Locating Health and Place: Historical and Contemporary Case of Baguio City
I Early American Imperialism in the Philippines
The establishment of hill stations in tropical Asia are clearly aligned with Hippocrates’s treatise on the role that climate plays in fostering health. During the early days of European colonialism in Asia, particularly in India, the colonialists believed that the hot and humid climate threatened their delicate health and well-being. As a result, they sought cooler places in the high mountains, establishing centers for healing and rejuvenation. These hill stations, as they were referred to, developed into resorts and vacation spots, and eventually into urban centers and cities.
A similar pattern occurred during the 1898 American acquisition of the Philippines, an archipelago of more than 7,000 islands. On a May morning that year, when news came that Commodore George Dewey sank the Spanish fleet, a chronicle stated, “you could almost hear the rustle of geographies and encyclopedias throughout the land” (Williams, 1913, p. 3). Without clear knowledge of the country and its people, the American imperialists settled in the Philippines. Presumptively, they gazed at the Filipinos as wards who were ignorant, superstitious, unsanitary, and unhealthy, and, therefore, in need of the Americans to civilize them. During their first years, the Americans were confronted with a “green hell, a hot and humid country seething with diseases, both familiar and unfamiliar” (Gillett, 1990, p. 570). Moved by a sense of moral obligation and enlightenment, the U.S. government believed it was essential to impose the American image onto the Filipinos.
A general perception and experience of tropical environments for the Americans, and Europeans for that matter, is that they are extremely unsuitable. The fear of unknown diseases and ways of life in hot humid climates drove them to seek higher elevations for settlement, at least to a height of a few thousand feet. In a report to the Board of Regents of the Smithsonian Institution, Robert De C. Ward rebuked the U.S. government for not learning from the European experience in Asia. He stated that there was “an almost complete, and to my own mind an absolutely inexcusable, ignorance on the part of our high military officials as to the proper selection, equipment and care of white troops who were to engage in tropical campaigns” (Ward, 1929, p. 618). The illnesses and deaths among the American troops could have been avoided if responsible officials heeded the lessons learned by the bitter experiences of European colonialists.
Prior to the arrival of the Americans, Spain ruled the Philippines for three centuries from a position of tyranny and draconian governance. The Spanish monarchy and Catholic Church demanded total obedience from the Filipinos, resulting in a “state of suspended animation, an isolated sprawl of specks on a map” (Karnow, 1989, p. 49). With the endorsement of the King of Spain, the Catholic religious orders from the Middle Ages (e.g. Augustinians, Franciscans, Dominican friars, Jesuits, and Augustinian Recollects) performed the duties of the colonial master over thousands of hamlet-like barrios. Their main purpose was to Christianize the indios by making them subservient to the Catholic Church establishment. A widespread public health policy was not at the forefront of their monasticcentered minds, even though diseases were rampant throughout most of the archipelago. Abhorred by the modernizing world, the Church neglected to improve the health and sanitation of the people at a large scale, and instead relied heavily on rote prayer, church traditions, and God’s will to heal the sick. Worcester, an American zoologist already living in the Philippines prior to the American regime observed health conditions during the Spanish rule and described them as “shocking in the extreme” (Worcester, 1921, p. 408). Tidal creeks reeked with contaminated filth, excrement and foul smells in Manila. The sanitation conditions in the provinces were even worse. Worcester noticed that many of the ailments were curable. For example, instead of allowing children to play with others infected with smallpox, they could have been quarantined. Clothing of infected family members would be re-used by healthy ones without being washed. Even the opening of windows at night, which the Spaniards practiced, was not followed by the Filipinos for fear that aswang (spirits) would visit them. Fresh cool air would have helped in ensuring good circulation at night.
However, some level of advancement was seen in Manila in the early nineteenth century, but only after 300 years of Spanish colonial rule. Several hospitals were established; the Central Board of Vaccination was created in 1806; and the first medical school in the University of Santo Tomas was founded in 1871 (Bantug, 1953). Dr. Jose Rizal, a Filipino national hero, was also sent to Spain to study medicine in 1882. In spite of these accomplishments, typhoid fever, cholera, and leprosy remained rampant. These were the conditions the Americans encountered when they landed in the Philippines to rule the country.
