Eubios Journal of Asian andInternational Bioethic
EJAIB Vol. 31 (2) February 2021
www.eubios.info

ISSN 1173-2571 (Print) ISSN 2350-3106 (Online)

Official Journal of the Asian Bioethics Association (ABA)

Copyright ©2021 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

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Editorial address, and all correspondence to:Prof. Darryl Macer Email: darryl@eubios.info

Editorial: Global solidarity for all generations
This issue features 16 papers on the impacts of COVID-19
pandemic on educational systems and society. Between all
generations and cultures we need to work together to rebuild
more resilient and loving societies. The consequences of thepandemic will continue to be seen even in the generation who aresmall children today. Intergenerational solutions are necessary
and we need to spend more time to document the elements ofcommunitarism that have been rekindled during this time.
Reinforcement of solidarity between all communities living indifferent parts of the planet will also be a lesson we can apply to
mitigation of further climate change. Most of the papers were
presented during the International Public Health Ambassador andBioethics Conferences. There are going to be clear educational
consequences for children at all ages of the educational system,
and for adults, and these will get worse the longer our school
lockdowns continue, together with abnormal social distancing.
Ryan explores how indigenous wisdom may be useful toemphasize the importance of solidarity. Suma Parahakaran andcolleagues, Eviota and Maboloc, and Bayod et al., present some ofthe educational consequences, and suggest some solutions.
Quemado and Octaviano provide an example of a community
extension program in schools in an indigenous community in thePhilippines.
We have all had a variety of experiences during 2020, and Esra
Bilir reports on the Turkish example of how the state facilitatedthe safe return of citizens from abroad. Chakraborty shares somere lections from the UK, and typical of many countries, the recent
waves of COVID-19 have been even worse than the earlier ones.
Manual and Migallos present a study of risky behaviour amongchildren, as they felt less vulnerable to get sick from COVID-19.
However, the essence of solidarity is that all memberscof society
protect each other, and especially our vulnerable elderly members.
Bhuiyan et al. raise concerns of how vaccine roll-out in
Bangladesh may be challenging given experience with othervaccines. Public information in Turkey is surveyed from SukranSevimli. There are mixed blessings from social gatherings inPakistan described by Naheed Feroz. There are also two papers on
the social issues of business communities in the Philippines. A
return to battering as a form of economic exchange is one of many
unexpected consequences of the pandemic. Please join theconferences to share in a wealth of information, and submit yourpapers to document more of our global lessons that will better
prepare us for next time.
—Darryl Macers

Contents
page
Editorial: Global solidarity for all generations - D. Macer
61
Indigenous wisdom and human solidarity in the midst
62
of COVID-19 - Christopher Ryan Maboloc
Children of COVID? The educational consequences of the65
epidemic on the new generations - Raffaele Mantegazza
A case study of teaching ethical values to STEM disciplines in
Malaysia: Why silence and mindful pedagogical practices matter 67-Suma Parahakaran, Ng Khar Thoe, Ooi Li Hsien, S. PremchandranHigher education in the Philippines during the COVID-19 Pandemic:\
Psychological risks, research opportunities and policy implications 74- Godiva Eviota and Christopher Ryan Maboloc
Multiple risky behaviors among adolescents: A convergent-parallel 78
mixed method - Cherry Mae M. Manual and Samuel F. Migallos
Marist welfare arm: A community extension program in Santa
89
Cruz mission schools- Loveleih G. Quemado and Marcela Octaviano
Maintaining grace under pressure: Challenges and insights of teachers
who are mothers during the COVID-19 pandemic98
R.P.Bayod, E.J.D.Forosuelo, D.A.Arnosa, H.C. Orion, J.M. Cavalida
Experiences from my Mandatory COVID-19 Quarantine Upon 104
Arrival to Turkey from the USA 104— Esra Bilir
A Reflection on Life in the United Kingdom during COVID 19 106
Phases - Rhyddhi Chakraborty
Choosing positivity in the midst of difficulties: The case of publicschoolteachers in Mindanao
109- R.P.Bayod, E.J.D.Forosuelo, D.A.Arnosa, H.C. Orion, J.M. Cavalida
COVID19 and Challenges in vaccination programs in Bangladesh 115
Md.R.Bhuiyan , T.Saha, Nazia Islam , T.Taramun , Y.Siddiquee, M..I.
Momo, M.Momtaj2, S.Chowdhury
Reviving the ancient business model: The case of the Digos
Barter trade during COVID-19 pandemic
119- Fatima M. Chin, Raymond K. Hastings, Randy A. Tudy
Evaluation of public health ethics, individual, collective and state withinstitutional, responsibilities and obligation during the COVID-19 124
pandemic through online media reports in Turkey- Sukran Sevimli
The untold stories of front-liners working under threat during the
COVID-19 Pandemic: Bases for policy and program formulations136- Erikka June D. Forosuelo, Rogelio P. Bayod, Nickle S. Maleficio
Social gathering in pandemic: A blessing or menace for Pakistan 140- Naheed Feroz, Asma Amir Ali, Sara Sheikh
The Philippine tax reform law for acceleration and inclusion (TRAIN): The surrounding factual, legal and ethical issues of the state’s
144
taxing power Angelo Andro M. Suan and Rogelio P. Bayod

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Indigenous wisdom and humansolidarity in the midst of COVID-19- Christopher Ryan Maboloc, PhD
Associate Professor of Philosophy, Ateneo de Davao
University, the Philippines
Visiting Professor for Global Justice, AUSN
Email: ryanmaboloc75@yahoo.com

Abstract
The COVID-19 public health crisis has changed the world. It
has also revealed the vulnerabilities of people. Capitalism or
its perverted form has shown its ethical de iciency as
modernization theory has dominated the paradigm ofprogress. Governments must recognize the fact thatmarginalized groups actually suffer more as societies
confront the grave existential threat of the pandemic. This
paper will look into indigenous wisdom in terms ofadapting to a new post-pandemic human order. The impactof the coronavirus is a product of a short-sighted economic
model that is focused on pro it making. In this study,
indigenous wisdom is described as being rooted in the
man’s natural environment while civilization points to theenlightenment concept of progress. The challenge is how
human solidarity, one that is open to identity and difference,
can be used as the guiding principle as communities
attempt to ind ways to overcome the impact of COVID-19.

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Introduction
The pandemic has shown how vulnerable human beings
are. The peril that the coronavirus has brought tohumankind is forcing even polarized nations to act with thesame vision of putting an end to the pandemic. Reportssuggest of the great hardships experienced by ordinary
people as the impact of the virus to human life and wellbeing has not abated. In weak democracies, strong populist
leaders are using their authority to subjugate the people byinfringing on their basic rights. A paradigm that is focusedon state-centric economic models of progress has actually
done more harm than good as millions of individuals
affected by restrictions look for ways to cope up with the ill
effects of the catastrophic nature of this public healthemergency.
Lockdowns are meant to control people. A big moral
wedge is created when a sector suffers while those who
possess wealth live in a more comfortable way. For example,
those with private cars have less inconvenience and risk to
exposure compared to people who utilize the public
transport system. This means that the poor and minority
groups suffer in varying degrees. Globally, the borders that
separate countries are proof of the existing divide between
peoples and societies. As the pandemic unfolds, politicians
remain stubborn as they seek to protect corporate interestsand pro it irst rather than the well-being of communities. It
is a question of policy. In the past, public health was seen asmeans to an end to achieve economic productivity. The
coronavirus pandemic has shown such to be wrong. Kolbert(2020) writes that “epidemics are, by their nature, divisive.
The rituals of daily life become opportunities fortransmission; the authorities enforcing quarantine become
agents of oppression.”

COVID-19 and the end of perverted capitalism
The COVID-19 pandemic has forced capitalism to embrace
the sharp edge of the spear. Stiglitz (2015) speaks about theunethical practices of corporate entities that caused a great
divide in the US that led to recession. The problem was theunethical behavior of bank executives that put to risk thewell-being of people. Now, the pandemic has made thisgreat divide more apparent. States and corporations haverealized the limits of their power and the inevitableconsequences. So, the coronavirus has put the whole world
into a standstill. The government-imposed travel bans,
factory shutdowns, border restrictions and lockdowns, havedramatically diminished global wealth. A global meltdown
has emerged. The question is, what has brought us to thispoint? The answer is that globalization caused the spread of
the virus. The interconnectedness of the world has paved
the way for the perfect infrastructure that would transmit
the deadly SARS-CoV-2 pathogen.
It is not an exaggeration to say that this pandemic has
become the crisis of our civilization. Mansueto (2020) aversthat advanced transport networks have enabled the virus totravel fast. Policy makers and health experts think thatwithout the vaccine, nothing will be able to stop the spread.
The World Health Organization says that vaccinations do
not mean zero transmission. Nayeri (2020) believes that“not only does the deepening of each existential threat
undermines human society, beginning with its mostvulnerable groups and regions, but all the threats interact ina nonlinear dynamic that ampli ies the overall crisis.” Heexplains that “unless this crisis of civilization is addressedin t he coming decades, t he col l apse of gl ob alanthropocentric industrial capitalist society is now
i n ev i t a b l e , a n d h u m a n i t y m ay n o t s u r v ive t h econsequences.” (Nayeri, 2020)
Liberal states will stop at nothing in terms of giving a
blank check to save capitalism. The number of cases has
dramatically risen in the US at more than 100,000 daily. It
has been reported that president-elect Joe Biden will
request Americans to wear masks for 100 days. Still,businesses must ind novel ways to open and ordinary
citizens must earn their income because the American
economy is based on consumption. Liberal states are simply
built on the promise of eternal wealth. But what thecoronavirus pandemic has revealed is the unsustainabilityof modern capitalism. For Mansueto (2020), capitalistic
domination is rooted in the Industrial Revolution. Now, the
COVID-19 pandemic is a reminder that the West needs tochange its course if it wants to save capitalism.
The death of capitalism means that the modern world
cannot rely anymore on the free market economy. With thecoronavirus pandemic, governments are beginning tounderstand that modern capitalism lacks the safetymechanisms that will ensure its very survival. Money is noteverything. When everyone stops buying goods, capitalism
becomes nothing. Stock markets were in a state of shock at
the start of the pandemic. Death is everywhere. Dominantbusinesses are in a standstill, noticeably tourism. All ofthese imply that the coronavirus can reshape the world andsocieties. In this regard, Tanabe (2020) explains that, “theglobal spread of COVID-19 has put social cohesion withinmany countries at risk as the impact penetrates deep into
our society.”

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Indigenous wisdom as a way of survival
The history of human civilization has demonstrated how thepowerful dominates the weak. Huntington (1996) has
explained the three (3) stages of civilization. The irst isconcerned with land expansion. The Christian crusades
were a prime example in the manner by which faith has
subjugated the weak. The second has to do with theannexation of peoples. With this, we can cite the Napoleonic
era and the evils of the Nazi period. The third is about
corporate domination. Wealthy and powerful companies
de ine global policies with an interest in pro it as theprimary motive. Corporate greed has compromised theenvironment and reduced people into instruments.
For Huntington, culture now comes to de ine theindividual. The identity immanent to man is something thatis not borne by his autonomy but by indigenization. Today,
there are tensions and violence due to ethnic con licts.
Again, this is a manifestation of the revolt of those who havebeen reduced into “subalterns”, to use the term coined byAntonio Gramsci. While Fukuyama (1992) insists onliberalism as the inal form of government, emerging
paradigms in politics have come to challenge this position.
For instance, multiculturalism expands the way modern
societies are conceived. Fukuyama relies on the demise of
totalitarian regimes as the basis for his theoretical claims.
But liberalism in the post-Cold War era is in a quandary. The
battle ield has turned into small nationalistic con licts
where communal values serve as the precept for humansurvival.
Some theorists express that the idea of civilization isantithetical to indigenous wisdom. By de inition,“civilization” is connected to the notion of economic andscienti ic progress whereas “indigenous wisdom” is linked
to the capability of a people to maintain a way of life that is
attached to nature. But because of economic expansion,
thousands of Indigenous Peoples (IP) have been displaced.
Indeed, minority groups are at the receiving end of modern
progress (Kymlicka, 2007). Since the Enlightenment model
grounds everything on human reason, ethnic groups arerelegated to the background where their culture isconsidered as inferior. Reason is seen as the sole authority
after faith. Indeed, the histories of the world forget theresilience of groups whose unique way of life is a taboo for aman of science. Right now, history is being re-written
beyond the metanarrative of Enlightenment, putting into
question the Eurocentric notion of man.

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Modernization theory is utilitarian in principle. Its
primary consideration as a development paradigm is the
expansion of the economic as well as the cultural power ofdominant societies. Its mechanisms and schemes
sometimes violate the rights of indigenous peoples as wellas the mainstream society. Sable (2020) notes the ethicallaws of modernization theory: “The implications of thistheory of valuation to globalization are anchored on thenotion that the owners of capital are motivated to engage
in economic investments by some form of hedonistic
expediency.” The point is that in such an approach, thepower apparatus is meant to protect corporate profit tobenefit the rich instead of the common good. Thus,
economism creates such “an environment that would
enhance investor’s incentives” (Sable, 2020).
Gaspar (2020) has studied indigenous communities insome parts of the Philippines. The anthropologist has
challenged local scholars in Mindanao to do research inorder to understand the role of indigenous wisdom inhuman survival. While Western societies value the progressin science, it is wrong to belittle the growth of local wisdomin the various facets of life and culture. Ethnic communities
have struggled against powerful interests and abusive
authorities but still, they have survived the odds given theirwell-knit communal bond. For Gaspar (2020), the respect
for natural harmony is important. Ethnic people never get
more than what they need from nature. This has enabled
them to live well, although it is undeniable that powerfulpeople continue to displace and threaten their peaceful wayof life.
In particular, Gaspar (2020) has exposed how extractive
industries like mining and logging affect local ethnic groups.
The oppression experienced by marginalized groups seems
apparent but many people in government turn a blind eye
because of money. Big corporations continue in theirdestructive ways at the expense of indigenous communities.
Even today, many ethnic groups are subjected to bias anddiscrimination. Their challenges are enormous. While thegeneral concern for public health is justi iable, the prejudiceagainst indigenous people is unacceptable. They are judged
as ignorant and ridiculed on social media. What people do
not understand is that vulnerable groups do not have thesame guarantee of legal protection compared to othercitizens. The approach of government leaders is wanting
and ethically de icient.
Ethnic communities have survived many disasters,
including man-made calamities such as military con licts
and environmental degradation caused by the blatantdisplay of power. This is due to the sense of belongingnessof ethnic people to nature. Wahl (2017) explains that“indigenous human cultures are an expression ofgenerations of co-evolution of humans within theecosystems they inhabited.” There is a bond between people
and nature. People learn to solve problems by looking into
the processes in the environment. They find ways to adapt.
We belong to the earth instead of the earth being ourpossession. Reflecting on how the coronavirus came to be is

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

like a way of looking deeper into our inner nature to realize
how we have disrupted the natural harmony in theenvironment.
The modern man must address problems with the toolsof empirical science. Lockdowns have affected the poor,
most especially in urban centers. The restrictions havecaused great disruptions to everyday life. People who
suddenly found themselves jobless realize that they can nolonger travel back to the provinces due to the lack of public
transport. In India, more than a million migrant factory
workers have to walk from the city to their home province.
Families with young children had no option but to do what
is unthinkable and that is to travel barefoot for days to a
destination as far as 400 miles. In the Philippines, access tohealthcare and other basic government services remain a
primary concern for some IP groups.
The threat from the coronavirus forces one to look into
local wisdom. For Gaspar, it matters to ask how ethnic
groups have survived for two thousand years despite all the
man-made and natural calamities in history. Human life is
not reducible to Western economic paradigms.
Modernization theory limits the way things are understood.
It reduces everything to the material meaning of humancomfort and convenience. But every progress is notnecessarily good. Gaspar (2020) underscores that “ofspecial focus in the critique of development projects is how
these have been implemented among Lumad [ethnic]
communities.”
The question we seek to address is human survival.
Indigenous groups have been subjected to centuries ofdomination and abuse. However, they have fought for thesurvival of their own way of life. The secret to this is theirability to blend well with nature. Indeed, ethnic groups havebeen displaced because of the construction of dams thatthreaten to inundate their villages. They have been forced toresettle to faraway places that are unfamiliar to them. But
the modern man has more problems than indigenous
peoples. It is in this regard that there is an interest to look
into the latter’s way of life and culture to determine how
they have managed the environment and maintained its
delicate balance although Wahl (2017) thinks that “to reevaluate the wisdom of traditional and indigenous cultures
does not mean returning to some supposed golden age whenhumanity lived in perfect harmony with the rest of nature.”

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Human solidarity in the midst of COVID-19
This pandemic has revealed something complex. It de ies
any ideological abstraction. As governments grapple withthe hard facts on the rising tide in the number of infections,many hands are tied as people realize that disciplinary
measures used to contain the virus run counter to ourfundamental understanding of freedom. In a post-pandemic
world, identity politics will have a prominent role in themanner by which societies relate to each other. The key
point here is the spirit of openness to the identity of othercultures. This is what the idea of difference politics is allabout.

In the West, people generally do not want to get
infected, but they also do not want their basic freedoms
curtailed. The most important humanist value is liberty.
This liberty is the essence of man. Being human means
being an independent subject. This subject is to be de inedby its own interests (Rawls, 1999). The human subject
desires those things that are to his own bene it. Humansurvival implies that man must depend on his natural
instinct. Survival is rooted in the preservation of human
freedom. But liberty comes as secondary in the East where
society prefers to give more importance to the family,
nation, and the meaning of the common good. Hence, in the
con lict between liberty and the good of the society, thelatter prevails.
Research studies with respect to communal approaches
have been done by Bayod (2020), Arambala (2020), andYoshizawa (2020). Bayod documented coping mechanisms
among the people in Davao del Sur during the pandemic,
including the activities of teachers and tribal peoples alikein the Southern Region of Mindanao. Meanwhile, Arambala
investigated the strict lockdown policies implemented by
the local government of Ozamiz in Northern Mindanao.
Yoshizawa, in comparison, re lected on her experience in
Bohol, an island province in the Visayas, as people
underwent lockdowns imposed by the authorities. The
reports show the de icits of state-centric approaches to the
problem of public health.
Some localities in the Philippines have emerged out of
the infection. This can be attributed not only to effective
control mechanisms but strong leadership as well as public
cooperation. The solidarity of local folks matters. Even
without the presence of modern IT technology, some places
have overcome COVID-19 due to the strong commitment ofpeople. In Baguio City, contact tracing has been effective sothat other LGUs want to replicate the strategy of the former.
Outside, South Korea, Thailand, and Vietnam have been
widely praised for their effective measures in containing the
SARS-coV-2 infections. Oriental societies, it can be argued,
have emphasized the importance of solidarity more than
individual leadership. Western societies emphasize thelatter.
A irm theoretical explanation is necessary when it
comes to strategies. Survival is a human instinct. But left tohis own elements, a poor man would not have the means to
overcome the effects of a pandemic. He needs the support ofthe community. Local wisdom and values save people better
than universal maxims. Indigenous wisdom instead ofWestern ideals give people the right strategy forward.
Gaspar (2020) shows how privileging one culture overanother is problematic. It is unacceptable because we needto equalize not the situations of people but their sense of
self-worth. The idea of justice has a communal context. A
person’s sense of civic duty is preceded by that sincerecommitment to a transcendental ideal.
Still, the coronavirus vaccine carries with it concerns
about justice. Rorty (1989) explains what is presupposed in
the communal approach and says that solidarity can only
begin by means of discussion and not on the basis of a

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

universal foundation. He rejects the representation theoryof truth. The truth in this mirror image is nothing but a
reproduction of certain norms. For instance, individualism
is founded in the Western way of life. But to some cultures,such a way of doing things is a detachment from thecommunity. Therefore, the West cannot impose its own
version of freedom because doing so contradicts what itmeans to be unique as a person, with a family background,
history, and tradition. This is what a sense of communal
belongingness means.
In the end, a post-pandemic world cannot be controlled
by a singular principle of action. In a world in which culturaldialogue is lourishing, people will value each other on thebasis of their unique identities. Life is beyond the binary
con iguration of black and white. This means accepting
others despite their differences. What the pandemic makes
manifest is that the human ego cannot be in control. The
emphasis on individual achievement or bene it must be set
aside when the good of community is at stake. The prime
interest cannot be pro it or money. Human life is what truly
matters when it comes to the common good.

Conclusion
The pandemic has made man realize certain things. It
reveals that the capital-driven world in which we live isunsustainable in the long run. Capitalism has created great
wealth for Western societies, but its demise is a result of its
internal contradiction. The modern ways of humans have
hastened the spread of the virus and impliedly, the demiseof an “old way of life”. The coronavirus shows the internal
weaknesses even of powerful states. Now, capitalism cannot
save man. The business-as-usual attitude of society mustcome to an end. Indigenous wisdom can help people
understand what this pandemic is about. This unfolding in
the history of humankind is a reminder from nature.
Indigenous peoples have learned how to adapt well with theenvironment. The way of life of IPs can teach people how toblend with nature and not disrupt the symbiotic
relationship between human beings and nature itself. The
indigenous way of life is a re lection as well as a critique inthe manner by which the modern man has lived in theplanet. In this respect, indigenous wisdom is a source ofhope as we try to overcome COVID-19. People can draw andlearn from other cultures those ways that have allowed
ethnic groups to live in harmony with nature. This return tothe natural ways of doing things can help humans overcome
the paralysis brought about by this pandemic. Ourdevelopment paradigm should focus on communal rather
than economic progress.
References

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Arambala, G. 2020. “Ozamiz Politics in the Time of COVID-19
Pandemic.” Eubios Journal of Asian and International Bioethics
30(4):191-195.
Bayod, R. 2020. “Ethics of Care and Philippine Politics during the
COVID-19 Outbreak.” Eubios Journal of Asian and International
Bioethics 30(3): 69-75.

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Fukuyama, F. 1992. The End of History and the Last Man. New York:
Avon Books.
Gaspar, K. 2020. “Extractive Industries.” In Ethics in Contemporary
Philippine Society. Edited by CRB Maboloc. Davao City: SMKC
Publishing.
Huntington, S. 1996. The Clash of Civilizations and the Remaking ofWorld Order. New York: Touchstone.
Kolbert, E. 2020. “Pandemics and the Shape of Human History.” The
New Yorker. https://www.newyorker.com/magazine/
2020/04/06/pandemics-and-the-shape-of-human-history
Kymlicka, W. 2007. Contemporary Political Philosophy. Second
Edition. Oxford: Oxford University Press.
Mansueto, M. 2020. “Enrique Dussel’s Philosophy of Liberation:
Philosophical Re lections at the Time of the COVID-19
Pandemic.” Social Ethics Society Journal of Applied Philosophy,
6(2): 173-208.
Nayeri, K. 2020, March 27. “The Coronavirus as the crisis ofcivilization.” Resilience. At: https://www.resilience.org/ stories/
2020-03-27/the-coronavirus-pandemic-as-the-crisis-ofcivilization/
Rawls, J. 1999. A Theory of Justice. Revised Edition. Cambridge, MA:
Harvard University Press.
Rorty, R. 1989. Contingency, Irony and Solidarity. Cambridge:
Cambridge University Press.
Sable, S. 2020. “The Ethical Flaws of Globalization.” In Ethics inContemporary Philippine Society. Edited by CRB Maboloc. Davao
City: SMKC Publishing.
Stiglitz, J. 2015. The Great Divide. New York: Norton and Company.
Tanabe, J. 2020. “Exploring a Post-Covid 19 Sustainable Peace
Model.” Social Ethics Society Journal of Applied Philosophy, 6 (2):73-103.
Walh, D. 2017. “Valuing traditional ecological knowledge andtraditional wisdom.” Medium:https://medium.com/age-ofawareness/valuing-traditional-ecological-knowledge-andindigenous-wisdom-d26ebdd9e141
Yoshizawa, A. 2020. “Making the Island a Fortress: Government’s
Measures and People’s Mentality against COVID-19 in Bohol.”Social Ethics Society Journal of Applied Philosophy, 6(2):333-358.

