Health service delivery with a twist: How dialogue contributes to effective service delivery for the Mamanwa indigenous peoples in Sitio Gitaub
Story and photos by Ed Quitoriano
At 9 a.m. on the 28th of February 2019, Sitio Gitaub looked desolate from across the river. This village is home to 32 households of indigenous peoples from the Mamanwa ethnic group. It is part of Barangay Awasian of Tandag City, Surigao del Sur province in the island group of Mindanao in the Philippines -- the same barangay that hosts the City Hall and Domestic Airport. It belongs to a city, but, socially, members of the community have very little interaction with Tandag’s urban society just seven kilometers away. They have a stronger connection with their kinfolk in Lanuza one to two days away on foot through mountain trails. In the past, they have used the same trails to move away from the fighting between rebels and government forces.
As previously agreed, this day would be the Gitaub Community Day – a day of sharing and storytelling with the Mamanwa community serving as host. For the first time, the City Health Office (CHO) of Tandag and the Barangay Local Government Unit (BLGU) of Awasian joined hands to deliver nine types of health services directly to where they were needed. Government is not totally unknown to the community. There is a two-room public primary school where 28 children from 1st to 4th grades are being taught by two female teachers who drive back to Tandag each day on their motorbikes. Beside the school are two other government-constructed structures, one of which is supposed to be the Day Care Center. Both are decrepit, empty, and unused. The houses on the terraced hillsides above the school were donated by a civic organization in 2005, in partnership with the government. At the river crossing below the settlement, a highway that will connect Tandag to Lanuza is being constructed.
What made this day special is the braided story behind it and the common intention that served as the glue. The story goes back to July 2018 when the project Strengthening Capacities for Conflict-Induced Forced Displacement in Mindanao (CAPID for short) of the German and Philippine Governments, implemented by GIZ with partners, was formally introduced to the city government, followed by the conduct of a pilot dialogue in August 2018. That dialogue brought together internally displaced persons (IDPs) and host families from the conflict-affected barangays of Maitom, Mabuhay, and Awasian, the Tandag CHO, and representatives of other local government agencies. During this period, the Mamanwas of Gitaub were pre-emptively evacuating from their homes each night for fear of getting caught in the crossfire between government forces and communist insurgents. They had been in a similar situation in the 1970s, 1980s, and 1990s, but have been unable to find a safe space for sharing the story. The August pilot dialogue was an opportunity, but, then, the lone Mamanwa representative, Laurita Behon, was still reluctant to get the Mamanwa concerns off her chest. She preferred to just watch and listen.
The second story is about the CHO. For Dr. Ruth Manacap-Araz, head of the agency, the August dialogue was a revelation of how government service could be improved if there was consciousness of dialoguing and psychosocial support. From there, Dr. Ruth made it an agenda to develop the Mental Health and Psychosocial Support (MHPSS) capacity of the CHO. The first opportunity was the CAPID-supported MHPSS training in Surigao City in December 2018.
The third story is about the BLGU of Awasian. The barangay officials have observed the nightly evacuation of Mamanwa families from Sitio Gitaub to Purok Bombils near the barangay center. The IDPs never explained their reason for evacuating and neither sought assistance. Each night, men, women, and children from 32 households would compress in five Mamanwa households in Bombils. Literally, that’s 30 persons in a house built for five – from July until November 2018.
The three stories converged to form a mutual challenge: how to start a conversation, build trust, and establish relationships. Datu Kaningag, the Mamanwa chieftain, posed the challenge to the state actors and the CAPID team: “Why don’t you come to our village? We are poor but we have food to share,” he said. The challenge was actually an invitation that Dr. Ruth and her staff (graduates of the MHPSS training) and the Awasian BLGU did not want to ignore. The provision of health services is at the core of the CHO and is in the heart of its staff. How it was delivered on this day would be different. There would be no extension of dental care, deworming, vaccination, and other services without storytelling and dialoguing. The Mamanwa client and the government health worker would be acquainting and communicating with, and treating, each other as persons, as equals.
To start the day, Laurita spoke words of welcome: “Gusto ko magpaila kaninyo kay wala mo makaila kanako (I would like to introduce myself because you don’t know me). Wala usab ako makaila kaninyo gawas ining inyong kauban sa GIZ (I also don’t know you, except the familiar faces from GIZ).” From there, CHO staff and barangay health workers set up nine makeshift stations, including a newly acquired mobile dental clinic. Health services interspersed with storytelling and active listening, children playing, food sharing during lunch, and focused dialogues after lunch. This was the first time the Mamanwas of Gitaub saw government with a human face. Similarly, this was the first time that younger CHO staff have come up close and personal to Mamanwa men, women, children, and the elderly.
The day was enchanting but not in any way a product of magic. The community became a micro image of a cooperation landscape that demonstrated the following:
- The human face of essential service delivery. Conventionally, a health client gets a number, goes into the queue, and is served like a subject who is poor and of ill health and extreme want. Here, the service provider and client mutually initiated the process with a smile and a conversation that shaped the way the service was delivered. The interaction binds the provider and client into a continuing relationship.
- The extended hand of government. One of the fundamental problems of governance has always been the difficulty of reaching out to the periphery. Conventionally, the façade of governance is seen by citizens through the face of politicians campaigning during the three-year cycle of local elections. Here, people saw the persona of government in where they live, not as a patron campaigning for votes but as an institution tasked to provide services.
- Consciousness of service providers. Traditionally, indigenous peoples have been treated as the “they” – the less understood, uneducated, and un-assimilated marginals of Philippine society. Here, what Laurita described as ‘porfessionals’ were one with the community, not representatives of government coming down from the pedestal of privilege and power.
- Active listening. For a long time, the Mamanwas and other indigenous peoples have been less heard than other citizens of the republic. Majority of Filipinos do not even know how to speak, neither understand, the language of indigenous peoples. Here, local state actors compensated for the shortcoming with non-verbal communication and relationship building. Most of all, the Mamanwas were able to find empathy to their experience in forced displacement.
The day closed with smiles, handshakes, and mutual commitment to continue talking. As the saying goes, good conversations have no ending and no beginning. What matters is the connection and the relationship that is immune from violence.