>>REBECCA:Likhaan and the Mae Tao Clinic
are both long-term counterparts of Inter Pares and they both provide health services to marginalized
people. This is Mae Tao Clinic, on the Thai Burma
border. They provide health care for people who have fled the war in Burma. It was founded
by Dr. Cynthia, this is her, and has expanded over its twenty years of operation from a
small shed, that was famous for using a rice cooker to sterilize equipment, into a full
community centre and hospital. In 2009, over 2,700 babies were delivered at the clinic. Likhaan is based in metro-Manila. It’s a
community based primary health organization that works in impoverished urban and rural
communities with an emphasis on women’s reproductive health and health policy. In 1999, Inter Pares facilitated the first
exchange between these two organisations and over the years several staff have found opportunities
for collaboration. In this photo, Likhaan’s ED Dr. Junice is accepting the Ramon Magsaysay
Award on Dr Cynthia’s behalf; an award Likhaan had nominated her for. This March when I travelled to Manila to meet
with Likhaan, I invited Dr Cynthia to join me. This was her first time to visit Likhaan’s
work and people were really excited to meet her. We spent three days in Manila learning
about Likhaan’s activities, their struggles and their hopes. Dr Cynthia was joined by Sophia, who is the
head of the reproductive health department and two other health workers, all from Mae
Tao Clinic. That’s me on the left. We were hosted by Kiko, an extremely fun and
energetic youth outreach worker. Kiko is from Pasay where an average home is 16 square meters
for a family of 8. Likhaan has helped people there organize into a housing association
and they are trying to buy their own land. This is Dr Junice, Likhaan’s ED. We first
went to Paradise. Built on a former garbage dump and fish pond, this community, named
Paradise, has been working with Likhaan for fifteen years. There is a public hospital
fairly close by, with an average of three people per bed. The paths were filled with
children, all running forward asking to be photographed. We arrived at the tiny clinic
and toured its four rooms. We packed the waiting room and sat and shared stories. While you look at these photos of Paradise
I will tell you a bit about what we learned about the context in which Likhaan works.
Education, up to high school is supposedly “free” – but students have to pay for desks,
a guard, toilet cleaning, books, etc Students often have to share chairs – 50 to 70 students
in each classroom the average drop-out age in some areas is as low as 8 schools are mainly
private, and most of these are Catholic schools. (The Catholic church is extremely influential
in government policy: condoms for example are not on display in shops and in some areas
of Manila public funding for contraception has been banned. Only 23% of sexually active
young people in the Philippines use contraception) Women have an average of 6 or 7 children,
and it is really common to see very young mothers. There are more physicians working
in private health care than in the public. Most people who get health care at all use
private services; basically those who can afford services get them. Unfortunately, the
entire focus of the US’s international development assistance (USAID) since 2003, has been on
building private health care. Likhaan has set up a pregnant women’s insurance
program in one of their communities a small group of pregnant women each contribute a
small sum and these funds are used to support the one or two women who have a complex delivery. There has been an upsurge in measles And there’s
been a decline in the number of breast feeding mothers – less than 20% – and most feed
for just a month or two and then stop because they need to work. Malnutrition is therefore
a big issue. Likhaan told us that, just before our visit,
the government had released statistics showing a surge in HIV prevalence which surprised
everyone. They explained that previously almost no one had been tracking HIV as the rates
had always been so low. On our second day, we went out to Manila city.
A group of Likhaan community volunteers greeted us
and described the community in which they work. The former mayor of Manila city had
banned all contraception services funded by the government. Prostitution of girls is a
major issue – one job earns 200 pesos for their pimp and 300 for the girl. The average
total family income is between 1 and 300 pesos per day.
Most people have no house, no electricity and water is very expensive. We pass a place
where a woman is selling water, each jerry can – about 20 litres – costing anywhere
from 8 to 25% of a family’s daily income. This by the way is footage of us entering
into the “compound” of Manila city. The Philippines were scheduled to hold local and
national elections in about two months. Likhaan used to ignore elections but they realized
that they are important to communities and so since 2004 they have engaged in election
campaigns. Given the generals’ plans for elections in Burma in 2010 all of this was
really interesting for our colleagues from Burma. While we were there Dr Junice asked the volunteers
what would they do if they were the next mayor – they talked about free education and
teaching family planning, they all wanted to look at the lack of jobs and low salaries
and over crowding in their communities… one woman said “we participate in elections
because we are interested in long term change. In the past, we used to vote for whoever paid
us” Back at Likhaan’s office we were able to
have some discussions around protocols and drugs in reproductive health care – it was
a rare opportunity to speak openly about sensitive issues such as post-abortion care, and to
compare strategies. Abortions are illegal in Burma, Thailand and the Philippines, and
unsafe abortions result in severe health complications for untold numbers of women. Dr Cynthia also asked about violence against
women and we were told that the norms are slowly changing. That neighbours will now
report abuse to police for example. But divorce is still not a real option for most women,
the justice systems continue to privilege men over women. These are pictures of the hospital that we
were able to visit on our third day. We met with the head of the obstetrics department
who told us that they had 58 beds, with usually 2 or 3 patients per bed. An average of 8-900
post-abortion cases per year. They used to receive family planning supplies from USAID
that went through the local government but now these supplies are all channelled through
to the private health care. We were given copies of forms for birth certificates and
patient records which will be really useful to compare to the clinic’s own templates. One evening we went back to the Likhaan office
where staff and friends all joined us in eating, dancing and karaoke. Burmese karaoke was a
hit, Dr Cynthia and Sophia taught some traditional dance moves, and Kiko and Junice demonstrated
a dance with bamboo poles. There were a few speeches but mostly this was just a chance
for us to laugh together. It really was just an amazing trip.