Children of COVID? The educational
consequences of the epidemic on
the new generations- Raffaele Mantegazza, Ph.D.
University of Milan-Bicocca, Italy
Email: raffaele.mantegazza@unimib.it
Someone already calls them the COVID generation, with ajournalistic simpli ication that does not lack a certain
effectiveness. They are the boys and girls who have gone
through this emergency, the irst generation after theSecond World War that has had to face the planetaryconsequences of a completely unexpected and particularly
violent event; what will become of them? And above all,what can we do for them and with them?
It seems to me that the emphasis on resilient children
and adolescents is very hypocritical; we don't have to worry
they are resilient; the youth will help them; they will come

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out sooner and better than us. There is no doubt thatchildhood and adolescence have great adaptability andresponsiveness to critical situations, but these skills must be
cultivated and supported by adults. Sometimes it seems tome that insisting on this dimension of self-regulation ofchildren means abandoning the adult role, saying that
ultimately children will do it alone and not thinking of
having to be questioned as role models. Children andadolescents only grow up within an adult project, whether
explicit or implicit, democratic or totalitarian. No child
grows up if there is no group of adults investing in him/her;and when you believe that childhood or adolescence is likechickenpox or childhood diseases, something to go throughby trusting some kind of natural development, in reality you
are leaving children and young people alone within theideology of the market and competition. If not, worse,
victims of violent and criminal projects.
The irst point is the relationship that these children will
have with their parents; especially for teenagers, staying at
home for months meant breaking that path of emancipationthat involves distance from home, through school or
through peer groups. Having spent so much time underparental gaze may have somehow meant a regression;
however, it has involved a number of problems related tothe process of growth and differentiation. For some time in
Italy there has been discussion about the excessive
attachment of children to families, also linked to theeconomic dif iculties for a young person in making his own
life project. These months lived side by side with parents
and siblings will have to be overcome through new forms ofdetachment and autonomy
Another important issue is that of intimacy. For many
young people it was dif icult to ind spaces of privacy within
the family universe. Just staying at home alone for an entire
afternoon when parents are at work for a boy or a girl is afundamental experience to take possession of the spaces of
the house and to experience one's own growth andautonomy in solitude. Especially for boys and girls who have
many brothers and sisters, the lockdown means forcibly
sharing many spaces, even private ones, and having
enormous dif iculty in obtaining their own personal space.
perhaps the difference between solidarity and isolation is in
the fact that the former is sought after and is the irst sourceof the ability to feel good with others while the latter is
imposed and risks locking the subject in a dead-end prison.
Have the young people experienced loneliness, isolation or
abandonment in these recent months?
Obviously, the fundamental theme is that of theresumption of socialization. School will be the irst area inwhich these children will have to learn again to be together,
to work together, to confront each other. In recent months,
many teenagers have experienced the phenomenon calledhikikomori, considered a form of pathology that a young
person or a teenager closes himself in his room for months
without ever leaving and without keeping any contact withthe world except through the web. All this has become
almost the norm for these young people; and especially inactivities outside the school, such as sport, it was impossible

for them to live those moments of confrontation with others
both physical and psychological which is why they are so
important for the growth of any young person.
The two aspects we have discussed so far areintertwined in what is perhaps the fundamental
characteristic of adolescents, namely the relationshipbetween the need for intimacy and the need forsocialization, a relationship that has been upset andrede ined by the pandemic. Paradoxically, the boys wereforced to remain alone when they wanted to be with others
and at the same time, they could not experience a true andprofound solitude, the one they seek in normal situations.
We do not yet know how this will affect their growth andthe work of elaborating their adolescence, but certainly thetheme of the relationship between loneliness andsocialization will have to be at the center of educational
practices, especially for the attention of adults
But perhaps the fundamental change, the aspect thatmust be placed at the center of the attention of research andeducational practices, concerns the theme of fear. Fear has
dominated these months; it has not always been processedin the correct way; the world of information has often fed itrather than teaching how to tolerate it; someone denying
the coronavirus tried to walk away from it as if fear did notexist. Especially the kids were afraid, and this risked
compromising that attitude of trust and openness towards
the world which according to psychology, from Erikson
onwards, is fundamental for this age of life. A great balance
will be needed to help these children to recover the sense oftrust, even physical, in other people. In any case theemergency should remind us of our fragility and our
exposure to evil and above all our non-immortality and noninvulnerability.
Unfortunately, one of the problems that add to thealready tragic experience of children is the insensitivity ofmany adults and unfortunately also of some teachers. It
almost seems as if the boys are not having a uniqueexperience in history, which affects them more than others
and which will affect their lives. A subtle form of denial
leads too many adults to fail to realize that children who
have been denied the right to school, the right to play, theright to socialize and the right to the outdoors will needhelp and guidance; and above all their sufferings must be
understood and not underestimated in a hypocritical way.
The emergency should have taught us that theeducational relationship is essential precisely at the
moment when everything seems to be questioned.
Education is an attempt to give meaning to what happens,or rather to ind it together with our pupils; it answers
questions of meaning without which you cannot grow up;
you do not insert an event in a biography. From this point ofview, it is truly irreplaceable because it goes alongsideconcrete material needs and forms the basis for theconstruction of an individual and collective identity.
Investing in education does not only mean preventing
future damage, which would already be an importantreason for making education one of the irst points of anysocial and political project; but in reality, education isEubios Journal of Asian and International Bioethics 31(2) (February 2021)

resistance in itself, the educational relationship that is kept
alive during emergencies is already the sign of the humanthat does not allow itself to be crushed by tragedies

A case study of teaching ethicalvalues to STEM disciplines in
Malaysia: Why silence and mindfulpedagogical practices matter- Suma Parahakaran, PhD
American University of Sovereign Nations; Malaysia
Email: sumjayan@gmail.com (Corresponding author)- Ng Khar Thoe, Ph.D.
RECSAM, Penang, Malaysia
nktrecsam@gmail.com- Ooi Li Hsien
Wawasan Open University
lhooi@wou.edu.my- Suja Premchandran
Senior Lecturer, DRB- HICOM University of Automotive
Malaysia
suja@dhu.edu.my

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Abstract
Science, Technology, Engineering and Mathematics (STEM)
in universities and schools require integrating knowledge
with experiential learning and analyzing the role of humanvalues in real life situations. Graduates of engineering,mathematics, biotechnology, agricultural engineering,
environmental technology, synthetic technology, andbioengineering will play a major role and contribute tohuman capital in the future. The integration of ethics andsustainable behavior has a prominent position in education.
The teaching pedagogies that re lect on sustainable
practices are limited. There is an urgent need to explore
teaching pedagogies and ways of prompting students tothink over sustainable ways because of the problems
addressed by the United Nations and the sustainable goals,
2030.
This study, in a workshop in Penang Malaysia, exploredwhether the Southeast Asian participants’ capacities related
to the integration of ethics and values into topics related to
STEM could yield results for sustainable development. The
methodology used was analytic inquiry and problem solving
coupled with inductive analysis.
The small sample involved in this case study revealed
that there was a signi icant scope for students from schools
and universities to gain re lective, contemplative andmindful capacities to explore sustainable practices. The
outcomes from Phase 1, Phase 2 and Phase 3 during theworkshop touched on health and well-being, core values,sustainable behavior patterns, human-environment
connections, social justice and equity issues. Results
revealed that pedagogical considerations are important to67

facilitate teaching of ethics and values both for micro andmacro-objectives of sustainable development. The indings
revealed that Kolb’s model for Science and Technology at
the re lective stage plays a crucial role in the integration of
ethics and values. It is at this stage that pedagogicalconsiderations may help elicit new ways for sustainablebehaviors and thoughts.

Introduction
The world is becoming a smaller place with internet
systems and this will require people from diverse
backgrounds to have a dialogue on the common ethicalthreads underlying different worldviews (Rai Singh et al.,2010). The Ministry of Higher Education of Malaysia hascreated a blueprint to embark on Education 4.0 for future
students’ working life (My HE 4.0). Education comprises oftailor-made courses that require constant reassessment tosuit the needs of the industry. Hence this requires teachers
to have continuous professional development so that they
can deliver the teaching and learning aspects in Education
4.0. The learning environment is created in a learningorganization with enhanced student learning outcomesthrough professional development (Darling-Hammond,
Hyler and Gardner, 2017).
Student learning is a signi icant aspect of Education 4.0
as most organizations have indicated that the future jobs at
all levels will require more skills, education, and complex
problem-solving ability. Furthermore, many employers haveidenti ied that the youth lack soft skills such ascommunication, courtesy, integrity, interpersonal skills,
positive attitude and work ethics (Robles, 2012).
The recent trend in the rise of applications ofbiotechnology, agricultural engineering, machine-learning,
and industrial technology calls for intense pedagogicalapproaches that address issues related to ethics, social
justice, and urbanization. In the USA nearly 80% ofengineering graduates do not have to take ethics related
courses. The missing element in the engineering content is
on ethics which focuses on individual professional
responsibility (micro-ethical issues) while there are macroethical issues related to development of technology(Herkert, 2010).
In September 2015, the General Assembly adopted the2030 Agenda for Sustainable Development which includes
17 sustainable goals (SDGs) (United Nations General
Assembly, 2015). According to the UNESCO (2019) theconcept of sustainable development was described as
development which supports the needs of the present andyet does not compromise the ability of future generations tohave their needs met. The sustenance of the future
generations depend on how much transformational
thinking will be integrated to balance the cause and effect ofhuman actions whether it is large data, or arti icial
intelligence for decision making. Sustainable development
and discussions in environmental education have become
more important than ever (Rull, 2014; Tilbury, 1995).

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

Contemplative methods for initiating discussion basedon ethical values
Individual ethics
There are limited science programs that teach how scienceis linked to the issues that are relevant to students’ lives,
environment and role as a citizen. This detaches students
from discussions on real life and technological applications(Hofstein, Eilks and Bybee, 2011). If educators use acomprehensive pedagogical approach using contemplative
approaches in discussion, it allows all members concerned
to integrate sustainability issues within the learning
context. Contemplative education involves a set of
pedagogies which can cultivate conscious awareness andmoral living and caring for others. In all contemplativeeducation, re lective practices support student thinking in
new ways which enable them to change their patterns of
thinking and behavior and adopt practices aligned with theconcept of sustainability.
As students integrate course content and ask essential
questions related to ethical values in their projects, they
begin to develop a positive sense of pro-social behavior(Herman, Zeidler and Newton, 2018). STEM education
requires students to “… accomplish complex tasks such as
brain implants, reducing carbon emissions, developing moreenergy ef icient trains, cars and planes, and making use ofsolar energy, it will be necessary for individuals not only tohave a deep usable knowledge in one ield, supporting theacquisition of a profound, more useable knowledge, but also
knowledge in other ields, so that collaborations to solvepressing complex problems can occur. Individuals will alsoneed the creativity to imagine new possibilities and tosynthesize ideas. They will also need to know how tocollaborate with individuals who have different expertise”(Krajcik and Delen, 2017, pp. 37-38).
These issues are important to address in education evenat primary levels.

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Professional ethics integrated studies for sustainable
development
Reviewing several studies on research and practice,
Wamsler et al. (2018) stated that a trend in 2015 revealed
an increase in contemplative teaching and practice within
the context of sustainability studies. There were limited
studies related to risk reduction education andcontemplative methods for climate change adaptation(Wamsler et al., 2018). Wamsler et al. (2018) identi ied
signi icant key aspects relevant to mindful inquiry
supporting their practical implementation in education andsustainability issues. They were: (1) subjective well-being;(2) activation of intrinsic/non-materialistic core values; (3)consumption and sustainable behavior; (4) the humannature connection; (5) equity issues; and (6) social activism.
Mindfulness and deep re lective capacities allow learners to
relax and provide space for further evaluation of how
humans can improve the context. Researchers stated that
mindful practices can change previously rooted
unconscious thinking, increase awareness and enhance therole of non-material values in people (Stanszus et al., 2017).

Teaching of science, technology, engineering andmathematics requires complex, higher thinking skills.
Teaching of sustainable development encompasses
divergent thinking as well as thinking processes which canbe channeled to new ideas with a lot of systems coming
together if teaching for affective dimension is incorporated.
Teaching practices for STEM currently are not taught in amore integrated way using real world contexts and this is ahuge gap. This lies in how the curriculum is designed for
STEM education (National Academies Press, 2014). The
values today “still center on growth and rely on technology
to mitigate environmental stress, depletion of natural
resources, and loss of biodiversity” (Martin, Maris andSimberloff, 2017, p. 6105). Hensley asserted that infusing
mindfulness in higher education will help promote transdisciplinary enquiry as well as transformational thinking of
our role in this planet through re lection, innovation andintegration (Hensley, 2019). Any thinking process which
involves unconventional processes will contribute to wider
alternative solutions as opposed to convergent thinking
which involves learning thought processes for a single
correct solution (Hensley, 2019).
Pedagogical considerations in the curriculum forteaching ethical values
Does the curriculum content enable student re lection? Do
teachers know how to strategize their teaching fordeveloping awareness in students on how to apply ethics toissues in real life contexts and to develop civic
consciousness in their own societies? Can results of suchlearning enter the didactic engagement between themembers involved in STEM education? Are teachers able tofacilitate such learning using their re lective capacities for
integrating ethics and values into STEM education? The
United Nations (UN) addresses several of these questions
when discussing the issues surrounding sustainability,
speci ically with clean drinking water:
The combined effect in a business-as-usual scenario might
have outstanding effects over the environment and will put at
risk maintaining the economic and social advances obtained:
to feed the world in 2050, food production may need to growby 70% which may require 50% more water but by 2025 twoin every three countries will be water stressed and 2.4 billion
people will face “absolute water scarcity” (United Nations,2014, p. 1).
In dealing with issues such as climate change,
mindfulness, and re lective inquiry, learning can lead todeliberate, lexible and adaptive responses to climatechange (Barrett et al., 2016). Being mindful helps toincrease awareness through attention, and openness to
expand individual thinking by being more lexible leading topositive behavior change (Barrett et al., 2016). A review of
research has shown that mindfulness contributes to wellbeing, empathy, compassion and helps with recognition ofboth goals and values. Other research has shown that
mindfulness can help in self-regulating behaviors (Ericson,
Kjønstad and Barstad, 2014). The use of the term
contemplation, re lection and mindful practices forEubios Journal of Asian and International Bioethics 31(2) (February 2021)

sustainability is therefore refer to deep learning which
involves understanding the context and questioning bothethical and practical issues at hand. A deep inquiry isnecessary because universal ethics suggests respect forevery human life. There are instances where the bene it of
one is taken for granted and causes harm to another, an
example being the dumping of hazardous materials indeveloping countries by industrialized nations (Macer,1998).

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Learning models for ethics and human values for
STEM education
Kolb (1984) asserted that the views of John Dewey’s modelof the learning process and that of the Lewenian model
were similar, in that impulses, feelings and desires ofconcrete experiences are transformed into higher
purposeful action. Experiential learning theory has to bedifferentiated from rationalist and cognitive theories oflearning as the latter focus on acquiring knowledge,
manipulating knowledge and recalling of abstract symbols.
Experiential learning is also different from behaviorist
theories of learning because these theories do not include
the role of consciousness and the subjective experience insuch learning (Kolb, 1984).
Experiential learning, according to Kolb, depends on the
direct concrete experiences an individual has at thatmoment. The learner is in a continuous process of learning,
forming new concepts from past experiences and themodi ication of previous knowledge (Kolb, 1984). Fourlearning abilities are important for experiential learningwhich are concrete experience abilities, re lective
observation abilities, abstract conceptualization abilities
and active experimentation. All four abilities must actively
construct knowledge to enable effective learning (Kolb,
1984). It is at the re lective observational stage thatstudents can discuss the integration of ethics and values forwhy, how and what purpose the technology is implemented.
STEM education should be coupled with the knowledgeof bioethics. Tampering with nature without limits canimpact many life forms. ‘The origins of our sel ishness andaltruistic (giving) behavior are fundamental to how webehave’ (Macer, 1998, p. 94). Macer (1998) stated that
although people claim that science is neutral, it does nottake away the fact that they are still responsible for
producing knowledge as they are in fact moral agentsthemselves as are all human beings.
Education in human values is signi icant in teaching
students about peaceful negotiation and cooperation. The
facilitation of values such as social justice, compassion andteamwork stimulate quick progress in participant learningand re lective capacities for the society as a whole. The
component of knowledge that stimulates transformation
can be activated with re lective practice because
sustainability is a lived experience according to researchers(Tilley et al., n.d.). From researchers’ perspective it isimportant that those involved in discussion aboutsustainability issues go through a process of re lective

69

thinking. Firstly, they record events and facts. Here thelearners re lect on what happens around them. At the nextlevel the learner is exploring greater awareness of what ishappening around them and within them. This is arecording of dialogue and non-verbal cues which include
affective responses. The third stage is the recording of
responses from the discussion which include
transformation. Here the learner will explore attitudinal or
behavioral changes in themselves or others. Re lection helps
expand a student’s understanding of knowledge beyond
what they are taught.
The key point to remember is that although much of thisthinking and activity around re lection stems from academia
this does not need to be academic thinking, it needs to be
more than theoretical or hypothetical. What makes re lection
on practice such a powerful tool is the combination of more
scholarly theorized thinking with practitioner’s real-world
experiences and learning (Helyer, 2015, p. 17).
At the stage of experiential learning stage, students canobserve and re lect on the situation and context. The low of
consciousness which involves perceptions, experiences andthe inner dialogue related to the ethical aspects forprotecting and managing the environment are directly
related to the stage of experiential learning.
“When humans are able to relate to a subject, they create
a bond, and that bond makes the concept stay in ourmemory longer. The connection between emotions andlearning is signi icant and generates deeper memories”(Rogers, 2015, p. 11).

Integration of ethical values based on inquiry into
daily school curricula for STEM education
Students may ask the following questions when designing
the machinery:
1. What are the ethical issues that arise related to theproject?
2. What is the issue being addressed in my country and in
my local areas? Is this the best solution for the problem
based on ecological and economical limitations?
3. What are the raw materials needed to build thismachine?
4. Are the raw materials readily available and are thematerial sources sustainable?
5. Can we afford to purchase the materials required tobuild this machine?
6. What is the expense of maintaining the machine?
7. Do people lose their jobs once this machine is madeactive or will the machine create new jobs?
8. How many people will be affected by the change inquality of life triggered by the machine?
9. What happens when we want to decommission themachine?
10. Are there non-degradable or non-recyclable parts?
Integrating ethical values in the discussion can help withre lective thinking about purposeful STEM projects. STEM
education must integrate discriminatory knowledge inEubios Journal of Asian and International Bioethics 31(2) (February 2021)

teaching, re lecting on the bene its for the largest number ofpeople and preserving biodiversity and balance of nature.
Discriminatory knowledge for STEM education can bede ined as the knowledge that takes into consideration thecomplexities of societies and the implementation of STEM
for the bene it of most people in society (Parahakaran, Ng
and Sean, 2017).
The process of critical enquiry prompts people toexplore the consequences of sustainability. This involves
multifaceted areas such as economic, political, social,
cultural, technological, and environmental forces that
nurture or regress sustainable development. People will beable to question about common resources and issues
related to both international and intergeneration equity
Fien and Tilbury, 2002).

Case study of teachers, educators, curriculum
developers working on STEM projectAn exploratory study was conducted with adults in aworkshop where eighteen teachers were involved in values
and ethics integrated STEM learning after a conference in2018. The workshop was to explore whether participants
could go through the process of re lection and work
together to think about sustainable issues in the future.
Methodology
The workshop was conducted in three phases and included
teachers from Brunei, Indonesia, and Malaysia. Phase 1
focused on orienting participants to the de Bono six
thinking hats. During phase 2 the participants were asked touse de Bono’s six hats while contemplating how to increase
the sustainability of STEM programs that integrate ethics
and values related to the issue at hand. Finally, during phase3, participants presented their conclusions from phase 2.
Edward de Bono’s six thinking hats align thought processes
from the affective and cognitive domains for group thinking.
The white hat helps in collecting information on thoughtprocess relating to: What information is presently known
about the issue; what does it convey? What is theinformation that is lacking? What information is needed andhow to get the information? The red hat processes thoughts
related to feelings, intuitions, and emotions while the black
hat retrieves information on what one has to be cautious
about, criticisms and assessing the risk of the action. The
yellow hat helps in thought processes relating to bene its
and feasibility of the idea while the green hat helps inretrieving information for creativity, new ideas, andpossibilities. The blue hat helps the facilitator to make adecision on the whole topic and issues concerned with it(Mathews, n.d).

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Sample: A workshop was conducted in RECSAM, Penang,
Malaysia with a sample consisting of eighteen adults who
were divided into three groups. Eighteen participants
inclusive of educators, curriculum developers, and policy
makers from Brunei, Malaysia, Indonesia were present at
this workshop.

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For Phase 1, de Bono’s thinking hats was introduced
using an example. The sample of teachers, educators andeducation of icials at the beginning were unsure of how toproceed with the de Bono thinking hats as tools. With
instruction and some prompting they were able to integrate
this method into their re lective process. The participants
were unsure of what values or ethics meant in relation to
STEM. One of the participants stated that values are “caught
and not taught.” The facilitator had to inform them thatvalues and ethics in STEM can be facilitated in two ways.
The irst is through values which are caught from people
around us and the second method was to facilitate
discussion on ethical and human values with regards toissues in their own learning contexts. An example wasprovided using Edward de Bono’s thinking hats.
Bono’s thinking hats principle and the task provided
were discussed on a white board. After producing an initial
draft, they started working together on other topics. At theend of the presentation, it was evident that the participants
could implement re lective practices using enquiry as astarting point.
Phase 1, pre-re lection phase: Participants understood theconcept of how to integrate values and ethics with an
example the facilitator provided. Participants were asked tore lect on any topic they found interesting. The facilitator
informed participants to select a topic of their choice.
However, a simple topic was introduced to the participants
and they were asked to use the de Bono principles. deBono’s six thinking hats is a system formulated by Edward
de Bono. The participants’ responses were limited in theirst phase. However, when they were appointed to theirown groups and asked to initiate the topics the participants
found it dif icult to do. A strategy had to be provided toinitiate re lection. Edward De Bono’s six thinking hats wasfound to help start the process and hence the concept was
introduced to guide the questioning process.
Phase 2 re lective, contemplative and mindful phase
In phase 2, participants applied the inquiry-based thinking
model using de Bono’s thinking hats to explore the chosencontext. In the second attempt the participants in one of thegroups who were curriculum developers and head ofeducation units, decided to plan a sustainability course after
they implemented a round of discussion on de Bono’s six
thinking principles. All the groups then discussed to con irm
a topic so that they could use de Bono’s thinking hats to
explore the use of each question. All three phases tookapproximately an hour and ifteen minutes to complete,with the re lection process taking the bulk of that time.
During phase 3 participants presented their output of the
discussions.
Output of the workshop for all three groups
The images are the outputs within forty- ive minutes after a
discussion from a workshop conducted in Penang, Malaysia
in 2017 for adults.

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

Group A: The topic under consideration was on how todesign their own solar powered F1 car (Figure 1)
Figure 1: Group A- Ethics and values based design of a Solar
powered car

71

ideas. They found the thinking principles a very goodstrategy to start the discussion; de Bono’s thinking hatswere applied to the project of hanging garden and bothethics and human values were integrated to explore theissues.
Figure 3:

A participant from the Philippines presented the resultsof their group discussion as: “The group thought about solar
invention and solar energy conservation. We are going to help
students learn values, from where they will get theirmaterials. What kind of materials to use? We want them toask; where do they get their materials? Do they exploit
workers? We do not want them to buy from places where they
exploit workers. We can think of patriotism. We can think ofhelping nations or Asian regions. Next is the cost of thematerials. The materials they buy should take into accountother ethical situations. This car will then have material
waste. It becomes potential hazardous material. They have tothink of solar F1 car. There can be a lot more. Learning about
values in the context of the project. This is a loop; implementdesign- fail- design – (value of perseverance).”

Group C hanging garden
The third group decided that they would organise a project
on a hanging garden and wrote: “This concept will keep
school alive as they will enjoy the environment. This projectwill be supported by the parent body and stakeholders. This
project will benefit everyone, and this was never done before.
This would be the first project in the district. We will decide
whether it would be vegetables, plants or hanging garden. We
will also participate in the school competition next year. We
found that the hanging gardens helped rescue garbage waste
and most of the hanging gardens was not only supported by the
Ministry of Education (MOE) but by the Ministry of Health andAgricultural officers. We confirmed that this will be part oftheir school project. We would plant vegetables and flowers”.

Participants also discussed online learning which
included using Edmodo platform to teach students how toshare their knowledge with all teachers in theircommunities. As observed in Fig. 3, the group participantschose to use a thought web to facilitate the generation ofTeachers had to initially differentiate between what
could be the potential bene its related to human behavior(ethics) and values (human attitudes and potential forenvironmental sustainability) within the context. The

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Blue hat: Participants responded to the irst question; aims of
the project; the stakeholders, duration, inancial aspect andresources.
Red hat: Happy to stay, alive and comfortable
Yellow: Stakeholder, Principal and Students
Green: decoration, plant vegetables, eat and sellBlack: Participants did not come out with responses due totime constraints
White: environment support, garbage, reduce wastefFigure 2 Group B- CourseforSustainable
Development. It illustrates
the re lective processes
and the concepts thatparticipants brainstormedat the initial stages for acourse on sustainable
development.

ffGroup B sustainability course
The group of curriculum developers, policy makers andeducators decided that they will plan for a sustainability
course. They used De Bono’s thinking hats to illustratedifferent topics for theircourse.

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

responses adjacent to the different colored hats correspondto the original thought processes as formulated by de Bono.

