A visit to Inazusa.

Now part of the city of Shimoda, Inazusa is a peaceful countryside village on the Izu Peninsula, the easternmost part of Shizuoka prefecture. It actually occupies almost half of the city area, but its population is just over 10% of the city's, standing at 2,855 as of 2008. 35% of them are over 65 years old, which is a little above the average rate for a Japanese countryside village. Many of them are farmers, but nowadays they run other businesses alongside to make both ends meet. In April, I had the opportunity to visit Inazusa Clinic, a relatively new clinic that was set up just five years ago by JADECOM (acronym for Japan Association for the DEvelopment of COmunity Medicine), one of few health care organizations putting effort in bringing health care to rural, isolated areas in Japan.

Inazusa had a clinic that was funded by the city of Shimoda until 2002, when the sole physician of the clinic neared the age of 90, and without a doctor to take over the job, was forced to close down. So the village went without a doctor for three years. People who could drive traveled 20 minutes south to central Shimoda, where they could find some privately-run clinics. Accompanied by two nurses and two clerks, Dr. Hajime Kawasaki is the head of Inazusa Clinic, and he kindly accepted my one-week visit. Because I didn't have too much time, I wanted to spend the time to know the village and its people, and at the end of the week be able to 'draw a picture' of how the community looks like.

The first place I went to to meet the villagers was Ryusouin. This little local temple has been holding what it calls 'Temple Wellness Renko' (traditional exercise) sessions, where locals come to do exercise with the the monk, who interestingly has a bachelor's degree in physical education. In a rural area like Inazusa, during the 'obon' (Japanese Buddhist custom to honor the ancestor's spirits) season or whenever a funeral takes place, the family of the deceased along with the monk walk through the town visiting each and every home so the deceased can bid farewell. And the monk here found out that there were many who complained about back pain or joint pains, and together with the awareness that he himself was lacking exercise, came up with the idea. About 10 people come to each session, which takes place four times a week, and pay 500 yen per session that runs for about one hour followed by chit-chat time with tea and sweets. Asking the participants, not all of whom are locals, they say they come to talk with the charming monk, more than for the exercise. The monk says that he hasn't been able to attract the people who he really feels he needs to do exercise with, especially more locals, and that certainly is an issue to be solved. Also, citing the temple's proximity to the clinic, he says he has many ideas he might want to try together. Monks could play an important role in bringing a community together, like in Buddhist countries such as Thailand.

Another place I visited was the local nursing home called Azusa-No-Sato, which literally means 'the village of Azusa'. Like many other similar facilities in Japan, it also operates so-called 'day care' activities where the elderly who live with their families at home come to spend a day to play, take a bath, and socialize with the fellow elderly, not only to have them enjoy time, but to spare some break for the care-giving families. The national elder-care insurance is where the money for the service comes from, and the families would usually pay about 2,000 yen (JPY) per day, though funding for the insurance comes partly from the insured's past monthly payments. Because the nursing home's service includes picking up as well as dropping them off, I had a chance to get a glimpse of the actual homes and the areas the people live in. For the staff, it's not an easy job. It requires lots of energy, both physically and mentally, and considering their often below-average salaries, I had the impression that many workers in this field were not enjoying their work. However, it was different, at least here. Yes, the staff were always thinking and doing what they have to, but still, they were enjoying joking and playing around with the elderly as well, in a genuine sense. A staff said, "This is not the kind of job you can continue if you don't enjoy it. I really like my job."

In Inazusa, or like in many other places, farmers have always naturally formed informal groups with fellow farmers nearby, like a neighbors' small gathering. Many of them would have lunch together, chit-chat, or even do some leisure traveling when they can spare the time. One of those groups, which calls itself Chalette, has interestingly founded a small 'manju' (Japanese traditional pastry with sweet red soy bean paste filling) shop. They say they wanted to do something different, something they enjoy doing, and something they can continue doing, and that's when they realized members in the group were good at making Japanese traditional pastries. So they collected 100,000 yen and started this shop. Conveniently located along a road that connects Shimoda and towns on the other side of the peninsula, the now well-known shop earns enough to fill the members' piggie banks. When they sell out, they sell out, but they don't increase their job because they want to enjoy it and don't want it to become a burden on them. "Family comes first. Job comes second."

