The people who make your world

 Many times I’ve promised myself not to bite into the tourist superstructure of whatever country I visit. It isn’t inevitable, there are always chances to avoid the accommodation designed for the casual visitors, it just needs a little extra work. As an outsider some options won’t be available, but the more out of the way places are the more people will make exceptions and go out of their way to help. More and more my attitude has been that space will be made, even at the expense of ousting families from their own home, for some ready cash. Now, that may sound barbaric, but look at it from a poor rural family’s viewpoint. Along comes an opportunity to see more cash per week than you could earn in a month, and that’s on top of your normal earnings. Yes, it does mean the whole family must squeeze into one room at night, but they don’t see that as a hardship. Speaking as someone who has given people a place to stay with no recompense I don’t think I’m taking the piss. (Photo: A rather beautiful moth which I can't ID, it's nearly as big as my hand though - Barangay Valencia, Cebu Island)

It isn’t quite the situation at the moment here in the Philippines, no-one has been ousted from their own space. The rooms I’m renting were used a long time ago by one of the family, but had been relegated to a store-room many moons ago. OK, it’s a good deal bigger than the average family has at their disposal, but I’m also paying twice as much as the average family earns each month. It was a good move for me. Though I was welcome to continue living with Cookie, Dindin and their kids I felt I was imposing on their very limited space as it was. I had no plans to hang around this long, my intention had been to reunite Zoe with her daughter, sort out the unwanted pregnancy and be on my way. Wouldn’t it be nice if things always went to plan? Actually, no! It would make life predictable, and in my mind somewhat boring. At the moment I can handle a bit of dependable, every day life though. Recent events have not enamoured me to this country, whilst individuals and families have been so kind the social system is medieval. (Photo: Next door neighbours, happy to run down the shop for mum - Barangay Valencia, Cebu Island) 

Everyone, without exception, complains of the corruption throughout the whole system within the Philippines, from the highest levels all the way to the bottom. A politician gets voted in and the first comments are of how corrupt they are. So how do they get in power? Mainly by buying votes, which I find a stunning concept. For a pittance in pesos, people will vote in someone they know to be corrupt. Which of course is bizarre, the very people who are destined to suffer the most give up their rights for a lousy buck. Short sighted is the kindest expression I could make, the trouble is no-one actually believes it will make a difference. With corruption running rampant through all sectors of society it seems nigh on impossible to change the whole system in one foul swoop. As with all institutionalised problems, what it really needs is to be uprooted and replaced wholesale, a mere shakedown just won’t do the job. (Photo: My...er hmm...friend, Zoe - Barangay Valencia, Cebu Island)

While in the hospital I was surprised to hear of the patients for the government hospital having to buy the drugs and supplies for their treatment. To my knowledge much of these are gifted by foreign powers or organisations to provide treatment to the poor and needy, treatment that would otherwise not be available. Instead of being provided free, they are sold, and treatment will not be given until the drugs are purchased. In effect the government are profiteering from medical supplies donated by foreign aid programs. There is a basic Social Services program whereby patients can receive treatment at a vastly discounted price, if your circumstances are judged to be desperate enough. This is government funded, and can offset the costs of treatment by up to 90%. Being as I wasn’t a family member I wouldn’t have been able to apply for this, despite Zoe having no income of job. They don’t interview the patient, they interview the watcher and make their assessment based on that. Personal family history is necessary for a successful application, I worry about emergency cases where a family member is not available for the process, surely they’d treat the patient anyway. (Photo: Lola, the matriarch of the family. I thought Lola was her name, but it means grandmother - Barangay Valencia, Cebu Island)

However much I’ve tried to come to terms with my experiences at the hands of the medical services here, I’ve failed. It leaves a lot to be desired. Though probably no worse than many developing countries it’s a far cry from what we’re used to in Europe. I’ve only had one foreign experience with hospitals before, when Cai died on that fateful trip to the States, and treatment certainly wasn’t withheld then. Without doubt life is cheap in most of the world, in rural areas of developing countries there is little hope of receiving vital medical treatment, which is why foreign aid is so valuable. Why does it take a major catastrophe, like Typhoon Yolanda, to wake the world’s population up to the deplorable health services that exist each and every day? My anger in the Cebu hospital was directed at the staff on the front line, maybe wrongly so, but if they don’t push for change who’s going to. They claim they are poorly paid, but earn much more than the average citizen in these parts. But health issues are far more widely spread than the supposed centres for health care. (Photo: Kurt, the second eldest of Cookie - Barangay Valencia, Cebu Island)

