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.

Mae Sot and Route 105.

In the northwest of Thailand on the Moei River border with Burma lies the small town of Mae Sot, the westernmost town of Tak province. The town is not only interesting for being a trade post between Burma and Thailand, but also for its diverse ethnicity: Thai, Burmese, Karen, Rohingya, Karreni, Mon, Kachin, and many other minority groups from across the river. Take a stroll in the market and you will notice that Thai is not necessary the major language spoken here. Due to the ongoing conflict between the Burmese military junta and the many ethnic minorities that inhabit the land along the border with Thailand, thousands have crossed the river and settled in villages and refugee camps along the border near Mae Sot.

A Muslim community is also present in Mae Sot, together with a mosque. One of my good old Thai friends lives in Mae Sot and she and her husband took me to a small cafe on a corner near the mosque. They make rot-tii-oo and tea at this place which seems to have become a pleasant get-together place for the locals to chit-chat during the early hours. Rarely will people be able to find any rot-tii-oo left after 10AM.

As of 2006, Tak province is home to 480,000, of which 150,000 are originally from outside the nation. And of that, approximately 80,000 are refugees that have either been registered or in the process of being so. Those who have managed to cross the border, most of whom are undocumented, have found shelter in border villages and refugee camps set up by the UN or other NGOs. And many of those who are not registered as a refugee work in the many factories near Mae Sot on a very low pay scale, though much better than in the land they came from. Meanwhile, Burma's population stands at around 47 million, of which Karens account for 7 million, the largest 'minority' group. Well over 600,000 have been displaced in camps within their country.

Naturally, Mae Sot is also the 'hub' for the many NGOs that work along the border to assist the endless number of refugees. Among them is a health care post called Mae Tao Clinic (MTC). Set up in 1989 by Dr. Cynthia Maung, herself a Karen who fled from Burma after the crushing of the '8888 Uprising' by the military regime, the clinic caters for those who travel across the border in seek of medical assistance, since there is none, if any, accessible, affordable health care available in Karen state (around 0.5% of the GDP is spent on health care), and for those who have already settled on the Thai side, but could not access health care because they are undocumented immigrants or simply for the lack of money. I met a lady who had walked for over a month from near Yangon, where she lost all of her family members in the deadly cyclone Nargis. She was suffering from PTSD (post-traumatic stress disorder).

Staffed with 530, of which 260 are health care professionals, and many of whom themselves are originally from across the border, the clinic is visited by approximately 400 every day, totaling over 120,000 patients per year. Although now well-known and attracting donations from all over the globe, the budget still remains extremely tight with an ever-increasing number of patients and a lot of issues have yet to be solved. Its in-patient facilities are still infection-prone, especially to the likes of tuberculosis, and more and more refugees give birth here, meaning more and more stateless children.

About 90 kilometers north of Mae Sot on Route 105 lies the refugee camp of Mae La, the largest of them all, housing 37,000 registered refugees and no less than another 30,000 unregistered ones. Because Thailand is not a member of UN's Convention Relating to the Status of Refugees, a person who wishes to be registered needs to be approved by both the UNHCR (UN Refugee Agency) and the Thai Ministry of Interior. With temples, churches, mosques, graveyards, schools, libraries, markets, and even a university, Mae La is like a huge refugee 'city', and so surprisingly, life here is not the worst for those who are registered, since they are eligible to receive food aid as well as space for housing, at no cost. Bored with nothing to do but unable to leave the camp nor return to their mother land, many couples fill the time to make babies, and family planning has become a seriously important topic. Others apply to live in a third country, while a handful work for the NGOs within the camp.

I visited one of Shanti Volunteer Association's (SVA) libraries, where children were forgetting their darker days and enjoying the time for learning. However, a boy who seemed unable to join the flock caught my attention. According to the staff, he had only arrived a couple of weeks ago, but just received the news that his father, who was also on the way, was killed in a fighting between Burmese government troops, the Democratic Karen Buddhist Army (DKBA), and the Karen National Liberation Army (KNLA), the military arm of the Karen National Union (KNU), which has been fighting for independence of the Karen state (in their words Kawthoolei). Whether or not that news was true is unsure, however, the extensive 'underground' information network of the people cannot be underestimated. And, the Thai cellphone can be used near the border even if it's on the Burmese side, as well.

Those who have been caught by the Burmese military or the DKBA have reportedly been forced to hard labor or simply 'used' as human walls in the event of fighting. In June, DKBA troops raided a Karen school, forcing students to flee to the jungle. 89 of them managed to reach Thai soil, however, nine of them caught malaria on the way in this naturally high-risk area for this fatal mosquito-borne disease. In the same month, near the Thai village of Mae Salit Luang landed four mortar shells launched from the Burmese side, prompting the Thais to increase border security. On June 15, the KNLA headquarters in Manerplaw fell to the Burmese army, and in May-June alone, no less than another 4,000 crossed the border.

'Chronic emergency' is the term many use to describe this region's volatile situation, which has not improved, or only deteriorated, since the conflict broke out in 1949.