Primary Health Care is both a philosophy of health care and approach to providing health services.  The focus on primary health care is on preventing illness and promoting health.  The five principles of primary health care are intersectoral collaboration, accessibility, appropriately technology, public participation and health promotion.  The principle we found to be the biggest issue throughout our two weeks in Janiuay was accessibility.

The barriers to accessibility include: poverty, cultural minorities, rural communities, values/beliefs, lack of education/knowledge about health, and stigmatized populations.  All of these barriers can be applied to the Ati community as well as other Barangays within Janiuay.

For the Ati community in Matag-Ub they have a barrier to not only health care accessibility but also to some basic necessities such as clean water and food.  Maslow’s Hierarchy of Needs states that one must fulfill certain aspects of their lives before they can move up to more complex ways of living.  This order includes: physiological needs (hunger); safety; love, affection and belonging; self-respect and self-esteem; and self-actualization.   We noted in the Ati community some of the families had difficultly providing three meals a day for themselves.  Without being able to fulfill their basic physiologic needs they often were not concerned with higher needs including proper health care.  An example we noted while in this community was their barrier to accessing clean drinking water.  The Aetas have to walk around one kilometer to get to clean drinking water.  Even though this may not seem very far it is hard terrain to be carrying water through; rice paddies, mud, hills, and bamboo bridges. As students we had the opportunity to hike through this vigorous terrain and it was a challenge. In their own community, close by, there is water available via a water pump however it is not suitable for drinking.

The Ati community also has decreased accessibility to a health care facility, as they have to walk down the hillside and then take a tricycle to access the clinic.  However, St. Paul University has decreased this gap to accessibility by acting as an entry point for the Aetas into the health care system. The students hike to the community 3x a week to provide minimal health care and education.

The town of Janiuay has a rural health clinic, as we have talked about previously, and in order to access these services people will walk for a long time.  As the map shows below there are only a few locations where health care is available.  These locations will only provide a midwife and only a few days a week. In order to access full services at the clinic, such as RNs, doctors, and dentists, they have a long way to go.  The farthest barangay Barasalon, requires a 16km walk to the barangay of Quipot where they can pay for a jeepney or tricycle that will take them the last 35km to their destination of Poblacion.  This is an accessibility barrier that we feel is very prominent.

We have learned a very important lesson during our time here.  In order for us as nurses to be able to provide the best care we can and to see improvement in health we need to go where the people are.  Even if this means hiking through rough terrain and getting muddy we are willing to go where we are needed.

This is the map of Janiuay that illustrates all the barangay’s in the area.  The white area in the lower right hand of the map is where the clinic is located. The barangay is called Poblacion.

The water well that the Ati community walk to everyday in order to get their safe drinking water

This is the pump located in the barangay of Matag-Ub where the people can access water.  However, this water is not suitable for drinking.  In order to access water for daily needs the people need to pump the water into their buckets. This process can be quite tiring and time consuming.