Mother Baby Friendly Tent: Care Practices and Psychosocial Support

ACF INTERNATIONAL
MOTHER BABY FRIENDLY TENT: CARE PRACTICES AND

PSYCHOSOCIAL SUPPORT A capitalization document on response to typhoon in the Philippines
RESPONSE TO EMERGENCY Sendong , PHILIPPINES Mother Baby Friendly Tent : Care Practices and Psychosocial Support
A CAPITALIZATION DOCUMENT IN THE PHILIPPINES
ACF INTERNATIONAL
Anne Filorizzo Head of Project Psychosocial January March 2012
Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
Photo on cover page: ACF Philippines
STATEMENT ON COPYRIGHT
ACF International
Reproduction is permitted providing the source is credited, unless otherwise specified. If reproduction or use of textual and multimedia data (sound, images, software, etc.) are submitted for prior authorisation, such authorisation will cancel the general authorisation described above and will clearly indicate any restrictions on use. Non-responsibility clause The present document aims to provide public access to information concerning the actions and policies of ACF. The objective is to disseminate information that is accurate and up-todate on the day it was initiated. We will make every effort to correct any errors that are brought to our attention. This information: is solely intended to provide general information and does not focus on the particular situation of any physical person, or person holding any specific moral opinion; is not necessarily complete, exhaustive, exact or up-to-date; sometimes refers to external documents or sites over which the Authors have no control and for which they decline all responsibility; does not constitute legal advice. The present non-responsibility clause is not aimed at limiting ACFs responsibility contrary to requirements of applicable national legislation, or at denying responsibility in cases where this cannot be done in view of the same legislation.
OBJECTIVE OF THE BOOK

To support the mandate of ACF in the fight against malnutrition by providing a capitalization document regarding the experience of care practices and psychosocial support as part of the response to emergencies in the Philippines.
TABLE OF CONTENTS
OBJECTIVE OF THE BOOK ........................................................................................................................ 4 TABLE OF CONTENTS............................................................................................................................... 4 INTRODUCTION ....................................................................................................................................... 5 1. PRESENTATION OF MOTHER BABY FRIENDLY TENT........................................................................ 8 2. HUMAN RESOURCES IN THE PROGRAMME: RECRUITMENT ........................................................ 11 3. TECHNICAL TRAINING.................................................................................................................... 14 4. SUPERVISION ................................................................................................................................. 17 5. team management: the 5 weekly action points............................................................................ 17 6. PRoject monitoring........................................................................................................................ 19 7. RESULTS......................................................................................................................................... 29 8. ACTIVITIES DEVELOPPED ............................................................................................................... 39 9. COORDINATION............................................................................................................................. 57 10. RECOMMENDATIONS.................................................................................................................. 59 11. PERSPECTIVES OF THE PROGRAM ............................................................................................... 62 12. CONCLUSION ............................................................................................................................... 64
INTRODUCTION
The island of Mindanao, Philippines, was hit by Tropical Storm Sendong with an international name Washi on the December 15, 2011 affecting 7 regions of the country. The regions Cagayan de Oro (CDO) and Iligan were severely damaged due to flashfloods and landslides. The Inter-agency Initial Rapid Needs Assessment (IRNA) led by OCD/OCHA last December 19, 2011 reveals that 24 out of 80 barangays of CDO were affected, 9 being severely damaged. Iligan City on the other hand, has 21 out of the 44 barangays affected, damaging worse its 10 barangays. Approximately 300,000 population in CDO and 135,000 in Iligan City were directly affected. From the same report, 6 evacuation Centers (ECs) in CDO shelter 3,762 families, while 3,635 families are housed in 6 ECs of Iligan City. From both provinces about 87,000 of the total affected population belong to 0-59 months and 23,000 are pregnant and lactating women. In December 20, 2011 updates from OCHA, out of the 927 death toll from all affected regions, 94% (875) of all deaths were : 579 from CDO, 279 from Iligan City 17 from the province of Bukidnon. In response to this emergency, the nutritions emergency pool from ACF international (Madrid) and the coordinator on medical and nutrition program of ACF wrote a proposal with two types of results expected: 1. A screening in the city of Iligan into the 44 barangays in order to evaluate how many children were suffering of malnutrition and prevent the outbreak of severely malnourished children. 2. The second was about opening mother baby friendly tent in 7 evacuation camps in order to promote breastfeeding and give some psychosocial support to the direct and indirect victims of Sendong, the most vulnerable people: pregnant women, lactating women and mothers with children below two years old. Both results tend to advocate on the activities against the unmonitored distribution of infant formula and powdered milk. At the same time Save the Children were conducting similar activities in Cagayan de Oro. It was the first time that the mission Philippines welcomed a psychosocial program in its department. They asked for some adjustments and understanding for every department of ACF. This response to emergency in nutrition and psychosocial participated to the good acceptance in Iligan city of ACF. They were approved by the large majority, by Unicef and Department of Health (DOH).
This capitalization is meant to be a report of the different steps of the program, its results, and the coordination needed but should, hopefully, be used too as a guideline of psycho socials interventions for the next response to the emergencies in the Philippines.
Part I
PRINCIPLES AND CONCEPTS
ACF-Spain
1 2 3 4 5
Presentation of baby friendly tent Human Resources Training Supervision Team management
9 12 15 17 18
7 Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
1. PRESENTATION OF MOTHER BABY FRIENDLY TENT

The child well being is the results of different components: health, food and economical resources and the caretakers behavior toward him. As the following scheme demonstrates, components are linked with each other. If the situation is unstable, the repercussion on the growth and/ or the development is direct. Care practices are in the center of this distribution of these components. Malnutrition or serious delays in child development are usually the result of multiple factors.
ACF chooses to define Care practices as: the behaviors and practices of caregivers (mothers, siblings, fathers and child care providers) that provide the food, stimulation and emotional support necessary for childrens healthy growth and development. These practices translate food security and health care into a childs well-being. Not only the practices themselves, but also the way they are performed (with affection and with responsiveness to children) are critical to childrens
survival, growth and development. It is impossible for caregivers to provide this care without sufficient resources, such as time and energy1. Six care practices have been selected in the Initiative Care Manual which was published by UNICEF in 1997: care for women, breastfeeding and feeding practices, psychosocial care, food preparation, hygiene practices and home health practices. Breastfeeding is an unequalled way of providing healthy growth and development of infants and it also has important implications for the health of mothers. In emergencies, breastfeeding can make the difference between life and death. Research proves that suboptimum breastfeeding contributes greatly to child disease2 and mortality3. Experience has shown that breastfeeding can become more problematic in emergency; among others due to trauma, stress and worry interfering with the milk flow; as well as due to wide spread myths and misconceptions, lack of time of the mother, insufficient support to the mother, wide spread unsolicited and unmonitored distributions of breast milk substitutes and other reasons. Most mothers can continue or re-start breastfeeding, if appropriate technical and psycho-social support is available, the caregivers coping capacity is promoted and supportive environments are created. In case of emergencies (natural disasters, severe conflicts), ACF used to assess the needs in water, livelihood and the risk of malnutrition outbreak. Because of the importance of the care practices, most of the missions adopted the concept of Mother Baby Friendly Tent in order to: To prevent increase of malnutrition, morbidity and mortality To help the family to adapt care practices to the emergency and post-emergency context To improve the wellbeing of the beneficiaries (infants, young children and their caretakers, pregnant women), taking into account life experience and past and present suffering To show families how to facilitate child development and survival To prevent or reduce the negative effects of unsolicited and unmonitored distributions of breast milk substitutes To provide appropriate and sustainable solutions for infants for whom breastfeeding is not an option
Engle, P.L., M. Bentley, and G. Pelto, The role of care in nutrition programmes: current research and a research agenda. Proceedings of the Nutrition Society, 2000. 59(1): p. 25-35. 2 Black R. et al., Maternal and child undernutrition 1: global and regional exposures and health consequences, The Lancet, DOI:10.1016/S0140-6736(07)61690-0, January 17, 2008, Published online: suboptimum breastfeeding results in 1,4 million deaths and 10% of disease burden in children younger than 5 years. 3 Save the Children UK, Hungry for Change, 2009
The main objective and conduct line is to take care of the mother/caregiver and let her/him take care of the child. The concept of the Mother Baby Friendly tent is to create: A place, where infants, young children and their caretakers as well as pregnant women are welcomed and given support. A safe place, where sharing of experiences and confidentiality are possible; yet privacy is ensured. A space where women/caretakers and their children can get together to spend an agreeable moment together. A place where sensitization, guidance and support is given to mothers/caregivers of infants and young children and future mothers. A place for promotion and reinforcing care practices for the child by parents, caretakers, families and communities. A place to reinforce community links, to meet and exchange thoughts; which can create opportunities to exchange on subjects such as breastfeeding, hygiene, nutrition, A place where mother/caretaker-child bonding can be developed and reinforced; as well as where mothers/caretakers capacity to care for their children despite the difficult living conditions can be reinforced. A place to prevent and detect acute malnutrition in infants, young children as well as pregnant and lactating women. A place to identify people in emotional distress; where psycho-social support or psychological care is offered. A place where the care to the infants might be provided in security and with good quality (ie give a bath, breastfeeding if too much proximity in the camps, etc..). A context in which optimal care practices are safeguarded and promoted through family support, community awareness and removal of barriers.
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Action Against Hunger has been involved in the IASC guidelines. This psychosocial program should provide support to the first and second grades of the pyramide. Nevertheless, a close coordination with the special unit is expected and must be developed since the beginning of the program.
Special -ised care
Caretakers with children less than 2 years old or pregnant women with problems that could seriously impact health and development
Basic Individual Aid Individual guidance and support
Caretakers with children less than 2 years old or pregnant women with difficulties
Access to the Baby Friendly Tent, Baby Corner or Mobile counsellor teams to meet, chat with others, relax, breastfeed Group activities: education sessions, group discussions, relaxation exercices, play sessions.
All caretakers with children less than 2 years old & pregnant women
The response to the Sendong emergencies is a program of three months in the city of Iligan, with seven tents in six different barangays (evacuation camps or close to the district health centers.
2. HUMAN RESOURCES IN THE PROGRAMME: RECRUITMENT

