Hugging a memory of Mita Pardo de Tavera

This blogger's seemingly endless cleaning of hard and soft files revealed this article I wrote in June 2005 for a magazine. I never got a copy of that issue and often wondered if the piece, an assignment, was ever used.All par for the course in the journalism game.

What I remember though of that morning spent with Dr. Mita Pardo de Tavera was how ageless she seemed. It must have been from the enthusiasm she exuded. She introduced me to a lean household staff, including a seamstress who sewed Pardo de Tavera's clothes, curtains, etc. She showed photos of how she looked as a young woman, saying, "I was morena, not mestiza. People think I'm mestiza because I  let my hair grow white."

By some serendipitous happenstance (what a pretentious phrase, that one!), an old pal recently emailed me her memory of Dr. Pardo de Tavera in the context of the woman doctor's participation  in the events leading to and after the People Power Revolt. And now, a few hours before Sunday breakfast, she  appears in my old e-mail files that I am drastically trimming down.

Thank you, Doc Mita, for all the still-relevant reminders on how medical practice ought to be, where government priorities should lie and how the Christ in Christianity is found not in churches but in fields of faith and deed.

The name of Mita Pardo de Tavera, secretary of social welfare and development during the administration of President Corazon Aquino, has often been linked with community health service, she being the founder and chair of Alay Kapwa Kilusang Pangkalusugan (AKAP). AKAP is the pioneer in the developmental approach to health care in the Philippines. It was introduced as a primary health care and community-based tuberculosis (TB) control program in 1974.

Pardo de Tavera, a medical graduate of the University of the Philippines College of Medicine in 1944 (her class is celebrating its diamond jubilee this year), first realized that health service must reach the neediest during the difficult wartime years when she was an intern attending to the sick and wounded at the Philippine General Hospital.

"Those were tough years," she recalled. "But I came from a nationalistic and idealistic family. My lolo Trinidad worked with and was a close friend of Rizal. It's in my blood. You can't take that away from me. I wanted to serve where people were sick with the most common illness then, TB. It was the sickness of the poor brought about by poverty, persecution, etc."

Her great grandfather Joaquin Pardo de Tavera was the lawyer of Fathers Gomez, Burgos and Zamora. For doing so, he was exiled to Guam, given pardon, then lived and died in Paris. Trinidad also served as a delegate to the Malolos Constitution, first secretary of foreign affairs under President Emilio Aguinaldo and was one of three heads of the first American-appointed civil government.

 

Dr. Pardo de Tavera joined Quezon Institute that became a military hospital of the Americans and then the Japanese. During those years there were no medicines, no vaccines to treat TB, not even x-rays. The sick were brought there to die.

She said, "What the Institute offered were services for the dying. We gave medicines for cough and fever. I taught the patients who were spitting blood to cough properly, hindi sa harap ko.I didn't wear a mask. My mother was very much against my working there. I was an only child. She was worried that I might catch TB. But nationalism is in our genes. I felt compelled to serve the people. God took care of me. I didn't catch TB."

All told she spent 30 years at the Institute. From the late 1940s to the '50s, the medicines for TB started arriving. But she realized that "what's important was how to prevent TB." She was a fixture at the Institute's children's pavilion which she described as "a hospital by itself" with a laboratory, x-ray facilities, dispensary, a floor for non-tuberculous pulmonary disease and another for TB of the bone and brain. 

She saw that "TB does not respect any organ. It goes everywhere." She started the specialization in pediatric TB. She rose to become executive secretary of the Institute, running branches throughout the provinces and islands, always going around the country. She even wrote a book, TB in Filipino Children. She resigned in 1974 for reasons she would rather keep private.

She sought out Bishop Julio Labayen to ask for his support so that she could start a program for the control of TB and other rampant diseases to be run by people in the parishes. Thus was AKAP born whose acronym stands for Health Movement of the People, For the People, By the People in English. After asking permission from him, he told her, "You're free to do it."

She began a four-year research, published as "A Model of Supervised Community Participation in the Prevention and Short-term Therapy of TB Among the Poor in Asia." She presented this at the 24th conference of the International Union Against Tuberculosis in Brussels, Belgium, in September 1978.

