(This talk was delivered during the Webinar of the Philippine Medical Students Association last March 6, 2021 in observance of the International Day of Working Women).
Doctors, soon to be, greetings of solidarity. It is with honor and deep appreciation that I accept this invitation to speak on the Women in the Health Sector. March is International Women’s Month and thank you for commemorating.
There is an ancient Chinese proverb, “Women hold up half of the Sky.” Mao Zedong also mentioned this in one of his speeches. If you try to visualize this literally, the image is powerful. What I see is, women making things lighter for everyone else, women contributing significantly in nation-building, in liberation, in societal transformation.
My talk has three key messages. First message is that women have taken a significant role in the health movement at every point of history. Second message is that women have responded according to the historical and political context and the models of health care that emerged also brought out the leadership of women. The third and final is that as the human rights and social justice movements became more advanced, inclusive and holistic, women contributed to health development through more meaningful societal change.
Key Message 1: Women have taken a significant role at every point of history.
During the pre-colonial period, the shamans were usually women. They were called the Babaylan or balian or katalonan. They were said to have the capability to communicate or appease the spirits of the dead and the nature. There were also male shamans but they changed to women clothes or they have to be feminized when they perform healing. They were called asok or bayok. The shamans were said to have spirit guides and this enabled them to contact the spirits and deities (anito or diwata) and the spirit world. The babaylans have specialties also. Some of them perform herbalism, divination, healing and sorcery.
Then you must have heard of women playing critical role in the Philippine revolution. Aside from fighting alongside men, they took care of the people and the casualties of war. And women continue to do this all throughout history.
Key Message 2: The models of health care resulted from the political and historical context with women’s leadership emerging and contributing to it.
I will walk you through the various models, namely: the Charity Model, the Medical Model, the Community-Based Model and the Community-Managed or the Citizenship Model.
The Charity model emerged after World War 2. Those who had disability or who had illnesses were considered as people needing help from those who had resources. This model addressed the issue of survival. There were various charitable movements or medical missions organized in our country. The hospital I am affiliated with, the Brokenshire Memorial Hospital was a result of that model. Dr Herbert Brokenshire was a navy doctor who started a mission in Davao City. Emma Noreen, a nurse, was also part of the mission. The philanthropists had their own biases and did put up charity organizations.
Then as the health technologies developed and more women also became health professionals, the Medical model emerged. This time, the medical professionals were at the helm of the organizations and institutions. With this model, patients were institutionalized. For example, those with tuberculosis or leprosy were isolated from the society. The women that emerged were the likes of Dr. Fe del Mundo who contributed to our medical curriculum for her book in Pediatrics. We have seen Dr. Nelia Cortes-Maramba, considered to a pillar in Toxicology and Phytomedicine (or Herbal Medicine) in the Philippines. In Davao City, we saw the establishment of San Pedro Hospital in 1969 at the helm of Dominican Sisters. Of course, there were other charity institutions and organizations at the helm of women. Sr. Manzano, the head of San Pedro Hospital would later become one of the founders of the Davao Medical School Foundation. The weakness of the Medical model is that it is prohibitive, and it does not welcome input from the families and the communities. But it did address the issue of functional independence of patients who recovered.
Where were the grassroots women?
The 70s decade saw a big political movement with more people getting involved in human rights movements. Globally, for example, the survivors of the Vietnam War, with their disabilities, and the resultant deformities of their offspring from the chemical warfare, asserted their rights, demanding social services, including health services. There were also Filipinos fighting America’s wars. This was also the scenario in the Philippines. There was better understanding of human rights. More citizens fought the US- Marcos dictatorship. Women also fought the dictatorship.
The Declaration of Alma Ata that embodied the principles of Primary Health Care happened in 1978. It asserted that health was not only a medical problem and that the social, political, economic and the cultural determinants of health had to be improved to make the population healthy.
The response to the growing disparities found the health movements such as Rural Missionaries of the Philippines establishing the Community Based Health Programs CBHPs). The community health workers (CHWs) were in the frontline in the community. Majority of the CBHP workers were women. We saw the CBHPs in Mindanao and all over the Philippines. This model (Social Model) saw the leadership among the CHWs, of the likes of Vilma Yecyec, who, at 71 years old, was recently imprisoned for trumped up charges. Various congregations of nuns were also involved by putting up support groups and community- based health programs all over the Philippines.
More women-doctors and health professionals were involved in this movement. While the National Capital Region had the likes of Dr. Mita Pardo de Tavera, Mindanao was never short of women-leaders. The women formed the health sector organizations, like WHEAL or Women in Health and I know for a fact that Ms Lyda Canson, chair emeritus of Gabriela in Southern Mindanao was part of this effort. Dr Trinidad Conchu- dela Paz, who was among the women pioneers of Davao Medical School Foundation also established the Katiwala Project and the Institute of Primary Health Care in 1978 and developed their own champions among the grassroots women. This model valued human rights and people’s participation.
There was also a change in the development indicators. It was also in the 80s that those in social development work dethroned the Gross National Product and Gross Domestic Product as an indicator for progress. The 80s decade used the Human Development Index (HDI) as an indicator for development. The health sector also saw the emergence of the gender-based analysis and more profound experiences in organizing various sectors. The women sector was probably the most resilient in grassroots organizing despite the attempts to discriminate, vilify and marginalize the women in grassroots politically. The 90s movement surfaced the Gender-related Development Index (GDI). This indicator came to be because it was noted that the more gender-inclusive or women-inclusive the society, the more developed it will be.