In many emergencies, ACF recruits people locally in the affected area. This is beneficial, as these people know the situation and the culture; and it is also positive to be able to provide people in need with a job. However, it is important to be aware, that many of these people are affected by the emergency as well. They may be displaced, are survivors of a natural catastrophe have lost loved ones, have lost their belongings One must take into consideration the mental state these people might be in and work in a way that respects their grief. It is hard to say what background or diploma Care Practices staff should have. Instead of pinpointing a certain profile, it might be better to indicate the qualities that are needed to be a counselor: Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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Have a minimum knowledge on infant and young child care practices, including feeding; and have the capacity and motivation to learn more in a short space of time. Having advanced knowledge on IYCF is an asset Have good listening and communication skills Have good empathy and be patient On the case of the Sendong emergency, most of the appliers were nurses with a background on psychological studies. This profile was very handful to response to health questions from the mother, more over the team was already aware a breastfeeding technique and nutrition elements. Furthermore, the medical knowledge helped the member of the team not to jump on conclusion, and think about plausible explanations before orienting the beneficiary to the psychologist. Example of Test for social worker Explain in few sentences what PSYCHOSOCIAL means for you? What are the skills and qualities of a psychosocial worker? Choose one topic for a group discussion among pregnant women. How will you organize and conduct the activity? What do you think are the possible challenges and how will you handle it? What are the needs of a child while growing up between 0 and 2 years old? What kind of information you would look for when defining poor mother-child relationship? What are the benefits of playing in child development? Give three examples of play activities you can suggest to a one-year old child. One of the mothers in the evacuation center does not want to come to the nutrition centre. What do you think are the reasons why she does not want to come to the centre? How will you motivate this mother to join the activities? What are Care Practices and Malnutrition? How are they related to each other? What are the principal consequences of malnutrition on a childs development and behavior? What are the benefits of breastfeeding in the mother-child relationships and development of the child? Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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What will you do if a mother starts to cry during the interview? What do you think are the feelings of the parents of a malnourished child? What are the differences of working for an NGO and any other type of company? Most of the beneficiaries (refugees) and their caregivers in the therapeutic feeding centre are mostly women. Is it better to have a male or female psychosocial worker? Explain your point of view.
Example of test for psychologist Describe an occasion when you found it difficult to work with someone from a different background? What is Mental Health? To your opinion, is there a link between Mental Heath and Nutrition?( Justify your answer Why do you think Mental Health and Care Practices component is important in the ACF intervention context? You should organize a Focus Group Talk with women who lost one of their children because of malnutrition. Explain the activity, methodology, objectives and scope/limitations of your activity. Give five indicators (warning signs) to consider mothers depression Explain why each vulnerability indicator is important to consider and how you suggest managing them in a short term follow up. Give five indicators to consider that a child is in distress by just observing him. If a mother comes to you in the therapeutic feeding center and complains about lactation difficulties but the child does not seem malnourished, what kind of hypothesis could you make about the relation between mother and child ? what would you plan to do with this dyad ? How do the parents of a malnourished child feel? How will you help these parents manage this situation? One of members of your team refuses to welcome the sister of a malnourished baby inside the tent because its a mother baby friendly area. Do you think he is right? What would you do if you were in that kind of situation? Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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In this specific program : 7 social animators and a psychologist have been hired. 14 Barangays Health Workers, volunteers from health centers of Iligan have been included on the program, thank to the city office who accepted to discharge them from some of their tasks in the district health centers. Note : 7 social animators, one by Mother Baby Friendly Tent were not enough to support the program. The BHW were working 2 to 3 mornings by week with the midwives in the health center. Sometimes, the social animator has to deal with 25 mothers and their children in the tent by himself. The program had sometimes lost on quality because of the over crowed of the activities.
3. TECHNICAL TRAINING
The team was trained on the 16th to the 18th of January. The first two days were only for the national staff. The training dealt with different subjects: Nutrition: supplementary feeding, relactation (SST techniques), use of MUAC Breastfeeding: explanation of the physical and emotional processes, Psychosocial: development of the child, play with a child under two years old Mother Baby tent: what is expected, how to welcome beneficiaries Every session has been ended up by role play to insure that the participants understood the focal point of the training. A pre and post test has been done at the beginning and the end of the session. The average of the results on the pre sessions was 13 / 20 and at the post test at 16/20. The basics were understood (for instance: composition of milk, the fact that a mother can lactate twins at the same time), there were still misbelieves about relactation techniques. To insure the better take care of the mother in need, the nutrition team will assist the first relactations process. Examples of questions : Breastfeeding shouldnt be day and night and on demand There is one type of milk produced by the mother providing the same elements A mother that is not well fed or a malnourished mother cannot breastfeed Trauma, shock and stress make mothers milk dry up Mothers can not breastfeed twins successfully because have not enough milk for both. The weaning means to stop totally the breastfeeding and give the child food at 6 months Mother Baby Friendly Tent: a capitalization document of an emergency response in the 14 Philippines
On the 18th, the national staff and the 14 BHW had been working together on the different activities expected in the mother baby friendly tent followed by role play. One hour was dedicated to breastfeeding. Planning of the three days of training. Day 1 9h 9h30 10h -10h30 10h30-10h50 10h50 - 12h 12h - 13h 13h - 14h 14h - 15h 15h - 15h15 Welcome / presentation of team and training Presentation of ACF international Pre - test breast feeding break Breastfeeding : global axes Lunch break Care practices & breastfeeding Nutrition : suckling technique + complementary feeding break Role play in group about mother having troubles with breast feeding Debriefing about the role play
15h15 - 16h30
Day 2 9h - 10h 10h - 10h30 10H30-10h50 10h50 - 12h 12h - 13h 13h - 15h 15h - 15h15 15h15 - 16h Day 3 9h30 - 10h15 10h15 -10h30 10h30 - 11h30 BFT : objective & activities (with participation of ACF team ) break Introduction to Care Practices
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post test/ corrections Dealing with common BF problems break How to welcome mother & child / role play lunch break Psychosocial support : play, massage, FGD break Role & function of a psychologist in a BFT
11h30 - 12h 12h -13h 13h - 14h lunch break Introduction to Psychosocial activities Role play " how to welcome mothers in bft " break Organization of the program
14h- 15h 15h- 15h15 15h15 - 16h
The hand over training Following the disaster the city of Iligan needed a support as to prevent malnutrition outbreak and maintain the well being of the survivors. The BHW have been working with the team during the 3 months. The team tried as much as possible to coordinate with the midwives. Because the Mother Baby Tent are an emergency response and evacuation centers are closing for relocation ones, ACF had to figure how maintain this type of activities without the structure. The focus had been on the midwives and the BHW form the main health center in Iligan. At the end of the program, they benefited from one day and a half training session. The afternoon is focused on refreshment about the breastfeeding and nutrition (SST, complementary food). The second day is dedicated to psychosocial activities. The objective is to find how they could can provide that type of activities into their health centers and be able to lead it, maintaining it in a sustainable way. An introduction to child development and mother signs of depression has been performed. They were provided of key elements around non pathological behaviors who have a impact of the children; how to help the mother to take care of the children, developing play sessions for instance while the family are waiting for consultation. All the participants left the training with a booklet (validated by the Department Of Health of Mindanao and Unicef) in Tagalog, with pictures, illustrations of breastfeeding and good care practices expected from a mother. It gathered the 6 care practices highlighted by Unicef. This should the tool that they can use in every situation, like guidelines to follow of the different advices with messages to transmit to the mothers.
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4. SUPERVISION
Every Friday afternoon, ACF staff meet for a superivsion meeting. The different cases and issues of the week are raised.The manager will provide some advices but above all, each member of the team is encouraged to express his ideas or advices. The objective is indeed to reinforce the team spirit and solidarity but, too, to reinforce their own knowledge and tools. For instance, one of the social animator exposed that mothers did not want to participate to bath sessions because of the weather. The mothers were afraid that the babies can get sick. Some members of team faced the same problem and shared with her how they convinced mothers to come to the bath sessions. Some of them pointed it while the focus groups of hygiene, insisting on the importance of bathing properly and every day their children. Other convinced one mother to be an example and a send one and a third one until the beneficiaries could state that the babies did not get sick if they are bathed when it rained. Some troubles with the focus group discussion have been raised. Some mothers were talking or leaving before the end of the session. The team ended with a brain storming about the do and not to do while the focus group discussion. They selected five majors point ( no phones, do not leave before the end, do listen to the other one respecting their point of view) and displayed the rules into the tent. They all decided to remind this point before every focus group and get the agreement of the mothers. The mothers who applied for these activities had to respect these rules or should feel free to leave before it starts. The team was introduced to the Alarm Distress BaBy and how to identify symptoms of depression. The informal advantage was that end of the week meeting ended up at 4pm and the team got use to have a drink all together right after the meeting for one hour or so. Their feed back was that they truly enjoyed this informal debriefing. Every thursday morning, the manager and the psychologist had a two hours meeting to discuss about the cases encountered by the psychologist on the field and about the staff members. This was a special time to be more clinical and get a better understanding of the survivors problematics.
5. TEAM MANAGEMENT: THE 5 WEEKLY ACTION POINTS

Some of the members had some difficulties to prioritization / organization. The manager asked them to establish 5 action points for the week, and evaluate on Friday if they were able to put on place, if not, for which reasons.
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Some of them work on their way to deal with the focus group like accepting silence and encourage the mothers to express themselves, some others about the tidiness of tent (being strict with the no shoes entering, cleaning the toys), some tried to get the BHW more involved into the psychosocial activities. The weekly objectives helped the member of the team to identify their weak points and work on it. Moreover, while the evaluation process; it has helped them to situate their capacity to deal with the program. From a managerial point of view, it helped to understand better the need of the team in term of supervision and training, tools ect The self weekly assessment took 15 minutes by week and was very helpful. Its strongly recommended to maintain it.
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Part II
PROJECT MONITORING AND RESULTS
ACF-Spain
6 7
Project monitoring Results
21 30
Mother Baby Friendly Tent: a capitalization document of an emergency response in the 19 Philippines Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
6. PROJECT MONITORING
1.Operationnal Choice of sites. The implementation of the tents was planned considering: the spaces in the camps allocated for a 42 square meters tents the number of pregnant and lactating women into the evacuation camps thanks to listing provided by the DOH a coordination with other NGOs or association providing services in this area in order to decrease the risk of overlapping activities. The target was, as already mentioned, the evacuation centers. The Mother Baby Friendly Tent to be really effective need to work in coordination with the midwives. More over ACF works with victims of the disaster that means, not only iDPs but home based too. For these reasons two reasons, two tents have been implemented in the barangay and not in the evacuation centers. The seven tents were implemented in: Tambacan Ubaldo laya, elementary school Santa Filomena, hugh school Barabgay of Santiago Madrassah in upper hinaplanon barangay Luinab, Gym 1 Luinab, Soa Shleter box There are two tents in the barangays of Luinab. The first one is an evacuation camp and the second a relocation camp. SSB is one of the biggest relocation camp In Iligan. It welcomed IDPs from different evacuation centers in the city including from Ubaldo Laya and Santa Filomena. ACF implemented the 7th tent in March there in order to : be able to follow up the mothers who left the two other camps and were into the program to welcome new IDPs from other barangays where the Mother Baby Friendly Tent had not been implemented. In the end of February, 8 relocation camps have been indentified: Name of the camp N of IDPs ( family ) welcomed or planned 176 181 154
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Santa Filomena Elementary school Santa Filomena High school Tambo tent city
San Roque Santiago ( Santa Elena) Luinab ( Gym 1) Diocesan Siao Shelter Box Luinab
50 107 75 264 557
ACF is implemented in five of them, with a little exception for Santiago, the Mother Baby Friendly Tent which is in the barangay of Santiago not into Santa Elena relocation camp. Even after the transfer of the IDP s from the gym to Santa Elena, the beneficiaries still came back to the tents. ACF had tried to open in Tambo tent city but there were no space available to install the tent. Implementation process After defining a first short list of evacuation camps with highest number of pregnant and lactating mothers, the manager should cross check the information with the Mental Health and Psychosocial clusters (if it exists) to get to know the different activities already on going in the camp. Then, he must visit the site and meet the camp manager. This responsible will provide a space. This space needs to be assess as secure and close from latrines and a bladder, should be shadowed by a tree (if there is no risk of earthquake ) and have enough space all around to catch the wind. The temperature inside the camp can be very high. If it is possible, the tent should be far from the road but not isolated for questions of security. Work plan The program should be run with a proper and validated work plan. All activities should be planned to avoid logistic issues. For instance, the end of admissions or distributions of baby kits have to be planned from the beginning. This work plan should be updated monthly. Sample of work plan week 8 week 9 week 10 Program Baby kits end of distribution end of distribution end of admission cloture of tents cloture of tents cloture of tents
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week 11
week 12
week 13
week 14
Food vounchers Admission
Special Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
activities 8th march Celebration of end of program Admin LOG PR Assess PR BK if if more relevant BK are needed last PR D3AF
BFU
BFU
Report Capitalization Unicef monthly /final Data collection Every day, the social animators send data of the day : The new beneficiaries (mother with children below 2 years old, pregnant and lactating and number of children below 2 years old) The frequentation of the tent (number of mother with children below 2 years old, pregnant and lactating and number of children who attended activities) in total. Same for the psychologist who send: The new beneficiaries (1st consultation) The number of one to one consultation The number of partcipants to psychosocial activities he animated. All this information is registered on a day-to-day data base. (Note : data base and forms in annex) The team registered in a form the admission and follow up. On Friday, these data are collected by the manager who : Check if the informations send by textos are the same than on the file, Can react faster if a tent has a decrease of frequentation or if an activity has not been ruled all week long. It is a real tool of supervision which allows intervening quickly and provide support to the member of the team who faces the issues. Logistical point.
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A list of the material which is used into the tent should be provided very quickly. It helps the team to monitor the material and be able to anticipate the needs.(Note : list of the material in annex). Profiles of beneficiaries Each woman who enters the program has been asked several questions regarding her marital situation, her number of children, if she is pregnant or lactating and her problematic. Her needs are evaluated and certain activities are proposed regarding her actual issues. All these datas allowed to design the profile of the beneficiary.(Cf annex) Linked to the food vouchers distribution planned, the social animators have been gathering information about the closest supermarket, the number of food distribution the idps and home based already benefit and the providers. It was a good way to establish for example that inhabitants of Ubaldo Laya had three more distributions than in Madrassah. 4 Sometimes these questions have been asked by the BHW or days of special influx. Some files were not complete. The marital situation
Most of the women are married, in particular in Madrassah. Few single mothers had been registered. The number of pregnancies post disaster (less than 3 months) into the program.
these informations have been transmitted to the food security department and not treated in this capitalization.
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Total of Women Santiago

Tambacan Santa Filomena Madrassah Ubaldo laya Luinab, gym 1 Luinab SSB Total
Total of Pregnant 57
101 50 49 67 39 7 370
305
485 185 176 247 227 51 1676
Total of pregnancy after Sendong 13

