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Body and Illness: Considering VisayanFilipino Childrens Perspectiveswithin Local and Global

Relationships of InequalityLisa M. Mitchell

Despite a plethora of studies counting, examining, assessing, and diagnosingFilipino children living in poverty, childrens own perceptions and concernsabout their health and security are rarely elicited. This article draws fromfieldwork in an urban neighbourhood in the Visayan Philippines among chil-dren who, every day, face a complex and precarious landscape dominated by

multigenerational poverty, social marginalization, recurring hunger, and thehazards of living and playing amidst mounting garbage and effluent. I discusschildrens perspectives on body and illness in this challenging environmentand examine their ideas within the larger context of adult-child, hierarchicalrelationships, and colonial and contemporary government discourses on chil-dren, health, and citizenship. I also examine childrens sense of place, agency,and vulnerability, and I discuss the view held by many adults in this com-munity: their childrens ideas hold little value.

Key Words: body mapping; children; health beliefs; Philippines; poverty

INTRODUCTION

My current research addresses childrens perspectives on living,playing, and going to school in their urban neighborhood on theVisayan island of Negros in the central Philippines. This project

Lisa M. Mitchell is Assistant Professor in the Department of Anthropology at the University

of Victoria. Her research interests are in the areas of health, illness, gender, reproduction andchildren. Correspondence may be directed to her at the Department of Anthropology,University of Victoria, Victoria, British Columbia, V8W 3P5. Phone: (250) 721-6282;E-mail: [email protected]

331

Medical Anthropology, 25:331373, 2006

Copyright # Taylor & Francis Group, LLC

ISSN: 0145-9740 print/1545-5882 online

DOI: 10.1080/01459740601025856

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came about after my colleague, Marjorie Mitchell, introduced me to

a neighborhood womens group concerned with persistent pro-blems of injury and illness among their children and grandchildren.After extended discussions with the women and a local NGO, weproposed a project focusing on what children had to say aboutgetting hurt, being sick, and staying healthy. In particular, the pro-ject was intended to identify childrens ideas about body, illnesscausation, and health; what strategies they engaged in to deal withand stay free of illness and injury; and their ideas about how tomake their homes and community safer. More broadly, the project

was intended to enhance youth empowerment; that is, throughinvolving youth in the project we hoped to create a social spacein which their voices, concerns, and perspectives could be articu-lated and disseminated not only to researchers but also to adultcommunity members. In suggesting this child-centered research,my colleague and I drew upon a revitalized anthropological interestin children (Scheper-Hughes and Sargent 1998; Stephens 1995) andaccounts of childrens involvement in community development.This enabled us to identify not only how child and adult per-

spectives on environment, health, and community may differ butalso how those differences might affect whether or not childrenbenefit from local initiatives to improve their welfare (Hart 1997;Nieuwenhuys 1997; Robottom and Colquhoun 1992).

The members of the womens group and other adults in the com-munity were skeptical of our approach. Some of this skepticismderived from their lack of familiarity with research, beyond whatthey knew of brief market surveys conducted by vitamin and phar-maceutical vendors. Most of the womens skepticism stemmed

from our proposal to make the childrens ideas and perspectivesthe focus of the project. Adults here show considerable affectiontoward their children and describe them as gifts from God, but theyalso regard them asmango(ignorant),basto(rude), disobedient, andin need of instruction. Many adults told us that their childrenknow nothing (wala sila sang nahibaluan). Creating spaces withinwhich childrens perspectives could be heard in this communitywas challenging; for instance, when we displayed the childrensdrawings in the neighborhood, only a handful of adults came to

look at them. The NGO with whom we worked suggested thatwe implement values training among the children and youngmothers. Our middle-class acquaintances in Bacolod City listenedattentively but echoed the need for values training, citing problems

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of gambling, drinking, unclean homes, and poor parenting among

squatters. Repeatedly, adults told us that Filipino children, parti-cularly in low-income neighbourhoods, were too ignorant and=orpoorly behaved to contribute anything of value to understanding,let alone improving, child health and security. Here, I am notprincipally concerned with the successes and limitations of child-centered research in medical anthropology but, rather, with theconnections between childrens ideas and what Prendergast(2000:103) refers to as their social contexts of power and value.Drawing from my work in a Visayan neighborhood, I situate the

childrens ideas and images of illness and body within largerhistorical, social, and material contextscontexts that inform thoseideas and images and shape how they are perceived and actedupon by both adults and children. The overlapping contexts ofpower and value upon which I focus include (1) the day-to-daydemands of living and playing in an impoverished community thatis struggling to survive the effects of imposed debt restructuring,neoliberal economics, and exclusion from regional developmentpriorities; (2) hierarchical adult-child relationships, including that

between researcher and child participant; and (3) colonial and con-temporary government discourses on school children, health, andcitizenship. I also examine childrens sense of place, agency, andvulnerability and revisit the adults assertions that their childrensideas hold little value.

CHILDRENS PERSPECTIVES: WRITTEN IN THE MARGINS

Despite a voluminous literature on the health, nutrition, and livingconditions of impoverished children in the Philippines, scant con-sideration has been given to what those children say are eitherthe sources of, or solutions to, their daily struggles. Furthermore,my analysis discloses how the health of childrens bodies and theirpractices of body care have been central to both colonial and post-independence agendas of Filipino nation building and moderniz-ing. Determining what children think about their bodies and theirhealth is not merely an exercise in ethnographic curiosity or

childrens token participation.1

Children under 15 years of agemake up 36 percent of the 84 million people in the Philippines(Human Development Reports 2005). The majority of those childrenand youth live in poverty, chronically undernourished and in poor

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health (Asia Child Rights 2003). Yet, a growing number of initia-

tives with working children in the Philippines and elsewhere haveshown that even young children and those living on their owncan contribute to the improvement of their own health and thatof their community (Hart 1997; Nieuwenhuys 1997; Robottomand Colquhoun 1992; Racelis and Aguirre 2002). Moreover, inter-ventions work better when childrens views are taken into consider-ation, when programs are based on what they identify as theirpriorities and needs, and when children are involved in makingdecisions about things that will affect their lives (Porio, Moselina

and Swift 1994:157; Racelis and Aguirre 2002).In focusing on childrens perspectives, my research engages arecent change in anthropological thinking about children. Conven-tionally, children have been conceptualized as incomplete adults, oradults-in-training, who passively acquire and reproduce culturalknowledge and who can best be understood by questioningparents, teachers, and health professionals. Within ethnographicwriting on the Philippines, for example, children have tended toappear primarily as silent recipients of adults child-rearing strate-

gies (Jocano 1969, 1983). Recently, anthropological approaches haveshifted to investigate the complexity and diversity of childrensperspectives, the range and impact of their social practices, andthe constraints on young peoples agency or ability to make andremake identity, practices, and relationships. As a result of thisshift, childrens agency in economic activity (Nieuwenhuys 1994),on the street (Beazley 2002; Panter-Brick, Todd, and Baker 1996),in negotiating gender and ethnic identities (Downe 2001;Mendoza-Denton 1996), and in political action (Sharp 2002) is

now more visible within anthropology.Anthropologists have infrequently attended to childrens per-spectives on their bodies, health, or illnesses (Bluebond-Langner1978 being a notable and early exception). However, severalresearchers in other social sciences have addressed childrensperspectives on illness and what Prout (2000:9) calls childrenswork on and with the body. Unfortunately, little of that workconcerns children living outside of middle-class England, Australia,or North America. When their ideas about body, illness, and health

are probed, it is clear that children are neither parroting nor mis-understanding adult knowledge (Backett-Milburn 2000; Williamsand Bendelow 2000). Not only are kids adept at understandingand intercalating different and often contradictory types of

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knowledge (Geissler 1998:142; Williams and Bendelow 2000), but

their ideas are drawn from a variety of sources, including theirown social worlds and experiences which were partially hiddenfrom adults and constructed by children themselves (Backett-Mil-burn 2000:89). The ways in which childrens experiences of thebody differ from those of adults, and the ways in which childrenuse the body as a crucial resource of meaning and agency, arealso receiving attention (Christensen 2000; James, Jenks and Prout1998:156). Work by James (1993), Mendoza-Denton (1996), andNichter (2000), among others, highlights child and youth attentive-

ness to the body not just as a site of cultural elaboration but also as ameans of creating and maintaining self-identity and relationshipswith others.

