We left the hotel in Tarlac at 7:00in the morning. In slightly rainy weather, our bus drove us to a village up a road with many cars. The road was well paved, but the lack of a median strip made me a little uneasiness. I saw cattle grazing in the field and an old man with a big hat in the cornfield. There, for the first time in the 6 days stay in the Philippines, I found the scenery that I had imagined before I left Japan. The bus passed in front of a school about 7:20, and we saw many children in uniforms. Seemingly, the morning comes early in the Philippines.

　

We visited a heath station in one barangays of Pampanga Province, located a little to the south of Tarlac, where we had visited the previous day. Many mothers and children were already in the building. A delicious smell hung in the air as we went inside. A big pan of soup was on the charcoal fire, which two women were stirring. Seemingly, the ingredients were chicken, onion, carrot, cabbage, noodle, milk, etc. What they do in this project is to give this food to the malnourished children in the village and teach their mothers about proper nutrition.

　

[Institution]

This barangay health center was built by MPC (Mount Pinatubo Commission=government office) in 1990. When it started as a hospital in 1994, one doctor, a nurse, and a midwife were stationed there. Under the jurisdiction of local government from 1998, the only staff stationed there was the midwife. There were many vacant unused rooms, such as the examination room, dentist's office, etc. in the building.

　

[Staff]

17 persons (1 rural health midwife, 1 barangay service point officer, 2 BNS, 6 barangay health worker, and 7 supplementary feeding volunteer)

　

[Role of the health station]

1. Hospital: Since a doctor comes to this center only once a month, a patient is fundamentally introduced to nearby rural health center (doctor, dentist, and nurse are there). Medicine is inadequate. Medical examination cost is no charge.

2. Nutrition supply to children: One meal is given daily to malnourished children on Monday - Friday every week. The menu is various. Materials are based on offering from SWDO- Social Welfare Development Organization (city government) and Nutrilinc (NGO).

3. Nutrition education to mothers: In carrying this out, the workers go out to one district once a week. The contents of the education are various and they include, in addition to nutrition, tooth brushing, bathing, child-rearing, information on diarrhea, a parasitic diseases, etc. Mothers are taught by presentations using paper play by the staff for better understanding.

　

[Cover range of health station]

This health station covers a population of 12,513 people (2034 families) out of which nearly 3000 as children less than 6 years old.

　

[Project]

Families with malnourished children are identified by a house visit conducted by two staffs (BNS and SFV) throughout the months of January to March in each district. The level of malnutrition is divided into 3 degrees: 1=mild, 2=moderate, and 3=severe. At present, there are 90 children (less than 6) of malnutrition, including five level 3 children. After a child on the feeding program reaches normal level, they receive nutrition supply for one more month, before they are released. For disabled children, the center staff visits their homes and the family is given guidance. On the day of our visit, I roughly estimated the number of children to be 40 to 50. The staff explained to us that the children who were absent were sick children, and the rainy weather seemed to have some influence also. Most mothers brought two children, and there was a child brought there by his elder sister. Perhaps it was just me, but I felt a tense feeling surrounding the atmosphere.

　

[Future view]

It seems that SWDO is going to continue the implementation of this nutrition supply program. Nutrilinc will support the program between the period from October 2001 to March 2004 in this barangay. The purpose of Nutrilinc is "to evaluate the recovery of children from malnutrition." One issue that attracted my attention was insufficiency of medicine. This means that the present supply from the government is inadequate. Measures, such as introduction of the Botika Binhi system, like the one we say in Tarlac, should be adopted. To a question "why are some mothers overweight whereas their children are malnourished", the answer was that some of them must be plain lazy. Education on behavior problems is now being given to them. There was a remark that if these kinds of meetings among mothers were also available in Japan, it may help in decreasing the incidence of maternal problems such as child-rearing neurosis. Seemingly, some health centers in Japan do have these kinds of programs.

