This past May, Jennifer Foster Ph.D, MPH, CNM (ret.), FACNM, FAAN embarked on the experience of a lifetime after venturing into one of the most remote villages in the southern Philippines. After meeting Sitti Usih, a clinical professor at the Notre Dame of Jolo College, Foster became fascinated with her work providing prenatal and postnatal care in the Badjao community. Ten years later, she found herself on a boat next to Usih, minutes away from witnessing the process with her own eyes.
Due to her background in midwifery, Usih made a connection with faulty at the School of Nursing during her practicum with Emory in 2009, consequently introducing her to Foster. A clinical professor at the time, Foster learned of her time spent with the Badjao community, one of the poorest and most disenfranchised ethnic groups in the Philippines. Their homes lack indoor plumbing and rest on stilts inches above the ocean. Usih would travel by boat to make home visits, where most of the births occurred with the help of a traditional midwife from the community. Enthralled by her various stories, Foster was more than excited when the opportunity presented itself to finally take part in this unique experience firsthand. “She welcomed me wholeheartedly,” Foster recalls, “I was completely unprepared for what awaited me.”
Foster flew from Guam, where she was visiting her son and his family, to Manila, and then boarded a four-hour plane ride to Zamboanga, a bustling city of about 1 million residents. Usih met her at the airport, along with another faculty member and several escorts, and they headed out to Jolo the next day. “I must confess I had some anxiety about going to Jolo,” mentioned Foster. “The internet is full of stories about the Abu Sayaf Islamic terrorist group committing acts of violence.” Foster’s apprehensions held validity. In the early 2000’s, two German tourists were beheaded and in January 2019, Abu Sayaf claimed responsibility for the bombing of a Catholic church on Jolo killing 20 and injuring many others. Despite her worries, Usih reassured Foster that the positive, long-term connections of her college with the community would protect them. They boarded the 30-seat plan for the 20-minute flight from Zamboanga to Jolo.
Upon arrival, Usih and Foster were met by four faculty members in full, traditional dress with ornate headscarves from the Notre Dame College of Jolo (NDCJ). The NDCJ only offers a few majors including education, psychology, criminology, and child development, while the Health Sciences department houses the nursing, midwifery, and pharmacy programs. The nursing faculty placed a garland adorned with a brass gong clasp over Foster’s head – an act of welcome and respect similar to receiving flower leis in Hawaii. They also greeted her with an enormous welcome banner, complete with her photograph, bylines and status at Emory. She was asked to speak to the nurse/midwifery students and met for almost an hour with about 50 eager listeners. “They asked me why I had come there.” Foster says. “They asked what nursing was like in ‘America.’ They asked how they could immigrate to the U.S. to work as nurses.” Despite a government legislation calling for the doubling of nurses’ pay, the compensation for the profession in the Philippines equals approximately $160/month, even with the considerable amount of responsibility.
“They treated me like a celebrity,” she recalls. “It felt like they hung on my every word and everyone wanted a picture with me after the meeting.” Feelings of astonishment and confusion flooded over Foster in response to the attention. “You are so brave!” someone exclaimed. “You have such heart!” cried another. It began to dawn on Foster that the visit held a special significance for them, regardless of her original intentions. She met with the president of the NDCJ, Brother Santoyo, who she remembers as “polite, kind and deferential” while he expressed his happiness with her visit and that her security was his main concern. The Philippine military called him, saying they learned of a foreign visitor on campus who planned on going to the Badjoa community the next day, insisting the group have a military escort.
Usih and Foster, along with photographic documenters, six Philippine soldiers carrying guns in full uniform, several faculty also curious about the community, selected students and extension staff, arrived to the remote village the next day. “My little dream of Sitti and me and a boatman translated into a reality of about 30 people,” says Foster. After a visit to the tiny health post run by the Department of Health of the Philippines, they completed two home visits. The first included a 14-year-old postpartum mom accompanied by a fussy baby, her grandmother and great-grandmother. Foster and Usih helped the baby latch to the breast, though they suspected the crying resulted from the heat and an oozing, infected umbilical cord which Usih treated with alcohol. While assisting the young mother, Foster noticed the ocean between the slats in the floor. “Everything there is connected to the water. The people swim, fish, bathe and defecate in the ocean water.” Locals informed her that the tides removed the sewage. “The water was crystal clear and the turquoise green color was just like I’ve seen in the Caribbean.”
The grandmother overseeing the 14-year-old explained that her mother was out of the village today as she brought out a bottle of formula (which everyone discouraged her form using.) “It’s amazing to me the reach of formula to the most isolated parts of the planet, like Coca-Cola,” Foster mentions. They got in the boat again to visit a pregnant mom where they conducted a fetal assessment and used a stethoscope to listen for a heartbeat. A stunning, unpopulated beach served as the perfect location for a lunch and swim break after the visits, and a way to escape the searing sun. “It was idyllic except for the end when a large mass floated by,” remembers Foster, “which was not the foreign monster fish I thought it might be; rather, it was a dirty, disposable diaper.”
The escorts, special operations men, and two overhead circling army helicopters made sure the group returned to Jolo without incident. After Foster and Usih flew back to Zamboanga, they met with two other faculty to visit a woman in western dress, the mayor of Zamboanga. The nursing faculty brought Foster traditional clothing to borrow for the occasion.
Foster ultimately felt guilty at the end of the trip for using scarce resources and so much military protection for something as personal and unofficial as her visit. Usih and Sermina, another faculty member disagreed. They explained the rarity of a foreign visitor in Jolo, specifically due to fear of terrorist incidents, and the military protection showed people that the military does indeed act to protect. Because the majority of people in this area of the Philippines are Muslim, they also mentioned the significance of portraying themselves in a positive light. They knew much about the negative press in the U.S. regarding Muslims, which greatly contradicted their own calm reality (they credit this to a lack of exposure in the media). “You were able to see firsthand,” they said, “that we are peaceful! We are Muslims, but we are not terrorists! We were able to show you that. We were able to show you the good work we are doing in nursing and midwifery!”
Usih and Foster submitted an abstract to the International Confederation of Midwives Triennial held June 2020 in Bali, Indonesia. Foster noted how she would love for Usih to present her work in this part of the world to other midwives and that if the abstract was accepted, she would work to find funding to send Usih to the conference in order to share everything she does for the community in Badjao. “I am grateful to Emory, such that I could meet Sitti Usih,” remarks Foster. “It was really one of the most extraordinary experiences of my life.”