61 18 18 6 5 5 126
22% of the women who entered the program are pregnant. 30% of them are pregnant from less than 3 months, which means after the Sendong. In Tambacan, 60% of these women are after sendong pregnancy . The health center of Tambacan should provide a special focus on them. Number of lactating women into the program. total of yes women Santiago 305 193 Tambacan 485 291 Santa Filomena 185 98 Madrassah 176 99 Ubaldo laya 247 141 Luinab, gym 1 227 129 Luinab , SSB 51 25 Total 1676 976
no 64 121 56 26 52 70 15 404
mix 34 4 9 9 2 4 0 62
The lactating women represented 58% of the program. This percentage has to be taken with an extreme cautious. A lot of women said that they breastfeed their children in order to be sure that they will benefit of the program. Number of children by women.
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Most of the women gave birth to 1 or 2 children. A special focus should be put on the number of mothers who had their first child. This could demonstrate that they lost the family usual support with the displacement and the relocation far from their family (the parents, especially from their mothers). Still more than 20% of the beneficiaries have 3 children and more which highlights the needs of reproductive health program. Regarding the impact of the project, because most of them only have on child, ACF insure good care practices and a real promoting of the breast feeding. Most of the women assure that they will breastfeed their future children, because they understood the importance of the mothers milk for the childs health, more over the bonding and its crucial importance in the child development. This data demonstrated too that if we welcomed 1676 women, it is nearly 4000 children who will benefit from the direct impact of the program. Number of family with children between 2 and 5 years old by sites
Women Santiago Tambacan Santa Filomena Madrassah Ubaldo laya Luinab gym 1 Luinab, SSB 305 485 185 176 247 227 51 1676
Number of family with children between 2 and 5 115 285 92 66 91 100 31 780
Over the 1442 women who already have children between 0 and 2 years old, 49% of all the total (lactating+ pregnant+ women with children below 2y.o) have children between 2 and 5 years old. This information should be used by the nutrition and the food security team in order to target the site of screening and help the helper to focus on area. For instance, in Tambacan, 58% are family with more than 2 children under 5 years old.
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Distribution of the age of the children who entered the program
The majority of the children had between 7 and 12 months. One more time, these results have to be used with cautious. Some children have been registered as 24 months. There are actually older. The mothers modified the age of the children to be allowed to enter the program and benefit from the activities, the baby kits and the food vouchers Some green cards have been checked but most of the time, the mothers did not bring them. The team tried as much as possible to control the situation, nevertheless, they found very hard to refuse the entrance to mothers in distress, who needed help. We have to agree on the fact that the more women benefit from care practices counseling the most people, the most these will be spread into the community. Moreover, most of these women may have others children who will benefit from what they have been learning in the Mother Baby Friendly Tent project. Gender of the children from 0 to 2 years old. Gender Sites Santiago Tambacan Santa Filomena Madrassah Ubaldo laya Luinab gym 1 Luinab, SSB Total of children 307 415 148 128 229 190 40 1457 girl 142 205 72 66 105 83 15 688 boy 165 220 76 62 114 107 25 769
The program welcomed 47% of girl and 53% of boy
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Gender and breastfeeding practices
These data have been calculated in order to search for unbalanced care practices regarding gender. These results demonstrate what have been observed, until 2 years old the caring of the child seems to be similar. Age and breastfeeding practices in percentage
These data should illustrate the decreasing of the breastfeeding with the increase of the age of the child. In this area, it seems that more than 60% of the women breastfeed their children until 18 months. Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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This graphics is probably hedged; we do not know how many mothers pretended to breastfeed to insure their registration in the program.
Pourcentage of breastfeeding by ages
The weaning transition does not seem to start from 6 months but earlier. The 47% of the 18 to 24 months does not benefit from breast feeding. The details by sites are in annex. It could be used as the indicators form prevention against malnutrition. Problematic The mothers into the program are concerned by the socio economical situation. Some of them described themselves as bad mothers because they can not provide food to their family or because they can not send their children to school anymore (distance from the cam to the school, livelihoods...). It took a while (one month on average) for the mothers to trust fully the member of the team and start to open about cases of maltreatment for instance. Regarding the program, the beneficiary came regularly with questions about the breastfeeding (Is it possible when the mother is sick, when the baby is sick). Despite the disasters effect, the beneficiary seems to start to be ready from mid February to be involved into projective activities. Numerous non pathological symptoms (like lack of sleep or to eat, feeling of loneliness, and fear of new disaster ) have been raised. Most of them were usual process after a natural disaster. Despite, studies demonstrate that 30% of the person will develop pathological symptoms.
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7. RESULTS
1.Quantitative data collected Number of mothers welcomed in the program by week .
The first week (the opening) was always synonymous of high numbers of entries. Some mothers never came back (which can explain that it is not always the same data basis used) Most of them followed the program. The announcement of the food vouchers distribution attracted new beneficiaries into the program on the weeks 6 and 7. Number of pregnant welcomed in the program by week
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The rise of the pregnant mothers on the 7th week could be linked with the food vouchers distribution and maybe the increase of pregnancy after the disaster. It matched with 2 months pregnancy for most of them and usually when they figured out their pregnancy. Number of lactating welcomed in the program by week
Some weeks (especially 3 and 4) the rain has been very heavy. We actually could state a decrease of the new entrances. The mothers already involved come back but it was more difficult to reach some new ones Number of children who entered the program by week
These data are similar to the entrance of the lactating women.
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Daily average frequentation of the women into the Mother Baby Friendly Tent by site. January Total LW PW 41 21 22 52 40 12 17 7 0 0 0 0 0 0 0 16 12 4 0 0 0 18 11 5 February Total LW 60 23 76 22 22 14 24 13 0 0 17 12 65 32 38 16 March PW Total LW 11 140 42 10 70 42 5 42 23 4 23 11 0 20 8 4 33 17 106 50 25 20 54 24
Sites Tambacan Ubaldo laya Santa Filomena Luinab Gym 1 Sao Shleter box Madrassah Santiago Total average
PW 72 19 7 2,5 2 7 8 31
The daily average of frequentation should have decreased. We assessed that the women came back on regular basis additional to the new beneficiaries. The explanations may be linked: The choices of the evacuation camps were strategic which allowed a lot of women to partipated actively several activities during the week without a need to take public transport or walk for more than 20 minutes. The dynamic of the activities, which changed from a week to the others one were attractive. (for instance introduction of psychodrama, story telling) Luinab gym 1 opened mid february and Soa Sheeter Box second week of March which welcomed new beneficiairies. Daily average of frequentation of the children into the Mother Baby Friendly Tent by site. Sites Tambacan Ubaldo laya Santa Filomena Luinab Gym 1
Sao Shleter box Madrassah Santiago Total average
January 42 44 15 0
0 11 0 16
February 38 24 19 20
0 14 20 19
March 133 32 35 13
13 22 31 40
The frequentation of the children is obviously linked to the presence of the mother 5
Any mother had the right to let her child by himself in the tent.
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Psychological support. -Number of beneficiaries referred for individual interview : 62 beneficiaries -Number of individual interviews conducted :100 beneficiaries -Number of group conducted with the support of the psychologist : 758 beneficiaries (cumulative) Number of participants in February : 310 Number of participants in March : 448 To face the demands, the psychologist decided to organize group rather than individual counseling. 2.Qualitative datas collected EXEMPLE OF A WEEKLY PLANNING OF ACTIVITIES Monday Tuesday Wednesday Thursday Friday 8 to WELCOME / information time 8.30 RELAXATION RELAXATION RELAXATION 9 for lactating for pregnant/ RELAXATION for pregnant for pregnant/ RELAXATION women lactating lactating for lactating baby mother baby bath baby bath 930 baby bath /massage massage with /massage /massage fathers! PLAY session FDG / 10 story telling art therapy story telling 0 to 11 nutrition months PLAY session PLAY session FGD BF/ 0 to 11 11 Art Therapy 0 to 11 play session 1 to 2 yrs Hygiene months months 12 13 lunch time play session 1 to 2 yrs play session 1 play session 1 play session to 2 yrs to 2 yrs 0 to 11 months RELAXATION FDG / Psychologist for pregnant hygiene Psychodrama FDG FDG Breast pregnancy feeding preparation baby bath of women's FDG child /massage day developpement Administrative time/ cleaning RELAXATION for pregnant play session 1 to 2 yrs baby massage with Fathers! preparation of women's day CLOSE
14
15 16 17
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This planning is displayed in every tent and adapted to the context. For instance, on Friday morning, the Muslims beneficiaries used to go to the mosque. The tent in Madrassah did not welcome any beneficiary. The tent was closed and the social animator was sent in other tent to provide some support to her colleagues. On this planning is underlying that : all day long, social animators welcome new beneficiaries Mothers can breastfeed their children in the breastfeeding area at any moments of the day ( even during the lunch break in this specific planning, on Wednesday afternoon, the psychologist has his counselling sessions in this area The tent is closed on Friday afternoon because the team has its supervision meeting. FREQUENTATION OF ACTIVITIES Total number of participants for care practices activities (cumulative). FDG nut&health 1203 259 77 109 202 195 151 2196 FDG Breastfeeding 1592 264 2 406 361 325 251 3201 FGD Pregnancy 1130 77 8 87 22 9 67 1400
Camp name Tambacan Luinab gym 1 SSB Ubaldo laya Santiago Madrassah Santa Filomena Total
FDG hygiene 1256 260 98 196 316 78 151 2355
Total number of participants for psychosocial activities (cumulative).

