Medical Anthropology, 25:331373, 2006 Copyright # Taylor & Francis Group, LLC ISSN: 0145-9740 print/1545-5882 online DOI:

10.1080/01459740601025856

Body and Illness: Considering Visayan Filipino Childrens Perspectives within Local and Global Relationships of Inequality
Lisa M. Mitchell
Despite a plethora of studies counting, examining, assessing, and diagnosing Filipino children living in poverty, childrens own perceptions and concerns about their health and security are rarely elicited. This article draws from fieldwork in an urban neighbourhood in the Visayan Philippines among children who, every day, face a complex and precarious landscape dominated by multigenerational poverty, social marginalization, recurring hunger, and the hazards of living and playing amidst mounting garbage and effluent. I discuss childrens perspectives on body and illness in this challenging environment and examine their ideas within the larger context of adult-child, hierarchical relationships, and colonial and contemporary government discourses on children, health, and citizenship. I also examine childrens sense of place, agency, and vulnerability, and I discuss the view held by many adults in this community: their childrens ideas hold little value. Key Words: body mapping; children; health beliefs; Philippines; poverty

INTRODUCTION My current research addresses childrens perspectives on living, playing, and going to school in their urban neighborhood on the Visayan island of Negros in the central Philippines. This project
Lisa M. Mitchell is Assistant Professor in the Department of Anthropology at the University of Victoria. Her research interests are in the areas of health, illness, gender, reproduction and children. Correspondence may be directed to her at the Department of Anthropology, University of Victoria, Victoria, British Columbia, V8W 3P5. Phone: (250) 721-6282; E-mail: lmm@uvic.ca

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came about after my colleague, Marjorie Mitchell, introduced me to a neighborhood womens group concerned with persistent problems of injury and illness among their children and grandchildren. After extended discussions with the women and a local NGO, we proposed a project focusing on what children had to say about getting hurt, being sick, and staying healthy. In particular, the project was intended to identify childrens ideas about body, illness causation, and health; what strategies they engaged in to deal with and stay free of illness and injury; and their ideas about how to make their homes and community safer. More broadly, the project was intended to enhance youth empowerment; that is, through involving youth in the project we hoped to create a social space in which their voices, concerns, and perspectives could be articulated and disseminated not only to researchers but also to adult community members. In suggesting this child-centered research, my colleague and I drew upon a revitalized anthropological interest in children (Scheper-Hughes and Sargent 1998; Stephens 1995) and accounts of childrens involvement in community development. This enabled us to identify not only how child and adult perspectives on environment, health, and community may differ but also how those differences might affect whether or not children benefit from local initiatives to improve their welfare (Hart 1997; Nieuwenhuys 1997; Robottom and Colquhoun 1992). The members of the womens group and other adults in the community were skeptical of our approach. Some of this skepticism derived from their lack of familiarity with research, beyond what they knew of brief market surveys conducted by vitamin and pharmaceutical vendors. Most of the womens skepticism stemmed from our proposal to make the childrens ideas and perspectives the focus of the project. Adults here show considerable affection toward their children and describe them as gifts from God, but they also regard them as mango (ignorant), basto (rude), disobedient, and in need of instruction. Many adults told us that their children know nothing (wala sila sang nahibaluan). Creating spaces within which childrens perspectives could be heard in this community was challenging; for instance, when we displayed the childrens drawings in the neighborhood, only a handful of adults came to look at them. The NGO with whom we worked suggested that we implement values training among the children and young mothers. Our middle-class acquaintances in Bacolod City listened attentively but echoed the need for values training, citing problems

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of gambling, drinking, unclean homes, and poor parenting among squatters. Repeatedly, adults told us that Filipino children, particularly in low-income neighbourhoods, were too ignorant and=or poorly behaved to contribute anything of value to understanding, let alone improving, child health and security. Here, I am not principally concerned with the successes and limitations of childcentered research in medical anthropology but, rather, with the connections between childrens ideas and what Prendergast (2000:103) refers to as their social contexts of power and value. Drawing from my work in a Visayan neighborhood, I situate the childrens ideas and images of illness and body within larger historical, social, and material contextscontexts that inform those ideas and images and shape how they are perceived and acted upon by both adults and children. The overlapping contexts of power and value upon which I focus include (1) the day-to-day demands of living and playing in an impoverished community that is struggling to survive the effects of imposed debt restructuring, neoliberal economics, and exclusion from regional development priorities; (2) hierarchical adult-child relationships, including that between researcher and child participant; and (3) colonial and contemporary government discourses on school children, health, and citizenship. I also examine childrens sense of place, agency, and vulnerability and revisit the adults assertions that their childrens ideas hold little value.

CHILDRENS PERSPECTIVES: WRITTEN IN THE MARGINS Despite a voluminous literature on the health, nutrition, and living conditions of impoverished children in the Philippines, scant consideration has been given to what those children say are either the sources of, or solutions to, their daily struggles. Furthermore, my analysis discloses how the health of childrens bodies and their practices of body care have been central to both colonial and postindependence agendas of Filipino nation building and modernizing. Determining what children think about their bodies and their health is not merely an exercise in ethnographic curiosity or childrens token participation.1 Children under 15 years of age make up 36 percent of the 84 million people in the Philippines (Human Development Reports 2005). The majority of those children and youth live in poverty, chronically undernourished and in poor

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health (Asia Child Rights 2003). Yet, a growing number of initiatives with working children in the Philippines and elsewhere have shown that even young children and those living on their own can contribute to the improvement of their own health and that of their community (Hart 1997; Nieuwenhuys 1997; Robottom and Colquhoun 1992; Racelis and Aguirre 2002). Moreover, interventions work better when childrens views are taken into consideration, when programs are based on what they identify as their priorities and needs, and when children are involved in making decisions about things that will affect their lives (Porio, Moselina and Swift 1994:157; Racelis and Aguirre 2002). In focusing on childrens perspectives, my research engages a recent change in anthropological thinking about children. Conventionally, children have been conceptualized as incomplete adults, or adults-in-training, who passively acquire and reproduce cultural knowledge and who can best be understood by questioning parents, teachers, and health professionals. Within ethnographic writing on the Philippines, for example, children have tended to appear primarily as silent recipients of adults child-rearing strategies (Jocano 1969, 1983). Recently, anthropological approaches have shifted to investigate the complexity and diversity of childrens perspectives, the range and impact of their social practices, and the constraints on young peoples agency or ability to make and remake identity, practices, and relationships. As a result of this shift, childrens agency in economic activity (Nieuwenhuys 1994), on the street (Beazley 2002; Panter-Brick, Todd, and Baker 1996), in negotiating gender and ethnic identities (Downe 2001; Mendoza-Denton 1996), and in political action (Sharp 2002) is now more visible within anthropology. Anthropologists have infrequently attended to childrens perspectives on their bodies, health, or illnesses (Bluebond-Langner 1978 being a notable and early exception). However, several researchers in other social sciences have addressed childrens perspectives on illness and what Prout (2000:9) calls childrens work on and with the body. Unfortunately, little of that work concerns children living outside of middle-class England, Australia, or North America. When their ideas about body, illness, and health are probed, it is clear that children are neither parroting nor misunderstanding adult knowledge (Backett-Milburn 2000; Williams and Bendelow 2000). Not only are kids adept at understanding and intercalating different and often contradictory types of

