Bye, Bye, Bulate: Promoting Health in the Children of Tondo

by Janine Liwanag

At seven in the morning, the sun was high up in the sky and beating down our necks as we stood on the side of the road. With my face mask and denim jeans on, I felt the sweat beading on the skin of my back. But I knew that waking up this early and going out in the summer heat was worth it, because inside the little chapel of Aroma, Tondo, something magical was happening.

When I volunteered for “Teach and Treat,” a health promotion outreach arranged by my college’s home organization, I did not really ponder on it before signing up. I just did it. I could have hesitated because it was a little out of my comfort zone; because it was my first outreach since before the pandemic; because it was scheduled after the end of my semester. But I was honestly a little excited.

It had been a while since I had last worked with kids, and the fact that this was specifically a health promotion outreach that applied my public health majors in a community close to my university made me want to go even more.

“Teach and Treat a Chikithink: Bye, Bye, Bulate” was organized by the UP Association of Public Health Students (UP APHS), in partnership with the UP Health Sciences & Pre-Medicine (HSPM) Society and Daily Manna Foundation, to teach the children of Tondo, Manila how to prevent soil-transmitted helminth infections. These are also known as STHs — or in simpler terms, mga bulate. What made it fun was that we did not just teach them through a boring lecture but a skit, some games, and a jingle. As the event name implies, we made sure to treat them with goodies and snacks after teaching them how to prevent STHs.

In our class on an introduction to health promotion and education, knowing the target audience was always emphasized. Since we were dealing with children aged around seven to ten years old, it was crucial to keep things interactive and understandable. If the kids cannot understand what a helminth is, then how can we expect them to comprehend how to prevent STHs?

Through a short skit, we introduced them to two worms: Asca and Rhyss. These character names were derived from Ascaris, a genus of parasitic worms. Every now and then, we would pause the skit to ask the kids questions, like, “Anong dapat gawin bago umalis ng bahay?” Seeing little hands shoot up in the air every time made me smile so wide. The kids, eager to win a prize, waited patiently for their chance to answer: “Magsuot ng tsinelas!”

Similarly, our jingle was created by getting a melody, writing catchy lyrics that explain STH prevention, and creating dance steps to go along with it. The entire goal was to come up with a jingle that was easy to understand and follow, making learning more fun than boring. I wanted to feel shy that my voice was playing loudly in the venue as they played the recorded jingle on repeat throughout the event, but it warmed my heart to see that aside from the volunteers, even the children were “LSS” to it.

‘Wag kalimutang magtsinelas bago tayo lumabas,

‘wag kalimutang magtsinelas, ‘di ba?

‘Wag kalimutang magtsinelas bago tayo lumabas

para bye, bye, bulate sa wakas!

Kamay, hugasan! Kamay, hugasan!

Kamay hugasan bago kumain.

Kamay, hugasan! Kamay, hugasan!

Kamay hugasan palagi.

When I was assigned to teach the jingle, I was honestly a little worried that maybe the children would have trouble learning it. However, I was pleasantly surprised to watch them pick it up so quickly and even have fun with it. The hours of screen time I had spent on TikTok seemed to pay off as I watched the kids copy the dance steps I had made with grins on their faces and a twinkle in their eyes. Even the shy ones started to open up as I smiled at them while dancing and after I gave them little high-fives for each round of singing.

One kid stole my heart by singing the jingle at the top of his lungs for every run. I also remember a girl smiling at me and doing some TikTok dance move before her group performed in front of everyone. Those moments washed away any worry I had before the event.

We all know how going into quarantine for two years stripped us of valuable face-to-face interactions with our friends, schoolmates, mentors. But I had not realized until this event how the pandemic had also taken away opportunities like this: to go out and do outreaches, apply what I study outside of school, make new friends. Sure, such opportunities may have existed even in quarantine, but they were limited or strictly online.