The organizing of women heightened and saw the emergence of the Citizenship model of health care, or Community-Managed model. Those belonging to the same sector, or those with the same sentiments or ethnic origin mainstreamed their issues. We saw the community or the authentic-issue bearers taking the driver’s seat, charting their own destiny. As an example, a barangay kagawad from Davao Oriental named Cristina Jose, demanded food for the Typhoon Pablo survivors. She probably was so effective that she had to be killed. Or earlier in the 90s, from the HIV survivors, Dolzura Cortez, Sarah Jane Salazar and Liza Enriquez who were the first to show their faces and got involved in HIV advocacy.
Davao City, my city, passed the city ordinance, the Women Development Code in 1998 and it was the joint effort of middle-class women in non-government organizations (NGOs) and civil society organizations (CSOs) engaging the city council and the grassroots women flexing their collective muscles in the streets to facilitate mainstreaming of the issues and gather support at the grassroots level.
Environmental degradation is such a huge issue for human health and that of other organisms, and we, doctors cannot save the whole community. But we saw Bai Bibyaon, together with other women, taking the cudgel for her community, waging pangayao (a justice system among the Talaingod Manobo, the highest of which is, resistance) against Alsons Company for its development aggression. Davao City has a Flora Salandron, a former barangay council official, the only kagawad opposing the coal-fired power plant in Binugao, Davao City. Monique Wilson led the grassroots women around the globe to fight all forms of violence against women. This is a kind of gender cultural revolution. Violence against women and children is a big health problem. This cannot be eliminated through medical solution. Women did right in addressing the socio-cultural determinants. The move creates pressure politics and thereby influences policy changes that translates into social programs.
In climate change response, women were in the forefront of the response. For instance, BALSA Mindanao, is organized mostly by women from the religious sector, professionals, students, and grassroots women. It has extended assistance also to Typhoon Yolanda (Haiyan) survivors in Tacloban but the organization has assisted Sendong and Pablo survivors in Mindanao. The earthquake that impacted Davao del Sur and North Cotabato was also assisted by the same entity. It is in the citizenship model that we see grassroots women making changes in policy and legislation as well as the social environment, and actively making decisions.
Unfortunately, for us women, various government administrations formulated and implemented laws to subdue the citizenship model. The culture of sexism and misogyny makes it even worse. The latest assault against Gabriela and all women is reflective of the sexist culture and deep-seated or well-entrenched misogyny and political bigotry. Any threat to free the society from various forms of patriarchy has always been met with suppression and even killing of women by state agents. Violence against women is institutionalized.
You have seen this during the pandemic. The grassroots women-leaders, despite extreme difficulty, tried to address the survival needs of its own sector and they were arrested. You have witnessed the killing of Dr. Mary Rose Sancelan, the lone doctor of Guihulngan City in Negros Oriental, who had the daunting task of controlling the pandemic in her region in Negros. She was head of the Guihulngan City Inter-Agency Task Force against Emerging Infectious Diseases.
Key Message 3: As the human rights and social justice movements have become more advanced, holistic and inclusive, women have contributed to health through more meaningful societal change.
Women have paved the way to further inclusion of the traditionally excluded communities, like the LGBTQ+, the indigenous communities, the people with disability, the elderly people, and other marginalized communities.
The key to the success of other countries is that they address the social determinants and inclusivity. Let me cite the women-led pandemic response. My favorite example would be Jacinda Ardern, who is the prime minister of New Zealand. This state has managed to elect politicians representing various sectors to ensure inclusive governance. They rejected populism. They were declared COVID-free early with sporadic outbreaks being promptly responded to. Kerala, a small state in India also has a woman leader, a former physics teacher, and a communist, whose early success in pandemic response was applauded globally. Unfortunately, it became a “victim of its own success.” Because they were able to contain the virus, only a small fraction developed immunity, making them vulnerable. There was a rise in infection late last year (2020), but the Indian Council of Medical Research noted that the sero-prevalence in Kerala was consistently and significantly lower than the whole of India. Kerala remains vulnerable. The case fatality is among the lowest at 0.4% and it has ensured that those who got infected recovered.
Seeing an indigenous woman in the congress in the person of Rep. Eufemia Culiamat is major victory for grassroots women. She is a survivor of red-tagging and vilification herself. She belongs to the community that resists the coal mining in their region. Coal mining has been known to have caused serious health problems to humans and other organisms, as well as, to biodiversity in which the humans live on.
In the age of citizenship, you will also see that the indicators of development have advanced. Benchmarking the countries is based on Sustainable Development Indices and Inclusive Development Indices. The implication of this that economic development is meaningless without the development of the people.
I long to see grassroots women rise to the highest positions in the government. We have seen enough of women officials subscribing to machismo and elitist politics. We reject every attempt to make women live in “learned helplessness” or “programmed ignorance.” What kind of government entities would use the terms such as change and development but would subdue all the women’s efforts to destabilize authoritarianism and machismo? Still, women do not back down.
Women push back. Critically engaged citizenship is still the key to meaningful change.
I really want to thank you, colleagues, for having me in this webinar. Thank you very much for continuing this liberating tradition of community-engaged medical education (CEME). I really hope to see all of you telling the stories of the communities from their perspective. Only then can we become authentic issue bearers. I encourage you to practice Narrative Medicine. Always remember that the empowered grassroots women make the road to health justice significantly easier.
(MindaViews is the opinion section of MindaNews. Dr. Jean Lindo is a medical practitioner doing community development work for four decades. Her clinical practice is Anesthesiology. She is chair of the inclusive women’s movement, Gabriela Southern Mindanao, and co-chair of Panalipdan! Mindanao a multisectoral network of environmental defenders all over Mindanao. She is faculty member of the Department of Community Medicine of the Davao Medical School Foundation).