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November 15, 2012

The Story of Teresa: Impact of Illness On The Patient, The Family and Society

The following story is shared to me by a good friend, Dr. Ryan Guinaran. This story was originally written by Lily Anne N. Safilo, a student of Dr. Guinaran in the Community Health and Culture subject of the Master in Community Health Development Course at the Benguet State University Open University. This story is a true-to-life story and the names of the people involved were changed.

TERESA is a student from Nab-ew a farming sitio of Tanaw, a remote barangay in Mt. Province. Her parents separated when she was only five years old. She is the oldest among three siblings. Since the income of her mother as a farmer was not enough for the family, Teresa helped her mother by selling “tinudok,” in school. She earned P30 per day. This amount was used to supplement their needs in elementary school.

When Teresa was in high school, she was sent to stay with her aunt in Poblacion. In exchange for free board and lodging, Teresa worked after school in the karaoke bar of her aunt as waitress. Upon graduation from high school, she did not immediately enroll in college because of financial constraints. She worked for a year in the karaoke bar of her aunt as a full-time waitress. When she turned 16, Teresa ran for a local youth position in the elections and won.

She enrolled during that school year as a barangay scholar in the state college. The barangay paid her tuition and miscellaneous fees. She shared a room near the school with another student from Tanaw. Each was paying 500 pesos per month. Her mother provided only 1,000 pesos each month for Teresa’s food and rent. This amount was not enough to cover Teresa’s needs so the latter decided to apply as part-time waitress in one of the karaoke bars. She was accepted and her shift was from 7 to 9 at night.

Often times Teresa lacked sleep and skipped meals. She also learned to smoke and drink alcohol. Before the end of the 1st semester, Teresa met Andres, a 30-year-old bus helper. Andres courted her and after a month, they were lovers. Three months later Teresa found out that she was pregnant. It was also at that time that she learned that Andres was actually married to someone.

Teresa told no one of her pregnancy for fear of losing her scholarship. She wore loose clothes and jacket to hide her belly. She continued working at the bar till her 5th month just as some of her co-workers were noticing that she has gained weight. To avoid further suspicion, she quit her job and applied as part-time seller in one of the stores near her school.

She never went home since learning about her pregnancy. She did not consult any health personnel about her pregnancy too. On her ninth month, she decided to go home to Nab-ew. That was the only time that her mother knew about the pregnancy. Two weeks prior to her expected date of giving birth, Teresa had her first pre-natal visit. She was given tetanus toxoid. The midwife told her what to prepare for delivery. She was also advised to deliver in the hospital.

Teresa started having labor pains in September just as the typhoon Ondoy was pouring heavy rains in Mt. Province. She refused to be brought to the hospital for she didn’t have money. One of her siblings informed the midwife of the situation but the midwife could not attend to the call because the Narig River was swelling and has gathered water till shoulder level. There was also no barangay official or a barangay health worker in Sitio Nab-ew to ask help from. The only midwife there covers three barangays including Nab-ew as her catchment area.

Since no other help was available, it was the grandmother of Teresa who assisted in delivering the baby. Teresa gave birth to Baby Narciso on September 25 at 4 am. Narciso was only 2.4 kilos at birth. A non-sterile “lang-it” or sharpened bamboo was used to cut his umbilical cord. Breastfeeding was initiated immediately after birth.

After 3 days, the midwife came to visit Baby Narciso and his mother. She bathed Narciso and cleaned his cord. There were no unusual observations seen on the child. Neighbors and friends also came to visit Baby Narciso since it was his “gubbaw” celebration or the indigenous thanksgiving and naming of the newborn.

Around 4 p.m. that day, Narciso had spasms and jerky movements. His grandmother also felt that Narciso was having fever but ignored it with the belief that it was an after-effect of the gubbaw. An hour later, Narciso refused to suck and breastfeed. The spasms and the jerky movement also persisted. The family was alarmed so they decided to take Narciso to the hospital.

They hiked for an hour before they reached the hospital. Narciso was no longer breathing upon arrival in the district hospital. The doctor said baby Narciso died of an infection.

Teresa was only 18 years old and she felt all the world was against her.

Clearly the case features an infant death. Narciso, Teresa's firstborn, died due to sepsis or overwhelming infection. For the young Teresa, this event (death of her child) has a huge impact on her. Not only to Teresa, this event also has an impact on her immediate family and her community as a whole.

If you were the caregiver or physician of the family of Teresa, how would you help Teresa and her family cope up with this death of a family member? One must take note that not only did the death of Narciso bring impact but the experience Teresa and her family underwent before Narciso died. Her difficult pregnancy and her predicament also has an impact on her.

Perhaps the more difficult to appreciate is the impact of this event on the community as a whole. Is there an impact to the community? What is the impact of the death of Teresa's child on her community as a whole?

The story of Teresa is still common especially in the most depressed areas and geographically isolated regions in the country.

UPDATE: For FCM-1, as discussed in class, each group will be coming up with a mini-film depicting how a particular illness or health challenge will have an impact on the patient and the family. The mini-film should not be more than 10 minutes, including opening and closing credits. Should the group use a language other than English, the mini-film must have subtitles in English. The following are the diseases or health challenges that each group must highlight in their mini-film:

Sajo, Jadda et. al.: Pulmonary Tuberculosis
Manlantao, et. al: Alzheimer's Disease
Antivo, et. al.: HIV
Bancoleta, et. al.: Spinal Cord Injury secondary to a motorcycle accident
Bueno, et. al.: Uterine Cancer (woman is married and childless)
Badillo, et. al.: Diabetic retinopathy
Lagtapon, et. al.: Maternal mortality (complicated pregnancy, mother died while delivering her child)
Cabalfin, et. al.: Stroke

The mini-film must be uploaded to either youtube or vimeo and must be "embeddable". Links to the uploaded mini-film must be sent to Doc Bien either by email, tweet or facebook not later than January 5, 2013.

Criteria for scoring will be:
1. Clarity of Application of Principles on Impact of Illness: 30%
2. Creativity, Originality, Story-line: 15%
3. Production and Cinematography: 20%
4. Appeal to the Viewers (Poll): 10%
5. Correctness of Application of Principles on Impact of Illness: 25%

For criteria No. 4, an online poll will be opened starting January 6, 2013 and will run for a week. The number of votes earned will dictate the points.
Top 1: 10 points
Top 2: 9 points
Top 3: 8 points
Top 4: 7 points
Top 5: 6 points
All the rest: 5 points

The group who will get a final average score of at least 93 will be exempted from the Midterm Exams (Doc Bien's segment only) and will get the score of their mini-film as their equivalent score for the exams. For the rest, the score earned from the mini-film project will constitute 30% of the midterm grades (Doc Bien's segment only) with the 70% coming from the midterm written exam.

For questions, tweet or leave an FB message.

Good Luck.

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2 violent reactions. React Here.:

Valencia, CJA said...

As the caregiver or physician of Teresa, I can' t assume or conclude the impact of that event to Teresa, her family and the community as a whole by simply knowing the story and their situation therefore I will first go to the community and and I will talk to Teresa, her immediate family as well as the other members of the community. I will get their perspectives regarding on what happened to Narciso and from our small talk, I'll be able to know their concerns, needs and the impact of that event to them the I'll draw out interventions to help the family cope up with Narciso's death. Based on the identified impacts, problems and needs, I will formulate solutions that will be favorable for Teresa, her family and other members of the community. I will also propose these possible solutions to the involved authorities for further evaluation and to check its feasibilty/sustainability.

There could be an impact on the community. From what had happened to Narciso, some might learn from it however some might just neglect it. They might think that they can't do anything about it and just deal with it.

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