Titre du document / Document title

Traditional medicine in the treatment of parasitic diseases in the Philippines

Auteur(s) / Author(s)

MONZON R. B. (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1)
Departments of Parasitology, College of Public Health, University of the Philippines,
Manila, PHILIPPINES

Résumé / Abstract

Parasitic diseases are a continuing public health problem in the Philippines. Soil-
transmitted helminthiases (ascariasis, trichuriasis, etc) are the most prevalent especially
among children. Other major parasitic infections that cause significant mortality and
morbidity in the population are malaria, lymphatic filariasis and schistosomiasis. Since
these parasitic infections are more prevalent in the rural areas of the country, traditional
drugs (medicinal plants) have evolved for some of them. These have been passed on
through folkloric tradition and are propagated by traditional medicine men known as
herbolarios. It is essential that these alternative chemotherapeutic agents be scientifically
tested in order to ensure their safety and effectivity for the human population that
depends on such. Among the plants that have been identified to have antihelminthic
properties are: Anona reticulata (custard apple), Areca catechu (areca of betelnut palm),
Quisqualis indica (niyog-niyogan or Chinese honeysuckle), Leucaena leucocephala (ipil-
ipil), Carica papaya (papaya), Cassia alata (alapulko or ringworm bush) and Ananas
comosus (pinya or pineapple). The only suspected antiprotozoal drug is an antimalarial -
Alstonia scholaris (dita or Australian quinine bark). There are also traditional drugs
claimed to be effective against parasitic infestations (scabies andpediculosis) such as:
Melaleuca leucadendron (cajeput oil tree), Tinospora crispa (makabuhay), Phyllanthus
nirui (sampasampalukan or egg woman), Cissampelos pareira (sinsaw-sinsawan),
Moringa oleifera (malunggay or horse-radish tree), Gliricidia sepium (kakawati), Cassia
alata (akapulko or ringworm bush), Plumeria acutifolia (kalatsutsi or frangipani) and
Anona squamosa (atis or custard apple). In vitro and in vivo laboratory trials always
precede human clinical trials due to ethical guidelines. Plants with antihelminthic
potential may be screened in vivo indirectly, by observing their effects on animals
infected with parasites that are taxonomically and physiologically similar to their human
counterparts. In vitro studies are also possible with larger species such as Ascaris
lumbricoides which can be maintained in physiological solutions and attached to
kymograms. Antimalarial properties may be tested in vivo using the Plasmodium berghei
- mouse model (Yoeli, 1965) or in vitro using Trager and Jensen's (1976) continuous
culture method for P. falciparum. Traditional drugs for the treatment of parasitic diseases
should be explored and developed since they are cheaper and more accessible to the rural
poor who have the greatest need for medical treatment. Likewise, they may offer an
alternative solution to the emerging problem of drug resistance which is a common
phenomenon especially among the synthetic and more expensive Western drugs that
developing countries have become dependent on.

Revue / Journal Title

Southeast Asian journal of tropical medicine and public health ISSN 0125-1562
CODEN SJTMAK

Source / Source

1995, vol. 26, no3, pp. 421-428 (24 ref.)

Prolonged rains cause disease crisis in the Philippines
Michael A Bengwayan
BAGUIO CITY, PHILIPPINES
Tuesday, July 15, 2008
THE prolonged rainy season, punctuated by typhoons and incessant floods, is causing an
infectious-disease crisis of nationwide proportions, threatening hard-won gains in health
and life expectancy in the country, and putting at risk the lives of thousands of children,
the World Health Organisation (WHO) warns.

Already, typhoid fever, glardiasis, diarrhea, pneumonia, pertussis (whooping cough),

cholera, hepatitis, influenza, measles, malaria, the common cold, chicken pox and the
dreaded fast emerging tuberculosis (TB) are making their presence felt especially in the
densely populated areas with unsafe water, poor sanitation and widespread poverty.

These areas are perfect breeding grounds for the outbreak of infectious diseases.

Of the diseases mentioned above, the Department of Health (DOH) identified four as the
leading causes of mortality in the country, namely: tuberculosis (all forms), pneumonia,
diarrheal diseases (including glardiasis and ameobiasis), and diseases of the respiratory
system (including pneumonia, pertussis and the common cold).

