Eleuthera Abus, 99, winces as the broken bones in her right arm move when she raises her arm. Her fall happened six months ago.
The 28-year-old medical professional who is seeing the patient on her porch says, "All I can do is manage her pain.". "She should have the bone pinned, really. But the girl's family won't let them take her to the hospital. ".
The daughters of Eleuthera don't lack compassion. They have little.
The small island of Diit where they reside is hundreds of miles across the sea from the closest surgical facility. It is a part of the Agutaya archipelago, a collection of islands stranded in the Sulu Sea off the coast of the Philippines.
Dr. Alena, as they refer to her, is the only physician for the neighborhood's roughly 13,000 residents. She is petite, wears glasses, and pulls her long hair back into a ponytail. She always has a big smile on her face, but she is actually quiet and determined.
The only island in the archipelago she does not visit is Amanpulo, which got its name from the opulent hotel that once hosted Tom Cruise and Beyoncé, according to rumors. On a clear day, it can be seen from Diit's beaches, which are only 20 kilometers (12 miles) away.
When Dr. Alena insisted that people isolate, she received death threats. She arrived just before the coronavirus hit. The world-eating pandemic wasn't, however, her only problem in this frequently ignored region of the Philippines. She faced the toughest problems facing her nation as she fought both new and old diseases. She claims she came to Agutaya with the intention of making "real changes," but she left feeling utterly dejected.
You wouldn't expect to find a recent graduate of the nation's top medical school in these isolated, lava-filled islands after spending your entire life in Manila, the populous Philippine capital. Dr. Alena volunteered to join a government program that sent her here, to one of the poorest municipalities in the nation, unlike so many of her peers who have moved away to pursue careers in Australia, America, and Britain.
From Manila, it takes 2.5 days to travel to the main island of Agutaya. It involves a single flight, followed by a sleepless 15-hour ferry ride at night from the port city of Iloilo to the larger island of Cuyo. After that, the only way into or out of Agutaya is a treacherous, two-hour trip in an outrigger canoe.
Agutaya appears to be a piece of paradise as the expert boatman maneuvers the outrigger over the reef and into the shallows. A wide expanse of white sand extends in both directions below the palm-lined shoreline. The water is so clear that colorful outrigger canoes appear to be floating in midair.
However, geography has its advantages and disadvantages. The dozen or so islands that make up the archipelago, which are dispersed over hundreds of square kilometers of water, are cut off for days or even weeks when the monsoon arrives with winds in tow. The hillsides are atop broad fields of basalt boulders and are covered in thick forest. The amount of arable land is minimal. The islanders are largely dependent on the sea.
In February 2020, Dr. Alena traveled to Agutaya for the first time. She chuckles, "When I first came here, I was 26 and a lot of people thought I was a high school student. The general public wouldn't think I was a doctor. ".
Within a month, she faced her first obstacle when the coronavirus put the Philippines on lockdown. It was closed off on the islands.
According to Dr. Alena, "the first year wasn't too bad.". "There were no local instances. However, the second year [2021] was the first time the government permitted everyone to visit their hometowns. Suddenly, people began to arrive from as far away as Manila. ".
The person in charge of enforcing their quarantine was Dr. Alena. People reacted violently, she claims, after learning they would be quarantined. "I received threats of death. Some people allegedly wanted to shoot me. ".
She realized why. Daily life is what people here do. For dinner, they eat the fish they caught in the morning. They would go hungry if they were unable to venture outside to fish.
Dr. Alena, who had abandoned her fiancé in distant Manila, was now resented as a government enforcer, far from being welcomed by the locals. "There were times when I was only able to cry. There were many tears, she claims.
She started adopting dogs to help her feel less lonely. While Vigly is little and reserved, Bruno is big with a tail that never stops wagging. They are her constant companions.
I spent a lot of time with them visiting the beach and viewing the sunset. I also began to draw. Even though my photos are terrible, this is a form of art therapy. ".
As soon as the vaccines began to arrive in the summer of 2021, the next problem arose.
Every island baranguay (village) required us to visit every home, according to Dr. Alena. Many people are unable to afford the travel costs to the clinic because the farthest island is nearly three hours away by boat. thus they wouldn't arrive. ".
Even so, the struggle wasn't limited to the distance: "There was a lot of mistrust, a lot of fake news about the vaccines being bad or that they can kill people. Social media is where many people in this country get their news, but they are not getting the facts. ".
The threat posed by Covid had started to lessen by autumn 2022. The vaccine rollout was successful despite the opposition. The virus had only claimed the lives of eight islanders in the entire archipelago.
But it didn't really offer much relief.
Every weekday morning, a line forms outside the main clinic on Agutaya as Dr. Alena and her staff continue their daily meeting.
A 50-year-old man who has had a suspected stroke is the first person in line that day.
Dr. Alena laughs at her own ignorance as she confesses, "Before I came here, I thought everything would be fresh and organic.". But eating a balanced diet in this place is very challenging. ".
For one thing, people there salt and dry their fish, which raises blood pressure. Diabetes is also more prevalent because it's simpler to locate soft drinks than pure water.
