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Appendix 1: Examples of research site selection
Appendix 2: Checklist of important background information
Appendix 2A: Example of background information from the Aetas of Canawan, Morong District, Philippines
Appendix 3: Some reminders about data-gathering: Do's and don'ts
Appendix 4: Notes on working with key-informants
Appendix 5: Recording and organizing fieldnotes
Appendix 6: Notes on translation from local to national languages
Appendix 7: An example of selecting key food items from Peru
Appendix 8: Vitamin A content of foot
Appendix 9: Notes on selecting the field data-gathering team
Appendix 10: Selecting representative samples
Appendix 11: Notes on the credibility of these
Appendix 12: Comments on using microcomputers
Appendix 13: Glossary
Selection of an appropriate
research community is a crucial first step in the process of
using this manual. The basic aim is to identify a location that
is: a) a population with significant vitamin A deficiencies, and
b) a community that is typical of a wide area of similar
communities. Government planners who sponsor the assessment and
the expected intervention program will want information that can
be generalized quite widely to other communities.
For example, the pilot study in India was located in a semi-arid region in the state of Andhra Pradesh. Although Andhra Pradesh is sometimes referred to as the Rice Bowl of India because of its fertile regions, there is a large semi-arid region in the state, in which agriculture is not as productive and where problems of vitamin A deficiencies are generally more prevalent. Dr. Pushpamma and her associates reported that "In a recent study assessing the prevalence of vitamin A deficiency...[in the study area] it was found that villages. . had a prevalence of around 4.5% Bitot's spots in preschool children...But during a recent survey (1993) the prevalence of Bitot's spots in preschool children in Sheriguda [the research community] was found to be 4.2%." Describing the ecological situation of the region, they said that "many villages in the Ranga Reddy District in Andhra Pradesh. . . [including the research site]...are dry lands and grow mostly staples such as sorghum (jowar) and pearl millet (bajra) which do not require as much water as rice." They also note that "Sheriguda is one of the typical villages of Ranga Reddy district, where all religion and caste groups are represented in the community."
The village of Sheriguda thus met both of the criteria above: having signs of vitamin A deficiency and being typical of a wide range of villages in the semiarid ecological zone. They also noted that the village is almost 100% Hindu and the caste composition of the village is broadly similar to the usual patterns in that part of India. "Looking at the caste distribution of the village, it was found that about 40% of the families belonged to the...[upper castes], 30% belonged to. . . [lower castes] . . .which includes. . .blacksmiths, carpenters, goldsmiths, shepherds...." The rest of the population consists of Harijan households and a few tribal families. The occupational structure of the village also corresponds to the typical village pattern of the dry region.
The village of Sheriguda also fits well with the other selection criteria: the area has a considerable range of vitamin A-rich foods, whose consumption could be increased; the locality is served by the governmental health structure; and it is accessible by road-about one hour's drive from the researchers' headquarters in Hyderabad (at the National Institute of Nutrition).
If a comprehensive intervention program is planned in an area with important cultural or ecological variations, it may be desirable to conduct data-gathering in two different communities. In testing this manual in northern Peru, the researchers felt that it would be very useful to get information from a rural highland village and also a low-income suburb of the city of Cajamarca. The latter community represents a rapidly growing type of population, in which people are partially cut off from traditional rural, low-cost food sources.
Setting up
research in two different communities required additional
assistants, but the Team leader was able to serve both sites, as
they were only about two hours walking distance from each other.
Training of the two research groups, supervision of operations,
maintenance of the secretarial support were easily coordinated as
all the team members were residents in Cajamarca.
The following is a list of
information that will help to understand the people of the study
community, their food system, and their vitamin A situation. It
may not be possible to get all of this information from existing
documents. In the background paper from the Philippines,
interviews with village leaders and elders helped to complete the
picture.
