i spent last week in the rural region of paranas, which is about two hours north of tacloban on the western edge of the almost entirely undeveloped island of samar. there is one town, but paranas is a vast municipality, roughly equivalent to an american county. it is the type of place where foreigners are required to meet with the mayor and the legislative assembly upon arriving, where mayors walk with limps because of past assassination attempts, and where the mayor hasn’t even been to some of the villages in his region because they are so inaccessible. yes, if you’ve noticed, everything is about the mayor.
after a refreshing hair-tousling ride from tacloban in the back of a pickup truck, i was ushered before the municipality’s legislative assembly for formal introductions. the dozen or so politicians sat in one of the only air-conditioned rooms for miles, on ornately carved hardwood thrones (a status symbol in these parts), and referred to themselves as “the honorable____”. that was just the legislative branch; next i needed to meet the mayor, who seemed like a great guy. later i learned that he payed everyone who voted for him in the last election the equivalent of $10. the guy he was running against payed $40 per vote. the municipality offers identity cards, but only those who voted for the current mayor get one. exclusively those with these cards are eligible for free municipality-sponsored raffles for televisions and new cars – all this in a place that claims not to have the resources to buy an ambulance.
while we were small-talking with the mayor a woman was brought in who had a bulging eye and desperately needed to travel to the nearest city for a ct scan. the mayor agreed to pay for it, presumably pending future favors. he peeled the required cash off the huge wad of bills that he pulled from his pocket. no one knows for sure if this is the town’s money or his personal benevolence; he’s doing a great job of giving folks the impression that it’s the latter.
the mayor spent an inordinate period of time assuring all present that the safety of this foreigner (me) would be sacrosanct. apparently western samar is home to some leftest rebels who may be interested in kidnapping a caucasian, or as the mayor put it, someone with such a “pointy nose” (to raucous laughter). he told me that i would not be allowed to to the barangays (villages) in the “hinterlands.” that is where we were panning to spend most of the week, so after the meeting i petitioned him to let me go and he relented.
the next day four great local interns (mel, jc, christine and karen) and i, along with a very flamboyant male nurse and a midwife hiked for two hours through the mud and waded through a thigh-deep river to an isolated barangay (village) called tipul, where we stayed for two nights. rubber boots were required, as the area has endemic leishmaniasis. part of the way i got to ride a carabao, or local water buffalo. the village’s dwellings were constructed of thatched palm and elevated from the ground on sticks. the village was full of of naked kids, stray dogs, roaming pigs and blaring taylor swift (they did have electricity). we stayed in the home of the barangay captain (the village political leader), where we slept on the floor on banana-leaf mats and pillows filled with rice and ate exclusively rice and fish broth for each meal. apparently they brought in the fish just because we were there, the implication being that all they usually eat is rice. even the rice was donated, as unfortunately the village has had a really tough time recently with their crops (predominantly rice and coconuts). according to the interns, the food we ate in the three days may have been the family’s food for the next month. we justified our sustenance by requesting more food aid for the village from the mayor upon our return. i carried in my own eight liters of drinking water, and it ended up being a good idea as there were plenty of folks with gastroenteritis from the village water source. all that water filled my backpack, so my only clothes were the ones on my back. gotta love putting on the same disgustingly sweaty clothes each day. no running water either. nothing makes you thankful for cold showers like no showers at all. the hospitality of the family who hosted us was profoundly humbling.
we held a medical “consultation” in the town square, dispensing an extremely small selection of medicines from the one box we had carried with us. most of the complaints were pediatric upper respiratory issues secondary to everyone having wood fires for cooking in their homes, and skin infections. everyone seems to believe that amoxicillin will solve any problem, including muscle pain and rhinorrhea. i got to see patients myself, with expert interpreting from the nurse. patients continued trickling in throughout the nights, and late one night some local men caught us some huge frogs, which we devoured in their entirety as part of a spicy coconut-based soup.
basically nothing is known about the health status of this community. no one knows what the leading causes of morbidity and mortality are, so part of the mission was to sign up and teach some new local health volunteers to fill out surveys to that effect. also to plan for emergency health events, which require the villagers to carry the sick in a hammock across the river and through the mud to the nearest road, at which point they need to send a messenger to send for transport as there is no cell phone service in the area. most everyone is illiterate – though there are teachers assigned to the village school, it takes them days to get there each week, such that classes end up only being held one or two days per week. one of the more concerning medical cases was an elderly woman with suspected pulmonary tuberculosis. this should be aggressively treated to prevent the infection of others, through direct observed treatment (dots). but the woman was too weak to walk to the clinic to get tested, and would not have the resources to stay for treatment. there is not currently anyone in the village who can administer dots, and there are even bureaucratic obstacles to collecting a sputum sample, so the case remains untreated. not cool.
we also held a clinic in the town of paranas. doctors (and everyone else) around here love to spend their afternoons drinking the local coconut wine, called tuba. a red bark is added to give a slightly bitter taste and a red hue. interestingly, it takes three years to grow a coconut, and while coconuts remain on the island of samar, none remain on the island of leyte (where tacloban is), as they were all destroyed by typhoon haiyan. in practical terms, in addition to more pressing concerns, this means no alcohol for the common man for the next couple years.
i stuck around samar for the weekend, and on saturday we took an excellent excursion two hours up a river in a “torpedo,” a 25-foot long narrow boat. there are three people manning the boat – one to drive it, one at the front to help steer, and a kid whose job it is to continuously bail out the accumulating water, as the boat leaks and also the entire trip was whitewater so we were constantly being soaked! at a point in the river there were some huge rapids, and we needed to disembark while the boatsmen expertly guided the boat through the rapids, using a pulley system set up for that purpose. we were able to do some swimming in the rapids as well! tula, the barangay (village) that was our destination, was heavily hit by typhoon ruby late last year, demolishing many dwellings and taking down lots of big trees.
after docking the boats, we still needed to wade through another river with knee-deep mud to get to the village. we brought along some vaccines, so i got to hone my baby-poking skills, just because we happened to be there! there was also a child there with hydrocephalus and an untreated meningomyelocele, issues i am very familiar with after a stint volunteering with a pediatric neurosurgeon in kenya prior to medical school. the required (partially corrective) surgeries would be free in the city, but his family doesn’t have the money for transport and accommodation once they’re there, so no surgery. he’ll probably die soon; profoundly sad.
this epic week ended with a saturday night trip to the local city, catbalogan, to our attending physician’s house, to sing non-optional late-night karaoke and to spend the night. everyone wanted me to sing until i started, then they wanted me to stop. i got off easy, as apparently when some people mess up a karaoke performance in the philippines they get lynched (multiple deaths after bad renditions of frank sinatra’s “my way”). we were fed the classic karaoking snack – sigsig, fried pig brains. an outrageous end to and outrageously amazing week!