The other significant medical issue is "sputum sampling" for tuberculosis, or TB, according to a sign at the clinic's entrance.
Dr. Alens claims that although 45 cases were reported in 2022, many more go undiagnosed.
Untreated TB, a bacterial infection, is fatal. Until it was largely eradicated from the world by the middle of the 20th century thanks to a combination of vaccines and antibiotics, it killed millions of people every year.
But there are still reportedly over a million cases in the Philippines. Its eradication is the long-term goal, according to Dr. Alena, who adds that it will be "impossible in the near future.". According to her, people frequently relapse due to a lack of access to healthcare, and some strains have even started to become drug-resistant.
Later that morning, a mother arrives at the clinic with her young son. The boy slumps on a chair, pale and lifeless. Dr. Alena thinks he may have dengue. It's confirmed a short while later. In addition to prescribing paracetamol, she advises his mother to keep him hydrated.
This place recently experienced dengue. The one case in January had increased to ten by March, despite the fact that Dr. Alena and her team had sprayed treated nets and killed the mosquitoes that spread the disease on school grounds.
The doctor is removing herself from the snaking patient line by 11:00. She must travel across to Diit, which is 40 minutes away by boat, so her skilled nursing staff will have to handle them.
Although poorer, it is more beautiful than Agutaya. There is only one concrete road that ends after a few hundred meters and there is no electricity or cell phone tower.
There is great anticipation for the arrival of Dr. Alena, affectionately known as the "medicine lady.". Numerous schoolchildren sprint down the beach. In order to spray insecticide on the school's grounds, Dr. Alena's dengue control team has given them the day off. She appears to be the pied piper as she moves through the community, a long line of laughing kids trailing behind her.
She stops by a wheelchair-bound elderly couple who are sitting outside their home along the beach. Both people are partially paralyzed after having strokes. His blood pressure is 150 over 90 when she checks it. It's high but appropriate for his age, she remarks.
The crowd that has gathered around is broken up by a woman in her 40s pushing her way through. A boy, possibly five or six years old, is being carried by the woman. She is instructed to sit down on a chair by Dr. Alena, who then starts inspecting the kid. His left testicle is incredibly enlarged. His lower abdomen has a hernia, as seen by the torch. His testicles have been pushed into by a portion of his intestine that has breached the bowel wall.
He will require surgery, the doctor informs the mother. The women's eyes go from hope to worry.
If she knows anyone who she could stay with on one of the larger islands, Dr. Alena asks her. The woman replies, "Yes, in Culion, a 12-hour boat ride away.
When I explain to them that they need surgery, you can see the fear and sadness on their faces as they come to terms with the fact that there isn't a treatment I can give them to reverse this, says Dr. Alena. Being the one to break the news is difficult, but you can see in their minds the question of how they will pay for it. ".
A hernia repair is a routine medical procedure in another country. However, it can destroy a family's savings in this situation, leaving them in debt for years.
It would be very beneficial if we could facilitate travel, she continues. That is challenging, though, as it will require numerous resources. ".
Dr. Alena's optimism and ambition after three years on the island have been replaced by the depressing realization that access to resources, or money, will always be the biggest obstacle.
The rocky hills that encircle the main island of Agutaya are surrounded by an all-weather concrete road. The local election campaign last year coincided with the start of construction. Before election day, one lane was completed, but after that, according to islanders, work ceased. No second lane has been added yet.
One local jokes, "The road won't get finished until after the next elections.".
An incomplete concrete structure that is slowly being taken over by vegetation is visible on the opposite end of the island, where rusting steel bars protrude from it.
Dr. Alena claims that it was meant to be the brand-new rural health unit. The local government ran out of money last year, which caused work to cease. She adds, clearly frustrated, "But they haven't fulfilled their end of the bargain.".
Large, strong clans, whose chiefs offer resources from Manila in exchange for votes, dominate Philippine politics, which is not driven by parties but by personalities. The population of Agutaya is too small, as described by a local woman: "There aren't enough votes here to make it worthwhile. ".
When it comes to elections, local politicians have little incentive to improve, and vote-buying is so common that it now appears to have a well-worn cost: 500 pesos, or $28 (£22). Money is pouring in, but corruption persists, and it appears that none of it makes it there. .
Dr. Alena sighs, "I came here very idealistic. "I was aggressive in my attempts to alter the way the neighborhood healthcare system operated. However, as time goes on, you come to the realization that three years is far too little time to make any significant changes. ".
Many islanders told her they would be sad to see her go as her three-year contract on Agutaya came to an end. She is "selfless and hardworking," according to senior nursing assistant Ricardo, who also noted that "time flies fast.".
Dr. Alena claims that she has felt let down and even cynical about her experience working for local government in the weeks since her return to Manila. She declined a job offer from the Palawan provincial health administration. She would rather work for an NGO or medical charity.
She visited Agutaya once a year with a group of specialized doctors as part of a program run by an NGO last week to perform quick operations.
She didn't need two and a half days this time, though. Three hours after departing from Manila, Dr. Alena and the other medical professionals arrived there when their private aircraft, which was paid for by foreign donors, landed on the runway of the opulent island of Amanpulo.
