Though we were supposed to depart at 6:30, some members were late they had no sleep celebrating the success of the reception yesterday. It made us nervous. The driver from today was skin-headed Bal. At first sight, he seemed scary, but we found him to be a very friendly person. There must be a lot of members who liked him. Dr. Inoue from WPRO also accompanied us on this trip. Just after we left Manila all of us went to sleep. Everyone was so tired.

　

At the Tarlac Provincial Hospital, we met Dr. Ramos, the head officer of Tarlac Provincial Hospital. Dr Ramos, with a mustache was very kind and made a lot of jokes and humors in his lecture. He asked each one of us the reason of entering medical school and what kind of doctors we want to be, and we made our self-introductions. After our introductions he gave us these comments: 1. Importance of respecting each other, 2. The importance of communication, 3. To feel for others. From CNN we see the lack of feeling others make the world full of terrorism and wars. He also mentioned the importance of (physically, mentally, socially, and spiritually) comprehensive view, which phrases he cited from the definition of the health by WHO. Moreover he mentioned the importance of QOL, that what people worldwide need are happiness, health, and making good relationships with each other. He pointed out the problems of socie surrounding current health care as follows. Our present society puts emphasis on productivity, and what will be the result? In the future, the population of the elderly with little productivity is going to increase (We have to reform the society which thinks highly of the productivity). In addition, social problems are most often dealt in a short-term perspective. Singapore for example. At first having only one child was recommended. But now because of the decreasing number of children the policy totally changed and having several children is regarded as preferable. That is the typical short-sighted politics.

The resource on this earth is limited. We cannot pour all the resource into medicine. We need to take hand in hand and solve these complex and complicated problems. Nowadays, the cartoon "Voltes V ", which was originally made in Japan, is popular in the Philippines. In this story, several heroes get together and combat with their enemies. We have to learn from this story and cooperate in order to solve the problems. By the lecture from Dr. Ramos, we got an opportunity to think not only on international health but also on social problems and the objective of international health cooperation.

　

Question and Answer:

Q: Does the decentralization work well?

A: Equity, but not equality. As you can see inside the Manila city there is an area for the residence for the rich like Makati. There is also another area for the residence for the poor like Smoky Mountain. The difference between the communities is too big.

　

Ms. Mercy Manlutac (Rural Health Midwife) gave us a lecture on Maternal & Child Health Activities in Barangay. Balibago (1^st) Primero Health Station.

　

The content of the service is family planning, sex education for women (for example, they explain why the contraception is effective by using an apron on which uterine and ovaries are drawn, and wearing it to explain the location of the organs and its mechanism) direction of feeding, delivery, and so on. The prescriptions are also written here.

Oral contraceptives, condoms and ORS are given out free. Midwives have the right to prescribe most medical treatments in this barangay health center. JICA invested 100 million yen in Tarlac. They hope that this project will not only enhance the development and establishment of the system in this province but also has effects on other areas in this country as well.

　

Ms. Manlutac then showed us a map on family plapning. It showed which family uses which contraceptives, such as condoms or oral contraceptives. According to the map, the percentage of not using contraception was the biggest, the second biggest used IUD, and the third used condoms. The population covered is 7,000 and there are 3 health stations including this health station in this area. As for the health staffs, there is only one midwife in these 3 stations and no doctors.

We understood how Ms. Manlutac made a lot of efforts in educating the people in her area by using pictures, figures, and tables that she made herself, and how she dedicated herself to her work. It must be important for the good midwives like her to increase in number in order to support the local health care.

　

Question and Answer:

Q: Are Catholics prohibited from having induced abortions?

A: There are those who consent after they are informed and choose induced abortions.

　

Q: Why are oral contraceptives preferable?

A: They only change the homeostasis, so many women think they don't affect the bodies. (According to Ms. Baba's opinion, it is because women here cannot expect contraception from their husband)

　

Q: How much is the cost of delivering a baby?

A: 500 peso in the barangay station. There are many who have deliveries at home and in such cases TBA (Traditional Birth Assistant) help them. The fee for TBA varies from very small peso to 2000 peso at most. Midwives make an effort to decrease the number of prenatal accidents, for example, giving them the education of hygiene.

　

Future challenges:

･As JICA devoted billions of yen to Tarlac with a population of about one million, in terms of cost vs. effect, it is needed to expand the result here in Tarlac to other areas as well.

･Though the midwife of this station is very hardworking and makes the statistic report every month, many of the midwives of other areas are not as accurate as she is. Therefore it is impossible to compare the data by area, and there needs to be more work done to solve this problem.

　

According to Dr. Inoue, the points of attention when observing barangays and health centers should be:

･infant mortality rate

･implementation of immunization

･Whether they have the basic data

･The standardization of services

･The number of the staff

･The position in the whole system

･The percentage of the fee that should be paid

･The population covered

･The number of medicine on the shelves

　

In the Philippines, there is a consumer's cooperation store for drug supply called "Botika Binhi" in each area. Botika Binhi is a project implemented by the collaboration of an NGO called SMBK (Samahang Manggagawa ng Binhing Kalusugan) , PHO (Provincial Health Office of Tarlac) and JICA, started in 1994. The main objective of the project is for the local people to have easy access to safe and basic drugs on their own, to be educated and extend their knowledge on health, and to actively take participation in health activities in the community.

　

In the village we visited, there are nearly 1100 families of which around 250 are members of the Botika Binhi. There is a membership fee, but there are also some privileges in becoming a member. The reason for those who do not join the Botika Binhi varies.

The Botika Binhi we observed was set in a room of the residence of the health volunteer responsible for the store. There, they had a stock of 12 kinds of drugs. 2 kinds of antipyretic analgesics like acetaminophen, several kinds of antibiotics, vitamin C, salbutamol sulfate (bronchodilator), INH (anti TB), mefenamic acid, the drug for diarrhea were there. We also saw iodine added salt. The available drugs are limited, but the confirmation that they can easily get the drugs as needed make people living there feel safe. Even as we were being explained about the system, there was a customer who had come to buy some medicine for his daughter.

　

Question and Answer:

Q: Some people cannot take certain sedatives. Is there any problem here?

A: I give them drugs according to the prescription, so no problem.

(We wondered what they do with patients without prescriptions.)

　

This film showing is a project promoted by JICA and the Department of Health, and its objective is providing children with knowledge on public health.

The film had already started when we reached the school, and we saw children watching eagerly. The film was about sanitation, such as how to wash a lavatory and dump rubbish. There were some funny scenes, so children won't lose interest. The mayor of Tarlac was also present to give a talk to the children on the importance of health after the show. We saw the importance of active involvement and interest of government officials for a health program to be effective in an area.

　

This clinic is mainly intended for children under five years old, and the lowest unit of the health organization that has a doctor. The staff consists of one doctor, one dentist, four nurses, six volunteers and one sanitarian. Patients are often referred to from a barangay. There is a flow line, registration→growth monitoring→anemia detection→assessment→nutrition→family planning→immunization→consultation. They use maternity passbooks provided by the JICA program implemented up until last year. The city pays doctors' fee and charges for medicine, so patients pay nothing. On the day we visited they had eight babies and little children.

This institution is public, and we may think medical treatment is done by mainly by the public facilities in this country But they have private institutions also. I got an image that private hospitals may provide better services but are much more expensive.

This area has no private hospitals, but I heard that some doctors hold 2 posts, one in a public and another in a private hospital to receive a double income, or because there is a lack of doctors.