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Findings and discussion
The above case study found that this sample of teachers,
educators and education of icials were at the beginning
unsure of how to proceed. In both attempts the facilitator
noted that the participants took time to start re lections on
the topic. They found it very challenging at the beginning.
This is probably due to the fact that the opportunities todelve into deep inquiry mode from an ethical perspective
maybe missing. One of the three groups could not initiate
the topic and the facilitator explained again with examples.
Firstly, the process of brainstorming ideas for a topic tooktime. The implementation of sustainability issues was an
added factor. By the end of an hour and quarter, all thegroups had completed the process. This attempt was
successful after few rounds of prompting and challenges
faced during the initial phases. The process of re lection
took time; de Bonos thinking hats are bene icial to start agroup discussion and individual thinking (Parahakaran, etal., 2017).
Several excerpts from the participants’ presentations inGroup C follow. The group thought about solar invention
and solar energy conservation. Using Edward de Bono’s
thinking hats principles, participants highlighted the issuesof social justice (exploiting workers), buying what is locallymade (using local resources rather than importing
materials), and renewable materials. Participants started tolook at many perspectives critically and they were involved
in divergent thinking.
The researchers used inductive teaching and learning
methods to drive the intervention. The intent was to orient
participants in a way that aided them in using inquiry-basedlearning, which was made popular by Prince and Felder(2006). According to Prince and Felder, instructional
methods include project-based learning, inquiry-basedlearning and discovery learning. The idea behind using
these techniques was that participants would be provided areal-life context for learning that allows them to use the deBono thinking principles to deepen their understanding of
the information presented to them and their own discussion
points. Participants entered into complex re lective
processes that required them to retrieve memories of theirexperience of integrating EHV into STEM education.
The outcome for participants was a complex set of ideasthat addressed the topic of sustainable values teaching in
STEM. Bono’s (1985) thinking hats helped initiate there lective process that led to generation of creative ideas.
After applying the thinking hats, they moved from there lective phase to contemplative stages of thought. This is
the phase where participants could generate ideas andthoughts which were: 1) in the living context, 2) requiredmaterials, 3) ethical and values based, 4) practically appliedin schools, and 5) advantageous to society.
The different aspects mentioned by Wamsler et al.
(2018) on subjective well-being, non-materialistic values
and on consumption and sustainable behaviors were all

elicited during the discussion of ideas in all groups. They
were: 1) subjective well-being; (2) activation of (intrinsic/
non-materialistic) core values; (3) consumption andsustainable behavior; (4) the human-nature connection; (5)equity issues; and (6) social activism.
Participants from one of the groups started working on
integrating values related to equity, local demand forresources, labor issues, patriotism, and loyalty to country.
The process of critical enquiry encourages people to explore
the complexity and implications of sustainability as well as
the economic, political, social, cultural, technological andenvironmental forces that foster or impede sustainable
development. This entails involving people in questions
about the ownership of common property resources, issuesof international and intergenerational equity, investigations
into regional and national ecological footprints and, mostimportantly, engagement in debates about qualitative
versus quantitative growth (Fien and Tilbury, 2002).
The workshop helped teachers and students incorporate
values and ethics into the STEM project. Bono’s (1985)
thinking hats were useful in facilitating a rich discussion.
Incorporating these techniques into STEM education willallow students to ask deeper questions such as: who will the
project bene it or harm? What will be the impact of the
project after ive years? Will it have a negative or positive
impact on people and the environment? Can this idea be
implemented in only one context or many other places? Is it
cost effective? Professionals can increase theircompetencies if they engage in re lective practices (Leitchand Day 2001).

Limitations and recommendations
More research is needed to structure the questions
depending on the contexts involved. In this case study the
topics chosen were different and the questions of inquiry
could not be generalized for all three groups. A larger
sample can be used to explore the elicited views of learners
depending on the category or topic selected. Questioning forsustainability purposes requires deep re lective capacities
and structured questioning methods for integrating theaffective domain. Educators, Curriculum developers, andteachers may need to structure the questions from ethicalperspective to elicit more questions. The method of Bono’s
thinking hats supported the basic steps for bringing the
cognitive and affective dimensions together.
Conclusion
Adults’ re lective experiences led teachers and educators to
discuss and retrieve their past knowledge and produce
innovative ideas. If re lective processes can help learners totransform their current pattern of thinking processes andco-create new knowledge there will be a paradigm shift inlearners. Silent and mindful practices also help in shifting
attention to motivational thoughts, having deep awarenessof others pain and compassion for other people and nature.

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)
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Higher education in the Philippines
during the COVID-19 Pandemic:
Psychological risks, research
opportunities and policy
implications- Godiva Eviota, Ph.D.
Mindanao State University, the Philippines
Email: godivarivera03@gmail.com (Corresponding author)- Christopher Ryan Maboloc, Ph.D.
Ateneo de Davao University, the Philippines
Email: ryanmaboloc@gmail.com
Abstract
The COVID-19 Pandemic has presented challenges to theeducational system in the Philippines during thecoronavirus pandemic. This study will look into some
practices that have contributed to psychological risks on thepart of students, the various opportunities for improvementin terms of research on the part of learning institutions, andpolicy implications that schools must look into in terms of
the pedagogical requirements amidst a public healthemergency. It is important to do a critical assessment
insofar as some of the approaches of educational leaders
have not considered the situation of learners. Consultations
have not been truly democratic, and the real stakeholders
are disadvantaged by the absence of meaningfulinteractions. The paper will make policy recommendations
on the above concern.

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Introduction
The coronavirus pandemic presents dif icult challenges tohigher education around the world. All of the 188 nationstates affected by the virus have pursued various means tocontinue the education of students in colleges anduniversities. Online learning has become the new normal forhigher education. But this is not without its corresponding
issues. According to Sensei Adorador (2020), online
learning appears to be forced on young people in the midstof the pandemic. Speaking about the margins of society, theyoung educator mentions the dif iculty of getting internet
connectivity on the part of the poor. Writing about thepeople in the margins of Philippine society, he says that “thevulnerable in this scenario are students who belong in thelowest strata of our community” (Ibid).
Critical Pedagogy in the new normal is not about inding
comfort or convenience in the delivery of instructions. As amatter of fact, the new normal in “education is about how
people humanize the world. Policy makers miss the point
when they focus on the delivery but do not pay attention to
the substantive aspect of learning” (Maboloc, 2020a). Policy

makers and school administrators are doing what they
think is feasible amidst the present circumstances. But the
problem is deeper than expected. It is rooted in thecharacter of higher education which has been reduced intoa means to achieve productivity on the part of the citizens of
the state (Abulencia, 2015). For instance, Thompson andThompson (2018) think that “one of the hardest-hitting
impacts of poor education on communities is the failure of
having a well-educated workforce.”
What universities and colleges are faced with is called
digital transformation through information andcommunications technology (ICT). This will require“abilities to apply ICT in every sphere of life on an
incremental level, thus universities must be up to the task of
preparing potential professional to be able to facechallenges and provide solutions” (Adedoyin and Soykan,2020). The migration of courses online is a systemic
approach to address the risks to public health in view of thecoronavirus. It requires “strategic preparation, trust
establishment and thinking in processes” (Kopp et al.,2019). Schools in the Philippines have done these things ascolleges and universities seek to pursue their mission ofadvancing the cause of higher education in the midst of apandemic.
But there are fundamental issues that need to be
u n c ove re d b eyon d t he te c hn i c a l p rotoc ol s a n drequirements. These things have remained hidden since
students themselves are afraid to speak and faculty
members are hesitant or may not have the opportunity to
be able to express their sentiments. We cannot take awayfrom the commitment of institutions of higher learning tosustain their operations amidst a debilitating public healthemergency, but it is also important to realize that the new
approaches employed by school administrators will not
really change the uneven educational structures in the
country. The right way forward is to make education truly
liberating, which will require the moral courage todismantle unjust systems and policies.

Psychological risks of online learning
While the need for lockdowns is seen as a measure to
reduce the impact of COVID-19 on the population, online
learning is seen as the means to ensure the continuous
learning of students. Universities and colleges in thePhilippines have used online modules and virtual
classrooms to address the need of students. On the part ofschools, this has been seen as a temporary measure, hopingthat with the vaccines, in-person instruction will return. But
while this is so, there are other risks that educational
leaders and teachers have not really considered in this “newnormal”. A inding on the mental health of students during
the pandemic reveals “a number of academic and everyday
dif iculties and high levels of mental health distress. Highlevels of depression were associated with dif iculties infocusing on academic work” (Recojevic et al., 2020).
In state universities, the level of anxiety of students who
belong to the poor sector of society is high to the effect thata number of students have dropped out from their classes

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after they realized that a basic need like food is more urgent
than an internet connection. Many parents feel thefrustration of failing their children from school. For some,
online education is a choice that is only available to the rich.
But a Filipino psychiatrist, Dr. Joan Rifareal, attributes themental health of students during the pandemic to aninterplay of factors (Magsambol, October 22, 2020). Reports
also indicate that 44,000 college students have chosen not
to enroll during the height of the pandemic (Magsambol,
Sep 10, 2020). To faculty members of state universities who
depend on loans to sustain their needs, online learning is
nothing but an additional burden. They feel that the new
system is a way to being subjected to the autocracy of
education leaders.
Some schools think that resorting to online modules will
help solve the problem of connectivity. The main purpose ofmodular learning is to allow teachers and students tointeract at any given time. This is called asynchronous
learning. The problem, however, is that the absence of ateacher in real time means that the students do not have aguide who can explain to them the topics in every course
outline. Teachers, upon the order of administrators, merely
rely on posted videos, recorded lectures, and power-point
presentations. The problem is that students do not have thesame academic aptitude, and for this reason, there are those
who are simply left behind. Top universities have good
admission systems. Other schools do not have any. For thisreason, there is no quality assurance.
The impact of this impersonal approach is not apparent
to policy makers in the state or even to the deans and othereducational leaders inside the institution. The problem isthat one cannot educate a child by means of memos toteachers, many of whom are also in quandary due to theirinability to adapt. There is a technological gap since manyteachers belong to the generation when “chalk talk” was themain methodology of teaching. Due to the inability of thestudents to have any meaningful interaction with theteacher, who is expected to have competence on the subject
matter, anxiety grows every day on the part of the learner,
who has to deal with the lack of social interaction withclassmates or peers.
Some approaches to the above problem appear
super icial. According to Toquero (2020), “strengthening
the educational planning and health measures in theuniversity can provide the students and the rest of the
stakeholders with an opportunity to continue learning
while preventing the spread of the virus.” The problem,
however, is that the lack of any meaningful interaction whenit comes to planning and the absence of real consultations
mean that the issues are not really discussed. Students
themselves do not have the capability to ask the hardquestions to teachers because the latter might take itagainst them. While the health risk is addressed by meansof online instruction, the psychological issues are not.
Toquero (2020), nevertheless, offers recommendations
when it comes to policy. She (2020) writes: “Schools need tostrengthen their medical services and student supportff

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

75

services so that constant monitoring and implementation ofhealth practices are followed within the vicinity and beyond
the academe. Due to global trends of the pandemic, higher
education needs to prioritize academic and career
counselling, and even the medical services and programs thatshould be accessible to the students in the university and eventhrough online means.”
The suggestion of Toquero (2020) is acceptable from amacro perspective but it fails to see the anxieties of students
who are being pressured by teachers in terms ofrequirements. The problem is actually the big ego of somesenior faculty members who seek to maintain their status or
image in the minds of the learners. It is a kind of reputationthat these people have actually been protecting without due
regard for the well-being of students and its impact on their
psychological health. This pressure adds to the stress ofthese young individuals who have been cut off from theireveryday life. Education in the midst of the coronavirus
pandemic does not encourage the desire to ind what makes
us truly human. It is still an abstract notion of reality thatprioritizes technical knowledge over the value of one’s
humanness. While some scholars reduce the issue of online
learning into a “question of compatibility” between school
and work, the point is that human attitude must be factored
in as a part of this complex issue and concern.

Opportunities for research in higher education
Higher education in the Philippines has many problems.
Except for a few schools, a large number of institutions in
the country are not that developed in terms of a research
culture. The pandemic should have allowed faculty
members of colleges to develop their craft or improve theirresearch capabilities or even writing skills, but the problem
is that school administrators have bombarded them withvarious things, including learning how to make modules oreven attend to matters that are supposed to be technical,
including the enrolment of students in the modules. The
modules do not educate a person – it is the teacher. The
problem, however, is not just technical. It is a matter ofculture. The culture is not ideal for higher order thinking.
This culture is toxic. Constantino (1966) blames it on the
country’s colonial experience. The hierarchies in schools
allow senior mentors to throw their weight on youngteachers. Schools belonging to an elite group also
undermine the graduate student who comes from theprovince. This type of elitism destroys the nature andcharacter of education in the country (Maboloc, 2020b). But
this unjust system is perpetuated because the wholecolonial educational system unfairly treats provincial
schools. In this way, what exists is a problem of prejudice.
The only way to overcome such prejudice is to recognize thecapacity of each person and give them the opportunity tolourish and develop (Nussbaum, 2006; Maboloc, 2007).
For instance, an imaginary line exists between some
af luent schools and their provincial counterparts. This
problem cannot be addressed since prominent professors
from top universities pride themselves in their

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

achievements. In the case of the Philippines, it can beargued that the teachers and researchers from provincial
schools have the ability to excel in research, too. The reason
has nothing to do with capability. The elitist nature ofhigher education in the Philippines prevents many graduate
students from achievements in the ield of research andpublication. While this is like writing something in boldstrokes, it can be said that improving the research culture in
the Philippine educational system is possible if we
recognize the talents of individuals.
The reality on the ground is less than ideal. The top
schools in the capital are favored by big employers,
including NGOs that advocate social justice and equality.
Unless Philippine society itself reverses this unacceptablesituation, the problems of the higher education system inthe country will linger on for decades. Instead of equalizing
the situations of Filipinos, online learning will only bene it
the rich and undermine the situation of the poor. Adorador(2020) is right in saying that some people in management
positions in schools “leave their colleagues behind. They are
motivated by their agenda, such as social and inancial
success. Thus, everything falls apart.”
It may be objectionable to say that “their superiors force
college teachers to submit the requirements and dismiss
dialogues between the administrators and the faculty”(Ibid.). Still, the truth of the matter is that consultations
assume a semblance of democracy, but in reality, people
who are in powerful positions have already made decisions.
Meetings in this way are just a matter of informing people.
Education in the country is simply a microcosm of therealities in Philippine society. Even top professors forget
about the need to care for their students and instead choose
to pressure them by throwing their weight on powerless
young human beings who are still groping to ind themeaning of life.
The right strategy is to see the pandemic as anopportunity to change the school system in the country. Ifschools are concerned about the access of students to theinternet, then the proper way of looking at this problem is
to give parents some breathing space in terms of theireducational expenses. If schools ind it painful to subsidize
the cost of internet connection of the students, they caninstead lower tuition fees or remove some school fees since
they are not actually utilizing physical facilities. There aresavings in electricity, water, and manpower as some staff aretold to work from home or altogether dismissed from work
since most campuses have been deserted; these can be used
to provide scholarship funds to poor students.

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Academic freedom and policy recommendations
The principle of academic freedom means that a teacher has
the right to pursue an inquiry concerning human knowledge
based on his professional competence and academic
background. The teacher has every right to develop theacademic content of the course that he is handling without
the control and domination by school administrators.
Academic freedom is meant to promote the freedom ofthought. A teacher must not be afraid to pursue knowledge.

Trust and professionalism are important. The school cannot
impose on teachers a policy that is inimical to theconstitutional “freedom of expression”. The school must
provide a democratic space and must empower teachers to
express themselves in the best way they see it as long as no
public morals or policy is being violated. A teacher must beallowed to speak the truth without the fear of repression.
Higher education in the new normal should be studentcentered, on the part of the teacher and student relation,and teacher-centered, on the part of the teacher and school
relation. What is the meaning of this? On the irst matter,
students should not be burdened by the pressure of thepersonalities that they have to deal with online. By
implication, they must see education as an exercise ofhuman freedom rather than an experience of being
manipulated by an adult who can use grades as a way toinstill fear in the minds of the learners. On the second
matter, teachers must be allowed to exercise their autonomy
in terms of how they deem it best to deliver the content of
the lessons online. The school must not be an impedimentin the desire of a teacher to bring out the best in his or her
students through a pedagogical method that promotes
rather human freedom. We recommend the following:
1. Synchronous and asynchronous methods must be
used. For example, platforms such as Google Classroom,
Zoom, Google Meet, and Moodle learning system can be
employed, but the school should never tell a teacher to limit
or just focus on one platform as this will preclude the abilityof the teacher to navigate the dif icult learning environment
during the pandemic. The idea is all about adaptability.
Teachers have different sets of skill and competencies. A
school may undercut the ability and put to waste the talentof a young teacher and the experience and mature judgmentof a senior faculty when it comes to the learning of students.
2. In the making of the “new normal syllabus”, thedisposition must observe a democratic-participative
approach. If the old way requires that terms in the syllabus
must solely come from a single author, that is, the teacher,this pandemic is the best time for students to open up theirviews, their feelings, and their projected actions on thepossibility of achieving the learning outcomes. The learning
outcomes are results of a process. They are a product ofconcerted efforts where the essentials of learning must be
made explicit. The unusual dif icult situation nowadays
needs teachers to be lexible and open to change, including
learning ICT.
3. Requirements and school assignments should be
limited. While board exam courses need some form of
mastery, rigid practice and serious reading, the teacher canrequire the students to submit a comprehensive paper thatsynthesizes the knowledge of the latter. When it comes toactual exams, they may be postponed to a later date after
the pandemic, but the student can still have an overall viewof the scope of knowledge and skill that a course may
require through essay type exams or problem-solving
exercises that do not put pressure on a student struggling
amidst the psychological effect and socioeconomic impact ofa public health emergency. Impliedly, the real purpose ofEubios Journal of Asian and International Bioethics 31(2) (February 2021)

learning is ultimately anchored to human values. There is
no better way to express this than in caring for the wellbeing of a young individual who can draw inspiration notjust from reading important literary texts but in the way theteacher herself handles the online class.
4. To neutralize the anxiety as a product of psychologicalrisks already experienced by students, universities andcolleges must provide both actual and virtual mental healthservices (Toquero, 2020). Those schools which are actively
giving psychological counselling must strengthen theirservices. In fact, schools must gather some data when it
comes to the health conditions of students so that schoolof icials can plan and strategize the approaches to make thewhole learning environment safe for everyone. As amitigating measure and to minimize risks to health, schools
should only allow in-person instruction after all students
have received their vaccines against COVID-19.
5. Middle and top administrators should be moretransparent and must be open to real dialogue withteachers and students alike. “Start from the ground”, theground as the nest of concrete realities, and let the voices ofthe disadvantaged be heard; such is a more appropriate wayof dialoguing and making policies. However, dialogues are
not simply for talking. School administrators and heads
must provide what students and teachers need in terms of
support especially in state universities to sustain online
learning. The focus should not be only about deliverables.
The assumption that a faculty member of a state university
will always ind a way is a false assumption.
6. The prejudice against provincial schools must be put
to an end. While rankings matter, for now, the focus should
be on strengthening the research capabilities of small
schools. The government and the private sector should give
grants to small colleges and not just big schools oruniversities that already have the resources. Science
without borders should be practiced by higher education.
This means emphasizing collaboration between top experts
from universities and young researchers from small
institutions. When it comes to science, nothing is big or
small. Every pursuit of truth is bene icial. The opportunity,
hence, must be open to everyone.

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Conclusion
The COVID-19 pandemic presents various risks. The
migration of courses by means of ICT is a given due to thehealth crisis. But it has also made manifest the issues andproblems underlying the Philippine educational system.
Toquero is correct in her macro analysis, but her paper has
not addressed the fundamental issues on the ground.
Mental issues that affect college students need to be looked
into by schools and other stakeholders. Beyond this, thestudy has shown how an elitist system actually undermines
the well-being of students. The nature and purpose of
education cannot be mere productivity. It is about howlearning makes us better human beings whose values re lect
the proper ends of human progress. But this cannot be
achieved if teachers and professors alike act in an immature77

way by pressuring students just to maintain theirreputation even in online classes. A true teacher guides achild not only in terms of concepts but must be a living
embodiment of social equity. A more democratic approachin terms of preparing students and teachers for this newnormal must be practiced by school administrators andmiddle managers, who must be open to real dialogue as a
strategic way to deal with this complex issue and concern.

References
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Adedoyin, O. and Soykan, E. 2020. “COVID-19 Pandemic and Online
Learning: The Challenges and Opportunities.” Interactive
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10.1080/10494820.2020.1813180
Adorador, S. 2020. “What is to be done? A re lection from anacademician from below.” Kyoto Review of Southeast Asia, issue
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Constantino, R. 1966. “The Miseducation of the Filipino.” The
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Kopp, M., Gröblinger, O., and Adams, S. 2019. “Five common
assumptions that prevent digital transformation at higher
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Maboloc, C.R.B. 2020a. “Critical Pedagogy in the New Normal.”
Voices in Bioethics, 6. At: https://journals.library.columbia.edu/
index.php/bioethics/article/view/6888
Maboloc, C.R.B. 2020b. “Nature and Purpose of Philippine
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Maboloc, CRB. 2007. “The Human Person in Martha Nussbaum’s
Capability Ethics.” Budhi: Journal of Ideas and Culture, 11 (1):
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Magsambol, B. 2020. “44,000 college students won’t enrol during
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Magsambol, B. 2020. “Students’ mental health during the
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Nussbaum, M. 2006. Frontiers of Justice. Cambridge, MA: Harvard
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Multiple risky behaviors among
adolescents: A convergent-parallel
mixed method- Cherry Mae M. Manual, PhD
Email: cherrymencias@gmail.com (Corresponding author)- Samuel F. Migallos, PhD
Email: samuelspc099@gmail.com
San Pedro College, Philippines

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Abstract
Aims: To examine the factors in luencing avoidance andengagement of adolescent students in multiple risky
behaviors as well as the level of risk stimulus, degree ofpsychosocial maturity, and extent of avoidance andengagement to each risky behavior referred to as drugs,
alcohol drinking, smoking, sexual behavior, and suicidal
attempts.
Design: The study employed convergent-parallel mixed
method, in which quantitative and qualitative data weregathered simultaneously to explore the protective andescalatory factors in luencing adolescents’ risky behaviors.
Methods: A questionnaire that evaluates the level of risk
stimulus, degree of psychosocial maturity, and extent of
avoidance and engagement to each risky behavior was
distributed to randomly selected 400 students aged 10-19
from public and private schools in Davao City, Philippines.
In addition, 12 interviews were conducted.
Results: Exposure of the adolescent students to risk
stimulus is low (1.72) with high psychosocial maturity(4.41). Engagement to alcohol drinking is higher (44.5%),
with a mid-level degree, as compared to smoking (12.5%),
sexual activity (12.5%), suicidal attempts (8.3%), and drugs(4% as the lowest) categorized as very low engagement.
Interpersonal factors affect decision of adolescents toengage in alcohol drinking (.000) while the intrapersonal
factor affects engagement or avoidance to risky sexual
activity (0.43). Assurance of security, self-esteem andmaturity, parental modelling, and gender sensitivity are all
factors in luencing adolescents’ behavior whether to engage
or avoid drugs, alcohol drinking, smoking, sexual activity,and suicidal attempts.
Conclusion: The study shows that when there is a feeling of
security, high self-esteem, good parental modelling, andsensitivity in understanding one’s gender, an adolescentful ills his proper responsibilities towards the society. On
the other hand, an insecure, unsafe, and confusedadolescent may feel disturbed and frustrated due to lack ofstability. Nurses and other personnel in schools, should
continue to emphasize student-school connectedness whereadolescent students feel that their school environment
supports their growth positively and that their environmentis healthy. Opportunities for family members to be actively
involved in the academic and non-academic activities of thestudents would help provide a security mantle asadolescents transition to adulthood.

Introduction
Adolescent health risk behavior studies are mostly seen in
the lens of psychology or social sciences because of the lackof a nursing model or framework that can be used tounderstand such phenomena. However, it is important for
nurses to understand the root causes of engaging in healthrisk behavior in order to come up with strategic healthintervention programs appropriate for adolescents.
A school nurse, in particular, should provide healthinformation to promote physical and mental health, andinformed healthcare decisions and disease prevention
leading to a better performance of the individual learnerand the school as a whole (Schaffer, Anderson and Rising,2015). Health risk behavior includes activities that increase
one's chance of loss of health status, and contributes topremature death and disability in adolescents and young
adults (Centers for Disease Control and Prevention [CDC],
2007).
Background
The World Health Organization (WHO) de ined adolescentperiod as those aging from 10-19. This age group had been
noted by the Department of Health in Davao Region to have
had an increase in live birth deliveries, cases of abortion,and still birth specially of women below 15 years old. Also,
sexually transmitted infections are reported to haveincreased among <15-24 years old (2013), while 3% ofyoung people aged 15-27 were reported to have hadcommitted suicide (DOH, 2015).
The study
Given the abovementioned risky behavior manifestations,this convergent-parallel mixed method study aimed to
examine the prevalence of adolescents’ involvement in risky
behaviors and the factors in luencing their avoidance andengagement to drugs, alcohol drinking, smoking, risky
sexual activities, and suicidal attempts. Unlike many studies
that have restricted their scope to youth (those belonging toage group 15-24), this study examines the entire adolescentperiod considering exposure to risk stimuli andpsychosocial maturity as posited in the integrative model ofadolescent health risk behavior (IMAHRB) by Keeler et al.,2010.
Historically, risk has been used as a neutral term, de inedas the possibility of loss or gain (Stalker, 2003). The
decision of whether to take the risk would depend on thebalance of what could be gained or lost by the action.
Moreover, the engagement in activity or behavior that may
result in negative health consequences is referred to as
health risk behavior (Jacobs, 2000).
From the viewpoint of Erikson in 1958 (as cited by
McLeod, 2012), an individual may undergo crisis. These
crises present challenges to one’s individual identity. He
further said that adolescence is a time of great change
where the body and sexual organs mature and where new
expectations for social and academic adjustments arise.
With these, self-image typically suffers, and life can be very
stressful, especially in the earlier transition stage.

