by: Charlotte Floors

1.1 Introduction
Indigenous communities in the Philippines have originally lived on food from seas and forests and from agriculture, such as fish, root crops, vegetables, rice, coconuts and game. Due to a history of trade and conquest of Spanish, American and other foreign colonizers, new kinds of foods unfamiliar to indigenous peoples came into the country, such as noodles from the Chinese and sugar from the Spanish.1 The Americans further developed the sugar industry and subsequently brought in fast-foods. Thus, foreign influences gradually changed the traditional diets of Filipinos. The spread of highly processed foods such as white rice and white bread can be ascribed to the difficulty of preserving unprocessed whole wheat flour and unpolished rice, which deteriorate easily when stored.

This was especially important when rice became highly commercialized, after the Green Revolution in the 1960s. It was during this time that rice-milling machines were more widely used. A cultural aspect also came into play: people saw white polished rice as ‘superior’ to the brown rice they used to eat. Brown rice looks ‘dirty’ and is considered ‘food for the poor’, while white rice is associated with wealth.2 Moreover, people became used to the taste of white rice.3 In fact, these processed products are much less nutritious than their traditional counterparts.4
People have gradually shifted from their traditional diets to one consisting of sugar, milk, meat and artificial additives, such as the widely-used monosodium glutamate (MSG). As a result, the number of people with health problems such as nutrient deficiencies, infectious diseases and chronic diseases have increase dramatically, both in rural and urban areas.
Dr. Susan Balingit is one of the founders of Sandiwaan, a non-stock, non-profit organization set up in September 2002 to provide a scientific but practical solution to the worsening health problems in Philippine society, especially in marginalized communities.

Sandiwaan was formed by like-minded men and women who were looking for a more sustainable and accessible solution to the increasing health problems of the country. Its vision is an empowered, healthy and dynamic Philippine society where communities are sustained on naturally growing food resources; value their local histories, indigenous knowledge and practices; have ecologically sustainable livelihoods; and participate in local governance. Its mission is to help in the rediscovery and utilization of traditional diets and indigenous resources of communities. To do so, Sandiwaan conducts research on emerging health problems, traditional food and dishes, and success stories of individuals and communities. They also provide trainings for health and wellness workers to promote health in the communities, and carry out programs focused on the different components of their vision.

1.2 Background

1.2a Dr. Susan Balingit
Before Dr. Susan Balingit (also known as ‘Doc Susan’) started with her advocacy for better health for Filipinos, she was an anesthesiologist, with a background in Western medicine. After her medical studies she worked in a Swiss hospital. In Switzerland, Susan followed ‘the American way of life’. She drank lots of soft drinks, avoided salads, and subsisted on junk foods. However, Susan soon realized that she wasn’t living the way she wanted and wasn’t becoming the person she wanted to be. She dropped anesthesiology and turned to Eastern health traditions, especially traditional Chinese medicine. From this new perspective, Susan learned that health was a state of balance in which food is the key. The forces of Yin and Yang shape this perspective. Opposite features are ascribed to different kinds of food (e.g., warm and cold), and balance between opposing elements becomes the goal. Susan compares the perspective to a swinging pendulum: when eating the right food, like vegetables and whole grains, the pendulum stays in balance. However, eating sugar and meat, for example, makes the pendulum swing to one side or the other, bringing imbalance to the body and leading to physical problems or illnesses.5

With this new perspective, and after realizing that she couldn’t really help ‘her people’ while working in a big hospital, Susan committed her life to communities in her own country. She worked with a number of NGOs and studied herbal medicines and traditional food practices. Susan is currently coordinating local health reform investment initiatives with the Department of Health in Nueva Vizcaya. She serves concurrently as consultant in several health programs. In addition, she advises patients who need special diets. Susan’s patients usually felt much better or even got cured after following her prescribed diet. She is now documenting these experiences and sharing them, as a way to convince others to try her approach.

1.2b IDEAS
Dr. Susan’s fame as a health promoter has spread over the years. She was invited by Institute for the Development of Ecological & Educational Alternatives (IDEAS), a local NGO, to visit the town of Quezon in Palawan and to give a training on health promotion. IDEAS is concerned with sustainable agriculture and has six staff members.

IDEAS was founded in 1986 in Cavite, where they started a solid waste management program, composting biodegradable waste into organic fertilizer. The organization also set up a sustainable agriculture project in Mindoro. In 1998, IDEAS opened a program in Quezon, Palawan. Quezon was chosen for three reasons: 1) the town had no NGO concerned with sustainable agriculture, 2) the farmers in Quezon were relatively poor, and 3) forest cover in the area was declining.

