Chapter I THE PROBLEM AND ITS SETTING

Introduction

Community is a group of people who resides in a certain geographic location in which they share common values and interest that allow them to live harmoniously. A healthy community is one of the key determinants of the holistic well-being of the residing families and where they portray a vital role in the general health of people as it influences each individuals views on health and on how they present health as accentuated in their daily way of living. A person to be healthy requires a physical, social, political, economic and spiritual environment where it is possible for him to live a full human life. It is because of this that we can say that a person is born to a community-a community that is formed by people who share common ideals and bounded by some degree of stability. The health status of the community is the determinant of the health status of a person. (Medina, 2001) To affect change in the community would involve community organization. It is not the sole role of the nurse to bring about change; the community itself should will it. With the cooperation of the people in the community and series of nursing interventions drawn form the profile of these families, no problem would be left too insurmountable to solve (Reyela, 2002).

It is believed that a community is considered to be healthy if the persons who inhabit in a certain area are able to comprehend and attain a healthy holistic status. Hence, one of the most essential sole responsibilities of a community health nurse is to provide guidance to the community in the direction of achieving their wellness potential in which we provide acceptable health attitudes and practices. In dealing with health concerns of a family, necessitates a more focused preventive endeavors and comprehensive perceptiveness of their individual needs and disparities. Concerns that influence health satisfaction of the rights and privileges of these vulnerable sectors are mounting. The fortification of the said right, one of which is the right to live a healthy life is essential to realize their fullness potential, development, and productivity. As an integral part in fulfilling the roles and responsibilities of a community nurse, one should focus on the health purposes and goals that are realized through the application of a series of nursing steps leading to the attainment of yearning results through the utilization of the nursing process that serves as the very essence of nursing in addressing community problems. Barangay Balite Lagao, General Santos City indicates the simplicity yet wondrous means of living of an urban community in the Philippine setting. The population is approximately 7423 residences, ratio of male 6% is to 4%, 6% are males: 4% are females. It is where we are given the chance to sort out the lives of an individual, an individual that comprises a family that serves as the basic

functional unit of a community, a community that is bounded by their harmonious relationship as they depict their lifestyles and practices which in turn mirror their health conditions. Throughout the entire exposure we are able to assess the factors that can affect the health condition of the community. These factors includes socio-economic, environmental, political, health services, family history and behavioral.

Statement of the Problem This study aimed to present a comprehensive view and assessment of Balite Lagao community through the selected medical technology students of BSMT2-B interrelation and immersion with the inhabitants and officials of Balite Lagao, General Santos City. It will specifically answer the following:
1. to holistically describe Barangay Balite in terms of :

a.

congregating

the

physical

and

geographic

data,

demographic data, economic conditions, and rates;

b.

mortality and morbidity

documenting the food preparation and nutritional status,

deworming status, Immunization status, Pre-natal check up and other services available.
c.

determining the community leadership and organization,

and development agencies existing in the community

2. to identify community health problems and needs as verbalized by the people and as observed by the students. 3. to identify any wellness state, health deficits, health threats, foreseeable crisis and stress points that exist in the community; 4. to formulate recommendations according to the problems identified within the community and to prevent further occurrence of possible problems that can affect the holistic health of the people living in the said community.

Chapter II PRESENTATION OF DATA

This chapter presents the information and assessment of the students about factors that affects the health.

I. Environmental Factors WATER SUPPLY Water is one of the most vital natural resource for all life on Earth. The availability and quality of water always have played an important part in determining not only where people can live, but also their quality of life. Even though there always has been plenty of fresh water on Earth, water has not always been available when it is needed, nor is it always of suitable quality for all uses. Water must be considered as a finite resource that has limits and boundaries to its availability and suitability for use. Assessment Based on the survey, the main source of water supply in this barangay is the water district. While other houses depend on water district, some are relying to water pumps. And these water pumps are unapproved types of facilities which may cause water-borne diseases like Diarrhea, typhoid, Hepatitis A and Bacillary

and Dysentery. Water may be positive with Coli bacteria and exposure to this contaminated water will predispose residences to water-borne diseases.