　

[LUZNNET-Luzon Non-governmental Organization Network]

Mr. Elmer A. Palacio, the representative of LUZNNET, explained to us about their organization. LUZNNET is a network of NGOs, which was established in March 2002 by the 15 NGOs conducting programs in the Luzon area. Their aim is empowering of the people of the community for the improvement of their quality of life. The main role of LUZNNET is:

1. To facilitate the sustainable community development.

2. To share skills and services among member NGOs

3. To establish a linkage with the government and other NGOs

　

[Nutrilinc-Nutrition and Livelihood Resource Center, Inc.]

Dr. Rosemarie, the representative of the organization, explained to us about Nutrilinc. Nutrilinc has been active since 1995. Their main concern is in the aspect of nutrition for the purpose of promoting health Activities are conducted at the barangay level. The main role of Nutrilinc is:

1. Coordinator for LUZNNET

Since LUZNNET is a new organization, Nutrilinc assists them to carry out their projects and communicate with the other NGOs.

2. Making partnerships at barangays

Lack of budget is always a problem. In order to gather funds, Nutrilinc opens seminars inviting people such as representatives of the rotary club or a local self-governing organization to gain their understanding towards the projects.

3. Health and Nutrition Committee

As the government policy, each province and barangay must organize a health/nutrition committee to deal with related problems. However, in most cases, these committees do not function. Therefore, Nutrilinc provides proper education/training for these committees in how to deal with the issues.

　

We visited Cuayan Barangay Health Center located in Pampanga to observe a project titled "Community Health Development Project for Selected Underserved in Central Luzon". This project is managed by LUZNNET, coordinated by Nutrilinc and supported by JICA. SAMAKA, a local counterpart for healthcare, also participates in this project.

[Activities]

1. Nutritional education for mothers of malnourished children

Nutrition and health class is held seven times a week and 30 mothers on average take part in it. The recipe for a proper meal for the children is distributed.

2. Training for health workers

A dietician is invited once a month from the city health center for training of the health workers.

3. Supplemental feeding program

Nutrilinc provides supplemental foods for malnourished children. The feeding activity is held from Monday to Friday, for 3 months especially during May to August, just before the harvest season when food lack the most during the year.

　

[My impression]

Having seen the project and asking questions, I came to know why these children become malnourished. One reasons was a lack of the mother's knowledge on nutrition. In this health center, the recipe as well a lectures for mothers did not seem to be based on proper medical-based dietetics but more on experience. I thought that this could be a problem in terms of program management. However, I also thought it is very effective to have women health workers educate the mothers, as lectures from women would be more acceptable and understandable for the mothers. From my observation, I was able to see the vitality of women, "mothers" as well as "health workers" in their efforts to make life better for them and their families. We appreciate their kind acceptance of our visit. (Sachiko Takada, Misaki Sugai)

　

　

After two fruitful days in Tarlac and Pampanga, we were on the road back to Manila. This was our 8^th day of our heavy-scheduled study tour, and almost every one of us just slept throughout the entire way, We reached Manila around lunchtime, and Val took us to a nice Filipino restaurant with great food and music. It was a good relaxing time for us, but we felt sad because we had to say goodbye to Val, who had been more than just our driver.

　

Dr. Inoue and Dr. Takashima from WHO spared us their time for an informal talk with us. And we had a very good and valuable time at a nice restaurant by the sea over coffee, cake and halo halo. We listened to their thoughts on their lives, marriage and so on. And they gave us a lot of advice and answered our questions kindly.

　

The night before the summing up meeting, we discussed what should be the themes of the meeting and decided on the following three.

　

1. What is happiness of the people

2. Merits and demerits of WHO, JICA and NGO

3. How each of us want to be engaged in international health care

　

Details are available in Japanese text only.

　

　

When asked the theme of today's lecture, Dr. Barua answered, " halo halo".

　

Like he said, his talk included a mixture of so many topics, such as his personal history, lessons from the 1995 Great Hanshin earthquake, a view of happiness and importance of pursuing self-identity. So it was indeed like halo halo, which means that many things are mixed.

　

Detail of Dr. Barua's lecture is available in Japanese text only.

　

We left our hotel a little before noon to catch the 14:30 flight back to Tokyo. We were all relieved that we made it through the tough tour, but at the same time sad that it was time to say goodbye to all the wonderful people we met during what now seemed to be a short stay.