One of the family I’m involved with here in Valencia has long-term psychological problems, it’s Post Traumatic Stress. Some years ago he witnessed a brutal and bloody murder, he desperately wanted to help the victim but couldn’t due to the presence of the very violent murderer. Since then he’s lost his grip on reality, and lives in a fairly constant state of angst. For a long time he was bound in restraints, deemed to be a risk to himself if not to others. Now he enjoys a certain degree of freedom. Whether he goes unmedicated due to finances or a reluctance to take what’s prescribed is unclear, but he spends long hours of the day and night locked in a darkened room. Psychologically he battles imaginary adversaries, reminiscent of Smaegol/Golom. He plays various parts of the deadly game; pleading for mercy and understanding, shrieking for vengeance and destruction, and placating in a calm and rational way. At times he will sit outside, observing, quiet, but apparently fine. I’ve been trying to work out whether his psychosis is brought on by being locked up, or whether he’s locked up when he starts being psychotic. From what I’ve observed it’s the former, which makes the mind boggle. He receives no professional help, is simply left to the mercy of his family. (Photo: Angel, Cookie's current youngest, having one of her fallen moments - Barangay Valencia, Cebu Island)

Despite adopting a cynical frame of mind over my insights to health issues in the Philippines, I consider myself lucky. Purely because I’ve seen the conditions people have to survive in, what they must put up with daily. Also because I’m not condemned to share the difficulties they must endure, I have a get out clause, I can run home whenever I want. I had been wondering whether this country might offer me an alternative to living in the UK, at present I can’t imagine it could. While I think highly of those I live amongst I have severe doubts as to the workings of their country. The last thing I'd want is to be one of those whinging ex-pats who does nothing useful, 

I'll see you in Cebu

It took me six days to wind my way from Manila to the Derawan Archipeligo. I chose carefully my modes of transport wherever I could, keeping the costs down as time was not exactly of the essence. Only once did I take to the air, which was the first leg of the journey, a necessary evil to reach the shores of enchanted Borneo. Once there I used, express buses, chicken buses, shared taxis, ferries and speedboats, sometimes spending nights travelling to save on hotel bills. The emphasis had changed on my unplanned return, speed was of the utmost importance. Without any idea of schedules or availability the whole affair was pretty hit or miss. First and foremost an airport had to be reached, which involved a speedboat trip and a taxi to Berau. As luck would have it a friendly taxi van sat waiting on the dock as I coasted in from Pulau Derawan. He quickly understood I was in a hurry, while we drove he frantically phoned various agents and by the time we were halfway to Berau he’d secured a seat for me on the first flight to Tarakan.

I bounced from airport to airport, booking the next available flight as I landed at each new point of transit, Berau to Tarakan, Tarakan to Tawau, Tawau to Kota Kinabalu, KK to Manila, and finally on to Cebu. It proved a dizzying process, but I suffered no delays, waiting very little time at any airport. Until I got to Kota Kinabalu that is, I couldn’t get a flight to Manila within thirty-six hours with Air Asia, the only other airline who flew to Manila had no office at the airport, so I had to wait until the following morning to book through an agent in town. Try as I might I attempt to maintain a philosophy of not worrying over a situation that is out of my control, you have to accept it with good grace. For once I was hard pushed to put this into practice, I knew someone’s well being was at stake. But I managed to book one of the last seats on a Cebu Pacific flight the following night, with an onward connection to Cebu City itself. It meant I would manage to return in a third the time to travel in the first place; mind you, it cost three times the price. (Photo: If I found a guesthouse with a toilet this bad I'd look somewhere else, it stank and was filthy - Vicente Sotto Memorial Medical Centre, Cebu City)

Arriving in Valencia was to the sight of Zoe lying on the floor, weak and feverish, finding the pain too much for her. I wish I could say money was no object, but it had to be considered. There were private hospitals, but they weren’t cheap, I was assured treatment was available at the government hospital in Cebu city, over two hours away. Apparently the initial abortion had been incomplete, leaving a good deal of the placenta still attached to the uterus. Infection had set in, haemorrhaging was becoming a problem and the need for treatment was getting crucial. To top it all there were virtually no options but public transport to get there, all I can say is I’m glad I carry co-codemol with me when I travel. With her pain deadened and her mind floating amongst the clouds we set off, first needing to ride by motorcycle taxi into Carcar, then a public bus onto the capital of the island, Cebu.