In 1968, about 92 percent of the land area of Palawan was still forested. By the mid-1990s, however, this had already declined to an estimated 50-60 percent.6 In 1991, Palawan adopted its Strategic Environmental Plan (SEP). Backed up by Republic Act 7611, logging in virgin forests was banned. According to RA 7611, the SEP is “a comprehensive framework for the sustainable development of Palawan, compatible with protecting and enhancing the natural resources and endangered environment of the Province” However, the ban didn’t automatically stop illegal logging. Many logging concession workers lost their jobs and wood prices went up. Illegal logging persisted, because wood was still needed for construction and housing. The practice of slash-and-burn (kaingin) farming also had a long tradition in the area.7 The influx of migrants, population increase, lack of livelihood opportunities, and the entry of mining companies pushed people to encroach into the remaining virgin forest even further.

The IDEAS program in Quezon consists of technical advice on agricultural practices and microcredit to small farmers. It also markets sustainably-produced products, such as oven-dried bananas and herbal tea. Sustainable agriculture includes the use of natural fertilizers. Backyard gardening encourages soil conservation. If soil depletion is arrested, people don’t have to abandon their land. Workshops are organized on natural methods of pest management or about different kinds of plants and why they grow in certain areas but not in others.

The program focused on existing organizations in the area. If there were none, IDEAS itself helped organize the people. They met once a month with the organizations, to discuss problems, motivate inactive farmers, and give advice where needed. The meetings are important for PO development and strengthening, as actual problems are discussed within the group and solutions and ideas are exchanged, with IDEAS acting as facilitator in this process. IDEAS also assists in the farmers’ ability to record the outcomes of their investment. This gives the organizations deeper insight into their achievements and greater motivation for the participants to stay active in the program.

As IDEAS experienced difficulties in motivating people to conserve their natural resources, it focused on a more personal level: people’s health. IDEAS studied the condition of people’s health and found out that water borne diseases, such as malaria and diarrhea, were the most prevalent in the area. In 2004, IDEAS invited Susan to conduct a health training in the area. Another NGO based in northern Palawan, the Palawan Centre for Appropriate Rural Technology (PCART) had already heard of Susan’s work. IDEAS and PCART are both members of the Palawan NGO Network Inc. (PNNI), which made it easier for the two NGOs to work together. The main goals of the training program were: 1) to find ways to limit deforestation from slash-and-burn farming, 2) to tap local food sources for household consumption 3) to help people rediscover these foods; and 4) to improve people’s health.
IDEAS is funded by the German NGO ‘Bread for the World’, which aims to change conditions, policies and programs that allow hunger and poverty to persist. It also applies for additional grants from local funders, like the Foundation for the Philippine Environment (FPE).
To promote its perspective, IDEAS runs its own one-hour radio program on a local radio station on Sundays, where it discusses its programs. IDEAS also pursues food consumption issues in meetings with POs, government officials and other NGOs, when ‘urban’ food is often served: sugary snacks, white rice, meat, bread and junk foods. Apart from this, IDEAS is involved in different councils within the municipality. It sits in the General Assembly (GA) of the Municipal Development Council and the Municipal Agrarian Reform office, and attends special meetings aside from the once-a-year GA.
In April 2008, a ‘Katutubo Food Festival’ will be organized. In this one-day cultural festival, people of the communities will bring and cook their own food and and play their own songs and dances. The Mayor of Quezon will give a speech and Doc Susan talk about her health program.

2. The Health Training
While the health training given by Doc Susan follows a tried and tested structure, the narratives or explanations may be adjusted based on the target participants. A training for day-care health workers from different barangays in the Municipality of Bontoc, Mountain Province, described below, gives an idea of the contents of the training.

2.1 Flow
The training starts with a rediscovery workshop in which participants, grouped according to age categories, are asked to recall their past and note their environment and health, using a questionnaire format as guide. The participants do this in a ‘narrative’ way: telling the story of their lives and the changes within it. However, with a large number of participants, this can be difficult. In this case, participants sometimes resort to a simple table of some ‘highlights’ from their lives. The results are then presented and discussed by the group.