She started the health program she envisioned in a crowded Tondo community. "I went by myself to the parish and talked to the women. I asked them, 'Gusto niyo bang matuto mag-alaga ng maysakit at iwasan ang sakit?'" Forthwith, she brought out some microscopes and taught the women the basics of diagnosis.

Next she went to a squatters' community in Constitution Hill, Quezon City, then on to Las Piñas and onwards to a squatter relocation site in Carmona, Cavite, doing the same thing, explaining to each parish priest what she wanted to do. She drove to those places by herself accompanied by Florencio Loraña who has been with her family since the '40s.

This was the time of the Marcos dictatorship. It came to a point when she was suspected of being a communist because of her approach, but the authorities did not touch her head of hair. She clarified, "I've been working for the poor. I'm more of a socialist, not a communist. The stand of my family has always been for the people. I was not behaving as a regular doctor would. That's why I left the practice—I wanted to work with the parishes."

But her stand against the dictatorship was always publicly known. She spent four months in the United States raising funds to oust Marcos, and she was part of the organization Women Against Marcos and the Dictatorship.

"Marcos never dared touch me," she said as a matter of pride. She imagined that it might have been because she was a UP graduate and a cadet sponsor at a time when Marcos was with the ROTC.

Who knows? He might have admired her from a distance.

Her visits to the communities astounded her. "Filipinos are exceptional. They have every reason to be angry at you, angry at your good clothes and car, and yet they welcome you. They serve biscuits. They open up and tell me the stories of their lives, the ordeals they had gone through. That's what so admirable—that they can forgive. There are no better people than we, the Filipinos, mga tunay na Kristiyano."

In teaching the prevention of TB and other diseases, her approach would take the path of a parable. She would tell the story of Jesus Christ and the 12 apostles. She would cite the apostles as the propagators of Christianity, "kung paano kumalat ang Christianity, parang dagat na di nauubos ang tubig. We taught the people, and they in turn volunteered to teach others."

At the time there were no educational materials for TB, only medical books for doctors. She knew that many in her audience could not reach nor understand mere words. Nor did she have a slide projector. She realized that in order to make them understand, her materials would have to have pictures. She spent her own money to publish illustrated pamphlets. She tapped a volunteer artist, Lino Montebon, who was referred to her by some medical mission nuns.

He also drew figures using a thick pen on thick katsa cloth, interpreting visually her ideas. Dr. Pardo de Tavera would bring these visual aids to the communities. These tools were a hit. "The people laughed and understood them," she said. "When they're laughing, you get their complete attention."

What she did not do was prescribe or dole out medicines. After her talk, she referred her audience to the health center or on their own they went to San Lazaro Hospital in Manila for the vaccines. She came up with another fully illustrated AKAP pamphlet, "The Control of Tuberculosis: Course of Instruction for Community Health Workers."

Even with a Tagalog version, she again realized that in this country, this reading material would not be understood in Cebu and other provinces. She used a multi-lingual approach, and translators helped her with the five languages per printed page.

She credited the parishes for helping her. "If not through them, I wouldn't have raised money for the booklets."

The booklet helped to train trainors. The training lasted for several days. In turn, each parish would offer her free bed, board and food. She has forgotten the number of the many communities she has visited all over the country.

But according to a handout she gave on AKAP-covered areas from 1974 to 2002, the program has reached as far north as Cagayan Valley, Isabela and Ilocos Norte and as deep south as Surigao, Bukidnon, Davao del Norte and Davao del Sur. In 2003, AKAP covered Real in Quezon, Bula in Camarines Sur and Calabenga, Camarines Sur.

This year AKAP trained more community health volunteers in San Narciso, Calauag and Infanta,
all in Quezon province, and Sangay and Buhi in Camarines Sur. "One of the toughest problems today is still TB. It's worse than 30 years ago because 72 percent of patients do not return to pick up their medicines that are free. TB today is drug-resistant. It's the same bacilli, but it has become reinforced in a way that medicines won't kill them anymore," she warned, adding that the Philippine Tuberculosis Society, of which she was former president, forecasted already that the TB rate would worsen.

AKAP has offered domicillary services. Dr. Pardo de Tavera explained, "This means going to the domicile to give the medicines. If a person has no money for transportation, he just goes to the courtyard of the church to receive the medicines."

