John Rae

Recent Assignments: Global Fund Philippines

   
After a day in Manilla we were off to Puerto Princesa on the island of Palawan. Here I was introduced to the Jeepney. The Jeepney is a WW2 jeep that has been streatched into a bus that can seat 20.
   
The Philippines is a fishing country. Fishing villages often start on shore and grow out into the sea. At the edge of Puerto Princesa we visited a neighborhood that has grown about 100 meters into the bay.
     
  
Both malaria and TB are endemic in this neighborhood where people live close together and sleep without enough bed nets.
   
This young man says he will not have sex with a woman until he is married. He said that before marriage many young men in the neighborhood find comfort with their male friends which increases their risk for contracting HIV.
   
Fresh fruit for sale.
     
  
The walkways that lead to homes further from shore are made of scrap pieces of wood. Everything moves which I guess is appropriate for people who spend much of their time working in boats.
   
The Philippine version of the Centaur- half man, half fish.
   
If there are not enough bed nets for the family parents are left with bad choices. Often the men and boys end up under the nets because they provide the family with income. Women and girls get sick more often creating a cycle of dependency
     
  
   
  
In Manila there is an entire neighborhood within the confines of the city dump. A few years ago a portion of the trash mountain gave way and buried part of the neighborhood.
     
  
This ‘trashalanch’ inspired the government to improve the regulations around the dump. Now trash pickers must be older that 15 and be licensed.
  
The neighborhood now has its own health center sponsored by the Global Fund.
  
Every morning rain or shine the recyclers greet each dump truck as it heaps its load on the top of the mountain. They all use a small hand held pick to turn over the contents.
     
  
Because people are living so close together under such trying conditions TB is a big problem.
   
Julia, in foreground, has TB and is under free treatment. Most of the members of the family have had TB.
   
Reynaldo, a father of 6, has TB. He and his family live in a wet cardboard, scrap wood, and tin shack in the shadow of the garbage mountain.
     
  
Reynaldo's registration card.
   
The course of medicine for TB lasts 6 months. The patient feels normal after 2 weeks. Compliance is a problem so TB nurses are charged with directly observing the patients adherence to the regimen.
   
If patients fall off their medicine they run the risk of developing Multiple Drug Resistant TB (MDR TB).
     
  
Julia, a mother of three, has developed MDR TB and was near death by the time she made it to the neighborhood health center.
   
Julia has been reunited with her family.
   
MDR TB takes 18-24 months of medicine to cure. The medicine often makes the patients feel terrible. Julia said that she would rather feel terrible and be with her kids.
     
  
Julia's sister also has TB.
   
On the island of Palawan we traveled 3 hours south from Puerto Princesa to a Batak village.
   
John made everyone get up at 3am so we could be at the village at dawn. Once off the paved road we traveled an hour up a river bed to reach the village.
     
  
The village had about 9 huts and 40 people and was nestled in a turn of the river.
   
The Bakak, which means "mountain people", live in the mountainous interior of Palawan. They are hunter gathers and spend weeks at a time in the surounding jungle.
   
In the jungle the Batak often do not carry mosquito nets and are vunerable to contracting malaria.
     
  
The nurses and doctors form the malaria team find 19 people out of 40 with malaria. The first step in testing is drawing a few drops of blood.
   
Next slides are prepared.
   
Rapid tests are available for more remote locations but the slide tests examined by trained health volunteers are more reliable.
     
  
Once the slides are prepared they are examined under the microscope. The volunteers go to week long training sessions to be certified to read the slides.
   
New bed net. The distribution and testing team showed up in this village north of Puerto Princesa with 400 bed nets. They were gone by midmorning. Another 200 nets were called in from the nearest warehouse.
   
This girl was participating in a Malaria day parade through the village to attract villagers to the distribution and testing.
     
  
This young mother of 5 said that this was her second bed net. She said that the family slept better and worked better now that they were not hounded by mosquitoes at night.
   
Finger pricks hurt.
   
Hurt young and old.
     
  
This boy was heading home to the jungle. He and his family had walked about 6 miles roundtrip to get tested and pick up the nets.
   
This family of 7 lived in a reed hut 4 meters by 4 meters.
   
This family of 6 lived in a reed hut 2 meters by 4 meters.
     
  
Malaria patient with his free medicine.
   
Pregnant women and children under 5 are especially targeted for bed net distribution.
   
In the mid 20th century the Batak were pushed into less fertile areas and have resourted to suplementing their income by harvesting rattan, tree resins, and honey.
     
  
The Batak were nomadic people but have since, at the behest of the government, settled in small villages.
  
Education is an important part of the malaria program. Here the villagers gather to listen to a presentation by the malaria team.
   
Participants are told how malaria works and shown the proper use and care of bed nets.
     
  
After the mosquito draws blood it must land on the wall to rest. Interior spraying helps keep down the mosquito populations.
  
In Manila HIV stigma is very high. There are three hospitals that provide free HIV counseling, testing and therapy.
   
The clinics are usually nestled in the back of the hospitals.
     
  
This HIV positive woman was found living on the streets. She was so traumatized by the experience that the psych nurse said that she was not able to give informed consent to have her face in the photos.
   
TB patient, Manila.
   
TB patient , Manila.
     
  
Decorations at the central park in Puerto Princesa. This park is a big pick up area.
   
The girls gtting ready backstage at the Phoenix Seafood Restaurant and Videoke Disco Bar in Puerto Princesa.
   
The Philippine government does not allow prostitution or brothels. The women are registered as 'entertainment experts' and the brothels must be bars or restaurants.
     
  
Peer educators work early in the evening when it is easier to get the girls' attention. Later the women will be too busy.
   
Yes the girls are numbered.
   
Some girls use prostitution as a stepping stone to something else, some to support their families, some to support a habit, and some because they are forced to, but I have yet to meet a commercial sex worker that likes what they do.
     
  
   
The girls waiting for the night to begin.
  
When the men start to arrive the women are required to participate in a choreographed presentation of themselves.
     
  
The peer educators that work on the streets are perhaps the bravest. They work in the open without the relative comfort and security of facilities like the Phoenix Bar.
   
The street peer educators are often seen as a threat by pimps and johns.
  
HIV/AIDS memorial evening in Manila.