In Marawi, crowded shelters and lack of running water hamper disease prevention

By Patricia B. Mirasol 

IN MARAWI CITY, people roam maskless despite the dangers of coronavirus disease 2019 (COVID-19). “They don’t really believe in it [COVID-19] or deny it still,” said Romain Pignard, project coordinator of MSF (Médecins Sans Frontières or Doctors Without Borders) in Lanao del Sur’s capital. “COVID is actually a big problem here especially since people live close to each other but do not want to wear a mask.”  

The vaccination drive is hitting a snag too, he added, since health-seeking behavior, in general, is an issue in the region. 

“Either they are afraid of the side effects, or they simply do not believe the vaccine works,” he told BusinessWorld in an interview before Delta cases were detected in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM).

As of Sept. 13, there are 14,666 COVID-19 cases in BARMM, which recorded five local Delta cases on Sept. 6. The region was the last in the Philippines to be hit by the highly transmissible variant. 

‘LIKE LITTLE HOUSES’ 
The people of Marawi are still dealing with the disruption of their lives and livelihood as a result of the 2017 siege of the city by Islamic State-aligned militants.  

Rehabilitation is ongoing, with around 200 permanent shelters turned over in July. A number of its 201,785 inhabitants reside in transitory shelters that are not ideal for disease prevention.  

These transitory shelters, as Mr. Pignard described, are “like little houses” where entire families reside in a space measuring five meters by five meters. Sanitation is uneven since some areas don’t have the infrastructure for running water. In these places, residents have to trek for water. 

The responsibility for sanitation has shifted to the local government and the barangays, said Mr. Pignard. For its part, MSF provides clean water for medical consultations. “This is non-negotiable,” he said. 

The organization also conducts epidemiological monitoring to mitigate the risk of outbreaks.  

You can promote health all you want, he pointed out, but “if you’re living in a transitory shelter 20 centimeters away from your neighbor, there’s not much prevention control you can have.”  

LEADING CAUSES OF MORTALITY
MSF started extending assistance to Marawi in the aftermath of the 2017 siege. The independent medical aid organization is focused on preventing non-communicable diseases (NCDs) and treating mental health conditions in the city’s health centers — with the threat of COVID-19 complicating matters. 

According to Lanao del Sur’s Integrated Public Health Office, NCDs like diabetes and hypertension are among the leading causes of mortality in the province, including Marawi.  

Based on data culled by the organization, there are 3,100 hypertension cases, 502 diabetes cases, and 696 cases with both comorbidities in Marawi. MSF manages between 600 and 800 of these cases.  

“Patients need to have a good understanding of the factors that positively and negatively impact their disease. It’s taking ownership of their health,” said Mr. Pignard. 

MSF’s Marawi project also encompasses capacity building, such as triaging, redefining protocols for prescriptions and follow-up consultations, and enabling the community to monitor diseases through medical equipment.  

“You cannot follow-up the same way you do in a normal urban setting,” Mr. Pignard said. “We hope that, by the time we exit, we will have this consolidated methodology.”   

CLAN FEUDS
Telemedicine is used in Marawi for mental health consultations. Outside the scope of obvious cases such as psychoses, individuals don’t recognize concerns — such as depression — that are under the umbrella of mental health.   

“This is not specific to Marawi,” said Mr. Pignard. “We see the same thing in Maguindanao… Mental health is a challenge everywhere.”  

MSF enlists the services of a psychiatrist from the Visayas region whose advice is then translated into the local language with the help of a nurse from the community.  

Clan feuds known as ridos — and the resulting relationship dynamics — pose another challenge for the MSF team.  

“Family feuds are highly difficult to read and require a granular understanding,” Mr. Pignard said, adding this challenge is specific to Maranao culture. “A staff at a barangay health station could be part of a [larger] feud, so you need to be careful. So far, we haven’t been accused of taking sides.”