Chieftain Onyong Parnay and other Pala’wan perform traditional rituals to treat sickness of individuals brought to his place.

It is a struggle for any mother to see her child suffering from any illness, and Jovina Sapan is no exception. As a mother of five in Rizal town, she is struggling to provide her children with the medical care they need to improve their health.

The distance normalizes the suffering of children from diarrhea and fever within their areas. Some Pala’wan will try to find remedies through traditional healing performed by elders, but they will only take their children to the nearest rural hospital once their condition worsens.

“Hindi muna kami nag-o-ospital, kasi dasal lang muna, inuuna muna ang dasal. Bago kami makakain ay pagtatrabahuan muna ang upa sa amin na P120 o P100. Lalo pa ipamasahe namin sa motor, ano pa ipambili namin ng asin namin? Wala na,” she said.

Jovina Sapan narrates their struggle in treating their children once they experience diarrhea and fever.

It could be better than other situations cited by Jovina, where other kids were simply left to suffer due to the lack of resources. Some children have died from malaria, which is the most prevalent disease among indigenous peoples (IPs) in the town.

Jovina’s sister-in-law, Netrina, lost her two children to malaria and was unable to bring them to the hospital. Now pregnant with her youngest child, Netrina admits that she is also afraid of receiving prenatal care from medical officers.

“Masakit din— Hindi niya dinadala sa ospital, pabayaan lang. Kung mabuhay o hindi,” Jovina said.

Jovina’s sister-in-law carries her baby and is expecting a new child to follow.

Hesitancy of IPs
Chieftain Narlito Silnay is aware that malaria and diarrhea are the top diseases affecting the Pala’wan community. The increased number of cases can be attributed to contaminated water sources and improper usage of mosquito nets.

“May kahirapan na maabot yong mga nasa bundok. Isang problema na tingin ko ay malayo, akyatin. Kapag may medical mission tayo pero alam mo naman si katutubo, pagpunta ron hindi sila na-entertain, nagugutuman. Si katutubo bahala na kung kailan ang buhay,” he said.

Pala’wan leaders share how they treat the indigenous group members who are suffering from illness.

He recalled that around 17 deaths were recorded in a single day back in 2010. Even after over a decade, most Pala’wans are still unable to take their sick children to the hospital.

The hesitancy of indigenous peoples (IPs) to seek hospitalization is rooted in insufficient finances and the fear of being left behind due to a lack of information about the process, he stressed. Even when medical missions bring them closer, they remain hesitant to socialize with others.

These hesitations have been recorded in history and observed among IPs over the years. According to History Professor Michael Angelo Doblado at Palawan State University (PSU), most IPs are reluctant to interact with those residing in downtown areas.

The tendency for the Pala’wan group is to distance themselves, especially when their fear of new medicine takes precedence.

Dependency on traditional healing
Instead of immediately taking their children to a rural hospital in poblacion, the IPs choose to attempt traditional healing and offer prayers for the sick. They believe that through rituals conducted by a traditional healer, a patient can experience healing.

Pala’wan men use some traditional instruments to perform a ritual led by an elder. (left) Elders and traditional healers use rokoroko leaves as herbal medicine to treat various illnesses. (right)

One of the most sought-after healers in the community is Chieftain Oyong Parnay, who inherited this practice from his parents. He employs agong, sanang, and gimbal in performing rituals for various ailments such as headaches and malaria. If the illness worsens, a basal ceremony is conducted to ensure that their prayers are heard by higher beings.

“Pagdating sa doktor, ang laki lang nong ginastos niya kaya ibinalik sa akin. Sa awa ng Panginoon, gumanda ang pakiramdam niya,” he said.

He learned that recommending appropriate herbal medicine could help improve the patients’ condition. He added that the ‘rokoroko’ leaves play an important role in the medication of indigenous peoples (IPs) as they are used to heal various illnesses.