Camp name Tambacan Luinab gym 1 SSB Ubaldo laya Santiago Madrassah Santa Filomena Total Relaxation 775 103 106 922 1489 515 469 4379 Art Therapy 1585 207 8 402 216 159 159 2736 Story Telling 1207 23 4 194 232 34 40 1734 psychodrama 831 74 0 93 64 12 25 1099 group therapy 946 119 21 104 79 91 74 1434
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Total of number of children into activities (cumulative) Camp name Tambacan Luinab gym 1 SSB Ubaldo laya Santiago Madrassah Santa Filomena Total
Massage baby 1456 33 0 224 511 349 103 2676
Bath session 1450 33 0 95 65 82 17 1742
Play Session 2504 280 84 571 1304 393 338 5474
Average of frequentation by mother in care practices activities by sites FDG nut&health 1203 2,5 259 1,14 77 1,75 109 0,45 151 0,82 202 0,79 195 1,32 FDG Breastfeeding 1592 3,3 264 1,16 2 ns 406 1,68 251 1,36 361 1,42 325 2,20 FGD Pregnancy 1130 2,3 77 1,97 8 1,14 87 1,30 67 0,36 22 0,49 9 ns
total woman Tambacan Luinab, Gym 1 SSB Ubaldo laya Santa Filomena Santiago Madrassah 483 227 44 241 185 255 148
FDG hygiene 1256 2,6 260 1,15 98 2,23 196 0,81 151 0,82 316 1,24 78 0,53
Mostly all the women attended to each focus group discussion about care practices.
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Average of frequentation of activities by women in psychosocial activities by site group relaxation total women 483 Tambacan Average/W 227 Luinab, Gym 1 Average/W 44 SSB Average/W 241 ubaldo laya Average/W Santa 185 Filomena Average/W 255 Santiago Average/W 148 Madrassah Average/W 775 1,60 103 0,45 106 2,41 922 3,83 469 2,54 1489 5,84 515 3,48 Art Therapy Story Telling 1585 3,28 207 0,91 8 ns 402 1,67 159 0,86 216 0,85 159 1,07 1207 2,5 23 ns 4 ns 194 0,80 40 0,22 232 0,91 34 0,23 psychodrama 831 1,72 74 ns 0 0 93 0,39 25 ns 64 ns 12 ns therapy 946 1,96 119 0,10 21 0,48 104 0,43 74 0,40 79 0,31 91 0,61
The activities which involved drawing or creating had more success than the psychodrama. Every day starts with relaxation session which attracted a lot of mothers. Average of frequentation of children massage baby 1456 3,5 33 0,17 2 224 1 103 0,70 511 2 349 2,73
total children Tambacan Luinab, Gym 1 SSB Ubaldo laya Santa Filomena Santiago Madrassah 415 190 40 229 148 256 128
bath session 1450 3,49 33 0,17 0 95 0,41 17 ns 65 2 82 0,64
Play Session 2504 6 280 1,5 84 2 571 2,5 338 2 1304 2 393 3
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Bath sessions were difficult to implement. Massage to baby were supposed to be effective enough to allow the mother to apply it at home with her baby. Play sessions are the one dedicated to child development. While mothers were having activities, often the BHWs were taking care of the children playing with them. Frequentation by activities comparative of two months by sites Tambacan Activities FDG Massage for baby play sessions Bath sessions story telling psychodrama/ GT relaxation Art therapy february total in month 46 8 38 9 0 4 9 13 total participants 1191 753 0 101 40 total in month 80 17 25 8 5 11 23 14 march total participants 2534 2408 total 126 25 63 17 5 15 32 27 total total participants 3725 3161 0 191 111 40
90 111
The frequentation in Tambacan had stand very high and had an impact on the quality. The social animator in charge tried to organize several activities simultaneously. She asked some mother to lead the focus group discussion on breastfeeding and hygiene in order to reinforce them and to be able to check on the other activities, lead by the BHWs. Madrassah Activities FDG Massage for baby play sessions Bath sessions story telling psychodrama/ GT relaxation Art therapy february total in month 13 6 23 5 0 1 0 5 total participants 341 231 0 20 total in month 26 22 27 16 2 3 6 6 march total participants 598 404 total 39 28 50 21 2 4 6 11 total total participants 939 635 0 82 0 0
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Madrassah was closed every Friday. The opening a social animator rules the activities. Two weeks later, he highlighted the difficulty for certain muslims mothers to talk with a men. He has been replaced by a women and the frequentation increased. Santa Filomena february march total
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Activities FDG Massage for baby play sessions Bath sessions story telling psychodrama/ GT relaxation Art therapy
total in month 30 5 36 4 0 2 9 19
total participants 431 376 0 39 142 57
total in month 27 18 25 4 8 4 7 10
total participants 643 493
total 57 23 61 8 8 6 16 29
total participants 1074 869 0 74 142 57
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The activities and the frequentation have increased in a stable way. The activities have been developed to respond to demand. The social animator showed initiative on art therapy encouraging the mother to learn others ways of expressing their feelings and emotions. Ubaldo Laya Activities FDG Massage for baby play sessions Bath sessions story telling psychodrama/ GT relaxation Art therapy February total in month 46 8 38 9 0 4 9 43 total participants 1093 473 0 84 total in month 11 24 23 16 6 5 25 14 march total participants 1183 632 total 57 32 61 25 6 9 34 57 total total participants 2276 1105 0 153 157 0
69 157
A really good management of the planning made Ubaldo Laya a site where mothers come back very regularly. A special focus has been made on the drawing and activities providing the opportunities of using its creativity. Santiago Activities FDG Massage for baby play sessions Bath sessions story telling psychodrama/ GT relaxation art therapy february total in month 17 20 31 10 0 3 21 10 total participants 1297 871 0 27 total in month 15 23 31 11 0 2 33 4 march total participants 899 572 total 32 43 62 21 0 5 54 14 total total participants 2196 1443 0 69 262 0
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42 262
Santiago is the only site where the frequentation has decreased, still welcoming a high number of beneficiaries. The social animator has decided to reduce the number of participants in order to focus on quality, decision totally supported by his manager.
Luinab Gym 1 Activities FDG Massage for baby Play sessions Bath sessions Story telling Psychodrama/ GT Relaxation Art therapy
february total in month 18 6 22 8 3 17 11 total participants 430 376 total in month 19 7 29 9 4 3 6 6
march total participants 415 237 total act 37 13 51 17 4 6 23 17
total total participants 845 613 0 69 0 0
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The site had difficulty at first to welcome mother because of the camp manager who refused to let the home based enter the site. The issue has been raised to the CCCM clusters in order to receive the support of IOM and other camps manager.
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Part III
ACTIVITIES
ACF-Spain
Mother Friendly Tent: a capitalization document of an emergency response in the the 39 Mother BabyBaby Friendly Tent: a capitalization document of an emergency response inPhilippines Philippines 8 Activities 45
8. ACTIVITIES DEVELOPPED
1.Psychological support The psychologist of the team had different follow up with the beneficiaries. The social workers were the one supposed to be able to identify the mothers who needs psychological support. The principal problem was at first link to the disaster. Indeed, some mothers were suffering from grief, with a mourning process on stand by. Some of them lost their children and could not cope with this situation. For instance, one beneficiary mother of a severely handicap child (William syndrome) was wondering why God save this child and killed the one who was healthy. Mothers with guilt of saving their own life and loosing their babies in the flood was a common topic and very hard to handle. Some cases of maltreatment have been raised and feeling of loneliness, with husbands who ran away from their duties and ole in the family. As expected, the majority of the non pathological symptoms found their explanations into the socio economical situation (living in Evacuation Centers, no job perspectives, no money, no food). Lack of sleep, feelings of insecurity, fears of heavy rains came back regularly on the one to one counselling. Examples of follow up files
date 03 feb age 30 problematic Lost 2 children during the flood Depressed for 1 week already Not in good shape, sad and very emotional Lost all of her 4 children Angry and depressed Cant sleep well, feels tired, mentally block Angry with the LORD Only 1 body of her child found, 3 still missing psychologist intervention Stress debriefing One on one counseling Relaxation technique date 28 feb problematic try to cope up within the existing resources Able to smile and laughed Have enough food inside the tent Life must go on as verbalized by the beneficiary Husband has worked already from DOLE Trying to cope with the help her husband and family She is presently 6 weeks pregnant Had hope that even her 4 children were gone life must go on Can now sleep even if its raining Accept the lost of her children Feels sorry about what she had been saying about God
07 feb
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Stress debriefing One on one counseling Relaxation technique Used emotions releasing technique like pulling of pillows, tearing down papers into pieces, punching sausages pillows to release anger
1 march
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Every two weeks, the psychologist provided a specific clinical case about a case he had to deal with. PRESENTING PROBLEM: Lisod kog tulog pila na ka adlaw, saba daghang mag siyagit..hubog og katawa katawa sa palibot...sige kod mata mata sa gabii labi na kung muulan dili gyud ko matulog kay mahadlok ko. Kung makakita kog mga bata nga 1 year old makahinumdum ko sa akong anak og mag hilak ko as verbalized by the beneficiary. I can not sleep at night recently, because its so noisy, some people talked very loud, laughing and drunk people around the tent. Remains awake in the middle of the night. I can not also sleep when rain comes at night; remain awake till the rain stop. Beneficiarys profile. Mrs. J, 27 yrs old, married A, 26 yrs old. She is two months pregnant. They had (four) 4 children ages 8, 7, 6 and a 20 months baby boy Al Rhased who is still missing from the flood. Religious catholic, currently living in the tent city at evacuation, Iligan City. She finished 3rd year high school and was forced to stop when she got married. BEHAVIORAL OBSERVATION: During the initial contact and first interview, the beneficiary seems surprise when her husband woke her up from sleeping at around 2:50 pm under the shade of the tree. I was then introduced by her husband and we sat at the bench. She appeared anxious and apprehensive. She looks fair in hygiene with dirty hair and untrimmed nails. Blouse seems not clean, crumpled and slightly lowered unto her shoulder. THE STORY AND INTERVENTION: We had a short conversation on the first day of interview last February 3, 2012. The beneficiary started to recall back what was happened during the flood. At around 11:15pm , their neighbour was shouting that night when the water was rising so fast. They lived near the river bank of Tambacan, Iligan City and because they were used to have the water raised every time there was a rain, they did not listen to the shout and call from their neighbours. She was very surprised seeing the water entered their house so fast with so many debris She was alone that night because her husband still did not come home from peddling peanuts in the street. She immediately picked her 4 children passing through their roof, transferring from one roof of their neighbour to another. Since the water current was too heavy, the place (roof) where they stayed moved and taken up by the flood going down to the bridge. Suddenly logs bumped at them so she lost every child on her hands including her 20 months son. She struggled to swim without her children, bumped every walls, drowned and hear the screamed of her children asking for help..(sobbing and stopped). Neighbours helped her other children and saved 3 of them but the youngest was missing.
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At the end of conversation, she said that she had wished and pray that the lost child was still alive and someone taking care of him. Stress debriefing was done for about an hour of talking. Closure was made with a request from beneficiary TO PRAY. I also had a one on one counselling and relation therapy was made at the end of the session. Follow up interview was made last Mar 1, 2012, she verbalized that life must go on after the incident and had used every resources available to forget the past with the help of her husband and family. She further said that she want job for her husband so they can moved on. At the moment there were no enough food available inside the tent and giving of relief goods and support from NGOs had stopped dropping in.
2. Drawing Drawing is a way to express emotions. It is a tool of art therapy. The first sessions were free sessions without any subject. Most of the women draws houses (the previous or the one they dreamed about) or about the flood. (for instance the family on the roof and some others locked inside the house). When they finished the activity, mothers are invited to present their drawings and explain the content. One of the subject is some session was about how do you imagine your children in 25 years? .The majority of the mothers draw their children being doctors or nurses, helping people. Some mothers have been invited to draw something that represent them (a fruit, a object, a flower..). All these times are supervised by the social animator. At the end of the activities, the mothers should exchange about what they felt and what they tried to express. By the time going, the team started to use scrap book techniques to develop other possibilities of expression to the mothers. A lot of these drawing were displayed into the tents.
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3.Story telling This activity has been built with the team. A first meeting has been organised in order to select the major problematic by sites. Each social animator described the issues raised by the mother. Once one problematic was chosen, one or several stories had been written. Handicap, role of the step mother, early pregnancy, maltreatment, lack of support from the family (the loss of the mother for a mother to be) and poverty are subjects picked by the team and developed in the stories6 . The objective of this activity is to provide the mothers the possibility to express their emotions indirectly. They have been asked to describe what their feelings about the protagonist, what he / she have done. Some of them shared their own experience; some others used the protagonist to talk about themselves. This activity should have been started from the beginning. The social animator fed back that they have learned a lot about the mothers thanks to this activity.
all stories are capitalized in the annex
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Example of a story. My mom only had one eye. I hated her, she was such an embarrassment. My mom ran a small shop at a flea market. She collected little weeds and such to sell, anything for the money we needed she was such an embarrassment. There was this one day during elementary school. I remember that it was field day, and my mom came. I was so embarrassed. How could she do this to me? I threw her a hateful look and ran out. The next day at school..."Your mom only has one eye?!" and they taunted me. I wished that my mom would just disappear from this world so I said to my mom, "Mom, why don't you have the other eye?! You're only going to make me a laughingstock. Why don't you just die?" My mom did not respond. I guess I felt a little bad, but at the same time, it felt good to think that I had said what I'd wanted to say all this time. Maybe it was because my mom hadn't punished me, but I didn't think that I had hurt her feelings very badly. That night...I woke up, and went to the kitchen to get a glass of water. My mom was crying there, so quietly, as if she was afraid that she might wake me. I took a look at her, and then turned away. Because of the thing I had said to her earlier, there was something pinching at me in the corner of my heart. Even so, I hated my mother who was crying out of her one eye. So I told myself that I would grow up and become successful, because I hated my oneeyed mom and our desperate poverty. Then I studied really hard. I left my mother and came to Seoul and studied, and got accepted in the Seoul University with all the confidence I had. Then, I got married. I bought a house of my own. Then I had kids, too. Now I'm living happily as a successful man. I like it here because it's a place that doesn't remind me of my mom. This happiness was getting bigger and bigger, when someone unexpected came to see me "What?! Who's this?!"... It was my mother...Still with her one eye. It felt as if the whole sky was falling apart on me. My little girl ran away, scared of my mom's eye. And I asked her, "Who are you? I don't know you!!!" as if I tried to make that real. I screamed at her "How dare you come to my house and scare my daughter! Get out here now!" And to this, my mother quietly answered, "oh, I'm so sorry. I may have gotten the wrong address," and she disappeared. Thank goodness... she doesn't recognize me. I was quite relieved. I told myself that I wasn't going to care, or think about this for the rest of my life. Then a wave of relief came upon me... one day, a letter regarding a school reunion came to my house. I lied to my wife saying that I was going on a business trip. After the reunion, I went down to the old shack, that I used to call a house...just out of curiosity there, I found my mother fallen on the cold ground. But I did not shed a single tear. She had a piece of Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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paper in her hand.... it was a letter to me. My Son, I think my life has been long enough now. And... I won't visit Seoul anymore... but would it be too much to ask if I wanted you to come visit me once in a while? I miss you so much. And I was so glad when I heard you were coming for the reunion. But I decided not to go to the school.... For you... I'm sorry that I only have one eye, and I was an embarrassment for you. You see, when you were very little, you got into an accident, and lost your eye. As a mother, I couldn't stand watching you having to grow up with only one eye... so I gave you mine... I was so proud of my son that was seeing a whole new world for me, in my place, with that eye. I was never upset at you for anything you did. The couple times that you were angry with me. I thought to myself, 'it's because he loves me.' I miss the times when you were still young around me. I miss you so much. I love you. You mean the world to me. My world shattered! Then I cried for the person who lived for me. My Mother. Comments of the mothers regarding this story : This story is really heart touching and arousing respect for our parents. I am so moved almost out of breath that I couldnt help but sit open-eyed and heart-broken. A real touching story that reminds me of the true unconditional love of Mother, that's how mothers are...and i always wonder why God make parents so loving and selfless while He provides them with selfish children...this story may be fictional but it nevertheless points out the very lacking in our human nature....the failure to fully appreciate the love of the person who loves us the most - that is, our mother.....I may have hurt my mother on several occasions, and after reading this story, i felt terrible of those times......and I was so touch wondering whether my own mother was ever hurt like this. Some mothers said that this story is really a good example of the hardships they undergo in order to let their son or siblings live their own life. They feel like a stepping stone to help their children to become better individuals. I Hope my children would realize how important their parents are. We hope they will realize that without us, they can't taste the beauty of living. Naughty children won't realize their wickedness unless they became parents and have ill-disciplined children too. Example 2 There was a woman named Jenny who came from a poor family and wasnt able to finish her education. Jenny got married to a hardworking carpenter named Ricky at a very early age. They were blessed with two children named Jane and Cathy. Even though they are not wealthy, Jenny is living happily with her family. Jenny loves to sew clothes which she used to sell to her neighbours. Everything that Jenny earned from selling clothes that she made was used to put up a little display area for her products. They just get the budget for their needs from her husbands earning. It didnt take Mother Baby Friendly Tent: a capitalization document of an emergency response in the 45 Philippines
long for her business to grow because the customers loved the designs and quality of her products. Years have passed until Jenny was already able to afford a huge place to sell their products. Because their business was doing really good, Jennys family moved from a small house to a big one which was located near their store. By that time, Jenny already had several employees which she trained herself. Jenny and her family were living a very prosperous life for several years until a very strong earthquake hit their place. Jenny and Ricky quickly held Jane and Cathy and they ran to the nearest hilltop for safety. They stayed there for the entire night with their neighbours for safety. When they returned on the following morning, Jenny and her family were so devastated when they saw that all the establishments on their area have been ruined including their house and store. They were saddened when they learned that lots of people didnt survived and were buried alive under the fallen building and trees. Jenny and her family are forced to live on the evacuation center because its unsafe to live again to their place. She had been crying for several nights because everything that she worked hard for are already gone, but she realized that theyre still very lucky because her family is still complete and thats more than enough for her to be able to carry on. At the evacuation center, they received so many used clothing as donations. Unluckily, most of the donated clothes didnt fit them. So Jenny decided to cut these clothes and stitched them into rugs. She then sold those rugs to her fellow evacuees. Since classes are postponed, Jane and Cathy helped in selling the rugs that Jenny made. Jennys earnings from those rugs are then used to buy materials to sew some clothes again. She was so excited about the idea of starting her clothing business again. Her husband constructed a little store for her products. It didnt go well at first, but Jenny didnt quit. She persevered until her effort paid off. Her business started to grow again and they were able to buy a bigger place for their products. This time, Jenny ensured that their store is already shock proof and she also made sure that half of her earnings would go to the bank in case another calamity would come.
Comments of the mothers regarding this story:
One mother asked if the story was real. The social worker answered that it had happened in order to help to realize that they could be the protagonist. One mother said it was similar to her own life story. She came from a poor family, but managed to start a small business that was gone after Sendong. She said that like the story, theyre still on the chapter when the family is struggling at the evacuation center but that they are still heading where the family was able to get up from the misery that theyre experiencing. Another said that she learned a lot from the story because during the typhoon Sendong, lots of family really lost their savings because they kept their money on their respective houses. If she would have enough money, she would start saving her money in the bank and if she would be able to buy or build a new house. This mother added that almost every mother at Mother Baby Friendly Tent: a capitalization document of an emergency response in the 46 Philippines
Madrassah are like Jenny. They got married early and were not able to finish schooling to focus on their children. According to her, the story of Jenny could serve as an inspiration because even if they dont have a college degree, there is still a huge possibility for them to succeed. If they would just have the right attitude; they know that in time, they would also prosper. One other mother said that she was somewhat relieved when she heard the story because she used to have a business which she lost after Sendong hit the city. Like the character, she was also devastated and she almost lost hope because she lost almost all the material that she and her family used to have. But right now, she was starting a buy and sell buisness which helped in her familys finances. A other beneficiary was thankful of the story because she got an idea that even with the simple resources, she could be able to make money out of it. This mother said that she would try. Her house and business were entirely ruined by the flood, but she was still thankful that her husband and all her 11 children survived. She said that she will try her best to be positive for her family. Right now, she still has so many worries, but she is trying to overcome it. She will be starting a small jewellery business soon and she is hoping that it would also succeed like her former business. 4 Psychodrama (activity lead by the psychologist) The psychodrama is a role play involving the beneficiary to play an unwritten role. In this role, the beneficiary is supposed to express true feelings toward individuals. The psychodrama setting should be provide to the beneficiaries with a safer and less threatening atmosphere than the real situation. When the drama has been completed, group members from the audience discussed the situation they have observed, offered feedback, expressed their feelings, and relate their own similar experiences. In this way, all group members benefited from the session, either directly or indirectly. The first psychodrama was over the flooding. It ended up in tears for the player and the audience. It has been very difficult to handle by the team. It has been decided to focus on psychosocial problematic like a sick mother who does not know how to feed her baby, knowing that she can breastfeed but stooping it because of the familys pressure. One session was about a teenager discovering that she is pregnant and how to tell her parents. Some mothers played and threatened their daughter to shave their hair in signs of shame, some played the fathers a debriefing one mother said that rather than creating new problem why not trying to solve this one . They played again and agreed that the best way to act is the mother to talk with their daughters previously to prevent any risks and if their daughter goes back home pregnant they will convince their husband to support her.
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In Madrassah, the psychodrama was around maltreatment or husband having different wives. The subject is taboo. This is reason why it was so interesting to observe mother evolving into the play, finding a free space to express true emotions and feelings, protected by the rules of the game ; indeed it was only a play role
5. Group talking The psychologist overwhelmed by the demands of one to one counselling could not be available for the beneficiaries who need support. The team decided to rule some groups of expressions of emotions. The three different groups talk of identification to are meant to be a first step to talk about the emotions. Because it was very difficult to the beneficiary to open themselves to unknown mothers, we choose to use symbolic element to help them to talk about themselves. Identification to a fruit. The psychologist asks the mother if they were which one they will be. The objective is to conduct the mother to identify their main state of mind. The mango was identify to a sweet person, avocado to bitter person, the orange to a dynamic one, the banana7 the type of person who helps the other one, the avocado because it is green is linked to someone healthy Identification to a tree. The bamboo was picked by women who fought their had good roots and even when it is windy they come back straight, the eucalyptus by mother who give the feelings to strong to the other but are in reality fragile, the coconut is the symbolism of the one who save lives (
the lnk does not seem to ease to understand. The banana is good when someone suffer from stomach ache, so if you eat it, you feel better. Conclusion helps to soften the pain
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coconut tree saved the life of a lot of survivors), the mango for the one who thinks providing shadows to their beloved when they need it.
Identification a flower.( few examples) The orchid, beautiful flower and stronger than the roses. The gamamillo for the mothers who wants to perfume their lives and the one of their families. The sempageto is the one for the believers in god, a saint flower used to decorate the saint status. The ten more important things in their life. The objective was to help the mothers to learn of to prioritize. The mothers first have to write on a piece of paper there own list. There are asked to borrow five of them and be able to explain why they are less important than the other one. Then three other have to be deleting with the same process of justification of why. At the end, the list was very different from one to the others. Certain mothers kept their own mother on the top list rather than their husband, certain their husband rather than their children. Some mothers put the neighbours on the top of their list or their siblings The last talk group what happens next One of the exit strategy and to prepare the mother of the cloture of the tents, some talk groups have been launched with a subject what will happen after the cloture of the mother baby tent . Each mother has to design one objective, in order to have a goal in their life. Same process than before, mothers write on a piece of paper their own objectives and the share it with the group. Some mothers would like to go back to school; some others would like to open a small business. Others are to focus on the relocation status. They think they can not start a new life till they are living in a relocation site. Some of the women said that they will find the strength to leave their husbands who maltreat them (and be supported by their new friends met into the tent) 6.Specific activities for pregnant women. Pregnant women need a special attention. The activities should be conducted with mothers in order to benefit of each other experiences. Relaxation exercises Individual discussions with pregnant women with whom problems have been identified such as fear for the future, uncertainty of her ability as a mother, or any other problem
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Group discussions and education sessions on the importance of optimal feeding of women during pregnancy; develop recipes with food available and affordable since the emergency and conduct cooking demonstrations. Group discussions and education sessions on what care practices the mother & fatherto-be can perform, such as talking to the baby, carressing the belly, thinking positive thoughts Group discussions and education sessions on optimal care practices for infants; possibly mixed with breastfeeding women to exchange experiences Referral to prenatal consultation and vaccination. If no such facilities exist nearby, one should advocate for the set up. Conducting prenatal consultations and vaccination of pregnant women in the BFT, corner or by mobile counsellors can be done only if time and staff capacity is present and it would not disrupt any other activities. It should be a temporary measure only, until the health facilities conducting those activities are functional again If necessary, advocate for blanket supplementary feeding distribution or micronutrient distribution for pregnant women Note: These sessions could be open to husbands or other family members as well
7.Specific activities for non breastfeed children Breastfeeding infants share a very close, affectionate moment with their mothers every time they breastfeed. This moment facilitates bonding between mother and child and makes the child feel safe and comforted. All this will contribute to the emotional, intellectual and physical development of the child. Non-breastfed children do not share this moment with their mother. In addition, they are more likely to be looked after by different carers, some of which can be very young themselves. It is therefore very important to compensate the lack of breastfeeding with other care practices that make the child feel loved, safe, cared for: Always feed the child while he sits on the lap of an adult, an arm around him; and feeding him patiently and at his own rhythm Play with the child, talk to the child, sing songs, tell stories Carry the child around on the back, in a sling, in a pouch; as much as possible Comfort the child when he is crying by picking him up, carrying him around, singing a song 8.Specific activities for children 8.1 Baby massage Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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Baby massage is soothing for the baby and mother/caretaker and stimulates development. It is an excellent way for mother/caretakers and baby to share an intimate moment to improve bonding; and it helps the mother/caretaker to become more sensitised, to respond better to the infants needs. It also has the following benefits: -It promotes better sleep -It facilitates body awareness -It gives sensory stimulation
-It improves blood circulation -It gives relief for teething pain -It helps to eliminate waste from the body -It helps to build parents and babys self esteem -It is a pleasurable experience
8.2 Play sessions Play is a necessity for a childs physical, motor, cognitif, affectif, social and cultural development. It is a way to stimulate and to allow the child to learn, to develop his brain.Even small children need to play, but need adults to give them guidance and encouragement, to stimulate their curiosity. Baby and young child play does not need to involve toys. One can do many thinks with songs, body movements, word games or with simple material that is present in the household (a piece of fabric, a piece of paper, a plastic cup). Play sessions in the centre can give parents examples on what activities they can do with their children. It will give them confidence in themselves, and allow them to repeat it at home. Playing together is also an act of bonding between caretaker and child, it is a moment where the child feels secure and loved; and the parent can relax and focus on the child. Making toys can be an activity in the centre. It will allow women to sit together in a relaxing activity, and take their mind of things. Making a toy for their child is also an act of care and love. It might stimulate them to play with the child later on. 9. Focus group discussion The emergency might have disrupted the way usual hygienic care for children was performed. This can be due to lack of water & soap, lack of material, lack of time of the caretaker In addition, deteriorated living conditions, such as crowded camps, might make appropriate hygiene even more important to prevent health problems such as diarrhoea, skin infections and other infections.
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Bathing a child is also an act of love and care between a caretaker and a child, whic can benefit the mother/caretaker-child relationship and the childs development.
Activities around hygiene practices can be: General hygiene education, specific education on hygiene for small children, food preparation Providing facilities in the Mother Baby Friendly Tent or corner for caretakers to give baby baths; especially when facilities withing their living environment are insufficient to perform this activity. This could be because of lack of water, soap or bassins to bathe in; but in cold environments it could also be the lack of a warm environment and warm water. Conduct group discussions on the subject. Demonstrations of baby bath can be a good starting point to launch such discussions The focus group discussions have been dealing with hygiene, breastfeeding, nutrition and with a special focus for the pregnant mothers. 10. Relaxation Relaxation was an activity ran every morning into the tent. The women benefited from exercises with breath in /breath out, some others days it is more focused on stretching the body very slowly. The main was that as much as possible, the women should be able to do the same exercises of relaxation at home. It is possible you follow the rhythm of music. Some specific exercises had been proposed to the women who complain that they could not when the weather turned into heavy rain. The social animator showed them different techniques like breathing in, counting until 5, releasing the air, these 5 times, with the hand on their stomach to feel the movement.
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11. Extra activities (Women day, cloture celebration ) The 8th of March The day of the women have been celebrated in each tent. the objective of the day was to celebrate the women and not the mothers The womens day has been a huge succes. 630 women participated to different activities.The morning, livelihoods (building pillows, hand pot, massage fro adults) have been ruled by the social animators and the BHWs. A quiz game over the subjects treated while the focus group, have been launched. The result was very convincing; women realized that they learned a lot. Every site bought a tree with flowers on to symbolize the circle of life from the winter tree to the spring one. The afternoon was a kind of celebration with in some places women dancing like in Santa Filomena. In Tambacan, women hair dressed each other. In Ubaldo Laya, they gathered in circle to sing songs of hope and love. In Ubaldo laya, mothers wrote on a display messages destined to all women in the world, addressing prayers of peace and love, hope and happiness. In Madrassah and Santa Filomena, women cooked specialities and shared the food. Cloture celebration. The cloture was announced by a display one week before. The cloture of the tent was the moment of singing and dancing. The beneficiaries were asked a couple of time for this peculiar activity. They wanted to demonstrate their skills in the artistic side. ACF provided cupcakes and juices from mothers and children. Prices like pillows, glasses, toothpastes, shampoo, were distributed to the best singers and dancers. Some camp managers allowed the team to use the gym because the tent was too small to welcome the mothers and the contest.
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The show was prepared and the mothers delighted to go on the scene and support the new friends.
12. Distribution of baby kit In situations where people have lost all or many of their belongings, mothers and caretakers might be in need of non-food items to provide appropriate care to their children. If these items are not included into general non-food items distributions, specific distributions of baby kits can happen through the BFT, corner or mobile teams or through health facilities. The contents of such kits must be based on specific needs as identified through an assessment, and be in line with what items people are used to (for example, there is no need to distribute disposable diapers to a population who does not use them). If those kits are to be part of a contingency stock, their contents should be based on the needs identified in a previous emergency or as estimated by the country team. Under no circumstances can such kits contain Milk or milk products in any form, Baby bottles or teats, baby cups with spouts, Commercial baby food, Gifts or donations from infant formula manufacturers containing logos The 1200 baby kits provided contained: -baby powder - a blanket for baby -shampoo for baby -desinfectant and cotton -soap -a nice bag and ACFs sticker The kit was given to the mother after her participation to the third activity. Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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Part IV
COORDINATION
ACF-Spain
9 10 11 12
Coordination Recommendations Perspectives Conclusion
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Mother Baby Friendly Tent: a capitalization document of an emergency response in the 56 Philippines Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
9. COORDINATION
1.Intra Coordination Nutrition: Every Friday, the nutritions team intervene into the mother baby tent in order to provide advices on supplementary and complementary food. They used this time to work on prevention and screening with mothers, who could be malnourished. If the children entering the program presented signs of malnutrition, the data were sent to the nutrition pool. This coordination allowed a fast response in case of accurate malnutrition symptoms Food security: Food Vouchers distributions are increasingly common. It is a system where beneficiaries receive a voucher, which they can exchange in designated shops to obtain fresh food, tools, building materials and more; according to the programme. They are an excellent way of providing aid to people in need by letting the people decide what is their own need. Voucher distribution schemes for lactating women could include: Complementary food vouchers: vegetables, meat, fruit to be used in the complementary food for children more than 6 months old; accompanied by thorough awareness raising and education on optimal complementary feeding in the current circumstances. Careful: if the food security situation is very poor and there are no other actions to obtain food for the family through general food distributions or food/cash for work or other interventions; the risk of sharing this complementary ration with the whole family will be too high, and the intervention will not achieve its objective. Complementary food vouchers should then be used in addition to general food aid. Nearly 1200 mothers of the program were given food vounchers, on the month of march. The distribution had been organized into the tents in 6 sites. Head of base A Sitrep has been sent every week to the head of base. The action has been summed up into a document called Map Every Monday a coordination meeting is organized in order to coordinate all the programs. 2.Inter Coordination (with others psychosocial health protection actors) 2.1 NGOs UNFPA Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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They are leading reproductive heath activities into the camps. ACF met them a couple of times. The coordination had nearly been effective; they started their intervention really late. IOM This ONG is present into the camp manager, managing and training the camp manager. It could a good contact if ACF decided to work with them (or train the camp manager on protection for instance) Department of Health Major actors, they provide services in Iligan. They ran of human resources and had some difficulties to gather the information on mental health. Still, they are focus point for psychosocial program. City Health Office At the Iligan level, they are invested over all in the nutrition sector. Save the Children Partner on consortium with ACF, they worked meanly in protection using psychosocial tools in cagayan de Oro. A closer coordination with them could be interesting.(sharing data, listings, problematic or assessment) Health of Mindanao Local NGO s , ACF referred all his beneficiaries who needed psychological support. 2.2 Clusters Protection The clusters Protection in Iligan were every three weeks and mostly were dealing with idps conflict. UNHCR was in charge wit h the DSWD. MHPSS The Mental Health and Psychosocial support Cluster was ran in Iligan and in Cagayan de Oro. Both were lead by WHO and psychiatrists. A Referral system had been set up but very few professionals were aware of it.
Advanced psychiatrist ( free consultation : Doc Sue, doc Sagge)
Mental health specialist ( HOM, MSU)
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PSS team Medical team EC team and community The clusters in ilgan became smaller and smaller. The local NGOS and professionals had decided to write a proposal in order to develop the psychosocial services in the city of Iligan. They need support on this process Nutrition Lead by Unicef, this clusters was very effective. Two times by week, a report upadates by the HoP nutrition and psychosocial had been send to the clusters nutrition to update about the frequentation and the numbers of beneficiaries into the program. CCCM (Clusters of camp & communities management) Lead by IOM , the clusters is an opportunity to get to know about the issues in the camp. This clusters is too a great hand to be in strategic sites for food distribution, WASH or psychosocial programs. 2.3) Contact list see Annex
10. RECOMMENDATIONS
1.Short term Sites recommendations: Tambacan : CFSI in partner with Save the children are conducting into the child friendly spaces psychosocial activities with children every day after 4pm.UNFPA intervened to talk about reproductive health. HOM is conducting psychosocial support. Tambacan have the highest level of pregnancy in our program. In case of continuation of the program, the social animator and the psychologist should at least spend a full day in the health center. Tambacan is the most crowded area and needs of support are still relevant. Ubaldo Laya (elementary school) : the evacuation camp, which is settle into an elementary school, is going to close. Most of the beneficiaries will be displaced in Soa Shelter Box. The mother baby friendly tent welcomed a lot of home based. Since the beginning of March very few other NGOs intervene in the area. Two cases of tuberculosis have been raised. Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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Madrassah (upper hinaplanon) : it is a muslims area. They had the less access to food distribution. Note that the evacuation camp won the price of the cleanest camp. The bladder is often empty and the population faced difficulties to have clean later. The Red Cross and World Vision intervened there until the end of March. Luinab, Gym1 : MERN in partnership with Save the Children conduct play sessions with children. Medicine students come regularly to ensure the god health of the idps. Luinab, Soa Shelter Box : CFSI (still partner with Save the Children) conducts psychosocial activities with children. This camp is going to be on of the biggest relocation camp. They faced a lot of issues with the rain; the camp is getting very muddy. There are very few shadows (trees). The tent will not be dismantled and be used for psychosocial activities. Santiago, barangay : the IDPs have been relocated in Santa Elena. It is a very poor area. The inhabitants of the area are working in the rubbish heap. CFSI and Mern are conducting activities for children, Save the Children distributed kit for children. The Red Cross provided water. UNFPA provided sessions of reproductive health and distribution of hygiene kits. The tent will not be dismantled. Following the training provided to the midwives, the one form Santiago asked if she could use the tent to conduct psychosocial activities. Santa Filomena, High & Elementary school: HOM is providing the psychological support. UNFPA conducted reproductive health sessions. The two camps are not well equipped on electricity and victims of numerous breaks out of light. At the protection level, it can be an issue regarding the comfort rooms and the showers areas. Sustainability The midwives and BHW had been trained on the implementation of care practices and psychosocial activities. They may be able to provide one afternoon by week focus group discussion on hygiene, pregnancy and breastfeeding. They were eager to develop group of expression of emotions but, still as they already are really busy, they do not think it will be sustainable. Recommendations regarding the needs of psychosocial support in Iligan. At Evacuation/ relocation centers : Needs of capacity building for camp manager (overall on GBV and Child protection) Establishing a clear communication chain and reference chain for people in distress which means to hire at the city office level employees in charge of the coordination. Developing community mobilization on psychosocial issues (for instance: remind IDPs and home based that being very anxious when it is raining is normal, not being able to sleep for days because of the rain is not...) At barangay level: Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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need to implement psychosocial area in health center in each baranguays targeting handicapped people and vulnerable people. needs to implement psychosocial area linked with midwives targeting the most vulnerable (lactating, pregnant and mothers with children below two years old) needs of capacity building regarding BHW, BNS and social animators to support the people in distress needs of psychologist to provide support beneficiaries suffering from PTSD and depression symptoms developing a "home visit "approach: offering the possibility to the family to beneficiate from the visit of social workers / BHW to help them to deal with some issues. At hospital level : needs of professionals al like psychologists and social worker to follow up the cases needs of specifics ad indentified as such areas to develop follow up for IDP's in order to provide psychological support for free needs of psychologists to intervene in the CMAM to support parents of malnourished children on treatment At psychiatric sector level: implement guidelines about distribution of medication : for instance no distribution of medicines without the follow up of the psychologist or psychiatrists. guidelines for proper follow up regarding suicidal attempts guidelines of proper follow up for people victims of violence and rapes. Special needs: an emergency team with psychologists and social animators should be created to intervene in demand in the different camps. This team should available all the time to process on debriefings sessions, to intervene after heavy rains episodes, cases of rapes on camps... IDPs and home based victims of the disaster need overall a place identified as a focal point to find psychosocial support. Each baranguays and evacuation / relocation centers should create this place ( tents, in health center, ...)
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11. PERSPECTIVES OF THE PROGRAM

