Poor left out in the cold in Philippines' race to stem coronavirus spread

Contagion

Ainie supports the quarantine and has urged her neighbors to obey orders. But she fears the challenge of warding off infection, amid blocks of makeshift homes with little ventilation or access to clean water, could prove too much for her village.

Some 800,000 families in the metropolis stay in shanties, where lives are lived in single rooms that can be as small as ten square meters.

To compensate, the poor turn alleys into extensions of their homes. Children, many saddled with chronic malnutrition, wrestle in the dirt or chase each other around water stations and makeshift, communal kitchens.

The government's campaign against the new coronavirus place frequent washing with soap at the top of its health guidelines.

But in Baseco, few of the thick, blue rubber tubes that snake around alleys end up in indoor kitchens or bathrooms.

Ainie lives in a two-story concrete home built by her husband, but the family needs to fill up water pails and drums to keep clean.

In the two villages off the Navotas fish market, many residents have to buy their drinking and cooking water for 50 cents a container. Income loss could force them to use contaminated supplies.

And then there is the issue of all of those cramped quarters at a time when people are being told to stay away from each other. 

"Seventy percent of Metro Manila lives in cramped communities like this," said the priest, who preaches at a parish dubbed "Mother of the Promised Land" in the poor district of Payatas.

Payatas is a slum where 5,000 families live around trash hills that also serve as the source of their livelihoods.

"They ride in cramped jeeps, trains, and buses, and walk in crowded alleys. Physical and social space literally does not exist," Father Pilario told LiCAS.news.

The champions of the poor, however, stress that they are not parasites. They do their share in protecting communities against infections.

The Baseco Muslim Association, which normally mediates neighborhood conflicts and monitors recruitment efforts by extremist groups, has swung to new coronavirus surveillance and education.

In Payatas, Father Pilario’s group of drug war widows and mothers suspended livelihood projects to sew face masks for residents who cannot buy them in stores. 

Father Billena’s church group teaches poor families to mix bleach and water as a cheaper alternative to alcohol, which stores are now rationing.

But these grassroots peacekeepers and aid givers fear the odds are stacked against Manila’s poor.

Dr. Julie Caguiat of the Community Medical Practitioners and Advocates Association slammed the spotty flow of information.

"An enlightened citizenry can help during crises. But nobody is telling them what to do," she said.

Her group tries to breach the information gap. But when local government officials are also confused by contradictory orders, constituents can miss out on critical aid, like testing and contact tracing.

Dr. Gene Nisperos, who works with the urban poor when he’s not at Philippine General Hospital, said a quarantine would work only with strong social support.

"You need to substitute people's income so they will stay home. You need to beef up medical supplies and knowledge in village health centers," he told LiCAS.news.

But the real problem, he warned, is the compromised immunity of poor citizens.

"Playing catch up with that will be as impossible as getting rid of poverty itself within a month," he said. 

“The best we can hope for is [mitigation]: Focus on the elderly and those with existing diseases,” he said. 

The virulence of new coronavirus is particularly strong with patients with preexisting conditions like hypertension, diabetes, and lung problems. 

That presents a nightmare in a country where a million citizens have tuberculosis and 50 percent of health spending is out of pocket.

The Philippine Health Insurance Corporation offers free testing for the new coronavirus, and members and their dependents can take advantage of isolation and hospitalization packages.

But the World Health Organization's country report for 2019 said not all the eligible members are aware of the benefits of the program.

The public health sector faces grave personnel and capacity problems. There is only one public doctor for every 31,000 Filipinos.

Dr. Edsel Salvana, a specialist in infectious diseases at the National Institutes of Health at the University of the Philippines, said the government foresaw the exodus to the countryside.

“[The lockdown] delay was humanitarian to give people from Manila time to return and people from the provinces, especially students studying here with limited resources, time to go home," he said in response to a question on Twitter.

"Social distancing recommendations began immediately," he added, a reference to local government officials ordering a 14-day quarantine on all arrivals.

The fleeing poor may have released some of the pressure on the national capital, but in the provinces, where the number of hospital beds are only a third of the capital’s capacity, the poor could find themselves at a dead end.

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