The next part concerns body functions: what does a body need to function well? Then, they deal with health as a social issue: what has shaped the way we eat today? Finally, discussions are held with the community about what can be done to promote good health, with focus on the specific situation of the community involved. In Bontoc, for example, the initial question from the day-care health workers was how to keep children healthy, which ended in a discussion about how to put into practice the lessons gained from the workshop. An experimental cooking session usually concludes the program, to share recipes and cooking ideas and to experience the tastes resulting from various ingredients, herbs and cooking techniques. In Bontoc this involved cooking with camote and beans. They also tried different ways of preparing ginger with the food.

2.2 Content and Outputs
It is important to understand the concept of ‘health’ during the training, as concepts of healthy food may vary. The main reason communities abandoned their traditional diets is the introduction of foods such as white bread, milk and sugar, as well as various snacks found in every sari sari store. The training introduces the idea that diseases can be caused by the consumption of these foods. People often eat these kinds of foods because they don’t think about the health implications and how these new foods differed from their traditional foods. Foods traditionally consumed by rural communities such as cassava and camote are often considered to be ‘food for the poor’ and are therefore unpopular. The training program stimulates people to revalue and rediscover these local and indigenous foods, especially vegetables.

Apart from rediscovering their surroundings and its effects on health, people are also encouraged to recall their traditional handicrafts/products (such as spoons and plates from coconut shells) or cultural expressions such as songs. The rediscovery process highlights indigenous knowledge and practices (IKP). Often communities felt ashamed of some of their traditions, such as eating with handcarved wooden spoons, or cooking food like rice inside bamboo cylinders over a fire. The IKP concept helps communities acquire a new appreciation of these old traditions; it makes people feel proud about their own culture.
By encouraging such rediscovery, other benefits aside from health and cultural preservation may come about, such as biodiversity conservation and poverty reduction. For example, sustainable crop production and forest gathering, draws farmers away from shifting cultivation. When farmers produce for their own consumption, the need to buy from the market goes down, saving them money for other purposes. Waste is also reduced, as people buy less junk or processed foods and have less non-biodegradable materials like plastics to dispose of.

3. Initiating a New Concept

In the first training Doc Susan gave in 2004, participants from different sectors were invited: one or two members from farmers’ organizations, barangay health workers (BHW’s), and employees from the Rural Health Unit (RHU) of the Quezon municipal government. This was meant to narrow the gap between Doc Susan’s health approach and the ‘modern’ approach. The local government’s health unit confronts ill health with vaccinations and medicines; Doc Susan attains natural healing through food – the food is the medicine. Another point of contention is the consumption of milk. Infant formula milk has been aggressively promoted commercially, leading many mothers to shift from breast milk to formula milk for their babies. Until recently, the government has tolerated the advertised claims – often false – of formula milk companies.8 Besides, milk is considered healthy by many Filipinos and government agencies. However, Doc Susan’s trainees learn that commercial milk contains various contaminants such as hormones and antibiotics and the undesirable side effects of these contaminants may negate the benefits.
A second training, given one year after the first, was also conducted for IDEAS members to re-echo the first training. The second training was also more specific, as people were already familiar with the subject.
After these initial two trainings, IDEAS continues to promote the concept: people are encouraged to eat vegetables and unpolished rice, to use herbal medicines, and to leave products such as white bread, white sugar, and milk out of their daily meal.

To promote the concept further, every organization picks one community health and wellness worker, who monitors developments in the community and is trained on the concept of IKP. These health and wellness workers were identified based on the first two trainings. IDEAS convenes them every three months, to discuss developments and give advice where needed. Often, other community members also attend.

These meetings usually include a cooking session, a walk through the vegetable garden, conversations about health problems, and other ways of helping the health and wellness workers in their efforts to motivate the community towards the ‘new way of eating’. A personal approach is often the most effective. Individual success stories help highlight the benefits of the new diet. Within the community, church occasions such as Sunday masses or weddings become occasions for people to cook together and share their new recipes.

The program reaches both men and women: men often dominate organization meetings; women may be present but they often stay silent during meetings. To reach women better, various strategies are tried, like conducting smaller, more focused, meetings within workshops; during cooking sessions; or in informal visits. Because the activities are done close to their homes, women are often more involved in vegetable planting or mean preparation activities, so these provide good opportunities for drawing in the women. Eventually, it is often the women who become promoters of the new diet.