1. The national vitamin A situation
2. Geography of the area
3. Brief history of the people in the study
4. Current situation of these peoplea. Village structure in context of the region
b. Transportation; communications
c. Census/information for the area
d. Family structure and way of life; recreation
e. Material culture; housing, clothing, etc.
f. Persistence of tradition
g. Agriculture/livelihood/income
h. Gathering and hunting
i. Customs and healthcare
j. Education
k. Water, sanitation, hygiene
l. Political/administrative structure
m. NGO's aid programs in the area5. Food availability
a. Major crops
b. Livestock
c. Market areas
d. Storage facilities in village6. Healthcare
a. In the community
b. Closest doctors, hospitals
c. Immunizations, local campaigns
d. Vitamin A distribution
The Vitamin A Problem in
the Philippines
Vitamin A deficiency is the leading cause of blindness and eye disorders among children in the Philippines, with about seventeen of them losing their eyesight daily from the problem. Nutritional surveys in the early 1980s conducted by the Nutrition Center of the Philippines show that 3.9% of 33,778 Metro-Manila children zero to six years of age and 4.4% of 9,103 from the provinces were deficient in the vitamin. Although there are no recent data available, increasing proportions of these children have become malnourished (using such parameters as weight and height) as the economic recession of the mid-1980s still persists today. The distribution of the children who are deficient is not known, though certain communities (i.e., remote rural barangays or villages, urban slums) and population groups (children from large families, with poorly educated mothers, from unlanded farm or small/hired fishing households) are considered at higher risk than others.
The current management strategy of the Department of Health is to provide 200,000 IU of vitamin A in a gel capsule every six months. This is given to children identified as suffering from deficiency or at high risk of developing the deficiency (such as those who are mildly, moderately, or severely malnourished; those with chronic diarrhea or recent measles). However, the policy is curative in approach, seeking to correct the deficiency when it already exists. More recently, a Sangkap Pinoy (literally, "Filipino ingredient") campaign was launched that would administer the high-dose vitamin A capsule to all children, with or without deficiency. As in other interventions of this nature, problems of supply and distribution affect its effective implementation. Moreover, administration of large doses must be adequately supervised because of the danger of toxicity.
Aside from the visual impairment, vitamin A deficiency also places the child at greater risk for infectious diseases, such as diarrhea and pneumonia and their complications. These infectious conditions are among the top ten leading causes of morbidity and mortality in the Philippines.
The Geography of Morong, Bataan
Morong is a municipality in the province of Bataan, about 150 km northwest of Manila. It lies at the foot of the tail end of the Zambales mountain range that extends from the north of the province of Zambales down the western side of the island of Luzon to end in Bataan. Morong has a population of about 19,000, living in five barangays or villages. It is bound on the north by the Subic Naval Base forest (which until 1992 was American territory), on the west by the Subic Bay (which opens into the South China Sea), on the south by the municipality of Bagac, and on the east by Mt. Natib (a dormant volcano). Morong's barangays are laid out in such a way that a portion of each lies along the coast and flat land, with larger areas at the foothills or mountain slopes. This is typical of many coastal towns in the country.
The study site is the sitio (a sub-unit of a barangay, usually delineated by a cluster of households) of Canawan, in the mountainous part of Barangay Binaritan. There is only one dirt road to Canawan, leading to a suspension bridge that can be crossed only on foot. After the bridge is an uphill climb to the cluster of houses that identifies the sitio. The whole area is about 165 hectares, designated by Presidential Proclamation #192 as the Canawan Negritos (the racial group to which the Aetas belong) Reservation Area.
A Brief History of the Aetas
Philippine history identifies the Negritos as the original inhabitants of the islands, thought to have crossed land bridges from central and south Asia before these were covered by water from the melting glaciers of the Ice Age. Subsequent waves of migrants of Malay origin came to the islands by boat and, largely by force, drove the Negritos towards the mountains. This was the situation when the Spaniards arrived in the 1500s and conquered the islands. Hence, much of the earliest written historical and cultural accounts of the Negritos come from the Spanish friars who attempted to convert them to Christianity, with little success.
