"COPAR to the MAX"
INTRODUCTION In biological terms, a community is a group of interacting organisms sharing an environment. In human communities, intent, belief, resources, preferences, needs, risks, and a number of other conditions may be present and common, affecting the identity of the participants and their degree of cohesiveness. In sociology, the concept of community has caused infinite debate, and sociologists are yet to reach agreement on a definition of the term. There were ninety-four discrete definitions of the term by the mid-1950s. Traditionally a "community" has been defined as a group of interacting people living in a common location. The word is often used to refer to a group that is organized around common values and social cohesion within a shared geographical location, generally in social units larger than a household. The word can also refer to the national community or global community. Communis comes from a combination of the Latin prefix com- (which means "together") and the word munis probably originally derived from the Etruscan word munis- (meaning "to have the charge of").Since the advent of the Internet, the concept of community no longer has geographical limitations, as people can now virtually gather in an online community and share common interests regardless of physical location. In The Different Drum: Community-Making and Peace, Scott Peck argues that the almost accidental sense of community that exists at times of crisis can be consciously built. Peck believes that conscious community building is a process of deliberate design based on the knowledge and application of certain rules. He states that this process goes through four stages: 1. Pseudo-community: Where participants are "nice with each other", playing-safe, and presenting what they feel is the most favorable sides of their personalities. 2. Chaos: When people move beyond the inauthenticity of pseudo-community and feel safe enough to present their "shadow" selves. This stage places great demands upon the facilitator for greater leadership and organization, but Peck believes that "organizations are not communities‖ and this pressure should be resisted. 3. Emptiness: This stage moves beyond the attempts to fix, heal and convert of the chaos stage, when all people become capable of acknowledging their own woundedness and brokenness, common to us all as human beings. Out of this emptiness comes 4. True community: the process of deep respect and true listening for the needs of the other people in this community. This stage Peck believes can only be described as "glory" and reflects a deep yearning in every human soul for compassionate understanding from one's fellows. More recently Peck remarked that building a sense of community is easy but maintaining this sense of community is difficult in the modern world. Community building can use a wide variety of practices, ranging from simple events such as potlucks and small book clubs to larger– scale efforts such as mass festivals and construction projects that involve local participants rather than outside contractors. Community building that is geared toward citizen action is usually termed "community organizing." In these cases, organized community groups seek accountability from elected officials and increased direct representation within decision-making bodies. Where good-faith negotiations fail, these constituency-led organizations seek to pressure the decision-makers through a variety of means, including picketing, boycotting, sit-ins, petitioning, and electoral politics. Community organizing is sometimes focused on more than just resolving specific issues. Organizing often means building a widely accessible power structure; often with the end goal of distributing power equally throughout the community. Community organizers generally seek to build groups that are open and democratic in governance. Such groups facilitate and encourage consensus decision-making with a focus on the general health of the community rather than a specific interest group. The three basic types of community organizing are grassroots organizing, coalition building, and "institution-based community organizing," (also called "broad-based community organizing," an example of which is faith-based community organizing, or "congregation-based community organizing"). A number of ways to categorize types of community have been proposed; one such breakdown is: 1. Geographic communities: range from the local neighborhood, suburb, village, town or city, region, nation or even the planet as a whole. These refer to communities of location. 2. Communities of culture: range from the local clique, sub-culture, ethnic group, religious, multicultural or pluralistic civilization, or the global community cultures of today. They may be included as communities of need or identity, such as disabled persons, or frail aged people. 3. Community organizations: range from informal family or kinship networks, to more formal incorporated associations, political decision making structures, economic enterprises, or professional associations at a small, national or international scale. Communities are nested; one community can contain another—for example a geographic community may contain a number of ethnic communities. CONGESTION: Ayusan Sur has a total population of approximately 680. The eastern part of the barangay is less populated that the western part. On the total population of the community, there are 180 households with 220 numbers of families. The community is male-dominated and most of them are single. As a residential area, the houses in the barangay are built according to the needs and the household status of living. As observed, the eastern part of the community is richer than that of