The three of us STOP Team members, as well as a dozen or so staff from the Expanded Programme on Immunization, the National Epidemiology Center, the WHO Country Office, and the Philippine FDA set out across the country to evaluate the surveillance system for adverse events following immunizations. I won't get too technical here, but it meant visiting every level of the health system, from the Region (roughly equivalent to the US States), down to the Barangay (village) Health Stations and local communities. It was a fascinating week. We moved around more or less non-stop, saw some beautiful areas of the country, and met some lovely people. We went to a remote fishing village and the the bustling regional capital city. Spoke with officials in their air-conditioned offices and with moms and community health workers in their homes. We got back to Manila late Thursday night, a bit tired and annoyed at the heavy traffic (my counterpart swears that it was "the lovers" out for Valentine's Day clogging the roads into the city).
The weekend brought a lovely hike to Taal Volcano (a lake within a volcano island within a lake within the island of Luzon, the largest of the Philippine archipelago). It was hot and dusty, and lots of horses passed us on the 2-mile hike up the crater, kicking dust into our faces and our surgical masks (sold to each of us by intrepid sales kids at the start of the hike, and much appreciated), but the view from the top was well worth it. I'll attach some photos below. We stopped for fresh fruit on the way to Tagaytay, and had an amazing lunch overlooking the lake after the hike. It was a splendid day, and I only got a *little* sunburned.
This week, we're starting field visits within Metro Manila (The National Capital Region) to assess immunization, surveillance, and child survival program effectiveness at the health centers. It's definitely going to be an adventure to navigate through this city. It took over an hour by taxi to return to our hotel from the regional office this afternoon. But it's also exciting, and will certainly give us a good idea of the challenges of implementing health programs in one of the world's most densely packed cities.
About that. I just don't have the words to express how full of people Manila is. I had dinner last night with a grad school friend who is working here in Manila, and he jokingly welcomed me to "the zoo." I have certainly never been anywhere as jam-packed as this city. Riding the LRT commuter train, you have to physically push yourself aboard, and elbows, shoulders, and handbags all just sort of meld into one solid mass of humanity. The train sways to the right, and the crowd, as one, sways. The train skitters to a stop, the crowd lurches forward. It's a bit jarring, but there's also a measure of camaraderie in the experience. I catch a smile occasionally from a fellow traveler as I shake my head about some aspect of the commute. Walking down the streets is equally overwhelming. Traffic comes at you every which-way--road rules seem to be loosely enforced at best. Pedestrians of all stripes, moving at all possible gaits, street vendors, beggars, food stalls, motorcycle tricycles for hire. It's noisy with honking cars, shouted phone conversations, the tinkling of bike-powered ice cream truck bells. It's smoky and polluted. It's all one big, well, zoo. It's really not hard to believe that this is one of the densest cities on the planet. It's an interesting (challenging?) place to be as an introvert, and particularly as an introvert grappling with learning a new culture. Overwhelming is not too strong a word.
But honestly, I kind of like Manila, and I certainly deeply appreciate the warmth, grace, and hospitality of our Filipino/a colleagues and hosts. This is a tremendously friendly place, and it's easy to feel welcome here. It's a brand new dynamic, though to be here as a short-term international consultant. A friend serving in STOP in Ethiopia wrote an email about the differences between Peace Corps and STOP and the PC attitude toward people like us consultants. I found her message particularly poignant and relevant. This experience is light years away from my Peace Corps service, and not only in terms of the monumental differences between my small city home in PC and the sprawling mega-city I find myself in. I have a fundamentally different role here, and my instincts to get to the grassroots level, to learn the language and to find my favorite local dishes and songs don't work in this role. I have no need to learn the language beyond friendly greetings and words of thanks, no need to ride arduous public transit for hours on end, and in fact, my time and energy is probably better spent elsewhere. I honestly will never know this country the way PCVs here do, nor in the way I knew Ethiopia. And it makes me a little sad. Not that I particularly want to go back to the days of sweaty interminable mini-bus rides, awkward family dinners with my host family, and linguistic and culture foibles. But I do miss that on many levels, and am grappling with what my new role here should look like and how I can interact with my local hosts and colleagues in a way that feels meaningful, in addition to providing the technical skills and assistance I've been brought here to provide.
Anyhow, a long post at the end of a long day. My brain is churning. This city and this experience certainly provide a lot to think about! More soon... for now, a few photos:
Taal volcano
Outbreak investigation? Or just dusty?
The view from the top of Taal Volcano
Lake Taal
Sunset from my balcony, Manila (it looks peaceful like this, doesn't it?)
Colleagues from the Region I Center for Health Development, Ma'am Johnna and Dr. Rosie
Checking out the vaccine storage facilities at the Regional Health Office
A quick stop on the road the catch a glimpse of the Hundred Islands National Park
Snack time at the Agoo health center (a very important time!)
Nurse epidemiologist Eloisa interviewing a family in a small fishing community. The baby had a fever after DPT immunization, but the family was willing to go back for her third dose anyway.
Vaccine vials missing labels because they've been carried in vaccine carriers with ice packs that melted.
Doctor Joyce from the National Immunization Program enjoying a sumptuous lunch of crabs, fried bananas, and sweet corn, at the Barangay (village) Health Station in San Manuel Norte.
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