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knowledge (Geissler 1998:142; Williams and Bendelow 2000), but their ideas are drawn from a variety of sources, including their own social worlds and experiences which were partially hidden from adults and constructed by children themselves (Backett-Milburn 2000:89). The ways in which childrens experiences of the body differ from those of adults, and the ways in which children use the body as a crucial resource of meaning and agency, are also receiving attention (Christensen 2000; James, Jenks and Prout 1998:156). Work by James (1993), Mendoza-Denton (1996), and Nichter (2000), among others, highlights child and youth attentiveness to the body not just as a site of cultural elaboration but also as a means of creating and maintaining self-identity and relationships with others. In short, over the past ten to 15 years, a new paradigm has emerged in anthropology and in other social sciencesone that recognizes that children have their own distinctive, meaningful, and coherent perspectives on the world. Indeed, it has become commonplace to describe children as social actors and cultural producers and to discuss how they are active and influential contributors to the social lives of their communities (Scheper-Hughes and Sargent 1998; Schwartzman 2001; Aitken and Herman 1997; Bucholtz 2002). While I do not dispute this general conclusion, my own research was conducted among children whose cultural productions and social agency are neither valued nor the focus of much adult attention in their world. Thus, in this article, I consider the ideas and practices of health and illness among children who are not only marginalized by NorthSouth inequality and by the widening gap between the rich and poor in their country and city but also by the adults in their daily lives. My focus is upon the embodied viewpoints of impoverished children who are often hungry and hurting, who live in distressed physical surroundings with few safe places to play, and whose ideas and activities are generally dismissed as inconsequential and incorrect by both parents and teachers. Based on the analysis of childrens drawings and talk, I address the following questions: (1) what do kids growing up in such circumstances think and say about body, illness, and health? (2) to what extent do they see themselves as able to mitigate illness and to avoid environmental hazards? and (3) how are childrens perspectives and practices shaped by their position within both local and wider structures of inequality? My goal is to draw attention to the ways that childrens ideas, experiences, and practices of

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health, illness, and body are tied to particular configurations of power, meaning, and place. In framing these questions, I am mindful of research that highlights the ways in which the social and material organization of inequality, marginalization, and power shape experiences of self, illness, and body (Lock and Wakewich-Dunk 1990; Scheper-Hughes 1992). For example, Prendergasts (2000:117) research in Britain underscores how restrictive teachers and school nurses, intrusive actions by male pupils, and inadequate school toilets and sanitary supplies meant that girls. . .lived menstrual experience as a constraining, secret and negative event, whatever their attitudes or approaches. Berman (2000) notes how social and spatial marginalization among street boys in Java is reflected in their narratives of survival and harm, and how it shapes their notions of self, causality, and agency. My own thinking owes much to Cindy Katzs (2004:156) writing, which situates the lives, ideas, and practices of children in low-income households within topographies of global capitalism; that is, within the broader contexts of global economic restructuring, industry outsourcing, and government disinvestment in education, health, municipal services, and social welfare. Focusing on childrens play, work, and learning in a village in rural Sudan and an urban neighbourhood of New York City, Katz (2004) traces the detrimental effects poor children experience when their communities do not benefit from rapidly circulating global capital but, rather, are pushed further into debt, hunger, and despair. Katz argues that poor children have a distinctive susceptibility to the harmful effects of global capitalism, in part due to the extraordinarily local nature of their lives, circumscribed by adults, school, and the immediate vicinity of home and neighborhood (2004:163). While Katz examines the role of childrens play, work, and learning in the social reproduction of their communities, my interest is with the connections between economic vulnerability, environmental degradation, and disenfranchised childrens experiences of body and illness. In conjunction with Katzs topographies, Orellanas (1999) and Aitken and Hermans (1997:64) observation that children see things in environments that we [as adults] may have forgotten to see, let alone understand is a provocative call to consider place in our analyses of childrens knowledge and practices. Here, I use place not as setting or locale but, rather, as it is used in Rodmans (2003:205, 216) notion of social landscape or place as lived

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experience. With few exceptions (Prendergast 2000; Olwig and Gullov 2003), the ways in which childrens perspectives on body, health, and illness are shaped by their lived experiences of place, by the material organization of social life, and by history, as well as by local meanings, social relationships, and the corporeality of their own bodies, are not often examined. In this article, I show that what children in this community draw and say about the body, including its contents, changes, sensations, and troubles, are complexly intertwined with the social and material dimensions of their worlds. Their narratives and images encompass not only what they have come to understand about the body and its functioning from a public school curriculum that originated during the early 20th-century period of American occupation and that was subsequently harnessed to a national ideology of modern Filipino identity but also meanings that emerge from daily having to negotiate unsafe play areas, open sewers, uncollected garbage and other environmental hazards, troublesome spirits, and the power inequities of adult-child relationships. To begin, I situate the children and then their drawings within the context of the community and the research project. I use one type of drawing as a departure point for my analysis, foregrounding the content of childrens life-sized body maps, their talk about them, and the social relationships within which they were produced (Rose 2001). I then turn to childrens comments about their experiences of illness and injury, situating their ideas about causality and place within both local and larger contexts of power and value.

PUROK DAGAT: LIVING ON THE MARGINS Like millions of children in the Philippines and elsewhere, the children discussed in this article are directly affected by the uneven and unjust effects of North-South inequality enacted through colonial expansion and contemporary global capitalism. Independence from the Spanish came in 1898, but Philippines political autonomy crumbled in 1902, with American territorial claims lasting through Japans Second World War occupation. A second independence was granted by the United States in 1946, but, between 1975 and 1986, the U.S.-supported Marcos dictatorship underscored the fragility of Filipino self-determination.

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Moreover, in the post-Marcos era successive governments have been faced with an ever-growing, foreign-owned national debt. Today, after 20 years of debt restructuring and trade liberalization, that debt stands at over US$60 billion, and a startling 89 percent of Philippine government expenditures go toward debt servicing (Bello 2005). According to government statistics, roughly 30 percent of Filipinos live in poverty; non-governmental organizations and poverty advocates place that figure at 75 percent or higher (Marquez 2005; Oliveros 2005). Plagued by government and corporate corruption and a stagnant domestic economy, the national government has repeatedly used its population as an economic resource, supporting the worlds largest exportation of human labour and becoming deeply dependent on the foreign currency remittances from its citizens working abroad (Oliveros 2005). On the island of Negros, where this project was conducted, mono-cropping, established in the late 1800s by the British and Americans and continued by national Filipino governments, has left local economies deeply vulnerable to fluctuations in the world price of sugar (Billig 2003). Government and entrepreneurial initiatives to diversify the islands economy through other export crops and tourism have not alleviated the profound inequities between rich and poor (Bacolod City Planning and Development Office 2005). Following the neoliberal model of the national government, the current plan for the islands largest city is to minimize business and employment regulation, implement One-StopShop-Investment to attract investors, and transform Bacolod into a centre for service, conventions, and tourism. Attracting corporate and private investors is the citys solution to declining national government revenues, deepening poverty and joblessness, and deteriorating infrastructure in a city in which nearly 40 percent of the population are under 17 and soon to be looking for work (Bacolod City Planning and Development Office 2002). The destruction of low-income neighborhoods to make way for expensive residential subdivisions, hotels, golf courses, and shopping malls; employment growth in low-paying, short-term service sector jobs; and the rising costs of everyday life due to privatization and the deregulation of oil and electricity, water, and health services has intensified poverty and suffering among the poor in Bacolod City. The children who participated in this research live in Purok Dagat, a pseudonym for one of Bacolod Citys many impoverished, disintegrating, and structurally effaced neighborhoods.