Present-day Negritos can be found in the mountains of the Philippine islands of Luzon, Palawan, Mindoro, Mindanao and Negros, Panay (among others) and are called by various tribe names (Agta, Aeta or Ita, Batak, Sambal, Mamanua, etc.) These different groups have their own language and ethnic identity. What characterizes them all as Negrito is their appearance. The following is a description given by Fray Antonio de Mozo (1763), a Spanish friar, as quoted by R. Rahmann: "...their color is a brownish or pallid (descolorido) black, their hair like that of a mulatto; their lips are not thick; many of them are very corpulent and all have large abdomens and generally both men and women appear feeble...."
The original Negrito population is believed to be hunters and gatherers and to date, certain groups like the Agtas are thought to partially subsist on this way of life. But even as early as the Spanish times, the Negritos have been known to practice swidden or slash and burn (gasak or kaingin in Tagalog) agriculture. Among the Morong Aetas, crops are raised mainly for their cash value and the money used to purchase meat, tobacco, and other occasional needs. In the past, when game could still be found in the forests, there was no need to purchase meat. But at present, the most likely source of animal protein in the wild are small birds and freshwater fish or shrimp, hence the dependence on market-bought meat. Gathering is limited to obtaining honey (pulut) from hives of wild bees. This process known as pukyut, namumukyntan, or namumuay is generally done on dry, nonwindy days. The bees are driven away by smoking the hive and the whole hive is obtained and the honey collected and sold for about Phillipine Pesos 1000 (about US $40) per gallon. Although foods from the wild are still part of their diet, the rapidly dwindling forest resources are forcing the Aetas to depend more and more on market foods.
The Aetas of Morong
History
It is believed that the Aetas were the first people to have lived in Morong before the coming of the Spaniards. Little is known of their history before the twentieth century except that the Aetas were known to have lived independently of each other and that they settled over a vast expanse of land covering the hilly terrain of Morong. The different places they previously occupied are known today as the sitios of Dose, Binugsok, Canawan, (in Barangay Binaritan), Gantuan, Marucdoc, and Hulong Baryo, (in Barangay Nagabalayong) and the plains of Barangay Poblacion. Some of these places are difficult to reach and are known locally as hulo.
It was during the term of the late President Manuel Quezon during the 1930s that most of the Aetas living in Morong were gathered at the prodding of a kabesa, or local chieftain, Pablo Sulangi (also known as mayor). They resettled together as one community in the hills which they called San Isidro (now known as Ukod, near the sitio of Sibol) which was by the Morong River. They were able to live here until the Japanese occupation during World War II. They were forced to hide from the Japanese and suffered from hunger as they were not able to practice their slash and burn method of farming (kaingin) for fear of being found.
Accounts are sketchy as to whether they were really able to return to their land after the war. But at the time of the Hukbalahap rebellion, they were forced to go down to the town or bayan (Poblacion) in order to flee from the armed conflict in the highlands. This occurred during the time of President Magsaysay (in the early 1950s). Eventually, the Huks decreased in number and surrendered. As the rebellion ended, they were able to return to their land in San Isidro.
They finally chose Canawan, a nearby piece of land which is situated a few kilometers away from the site of the PRPC. Eventually, the government, through the issuance of Proclamation #192, allotted 165 hectares of land from the Bataan National Park Reservation for the creation of the Canawan Negritos Reservation Area. It ordered the exclusive use of the land for the benefit of the Negritos living within the area. The administration and management of the land was put under the Department of Environment and Natural Resources (DENR) and the Office of the Northern Cultural Communities (ONCC).
Geography of Canawan
Canawan (also Kanawan) is a sitio (a subunit of a barangay, or barrio) of the barangay of Binaritan in the municipality of Morong. Its total land area is 165 hectares. It is bounded by the municipalities of Hermosa, Orani, and Samal and the adjacent sitios of Nagbaytu, Nocil, Repacpac, and Tiaong which are all found in the barangay of Binaritan. The predominant terrain is composed of hills of denuded forests. A nearby mountain, Mount Natib, is also a dormant volcano.
