Sunday, March 12, 2017

Mumbaki: of tradition and science

Doktor ka lang, hindi ka Mumbaki…Mumbaki ay manggagamot ng kaluluwa” such a powerful line from Apo Dangunay (Gruta) to Dr. Felix Lorenzo (Torre) on the Apo’s brink of death still holding firmly to his ancestral beliefs while receiving palliative care from the municipal physician. The film Mumbaki showed a perfect example of how modern medicine and traditional beliefs polarize and unite depending on how societies cope and adapt.

As the Ifugao culture changes over time, the protection of ancestral domains and tribal wars are still evident among different indigenous tribes, and in this film, it is between the Alimit and the Lidum tribes. This tribal rift caused complications in the latter’s attempt to access antibiotics to cure the spreading illness (pneumonia) in their vicinities. Their strong disagreements and quest to avenge the deaths of their loved ones altered their health-seeking behaviors to a licensed professional service provider.

The Department of Health through its program the “Doctors to the Barrios” Program (DTBP) aimed to respond to the growing gap in health human resources in the rural areas served as a milestone in address the health needs of the communities that are far from accessing the nearest health facility. However, the physicians who are trained are mostly of the westernized medical perspective and therefore had hard time adjusting to the communities they later immersed with. It was incidental that Dr. Lorenzo was there to orient Dr. Dumalilon (Santiago) and his fiancé Dr. Madrid (Alejandro). It was also incidental that Dr. Dumalilon is a native of the Lidum Tribe, making it easier for them to interact with the locales and for the locales to trust them. In no such cases, physicians would have to spend longer time in establishing professional and personal rapport with the community and to gain their trust especially if the community is an indigenous tribe. This is one gap of the Doctors to the Barrios Program which needs to be addressed – train local physicians and return them to their communities after training. 

Physicians who are trained but not locales are still considered ‘outsiders’ of the community and therefore cannot intervene directly even though it be medically disturbing or threatening to the health of the community. An example to this was when the two tribes met as per request of Dr. Dumalilon to have a peace talk. Dr. Lorenzo informed Dr. Madrid that they should not be part of the discussion and they must leave. The DTBP must ensure that if physicians are not locales they should be given a formal transition training period where they will be given ample support in working with local leaders and the community they will serve.

One thing the DTBP as a program and the westernize/modern approach to health care was that it became blinded to indigenous and traditional medicine of which many indigenous tribes are still practicing. Although portrayed as respected in the movie, trained physicians would have hard time convincing local shamans to use modern medicines as cure for illnesses. Often this would emanate as internal conflicts with the physicians with some desiring to cease their operations and return to their bases (as exemplified by Dr. Madrid). 

As for Dr. Dumalilon, his internal conflict is greater as he should battle his modern medicine training versus his traditional roots. But Dr. Dumalilon was successful in infusing both as seen later in the movie, where despite having to avenge the death of the members of his tribe, he, as a trained physician following his Hippocratic Oath, supplied antibiotics (through Dr. Lorenzo) to the opposing tribe to cure the epidemic.

However, health service delivery would have challenges in its implementation because of the resistance of a few (most likely the influential local leaders) but would receive some support from some whom have either seen the benefits of such service or have been explained and became believers. An instance in the film portrayed that some of the tribeswomen were more inclined to receiving modern medicine in fears of contracting the deadly epidemic.

Health promotion in the community as portrayed in the film is largely done by the doctor-to-the-barrio or commonly known as a DTTB and traditional healing is promoted by the Mumbakis themselves. No other groups or entities conducting health promotion and disease prevention strategies shown in the film.

The national/local government role was not properly highlighted in the film, except during the investigation of a tribe leader, in the presence of the DTTBs (as representatives of the Department of Health) or as a destination for dying community members needing immediate medical care.

Taking from Mumbaki and in the portrayal of Dr. Dumalilon, modern medicine and tradition can go together without totally sacrificing one over the other. It takes a locale to deeply understand and intervene with the culture of the community so that any new interventions will be successful and receive appreciation and participation from the recipients and partners of care without trampling cultural heritage, indigenous identity, and sacrificing scientific and medical know-how. 

This is an analysis paper submitted for the partial requirements of the DLSU Master of Health Social Science.

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