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Purok Dagat is a place where the structural violence of inequitable colonial and neocolonial political and economic processes is lived directly by its residents and, especially, by its children. Nearly 1,600 residents live in 250 small shacks, and eviction by landownersseveral of whom now live for most of the year in the United Statesis a recurring crisis for families. Incomes are low, and unemployment is widespread and persistent; children grow up in households where older siblings, parents, and grandparents struggle to find enough work to sustain the basic necessities of life. Fish stocks are dwindling due to overfishing and the pollution of marine waters, but many adults have no alternative other than trying to support their families by fishing or fish vending. Men find occasional jobs in construction or transportation, while women earn some money by taking in laundry or by operating small, housefront chungi shops selling coffee, cigarettes, alcohol, small packets of food known as chichurias (junk food), and soap. Older teens and youths in their twenties compete for temporary, low-paying service jobs in the citys shopping districts; in many cases, their parents have to borrow money to cover the associated and sizable application, health certification, and store uniform fees. As a coastal settlement on the citys social and economic margins, Purok Dagat is further marginalized by recurring flooding and erosion and, until recently, its exclusion from Bacolod city limits. Other than some fortifications to combat coastal flooding, the city government has invested little in this neighborhood. Rather than solidifying residents claims to entitlements such as potable city water and other improvements, the city exacerbated the neighborhoods peripheral status by using it as a landfill site for municipal waste. Purok Dagat is now a deeply distressed and dangerous environment. Compounding overcrowded and precarious housing and seasonal flooding, uncollected refuse has contaminated ground water, increased numbers of insect and rodent pests, and diminished fish and shellfish stocks. Sections of the original dumpsite are now covered by sand and dirt, but uncontrolled dumping by area residents continues (see Figure 1). Basic garbage, sewer, and water services in Purok Dagat are unreliable. Municipal water is available for a fee, but adults have concerns about its potability. Because toilet and sewage facilities are inadequate, many people use the ocean shoreline, a favourite play area for children. About one-half of Purok Dagat residents are under 18 years of age. School attendance and completion is high here. In addition

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Figure 1. Section of Purok Dagat. Photo credit:#Author.

to schoolwork, purok kids perform numerous household chores, and boys, especially, may earn a few pesos by feeding pigs and chickens, scavenging plastic, glass, and metal, and doing odd jobs for wealthier neighbors. During school vacation in particular, children have free time, and their joyful presence in the purok is evident in their boisterous play, shouts, and laughter. Favorite activities among children include eating, watching TV, swimming, and playing hide and seek and tag. Girls have elaborate clapping and singing games, and boys love to play basketball and to race, jump, and fly spiders and beetles tethered on thread. Teenagers like strolling with their barcadas (groups of friends) along the roadside or at a nearby mall. Although municipal health officials consider the current rates of child malnutrition in this area to be low, purok children suffer from a range of other health problems, including endemic intestinal parasites, scabies and conjunctivitis, recurrent fevers, diarrhoea, and respiratory infections (bronchitis). Hepatitis and tuberculosis are found throughout the community. Per capita government health care expenditures in the Philippines are among the lowest in the Asia-Pacific region; imposed restructuring and debt servicing have reduced those expenditures to less than 2 percent of GNP (Simbulan 2001:10; n.d.). In consequence, the poorly equipped

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barangay (community) health center, which serves over 33,000 people, is so understaffed that patients may wait hours only to be handed a prescription for medicine they cannot afford (since supplies of free medicine have run out). The barangay health worker receives her paltry government stipend infrequently but continues to provide services to purok residents, giving basic first aid and reminding TB patients to take their medicines and mothers to bring in children for immunization. As a result of restructuring and declining government revenues, health services are increasingly privatized, but the costs of those services, of prescription medicines, and of basic fees for emergency care at the public hospital are prohibitively expensive for most households. Instead, residents may use a variety of plant- and food-based remedies as well as treatment by local healers known as hilot, who specialise in massage, and loyaloya, who specialise in prayer.

ASKING KIDS TO DRAW AND TALK Drawing was one of several research methods used to elicit childrens perspectives on living, playing, and working in this community.2 We hoped that drawing would be fun for children and would enable them to feel comfortable and confident participating in a research project, an activity that was unfamiliar to them and to their parents. Drawing activities further appealed to us as being a method that might not privilege adult knowledge or verbal skills (Dell Clark 1999) and that might assist children to express experiential states (pain, sensation, anxiety, discomfort, unhappiness, frustration) that could be difficult to put into words (Cornwall 2002; Diprose and Ferrel 1991). While several types of drawings made by the children were germane to the question of bodily knowledge, health, and illness, this article focuses on body mapping. Prior to discussing and critiquing body mapping, however, it is important to look at the ethical aspects of childrens participation in this project. Following Aldersons (1995) and Harts (1997) writing on ethical principles and rights-based approaches in child research, we recruited children who expressed interest in the project and whose parents had consented to their participation. Kids met individually or in small groups with research assistants from the purok to discuss the project in Ilonggo. Research assistants carefully explained that

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I wanted to learn what children thought about their health and illness and about staying healthy in their purok. The nature of childrens participation was explained, and research assistants emphasized that kids could participate in the activities even if they did not want to be included in the research. Children were first told about how and where their drawings and statements might be disseminated (articles, public talks, museum exhibits). Initially, they were asked to choose a pseudonym so that they would not be identifiable in publications. However, neither children nor parents liked the idea of a pseudonym (it was equated with a criminals alias). Significantly, many children wanted to have their contribution, especially their drawings, acknowledged with their own name. After discussions with children and adults in the community, as well as with the ethics committee at the University of Victoria (the university with which I am affiliated), confidentiality was redefined to enable children to use their own names. The researchers reserved the right to use a participants pseudonym if her or his drawing or statements contained sensitive material. For body mapping, kids worked in pairs, using wax or pencil crayon to outline each others bodies on large sheets of paper.3 Once the outlines were completed, each child worked individually, making the drawing into a life-sized portrait and then responding to the instruction: draw what you think is inside your body (Maayo ko nga idrowing mo ang tanan nga ara sa pamensaron mo mga bagay nga ara sa sulod sang lawas mo). When children indicated their drawings were finished, they talked in Ilonggo with research assistants from the community about what they had drawn, and they identified sites and sources of bodily distress, discomfort, and pleasure. The body maps were intended as a means of enabling children to express their views and concerns regarding their health, illness, and injuries as well as their ideas about the body, including its interior and workings. Specifically, the goals of the drawings were (1) to provide an interesting and enjoyable way for kids to focus on and talk about self-drawn images of their own bodies (as opposed to an impersonal and standardized body); (2) to provide them with non-verbal as well as verbal channels for expressing their ideas about their bodies and health; and (3) to enable them to approach that discussion with some detachment (i.e., without having to point at or touch their own bodies). Children also participated in a series of focus groups, some gender-specific, about their drawings and

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their thoughts on health and illness. Although I conducted individual interviews, the children preferred group interviews. Those conversations took place in English and Ilonggo, with a translator; tape recordings were transcribed verbatim and translated. Over the course of the project, 88 children between the ages of six and 15 years, including roughly equal numbers of girls (46) and boys (42), none of whom was disabled, drew at least one individual body map. Initially, we intended to focus the research on school-age children, but the age range also reflects a general disinterest among youth over 15 years of age in drawing activities. On the other hand, children under six enjoyed drawing but did not want to talk with the researchers. This article draws upon qualitative content analysis of the body maps and upon conversations and focus groups among 35 to 40 children who, through their ongoing interest in the study, became the self-selected core participants in the research. I distinguish my use of childrens drawings from those that appear in some psychological and=or educational research. I am not using the drawings to assess what the depiction of the human figure by children at various developmental stages=ages indicates about a childs representational ability, cognitive development, emotional maturity, social adjustment, or values (Aptekar 1988; DiCarlo et al. 2000; Goodenough and Harris 1963; Koppitz 1984). Nor is my work directly comparable to studies that assess childrens knowledge of the body for its completeness and accuracy regarding internal anatomy and functioning (Reiss and Tunnicliffe 2001). Neither developmental nor realist perspectives take into account childrens interpretations and experiences of their bodies. Even more significantly, these perspectives fail to examine childrens ideas about, and experiences of, their bodies within the specific cultural, social, and material contexts of the childrens lives. Using a critical visual methodology, my approach to the childrens drawings includes an analysis not only of their content but also of the circumstances of their production, circulation, and consumption (Rose 2001). Although I address some aspects of how these drawings have circulated and been viewed within and beyond the community, my focus here is on contenton what children drewand on the production of these drawings. I analyzed the content of the body maps by coding and counting drawing elements (labelled organs and body parts, unlabelled structures); by comparing body maps to other drawings made by the children; and, especially, by examining body maps within the context of