Another group of farmers founded a community farmers' market called 'Kimagure Shop', which literally means 'the range of products and price is up to the mood of the day'. When crops are harvested, it normally goes through a number of wholesale dealers before it reaches the consumer, and along the way the cost adds up and is represented in the price. So, what this community market does is farmers directly come from the fields to drop off their products, specify a price, and the market sells them off here, and 88% of the income goes back to the producer. This way, the farmers get bigger margins but the consumer gets them for less than what they would pay in an ordinary supermarket. Plus, the products are consumed relatively locally. So the products sold depend on the season, and now over 90 producers, not only farmers but local bakeries and flower shops, drop the market. It's becoming a place where not only the people of the community gather, but chit-chatting between the locals and travelers as well, being located alongside a main road.

Inazusa is certainly a typical rural village, but does have many encouraging activities run by the locals that are helping to sustain happiness in the community. :)

A glimpse of the Philippines from Negros.

In early March, I had the opportunity to visit Negros Occidental province in the Philippines, thanks to Dr. Yasuhiko Kamiya at Nagasaki University and the Japan Association for International Health's Student Division (JAIH-S). I was based at Bago Health Center in Bago City, about a 30-minute drive south of Bacolod City, the capital of the province. The kind staff at the health center allowed me to stay at one of their houses, and I stayed with Joseph Aunzo, who is a nurse at the office, and his family. Every morning, it's not the alarm clock that wakes you up but the chickens that start crying no later than 6AM. I headed off to the office with Joseph every morning by 8AM and had days full of observing the many activities not only of the health center, but of schools, local villages, non-profit organizations, etc.

Due to the fact that I only had a week in the region, my primary goal for the visit was know the daily lives of the people who live in the area, and get a glimpse of the social aspects, such as the cultural, economical, political background of the community that they belong to. And from there, with a health-oriented perspective, I wanted to see what the problems, or the weaknesses, of the communities are, how the people themselves are feeling, and what they are actually doing to tackle these issues. I also had the opportunity to meet some local politicians, and wanted to know how the government sees the communities and what they are doing.

One day, I was with Dr. Kamiya, and we made a home-visit to a nearby village. This house was the home of a child with cerebral palsy, one of many disabled children Dr. Kamiya had been personally supporting for many years. He not only donates older wheelchairs and fixes those that are broken and reuses them, but listens to the child, the family, and discusses with them what can be done. The house was an ordinary house that you find anywhere in the rural areas in this part of the country, and though not affluent, the family had been taking care of the child for well over 10 years, ever since he became handicapped. However, the family didn't have enough money to buy medicine. There are established non-profit organizations, such as Negros Occidental Rehabilitation Foundation Inc (NORFI) and Volunteers for the Rehabilitation of the Handicapped and the Disabled (VRHD), both based in Bacolod, but they obviously cannot be permanent solutions. On another day, when we visited another village, the people there had listed the five major issues in the community, and the lack of money to purchase medicine and the insufficient number of health-care professionals made up two of them.

In the Philippines, the population is still growing at a fast rate. Families make many children so as to have them work and increase the household income. Catholic being the major religion, ever since the Spanish colonization days, may not be helping as they discourage contraception. Many people who worked in the health center also came from big families, some of them having seven siblings. When I visited a local elementary (primary) school, there were children full of smiles playing around, but some were saying to me "I don't have money to pay for lunch", "my house doesn't have a shower", "... because we're poor". Or were they seeing me as a donor? Comprised of six years, about 10 to 15% don't make it through the curriculum due to financial reasons, according to the teachers. The schools is trying to find scholarships, but obviously, there aren't enough. Yes, poverty, in terms of lack of cash, is an important issue and lies at the root of many problems, however, it was unfortunate that I wasn't able to feel the local people's will to do something creative to help the situation.