In short, over the past ten to 15 years, a new paradigm hasemerged in anthropology and in other social sciencesone thatrecognizes that children have their own distinctive, meaningful,and coherent perspectives on the world. Indeed, it has becomecommonplace to describe children as social actors and culturalproducers and to discuss how they are active and influential con-

tributors to the social lives of their communities (Scheper-Hughesand Sargent 1998; Schwartzman 2001; Aitken and Herman 1997;Bucholtz 2002). While I do not dispute this general conclusion,my own research was conducted among children whose culturalproductions and social agency are neither valued nor the focus ofmuch adult attention in their world. Thus, in this article, I considerthe ideas and practices of health and illness among children whoare not only marginalized by NorthSouth inequality and by thewidening gap between the rich and poor in their country and city

but also by the adults in their daily lives. My focus is upon theembodied viewpoints of impoverished children who are often hun-gry and hurting, who live in distressed physical surroundings withfew safe places to play, and whose ideas and activities are generallydismissed as inconsequential and incorrect by both parents andteachers. Based on the analysis of childrens drawings and talk, Iaddress the following questions: (1) what do kids growing up insuch circumstances think and say about body, illness, and health?(2) to what extent do they see themselves as able to mitigate illness

and to avoid environmental hazards? and (3) how are childrensperspectives and practices shaped by their position within bothlocal and wider structures of inequality? My goal is to draw atten-tion to the ways that childrens ideas, experiences, and practices of


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health, illness, and body are tied to particular configurations of

power, meaning, and place.In framing these questions, I am mindful of research that high-

lights the ways in which the social and material organization ofinequality, marginalization, and power shape experiences of self,illness, and body (Lock and Wakewich-Dunk 1990; Scheper-Hughes1992). For example, Prendergasts (2000:117) research in Britainunderscores how restrictive teachers and school nurses, intrusiveactions by male pupils, and inadequate school toilets and sanitarysupplies meant that girls. . .lived menstrual experience as a con-

straining, secret and negative event, whatever their attitudes orapproaches. Berman (2000) notes how social and spatial margina-lization among street boys in Java is reflected in their narrativesof survival and harm, and how it shapes their notions of self,causality, and agency. My own thinking owes much to CindyKatzs (2004:156) writing, which situates the lives, ideas, and prac-tices of children in low-income households within topographies ofglobal capitalism; that is, within the broader contexts of globaleconomic restructuring, industry outsourcing, and government

disinvestment in education, health, municipal services, and socialwelfare. Focusing on childrens play, work, and learning in a villagein rural Sudan and an urban neighbourhood of New York City,Katz (2004) traces the detrimental effects poor children experiencewhen their communities do not benefit from rapidly circulating glo-bal capital but, rather, are pushed further into debt, hunger, anddespair. Katz argues that poor children have a distinctive suscepti-bility to the harmful effects of global capitalism, in part due to theextraordinarily local nature of their lives, circumscribed by

adults, school, and the immediate vicinity of home and neighbor-hood (2004:163). While Katz examines the role of childrens play,work, and learning in the social reproduction of their communities,my interest is with the connections between economic vulnerability,environmental degradation, and disenfranchised childrens experi-ences of body and illness.

In conjunction with Katzs topographies, Orellanas (1999) andAitken and Hermans (1997:64) observation that children seethings in environments that we [as adults] may have forgotten to

see, let alone understand is a provocative call to consider placein our analyses of childrens knowledge and practices. Here, I useplace not as setting or locale but, rather, as it is used in Rodmans(2003:205, 216) notion of social landscape or place as lived

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experience. With few exceptions (Prendergast 2000; Olwig and

Gullov 2003), the ways in which childrens perspectives on body,health, and illness are shaped by their lived experiences of place,by the material organization of social life, and by history,as well asby local meanings, social relationships, and the corporeality of theirown bodies, are not often examined. In this article, I show that whatchildren in this community draw and say about the body, includingits contents, changes, sensations, and troubles, are complexly inter-twined with the social and material dimensions of their worlds.Their narratives and images encompass not only what they have

come to understand about the body and its functioning from a pub-lic school curriculum that originated during the early 20th-centuryperiod of American occupation and that was subsequentlyharnessed to a national ideology of modern Filipino identity butalso meanings that emerge from daily having to negotiate unsafeplay areas, open sewers, uncollected garbage and other environ-mental hazards, troublesome spirits, and the power inequities ofadult-child relationships.

To begin, I situate the children and then their drawings within

the context of the community and the research project. I use onetype of drawing as a departure point for my analysis, foreground-ing the content of childrens life-sized body maps, their talk aboutthem, and the social relationships within which they were pro-duced (Rose 2001). I then turn to childrens comments about theirexperiences of illness and injury, situating their ideas aboutcausality and place within both local and larger contexts of powerand value.

PUROK DAGAT: LIVING ON THE MARGINS

Like millions of children in the Philippines and elsewhere, the chil-dren discussed in this article are directly affected by the unevenand unjust effects of North-South inequality enacted through col-onial expansion and contemporary global capitalism. Independencefrom the Spanish came in 1898, but Philippines political autonomycrumbled in 1902, with American territorial claims lasting through

Japans Second World War occupation. A second independencewas granted by the United States in 1946, but, between 1975and 1986, the U.S.-supported Marcos dictatorship underscoredthe fragility of Filipino self-determination.


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Moreover, in the post-Marcos era successive governments have

been faced with an ever-growing, foreign-owned national debt.Today, after 20 years of debt restructuring and trade liberalization,that debt stands at over US$60 billion, and a startling 89 percent ofPhilippine government expenditures go toward debt servicing(Bello 2005). According to government statistics, roughly 30 percentof Filipinos live in poverty; non-governmental organizationsand poverty advocates place that figure at 75 percent or higher(Marquez 2005; Oliveros 2005). Plagued by government and corpor-ate corruption and a stagnant domestic economy, the national

government has repeatedly used its population as an economicresource, supporting the worlds largest exportation of humanlabour and becoming deeply dependent on the foreign currencyremittances from its citizens working abroad (Oliveros 2005).

On the island of Negros, where this project was conducted,mono-cropping, established in the late 1800s by the British andAmericans and continued by national Filipino governments, hasleft local economies deeply vulnerable to fluctuations in theworld price of sugar (Billig 2003). Government and entrepreneurial

initiatives to diversify the islands economy through other exportcrops and tourism have not alleviated the profound inequitiesbetween rich and poor (Bacolod City Planning and DevelopmentOffice 2005). Following the neoliberal model of the national govern-ment, the current plan for the islands largest city is to minimizebusiness and employment regulation, implement One-Stop-Shop-Investment to attract investors, and transform Bacolod intoa centre for service, conventions, and tourism. Attracting corporateand private investors is the citys solution to declining national

government revenues, deepening poverty and joblessness, anddeteriorating infrastructure in a city in which nearly 40 percentof the population are under 17 and soon to be looking for work(Bacolod City Planning and Development Office 2002). The destruc-tion of low-income neighborhoods to make way for expensiveresidential subdivisions, hotels, golf courses, and shopping malls;employment growth in low-paying, short-term service sector jobs;and the rising costs of everyday life due to privatization and thederegulation of oil and electricity, water, and health services has

intensified poverty and suffering among the poor in Bacolod City.The children who participated in this research live in PurokDagat, a pseudonym for one of Bacolod Citys many impoveri-shed, disintegrating, and structurally effaced neighborhoods.

