by Alan Weisman
When those Hollywood years began, the Philippines had just 7 million inhabitants, so a quarter-million Filipino deaths in the three-year Philippine-American War was not insignificant—except, perhaps, to the United States, where the only Americans who’ve even heard of that guerrilla conflict are usually of Filipino descent. (A pity, because it so much resembled the later U.S.-Vietnam War that, were its history better known, a disaster might have been averted.)
When the Republic of the Philippines became independent in 1946, there were 18 million Filipinos. Today, there are nearly 100 million: as the rest of the planet’s population quadrupled in a century, the head count here quintupled in half that time.
A big reason why is that today’s Philippines—an archipelago of 7,100 islands facing Communist China, Muslim Indonesia, and Buddhist Southeast Asia—is the most Catholic country in Asia and, some say, the last bastion of the Vatican’s theocratic empire.
Catholic Spain’s government may hand out free condoms, and abortion may be legal in Catholic Italy, but in the Philippines, the Church never surrendered. In 2010, newly elected president Benigno (“PNoy”) Aquino III, son of former president Corazon Aquino, who died in office the year before, inadvertently incurred Rome’s wrath even before he was inaugurated. During a postelection visit to the United States, he was asked by some San Francisco Filipinos if he favored a reproductive health bill. Such bills, which would make family planning the business of the national government, including distribution of free contraception and maternity care for the poor, had been introduced regularly in the Philippine congress for forty years, and regularly shot down.
Under Aquino’s deeply religious mother, whose own election over dictator Ferdinand Marcos was hailed as a divine miracle, there was no chance for such sacrilege to become law. Beloved for her courage after her senator husband was assassinated, Cory Aquino was cherished most of all by the Church, whose interests she literally held sacred. Following her funeral at Manila Cathedral, a campaign commenced for her beatification. But any assumptions that her equally popular son shared his mother’s piety were dashed by his response in San Francisco. He was president of all Filipinos, PNoy replied, not just the 80 percent who are Catholic. He believed that couples knew best how many children they wanted, and that government should make appropriate services available.
His remarks made the headlines back home. The Catholic Bishops’ Conference accused the United States of meddling in Philippine affairs, and hinted that Aquino was brainwashed while on U.S. soil. Manila’s archbishop promised civil disobedience and mass demonstrations, which did not materialize, and threatened the president with excommunication. Aquino, in turn, invited the bishops to lunch at Malacañang Palace to talk, making their belligerence look foolish. He would not back down from supporting any of six reproductive health bills relentlessly presented by one side and parried by the other. About the only agreement between the two was that legalized abortion was not on the table. One thing at a time.
Which is why Roland will continue in his current employ for the foreseeable future. It wasn’t what he had planned. He went to college to become a registered nurse. In the Philippines, nursing is not just a job or a calling: it is a ticket. In a country now far too populous to employ and feed its people, people themselves have become the Philippines’ chief export—acknowledged by the existence of a government agency, the Philippine Overseas Employment Administration, to assist OFWs: Overseas Filipino Workers.
At any given moment, over 10 percent of Filipinos are working somewhere else. Men mostly get “3-D” jobs—dirty, difficult, dangerous—in construction, stoop farm labor, or as seamen. Women are mainly maids, more than 2 million in the Middle East alone. In Saudi Arabia, Filipinas are practically essential domestic appliances. Roland was headed to Jeddah, where a nurse makes more in a day than in a month back home. There is a serious doctor shortage in the Philippines, because they can earn far more working on other continents as nurses.
But Roland’s infirm mother needed care, and his father was already working in Riyadh most of the year. So he answered an ad for a community outreach nurse in a charitable clinic providing obstetric and gynecological care for women who couldn’t otherwise afford it. He liked the work. Many patients came from a shantytown he passed every day near Manila Bay, a former garbage dump where thousands of cannery workers tiptoed over rusting steel I-beams laid across plastic-choked drainage ditches, hoping to avoid infection from leptospira, a meningitis-causing bacterium spread through rat urine. There was no way to avoid dengue.
