PROFESSIONAL EXPEREINCE IN THE COMMUNITY SETTING AT BULUAN DISTRICT HOSPITAL AND RURAL HEALTH UNIT, 2009.

DENNIS N. MUOZ, P.T.R.P., R.N., R.M.

ARMM remains at the bottom from other regions of the country in terms of health conditions of its constituents. Maguindanao is recognized lacking of sophisticated health facilities, manpower and financial support that shall cater the suppose to a more than four (4) millions population of the region. Further, the problems have been aggravated and troubled by the prevailing peace and order situation in the area. Since July 2008, more than 300 residents of the Municipality of Buluan Maguindanao province, that have been displaced by the on-going war between the Philippine government military and the rebel forces of the Moro Islamic Liberation Front and worst case is, the internal political conflict between two dominant tyrants and lords of power in the region leading to a more troubled health condition of the locality. Let me first describe the picture of the Filipino-Muslim inhabitants of the locale of Buluan, followed by the health and cultural implications of the muslim practices in the area, as well as theoretical application of Leininger s theory. Different inhabitants in Mindanao result in big differences of practices and beliefs. Discrimination is common and this happens everywhere. Despite this, Lumads, Catholic Christians, and Muslims are free to express their beliefs and practices. Lumads have not succumbed to the modern ways of living. Up to this day, they prefer to live in the mountainsides of Mindanao, living the traditional life. Their beliefs can be seen through the ornaments of every woman and the woven dresses they wear. They believe in spirits and gods. There s a god for land, another for water, another for harvest, to name a few. For them, the mountain is sacred. Death and illness or bad faith is believed to be the god s way of showing anger. Offering of live animals like pigs and chicken are common during tribal ceremonies for a good harvest, health and protection, and thanksgiving. Mindanao is one large community of diverse people. Understanding one another regardless of his or her religion or belief is best because we are all children of God, each created unique. Respect, understanding, and appreciation of differences are important. The Muslims in the locale were truly faithful and religious like Christian, believing in monotheism. The place of worship and meditation is in the mosque. Congregational prayer is traditionally done every Friday. They follow the five pillars of Islam, which requires them to pray five times a day. Another global practice of Islam is the Ramadan, where Muslims abstain from food, drink, and sex. However this practice is not binding to all Muslims; on occasions, pregnant women and old folks Muslims are exempted from doing such religiosity due to some health related reasons and as part of being adherent to the sacred words and writings in the Holy Quran. Idle Fetre is a major Muslim prayer practiced signifying the end of Ramadhan. Idle

Adha is prayer and celebration practiced by muslims Hadji (referring to a male) and Hadja (referring to a woman) who went to Holy Land in Mecca. As a nurse, it is our morale and humane act to understand cultural diversity as to the way Muslims wore clothes especially among women. Indeed, it has major implications to their practices that women has to wear malong or abaya , a kind of Islamic clothing and the wearing of hijab - a fine veil or head dress to cover the hair, cheek and neck of a woman is a must. Therefore, it is important that male or female nurse to be very careful not to reprimand them to remove such clothes unless otherwise it interfere the initiation of care during emergency situations and or for the purpose of maintain sterility and safety. The old Muslim folks are considered the leader, and the source of wisdom, they are the most respected group since their influence to the tradition is so strong and inviolable. They congregate during occasions which require celebration and conventions of the elders, relatives and clans. Some Muslim traditions have health implications and ceremonial practices that have been rooted since immemorial remain a practice even up to modern days. To mention the few, here are some of those traditions I encountered during my period of exposure and immersion in a Muslim community of Buluan Maguindanao such as Kalilangthe form of Muslim wedding, Kanduli - a muslim ceremony that may be associated to commemoration of death or burial of their love ones; Sagayan or Bagipat - another traditional religious ceremonials and celebrations are conducted for the purpose of driving spirits and act of healing for those who are sick, ill and spiritual possession where the officiated by a Taligamut or the quack doctor ; Mauludin Nabhi this is a time Prophet Mohammad announced to his followers of faith in Islam where all young Muslims have to baptized, this is called Antiyak or Tabungawan, as mentioned in their local dialect, accompanied by circumcision among young males. Therefore, circumcision has its religious significance as part of tradition and for the purpose of health and sanitation. The traditional health faithful and practitioners remain another challenge on my part as community health nurse and as DR Nurse before. Let me compare Modern day western Medicine man from a traditional practioner and their corresponding designations as traditionalist practioner: Taligamut - A male quack doctor Walian a female midwife or a nurse Pakayan or Duka a Witch who makes love potion, magic spells and witchcrafts Pagalamatan clairvoyant, mystic or fortune teller

Implications of above examples

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Transcultural nursing helps heighten my awareness of ways in which Muslim- Maguindanaon clients integrate faith and health system to work and take effect the desired action for which they are intend to practice. There are ways or practices which the nurse may perceive as exactly dangerous or may endanger the life of the client if we are to refer the acts from western medicine concept. one might say it is truly stepping beyond the point of the health care system, but it is therefore the initiative and effort of the nurse to identify the strength and limitation of such act provided, it doesn t interfere or endanger the life of the client in general, so they may continue to evolve do such act. I learned to foster understanding, respect and appreciation of such unique individuality and diversity of patient s beliefs, values, spirituality and culture regarding illness, its meaning, cause, treatment, and outcome. Refer how they integrate the developmental patterns of every individual young muslim is relative to religious reference. Example, Circumcision is patterned with religious celebration Mauludin Nabhi . Sensitivity to practicing midwifery and nursing should also be considered, like the case of the Walian or the traditional birth attendant is also one factor which sometimes cause of most disagreements of practices in the Rural health unit , especially woman who gave birth in the far countryside. What the modern medicine can offer to these traditional birth attendants is to teach them the proper and safe process of handling a baby during labor. Nowadays, traditional birth attendants are encouraged to help the women and assist during delivery at the RHU providing comfort and assistance during post partum. To sum up, Identifying religious and cultural difference strengthen my commitment to relationship-centered medicine that emphasizes care of the suffering person rather than attention simply more to the pathophysiology of disease, and recognizes the physician as a dynamic component of that relationship.