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Purok Dagat is a place where the structural violence of inequitable

colonial and neocolonial political and economic processes is liveddirectly by its residents and, especially, by its children. Nearly1,600 residents live in 250 small shacks, and eviction by land-ownersseveral of whom now live for most of the year in theUnited Statesis a recurring crisis for families. Incomes are low,and unemployment is widespread and persistent; children growup in households where older siblings, parents, and grandparentsstruggle to find enough work to sustain the basic necessities of life.Fish stocks are dwindling due to overfishing and the pollution of

marine waters, but many adults have no alternative other than try-ing to support their families by fishing or fish vending. Men findoccasional jobs in construction or transportation, while women earnsome money by taking in laundry or by operating small, house-front chungi shops selling coffee, cigarettes, alcohol, small packetsof food known as chichurias (junk food), and soap. Older teensand youths in their twenties compete for temporary, low-payingservice jobs in the citys shopping districts; in many cases, their par-ents have to borrow money to cover the associated and sizable

application, health certification, and store uniform fees.As a coastal settlement on the citys social and economicmargins, Purok Dagat is further marginalized by recurring floodingand erosion and, until recently, its exclusion from Bacolod citylimits. Other than some fortifications to combat coastal flooding,the city government has invested little in this neighborhood. Ratherthan solidifying residents claims to entitlements such as potablecity water and other improvements, the city exacerbated theneighborhoods peripheral status by using it as a landfill site for

municipal waste. Purok Dagat is now a deeply distressed anddangerous environment. Compounding overcrowded and precari-ous housing and seasonal flooding, uncollected refuse has contami-nated ground water, increased numbers of insect and rodent pests,and diminished fish and shellfish stocks. Sections of the originaldumpsite are now covered by sand and dirt, but uncontrolleddumping by area residents continues (see Figure 1). Basic garbage,sewer, and water services in Purok Dagat are unreliable. Municipalwater is available for a fee, but adults have concerns about its pota-

bility. Because toilet and sewage facilities are inadequate, manypeople use the ocean shoreline, a favourite play area for children.About one-half of Purok Dagat residents are under 18 years of

age. School attendance and completion is high here. In addition


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to schoolwork, purok kids perform numerous household chores,and boys, especially, may earn a few pesos by feeding pigs andchickens, scavenging plastic, glass, and metal, and doing odd jobsfor wealthier neighbors. During school vacation in particular,children have free time, and their joyful presence in the purok isevident in their boisterous play, shouts, and laughter. Favoriteactivities among children include eating, watching TV, swimming,and playing hide and seek and tag. Girls have elaborate clappingand singing games, and boys love to play basketball and to race,

jump, and fly spiders and beetles tethered on thread. Teenagers likestrolling with their barcadas (groups of friends) along the road-side or at a nearby mall.

Although municipal health officials consider the current rates ofchild malnutrition in this area to be low, purokchildren suffer froma range of other health problems, including endemic intestinalparasites, scabies and conjunctivitis, recurrent fevers, diarrhoea,and respiratory infections (bronchitis). Hepatitis and tuberculosisare found throughout the community. Per capita government

health care expenditures in the Philippines are among the lowestin the Asia-Pacific region; imposed restructuring and debt servicinghave reduced those expenditures to less than 2 percent of GNP(Simbulan 2001:10; n.d.). In consequence, the poorly equipped

Figure 1. Section of Purok Dagat. Photo credit:#Author.

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barangay (community) health center, which serves over 33,000

people, is so understaffed that patients may wait hours only to behanded a prescription for medicine they cannot afford (since sup-plies of free medicine have run out). The barangay health workerreceives her paltry government stipend infrequently but continuesto provide services to purok residents, giving basic first aid andreminding TB patients to take their medicines and mothers to bringin children for immunization. As a result of restructuring anddeclining government revenues, health services are increasinglyprivatized, but the costs of those services, of prescription medicines,

and of basic fees for emergency care at the public hospital areprohibitively expensive for most households. Instead, residentsmay use a variety of plant- and food-based remedies as well astreatment by local healers known as hilot, who specialise in mass-age, and loyaloya, who specialise in prayer.

ASKING KIDS TO DRAW AND TALK

Drawing was one of several research methods used to elicit chil-drens perspectives on living, playing, and working in this com-munity.2 We hoped that drawing would be fun for children andwould enable them to feel comfortable and confident participatingin a research project, an activity that was unfamiliar to them and totheir parents. Drawing activities further appealed to us as beinga method that might not privilege adult knowledge or verbalskills (Dell Clark 1999) and that might assist children to expressexperiential states (pain, sensation, anxiety, discomfort, unhappi-

ness, frustration) that could be difficult to put into words (Cornwall2002; Diprose and Ferrel 1991). While several types of drawingsmade by the children were germane to the question of bodilyknowledge, health, and illness, this article focuses on body map-ping. Prior to discussing and critiquing body mapping, however,it is important to look at the ethical aspects of childrens partici-pation in this project.

Following Aldersons (1995) and Harts (1997) writing on ethicalprinciples and rights-based approaches in child research, we

recruited children who expressed interest in the project and whoseparents had consented to their participation. Kids met individuallyor in small groups with research assistants from thepurokto discussthe project in Ilonggo. Research assistants carefully explained that


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I wanted to learn what children thought about their health and

illness and about staying healthy in their purok. The nature ofchildrens participation was explained, and research assistantsemphasized that kids could participate in the activities even if theydid not want to be included in the research. Children were first toldabout how and where their drawings and statements might be dis-seminated (articles, public talks, museum exhibits). Initially, theywere asked to choose a pseudonym so that they would not be ident-ifiable in publications. However, neither children nor parents likedthe idea of a pseudonym (it was equated with a criminals alias).

Significantly, many children wanted to have their contribution,especially their drawings, acknowledged with their own name.After discussions with children and adults in the community, aswell as with the ethics committee at the University of Victoria(the university with which I am affiliated), confidentiality was rede-fined to enable children to use their own names. The researchersreserved the right to use a participants pseudonym if her or hisdrawing or statements contained sensitive material.

For body mapping, kids worked in pairs, using wax or pencil

crayon to outline each others bodies on large sheets of paper.3

Once the outlines were completed, each child worked individually,making the drawing into a life-sized portrait and then respondingto the instruction: draw what you think is inside your body(Maayo ko nga idrowing mo ang tanan nga ara sa pamensaron mo mgabagay nga ara sa sulod sang lawas mo). When children indicatedtheir drawings were finished, they talked in Ilonggo with researchassistants from the community about what they had drawn, andthey identified sites and sources of bodily distress, discomfort,

and pleasure.The body maps were intended as a means of enabling children toexpress their views and concerns regarding their health, illness, andinjuries as well as their ideas about the body, including its interiorand workings. Specifically, the goals of the drawings were (1) toprovide an interesting and enjoyable way for kids to focus onand talk about self-drawn images of their own bodies (as opposedto an impersonal and standardized body); (2) to provide them withnon-verbal as well as verbal channels for expressing their ideas

about their bodies and health; and (3) to enable them to approachthat discussion with some detachment (i.e., without having to pointat or touch their own bodies). Children also participated in a seriesof focus groups, some gender-specific, about their drawings and

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their thoughts on health and illness. Although I conducted individ-

ual interviews, the children preferred group interviews. Thoseconversations took place in English and Ilonggo, with a translator;tape recordings were transcribed verbatim and translated. Over thecourse of the project, 88 children between the ages of six and 15years, including roughly equal numbers of girls (46) and boys(42), none of whom was disabled, drew at least one individual bodymap. Initially, we intended to focus the research on school-age chil-dren, but the age range also reflects a general disinterest amongyouth over 15 years of age in drawing activities. On the other hand,

children under six enjoyed drawing but did not want to talk withthe researchers. This article draws upon qualitative content analysisof the body maps and upon conversations and focus groups among35 to 40 children who, through their ongoing interest in the study,became the self-selected core participants in the research.

