After a year of clerkship, we would like to thank our family and friends, and all those who supported our community medicine elective in Visayas.

Dr. Ernesto Tan

Engr. Cesar Azurin

Dr. Maximino Elgar

Dr. Letty Limjoco Sarte

Mr. Mahar Mangahas

Dr. Mediadora Saniel

Dr. Enrique Ona

Dr. Lisa Prodigalidad Jabson

Dr. Butch Manalastas

Drs. Mike & Rose Liquete

Mr. Josefino Sto. Domingo

Dr. Thelma Tupasi-Ramos

Dr. William Yao

Dr. Rey Matias

Dr. Yopz Punzalan

Dr. Alex & Dean Josefina Tuazon

Dr. Rafael Bundoc

Dr. Jody Dalmacio

Dr. Rene De Grano

Dr. Tony Drexler

Dr. Antonio Dans

Dr. Rafael Claudio

Mr. Eduardo Banzon

Drs. JayJay & Tech Cruz

Dr. Venancio Gloria

Dr. Tita Tuazon

Dr. Reynaldo Joson

Mr. Gus Lagman

Dr. Gene Abes

Dr. Tony Abaya

Dr. Arturo Pesigan

Dr. Carlos Chua

Dr. Jose Pujalte

Atty. Arsenio Cabrera

Dr. Girlie Bacsal

Mr. Jesse Kiok

Mr. Tony Chan

Dr. Mamerto Almelor

Mr. & Mrs Jun Arles

Dr. Llanto & family

Dr. Jaime Galvez-Tan

After a few days of rest and tour in Bohol, the medical students were back in Cebu. This time, they went to Tabuk, Mandaue for their last tuli mission as requested by their fellow classmate in UP College of Medicine, Ms. Liz Jamora. This was done at the community’s gym area, and it was quite a windy day that kept on blowing the sterile gauzes from the operating table. The supply of gloves, sutures, and surgical equipment was limited so the medical students and other volunteers just queued for the scissors and clamps being sterilized, and they used the available gloves even if the gloves does not fit their size. Again, sutures were sterilized with lysol to be reused to other patients in line. More than 150 children were circumcised and the mission finished early in the afternoon despite the lack of medical supplies.

Next the med students’ itinerary was Trinidad, around 3 hours away from Baclayon. Upon arriving, we were introduced to Nanay Remedios Fuentes and remained at her home while waiting for the other health committee members. It was originally planned to have a reproductive health lecture with the youth council as the audience but since majority were tending to the fields or in Tagbilaran for their summer jobs, it was cancelled. The members of the health committee were also unavailable so the students proceeded to their foster parent Nanay Conching’s house.

At around 8 p.m., the students and members of the community gathered at the multi-purpose hall for Solidarity Night/welcome party for us which was organized by TTIFA. It was also a cultural presentation of sorts which featured the organization’s history, as well as showcased the talents of their community members, young and old alike. Nanay Conching started with a poem that spoke of their plight, struggle and triumph as a community, while children (none older than 14) performed songs and oration that spoke of peace and respect for children’s rights. Afterwards, the medical students were asked to introduce themselves to the community members. They also thanked the community for welcoming them and for the very unexpected but touching program they prepared. It was then decided that the students would meet with the health committee the following morning since the meeting earlier did not push through.

The morning after, the students had a meeting with the members of the Health Committee that was formed in 1998. Concomitant with an outbreak of skin diseases in the community, and faced with inaccessible health centre not even a pharmacy, the community members had resorted to equipping themselves with knowledge on basic health care. They underwent Basic Health Skills Training as organized by the VPHCSI. Currently, the Health Committee has 20 active members, although the health leaders also claim that almost all women are somehow members of the committee. Most of them are able to perform Vital Signs Monitoring, hilot, reflexology and ventosa. They admitted that they still need more practice in some areas though. The committee meets regularly every 1st Friday of the month.

The committee also has a pharmacy-Botika sa Barangay, but is currently out of stock. Medicines usually include paracetamol, amoxicillin and oresol. Most of these came from donations and are sold at a lower price—an IGP for the committee. Majority of the community members however rely on herbal medications for the most common illnesses.