I asked the staff at the health center and the hospital. Here, the local government needs to find budget to lure health-care professionals to this area. Because there isn't enough cash, there isn't a sufficient number of them, especially physicians. For example, Bago Municipal Hospital, the only public general hospital in the area, had 50 beds and an emergency room (ER), but there were only five physicians. There were, however, plenty of nurses. However, many of them are working without pay, and there's a background story to this. In the Philippines, about 40,000 new nurses pass the license exam (out of 100,000 total), but that is more than the demand. And even if you are in a relatively high position, such as a chief nurse, you still only earn about US$400 per month. So, what is happening is many are moving out to work in Europe, the U.S., and more recently the Middle East, especially Saudi Arabia and United Arab Emirates. From there, they send part of their income back to their families still living in the Philippines. The nurses who are working without pay are those trying to keep up with their nursing skills while preparing to work abroad. In Ma-ao, the village I visited, there was one physician, which is rather rare, because there are many public clinics that don't have a physician nor a nurse, and a midwife is carrying out all the diagnosis and treatment.

So, what's the government doing? Ever since the Philippines became independent from the U.S., politics have never been stable, effectively slowing down the issue of bringing affordable, if not universal, health care. Staff at the health center do say that "the government is putting at least some effort and its gradually starting to improve", but its certainly far from catching up. When I visited, it was near general elections so lawmakers had once again pretty much halted lawmaking and shifted to election projects. And every time an election happens, vote buyouts are very common, and the locals use the money to help pay for their daily expenses, including health care. The people say they don't have money. The government says they don't have money either. So who does? Of course, there are the huge multi-national corporations and related politicians, who have a hold of much of the country's wealth. Some Filipinos sarcastically put it this way: the Pareto principle (80% of wealth is in the hands of 20% of the population) is more like 95% to 5% for the Philippines.

It was a short stay for me, but I was able to meet a variety of people. However, as I mentioned earlier, the lack of money is at the root of many problems, but many people have stopped their thinking there. Yes, financial support is important, but that's an issue that will be around all of the time. What's important is how creative the people in the community together as a whole can become to overcome hurdles, including money, to make their daily lives happier. Yes, it's not easy, and it's not accomplished in just days or weeks. Some staff said that foreign visitors coming and praising the work the villagers do helps them gain confidence and move on. I guess that is important as well, but eventually, the people should be doing the things because they together feel the need to do so, not because somebody from another country is saying they're doing a 'good job'. When a people together become able to address its own issues, and creatively use their strengths and resources to tackle them, that is when a village starts to become truly independent, and it is what leads to empowerment and social development.

However, I want to make sure I am not saying the people have lost vitality. Yes, there are many who have fled overseas, but, there are many who have chosen to stay, even though their salaries are only a fraction of their counterparts in Europe or the U.S. They love their hometown, they don't want to be far from their families, or they have a strong passion for the work they do. Conversations with Nona Obando, the chief nurse at the health center, and Dr. Ramon were memorable, especially because I felt how much passion and pride they have not only for their responsibilities, but their home city. These altogether are invaluable assets to the local community and what helps it keep going. And then again, even for the people who have fled overseas, their feelings for their families and hometowns are the same. I have seen people in Japan and the U.S. who have lived for over 10 years without returning, but still continues to send money back to their families.

Immigrants are there all over the world, and ever more so with globalization. Whether documented or not, they all come because they want to make their daily lives better, because they want to support their families. And their longing to live in their hometown does not change. I would like to express my appreciation for Dr. Kamiya, JAIH-S, Nona, Joseph, Dr. Ramon, Dr. Pilar, and all the staff at the Bago City Health Center for their kindness and letting me have this opportunity.

A visit to Sanyukai.

Poverty. What does it mean?