TOILET FACILITIES A toilet is a plumbing fixture primarily intended for the disposal of human excreta: urine and fecal matter. Additionally, vomit and menstrual waste are sometimes disposed in toilets in some societies

(http://enwikipedia.org/wiki/toilet). Toilet facilities can be identified as either into a water sealed type, flush septic tank type, pit privy type, unsanitary type, bedpan or anywhere. A toilet is a facility at home created to provide as a place wherein it is used for the disposing of body waste out the body which is used by all members of the family in each households living in a community. Assessment Each household contain at least 1 toilet. Based on the observation, even though people have toilet on their homes, some of them are not well trained on having proper excreta disposal. Excreta are found near the irrigation canal. E. coli is found in the human waste and since these wastes are found near irrigations, it is directly in contact with water when the irrigation overflows during heavy rains. Children within the community aging from 3-5 years old would be exposed to E. coli if they play on the ground and they can acquire diarrhea.

Drainage System Drainage System is a system of watercourses or drains for carrying off excess water from land by means of drains, conduits, canals and etc. (www.thefreedictionary.com/drainage+system). Drainage itself refers to the pathway of waste from the various sources within a community. There are two types of drainage: the open drainage (a type of drainage where excess water flows through a system of pipes to an open pit) and the blind drainage (a type of drainage where waste water flows through a system of closed pipes to an underground pit or covered canal). (Maglaya Book, 2004). Assessment The drainage system of barangay Balite Lagao is an open drainage. It is flowing directly to the irrigation canal. This implies the community is predisposed to acquire diseases since almost all of the population has an open type of drainage system. A simple or heavy rain can cause flooding and water will be stagnant that can cause favorable conditions of mosquitoes that can transmit to malaria and dengue. Malaria and dengue is a serious disease spread to mosquito bites. Like malaria, dengue spreads through mosquito bites.

Waste/Sewerage and Garbage Disposal Waste/sewerage refers to the water-carried waste, either in solution or suspension that is intended to be removed from a community. In loose American Language usage, the terms sewage and sewerage are sometimes interchanged. Garbage is classified into many different types. The most common methods of classification are by their physical, chemical and biological characteristics. The garbage can be disposed through collection, transport, processing, recycling or disposal, and monitoring of waste materials. This is usually relates to materials produced by human activity, and is generally undertaken to reduce their effect on health, in the environment or aesthetics. The solid, liquid and gaseous or radioactive substances, with different methods can evolve. When there is proper garbage disposal, the community will have a clean environment.

Assessment Sewerage systems are flowing directly into the irrigation canal. Sometimes it overflows and is stagnant. Garbages are segregated at source (biodegradable, non-biodegradable, recyclable). It is collected every week but there is no fixed

schedule of collection. The collectors do not collect the garbages if it is not segregated. Most people in the community use burning as their way of garbage disposal. This indicates that the people still continue this method of unhealthy. Most household still continue the use of burning and dumping which could be attributed to the people unchanging behavior. People should know the right way to dispose their garbage to minimize the spread of infections and reduces the risk of accidental injury to the community; it helps provide an aesthetically pleasing atmosphere, reducing odors, attracts fewer insects and does not attract animals and reduces the likelihood of contamination of the soil or ground water with chemicals or microorganisms

Transportation Transportation is a means of travelling or any device used to move an item from one location to another. Public Transportation is a service that is available to the general public and that carries passengers to destinations for free (Microsoft Encarta Premium 2009).

Assessment The main transportation in this barangay is tricycle. We can account some of the respiratory problems experienced by the residences to their

exposure to carbon monoxide/vehicle smoke. The environment plays an important role in the development of diseases. Carbon monoxide can weaken the immune system thus predisposing people to other diseases other than respiratory diseases.

II. Behavioral Factors Common Practices in Food Handling, Preparation and Consumption Since carenderias are rampant, the students observed that a food worker touches the food without washing their hands, utensils are not sterilized, food served are not properly covered which may cause contamination.

III. Health Factors Leading Causes of Mortality Death is indeed inevitable. People die due to many reasons, at no exact time at no exact place with indefinite reasons. But with the case of the mortality rate at Barangay Balite Lagao the leading causes are hypertension, dengue, and diarrhea. In addition, from birth to 6 months, SIDS (sudden infant death syndrome), 3-5 age is prone to diarrhea, 6-10 age is more prone to dengue, 35-

65 age is prone to hypertension. The most prone to this diseases are the males with a ratio of 7% to 3%, 7% males : 3% females, that causes morality.

Assessment Based on the students observation the dengue cases are linked to the stagnant water in the sewage/drainage systems. Due to the fact that mosquitoes breeding sites are stagnant water, thus dengue is rampant. While surveying the barangay, the students saw worms on the ground where the children play. In addition, excreta are found near the irrigation canal. E. coli is found in the human waste and since these wastes are found near irrigations, it is directly in contact with water when the irrigation overflows during heavy rains. Children within the community aging from 3-5 years old would be exposed to E. coli if they play on the ground and they can acquire diarrhea.

