‘From worm to man’: The throes of the schistosomiasis-STH burden in the Philippines

Written by Danielle Uayan

In a documentary hosted by Kara David (2008), schistosomiasis was highlighted as the seemingly insurmountable plague that haunted Trento, Agusan del Sur. David was showed trudging through the muddy plains of barangay (village) Basa, and she had discovered that almost every child had all the same symptoms: abdominal bloating, yellowing eyes, and stick-thin arms and legs. No family in the barangay was spared from the disease. Medicine was scarce in February 2007, only one canister of Praziquantel was sent by the Department of Health (DoH). It could help only 150 people. Around that time, 30,000 people were affected by the disease.

I came across that documentary back in 2012. I was in Cagayan de Oro, staying in the city I was born in for the holidays. I watched it alongside my parents, and I remember my dad telling us that he used to pass by Trento when he was in college. Back then, the town was an underdeveloped agricultural municipality, cut-off from the rest of the province due to its topography. He commented that he was disheartened to know the place was in such a state, but was not at all surprised to find there was not much of a difference from the Trento he saw decades ago.

It was that particular conversation that ignited my interest in the Philippines’ so-called War Against Worms. A quick search in academic journals would reveal that the situation in Trento is not at all unique to the municipality: Northern Samar is considered one of the highly endemic places in the country for schistosomiasis, and has been the case for more than three decades despite current control measures. The battle against parasitic worms has been going on for so long with no show for improvement that cases of  schistosomiasis and Soil-transmitted Helminthiasis (STHs) are considered ‘normal’ by almost everyone.


Woman coming out of the DoH-run Schistosomiasis Center in Catarman, Northern Samar

Mga bata dito eh madalas magka-bulate [The children here get worms often],’ one Northern Samar native and mother of five told me. ‘Eh, ayun. Ganoon talag’a [It’s just how it is]. When I asked whether they take medicine for it, she responded that they do, but that ‘Mahirap. Bumabalik talaga’ [It’s hard because it keeps coming back]. ‘Mayroong maliliit na bulate na kulay puti. Makati sa puwit. Nawawala rin naman yun maski walang gamot’ [There’s a white worm that’s itchy on the bum. It disappears even when (you) don’t take medicine], she added.

I told my father about it when I came back and he relayed to me his own childhood memories in Camiguin, an island province in Mindanao. He said that all of his playmates, himself included, were infected with tapeworms at one point in their lives. ‘We’d even take turns pulling the worms out of our bums,’ he said in an amused tone. I asked him the same question I did with the lady, and he replied, ‘We did take medicine. The kids were given medicine regularly by the health center in our barrio. But really, back then, I didn’t think of it as serious. People in general did not think it’s serious… The conventional [thinking] was that it is something that goes away as you grow older. Getting worms was a rite of passage, almost’. My mother, also a Camiguin native, chimed in on the conversation. She narrated that even she, a person who had reasonable access to water, sanitation and practiced good hygiene as a child, was infected twice. ‘Aside from medicine, I was asked to eat guyabano to get rid of [the worms],’ she said, ‘The guyabano fruit, not the leaves. I can’t recall why they made me eat it, though.’

All of their statements got me thinking, and in the end, I had more questions than answers. Even with all the medical interventions in place, why are schistosomiasis and STHs still prevalent? What does it take to eradicate such ancient diseases? Is it impossible in our country? What exactly are we doing wrong?

It’s not until I looked further into the classification of parasitic worm infections that I was able to get at least an idea: the infections belong under a group of seventeen diseases termed Neglected Tropical Diseases (NTD), which affect more than a billion of people that mostly belonged in the lower socioeconomic strata. In other words, schistosomiasis and STHs are burdens of the poor.

After learning about that, the aforementioned public health problems turn into something more in my mind. It makes a ton of sense: a person’s socioeconomic status greatly influences the kind of environment he would be regularly exposed to, would determine the degree of accessibility and affordability of medicine and treatment, and most of all, would factor in on his health perceptions and health-seeking behavior. Alleviating poverty, therefore, would be the ultimate solution.

But how?

Much cooperation from different areas in society is needed in order to win the battle against NTDs, and understandably, the health sector can only do so much in mitigating the ever-growing number of cases. It’s not impossible to say the least, but it would definitely be difficult. Despite it all, I can truly say that I remain optimistic. The cornerstone of human civilization is constant innovation, after all, and I am banking on that quality, coupled with Filipinos’ trademark resilience and resourcefulness, to put an end to this war. We have no shortage of brilliant and principled people coming from all disciplines, and the advent of social media and technology has made it easier for us to band together to eliminate STHs. I am thrumming with excitement just thinking that it could finally happen in our time.