Many say it's about not having enough money to make a living, while some others put it in a different way: they are people who have not only lost their money, but also their families and all their trustworthy social relationships, as well as self-esteem and pride. While a good portion of the general public in other countries still see Japan as the darling of economic prosperity, and even the typical Japanese are not too aware, the poor population has been slowly increasing over the years, and at a quicker pace more recently. Poverty does exist in Japan, and it does in Tokyo.

In April, I paid a visit to Sanyukai again, a non-profit organization (NPO) that runs a free clinic, provides temporary housing, clothes, and food for the homeless. Located in the heart of Sanya district, an area that has become synonymous with poverty and homelessness, the group has been carrying out outreaches to hand out clothes and food, and so-called 'clinic tickets' for those who seek medical consultation for over a decade. The clinic is totally free (one of only two free clinics in Japan for the homeless), but naturally, it's sometimes not easy for a person to come and drop by, but reaching out to them and giving them these 'invitations' not only encourages them to come but also "makes them feel easier" to do so, says one staff. Situated in the northeastern part of the huge bustling city, Sanya has been a home for many who work on a daily wage basis, taking advantage of its proximity with factories in the area and the abundance of rediculously-cheap hostels.

So what did I do? I participated in one of the outreaches they carry out on Wednesdays and Thursdays. Why? Because I like it. And this phrase means much more than it's said. I go to Shinjuku every day, and it's not too difficult to find a homeless there since nearby Shinjuku Central Park is home to a good number of them, so I have always felt that they are part of the picture I am in in some way. But what is there that I could do by myself? If I do have some leftover food I am not going to eat it, could I give it to them? But what would that do to their self-esteem? Do they really want that? After all, unlike in the U.S., begging is not common here. We belong to the same world, the same society, but there is something that is separating us. But through the outreach, I can be of some help and talk to the homeless without hesitating, and it really gives you the feeling that as if it not only opened the door for them but for yourself too. It's like this: they are near you but not as near as it seems, but you've finally found a way to step closer to them. Surprisingly, many seem to be happy even when we just say "hello, how's it going?". They've got lots of things they want to talk with you. That smile on their faces I don't forget.

What is poverty? What is homelessness? I've been thinking about this for a while, and ironically, Mr. Hiroshi Goto, one of the staff there, pointed out something that I had heard before two years ago from a staff working in a homeless shelter in San Francisco: we shouldn't really 'categorize' them as homeless, but as people who have had various difficulties in the past that led them to how they are now. And that's true. They have come different ways. The 'issue' for each of them is different from person to person. And in the U.S., add to that those who have willingly chosen to become homeless. But there are things they have in common too. They have no money, no shelter, nobody to rely on, and have been deprived of dignity and self-respect.

The number of people living under government aid, called the Temporary Assistance for Needy Families, has been increasing, and at a faster pace now with the slowing global economy. Back in 1992, that number was 585,972, but it reached 998,887 in 2004 and surpassed 1,000,000 in 2005, and as of March 2009, it stood at 1,168,306. Now, especially in these unsure times, it is not so difficult for a person to take a moment or two to think about poverty and take that as an issue that is not unrelated. With just a combination of some accidents, wrong-doings, or unfortunate consequences, anyone could find him/herself without a home. However, we must also keep in mind that the real homeless, the 'true' poor, have been deprived of all they could be, including friendships, families, and even their self-esteem. Whether that is the responsibility of the individual, or another, or the society, or more than one of those, varies from person to person. But we have to understand. And I think there is something we can do.

Sanyukai is not merely a group that gives out a hand to the homeless, but one that is helping the absolute poor and using several creative ways at different levels to help the homeless empower themselves and become self-dependent. The true poor are deprived of their family and friends, and it starts from re-building relationships or making new ones. Every day, Sanyukai puts seats and some tables in front of their compact three-story building, and it acts as a place of gathering for the homeless. Sipping a cup of green tea that Sanyukai serves, they come and tell about the meal they had the evening before or joke about the noisy neighbor cat that wouldn't let him go to sleep. It's a place for socializing and relaxing, and up to around 15 people can be seen on some days. Some stay for lunch and eat with the staff. Whether it's a staff or a visiting homeless, everyone eats the same food here. And many of them visit on a routine basis, some even every day, so it is also an effective way for the staff to see who didn't appear on a day and try to find out what happened.