Historically, the reliance of IPs on traditional healing before seeking hospitalization is rooted in centuries of cultural practice preceding Spanish colonization.

“Malalim yong pagkakaugat ng kanilang kultura at kaugalian, kasama yong lahat ng pamamaraan ng pamumuhay partikular sa ating yong paggamot. May sarili silang pamamaraan at pinaniniwalaan din yon,” Doblado said.

Struggle of medical officers
In her 15 years of service as a rural health nurse, Rutchel Laborera could say that the fear of indigenous peoples (IPs) regarding hospitalization has lessened. However, she observed that a significant challenge in connecting IPs with medical health assistance lies in their tendency to absorb traditional practices and their discernment of health-related information.

At times, the teachings of IP elders and the information disseminated by rural health units (RHUs) contradict each other, greatly influencing how IPs perceive different forms of health assistance.

“Behavior talaga, kahit ituro mo na ay hindi pa rin nila sinusunod—sobrang laking problema nito dahil ito na ang nakaugalian na pinipilit na tama, ang effect ay napapahamak sila,” she said.

The rural health unit of Rizal town at Poblacion area.

IPs account for approximately 95 to 98 percent of malaria cases, teenage pregnancies, and maternal deaths.

Historical records in Palawan indicate that it was not until the American Occupation in 1903 that access to health services was extended to IPs, primarily to tackle the issue of malaria.

One of the challenges faced by health workers in establishing connections with the Pala’wan community in the mountains is the constant shifting of IP settlements. Nevertheless, Laborera comprehends that this cultural practice is driven by their survival needs.

“May fear sila, marami kasi silang pinapaniwalaan. Sa side ng IP na nagtuturo sa kanila, feeling nila ay nagko-conflict sa amin or sa other agency na binibigay na kaalaman. Kahit anong atake sa kaalaman, may isa lang na kokontra dahil ayaw nila, maubos agad at sarado agad ang utak,” she said.

IPs volunteer for fellow IPs
Medical workers understand the importance of gaining the community’s trust before providing extensive medical assistance in the area. To expedite this process, the rural health unit (RHU) has enlisted the help of indigenous peoples (IPs) who serve as medical volunteers to educate their fellow IPs.

Among them is Jocelyn Enlawod, who performs malaria rapid diagnostic tests. With 13 years of experience, she has come to realize that there are still IPs who lack awareness about malaria and fail to understand the connection between diarrhea and their lifestyle choices.

Some samples of malaria rapid diagnostic tests used in remote areas of Rizal.

“Hindi naman sila mahirap hikayatin minsan pero takot din sila magbaba— nahirapan din kami nong taon ng COVID na kapag pinupuntahan namin ay halos magtakbo sila,” she said.

She observed that their fear of seeking medical assistance was exacerbated by misconceptions about contracting the COVID-19 virus and the effects of vaccination. To help address this concern, she puts extra effort into doing her job and visits IPs per house.

Investment in communication
To influence the behavior of IPs, leaders should be more empowered and trained to discern information and relay it to the community, Laborera said. Empowerment will be sustainable if it is heavily supported by concerned agencies, not just in the health sector but also offices like the National Commission on Indigenous People.

“Sana ay active at proactive ang pagsama sa kanila, hindi pang bisita lang kung hindi tuloy-tuloy. Yong sustainability ng presensya na sila ang magbigay ng gabay at matutukan ang bawat issue,” she said.

Even a local historian is confident that education can influence behavior. The increasing number of IPs finishing their studies and earning various degrees will help them make more informed decisions in the future.

A particular mosquito net provided by the rural health unit to help combat the cases of malaria in Rizal town particularly among indigenous groups.

Maintaining their cultural practices in healing serves as their identity, but they should not rely on it alone if facing serious medical problems like malaria.

“Sa tingin ko, kapag mas na-expose sila sa makabagong paraan sa pamamagitan ng education, mas magiging open sila,” Doblado said.