Mission: Improving maternal and child health in Sarangani

MANILA, Philippines - Ginalyn Wanan walked three kilometers from where she lives in a remote T’boli community in Maitum carrying her seven-month-old baby to the health center for her baby’s post-natal health checkup. It’s a fairly short distance, considering that the farthest sitio is 15 kilometers away and would normally take about four hours of travel time by horse or by foot. Ginalyn is 21 while her husband, a farmer, is 28 years old. They were married when she was 15. All her children —- six and three years old, and seven months old — were born at home, delivered by a hilot, the traditional birth attendant. All her babies are breastfed. She brings them to the health center for their immunizations.

Wanted: One midwife for every barangay

Josielyn Lazelle, the midwife at the health center, takes care of three barangays in this remote municipality in Sarangani province. One barangay is 100-percent Muslim while the others are made up of Christians and indigenous peoples (IPs), which include the T’boli, Manobo, and Blaan tribes. Forty-five percent of Sarangani’s population consists of IPs. While the current DOH directive specifies one midwife per population of 5,000, it would be more realistic if the allocation were based not only on the population but also on the terrain, which in this case would include mountains, rivers, and plains, as well as the distances between the remote communities. “The ideal situation would be for every barangay to have one midwife who would also reside there,” says Sarangani provincial health officer Dr. Antonio Yasana.

Dr. Martha Cayad-an, UNICEF health and nutrition specialist, presented the following statistics: “Fifty percent of neonatal deaths occurs in the first two days of life. The risk of maternal death is highest during childbirth and within 24 hours after delivery. The first 28 days of life account for 47 percent of under-five child deaths. Every year, around 34,000 Filipino neonates die, mostly of preventable causes. Inappropriate hospital and community practices are directly related to high rates of newborn deaths.”

The Kiamba District Hospital has 10 beds, four nurses, three shifts, one doctor per shift, and one ambulance. The building looks old and can use some repairs. In front of it is a newer structure, the Kiamba Lying In Clinic. The clinic is still wanting in basic equipment such as blood pressure apparatus, of which there are not enough, and a weighing scale. The one they have no longer works.

Pregnant mothers come for prenatal checkup and consultation usually in their second or third trimester. “They are usually still in

Kiamba Mayor Raul Martinez, Dr. Antonio Yasana, Dr. Martha Cayad-an, and UNICEF communications chief Angela Travis

denial during their first trimester,” says Betty Baigan, one of the nine midwives attending to Kiamba’s 19 barangays. “Many still insist on giving birth at home, because they don’t have money. Unlike in the clinic, they can postpone paying the hilot. Most IPs have their mothers attend to their deliveries or they deliver their babies themselves.”

Three UN agencies (UNFPA, UNICEF, WHO) formulated an AusAID-funded program on maternal and neonatal health, in close collaboration with the national government represented by the Department of Health (DOH). The overall strategy is “to strengthen the local health system” with “improved access to quality continuum of care and services,” from pre-pregnancy to pregnancy, delivery and post-partum care for mothers, as well as newborn, and childhood care.

Sarangani Governor Miguel Dominguez, who understands the cultural diversity of his constituents, finds merit in taking the traditional birth

Midwives and health workers at Barangay Lagundi Health Station

attendants into the fold, so to speak, so that they can be exposed and oriented to safe birth delivery practices. In time, it is hoped, home-based deliveries by traditional hilots will be replaced by skilled birth attendants.

Infant care/breastfeeding

At the Health and Nutrition Post at Purok Everlasting in Lomuyon, women are taught how to read, write, and count using basic health and nutrition messages as course content in the Female Functional Literacy program. They learn about infant care and the need for immunizations, as well as about breastfeeding, which should be initiated within one hour of birth.

Young mothers had gathered for a lively interaction with TV personality Daphne Oseña-Paez, a UNICEF spokesperson and breastfeeding advocate. A mother of three, she had a difficult first pregnancy, she relates, requiring complete bed rest, which gave her the time to read and learn all about the merits of breastfeeding. She is currently breastfeeding her youngest daughter, as she did her first two.

Gelyn and Jeselle, 22 and 28 years old, are both aware of the benefits of breast milk which, they said, make their babies more resistant to illnesses. “Besides,” Gelyn said, “it’s cheaper than powdered milk.”

The new protocol also recommends cord clamping after one to three minutes and immediate drying of the newborn. The baby should be kept warm and not separated from the mother.

Vanessa Tobin, UNICEF head of mission in the Philippines, inspected the mechanical delivery bed donated by UNICEF in 2006. Showing signs of wear and tear, it had obviously been put to good use, she remarked. There’s an average of 30 deliveries a month at the maternity home in Maitum, which has been recognized as a “child-friendly” municipality.  At the Maitum Municipal Hospital, Tobin met with Dr. Eden Tagani and gave her booklets on maternal and infant care produced by UNICEF.

We did not expect to see the familiar Starbucks sign at the end of a long stretch of dirt road with rice fields on both sides in Sitio Mangulo, Barangay Kalaong in Maitum but there it was, in front of the day care center which the coffee chain sponsored as part of their CSR together with UNICEF. Nearby is a health and nutrition post and female functional center where IPs gather, along with their breastfeeding babies, to meet with barangay health workers. Like mothers everywhere, it seems their work is never done.

Indeed, it’s a myth that “labor ends when the baby is born.”