Jan 052011

It’s been a year since the last time that Ugat ng Kalusugan staff did a needs assessment in various areas in Puerto Princesa in order to find the next location where Ugat ng Kalusugan / Roots of Health can extend its helping hand.

To begin with, we conducted informational interviews with key informants in Puerto Princesa, including with representatives from the City Health Office, the Population Commission, and representatives from Palawan State University and other local NGOs. Once these informants had highlighted communities that are particularly underserved, we visited City Hall and analyzed the most recent census data from those communities. We then narrowed down the possible communities to five different locations. We went to those communities and met with the Barangay heads and health workers to find out more information about the families living there. Finally, after all these meetings, Lyn-Lyn and I began conducting house-to-house surveys in each of the locations. In preparing for our interviews, I was inspired by something that Ms. Habaradas, one of my former mentors at PSU College of Nursing and Health Sciences, told us when we met with her. She said, “Every community has their own need and you’ll see it if you just deeply search for it.” I felt excited and as we prepared for our surveys, I thought to myself, “I want to discover what this community needs, and see what I can do help.” Armed with our clipboards, interview forms, pens, umbrellas and water, we set off. Unfortunately in all our excitement we forgot to bring the camera, but we can go back and take some photos later.

Our primary objective was to gain information about each of the sites we were considering. We planned to interview at least 15 women from 15 different households to gain knowledge about their health beliefs and practices, as well as about their socio-economic status. The 15 surveys from each community are not statistically representative of the whole community, but can paint a useful picture of what some of the community needs and issues are.

Our first site was Purok Matiyaga in Barangay San Jose. To our surprise, we found that the informal name for the area we were looking for is “ Little Tondo”. Tondo is known as one of the poorest areas in Manila with many slums. It is one of the most densely populated areas of land in the world. Contrary to our expectations based on Manila’s Tondo, this “Little Tondo” in Puerto Princesa is not very populated, and is peaceful and simple. Most of the residents are from the Tagbanua tribe – one of the three main groups of indigenous peoples in Palawan. The community is near the sea, there are lots of trees and it is pretty. When we went there it was quite muddy due to the previous day’s rains. Most of the families we came across were busy peeling the kasoy (or cashew) seeds. This is the main source of income for many of the families in the community.
To give you more of an idea of what the community is like, here are some of the key data we gathered:

Socio-Economic Indicators
• 1/3 of respondents have a monthly household income between P501 and P1,500 (roughly $11-$34). Another 1/3 live on between P1,501 and P3,000 ($34-$68) each month . The last 1/3 live on between P3,000 and P6,000 ($68-$136) per month.
• Only 40% of respondents have work or a way to earn income.
• The majority of respondents store excess food in containers with lids. Three respondents share a refrigerator, and two more store leftovers in baskets. One respondent said that her family never had any leftover food.

Water and Sanitation
• All of the respondents obtain their drinking water from a well.
• Half of the households do not have a toilet so residents use their neighbor’s toilets, or urinate and defecate outside their homes. The other half of respondents have a water-sealed toilet (toilet without a cistern or flush mechanism – one pours water into the toilet to get rid of waste).

Pregnancy and Children
• Only 6 out of 15 respondents are practicing a family planning method. The other 9 respondents are not currently using any family planning methods.
• Of the women using modern forms of contraceptives, 1/3 pay for the medicines themselves but 2/3 must rely on free supplies.
• 9 of the women have had 3 pregnancies or less. On the opposite end of the spectrum, 2 women have had between 9 and 11 pregnancies.
• Before their last pregnancies, 33% of respondents were using contraceptives and stopped in order to conceive. In contrast, 66% of respondents had not been using any form of contraception before they became pregnant.
• The majority of women interviewed said their ideal number of children is between 2 and 3.
• Many of the women had more children than their reported ideal number so we asked them about the difference. Some women had more children than they wanted because they were trying again for a boy or a girl, but more respondents said they had more children than they wanted because of unplanned pregnancies.

• When they or their children are sick, nearly half of respondents seek care from a doctor, a quarter see traditional healers and the rest access care from the Barangay Health Center. One woman said she just mixes herbal medicines to cure herself.
• When asked for their preferred attendant at birth, 10 respondents said they wanted their birth attended by a traditional healer, 3 said they prefer a midwife and 2 said they wanted a doctor to attend their births.
• When asked where they preferred to give birth, 11 respondents said they prefer to deliver at home, 2 said they wanted to deliver in a hospital and 2 said they wanted to give birth in a health center.
• After their last pregnancy, 6 of the respondents had 1-3 postnatal visits at the health center. 9 of the 15 respondents did not have any postnatal check ups because they did not know about them.

Beliefs about Family Planning
When asked about their beliefs on family planning, 8 of the 15 respondents said they thought that when one drinks hormonal contraceptive pills that they do not dissolve or get absorbed into one’s body, and can become tumors, or cause cancers that necessitate cleaning out the uterus.

Some other beliefs include:
• “DMPA (the injectable contraceptive) will cause baldness”
• “If a condom breaks inside your body it stays there and doesn’t get absorbed or come out of your body”

Pregnancy Beliefs
More than 1/3 of the respondents believe that if you are pregnant and sit near a door, you will have a hard time with giving birth.
1/5 of respondents said that if you see a rope, that you should not walk over it but instead avoid it so that your baby’s umbilical cord won’t get coiled up.
One woman believes you should not eat any bloody foods like fish while pregnant as this might cause you to hemorrhage after delivery.

As I write this blog entry, we are still finishing our surveys and analysis from the other four communities we are considering. We hope to choose the most underserved community based from the results of our surveys by early December. We hope to begin our work in our new location by mid to late January 2011.

I want to end this blog by leaving you this quotation: “Don’t ask what the world needs. Ask what makes you come alive and go do it, because what the world needs is people who come alive”- Howard Thurman