In case of ECHOs validations, the team should : Intervene in health centers providing focus group discussions and psychosocial activities, focusing on pregnant mother ( prevention against malnutrion) and teenagers (being able to evaluate if the baby is willed or not, if the sexual intercourse was willed or not) Intervene in OTP in order to provide psychosocial support with the parents of malnourished children, implementing care practices and focus group (changing behaviours) with the families Implemented Home visits support with the BHW to ensure a proper follow up of the pregnant mothers and the families of malnourished children. The social animators should intervene on morning and afternoon in different places, to ensure their presence in all health centers. The manager of the program should focus on the coordination with the employees of the health centers in order to start the hand over of the activities as soon as possible. The ACF team should the last month only supervise the implementation of the activities in the health centers and helping the employees and schedule and maintain them. She/ he must attend to cluster MHPSS in order to advocate for the allowances of budget by the city office in order to create psychosocial position on health centers. The manager should focus on the training of the psychologist around protection, ensuring a coordinate referral pathways. They have been asking of training on identifying problematic and developing their skills in psychosocial activities. They really feel at ease with the care practices ones. At the mission level, the position of the manager of this program must be discussed in coordination meetings. This expert in psychologist should deal directly with the other coordinator rather than being under the nutrition pool. Any technical support could be provided by the technical referent in Manila, neither Madrid. The process to reach ACF Paris is very long. Furthermore the psychologists department in Paris is already really busy 2 . Middle term As introduced, the mission Philippines had welcomed for the first time psychosocial activities. The position of head of program was not very clear, the objectives of psychosocial part into nutrition program neither for the ACF team. This opening is a good opportunities to start to think about the implementation of psychosocial activities integrated with existing programs in the mission Philippines. Mother Baby Friendly Tent: a capitalization document of an emergency response in the 62 Philippines
A proper assessment should be conducted for one months and a half (estimated) with three steps: 1)Field visits and interviews with Head of Base, head of project and national keys position to understand the program and issues. The evaluator should go to every ACF base in the Philipines in order to gather the needs. 2)The second step should to spend a full week with the different member of the coordination team. This may lead to clear reflexion about the strategy of the different department and how the psychocoial could the implemente in a relevant way. The evaluator should try to contact the Departement of Health to gather informations about the mental health and psychosocial strategy at the national level. 3)Writing a strategy to develop a psychosocial sector and recommandations to integrated with the existing programs. 3.Long term A reflexion should run in Head Quarter in Manila level. A department of Mental Health and Care Practices should open and a psychologist position should be added the emergency pools. This added value must be worked with ACF Paris.
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12. CONCLUSION
The sendong disaster had terrible consequences on the population. Many families had lost a child, a father, a mother. Philippinos have demonstrated their ability to support each other and to be volunteers and provide solidarity. A huge work is on going in order to gather the lessons learned and be ready for the next disaster. The Mother Baby Friendly Tent had been the step for ACF Philippines to develop psychosocial support. The impact had been demonstrated, the results convincing. I truly hope that Mission Philippines will be in very few months considered the precursor of ACF Madrids mission in care practices and psychosocial programs
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Part V
ANNEXES: Story telling
ACF-Spain
A B C D E F
Breastfeeding stories Handicap story Maltreatment story Poverty story Single mother story Teenager mom story
68 73 75 76 79 82
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A. BREASTFEEDING STORIES
A depressed mother Apple, an 18-year old mother who is a battered wife. She has a 3 months old baby. She is emotionally depressed and under stress because of her situation at home. The infants father was mentally ill and sometimes beat the mother and her children. Due to the situation, relatives and neighbors had told the mother that her breast milk was not good and would make the baby ill, because of their belief that if the mother is under stress ,the milk will absorbed it and that makes the baby weak and vulnerable. She has also the fear of losing her milk, as well. The mother became worried because of the different story brought by the people surrounded her. She went to her cousin asking for help, and advises her to stop the breastfeeding because she is not healthy anymore. And she finally went to Health Center and shares her problem. Apple had been talked by the health worker. And the health worker refers her to the social worker. The social worker sit with the mother ,listened and talked to her, reassuring her, telling that stress does not prevent mothers producing milk and that she did great in taking care of her child. She is a loving mother and the baby is healthy and playful .And if she continues her breastfeeding, the baby will be always healthy and away from any diseases and infection. And the baby will receive the emotional care she needed and helps the baby develop and grow. Thats why Apple decided to continue her breastfeeding with her baby. The social worker visited the family at home and talked to the mother-in-law, asking here to help the infants mother with the breastfeeding, give her companionship and the kind of touch she may find comforting. And support her whenever she got problem. Her son is now exclusively breastfed and weighed normal.
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A mother who uses cup feeding technique A mother who is 5 months pregnant and have a 1year old child whom she breastfed. Her husband has a stable job. They are happy and have a harmonious living. One day, the tragedy (flash floods) happens. They are all alive and safe but the pregnant mother accidentally drinks water from the flood. She was confined in the hospital for weeks and she decided to stop breastfeeding her 1year old son. The couple are worried because theyre son always cry and feels weak looking for the milk of her mother. The baby looks thin and irritable. They couldnt do anything because children below 5years old arent allowed in the hospital due to their health stake. The doctor gives safe medicine to the mother that would not disturb her baby in the tummy and to her breastfeeding. A family friend who have been advices by Health Center about this situation and immediately told the couple to breastfed their baby through cups of her breast milk. Every six hours, the mother would pump her breast and put the milk in the cup and send it to her son to drink. They make sure the cups were clean, sanitized and wellcovered. Their son doesnt feel weak anymore. He back to being playful and healthy. After one week of confinement in the hospital, the mother is at home and breastfed her son again every day and night.
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A Discouraged Mother A mother has an emergency vacation abroad and she is alone. Her baby is with her husband. The husband couldnt think of anything to feed her 3-months young baby but to bottle fed. After one month of the mother being away at her baby, feels reluctant to breastfed him again thinking the baby wouldnt like her milk, and if her milk supply will not be enough to satisfy her baby. And that time the baby suffers diarrhea. A lot of things she hears about her friends and in-laws, that the baby is already comfortable in the bottle fed and that her stomach might be affected due to changes of milk intake. The other would say that the baby is going well and grows faster than those times the baby is breastfed. Due to the situation, the mother feels depressed and confused on what to do. She also feels guilty of having her baby suffers to this situation. She came to health service and asks help about her situation. The health worker asked the mother to breastfed her baby in front of her to show how she breastfed. She helped the mother by touching her shoulders and rubbing it. She observes the mother and the baby, and asks her to look at her babys eyes and talked to her. And that she should not think of anything else but her baby only. Reassuring here and her ability to breastfed and building her self-confidence. The health worker also sees the health of the baby, and finds out that he is overweight. The health worker started to teach the mother how to decrease the number of bottle feeds gradually and increase the number of breastfeeds. She decrease d daytime formula feeds from 6 to 5, then became 5 to 2 later on. Then the mother also increased daytime breastfeeding from 2 to 4.Then give breastfeeding again in the night, for three days Over the next three days, the mother gave only one formula feed per day, and later on she exclusively breasted it day and night. The health worker visited the mother and talked to the husband, asking her to help her with breastfeeding and to support her all through. By the time the infant was 4 months old; she was exclusively breastfed and weighs normal.
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A mother who complain of having a sore breast and small nipple A mother came to the health center and asks help with with her problem about her breast having sore. She complains of having painful breastfeeding. She asks for medicine to fully heal her breast. Three days ago ,the mother complain of breast feeding her baby because of biting her nipple(mother thinks her nipple is too small for the baby to suck, thats why the baby is getting hard on it and just bite the nipple of the mother)thats why she got a sore. The mother is worried of having to stop her breastfeeding temporarily because the baby might not like her milk anymore. Because of this situation, relatives and neighbours told the mother to fully stop breastfeeding because her breast milk might not be good and fresh anymore after the medication and would make the baby sick. And that she doesnt have the big nipple that the baby needed to suck easily. So she felt she could not breastfed anymore after her medication. The social worker talked with the mother, make her feel assured that she has the ability to breastfed and try to build her self-confidence. She reminded the mother that her breast milk is not affected by the medication if she will stop it after her sore will be healed. The milk will stay fresh always. And the size of her nipple doesnt affect her milk nor its supply. It make takes a week to completely breastfed her baby, but for the meantime , the social worker suggested the mother to breastfed her baby to someone, like her sister or friends to ensure the babys health and nutrition and will not be introduce to any formula milk anymore.
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A mother and her condition on how to manage proper hygiene Angelita, a 34 year old mother, and a very good housewife. She takes good care of her family. Every time the baby(1 year old) get sick ,she immediately send him to hospitals, give some vitamins and his medicine, cook his favorite food, take him a bath and clean him every day. She had her bonding through watching television, etc. and especially during breastfeeding. One day, the mother gets sick. She cant easily work the chores, and even take care of her baby. Her husband is also busy on his work. The mother couldnt manage to take the baby a daily bath, doesnt clean him often, and afraid to breastfeed because of her belief that the baby might get sick, too, because of her milk. The mother gets worried. She gives the baby a vitamins, but not breastfeeding him. Sometimes the mother feels relief because the baby is already eating different foods good to him and thinks food alone can help the baby survive. Until one time the baby gets sick. The mother feels worried and guilty because she doesnt breastfeed the baby. She went to the health center for medicine. The health worker ask her about the situation, and she talked to the mother that being sick doesnt affect her milk ,doesnt changes the taste and its temperature .And that the baby must be continue to breastfed to prevent him against infection and diseases while having his food . The mother feels happy ad realizes that her belief is wrong. She went home and gets breastfed her baby every day and night. And her friend helps her to find a nanny that could help the mother every time she gets sick, so that the baby will always be in proper hygiene and prevent against diseases.
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B. HANDICAP STORY
Salze Casilac Mother and Son: My mom only had one eye. I hated her, she was such an embarrassment. My mom ran a small shop at a flea market. She collected little weeds and such to sell, anything for the money we needed she was such an embarrassment. There was this one day during elementary school. I remember that it was field day, and my mom came. I was so embarrassed. How could she do this to me? I threw her a hateful look and ran out. The next day at school..."Your mom only has one eye?!" and they taunted me. I wished that my mom would just disappear from this world so I said to my mom, "Mom, why don't you have the other eye?! You're only going to make me a laughingstock. Why don't you just die?" My mom did not respond. I guess I felt a little bad, but at the same time, it felt good to think that I had said what I'd wanted to say all this time. Maybe it was because my mom hadn't punished me, but I didn't think that I had hurt her feelings very badly.
That night...I woke up, and went to the kitchen to get a glass of water. My mom was crying there, so quietly, as if she was afraid that she might wake me. I took a look at her, and then turned away. Because of the thing I had said to her earlier, there was something pinching at me in the corner of my heart. Even so, I hated my mother who was crying out of her one eye. So I told myself that I would grow up and become successful, because I hated my oneeyed mom and our desperate poverty.
Then I studied really hard. I left my mother and came to Seoul and studied, and got accepted in the Seoul University with all the confidence I had. Then, I got married. I bought a house of my own. Then I had kids, too. Now I'm living happily as a successful man. I like it here because it's a place that doesn't remind me of my mom.
This happiness was getting bigger and bigger, when someone unexpected came to see me "What?! Who's this?!"... It was my mother...Still with her one eye. It felt as if the whole sky was falling apart on me. My little girl ran away, scared of my mom's eye. And I asked her, "Who are you? I don't know you!!!" as if I tried to make that real. I screamed at her "How dare you come to my house and scare my daughter! Get out here now!" And to this, my mother quietly answered, "oh, I'm so sorry. I may have gotten the wrong address," and she disappeared. Thank goodness... she doesn't recognize me. I was quite relieved. I told myself that I wasn't going to care, or think about this for the rest of my life.
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Then a wave of relief came upon me... one day, a letter regarding a school reunion came to my house. I lied to my wife saying that I was going on a business trip. After the reunion, I went down to the old shack, that I used to call a house...just out of curiosity there, I found my mother fallen on the cold ground. But I did not shed a single tear. She had a piece of paper in her hand.... it was a letter to me. My Son,
I think my life has been long enough now. And... I won't visit Seoul anymore... but would it be too much to ask if I wanted you to come visit me once in a while? I miss you so much. And I was so glad when I heard you were coming for the reunion. But I decided not to go to the school.... For you... I'm sorry that I only have one eye, and I was an embarrassment for you.
You see, when you were very little, you got into an accident, and lost your eye. As a mother, I couldn't stand watching you having to grow up with only one eye... so I gave you mine... I was so proud of my son that was seeing a whole new world for me, in my place, with that eye. I was never upset at you for anything you did. The couple times that you were angry with me. I thought to myself, 'it's because he loves me.' I miss the times when you were still young around me.
I miss you so much. I love you. You mean the world to me. My world shattered! Then I cried for the person who lived for me. My Mother.
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C. MALTREATMENT STORY
There was a beautiful woman named Nelly. She is a family oriented person and kindhearted. Nelly is very and deeply in love with her long time friend in high school named Diego. Diego is a type of person that has no any plans for his future and only lives on what the day brings. In a one night party, Diego and Nelly met.
They both enjoyed the night with their other friends. And they become friends. Time passes by, the friendship they had turns into a more intimate and serious relationship. Because they were so in love with each other, Nelly and Diego decided to get married even without stable jobs. Nelly got pregnant and starting to live a life as a plain housewife. Nelly spends her everyday life on her husband and to the household chores while Diego is busy on looking for a job for his family.
Unfortunately, Diego didnt find any job. When Diego got home, Nelly asked money to him to buy their food. But Diego started to murmur and have some complaints. Diego cannot give the basic needs of his family that is why he tries to displace his anger and disappointments to his wife. Diego was used to do the maltreatment to his wife every time they quarrels and have some misunderstandings. And the time came, Nelly gave birth to a beautiful baby boy but still diego doesnt change the way he treats his wife. Nelly feels unsecured and very afraid to her husband.
Nelly is also anxious to the future of their baby if Diego will not change. She is also very afraid of what her husband can do more when they quarrel again. Because of what she feels, nelly is looking for someone that could help her and fortunately, nelly finds someone from their neighbour whom she feels security and being comforted. Cassandra was the name of their neighbour. Cassandra happens to have a daughter that has same problem and sentiments.
Every time diego is not around, nelly goes to Cassandra to expressed her hardship and problems. Cassandra gives her advices on what to do when the incident will happen again. Her advice was nelly should leave diego for the sake of their baby. And the incident happens again, this gives nelly a reason to leave her very irresponsible husband. Nelly resorted to such decision because she is very frightful of what her husband can do more that would make her safety and her baby at stake. Although it was hard, nelly should embrace the fact and do the right thing for her own good and to the best for her baby.
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D. POVERTY STORIES
There was a woman named Jenny who came from a poor family and wasnt able to finish her education. Jenny got married to a hardworking carpenter named Ricky at a very early age. They were blessed with two children named Jane and Cathy. Even though they are not wealthy, Jenny is living happily with her family. Jenny loves to sew clothes which she used to sell to her neighbors. Everything that Jenny earned from selling clothes that she made was used to put up a little display area for her products. They just get the budget for their needs from her husbands earning. It didnt take long for her business to grow because the customers loved the designs and quality of her products. Years have passed until Jenny was already able to afford a huge place to sell their products. Because their business was doing really good, Jennys family moved from a small house to a big one which was located near their store. By that time, Jenny already had several employees which she trained herself. Jenny and her family were living a very prosperous life for several years until a very strong earthquake hit their place. Jenny and Ricky quickly held Jane and Cathy and they ran to the nearest hilltop for safety. They stayed there for the entire night with their neighbors for safety. When they returned on the following morning, Jenny and her family were so devastated when they saw that all the establishments on their area have been ruined including their house and store. They were saddened when they learned that lots of people didnt survived and were buried alive under the fallen building and trees. Jenny and her family are forced to live on the evacuation center because its unsafe to live again to their place. She had been crying for several nights because everything that she worked hard for are already gone, but she realized that theyre still very lucky because her family is still complete and thats more than enough for her to be able to carry on. At the evacuation center, they received so many used clothing as donations. Unluckily, most of the donated clothes didnt fit them. So Jenny decided to cut these clothes and stitched them into rugs. She then sold those rugs to her fellow evacuees. Since classes are postponed, Jane and Cathy helped in selling the rugs that Jenny made. Jennys earnings from those rugs are then used to buy materials to sew some clothes again. She was so excited about the idea of starting her clothing business again. Her husband constructed a little store for her products. It didnt go well at first, but Jenny didnt quit. She persevered until her effort paid off. Her business started to grow again and they were able to buy a bigger place for their products. This time, Jenny ensured that their store is already shock proof and she also made sure that half of her earnings would go to the bank in case another calamity would come.
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Reactions from the mothers: Mother 1: One mother asked if the story was real, so I told them that it happened in real life so that they would think that since it happened in real life, it could also happen to them. Mother 2: While I was telling the story, this mother said that I was like telling her story because they came from a poor family, but managed to start a small business that was gone after Sendong. She said that like the story, theyre still on the part where the family is struggling at the evacuation center. She added that theyre still heading to the part where the family was able to get up from the misery that theyre experiencing. Mother 3: She said that she learned a lot from the story because during the typhoon Sendong, lots of family really lost their savings because they kept their money on their respective houses. If she would have enough money, she would start saving her money in the bank and if she would be able to buy or build a new house, she would see to it that it would be away from the river so that she wouldnt be nervous whenever it rains. Mother 4: This mother said that almost every mother at Madrasah are like Jenny who married early and was not able to finish schooling because as Muslims, they are somewhat obliged to marry early and because they had children at an early age, they were forced to stop schooling and to focus on their children. According to her, the story of Jenny could serve as their inspiration because even if they dont have a college degree, there is still a huge possibility for them to succeed. If they would just have the right attitude; they know that in time, they would also prosper. Mother 5: She said that after Sendong, she was happy that her family was still complete. Even though their house was washed out by the flood, it didnt bother her that much because as long as her family is complete, she would be very contented with her life. She and her family are not used to a wealthy life, so living at the evacuation center is not much of a problem for her and her family. They also received lots of used clothing that didnt fit them, she almost threw all of it away, but she is considering of stitching some cut-out clothes to make rugs. Mother 6: This mother said that she was somewhat relieved when she heard the story because she used to have a business which she lost after Sendong hit the city. Like the character, she was also devastated and she almost loses hope because she lost almost all the material things that she and her family used to have. But right now, she was starting a buy and sell business which helped in her familys finances.
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Mother 7: She was thankful of the story because she got an idea that even with the simple resources that the Jenny have after the earthquake, she was able to make money out of it. This mother said that she would start looking for available or cheap resources around her that she could use to start a business. Mother 8: Her huge house and business was entirely ruined by the flood, but she was still thankful that her husband and all her 11 children survived. She said that she will try her best to be positive for her family. Right now, she still has so many worries, but she is trying to overcome it. She will be starting a small jewelry business soon and she is hoping that it would also succeed like her former business. Mother 9: Although all her family members survived, she was very sad for several days for losing their house and things from the storm. She said that she just convinced herself over and over again that she was still among the lucky ones to survive. She considered this as a second life and she realized that she still have a purpose in this life because she could have died from the flood, but she miraculously survived.
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E. SINGLE MOTHER STORY