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

This study was conducted between January 2017 toMarch 2018 in Davao City, Philippines where a total of
25,492 were enrolled in four schools selected in Davao City.
This selection may limit the relevance of the indings forother cohorts such as adolescents out of school, but allows
examination of the psychosocial maturity of the participants
thus contributing another to an understanding of what
in luences an adolescent to engage or avoid health risk
behaviors.
The following seven research questions were explored:
Which of the following factors are protective or escalatory(cultural, intrapersonal, interpersonal)? What is the extent
of the participants’ engagement in risky behaviors? What isthe extent of exposure to risk stimulus? What is the degreeof psychosocial maturity? What are the meta-themes of theintegrated quantitative and qualitative data? How do theparticipants describe their cultural, intrapersonal, andinterpersonal situations? How do these situations in luence
avoidance and engagement in risky behaviors?
DesignThe study employed a convergent-parallel mixed
method, in which quantitative and qualitative
data were gathered simultaneously to explore
the protective and escalatory factors in luencing
adolescents’ behavior towards risky behaviors.

A semi-structured interview was used for the qualitative
aspect of the study. The interview questions were divided
into two parts. Part one was a list of 23 open-ended
questions to know the cultural, intrapersonal, andinterpersonal situations of the participants, while part two
consisted of 10 questions to know the factors in luencing
the participants to engage in each health risk behavior.
All participants as well as their parents or guardians were
given a detailed explanation of the study. Those who agreed
and were able to submit their signed consent forms took
part in the data collection.
The interview questionnaire had been evaluated in sevenpilot interviews. Following the pilot, revisions were made.
The interviews took place in the principals’ of ice or school
clinic depending on the venue designated by each School
Head. Each interview lasted approximately 10 to 30 minutes
and was recorded with the participants’ agreement.
Ethical considerations
Multiple Risky Behaviors Among Adolescents: A
Convergent Parallel-Mixed Method Study

Participants
The participants were 400 students aged 10-19
from public and private schools in Davao City,
Philippines enrolled in either elementary, juniorhigh school, senior high school, or college level.
The total number of survey participants wereequally divided among four schools included in
the list of Department of Education that has atleast 500 currently enrolled students. Simple
random sampling (computer-generated process)was used to determine the 100 participants per
school. For the qualitative data, 12 participants
using purposive sampling were interviewed toarrive at a deeper understanding of the data
regarding the protective and escalatory factors ofengagement and avoidance to health risks
behaviors.

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Data collection
The quantitative data were gathered using a
structured classi ication type and Likert scaledquestions with six sections: personal
information; protective and escalatory factors
with reference to the Adolescent/Youth
Assessment form or HE3ADS4 of the
Department of Health; level of exposure to risk
stimulus; degree of psychosocial maturity; decision to
engage or avoid risky behaviors; and extent of engagement
to each risky behavior.

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Figure 1. Data Collection and Analysis Procedure80

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

The Institutional Research Ethics Committee of San Pedro
College approved the study on September 2017. A copy of
the approved research proposal was then submitted to theDivision Superintendent of the Department of Education in
Davao City for their ethical review. A letter of endorsement
was given by the latter which was then presented to thepresidents of the selected schools. Participants who met thestudies’ criteria received a detailed explanation regarding
the study. A copy was also given to their parents, andconsent forms were secured.
Data analysis
The responses to the questions were coded, mostly on the
Likert scale. All the data were entered in Microsoft Excel
with their corresponding codes. Data analysis was
conducted using SPSS software (IBM SPSS Statistics). The
statistical methods used were frequency mean, percentage,
binary logistic regression, chi square test, and discriminant
analysis.
Categorization of signi icant statements and identi icationof emergent themes was done using Collaizzi’s 7-stepmethod. Verbatim statements were transcribed, coding
participants with pseudonyms. A total of 265 signi icant
statements were identi ied, 37 clustered themes, and sevenmajor themes emerged.
Methodological triangulation method was used to merge
the quantitative and qualitative data following the steps of
Risjord et al. Four meta-themes emerged as a product ofconvergence-coding matrix.
Validity and reliability
The tool was submitted to three experts for content
validation and was rated according to clarity, objectivity,and conciseness. The mean result was 4.03 categorized asvery good. Reliability test using Cronbach’s Alpha yielded apercentage of 80%. According to Newton et al., Alpha index
should be between 0.77 and 0.87.
Results
Out of the 400 participants, 32% were below 14 years old,
44% were ages 14-16, and 24% were in to age group 17-19.
The majority of participants were female (61%), enrolled in
Junior High (48%), and Roman Catholic (82%).
Table 1: Protective or escalatory factor category

Protective or escalatory Factors
The data revealed that socioeconomic status (M=4.14),
family structure (M=4.06), safety (M=3.41), personality
traits (M=4.04), sexuality/gender (M=3.70), peer
relationship (M=4.50), and parental relationship (M=4.02)
were all protective factors or factors in luencing avoidance
towards risky behavior.
Extent of engagement according to demographic pro ile
Ages 15-19 had a higher percentage of engagement in all
risky behaviors than those from age group 10-14 (Figure 1).
Male participants had a higher engagement in drugs (69%)
as compared with female and LGBT participants. Female
participants had a higher engagement in alcohol drinking(63%), sexual activity (56%), and suicide attempts (64%).
While in terms of smoking, male and female had an equal
percentage of engagement (48%).
Extent of exposure to risk stimulus and degree ofpsychosocial maturity
The extent of exposure of the participants to risk stimulus
was categorized as low (M=1.72) while the degree ofpsychosocial maturity in terms of perspective,
responsibility, and temper was found to be high (M=4.42).

015 to 19

4.14

Protective

Family structure

4.06

Protective

Safety3.41

Protective

Personality traits

4.04

Protective

Sexuality/gender

3.70

Protective

Peer relationship4.50

Protective

Parental relationship

4.02

Protective

90

Total

3.98

Protective

45

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LGBT

Students in private schools engaged more in drugs(63%) than those from public school. On the other hand,public school students were more engaged in smoking(54%), alcohol drinking (62%), sexual activity (54%), andsuicidal attempts (61%). Junior High School students had ahigher percentage of engagement in all risky behaviors(Figure 2) except for alcohol drinking where Senior HighSchool were more engaged (40%).

Socioeconomic statusfFemaleMale

Figure 1a. Percentage of engagement per demographic
pro ileInterpretationf

10 to 14

45

Mean

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Smoking
Sexual Ac vity

90

Figure 1b. Percentage of engagement per demographic
pro ileDrugs
Alcohol Drinking
Suicide

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Drugs
Alcohol Drinking
SuicidePublic school

Elementary

Smoking
Sexual Ac vity

SHS

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

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100

87.5

91.7

87.5

44.555.5

50
0

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12.5

Drugs

SmokingEngagement

12.5

8.3
Suicide a empts

Avoidance

Figure 2. Difference between engagement and avoidance
Level of engagement and avoidance in risky behaviors
As shown in Figure 2, percentage of avoidance was higher
than engagement. The results suggest that the participants
had a very high avoidance and very low engagement indrugs, smoking, alcohol drinking, sexual activity, and suicide
attempts. However, in alcohol drinking, they had mid-level(average) engagement and avoidance.
Demographic pro ile and level of engagement
The data analysis of the questionnaire revealed that age
affects level of engagement in alcohol drinking (.000),
sexual activity (.000), and suicide (.001) (p<0.05). Gendersigni icantly affects behavior towards alcohol drinking(.032) and suicide (.004) (p<0.05). Type of school showed asigni icant difference towards alcohol drinking (0.17)
engagement, while educational level revealed a signi icant
difference in engagement to drugs (.033), smoking (.043),
alcohol drinking (.000), sexual activity (.000), and suicide(.000) (p<0.05).
Analysis of the 5 main themes
Twelve interviews were conducted among the 400
participants who answered the questionnaire. The
participants storylines were carefully read, reviewed andencoded. The main concepts obtained from the data werecategorized into ive main themes:
1.Feels safer at home than in school or outside
2. Described self as a good person
3. Certain about one’s sexuality
4. In luenced by peers to engage in risky behaviors
5. Strongly in luenced by parents to avoid risky behaviors
Table 2: Relationship between demographic pro ile andlevel of engagement
Age

GenderSchool

Educational
level

Drugs

.666

.052

.134

.033

Smoking

.687

.243

.138

.043

Alcohol drinking

.000

.032

.017

.000

Sexual activity

.000

.108

.790

.000

Suicide

.001

.004

.558

.000

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p < 0.05

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Feels safer at home than in school or outside
Thematic analysis supports that home remains the safest
environment for the adolescents. This is in the premise thatloved ones or important parental igures are present in theirenvironment such as their grandparents, parents, siblingsand close relatives. Furthermore, the study showed thatthese homes are also provided with technical necessities
like television, gadgets and even internet – a positive effectof technology. In contrast, the school and community wereperceived to be the opposite. These environments,
according to the participants, had bullies, gangsters, with
exposure to violence, smoking, alcohol drinking, and drugs.
The risky environment had somehow brought unpleasantexperiences.
Described self as a good person
Participants viewed themselves as good persons as revealedin their descriptions as being friendly, innocent, studious,and even a bit shy. Helseth and Misvaer (2010) said thatadolescents’ quality of life is about the positive cycles of life.
Feeling good, being satis ied with oneself and having an
overall positive attitude are in most cases described as thestarting points ir a positive cycle.
However, the participants expressed that once they are
provoked or feel threatened, they become mean or hostile.
There were episodes of ighting with parents or withclassmates. Others also expressed being envious with thematerial possessions of the people around them like theirclassmates’ cellular phones or new bags.
This shows that a positive environment helps develop
positive dispositions or self-esteem among the adolescents.
In the contrary, it projects a negative attitude in anenvironment that is negative to their perceptions.
Certain about one’s sexuality
On their gender, adolescents have already recognized andaccepted their respective gender preference. Girls like theircliques with other girls and the boys as well. Peers socialize
gender as well. For example, the more time males spendinteracting with male peers, the more gender typed theirpersonality will become (McHale et al.,2009). Parents also
had impacts on their child’s gender orientation. Adolescents
whose parents express traditional attitude toward genderroles are more likely to hold traditional attitudes
themselves (Tenenbaum et al., 2003). Having gay or lesbianparents, however, has little effect on their romantic
attractions and behaviors (Wainright et al., 2004).
In luenced by peers to engage in risky behaviors
Peers emerged as the sole in luencing factor to engage inrisky behaviors. Prinstein (2009) said that adolescents arequite likely to emulate the behavior of popular peers. They
have a strong investment in social comparison and re lected
appraisal and meeting the demands of those considered themost popular in the peer group.
Participants pointed out that they tried drinking
alcoholic beverage and smoking when asked to by their

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

friends. It all started out with their curiosity which thendeveloped into a habit that resulted in avoiding school rules
to bring prohibited items inside the school. Some others
were involved with gangsters at school at an early age that
led them to experiment in addictive substances as a sort ofbonding.
Sexual activity engagement is said to be common among
young girls who have older boyfriends with a stable job.
Hence, despite their young age, this gave them security andassurance that they would be taken care of if they got
pregnant. In terms of committing suicide, depression due tostress brought about by family problems and schoolpressure led them to try doing it. Suicide has also been
perceived as the solution to stop bullying in school.
Strongly in luenced by parents to avoid risky behaviors
The adolescents said that their parents in luenced themstrongly to refrain from engaging in risky behaviors. The
constant reminders of their parents made them conscious of
the consequences of their risky behaviors. They did notwant to disappoint their parents. Constant reminders are
not only focused on the ill effects of risky behaviors to theireducation, but also health problems. Also, reminding themof their long-term dreams is an effective strategy that theirparents do for adolescents to self-regulate.
To those who had been involved already with risky
behaviors, continued support by their parents to theirrecovery made them realize not to do it again. It gave themthe drive to live and to continue theireducation.
Analysis of the 4 meta-themes
The quantitative and qualitative results wereseparately analyzed and then merged in amethod called methodological triangulation.
Step 1 is following threads where signi icant
verbatim statements from the interview (n =12), seven emergent themes, related threads
from the verbatim data as well as the mean
results of the quantitative data (n=400) werelisted in a matrix. The purpose of following
threads was primarily to identify whichamong the qualitative themes converged with
the quantitative results. The converged
themes were used for Step 2 which is theconvergence of coding matrix containing thethemes, subthemes, related threads, andconvergence assessment (meta-themes):
1. Assurance of security
2. Self-concept and maturity
3. Gender sensitivity
4. Parental Modelling

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Assurance of security
There was convergence in the results that adolescents feelsafer at home than in school as well as the feeling of
security from the parents’ presence and worries. Safety
provided by home from gangs was complemented with themonitoring done by the district of icials within thecommunity to ensure safety.
Self-concept and maturity
There was agreement (convergence) between thequantitative and qualitative results on the theme of being agood daughter/son and being open to the opinion of others.
Further, the concept of being a good person but with someweaknesses was complemented by being rarely angry. The
attitude of being not so friendly by the participants in theinterview diverged with the participants who said that they
were friendly persons.
Gender sensitivity
There was convergence in the results that the participants
were happy and comfortable with their sexuality. There wasa concept that emerged from the qualitative data that theadolescents openly accepted the gender preference ofothers. There was no related idea in the quantitative results.
Parental modelling
In this meta-theme, there was convergence that parents
were considered as an important factor for the participants
to deter from risky behaviors. The act of constantcommunication between parents and sons/daughters also
contributed to the avoidance of risky behaviors. One idea
emerged that the past experiences of family members arereasons for deterrence.

Figure 4. Summary of results based on Integrative Model of
Adolescent Health Risk Behavior Model
Discussion
Conger et al. (2010) explained that the emotional responseof the family and the individual determine the psychologicaleffect of an event. When parents become depressed, angry,
sullen with one another and have increased con lict, theresult is often harsh and inconsistent parenting orwithdrawal. For adolescents, that can lead to an increase inrisky behavior and less development of the sorts ofEubios Journal of Asian and International Bioethics 31(2) (February 2021)

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competencies that protect them from those risks. Thus, apositive environment around the participants evokes
positive responses from them to help avoid exposure torisky behaviors.
The adolescents have responded that when the basic
needs of the family like food, shelter and even school feesare provided or when the income of the family is enough orwhen the adult members of the family are productive
through their work or business, these conditions provided
the mantle of protection for them. In turn, the positiveenvironment manifested a positive disposition among theparticipants like through being a friendlier person andbeing open-minded which in luenced them to avoid risky
behavior. On the other hand, although sexuality or gender isgenerally a protective factor, the sub-variable of mutual
attraction between a male and female is an escalatory factor
to engaging in risky behavior. This however is not
surprising given that adolescence is a transitional period
starting at puberty which ends at adulthood. Erikson in
1963 (as cited by McLeod, 2012) stated in his theory thataside from the observable physical changes in both maleand female sexes, adolescence brings about emotional andcognitive development encompassing other factors such as
gender identity, development of intimate feelings orrelationships, sexual orientation and experimentation.
Development theories suggest that even as adolescents are
growing to become more independent physically,
emotionally and cognitively, they are still growing as
individuals.
Among the risky behaviors identi ied, drug use (4%) isless common compared to alcohol drinking (45%). A
considerable number (13%) of participants were into
smoking and sexual activity and a few attempted suicide. Of
the 178 (45%) involved in alcohol drinking, the age group
15-19 had the most engagements and they were mostly
women. While there were more male participants engaged
in drugs, female participants from public schools had ahigher percentage of engagement in alcohol drinking, sexual
activity, and suicide attempts.
Figlio and Ludwig in 2012 discussed that it is often
perceived that private schools are ‘better’ than publicschools in discouraging delinquent behavior but there is noplausible independent source that can support the claim.
However, previous studies have found some evidence that
Catholic schools increase civic engagement (Dee, 2005), andthat religious participation generally might change behavior(Gerber et al., 2010; Hungerman, 2010). Students in
Catholic schools also spend more time on homework andextracurricular activities than those in public schools (Figlio
and Stone, 2000). Also, private schools may indirectlyreduce teen problem behavior by exposing them to more
pro-social peer groups, or by improving students’ academic
achievement. The irst possibility is suggested by the factthat private schools have a greater ability than publicschools to select and expel students and may thus be lesssusceptible to ‘epidemics’ of problem behaviors.

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The school rules must be constantly repeated to bothstudents and parents through student-parent orientation.
Evidence must be kept by the school that the students andparents accept all rules and regulations and commit tocomply with it. Boundaries for infractions must be wellde ined especially on areas of understanding school vicinity
or within school premises. Grounds and sanctions must be
clear and not be subjected to many interpretations. The
Prefect of Student Formation must be active in monitoringand providing interventions that can help adolescents avoid
violating school policies especially in Public schools.
Consistently, the study also showed that there issigni icant difference in the engagement on alcohol drinking
and suicide in the context of gender. The study revealed that
there were more females who engaged in alcohol drinking(62.9%) and committed suicide (63.6%) but more males
engaged in drugs. This show a similar trend to the Galveston
study in 2012 where use of cocaine and other illegal drugs
was more common among males than females. But, drinking
history was more common among females. Also, researchsuggests that suicidal thoughts are more common amongfemales than males particularly under the age of 25 (Krug,
2002).
Junior high-school students had a higher engagement indrugs, smoking, sexual activity, and suicide attempts while
senior high-school students had a higher engagement inalcohol drinking. Despite the trend of age group 15-19
showing higher engagement in risky behavior, data showedno signi icant difference between age and the level ofengagement in drugs and smoking. At any particular pointin the adolescent life, taking illegal drugs and smoking canbe perpetrated depending on their availability and decisionof the person. However, there is a signi icant difference
depending on age and engagement in alcohol drinking,sexual activity, and suicide. This may be related to thedevelopment of physical and mental capacities of theadolescents.
The extent of exposure of the participants to risk
stimulus is low. This data revealed that Davao City is apositive and healthy community to live in. Generally, there
was a low in luence of peers and family members insmoking and alcohol drinking. This means it was a personal
decision of the participants to engage in these risky
behaviors. This situation suggests these are attempts at
experimentation as they experience puberty during their
growth and development from the viewpoint of Erikson (ascited by McLeod, 2013). Furthermore, participants had
rated very low exposure in the context of drugs and sexualintercourse or intimacy. The strong campaign of thegovernment (both local and national) against illegal drugs
could have had a signi icant impact on the perception ofparticipants. This also implied that peace and safety prevailin Davao City where one can have fun but laws are observed
and strictly imposed (Olojan, 2016).
Cited in the IMAHRB by Keeler and Kaisser (2010) was
the concept of psychosocial maturity by Greenberger andSorensen in 1974 which was later expanded by Steinberg

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and Cauffman in 2000. Psychosocial maturity was de inedas the capacity to function adequately on one’s own, tocontribute to social cohesion, and to interact adequately
with others. Characteristics of a psychosocially matureadolescent include those related to perspective,
responsibility, and temperance. All three describe that anindividual has the ability to base decisions on possible
future effects, health outcomes, and the effects of decisions
not only to self but to signi icant others. The psychosocial
maturity of the participants in terms of perspective is veryhigh. This data showed the participants have better
perspective or understanding of the ill-effects ofengagement in risky behaviors. In terms of perspective, they
have intentions to become successful in the future, thus they
intend to keep themselves healthy (rated very high); thatinvolvement in risky behavior may negatively affect their
future (rated high); and that they understand that engaging
in risky behaviors may somehow affect their future. The
participants also rated high on responsibility andtemperance. The data showed that they have the ability tostay away from negative in luences of peers, understand thepossible consequences of their actions and they can makedecisions for themselves. This can also be alluded to a
positive cultural and environmental situation at home andthe social functions (clubs and organizations) they are
involved in.
The study also revealed the high temperance of theparticipants. Data showed they have the capacity to re lect
or give enough thought over critical decisions they make.
Parents are still a recognized sources of advice; thus, theirpresence and constant guidance strongly in luence theirchildren’s decision-making process. Steinberg et al. in 2010
discussed in a study on youth violence and juvenile justicethat young people are expected to take on more matureroles and responsibilities and igure out how to become
healthy and responsible members of the society. Further
they emphasized that in order to achieve suf icientpsychosocial maturity and, along with it, the abilities tofunction as independent and productive adults, youths incontemporary industrialized society need to complete a
series of development tasks in each of the three areas of
psychosocial maturity. Thus, adolescents must be given
avenues to carry out independent decisions, to contribute
ideas in school and at home, to be appreciated in every
accomplishment and to be encouraged in every failure inorder for them to psychosocially mature as they grow.
In all of the results in the quantitative survey, thematic
analysis supports that home remains the safest
environment for the adolescents. This is in the premise thatloved ones or important parental igures are present in theirenvironment such as their grandparents, parents, theirsiblings and close relatives. Furthermore, the study showedthat these homes were also provided with technologicalnecessities like television (most common), gadgets and even
the Internet. In contrast, the school and community wereperceived to be the opposite. These environments according
to the participants had bullies, gangsters, and were exposed
to violence, smoking, alcohol drinking and drugs. This risky

environment had somehow brought unpleasantexperiences. The adolescents had been victims or witnessesof bullying, gang ight, ist- ight, drug or alcohol invitations
and even intruders in their boarding houses. Some of these
events happened inside the school campus. The Departmentof Education still has a long way to go to make the school
environment a child-friendly one. If students perceive theschool as unsafe, it could affect their studies and school
performance. From 1993 to 2007, school absences due toconcern for safety rose from 4.4% to 5.5% (CDC, 2010).
One survey of middle school students reported thatnearly 13% of sixth, seventh, and eighth grade students
missed class because they felt unsafe in school and 27%
reported they were threatened with violence (Orpinas et al.,2000). Twenty-seven participants indicated that they felt
unsafe for reasons other than being teased, and unrelated toacademics. These incidents created a general feeling ofuneasiness resulting from (a) witnessing ighting or
bullying, (b) knowing of the presence of weapons and gangs,(c) feeling vulnerable to unruly students, (d) witnessing
drug dealing, (e) hearing of a possible child enticement, and(f) other perceived threats.
In terms of describing their personality, participants
view themselves as basically a good person as revealed intheir descriptions as friendly, innocent, studious, and even a
bit shy. Helseth and Misvaer (2010) said that adolescents’quality of life is about the positive cycles of life. Feeling
good, being satis ied with oneself and having an overall
positive attitude are in most cases described as the starting
points of a positive cycle. To get into and stay in a positive
cycle, a positive self-image, good friends and good family
relations are important. Consequently, adolescents' qualityof life is threatened when these factors are negative. The
participants, however, noted that once they are provoked orfeel threatened, they become mean or hostile. There were
episodes of ighting with parents or with classmates. Others
also expressed being envious with the material possessionsof the people around them like their classmates’ orneighbors’ cellular phones or new bags. This shows that apositive environment develops a positive disposition or
positive self-concept among adolescents. In the contrary,
this may project a negative attitude in an environment thatis negative to their perceptions.
Hoffman and Futtherman (1996) commented that many
adults have dif iculty acknowledging adolescents as sexual
beings, and therefore adolescent sexuality is viewed as
something which must be controlled and restrained. As aresult, sex education in schools either does not take place or
promotes only certain risk reduction measures (mostusually abstinence). However, in this generation through theincorporation of reproductive lessons in schools,
adolescents are knowledgeable about their sexuality andgender preference. The family, peer groups, and media allparticipate in socializing gender.
Peers emerged as the sole in luencing factor to engage
in risky behaviors. Prinstein (2009) said that adolescentsare quite likely to emulate the behavior of popular peers.
They have a strong investment in social comparison andEubios Journal of Asian and International Bioethics 31(2) (February 2021)

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re lected appraisal to meet the demands of the mostpopular in their peer group. He noted the importantdistinction between adolescents who are well liked andthose who are identi ied as popular, the latter signifying
those who are at the top of a dominance hierarchy. It is thedominant individuals who seem to be the most in luential,
particularly with regard to high-risk behaviors. They tend to
be both aggressive and usually more prone to thosebehaviors. Moreover, it is rare for friendship dyads to occur
in isolation; more typically they occur within a friendshipnetwork or clique. These social patterns are very dif icult to
study, he added, because they evolve so rapidly. Even those
who do not interact with one another within the peer crowdmight feel the need to adopt the attitudes or behaviors of
the crowd with which they would like to associate.
In addition, adolescents spend a lot more time with
their peers than younger children do and are more heavily
in luenced by them than younger children are. The drive foraf iliation and acceptance at this stage makes adolescents
more open to peer in luence and tends to promote the rapid
development of new relationships (Brown, 2011). Peerpressure is considered in the literature to have a signi icant
in luence on the youths` sexual behaviors (Bernstein, 2001).
It can encourage youths to experiment a range of sexual
behaviors, and doing so may lead to an increased risk ofunwanted pregnancy and contracting sexually transmitted
diseases, including HIV/AIDs (Kirby, 2007). On the other
hand, despite the negative in luence of peers, one of theemergent themes is the feeling of being happy and inspiredin the company of friends.
Therefore, friends must be chosen well and parents
should be keen in knowing the whereabouts of theirchildren so that proactive interventions and decisions canbe made towards the adolescent crisis of choosing what isright and wrong. Collaborative programs can also be
initiated between the school nurse and guidance counseloron giving educational activities that promote harmonious
relationship towards classmates and friends such as the“friendship factor” session where students will be oriented
on the characteristics of good friends from those who will
be a bad in luence to them.
Parents have a strong in luence on decision not toengage in risky behavior. Gonzales (2011) explained that
effective parenting (nurturing, supportive parenting that
includes clear and consistent discipline) can prevent
negative behaviors and promote prosocial behaviors andvalues. It also helps children develop various competencies
that are protective. Parental monitoring and supervision
may prevent children from associating with deviant peers.
High levels of family con lict and poor communication skills
disrupt parenting and family relations, reduce children’s
emotional security, and reinforce the use of aggression andinterpersonal hostility. Further, he added that high levels ofsocial anxiety or low levels of self-esteem tend to makeadolescents more likely to adopt the perceived behaviors of
their peers, than those who have been rejected.