Roland believed that Jesus wanted him to help the poor. He belonged to the Legion of Mary, a lay devotional organization, and attended Mass daily with his fellow Legionnaires. Every week, he carried a statue of Mary to a different house and taught a family how to pray the Rosary. But he found himself in a dilemma when his job began to conflict with his Legion service.
Manila, Philippines
No one had tried to hide anything from him. At his hiring interview, he was asked how he felt about contraception. Like nearly everyone he knew who wasn’t a priest, he felt it was a couple’s decision.3 As a nurse, he knew that spacing children was wise.
He learned that the letters “MR” on a patient’s chart stood for “menstrual regulation,” a euphemism for adjusting a woman’s cycle with birth control pills. Although the Philippines had no national family-planning program, regions and municipalities could pass their own rules. In Malabon, contraceptives were legal, though often scarce; in Manila proper, seat of the archdiocese, they were banned, so it was wise not to advertise that they were being administered.
But what did “VA” on a woman’s chart mean? After his probationary period ended, he found out one night while on duty at the clinic’s minisurgery. Even when asked to assist, at first he wasn’t exactly sure what he was seeing.
“It’s nothing like what pro-life groups or the Church claim. They say you see a small fetus. It’s nothing scary, just blood and some tissue. It’s a medical procedure. And it does regulate a woman’s menstruation.”
“MR,” he now realized, also referred to the two-part procedure that uses mifepristone, or RU-486, to loosen the placenta from the endometrium, soften the cervix, and begin contractions, followed by misoprostol for final contractions to pass the material from the uterus. The procedure Roland saw that night was a “VA”—a manual vacuum aspiration: a method of abortion requiring no sharp implements, just a speculum, a clamp, a thin plastic tube, and a large-barreled syringe. As he came to understand, many preferred the two-step chemical solution because it was nonsurgical. But mifepristone and misoprostol needed to be smuggled into the country. Vacuum aspiration was a sure bet.
“VA” could also stand for vehicular accident, should authorities unexpectedly appear, demanding to see charts. Clinics like his have endured police raids, and stings by phony patients bearing marked bills and hidden cameras. They now take only confirmed referrals from friends or former clients, and operate behind double-locked doors.
Fear of the law was nothing compared to fear for his mortal soul, which Roland did for the first few days afterward. He knelt and asked forgiveness, but for reasons he can’t explain, he never went to confession. Instead, he entered “a reflection on my personal relationship with our Creator, my profession as a nurse, and my work providing compassion to women, especially to the poorest of the poor.”
He’d seen mothers of five, torn between buying pills or food for their children. There were women whose OFW husbands—home for their annual visit from Russian oil drill ships, Singapore restaurants, or Texas airline maintenance crews—stayed long enough to impregnate them for a seventh time. Or women accidentally pregnant just as their own OFW jobs finally came through, such as a frantic nursing instructor friend who was headed to Chicago.
And pregnant rape victims. Such women would go to the street market outside Manila’s Black Nazarene basilica where, amid rosary beads and pirated DVDs, herbalists sold 200-peso bottles of pamparegla and ulcer
tablets from China. Roland sometimes had to clean up the frightening results.
Fifteen years after being trained to perform abortions himself, he now does five to ten a month under sanitary hospital conditions, unlike most of the estimated 750,000 annual illegal abortions in the Philippines. The majority involve catheters threaded into the uterus, or to induce contractions, herbal potions like pamparegla or makabuhay vine extract (also used as a pesticide), or overdoses of ulcer medicine. Or women find a hilot—a Filipino combination of masseuse and chiropractor—who looks for an abdominal mass and crushes it with her hands. The procedure, repeated until bleeding commences, requires women to bite on a blanket to avoid screaming.
To avoid a conflict that might bother his conscience, Roland quit the Legion of Mary. He still attends Mass sometimes, but he has never returned to confession and doubts he will.