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the childrens narratives about body, health, and illness.4 How the drawings were seen and talked about by adults within the community highlighted the fact that, in addition to content, an analysis of the particular circumstances, methods, and relations of the drawings production is important (Rose 2001:32). When the drawing activities began, children were eager and excited to participate but waited expectantly to be told which colours to use and what to include in their drawings. With encouragement from the researchers, the children drew, yet it was clear that some children and parents regarded the drawing activities, especially the body mapping, as tests or evaluations. Adult research assistants from the community, as well as parent onlookers, were alert for what they considered to be inaccuracies in the drawings. As the children drew, adults called out: Is that all that is inside you? What about your lungs? Where is your stomach? Who pays for your fancy clothesa rich man? In some ways, as a method used to enable childrens thoughts and perspectives to come into view, drawing worked well. However, it also made the childrens ideas accessible to adults in the community, who proceeded to correct, ridicule, and, on occasion, praise them. Further, drawing highlighted our status as maestras estranheras (white foreigner teachers). Although children did not seem particularly distracted or distressed by the comments made by adult onlookers, we wanted to lessen the imbalance inherent within adult-child relationships an imbalance that the drawing activity brought to the fore. Consequently, we moved the drawing venue from an outdoor chapel to a less public space so that children could work without interruption; as well, we involved youth research assistants and encouraged adult research assistants not to comment on the drawings. The childrens enthusiasm for drawing never flagged, and, as the following analysis suggests, they did find ways to express a range of ideas, perspectives, and experiences relating to their bodies.

SCHOOL, STATE, AND OTHER BODIES As I discuss in this section, the body maps revealed a particular bodyone that children encountered in school lessons on health, hygiene, and human anatomy. The majority of the drawings, in one way or another, through content, organization, and=or

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labelling, shows the impress of contemporary biomedical-scientific representations of human internal anatomy. In other words, there are clear resemblances between the childrens drawings and those common to science textbooks and health posters: humans with torsos flayed to reveal neatly arranged internal organs. Not only is this exemplar body part of health and science curricula in the public schools but it is also embedded within a larger state discourse on children as part of the nation as well as within both colonial and more recent relations of power and authority. Most children interpreted the request to draw what is inside of you to mean draw what is inside your torso;" few included features located inside the limbs. What children depicted within their bodily interiors appears in a wide variety of ways. Most common are irregularly shaped circles, or sacs, of varying sizes as well as both long and short, wavy and straight, lines and tubes. Some of these visual elements were immediately recognizable to the researchers. For example, the heart drawn as a red Valentine shape, the ribs as lines or bars across the chest, the stomach as a large circle roughly midway down the torso, and the brain as a circle inside the head. Some children filled the entire torso (shoulder to groin, or side to side) with their depiction of their insides; most interiors appear quite empty. Organ size varied considerably, but the positioning of the most commonly drawn organs relative to others was similar: hearts were usually in the upper center of the chest, while stomachs and intestines were lower down. The textbook representation of the bodys interior was most evident in the drawings done by boys 13 to 15 years of age (see Figure 2), all of whom said they had studied human anatomy in high school science. The abdominal and chest cavities of their body maps are full of organs, drawn in considerable anatomical detail, often overlapping and interconnected and usually labelled in English. They included organs rarely or never mentioned by younger children, including testes and trachea. Boys in this age range also tended to include the interior of their limbs: bones, muscles, nerves, and veins. More commonly, the school-disseminated anatomical body in childrens drawings resembled Figure 3. The child has drawn her face and hair, and some clothing, and has depicted her insides as a heart, a large sac (usually identified as stomach or intestine), a tube (often unidentified), some ribs, and external genitalia. While other internal body parts were often unconnected, there is evidence

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Figure 2. Body map by Brian Rei Macaya, 14. Photo credit:#Author.

of childrens ideas about a digestive system. Most often they drew a tube or line from mouth or throat downward to an interior sac or tube labelled tiyan (stomach) or tinae (intestine); less often, that line continued to a point labelled monay (vagina) or buli (anus) (see Figures 3 and 4). This view of the bodys interior as differentiated parts having some functional organization is paralleled by

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Figure 3. Body map by Chucky Morada, 10. Photo credit:#Author.

the childrens explanations that brains are for thinking, lungs are for breathing, and stomach and intestines are where food is stored or cleaned (matinlo). While a few children said the heart pumped blood, it was more commonly described as the source of their life (kabuhi sa akon). This functional organization of differentiated internal anatomy what Christensen (2000:52) refers to as a professional discourse on the somatic bodyoccurred broadly throughout the entire group, with minimal variation between boys and girls; however,

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Figure 4. Body map by Ana Ybanez, 12. Photo credit:#Author.

the drawings by the youngest children, those least familiar with the school-disseminated body, are distinctive in several ways. The sixto-eight-year-old kids generally included only two or three internal organs or structures: the heart (nearly always drawn as a red Valentine heart) and a roughly circular sac or tube labelled stomach

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or intestine. In contrast, older children drew more structures within their interiors and made more connections among them, in some cases representing other functional systems, such as a respiratory system. Although they did not include the kidney and liver drawn by these older children, and only one or two drew the liver or ribs, some of the six-to-eight-year-olds filled their bodily interiors in other ways. A few drew only two or three organs but made them very large. Some included the heart, stomach, and intestines but also drew or shaded and labelled the interior of the bodys torso as though it were filled with dugo (blood) (see Figure 5 and Figure 6). Despite my own somewhat naive expectation that body mapping would create a visual field privileging childrens views of the body, the inside-out view of the body asked for in this activity is, in fact, a particularly adult perspective (Mitchell 2006). Moreover, because these children were producing images for adult American university teachers, they interpreted body-mapping as: draw what your teachers have told you is inside your body. Asking children to draw their bodily interior privileged school learning as well as older children, who were more familiar with the schooldisseminated notion of the anatomical body. And asking children to make body maps individually seemed to privilege what one anonymous reviewer described as an individualised= bounded=privatised experience of body rather than a collective community body.5 While this drawing activity was intended to suggest what each child sensed and thought of his or her own body and did not ask children and parents to produce a collaborative or negotiated understanding of the childs body, the resulting drawings made it clear that the school-disseminated body is also a collective body. This anatomical, functionally organized body is collective not just because it is widely taught in the Philippine school system as the correct representation of the body but also because it is sanctioned by adults (as evidence of the childs compliance with school teachings) and by the state (as evidence of a modern, rational Filipino citizen-subject). Much as it starkly revealed the power=knowledge differential between adult foreign researcher and child Filipino participant, body mapping also highlighted the broader colonial and contemporary social relations of power and authority within which children experience, represent, and are taught to understand their bodies. Thus, at one level, the fact that children envision their bodily interiors through the lens of medical-scientific representations of

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Figure 5. Body map by Myra Marry Grace Villarey, 7. Photo credit:#Author.

human anatomy should not be surprising. Scientific models of health and the body have been part of the elementary school curriculum since the early 1900 s, when they were used as part of the American occupation of the Philippines to correct Filipino ideas about body, health, and disease and to create a disciplined

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Figure 6. Body map by Welson Tillaflor, 8. Photo credit:#Author.

