IPIL, Zamboanga Sibugay (MindaNews) – Located in a mountainous border area, Domandan is the farthest barangay in the municipality of Ipil, the last mile that health workers of this town would need to go to deliver the COVID-19 vaccine. However, unlike other geographically-isolated and disadvantaged areas (GIDA), this Subanen village is fairly accessible by either a habal-habal (public utility motorcycle) or a motorized tricycle cab. The road has been improved after the pandemic lockdowns in 2021, leaving only a couple of kilometers of uncemented road.
“Going up to Domandan is a lot easier now,” said Heizel Jane Bordado, 33, municipal health nurse assigned in the area.
Bordado bought a motorcycle, which she drives to Domandan as commuting by public transport is costly and time-consuming. Riding a tricycle would cost P50 pesos each with three other passengers or P200 for a lone passenger who wants to avoid long waiting hours. The distance from the town center of Ipil to the village is estimated at 12 kilometers, a 45-minute drive for the nurse. Her travel costs to the barangay, like most of other rural health workers, is not covered by the Rural Health Unit (RHU). Such was the case even during the pandemic.
“I used to get minor bruises from accidents in navigating the rough road on my motorbike and I spend my own money for the gasoline,” Bordado said.
Distance and cost of travel are among the factors for the inability of the RHU to achieve 100% of its vaccination target for barangay Domandan. Of its estimated 849 residents, 466 aged 18 and above were prioritized for vaccination, of which 354 or 76% were vaccinated.
The vaccination success for booster shots was bleaker. Of the same target number of individuals from barangay Domandan, only 12 availed of the booster shots.
Roughly 70% of the population of Domandan lives below poverty line and are subsidized by the Pantawid Pamilyang Pilipino Program (4Ps) of the national government. The main source of livelihood of the residents is rubber plantation farming.
The situation is similar in Barangay Taimalang, another GIDA in Ipil, which has a population of 2,083 individuals as per data from the Philippine Statistics Authority (PSA). The actual population according to the RHU data is 2,232 individuals. Of the 1,423 individuals aged 18 and above who were prioritized for vaccination. Only 559 individuals availed of primary vaccination, roughly 39.28% of the target. Only 25 availed of the booster shot as of January 11, 2023.
Barangay Timalang is seven kilometers away from the town center, accessible via rough roads. The cost of passenger transport aboard a habal-habal is P150 per trip. Mae Aisa Cañete, 37, the rural health nurse assigned in the village, also drives her own motorcycle to reach the area.
The village is populated by Subanen and Visayans. Of the estimated 372 households, 81% are beneficiaries of the 4Ps program, indicating that they live below the poverty line. Like the residents of Domandan, their main source of livelihood is rubber plantation farming, in addition to coconut farming.
Punishment
“Dili na g’yud ko magpabooster pa tungod kay luya ang lawas ug laylay ang mga bukton (I will never have a vaccine booster shot because the body becomes),” said Donald Gumugod, 62, the punong barangay (village local chief executive) of Domandan.
Gumugod said the same sentiment is shared by other members of his village. “Ang mga tawo magbinantanay sa unsa ang nahimong epekto sa bakuna sa uban, (Villagers keenly observed what the effect of the vaccination was to those who had the shots),” the punong barangay said. He explained that the side effects exhibited by those who were injected with the vaccine convinced others not to get themselves vaccinated.
The nurses assigned in Domandan and Timalang said residents of the rural barangay tended to view the COVID-19 vaccination as a “punishment.”
“They were averse to the side effects of the vaccine, which rendered them feeling sickly for a few days,” Bordado said. “For them, it is like a punishment,” she added.
Myths and wrong information are also prevalent among the local residents. The most common ones, as identified by Bordado and Cañete, were: the vaccine causes sterility, will result to illnesses, or will turn the vaccinated person into a zombie.
People also believed that their distance from the town center will serve as barrier against COVID-19.
The punong barangay thought that his village did not have COVID-19 cases as they went on a total lockdown at the height of the pandemic in 2021. However, the RHU recorded two COVID-19 positive cases of individuals from Domandan – one in 2021 and another in 2022.
Timalang registered two COVID-19 positive cases and one probable case in 2021.
All the five individuals were immediately quarantined and given medical care, preventing further transmission.
The villages of Domandan and Timalang had an established barangay health system that enabled them to cope with the pandemic. Domandan has a newly constructed barangay health station with three barangay health workers (BHW) and one nutrition scholar taking turns on duty at the facility. For their services, the BHW receives a monthly allowance of P1,500 each from the barangay government and P3,000 from the RHU. Timalang, on the other hand, also has a barangay health station with eight BHWs and two nutrition scholars. They get the same monthly allowance.