4. The Program in Practice

4.1 The communities

IDEAS started its sustainable agriculture program with 13 people’s organizations, consisting of around 20 members each. The communities are all located in the Municipality of Quezon. The experiences and practices presented here were documented from visits to sitios in barangays Maasin, Isugod and Panitian.
Sitio Tumarbong in barangay Maasin consists of around 70 households. The local tribal organization is “Samahan ng Katutubong Magsasaka sa Ikba”. It joined IDEAS’ sustainable agriculture program first, and then the health program later. The houses in the sitio are scattered, and some houses may be 1 km away from each other. The area is partly covered with virgin forest and is partly used as farmland by the community – to plant vegetables, coconut trees, corn and rice. Other areas have also been used for this purpose.
Vegetables are abundant; in addition to what they gather from the forest, people also plant vegetables such as calabasa (squash), talong (eggplant), pechay (chinese white cabbage), okra, various root crops such as camote (sweet potato), gabi (taro), cassava and patani (lima beans).
While there are some free-range pigs and chickens, people don’t consume much meat. Chicken may be consumed once a month, or on special occasions such as weddings or funerals. Sometimes wild pigs are caught and eaten but this is rare. People also supplement their income with fishing, or collecting crabs, especially in households only 1 km away from the seashore.
Coconut is regularly used in meals: dishes like vegetables are cooked in coconut milk, mashed banana is wrapped and cooked in coconut leaves. Mushrooms and leafy vegetables from the forest are common in dishes..

The community is strategically located: it is close to the forest, but is also engaged in farming. Combining vegetables gathered from the forest with crops produced from their fields is a common practice.

During our visit to the sitio, Nacia Uliba, a barangay health worker (BHW) tells the story of her sick nine-year old daughter.
‘My daughter suffered from meningitis and had to be brought to the provincial hospital. In the hospital, they would give her milk because she was unconscious and unable to eat solid food. But I wanted her to eat steamed vegetables and unpolished rice. I negotiated to cook food for my daughter in the hospital kitchen because I didn’t believe milk would help her. Even my family got angry with me because I did that. They didn’t understand why I wouldn’t follow the doctor’s advice. I fed my daughter with porridge, a mix of unpolished rice, camote and other vegetables, for 13 days and she got better.’

Nacia was one of participants in the training. As a BHW, she is the first person people go to when they get sick. BHWs are not authorized to treat sick people; they are told to refer the person to a midwife or a doctor. Nacia simply tells her patients to eat only local food, mostly vegetables and unpolished rice.

Though this is one way of spreading the idea, not all BHWs promote the new diet. But Nacia, who saw her daughter’s health actually improve, is convinced of the new diet. Personal stories like this often encourages others to try the proposed diet. Sometimes, an illness provides the incentive to change diet. The most common illnesses in the area are diarrhea and malaria. Nacia, who is also a microscopist (she takes blood samples to look for malaria), records data on malaria incidence in the area. The table in page 106 reveals a possible correlation between the new diet and the low incidence of malaria among community members who are members of IDEA.

Although the relatively lower incidence of malaria among IDEAS members suggests a correlation, further research is needed to establish the connection.

According to Doc Susan and other community members, mosquitoes are more attracted to persons that consume more sugar. This may explain how a low-suger diet can decrease the risk of malaria, simply by reducing the risk of being bitten. They also attribute the lower incidence of malaria to the higher resistance resulting from the healthier food. In 2001, the government introduced an anti-malaria program: Kilusan Ligtas Malaria (KLM). The program entailed providing mosquito nets, spraying insecticide and educating communities about prevention. Activities such as stream cleaning and burning dry leaves to make the site less favorable for mosquitoes were undertaken. Barangay microscopy centers were also established to take blood smears and provide treatment.

In the case of diarrhea, followers of the diet believe that the disease is more likely to occur in people with lower resistance. Following the new diet is said to improve people’s resistance to disease, thus reducing the number of diarrhea cases. IDEAS started installing water pumps in the barangays of Pinaglabanan, Isugod, Maasin, Panitian, Tabon and Sowangan in 2006. The program continues today, using the manual drilling equipment that IDEAS provided. The water pumps reduced the risk of water contamination and diarrhea.

The situation in the other sitios is similar: they are far from the urban areas of Quezon, near forests, or among farmlands. The organizations involved in the IDEAS program are all tribal groups: Bunyugan Pala-Wan Dotdibwat Quezon in sitio Tagbarukbok, barangay Isugod and Samahan ng Nagkakaisang Katutubo sa Magara in sitio Magara, barangay Panitian. Three tribes in the area are a member of Matripal (Magkakaisan Tribunang Palawan). They are also members of PNNI. The tribes have their own ancestral domains and don’t go out of these areas. Problems have arisen with mining companies and illegal loggers: communities are often offered huge amounts to sell their lands. One of the communities involved with the IDEAS program has already declared that they would not sell their land for anything, which might be an effect of IKP: people are proud of what they have.