and productive colonial subject (Rafael 2000). Across the Philippines, American teachers and physicians subjected school children to daily surveillance, instruction, and testing (Anderson 2002; Martin 2002;

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Sobritchea 1990). From lessons in hand-washing and proper toilet habits to marching drills and inspection of school uniforms, a new habitus of (potentially) adult, rational, self-regulating hygienic citizenship was imposed (Anderson 2002) to prepare school children for the possibility of full citizenship in an independent Philippines nation (McElhinny 2005:186). More recently, the body and its composition, functions, and care have been tied to nation-building and citizenship as part of a larger pedagogical strategy, enshrined in the Constitution of the Philippines, to inculcate nationalism and patriotism,. . .develop moral character and personal discipline,. . .[and] broaden scientific ~ as and Ditapat 2000:112). and technological knowledge (Marian In conjunction with campaigns of national pride and identity (Constantino 2002 [1966]:182), the government has emphasized that children of the new Filipino state have obligations to improve their country (Mulder 2000:61). As one instructional chart specifies, children must obey parents and teachers, have good personality, . . . health, . . . [and] personal cleanliness, and must help to maintain cleanliness and orderliness at home and its surroundings (Secondary Education Development Project n.d.). Beginning in the primary grades, children are instructed in proper care of the body, including clothing, grooming, regular washing, and getting regular exercise and adequate sleep. Classrooms in Bacolod public schools display government public health announcements about tuberculosis, polio, and SARS, and they often also display one of the following posters: Causes of Disease, Cleanliness Chart, or the A1 Filipino Child Chart, with its nine body care directives, including wash your ears, wash your legs and feet, clean your nose [and] cut your nails (see Figure 7). Despite the fact that debt restructuring eliminated the local school meal program, with the result that children often go to school hungry, the school curriculum instructs Purok Dagat kids to eat three balanced meals a day. And, of course, teachers complain that underfed children do not listen to instructions. While the majority of Filipinos live in poverty and have no access to reliable medical care (Marquez 2005; Simbulan 2001:16), children are taught that their claims to being good and loyal Filipinos depend upon their personal values and behaviour, including their responsibility to obey adults, to keep themselves clean, and to be healthy. How well children reproduce this body and its associated values and behaviors becomes a measure of their worth as young Filipinos. Parents negative comments about their childrens

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Figure 7. A-1 Filipino Child Chart. # Cebu Green Emerald Marketing. Reprinted with Permission.

drawings now take on a different significance, highlighting their anxiety about how foreign researchers might judge their children as well as the close connection between childrens ability to reproduce what they have been taught and their status as properly obedient. While this school-based, collective body did dominate the body maps, the presence of some visual elements and the absence of others suggest that the children were not merely engaging in the

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passive reproduction of school lessons. As other researchers with other children have found, the children in this project understood their bodies through diverse and sometimes contradictory domains of knowledge (Backett-Milburn 2000; Geissler 1998; Williams and Bendelow 2000). Specifically, their drawings show, in limited ways, how they intercalated the functional anatomical body with their own sensations and experiences as poor children and with other culturally meaningful ideas about health and illness. Significantly, their perspectives cannot easily be reduced to a simple binary: school-based representations=non-school-based representations. The reality is more complex and heterodox. For instance, as visual evidence of their frequent hunger, diarrhoea, and other gastrointestinal problems, stomach and intestines often loom large in their drawings. The heart, sensed directly and described as the source of life or place of emotions (balatyagon), is similarly prominent in body maps. Notably, the heart that most children appropriate for their own drawings (77.3 percent of 88 drawings) is not the textbook multi-chambered (anatomical) heart but, rather, a large red Valentine heart (often seen in television cartoons and print comics). The distinction that many children made between stomach and intestine is indicative of the anatomical body learned at school, local beliefs that parasites or worms (lugay) live in their intestines, and the abdominal pain and yellow skin that children associate with parasites. Younger children are especially prone to lugay, perhaps because they are not able to be as vigilant as are older children in avoiding contact with human and animal excrement. As a result, the younger kids are particularly familiar with purga, deworming remedies that they say clean the intestines, and they talk quite unselfconsciously about having worms pulled from their noses and anuses. At that same time that they carefully distinguished stomach and intestine, none of the children included a bladder in their body maps; instead, they associate peeing (para maka ihi) with the penis and the vagina. A few of the 46 girls (6.5 percent) drew and labelled ovaries and bi-horned fallopian tubes, but none included a uterus. Among girls and some women in this community, the uterus (matrice) is a place where a baby grows and is not associated with menstruation. Girls explained the absence of the uterus from their drawings by saying, wala ako gabusong (Im not pregnant). Childrens ideas about the body draw upon knowledge that is not sanctioned by either the school or the health clinic. For instance,

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although our conversations about health and illness often led children to talk about locally meaningful non-biomedical disorders such as tuyaw (an illness that includes fever, rash, and stomach ache and that is caused by spirits), they almost never mentioned these during the body-mapping sessions. Yet, some of the children nine years and older included in their body maps a very large atay (liver), an organ that they know to be the favorite meal of bloodthirsty, supernatural aswang who are said to roam the community. Similarly, although it rarely showed up on their drawings, many children told us they had had kibit, or what is known as piang on nearby Bohol and Cebu islands (McNee et al. 1995; Tallo 1999). Distinct from bruising (pakris) and skeletal breaks, kibit refers to pain and swelling resulting when something inside the body is fractured. Children say that kibit occurs if they fall or stumble and land heavily. Precisely which internal structure is harmed is unclear; some children (and adults) say that kibit is a fracture or dislodging of veins (ugat), but most say they do not know, thereby refusing to locate kibit within, or reduce it to, the biomedical body. Not surprisingly, children asserted that kibit does not respond to biomedical remedies but, rather, to hilot, the vigorous massage of local healers. The request that they draw themselves and their bodily interiorsa request that, as I have argued, evoked schoolbook diagrams of naked flayed bodiescreated tensions that the children sought to resolve. One way that they kept the body closed and whole and thus familiar was to include its surface. The presence of skin was hard to detect, although a few children coloured their arms and legs. In many of the drawings, the bodys surface remains visible as more than half of the children included either nipples= breasts or the navel along with their depiction of the bodys interior organs (see Figure 4 ). Yet, breasts, navels, and external genitalia suggest that the request draw what you think is inside of you evoked in the children an image of nakedness. Boys and girls over about ten years of age had problems depicting themselves as naked, which is not surprising as only very young children appear in public unclothed. While less than 25 percent of the six-toeight-year-olds included clothing in their drawing, over half of the older children did. Some children managed their nakedness in the body map by rendering their clothing present but transparent (see Figure 8 ). Thus, in addition to including shorts or skirts in their body outline, they drew breasts with bra straps, torsos with

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a T-shirt neckband and armbands, and they depicted waistbands and underwear lines merging with interior bodily structures. More than modesty is operating here. It is clear from the body maps and the other drawings that children saw these renditions as an

Figure 8. Body map by Rene Alisbo, 11. Photo credit:#Author.

