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The Social Determinants of HPV and Cervical Cancer in a Foreign Land

By

Dr. Miguel Dorotan

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Photo by: Jhpiego Success Philippines

5 minutes read

While highly preventable if detected and treated at its precancerous or early stage, cervical cancer remains a global burden. About half a million women are diagnosed with this malignancy every year globally, and more than half of them die in the same year of diagnosis. In Southeast Asia, cervical cancer is the second most common cancer in women, and with roughly 175,000 new diagnoses annually, the region has one of the highest incidence rates of cervical cancer in the world (Globocan 2020). 

The Philippines, classified as a low- to middle-income country (LMIC), records approximately 8,000 instances of this malignancy annually. As these cases accumulate, they strain governmental resources, deplete personal funds, jeopardise or outrightly disrupt family bonds and morale, and increasingly threaten the economic participation and contribution of women in their productive years. A staggering 68% of Filipino women diagnosed with this malignancy succumb to it within the same year of diagnosis. This elevated mortality rate is predominantly attributed to delayed detection and treatment. In the Philippines, around three out of every four new cases (75%) are identified in the advanced stages, when treatment can no longer salvage the patient. This trend emphasises the significance of innovative treatment-linked cervical cancer screening during women’s ages when, as studies indicate, the malignancy is most likely to be detected and effectively treated at its precancerous or early stages.

In 2019 , a Filipina foreign domestic worker was diagnosed with cervical cancer while working in a foreign land for several months. She was fired and sent home. Most cases of this cancer are in low- and middle-income countries (LMICs), lending support to views that cervical cancer is a disease of inequity borne of the gap between developed and undeveloped or underdeveloped countries. The social determinants of health play vital roles in these inequities.  These include the differences in socio-cultural practices and religious taboos, where and how health information or fake news travel and the shelter or housing conditions are some of the key factors that affect the health seeking behaviours of and access to healthcare services of Female Foreign Domestic Workers (FFDWs) from the Philippines. 

Cultural practices and religious taboos

The Philippines is known to be an English speaking country. This is one of the reasons also why we have plenty of foreign domestic workers being outsourced to other countries including Singapore. However, there are differences in how words and language are used between the home country and the host. While sexual and reproductive health in the home country is advancing, communicating these to the public is challenging as many still find it taboo to be discussed. This barrier prevents awareness and knowledge sharing about HPV and cervical cancer. 

Physical and digital spaces

Public Health people would often emphasise the importance of health literacy – how much do we understand our health needs and how to address the gaps. We, the public health practitioners and doctors have the information and knowledge to share but we often wait for our patients to come and see us before we could advise. During the consultation event hosted for the Philippines Country brief, there was a question on where or how the Filipino domestic workers spend their time together and how do they access health information. Nowadays, digital spaces are as important as physical spaces in sharing correct but also, unverified information. 

In Singapore, Filipino FDWs would be seen congregating in Victoria park within the civic centre or near lucky plaza in Orchard. On their days off, they would come together and ask to talk about what’s the latest. This question would lead to stories about family, friends, celebrities, and other trends, including health. They would talk for hours while sharing a meal or two. Filipinos love food and social media. While one hand is holding their favourite chicken, the other will be scrolling the latest trends on tiktok and Facebook and sharing with each other.  

How much health information do they get and share during these “day offs”? Does cervical cancer even get mentioned? If not, then we now know where and how to reach them. 

Dependency to the employer in terms of access to health services

Related to physical spaces, is their living environments. If they are not with Filipino friends, most likely they are confined within the private household. Their employers are seen to be the gatekeepers of information. HPV and Cervical cancer prevention and screening information could only reach them if their employers share this to them. That is if their employers are also knowledgeable on the topic and see that the health of their FFDWs are part of their obligation. To add to the challenge, the information about HPV vaccine might be available, but access to it, is another thing. Who would cover the cost of these vaccinations? 

What Now?

For a foreign domestic worker, who is responsible for their health? Home country of host state? While there might be certain bilateral agreements between countries, the provision of information and healthcare in both are limited. Before leaving the Philippines, FFDWs are only subjected to a limited and inadequate health screening. Once in Singapore, the FFDWs find themselves lost in the Healthcare system designed primarily for their employers. So what now? 

Here are some of the recommendations: (1) comprehensive sexual education in the home and host countries; (2) tailored public health campaigns through culturally sensitive and appropriate language; (3) increased coordination between Philippines and Singapore to address the healthcare gaps; and (4) get the employers involved.

Not until both countries (home and host) truly discuss and embrace the idea that FFDWs’ health is paramount to the development of both states, then we will continue to see fragmented and health inequity among Filipino Foreign Domestic Workers in Singapore. Only by providing strategic investments in prevention and control efforts will we save lives and contribute to the overall well-being and empowerment of Filipino FFDWs in Singapore and beyond. 

For detailed insights, consult the country brief “HPV and Filipina Foreign Domestic Workers in the Context of the World Health Organisation’s 2030 Elimination Goal”.

References

A. Environmental Stewardship
To protect the environment, we organize programmes like mangrove nursery and Reforestation, Coastal and River Clean-Up, Community Based Environmental Solid Waste Management, Environmental IEC Campaign and Eco-Academy

B. Food Security and Sustainable Livelihood
To ensure a sustainable livelihood for the community, eco-tourism include Buhatan River Cruise Visitor Center Buhatan River Mangrove Boardwalk are run by the community. Others include Organic Vegetable and Root crops Farming, Vegetable and Root crops Chips and by-products Processing and establishing a Zero waste store.

C. Empowered Communities
To empower the community, we provide product and Agri-Enterprise Development Training, Immersion and Learnings Exchange Program, Earth Warrior Training and Community Based Social Entrepreneurship Training

Author

Dr. Miguel Dorotan

Public Health Practitioner

Dr. Miguel Dorotan is an experienced public health practitioner specializing in Health Systems Research, Health Emergency and Disaster Risk Reduction and Management, and Program Management.  He has a  Masters in International Public Health from Liverpool School of Tropical Medicine (UK) under the Chevening Scholarship, Doctor of Medicine from University of Santo Tomas and B.A. Major in Behavioral Science from the University of the Philippines Manila. He worked within the Philippines and the region with the Philippine Local Government Units, DOH, Save the Children, Red Cross, World Health Organization and AIHO. He responded during Super Typhoon Haiyan, Nepal Earthquake, and Marawi Crisis and, Rohingya Refugee Crisis in Bangladesh.

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