With regards to reproductive health issues, the CHWs presented no major problems. Some mothers have 9 children, and the others have at least 5, but the CHWs themselves have asserted that Family Planning is not necessary. There is also no report of sexually transmitted infections. In terms of maternal health care, a mananabang or hilot (traditional birth attendant) is sought, but referrals to the midwife at the “nearest” health center are made for complicated ones, like difficulty in delivery of the placenta for example.

The CHWs have also identified lack of toilets as well as distance from the source of water as other health issues. A deep-well is located somewhere downhill, and serves as a communal source of water. Boiling of drinking water is not a common practice in the community so that there have been few cases of diarrhea in the past. Drinking preparations of guava leaves were said to have been useful in some cases. The CHWs admitted that although they would boil water upon learning of the outbreak, they would eventually break off from the practice once it subsides. There have been no mortalities so far.

In terms of involvement of the local government in providing basic health services, the community admitted that the LGU specifically the barangay’s support has been limited to donation of medicines alone. In fact, everything found in their sitio—basketball court, chapel, pharmacy, has been built on funds generated by TTIFA itself. In the end, the CHWs admitted that they get minimal support from the municipal government, as has been exemplified by their absence of electricity. They said that the Mayor would have agreed to install electricity already but since the Congressman, who happens to be the husband of the Mayor, lost in their sitio during the elections, having electricity may still be far from becoming a reality.

Together with VPHCSI volunteers and doctors, the medical students went to a small town called Tangnan in the island of Panglao to give free medical consultations and medications to the community. Encountered medical conditions were hypertension, diabetes, asthma, allergic rhinitis, fever, cough and colds. If there were no available medications for their condition, they were advised to go to their local health center or nearby hospital. There was a nurse volunteer and VPHCSI staff to help the medical students in relaying information and communication in “Bisaya”.

The medical students were surprised to see the number of children to be circumcised. They started at 9am and ended at 7pm. There was a time that there were no more surgical gloves and it was suggested by a doctor to wash the used gloves with alcohol. Fortunately, supply of gloves arrived as the tuli mission continued. The UP medical students thought they were better in doing the circumcision procedure to the children, as they noticed more children were crying on the area of doctors doing the circumcision. It was found out later that the technique of other doctors was inappropriate and they just continued to cut and clamp without waiting for the anesthesia to take effect. With the help of other volunteers, the total number of children circumcised was around 287.

The medical students went to the municipality of Loon and had a courtesy call with Mayor Lloyd Peter Lopez. The mayor was also a practicing physician before going into government service. He informed us that there were no major health problems in Loon except for the increasing population in the area which might generate health issues in the near future. The group asked if the mayor still practices his profession of being a physician and told us that the law the does not allow him to practice his previous profession, but it does not stop him to help those in need of a doctor when there is none.

The group then went atop a hill in Loon to visit the Virgin Coconut Oil (VCO) processing plant which was also a source of livelihood for the women of Loon. The women who worked at the plant also teach other women to make VCO at their own home. They attested to the efficacy of VCO in lowering blood pressure and treating burns.

They then proceeded to the learning center of the United Women of Loon and had an orientation about the different herbal plants being processed as alternative medicines. This was a house where the women stored drums of fermented coconut vinegar and bottles of mother tincture of different herbal plants. There was a process/ritual of making each mother tincture of herbal plants. These mother tinctures were the essence for making different dilutions of herbal medications, each herbal medication with a definite amount of dilution with gin which was a cure for a number of ailments.

The group departed for Bohol on the night of May 6 and arrived early at the port of Tagbilaran. They had their breakfast at the city before they took the multicab going to Baclayon. The VPHCSI staff house was located at the back of the oldest coral church in the region. The group went for a swim near the bay area of Baclayon then had an orientation with Dr. Grace Molina regarding the schedule of activities while in Bohol.