85

Poor family relationships make adolescents more likely
to attract and af iliate with deviant peers and to adopt theirattitudes. According to Datu (2012), reinforcing theconception of happiness as a satisfaction of needs in its
interaction with the social support system (e.g. primary,secondary) causes a feeling of contentment and joy frommeaningful relationships. This is a central theme that was
found in the participants’ responses. The most crucial
relationships emerge from family, friends, peers andcolleagues. For example, one participant said: “Whenever I
see and keep in touch with my parents and my friends, I feelglad and happy.” Most of them shared commonalities interms of prioritizing the impact of relationship satisfaction
on the achievement of a positive and joyous state. In a study
conducted by Fernandez (Ateneo De Manila University) in
2011, results revealed that Filipino adolescentsconceptualize support mainly as hand-on support. They
appreciate when they receive advice, personal assistance,and being challenged because they consider these as
expressions of care and concern rather than intrusive acts.
The Filipino identity, at any age, is characterized by acollective sense-concept. For example, for an adolescent to
be told what to do, does not violate personal boundaries.
Furthermore, Filipino adolescents value the wisdom of theirparents, teachers and mentors, and feel supported whenthese people intervene in their lives.
Moreover, assurance of security is an important aspectin the life of an adolescent. When there is a feeling of
security, an adolescent ful ills his proper responsibilities
towards the society. On the other hand, an insecureadolescent feels disturbed and frustrated due to his lack ofstability. He may not be able to cope with the demands of anormal social environment. Therefore, there is a need to aproper congenial environment at home for the child’s stable
and secure personality development (Manisha, 2016). Goel
(2002) emphasized that feelings of security–insecurity
signi icantly and positively relate to family attachment.
Further, self-esteem refers to a student’s perceptions ofcompetence or adequacy in academic and non-academic(e.g., social, behavioral, and athletic) domains and is best
represented by a pro ile of self-perceptions across domains(Manning, 2007). Its signi icance is often exaggerated to theextent that low self-esteem is viewed as the cause of all eviland high self-esteem as the cause of all good (Manning, Bearand Minke, 2006). Promoting high self-esteem is importantbecause it relates to academic and life success. As students
transition from mid-level to high school, their self-esteem
gradually grows. Moreover, adolescents face a number of
unique developmental challenges, including coping withabrupt changes in their bodies, managing their sexualinterests, forming new kinds of relationships, and planningtheir academic and occupational future. Gender affects how
youths manage all of these challenges (Perry and Pauletti,2011). It is important to identify the origins of these
relationship styles because they predict important aspectsof social and personal functioning in adulthood; e.g.,
avoidant men are more sexually promiscuous; preoccupied

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

women are more angered by perceived partner lack ofsupport (Perry and Pauletti, 2011).
Lastly, parents affected their offspring's use of alcoholand cigarettes both through modeling and parenting
behavior. However, the importance of modeling relative toparenting behavior differed by the type of substance (Whiteand Buyske, 2000). Therefore, parents must see to it thatthey play their part as the role model of the family because
an adolescent who is deciding what he wants when reaching
adulthood is very observant and tends to imitate what hesees and experiences inside the family.
Conclusion
Based on the results of the study, it can be said that threefactors, namely culture and social environment,interpersonal relations, and intrapersonal factors of theparticipants directly contributed to their positive behavior.
The weak involvement of the participants in risky behaviorsconnotes that students enrolled in both public and private
schools in Davao City are sensible, well-grounded
individuals who respect the authority and advice of theirelders. Among the signi icant in luences in reducing risky
behaviors are the advices and guidance of their parents,
other family members, and teachers. The decisions of theparticipants in the non-engagement in risky behaviors aretaught at home and in school.

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Recommendations
Schools should continue to emphasize student-school
connectedness where students feel that their school
environment supports their growth positively and that theenvironment is healthy. This could be done by providing
opportunities for family members to be actively involved in
the academic and non-academic activities in school like“Family Day” celebration, quiz bee for students and theirparents, consultation days, among others. Parent
monitoring and guidance are important in transition ofadolescents to adulthood.
The school nurses may have been successful in
informing the students of the negative health outcomes inusing drugs, smoking, risky sexual activity and suicidal
attempts but emphasis must be more on the reduction of
alcohol drinking which is quite common. There seems to bea lack of enforcement of laws and monitoring of small stores
selling alcohol in the community. The model also explainsthat involvement in risky behaviors results in poor healthoutcome and vice versa.
Future nurse researchers are recommended to do a
study that will focus on the prevalence and the healthoutcomes as illustrated in the IMHARB. The method
selected in this study provided a cross-sectional analysis bycomparing both quantitative and qualitative results. Thiscross-sectional analysis was needed to examine theparticipants by determining commonalities between thetwo sources of information. Nurse researchers arerecommended to use a mixed method, either convergent,
exploratory, and explanatory to ensure of getting enoughdata and results.

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Marist welfare arm: A community
extension program in Santa Cruz
mission schools incorporated- Loveleih G. Quemado, Ph.D.
Email: loviequemado@yahoo.com (Corresponding author)- Marcela Octaviano, MA
Email: marcelabalao@yahoo.com
College of Arts and Sciences, Notre Dame of Marbel
University, Koronadal City, South Cotabato, Philippines

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Abstract
This phenomenological study was conducted to gain
insights from the experiences of the personnel of Santa Cruz
Mission School, Incorporated (SCMSI) on their involvementin the implementation of the Notre Dame of Marbel
University (NDMU) community extension program forindigenous students. The study was conducted in Lake Sebu,

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South Cotabato with the faculty and staff of SCMSI who havebeen actively involved in most activities in ive years(2014-2019). In-depth Interviews with three key
informants uncovered their perspectives of the program,the program outcomes and the facilitating and hinderingfactors for implementation. Insights drawn from theemergent themes are recommended for consideration in
formulating plans for other extension communities.

Introduction
Notre Dame of Marbel University (NDMU) is one of theseorganizations that responds to the needs of the lessfortunate. NDMU being run by Marist Brothers, through its
welfare arm, the Champagnat Community College (CCC)
developed a Community Extension Program for its
extension community, the Santa Cruz Mission Schools
Incorporated (SCMSI) located in Lake Sebu, South Cotabato ,which is implemented by the university administrator,
personnel, and students.
CCC shares with the vision of the university in building a
progressive and healthy community (CCC Manual, 2016) todemonstrate the university’s trademark “an institution thatcares for humanity”. The community extension program
been desired by the Marist Brothers whose advocacy istaken from the values of their founder, St. Marcellin
Champagnat who asserts “Love of the poor is a precious
heritage” (CCC Manual, 2016).
CCC has been established “to assist in the development ofcommunities through the provision of education to the Tboli
people from the hinterlands of Lake Sebu in the Province ofSouth Cotabato in Mindanao, Philippines.” Extension
community refers to the community being served by theagency or institution that are considered deprived,
depressed and underserved (CCC Manual, 2010). It is in
response to the call that schools must also extend help tohighlight their latent functions.
Schools can be agents of social change because of theirpotential to perform key roles in spreading new things andideas (Arriaza, 2004). “They are the path for initiating anddisseminating innovations” (p.14). The schools, asinstitutions convene people to meet primarily forsupporting the educational mission and the countless
purposes of civic life. This principle inspired various
colleges and universities in implementing their community
ex te n s i o n s e r v i c e s [ p ro g ra m ] fo r m a rg i n a l i z e dcommunities; although historically, extensions as a mode ofknowledge exchange have existed across the world with amore or less institutional forms in Mesopotamia, Egypt,
Greece and Phoenicia (Jones and Garforth, 1997).
Community Extension Services of NDMU to SCMSIThe Community Extension Services (CES) of ice is directly
under the of ice of the University President. CCC’s objectives
are: to develop and implement innovative sustainable
programs that will help improve the quality of life ofdeprived, depressed, disadvantaged and underserved
communities; to establish strong linkages, and network

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with LGUs, NGOs, GOs, POs and funding institutions forinter-institutional cooperation toward service area fordevelopment and possible fund sourcing of program ininternational and national levels; and to strengthen ongoing programs through participative efforts in planning,
management, implementation, monitoring and evaluation(CCC Manual, 2010). In collaboration with different colleges,
university clubs and organizations,
CCC is implementing the following programs in Santa
Cruz Mission Schools, Inc.; education and socio-cultural,faculty and instruction, student development services,
facilities and instructional support, and skills training andlivelihood projects. Various colleges, clubs, andorganizations take turns in conducting community
extension services in the area as time permits.
The term ‘extension’ is more recent because thisoriginates from academia and its irst use was recorded in
Britain in the context of ‘university extension’ as describedby Israel et al. (2011). Extension program is de ined as“comprehensive set of activities that are intended to bringabout a sequence of outcomes among targeted clients” (Rubio
and Sastre, 2016). Among other things, extension programs
are characterized by the following; “a focus on the needs ofthe clients, the intent to affect particular learning andb eh a v i o r o u tco m es , m u l t i p l e a c t i v i t i es th a t a recomprehensive in nature, and the presence of formal
evaluation” (Rubio, et. al, 2016, p. 110). Community
extension programs were organized into the national
system in 1952 before it became a thrust of the educational
system to support the poverty reduction program of thePhilippine government (Rubio, et. al. 2016).
The constructivist approach to learning considers
community as a source of knowledge that both educatorsand students alike need to access in order to understand thecultural, social, and linguistic barriers that separate schools
from the communities (Arriaza, 2004). The constructivists
believe that a community is a “school’s natural extension
because students exhibit cultural traits that spring fromwithin the community they come from” (p.2). In this context,“educators encourage the school’s involvement incommunity’s social event as long as this yields knowledge” (p.
15). Constructivist theories are in luential throughout thelearning sectors as this suggested the processes calledaccommodation and assimilation originally presented by
Jean Piaget in 1950 (Duveskog, 2013). Piaget (1950) argued
that through these processes, “individuals construct a newknowledge out of their experiences” (p.22).
Assimilation occurs when a new experience is aligned
and integrated in individuals’ already existing framework
and perception of the world; while accommodation is theprocess of reframing one’s mental representation of theexternal world to it the new experiences (Duveskog, 2013).
Further, the constructivists approach in facilitating
empowerment stipulated that knowledge, behavior andsocial relations must be created by human agent as “aconsequence of critical thinking, experimentation andcommunicative action and the core feature is the ownershipof the learner” (p. 22). This claim is also supported by theprinciple of experiential learning. From the learningtheories of Dewey, Lewin and Piaget, Kolb developed asimpli ied and harmonized learning model—the Kolb
learning cycle which is also described as experiential
learning (Duveskog, 2013). The basic assumption is that thelearning is always rooted in the prior experience (Kolb,
1984), and through the transformation of this experience,
knowledge is created (Percy, 2005).
The process of experiential learning is one that links
education, work and personal development and it is highly
relevant as shown by the experience of community
extension workers in the study of Duveskog (2013). The
community extension workers while working in groups
were able to ind their own solutions to problems throughtesting and experimentation of ideas and practices. This
coincides with the position of Fletcher and Vaughn (2009)
in their study of student-volunteers. Accordingly, students
that volunteered or doing volunteer work are doing it“because the activities were related to their courses” (p.111).
Thus, the experiences derived from the volunteer works will
help them in their future career as this will provide
enhanced knowledge in their craft as they will have a realworld experience when it comes to their courses (Rubio et.
al., 2016). Student motivations for volunteer works arevaried (Taylor and Keim, 1999).
Cha et al. (1994) argued that community extension
programs are formed to foster students’ experience andboost community resources at a minimum cost. This
collaboration between the students and community people
enhances their capabilities and it paved the way for theestablishment of their social capital. Coleman (1988) puts
forward that social capital “strengthens the interrelationships between individuals and facilitates theexchange of services as it greases the wheel that allows thecommunity to advance smoothly” (p. 288). He de ined social
capital as “a variety of entities consist of some aspects ofsocial structures that facilitate certain actions of actors –whether personal or corporate actors—within the structure”(p.10). Moreover, Fukuyama (1995), regarded social capital
as a constructive element in the creation and maintenanceof economic prosperity, regional development (Grootaert
and Bastelaer, 2002), collective action (Burt, 1992) anddemocratic governance (Putnam, 2000).
Lin (2001) refers to these connections as social
networks, “the social relationships between individual actors,
groups, organizations, communities, regions and nations thatserve as a resource to produce positive return” (p.10).
Similarly, Ishimaru (2014) argues that although social
capital has been interpreted within various perspectives but
this concept focuses on relationships between individuals,
networks, norms and resources.
Furthermore, Deci and Ryan (2000) contend that theconcept of social capital parallels other concepts of action. It
comes into being through the combined actions of several
or many people. The decision of one individual has
consequences for all. In this notion, social capital is
attributed to social structures that it only exists when it isshared. For Anirudh and Uphoff (1999), “social capital is anEubios Journal of Asian and International Bioethics 31(2) (February 2021)

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accumulation of various types of intangible, social,
psychological, cultural, institutional and related assets thatin luence cooperative behavior” (p. 202). It improves with
use and deteriorates with disuse (Deci and Ryan, 2000).
Often argued as mechanism to enhance institutional
development, social capital needs to be complemented so as
to translate individual attitude and values to cooperative
behavior and transformed into positive outcome that
promote community agency (Arriaza, 2004). Agency isde ined by Sen (2005) as "what a person is free to do andachieve in whatever goals or values he or she regards asimportant" (p. 154). Agency is related to empowerment,
autonomy, self-direction, self-determination, liberation,
participation, mobilization, and self-con idence. Several
authors frame empowerment as an increase in power,
understood as control or real ability to effect change. While,a widely cited de inition of empowerment is from the World
Development Report in 2000/2001 which views it as theprocess of enhancing the capacity of the poor people toin luence the state or institutions that affect their lives, bystrengthening their participation in political processes andlocal decision-making.
Saeed et al. (2005) argue that any ‘workable’ de initionof empowerment needs to include two main aspects—theinformation and in luence because these will allow people
to express their preferences and have an effective impact onparticular decisions. Bennet (2002) emphasized thatempowerment is also based on social mobilization thatgives people voice and allows them to demand . Friedman(1992) argued that de initions must “focus on the moral
aspects of empowerment, such as ful illment, human rights,
and the removal of oppression and injustice” (p.13).
Boyle (1981), contended that a program refers to acomprehensive set of activities that includes an educational
component which is intended to bring about a sequence ofoutcomes to targeted clients. Extension programs areorganized in a variety of ways to address many different
needs and issues. Every program has measurable outcomes
because without measurable outcomes, programs are reallyjust activities.
As the phenomenon of student community engagement
has become more widespread, a ield of scholarship has
validated the importance of this work (Erickson, 2010).
However, the premise of engaging students in service with
community partners are based on the assumption of mutual
exchange, both partners –the students and community
organizations give and receive something of value. Scholars
have agreed that community service enhances theeducational outcomes for students and they also agreed on
the core set of best practices to create from these outcomes(Erickson cited in Eyler and Giles, 1999). But, because of thevery little research on community outcomes of community
engagement, scholars have not reached a consensus about
what constitutes a best practice for community partners oreven what types of bene its might accrue to communities
that participate in these mutual exchanges with academic
partners (Erickson cited in Cruz and Giles, 2000).

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A number of indirect impacts in community extension
services have also been discussed in some studies. For
instance, Carrasco and Alcalla (2009) mentioned about
partnerships with universities opened doors to broader
networks and possibilities, and enhanced the legitimacy ofcommunity projects to funding agencies because of theirpartnership with universities is another impact.
Accordingly, students bring a fresh look at the communityfrom a critical and informed distance and a new perspective
to neighborhood issues (Carrasco and Alcalla, 2009).

Santa Cruz Mission School, Inc. as the Extension
Community
Santa Cruz Mission School, Inc. (SCMSI) is a non-stock, nonpro it Catholic institution organized in Lake Sebu, South
Cotabato, Mindanao, Philippines in 1961. It was registeredwith the Securities and Exchange Commission (SECRegistration No. 36994) on December 9, 1968 as a NonGovernmental Organization to assist the Indigenous Peoples(Tboli, Manobo, Blaan, Ubo, Kalagan and Maguindanao
Muslims) to realize their full human potential as individuals
and as people (CCC Manual of Operation, 2016). However,
the indigenous groups being served by the SCMSI are within
Lake Sebu area which comprised only of the Tboli.
Accordingly, due to limited operating expenses, the 26
service centers of Santa Cruz Mission back in 1980s are now
reduced to 3 communities as others are already turned-overto the management of the government, speci ically, theDepartment of Education (DepEd). During 1980s, SCMSI
had programs on Education, Health, Community
Organization, and Sustainable Agriculture, however, these
programs were all foreign-funded and at present, SCMSI
focuses on Education because of the lack of funds to operate
other programs.
These SCMSI centers were established to address theeducational needs of indigenous cultural communities withthe mission of “In the Service of Tribal Community”, alongwith its vision statement: “The Santa Cruz Mission School, Inc.
is responsive to the educational needs of indigenous culturalcommunities, envisions a catholic education. Contextualized
in the life of the indigenous people thereby uplifting theiridentity and empowering them as peoples toward selfreliance.” (SCMSI Revised Manual of Operations, 2016).
NDMU has been implementing the CCC’s community
extension program for a duration of ive years up to March2017. Program evaluation (Alkin, 1990) was conducted todetermine the impact of the program to the various aspects
in the school- community.
This qualitative phenomenological study explored theexperiences and gained insights from the perspectives ofthe faculty and staff of the extension community who weredirectly involved in working collaboratively with NDMU-CCC
personnel during the implementation of the community
extension program to SCMSI. “Phenomenology is anapproach to qualitative research that focuses on thecommonality of a lived experience within a particular group.
The fundamental goal of the approach is to arrive at as92

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

description of the nature of the particular phenomenon”(Creswell, 2013).
This is a transcendental -phenomenological study in thecontext of Santa Cruz Mission School, Incorporated in Lake
Sebu, South Cotabato. It is transcendental since it is focusedand detailed, in which the perspectives on implementation
are carefully scrutinized and articulated based on the data
presented by the participants. As Husserl (1997) andMoustakas (1994) assert “The researchers must set aside
prejudice, prior knowledge, judgements, and preconceptions
about the phenomenon to hear the contribution of research
participants with an open mind.” This also means that indoing so, the researchers are entering a state “where
everything is perceived freshly as if for the irst time”(Moustakas, 1994) which is “free from constructs of theintellect and society as possible” (Groenewald, 2004, p.12).
This study also followed the stages in the transcendental
phenomenological study contended by Creswell (2013).
The study will bene it the providers and service
communities in understanding their roles as partners inorder to maximize the internal resources available in thecommunity. It is also a great help for the volunteers who
conduct the community extension services to thecommunity so they will initiate activities that willappropriately respond to the needs of the servicecommunities. Furthermore, this study will also assist
community development agents of different organizations
to understand, evaluate, and strengthen their partnershipwith their extension communities.
This study speci ically answered the following questions:
1. What are the perspectives of SCMSI employees of theCommunity Extension Program of NDMU?
2. What are the outcomes of the community extension
program to the SCMSI community?
3. What are the contributing and inhibiting factors that
affect the implementation of the community extension
program? What were the contributing and hinderingfactors that affected the implementation of thecommunity extension program?

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Methodology
This study was conducted in Lake Sebu and describes theperspectives of the participants about the implementationof the community extension program of NDMU through CCC
to Santa Cruz Mission Schools, Inc. It interviewed four
teachers and staff who were actively involved in working
collaboratively with the representatives of NDMU in thedelivery of the community extension services.
The data were gathered through in-depth interviews withthe key informants who were purposively chosen. A semistructured interview guide was formulated in English
language. Follow up questions were also asked in order toextract the appropriate information to substantiate the data.
Information gathered were transcribed and translated toEnglish since some answers were stated in Tagalog, Tboli,
and Ilonggo. After the transcription, follow up interviews
through mobile phone were done in case of missing
information.

For ethical considerations, the researchers asked
permission from the president of the school that aninterview will be conducted to the participants which will
be tape-recorded for easier transcription. An informed
consent form was also accomplished by the participants toensure their permission and there would be no ethical issue
that will arise. The objectives of the study and somepossible bene its to the school from the results of the study
were also discussed before the questions.
For data analysis, the researcher considered theprocedure that Moustakas (1994) which focused on thedescription of the experiences of the participants.
Bracketing was also observed by the researcher in the dataprocessing. Building on the data from the researchquestions, the researchers went through the interview
transcripts and highlighted signi icant statements thatprovide understanding of the participants’ perspectives on
the phenomenon. Moustakas (1994) called this step
horizontalization. After which, formulated meanings weredeveloped from the signi icant statements, and fromsigni icant statements cluster of themes were developed
where emergent themes have surfaced. Based on theemergent themes, the researchers presented theparticipants’ perspectives about the implementation of thecommunity extension program of NDMU.

Results and Discussion
Participants’ perspectives on the community extension
program of NDMU
Community Engagement through Education
Time and again the importance of education cannot be
overemphasized. For the Tboli people it is an agent in theattainment of their dreams and their hopes for a brighter
future. The participants believe that one bene it brought to
SCMSI is community engagement through education. NDMU
helped to address educational issues through enhancing theteachers’ capability. Accordingly, this leads to theimprovement of SCM students’ academic performance.
My experience so far is that the teachers have shown realconcern when they came to our school and conducted
seminars. Sometimes, I received calls that they are coming asa group. They bring us new knowledge and expose us to newstrategies in teaching which we have applied in ourclassrooms. So, I think overall, that they like to be with thepeople in the community. (p. 10, line 3).
The statement concurs with Mapp’s (2002) study ascited in Matoke (2014) which reveals that it is essential for
programs to implement strategies that will develop
partnerships in order to serve a diverse population. The
lectures during seminars, trainings and workshops
conducted by NDMU representatives, provided themembers of the SCMSI community an opportunity to be
educated in various aspects.
For instance, sessions for teachers enhanced theirknowledge on teaching strategies while lectures forstudents provided new ideas which are believed to havehelped them in understanding their roles as members of theindigenous community. These community engagements areEubios Journal of Asian and International Bioethics 31(2) (February 2021)

in the form of formal, informal and non-formal education.
One participant shared that the hands-on trainings for
agricultural skills development have given the indigenous
people the means to pursue their dreams and aspirations inlife.
In addition, another participant shared that, “WhenNDMU teachers and personnel responded to our call for
scholarships they give assurance of the education to ourstudents. It is an opportunity given to us to help our students
pursue their education in college”. “NDMU has been willing to
educate us and our students. We are happy to see everyone
enjoying the opportunities to be in school rather than staying
at home and waiting for the end of the day.” (p. 4, line 8).

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Contributions to Teachers and Students Holistic
Development
The second theme that emerged is about how the program
contributed to the teachers and students’ development. An
effective teachers’ development is crucial for creating aquality learning environment. This is what NDMU has
envisioned when faculty from the different colleges came to
SCMSI to conduct sessions on professional development ofteachers. The participants viewed that the content-driven
sessions about the new trends in teaching are for long term
development that teachers will bene it from. Castleberry(2010) puts forward the idea that teachers must be
equipped with new knowledge, “to individualize instruction
for a diverse population of students, to help all students
achieve high standards, to introduce new technologies into
the classroom, to become experts in student growth anddevelopment, to help manage the school, and to reach out toparents and the community”. The training and seminar given
by NDMU was anchored in these ideas and delivered in amanner that is culture-sensitive to the Tboli. Hence, thisintervention has alleviated some of the challenges
experienced by SCMSI teachers in teaching the indigenous
children.
Moreover, holistic development of SCM college students
was addressed by NDMU through activities on pro-social
values and character formation. For instance, this was done
through recollection, retreats and other activities that
helped the students to enhance their personal values andsocial relationships with teachers, peers and community. As
Jenney (2010) asserts, educational institutions promotecharacter formation to make the college or university
become distinct from other institutions by not only
educating the minds of young people, but also by developing
character and civic responsibility (p. 5). Character
formation also enhanced and strengthened pupils/students’
self-esteem and con idence.
The trainings, seminars and workshops conducted by
NDMU such as leadership trainings, sports and thecommunity immersion within SCMSI campus made ourpupils, students and of icers’ area more responsible to theirtasks and jobs. It strengthened student leadership skills
with sense of commitment and service-oriented (p. 2, line
6).