I distinguish my use of childrens drawings from those thatappear in some psychological and=or educational research. I amnot using the drawings to assess what the depiction of the humanfigure by children at various developmental stages=ages indicates

about a childs representational ability, cognitive development,emotional maturity, social adjustment, or values (Aptekar 1988;DiCarlo et al. 2000; Goodenough and Harris 1963; Koppitz 1984).Nor is my work directly comparable to studies that assess chil-drens knowledge of the body for its completeness and accuracyregarding internal anatomy and functioning (Reiss and Tunnicliffe2001). Neither developmental nor realist perspectives take intoaccount childrens interpretations and experiences of their bodies.Even more significantly, these perspectives fail to examine childrens

ideas about, and experiences of, their bodies within the specific cul-tural, social, and material contexts of the childrens lives.Using a critical visual methodology, my approach to the chil-

drens drawings includes an analysis not only of their content butalso of the circumstances of their production, circulation, and con-sumption (Rose 2001). Although I address some aspects of howthese drawings have circulated and been viewed within andbeyond the community, my focus here is on contenton what chil-dren drewand on the production of these drawings. I analyzed

the content of the body maps by coding and counting drawing ele-ments (labelled organs and body parts, unlabelled structures); bycomparing body maps to other drawings made by the children;and, especially, by examining body maps within the context of


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the childrens narratives about body, health, and illness.4 How the

drawings were seen and talked about by adults within the com-munity highlighted the fact that, in addition to content, an analysisof the particular circumstances, methods, and relations of the draw-ings production is important (Rose 2001:32).

When the drawing activities began, children were eager andexcited to participate but waited expectantly to be told which col-ours to use and what to include in their drawings. With encourage-ment from the researchers, the children drew, yet it was clear thatsome children and parents regarded the drawing activities,

especially the body mapping, as tests or evaluations. Adult researchassistants from the community, as well as parent onlookers, werealert for what they considered to be inaccuracies in the drawings.As the children drew, adults called out: Is that all that is insideyou? What about your lungs? Where is your stomach?Who pays for your fancy clothesa rich man? In some ways,as a method used to enable childrens thoughts and perspectivesto come into view, drawing worked well. However, it also madethe childrens ideas accessible to adults in the community, who pro-

ceeded to correct, ridicule, and, on occasion, praise them. Further,drawing highlighted our status as maestras estranheras (white for-eigner teachers).

Although children did not seem particularly distracted or dis-tressed by the comments made by adult onlookers, we wanted tolessen the imbalance inherent within adult-child relationshipsan imbalance that the drawing activity brought to the fore. Conse-quently, we moved the drawing venue from an outdoor chapel to aless public space so that children could work without interruption;

as well, we involved youth research assistants and encouragedadult research assistants not to comment on the drawings. The chil-drens enthusiasm for drawing never flagged, and, as the followinganalysis suggests, they did find ways to express a range of ideas,perspectives, and experiences relating to their bodies.

SCHOOL, STATE, AND OTHER BODIES

As I discuss in this section, the body maps revealed a particularbodyone that children encountered in school lessons on health,hygiene, and human anatomy. The majority of the drawings,in one way or another, through content, organization, and=or

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labelling, shows the impress of contemporary biomedical-scientific

representations of human internal anatomy. In other words, thereare clear resemblances between the childrens drawings and thosecommon to science textbooks and health posters: humans with tor-sos flayed to reveal neatly arranged internal organs. Not only is thisexemplar body part of health and science curricula in the publicschools but it is also embedded within a larger state discourse onchildren as part of the nation as well as within both colonial andmore recent relations of power and authority.

Most children interpreted the request to draw what is inside of

you to mean draw what is inside your torso;" few included fea-tures located inside the limbs. What children depicted within theirbodily interiors appears in a wide variety of ways. Most commonare irregularly shaped circles, or sacs, of varying sizes as wellas both long and short, wavy and straight, lines and tubes. Someof these visual elements were immediately recognizable to theresearchers. For example, the heart drawn as a red Valentine shape,the ribs as lines or bars across the chest, the stomach as a large circleroughly midway down the torso, and the brain as a circle inside the

head. Some children filled the entire torso (shoulder to groin, orside to side) with their depiction of their insides; most interiorsappear quite empty. Organ size varied considerably, but the posi-tioning of the most commonly drawn organs relative to otherswas similar: hearts were usually in the upper center of the chest,while stomachs and intestines were lower down.

The textbook representation of the bodys interior was mostevident in the drawings done by boys 13 to 15 years of age (seeFigure 2), all of whom said they had studied human anatomy in

high school science. The abdominal and chest cavities of their bodymaps are full of organs, drawn in considerable anatomicaldetail, often overlapping and interconnected and usually labelledin English. They included organs rarely or never mentioned byyounger children, including testes and trachea. Boys in this agerange also tended to include the interior of their limbs: bones,muscles, nerves, and veins.

More commonly, the school-disseminated anatomical body inchildrens drawings resembled Figure 3. The child has drawn her

face and hair, and some clothing, and has depicted her insides asa heart, a large sac (usually identified as stomach or intestine), atube (often unidentified), some ribs, and external genitalia. Whileother internal body parts were often unconnected, there is evidence


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of childrens ideas about a digestive system. Most often theydrew a tube or line from mouth or throat downward to an interior

sac or tube labelled tiyan (stomach) or tinae (intestine); less often,that line continued to a point labelledmonay(vagina) or buli(anus)(see Figures 3 and 4). This view of the bodys interior as differen-tiated parts having some functional organization is paralleled by

Figure 2. Body map by Brian Rei Macaya, 14. Photo credit:#Author.

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the childrens explanations that brains are for thinking, lungs arefor breathing, and stomach and intestines are where food isstored or cleaned (matinlo). While a few children said the heartpumped blood, it was more commonly described as the source oftheir life (kabuhi sa akon).

This functional organization of differentiated internal anatomywhat Christensen (2000:52) refers to as a professional discourseon the somatic bodyoccurred broadly throughout the entiregroup, with minimal variation between boys and girls; however,

Figure 3. Body map by Chucky Morada, 10. Photo credit:#Author.


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the drawings by the youngest children, those least familiar with the

school-disseminated body, are distinctive in several ways. The six-to-eight-year-old kids generally included only two or three internalorgans or structures: the heart (nearly always drawn as a red Val-entine heart) and a roughly circular sac or tube labelled stomach

Figure 4. Body map by Ana Ybanez, 12. Photo credit:#Author.

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or intestine. In contrast, older children drew more structures

within their interiors and made more connections among them, insome cases representing other functional systems, such as a respir-atory system. Although they did not include the kidney and liverdrawn by these older children, and only one or two drew the liveror ribs, some of the six-to-eight-year-olds filled their bodily inter-iors in other ways. A few drew only two or three organs but madethem very large. Some included the heart, stomach, and intestinesbut also drew or shaded and labelled the interior of the bodys torsoas though it were filled withdugo(blood) (see Figure 5 and Figure 6).

Despite my own somewhat naive expectation that body mappingwould create a visual field privileging childrens views of the body,the inside-out view of the body asked for in this activity is, infact, a particularly adult perspective (Mitchell 2006). Moreover,because these children were producing images for adult Ameri-can university teachers, they interpreted body-mapping as: drawwhat your teachers have told you is inside your body. Askingchildren to draw their bodily interior privileged school learningas well as older children, who were more familiar with the school-

disseminated notion of the anatomical body. And askingchildren to make body maps individually seemed to privilegewhat one anonymous reviewer described as an individualised=bounded=privatised experience of body rather than a collectivecommunity body.5 While this drawing activity was intended tosuggest what each child sensed and thought of his or her own bodyand did not ask children and parents to produce a collaborativeor negotiated understanding of the childs body, the resultingdrawings made it clear that the school-disseminated body is also

a collective body. This anatomical, functionally organized body iscollective not just because it is widely taught in the Philippineschool system as the correct representation of the body but alsobecause it is sanctioned by adults (as evidence of the childs com-pliance with school teachings) and by the state (as evidence of amodern, rational Filipino citizen-subject). Much as it starklyrevealed the power=knowledge differential between adult foreignresearcher and child Filipino participant, body mapping also high-lighted the broader colonial and contemporary social relations of

power and authority within which children experience, represent,and are taught to understand their bodies.Thus, at one level, the fact that children envision their bodily

interiors through the lens of medical-scientific representations of


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human anatomy should not be surprising. Scientific models

of health and the body have been part of the elementary schoolcurriculum since the early 1900 s, when they were used as part ofthe American occupation of the Philippines to correct Filipinoideas about body, health, and disease and to create a disciplined

Figure 5. Body map by Myra Marry Grace Villarey, 7. Photo credit:#Author.