“To confess what? That I’m helping women in need? This is between me and God now. This doesn’t go through priests.”
ii. Passage and Reef
Luzon is the largest, longest, and northernmost of the major Philippine islands. At its southern shore, sixty-five miles below Manila, men with paddles strapped to their feet shuffle through muck laden with heavy metals in the tidal flats of the Calumpang River for clams. To the east, the shoreline rises into bluffs topped by flaring stacks and cylindrical tanks of oil refineries. A concrete pier large enough to receive petroleum tankers juts into the water, pointing into the Verde Island Passage that separates Luzon from the thousands of Philippine islands below.
Only fifteen miles across, the Verde Island Passage is narrow enough that several of those islands are visible on the horizon. It is also a bottleneck through which tropical marine species pass between the South China Sea and the Pacific—a bottleneck with a coral net to catch them. A UN Food and Agriculture Organization study of the Coral Triangle—the region bordered by the Philippines, Malaysia, Indonesia, Papua New Guinea, East Timor, and the Solomon Islands, known as the center of Earth’s marine biodiversity—determined that “the center of the center” is the Philippines, with 5,000 species of mollusks, 488 corals, five of the world’s seven sea turtle species, 2,824 fish species, and thousands of other aquatic organisms. The richest concentration of all—more than half the species found in the entire study—is Verde Island Passage, making it the planet’s most biologically diverse body of water.
Verde Island itself is a green dot, three miles by four, its profile like a brontosaurus lying low in the water, with a thousand-foot hump on its eastern end and a long neck that stretches west, ending in a small hump. Reached by outrigger ferry, it lies midway between Luzon and Mindoro, an island dominated by mile-high mountains. Other tiny outriggers roam the passage, piloted by solo fishermen. Except for nylon cord used to lash their bamboo struts, the technology is little changed from that used by humans who left these islands to discover Polynesia and Hawaii.
A fishing village, San Agapito, one of six packed onto Verde Island, hugs a turquoise inlet on its southeastern shore. Behind a beach of light brown sand, coconut palms rise above a row of neat houses of bamboo and basket-weave thatch. A path lined with multicolored painted stones, barely wide enough for a three-wheeled cargo bike, is the only road. In the yards grow yellow orchids, hibiscus, anthuriums, and jasmine. The village is spotless—the road is swept daily—and quiet: the only electricity is from a diesel generator that runs after sunset for four hours. There’s a whitewashed Catholic church with a blue tin roof, and a one-bed maternity ward and immunization clinic.
Romeo Gonzalez, in a straw hat and patched red bathing trunks, sits on a bench in a thatched, open-air hut, teasing knots from a nylon seine. His family has lived on Verde Island since people arrived in the Philippines, he says. A widower in his forties—his wife died young, of a heart attack—he has always fished: for grouper, octopus, fusilier, moonfish, humpbacked wrasse, gizzard shad, Indian halibut, and skipjack tuna. At low tide, he goes for oysters, lobster, and baby white shark. Mostly, he nets; for squid and cuttlefish, which range up to four kilos, he jigs at night with a lamp and a hook.
The problem is that over the past decade, there are far fewer fish.
“Too many people using cyanide,” he says, a technique for stunning coral reef fish that is often lethal to the coral. “Too many people, period.”
At least no one here uses dynamite, the other illegal way of scooping up many fish quickly. You need a compressor, he says, to dive deep and spray cyanide, and he doesn’t have one. He also doesn’t have many children. “Just three. We were one of the first couples to use family planning.” But there were supposed to be only two. The method they used, withdrawal, surprised them with a third.
“Today there are pills, condoms, shots that last three months. That’s good. Otherwise, families would have eight. Eleven, even. There are thirteen hundred people in this village, and four hundred of them are fishermen.” With the other villages, he adds, waving his cigarette at the rest of the island, there are at least fifteen hundred fishing boats. “Plus the ones who invade from Mindoro.”
“Hi, Romeo.”
Shading his eyes, he sees it’s Jemalyn Rayos, her pink cooler hanging from a shoulder strap. From it he selects a melon-flavored fruit ice; she, her seven children, and her eight siblings make and sell them around the island. Jemalyn, in her late thirties, is also San Agapito’s midwife, and recently became a family-planning peer educator, which generated much kidding. “I know, I know,” she says. “Only before, I didn’t.” She advises her own seven kids, and everyone else, to stop at two.