Whereas the Catholic orders created and administered sporadic health services throughout the country prior to 1898, the American Army medical service took the matter seriously and applied the Hippocratic notion that “deep study and self-control” and “meteorological data” are essential to identify the etiology of disease (Doherty, 1900, p. 1526). Be that as it may, Dr. Doherty was already influenced by the application of the germ theory
Locating health and place: case of Baguio City 37 that prevailed in the medical field at the time. In his early report, he listed endemic diseases like malaria, “larvate paludism,” dysentery, beri-beri (a type of scurvy), intestinal inflammation, and Manila fever, among others, as prevailing illnesses. He continued to explain that the tropical humid climate of the Philippines exacerbates the growth and spread of diseases. Because far more American soldiers were dying from diseases than from battles with the native “insurgents,” it was imperative for the U.S. imperial government to create a public health system that included the development of public policy, as well as an administrative network to implement these regulations. Initially, a military-based corps of surgeons with strict discipline and a clear chain of command was installed in the country, but they quickly learned that a more holistic approach was needed to save the American troops. After careful observation of the ways of the Filipinos, the Americans concluded that addressing sanitation and hygiene were the most urgent health priorities.
In 1901, a Board of Health for the Philippines and the City of Manila was formed. Furthermore, an organized and coordinated system of 300 district health officers was installed throughout the country. But the road to national public health development was long and far-reaching. Change was difficult because the new imperialists did not understand the Filipino people and their culture in the context of the environment. The Americans continued to suffer from illnesses due to their inability to cope with the tropical climate. Sunstroke, heat exhaustion, sleeping sickness, tropical abscess of the liver, hookworm, ulcers and other intestinal parasitical infectious fevers of different kinds, as well as skin infections took hold on the American troops, officials, civil employees, and their families (Ward, 1929). A permanent solution had to be found.
From 1899 to 1902, after intense armed conflict between Filipino nationalists who fought for independence and the American forces, the country “settled” with conciliatory agreements made.1 Dispirited and dejected, the Filipinos were simply forced to “move on.” The United States was ready to rebuild the country. A solid testament to America’s imperial legacy in the Philippines is the installation of public infrastructure. At the outset of the American occupation, a survey of facilities revealed inadequate water systems (except for some sections in Manila), no reservoirs, and a single pipeline or artesian well for millions of people (Heiser, 1918). Poorly engineered sewer systems in highly populated areas existed. There were no regulations for the burial of dead bodies. Human waste, usually carrying diseases, was dumped in the canals and esteros. Large amounts of garbage piled up on the streets. Slum houses were built on tidal flats. A national American policy had to be enacted to achieve “sanitary regeneration of the Philippines Islands” (Heiser, 1918, p. 63). The United States sent a contingent of competent physicians and surgeons who brought with them hospital equipment and supplies. But these medical provisions were primarily used for the treatment of their troops. Eventually, Filipinos from “good family backgrounds” were trained locally as physicians and nurses. Many were also sent to the United States for professional education to carry out this national transformation in public health and sanitation when they returned to the homeland.
Additionally, a massive public works plan was initiated to construct modern water and sewer systems, hospitals and health centers with laboratories, and market facilities. In all their ideals, the Americans maintained a position of generosity and reassurance. They adamantly claimed that the purpose of American sovereignty was for the “well-being, the prosperity, and the happiness of the Philippine people and their elevation and advancement to a position among the most civilized peoples of the world” (Report of the Philippine Commission to the President, 1900, p. 4). They disassociated themselves with the European colonialist mindset of conquest and domination, instead striving to imbue the American occupation with principles of justice, liberty, and protection of law, rather than oppression, slavery, and arbitrary power. The desire to shift power from a military government to a civil one was fundamental to the Americans’ nation-building approach.
To show its intention of benevolence, the United States promised a massive infrastructure program to build roads, bridges, and railroads (Akers, 2017). The dual purpose of empire-building and protecting the health of U.S. troops necessitated the construction of a modern transportation network. The railroad, particularly, was considered a symbol of growth, prosperity, and technological sophistication. But the Americans’ goal may not have been as altruistic as they presented it. The Report of the Philippine Commission to the Secretary of War, covering the period from December 1,1900 to October 15,1902, hints at ulterior motives. The document states that the Philippines has rich and wonderful natural resources—“nature has done everything, but man has done very little” (p. 61). Considering that most of the Filipinos were poor and lived in coastal areas, which limited their commerce to “coastwide trade,” it was imperative to improve the railroad infrastructure in order to penetrate and open up the interior of the great islands. The Americans were interested in harvesting the great mineral, timber, and agricultural resources of the islands.
American officials back in the United States strongly supported the program to exploit the country’s natural resources through infrastructure development. One of the first major public work investments was the upgrade of the Manila-Dagupan railroad, a crumbling and deteriorated track running from the capital city to northern Luzon.2 Neglected by the Spanish regime, this railroad played a critical role in the American exploration of the Benguet mountains and eventually Kafagway.3