There is a single dirt road accessible to vehicles. It leads from Neighborhood Five of the PRPC to Sitio Naghaytu where a newly renovated hanging bridge (suspension type, only for foot travellers) about thirty to forty meters in length, serves as the only link to Canawan from the lowlands. This crosses the Batalan River which is a tributary of the Morong River. Another path for travellers is accessible only by foot from Neighborhood Four of the PRPC to Nagbaytu. It takes about twenty to thirty minutes uphill from the bridge to reach Canawan proper where most of the families have built houses. Other houses, which are situated in the hulo or in places farther away from the center of the sitio, are built near the fields they cultivate. In order to get to the hulo, it takes another thirty minutes to about an hour of hiking through rolling hills.
There are no official census records of the actual number of people living in Canawan. However, it is of common knowledge that Canawan is almost exclusively inhabited by Aetas, except for some families of interracial marriages (i.e., of Aetas and the lowlander Tagalogs). There are also about five to six of pure Tagalog origin in contrast to a generally accepted estimate of thirty Aeta families with families of an interracial nature regarded as of Aeta origin.
The Aeta Way of Life
The Family and the Preservation of Culture
The life of the Aetas of Canawan specifically revolves around the structure of the extended family. Almost all members of the tribe are related in some way to each other, as they often share the same family (last) names (e.g., Malunik, Quintain, Cayetano, Alejo). This may be due most probably to intermarriages among the families of the tribe. It may be gathered from the small number of families (about thirty) living in Canawan, that support is obtained through family relations. This realization would be helpful in defining how the preservation of their culture is based on a concept of clan unity.
With regards to their material culture (i.e., agriculture, working tools, manner of dress, decorative ornaments), there seems to be a paucity of evidence for the persistence of tradition in their culture as the culture of the lowland Tagalogs has already pervaded the Aetas. The presence of the Tagalogs and the degree of inter action between them and the Aetas have occasionally influenced the latter's acceptance of change. This may be indicative of how the Aetas may selectively value certain aspects of their culture while regarding others as less important.
Agriculture
The means of livelihood of the Aetas is essentially agricultural with the use of the slash and burn practice (kaingin or gasak), that has been used for many generations, as their preferred method of farming. Produce are mainly root crops (mostly sweet potatoes, or kamote), bananas, and a variety of vegetables. Rice is not commonly planted and is usually bought to supplement their insufficient stores.
Most of their produce is sold through a cooperative, which is based in town. The Aetas like everyone else in the cooperative have an agreement to supply a certain kind of food item that is usually either a harvested vegetable or a fruit. Deliveries are then made to a designated market which is at the Phase I of the PRPC. Thus, their choice of what to plant is predetermined by an agreement with the traders in the cooperative and the market. Most of the foods they consume are bought at the same market with the money they earned from selling their farm produce.
Unfortunately, the DENR recently imposed a ban on gasak farming in order to preserve the remaining trees in the already denuded forests of Morong. Subsequently, the Aetas were forced to develop their lands for farming and are now also considering soil management and preservation.
Gathering and Hunting
Although most Aetas engage in farming, they seldom hunt for wild deer, pigs, monkeys, and lizards any longer. Gathering is likewise rare and is usually limited to honey (see above). The Aetas regard gathering of honey as one way to generate income, especially when farming is difficult during the dry season.
Customs and Healthcare
Regarding their concept of health and illness, their beliefs in spirits still persist. They still practice a ritual called kagon, a form of faith healing performed with dance and guitar music, so that spirits will depart from individuals afflicted with an ailment. Also, it is customary to see Aetas wearing a necklace of stringed pieces of sticks so that bad spirits like lamang-lupa are prevented from causing illnesses.