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and productive colonial subject (Rafael 2000). Across the Philippines,American teachers and physicians subjected school children to dailysurveillance, instruction, and testing (Anderson 2002; Martin 2002;

Figure 6. Body map by Welson Tillaflor, 8. Photo credit:#Author.


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Sobritchea 1990). From lessons in hand-washing and proper toilet

habits to marching drills and inspection of school uniforms, a newhabitus of (potentially) adult, rational, self-regulating hygieniccitizenship was imposed (Anderson 2002) to prepare school childrenfor the possibility of full citizenship in an independent Philippinesnation (McElhinny 2005:186).

More recently, the body and its composition, functions, and carehave been tied to nation-building and citizenship as part of alarger pedagogical strategy, enshrined in the Constitution of thePhilippines, to inculcate nationalism and patriotism,. . .develop

moral character and personal discipline,. . .[and] broaden scientificand technological knowledge (Maria~nnas and Ditapat 2000:112).In conjunction with campaigns of national pride and identity(Constantino 2002 [1966]:182), the government has emphasized thatchildren of the new Filipino state have obligations to improve theircountry (Mulder 2000:61). As one instructional chart specifies,children must obey parents and teachers, have good personality,. . . health, . . . [and] personal cleanliness, and must help to main-tain cleanliness and orderliness at home and its surroundings

(Secondary Education Development Project n.d.). Beginning in theprimary grades, children are instructed in proper care of thebody, including clothing, grooming, regular washing, and gettingregular exercise and adequate sleep. Classrooms in Bacolod publicschools display government public health announcements abouttuberculosis, polio, and SARS, and they often also display one ofthe following posters: Causes of Disease, Cleanliness Chart, or theA1 Filipino Child Chart, with its nine body care directives, includingwash your ears, wash your legs and feet, clean your nose [and] cut

your nails (see Figure 7). Despite the fact that debt restructuringeliminated the local school meal program, with the result that chil-dren often go to school hungry, the school curriculum instructs PurokDagat kids to eat three balanced meals a day. And, of course, teacherscomplain that underfed children do not listen to instructions.

While the majority of Filipinos live in poverty and have no accessto reliable medical care (Marquez 2005; Simbulan 2001:16), childrenare taught that their claims to being good and loyal Filipinosdepend upon their personal values and behaviour, including their

responsibility to obey adults, to keep themselves clean, and to behealthy. How well children reproduce this body and its associatedvalues and behaviors becomes a measure of their worth as youngFilipinos. Parents negative comments about their childrens

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drawings now take on a different significance, highlighting theiranxiety about how foreign researchers might judge their childrenas well as the close connection between childrens ability to repro-duce what they have been taught and their status as properly

obedient.While this school-based, collective body did dominate the bodymaps, the presence of some visual elements and the absence ofothers suggest that the children were not merely engaging in the

Figure 7. A-1FilipinoChild Chart.#Cebu Green EmeraldMarketing. Reprinted with Permission.


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passive reproduction of school lessons. As other researchers with

other children have found, the children in this project understoodtheir bodies through diverse and sometimes contradictory domainsof knowledge (Backett-Milburn 2000; Geissler 1998; Williams andBendelow 2000). Specifically, their drawings show, in limited ways,how they intercalated the functional anatomical body with theirown sensations and experiences as poor children and with otherculturally meaningful ideas about health and illness. Significantly,their perspectives cannot easily be reduced to a simple binary:school-based representations=non-school-based representations.

The reality is more complex and heterodox. For instance, as visualevidence of their frequent hunger, diarrhoea, and other gastro-intestinal problems, stomach and intestines often loom large in theirdrawings. The heart, sensed directly and described as the source oflife or place of emotions (balatyagon), is similarly prominent in bodymaps. Notably, the heart that most children appropriate for theirown drawings (77.3 percent of 88 drawings) is not the textbookmulti-chambered (anatomical) heart but, rather, a large red Valen-tine heart (often seen in television cartoons and print comics).

The distinction that many children made between stomach andintestine is indicative of the anatomical body learned at school,local beliefs that parasites or worms (lugay) live in their intes-tines, and the abdominal pain and yellow skin that children associ-ate with parasites. Younger children are especially prone to lugay,perhaps because they are not able to be as vigilant as are older chil-dren in avoiding contact with human and animal excrement. As aresult, the younger kids are particularly familiar with purga,deworming remedies that they say clean the intestines, and they

talk quite unselfconsciously about having worms pulled from theirnoses and anuses.At that same time that they carefully distinguished stomach and

intestine, none of the children included a bladder in their bodymaps; instead, they associate peeing (para maka ihi) with the penisand the vagina. A few of the 46 girls (6.5 percent) drew and labelledovaries and bi-horned fallopian tubes, but none included a uterus.Among girls and some women in this community, the uterus(matrice) is a place where a baby grows and is not associated with

menstruation. Girls explained the absence of the uterus from theirdrawings by saying, wala ako gabusong (Im not pregnant).Childrens ideas about the body draw upon knowledge that is

not sanctioned by either the school or the health clinic. For instance,

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although our conversations about health and illness often led chil-

dren to talk about locally meaningful non-biomedical disorderssuch astuyaw(an illness that includes fever, rash, and stomach acheand that is caused by spirits), they almost never mentioned theseduring the body-mapping sessions. Yet, some of the children nineyears and older included in their body maps a very large atay(liver), an organ that they know to be the favorite meal of blood-thirsty, supernatural aswang who are said to roam the community.Similarly, although it rarely showed up on their drawings, manychildren told us they had had kibit, or what is known as piang on

nearby Bohol and Cebu islands (McNee et al. 1995; Tallo 1999).Distinct from bruising (pakris) and skeletal breaks, kibit refers topain and swelling resulting when something inside the body isfractured. Children say that kibit occurs if they fall or stumbleand land heavily. Precisely which internal structure is harmed isunclear; some children (and adults) say that kibit is a fracture ordislodging of veins (ugat), but most say they do not know, therebyrefusing to locatekibitwithin, or reduce it to, the biomedical body.Not surprisingly, children asserted that kibit does not respond to

biomedical remedies but, rather, to hilot, the vigorous massage oflocal healers.The request that they draw themselves and their bodily inte-

riorsa request that, as I have argued, evoked schoolbook diagramsof naked flayed bodiescreated tensions that the children soughtto resolve. One way that they kept the body closed and wholeand thus familiar was to include its surface. The presence of skinwas hard to detect, although a few children coloured their armsand legs. In many of the drawings, the bodys surface remains

visible as more than half of the children included either nipples=breasts or the navel along with their depiction of the bodys interiororgans (see Figure 4 ). Yet, breasts, navels, and external genitaliasuggest that the request draw what you think is inside of youevoked in the children an image of nakedness. Boys and girls overabout ten years of age had problems depicting themselves as naked,which is not surprising as only very young children appear inpublic unclothed. While less than 25 percent of the six-to-eight-year-olds included clothing in their drawing, over half of

the older children did. Some children managed their nakednessin the body map by rendering their clothing present but transparent(see Figure 8 ). Thus, in addition to including shorts or skirts intheir body outline, they drew breasts with bra straps, torsos with


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a T-shirt neckband and armbands, and they depicted waistbands

and underwear lines merging with interior bodily structures. Morethan modesty is operating here. It is clear from the body mapsand the other drawings that children saw these renditions as an

Figure 8. Body map by Rene Alisbo, 11. Photo credit:#Author.

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opportunity to clothe themselves in imagined and desirable ways.

None of their body maps includes school uniforms or torn anddirtied clothing; rather, boys clothed themselves in brand-namesportswear, especially basketball shorts and jerseys, and girls fash-ioned beautiful dresses and hair accessories for themselves.

