Pediatricians earn a lot in Manila

: Many do not survive

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By Bernhard Ehlen

My clothes still stink for four days. At first it choked me badly: that bestial rotten smell on the Manila dump. 20,000 people live here in the garbage and from garbage. What the quarters of the rich wash up is tossed to and fro day in and day out by bulldozers, then poked, sifted, and plucked a hundred times over.

Mostly children are involved in this degrading, choking activity. Twelve hours a day they collect what seems to be usable somehow: broken glass, scraps of paper, crown corks, tin cans, plastic cups. What is left of the garbage is set on fire and then smoulders for days, emitting acrid smoke, under the feet of the young heavy workers. "Smokey Mountain", a low point of the misery of the third world.

For eight years there has been a table with a white plastic tarpaulin in the middle of the garbage once a week. Medical instruments, bandages, wound alcohol and drugs are spread out on it. Under the table, in the shade, is a cool box with vaccines, especially against tetanus. Swarms of flies buzz above everything. At this point the garbage has not burned for a long time. There is nothing left to burn. The more flies are coming.

Two doctors are sitting at the table. Thomas Guthoff, pediatrician from Wuppertal, has been here at the garbage dump in Tondo for three months. In front of him lies Rosalia, one year old, her body turned red. She gasps for air. Rosalia is now the seventh child with measles. The vaccination comes too late for the girl. In addition, it has severe pneumonia. No wonder with the stinking smoke. Antibiotics are used. Thomas Guthoff has just completed his specialist training at a German children's clinic. Before he settles down, he wants to be a doctor for a few more months where help is most needed.

At the other end of the table, Lothar Watrinet, retired chief physician from Troisdorf near Bonn, examines little Roberto. As a senior doctor, Watrinet is already doing his second assignment with the “Doctors for Developing Countries”. Roberto's stomach is bulging and bloated. Almost every child here has worms, and almost all of them suffer from diseases of the airways: bronchitis, pneumonia, tuberculosis. The struggle for life in the garbage of prosperity leaves its mark. Those who survive here have mostly made it, are immunized for later. But many do not survive.

Always hungry

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On Fridays, after work on Smokey Mountain, the German doctors go "into the green" to Bagong Silang. The Marcos government had already created a resettlement area for the “squatters”, the illegal slum dwellers, around twenty kilometers from Manila. They have been carted here for ten years and forcibly resettled here. There are now over 300,000. The project is well meant because it is far from the oppressive narrowness of the big city slums. But there is no work here. So the men stay in town wherever possible, hoping to get a job there at least occasionally. Perhaps in the port, even if only a third of the minimum wage provided by the state (106 pesos, almost six marks) is paid there. They carry sacks and boxes and gasp in their tuberculosis. A trip home to the family in Bagong Silang costs one day's earnings. They can afford it once a month at most. One day, many of them will no longer drive at all.

You can live in Bagong Silang, even if you are permanently hungry, provided you don't get sick. Health insurance is unknown here, as is almost everywhere in the third world. Every tablet, every adhesive plaster has to be paid for. A simple antibiotic for the minimum period of treatment for a child requires more than half the monthly wage. The drug prices in the Philippines are the highest in the developing world. Most of the drugs come from German or Swiss manufacturers. It does very well from the sickness of the poor.

Doctors also hold consultation hours here in Bagong Silang on Tuesdays and Fridays. Examinations and advice, like the medication, are free of charge - almost, because a tiny recognition fee is requested as a personal contribution. Every consultation hour begins with a lesson in hygiene, family planning or preventive education by the Filipino employees. Up to 160 emaciated people then expect advice and help from doctors. For a number of patients, the costs for urgent hospital treatment are also taken over, which are otherwise unaffordable for the residents here.

The committee's work began in Calcutta, arguably the worst city in the Third World. Around 800,000 people live, live, sleep, eat - and literally die on the streets in this city. The pavement dwellers usually don't have much more than the scrap of paper they are lying on and a piece of plastic tarpaulin to protect against the monsoon rains. 800,000 people with names and faces.

Center of Child Labor

One of the most notorious slums, Tikia Para, is not far from Howrah Station. The train station is the gateway and terminus for tens of thousands of wretched figures every day, sometimes driven out by floods, sometimes by catastrophic drought, or condemned to starvation at home by the generation-long division of land. In the hope of survival, they wash up here from the interior of the gigantic subcontinent: in Howrah, Calcutta's largest slum district.

Tikia Para is one of the child labor centers in Howrah. The youngest worker is five. With delicate fingers, the little ones attach tiny metal lamellas in toy harmonicas. Slightly older children dozens of up to ten hours a day, six days a week, crouch in dark crates. They punch metal disks and press rivets. The children's wages are ninety pfennigs a day. According to the latest estimates, there are 16.6 million child laborers in India. A taboo subject - even in Calcutta.

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Gisela Stöckle, a young general practitioner from Karlsruhe, has given up her work at home in a group practice for four months. In Tikia Para she now examines up to 150 patients every day: mothers who can finally introduce their skinny children to a doctor, hobbling rickshaw coolies with rattling tuberculosis, old, worn-out women with chronic back pain.

The fat belly of the little patient reveals at first glance: Nadar has worms. Every now and then the mothers bring these disgusting things with them in vessels as a sad confirmation of their children's complaints: glassy worms up to eight inches long that often crawl out of the little one's mouth and nose at night.

