25 September 2023
Ruben Dimayuga, now a Municipal Health Officer (MHO), doubles up as the Doctor-sa-Barrio of San Gabriel--a farming community with a population of 35,000 in Iloilo Province. As the town’s sole medical doctor, he mans the clinic in San Gabriel, taking charge of planning and implementing health programmes whilst training its small staff and visiting the surrounding areas.
The programme Doctor-sa-Barrio (DTTB) was initiated in 1993 by the Department of Health (DOH) to service the needs of the rural population within a given catchment area. The goal is to provide one doctor per 40,000 residents. Accordingly, medical schools give specialised DTTB training. As with Ruben, many of these doctors hail from the vicinity where they serve, and therefore, are familiar with the area. “We come back even if we have been away for years—in my case 15 years—because we are attached to our communities and want to give back”.
“I am lucky,” Ruben adds, “I have a friend from med school who is also an MHO. He takes care of over 90,000 people—waiting forever for his partner, a Doctor-sa-Barrio the DOH has been promising him.
“San Gabriel is one of those forgotten locations in the Philippines. When I first came back to the town where I was born, my feeling was that it was a place frozen in time. It hadn’t changed much since I left after graduating from high school and earning a scholarship. But now, as I had nowhere to stay, the mayor offered a small room in their renovated garage for me to rent. At the munisipio (town hall), my clinic was an old stockroom, similarly small and damp. During my first week, I made these two rooms more comfortable with money from my own pocket, as they would be my residence, clinic, and office. By the end of the second week, I was ready to open the clinic, but surprisingly, not a single soul came to see me. Days passed. Except for staff from the munisipio coming for an occasional band-aid, or perhaps to check on their blood pressure, I had nary a patient. In a way, I felt relieved. I had a meagre budget and limited medical supplies.
“Maybe, I thought, it’s because San Gabriel is by the national road and the other town clinics as well as the hospital are quite accessible. Things should change when I put on my other shoe as Doctor-sa-Barrio and visit the hinterlands. So, over the next week, I readied my backpack and generic medical supplies. I contracted a young man who operated as courier for the municipio, driving around with the municipio-owned motorbike. I would pay for gas and his merienda (snack), I proposed, and he would act as my guide and assistant, ferrying me around the more remote villages of San Gabriel. Since he was under-utilised by the town, anyway, he readily agreed.
"We drove through the vast expanse of land adjoining the town proper—old haciendas that dominate the landscape closest to the nearest foothills. I knocked on doors of mostly nipa huts where I found more interest in my offered services. Too far from the national road that connects these villages to towns, the alternative would have been for the residents to hire tricycles that serve as motor-taxis at “exorbitant” rates. Simply to visit my town clinic, for example, they would have to pay as much as a day’s wage. On the other hand, I could visit them for free.
“These village folks otherwise survive through traditional beliefs and practices. Many swear by herbal medicine: turmeric or ginger for sore throat; lagundi, oregano, or tawa-tawa leaves for coughs and asthma; and sambong leaves when one has a fever. These herbs provide ginhawa (overall relief) to the patient, and for most, they are sufficient to meet their idea of “good health.”
“When the herbal remedies fail, it might be time to see a sorohano or an albularyo (medicine man or healer) to drive out illnesses caused by an evil spirit. Likewise, a hilot (unlicensed midwife) can apply pressure to muscles and joints to promote body healing. I think these practices are completely understandable when access to modern medicine poses a real challenge. Also, these can actually be beneficial if the patient develops a more positive outlook and a sense of agency towards health care. In fact, I still believe in some of these treatments myself.
“I have since had many experiences showing how traditional practices can complement modern medicine. Early on, for example, my motorbike driver and I met a woman and two men along a pathway, carrying a small child on a hammock supported by wooden poles. They were going through the jungle to the next village to see an albularyo. I introduced myself as the new town doctor and asked if I could be of help. Thereupon, perhaps desperate for any help, the group put the hammock down.
“The little girl—about eight years old-- had an unhealthy pallor, and she was burning with fever at my touch. I always take with me a little medical kit, so I brought out my thermometer and registered her temperature at 39 degrees Celsius. As she was also dehydrated, I offered her some water from a paper cup and tumbler I kept in my supply bag, and I gave her mother a foil pack of eight tablets of paracetamol and some rehydration sachets, together with some instructions.
“The mother narrated what had happened. Her daughter was playing near the dug-out well from where the family got its water. But disobeying her orders NOT to go near the huge lunok (balete tree) close to the well, the little girl hid there whilst playing with her friends. That afternoon, she got a high fever along with vomiting and diarrhea. It had been a couple of days since, and the mother suspected that her daughter had disturbed the duwende (elf) living in the lunok. A part of me still believes in this. Nonetheless, when we arrived in the village, I went to the well myself and saw how murky the water was--probably the result of the recent dry spell. So, I instructed them to boil their water before drinking it.
“Even as they nodded, I wasn’t sure that they trusted me. But then, suddenly I got an idea. I asked them the name of their albularyo, and proceeded to search him out. Even from afar and some fifteen years between then and now, I instantly recognised Artemio. He worked the banana plants and the nearby fields when, as a school boy, I was staying with my Lola Ising. He now goes by the name Tata Teming, the albularyo. He told the villagers he got his anting-anting (talisman) when, one Good Friday, he swallowed a banana blossom under a full moon. For a small donation, he could henceforth heal people.
“As chance would have it, there was a toddler being brought before him, and I followed everyone to his “clinic”, a darkly lit room. The boy was complaining of lightheadedness and loss of appetite—he also had a slight fever. Tata Teming immediately diagnosed it as usog (an evil eye hex). He proceeded to perform a ritual called pagtatawas to determine who had hexed the child. On a basin of water, he sprinkled holy water--which he said was supplied by a priest. He blessed it again, uttering a strange language. Then, he held a large spoon with wax over a burning candle. More prayers as he made the sign of the cross whilst pouring the molten wax on the water, hardening it. A strange figure rapidly formed. Everyone gasped! Tata Teming rotated the figure on the water this way and that until he saw a man on a bicycle, the bits and bobs of wax, he explained to the family, were the wheels of a bike, and the silhouette in the middle was that of a man. It looked random to me, but it all made sense to the parents of the child. Such a man did approach them a couple of days before and commented about their son. But the parents failed to counter the usog by uttering “pwera usog” (forbid hex). Anyway, with the pagtatawas done, the child should now get well. But just in case, they could come back, and Tata Teming would perform another ritual called pagpapausok to smoke out any remaining hex. Surprisingly, after the pagtatawas, and to everyone’s relief, the toddler said he felt a lot better. I thought “placebo”, but who was I to question?
"When we were alone, I approached Tata Teming with my proposal—perhaps we could have a partnership: he with his traditional medicine and I with my modern medicine. Tata Teming knew my Lola quite well and readily agreed—his practice was doing well, but he was getting old and needed to slow down. Ours proved to be an auspicious partnership, especially when the coronavirus struck and we needed to inoculate everyone. I would never have been able to do this without Tata Teming.
"I am now proud to say I am well settled in San Gabriel-- going back to my roots, and serving the community I love. I stay in town three days a week, and the next three days I spend on barrio visits. I got myself a motorcycle and have trained two orderlies—one to help me in the clinic and the other to function as my assistant during my barrio visits. I was also able to lobby for a nurse from the provincial hospital who is now on loan to my clinic.
"I must admit, however, that even so, Tata Teming plays a critical role. I call on my partner to help me persuade a difficult patient and/or their family to follow my instructions, perhaps coupled with an incantation from him, as many folks still trust his treatments more than mine".