As of December 2020, there are over 450,000 cases of COVID-19 in the Philippines – nearly half of which have been detected in the densely populated region of Metro Manila.

Densely populated communities

Protecting people from the COVID-19 pandemic is especially challenging in Manila. Allen Borja, an Infection Prevention and Control (IPC) nurse in the MSF project in Tondo, Manila, describes his visits to the slums.

“One barangay (smallest administrative unit) we supported had a population of 55,000 people, while another one has 61,000. This is based on the 2015 Census. The population is fluid, and every three months there are new residents who settle here.”

Borja shares that in some barangays, “The nicest houses have two rooms, while others are just a tarp held up with some wood. Many houses have no windows. Sewage and waste flow freely on the streets. Things that most people take for granted are not available in many houses - mattresses, flooring of any sort, or any form of light. The streets between houses are narrow and filled with open waste and closed water pipes side by side. Pollution and air quality are very bad. Some children openly defecate in the street. Many people have open wood fires burning indoors; the ash in the air makes it extremely hard to breathe.”

A heavy toll on mental health

Until the end of August, patients were allowed to isolate at home, but this was a challenge in the slums of Tondo. MSF social worker Lyka Lucena said, “Home isolation is very difficult – almost impossible – for people living in Tondo. It is rare to find a separate room for the patient. A lot of patients were struggling to meet basic needs due to economic concerns such as sudden unemployment and loss of income source for those in the informal economy. Those who did not lose their jobs could not report to work due to transportation limitations. A lot of people have gone hungry, even hungrier in these depressed communities. Most patients were the main providers of the family thus their families were also affected, including those who were sending money to the province."

To help people in home quarantine, MSF teams provided over 2,000 COVID-19 kits, containing disposable masks, thermometer, alcohol, hand soap and the contact card of a social worker. The teams also provided kits for their contacts, containing similar items. Since those in quarantine could not work, MSF collaborated with a local faith-based congregation, the Missionaries of Charity, to provide food packs as needed.

Due to these difficult conditions, Lucena adds: “The majority of people in home quarantine were experiencing anxiety and depressed emotions. They were worried about infecting other people especially their loved ones. They were also scared of getting sick or getting COVID-19 again. A lot of patients were experiencing loneliness due to being away from their families. Many people shared feelings of anger, frustration, and helplessness about their situation.”

MSF teams offered remote mental health support to those in isolation at home. “We tried to help alleviate their distress by identifying and emphasising their healthy coping strategies and to establish ways of helping themselves. We also made sure to address feelings of being discriminated and stigmatised. We also encouraged patients to reconnect with their loved ones such as family, friends, and other social groups, reminding them of their social support system and finding untapped groups,” said Lucena.

Since October 2016, MSF has worked in the slums of Tondo, in Manila, the capital of the Philippines. Access to affordable health care is a huge challenge for people in these slums. This photo was taken in 2017, but living conditions in these areas remain the same. © Hannah Reyes Morales 

Supporting the community

In the barangay or community health centres, MSF contributed to improving infection prevention and control (IPC) measures, through staff training, the provision of personal protective equipment, handwashing stations, soap and other cleaning supplies, acrylic barriers, and educational material on COVID-19. MSF also assisted with contact tracing through the provision of transportation.

Support to COVID-19 patients, and close contacts, included the provision of kits that contained face masks, alcohol, hand soap, and a thermometer. Patients also received mental health and psychosocial support.

MSF also supported the barangays, by providing the barangay health emergency response teams with IPC supply: face masks, face shields, alcohol and hand soap. MSF teams produced COVID-19 risk communication video materials and provided health promotion tarpaulins, as well as promoted hand hygiene through various activities. A total of 14,000 masks were distributed.