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Powders and potions
Witch doctors and baby formula companies are contributing to the excessively high infant mortality rate in the Philippines. Daniel Jeffreys visits the slums of Bacolod City to discover what this means for the poorest of the poor
Feb 01, 2009

On Negros Island, in the central Philippines, tears glisten on Honorato's cheeks in the early morning sunshine. The nine-year-old is trying to speak but sobs stuck in his throat block the words. The whitewashed buildings at the Progresso TB Care Recovery Shelter, near Bacolod City, the capital of Negros Occidental province, intensify the sunlight and make Honorato close his eyes. He seems to shudder, as if recalling that his pain began in a dark place: a shanty hovel without running water, where his father struggled to feed him and six siblings on the equivalent of HK$5 a day.

That was where he contracted tuberculosis, a disease the World Health Organisation calculates afflicts more than 80,000 Filipinos a year, spread by unclean conditions and poverty. The infection rate in the country in 2006 was 171 per 100,000, one of the highest in the world.

"Honorato came to us when he was eight," says Susan Bucayani, who runs the shelter. "He suffered terrible pain but now he's getting better." Bucayani gives Honorato an encouraging smile but the boy is frozen, he looks around at the other patients, who have come to hear him speak, and half a dozen aid workers from Hong Kong, and his tears flow again. Bucayani takes pity and sends him back to his seat. He is replaced by another boy, Alfredo, an 18-year-old with a dazzling smile. A victim of bone tuberculosis, his growth was stunted and he is no taller than an eight-year-old.

Progresso is funded by International Care Ministries (ICM), a non-profit Hong Kong-based organisation devoted to the care and education of the poorest Filipinos. It was founded by Sharon Tan Pastre, a Hong Kong interior designer who was moved to act when she visited her domestic helper's family in Bacolod and saw the poverty they endured. Most of ICM's aid recipients exist on less than HK$1 a day. Last year, the Progresso centre cared for 78 patients and it expects to treat 96 in 2009, although ICM, like other charities in the region, is anxious about the current economic environment and how it will affect its mission.

"If kids with TB don't get treated they can die or suffer terrible deformities and kids who don't get basic literacy and numeracy are not allowed to enter the public education system," says Julie Turner, an ICM aid worker who lives in Hong Kong and visits Bacolod frequently. "We can run a school for 25 children for one year on HK$40,000 and the kids get educated and one hot meal per day. As we only choose children from the poorest of poor families, that is often one more than most have ever seen before. But all that money comes from Hong Kong and I'm scared that people will stop giving."

That could mean children such as Honorato will not get cured. Not that poverty was the only reason the boy's treatment began late.

"Honorato was in agony for three years with tuberculosis of his thyroid glands but the `quack' doctor in his village told his parents not to take him to one of our clinics," says Bucayani. "The quack said that Honorato's parents would make his sickness worse if he was taken to a modern doctor. Alfredo's parents also delayed his treatment because of a quack doctor and now his limbs are permanently deformed."

Quack doctors exist in the slums of Bacolod and throughout the impoverished shanty towns of the Philippines, where they are known as albularyos, babaylans or mangkukulams. Whichever term is employed, the way they operate is essentially the same. Part herbalist, part faith healer and part shaman, most practise a version of hilot, an ancient healing technique involving plant extracts and rituals. Quack doctors who are also willing to place a curse or a hex on an enemy are known as brujas, the Tagalog word for a witch. In Bacolod, the quack doctors are most frequently called babaylans and they are seen as gifted women - men cannot be babaylans - who are able to cure the soul, see the future and drive out evil spirits. They thrive in the slums because "they are cheap", says Dr Howard Sobel, a senior medical officer with the World Health Organisation in Manila.

"The best defence against witch doctors is to provide poor people with real medicine that cures their sickness. After that, the quack loses her power. When there is no access to modern medicine, the quack doctors thrive," he says.

And that's what worries aid workers such as Turner and Bucayani. With the world in economic turmoil, ICM will probably have less money with which to protect the most vulnerable. And vulnerability is almost a chronic disease in the Philippines. The country's wealth has been stolen or squandered over the years by a string of corrupt politicians and its people have been preyed upon by everyone from local shamans to large multinational corporations.

The impact of this exploitation is on display during a long trek through the Riverside slum, between Bacolod and the local airport. The sun is high in the sky and it's hot but nowhere near the stifling temperatures that will grasp the slums once summer arrives. Macario, the unofficial mayor of Riverside, is looking for the district's babaylan. Although the slum has its own church and versions of Catholicism are widely practised, most residents here still believe in the brujas and albularyos.