Root Causes
More than the misinformation and myths, poverty and lack of post-vaccination support were seen as the bottom line for the low vaccination rate in the two far-flung barangays.
“The cost of transport from their barangay to the central vaccination center is prohibitive for many of the residents of Timalang, said Cañete. The same was the case for Domandan, according to Bordado.
Bordado also said residents who refused vaccination were apprehensive because they did not have easy access to health services in case of adverse effects on them. “They do not have the means of communications with the health responders,” she said.
She also added that many residents were averse to the vaccination because in the event that they suffer side effects, even mild effects like fever and prolonged fatigue, the poor did not have money to buy paracetamol and supplements to alleviate their conditions.
Bordado said post-vaccine care is a weak aspect in the vaccination process.
Bordado and Cañete further explained that for the poor villagers, feeling sick and not being able to work for even just two days is not an acceptable option because this would mean not being able to bring food to the table for the entire family.
Post-COVID-19 Health Care
Explaining the behavior of the adult population who were averse to the vaccination, Dr. Adnilre Verzon, Municipal Health Officer (MHO) of Ipil, said “malnutrition among adults in rural and far-flung areas is high.” While adult malnutrition may be the underlying vulnerability of the adults to the side effects of the vaccine, such as fever and general feeling of fatigue, “there is no study corroborating this observation,” she said.
Dr. Verzon is recommending the provision of adequate medicines for the anticipated side effects of the vaccination. This includes 10 tablets of paracetamol for fever and pain, and five tablets of antihistamine for possible allergies. She said the RHU provided such medicine support in the earlier part of the vaccination campaign but this was not continued because the RHU ran out of supplies.
The MHO also recommended post-COVID-19 vaccination care. She said continuous monthly monitoring should be undertaken to assess untoward reaction for a year. In addition, she said teleconsultation should be established to provide residents of far-flung areas immediate access to consultation with health workers after the vaccination. While cellphone signal is available in these areas, the cost of communication may not be affordable for many of the residents belonging to poor households.
Dr. Verzon lamented the lack of financial provision for the transportation of COVID-19 health care workers assigned in far-flung areas. She said the annual budget of the RHU and the municipal government had been fully sourced for COVID-19 intervention for the past three years. External support for the transportation of health workers is needed.
Heroes for Health
COVID-19 infection has slowed down in the municipality of Ipil since the first cases were recorded in July of 2020, and reached its peak in 2021. Records from the RHU indicated that when the pandemic started in 2020, 64 individuals were infected, eight of whom died. In 2021, the infection peaked to 1,125 positive cases, killing 47 of its residents. By 2022, the number of cases went down to 310 positive cases and the severity of the infection was losing steam with only two recorded deaths. At the start of 2023, the number of COVID-19 cases is down to only three individuals.
“When referral hospitals in Zamboanga City started not to accept patients from our municipality in 2021, we knew that the COVID-19 pandemic was a serious matter,” said the 62-year old Anamel C. Olegario, mayor of Ipil.
“We did not hesitate in immediately allocating resources to combat the contagion,” the mayor said. The municipal government disbursed P6 million for food assistance during the lockdown in 2020. In 2021, another P2 million was allocated to supplement expenditures for the vaccination of local residents. In 2022, additional P2 million was allocated for COVID-19 response.
On top of the municipal allocation, funding from the Municipal Disaster Risk Reduction Management (MDRRM) fund was also mobilized for COVID-19 response. According to Raymond Hinggo, 34, officer-in-charge of the MDRRM Office, P4.743 million was allocated in 2020, another P6.7 million in 2021, and P4 million in 2022. For 2023, a fresh fund amounting to P1.5 million was allocated for COVID-19 response. The MDRRM budget was mostly allocated for medical supplies, medicines, support for transportation, and food for emergency responders.
The municipality of Ipil also received P18 million from the national government through the Bayanihan I program, another P30 million was allocated for medical equipment under the Bayanihan II program.
More than the availability of funds, the mayor said the support of civic groups, business community and individuals in the municipality helped the local government beat the pandemic. “We enjoyed the support and cooperation of the residents of Ipil, which made the battle against COVID-19 a winnable endeavor,” the mayor said.
Ipil’s battle against COVID-19 took its toll among the frontliners. From 2020 to 2022, a total of 20 barangay health workers, two barangay nutrition scholars, 40 municipal health personnel, and six members of the disaster response team were infected with the virus. The mayor and the two medical doctors of the RHU were also infected. One barangay health work died.
The MDRRM officer and his pool of volunteers were quarantined four times in a span of two years.
