The Philippines hadn’t been on my traveler’s bucket list, but when I received an email from ACYPL asking whether I’d be able to serve as an American mentor to three Filipinos participating in the Young Southeast Asian Leaders Initiative (YSEALI) Professional Fellows Program, I immediately said, “Yes.” My responsibilities were threefold: 1) Partner with other Colorado-based ACYPL alumni to schedule cultural activities or opportunities to learn about Colorado’s economic diversity; 2) Facilitate fellowship placements in nonprofit, public health, and city agencies; and 3) Agree to serve as a mentor to advise the three fellows, Catmon Municipal Councilor Earl Tidy Oyas; Mansalay Municipal Councilor Shernan Fajutnao Gamol, and Zuellig Family Foundation Operations Associate Jenny Macaraan.

In exchange, I would travel to their homes in the Philippines to learn about the challenges they sought to address by participating in the program, and see how much progress they had made in implementing their action projects using the skills and networks they gained in the United States.

I struggle to find the words to describe the magnitude of economic opportunities and improved health outcomes that Earl, Shernan and Jenny hope to achieve as a result of their YSEALI professional fellows experience. Having never met prior to this program, they drew upon their different experiences but similar commitment to empowering individuals in their communities.

As municipal councilors – an elected position parallel to city councilors in the United States – Earl and Shernan are in positions to allocate resources to their local communities to address economic, health, educational, and cultural disparities. As an expert on implementing federal health care policy at the local level, Jenny trains elected officials like Earl and Shernan on how to leverage limited financial and personnel resources to improve health disparities – which in turn contributes to economic stability for the community.

But the reality is much more nuanced and complicated than that.

Political Challenges in the Philippines

Between the white sands of Mactan, and island-hopping in Bulalacao, I learned that publicly funded programs in the Philippines are affected by a complicated calculus that includes assessment of a given area’s population, geographic size, economic output, and classification as a municipality, city or highly urbanized city. Each sub-national government unit receives an annual allocation of federal funds based on those circumstances. And Philippine provinces – equivalent to states – are comprised of cities and municipalities, but exclude highly urbanized cities located within their borders. Municipalities and provinces must compete for revenue to support public safety-net programs. This political-economic model affects Earl’s and Shernan’s desire to develop innovative jobs-training programs in municipalities that are geographically isolated from major economic centers.

Even more complex is that Earl and Shernan’s respective municipalities have economies that are heavily agrarian, dependent on farming and fishing for food production with limited exports to other municipalities or regions elsewhere in the country.

In a 21st-century global economy where high-tech skills trump family-run farming and fishing operations, I empathize with Earl and Shernan’s desire to connect youth in their communities to higher-paying careers. I got a glimpse of what it takes to promote increased educational attainment for high school students in Catmon and Mansalay, specifically in areas that currently lack long-term regional economic development plans to attract job-creating industries or private capital investments for public-private partnerships.

A Complex Culture

And yet, the deep cultural heritage prevalent in both Catmon and Mansalay offers its own attractions and a basis for tourism-based economies. Catmon’s St. William Parish Church tells the history of the area from its pre-colonial times, through Augustinian missionary efforts, and World War II. Oriental Mindoro’s coastal highway, connecting the airport city of San Jose with the provincial capital of Calapan, splits Mansalay Bay from the mountainous region where Mangyan communities live in the hills. Each provides a glimpse into the culturally complicated history of the Philippines, which was a Spanish colony from 1521 to 1898 before becoming an American protectorate from 1898 through 1948.

I learned that the Philippines, since gaining its independence, has been heavily influenced by its historic ties to both Spain and the U.S., its proximity to other Southeast Asian countries, multiple generations of Chinese descendants, periodic separatist movements, and a culture that values community and family over individualism. In a country whose geographic footprint spans more than 7,100 islands and boasts between 100-200 native languages, I felt a recurring tension between adherence to traditional customs and adoption of modern practices.

A Complex Healthcare System

Tension appeared to contribute to differences in health outcomes throughout the Philippines. I was told about difficulties encouraging some Filipinos to adopt Western medical practices, given the longstanding reliance on traditional community healers. That, combined with economic disparities, informs Jenny’s work to improve maternal and infant health by partnering with local governments to increase access to vaccinations and facility-based prenatal and birthing care.

After touring health clinics and hospitals, I saw examples of ongoing efforts to increase health literacy among the general population with extremely limited resources. In meetings with the mayor of Mansalay, I learned that PhilHealth – a publicly funded health insurance program equivalent to Medicaid and Medicare – requires certification of facilities before Filipinos can access them. So while Mabini’s health clinic was PhilHealth-certified for vaccinations, it hadn’t achieved its PhilHealth certification for other health care services raising questions about how or where uninsured residents of Mabini could access affordable care.

Through meetings with regional Department of Health staff, I learned that despite nationwide prioritization to achieve Millennium Development Goals, these were largely contingent upon the allocation of scarce public resources for preventative healthcare. Yet cities and municipalities are required to allocate less than 10% of their annual budgets to meeting their communities’ health care needs – more commonly allocating 5%-6% instead, so providing this level of care is often challenging.

Jenny trains mayors and city councilors about the value of increasing budgetary allocations toward preventive public health solutions after conducting a community health needs assessment. Publicly funded health-improvement options can include universal access to potable water, developing or improving solid-waste facilities, universal vaccinations, rabies treatment, regulating prostitution to decrease the spread of sexually transmitted infections, acquisition of ambulances, deploying community health workers to provide health education in remote areas, purchasing and using health information technology to track vital records, and continuous access to birthing facilities and blood banks to reduce maternal mortality attributed to postpartum hemorrhaging.

Back in the US
Now that I’ve returned to the U.S. and had time to process my experiences, I believe the YSEALI Professional Fellows Program can have far-reaching impact beyond its current participants. Pending funding, Jenny, Earl, Shernan and I have agreed to collaborate to roll out a mobile app to increase public knowledge about health care services in their communities.

I’ve approached my employer about strategies to increase breast cancer resources among Filipinos in both the U.S. and the Philippines. The long-term impact of this program has yet to be fully realized, but has provided a foundation for sustainable partnerships.

Toni Panetta is the Director of Mission Programs at Susan G. Komen Colorado