: Increasing awareness through lectures; activities that address to lifestyle changes
6.
Poor
solid waste management
Waste management is one very common area of interest of medical students - as it is a problem consistently present in almost all communities. With the advent of global warming and ecological destruction, it is but imperative that we find ways on how to manage our waste and dispose of them properly. We are lucky though that the government has been very active on the promulgation of the Solid Waste Management Act, RA 9003, which aims on the
By using these
methods we felt confident enough that we came up with reliable prioritized
problems and finding interventions to these problems will, more or less, be
easier to do. These interventions will also allow the community people to be
self-reliant and organized, which is the primary purpose of this community
exposure.
Paying Respect
It was September 2012 when we took our first step at the Municipality of Manuel A. Roxas Zamboanga del Norte. A warm welcome was initiated as we arrived by the RHU staff headed by our community preceptor Dr. Leigh Arouet Lluisma. We knew that day that Roxas will serve as our second home for the upcoming 4 (four) years as a medical students. As an initial step we must recognize and identify significant personas which will serve as a big help for us to accomplish our mission here and that is to make a difference.
On the very first morning after our arrival we attended for the first time the municipal flag ceremony together with the municipal employees. It was also during that ceremony that our preceptor introduced us to the entire Roxas community as a medical student. After the ceremony we got ourselves a tour at the municipal office and introduced us to different department head. And lastly after the short tour, we had our first meeting the municipal mayor Eduardo Yebes. The mayor was so accommodating as he expressed his willingness to support us on whatever projects and programs that we intend to do.
Women Empowerment - A Key to Effective Family Planning
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| The Problem |
Family Planning is an internationally proven strategy that helps
empower couples with the information and opportunity to plan and space their
children. This will not only strengthen the family as a unit but also optimize
care for children who will have more opportunities to be educated, healthy and
productive. Recent researches are shedding light on how family planning
increases survival, improves health, and helps achieve Millennium Development
Goals. Indeed, Family Planning is a smart, sensible, and vital component of
global health and development.
However, there are a number of challenges that stand in the way in
making contraceptives widely available and accessible. These challenges include
high cost of quality contraceptives, religious, cultural and knowledge barrier.
In rural areas, like in Pangulogon, modern contraceptives are often scarce, and
only few trained professionals are available to provide Family Planning
services. The distance of the place to the health unit also serves as an
obstacle. These are some reasons why there is a slow trend in reducing fertility
rate and increasing contraceptive prevalence rate, especially in far flung
areas.
Survey shows that in 2011, Barangay Pangulogon accounted only 32.7%
of contraceptive prevalence rate which is lower than the target of 70%. This
means that out of 58 couples in reproductive years, only 19 are using
contraceptive method. This is an alarming finding as this revealed that only
few couples used contraceptive methods and this reflects poor outcome of Family
Planning program in the place. This calls for an intensive campaign to make
contraceptive methods more accessible and available to the community. To bridge
the gap, the Team Pangulogon ADZU-SOM students spearheaded a Family Planning
Awareness Program among Mothers in reproductive years with the theme, “Responsableng
Maguang”, on April 12, 2013 at the Pangulogon Chapel. This was also our
response to the call of empowering mothers to make informed choices about the
use of contraceptive method and improve their quality of life. Fifty mothers
attended the activity and they were attentive as the medical students discussed
the goals, benefits, and Family Planning methods. Emphasis was made on the
effectiveness, side effects and complications of the available contraceptives
in the Rural Health Unit. It was also made clear that the lecture does not
enforce the use of contraception as the decision still lies in the hands of the
couple. Moreover, a consultation/counselling with a trained health professional
or a physician was advised before the use of any of the contraceptives
mentioned to avoid adverse side effects and complication. The activity was a success and we hoped that
we were able to give them enlightenment on Family Planning and the roles that
women actively play in its effective implementation.