the other side. Almost all their houses were built in concrete cement and most of them have descent works or source of income. VULNERABILITY: "There can be no vulnerability without risk; there can be no community without vulnerability; there can be no peace, and ultimately no life, without community." When sin entered the world, mankind experienced whole life brokenness. Not only are we separated from God by our sin, but we also suffer physical illness, harsh environmental conditions, and broken relationships. The ones who feel the effects of this whole life brokenness the most are the poor. Poverty is still the reigning problem of the society today. Moreover, it seems that it’s getting worse everyday as evidenced by continuous crisis that the people are experiencing. The causes of poverty include poor people's lack of resources, an extremely unequal income distribution, conflict, and hunger itself. By causing poor health, low levels of energy, and even mental impairment, hunger can lead to even greater poverty by reducing people's ability to work and learn. ―Libreng Pakain‖ is a program of the government that will help the malnourished people, especially the children because they are the most visible victims of under nutrition. Infectious diseases continue to blight the lives of the poor people. But, so far, the government provides means on decreasing the burdens of the people by implementing programs like the ―Cheaper Medicine Bill‖, ―Medical Mission‖. ―Libreng Bakuna‖. In a way, this will help the people to have a greater chance of treating their sicknesses or illnesses and for them to improve their health status. Furthermore, the government had provided the ―Botika ni Gloria‖ to help the less fortunate communities to lessen their expenses in buying medicines or drugs. SOCIAL ORGANIZATION: Effective communication practices in group and organizational settings are important to the formation and maintenance of communities. In the community’s social aspect, there are organizations identified. These organizations were made for the people to be socially active. Socialization is influenced primarily by the family, through which children first learn community norms. SiSa, a religious organization was made to uplift the people’s spiritual well-being. This religious organization is essential, for alone our vision is too narrow to see all that must be seen. As one community, their vision will be widened and their strength will be renewed. The main organization of the community is BALIKATAN, which is being led by Mrs. Milagros Paz. This organization has an income-generating program; wherein, they help the low-income families through ―pautang‖ (e.g. self-employed pottery making; sari-sari store). Community service is usually performed in connection with a nonprofit organization, but it may also be undertaken under the auspices of government, one or more businesses, or by individuals. It is typically unpaid and voluntary. Social welfare assistance is also extended to families financially incapable to defray their medical needs especially serious illness. Another active organization is the United Neighbor’s Association led by Mrs. Alberta Alcartado. Other organizations that are partially active in the community are: KALIPI (Mrs. Estrelita Atalin), Senior Citizen (Mrs.Maxima de Peralta), Timpuyog ti Agdadamili (Mrs. Maxima Frando), RIC (Mrs. Delia Quebral) and Fisherman’s Organization (Mr. George Amano). POLITICAL: Brgy. Ayusan Sur General Organizational Structure Efren Rabago (Brgy. Chairman) Jason del Castillo (SK Chairman) Pedro Rabe Hipolito Arista Cynthia Alconis Estrelita Atalin Anastacia Arista Gerald Amano Marites Ladines (Brgy. Treasurer) SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS A community is simply defined as a group of people sharing common geographical boundaries, common values and interests. A community’s socio-economic and cultural characteristics define their way of living and contribute in molding the personality of every individual in the society. Life within a society is on its social aspect. It is composed of leisure, pious or serious activities that let people get new acquaintances. Organizations train its members to be more productive for the benefit of a greater humanity like a sharpener to a pencil. On the spiritual aspect, people are guided and enlightened through their religion which is their faith itself. Religion is the center of spirituality. Hence, people live with their faith (religion). 86.98% of the total population is Roman Catholic. The remaining 13.02% is distributed evenly to Born Again, Pentecost, Iglesia ni Cristo, Mormons, Seventh Day Adventist and Protestant. As what the student nurses have observed, religion is not a barrier on the community. To support this fact in Ayusan Sur, there are followers/devotes of different religion that live in just one house and religion has never been a problem to them. Most of the people in Ayusan Sur are employees and laborers yet there are still some who defend in selling, farming, tailoring, fishing, and baking and pottery industry. There is a bakery and a junkshop on the eastern part alongside the road in Ayusan Sur and there are also stores which provide people the things they need. It was noted when the student nurses conducted the survey that the ASIAN Beer Corporation's storage located east of the barangay road creates flood when heavy rain strikes. The rain water from the said storage flows into the yards of the community people that will cause flood due to the lack of drainage. Some defend on vegetable gardens, piggery, poultry, fruit trees and fishery which are used for family purposes and subtle in selling but there are also residents who are unemployed. When it comes to decision-making, both of