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Facilitated in the Preservation of Cultural Heritage
Living and working in a community with rich cultural
heritage is considered by participants not only as a
responsibility but also somethng they are accountable for.
They feel the need to preserve the cultural heritage of thepeople. They believe that South Cotabato is rich in cultural
diversity and this is one advantage of the province. Thus,
they are obliged to serve like stewards of this cultural
heritage as what they are doing in the Tboli communities.
Further, the community extension program to SCMSI, gave
the faculty and students a wider horizon to showcase theirculture through performing arts to different events hosted
by the university both inside and outside the two campusesof both schools. The participants shared that they were
happy and excited every time NDMU invited the dancetroupe of Tboli students to perform: “They also strengthened
our school collaboration, networking and linkages. The
activities on preservation of showcasing our cultural heritage
also leads to unity and diversity. They also help promote theschool identity as the center of IP education.” (p. 6, line 6).
World Bank (1994, cited in Anasi et al., 2013) de ined
cultural heritage “as a record of humanity's relationship to
the world, past achievements, and discoveries. It is thepresent manifestation of the human past. It refers to sites,
structures, and remains of archaeological, historical,
religious, cultural or aesthetic value”. The collective part of
the Tboli society were disseminated through the help of
NDMU which gives members of the dance troupe the chance
to explain the nature and meaning of the speci ic
performance that depicts the culture. Dissemination issigni icantly appreciated since it a way to ley the people
understand and accept the culture that somehow have beenforgotten or set aside. It is one of the indings of the study ofAnasi, et al (2013), which states that one of the greatbene its of human society is dissemination of cultural
heritage.
Conversely, Santa Cruz Mission School, Incorporated has
been NDMU’s partner also in the establishment of Mindanao
Center of Culture in the university’s library. The faculty andstaff from SCMSI had contributed ideas on how to design
the center and identify particular icons and tangible
heritage that must have been displayed in order for people
to understand the Tboli culture. Also, the researchers
learned from the participants that the preservation of Tboli
culture has long been practiced by them since Catholic
Missionaries presence in the area. More so, they are awareof the institution of Indigenous Peoples’ Education being
spearheaded by Department of Education.
“As Tboli teachers in the SCMSI, we are also invited toshare our knowledge about the particular things being
displayed at the NDMU library ‘Center of Culture’. I feel that inthat way I did my responsibility to preserve the cultural
heritage that have been part of our life ever since. Thank you,
NDMU for the opportunity.” (p. 7, line 9).

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Collaborative Efforts Towards Mutually Bene icial
Pursuits
Mutual bene its can be achieved through collaboratively
accomplishing the goals and objectives of community
extension program. This collaboration between NDMU and
SCMSI was made effective through a Memorandum ofUnderstanding (MOU) in 2013. NDMU has responded to theeducational needs of SCMSI’s faculty, staff and students
through provision or school supplies, scholarships,
uniforms and other material resources to suf ice the needsof the students. Similarly, NDMU students brought gifts tothe bene iciaries during Christmas. Stewart (2011) assertsthat extension partnership must provide a structure thatenhances the capabilities of the clientele trough educational
resources. One participant claimed that working with
NDMU for ive years is like working together, journeying
together towards what they are now as an educational
institution. Stueart (2011) further claims that “throughpartnerships, individuals and organizations have enhanced
program development efforts for sustaining and increasing
productivity” and indeed this is visible in the two schools’
working relationship.
The relationship between NDMU and SCMSI personnel isalways at the center of activities. However, one of theparticipants shared that most of the time the community
outreach activities conducted in the school are planned by
NDMU groups that implemented their plans without
consulting the people. The participant feels that theteachers and students are just but recipients of services
rendered by NDMU. It is clear, that the activities are
centered on the plans of the clubs and organizations ofstudents which are anchored on the vision-mission of
NDMU but sometimes do not address the needs of theservice community.
However, despite the lack of consultation with theservice community, the personnel of SCMSI still
cooperatively pursued the activities because they believedin shared responsibility. One participant claimed that theactivities could be more proli ic if they were informed thus,
they could have suggested the most appropriate actions to
be taken to address the felt needs of the partner community.
As Lieberman (2000, cited in Silanes and Valero, 2013)
contends that “a shared responsibility emerges when theparticipants sense that network activities are aligned with
their needs and demands for support activities that canchange their own teaching practice”.

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Outcomes of Community Extension Program to the SCMSI
Community
The participants’ perspectives on the outcomes ofcommunity extension program of NDMU are discussed
below.
Positive Community Changes
Positive community changes can be considered as one of the
key underpinning outcomes that emerged from theparticipants’ perspectives. The participants were happy forthe contribution of community extension program that it
brought changes at SCMSI community. For example, theinstallation of electrical wires by the engineering students
in almost all buildings has brought positive effect to theservices of the school towards the students. One of theparticipants shared: “The engineering students made our life
as teachers easier because we can already work on our taskseven at night time without worrying that the old wires will
malfunction. I believe that NDMU is proactive in thinking of
this positive result for our school. We are grateful for thiseffort.” (p. 11, line 22).
Another participant shared: “NDMU donated a lot offacilities for instructional support to SCMSI such as
computers, books, kitchen utensils, sports equipment,laboratory facilities, AVP materials. These facilities helped
also upgrade the standard required from us by DepEd and
CHED.” ( p.11, line 25).
The positive changes in the community seemed to havemotivated NDMU to even conduct extensive activities. Mostof the community service providers were motivated by thehigh visible impact of the community-based intervention onpoor and vulnerable communities (Datiko et al., 2015).
The participants said that “students and pupils are also
assisted in terms of physical alertness and medical assistancethrough dental check-ups”. Indeed, the gratitude and positive
feedback shown by bene iciaries in the service community
is also a source of satisfaction for the groups that have cometo conduct their activities.
Moreover, when the participants were asked about thechanges brought by the extension program, one of themshared: “Community Agricultural and Educational Program(CAEP) department of SCMSI appreciates NDMU’s advocacy
in doing extension programs that bene it the indigenous
people in terms of learning and improving their talent. CAEP
department supports programs that motivate the student indifferent ields of learnings specially in agriculture. It isindeed important because the students can apply theirlearnings into real-life situations”. Furthermore, a goodnumber of graduates from the school who bene ited fromthe scholarship and are now part of SCMSI workforce; anevident outcome of the community extension program.
Increasing the Skills of the Workforce
The fact cannot be ignored that the shortage of skilledteachers in the Philippines is increasing. As an effect, manyeducational institutions hire teachers that sometimes lackthe quali ications and SCMSI is one institution that does
this. SCMSI administrators do not have the capacity to hireseasoned teachers and it has been hard for them to copewith the demands of the higher education that most of timecompromised the quality of instructions. Teachers are thebackbone of the educational institutions and a skilled andtalented workforce is critical for business success in all
sectors (Region Bulletin, 2004). The participants sharedthat the various support given by NDMU to the SCMSI staff
speed up the accomplishments of their requirements to theCommission on Higher Education and were able to makethem equipped with skills they needed. One of theparticipants shared:

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

NDMU assisted SCMSI Faculty and staff through thefollowing: curriculum development and syllabi-making,training for science and mathematics in the 21st century
teaching, training for our librarian and other related
activities was of great impact to SCMSI faculty development.
(p. 10, line 27).
Apparently, educational extension programs that range
from short-term information dissemination processes tolonger-term will lead toward transformation (Williams,
Dickey, and Hergert, 2001, cited in Hilliker, et al, 2007).
Indeed, the enhancement sessions conducted by NDMU
skilled-up the SCMSI workforce.
However, McCamby (2017), in the article “The Catalyst”
talked about the strategies for continuing education andworkforce development; and asserted that “both workforce
training and continuing education have become a criticalcomponent to maintaining a competitive workforce andpersonal enrichment. It can be vital to the individual
employee as well as the business as a whole” (p. 9).

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Interconnectedness of its People through Spirituality
Another emergent theme that came out from theparticipants’ perspectives on the explicit outcome of thecommunity extension program is the interconnectedness ofthe people in the community through spirituality. The
spiritual formation given by the Campus Ministry andReligious Education (CMRE) department has strengthened
the connections among the members of the community.
This is due to the spiritual guidance given to the students bymaking the Marist values known to them. By identifying
themselves as part of the Marist community, people in
SCMSI feel the interconnectedness of one another being
part of the mission of St. Marcellin. This connection among
the community members help them ind their life’s meaningand purpose.
The impact of NDMU community extension program to
SCMSI in terms of spiritual formation is that they are not
only bringing happiness but they also bring spiritual lesson
especially during the feast of one particular saint. Throughthis activity, our pupils learn more about the backgroundand religious deed of a saint which are not yet familiar tothem.
Many people ind meaning and purpose in their life andthe answers to their personal spiritual questions throughexperiencing connectedness. Connectedness can be seen as
being a harmonious relationship or 'oneness' with self,'other' (Willson and Suhud, 2016). This interconnectedness
is considered an integral part of any conceptualization of
spirituality and religion. However, in understanding these
themes, it is important to highlight the stand of NDMU inthe spiritual formation of students at SCMSI. As thespirituality of Tboli emanates from their culture, and as
NDMU respects culture as enshrined in its core values; theconsequence is, NDMU also exhibits high regard for Tboli
spirituality. As Wane (2007, 2009) ‘indicated that there isno need to name one’s spirituality, however one should
allow a space for it and provide space for students to de ine

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their spirituality from the roots or religious backgroundbecause the de inition of spirituality has to be open ended(Wane and Ritskies, 2011). Moreover, the extension
activities enabled NDMU students to learn from thecommunity people. The spiritual formation program
focused its activities on the cultivation of altruism andempathy and these activities teach the students the ways of
the Tboli people and the process enabled them toexperience their community life. “The community extension
experience brought happiness to us as they share to us stories
of Catholic saints, their hardships and their joy and theultimate meaning of their earthly existence”. (p2, line 18).
Further, spirituality teaches them about empathy.
Empathy refers to the ability to enter another's frame ofreference and sense the meaning in her or his inner world(Rogers, 1957, cited in Giordano et al., 2014). Two potential
predictors of empathy are religion and spirituality. Given
the empirical role of empathy in understanding the
behaviors of every member of the community, theparticipants’ perspectives that interconnectedness throughspirituality as one of the outcomes of NDMU’s community
extension is manifested in the physical and emotional
connections of the members during the retreats andrecollections conducted for them almost every year since
the collaborative partnership between two schools has
started.
Our pupils learn to develop companionship, giving of
happiness, sharing of blessing and love, and helping hands
to the needy. All these factors were being practiced during
Christmas season as NDMU always invite and welcome us tocelebrate with them the birth of our Jesus Christ. SCMSI
system is supportive of the same activity of campus
ministry in the school. We hope that NDMU continue tosupport our spiritual activity.
Contributing Factors that Affect the Implementation of
the Community Extension Program
Every program that reached its optimum level in achieving
its goals has contributing and hindering factors. These aretaken into account in order to improve the delivery ofextension services in the next communities.
Organizational Capacity
The capacity of NDMU to adopt SCMSI as its service
community is one of the contributing factors that made theextension program successful. It is one of the themes thatemerged. A number of school-based activities being
implemented by different colleges of NDMU are responses
to the needs and calls of SCMSI and have been said to beeffective at reducing behavior problems of the students andhelped them become resilient in facing challenges. These
are manifestations of the readiness of NDMU to share andextend help to the service community. However, theparticipants also view that there are certain gaps in theimplementation of the community extension program,albeit the well-designed interventions. Thus, it encourages a
relatively more variability in implementation system

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considering the context that is sensitive to geographic,
economic, cultural and other conditions (Spoth, Schainker,
Redmond, Ralston, Yeh, and Perkins, 2015).
As one of the participants shared: “It is hard to say if theassistance given is really answering the needs of thecommunity but still we are grateful to them. NDMU has all
the resources but sometimes these resources are not what thestudents need. I mean the gifts, the dole-outs that they giveare only temporary.” (p. 11, line 7).
Experience with Collaboration
The NDMU’s experiences in collaboration with otherorganizations greatly contributed to the smooth
implementation of the community extension program.
NDMU has been working with a number of NonGovernmental Organizations (NGO) for more than sevendecades already. The formative experiences of theadministrators and personnel promoted collaboration
among the NDMU and SCMSI communities. Collaboration
among faculty and staff employees has been suggested as ameans to attain a number of important outcomes to higher
education such as student learning and institutional
excellence (Markland, 2009). The participants shared that
NDMU administrators are seasoned in collaborating withSCMSI administrators, local government units and otherstakeholders.
Hindering Factors that Affect the Implementation ofCommunity Extension Program
Technological Barriers
Technology could make knowledge sharing and knowledgetransfer easier and more effective. It could createconnections between employees and an organization.
However, the lack of technology that can facilitate
knowledge transfer between the partnering organizations(SCMSI and NDMU) is considered a barrier in this case. For
instance, SCMSI lacks computer units and other resources
and they are still using the old system which does notsupport the nowadays requirements. Also, providing themwith new technology could be an obstacle because they stillneed training for its use. Moreover, the geographicallocation of SCMSI rendered it dif icult for fast internet
connections that they can use in of ices and classrooms.
This area has to be separately addressed if knowledgetransfer is expected during community extension activities.

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Different Organizational Culture
To ful ill its mission, SCMSI needs to operate within astructure that is best suited for its purpose as anorganization. In the process of partnership, lapses in theorganizational structures of SCMSI were identi ied by
NDMU, however, this area is not within the ambit of thecommunity extension services. For instance, it is noticeable,that that succession of leadership in the management of
SCMSI is not properly stipulated in their retirement policies.
Arbitrarily, this hinders the infusion of new ideas ande n e r g i e s i n t h e o r g a n i z a t i o n . M o re s o , N D M U
representatives noticed that job descriptions of the SCMSI

employees are not properly designated. Thus, there are
instances during the community extension that confusion
arose as to their responsibilities.

Insights and Implications
This study explores on the perspectives of Santa Cruz
Mission School employees on the community extension
program, as a Marist Welfare Arm of NDMU. This
undertaking is in consonance with the mandate that
universities and colleges shall perform an active andconstructive role in rural development. Universities need toadjust their programs to accommodate new teachingmodels and to foster partnerships with various institutions
such as schools and academia and rural space stakeholders.
Because universities and colleges can provide knowledge
for rural development; as such, they have the responsibility
to facilitate learning to those who work in the managementof rural development (Achaean and Holmes, undated).
The employees of Santa Cruz Mission believed that thecommunity engagement of NDMU improved the delivery ofclassroom instructions. Also, the support of NDMU in the
education program of SCMSI is extensive as it covers not
only the transfer of knowledge in terms of training ofteachers and students but also in terms of fund transfer andother donations in order for them to sustain their operation.
The engagement in SCMSI highlighted the importance ofleadership training among their students because theircommunity needs true leaders that are concern about
people’s welfare. However, leadership development does
not happen in the vacuum; additional efforts must be made.
According to the participants/key-informants of this study,
the leadership training programs and team-building
activities had a profound effect on student-leaders. This
study also inds out that if economic and community
development are to occur, it is the responsibility of theleaders to make it happen. Thus, the time, effort and money
for training student-leaders at SCMSI are properly invested
as future leaders are much needed by their community.
Preservation of cultural heritage is not new to SCMSI. It
is deep in the consciousness of people (Tboli) working at
Santa Cruz Mission because efforts on cultural preservation
and restoration have been made in the past by former
Catholic Missionaries who have long existence in Santa Cruz
Mission. In fact, the fruition of this effort has beenrecognized throughout the province of South Cotabato byhighlighting the culture of the people in the tourism
campaign of the province. Consequently, the conviction of
the people in cultural preservation is also demonstrated intheir efforts to promote indigenous peoples’ education.
Indigenous Peoples education however, has been
institutionalized by the Department of Education throughDepEd Order No. 62, series of 2011 which is entitled as
National Indigenous Peoples Education Policy Framework.
Thus, in reference to this, NDMU also showed support towork alongside the government by encouraging SCMSI tocontinue their advocacy of educating the Tboli children with
their culture as the core of their education. The support of
NDMU to all these undertakings would nurture a situation

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

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that will lead to respect and tolerance among different
ethnic groups in the province. This is in consonance withthe mandate by UNESCO that is “advancing through theeducational, scienti ic and cultural relations of the people of
the world; the objectives of peace and the common welfare of
mankind” (UNECO Constitution, 1945).
The teachers and students of SCMSI are not only
recipients of the extension services of NDMU, they also
provide critical local knowledge for the students and faculty
members of the latter. Thus, democratic participatory
opportunities are intangible but important outcomes ofuniversity-community partnerships (Fischer, 2009). This
democratic participatory approach was observed in the
conduct of community extension at SCMSI because theprojects being undertaken by NDMU were all suggested by
SCMSI at the onset of the extension program.
The extension activities enabled NDMU students to learn
from the community people. The spiritual formation
program focused its activities on the cultivation of altruism
and empathy and these activities teach the students theways of the Tboli people and the process enabled them toexperience the Tboli community life.
SCMSI has not woven into its organizational structure
the sustainability scheme of the projects after thetermination of its partnership with NDMU. This researchhighlights the need for capability building of SCMSI as anindependent institution. However, this research also agrees
with some scholars that capabilities are not seen as
exclusively within the ambit of community to develop but
broader social responsibilities are required. There is a needfor the management of SCMI to set long-term goals anddetermine strategies that will generate desired outcomes.
Moreover, this study shows that some improvements inthe community can occur through the willingness of theacademic institutions to share their expertise and relatedresources. This is evident in the partnership of NDMU and
SCMSI. It becomes a form of knowledge sharing as itpromotes mutual exchange between partner organizations(Donato, 2006). If students (NDMU) are engaged incommunity service and when their gained knowledge ispracticed, more effective learning will happen. As such, itwill result to integral formation of a person that is
manifested in a person’s commitment to uplift his/her
fellow human beings. This concept is further illuminated in
the thoughts of John Dewey which is both a philosopher andan educator. According to him, education is a continuousreconstruction of experience that promotes growth towards
social ends (Donato, 2006). He emphasized the importanceof “learning by doing” as opposed to authoritarian teaching
methods. He viewed the community as an integral
component of educational experiences that will enhance
students’ education and develop societies (p. 3).
Another implication is the development of the sense ofvolunteerism among NDMU students. The experience
derived from the volunteer works will help them in their
future career as this will provide enhanced knowledge intheir craft because of the real-world experience as97

application of their courses (Rubio, et. al, 2016). As argued
by Taylor and Keim (1999), the motivation of students involunteer work are varied i.e., resume, credit, recognition,
civic responsibility, understanding of others, re lective
communication abilities and community extension
programs. They are intended for the following; helping
others, changing society or laws related to social issues,
promoting personal enjoyment, gaining experience for
employment and raising money for a cause (p. 82).
Furthermore, Cha, Rotman and Smith (1994) argued that
community extensions programs are formed to foster
students’ experience and boost community resources at aminimum cost.
However, since this study focused on the employees ofSanta Cruz Mission, it also recommends that future
researchers will explore on the contexts of NDMU faculty
and students who conducted the community extension
program. Also, it is important that SCMSI students who
were recipients of the extension services can be part of theresearch undertaking to come up with a holistic view of the
NDMU community extension program.

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Maintaining grace under pressure:
Challenges and insights of teachers
who are mothers during the
COVID-19 pandemic- Rogelio P. Bayodroger.bayod@gmail.com- Erikka June D.Forosueloerikkajunedecrepito@gmail.com- Darwin A. Arnosadarwinarnosa@gmail.com- Hermogenes C. Orion, Jr.
orionjrhc@gmail.com- Jean M. Cavalida
cavalidajean@gmail.com (Corresponding author)
Cor Jesu College, the Philippines
Abstract
The outbreak of COVID-19 has forced schools to implement
online or blended learning system where students stay athome while attending to their classes and doing theirlearning tasks. While some parents are fortunate to be with
their kids and guide them in their educational journey,working mothers, especially teachers who are also expected
to guide other students, have faced additional challenges on
how to balance their time and attention to the needs andconcerns of their students online and also the needs andconcerns of their children who are staying at home anddoing their online classes. This present study focuses on thechallenges, coping mechanisms as well as insights andsuggestions of teachers who are also mothers of pre-schoolor elementary children. We argue that many of the teachers
experienced various challenges especially on how to double
their effort to satisfy the needs of both their children andtheir students; they developed an attitude of grace underpressure because they were left with no other choice but toembrace this so-called new normal. Many of them believedthat as human beings, they are gifted with utmost
capabilities, lexibility and resilience to face all thechallenges and more importantly, to play the role expectedby the family and workplace. But still, they have the desirethat employers will be considerate on their present
predicament by not requiring them to go to school and to
submit plenty of paperwork. In addition, they wish that
employers will provide them moral and inancial support tocombat the pandemic.

Introduction
Grace under pressure means that an individual is not
nervous in a given predicament instead acting agile inholding one’s composure. Feeling pressured is notuncommon to most people. We experience inancialpressures, social pressures, career and professionalpressures, relationship pressures in marriages,
partnerships, parenting, and more. In today’s new normal
because of the pandemic, mothers with academic jobs try tobalance duties in school and responsibilities of guiding theirchildren in their online classes. With activities and tasks
piling up, these teachers who are also mothers slowly
develop pressure. According to Doubt (2018), pressure is afeeling we generate inside of us in reaction to outer stressful
stimuli. And every time we feel pressure, we tend to getback our energy from the constant state of worry andurgency. Imagine making a balance between duties andresponsibilities at work and performing motherly activities
that also entail full energy to guide the children to cope withthe demands of online classes apart from routine household
jobs. Academic mothers have to deal with work and family
con lict because simultaneously complying with both would
only mean dif iculty in compliance with the other.
According to Manzo and Minello (2020), the lockdown
has exacerbated gender disparity, since women, especiallythose with children, spend more time in care activities thanthey did before. For working mothers, they must ensure thatboth tasks are maintained well enough to be able to address
work and home related responsibilities. Clark and Knights(2015) mentioned that aside from the uncertainty causedby the pandemic, insecurity and stress have always existed
in the academic career path. This can also bring pressure to
the teachers who are mothers because there is an
overwhelming demand in the area of teaching in this newnormal. They need enough courage, and it is the grace
under pressure that enables them to maintain thecomposure and a sense of security so that they can handle
all the pressure.

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What motivated us to conduct a study on the experiences ofteachers who are mothers of pre-school, kindergarten andelementary kids and are having online and/or modular
classes was the thought these mothers might be facing greatchallenges during this time as they are expected to assist
their kids and at the same time as teachers, they are
expected to do their tasks of educating their students andother functions by their supervisors. As teachers we have
irsthand experiences of how challenging education in the“new normal” is. We experience sleepless nights preparing
lessons for online classes as well as modules. We also
experience adjusting our budget in order to buy the neededgadgets for online classes and in securing “strong” internet
connection/signal. But these adjustments and dif iculties
that we experience, are simple compared to the experiences
and challenges faced by our colleagues who are mothers.
Thus, we decided to conduct this study. We interviewed
teachers who are mothers of pre-school, kindergarten andelementary kids. We limited our selection to only teachers
who are mothers of pre-school, kindergarten andelementary kids because these kids need special attention
and guidance from the mothers and other adults in thefamily as regards to online and/or modular classes. We
asked for their consent and explained to them the purposeof our study and assured them that their names will not be
divulged and if ever they feel that they do not want tocontinue with the interview they can withdraw anytime. We
were able to get 15 participants for this study. Because of
the pandemic, we conducted our interview via Facebook
messenger. Following Colaizi (1968), we carefully read andre-read the statements and looked for emerging themes.

Results and discussion
We organized this section according to the following
research questions: 1. What are the challenges/dif iculties
you encountered as a teacher at the same time a mother ofsmall children having online and/or modular classes athome? 2. How did you cope with the challenges/dif iculties?
3. What lessons/insights did you get from your experiences?
and 4. What do you think can the school administrators do
to help you?
Challenges/dif iculties experienced by teachers who
are mothers of school children
A challenge or dif iculty that is enough and proportionate topeople’s capacity is an impetus to ignite creativity andresourcefulness among individuals who have experienced it.
However, a challenge or dif iculty that is too much may
break a person. Indeed, a challenge or dif iculty may either
make or break a person. For the participants of our study,
the challenges or dif iculties that they experienced asteachers and mothers of small children doing online and/or
modular classes at home during a pandemic fall into thefollowing themes: dif iculty in managing time and their tworoles, inancial constraints, and physical as well as emotional
exhaustion.

