i spent last week in the rural
region of paranas, which is about 2 hours north of tacloban on the western edge
of the almost entirely undeveloped island of samar. there is one town, but paranas
is a vast municipality, roughly equivalent to an american county. it is the
type of place where foreigners are required to meet with the mayor and the
legislative assembly upon arriving, where mayors walk with limps because of
past assassination attempts, and where the mayor hasn’t even been to some of the
villages in his region because they are so inaccesable. yes, if you’ve noticed,
everything is about the mayor. after a refreshing hair-tousling ride from
tacloban in the back of a pickup truck, i was ushered before the municipality’s
legislative assembly for formal introductions. the dozen or so politicians sat
in one of the only air-conditioned rooms for miles, on ornately carved
hardwood thrones (a status symbol in these parts), and referred to themselves
as “the honorable____”. that was just the legislative branch; next i needed to
meet the mayor, who seemed like a great guy. later i learned that he payed everyone
who voted for him in the last election the equivalent of $10. the guy he was
running against payed $40 per vote. the municipality offers identity cards, but
only those who voted for the current mayor get one. exclusively those with
these cards are eligible for free municipality-sponsored raffles for
televisions and new cars – all this in a place that claims not to have the
resources to buy an ambulance. while we were small-talking with the mayor a
woman was brought in who had a bulging eye and desperately needed to travel to
the nearest city for a ct scan. the mayor agreed to pay for it, presumably
pending future favors. he peeled the required cash off the huge wad of bills
that he pulled from his pocket. no one knows for sure if this is the town’s
money or his personal benevolence; he’s doing a great job of giving folks the
impression that it’s the latter.
the mayor spent an inordinate period
of time assuring all present that the safety of this foreigner (me) would be sacrosanct.
apparently western samar is home to some leftest rebels who may be interested
in kidnapping a caucasian, or as the mayor put it, someone with such a “pointy
nose” (to raucious laughter). he told me that i would not be allowed to to the
barangays (villages) in the “hinterlands”. that is where we were going to spend
most of the week, so after the meeting i petitioned him to let me go and he
relented.
the next day four great local
interns (mel, jc, christine and karen) and i, along with a male nurse (who
takes the term “flambouyantly gay” to levels never before witnessed by humanity)
and a midwife hiked for 2 hours through the mud and waded through a thigh-deep
river to an isolated barangay (village) called tipul, where we stayed for 2
nights. rubber boots were required, as the area has endemic leishmaniasis. part
of the way i got to ride a carabao, or local water buffalo. the village’s
dwellings were constructed of thatched palm and elevated from the ground on
sticks. the village was full of of naked kids, stray dogs, roaming pigs and
blaring taylor swift (they did have electricity). we stayed in the home of the
barangay captain (the village political leader), where we slept on the floor on
banana-leaf mats and pillows filled with rice and ate exclusively rice and fish
broth for each meal. apparently they brought in the fish just because we were
there, the implication being that all they usually eat is rice. even the rice
was donated, as unfortunately the village has had a really tough time recently
with their crops (predominantly rice and coconuts). according to the interns,
the food we ate in the 3 days may have been the family’s food for the next
month. we justified our sustenance by requesting more food aid for the village
from the mayor upon our return. i carried in my own 8 liters of drinking water,
and it ended up being a good idea as there were plenty of folks with
gastroenteritis from the village water source. all that water filled my
backpack, so my only clothes were the ones on my back, justifying this blog’s
title. gotta love putting on the same disgustingly sweaty clothes each day. no
running water either. nothing makes you thankful for cold showers like no
showers at all. the hospitality of the family who hosted us was profoundly
humbling.
we held a medical “consultation” in
the town square, dispensing an extremely small selection of medicines from the
one box we had carried with us. most of the complaints were pediatric upper
respiratory issues secondary to everyone having wood fires for cooking in their
homes, and skin infections. everyone seems to believe that amoxicillin will
solve any problem, including muscle pain and rhinorrhea. i got to see patients
myself, with expert interpreting from the nurse. patients continued trickling
in throughout the nights, and late one night some local men caught us some huge
frogs, which we devoured in their entirety as part of a spicy coconut-based
soup.
basically nothing is known about the
health status of this community. no one knows what the leading causes of
morbidity and mortality are, so part of the mission was to sign up and teach
some new local health volunteers to fill out surveys to that effect. also to
plan for emergency health events, which require the villagers to carry the sick
in a hammock across the river and through the mud to the nearest road, at which
point they need to send a messenger to send for transport as there is no cell
phone service in the area. most everyone is illiterate – though there are
teachers assigned to the village school, it takes them days to get there each week,
such that classes end up only being held one or two days per week. one of the
more concerning medical cases was an elderly woman with suspected pulmonary
tuberculosis. this should be aggressively treated to prevent the infection of
others, through direct observed treatment (dots). but the woman was too weak to
walk to the clinic to get tested, and would not have the resources to stay for
treatment. there is not currently anyone in the village who can administer
dots, and there are even bureaucratic obstacles to collecting a sputum sample,
so the case remains untreated. not cool.
we also held a clinic in the town of
paranas. doctors (and everyone else) around here love to spend their afternoons
drinking the local coconut wine, called tuba. a red bark is added to give a
slightly bitter taste and a red hue. interestingly, it takes 3 years to grow a
coconut, and while coconuts remain on the island of samar, none remain on the
island of leyte (where tacloban is), as they were all destroyed by typhoon
haiyan. in practical terms, in addition to more pressing concerns, this means no
alcohol for the common man for the next couple years.
i stuck around for the weekend, and
on saturday we took an excellent excursion 2 hours up a river in a “torpedo,” a
25-foot long narrow boat. there are 3 people manning the boat – one to drive
it, one at the front to help steer, and a kid whose job it is to continuously
bail out the accumulating water, as the boat leaks and also the entire trip was
whitewater so we were constantly being soaked! at a point in the river there
were some huge rapids, and we needed to disembark while the boatsmen expertly
guided the boat through the rapids, using a pulley system set up for that
purpose. we were able to do some swimming in the rapids as well! tula, the
barangay (village) that was our destination, was heavily hit by typhoon ruby
late last year, demolishing many dwellings and taking down lots of big trees.
after docking the boats, we still needed to wade through another river with knee-deep
mud to get to the village. we brought along some vaccines, so i got to hone my
baby-poking skills, just because we happened to be there! there was also a
child there with hydrocephalus and an untreated melingomyelocele, issues I am
very familiar with after a stint volunteering with a pediatric neurosurgeon in
kenya prior to medical school. the required (partially corrective) surgeries
would be free in the city, but his family doesn’t have the money for transport
and accommodation once they’re there, so no surgery. he’ll probably die soon,
profoundly sad.
this epic week ended with a saturday
night trip to the local city, catbalogan, to our attending physician’s house,
to sing non-optional late-night kareoke and to spend the night. everyone wanted me to sing until i started, then
they wanted me to stop. we were fed the classic kareoking snack – sigsig, fried
pig brains. an outrageous end to and outrageously amazing week!
