When his daughter died at the age of four, Paciano Madlay thought she was just an unlucky victim of a wicked spell. At least that was what the village medicine man told him. It also wasn’t exactly strange, as their tribal culture subscribed to animistic beliefs that nature spirits do harm to people on occasion.
“Tatlong araw lang siyang nagka-sakit. Hindi na naagapan ng doktor. Tumirik ang mata niya at mataas ang lagnat. Sabi ng mga albularyo ‘nabati’ lang,” Madlay, 47, a Palaw’an native from Brooke’s Point, recalled.
It was only later that he was convinced by local health workers that his daughter had died of malaria. “Nalaman na lang namin no’ng nawala na siya na malaria pala,” Madlay told Palawan News.
His daughter’s death opened his eyes to the dreaded malaria disease and how prevalent it is among his people. He wanted to be part of the solution and vowed to help others not suffer the same fate as her.
“Iyan na rin ang nagpapagaan sa loob ko na sana ‘di mangyari sa mga iba kong kamag-anak. Sa anak ko kasi hindi pa talaga alam no’n. Ngayon na may mga test na, sana wala nang kailangang mawala dahil sa malaria,” he expressed.
In 2011, Madlay reluctantly signed up for training to become a village microscopist under a program launched by the provincial government in partnership with a private foundation. He recalled that when he was first offered to train under the program by the Pilipinas Shell Foundation Inc. (PSFI), he was hesitant to join because of his lack of education.
“Hindi ako nakapag-aral dahil sa hirap ng buhay. Noong nag training kami sa Puerto [Princesa], una ayaw ko po pumasok sa ganyang trabaho lalo na’t di naman ako nakapag-aral, ‘di ako marunong gumawa ng mga report. Pero sabi nila ‘turuan ka nalang namin kung papayag ka mag RDT’,” he said.
Malaria is a mosquito-borne disease caused by Plasmodium parasites, spread by female Anopheles mosquitoes. There are five species of parasites that cause malaria, and all of them, according to the Kilusan Ligtas Malaria, are prevalent in most communities in Palawan.
Symptoms like fever, headache, and chills may be mild, making it more difficult to detect. Hence, malaria can evolve and cause death even just within 24 hours.
As of the latest report of the World Health Organization in 2022, malaria remains one of the leading causes of child mortality. The WHO estimates more than 600,000 child deaths every year due to malaria.
Although malaria has been delisted among the Top 10 leading causes of death in the Philippines, the national government, together with non-government agencies, are still on a tight watch in eradicating the disease and achieving the goal of a Malaria-free Philippines by 2030.
In the Philippines, Palawan is still considered the “malaria capital” of the country, with local cases accounting for more than 90% of the country’s totals.
On-site interventions by programs like PSFI’s malaria eradication drive that has been going on for over two decades have had significant successes. There had been zero deaths reported for 2022, even as the province recorded a total of 2,012 cases for the year.
Palawan has already come a long way since the late 1990s, when the province reported approximately 78,000 malaria cases and 100 deaths each year.
In 1999, the provincial government, in partnership with PSFI, launched the Kilusan Ligtas Malaria (KLM or Movement Against Malaria), a community-based sustainable project for malaria prevention and control.
A year later, KLM was able to recruit and train 425 barangay microscopists—one for each affected barangay in the province—and several hundred rapid diagnostic test (RDT) personnel and volunteer community health workers in the succeeding years. One of them was Madlay, who had since been assigned to the municipality of Brooke’s Point.
In 2016, Madlay was recognized by the Department of Health (DOH) for his contributions to the campaign and conferred the “Bayani Ng Kalusugan” award.
Madlay lives in the mountains of Sitio Bayog, Bgy. Aribongos, Brooke’s Point, Palawan. Brooke’s Point is approximately four hours away from Puerto Princesa City, the province’s capital. From the municipality’s town proper, Sitio Bayog can be reached in around 30 minutes via four-wheeled vehicle or tricycle. Then, there would be another 30 minutes of challenging hiking before reaching the mountain’s halfway, where Madlay’s house is located. But this is not even half of what he traverses almost every day as an RDT personnel.
He is the RDT in-charge of more or less a hundred households in his sitio, but he also walks kilometers away to other remote mountains to reach malaria-infested communities.
“Minsan sobra isang araw ang lakad namin para mapuntahan ‘yong mga tao at matest at magbigay ng kaalaman sa malaria. Doon na kami matutulog sa mga madadaanang bahay,” he said.
Aside from the strenuous trek that comes with his volunteering, he also understands that this is not a nine-to-five job. The demands of his work made sacrificing his time for family and livelihood inevitable.
“Mahirap po kung iisipin, dahil hindi na rin makapagtrabaho ng iba dahil araw-araw halos kami umiikot sa mga tao dahil di mo alam kung may karamdaman sila o wala. Pero, ayun, kahit may trabaho ako, kapag may pasyente talaga iniiwan ko ang trabaho ko. Yung trabaho ko makakahintay pero pag ang pasyente lumalala hindi ‘yan makakahintay kaya inuuna ko nalang sila,” he said.
