The oldest human fossil remains are found in Palawan, on the western fringe of the archipelago. These remains are about 30,000 years old, suggesting that the first human migrations to the islands took palce during the last Ice Age, when land bridiges connected the archipelago to mainland Asia and Borneo.
The islands were eventually inhabited by different groups that developed domestic trade linkages. The archaelogical evidence shows a rich pre- colonial culture that included skills in weaving, ship-building, mining and goldsmithing. Contact with Asian neighbors date back to at least 500 B.C. Trade linkages existed with the powerful Hindu empires in Java and Sumatra. These linkages were venues for exchanges with Indian culture, including the adoption of syllabic scripts which are still used by indigenous groups in Palawan and Mindoro. Trade ties with China were extensive by the 10th centuray A.D. while contact with Arab traders reached its peak about the 12th century. By the time the Spaniards arrived, Islam was well established in Mindanao and had started to influence groups as far north as Luzon.
Many existing health beliefs and practices in the Philippines are rooted back in the pre-colonial period. This includes magico-religious elements, such as beliefs in spirits and sorcery as causes of illness, as well as empirical aspects such as the use of medicinal plants. Archaelogical sites in the Philippines have yielded skeletal remains showing intricate ornamental dental work and the use of trephination (boring a hole into the skull as a magical healing ritual).
Today's traditional medicinal practitioners can trace their origins back to the pre-colonial period - the psychic surgeons, with their flair for drama, parallel the pre-hispanic religious practicioners (babaylan and catalonan) who also played roles as healers.
The Spanish Occupation
When the Spaniards arrived in the Philippines, the indios (natives) had reached different levels of political development, including simple communal groups, debt peonage (often erroneously described as slavery) and proto-feudal confederations.
The Spaniards imposed a feudal system, concentrating populations under their control into towns and estates. During the first two centuries of their occupation, the Spaniards used the Philippines mainly as a connecting point for their China-Acapulco (Mexico) trade. The country's economic backwardness was reinforced by Roman Catholicism, which was practiced in a form that retained many pre-colonial elements such as animism while incorporating feudal aspects of the colonizers' religion such as dogmatism, authoritarianism and patriarchial oppression. The Spaniards wer never able to consolidate political control over the entire archipelago, with Muslims and indigenous resisting the colonizers most effectively. Among the groups that were subjugated, there were numerous localized revolts throughout the Spanish occupation.
In the 19th century, the Philippines was opened to world trade, allowing the limited entry of liberal ideas. By the late 19th century, there was a distinct Filipino nationalist movement which erupted into a revolution in 1896, culminating with the establishment of Asia's first republican government in 1898.
Spain laid the foundation for a feudal health care system. The religious orders built charity hospitals, often next to churches, dispensing services to the indio. Medical education was not extended to the indio until late in the 19th century, through the University of Santo Tomas. This feudal system of the rich extending charity to the poor persists to this day among many church-run as well as non-sectarian institutions.
The U.S. Occupation (1898-1946)
The first Philippine Republic was short-lived. Spain had lost a war with the United States. The Philippines was illegally ceded to the United States at the Treaty of Paris for US$20 million, together with Cuba and Puerto Rico.
A Filipino-American War broke out as the United States attempted to establish control over the islands. The war lasted for more than 10 years, resulting in the death of more than 600,000 Filipinos. The little-known war has been described by historians as the "first Vietnam", where US troops first used tactics such as strategic hamleting and scorched-earth policy to "pacify" the natives.
The United States established an economic system giving the colonizers full rights to the country's resources. The Spanish feudal system was not dismantled; in fact, through the system of land registration that favored the upper Filipino classes, tenancy became more widespread during the US occupation. A native elite, including physicians trained in the United States, was groomed to manage the economic and political system of the country. The U.S. also introduced western modells of educational and health-care systems which reinforced elitism and a colonial mentality that persists to this day, mixed with the Spanish feudal patron-client relationship.
Militant peasant and workers' groups were formed during the U.S. occupation despite the repressive situation. A movement for Philippine independence, involving diverse groups, continued throughout the occupation. A Commonwealth government was established in 1935 to allow limited self-rule but this was interrupted by the Second World War and the Japanese occupation. The guerilla movement against Japanese fascism was led mainly by socialists and communists, known by their acronym, HUKS. Shortly after the end of the Second World War, flag independence was regained although the U.S. imposed certain conditions, including the disenfranchisement of progressive political parties, the retention of U.S. military bases and the signing of economic agreements allowing the U.S. continued control over the Philippine economy.
The Philippine Republic (1946 - )
The political system of the Philippines was basically pattered after the U.S., with a bicameral legislature and a president elected every four years, limited to one re-election. Philippine democracy remained elitist with two political parties taking turns at the leadership. In 1972, Ferdinand Marcos declared martial law as his second term was about to end, amid a resurgence of a nationalist movement that was questioning treaties on the US military bases and the U.S. economic "parity" rights.
Political repression reached its height under Marcos. His preferential treatment for foreign investors further contributed to the deterioration of the Philippine economy, particularly with the use of government funds and foreign loans for the Marcos family and their cronies. Until the 1960s, the Philippines was economically among the most developed countries in Southeast Asia; today (1991 when this was written - Ken), it is the second poorest country in the region.
In the early years after the declaration of martial law, opposition against Marcos was spearheaded by the Left. A new Communist Party was established in 1968, followed by the New People's Army (NPA) in 1969. After Marcos's declaration of martial law in 19782, a broader political grouping called the National Democratic Front (NDF) was established with an anti-imperialist, anti-feudal and anti-fascist line. In the southern Philippines, the Muslim fought for secession through the Moro National Liberation Front (MNLF).
The assassination of Senator Benigno Aquino Jr. in 1983 precipitated an economic and political crisis that further broadened the ranks of those opposed to Marcos. Strapped for funds, the Marcos regime agreed to a "stabilization plan" from the International Monetary Fund (IMF) that plunged the economy back to 1975 levels. In February 1986, after holding blatantly fraudulent presidential elections, Marcos was overthrown by a civilian uprising supported by the military. Marcos's rival in the election, Corazon Aquino, became the new president.
The economic and political crisis in the country continues even the the restoration of formal democratic processes including the ratification of a new Constitution and the election of a Congress. The new Congress remains dominated by the elite, including former officials during the Marcos dictatorship. Economic policies remain essentially conservative with an Omnibus Investments Code that favors foreign investors and a limited land reform law. The new government has pledged to pay the entire foreign debt of US$28 billion, much of which had been incurred by Marcos under anomalous conditions. In 1990, the government agreed to another IMF stabilization plan that includes cutbacks on government budgets; reduction or elimination of subsidies and increased taxes. Graft and corruption remains endemic and has eroded support from the middle class.
The new government is essentially a fractious coalition of conservative forces representing traditional interests as exemplified by their policies on land reform, labor, foreign investments and their antagonism toward progressive groups. The perennial attempted coups by right-wing elements in the military are manifestations of power struggles among the members of the conservative elites, who ride on continuing discontent among the people brought about by the slow pace of economic and political change. Independent and progressive groups that work with peasants, workers, students and other sectors have sustained the struggle for more substantial social changes but face increasing repression, particulalrly from paramilitary (vigilante) groups formed with the tacit support of the government.
Serious questions about the dominant models of development, including those used in health care with its hospital- and doctor-centered orientation, have spurred new initiatives in health care among altlernative organizations. Community-based health programs are part of the popular movements that seek to democratize health care even as the struggle goes on for other structural reforms.
Reprinted with permission from Health Alert Special Issue 116- 117. Produced by the Health Action Information Network (HAIN), Quezon City, Philippines.