Santa Filomena Story Telling Session MARISSA AND PAUL By Enna P. Cabrera Marissas life was quite simple. She was never used to complications. Her sixteen years of existence have been all about waking up at dawn, fixing Mothers breakfast, cleaning the house, feeding the chickens, fixing Mothers lunch, afternoon nap, tending the garden with Mother fixing mothers dinner, fixing Mothers bed, listening to mother sing their favorite song, lulling her to sleep. The only person in the world who loved her is Mother. She never knew Father because he left even before she was born. Mother said he was never cut out for marriage and children because he was such a free-spirit. Sometimes, Marissa was tempted to ask Mother about him but almost immediately, she changes her mind. Some things are better left unsaid. Besides, she couldnt miss the flicker of rage in her mothers eyes whenever Father is mentioned. Shes painfully shy. Mainly because of the glaring birthmark on her right cheek. She couldnt blame the other kids for making fun of her and calling her names because of the hairy mole that was the size of a 25 centavo coin. Mother used to say that they wouldnt know true beauty even if it hit them square in the face. You have something special in you, my darling. Your gentle and quiet spirit is more exquisite than the glorious morning sky. Marissa believed what Mother said. But she knew that the other kids didnt. So, she wore her hair long and hid her face with it whenever she ran errands for Mother. She stopped going to school two years ago when mother got hit by a car. The accident crippled her rendering her weak and unable to manage the house all by herself. It doesnt bother Marissa to do more chores because she knew that would mean less time talking to other people and more time with Mother. Mother didnt want to see a doctor or a therapist because she said that they didnt have enough money to pay for a visit and that she would get better. Although it worried Marissa a bit, she figured Mother knew best. One day, while she was weeding the garden, mother shifted in her worn-out wheelchair. She told Marissa how much she loved her and how proud she was of her. Mother was wistful and teary-eyed when she recalled how joyful she was when she first knew that Marissa was growing inside of her belly. She remembered her first kick like it happened yesterday. Your father and I may have disagreed on so many different things but both of us knew that you were special. They never thought of getting an abortion. Father just wanted more in life thats why he left before he could see Marissa. My darling daughter, promise me one thing. Be better than me. Love. Forgive. Enjoy life. There is so much to live for. Remember, you are beautiful----you have always been. Mother died in the Flood. It happened one night while the whole town was sleeping. Marissa tried to save her from drowning but she failed. It pains her to this day. The house was washed out. So was almost a quarter of the towns population. Everyone she knew who was left alive was forced to live in a very uncomfortable evacuation site. Her house is now a 4 sq. meter tent. She has never felt more alone in her whole life. Everything that mattered Mother Baby Friendly Tent: a capitalization document of an emergency response in the 77 Philippines
to her slipped through her fingers in a matter of minutes. Life was so unfair. Why did Mother have to die? Paul is bored with his life. He misses his girlfriend who works in the city. Lately, shes been texting him less and less often. Im sorry Paul, I cant talk now. Im busy with work. Maybe shes lying. Maybe shes with another man. The mere thought of it pierces his heart. To keep himself from thinking, he decides to pay his uncle a visit at the nearby evacuation site. Marissa was cleaning her tent when she heard someone ask her if she knew a Mr. Morales. She said she did and she pointed towards the direction of his tent without getting out of hers. This seemed to bother the man because she was hiding her face with her hair while she was talking to him and he couldnt see her clearly. Nonetheless, he thanked her and went to his uncles tent. Days passed and Marissa notices the same guy passing through her tent almost every afternoon. There was something about him that intrigued her. The one thing that struck her was the sorrow in his eyes that mirrored hers. Somehow, she felt that he knew what is was like to suffer loss. Paul was devastated. His girlfriend decided to end their relationship. She said she didnt love him anymore and that she was in love with somebody else. He couldnt believe it. He decided to visit his uncle again. His uncle always knew what to say about these things. Marissa was washing her clothes by the tent when he passed by. He looked sadder than usual and his face had the look of dejection. He just went to Mr. Morales tent only to find out that the old man went to the city and wouldnt be back for a few weeks. He was walking by Marissa pensively when he didnt notice he dropped his house keys. Excuse me sir, you dropped your keys. Marissa said through her hair, careful to conceal her birthmark. The man thanked her and introduced himself. Thank you, Miss. I owe you another favor. He smiled. Im Paul. I remember that you were the one who pointed me to my uncles tent. I wouldnt have found it in this labyrinth if you didnt help me. Marissa immediately liked him. Thats ok, Im Marissa. Paul was still smiling when he invited her to have lunch with him to pay her back for her kindness. He wouldnt take no for an answer. He said she looked like she needed company as much as he did anyway. Marissa quickly finished her chore and fixed her hair before they left. He was the second person who didnt treat her like she was subhuman because of the way she looked. Since Mother passed, she didnt talk to anybody except when its necessary. This was the first time that Marissa felt comfortable with somebody else other than her. Before they knew it, they spent the whole afternoon together. Although she still somehow felt self-conscious about her face, there were times when she forgot about the hairy mole on her cheek. Paul didnt seem to mind. They talked about almost everything. Marissa didnt want the day to end. And when it finally did, Paul asked her if she would mind if hed drop by every now and then. She couldnt believe what she was hearing. Of course she said she wouldnt. Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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Before she knew it, Paul became her regular lunch date. They would spend the afternoons watching the sun set by the nearby beach. Even then, she still knew little about Paul. He didnt talk much about his life. Only about his love for art, movies and writing. Marissa was used to not asking too many questions even when Mother was alive. She figured some things were better left unsaid. Still, she loved hearing his stories. Eventually, she noticed that Paul was the last one that she thinks about before going to bed and the first person she remembers as soon as she wakes up. She recalls Mother talking to her once about love. It sure sounded like the way Marissa is feeling for Paul. So it was no surprise when she decided to let him stay for a night in her tent when it was pouring especially hard. Aside from the fact that she would love to spend more time with Paul, the rain reminded her of that fateful night when she lost everything she ever cared about. One thing led to another and the next thing she knew, it was morning. She felt sore between her thighs but she was really blissfully inlove. It only happened once because Paul made sure that nobody would raise their eyebrows at Marissa. She sometimes wished that he would spend the night again but he never did. Soon, he landed on a job in the city and promised to call her everyday while he was away. With the little money she had, she bought a cellular phone so they could keep in touch. He never called either. Weeks passed and Marissa got more worried. Aside from the fact that she misses him, she missed her period twice since her night with Paul. Eventually, her belly grew. She knew she was carrying his baby. She didnt know what to do. She tried to contact Paul but his phone was turned off. After a few days of trying, she gave up and decided to ask Mr. Morales about him. She felt as if invisible hands were crushing her heart when the old man told her that Paul got back together with his ex-girlfriend and is about to get married. She wanted to get a knife and slit her wrists with it. She wanted to jump off a bridge somewhere and just vanish into oblivion. She wanted to do so many things to hurt herself. But she remembered what Mother said just hours before she died. My darling daughter, promise me one thing. Be better than me. Love. Forgive. Enjoy life. There is so much to live for. Remember, you are beautiful---you have always been. Marissa decided to live. For herself and for her baby.
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F. TEENAGER MOM STORY