Her employer is Poverty-Population-Environment, the continuation of an internationally funded program that ended in 2008 called IPOPCORM, a digestible acronym for a serious mouthful: Integrated Population and Coastal Resource Management, an idea that makes sense in a country with one of the world’s longest coastlines. It is also where, IPOPCORM’s founders realized, the highest human fertility rates occur in the areas of highest biodiversity—a logical outcome of bountiful fecundity, but one approaching a classic tipping point. Filipinos get 80 percent of their protein from seafood, and their numbers had grown beyond the capacity to feed them all. The country’s richest seas were being devoured, and among the imperiled species was the one doing the devouring. At the epicenter of the Coral Triangle, the Philippines was the marine equivalent of Uganda with its gorillas—only here, people weren’t gobbling habitat: they were eating the wildlife itself.
The organization that connected the dots between rising population and diminishing fish catches was a Philippine NGO born of the AIDS crisis. Its director, Dr. Joan Castro, grew up in an Igorot family in indigenous northern Luzon, so deep in the mountains that she’d never tasted shrimp or crab until she traveled seven hours to Manila to study medicine. Her mother was one of seven, her father one of eleven. When they married, boar, deer, and river eel were already growing scarce, so they held themselves to four and taught their children why.
Castro planned to study obstetrics, but in the 1990s, growing numbers of OFWs were returning infected with HIV—especially Filipino sailors, working the flagships of practically every maritime nation. After graduating, she ran an AIDS counseling hotline, phones being the safest way in a homophobic Catholic country for a frightened person to approach a doctor about sexually transmitted disease. The program was underwritten by USAID, and young Joan Castro caught the eye of Leona D’Agnes, an American public health specialist. After years in Thailand and Indonesia, D’Agnes had come to the Philippines to begin a branch of PATH,4 an international family-planning foundation. Traveling through this impoverished country with such spectacular marine fauna had given her an idea, and Joan Castro seemed just the doctor to help implement it.
To finance the program they dubbed IPOPCORM, they approached environmental agencies, arguing that the best way to preserve the Philippines’ matchless aquatic environment was through reproductive management in the communities that depended on it. To family-planning funders such as USAID and the Dav
id and Lucile Packard Foundation, they argued the converse: that by helping fisherfolk create marine reserves to save their livelihoods, they could persuade them to produce fewer children. Armed with a species map from Conservation International, and with data mined from the national census and thousands of municipal records, they identified the thirty-five areas of highest marine biodiversity cross-referenced by population density, and then focused on the twelve most imperiled of these hot spots.
Over eight years, IPOPCORM spread to 1,091 coastal communities in eight Philippine provinces, and its successor program now focuses on the most impoverished, such as this one. Romeo points with his fruit ice to the fish sanctuary, where no one is allowed to dive. Sixteen more similar sanctuaries ring the island. Each village has coastal resource managers, who patrol and go door-to-door, talking conservation. Enforcement is a communal effort. It largely works, says Romeo, though he admits that there’s a lot of diving around sanctuary edges. Jemalyn is one of four volunteer health workers who also go house to house, teaching women and schoolgirls about family planning, receiving the peso equivalent of US$28 each month as honoraria.
Since the PATH Foundation came in 2009, she gets enough pills to give out. “Most women want them: if they get pregnant, they can’t migrate to get a job. Some are scared of side effects. We tell them it’s a lot safer than drinking boiled makabuhay vine to get rid of an unwanted pregnancy. The population here is still growing. But slower.”
“We hope the fish population is growing, but faster,” says Romeo.
The next-to-smallest primate5 on Earth, the tarsier, has huge eyes that, apart from its bat-like ears, make it resemble E.T., the Extra-Terrestrial—that is, if E.T. could fit in the palm of a human hand. The tiny tarsiers are also the oldest existing primate; the family Tarsiidae predates our own, Hominidae, by at least 40 million years.