Last month, Sanyukai was ordered by the metropolitan government to stop handing out its weekly free meals in one of the areas, after local residents filed a number of complaints saying the outreaches attracted more homeless and that "children are afraid" of them. One of the continuing challenges is how to have the local community understand their activities. There is a quote from a book by French writer and aviator Antoine de Saint-Exupéry. "Men travel side by side for years, each locked in his own silence or exchanging words which carry little or no fright, until danger comes. Then they stand shoulder to shoulder. They discover that they belong to the same family."

Go to the people.

Go to the people,
Live among them,
Learn from them,
Love them.
Start with what they know,
Build on what they have;

But of the best leaders,
When their task is accomplished,
Their work done,
The people all remark:
WE HAVE DONE IT OURSELVES.

- Yen Yang Chu (1893-1990)

A visit to Ban Rong Ta Tee.

During August 10-12, 2007, which is already over a year ago, the "Intergration of Health and Social Development: Thailand's Experience" program run by Mahidol University's ASEAN Institute for Health Development (AIHD) took us to Ban Rong Ta Tee, a village located in the northern part of Lan Sank District, Uthai Thani Province, in central Thailand. We would be home-staying in that village with the respective families for three days and two nights, carry out a small research by interviewing the villagers about what we wanted to know about, and come up with some kind of conclusion to present. Never did I think that that experience would have a tremendous impact on the way I see things...

Dr. Chokrachan Chairoeksuksan, a family medicine physician at Lan Sak Hospital, gave us an overview of how health care is provided in this rural area, in its most effective and efficient way possible. Lan Sak District is divided into six sub-districts (tambol), which in turn are made up of 84 villages. Primary medical care is taken care of at the 'primary care level', which is the local public health center, 10 of which are spread throughout the district. If the medical issue could not be solved there, the patient would be referred to the 'secondary care level', which is in this case Lan Sak Hospital. If further specialized care is necessary, that is the responsibility of the 'tertiary care level', which is in this case Uthai Thani Hospital, the largest public health care facility in the province.

The public health center in Ban Rong Ta Tee community is one of 10 in the district and serves 5,263 people and 1,122 households. There are 104 health volunteers working in the villages and they play a key role in promoting health. Those who tend to act as leaders in their neighborhood, are more conscious about health, and are willing to receive some essential medical care training, would be a good candidate for a health volunteer. They would be responsible for connecting the villagers and the health center, including taking patients there when they need the help or gathering villagers to the health center for health promotion activities. There are no physicians at the health center and just five people (manager, community health worker, nurse, nurse's aid, janitor) run the center. The mobile physician team comes here once a month. I became good friends with the nurse, Wanrob Klomlit, who everyone calls Rob, maybe partly because he's the same age as I am.

Now, when we carried out our interviews in the village, our group decided to ask questions about the number of members in the household, their jobs, income, food habits and change over years (if any), their favorite foods, past medical history, smoking and drinking habits, education received, and what they would do in case of an illness. It was really interesting. Truly. Although each household was different, household after household, we started to get the bigger picture of the village. What kind of people live here? What are the strengths of the people? What are the weaknesses or the issues that underlie? What can be done by themselves to overcome those issues?