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opportunity to clothe themselves in imagined and desirable ways. None of their body maps includes school uniforms or torn and dirtied clothing; rather, boys clothed themselves in brand-name sportswear, especially basketball shorts and jerseys, and girls fashioned beautiful dresses and hair accessories for themselves. ILLNESS, PLACE, AND SOCIAL RELATIONSHIPS Through these maps, children articulated their understandings of the body, particularly as these understandings are shaped by what they learn at school. Additional ideas, along with more of their subjective lived experiences of the body, came into focus when they were asked to talk about their past illnesses, injuries, and discomforts. What became clear were the lived connections between childrens experiences of their bodies and of their surroundings. Although my focus here is on the links children made between places and illness and injury, it is important to note that they do not regard their purok primarily as a place of risk and danger. On the contrary, Purok Dagat is perceived as a place of home, family, and friends; of security, pleasure, and beauty; and of play. Yet, when children talked about illness and injury, they were usually also talking about places and activities:
Sang pag-ulan sang domingo pagpaligo sa ulan, naghilanat ko, sakit sa ulo ko, sakit tiyan ko. On Sunday when it rained, I took a bath in the rain and had fever, headache, stomach ache. -Archie Pimentel, 9 Sakit sa tiyan nagkaon ko puto nga pan-os. My stomach hurt when I ate puto [rice cake] that was not fit to eat. -Eden Grace Mapilit, 13 Sakit tyan kay damo gin ka-on nga mo aslom nga prutas. Sakit ulo kay naga sulay sa ulon purma. Sakit sang tiil kay surva ka lakat kag wala naga tsenilas ang mata haga [pause] sakit kay nga sulod ang balas ang siko sakit kay nga bung-go. [I had a] stomach ache, because I ate lots of fruit that is sour. [I had a] headache, because I always take a bath in the rain [and] sore feet, because I roam around without sandals. My eyes hurt, because the soil gets in my eyes. I bang my elbow on something. -Shirley Mendoza, 8 Galagaw ko waay ko baalu nga katapak ko tag-lugar pag-abot ng balay nagpahuway ko indi na ko ka tindog, galuay, wala gana magkaon nagpatawag si nanay manughilot siling maghilot nga tag-lugar siling ya manuob kag mangayo pasensya. I roam around and accidentally step on tag-lugar [environmental spirits]. When I went home and rest, I cant stand anymore. Im weak and no appetite; my nanay [mother] called up the hilot, [healer] who told us that I was hurt by tag-lugar [spirits] and told us

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to make tu-ob [burn incense and=or herbs] and to ask forgiveness. -Renalyn Alisbo, 10

The list of illness and health problems that concerns the children is not the list that attracts either national or parental attention. Posters and warnings about diseases of national concerntuberculosis, SARS, AIDS, dengue feverappear in school classrooms and the health clinic, but most children had little to say about them. When asked about their concerns regarding child health in Purok Dagat, parents nearly always begin by mentioning the financial burden caused by pharmaceutical medicines, doctors visits, and hospital emergency care. The costs of imposed restructuring and the increased privatization of health care are borne disproportionately by lower-income Filipinos like the residents of Purok Dagat (Simbulan 2001:12). When asked to identify specific disorders, parents usually listed asthma (hapo), fever (hilanat), the dangers of children playing or walking near the congested roadway (there are no sidewalks), and illicit drug use. The childrens narratives (see above) suggested a somewhat different list. Although they sometimes talked about fever, children rarely mentioned respiratory conditions, and they saw drug use as a problem exclusive to gangs of older boys and young men. When talking about their own bodies, children were much more likely to describe stomach aches, headaches and toothaches, sore feet, skinned knees, and cuts (which parents mentioned only if stitches were required). Children also referred to kibit and tuyawtwo culturally specific conditions that parents mentioned only infrequently and both of which I discuss later. Despite parents assertions that their children knew little or nothing, children rarely responded to our questions about the causes of bodily harm by saying, I dont know. Instead, they identified specific causal factors, and they did so in a way that was remarkably consistent across age and gender. In particular, children see their bodies as vulnerable to environmental factors, especially to weather and to living in dirty (higko sang palibot) surroundings. When asked how they had acquired a cold or a fever, children (and their parents) invariably responded that they had been bathing (pagpaligo) in the rain or that they had been exposed to a cold wind (tugnaw hangin).6 Headaches were often attributed to too much play or work in the sun or to bathing or playing in the rain (gahampang sa ulan). The health effects of seasons, rain,

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and temperature changes are reported throughout the Visayan Philippines (Jocano 1969; McNee et al. 1995; Nichter 1994; Tallo 1999). These factors are probably traceable to ideas about hot-cold qualities (which are widespread in Malay-descended populations) (Becker 2003; Laderman 1987), to Visayan beliefs about powerful and evil (maligno) winds (Jocano 1969; Tallo 1999), and to humoral notions of body and illness brought by the Spanish colonizers (Nichter 1994:653).7 Classroom instruction on illness prevention also refers to staying out of the sun and rain, and to avoiding sudden changes in weather. A second recurring element in childrens statements about illness and injury is higko, or dirt.
[What made you sick?] Higko kag ang basura, kalog higko sang tao kag sapat. Dirt and garbage and the canal with dirt from humans and animals. -Jo-an Jaena, 12 Ang masakit halin sang basurahan kag ulon kag init makaka-on sila sagig panos nga pagka-on halin sa basurahan kay maka inom sang higko nga tubig. I got sick from the dumping site, from the rain and heat of the sun. I also ate rotten food from the dumping site and from drinking water that is dirty. -John Paulo Barnes, 9

Children refer to higko both as a general explanation for sickness and as the cause of specific problems, including skin rashes, stomach ache, and fever. Bacteria or germs (kagaw) were rarely mentioned, but a few older children equated them with higko. Some children explained higko as refuse or waste (basura), as human or animal excrement, or as rotten or expired food, while some used it to refer to intestinal parasites (lugay). Flies, mosquitoes, and cockroaches are higko because they contaminate bedding and food and bite childrens bodies. Significantly, it was not always higko, per se, that made them sick but, rather, the many higko nga lugar, or dirty places, in the community. Among those places are the shallow drainage canals=ditches, which are full of fetid water and are located outside their homes, and the basurahan, open dumping sites that contain rotting food, bags of excrement from houses without toilets, and the corpses of dogs and cats. Even some of their favorite play areas are higko nga lugar, including the garbage-strewn beach and the ocean, into which garbage and raw sewage are emptied. Moreover, as etiological factors, dirt, weather, poverty, and the structural and physical marginalization of this purok by the citys

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wealthy and powerful coincide when children note that they are especially likely to get sick during the rainy season, when inadequate, overflowing drainage canals, floodtides, and typhoons bring garbage, mouse and rat urine, and other higko into their homes. The general importance of temperature, wind, and rain and heightened anxiety about the rainy season may be metaphorical referents to residents perceptions of a lack control over their environment and the literal submerging of their tenuous claims to land and legitimacy in this city. At this especially unpredictable time of year, physical and social vulnerability and marginalization may coincide to heighten child and adult anxiety about individual and collective security. Research in another Visayan community suggests that local notions of dirty and clean operate as a binary pair that functions to make both physical and moral classifications. Among farmers on the neighboring island of Bohol, hinlo, or clean, describes the desirable state of fields, households, personal hygiene, and appearance (Borchgrevink 2002). Using Mary Douglass (1966:40) conceptualization of dirt as matter out of place, as something that threatens the social order, Borchgrevink (2002:235) suggests that, among these Cebuano speakers, hinlo is equated with spaces that are domesticated or humanized, while hugaw is equated with dirty and with the opposite of domesticated spaces (i.e., a lush and rampant nature). In Purok Dagat, children distinguished higko from balas (soil or sand), and they further contrasted higko to clean (hipid or tinlo). However, the sparse clumps of bushes and stands of trees and an uncultivated, uninhabited area near the river were not described as higko nga has or lugar, although they were sometimes referred to as wild (ila wayang). As I discuss later, these spaces were nonetheless regarded as potentially harmful.8 Eating and food received particular attention in childrens discussions of causes of bodily distress and sickness, an observation that has been noted in other research on Filipino children (Villanueva-Noble 1998). Children are often hungry in this community, and they include hunger as a source of stomach pains and headaches. In Purok Dagat, most children eat at least twice a day, but portions are small and of low nutritional quality, usually consisting of instant noodles, rice, and a bit of fish washed down with sweet carbonated soft drinks. Snacks, when they can be afforded, are sugary or salty, high-fat junk foods. When young