Along with the training she gave, she continued to fight Marcos. "I found it enjoyable because I was under the protection of the parishes. You can't tell apart anymore my commitment to the people and against the dictatorship."

So AKAP started spreading the gospel of how to prevent and cure TB, but when she went to Antique, she saw that TB was "just one of many problems." Her audience even asked her to teach them first aid. The number one problem was diarrhea.

Meanwhile, the presentation of her paper in Brussels antedated the World Health Organization's espousal of primary health care. She claimed, "The AKAP program is the first in the Philippines, in Asia and probably the world.  Everybody first heard about my teaching illiterate people, and this caused a furor in Brussels."

But the other doctors got excited, and an organization from The Netherlands donated the equivalent of P4-5 million to AKAP. AKAP was formed for the purpose of teaching people about TB and other diseases. Among those in the core group were Bobby and Sylvia de la Paz, Jaime Galvez Tan, Manuel Dayrit and his wife. The De la Paz couple chose to be assigned to a remote part of Samar where Bobby was later shot dead on suspicion of being a communist.

Pardo de Tavera rushed to Samar. "Bobby's blood was still fresh. When I went there,
the military respected me very much."

She undertook the task of helping produce AKAP educational materials. She wanted a small, light pamphlet that could easily be protected from getting wet when one crossed a river, for example. The extent of literacy was such that she discovered people in many remote places who could not even read or write their names, but their pride was such that they would not admit this. Instead, they would say that they forgot their eyeglasses or that they had a headache.

The pamphlet that was eventually printed just had very simple sentences, sometimes a few phrases but was heavily illustrated. An example of a page showed the contrast between a clean house and one with unsanitary living conditions.

The author said, "I enjoyed writing this. With Filipinos you have to make them laugh so you can be understood."

It took her four years to finish writing the materials, and she wrote all in all 85 pamphlets. She wrote them at home at night. "It's nothing technical. It's full of commonsense knowledge. The subjects covered came from the people themselves."

To this day when she drops by the market, people would go up to her and introduce themselves as among those she had trained in the past or were part of the audience.

She saw that what people did not understand was that many die from diseases that are preventable. "Curative medicine is just money that goes to the doctor and the drug company. Isn't it shameful that the number one cause of death is diarrhea? Then come bronchitis, pneumonia, hypertension, all preventable. Look at the typical Filipino diet: isang kurot ng bagoong, isang dakot ng kanin. Pneumonia is sometimes mislabeled when it's actually TB. People are ashamed of TB. As for malaria, I tell people to buy a mosquito net. It's that simple. You don't have to buy expensive sprays that cause more complicated diseases."

AKAP also ventured into organic agriculture that espouses the non-use of chemical sprays and fertilizers. In every health team sent out, an agriculturist is included.

Pardo de Tavera described herself as a doctor who is "not bihasa sa opisina. Primary health care is my mission. If I'm just making money, that's prostitution of my profession. I had 30 years in curative medicine, and I didn't like myself although nandiyan ang pera. Through primary health care, I learned to like myself more. I'm happy to be the physician who has given all her life to the people."
 

The seeds AKAP has sown have borne fruit in other countries. AKAP has trained Japanese priests and nuns. What AKAP has being doing is being replicated in places like Cambodia and East Timor.
       

Bishop Labayen became Pardo de Tavera's "ardent admirer" so much so that the space above the garage of the Catholic Bishops Conference of the Philippines office in Pasay City was offered as AKAP's office during its first few years.

Pardo de Tavera said because of her age she cannot go to far places that require long rides overland anymore because she has to urinate every so often, but she still trains trainors at her residence in Dasmariñas Village, Makati. She chose the lot that is on the corner of E. de los Santos Ave. and Pasay Road, not in the more quiet interior of the village, because "I want to be close to the people. I don't like going to Rustan's (which is near her house). I prefer going to Tutuban."

She said, "Thank God I have no illness. My blood pressure is normal. I have no heart disease. I sleep very well. I've always had faith.  I hope God will give me more years so I can continue to serve."--Elizabeth Lolarga, June 2005

Photo from the online file of the Ateneo Library of Women's Writings