"I think over 80 per cent of the people here believe in hilot and go to the quack doctors when they are sick," says Macario, through a translator. "I believe in the bruja for some things. There are evil spirits here. If I have a stomach ache, I always see the babaylan."

There is a surprising degree of order in Riverside. Streets follow tributaries of a stream and the interiors of shanty houses - made from scraps of wood, pieces torn from advertising hoardings, cloth and cut trees - are scrubbed clean. Many of Hong Kong's domestic helpers began their lives in houses like these, where their mothers fought a never-ending battle to keep their home free from dirt and disease.

A dozen young men outside a shanty house are washing down a lunch of mussels from the heavily polluted waters nearby with hard coconut liquor, called lambanog. Although they are intoxicated to the point of incoherence - a Sunday afternoon tradition for many of the local men - they are still able to give directions to the babaylan.

She lives on the edge of the slum, in a new house built by Gawad Kalinga, a charity set up by members of Couples for Christ. Gawad Kalinga is replacing shanty homes with three-room concrete structures that include plumbing and cost only US$1,500 to build - in Bacolod a little goes a very long way. The houses are intended for married couples but Mata, a babaylan who is also a bruja, lives here with her brother.

"Evil spirits cause sickness," she tells the translator. "I draw out the spirits. Medicines can only provide a temporary cure. The spirits always come back unless I defeat them."

Mata's brother suffers from arthritis. She leads him outside and starts a ritual. She rubs a piece of ginger over his body, seeking out the spots where his pain is most intense. Her brother, whose joints look sore and painful, winces at her touch. She rubs in silence, a distracted expression on her face. Once she has finished, she cuts the top off the root.

"The piece I cut off now contains the evil spirit," she says. "We will throw that away and that casts out the evil. The evil comes from dead ancestors who are in pain." She passes the root to her brother.

"I give him what's left and that will keep the evil spirits away."

Mata becomes agitated. When asked why, she explains that her brother cannot pay for the treatment; he has no money. She says that when people cannot pay she will end up enduring the pain herself, their sickness will become her sickness. It's a way of manipulating people into paying that Mata uses without shame.

"I don't want to feel my brother's pain," she says. "I am often in agony from the people who have no money to pay me because I carry their sickness in my spirit."

Mata was seen earlier in the day, picking up antibiotics from a visiting clinic provided by ICM. When challenged, she explains that she mixes the drug with her own herbs so that the medicine can cure the body and the spirit. And she insists that the antibiotics will not work unless she has passed some ginger over the tablets first.

Preying on the superstitions of the poor has allowed brujas like Mata to stay in business, causing suffering to children such as Alfredo and Honorato. And if the global recession reduces charitable giving, her power, and that of those like her, will grow; a woman with raging toothache or neo-natal complications will try whatever she can afford to ease her pain - and that often means a babaylan.

The Matas of this world are not the only predators stalking Bacolod's slums; multinational food companies such as Nestle, Wyeth, Abbot and Mead Johnson are also taking what they can. ICM and other charities in the Philippines have been working hard to reduce birth rates in the slums and increase the number of mothers who breastfeed. The multinationals, often in concert with the Catholic Church - some priests used to instruct their parishioners to burn rice distributed by non-denominational charities such as ICM - have been doing the opposite. Enthusiastic supporters of the Catholic Church's blanket ban on contraception in the Philippines, these corporations have made hundreds of millions of dollars here by promoting high birth rates and seducing the poor into the dangerous belief that infant formula is better than breast milk. In so doing, they have contributed to hundreds of thousands of deaths.

According to statistics from 2007, the latest available, only 16 per cent of Filipino children between four and five months old are exclusively breastfed, one of the lowest documented rates on Earth. Sixteen thousand Filipino children die each year as a result of "inappropriate feeding practices", a death rate that is kept high because 70 per cent of Filipinos do not have access to clean water, thus formula is often contaminated with sewage before it is consumed.

"Breastfeeding saves lives," says Sobel. "Children who are breastfed are much less likely to suffer neo-natal sepsis [a bacterial infection that occurs in the first 28 days of life]. Breastfeeding is an unequalled way of providing food for infants and it has important implications for the health of mothers."

The WHO recommends that a mother begins breastfeeding within an hour of giving birth and continues doing so for at least six months, although two years is optimal. Despite that, the milk powder companies have flooded the Philippines with advertising in recent years to persuade mothers that formula is better than breast milk, claiming that powder "builds better babies" with "smarter brains". And the advertising has worked; some families spend as much as 80 per cent of their income on infant formula.