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children were asked to name their favourite activity, most responded, eating. Although their parents deny it, children do scavenge for food on the dumpsites. As the children indicated in several of their earlier statements, expired or rotten food (higko nga ka-on) is another common explanation for stomach upset or diarrhea. These ailments are also attributed to the worms that consume what children eat as well as to eating aslum, or sour foods, such as santol fruit or one-peso bags of salted sour green mango.
Masakit ang tiyan kay wala paka ka-on sang ka-on, nga ka-on sa sang prutas nga aslum. My stomach hurts, because I eat sour fruits before rice. Eduardo Escala, 9 Lupot wilu pamakakaon sang hanon nga kaon sang prutas. I got diarrhea because I hadnt eaten rice, and I ate fruit. Nenmar Alvarez, 11

Children clearly associate their environment with risks of illness and injury, especially from rain, sun, and dirty surroundings (higko sang palibot). The importance of environmental factors in Filipino childrens ideas about health and illness has been noted elsewhere (Villanueva-Noble 1998:142; Jocano 1969). Yet, in Purok Dagat, childrens comments illuminate not just the presence of these factors (which are a source of bodily harm) but also the interaction between them and their activitiesplaying, running, swimming, scavenging for food, and so on.
I get sick because I am always running around, and I get caught by the rain. Arjie Buen, 14 Ang masakit halin tongod gahanpang ko basurahan higko mabalto. I get sick, because I play at the garbage dump that is dirty and smells bad. Christian Mark Tombrio, 12 Sang Monday naghilanat. [On Monday I had fever] Diin naghalin ang hilanat? [Why?] Kay gapaligo ko sa baybay. Because I took a bath at the sea. [Are you allowed to swim in the sea?] Indi [No]. Rachel Britannia, 7

Childrens comments about bodily harm and injury recall Orellanas (1999:73) findings about the importance of social relations for the meaning children attach to the landscapes in which they live. Similarly, Christensen (2000:47,55) sees this connection between context and social relationship as particularly relevant for understanding Danish childrens experiences of everyday illness, falls, cuts, and scrapes. She suggests that childrens accounts showed that experiencing vulnerability also related to the experience of

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losing social position, activities and relationships and changes in their environment (Christensen 2000: 47). In Purok Dagat, children often attribute bodily harm to transgressing social rules, including parental instructions. As children tell it, they get hurt or fall ill when they engage in forbidden types of play (swimming at high tide, taking a bath in the rain, climbing fruit trees or fences and getting onto roofs, running without sandals), or even hampang tudoplaying too much. They get hurt when they play at locations they have been told to avoid karsada (the roadside), pika-pika (breakwater), and the basurahan (the garbage dump). And they experience pain and discomfort if they fail to follow parental instructions concerning body care brushing teeth, resting, avoiding sour foods before eating rice, or eating too much sour food. It is not only parents and other adults who must be heeded. Children link harm and illness to their contact with other powerful entities in their communityengkantos. Described in ethnographic and historical work on Visayan societies (Aguilar 1998; Borchgrevink 2002; Lynch 1984 [1949]; Pertierra 1995), engkantos are spirits who live alongside human residents. In Purok Dagat, some mariit, enchanted places occupied by these spirits, are known to the children (and to adults), but engkanto are invisible and thus notoriously hard to avoid. Young children receive some protection as their mothers keep them close to home and pin protective slices of ginger to their clothing. But older children who venture farther as they play and walk to and from school must be careful not step on either the engkanto or on their houses, which are visible as mounds of earth. Luckily, some types of engkanto are creatures of habit, and children know they should not shout or make loud noises when these spirits are resting each day at noon or when they are roaming through the community on Tuesdays and Fridays.9 Similarly, when they must relieve themselves outside, children call out, hoping to warn the spirits to move away. It is not possible to avoid engkanto completely, and children suffer from tuyaw, or the temporary skin rash, fever, and stomach ache caused by contact with these spirits. Like kibit, tuyaw is not recognized by the physicians and nurses who staff the local health clinic; it can be diagnosed and treated only by local healers. Encounters with the spirits can be lethal. Children have a variety of stories about deaths caused by aswang, a particularly malevolent category of engkanto. Aswang transform from human to non-human

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form and crave the tender livers of young children and human fetuses. On the neighboring island of Bohol, engkanto dwell in those places that are considered undomesticated and natural (hugaw) (Borchgrevink 2002:235). Similarly, children in Purok Dagat identified certain trees and clumps of bushes as places where engkanto dwell, regarding them as dark (madulom) sites, places of worrying sounds and shifting, shadowy shapes. Kids pointed out that spirits also live in other madulom placesin the rafters and at the back of houses, in the space below traditional raised houses, and in comfort rooms (toilets) and wells. While only some of these spaces are considered dirtycomfort rooms and the rear of houses, where pigs may be keptthe childrens comments highlight that engkanto inhabit the margins of domesticated human spaces. Way up high, deep down low, and toward the backthese orientations are echoed in stories about spirits who fly, travel underground, and shun the light (Pertierra 1995:80).

CONCLUSION My intent in this article is to bring both local and broader contexts of inequality, power, and authority to bear on understanding how a group of impoverished children in the Visayan Philippines talk about their bodies. As Katz (2004:163, 182) suggests, it is precisely the fact that childrens lives are extraordinarily local that makes them distinctively vulnerable to the harmful effects of those local and larger topographies of capitalism (156). Circumscribed socially and geographically by adults, school, and the immediate vicinity of home and neighborhood, children must bear directly the effects of poverty, structural adjustment, inadequate social welfare, dilapidated homes, and lack of basic community services and amenities as well as the sporadic emotional and violent outbursts of adults who are frustrated by too little money and by their grinding subservience to those who are better off. The health concerns headache, stomach ache, cuts, scrapes, kibit, and tuyawvoiced by the children in this Visayan community are the sort that adults in the Philippines (and elsewhere) typically refer to as minor or nothing much (Christensen 2000) in comparison to the life-threatening problems of tuberculosis, polio, dengue fever, and malnutrition. But childrens concerns are neither insignificant nor

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simply reflective of an incomplete or inaccurate understanding of their bodies and of what makes them ill. Rather, in pointing to their distinctive locations within (and experiences of) place, adult-child relationships, and larger structures of inequality, childrens thoughts and concerns are both testimony to the lived realities of growing up in poverty and a means of understanding how they make sense of their bodies within these circumstances. Cuts and scrapes indicate the particular vulnerabilities of children in a community lacking safe play areas, a community built upon the discarded razor blades, barbeque sticks, broken glass, jagged tin cans, and other mundane waste of urban life. Stomach aches and yellowed skin (from intestinal parasites) are the embodied effects of experiencing poverty and inadequate sanitation, literally close to the ground. Headache and stomach ache are bodily expressions of hunger, of scavenging for expired food, of inadequate shelter, and of the small pleasures of eating cheap but non-nourishing junk food. Kibit and tuyaw further signal the distinctive vulnerability of children in a landscape made dangerous by hazards both seen and unseen, where adults and adult knowledge offer only partial protection. Stories and the sensed presence of engkanto, in particular, are meaningful symbolic vehicles through which children express their sense of vulnerability and their recognition that, despite following adult instructions, they still get sick. And the dangers are not (or are not only) dirt and garbage but larger, invisible forces that are both powerful and predatory. The concerns of children are often overlooked not only by government health priorities and school curricula but also by parents; nonetheless, those daily pains and discomforts shape how children view the world. The fact that their concerns are overlooked or disregarded by those with relatively more power then they possess means that children must come to terms with some types of bodily pains and problems on their own. Well aware that what is taught about the body and health in school is considered by teachers and parents to be important and authoritative, children can reproduce this knowledge when required. For example, not only did children model their body maps on what they had learned in school but they also echoed this knowledge in their ideas about avoiding higko (dirt) and the importance of staying hipid (clean). Within the context of 20 years of debt servicing, economic restructuring, deteriorating health services, and a neoliberal state rhetoric concerning the duty of individual children to be clean