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Dif iculty in managing time and their two roles (teachersand mothers). Asked about their challenges and dif iculties
as teachers and as mothers in the “new normal” mode ofeducation, they all mentioned experiencing dif iculties andchallenges in managing their con licting time as teachers
expected to conduct online and/or modular classes to theirstudents while also assisting their kids with their online or
modular classes. There was dif iculty in managing their timesince most of them said that the schedules of their online
classes were the same with the schedules of the online
classes of their kids at home; they also experienced
dif iculty in managing their roles as teachers and as
mothers. As much as they would like to be with their kids toassist them and to inspire them, they are also expected to
conduct classes and guide their students.
This is beautifully captured by one participant, a college
professor who is also a mother of two kids who are preschool and elementary students, when she said: “Although I
learn to multi-task, I have dif iculty in terms of giving quality
time for my kids and to assist them in their school tasks. As an
educator, I want to be hands-on in terms of academicallyguiding my children while they are having classes at home,
but I am limited because of my duties and responsibilities inschool. In most instances, our class schedules are the same, so
I have to stop for a while to attend to the concerns and needsof my kids when they are also having their online classes. It isvery stressful. It disrupts my on-going online classes.”
Since their kids are having their classes at home, all ofour participants really wanted to assist their kids with their
online classes, but they cannot just do that because theyalso have online classes to attend to. It became morechallenging when they only have one gadget like laptop at
home and they have to share this gadget with their kids. In
fact, one participant said: “As a working teacher/mother witha kid who is also having his online class, there are several
challenges that I've encountered. One is when we are having
con licting online classes and we only have one laptop
available. Another challenge is when no one is available toassist my son during his online class because everyone in thehouse who knows how to utilize the laptop is busy.” This was
supported by another participant when she enumerated all
the challenges that she experienced such as: “juggling thetime to prepare their materials before 8:00AM and making
sure that all links are working well, connection is stable,
modules are prepared. In terms of monitoring, I fear that they
are going through tough times coping with the new normal. I
have less ability to monitor their activities, behavior and theirprogress.”
Aside from dif iculty in managing time, all ourparticipants had dif iculty in managing their roles asteachers and as mothers. One participant who is a single
mother empathically narrated her ordeal: “I have to balance
between four (4) roles: Being a college professor, I have todeal with my teaching loads plus I have to check if mystudents are still on track and if they have dif iculties, I haveto adjust to it. I set deadlines but still accept late submission
and send feedback on their work. Aside from that I also talk tothem to encourage them to continue, because some are now

experiencing frustration due to their home related problems
and internet connectivity. As a mom, I have to guide mydaughter on her online class, have to check her output and at
the same time allocate time for her tutorial lesson specially inher math subjects. As a father, since I'm a single mom for 11
years, I have to engage in other jobs, like engineering related
works to have suf icient funds to compensate for our dailyneeds and to pay for our rent and buy essential stuff. As around-the-clock helper, I have to do all the household chores
from preparing meals, doing the laundry and doing thecleaning.”
Indeed, education in the “new normal” where students
are forced to stay and have their classes at home, is very
challenging not only to the students but also to the teachersand most especially, teachers who are also mothers. In the
study by Bayod and Bayod (2020), they found out that mostparents who were teachers shared that it was dif icult forthem to really guide their children during the free online
tutorial program that the educators had offered to children
during the early onset of the COVID-19 pandemic. They pilot
tested their program last summer to ind out how thestudents and parents would receive and assess it. Whilemost of their parents and children found the program very
helpful, they also reported signi icant challenges and one ofthose was the time the parents needed to monitor their kids
since they also had work to do.
The demands on working parents in the new normal
are stressful, and illogical. The burden on mothers tends tobe worse. According to a large biological study of eleven key
indicators of chronic stress levels in the UK, working
mothers with two children were found under pre-pandemic
conditions to be 40% more stressed than the average
person (Chandola et al., 2019). These working mothers haveno choice than to serve both jobs which would meansacri icing the quality of the other task because it is dif icult
to serve two at the same time. Though quarantine meansthat time shared with loved ones has increased, it also posesa major burden on parents’ shoulders, as they are called totake an educational role while also trying to live their own
lives and get on with their everyday job commitments. Thissituation has signi icantly increased the risk of experiencing
stress and negative emotions in parents, with a potentiallycascading effect on children’s wellbeing (Sprang and Silman,2013).
Financial constraints. Another theme that emerged fromthe answers of our participants to our interview questions
was inancial constraints. This is because they were caught
unprepared for the inancial implications of the pandemic.
Most of our participants did not have stable internet
connection in their homes. In addition, they did not buy
separate laptops for their pre-school, kindergarten andelementary kids. Thus, when this online and/or modular
classes at home were introduced as the “new normal” modeof education, it resulted in inancial struggle. Ourparticipant who is a single mom shared her inancial
struggle: “I need to have my own laptop and my daughter
should have her own. Plus, I need to invest in internet

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

connectivity, I have to spend 1,000.00 per month on each
modem to lessen connection related problems.” This was
supported by another participant when she said: “I need tobuy a new gadget for them to join the class.” The same
concern was shared by another participant: “I have dif icultyin terms of availability of laptop. At irst, what I have isenough since the kids are having cellphones and I have my
laptop but phones are not enough, so I need to buy laptops for
my two kids but it’s not in my budget.”Since the home turned into the classroom, some parents
have not prepared for their role as teachers. Many parents
struggle to perform this task, especially those with limited
education and resources (Yan, 2020). The most basic needs
in today’s pandemic are internet connectivity, laptop, andcellphones to be able to join online classes and cope withthe online requirements. Some parents are not privileged
with these resources and yet they tried to meet ends just to
sustain their children in their online classes. The cost andcoverage have become the main problem in joining theonline learning platform. This is supported by Marcial et al.
(2015) inding that the most severe barrier is the issue of
cost and access to the internet.

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Physical as well as emotional exhaustion. Most of ourparticipants experienced physical and emotional stress.
They shared that their patience was tested during this time.
For instance, one participant said: “I experienced lack ofsleep and not being on time during meals since I was given
subjects that are not my "common" teaching loads just to
cope up with the load requirements of the college. I have toallocate time to prepare for the module and should upload it
to google classroom before starting an online class withthem.” This was supported by another participant when she
said: “I am physically and emotionally exhausted. It is indeed
tiring, so tiring making modules and monitoring students
while checking on their works of the day.” Anotherparticipant said: “every day is a struggle for me as a momwith kids having an online class, especially dealing with mygrade 1 because our day will depend on the mood of mydaughter. I have to wake up early to attend the needs of mykids before their class and my class. I have to take theresponsibilities and role of their teacher and sometimes they
will not listen to me. It is so tiring both physically andemotionally.”
While many parents have lost their jobs, others havelearned to work from home while simultaneously assisting
their children in various virtual activities. Balancing
everything may take more time throughout the day and may
require parents to engage in more work activities outside of
their typical work hours, after schooling ends for the day orchildren have gone to bed (Grif ith, 2020). This leads
parents especially mothers to feel physical and emotional
exhaustion because of the new task they engage in andmajority of these tasks are new to them which requires aperiod of adjustment to get used to it.

101

How do they cope up with their struggles?
People commonly develop coping mechanisms when theyencounter different problems. Our participants shared how
they coped with the challenges and dif iculties theyexperienced as teachers and mothers. As we analyzed their
responses, we found out that their answers fall into thefollowing themes: time management, self-motivation,prayers and presence of mind.
Time management. All of our participants have time
management skills because they have many roles to play inlife. However, this new educational set up has pushed themto manage their limited time even more. In fact, one
participant said: “I learned that time management is not only
important but a must in today’s realities. I have to scan
modules of my kids ahead of time so that I will be oriented on
their lessons because I am the one tutoring them in theirlessons and then I also do advance studies for my own classes
with my students.” Time management also helps them inmanaging their limited gadget such as laptop. For instance,
one participant shared: “whenever we have con licting
schedules, I just have my class at school using the of ice
computer and my phone. And when no one is available in thehouse to assist him because my husband is also very busy as afront-liner, I usually go home and assist him with his class fortwo hours.” Another participant says, “I manage my time welland set my motivation goals on a daily, weekly and monthly
basis.”
Time management is a discipline according to Gresakova
and Chlebikova (2020). Ef icient use of time means
following certain rules and being maximally focused onyour work. Teachers who are also mothers graduallypractice time management because it will enable them tosave time and energy in performing their duties andresponsibilities. It is not an easy task to have two or moreroles. It takes courage and determination to be satisfactoryin both jobs. The more these mothers are exposed to similar
circumstances every day, the more they become resilient infacing the challenges brought about by the new normal.
Self-motivation. Most of our participants shared theircoping mechanisms which fall into motivating themselves toface the present situation and accept it. For instance, one
participant said: “to perform many tasks is truly challenging.
But because I am left with no choice, I have to accept mypredicament and be positive with the situation. I conditioned
myself that I have to deal with the new normal because morethan the demands of my job, my kids need me even more inthis time of pandemic.” Another participant said: “I justmotivate myself and I am just thankful that I still have my job
to support my family’s needs.” Another participant said: “Ijust stay calm and positive by motivating myself that these
dif iculties are just temporary.” Believing that everything will
just pass is a good coping mechanism for many people. Thisis an example of a “one liner” that helps people endure thedif iculty they experienced (Bayod, 2020). Indeed, in the
midst of the many challenges they experienced, theyEubios Journal of Asian and International Bioethics 31(2) (February 2021)

developed self-motivation to be able to keep their sanity.
This is beautifully captured by one participant when she
said: “I need to encourage myself to be more patient andavoid showing a bad temper to my daughters. I also motivate
myself that I can really overcome all these dif iculties throughprayer and hard work.”
Self-motivation is the force that keeps persons going on– it's the internal drive to achieve, produce, develop, andkeep moving forward. For mothers who maintain dual tasks,
there is a need to condition their selves to sustain them anddevelop resilience during critical and dif icult times. All
mothers are working mothers, striving under the fallacy
that things will look up, sleep cycles will auto-adjust, moodswings will halt, dark circles will disappear, and she willrevert to work relishing in the afterglow of conception thatrarely happens. Most mothers are exhausted, guilt-ridden,
tired, and ighting, whether they work at home or workfrom home (Wives, n.d). With these various roles expectedof working mothers, self-motivation can be very effective in
unleashing negative thoughts and conditioning oneself to be
tough because the family especially the children rely on
them.
Prayers and presence of mind. A lot of our participantsalso shared that prayers and presence of mind help them a
lot in terms of coping with their dif iculties. Indeed,spirituality is a very important resource for people to deal
with any struggle or problem that they face (Bayod, 2020).
This is true to many of our participants. They said that they
resorted to prayer in order to help them cope with thechallenges. For example, one participant said: “constantprayer and presence of mind really keep me sane during thistime of pandemic.” Another participant said: “I began to be
more prayerful and to meditate. It helps me ease the physicaland emotional burden.”As many have said, this is a wonderful time to develop astronger relationship with God by concentrating on
personal religious activities. According to Koenig (2020),
when life was “normal,” one might have been so busy that
there was no time for spiritual matters, with hobbies, jobs,
housework, recreational activities, social and family
activities illing up every moment of the day. Now that
normal activities have virtually come to a halt, there is lotsof time for activities that will help build spiritual health. It isbest to pray to God and ask for his Divine intervention andmore so, focus on doing what is best for the family mostespecially for the children.
Insights of teachers who are mothers
We also asked our participants about the insights they getfrom their experiences. Their insights fall into the following
themes: Life is a matter of choice and trust in peoples’
capacity.

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Life is a matter of choice. All them shared that indeed they
still have a choice in terms of responding to the challenges.
This is beautifully captured by one participant who said:“Because we carry ourselves to this situation, we are also

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responsible with whether or not we succumbed into fear of
the unknown or to embrace the changes brought about by the
unknown.” This is supported by another participant when
she said: “Even when life hits you hard, the decision will
always be coming from you whether you want to overcome or
let it sink you. And that even in struggles, one can see the true
colors of those people surrounding us. And that this pandemic
brings out the best and worst in us, and its upon us who will
emerge more. This also gives me enough time to rethink andre lect on my life choices.” All of them chose to ight because
they have their families to support and sustain.
During uncertain times, workers look for trust,compassion, stability, and hope from their leaders; people
want to be part of the solution and are incredibly resilient
when action plans are clear (Harter, 2020). Working
mothers need psychologically safe environments to protect
the well-being of their families. As they start to develop
resilience, they have inner fears and need not only theirown self to help them get going but also the people thatsurround them play a big role during this dif icult time. This
type of environment boosts self-compassion and self-carewhile building resilience among workers; organizationaland employee resilience help control mental health issues
that may interfere with work–life it (Blake et al., 2020).
Trust in peoples’ capacity. Another beautiful insight sharedby our participants is their belief in human potentials. One
participant said: “I believe that human beings are gifted withutmost lexibility and intellect to be able to adjust to a given
situation.” Another participant says that “she needs to trustin her students’ capacity to learn and be productive even in
online classes”. This participant said that she fears thatmaybe her students cannot really learn many things fromher. She further said: “she also needs to trust in the capacityof her kids to cope up with their studies even if she is notalways there to guide and assist them.”
It is said that capacity is the ability or power to contain,
absorb, or hold. Human beings are gifted with intellectual
capacity that can either make or break their life. Resilienceis strongly predicted by the cultivation of social support(Ozer, Best, LIpey, and Weiss, 2003) and adaptive skills(Burton, Cooper, Feeny and Zoellner, 2015), suggesting it islearned and acquired. Individuals and communities canin luence one another to cultivate resilience.
What help they need from school administrators?
To be able to rally for some support from the school
administrators, we asked them what the school
administrators can do to help them. Their answers fall into
the following themes, be considerate and provide someinancial support.
Be considerate. All of them wished that school
administrators be considerate of their circumstances by
allowing them to have lexible time schedules in theirrequired school attendance and also in the submission
deadlines of their paperwork and other tasks. Some evensaid that they hope school administrators would allow themEubios Journal of Asian and International Bioethics 31(2) (February 2021)

to bring their kids to their of ices: “for us working mothers,
they need to give us special consideration by giving us time togo home early from work” according to one participant.
Another says, “I hope the school administrators will beconsiderate with the demands of paperwork that can add toour burdens. This is a give and take relationship. In return, we
will also make use of our own initiatives to help the school
sustain in this trying time by providing quality education to
our students.” Another participant said: “I think the school
administrators must consider us teachers who are also
mothers/fathers to give us time to assist our kids during theirmodular/online classes because it is during these times thatthey need also our constant support and assistance as theirparents.” One participant said: “I hope the administration
sees what we are going through right now, I know it is notpossible, but I would love to bring my child once in a while toschool just to assist him during his online class. It is his
outmost desire to be in school. And I think this will help him
cope with his boredom at home.” She further said: “I would
appreciate allowing us to be home earlier. Going home at 4 isgreat.” A teacher who is a single mom said: “theadministration can help us, by not requiring us to bephysically present in school and in those activities that are
not essential.”
Research suggests that when people at work are treatedwith kindness, energy levels are increased, biologicalmarkers of stress such as blood pressure are lowered, andpeople feel more satis ied with their job. Productivity also
increases (King’s College London, 2020). If employers are
more considerate to their employers, they learn the value oftrue service and dedication. In this trying time, putting
oneself in the plight of the other helps one realize that being
in a situation with no choice other than to embrace the newnormal entails understanding on both the employee and theemployers.

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Provide some inancial support. They also hope that
school administrators will provide some inancial support
in the form of subsidy to internet and loans to buy gadgets
such as laptops. For instance, one participant emphaticallysaid: “And I think, a lot of parents are struggling right now
with inances, if they can allocate special loans that would be
an option. Another thing, instead of requiring a 7.0 load andreducing some loads, I think it's time to change that system,
since other schools require only a min of 6.0 loads to theirfaculty. …. It's time to show their compassion to their faculty
and staff.” Another participant said: “I think the school as myemployer can at least help us make our lives a lot easier by
providing us both moral and inancial support to combat the
pandemic.”
In these challenging times, inancially vulnerable
individuals need support to maintain inancial activity. At
the same time, there is a delay in income, unexpected loss of
income and a severe change in circumstances, and these
individuals need to pull through. Individuals going througha vulnerable state must be resilient, they should have theability to bounce back, adapt to changing circumstances

103(Salignac et al., 2019) and withstand inancial or emotional
shocks (Mogaji, 2020). It is signi icant for the teachers who
are also mothers to be given inancial assistance and related
considerations. The administration’s ingenuity in crafting
favorable considerations to both parties becomes very
challenging because it is understood that everyone isaffected by the pandemic.

Conclusion
Working women play various roles in managing career
while attending to household duties and responsibilities. In
this pandemic, their jobs have become more complex
because they have to deal with many changes that takeplace especially in their children’s modality of learning. This
holds true for teachers who are mothers as they are torn
between performing their task as educators while at thesame time guiding their children to cope with their online
classes. The challenges and dif iculties they encounter are inmanaging time and their two roles, inancial constraints,
and physical as well as emotional exhaustion. These
teachers/mothers are able to deal with their predicaments
through time management, self-motivation, prayers andpresence of mind. With their work and household
experiences in the new normal they realize that life is amatter of choice and that trusting in people’s capacity isfavorable to learning the value of resilience. It is theirappeal that school administrators would be considerate andat least provide inancial support or be resourceful andcreative in designing ways and means to help the employees
manage the critical times because this is a way to motivatethem to become productive and ef icient at work even in achallenging work set-up. Maintaining grace under pressure
becomes a necessity now for working mothers. It is
important that they learn how to keep up with pressure andstill uphold their composure to be able to concurrently
manage the demands of their work and the loads of being amother to children experiencing the consequences of theCovid19 pandemic.
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Experiences from my Mandatory
COVID-19 Quarantine Upon Arrival
to Turkey from the USA- Esra Bilir, M.D., CEEGH
Senior Research Fellow, American University of Sovereign
Nations, Sacaton, AZ 85147, USA
Email: esragbilir@gmail.com
ORCID: https://orcid.org/0000-0003-4499-6543
It gives me great pleasure to share my mandatory
coronavirus disease 2019 (Covid-19) quarantine experiencein Ankara from 25 April 2020 to 8 May 2020. This
experience was deeply in luential in terms of my own healthand experience as a junior medical doctor. I will evaluate it
based on the World Health Organization's de inition ofhealth (1). Brie ly, it has three components: physical,
mental, and social well-being.
I had the Turkish Airlines evacuation light ($899.10 perperson) that was solely for Turkish citizens from Los
Angeles, the USA to Ankara, Turkey. The Turkish Embassy in
Los Angeles contacted Turkish citizens regarding thisspecial light. To buy a ticket, one had to accept the
fourteen-day quarantine. There was no business class ticket
as they were reserved for the elderly and the passengers
with children. The plane was almost full (only 20 empty
seats); thus, no physical distancing. All the passengers were
wearing different types of masks, such as surgical andfabric. However, the correct use of the masks was visibly
low. Although the majority of the passengers were young,there were also elderly (>65 years-old), pregnant women,
and newborns. The cabin crews were wearing disposable
protective gear, mask, and goggles, which will be referred to
as full personal protective equipment (PPE) in this paper.
The cabin crew provided masks upon request. During thethirteen-hour long direct light, only packaged food wasdelivered twice (Figure 1).

Figure 1: Packaged food including water, juice, pastry,
sandwich, cake, cracker, and dried grape and tissue given
during the light

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Once we landed at Ankara Esenboğa Airport, thepassengers were told not to take any pictures by anannouncement. The of icials from the Ministry of Healthmeasured everyone's temperature with a non-touch
thermometer . Our passports were collected. It took almost
an hour to start disembarking from the plane. Later, they

announced our full names, one by one, to leave the plane.
Herein, they violated our
privacy by giving our fullnames. Alternatively, they
could have announced
our seat numbers, whichwere unique. We
collected our passports
and collected our luggage(Figure 2). We did notenter inside of the
airport.

105

could be a perfect example of promoting mental and social
health during our stay. However, it is worth giving credit tounlimited internet due to the fact that we use it to interact
with other people. I think providing internet access wasvery essential for me to maintain my contact with my family
and friends who were worried about me and needed to seethat I was ine and safe. I believe internet access played avery important role for my mental health.
Figure 3: A) bed, bath towel,
hand towel, disposable slippers,
and prayer rug;

Figure 2: Collecting ourluggage and getting the
bus

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Four parties managed our stay at the dormitories: i) The
Disaster and Emergency Management Presidency (AFAD),ii) Turkish Red Crescent Society, iii) the Ministry of Youthand Sports, and iv) the Ministry of Health. We went to thedormitories by bus, during which the rule of physicaldistance was followed. During this travel, we learned fromthe driver where we would stay for the irst time. When wearrived, the of icials with full PPE cleaned our luggage withdisinfectant. They helped us to carry our luggage to ourrooms. Single people were given single rooms, whereasfamilies could choose to stay together.
The rooms had private restrooms and bathrooms, study
desk, chair, 24-hour hot water, 24-hour heating, fridge, andunlimited internet. The rooms were equipped with many
essential items, including many toilet papers (Figure 3A and
B). Unfortunately, there was no key to lock the door. The
informed consent papers, a notebook to share ourquarantine experience, a paper asking our contact
information and medical history, and an information sheet
about the daily routines, Covid-19 precautions, and contact
information were also present at the rooms. Due to the
Covid-19 risk, our rooms were not cleaned by staff.
Nevertheless, they provided all the necessary equipment toclean the rooms. However, it remains unclear if the people
who needed help for this received any help from any of thestaff. Overall, these re lected Turkish hospitality and oursocial government.
All the staff always strictly wore full PPE during our stay.
The daily routine for 14 days included the delivery of
breakfast, lunch, dinner, hot water, at least two liters ofdrinking water, bread, fruit, tea, coffee, sugar, and several
disposable cups. A representative image of breakfast andlunch/dinner was shared (Figure 3A and B). Daily market
service was also offered to buy junk food, fruits, andtobacco. It was disappointing to see the selling of tobaccoand also junk food. Once, they delivered a packet of
chocolates. The of icials working for the Ministry of Youthand Sports offered us to choose a gift book among many
international and national novels, such as The Little Prince,
Madonna in a Fur Coat, and The Ballad of Ali of Keshan. Thisff

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

B) a package of wet wipes,
shampoo, shower gel,towel, water (2 L), pen,iber scrub, liquid soap,
cartoon cups, thermos
vacuum lask water bottle,
apple, orange, tea bags,
coffee, sugar, notebook,garbage bag, and cologne.
Figure 4: A)
Breakfast includingb r e a d , p a s t r y,
tomato, cucumber,cheese, olives,butter, jam, andegg;B) Lunch/Dinnerincluding bread,juice, salad, soup,bulgur pilaf, chicken,
and milk
L a t e r, o f i c i a l scollected the signed informed consent form. However, they
delivered the same form twice and collected them as well.
Although there was a part to ill in by an authority that
informed us, we were not verbally informed, which was
highly reasonable during the pandemic, instead, we only
read the text and illed in the necessary parts. They also
gave us a one-page survey to evaluate our stay at the
government dormitories on a scale to none to excellent. I

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

assume that we all had the question of when and how wewould go to our homes since the beginning. On 30 April
2020, a person from AFAD came and informed me that I
would leave on 8 May 2020. Once I said my family could notcome to pick me up, he said that AFAD would.
As part of the daily routine, the healthcare professionals
measured body temperature by non-touch and assessed theCovid-19 symptoms (dif iculty in breathing, cough, and sorethroat). They questioned whether I use any medication
regularly due to their chronic condition and, if so, provided
them. We left our rooms twice for Covid-19 testing on 27
April 2020 and 6 May 2020. The healthcare professionals
collected samples from the tonsils and nasopharynges,
bilaterally. The day after the testing, the results wereavailable on the "E-Nabız" that is a national online system toreach health data. These were very important for ourphysical well-being.
Around 9.00 am on 8 May 2020, the of icials started thedeparture by announcing the full names of the people andasked them to come downstairs with their luggage. Herein,
the second time they violated our privacy by giving our fullnames. Alternatively, they could have announced our room
numbers, which were unique. The personnel, wearing only
surgical masks, helped us from dormitories to buses forcarrying our luggage. Before getting to the buses, ourluggage was cleaned with a disinfectant like on our arrival.
We were seated according to the physical distance on thebuses—only a couple who stayed in the same room during
the quarantine sit together. For the third time, they violated
our privacy by giving our full names on the buses to checkthe list of the passengers. Since the intercity travel was
forbidden in Turkey, the buses had of icial approvals to doso. The people who were going to close cities had the samebus. For example, I shared the bus with people from Antalya,
Denizli, and Burdur. The deliveries were only to city centers,
not the towns. Wearing a mask was mandatory during thetravel. Unfortunately, the proper mask-wearing was low
during bus travel like the light.
In conclusion, I summarized my mandatory fourteen-day
quarantine due to coming from the USA as a young
physician. Overall, it was a positive experience. Whenconsidering the three components of being healthy, it was
clear that the Turkish government had all the efforts
without any charge. Although on several occasions, privacy
was violated, and informed consent was obtained
improperly, it was understandable due to the chaotic
pandemic environment. However, the suggestions made inthis article should be followed for the people who will
undergo the mandatory quarantine.
Finally, I would like to thank the university students who
had to return their homes for us to stay in their rooms, all
the personnel who treated us with great empathy, andmostly the healthcare providers for their endless efforts toight against Covid-19. The critical feedback provided by
Kubilay Kaymaz, M.D. was greatly appreciated.