By: Marrion Michael D. Lluisma
This is a story of a girl named Andrea, 15, in love, and doing well in school. She is intelligent, friendly and fun to be with. She is 6th among 8 children and belongs to a broken family. Her parents got separated when she was 5 years old. Her mom got married to another man and that man became her stepfather. Andrea was deeply in love with her boyfriend named Charles. Who was a basketball varsity, heartthrob, and who is in senior year. Her friend Christina and Bianca dont like Charles ever since he courted Andrea. Because they believed that this guy is just having fun and is not ready for a serious relationship. They keep on telling Andrea to keep an eye on her guy and dont give your full trust on him because they dont trust him that much. She will just hurt you and leave you alone in times of trouble. Because of her strong feelings and trust to her boyfriend, she ignored the advices of her best friends. She is spending most of her day with her boyfriend and at this time not with Christina and Bianca. Her best friends were really disappointed to her for she exchanged their friendship with that guy she knew for a week. There is no communication between Andrea and her best friends after that day, Andrea ignored their presence when she is with her boyfriend. After one month of being boyfriend and girlfriend, Andrea didnt have her period that day she was expecting it would come. For her it is no big deal. Thinking it is just late because of her active lifestyle. One day turns into week and then two and three. Andrea doesnt know what to do and very anxious for she has a strong feeling that she is really pregnant. She called her friends but they are not answering her phone calls. She cried and got nervous because she is afraid that her parents will know and she cant finish her studies. It came to a point that she thinks that abortion might be the best solution of her problem. But she is afraid of what might happen to her. To confirm her pregnancy she ran into the nearest pharmacy and bought pregnancy test kit. With great embarrassment, she asked the pharmacist for a test. She ran home with the kit hidden under her shirt and locked herself in the bathroom. Those three minutes were the longest, most anxious moments in her life. She couldnt bear to look at first and then, slowly, she turned her head and saw a double line indicating that she is positive for pregnancy. At first she was disbelieving. She thinks on what to do next facing the mirror in her bathroom. By the time she left the bathroom. She began to imagine what she looks like when her tummy gets bigger and bigger. She have this feeling of excitement of the idea that she would be a mother but still anxious on how to explain it to her family and friends. She called the father to be and told him that he will be a father in the future. The father to be was shocked of her announcement and has a doubt if he is really the father of that unborn child. She wasnt expecting that respond of Mother Baby Friendly Tent: a capitalization document of an emergency response in the 80 Philippines
her boyfriend. Because of her great love of her guy she didnt process his doubt and consider that major reaction as normal reaction to that great news. That night during the dinner she announced her pregnancy to her family. Everyone is speechless and shocked. Her mother suggested for an abortion because she fear that Andrea will be expelled in school for that reason but she insist. She ran away from home together with her boyfriend. She called her best friends Christina and Bianca and told them of what happened to her. At first they are angry for not listening to them but eventually accepted the situation because they cant turn back time. Andrea moved in with his boyfriend and his family. Andrea and Charles went to the doctor for a prenatal visit. Both of them are very excited for the baby to come out. Andrea continued schooling and study so hard for her baby. Around 5th month of pregnancy, her belly starts to grow bigger and her breast started to get a little heavier. Andrea stops schooling because she is uncomfortable going to school and stressful on her part. By the time the baby was born. Everyone is so happy and excited to see and touch the baby. And she already has a baby girl at an early age. They both named the baby Cassandra. Their first 2 months as parents is quiet difficult task for them because they are both first time mother and father. Things are going smooth and nice until it came to a point that Charles was tired taking care of her daughter and leave all parenting role to her and most of the day he spends his time with friends at the game house and sometimes went home late under the influence of alcohol. It is unfair on her part because she refuses to go shopping and hangout with Christina and Bianca because she dont have money and she need to take care with her baby and do some household chores. Andrea was really tired and hopeless to have a happy family. She wasnt able to enjoy much of her teenage years. She wants to turn back time to correct all the wrong actions she has done. But she did not regret that she already have Cassandra in her life. Her relationship got worst because they keep on arguing and quarrelling most of their day. It is better for them not to see each other to prevent an argument and trouble. They are sleeping at separate bedrooms and if it is a need for them to speak, it was through Charles parents. She already accepted that their relationship will not last long. That they never loved each other and their relationship was based on a sexual attraction. Several months later, she left his home with Cassandra and moved back to her parents. She was so thankful that they accepted her apology and her baby Cassandra. She continues schooling and eventually was able to graduate in high school. She plans to enroll to college but she doesnt want to ask money to her parents for the tuition fee. She wants to work on her own to support her college plan. Her daughters father visits her occasionally but they rarely spoke with each other and when they did, it was never nice. Andrea was able to enter college. She took up business course at state university, but until 2nd year college only because she got married to person she loved named Kian. Her husband accepted her past and her daughter Cassandra. Her family was her main motivation to strive hard in life and Mother Baby Friendly Tent: a capitalization document of an emergency response in the Philippines
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wanted to finish what she started. She got pregnant with her husband Kian and so happy for she will have a baby boy in the future. She feels successful and fulfilled as a mother but still the road is not easy. Andrea realized that being a parent at an early is the most complicated and yet a very rewarding job.
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Mother Baby Friendly Tent: Care Practices and Psychosocial Support