The little things, like maintaining eye contact with the kids while teaching them the jingle, bending down to ask them for an apir after each run, leaning my head against the shoulder of a volunteer I had met that day and quickly befriended—those were the kinds of experiences I had missed out on.

What made it more special was witnessing my public health majors being applied in real life. When I learned that thirty children aged around seven to ten years old were participating in the outreach, I thought about my group’s health service management project. We had designed a startup and proposed a health service, which required information like SMART objectives, the target audience, etc. When the volunteers were oriented that we had to be mindful of how we interacted with and taught the children, I was reminded of the different communication strategies in our health promotion lectures. When I realized that the worms in the skit were named after an actual genus of helminths, I began to wonder what my future parasitology majors would be like.

“Teach and Treat” brought to life the definition of public health as the art and science of preventing disease, prolonging life, and promoting health. It is not enough that we public health majors are learning the names of the different species causing helminthic infections. We also have to be able to effectively communicate what we learn to actual communities at risk. Our work goes beyond numbers and microscopes. We can be lyricists, actors, emcees, and dancers, too. And I think that is important to show the kids.

Growing up, we were taught to envision a man in glasses and a white lab coat when we hear the word “scientist.” When referring to “health,” we think about illness, about hospital treatment.

But health is also about washing our hands; about the people who taught us how to properly wash our hands. It prioritizes prevention rather than just focusing on cure. And if the kids see us, their ates and kuyas, in our casual jeans and blue shirts talking about helminths and tsinelas in ways that they understand, then maybe they will realize that health does not have to be so complicated and technical. Maybe it is as simple as a song and a dance they will remember for their catchy tunes and accessible lyrics.

On the shuttle ride back to Taft, pastora from the Daily Manna Foundation talked about how important it was to teach the kids how to prevent STHs in a way that stuck with them. She said, “Minsan, kapag bumabalik kami, merong bulate ulit [ang mga bata]. So, kailangang gamutin ulit.”

Leaving the kids with a skit and jingle in their memory, along with the alcohol, slippers, and fans with information about STH prevention from HSPM in their goodie bags, I have to trust that we were able to impart knowledge that would stay with them not only in the short-term, but also in the long-term. As I have learned in my majors, follow-ups are important in program evaluation when conducting public health interventions, so we will probably hear again from Daily Manna a while from now.

I really am hopeful for the follow-ups because we met two boys outside of the chapel while waiting for our transportation after the event. With little smiles on their faces, they asked if we were coming back to conduct more outreaches. I realized they were not part of the participants in the program that had just concluded. Laughing to themselves, they talked under their breaths about also getting to eat the Jollibee we had given the other kids—just from the ground. Hearing that broke my heart a little, but I knew it was not possible to accommodate all the children in the community because of our limited resources and space.

However, since July is National Deworming Month, the Department of Health will be going to the same community in Aroma, Tondo to conduct a deworming session. Hopefully, those two boys along with the other kids will be able to join. Efforts like these with different institutions combined with the STH prevention strategies taught to the kids maximize the resources available to leave a larger impact on such communities. It was inspiring to see the interventions I used to only read on paper play out right before my eyes.

I am grateful for the opportunity to volunteer at Teach and Treat because it allowed me to engage in public health outside of the four walls of the classroom. Leaving the streets of Pedro Gil and Padre Faura to visit a community not that far away from UPM opened my eyes to what I was capable of doing even before getting my degree—even before getting a job.

Honestly, after a grueling first face-to-face semester with consecutive exam weeks and long hours in the lab, I did not know that the outreach was just what I needed to end my second year as a public health major. It reminded me that there is more to life aside from the grade computations and shattered glassware. Life is also about going outside of my bubble, making important connections, and bringing my skills to where they are needed.

At the root of public health as an art and science, what brings it all together is compassion. So, while I say bye, bye, bulate, I am also saying hello to the next two years of my public health majors. While the future seems a little daunting, I am excited for the next opportunities to serve.