In The Fields
Understanding the Risk of Leptospirosis Infection Among Filipino Farming Communities
by Janine Liwanag and Veronica Guinto
When the rain comes, so do the rats.
It is well-known that a little rain goes a long way if one studies in Manila. For students of the University of the Philippines Manila (UPM), the slightest crack of lighting and the faintest rumble of thunder can become ankle-deep flood waters along Pedro Gil and Padre Faura within only half an hour. Many have no choice but to wade through these floods and risk getting infected with leptospirosis.
Leptospirosis, a bacterial disease carried by humans and animals, is caused by pathogenic Leptospira species. It is often spread through contact with soil or water contaminated by urine containing such pathogens. This is what UPM students are possibly exposed to every time they brave “Taft River,” especially with the campus’s not-so-unusual rat sightings, making it even more likely to get infected since rats are one of the carriers of Leptospira.
However, students are not the only ones at risk for leptospirosis. As of Sept. 2, the Department of Health (DOH) had already recorded 3,728 leptospirosis cases nationwide for this year alone, which is 70% higher than the record for the same period in 2022. According to DOH, 6% of leptospirosis cases this year are students. The leading subgroup is actually those with farming-related occupations who comprise 14% of cases — twice the proportion of students.
It is unsurprising that farmers are at particular risk of leptospirosis infection given their work in farmlands where the environment may have different pathogens transmitted by animals. Despite this, there is a significant lack of leptospirosis research among Filipino farming communities.
This is the problem a group of recent BS Public Health (BSPH) graduates tried to solve through their undergraduate thesis.
Leptospirosis in Philippine farming communities
The Dean’s Award for Outstanding Research in Medical Laboratory Science (MLS) honors the most notable thesis of graduating students in the MLS track under UPM’s BSPH program. Last Jan. 18, 2023, the award was bestowed upon Acain, Año, Cadano, De Jesus, Garcia, and Limsiaco with their adviser Dr. Sharon Yvette Angelina Villanueva for their research entitled, “Detection and characterization of Leptospira in selected farming communities in Tuguegarao City, Municipality of Tolosa, and Dipolog City.”
From the selected communities, which are located respectively in Regions II, VIII, and IX, 72 soil and water samples were analyzed. According to the 2021 Field Health Services Information System report by DOH, the three regions are among the top six in the Philippines with the highest prevalence of leptospirosis cases.
Of the samples, 33 tested positive for Leptospira, two of which were found to be intermediate pathogenic species. This raises concern for farming communities, as according to the group:
“Farmers are among those who have a higher risk in acquiring leptospirosis due to the nature of their occupation through which they are exposed to soil and water where reservoir hosts, such as ruminants and rodents, may have expelled their bodily fluids (i.e. urine) … The environmental characteristics of farmlands are often, if not always, conducive for the growth of Leptospira. Without proper protective equipment, farmers are put at a high risk of being infected…”
Moreover, as found by the Philippine Institute for Development Studies in 2022, national health insurance coverage across the country remains below 70%. In areas outside greater Metro Manila, where average income is lower, health insurance coverage can dip below 50%. This affects farming communities who are found in rural areas.
Where leptospirosis conjures images of unrelenting floods in the minds of UPM students, environmental studies like these drop the veil on its lesser-known forms of transmission. For the heavily exposed Filipino farmer, hospitalization spells both physical and financial doom.
The irony of the Philippine agricultural sector
The risk of leptospirosis infection among Filipino farmers is not one-dimensional. The mere existence of pathogenic Leptospira is not the only problem that needs to be addressed.
The sad reality is that those feeding the nation are actually undernourished. According to the Philippine Statistics Authority (PSA), farmers were the second poorest basic sector in 2021 with a poverty incidence of 30%, while fisherfolk were the poorest at 30.6%. These two sectors also recorded the highest poverty incidences in 2018 and 2015.
But one must question how poverty is defined in the first place. In 2021, the established poverty threshold or the monthly minimum income a family of five needs to meet basic food and non-food needs was Php 12,030, when it was only Php 10,756 in 2018.
Experts have criticized this standard by PSA because it underestimates how many Filipinos are actually poor according to real-life conditions. For farmers’ group Kilusang Magbubukid ng Pilipinas, such data alone cannot reflect the harsh realities that farmers and fisherfolk face in far-flung areas.
How can farmers rise from poverty when they bear the brunt of environmental disasters, losing their crops due to a climate crisis largely caused not by them, but the Global North? How can they rise from poverty when they are forced to sell their harvests at market prices that leave them nearly nothing to feed themselves? When they have faced centuries of landlessness, having no security over the land they have tilled for generations?
In pursuit of profit, private corporations continue to dominate the agricultural sector, displacing farmers who should have rights to these lands in the first place. And when farmers do assert their land rights, they are subjected to violence.
It then becomes obvious that farmers’ health is not simply an issue of bacteria. Farmers’ health is not as simple as contact with infected rat urine leading to leptospirosis infection.
This issue also deals with the existence and effective implementation of policies that protect farmers’ rights to life and land, as well as health policies, programs, and services regarding leptospirosis in rural areas. It involves farmers’ nutritional status and how their undernourishment can worsen the effects of leptospirosis. It deals with whether farmers can afford to get treated when it costs time, money, and distance. In fact, one must start with whether farmers can afford to get sick at all if getting sick means not being able to work even just for a day.
As stated by the group:
“Conducting research with this particular group raises awareness and provides knowledge on the potential risks of infection. With these baseline data on the presence of Leptospira in their environment, policy-making bodies, and their community leaders, with the help of the health department from the local units, may be encouraged to design, if not strengthen, prevention and control measures against leptospirosis. These projects may also focus on health promotion and education on leptospirosis, sanitation, and capacity-building of the local health warriors such as the [barangay health workers].”
Health is and always will be political, especially when discussing a sector that has long been oppressed by the state. Research like this brings to light the issues that can easily go ignored even if it affects those feeding the Filipino population.
Protection for farming communities
A country fed by farmers owes them protection.
Exposing the quantified existence of pathogenic Leptospira in farming communities should serve as a wake-up call to policy-making bodies, from local health units to DOH. Whether through more comprehensive pathogenic control measures or expanded leptospirosis and sanitation education in younger generations, farmers should not be left out of public health interventions.
As the group put it:
“We … hope that this could be a reminder for all of us that there are rural areas and communities exposed to certain health risks which are often neglected and set aside instead of being given attention.”
Alongside policy changes, environmental research is necessary to fill this gap. To clarify the full extent of farming-related leptospirosis, such data can be collected on a national scale and included in regular health surveys. As UPM students, the developed expertise in disseminating information to the public must be applied through cultivating relationships with local communities. Sustainable disease prevention, after all, begins with awareness.
It will not be long until clouds darken over Manila again, carrying harrowing onslaughts of rain. Soon, these clouds will drift beyond the skyline, to farms where hospitals are a privilege farther than a street away.
When the rain comes again, where will the farmers turn?