4.2 The Effects
Communities have not necessarily changed their livelihoods, but there has been a change in how they pursue their livelihood. Before the health program came in, people would market their crops in Quezon, to buy goods like instant noodles, snacks and bread. Or they sold their crops to middlemen who visited the communities once or twice a week. The health program encouraged them to consume their own food crops, and sell only the surplus to the market. Currently, the communities have adopted this practice: they produce crops for their own consumption, and sell the surplus to the market. It led to a decline in junk food consumption and reduced the amount spent on these foods.

The sustainable agriculture program reduced farmers’ costs: they don’t use expensive fertilizers and chemicals anymore. Old practices used to rapidly deplete the soil’s productivity, forcing farmers to open up new areas for farming. With the new sustainable farming practices which maintain the fertility of the soil, there is no need now to open up new areas regularly. However, slash-and-burn farming is an old tradition in the area and is still being practiced. The practice is hard to change within these communities, as it has become part of their culture. The sustainable agricultural program has made them more aware of their environment and the effects of their behavior, especially since the population has increased and migrants have moved into the area. Slowly households are shifting from this practice to sedentary agriculture.

IDEAS estimates that around 90 % percent of its members follow the proposed diet. However, they do so in varying degrees, like limiting sugar intake, avoiding MSG and consciously choosing indigenous vegetables. What is important is that people are rediscovering their indigenous food ingredients and recipes and are beginning to appreciate their nutritive value and healing effect on the body. Before they gained more knowledge about health, people had some idea about ‘bad’ or junk foods. But since the health training, they have also learned what are the ‘good’ foods and why they are so. The bad effects of sugar found in many processed products and even in ripe fruits were also new information for the community members. Pork had been a popular food before, but consumption has now decreased, which the community members ascribe to the knowledge they gained from the health program. Some men in the community admit that they changed their meat consumption when they acquired health problems such as hypertension and arthritis, which they heard about in the training.

The benefits of waste reduction and biodiversity resulting from their change of behavior are also now understood by the community. Their new appreciation of food has also lead to a new appreciation of their culture: their songs, cooking methods, and even their utensils such as cups and spoons.

5. Keys to Success
There are a number of reasons why the program was successful in the areas we visited. One positive factor is the relative remoteness of the sitios. People live close to the forest. Gathering wild plants and vegetables and farming has been a long tradition, one that is still easily recovered. Another reason is the poverty: eating the proper local food for better health is much cheaper than seeing the doctor, buying commercial medicines and seeking hospital treatment. Moreover, doctors are not readily available: one nurse is available per barangay but people need to go to the town center for hospitalization or even to Puerto Princesa or Manila in severe cases. Quezon may be as far as 9 km (depending on the household) from barangay Maasin and 25 km from barangay Isugod. People have to walk or use a tricycle on the rough road. The lack of easily-accessible medical care makes people eager to learn how to keep healthy and disease-free.

The ’modern’ way of health care, as promoted by doctors and hospitals, is vaccination and medical treatment, not a change in food habits. For IDEAS, however, diet is the most important factor in promoting health. This may be a reason why there is not much cooperation between IDEAS and, for example, the Rural Health Unit (RHU), which gets funded by the Department of Health. The RHU is not even aware of the on-going health promotion program of IDEAS. This is probably due to a change in personnel, as the people we saw were not those who attended the first health training. The training was neither re-echoed nor promoted within the unit. These differences in perspective towards health problems may hamper the spread of the concept to other parts of Palawan and the country.

Relative isolation from urban areas has both its advantages and disadvantages. People are more interested in trying ‘urban’ products if these products are not readily available. The incidence of sickness in rural areas is often lower compared to the highly populated city. This does not give people a strong incentive to eat healthy foods; they are not that sick after all. Malaria is an exception, which is found more in the rural areas.
The more natural surroundings of rural barangays is an advantage. Vegetables and herbs are easily available. However, the association of nutritious food products like camote and cassava with poverty is often a problem. Still, after the introduction of the health program, this image has changed gradually. People found new ways of cooking and saw that the food they had was in fact of much better than those in urban areas.
However, a general shift to a diet of vegetables and unpolished rice remains a challenge. When I asked the daughter of a health and wellness worker what her favorite food was, she replied: ‘spaghetti’.