I was aghast walking through the doors of Emergency, my first sight was a room overflowing with activity, beds were crammed in randomly, there wasn’t the slightest semblance of order to be seen. Visitors outnumbered medical staff or patients, in fact the medics almost had to fight their way through to treat the sick and injured. Amongst the mayhem a patient was being given CPR, the nursing team having to elbow people out their was to gain access and try to save a life. Thankfully being admitted was a painless process, the quickly checked Zoe’s details, assessed her condition and passed her on to the relevant department. They actually have a specific room for gynaecological emergencies, though at the time the necessity wasn’t apparent. What immediately became apparent was the appalling conditions under which people were subjected to in an effort to receive vital treatment. The walls were filthy, the floor as bad and the corridors lined with people squatting, sleeping, eating and trying to take their minds off the trauma effecting their lives. (Photo: Sent back to purgatory - Vicente Sotto Memorial Medical Centre, Cebu City)

Thinking there was a spare seat in the gyno room was a sad mistake, no-one sat there because the seat was thickly coated with relatively fresh blood. Drops of dried blood spotted the floor, across the walls could be seen smears of it. While we were there one poor woman sat with blood dribbling down her inner thighs, not a single member of staff took any notice. The reason for each patient having an entourage of visitors (they actually call them watchers) quickly became obvious. The nursing staff only administer the strictly medical procedures, all the rest is left to the watchers, that includes wiping up any mess, cleaning the patient, fetching and carrying food, water and traipsing around non-stop to procure the drugs and sundry items needed for treatment. Everything must be purchased, with the exception of rubber gloves the staff use, cotton wool they use for swabbing and tape. My first job was to do the rounds of pharmacies buying a long list of drugs and supplies. IV drips were included, dextrose solution for the drip, adult nappies to stop any spillage from the haemorrhaging, anti-biotics, anaelgesics and transfusion kit, to name but a few items. (Photo: When things are feeling rough think of happier times, Jaslyn and Angel - Valencia, Cebu Island)

The whole episode was a palaver, there was no centralised pharmacy, the hospital itself hosted four of them, and if they were out of stock of anything the only options were the more expensive, private, pharmacies across the road. Everything has to be paid for up front, often meaning retracing your steps many times between the cashiers office and various pharmacies. The turnover in the hospital is phenomenal, the human traffic within the grounds never stops, it’s business twenty-four/seven. People can be found stretched out sleeping in corridors, stairwells, along concrete walls and filling every waiting room. Many of the poorest people are from out in the provinces, for a watcher to accompany them their only choice is to stay with the patient. So you find each patient with at least one permanent visitor, and they need a person to care for them, because you can be damned sure the nursing staff won’t.

It took a six hour wait before they came for Zoe, she went in for a RASPA procedure, to remove whatever remained of the placenta or conception tissue (I think that was their terminology). None of the rooms in the ER sections had curtains or any degree of privacy, patients were examined pretty much in full view of all and sundry. The only concession was the full internal examinations in the gyno section, though they did less thorough examinations for all to see. When they brought the trolley for OR, she had to strip naked, in the corridor, with a host of curious onlookers happily watching. The orderly did nothing to help, rather copped for a good look himself in the process. If I hadn’t been there to protect her modesty it would have been a full frontal show for all. But if I thought that was bad, the worst of it didn’t’ emerge until after the procedure was complete. (Photo: An ingenious use of natural resources, a coconut scrub for buffing floors. It works wonderfully! - My temporary home in Valencia, Cebu Island)