ILLNESS, PLACE, AND SOCIAL RELATIONSHIPS

Through these maps, children articulated their understandings of

the body, particularly as these understandings are shaped by whatthey learn at school. Additional ideas, along with more of their sub-jective lived experiences of the body, came into focus when theywere asked to talk about their past illnesses, injuries, and discom-forts. What became clear were the lived connections betweenchildrens experiences of their bodies and of their surroundings.Although my focus here is on the links children made betweenplaces and illness and injury, it is important to note that they donot regard their purok primarily as a place of risk and danger. On

the contrary, Purok Dagat is perceived as a place of home, family,and friends; of security, pleasure, and beauty; and of play. Yet,when children talked about illness and injury, they were usuallyalso talking about places and activities:

Sang pag-ulan sang domingo pagpaligo sa ulan, naghilanat ko, sakit sa uloko, sakit tiyan ko. On Sunday when it rained, I took a bath in the rain andhad fever, headache, stomach ache. -Archie Pimentel, 9

Sakit sa tiyan nagkaon ko puto nga pan-os. My stomach hurt when I ateputo [rice cake] that was not fit to eat. -Eden Grace Mapilit, 13

Sakit tyan kay damo gin ka-on nga mo aslom nga prutas. Sakit ulo kaynaga sulay sa ulon purma. Sakit sang tiil kay surva ka lakat kag wala nagatsenilas ang mata haga [pause] sakit kay nga sulod ang balas ang siko sakitkay nga bung-go. [I had a] stomach ache, because I ate lots of fruit that issour. [I had a] headache, because I always take a bath in the rain [and] sorefeet, because I roam around without sandals. My eyes hurt, because the soilgets in my eyes. I bang my elbow on something. -Shirley Mendoza, 8

Galagaw ko waay ko baalu nga katapak ko tag-lugar pag-abot ng balaynagpahuway ko indi na ko ka tindog, galuay, wala gana magkaon nagpa-tawag si nanay manughilot siling maghilot nga tag-lugar siling ya manuob

kag mangayo pasensya. I roam around and accidentally step on tag-lugar[environmental spirits]. When I went home and rest, I cant stand anymore.Im weak and no appetite; my nanay [mother] called up the hilot,[healer] who told us that I was hurt by tag-lugar [spirits] and told us


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to make tu-ob [burn incense and=or herbs] and to ask forgiveness. -Renalyn

Alisbo, 10

The list of illness and health problems that concerns the childrenis not the list that attracts either national or parental attention. Pos-ters and warnings about diseases of national concerntuberculosis,SARS, AIDS, dengue feverappear in school classrooms and thehealth clinic, but most children had little to say about them. Whenasked about their concerns regarding child health in Purok Dagat,parents nearly always begin by mentioning the financial burden

caused by pharmaceutical medicines, doctors visits, and hospitalemergency care. The costs of imposed restructuring and theincreased privatization of health care are borne disproportionatelyby lower-income Filipinos like the residents of Purok Dagat (Simbu-lan 2001:12). When asked to identify specific disorders, parentsusually listed asthma (hapo), fever (hilanat), the dangers of childrenplaying or walking near the congested roadway (there are no side-walks), and illicit drug use. The childrens narratives (see above)suggested a somewhat different list. Although they sometimes

talked about fever, children rarely mentioned respiratory con-ditions, and they saw drug use as a problem exclusive to gangsof older boys and young men. When talking about their ownbodies, children were much more likely to describe stomach aches,headaches and toothaches, sore feet, skinned knees, and cuts(which parents mentioned only if stitches were required). Childrenalso referred to kibit and tuyawtwo culturally specific conditionsthat parents mentioned only infrequently and both of which Idiscuss later.

Despite parents assertions that their children knew little ornothing, children rarely responded to our questions about thecauses of bodily harm by saying, I dont know. Instead, theyidentified specific causal factors, and they did so in a way thatwas remarkably consistent across age and gender. In particular,children see their bodies as vulnerable to environmental factors,especially to weather and to living in dirty (higko sang palibot) sur-roundings. When asked how they had acquired a cold or a fever,children (and their parents) invariably responded that they had

been bathing (pagpaligo) in the rain or that they had been exposedto a cold wind (tugnaw hangin).6 Headaches were often attributedto too much play or work in the sun or to bathing or playing inthe rain (gahampang sa ulan). The health effects of seasons, rain,

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and temperature changes are reported throughout the Visayan

Philippines (Jocano 1969; McNee et al. 1995; Nichter 1994; Tallo1999). These factors are probably traceable to ideas about hot-coldqualities (which are widespread in Malay-descended populations)(Becker 2003; Laderman 1987), to Visayan beliefs about powerfuland evil (maligno) winds (Jocano 1969; Tallo 1999), and to humoralnotions of body and illness brought by the Spanish colonizers(Nichter 1994:653).7 Classroom instruction on illness preventionalso refers to staying out of the sun and rain, and to avoidingsudden changes in weather.

A second recurring element in childrens statements about illnessand injury is higko, or dirt.

[What made you sick?] Higko kag ang basura, kalog higko sang tao kagsapat. Dirt and garbage and the canal with dirt from humans and animals.-Jo-an Jaena, 12

Ang masakit halin sang basurahan kag ulon kag init makaka-on silasagig panos nga pagka-on halin sa basurahan kay maka inom sang higkonga tubig. I got sick from the dumping site, from the rain and heat of thesun. I also ate rotten food from the dumping site and from drinking water

that is dirty. -John Paulo Barnes, 9

Children refer tohigkoboth as a general explanation for sicknessand as the cause of specific problems, including skin rashes,stomach ache, and fever. Bacteria or germs (kagaw) were rarelymentioned, but a few older children equated them with higko. Somechildren explained higko as refuse or waste (basura), as human oranimal excrement, or as rotten or expired food, while some usedit to refer to intestinal parasites (lugay). Flies, mosquitoes, and

cockroaches are higko because they contaminate bedding and foodand bite childrens bodies. Significantly, it was not always higko,per se, that made them sick but, rather, the many higko nga lugar,or dirty places, in the community. Among those places are theshallow drainage canals=ditches, which are full of fetid water andare located outside their homes, and the basurahan, open dumpingsites that contain rotting food, bags of excrement from houses with-out toilets, and the corpses of dogs and cats. Even some of theirfavorite play areas arehigko nga lugar, including the garbage-strewn

beach and the ocean, into which garbage and raw sewage areemptied.Moreover, as etiological factors, dirt, weather, poverty, and the

structural and physical marginalization of this purok by the citys


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wealthy and powerful coincide when children note that they are

especially likely to get sick during the rainy season, when inad-equate, overflowing drainage canals, floodtides, and typhoonsbring garbage, mouse and rat urine, and other higko into theirhomes. The general importance of temperature, wind, and rainand heightened anxiety about the rainy season may be meta-phorical referents to residents perceptions of a lack control overtheir environment and the literal submerging of their tenuousclaims to land and legitimacy in this city. At this especiallyunpredictable time of year, physical and social vulnerability and

marginalization may coincide to heighten child and adult anxietyabout individual and collective security.Research in another Visayan community suggests that local

notions of dirty and clean operate as a binary pair thatfunctions to make both physical and moral classifications. Amongfarmers on the neighboring island of Bohol, hinlo, or clean,describes the desirable state of fields, households, personalhygiene, and appearance (Borchgrevink 2002). Using Mary Dou-glass (1966:40) conceptualization of dirt as matter out of place,

as something that threatens the social order, Borchgrevink(2002:235) suggests that, among these Cebuano speakers, hinlo isequated with spaces that are domesticated or humanized, whilehugaw is equated with dirty and with the opposite of domesti-cated spaces (i.e., a lush and rampant nature). In Purok Dagat,children distinguished higko from balas (soil or sand), and theyfurther contrastedhigkoto clean (hipidortinlo). However, the sparseclumps of bushes and stands of trees and an uncultivated,uninhabited area near the river were not described as higko nga

lugar, although they were sometimes referred to as wild (ilaahas orwayang). As I discuss later, these spaces were nonetheless regarded

as potentially harmful.8

Eating and food received particular attention in childrensdiscussions of causes of bodily distress and sickness, an observationthat has been noted in other research on Filipino children(Villanueva-Noble 1998). Children are often hungry in this com-munity, and they include hunger as a source of stomach painsand headaches. In Purok Dagat, most children eat at least twice a

day, but portions are small and of low nutritional quality, usuallyconsisting of instant noodles, rice, and a bit of fish washed downwith sweet carbonated soft drinks. Snacks, when they can beafforded, are sugary or salty, high-fat junk foods. When young

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children were asked to name their favourite activity, most

responded, eating. Although their parents deny it, children doscavenge for food on the dumpsites. As the children indicatedin several of their earlier statements, expired or rotten food(higko nga ka-on) is another common explanation for stomachupset or diarrhea. These ailments are also attributed to theworms that consume what children eat as well as to eatingaslum,or sour foods, such as santol fruit or one-peso bags of saltedsour green mango.