In 2006, Filipinos spent 21 billion pesos (HK$3.5 billion) on baby milk powder, which ranked third in the list of consumer products in the country when measured by sales. Until last year, when new regulations came into force, baby formula companies spent more than US$100 million a year advertising breast milk substitutes in the Philippines, the equivalent of half the annual budget of the country's Department of Health. Despite there being few televisions in the slums, the vast majority of their residents had seen baby formula advertisements in 2006, according to the WHO, and most could recite the contents.

Tala is one of them. She lives a few miles from the Riverside bruja, in another part of the sprawling slum. She has eight children - a common figure in Bacolod. She has lost two babies, who died within hours of their birth. In her arms is her youngest, Chesa. Tala's husband is a fisherman and brings home HK$8 a day.

"I spend more than two thirds of that on baby formula for Chesa," she says. "It's very hard. The other children have to eat less until Chesa does not need the formula any more."

Four of Tala's children sit on the steps of their one-room shack. One plays in the thick black muck of the riverbank nearby, looking for tiny crabs. The two eldest have gone to look for work. The four on the steps look hungry and tired. One has a runny nose, another a weeping eye. These seem like minor infections until the environment is taken into account; in the slums a cold can become something much more serious and Tala has no money for medicine. She has used quack doctors when her children have been sick, although nothing they did helped the babies who died.

"We eat rice when we can, some fish," says Tala. "Now Rosario has got a place at the new school and she gets a hot meal every day."

The school is one of ICM's projects. Rosario takes an empty lunch box with her to the classroom. At midday, she gets a hot meal and there's often enough left over for her to bring a full box home in the evening, a double blessing on those days when her father returns from the sea with an empty net. If Tala could spend less on baby formula she could transform her family's fortune in other ways. "I would like to buy paper and pens for Rosario," she says. "She makes very beautiful pictures. I think we could even sell them. And I could buy some needles for sewing. Then I could make more money."

When the ministry of health issued rules prohibiting the advertising and promotion of baby formula in 2006, there was intense lobbying against the measures from the United States embassy in Manila, the chief executive of the US Chamber of Commerce in Washington and the US regional trade representative for the Philippines. After the Chamber of Commerce said the rules would jeopardise the Philippines' reputation "as a stable and viable destination for investment" a restraining order was imposed, which the ministry fought. The ministry's case was led by Nestor Ballocillo, the country's assistant solicitor general.

On December 6, 2006, Ballocillo and his son were assassinated near a bus station in Paranaque city, in Metro Manila. His killers have not been found. The outrage caused by Ballacillo's death helped create support for overturning the restraining order on the new rules, although, in the end, according to Sobel, the Supreme Court lifted the ban based on the merits of the case. All advertising and promotion of infant formula for children up to two years old is now forbidden and formula companies are banned from giving away gifts or samples and from providing assistance to health workers or classes that promote baby formula to mothers.

However, according to the WHO, the rules have yet to bite. "Advertising is still taking place," says Sobel. "And it's too early to say if there has been any noticeable reduction in the use of baby formula or an increase in breastfeeding."

Others are more sceptical. The milk powder companies have been so successful that the culture of breastfeeding has all but disappeared in many parts of the Philippines and Baby Milk Action (BMA; www.babymilkaction.org), a Britain-based charity that has fought against the global powdered milk industry, says that Nestle and other companies will find a way around the regulations because the potential profits are so huge. The consequences will be unpleasant. As BMA's website explains: "A breastfed child is less likely to suffer from gastroenteritis, respiratory and ear infections, diabetes, allergies and other illnesses. In areas with unsafe water, a bottle-fed child is up to 25 times more likely to die as a result of diarrhoea."

Tala knows all about the dangers of diarrhoea. Her fourth child died from an amoebic infection and all of her children have had bad scares as a result of gastro-intestinal infections. One version of her future is a microcosm of what will happen in the Philippines if a slowdown in charitable giving cripples non-profit organisations such as ICM: Tala will probably have more children, some may die, those who get sick will be forced to rely on the quack doctors and if they are unfortunate enough to contract TB, they are unlikely to get the kind of care that has given hope to children such as Honorato and Alfredo. And Tala's daughter or others like her will not get the chance to attend school and begin breaking the cycle of poverty. All of this will take place as the Philippines' economy reels from the double blow of fewer exports and a sharp slowdown in remittances from Filipinos working overseas, in places such as Hong Kong.

Incoming funds from overseas workers exceed foreign investment in the Philippines and as unemployed bankers shed their domestic helpers and drivers, the money filtering down to the slums of Bacolod is bound to diminish. The only thing guaranteed to increase in those circumstances is the vulnerability of the poor to the witch doctors and baby formula companies who have exploited them for generations.

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