So our group's research theme was this: the effect of lifestyle change on the community. We focused on the villagers' lifestyles, especially food habits and health care habits. And as we carried out are interviews of the villagers household by household, we realized that between generations, there lay some differences. So, to have a better glimpse and understanding, we decided to categorize the villagers into three generations; the first of which we defined as 50 years old and over, no-longer-working-in-Bangkok generation, the second would be 30-49 years old and the working-in-Bangkok generation, and the third is defined as up to 29 years old, the young workers and the children. Here, when I mention "working in Bangkok or not", I mean by the phenomenon where the working age group are increasingly getting jobs in the huge bustling capital of this kingdom, instead of working in their local hometown villages. So when visiting a household, it was not uncommon for us to see a family of grandparents living with their grandsons. Their parents? Down in Bangkok, or Krung-tehp, as the Thais call the capital.

Generally comparing the generations, we found out that basically everyone eats and likes the traditional Thai food, such as the som-tum (papaya salad), kao-man-gai (boiled chicken on rice), seafood, etc, but we found out that the third generation likes western fast food as well or even more, such as pizza, french fries (chips), or candy bars. Younger people like to drink beverages such as coke too and consume more fried food. In terms of health care, there were almost none who did not believe in contemporary medicine. Everyone had good relations with the health center and would generally accept any kind of general treatment, whether western or oriental/traditional medicine. In Thailand, herbal medicine is officially recognized by the public and the government. Some elderly still relied on things such as ointment made by themselves from resin or herbal fruits that are not seen in health care facilities, but after all, if they have been living with it for decades and they're happy with them, and don't have health issues, why tell them to stop.

All in all, we saw two major issues in the community. A risk of lifestyle-related diseases akin to those now a problem in western countries, among the second and third generations is the first. Many in the second group already had past histories of hypertension, high cholesterol, diabetes, cancer, etc. The second is, with more and more younger generations going to Bangkok and deciding to live their for a long term, the village population is aging, which could lead to decreased livelihood or even the collapse of the community in the end.

However, there were certain strengths as well. The smoking and drinking population is not so large (Buddhism and monks have a big effect), they have a good environment with lots of nature, clean air, no traffic jams, and a relatively stress-free life, especially when compared to Bangkok. And even if many of the second generation move down there, there are still some that choose to remain in the village, and with the Thai tendency to regard their parents and families highly, those in Bangkok are unlikely to stay there forever, at least for now. Many village homes are centered around the health center and the adjacently-located primary school (elementary school), and the relationship between the health center staff and the villagers is good. They know each other well and the villagers feel easy about visiting, thanks partly or largely to the health volunteers.

Rong Ta Tee Health Center has a variety of health promotion activities such as the mosquito project (over 92% of homes now use measures to keep mosquitoes out of their water), aerobic exercise on weekends, elderly persons' education for self-help, breast and cervical cancer prevention, diabetes and hypertension project, HIV/AIDS project, increasing well-being project, developing exercise leaders project, and promoting good health among the elderly project. Now, we felt that they should now put more effort in aiming some projects at the first generation, the young. They should take advantage of the proximal location. Also, they should start thinking of ways to re-develop the community by means of creating new values, such as community-oriented small businesses. Doing this with existing resources both material-wise and manpower-wise would be a key.

But so, how did all this have a 'tremendous' impact on the way I see things? Well, I guess I learned two big things. One is that, the economical power of a community does not necessarily reflect the quality of life (QOL) of its people. In other words, it doesn't mean that if a family is not financially rich, they are not happy, and vice versa. Whether it's those living in Bangkok, Tokyo, or London living a daily life in the bustling streets full of stress, do all of them look like they are living a happy life? Through the interviews, I truly felt that many families in the community are living a happy life, in spite of some of their economic status being not so high at all compared to the average Thai. Happiness and economic development: they're not unrelated, but they don't necessarily come together. The other thing I learned is how much a people can get things done together themselves with minimal top-down type professional aid. With the health volunteers playing an important role, many villagers knew how to take care of themselves, and knew what needs to be done and who to go to in the event of a health problem. There were lots of on-going community involvement activities that are facilitated by the people.

Community-oriented, people-centered health care through community organizing and building, unlike those hospital-oriented, physician-centered medical care seen in economically developed regions. That is a critical part of primary health care (PHC), as the WHO said together with UNICEF at the Alma-Ata conference back in 1978. Health care for the people by the people... there are lots Japan and the western communities should learn. :-)

A visit to Magnet.

