Challenges in Public Health in Remote Philippine Island

Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
GUIDELINES IN WRITING A REFLECTION PAPER

1. Place the activity in an A4 bond paper
2. Font style will be Times New Roman and Font size will be 12
3. Spacing- single
4. Minimum of 150 words
5. Submission date: February 28, 2022
RUBRICS FOR RATING

CRITERIA EXCELLENT AVERAGE FAIR POOR
Depth of Response Response Response Response
Reflection demonstrates an in- demonstrates a demonstrates a demonstrates a
depth reflection on, general reflection minimal reflection lack of reflection
and personalization on, and on, and on, or
of, the concepts personalization of, personalization of personalization of,
discussed. the the concepts, the concepts
Viewpoints and concept.Viewpoints Viewpoints and Viewpoints and
interpretations are and interpretations interpretations are interpretations are
insightful and well are supported. unsupported or missing,
supported. Clear, Appropriate supported with inappropriate,
detailed examples examples are flawed arguments. and/or
are provided, as provided, as Examples, when unsupported.
applicable applicable. applicable, are not Examples, when
provided or are applicable, are not
irrelevant to the provided
assignment.
SCORE 10 7 5 2
Required Response includes Response includes Response is Response excludes
Components all components and all components and missing some essential
meets or exceeds meets all components and/or components and/or
all requirements requirements does not fully meet does not address
indicated in the indicated in the the requirements the requirements
instructions. Each instructions. Each indicated in the indicated in the
question or part of question or part of instructions. Some instructions. Many
the assignment is the assignment is questions or parts parts of the
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Email: cn@unp.edu.ph Telephone #077-604-2500 Certificate. No. SCP000580Q
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
addressed addressed. of the assignment assignment are
thoroughly. are not addressed. addressed
minimally,
inadequately,
and/or not at all.
SCORE 10 7 5 2
Structure Writing is clear, Writing is mostly Writing is unclear Writing is unclear
concise, and well clear, concise, and and/or and disorganized.
organized with well organized with disorganized. Thoughts ramble
excellent good Thoughts are not and make little
sentence/paragraph sentence/paragraph expressed in a sense. There are
construction. construction. logical manner. numerous spelling,
Thoughts are Thoughts are There are more grammar, or
expressed in a expressed in a than five spelling, syntax errors
coherent and coherent and logical grammar, or syntax throughout the
logical manner. manner. There are errors per page of response.
There are no more no more than five writing.
than three spelling, spelling, grammar,
grammar, or syntax or syntax errors per
errors per page of page of writing.
writing.
SCORE 5 3 2 1
TOTAL 25
1. What happened in the article?

We think sometimes that poverty is only being hungry, no money, no jobs, and low salary.
The poverty of being in a place that includes deficiencies in basic services and facilities such
as schools, sanitation, electricity and clinics or health centers is the greatest poverty.
The study describes the conditions of public health sector in the Island Municipality of
Jomalig, Quezon Province in Luzon, Philippines. Located at the far north-eastern side of
the Quezon Province,
This study examines the challenges in public health aspirations in a location considered to
be a geographically isolated and disadvantaged area (GIDA).
2. Who was involved?