Despite these challenges in distance and accessibility, Paciano describes his work as an RDT personnel a fulfilling experience.
“Kahit mahirap mag ikot, para sa akin hindi ko na nararamdaman ang hirap lalo na kung maka test ako at magamot sya at gumaling siya, masaya ako. Ginaganahan ako kahit anong layo, gusto ko sila gumaling na di na kailangan pumunta sa ospital,” Paciano recounted.
“No’ng hindi pa ako RDT, marami na talagang nagkakasakit na malaria pero saka lang nalalaman pag nadala na sa center o sa ospital. Pero no’ng nag RDT alam naming agad sa sintomas palang. Nung unang buwan ko naka kuha ako mga 30 na pasyente positive for malaria sa Sitio Bayog. Sa katagalan sobra isang taon, bumaba na at hindi na umaabot sa 30 ang may malaria at amat amat na silang pumupunta sa bahay kapag nakakaramdam ng sintomas dahil may libreng gamot galing sa KLM,” he added.
Through the cash incentive he got from the award from the DOH, he was able to construct a bigger “kubo” beside his house, which now hosts malaria patients whenever they need a place to stay as they recuperate from the disease.
Confronting the problem
“Ang buong Pilipinas actually ay nakatingin talaga sa Palawan as of now kaya sunod-sunod din activity natin dahil tinitignan ano pa pwedeng gawin ni Palawan para mas mapababa pa ang kaso medyo mabagal, pero nag-iimprove naman lalo na sa fatality rate,” Aileen Balderian, KLM’s program manager, told Palawan News.
Balderian explained that this improvement can be attributed to the continuous work of the government in implementing malaria control programs such as KLM, in partnership with NGOs like PSFI.
PSFI provides the mobilization funding for the program. Through donors such as the Global Fund, they are able to procure and distribute mosquito nets skewered with insecticides, medicines, test kits, etc. The program similarly offers fogging services, conducts community clean-up drives, and capacity-building activities for volunteers.
Additionally, through their consistent information education campaigns (IECs), people are now more knowledgeable about the disease compared to decades ago.
“Dahil mas alam na ng mga tao kung paano iwasan ang sakit na ito, mas pumupunta na sila sa health center, or kung di man sila makababa ang ating mga volunteer mismo ang umaakyat sa mga community para hanapin ang mga may sakit at agarang bigyan ng lunas libreng gamot hanggang matapos ang treatment nandun sila para subaybayan ang pag inom ng gamot,” she told.
The PSFI’s contract with KLM will end in 2023. With fewer stakeholders to fund, the program is working doubly hard towards sustainability in the community.
Marites Manderi, community project officer of PSFI, said their organization is already in its transition period where they are conducting a series of planning with the LGUs and stakeholders to prepare for their exit.
“Iyong funds kasi ay hanggang 2023 nalang so hopefully by next year, bumaba na rin talaga ang kaso para kaunti nalang din ang kailangan itarget ng mga maiiwan [sa programa],” she said.
The provincial government of Palawan is finding ways to strengthen the program, such as adding more volunteers, which would better aid the province to reach its target in terms of malaria elimination.
“Kaya mas pinapaigting ang effort lalo ng Palawan kaya naghahanap pa rin kami ng mga worker na mas titingin sa mga kabundukan natin. Ito rin kasi ang problema natin kung maabot na sila ng ating mga worker may mga iba na wala na doon dahil palipat lipat ng communities. But of course, di po yun hindrance for Palawan para mag stop mag work. Gumagawa ang province ng ibang effort para mahikayat sila [na magvolunteer],” Balderian said.
The provincial government’s construction of halfway houses and Indigenous Peoples (IP) villages has also been helpful in providing medical services to far-flung areas, which were hard to reach by volunteers and health workers.
“Ang number one problem natin sa Palawan ay ang Rizal, so nag-start ang KLM together with PGP, PSFI, and Rizal ang una magkaroon ng halfway houses at IP village para doon na sila manirahan sa mas mababang bahagi. Ngayon na may mga IP village na, mas madaling naibibigay ang health services ng mga katutubong kapatid natin kumpara sa naka scatter sila sa kabundukan,” Balderian stated.
The provincial government is also practicing an integrated health approach in combating diseases in Palawan. This means that whenever health workers visit communities, they do not only perform services related to malaria but also other medical concerns.
Madlay hasn’t changed his mind about continuing to help his people fight malaria by volunteering.
“Hanggang malakas pa tuloy tuloy lang po maliban kung ‘di na kayang umakyat [dahil] matanda na talaga. Gusto kong makatulong sa kapwa lalo na’t malayo kami sa bayan,” Madlay asserted.
“Yung mga kasamahan naming katutubo wala talagang kakayahang pumunta sa ospital kung di mo i-a-assist. Ngayon dalawa lang din po kami ng anak ko na nag vo-volunteer sa sitio. Kulang po talaga. Kaya mas maganda kung dito na sa sitio namin may health center para di na kailangang bumaba pag malala na,” he said.
(This story was made possible through a grant by the Philippine Press Institute under the auspices of the Hanns Seidel Foundation.)