Hepatitis was also identified by the DOH as a fast-rising killer since 1995.

The figures cannot be more frightening than these. From 1999 to 2003, the DOH reported
that the four communicable or contagious diseases killed a total of 78,307 people.

This appeared to worsen as in the following year alone, almost the same number, 70,189
deaths were registered.

The figures jumped to scary proportions in 2005 and are expected to worsen at the end of
this year.

The top eight causes of morbidity in the country are all communicable or infectious
diseases: diarrhea, pneumonia, bronchitis, influenza, tuberculosis and respiratory tract
ailments, malaria, measles and chicken pox.

Together, they have caused the sickness of 3,127,688 Filipinos in the same year.

The same disease struck 4,400,000 of the citizenry in 2005, sources from the Modified
Field Health Service Information System of the DOH showed.

In the WHO's August Infectious Disease Report, the Philippines, Indonesia, India,
Pakistan and Bangladesh were identified as facing the threat of infectious diseases,
especially tuberculosis, accounting for one of every two of the yearly 13 million deaths.

Every hour, 1500 people die from an infectious disease, over half of them children under
five years old. The rest are working-age adults, many of them breadwinners and parents,
WHO added.

The continuous unfavourable weather conditions are aggravating factors to a population

which has not been immunised during their early years either because of government
neglect or plain poverty, WHO said. It is further worsened by mass population
movements as in the influx of the rural folks to the city.

In Manila alone, an estimated 3.5 million of its population is a result of migration of the
rural poor from the provinces.

In Jakarta, Indonesia, where population has bludgeoned to a staggering 13 million

because of rural migration to the city, the government is pushing back the rural migrants
to the countryside with lesser population in a program called transmigration.

WHO said that many infectious diseases have recently been discovered as results of
chronic infections.

This is true in the case of cancers, particularly cervical cancer, liver cancer (caused by
hepatitis B and C) and bladder cancer, which is caused by schistosomiasis, a disease
prevalent in the island of Mindoro.

The difficulty in controlling infectious diseases today, WHO said, has been traced
recently to increasing resistance of microbes to antimicrobial drugs such that the arsenal
of drugs available to treat infectious diseases is being progressively depleted. This is
especially true with tuberculosis.

Tuberculosis being one of the leading infectious disease killers, WHO warned Southeast
Asian countries, the Philippines included, in its WHO Report on Tuberculosis Epidemic
that unless aggressive action is taken by the governments, one billion people worldwide
will be infected by the disease, 70 million of whom will die by year 2020.

Tuberculosis remains the most deadly infectious disease worldwide and has caused more
deaths than any other in 1998, it said.

The Philippines is one of the countries where primary tuberculosis cases are
concentrated, it added, saying the government must have a commitment to sustain
tuberculosis control.

Identifying what it called critical elements to break the cycle of tuberculosis transmission,
WHO is recommending health agencies of developing countries to conduct sputum smear
microscopy, short courses on anti-tuberculosis drugs and tuberculosis monitoring and
reporting system.

"Inadequate treatment of tuberculosis leads to marked drug resistance among patients and
consequently increases the threat to multidrug resistance to tuberculosis. When this
happens, it is simply a waste of resources and makes tuberculosis control programmes
more difficult and more expensive," WHO said.

When tuberculosis is normally treated, it costs between US$40 ($54) to US$60 per
patient but once patients become multi-drug resistant, second-line drugs needed for the
treatment will cost between US$1,000 and US$10,000 depending on the regimen.

Such prohibitive cost, which cannot be met by governments of many developing

countries running under a cash-strapped health programme, will only increase potential
infection of more people, WHO concluded in its report.

The Brunei Times

Philippines – Enhanced and Rapid Improvement of
Community Health (EnRICH)
Empowering Communities to Proactively Face Health Issues

ACDI/VOCA implemented this activity in the Maguindanao and Tawi-Tawi regions of

the Philippines. Tawi-Tawi, the southernmost province in the Philippines, is a remote
group of over 300 islands, which was gripped by poverty and underdevelopment. The
province is part of the Autonomous Region of Muslim Mindanao (ARMM), which is 90
percent Muslim and administratively independent of the predominantly Catholic nation.
This unique political situation had been the backdrop for generations of violence between
the Philippine government and Muslim separatist forces. Unrest, underdevelopment and
the sprawling geography had combined to choke Tawi-Tawi’s population off from the
modernization and prosperity spreading throughout much of Southeast Asia.
Maguindanao had similarly suffered from the conflict in the region, and its difficult
geographic location made stability and development an even greater challenge.