The people involved are the researcher, the health professionals and the village health
workers in the Island. The participants of the study were the public health staff in the island.
The researcher was able to interview the health professionals (nurses and a midwife) manning
the main public health facility in the island municipality while in the case of the other
villages, health volunteers or the Barangay Health Worker (BHWs) were interviewed.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
3. What is the most important/ interesting/ relevant/ useful aspect of event, idea, or
situation? How can it be explained?
According to the article, geographically isolated areas have high incidence of poverty, they are
associated with poor
basic services and facilities such as schools,
sanitation, electricity and clinics or health centers. Some of
these conditions have led to the deaths of poor children or
have put them in poor health conditions.
The relatively “complete” health services are only available at the island’s main health center yet
unfortunately, some people who seek treatment and health care could not visit due to distance and
the accompanying expenditures. However,
aside from poverty, the
conditions of public health facilities including the quality of
health professionals and workers determine also the
trajectories of health outcomes. While, for example, improved
access to better public health facilities and their services can
reduce the mortality and morbidity rates associated with
unhygienic medical procedures, some health workers were
found out to be prescribing drugs despite being untrained to
do so, which could lead to serious health complications among
the public.
Aside from the infrastructural and training aspects, problems
in human resources and leadership contribute negatively to
health-related services. The management in the provincial and
local level were found out to be contributory to low-quality
service in these health facilities.
Other factors affecting health status of the population include the reliance to “faith healers”
(quack doctors or Albularyos) and the delay of parental reports of their health condition and the
condition of their children, both of which result to the “escalation” of illness. Among others,
challenges and aspirations of the island’s public health sector include electric supply, better
budgetary allocation for their facilities, and equipment and additional training for the barangay
(village) health workers.
In terms of mortality and morbidity rates of Jomalig Island, there were no reported alarming rates
of mortality. Rare are cases of mortality due to illnesses but some
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
minimal cases of death are reportedly due to natural death

and hypertension. Consistently, all Barangays recorded cases
of ordinary colds and cough and especially diarrhea. The
changing weather in the island is seen as a strong factor that
causes colds and cough among children. The striking
consistency of diarrhea in these communities is attributed to
the open defecation practices of some residents in far-flung
communities (in sitios or sub-villages]. Health professionals
believe that such a practice contaminates the water source
below and even in the seas where they just throw their feces.
DISCUSSION
The island municipality is far from being an ideal place to

have a medical treatment, even to be sick. Aside from health
centers being underequipped and undermanned,
infrastructures such as roads and health facilities in the Island
cannot be said to have a supporting environment to cater
quality health services. Health centers in the area could only
respond and treat to basic illnesses that require no complex
medical procedures and medication. At the end of the day,
patients with deeper health issues as well as those with
emergency cases that require major surgery and immediate
medical attention still have to seek help outside Jomalig.
Dental services are not also available.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Travel costs, distance, transportation and poor network signal

in some areas all play roles leading to mortality and morbidity
among the population. Among the very poor people, who are
also the most vulnerable to sickness in Jomalig, is the struggle
to report their illnesses at times due to expensive travel cost
from the sitios to health centers. Even if they are able to
consult health professionals in their respective health centers,
cases which have to be treated somewhere else like in Lucena,
Polilio, and Panganiban or in Manila are left in the same status
since travelling is costly, how much more the cost of having to
be treated. They even have term called “pasahirap” to refer to
free ride boat passengers. This is why transportation system is
a crucial strategy in serving socially excluded population. 21 Not
only the distance affects negatively the population to access
health services but also the services being done and offered by
health workers. Some BHWs are reportedly not so consistent
in attending training sessions and reporting cases in their
respective areas due to the travel cost. In emergency cases
also, availability of transportation and the distance are all
crucial factors for attending to the patients’ needs. Added to
this is the status of network signal in the island.
Communication between health authorities in the island is
hampered by poor or even absent signals in some areas.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Immediate medical advice and other related medical

instructions are not followed immediately because of poor
signal in some areas, thus putting peoples’ health and life at
risk.
Other factors that negatively affect the health status of

population are beliefs which are counter-scientific in nature
and those that exhibit people’s stubbornness. Albularyos are
flourishing and people are buying their services that
sometimes led to the “escalation” of illness. People’s attitude
also in terms of sanitation, of practicing open defecation
despite local authorities’ intervention, grows problematic as
cases of diarrhea increase also. Thus, peoples’ unwillingness to
health measures in the island has compounded the already
fragile health services provided by the health centers.
The health services in the island are therefore far from being
perfectly dependable. In the World Health Organization
(WHO) tracer for general readiness, the island’s health centers
can be said to have limited capacity. The absence of electricity,
strong communication signal, emergency transport, proper
facilities and basic lab tests have all been part of the struggles
of health workers to deliver efficient and quality health
services. However, to mitigate the impact of having not so
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
effective health services in the island, the population must