The ward she was taken to for further evaluation, and eventual discharge, was called the holding area. Patients were squeezed in, two to a bed, and I kid you not. Most beds had two patients and any number of watchers inhabiting whatever space they could manoeuvre themselves into. It was sweltering in there and even dirtier than ER had been. Behind Zoe’s bed was a used drip tube with empty dextrose bottle still attached, a filthy rag lay under the bed, and the sheet was grubby grey with blood and other questionable stains adorning it. Feral cats prowled the actual ward, and no-one took a blind bit of notice. And if the wards were bad the toilets should have been condemned for demolition, or buried in a plague pit. Having no water or available tissue was standard for many of them, having running water in the cubicle was the exception rather than the rule. Without money there was no palatable water available anywhere, ceiling fans weren’t working making it almost unbearable, and when they did call in a technician he only fixed the one over the nurse’s station, leaving the patients to suffer.

I was disgusted with the conditions, and appalled at the lack of care for the patients. Nurses repeated the same skin test on Zoe many times, because they didn’t even bother to read her chart. Attempts at inserting an IV were clumsy and thoughtless, they were damned arrogant to top it all. As a double check another ultra-scan was ordered, which of course I had to pay for. From the results the doctor promised an examination would be performed, it was doubtful another RASPA procedure would be necessary. After six hours an examination still hadn’t taken place, so they requested another RASPA as a precautionary measure. Another seven hours and it still hadn’t been done. By the time she went to OR again it was over thirteen hours she’d been without food or drink, by order of the medical staff. When they didn’t perform the RASPA, but decided to reschedule for a full general anaesthetic. Due to Zoe’s anxiety she found it hard to relax sufficiently for the cervix to dilate properly. It felt like the last straw for us both! (Photo: Living area, with open grilled windows, great for ventilation - My temporary home in Valencia, Cebu Island)

I was at my whit’s end, bearing in mind I was in the middle of my third night with no sleep I’m not surprised I began to get more demanding. ‘When will this be rescheduled for?’ Reassurance was given, within the hour they claimed. After another four hours, still with no news of the operation we upped and left. You can be damned sure they didn’t like that, not in the slightest. Security were called and they stopped us leaving the premises, physically. They escorted us back to the ward, and even after signing discharge papers they refused our departure. Tempers were frayed, accusations of incompetence made, until finally the doctor actually put in an appearance and let loose a vicious tirade at us. She threatened to report Zoe to the police for having an illegal abortion, so much for doctor patient confidentiality. I can appreciate her being overworked, but she was downright nasty. When pointing out the terrible conditions the patients were subjected to she retorted, ‘This is a charity hospital, what do you expect?’ My answer was simple, ‘proper medical care’. (Photo: Sleeping space, amazing how quick you get used to a thin foam mattress. - My temporary home in Valencia, Cebu Island)

Parting criticism by a nurse was about my calling them incompetent in front of other patients, he felt it might give them cause to question the process’ they’re subjected to. Now we can’t be having that can we? I raised the question as to how many points on the patients Bill of Rights they’d failed to adhere to. I was told the patients have no right to see the Bill of Rights, they’ll be informed of any relevant points by their doctor, if and when it’s thought to be necessary. We were released, and felt relieved to be out of the place. Of the few shadows seen on the ultra-scan, well they seemed to have come out as discharged blood clots. Zoe is feeling well and content her ordeal is finally over. All abortion is illegal in the Philippines, and like backstreet abortions the world over, the rate of malpractice is high. To have a section of ER specifically for such problems only highlights the dangers of keeping the process illegal. Raising the question of legalising abortion is supposed to be on the governments agenda now, though I’m sure with Typhoon Yolanda there are more important issues to deal with.

As for me, well I'm back in the provinces of Cebu having spent all my allocated money for the trip so far, and then quite a bit more. I've not applied myself to my writing and am determined to do so. The outcome of this is to rent a home for at least the next two months, at £60 a month I hope to bolster my finances before throwing myself at the wider world again. In the meantime I have the perfect opportunity to get stuck into my book again. The space had been used for storage above a shop for some time now, but it used to be someone's home once. After a thorough clean and polish it's been transformed into a spartan but usable space. (Photo: And lastly my work space, to one end of the bedroom. It gives a good view onto the street below, so I can while away the hours while contemplating my choice of expression. - My temporary home in Valencia, Cebu Island)