In response to the increasingly dire situation in Tawi-Tawi, ACDI/VOCA began the

USAID-funded Enhanced and Rapid Improvement of Community Health (EnRICH)
project in September 2002, which ended in February 2007. The project empowered
communities to face health issues proactively, giving them the tools and knowledge to be
effective.

The first major initiative of the EnRICH project was to promote reproductive health,
specifically the overall health of women of reproductive age and children under five, with
a particular emphasis on family planning. An important goal was to raise the rate of
contraception use, which had been 25 percent below the national average. This
discrepancy was largely due to the fact that women in the ARMM region had considered
themselves bound by religious restrictions that disallow contraceptive use. The success of
the EnRICH project hinged on the participation and support of the community which was
led by a handful of Muslim religious leaders. A cornerstone of the EnRICH program was
the organization of a discussion entitled “Mussawarah on Responsible Parenthood: The
Islamic Perspective,” during which religious leaders unanimously agreed to issue a fatwa,
or legal statement, in support of family planning. With the support of the local religious
leaders who showed a willingness to modernize to improve livelihoods in their
communities, ACDI/VOCA worked successfully to raise consciousness about family
planning throughout the community.
Another program goal was tackling tuberculosis, a disease that is highly prevalent in the
region. The program focused on TB prevention and treatment, with an emphasis on
children under 5 and women between the ages of 15 and 45. ACDI/VOCA staff in Tawi-
Tawi and Maguindanao disseminated education to prevent this disease and trained health
workers in best practices for treatment.

In addition to its efforts to revitalize and modernize health care practices, ACDI/VOCA
took strides to revamp the health care infrastructure in the region. The repair and
operation of a floating clinic that had become inoperable after years of insufficient
funding was the centerpiece of this effort. The refurbished clinic’s rehabilitation is
complete, and the Provincial Health Office of Tawi-Tawi has used it to take doctors and
medical staff to patients on remote regions who otherwise would lack access to health
care. They often served more than 1,000 individuals on a single outing.

Training volunteer health workers to educate and empower the people was also a
component under the EnRICH program. To make educational programs available to all
residents of Tawi-Tawi’s 300 islands and some regions of Maguindanao, ACDI/VOCA
implemented the innovative Distance Education Program through a local radio station.
The program targeted five municipalities in Tawi-Tawi and three in Maguindanao,
educating health workers on family planning and maternal and child health issues. The
health workers met in a classroom in their community and listened to the educational
program together. The one-hour educational program aired once every week for six
months.

Additionally, ACDI/VOCA organized Healthy Family Coalitions. These now registered

organizations were previously informal groups of citizens and healthcare practitioners
working on issues related to healthy families. Now since registered, these groups applied
for small grants from the EnRICH project that provided them with funds to implement
small, feasible activities in their communities. A favorite activity was the creation of
local health clinics.

With new education initiatives and updated infrastructure, EnRICH changed the way
health care is delivered in Tawi-Tawi. Age-old practices yielded to modern ones, and the
program enabled citizens to take control of their health, allowing them to contribute
toward developing a prosperous and peaceful home in the turbulent region.
Diagnosing the Future of Community Medicine in the Philippines
Our country is in dire need of doctors for the people. The starkest indicator of this
dilemma is the state of community medicine practice in the country and likewise the
dwindling number of community physicians.

BY PHILIP PARAAN
Bulatlat

Our country is in dire need of doctors for the people. The starkest indicator of this dilemma is the state of
community medicine practice in the country and likewise the dwindling number of community physicians.

According to the National Institute of Health, there have been more than 9, 000 physicians who have left
the country as nurses between 2002 to 2005. Likewise, the Health Alliance for Democracy said around 80
percent of public health physicians have taken up or are enrolled in nursing. This year, it said, 90 percent of
municipal health officers (MHOs) are taking up nursing and are expected to leave the country. The number
of obstetricians and anesthesiologists are also fast depleting, followed by pediatricians and surgeons.