start to work on better environment and eradicate old popular
beliefs that are not helpful in sustaining positive health
outcomes. By transforming those sets of beliefs and practices
into behaviors consistent with attempts to achieve good health
and preservation of life, health centers in the island can
monitor more effectively the real health status of people
within their jurisdiction, save government resources and help
more patients in the process.
Enduring the underfinanced and undermanned health facilities, the island’s population also
suffers the consequences on overall health owing to limited movements and communication due
to the geographical characteristics of the municipality. Emergency boats per village, health
education campaign that focuses on eliminating open defecation and reliance on quack doctors,
stand-by generators for the health centers, and radio communication system are strongly
recommended to mitigate the negative impacts of living within GIDA communities.
4. What have I learned?
We should learn how to be contented with what we have because there are those
in worse situations than us. Just like the residents of island of Jomalig, they were
enduring the underfinanced and undermanned health facilities. They suffer the
consequences on overall health owing to limited movements and communication due to
the geographical characteristics of their municipality. We should be thankful that we are
born in a more developed community with a better health facilities and services that
would give us a higher quality of care.
The importance of studying or conducting research not only in geographically isolated

and disadvantaged areas but in vulnerable communities that lack adequate health facilities
and basic services is that we would be able to know, investigate, and interpret the issues
and situations of other people in a remote setting.

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Title
Quote about the title

“In Community Health Nursing, engagement, involvement and education are the most
important components for the success of a health program. A more educated society is a
healthier society.”
Meaning of the title

The community health nurse's role as a health educator is one of their major responsibilities.
They educate people about behaviors that promote wellness.
They serve their community in a variety of services, using health-focused strategies to
improve the well-being of their community members.
They can serve in a range of settings, implementing the proper health education techniques to
aid in the creation of systems, interventions, and policies that are beneficial to the wellbeing
of individuals, groups, and communities.
health educators collaborate with individuals, families, communities, as well as public and
private organizations
to create, implement, oversee, and analyze programs and strategies that promote health and
well-being.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Qualities of an Excellent Nurse Educator

- Have work experience and clinical knowledge
- Education and the Drive for Continuous Learning
- Have the ability to explain information effectively
- Have an excellent communication and collaboration skills
- Demonstrate professionalism, competence and a commitment to their clienteles to
garner the respect of others.
Primary goal
- Assessing the overall health needs of a specific population
- Developing policies, programs, and events to educate individuals or communities on
health conditions
- Defining and planning the desired outcomes and engaging priority populations
- Producing plans and materials for implementation and evaluation of health programs
- Coordinating and delivering health education and promotion interventions
Other goals
- Nurses must also make sure that patients have the best possible understanding of their
health, ailments, drugs, and treatments. The practice of educating about health places a strong
emphasis on self-care ideas, illness prevention methods, and health promotion tactics.
- A nurse should take the time to explain to the patient and their family or caregiver
what to do and expect when they leave the hospital or medical clinic. Nurses should
also ensure that the patient feels supported and knows where to seek additional
information if needed.
- By guiding patients and their families, nurses can also provide patients with
appropriate referrals for other services, resources, and classes.
importance

Challenges in Public Health in Remote Philippine Island

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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

GUIDELINES IN WRITING A REFLECTION PAPER

RUBRICS FOR RATING

1. What happened in the article?

2. Who was involved?

minimal cases of death are reportedly due to natural death

The island municipality is far from being an ideal place to

Travel costs, distance, transportation and poor network signal

Immediate medical advice and other related medical

Other factors that negatively affect the health status of

effective health services in the island, the population must

The importance of studying or conducting research not only in geographically isolated

Quote about the title

Meaning of the title

Qualities of an Excellent Nurse Educator

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