the father and mother conspires and decides about issues that should be faced and talked about. But as shown in the survey, women dominate men in such matters. There are so many active organizations on the community; among which are SISA, SARANAY, RIC, BALIKATAN, BNJ, BHW, BPC, COYA, SK, Kalipi, Fisherman’s Organization, Potable Water Organization, Tanod and Barangay Council. Economic aspects which concerns the management of money, industry and trade together with social and spiritual aspects makes Ayusan Sur. VALUES AND CULTURAL ASPECTS Our society is made up of people from many different culturally diverse backgrounds. Included in cultural diversity are people of varying racial classification and national origin, religious affiliation, language, physical size, gender, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. (Campinha-Bacotd, 2003) Cultural diversity is an integral component of both health and illness because of genetic characteristics and the cultural values and beliefs we learn in our families and communities. (Taylor, et al.) Barangay Ayusan Sur considered as depressed, oppressed, poor and exploited community has people who strive hard just to survive and finance their everyday needs. In terms of food consumption, most of the members of each family consume all the food blessings that are served. But there are also some factors that affect the kinds of food that they eat. One is Religion. Aside from Roman Catholic, followers of other religious organizations such as Iglesia ni Cristo, Pentecost, Born Again, Protestant, 7th day Adventist and Mormons exist in the community. Members of those religions don’t include ―dinardaraan‖ in their diet because it is written in their bible. This implies that religion serves as a barrier in eating some kinds of foods. Another factor is the health status of an individual. People who are hypertensive do not consume fatty foods as well as those which are high in salt because it may worsen their situation. It is also the same scenario for other people suffering from other diseases because they are also advised to minimize the consumption of other kinds of foods depending on their ailment. Regardless of those factors, still, the majority of the residents are not choosy in their food intakes. In terms of child-feeding, most parents are well-oriented about the contributions of innutritious and innutritious food to their children. They avoid feeding them with junk foods and soft drinks. They usually prepare vegetables, fish, and meat to their siblings. The result shows that most children (86%) were breastfed while some (14%) were not, they introduced formula milk instead. According to the survey that has been conducted, it was concluded that most of them knows the essence of trusting one's self in a healthcare provider like doctors or physicians when they have health problems. The citizens verbalized that if there disease is not that too severe like colds, fever, cough, headache, stomachache, they just buy an over the counter drugs that is appropriate to the said diseased. Some of these drugs are Paracetamol, Neozep, Kremil-S & Biogesic. They also verbalized that they buy the same drugs that had been prescribed by their physician before. For an instance, people with high blood pressure take their maintenance drug. But during the house to house visits, it was found out that some tend to change the frequency and that their doctor had advised. Some of the hypertensive folks believe that if their blood pressure is within normal, they would skip the supposedly dose. On the other hand, if they feel signs or symptoms of their current illness that’s the time that they take their medicines. The researchers also found out that some families still recognize the significance of herbal medicine in treating discomforts. HOME AND ENVIRONMENT Housing: Majority of the residents in Barangay Ayusan Sur confirmed that they do not own the lot where their houses are built. The most common type of house construction they have is usually the medium-type of house, composed of mixed materials (e.g. nipa roof but with wooden walls and floor); others are composed of concrete walls and floor. Most houses contain 4 rooms: a living room, a kitchen, a bedroom and a toilet, respectively. The type of toilet facility a large amount of residents use is the water-sealed. Nearly all houses have the open draining system; water wastes flow to the open canal beside the houses. Breeding sites for mosquitoes, flies, cockroaches, and rodents are to be anticipated due to the open drainage system that serves as reservoir for those vectors. When it comes to garbage disposal and management, it is not that pretty good because most families do not practice the proper and correct way to segregate their garbage and wastes; they usually burn those garbage disposed. Other options are burying and open dumping elsewhere. So far, the condition is not yet too shocking to cause a mass disease distribution in the community. When it comes to their supply of electricity, a good number of houses are connected. Appliances like television, electric fan, radio, and the like play a very important role for every family’s leisure time and relaxation in this community. Most of the families own and domesticate animals which roam around their surroundings, specifically dogs, cats and the like. There is water supply in the barangay; the source of the water they drink is NAWASA and also, the potable water located at their barangay plaza. They usually place it on covered water jugs; others put it on water pitchers, while others choose to place it on drinking bottles for refrigeration. No other treatments such as chlorination and boiling are prepared or done on the water they drink; they just drink it straight