Masakit ang tiyan kay wala paka ka-on sang ka-on, nga ka-on sa sang prutasnga aslum. My stomach hurts, because I eat sour fruits before rice.Eduardo Escala, 9

Lupot wilu pamakakaon sang hanon nga kaon sang prutas. I got diarrheabecause I hadnt eaten rice, and I ate fruit. Nenmar Alvarez, 11

Children clearly associate their environment with risks of illnessand injury, especially from rain, sun, and dirty surroundings (higkosang palibot). The importance of environmental factors in Filipinochildrens ideas about health and illness has been noted elsewhere

(Villanueva-Noble 1998:142; Jocano 1969). Yet, in Purok Dagat, chil-drens comments illuminate not just the presence of these factors(which are a source of bodily harm) but also the interaction betweenthem and their activitiesplaying, running, swimming, scavengingfor food, and so on.

I get sick because I am always running around, and I get caught by the rain.Arjie Buen, 14

Ang masakit halin tongod gahanpang ko basurahan higko mabalto. I get sick,because I play at the garbage dump that is dirty and smells bad.

Christian Mark Tombrio, 12Sang Monday naghilanat. [On Monday I had fever] Diin naghalin ang

hilanat?[Why?] Kay gapaligo ko sa baybay. Because I took a bath at the sea.[Are you allowed to swim in the sea?] Indi [No]. Rachel Britannia, 7

Childrens comments about bodily harm and injury recall Orella-nas (1999:73) findings about the importance of social relations forthe meaning children attach to the landscapes in which they live.Similarly, Christensen (2000:47,55) sees this connection between

context and social relationship as particularly relevant for under-standing Danish childrens experiences of everyday illness, falls,cuts, and scrapes. She suggests that childrens accounts showedthat experiencing vulnerability also related to the experience of


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losing social position, activities and relationships and changes in

their environment (Christensen 2000: 47).In Purok Dagat, children often attribute bodily harm to trans-

gressing social rules, including parental instructions. As childrentell it, they get hurt or fall ill when they engage in forbidden typesof play (swimming at high tide, taking a bath in the rain, climbingfruit trees or fences and getting onto roofs, running withoutsandals), or even hampang tudoplaying too much. They gethurt when they play at locations they have been told to avoidkarsada (the roadside), pika-pika (breakwater), and the basurahan

(the garbage dump). And they experience pain and discomfort ifthey fail to follow parental instructions concerning body carebrushing teeth, resting, avoiding sour foods before eating rice, oreating too much sour food.

It is not only parents and other adults who must be heeded.Children link harm and illness to their contact with other powerfulentities in their communityengkantos. Described in ethnographicand historical work on Visayan societies (Aguilar 1998; Borchgre-vink 2002; Lynch 1984 [1949]; Pertierra 1995), engkantos are spirits

who live alongside human residents. In Purok Dagat, somemariit,enchanted places occupied by these spirits, are known to thechildren (and to adults), but engkantoare invisible and thus notori-ously hard to avoid. Young children receive some protection astheir mothers keep them close to home and pin protective slicesof ginger to their clothing. But older children who venture fartheras they play and walk to and from school must be careful not stepon either the engkanto or on their houses, which are visible asmounds of earth. Luckily, some types ofengkanto are creatures of

habit, and children know they should not shout or make loudnoises when these spirits are resting each day at noon or when theyare roaming through the community on Tuesdays and Fridays.9

Similarly, when they must relieve themselves outside, childrencall out, hoping to warn the spirits to move away. It is notpossible to avoid engkanto completely, and children suffer fromtuyaw, or the temporary skin rash, fever, and stomach ache causedby contact with these spirits. Like kibit, tuyaw is not recognizedby the physicians and nurses who staff the local health clinic;

it can be diagnosed and treated only by local healers. Encounterswith the spirits can be lethal. Children have a variety of storiesabout deaths caused by aswang, a particularly malevolent cate-gory of engkanto. Aswang transform from human to non-human

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form and crave the tender livers of young children and human

fetuses.On the neighboring island of Bohol, engkanto dwell in those

places that are considered undomesticated and natural (hugaw)(Borchgrevink 2002:235). Similarly, children in Purok Dagat ident-ified certain trees and clumps of bushes as places where engkantodwell, regarding them as dark (madulom) sites, places of worry-ing sounds and shifting, shadowy shapes. Kids pointed out thatspirits also live in other madulom placesin the rafters and at theback of houses, in the space below traditional raised houses,

and in comfort rooms (toilets) and wells. While only some ofthese spaces are considered dirtycomfort rooms and the rearof houses, where pigs may be keptthe childrens comments high-light that engkanto inhabit the margins of domesticated humanspaces. Way up high, deep down low, and toward the backtheseorientations are echoed in stories about spirits who fly, travelunderground, and shun the light (Pertierra 1995:80).

CONCLUSION

My intent in this article is to bring both local and broader contextsof inequality, power, and authority to bear on understanding how agroup of impoverished children in the Visayan Philippines talkabout their bodies. As Katz (2004:163, 182) suggests, it is preciselythe fact that childrens lives are extraordinarily local that makesthem distinctively vulnerable to the harmful effects of those localand larger topographies of capitalism (156). Circumscribed

socially and geographically by adults, school, and the immediatevicinity of home and neighborhood, children must bear directlythe effects of poverty, structural adjustment, inadequate social wel-fare, dilapidated homes, and lack of basic community services andamenities as well as the sporadic emotional and violent outbursts ofadults who are frustrated by too little money and by their grindingsubservience to those who are better off. The health concernsheadache, stomach ache, cuts, scrapes, kibit, and tuyawvoicedby the children in this Visayan community are the sort that adults

in the Philippines (and elsewhere) typically refer to as minor ornothing much (Christensen 2000) in comparison to the life-threa-tening problems of tuberculosis, polio, dengue fever, and malnu-trition. But childrens concerns are neither insignificant nor


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simply reflective of an incomplete or inaccurate understanding of

their bodies and of what makes them ill. Rather, in pointing to theirdistinctive locations within (and experiences of) place, adult-childrelationships, and larger structures of inequality, childrensthoughts and concerns are both testimony to the lived realities ofgrowing up in poverty and a means of understanding how theymake sense of their bodies within these circumstances. Cuts andscrapes indicate the particular vulnerabilities of children in acommunity lacking safe play areas, a community built upon thediscarded razor blades, barbeque sticks, broken glass, jagged tin

cans, and other mundane waste of urban life. Stomach aches andyellowed skin (from intestinal parasites) are the embodied effectsof experiencing poverty and inadequate sanitation, literally closeto the ground. Headache and stomach ache are bodily expressionsof hunger, of scavenging for expired food, of inadequate shelter,and of the small pleasures of eating cheap but non-nourishing junkfood. Kibitand tuyaw further signal the distinctive vulnerability ofchildren in a landscape made dangerous by hazards both seenand unseen, where adults and adult knowledge offer only partial

protection. Stories and the sensed presence of engkanto, in parti-cular, are meaningful symbolic vehicles through which childrenexpress their sense of vulnerability and their recognition that,despite following adult instructions, they still get sick. And thedangers are not (or are not only) dirt and garbage but larger,invisible forces that are both powerful and predatory.