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ACF INTERNATIONAL

MOTHER BABY FRIENDLY TENT: CARE PRACTICES AND

A CAPITALIZATION DOCUMENT IN THE PHILIPPINES

Anne Filorizzo Head of Project Psychosocial January March 2012

Photo on cover page: ACF Philippines

OBJECTIVE OF THE BOOK

1. PRESENTATION OF MOTHER BABY FRIENDLY TENT

Special -ised care

Basic Individual Aid Individual guidance and support

2. HUMAN RESOURCES IN THE PROGRAMME: RECRUITMENT

14h- 15h 15h- 15h15 15h15 - 16h

5. TEAM MANAGEMENT: THE 5 WEEKLY ACTION POINTS

Project monitoring Results

50 107 75 264 557

Food vounchers Admission

Total of Women Santiago

Total of pregnancy after Sendong 13

Distribution of the age of the children who entered the program

The program welcomed 47% of girl and 53% of boy

Gender and breastfeeding practices

Pourcentage of breastfeeding by ages

These data are similar to the entrance of the lactating women.

FDG hygiene 1256 260 98 196 316 78 151 2355

Total number of participants for psychosocial activities (cumulative).

Massage baby 1456 33 0 224 511 349 103 2676

Bath session 1450 33 0 95 65 82 17 1742

Play Session 2504 280 84 571 1304 393 338 5474

bath session 1450 3,49 33 0,17 0 95 0,41 17 ns 65 2 82 0,64

total participants 431 376 0 39 142 57

total participants 643 493

total participants 1074 869 0 74 142 57

february total in month 18 6 22 8 3 17 11 total participants 430 376 total in month 19 7 29 9 4 3 6 6

march total participants 415 237 total act 37 13 51 17 4 6 23 17

total total participants 845 613 0 69 0 0

all stories are capitalized in the annex

Coordination Recommendations Perspectives Conclusion

Advanced psychiatrist ( free consultation : Doc Sue, doc Sagge)

Mental health specialist ( HOM, MSU)

11. PERSPECTIVES OF THE PROGRAM

E. SINGLE MOTHER STORY

F. TEENAGER MOM STORY

ACF United Kingdom

ACF United States

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