When an illness persists though, the Aetas seek medical consult either at the local clinic (in Canawan proper) built by the World Relief Corporation (WRC, an evangelical organization based in the USA, prepares children for eventual transfer to their permanent homes in America; they also have a separate volunteer program to give aid to the Aetas by holding free clinics in their area). This is staffed by a nurse only on Monday mornings. Other health facilities include the PRPC hospital and the rural health unit (RHU) in town. Medicines with generic names are made available by the WRC at the local clinic. A weighing and feeding program for the underweight and the malnourished is also being undertaken by the WRC. However, because of the lack of resources and appropriate health education, the Aetas' state of healthcare remains much to be desired.
Availability of Water, Sanitation and Hygiene
With the help of the WRC, the recent installation of a water system composed of steel pipes, rubber hoses, and faucets has facilitated the delivery of water from a nearby spring to Canawan proper. Though the people now enjoy running water which they use for bathing and laundry, it has apparently helped the Aetas in their hygiene practices only in a limited way. One may think that the ready availability of water at present has changed the manner in which the Aetas have minimally regarded cleanliness in their daily routine. Actually, they change their clothes only after a few days of wear. Children of the tribe are usually seen playing half naked and clad only in dirty shirts caked with mud. Their parents are similarly unmindful of the way the children play in the soil and afterwards eat with their bare, dirty hands. Furthermore, a common sight is that of children suffering from colds with a long, yellowish discharge admixed with dirt continuously dripping from their noses.
Sanitation, however, is not much of a problem, as the Aetas have a minimal amount of things to dispose of. Their only material possessions are a few changes of clothing, cookware, utensils, plates, and homemade furniture, such as benches and tables.
Similarly, the Aetas have no toilet facilities in Canawan as the practice of defecating in nearby fields and burying stools in the soil is common. Remarkably, there have been no reported major outbreaks of diarrhea! diseases among them, and as one Tagalog put it: "Sanay na ang mga iyan sa marumi!" (They are used to being dirty!), implying that personal hygiene is less significant for the Aetas, than it is for the Tagalogs.
Political and Administrative Structure
The kapitan previously known as the kabesa is regarded as the tribal chieftain. Usually, the tribesmen consider the oldest among them as their leader. The tribesman believed to be the oldest is Aquino Malunik, who was once the leader of the tribe. He was the former kapitan when the Aetas transferred from Limon to Canawan. After his term of office, succeeding leaders have consulted him for a number of reasons, political and otherwise. (His accounts of the Aetas' history and culture have been made one of the sources of this monograph).
The Health Status of the Aetas in Canawan
Food availability is of prime importance. The lack of livelihood alternatives and the reluctance to adopt new farming technology seem to be the general hindrances not only to their economic upliftment, but, more crucially, to their survival. The Aetas, particularly their children, face the perennial problem of malnutrition. The scarcity of readily and locally available sources of protein, as evidenced by the absence of livestock, may be due to their reliance on planting as the primary means of livelihood. Almost all of those interviewed say that the Aetas plant cash crops such as sweet potatoes, and a variety of vegetables. But among them none are known to have livestock, except for those who raise a few chickens. As previously mentioned, they seldom hunt for animals such as wild deer and pigs. They travel a distance of four to five kilometers to the PRPC market to sell their produce, and earn just enough money to buy the rice and other vegetables or fruits that they (ironically) were not able to plant- they have an agreement with the cooperative to plant only what the market wants to sell.
It is important to note that the problem of food availability may be linked to the lack of a health program that would address the health needs and the socioeconomic problems of the Aetas. Even though the WRC voluntarily sends a nurse weekly to look after the health of the Aetas, a viable program is necessary- one that invests in the participation of the community and captures their interest-primarily in order to determine which health problems need more attention.
The basic problems, as previously mentioned, have been malnutrition and the availability of food, however, some cases of diarrhea and measles have occasionally been reported. Though data regarding what cases of morbidity and mortality can be obtained from the WRC staff working in Canawan, there are no readily available records from the rural health unit (RHU). Recently, a medical team from the RHU at the municipal office arrived in Canawan to administer vaccines during a day allotted for a nationwide mass immunization campaign. Healthcare workers present admitted that Canawan is seldom visited by the RHU staff. The important reasons cited were the great distance from Canawan to the RHU and the difficulty in travelling due to the hilly terrain.