from the source. Their food, on the other hand, is stored in baskets while a few choose to store the food through covered dishware or plates; others prefer to place it in their refrigerator. Accidents hazards are not always absent in a home and community environment but can be minimized with precautions. For the most part of the barangay, the student nurses have observed that a large amount of families residing there have poor environmental sanitation as evidenced by the location of their houses just along the national road that makes them exposed to air and noise pollution and that of the open drainage system that contributes to the chances for insects, rodents or vectors to breed and proliferate in large amount that can bring about to probability of developing diseases in the community. Kind of Neighborhood: The point on which the houses, located in the western part of the barangay, are established is too congested. The spacing between houses situated there is approximately one meter apart to result to crowding; while the spacing of the houses in the eastern part is approximately two or three meters apart. The population density on the western part is obviously more maximal compared to that of the eastern part. Social and Health Facilities Available: The families share with other residents in using available social facilities. One of these facilities is the Barangay Plaza which caters to the needs of all the residents of Barangay Ayusan Sur especially the men because a basketball court is situated just inside the plaza. The plaza aims to serve the residents in terms of social gatherings and social activities. The basketball court, a very important sport facility serves as a training ground for sports enthusiasts, and also serves as training ground for the sport development of the youth. The Barangay Chapel, which stands at the center of the plaza, is the site of religious activities. The location of the chapel speaks for itself that God should be in a clear and holy place. Some meetings, social and cultural gatherings also take place there when the plaza is unavailable for unexpected cause. There is also a Day Care Center located at the right side of the plaza. Just beside it is the Barangay Health Station that offers health facilities and services for the whole barangay. Communication and Transportation Facilities: Tricycle, one transportation facility which is very valuable for the development of the community, motorcycles and other vehicles roam around as their means of transportation. Tricycles bridge the gap between Barangay Ayusan Sur to the city proper. Tricycles also provide a fast transport of agricultural products and many more directly to the market. Bakery and sarisari stores are also visible within the vicinity. VALUES AND PRACTICES ON HEALTH PROMOTION / MAINTENANCE AND DISEASE PREVENTION The family is the basic unit of society. It is composed of members with specific roles and interacts with each other maintaining common culture. Family is composed of father, mother and their children. People descended from a common ancestor, association of people who share common beliefs or activities. It is affected by the changes that occur within the society and being reflected to the family life. Crisis occurs or presence of illness on a certain family. They believe heavily on ―quack doctors‖ or the so-called ―albularyo.‖ Most of the families have stocks of medicines that are used for maintenance especially those hypertensive people yet some of them still don’t have any stock medicines that can be use in case of emergency. Many of them never visit the doctor for a check-up until the case or illness is not yet severe because most of them believe in herbal medicine. The families with high status in life go to the district Hospital whenever a member of the family got sick. Diet among the community people is also a factor that needs more nutritional teachings. Some of them are fond of eating foods high in sugar, salt, carbohydrates, fats, so with those foods containing high cholesterol because of these eating habits, they are prone to different illnesses such as genitourinary tract and circulatory disorders. The most predominant case is hypertension as evidenced by elevated blood pressures taken during the house to house visits. Since it was obtained during survey and interview that the barangay on the brighter side prefer to eat vegetables and fish, and drink water. Pregnancies are often dominated by women ages 21-26 rather than those who are in the earlier and latter stage. According to the result of the data gathered during the interview, student nurses obtained that 69.74% of infants’ ages 0-5 years old were breastfed and 30.26% were fed of formula milk. The student nurses found out that many of those infants who are breastfed were also given formula milk. The Barangay Nutrition Scholar, Mrs. Estrelita Alconis, R.M. and the Barangay Midwife, Marilyn Arista facilitate the Immunization Activities of the barangay scheduled during Fridays. During the said schedule, people especially the pregnant and postpartum mothers visit for check-up, and so with the infants. Adult are being monitored through BP taking, vaccination and check-ups to achieve optimum health. With regards to lifestyle, the student nurse found out during series of interview that a number of residents engage in alcohol drinking and cigarette smoking that they even started it during their teenage life and some ended it only during their adulthood. This scenario escalates the possibility of acquiring hypertensive and other respiratory related disorders which are dangerous and fatal. Some of them said during the interview that smoking is already a part of their daily routine or habit that they can’t get rid of and if they