Working with the RHU, the MDRRM office was responsible for transporting COVID-19 patients and those who were probably infected because of close contact with an infected person to hospitals and quarantine facilities. They disinfected areas and offices that had reported cases of infection. They were also assigned to transport locally-stranded individuals.
“Helping those from the GIDA was challenging,” said Hinggo. The MDRRMO said lack of transportation, drivers, and communication equipment connecting the center with the isolated areas made the task difficult.
The MDRRMO and the RHU had only one ambulance and one rescue vehicle at their disposal to cover and respond to emergency incidences in the 28 barangays that comprise the entire town.
In the end, Ipil succeeded in curbing the spread of COVID-19.
In 2021, the Inter-agency Task Force Against COVID-19 prioritized 65,586 individuals for primary vaccination. This target corresponded to 80% of the population aged 15 and older. Of this target, the municipal government was able to vaccinate 62,486 individuals, equivalent to 95.27% accomplishment rate.
Based on the ratio of reported cases recorded by the RHU, the cases of infection in 2021 and 2022 dramatically dropped by 72.44% and cases of COVID-19 related deaths dropped by 95.74% after the successful primary vaccination campaign in the entire municipality. This ratio is based on layman’s computation and does not account for the number of populations tested for COVID-19 infection, as there is no data for such.
The MHO also observed that the cases of severely affected individuals also greatly decreased as indicated by hospital confinement. From 2022 to 2023, “there had been less admissions in the hospital and decreased cases of COVID-19-related deaths,” Dr. Verzon said. This observation is validated by the data from the Ipil RHU Surveillance Unit indicating a COVID-19 hospital admission of 255 cases in 2021 and 88 in 2022.
The downtrend of COVID-19 hospital admissions in Ipil is likewise observed in the entire province of Zamboanga Sibugay. According to records of the Department of Health provincial office, COVID19-related hospital admission for the entire province in 2021 was 893 cases and 452 in 2022.
“Cases for COVID-19 in the province have already decreased,” said Dr. Herbert Saavedra, DOH Provincial Officer. He added that only five cases have been recorded at the start of 2023.
The DOH awarded the municipal government of Ipil the “Heroes for Health Award” in 2023 for “…the admirable resiliency and commitment to successfully implement the Prevention, Detection, Isolation, Treatment, Recovery, and Vaccination (PDITR+V) strategy and unrelenting efforts and invaluable services rendered in the midst of the COVID 19 pandemic.”
Low Uptake for Booster Shots
For the frontliners against COVID-19, the fight to curb the pandemic continues. “The entire province of Sibugay has not yet reached the 70% target vaccination coverage,” Saavedra said.
Zamboanga Sibugay’s population as of the May 2020 census of the PSA is 669,840.
Primary vaccination for the entire province reached 87.88% of the target population, corresponding to 416,858 individuals for the first vaccine shot. The second vaccine shot reached 82.6% of the target population.
However, for the first booster shot, only 14.74% of the target was achieved. For the second booster shot, the accomplishment is only at 2.21% of the target.
“There is low acceptance of the COVID-19 vaccine booster shots,” Dr. Verzon said. “This is despite the efforts of the health personnel to convince people of the necessity for additional vaccination,” she said.
Bordado and Cañete, the two nurses assigned in the hinterland barangays, said residents no longer see the need for the booster shot. They also expressed difficulty in finding new ways of communicating the need for the booster.
“During our campaign for the primary vaccination against COVID-19, we told the people that the vaccine will protect them from the severity of the disease. What do we tell them now as regards to the booster shot? Our message for both the primary vaccines and the booster shots are the same, thus the people no longer see the need to get another shot,” they said, adding the people “could see that the situation has greatly improved as the cases and severity of infection in the municipality have already dropped.”
Still the RHU continues to exert effort to deliver the COVID-19 booster shots to the people and to the remote areas. The RHU’s vaccination site in the town center continues to operate daily. Complementing the centralized effort, the RHU deployed the nurses to conduct vaccination in the barangays, especially the GIDAs.
“The DOH, with the assistance from the International Committee of the Red Cross (ICRC), is assisting the RHUs in the delivery of the vaccine to far-flung areas, Dr. Saavedra said. He added that recently, the ICRC donated Personal Protective Equipment (PPE), vaccine carries and disposable syringes to the Ipil RHU.
To boost the campaign, the RHU conducted a municipal-wide flash mob dancing to urge people to avail of the booster shot vaccination in 2022. The event carried the message, “Sabay-sabay tayong babangon, magpabooster ngayon.” (We shall recover together, get a booster shot now). (Jules Benitez / MindaNews)
