Community Health Workers Training

The foundation of Our Lady of Peace Mission, Inc has the unique program of training community health workers from the Indigenous Peoples. The local government employs barangay health workers, these workers have minimal coverage to the remote areas inhabited by the IPs. The IPs from the different regions were gathered for a 21-day training. The training is the intensive phase (Phase I) while the on-site monitoring is Phase II. This report will focus on Phase I which was held last Novemeber 5 to 25 at the Our Lady of Peace Hospital and St. Andrew Hall of St. Andrew Canthedral.

The participants in their local clothes.
One-hundred fifty seven (157) have graduated from the seventy-two tribes of the Philippines from the previous 5 batches of CHW training. The 6th batch trained thirty-one (31) more from the tribes of Bl'aan, Kaulo, Teduray, Kankana-ey, Manobo, Subanen, Tagakaolo, Talaandig, Yakan, Aeta, Iwak, Bantoanon, Agta, Mandaya and Kalinga. This added four more tribes from the previously unrepresented tribes namely Kalinga, Iwak, Teduray and Bantoanon.

The participants were recommended by the NCIP, graduates of the program and NGO partners in the community such as the Isabela Foundation Inc., Christian Children's Foundation, Tuklas Katutubo, Alagad sa Panglawas (Servants for Health) and Mamalo Descendant Organization (Cotabato). The particpants of the 6th CHW training were 1.)Tita Tusan (B'laan, Davao del Sur), 2.)Delma Wano (B'laan, Davao del Sur), 3.)Maricel Sakilan (B'laan, Davao del Sur), 4.) Vizminda Dela Cruz (Kaulo, Davao del Sur), 5.)Ernesto Alfonso (Te'duray, Shariff Kabunsuan), 6.)Lito Mosela (Te'duray, Shariff Kabunsuan), 7.) Emely Mardo (Kankana-ey, Infanta Pangasinan), 8.)Vicente Dag-uman (Subanen, Zamboanga del Sur), 9.)Gilda Hermoso (Manobo, Davao del Sur), 10.)Juanito Campong(Kalagan, Davao del Sur), 11.)Elizabeth Bitco (Tagakaolo,Sarangani), 12.)Lourdes Danio(Talaandig, Bukidnon), 13.)Kuring Dailun (Yakan, Basilan), 14.)Emelie Baluan(Manobo, Carmen Cotabato), 15.)Lanie Cosme(Aeta, Iba Zambales), 16.)Liway Jugatan (Aeta, Bihawo Zambales), 17.) Dario Bugtong (Iwak, Nueva Viscaya), 18.) Mylene Atanacio (Aeta, Bihawo Zambales), 19.) Margie Maaba (Bantoanon, Romblon), 20.) Veronica Domasig (Agta, Sorsogon), 21.)Julia Barrameda (Agta, Sorsogon), 22.)Ruby Dumaog (Manobo, Bukidnon), 23.) Alvin Sandag (Manobo, Bukidnon), 24.)Fe Ann Lanipao (Kalinga, Mt. Province), 25.)Shisterly Famisan (Aeta, Zambales), 26.) Daisy Capellan (Aeta, Botolan Zambales), 27.) Allan Pahanay (Manobo, Bukidnon), 28.) Susan Hugnaan (Talaandig, Davao del Sur), 29.)Jeoffrey Liguez (Mandaya, Davao Oriental), 30.)Pilar Acar (Yakan, Basilan), 31.)Virginia Ayodoc (Kankana-ey, Mt. Province).
Learning how to examine the ear.

Implementing this progrom for 2 years with encouraging feedback from the communities, the 6th batch was pursued with improvements from the previous curriculum. The 1st phase included the CHW intensive training. It employed lectures, group discussions, demonstrations, return demonstrations, role playing and creative presentations as teaching methods.

Health is affected by multiple factors. The IPs are keen to this as their health care is entwined with ther spiritual, cultural and social beliefs. The World Health Organization believes that health is not merely the lack of disease bu the total well being of a person. Consequently, the first week of the training was spent on and discovering the traditional health practices, cultural beliefs, rights and responsibilities of the IPs and human dignity. These topics were also intended to empower the participants.

The discussion on the biological aspect of health was strategically distributed on the three week training. The participants were very interested on topics that promoted skills development such as ventusa or moxibustion (a traditional palliative technique for muscle pains), suturing of minor wounds, child delivery, vaccination, preparation of herbal medicine, nutrition, weighing of children, first aid, emergency rescue and transfer, basic life support, history taking and physical examination. The participants were equipped with a medical kit that allowed them to do procedures on their own. They were also provided with a module that covered most of the topics. They were later assessed through an objective-structures clinical examination which is an oral and practical exam on their clinical knowledge and skills. Those with unsatisfactory performance were later tutored individually.