The concerns of children are often overlooked not only bygovernment health priorities and school curricula but also byparents; nonetheless, those daily pains and discomforts shape

how children view the world. The fact that their concerns are over-looked or disregarded by those with relatively more power thenthey possess means that children must come to terms with sometypes of bodily pains and problems on their own. Well aware thatwhat is taught about the body and health in school is considered byteachers and parents to be important and authoritative, childrencan reproduce this knowledge when required. For example, notonly did children model their body maps on what they had learnedin school but they also echoed this knowledge in their ideas about

avoiding higko (dirt) and the importance of staying hipid (clean).Within the context of 20 years of debt servicing, economicrestructuring, deteriorating health services, and a neoliberal staterhetoric concerning the duty of individual children to be clean

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and healthy, the overlooking of childrens concerns has yet

another dimension. Filipino children, particularly those in impover-ished neighborhoods, have long been the target of colonial andnational government programs focused on sanitation and hygiene,disease reduction, and population betterment, all of which aredisseminated through elementary and high school curricula.Emphasizing mastery over the body through memorizing termin-ology, through gaining a knowledge of basic human anatomy,and through the inculcation of daily practices of hygiene, dress,and obedience to authority, school appears to offer those children

the means to minimize risk, avoid illness, and achieve health.However, for many of the children living in poverty, the clean,well-fed, healthy and disciplined A-1 Filipino Child of theirclassrooms is materially and socially unattainable. Directives toavoid mosquitoes, flies, and rats; piles of garbage; and gettingcaught in the rain are impossible strategies of disease preventionfor children living in Purok Dagat. Without adequate housingor waste disposal, there are virtually no safe spaces in whichchildren can play. Without clean water, waste disposal, or adequate

toilet, bathing, and laundering facilities, staying clean is anexhausting and time-consuming activity. Girls do hours of launder-ing each week; boys tote heavy containers of wash water from thelocal pump and wells; and both work to keep rats, flies, windblownrefuse, and sewage from swollen canals out of their homes. More-over, standards of obedience, attention, and academic successbased on assumptions of well-nourished, well-rested bodies areunattainable for children whose daily intake of poor-quality foodis insufficient for growth and development much less for attention

to duty and citizenship. The childs failure, evidenced in hunger,inattentiveness, and illness, then perpetuates colonial and contem-porary class-based assumptions about the ignorance and laziness ofimpoverished children. Rooted in a pedagogy that infantilizes thepoor, identifies them as at risk, and blames them for failing tomeet national goals of health, illness reduction, and waste manage-ment, schools offer the children of Purok Dagat little to mitigatetheir daily health concerns.

Nonetheless, the language of self-care, self-blame, and indivi-

dualized responsibility for health is central to the childrens views.Listening to their mothers and teachers chastize them for eating thewrong things, for getting dirty, for not resting, for wanderingtoo far from the house or otherwise misbehaving, kids internalize


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the idea that illness and injury result from their own behaviour

and disobedience. By reproducing this neoliberal public healthmessage of individual responsibility, children acknowledge theirlowly place in the adult-child hierarchy, while, at the same timeand at some level, demonstrating that they are good children.They have learned the neoliberal lesson of self-regulation well.Furthermore, this self-attribution deflects blame from poor parentswho are not only too exhausted by the unrelenting tasks of provi-sioning a family to monitor each offspring closely but, given thisenvironment, are also fundamentally unable to protect their chil-

dren from harm. Despite the constraints of generation, politicaleconomy, and environment, children do not see themselves assickly (masakiton), nor are they particularly fearful of their sur-roundings, always responsive to adult demands, or amenable topassively reproducing what they learn at school. They routinelyignore adult instructions, warnings, and cautions. They play wherethey want; eat chichirias (junk food); say they have washed whenthey have not; craft their own ideas about body, illness, and danger-ous places; and inhabit their community with pleasure, ebullience,

and a sense of security and belonging.In their ideas about body and illness, children in Purok Dagatexpress a sense of limited agency that is meaningful to adults andchildren alike. In attributing harm and illness to spirits; to the wind,rain, and extremes of temperature; and to thehigkoand garbage thatpervade their surroundings, children vividly and metaphoricallyexpress a sense of their own vulnerability and limited scope foravoiding illness and injury. Their statements are broadly similarto the passivity and deflected agency that Berman (2000:159)

notes among children who are socially and spatially marginalizedon the street in Java. In addition, their ideas replay widespreadVisayan ideas about constant threats and the inevitability of illness.Similarly, within the material, social, and interpretive reality oftheir surroundings, there are few spaces that adults or childrenregard as safe or clean (tinlo)the interior of some housesand classrooms, some of the purok pathways, parts of the school-yard, basketball courts, and one small plaza (or courtyard). Yet,playing in these spaces exposes children to the scrutiny of adults

and to the demands of homework and household chores. In fact,the places that children consider desirable because of their potentialfor offering uninterrupted non-scrutinized play are dirty orpopulated byengkantothe open dump, stands of trees and shrubs,

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the beach, the ocean. Not only are these locations in which children

are at increased risk of illness and injury, but they are also preciselythose spaces that adult directives tell them to avoid. Even youngchildren possess considerable knowledge about dangerous placesin their purok, but, like their older brothers and sisters, they aredrawn to those areas as offering fun and being free from adult scru-tiny. Moreover, there are no other options. While some of the chil-drens ideas about risk and illness might cautiously be consideredinstances of resistance to the constraints of school-based, adult,official views of body and illness, those same ideasand,

especially, childrens willingness to ignore adults and take risksperpetuate the adult view that children are unruly and must be con-strained and instructed.

In its 2005 report, The State of the Worlds Children, UNICEFestimates that more than one billion children live in environmentsthat pose significant challenges to their health. Growing up inone such environment in the central Philippines, the children ofPurok Dagat negotiate and make sense of body and illness in a com-plex and precarious landscape dominated by multigenerational

poverty, joblessness, social marginalization, dilapidated housing,inadequate health services, recurring suffering, harmful spirits,and the daily hazards of living and playing amidst mountinggarbage, discarded junk, and animal and human sewage. That theyare not cowed or disheartened by such formidable obstacles is cer-tainly testimony to their resilience and creativity. But a curriculumconsisting of bodily regimes of control and of largely unattainablestrategies of risk reduction and disease prevention offers neitherprotection for individual children nor the potential to transform

the relationships of inequality that dominate their lives and pro-duce their suffering. Rather, it serves to inculcate and reproducethe belief that the poor are poor by their own hand. In this sense,Katzs (2004:183) conclusion that poor children are increasinglymade to bear the costs of social reproduction under global capital-ism is particularly poignant and disturbing.

ACKNOWLEDGMENTS

This article is based on fieldwork conducted during several periodsfrom 2001 to 2005. Funding for this research was provided by aSocial Sciences and Humanities Research Council of Canada


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Standard Research Grant (20022005) and a University of Victoria

Faculty Research SSHRC 4A Grant (200102). I am indebted tomy colleague, Dr. Marjorie Mitchell, for her comments on this arti-cle; to the children for their enthusiastic participation in theresearch; to the KASAKInanays;to Julie Dojillo and NGO Balayan;and to several University of Victoria students, especially SomaMorse, for research assistance.

NOTES

1. Exceptions include Szanton Blanc (1994) and Racelis and Aguirre (2002).2. In addition to a variety of drawings, we conducted household surveys, monthly

child health logs, and interviews and focus groups with children, parents,teachers, community health workers, and healers.

3. This technique was adapted from several sources, including Cornwalls (2002) useof reproductive maps drawn by women in India and Geisslers (1998) use ofabdominal maps drawn by Luo children.

4. The body maps were coded separately by myself, my colleague, and a researchassistant, and we noted few discrepant codings. I and at least one research assist-ant also separately analyzed other drawings and photographs according to theme.

5. Thank you to the anonymous reviewer for pointing this out.6. Bathing in the rain describes both being drenched during a rainstorm and,

literally, using the rain as a means of washing or cooling ones body.7. In fact, particularly among children, I found little evidence of a systematic or

elaborated hot-cold system of classification for food or illness, although it doesappear in womens and healers talk about prenatal and postpartum care.

8. A detailed analysis of the childrens classifications and experiences of place willbe the focus of a subsequent article.

9. The days whenengkantoare most active are the two days of the Catholic rosaryssorrowful mystery recalling Christs suffering and crucifixion (Aguilar 1998:161).

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