The group had the morning of May 4 to rest post-Negros Oriental trip. At 2pm, they met with Ate Jessica and Lindsay of VPHCSI, then took a 2-hour ride via a V-Hire van from the city to Toledo. From Toledo, they took a 45-minute ride to Aloguinsan via multicab. Upon arrival at Aloguinsan, the driver of the multicab generously offered to take us to the school behind which the rural community was located. However, there was a slight altercation between the multicab driver and the habal-habal drivers regarding who should take the group to the community. It was only found out later that the community can be travelled by foot from the Aloguinsan terminal.

The group was expecting to be toured around the community but just stayed inside the house of Mang Ver, the head of the farmers’ association there. Mang Ver told the group that the community’s priority was the problem with land ownership and economic gains rather than health, although the community welcomes health workers to regularly educate them on health and nutrition.

This trip was supposed to be for the medical students to observe the Basic Health Skills Training for Community Health Workers of Kahugpungang Mag-uuma sa Aloguinsan – Project: Capability Building on Community-based Health Programs in Cebu supported by VPHCSI and DSWD. The students were there to add, if necessary, information on what the VPHCSI volunteers were teaching to the CHWs. The medical students were to observe the training since what the volunteers were teaching was in their native dialect which the medical students barely understood. The medical students thought that the health modules produced by VPHCSI were relevant and sufficient to educate the community health workers.

It was raining in the morning when the medical students and Kuya Tey and Ate Che decided to travel down the mountain. The original schedule was to stay in the clinic for one week but was cut short due to suppposed military activity in the area. It had been raining for the past two days and the group was wondering how the habal-habal could reach them as the route was so wet, slippery, and muddy.

Ate Nilda of the Kansalakan Mountain Clinic told the group that the only way to go down the mountain was to traverse another mountain and go to a town there where the habal-habal drivers were waiting because there was another route that was passable to the drivers.

As the rain continued to pour, the group started the hike down and up hills which was difficult as each step on the muddy route was knee-deep and all the mud were stuck on the footwears of these group of adventurous medical students. Dirt, mud, and slippery stones came as a challenge to these hikers. They also had to cross an old hanging bridge wherein one had to be careful crossing because there were gaps of broken wood on the bridge and a wrong step might lead to a fall down the raging river.

There were also local people travelling the route taken by the group, and it was easy for them walking barefoot on the slippery trek while carrying sacks of their goods with both hands and one on their head. There were paths that some of the medical students have to walk on barefoot which was better than having mud stuck underneath their sandals that made it more difficult for them to walk on.

After a 2-hour hike, the group reached the town where the habal-habal drivers were waiting. There were only two motorcycles so five people were to ride on each habal-habal. As the habal-habals rode down the mountain, there were also muddy and rocky routes that the group had to get off their designated habal-habal and walked. They also walked across a river knee-deep.

After another 2-hour habal-habal riding, the group arrived at the port of Gihulngan. They changed clothing, had lunch, and treated themselves to a videoke as they wait for the scheduled ferry to take them back to Dumanjog, Cebu.

Located deep in the mountains of Negros Oriental, Kansalakan Mountain Clinic (KMC) was established in September 11, 1972 by Franciscan Friars because of lack of access to health care in the area. Many patients die without reaching the hospital or even being seen by a physician because getting to the nearest hospital takes about 2 days of walking (back when there were no habal-habals better known as motorcycles). It has 3 extension clinics run by CHWs who were trained in KMC, the closest of which is 1 hour by foot. Services include Minor surgery (cirumcision, excisions), consultation, wound dressing, and foreign body removal. The clinic also has a cooperative (established in 1992) which sells medicines. Currently, there are 28 CHWs, 22 of which are active. Aside from health, the Franciscan Friars also helped in the peoples’ livelihood through Animal Dispersal and sewing classes.

The day started off with a courtesy call to the barangay captain, Wilfredo Fuentes who also kindly served us dinuguan. Afterwards, we went back to the clinic where the CHWs were making lagundi syrup (for cough). After lunch, we then gave them a refresher course on vital signs taking and an overview of pediatric drug dosing. Although some of the CHWs were adept in taking the vital signs, majority still needed to practice on their skills especially since they are the ones manning the extension clinics.