(Nerissa and her baby. Photo by the author)
MANILA, Philippines - Nerissa Salonga steels her frail body to get up from a makeshift bed inside a tattered hut in Sitio Kanawan, a farming community of the native Aetas in the province of Bataan, somewhere in the northern part of the Philippines.
The 22-year-old mother had given birth to her sixth child two months ago but still feels very weak as if it had been just yesterday. She needs to make some milk for her two-month old baby crying hungrily beside her but can barely gather enough strength to move. In the dimly-lit shelter, she sits and moves a few inches to reach for the bottle of milk at the far end of their bed, a slab of narrow wood.
She almost could not do it. Nerissa feels like she is breathing her last breath. She has been feeling very weak and has not been able to eat properly. It shows in her thin frame that has lost more than ten pounds. For several weeks already, she has been vomiting and has lost buckets of blood when she gave birth. And her dark skin could not conceal the paleness in her face.
It happened on a moonlit morning, at an hour when the only sound one usually hears is the crowing of roosters. This time, it is Nerissa's shrieks of pain that cut through the wee hours of dawn. The wailing echoed in the remote community that can be reached only after a five-hour drive from the Philippine capital of Manila and a 30-minute uphill trek across a mountainous area and a wobbly hanging bridge that spans over a flowing river.
In another hut, not so far away, lives the woman hailed as the midwife of the community. She shows me her sun-roasted and wrinkled hands. These, she says, may be old and tired but have brought out dozens of babies into the world. She has mastered the craft of childbirth, she says, and knows it like the back of her hand. Yet, she not is not really a midwife, a nurse or a doctor. She says she is just guided by instinct and it has always been that way.
Except in Nerissa’s case, she says. Nerissa’s screams of pain were not the usual sounds of agony of a woman giving birth. It was too much, she says.
However, the community “midwife” had no choice but to deliver Nerissa’s baby. Moving her to a hospital in the faraway city outside the village was just impossible. Sitio Kanawan, after all, is a remote place that is connected to the world only by a narrow, dilapidated and unstable hanging bridge.
Carrying a sick person would mean gathering at least ten men. And so Nerissa endured the pain and gave birth.
I met her in July last year, two months after she gave birth.
Two weeks after I met her, Nerissa died of complications related to childbirth. I was shocked. I thought she would recover and regain her strength in time.
Nerissa’s case is among the many stories of maternal deaths in the Philippines.
Indeed, maternal deaths remain rampant in a country of 92 million people sharing a budget of at least P1 trillion or USD20.8 billion a year.
Given this situation, the Philippine government, particularly the Department of Health has conceded that meeting Millennium Development Goal 5 by 2015 would be very difficult. It has noted this problem in its progress report on the MDGs which I have cited in a previous entry.
The goal is to reduce the maternal mortality ratio by 75 percent between 1990 and 2015. In the Philippines, the target is to bring the ratio down to 52 per 100,000 live births by 2015 from the current 162 per 100,000 live births.
The Health department has said that it is stepping up efforts to reduce the ratio.
In an article by online news source IRIN published last May 26, 2010 in the Thomson Reuters website, an official of the Health department said providing further training to midwives would significantly help improve the maternal mortality ratio in the country.
The article quoted Rosalie Paje, division chief of the Family Health Office under the Department of Health, as stressing the importance of maternal healthcare. "Midwives play a crucial role in providing maternal healthcare, especially in geographically isolated and disadvantaged areas and those affected by armed conflict where doctors and nurses are scarce," Paje said in the article.
Furthermore, there are an estimated 17,500 midwives registered under the Professional Regulation Commission (PRC) working in the public health sector, the article said.
“But that is barely enough to service the 41,841 barangays (the smallest government unit) throughout the archipelago nation,” it also said.
And this harsh reality couldn't have been more felt by Nerissa that early morning last year in the hills of Kanawan.
Having had complications during the birth of my daughter, I know that things could have turned out differently for the both of us had we not had access to proper medical facilities. It is a tragedy that women continue to die preventably. Building hospitals that are readily accessible might not be possible, but proper training of women such as Nerissa’s midwife might save lives. My heart goes out to those 6 children she left behind - what will happen to them?
Jodi,
I totally agree. Proper training and enough funds for that would really go a long way. Her husband takes care of the children. It is really sad.
Sorry to hear about your own story.
Thanks for reading and thanks for the comment.
It’s awful that MDG 5 is the most off track internationally - wonder if hat would be the case if men gave birth?
Great blog about a sad and unfortunately all too frequent event.
Good writing, gripping story, sad reality…
Thanks for sharing this sad story Iris. Is Nerissa the woman in the picture? She really looks thin and weak. Difficult to imagine how a person in such poor physical condition can face a pregnancy and give birth, especially with no proper medical assistance. Also, if she was only 22 and already a mother of six, she must have been a kid herself when she had her first child. Really sad and disturbing.
Bart,
Thanks for reading. Sad reality, indeed.
Hi Iris!
Simply incredible. A very gripping read…some very disturbing facts…
Thanks for that, really. I hope we all can change this reality…
Dear Luan,
Thanks. Very disturbing indeed. It goes to see that the Philippines is really very far, far behind in meeting MDG 5. And I know other countries are, too. I totally agree with you. Hope we can change this reality.
Iris,
Well documented. I must say that the image is of a very high quality. Pitty the topic is so sad.
Thanks for your comment Johan. Yes, it’s really heartbreaking.
Iris, a very important story reflecting the reality of progress towards MDGs, and one that I really hope you can continue to follow up on and keep in touch with her husband and family. Thanks for posting.
Moving piece, Iris. Do you know of any other steps the government is taking besides just increasing training for midwives, like expanding public health programs or trying to encourage more doctors/nurses into the areas that need them most?
Guy,
Thanks for the comment. It’s especially helpful and important to get tips and reminders from a veteran journalist like you who has extensively covered different development issues. I will.
Thanks again!
Maria,
Thanks for reading. You are right the government is trying to encourage more doctors and nurses into areas that need them most. It’s also working to increase revenues but I’d look into other specific programs and will get back to you.
Thanks again!
An important story, well told.
Thanks so much Clare.
The fact that this is a reality is so disturbing, especially for us women. What a haunting, gripping entry…
Can I repost?
Mich,
Yes, it is very disturbing. Feel free to repost. Thank you.
Iris, very, very sad story. Thanks for sharing.
Is there a chance for community midwife to have a midwife training you are talking about?
I feel sorry for the father and six children. It must be hard without their mum.
Radka,
Thanks, too for reading. Very sad story, indeed. Yes, hopefully, there will be a chance for that training. I will alert the authorities, too.