This observation can be associated to the fact that children from 3-5 age is more prone to diarrhea. This is because Furthermore, the students found out that most men are chain smoker. Smoking is one of the major risk factors of NCDs (non-communicable diseases) like hypertension. Since these men are predisposed to smoking, the chance of having hypertension is high.

Cough is a common problem among the residents. This is due to exposure to changes in climate, unhealthy lifestyles and low resistance against certain agents (bacteria, virus). Others experiences common manifestations of illness due to unhealthy diet because of the nature of lifestyle of residents. Say for example tricycle drivers, their exposure under the heat of the sun and carbon monoxide/vehicle smoke makes them at risk for heat stroke and lung cancer. II. Health Services Immediate source of Medical care (institution)

According to Chua, et.al. (2005), the 2003 National Demographic and Health Survey found out that more Filipino households are visiting public health facilities than private clinics and hospitals. Barangay Lagao has four health centers namely Lagao Main Health Center, Hikban Health Center, Stabillo Health Center and Balite Health Center. The health services are only available based on the scope of places they handled. In Barangay Balite, it includes Purok 7, 8, 11, 12 and 15.

Methods of Referral System

PRIVATE DOCTORS HOSPITAL (GENERAL SANTOS CITY HOSPITAL) SPECIALISTS

BARANGAY LAGAO HEALTH CENTER (MAIN HEALTH CENTER)

Barangay Balite Health Center

Hikban Health Center

Stabillo Health Center

This diagram shows the referral system of the community. From their own health center, people are being referred to their main health center which is the Barangay Lagao Health Center. From the said health center, people have their consultations and health concerns raised to private doctors, specialists and hospitals. Availability of medicine and clinic supplies The Barangay Health Center somehow caters the health needs of the residents in Balite. Truly, the scenario with regards to health support is inadequate, yet through the aid of the Main Health Center and Local Government Units some of the supplies especially with regards to public health programs implementation. The World Health Organization (WHO) defined health in its broader senses, "it is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."Yet in spite of how health care provider would want to extend health throughout all the individuals, still, its not enough. Since the Doctor and other health team assigned at Balite reports at the Main Health Center, some the residents are being deprived of the

health they would want to achieve. Thus the location of the area and the busy schedules of the health provider becomes a barrier. To promote health at its optimum level, the barangay health center caters consultation and the other public health programs provided by it. The residents of Balite recognize the health center when they experiences common symptoms which includes cough, fever and colds and are prescribed with certain indicated medications which the residents obtained through whatever means (Botika sa Barangay, health center). Immunization Status Immunization is the process of rendering a person immune by active (toxoid, inactivated, killed organisms) or passive process.

In here, immunization status is only applicable to ages 0-1 year old. Based on the students survey, mothers can avail this service for free. Immunization service is available every Wednesdays. Babies who have received complete immunization are most likely to be susceptible to having such types of diseases (measles, chicken pox, tetanus and etc) and may even die the moment the disease occur that their immune response is week. Babies who have already completed, on the other hand, is likey to be compromised with the disease since they have stronger immune response.

Deworming status

According to the Department of Health (2000), many programs on the deworming of children have recently been established to effectively and efficiently control the soil transmitted helminthiases and mass deworming is considered. On the other hand, there are still children who had never been dewormed. Children belonging to 2 to 6 years old are easily infected and they should be given treatment. Intestinal parasites live as long as 5 years, passing out as much as 240, 000 eggs per worm per day. With unsanitary disposal of human stools, the eggs develop in the soil and can mechanically infect humans when fingers, food or water are contaminated with parasite eggs from the soil or when infective larva of hookworm in the soil penetrate the skin of barefooted individuals. In areas where water is not safe for drinking, families should learn how to boil properly (at least 2-3 minutes from boiling point) or chlorinate.

Prenatal Check-up A pregnant woman would never know whats going on with the fetus inside mothers womb unless she have it regularly checked and monitored. Prenatal check-up there are many cases of cerebral palsy in babies due to lack of knowledge of those moms to be. Some of them take medication without knowing they are bad for the babies health which ends up causing abnormalities to the fetus. Some dont even

bother to go on a check-up to find out if the baby is healthy or not.

Prenatal check-ups are made available at the barangay health center every Tuesdays which are headed by the midwives.