During the recent National Colloquium of Community Medicine: “Pearls and Perils in Community
Medicine-Issues and Challenges in the 21st Century” held Nov. 28, community medicine practitioners and
advocates met and discussed the state of the practice in the country.

Dr. Melecia Velmonte, chairperson of the Community Medicine Development Foundation (COMMED),
said that while community medicine is relatively a new field in the Philippines, it is best understood in the
context of health and development. It also represents state of the country’s health situation.

Among the measures identified that would help promote this discipline include integrating the concept of
community–based medical practice into the medical curriculum and also linking the Philippine health
situation to diseases as well as other subjects in the medical curriculum. Furthermore, there is a need for a
value re-orientation in the medical school-hospital support system to promote the viability of community
medicine practice while the medical academe should actively promote and advocate community medicine
as a career path among young doctors and medical students.

In the future, the best practices in community medicine should be documented and a strong system of
supportive mechanisms for community medicine practitioners both in the public and private sectors should
be developed.

“The health of the poor is a cardinal indicator of the state of people’s health,” Velmonte says. Among the
resolutions passed was the formation of a community physicians’ organization to advance the discipline not
only in the academe and medical community but also to gain ground in the promotion of health and
development for the marginalized sectors of society.

Anatomy of community med practice

Also called “social medicine” in western medical tradition, community medicine embraces the medical
philosophy of the distinguished German pathologist Rudolf Virchow.

He said doctors were supposed to defend the poor because of the impact of their social conditions. He said
poverty-related diseases are preventable.

It entails a process where health professionals become one with the people in understanding their situation
and in analyzing the root causes of ill health and disease.
Since then, social medicine proponents and advocates believe that the health of the population is a matter of
social concern where society promotes health, not only through individual means, but also through social
and collective undertakings. In this context, they uphold emphasis on the health of the poor as a cardinal
indicator of how well physicians are taking care of people’s well-being.

Global initiatives have been developed towards the realization of these noble principles. Among them was
the Third International Conference on Medicine in 1966 that described the first community-oriented
medical curriculum. Another was the 1978 Declaration of Alma Ata that defined the primary health care
approach. In 1985, the World Health Assembly issued an official statement on community orientation. The
Philippines was a participant to all these initiatives.

In the Philippines, experiences in community medicine and community health work have spanned more
than four decades. Communities where there are community health practitioners count their achievements
and successes. Over the past 40 years, education and training on the scientific causes of ill health and
disease were disseminated in remote and far-flung barrios. In several areas, health programs have been set-
up.

Later, these programs were managed by mothers trained as community health workers who have learned to
use various modalities of treatment ranging from conventional, traditional and alternative. The most
valuable lesson learned in these communities is that despite a hostile environment, the key is collective
action to obtain measures to respond to their health needs.

Health workers, together with people’s organizations, have negotiated with local government officials for
higher health budgets. These have resulted into better health care services for the people and work-related
benefits for public health workers.

The odds and challenges for community doctors

Taking the side of people’s health comes with a cost.

Oftentimes, community med practitioners are faced with pressures from family and friends. They are
looked down by other peers in the medical field and are considered in the lowest rung of the medical field.
In the medical organization, they lack acceptance, are denigrated by peers and colleagues in the medical
field while also lacking support systems from the medical school-hospital set-up. In the process, they fall
into a sense of helplessness.

On the other hand, there are also frustrations due to non-medical factors affecting healing and treatment.
They cope with the spiraling cost of living when salaries remain low. Many community health physicians
have earned the ire of the status quo and the government that has subjected them to political pressures,
harassments and red baiting. A number of community doctors are now being tagged as members of front
organizations of insurgents. Recently, the case of Kalinga’s Dr. Chandu Claver and his near fatal
encounter in the hands of highly armed gunmen believed to be soldiers, reflects the persecution most
development workers including doctors have to endure. In some cases, they are openly harassed, included
in military orders of battle (OB), and are falsely charged with rebellion.

Community physicians are constantly challenged on how to deliver quality health care amid the struggle
against recurrent poverty, hunger and social inequities. They are confronted with the high cost of medicines
and the lack of public health facilities.