do, it might just cause their death. Activity and rest among the community people do not differ. They wake up early in the morning- some go to work and some go to school for learning. Exercise is not a problem to them for many of the residents considered their work as their exercise. Aside from their hectic schedules, they also have their recreational activities when they get tired. Watching TV and listening to radio are their relaxation after their work and studies. When they feel stressed they just take a nap to regain their strength. At night, most of the families sleep late – about 10 P.M. to12 midnight but then they would wake up the following morning around 4am to 6am and would do the same routine again. Past efforts to change harmful health practices often have failed to analyze their causes, instead citing ―tradition‖ as the only reason for a practice. Reformers need to understand why people do what they do; only then can plans for change be formulated. As development expert Robert Chambers writes: ―Social change flows from individual actions. By changing what they do, people move societies in new directions and they change. Big, simple solutions are tempting but full of risks. For most outsiders, most of the time, the soundest and best way forward is through innumerable small steps and tiny pushes . . . many small reversals then support each other and together build up toward a greater movement.‖ FIRST LEVEL ASSESSMENT Health Problems 1. PRESENCE OF ILLNESS Cues: Most of the people in the community are suffering from hypertension. As of 2007, there are 12 cases of hypertension – most leading causes of morbidity in the community. During the home visits, the student nurses observed that most of the people in the community are hypertensive as manifested by elevated blood pressure obtained. 2. POOR ENVIRONMENTAL SANITATION Cues: Dumping and burning of garbage are being practiced by the people in the community. Several houses in the community are slightly congested with a distance of approximately 1–2 meters away from each other. Almost all of the people in the community do not have proper food storage. The location of the community is just along the national road so they are exposed to air and noise pollution. 3. PRESENCE OF BREEDING SITES Cues: Open drainage system nearby houses that serves as breeding sites of vectors such as mosquitoes, flies and so on. Improper waste disposal that turn out to be a favorable reservoir for certain vectors. 4. IMPROPER FOOD HANDLING / STORAGE Cues: Based on observation, a number of people in the community do not practice proper hand washing before eating. Majority of the families use covered plates in storing their foods. 5. PRESENCE OF ACCIDENT HAZARDS Cues: Stray animals along the national road. Pointed or sharp objects, poisons and medicines are not properly kept. Burning of their garbage close to their houses. Absence of street lights that may lead to vehicular accidents. 6. PRESENCE OF STRESS – PROVOKING FACTORS Cues: Some members of the family in the community have conflicts, disagreements, and misunderstandings. SECOND LEVEL ASSESSMENT Problems and Cues Second Level Assessment HEALTH THREAT 1. PRESENCE OF ILLNESS Cues: Most of the people in the community are suffering from hypertension. As of 2007, there are 12 cases of hypertension – most leading causes of Inability to provide adequate nursing care to the sick, disabled, dependent, or vulnerable risk member of the family due to inadequate knowledge about the disease / health condition. morbidity in the community. During the home visits, the student nurses observed that most of the people in the community are hypertensive as manifested by elevated blood pressure obtained. 2. POOR SANITATION Cues: Dumping ENVIRONMENTAL and burning of Inability to provide a home garbage are being practiced by the people in the community. Several community houses are in the slightly environment which is conducive to health maintenance and personal development due to lack of skill in carrying out measures to improve congested with a distance of approximately 1–2 meters away from each other. Almost all of the people in the community do not have proper food storage. The location of the community is just along the national road so they are exposed to air and noise pollution. home environment. 3. PRESENCE OF BREEDING SITES Cues: Open drainage system nearby houses that serves as breeding sites of vectors such as Inability to provide an environment which is conducive and to health personal maintenance mosquitoes, flies and so on. Improper waste disposal that turn out to be a favorable reservoir for certain vectors. development due to limited physical resources. 4. IMPROPER FOOD HANDLING / STORAGE Cues: Based on observation, a number of people in the community do not practice proper hand Inability to provide a home environment which is conducive to health maintenance and personal washing before eating. Majority of the families use covered plates in storing their foods. 5. PRESENCE HAZARDS Cues: Stray animals along the national road. Pointed or sharp objects, OF ACCIDENT development due to low salience of the family. Inability to provide an environment which is conducive and due to to health personal insufficient maintenance development poisons and medicines are not properly kept. Burning of their garbage close to their houses. Absence of street lights that may lead to vehicular accidents. 6. PRESENCE OF STRESS – knowledge on ways of preventive measures. PROVOKING FACTORS Cues: Some members of the family in the community have conflicts, disagreements, misunderstandings. and Inability to provide an environment which is conducive to personal development supportive due to insufficient among relationship family members.