So, I often talk about community health... but what is it that started everything?

It all started on March 24th, 2007, when I paid a visit to Magnet, a clinic located in the heart of the Castro neighborhood in San Francisco. I was then on a program run by VIA (Volunteers in Asia), a non-profit organization (NPO) originally based at Stanford University. With men walking down the sidewalks holding hands, a movie theater showing dramas of love between men, and shops whose walls are covered with posters of naked men, it was not a scene that you are used to seeing.

The Castro came of age as a gay village following a controversial 'Summer of Love' in the next-door Haight Ashbury district in 1967. The gathering brought tens of thousands of middle-class youth from all over the United States. The neighborhood, formerly known as Eureka Valley, became known as the Castro, after the landmark theater by that name near the corner of Castro and Market Streets. The community was hit hard by the HIV/AIDS crisis of the 1980s, and beginning at that time, city officials began a crackdown of bathhouses and launched initiatives that aimed to prevent the spread of AIDS. Today, kiosks lining the streets have posters promoting safe sex and testing alongside those advertising online dating services, and the city of San Francisco is home to around 100,000 to 200,000 homosexuals.

Asking about the roots of the community, many bring up the name Harvey Milk, a gay rights activist and the first openly gay man elected to San Francisco's Board of Supervisors, or to any substantial political office. He was elected in 1977 representing District 5, which included the Castro. However, I felt that another, more recent activity was helping to bring the gay people together and empowering the community: Magnet.

Although a clinic, it does not look like the conventional one in your neighborhood. The front side of the building facing the street is glass, instead of a wall with small windows, allowing everyone who walks by to have a view of the interior. As soon as you enter, a clean room with leather sofas and tables and a corner that resembles an Internet cafe greets you. A large bulletin free for anyone to post events in the community is near the corner and artwork of gay men adorn the walls with metallic coating. The examination rooms are located at the rear of the one-story building, however, for privacy these rooms are lined with walls and not glass, of course.

Founded by the 'Castro Guys', a group of health care professionals who were gay, Magnet's vision is to promote the physical, mental, and social well-being of gay men. Run by gay men (all staff are gay and half of them are HIV positive) for gay men, it offers free sexual health services such as confidential HIV antibody testing, testing and treatment for syphilis, chlamydia, and gonorrhea, and hepatitis A and B vaccination. Other than for sexual health, it provides services such as ear acupuncture, chair massage, hypnotherapy, general mental health counseling, and a flu clinic. Although financial support was scarce in the beginning, now it is supported by a major pharmaceutical company which pays roughly 80% of the costs, and the rest is paid for by donations from the people in the community.

However, in addition to providing sexual health services, Magnet holds a variety of on-going community activities. This ranges from book readings and art exhibits (as mentioned earlier) to town hall forums and health chats, or karaoke and dance nights to gay weddings. And even when there are no particular events, people drop by the clinic just to chat with others or share stories. In other words, Magnet acts as not a mere clinic, but more like a community center that brings a people together in an affirming environment that embraces the diversity of the culture that exists. This is a place where gay men can access resources and make connections and friendships between each other that not only helps to promote individual health but also community health.

Magnet is an example of community health, but to be more exact, this is a form of primary health care (PHC), as defined by the World Health Organization (WHO). It is health for the people, by the people. Everyone walking on the streets of the Castro knows the Magnet. I was utterly amazed at the potential of how a small clinic can bring together a people who have been isolated and considered socially-handicapped by the rest and act as a catalyst in empowering the community as a whole. It serves as a place to meet people and bring everyone... the entire community together. Like a magnet, it truly lives up to its name, or much more than that.

So this is how everything started for me. Community empowerment for the people by the people through community building and organizing, with a touch of creative thinking and facilitation, in this case, from a health care perspective. Simply exciting. :-)