Further interviews with the municipal health officer, nurses, midwives, and barangay health workers revealed that the usual causes of morbidity, not only of those living in Canawan but also of the whole of Morong, are respiratory infections, diarrhea, and malaria. They further related how different programs of the Department of Health and also of the municipal government are presently being implemented for disease control.
As for evidence of the prevalence of vitamin A deficiency (VAD), there have been no actual cases detected in recent years. Although there ate records of patients consulting at the RHU for eye symptoms, there is no appropriate documentation of alleged eye signs indicative of deficiency of vitamin A.
Aside from
a presumably adequate dietary intake due to readily available
sources of vitamin A-rich foods, the RHU is also implementing a
program of administering vitamin A capsules to children with
severe cases of malnutrition. Vitamin A is also given to children
who come for anti-measles vaccination at nine months of age, and
pregnant women who come for their tetanus toxoid immunization.
Advice is also regularly given to mothers concerning foods that
are important sources of vitamins and minerals.
Most people who develop
projects using this manual will have previous experience in
various kinds of research and intervention programs. Therefore,
many of these elementary principles of community-based work will
already be well-known. This list of do's and don'ts
will be useful when you are training team members who are new to
this kind of activity.
i. Do remember to clear your data-gathering activity with local authorities, local governmental persons, and community leaders. Failure to follow and respect lines of local authority can lead to serious obstacles that compromise the data-gathering and subsequent intervention programs.
ii. Do explain your general purpose to the people that you interview and explain where the information is likely to be used. This explanation is part of the information that people should have as a basis for agreeing to be interviewed. This is what we mean by informed consent as required by governmental and international standards of ethics.
iii. Do not coerce individuals to respond to interviews or other data-gathering. Individuals should be assured that their participation is voluntary and that they have a right to refuse to answer questions.
iv. Do not, as a researcher, promise the community leaders or any other individuals anything in the way of future benefits or services in relation to this study.
v. Do promise to share the results of the study with the community and those contributing their time as interviewers.
vi. Do be considerate of people's time schedules. If possible, data-gathering should be carried out during times of the year and days of the week, when people are not burdened with heavy work in harvesting or other activities.
vii. Do try to set up appointments with people, so that interviews are scheduled at times of the day and week that are most convenient for them.
viii. Do assure your informants and respondents that everything they say to you will be confidential and will not be told to other persons.
ix. Do not criticize individuals concerning their food habits, hygiene practices, and other behaviors, no matter how much they differ from what you think they should be.
x. Do not ridicule or correct persons if they tell you ideas and beliefs that you regard as superstitious or old-fashioned. Instead, you and your field team should treat all ideas, beliefs, and attitudes with respect and interest.
xi. Do not assume that all the statements of your key informants (and other sources) are correct and accurate. Always look for confirmations and ways to verify statements through checking with other persons and information sources. Also, it is a good idea to be cautious in accepting written reports concerning a locality or community. These, too, might be biased or out of date.
xii. Do be aware of local, intracommunity differences in cultural beliefs, knowledge, and behaviors. In all communities, there are variations in food use, diet, and other behaviors, even though food use in general is highly patterned. The differences found in some families are often important clues to directions of change, as well as indications of patterns of behaviors that might become general, under favorable conditions.
xiii. Do not wear out your respondents or informants with lengthy interview sessions. Try hard to discover an ideal duration (often about one hour), beyond which your informants' patience and attention begins to weaken.
xiv. Do maintain an attitude of interest and sincere learning about local food and diet ideas and practices. The data in projects like this are much more believable and the relationships with local community people are much more pleasant if the data gathering team shows sincere interest in the ideas and practices of the community people.
xv. Do be aware of special cultural and social sensitivities of the local population, particularly special religious areas, religious beliefs, and ritual behaviors. For example, you should be aware of general religious food restrictions in the community. In households with religion-based vegetarian practices one must use extreme caution in introducing any questions about meat-eating.