Does a worming cure even make sense in this confined space of dirt, vermin and sewage? Almost every child here has worms. Before the problem is tackled at the root, before the open sewer system, which overflows with every monsoon rain and which runs smelly through the tiny courtyards and residential huts, disappears, these disgusting parasites will return again and again. Stöckle administered the wormer. Nadar will be worm free for the next two or three months. His malnourished body is given a little break.

More than two thirds of children under five are malnourished in the slums of Calcutta. Every two seconds in our world a child dies unnecessarily - because a few pennies are missing for food, for protein, for a medicine. Here this sad truth is within your grasp.

Alice Dünchem, orthopedist and dermatologist from Hamburg, is currently working - after four assignments in the Philippines and in Calcutta - for two months in neighboring Bangladesh. This is where the Dhaka committee set up its latest and sixth project. The four ambulances are here along the railway in the midst of miserable huts made of rags and cardboard.

Bangladesh is considered the poor house in the world. Over 110 million people live in an area just twice the size of Bavaria. Only five percent of them have enough to eat. The lack of vitamins and minerals leads to blindness in around 20,000 children every year. Most of them were already malnourished as embryos in the womb. Every seventh child is stillborn. About half a million of the live births die before their first birthday. In two-thirds of those who die in the first month, tetanus is the cause of death - and could easily be prevented by vaccinating the mother for a few pfennigs.

In the port of Dhaka, three quarters of all porters are children between the ages of seven and fifteen. Thousands of rickshaw drivers are also minors. You can't even hit the bike pedals when you're sitting down. If you want to survive, with 38 percent unemployment in the country, you have to try to get a job or go into prostitution as a child. Only about every fifth child grows up reasonably healthy in Bangladesh.

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Those who survive as babies are at most two steps ahead of death. Almost 250,000 children die every year between the ages of one and four from malnutrition, infectious diseases and diarrhea. Because there is a lack of clean water, typhus, dysentery and cholera, pneumonia, malaria and tuberculosis are deadly dangers after weaning. Over eighty percent of children under fifteen have worms. Statistically, there is one doctor for every 8,000 inhabitants. And he lives - because he wants to earn money that the poor don't have - mostly in Banani, the wealthy district of Dhaka.

“Here we provide disaster relief every day!” Says Oswald Bellinger, who switched his job as an assistant doctor at the Frankfurt University Clinic for one and a half months to work in the slum in Dhaka.

Perhaps the worst place of work is on the embankment, along the Dhaka-Chittagong line: Gandaria. Over 5000 people live here in the most primitive huts, some in holes in the ground. When the monsoon rains pour, almost every day from June to September, everything here is under water for several hours, sinking into the dirty mud. Again and again the residents report to the German doctors about small children who drowned in this flood.

Every day 7,000 children in the developing world die of diarrhea because they and their parents do not have access to clean water. 8,000 children die every day from infectious diseases because they are not vaccinated. 6,000 children die of pneumonia every day in the Third World. 180 million children suffer from malnutrition. What effect are these few German doctors doing, one might ask? The famous drop in the bucket? It's not about stones. It's about people who are suffering, in pain and in need of help now and here where we are. It's about Rosalia, Nadar, Roberto, Fatima and their sisters and brothers.

Of course, prevention projects against hardship and illness would be better. And above all: structural-changing measures against global economic injustice. But advice alone does nothing. 1.5 billion people are still completely without medical care. We do what we can do now and here. Even if the help is only a drop. Every drop hits people by name and face.

Vaccination campaign in the mountains

On Mindanao, the neglected thirteen million south island of the archipelago, helpers and employees of the Jesuit Medical College accompany us on our tours inland. They are medical-technical helpers, translators and at the same time necessary mediators to the shy mountain dwellers. For three and a half years the committee has been participating in the major vaccination campaign of the World Health Organization in this heavenly beautiful region, which is still almost inaccessible for a long time.

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The vaccination missions are carefully prepared by a small group of local employees over a period of several weeks. In small advance teams, they educate the poor farm workers and their families about the point of vaccination right down to the last mountain hut. Then the doctors are on the move five days a week in off-road vehicles and on foot to vaccinate against childhood diseases that we have long forgotten, such as tuberculosis, measles, tetanus and polio. It is not uncommon for them to come to areas where a doctor has never set foot before. "All exertions will be rewarded a hundredfold when I see how useful our help is here 'directly under the skin' - and helps to eradicate these child-killing infectious diseases", reports Barbara Naatz, general practitioner from Rostock, one of the first members of the committee to join the new team Federal states.

A doctor starts such a project every two to three days. Since December 1983 there have been almost 600, a good third of them doctors. More than a hundred have already been used two or more times. Most of the committee's staff are clinicians who have given up their annual leave for this role. Every third doctor, however, is a resident and had to look for a representative for this period.

Helmut Spiess, recently retired senior doctor from Aachen, uses the scalpel. A short cut, the eight-year-old patient screams. The kidney bowl that Josy, our helper, presses against the thigh fills with pus. Who would have thought there could be so much pus in such a small child's leg? For five days, Dr. Spit here in the slums of Manila. The language and the way of life of the people are alien to him. But as an experienced doctor he knows how dangerous such a huge abscess close to the groin can be. Little Fatima had barely been able to sit or stand for days, every movement brought hellish pain. Now she looks at the strange doctor with wide eyes, relieved. Should such a deployment of only a month and a half really make no sense?

Contact address: Committee Doctors for Developing Countries, Elsheimerstr. 9, 6000 Frankfurt am Main 1. Donation account: Evangelical credit cooperative, bank code 500 605 00, account 4888880 (Doctors for Developing Countries).