The government’s policies on health human resource have led, directly and indirectly, to the decline in
community health practice. In fact, advocates believe that it is equally hard to count the number of
practicing community health workers as it is equally hard to count those who left the country for
employment.
Contributing to the migration of health professionals are push factors that include phenomenon of
globalization, privatization of public hospitals, medical zones, cost recovery schemes and the
rationalization program which are being promoted purportedly to bring improved health services closer to
the majority of the Filipino people.

Beyond health

Dr. Ramon Paterno, of the Community and Family Medicine of the University of the Philippines College of
Medicine, in his presentation entitled, “Pesos. Politics and Pathology: Addressing the Social Determinants
of Health,” raised the question: “What good does it do to treat people’s illnesses and then send them back
to the conditions that made them sick?”

This succinctly reinforces the need for more community-based approaches to health. Thus, the role of
community physicians to go to the community and organize among the people is an imperative and that the
only way to stem the causes of the people’s health problems is to address its social determinants. Bulatlat

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© 2006 Bulatlat ■ Alipato Media Center

Community Health Information Tracking System
(CHITS), Philippines
Page Tools

Grant Amount: US$ 22,642

Keywords: TELEHEALTH, PRIMARY HEALTH CARE, INTERNET, SMS,

PHILIPPINES

Geographic coverage: Philippines

Objective

The objective of this project is to improve injury prevention programmes through an

injury registry.

Research context

In this study free and open source tools from the Linux community combined with
participatory people-centric strategies were employed to enable implementation of an
injury surveillance system by health workers. The project has three main components: a
Short Messaging Service (SMS) for reporting injuries, training of health workers on
injury surveillance and a web-based system for the graphic presentation of injury data
used by decision makers. The pilot project was implemented in a poor urban village of
the Philippines. SMS was selected because of its widespread penetration in the
Philippines and its wireless capabilities.

Target beneficiaries

The beneficiaries of this project are community health workers in Pasay City, Metro
Manila, Philippines. Other beneficiaries are local government officials who can use the
health reports generated by the system for community and local level decision-making.

Outputs

• Rapid prototyping of injury codes, SMS and landline phone submission formats
and protocols, community health worker surveillance kits;
• Data modelling for the surveillance system;
• Development of applications to receive data and generate reports, including bug
fixes and enhancements;
• Training on the system including preparing related content such as manuals,
exams and certificates;
• Pilot testing and evaluation of the system; and
 • Deployment of the system with actual submissions of data.

Research results and outcomes

The project’s initial aim was to create a data collection system using SMS over mobile
phones, called the Community-Based Child Injury Surveillance System. After
preliminary investigations, however, the researchers discovered several constraints
associated with the original strategy. These related to the cost of sending messages and
public health policies that only allowed official government health centres to submit
health data.

The project responded to these factors by shifting strategies and creating a computer-
based information system that served, primarily, the needs of the health centre facility
and, secondarily, of the national public health system. The project was renamed CHITS
(Community Health Information Tracking System).

By employing a combination of methods, including community immersion, systems

analysis, joint rapid application development, onsite technical assistance and grassroots-
oriented training, CHITS was piloted in two of thirteen health centres in Pasay City. The
pilots had two major components: first, an extensible and customizable software engine
for health facilities and second, a training programme for health data collectors, such as
health centre staff and community health workers.

The researchers note that developing a community-based health information system is a

challenging task, closely approximating the level of difficulty found in the development
of hospital and clinical information systems. By paying close attention to health centre
events and culture, and by employing purposeful immersion in the end-user's way of life,
the researchers were able to gain immense insight into their needs and requirements and
apply these insights into software code, a process called “evolutionary software
development.” The researchers were originally leaning towards a technology-centric
implementation of an information system. With deeper analysis and understanding of the
needs and requirements of end-users, the researchers were able to put technology in its
place to serve the genuine needs of community health workers.

The CHITS project has seen a number of opportunities for further development and
replication. A blood bank and a national surgical registry are already using the CHITS
generic software engine. CHITS also attracted the attention of the Department of Health
and the CHITS Tuberculosis (TB) module has been presented to TB control programme
managers in the private health sector who are considering the system for adoption. There
are also plans for citywide implementation of CHITS in the cities of Pasay and Marikina.
Inquiries from three other municipalities have also been made.

Awards

CHITS was selected as a finalist in the 2006 Stockholm Challenge under the health
category. To learn more see: http://event.stockholmchallenge.se/finalists.php