A government hospital is usually the preferred facility to seek medical and clinical consultation by people in a rural community and they do come when they are already sick. Everyday hundreds of clients seek consultation. A review of the out patients census and data for the first two quarters of 2014 in a hospital in Philippines showed that the top three leading causes for which patients sought medical and clinical consultation were--TB, upper respiratory tract infection/asthma and pneumonia.
These are all lung related conditions and diseases. Looking at the socio- economic profile of the patients, a majority of them come from the low- income strata of society--the poorest of the poor, living in isolated and disadvantaged areas. This is just not an isolated case—the situation is more or less the same across other rural health facilities as well. The public health unit of the hospital has been making great strides in reaching out to these people, and encouraging them to access services provided by the primary health centre in order to prevent diseases and illnesses that may disrupt their ability to earn a living.
Among the clients being followed up is a family with 5 children. The father, fondly called Tatay Emong, is a construction worker, who stopped working because he is currently being treated for TB. He is now in the 4th month of treatment under DOTS. Two of his children are regular clients of the hospital because of asthma like attacks and difficulty in breathing. His wife, Aling Nena is forced to make a living for the family. The family is caught in a vicious cycle of being ill and well.
Aling Nena earns a living by repacking charcoal, and selling it to their neighbours within the barangay. She cooks their food on charcoal fire too. Her husband sells hot coffee among jeepney drivers passing by. He uses charcoal fire to boil water for the coffee. Their community is a picture of households suffering not only economically, but stricken by poverty, with health challenges and risks brought about by their indiscriminate use of charcoal fuel, burning garbage with a belief that it drives insects away, mosquito coils at night time, and use of kerosene torches to light their homes and shanties. There are not enough sanitary toilets and clean water to serve the community with more than a hundred families.
A regular community gathering called ‘family development session’ sponsored by the welfare office only checks on making sure that all children aged five years and below have been immunized, and are regularly attending school. What is missing is an integrated approach in the conduct of community education and health promotion that would include indoor pollution and how it affects the wellbeing and overall health of individuals.
Surprisingly, community health workers and volunteers are not aware about indoor pollution, its sources and its effects on respiratory system. When the health workers were asked about this, they said that this task was the responsibility of the environmental sanitation programme. The current approach in addressing community concerns related to health, sanitation and environment is too vertical and is fragmented. The horizontal coordination among programmes does not exist. If even sanitation and environmental education and promotion are implemented, indoor pollution is not covered. There is a clear gap due to which indoor pollution is not well recognized as a public health issue.
National governments must realize about the importance of indoor pollution, develop framework for its integration in current health programmes, provide programme direction, develop policy support, enhance capacities for implementation among local government units down the barangay levels, and for the local government units to maximize existing systems and structures as an opportunity for indoor pollution campaign integration.
Educating communities about indoor pollution and its effects is one small step that will catalyze bigger actions engaging community people, the health providers and governments and decision makers.
Nenet Ortega, CNS Correspondent, Philippines
20 September 2014