A CHW trying to auscultate a participant in a training.
The second week featured the community aspect of health. It emphasized the need for prevention rather than cure and that in essence CHWs need to work with the community since prevention requires collective effort. Hence, the topics on leaderships, community diagnosis and planning were important. From these topics, the CHWs became more expressive in communicating, a skill they would need in leading and teaching. They were taught on making plans with the community and not by themselves so as to gain more support in implementing the plants. Most importantly, they were oriented to work with the local government as they have to make courtesy calls with the local officials and non-government agencies as well as they anchor in the community as a new CHW.

The third week introduced to the participants the presence of national agencies which offered assistance to the IPs. The roundtable discussion was particularly meaningful with the attendance of representatives from the NCIP (government agency), Tuklas Katutubo (Civic group), Episcopal Commission on Indigenous Peoples (Religious sector), FOLPMI (NGO), Community Medicine Foundation (NGO), and University of the Philippines Pahinungod (Academic Sector).

The participants aired the problems faced in the community and their grievances. Most of the sectors were able to offer solutions or explanations to their problems. For the unresolved cases, the participants were encouraged to put them into a letter that were later coursed through FOLPMI and sent to the concerned institutions. These unresolved concerns were about long fought rights on the ancestral domains in the ARMM Region, mining in Sorsogon, Educational Scholarship for the IPs, lack of potable water, livelihood and lack of health centers or medicines in the area. The Teduray represented by two participants expressed the lack of assistance from the ARMM local government. Tedurays who are non-muslim belong to the ARMM region. Their land has been slowly encroached by the Muslims for timber. The dignity of the ethnic minorities are often anchored on the land they are residing, cultivating and protecting, thus land grabbing is a great atrocity to their cultural identity.

The CHWs doing basic life support the guidance of Red Cross volunteers
In Sorsogon on the other hand, mining operations have been ongoing intoxicating the marine life and depleting the daily catch of the ethnic minority. Lack of educational grants for the IPs was also brought up since only a few institutions have been supportive. The IPs have difficulty in competing with the lowlanders in obtaining scholarships with their meager resources. As reported by some participants, there are some areas in the Philippines inhabited by the ethnic minorities that are not reached by the services of the barangay health center. Three of the above participants reported such cases. In addition, immunization programs couldn't even reach their areas. Some areas have barangay health centers but lacked the personnel such as the BHW. Some lack the facilities or medicines. After the devolution of the Department of Health, the operation of the health centers became under the local government. The decision on maintaining or improving the health centers became highly politicized.

The 6th CHW training was generally successful. All the participants exhibited enthusiasm and satisfactory aptitude as new community health workers. Their achievement was certified by Sr. Eva Fidela Maamo, SPC, MD and by the government partners namely Dr. Carlos P. Buasen, director of the office of education, culture and health of NCIP, and Dr. Francisco T. Duque, III, the Secretary of the Department of Health. Preventive medicine was the emphasis of the whole training while equipping them as well with knowledge and skills in treating their patients. More importantly, the CHWs had workshops on leadership, community planning and networking with government and nongovernment agencies which is important in the nature of their job. The participants had a positive feedback on the duration, venue, facilities and personnel of the training. The training was both extensive and practical.

The training offered a venue for multisectoral partnership between the different tribes, government and nongovernment agencies. With the 6th batch, the FOLPMI has produced 188 graduates from the 77 tribes of the Philippines. There are 41 remaining unrepresented tribes. Thus, it is to recommended to pursue the 7th CHW training for them. In addition, it is recommended that Phase II be implemented which is the on site visit together with the updating and planning. It is important that the graduates are supported as they return to their hometown. They need to be integrated to the local health units of the barangay.

A few weeks after the training, a follow-up through the phone was done on the participants revealing 5 of them had gotten jobs and projects relating to health under the local government or community. The other participants who were BHWs continued their work. In addition, concerns on scholarship and ancestral domain were pursued. The FOLPMI has been searching for sponsors for scholarship grant while the Tedurays kept their communication as the FOLPMI became the bridge in lobbying their land rights to the NCIP.

The participants were interested in starting a Botika ng Barangay (local pharmacy) which is a program of the Department of Health. An orientation on Botika ng Barangay was done during the intesive phase. They recommended doing the training per region. Unfortunately, the personnel from the regional offices were often working on field making them elusive to communicate. Thus, it is suggested that the next CHW training should include the whole training of the Botika ng Barangay since the certificates that they will receive will be honored by the different regional offices.

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