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and healthy, the overlooking of childrens concerns has yet another dimension. Filipino children, particularly those in impoverished neighborhoods, have long been the target of colonial and national government programs focused on sanitation and hygiene, disease reduction, and population betterment, all of which are disseminated through elementary and high school curricula. Emphasizing mastery over the body through memorizing terminology, through gaining a knowledge of basic human anatomy, and through the inculcation of daily practices of hygiene, dress, and obedience to authority, school appears to offer those children the means to minimize risk, avoid illness, and achieve health. However, for many of the children living in poverty, the clean, well-fed, healthy and disciplined A-1 Filipino Child of their classrooms is materially and socially unattainable. Directives to avoid mosquitoes, flies, and rats; piles of garbage; and getting caught in the rain are impossible strategies of disease prevention for children living in Purok Dagat. Without adequate housing or waste disposal, there are virtually no safe spaces in which children can play. Without clean water, waste disposal, or adequate toilet, bathing, and laundering facilities, staying clean is an exhausting and time-consuming activity. Girls do hours of laundering each week; boys tote heavy containers of wash water from the local pump and wells; and both work to keep rats, flies, windblown refuse, and sewage from swollen canals out of their homes. Moreover, standards of obedience, attention, and academic success based on assumptions of well-nourished, well-rested bodies are unattainable for children whose daily intake of poor-quality food is insufficient for growth and development much less for attention to duty and citizenship. The childs failure, evidenced in hunger, inattentiveness, and illness, then perpetuates colonial and contemporary class-based assumptions about the ignorance and laziness of impoverished children. Rooted in a pedagogy that infantilizes the poor, identifies them as at risk, and blames them for failing to meet national goals of health, illness reduction, and waste management, schools offer the children of Purok Dagat little to mitigate their daily health concerns. Nonetheless, the language of self-care, self-blame, and individualized responsibility for health is central to the childrens views. Listening to their mothers and teachers chastize them for eating the wrong things, for getting dirty, for not resting, for wandering too far from the house or otherwise misbehaving, kids internalize

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the idea that illness and injury result from their own behaviour and disobedience. By reproducing this neoliberal public health message of individual responsibility, children acknowledge their lowly place in the adult-child hierarchy, while, at the same time and at some level, demonstrating that they are good children. They have learned the neoliberal lesson of self-regulation well. Furthermore, this self-attribution deflects blame from poor parents who are not only too exhausted by the unrelenting tasks of provisioning a family to monitor each offspring closely but, given this environment, are also fundamentally unable to protect their children from harm. Despite the constraints of generation, political economy, and environment, children do not see themselves as sickly (masakiton), nor are they particularly fearful of their surroundings, always responsive to adult demands, or amenable to passively reproducing what they learn at school. They routinely ignore adult instructions, warnings, and cautions. They play where they want; eat chichirias (junk food); say they have washed when they have not; craft their own ideas about body, illness, and dangerous places; and inhabit their community with pleasure, ebullience, and a sense of security and belonging. In their ideas about body and illness, children in Purok Dagat express a sense of limited agency that is meaningful to adults and children alike. In attributing harm and illness to spirits; to the wind, rain, and extremes of temperature; and to the higko and garbage that pervade their surroundings, children vividly and metaphorically express a sense of their own vulnerability and limited scope for avoiding illness and injury. Their statements are broadly similar to the passivity and deflected agency that Berman (2000:159) notes among children who are socially and spatially marginalized on the street in Java. In addition, their ideas replay widespread Visayan ideas about constant threats and the inevitability of illness. Similarly, within the material, social, and interpretive reality of their surroundings, there are few spaces that adults or children regard as safe or clean (tinlo)the interior of some houses and classrooms, some of the purok pathways, parts of the schoolyard, basketball courts, and one small plaza (or courtyard). Yet, playing in these spaces exposes children to the scrutiny of adults and to the demands of homework and household chores. In fact, the places that children consider desirable because of their potential for offering uninterrupted non-scrutinized play are dirty or populated by engkantothe open dump, stands of trees and shrubs,

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the beach, the ocean. Not only are these locations in which children are at increased risk of illness and injury, but they are also precisely those spaces that adult directives tell them to avoid. Even young children possess considerable knowledge about dangerous places in their purok, but, like their older brothers and sisters, they are drawn to those areas as offering fun and being free from adult scrutiny. Moreover, there are no other options. While some of the childrens ideas about risk and illness might cautiously be considered instances of resistance to the constraints of school-based, adult, official views of body and illness, those same ideasand, especially, childrens willingness to ignore adults and take risks perpetuate the adult view that children are unruly and must be constrained and instructed. In its 2005 report, The State of the Worlds Children, UNICEF estimates that more than one billion children live in environments that pose significant challenges to their health. Growing up in one such environment in the central Philippines, the children of Purok Dagat negotiate and make sense of body and illness in a complex and precarious landscape dominated by multigenerational poverty, joblessness, social marginalization, dilapidated housing, inadequate health services, recurring suffering, harmful spirits, and the daily hazards of living and playing amidst mounting garbage, discarded junk, and animal and human sewage. That they are not cowed or disheartened by such formidable obstacles is certainly testimony to their resilience and creativity. But a curriculum consisting of bodily regimes of control and of largely unattainable strategies of risk reduction and disease prevention offers neither protection for individual children nor the potential to transform the relationships of inequality that dominate their lives and produce their suffering. Rather, it serves to inculcate and reproduce the belief that the poor are poor by their own hand. In this sense, Katzs (2004:183) conclusion that poor children are increasingly made to bear the costs of social reproduction under global capitalism is particularly poignant and disturbing.

ACKNOWLEDGMENTS This article is based on fieldwork conducted during several periods from 2001 to 2005. Funding for this research was provided by a Social Sciences and Humanities Research Council of Canada

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Standard Research Grant (20022005) and a University of Victoria Faculty Research SSHRC 4A Grant (200102). I am indebted to my colleague, Dr. Marjorie Mitchell, for her comments on this article; to the children for their enthusiastic participation in the research; to the KASAKI nanays; to Julie Dojillo and NGO Balayan; and to several University of Victoria students, especially Soma Morse, for research assistance.

NOTES
1. Exceptions include Szanton Blanc (1994) and Racelis and Aguirre (2002). 2. In addition to a variety of drawings, we conducted household surveys, monthly child health logs, and interviews and focus groups with children, parents, teachers, community health workers, and healers. 3. This technique was adapted from several sources, including Cornwalls (2002) use of reproductive maps drawn by women in India and Geisslers (1998) use of abdominal maps drawn by Luo children. 4. The body maps were coded separately by myself, my colleague, and a research assistant, and we noted few discrepant codings. I and at least one research assistant also separately analyzed other drawings and photographs according to theme. 5. Thank you to the anonymous reviewer for pointing this out. 6. Bathing in the rain describes both being drenched during a rainstorm and, literally, using the rain as a means of washing or cooling ones body. 7. In fact, particularly among children, I found little evidence of a systematic or elaborated hot-cold system of classification for food or illness, although it does appear in womens and healers talk about prenatal and postpartum care. 8. A detailed analysis of the childrens classifications and experiences of place will be the focus of a subsequent article. 9. The days when engkanto are most active are the two days of the Catholic rosarys sorrowful mystery recalling Christs suffering and crucifixion (Aguilar 1998:161).

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