Family Planning and Method Family planning refers to an organized, scientific, and manageable planning and spacing of child birth according to wishes of the couple rather than to chance. An acceptor of family planning method indicates that a person accepts any means of family planning that may or may not be user. While continuous users are those that both accept and uses any form of family planning. Based on our observations, a number of family members that is beyond what a family can afford may pose a threat to the level of wellness in each of the family member. A bigger family may means scarcity of food and resources available for consumption. If this is tolerated, problems like malnutrition, inadequate living space are most likely to occur.

Schedule of Activities MONDAY A.M- District Meeting TUESDAY Prenatal Check-up

WEDNESDAY Expanded Program for Immunization

THURSDAY- FRIDAY Resupply of: TB drugs Family Planning

IV. Socio- Economic Factor Main Source of income Source of income is very essential and important for each individual. Income is the money or other assets received, esp. periodically or in a year, from ones business, lands, works, investments, etc. (Oxford Dictionary, 2003). Based on our ocular observation, the main source of income in Balite are Sari-sari stores and Food establishment like Carenderia. This implies that favorable living conditions depends on certain income earned by a family per month because they can buy what they wanted for such abundant income being received every month. Monthly income really has an influence to the development of the family. Families with bigger amount of monthly income are able to avail themselves of better housing and proper nutrition. This has a big impact in the health of the family because having such income cannot support

any types of needs like nutritional, financial, and educational needs, including the facilities that may affect monthly budget income.

Housing Ownership Housing ownership means that if the families have owned the house they are in that means that the housing ownership is classified as owned. That simply means that they have the full authority over their house. While on the other hand if the house is rented this would mean that the renter will dont have full authority of the said house and will pay for the cause of living in the house and thus, will be classified as rented. This indicates that majority of the families own their houses per see. This resembles that out of the high availability of the commodities, the family still able to ponder to allot savings in attaining their personal houses in providing roof for their children as form of shelter and home. Type of Housing The type of housing of the community members also reflects their social-economic status. Usually those families that have average and high income rates have houses which are concreted. These families can afford to buy materials that are expensive for the building of the house. While for the families who has low income rate are usually have the ordinary or scrap type of houses because the raw materials are cheaper and more comfortable compared to the concrete houses materials.

Since most of the houses are ordinary in representation, these consider that their houses are made of wooden materials as foundations and framework in construction. This may be addressed also that modernization was not evident in their community as to transformations of houses following adaptation immediately in the trend of the recent status of the urban society. However, factors such as financial constraints and convenience must be considered in response to the adaptability of the people in the community as well as their sense of considering their houses their basically as it is.

Chapter III RECOMMENDATIONS and CONCLUSIONS

Presented on this chapter are the conclusions and recommendations which were based from the data presented, interpreted and analyzed.

Conclusions During the students observation, we conclude that the community has major problems they were not able to work out without help from proper organizations, appropriate people and from Barangay leaders and they lack

resources such as financial, facilities and many more. We therefore conclude that the community needs help from the government and non-government observations, however the people are not fully cooperative and collaborative because they were not informed and aware because of this, instead of helping in their community they do nothing and wait that help will come. The community, Barangay Balite, is a typical community which has major problems thus we cannot call it a healthy community due to problems with different concerning factors, but we can state that the community has a potential to enhance their wellness and living as long as there are people who will help and guide them to achieve the highest possible level wellness and they should start it by being responsible of their actions and be disciplined of their behavior, because as what we have observed most of their problems have a relation to their attitudes and lifestyle, thus people should help themselves as well as collaborate, cooperate and participate with other organizations to achieve a healthy community. Recommendations The following recommendations were made: 1. Community should have youth organization that implements activities for them to divert their attentions from drugs, smoking and alcohols. 2. Maintain proper hygiene by taking a bath every day, trimming their nails, washing of hands before and after eating; change their clothes if it is soiled and brushing their teeth regularly.

3. Annual water quality assessment should be done to monitor the condition of the water facilities. 4. People should clean their surroundings regularly especially their drainage system avoid the presence of mosquitoes and other vectors. 5. People should be encouraged to practice proper waste disposal. Proper waste segregation should be observed and the garbage container must have a cover and properly labeled. 6. Food establishments must improve their cooking and storage facilities by having appropriate container that has cover to avoid contact with vectors. 7. People should maintain a good and clean environment. The breeding and resting sites such as used wheels should be eliminated to avoid presence of mosquitoes and other vectors. 8. Improve the familys health attitude by utilizing not only the health services but also the other facilities offered by the community. The family should know the proper intake and dosage of medicines. 9. Children must be thought of proper excreta disposal. 10. Community must promote healthy communication among the leaders and the people to address the problems.