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Reference (1) Preamble to the Constitution of WHO as adopted by
the International Health Conference, New York, 19 June - 22 July
1946

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106

A Reflection on Life in the United
Kingdom during COVID 19 Phases- Rhyddhi Chakraborty, Ph.D., FHEA
Programme Leader, Global Banking School, London, U.K.
Email: rhyddhi.chakraborty@gmail.com
London, United Kingdom, being a multicultural andcosmopolitan city, gives enough opportunities to interact
with people of diverse background. On the auspicious day of
Buddha Purnima (7 May 2020; Birthday of Gautama
Buddha), I irst sat to pen down my experiences of
COVID-19. I re lected on this and tried to capture mymemories of the discussions on COVID-19 with Chinese, Sri
Lankan, American, and Bangladeshi colleagues and, ofcourse, our students from parts of the world.
In December 2019, when COVID19 was spreading in
China, sitting in London, United Kingdom, one of myChinese colleagues shared that a particular kind of fever
was already circulating in China from November 2019. With
Chinese New Year in January 2019, more people travelled inand out of country, worsening the situation and prompting
government of icials to take necessary steps, evenmonitoring social media websites and controlling theinformation low about this newly circulating fever. As
China’s lock down strategy was catching global attention,
my colleague mentioned that her mother got stuck in a local
temple when lockdown was announced in their native state.
Just as she was getting worried about the situation backhome, she was also sharing the news of how people wererespecting the lockdown measures, staying at homes,
counting 100s of seeds in a strawberry to be entertained,
engaged, to pass the time. She also mentioned how the local
councils were visiting each and every household, helping
people with food and other necessary stuff. Our discussion
about the new disease in China continued, this new fever
was named as COVID-19 and was gradually taking the formof pandemic. By mid-February 2020, my Sri Lankancolleague reported that they had only about 4 cases and she
was very pleased with the Sri Lankan government’s
strategic measures in dealing with the cases.
The irst reported case in the United Kingdom wasreported in the news in late February. On 11 March 2020,
COVID19 was declared a pandemic. As the news broke out,me and my colleagues started discussing about essentials:
masks, gloves, sanitizers, paracetamol, we need to stock. As
we were keeping eyes on the daily increasing numbers, wewere getting aware of the medical emergency in near future.
As a higher education institution, we also started giving
calls to our absentee students on daily basis to enquire
about their health and safety. And our campus started being
sanitized often.
Meanwhile, I got to know that shortage had alreadystarted in local supermarkets for sanitizers, toilet rolls, eggs
and milk. Our online surveys also resulted in prolonged waitfor delivery of masks, gloves, sanitizers and even some food
stuffs but I managed to order different kinds of masks,

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sanitizers, and toilet rolls through Amazon and received themessage that these cannot be delivered before April.
Perceiving the inde inite shortage of sanitizer and masks, I
even called my mother back in Kolkata, India to parcel somebottles of sanitizer and masks for us, of course, keeping her
safe share intact. For, Kolkata had not had any COVID19
cases at that time.
The situation was turning grim, with spiking numbers ofmortalities and morbidities. On 16 March 2020, Prime
Minister Mr. Johnson, in his daily brie ing, advised everyone
to work from home, if possible. Many academic institutions,
including schools, local parks and shops were shut from thevery next day. My husband was already working from home.
Myself, being in teaching, was going to work as we did nothear anything from the awarding body and Department of
Education. Fear, anxiety of catching infected aerosols on
public transport and use of mask and sanitizer became mydaily companion, whenever, I was outside the house. I was
getting more concerned about social distancing andpersonal hygiene. Meanwhile, as teachers, we were in aprocess to complete the whole curriculum throughclassroom teaching, conducting students’ presentations. I
also heard through my students that few nearby schools andpeople from local communities were found to have positive
COVID cases. This was only the second week of March 2020and I could feel a chain of infection spreading from one
community to another, from Brighton to York, from London
to Glasgow. Shall I consider this as my awareness or concern
or am I being too anxious unnecessarily- I was not sure atthat time!
I continued to travel to work, with more than an hour
journey through public transport and gradually I observed
how the public transports were getting emptier day by day
even in the rush hour. Anticipating the worse time ahead,
every evening while returning from work, I was doing myfood shopping, in bits and pieces. One evening, I went forfood shopping to a big brand of Supermarket near Bethnal
Green Station and I overheard a staff staying that they are
two weeks short of milk, eggs, toilet rolls, sanitizers. The
saying saddened me for a while, for, I never imagined that I
will witness such a crisis situation ever in my lifetime! As I
tried to introspect on the shortage, I observed a stark
shadow on the face of the elderly customer speci icallylooking for those materials.
My search for eggs that day, made me visit different
shops and resulted in buying 30 eggs in bulk with a goodprice. The reason being the shopkeeper prioritized me as awoman who needs to take care of the family! Indeed! I am awoman and I have to take care of my beloved. That day,while walking back from the shop, diverse thoughts
emerged in my mind; if being in the UK, I face food scarcity,
shortage of sanitizers and other essentials, what aboutothers in the developing countries? what about my mother?
other elderlies? how will they be able to manage and copewith the situation irrespective of their geographicallocations, if the crisis take control of the whole globe?.

107

Being concerned, it became a every-day custom to keep
an eye on the media brie ings either by the PM or by top
government health and non-health of icials. When thedeath toll reached 1000, on Sunday 22nd March, I informed
my line manager that considering the safety of all, I shouldbe permitted to work from home. As my request was underconsideration, on 23rd March 2020, PM Mr. Johnson,
politely asked everyone to stay at home except the key
workers such as healthcare staff, social care staff, volunteers
working in health and social care sector, bin collectors, foodsuppliers, postmen and other key workers including
teachers to teach children of key workers. Restrictions werealso put on place to close all community parks, garden
centres, non-essential shops. On the very next day, parks in
our neighbourhood got locked.
As I took time to understand the polite request of PM, myhusband made me understand that this means we are in
lockdown state but it is a “liberal lockdown”, unlike Italy,
Germany, Spain, France. So, the “New Normal” started forme! Staying at home, going out only for food shopping or
walk. To my husband, this measure turned out to be a“necessary evil” like income tax.
With sharp spike in cases, the government declared
shortage of Personal Protective Equipment (PPE) and every
day came up with slide presentation to show the numbersof new cases, number of hospital admissions, number ofdeaths in hospitals (initially and then also numbers of
deceased from care homes) and also graduallycommunicated that the country started manufacturing its
own PPE. Through the end of March and beginning of April,
the cases started jumping every day and ICU capacities in all
hospitals were overwhelmed. The need arose for new
hospitals. In just 10 days, a temporary hospital named,“Nightingale Hospital” (to commemorate 100 years of thedeath of Florence Nightingale) came in place in London withthe help of Army. Several other hospitals of the same namewere built in other cities including Birmingham, Harrogate,
Manchester, and Bristol. My in-laws’ house being close tohigh road and having two big hospitals near-by, I could hear
the rising frequencies of ambulance sirens from one cornerof high road to another. A day came when one of the two
nearby hospitals had to close its door for being
overburdened with COVID-19 patients. My ex-colleagues
from the social care charity reported that they were keeping
very busy taking care of their elderly clients living either incare homes or had been very vulnerable otherwise. So, it’s
not just health sector but COVID 19 also overwhelmed thesocial sector.
When I started writing these lines, COVID 19 pandemic
had already affected the UK and its been 1 and half monthsof the country being under lockdown. I kept on trying toadjust to this work-from-home style balancing household
commitments. Initially, I felt busier than usual. I was happyon one side that I got more time to dedicate to my pending
research work, and spend more time to family. On otherside, household chores seemed never ending withresponsibility to arrange breakfast, lunch, snacks, and108

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dinner, more so, to bring in variety on the plate with limited
stock on the shelves of the supermarkets. As the new set up
for teaching and learning continued for me, I started looking
for more research opportunities; webinars (even from
China), research collaborations, and more online platforms
to be connected to the globe.
In context of research, to boost the researchers’
motivation, I witnessed all publication houses started giving
more online accesses to articles, especially on epidemics
and pandemics. One day I received an email from
SpringerLink mentioning that with my consent, my research
article would be given open access to help researchers of
the world. To be connected, to enhance the scope, one of myteachers in USA, organised committees to conduct more
research on COVID 19 and I was absorbed in suchcommittees. I felt really privileged and happy to dosomething for the society through the Eubios Ethics
Institute. Thank you Prof. Darryl R J Macer.
Gradually, I observed people started adjusting to this new
lifestyle. New rules were created for supermarket foodshopping. Many like me started shopping groceries online,
however, different supermarket slots were still allocated to
ICU workers, NHS staff, the elderly and markings were put
on place for people to stand 2 metres apart. Families, notliving together in one house, were not allowed to meet face
to face but outside doors/windows. People, being rational,
used this opportunity to feel connected through social
media. I could see more Facebook live pages for different
cultural programmes from Leeds, Shef ield, Birmingham,
Cardiff, and even from Kolkata uniting the globe amidst thiscrisis. I also witnessed several others enjoying theirculinary, art, and craft skills and exercised different fundraising options to help and save health workers of thecountry. However, uprising incidences of domestic violence,increased rates of divorce appeal also caught media
attention during this time.
While some were busy utilising their quality time in aquality manner, many others, in my circle, did repent thatthey could not go out for vacation during Easter break. Well,
its just been few days, if you start repenting in such a brief
span of lockdown time, can you ever imagine of all thosepeople, the refugees in the crisis zones who had not got any
form freedom left in their lives! This is a very deep
philosophical discussion, so better not to get into this.
To explore more during this time, we discovered that ouryoga teachers have started conducting online classes withparticipants joining from Italy, Australia, and Germany. We
started practicing more yoga and exercise and explored
more of Zoom, Google Meet, Hangouts, and Skype. The
lockdown by then had made us a bit tech savvy! I felt that I
probably had wanted this long outstanding break from mystereotype daily life.
To encourage all those at the frontline, it became a ritualon every Thursday 8 pm to clap for the COVID19 heroes.
Even few days back, my yoga teacher mentioned irst weneed to clap at 8 pm and then yoga session. A positive signof love and caring in this negative time! The 9 weeks
applause began on 25th March and ended on 28th May withthe relaxed lockdown measures from 8 June. Kind ofcommunity solidarity was also noticed when Hindu andSikh temples, students and staff of different higher
education colleges started delivering food to the frontline
workers. A few incredible things did happen during the
lockdown period in the U.K.. Mr. Thomas Moore, popularly
known as Captain Tom, a former British Army of icer servedin India and Burma, became a popular igure overnight. His
popularity gained attention for his achievements of making
laps in his garden. With deep courage, he decided to raisemoney for charity in the run-up to his 100th birthday
during the COVID-19 pandemic. At the end he raised around£100 million. On his 100th birthday, he then received 100s of
cards and gifts which were accommodated in the local
grammar school in Bedford. Does not this gesture show akind of harmony in crisis?
With regard to socioeconomic and environmental
conditions, COVID19 had created a big impact. Amazon andother retails had stopped provisions to buy, sell, and deliver
nonessential products. From end of April, I got news of job
cuts, hour cuts in my own circle and even heard of my own
colleagues been furloughed, made redundant within short
notice. My organisation was a small re lection of the bigger
picture of the world! I got to know that many academics
were been laid-off as COVID 19 situations were worsening
all over the world. However, there is other side of the coin as
well- homeless people were given shelter in a luxury hotelin Manchester to keep them safe and warm; local councils
supplied food to vulnerable who are unable to go out forfood shopping; more birds have made their appearances on
the island and many have returned after years. As lesspeople were rambling through the woods, blue bell started
showing its glory to bunnies, deer started strolling on theotherwise busy East London localities.
During the lockdown phase, every day, I looked forward
to news of safe and secure options to save all lives. Every
week, I observed bin collectors, being dropped off by the
council bus and being picked up by the same bus after bincollections. In usual times, they travel by the same litter
picking vans while collecting the rubbish. Social distancing
restrictions being in place, with no more than two people
together in one place, they were given the council bus ride
to work.
From May onwards, disproportionate impacts of
COVID19, on some population groups was gaining attention.
Before that Covid19 had only exposed different underlying
vulnerabilities and made us witness passing of many lives.
End of April, my husband was noti ied by NHS to be at highrisk category for medical conditions of childhood diabetes,
COPD, and being recorded with the history of a rare chest
infection. He had been asked to shield till end of July.
Overnight I felt- COVID 19 could be alarming. Very
spontaneously I felt the urge to knock all my contacts, inLondon and Shef ield to check about their whereabouts. Outof my special bond, I started calling my mother more often
and sent texts to Aunty Naka for she is living by herself
undergoing treatments for breast cancer. I also contacted
my friends and colleagues all over the globe and it is in April

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I got the news that next to kins of two of my friends had
been COVID19 infected. One of them being a doctor in
hospital, most likely contracted it from the hospital. Morenews of illnesses and deaths started coming from mid-April
and by the end of April, I lost one of my beloved colleagues. I
was numb for few minutes on that morning, for I spoke to
him last on 30th March 2020 and he responded with positive
vibes even with treatments for pancreatic cancer andmentioned being with his son. You will always be in mythoughts TP!
Lockdown has been more relaxed, with travel restrictions
on place, from 8th June in the UK. It has given the scope tomanufacturing and food industries to regain the economy
but for many people who had to go back, perhaps, it was a
bit too early to break the safety chain. However, we love tohave trust on authorities. Meanwhile, I was blessed tocontinue work from home.
To inish up- I would like to draw attention to the crosscultural London again. On the occasion of Buddha Purnima, I
wished my Sri Lankan and Chinese colleagues who practice
Buddhism (You can call it a lockdown effect to get moretime to ask about each other). In response to my calls, my
Chinese colleague replied that they observed Gautama
Buddha’s birthday few days back in April and she waspleased to know about Buddha Purnima being celebrated inIndia. My Sri Lankan colleague, on the other hand, repliedsaying that they address Buddha Jayanti as Vesak andprepare hand lanterns to decorate the house on the day. She
had been pleased to know that Buddha Purnima is also a big
celebration in India, and wished me Happy Vesak! The world
is amazing- when you bond to spread smiles on face- is notit?
As on 25th January 2021, UK had suffered three phases oflockdown measures. Currently, we are on the third
lockdown phase in the UK with regulation for all to workfrom home. This phase started from midnight of 5th January
2021 as a result of the circulation of a new strain of SARSCOV2. The new strain has been found to be more infectious
and virulent. The third lockdown measure has been morestricter than the second phase which started from 4th
November 2020 for a month with all non-essential shops
being asked to close but schools, colleges, universities were
kept open until Christmas break. It is in this lockdown
phase, my beloved and few of my family members either
tested positive or admitted to ICU and I had to be on selfisolation for 28 days.
Nearly one month has passed in this third and strict
lockdown. On re lection, I could recapitulate 2020 as amemorable year in our lives. As a family, we witnessed a lotthe year started with an outbreak of ire in our house; we
had undergone few medical procedures; I moved into a newjob with more responsibilities and longer work hours, we
got irst-hand experience of COVID-19 and witnessed towhat extent the SARS-COV-2 can weaken a human biologicalsystem. Life has taught us a lot in the lockdown phases. At
the beginning of December 2020, when the country was
under the second lockdown phase, the COVID vaccination

109

started in the community. The vaccination rolled out
respecting the triage system. My family in the UK, except
myself, being in the irst, second, third, and fourth category
been vaccinated with the irst dose in January 2021.
Discovery and vaccination strategy had really been a bliss in
the COVID infected glocal community but question of theef icacy of the vaccine and the fear of more deadly strain
will always accompany us and will remind us of the dangerof the emerging infectious diseases. In sum, COVID-19
teaches us life lessons - how to behave with more individual
and shared responsibility to mitigate the greater danger ofthe public health concerns. I am almost at the end of thewrite up when I received two news to ponder- a) the cold
storage rooms, rather the open market, in the Wuhan city,
could be the potential source of the transmission of SARSCOV-2, b) Captain Tom Moore passed away from COVID-19
pneumonia. Both the news did put me in deep thoughts
with a hope of a better prepared world in future as I wait for
the ease of the lockdown phases by Easter break and thecountry moving back onto the Tiered phases.
Acknowledgments
I thank Titas Chattopadhyay who encouraged me to write
my COVID19 re lection. My special gratitude goes to
Sharmistha Chakraborty for her keen eye to detail andasking me to re ine the draft to make it morecomprehensive. I also owe thanks to Swagata Chatterjee forreading the irst draft and suggesting to add about Uncle
Tom. And to be steady in this unprecedented time, I cherish
the support from all my colleagues and friends.

Choosing positivity in the midst ofdifficulties: The case of publicschoolteachers in Mindanao- Rogelio P. Bayodroger.bayod@gmail.com (Corresponding author)- Erikka June D.Forosueloerikkajunedecrepito@gmail.com- Darwin A. Arnosadarwinarnosa@gmail.com- Hermogenes C. Orion, Jr.
orionjrhc@gmail.com- Jean M. Cavalida
cavalidajean@gmail.com
Cor Jesu College, the Philippines

Abstract
The outbreak of COVID-19 has changed the curriculum
implementation bringing additional burdens to the alreadychallenging and stressful situations of many public school
teachers, especially in Mindanao. Some teachers diedbecause of fatigue, while others experienced burn-out andmental health related problems. However, there are thoseEubios Journal of Asian and International Bioethics 31(2) (February 2021)

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We, the authors, are also teachers but we are teaching inhigher education and private institutions, mostly preparing
students to be teachers, psychologists or guidancecounselors in public schools and business professionals.
Thus, we know of many teachers in public schools since
many of them have been our students, classmates in thecollege and also friends. One of the activities that we doaside from teaching is to follow up to our former students.
During this pandemic, we have plenty of time to send
personal messages to many of our students and former
students, asking them how they are doing in their academic
journey. This is how we come up with this research project
because in our conversations with our former students who
are now teachers in public schools, we found that many ofthem chose to stay positive in the midst of many negativities
that they experienced in their work and in the department.
Many of them said that they continue to ind beauty in the
midst of the mess. Because of this, we asked them if they arewilling to be our participants in this research project which
they happily agreed. They even helped us to look for someother teachers whom they know. Thus, we were able to doonline interviews to forty-six (46) teachers for this research
project. Twelve of (12) of them are assigned in the Divisionof Davao del Sur, eight (8) are assigned in the Division of
Digos City, ive (5) are assigned in the Division of Davao
Occidental, ifteen (15) are assigned in the divisions ofSarangani and South Cotabato, ive (5) are in the Division of
North Cotabato and there is one (1) who is assigned in the
Department of Education division of CARAGA in Butuan
City.

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Introduction
A “blessed mess”, “blessing in disguise” are terms thatsignify something beautiful that came out because ofnegative events or experiences such as sickness, trials, or
pandemic. In today’s new normal activity because of thepandemic, many people experience bad things such loss of
loved ones, loss of jobs, or additional stress or pressure atwork. People have different reactions or responses tonegative events. Some wallow in pain while others choose torise up and ind beauty and meaning in the midst of their
negative circumstances (Bayod, 2020). This scenario is notuncommon to many teachers. When the public schools in
the Philippines started their “new normal” way of education
on October 5, 2020, many teachers were caught off-guard in
facing the many demands of the new educational set-up.
Many of them, aside from focusing much on preparing andprinting the modules, had to solicit for material via social
media to various people whom they hoped would be
generous enough to provide the needed materials such as
bond papers, printers, ink and others. The next weeks
became more stressful to them especially to some teachers
in the far- lung areas in Mindanao because they have totraverse mountains and hills in the midst of either scorchingheat of the sun or muddy trails because of rains to bring themodules to their students and to get the modules
supposedly answered by their students.
Indeed, Clark and Knights (2015) were right when theysaid that aside from the uncertainty caused by the
pandemic, insecurity and stress have always existed in theacademic career path. They claim that one of the moststressful jobs is becoming a teacher. But to teach others is
also one of the most ful illing jobs in one’s lifetime. It all
depends on the situation and especially, right perspectives

fof the teachers. While others continue to be bitter about thesystem, the set-up, the policies and even the comments ofsome parents against them, there are some who havedeveloped an attitude like that of scavengers and continue
to discover beauty and goodness in the many things.
Through this endeavor, we present the emotional andmental dif iculties of teachers, who because of strong will
and commitment in pursuing their job despite thepandemic, become champions in realizing the goals of
educating the youth. Previous research has shown thatwhile many teachers ind online instruction to be
rewarding, those who are new to it tend to report having todeal with increased workloads and a variety of challenges
related to using the technology, communicating withstudents, organizing synchronous sessions, and measuring
student outcomes (Choi and Park, 2006; Conceição, 2006).
These dif iculties tend to occur with any transition to online
teaching, no matter how gradual. It must have been a path
dif icult to traverse and new learning experience to conquer,and yet teaching is a passion and the desire to teach is in thehearts and minds of this profession. In this paper, we will
give them the opportunity to share their stories,
experiences and also insights.

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who chose to rise above the challenges and continue to ind
beauty in the midst of the mess they experienced. This
present study focuses on the creative ways of publicschoolteachers in Mindanao on how they maintain theirsound mental health in spite of all the dif iculties theyexperience in the present educational set-up of the
Department of Education (DepEd) because of the COVID-19
pandemic. We argue that indeed, many teachers haveexperienced dif iculties in coping with the demands of theirwork because of the Alternative Delivery Mode (ADM) that
DepEd is imbedding, but they chose to rise above thecircumstances and ind beauty and inspiration to maintaintheir sanity in the midst of strain and exertion. These
teachers have shared their advices and insights which might
be helpful to some other teachers especially those who
succumbed to despair and are on the brink of giving up. It is
the aim if this study to share the plight of the publicschoolteachers in their own battle to keep up with theacademic demands in the time of the pandemic, and yet, still
be able to achieve delivery of quality education among thestudents. This study can also provide additional input forthe schools and the DepEd in general to come up with
policies and programs that will ensure the mental health ofteachers during this pandemic.

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Our journey as teachersPurpose of the study and research questions
Our main purpose for conducting this research project was
to gather positive stories and experiences from the teachers
despite many negative things they have experienced. It has
been reported in the national and local news that teachers
have started to experience burn-out due to heavy demands
and pressure in the new educational set-up. In fact, as ofthis writing, one teacher from the Division of South
Cotabato died due to fatigue. Indeed, the demands ofeducation in the new normal for teachers are too heavy. In
addition, teaching online has not been so inspiring for those
who really want to see their students inside the classroom
and engage them with different activities. But all these are
not possible because of this pandemic. Instead of dwellingin the negative, we highlight the positive experiences ofteachers so we can inspire other teachers to be positive inthis time of pandemic. By this, we asked our participants thefollowing research questions:
1. With the realities of the new normal mode of educationand its pressing demands, how did you manage tomaintain your psychological and mental health?
2. What advice, insights or learning can you share with otherteachers who have experienced dif iculties and mental
health problems brought about by this pandemic?
Ways of maintaining psychological and mental healthJack Can ield (2005) says that the number one rule for a
successful life is to take one hundred percent personal
responsibility for our life. In the book, he says that “one of
the most pervasive myths in the America [and maybe inmany parts of the world: our own emphasis] today is that
we are entitled to a great life – that somehow, somewhere,
someone is responsible for illing our lives with continual
happiness, exciting career options, nurturing family time,and blissful personal relationships simply because we exist”.
But the truth according to Can ield is that there is only
person responsible for the quality of life you live and that
person is you. Of course, Can ield is not disregarding thefact that structural injustices and coercive systems ofgovernance will affect our effort to achieve a good life. What
he is trying to say is that our attitudes in the midst ofadversities will matter a lot. This is also what we found in
this research project with public schoolteachers in
Mindanao. Their attitude to focus on the positive things likedoing something more bene icial that they enjoy doing torelieve stress, living a positive healthy lifestyle, and talking to
god and to someone they trust are their different ways ofmaintaining their psychological and mental health as publicschoolteachers in this dif icult time in the new normal.

Doing something more bene icial that they enjoy
doing to relieve stress

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All of our participants said that in order to maintain their
psychological and mental health, they engage in different
activities that they enjoy doing and are also bene icial for
their total wellbeing. Many of them engaged in gardening.
Some developed their skills in cooking, dancing and singing

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

111

while others developed new friendships because of biking
and spending time in walking along the beach or beautiful
nature. For instance, a Mathematics teacher in the Divisionof Davao del Sur said: “I do a lot of hobbies to avoid
depression and stress…. I do gardening, I practice playing theukulele and drawing/painting and read a few novels if I can. I
am also avoiding from negative news, rumors, and negative
people by getting busy and enjoyable bene icial stuff.”
Another Mathematics teacher from the Division of Davao
Occidental shared: “In this time of pandemic, I do a lot of
activities to maintain my positive mindset: socialize withfriends through Facebook and messenger, making myself busy
with works given by my Principal. I also do gardening,planting lowers, buying pots, online selling and buying,eating foods sold online and biking which is my new hobby.” Ateacher from the Division of North Cotabato also shared: “Todeviate my attention from stress, I spend time talking to myplants in the garden, take care of them, taking pictures ofthem and posting them on Facebook. The good thing is that I
earned extra income because a lot of my friends contacted me
to buy my lowers and so I focused much of my spare time on
gardening and selling lowers online. Not only did I gain
additional friends and income because of this, I also
discovered that I have talents in gardening and selling
lowers. I think I have discovered another career which I solove doing.” Another teacher who is assigned in the
Sarangani province af irmed these teachers when she said:“Instead of focusing on the problem, I focused on doing things
which are bene icial to me and to my family. I do online sale ofplants and food stuff. I spend time in the garden, taking careof my plants and I discover that I have green thumbs and I am
capable of nurturing them and I feel so good every time I see
my lowers grow and bloom. I also earned extra income
because there are plenty of people who are crazy about plants
and lowers during this pandemic. I even gained friends
because of it.” The experiences of these teachers haveaf irmed a pervious study by Bayod et al. (2020) on thebene icial effect of gardening to the gardener. In that study,
it was found that gardening also contributed to thewellbeing of the people and helped them gain additional
friends and income.
These ideas support the study of Scheier (1985 as citedby Yugay, 2019) regarding the real power of positive
thinking or dispositional optimism. According to him, there
is a direct link of positive outlook on life to our overall
health: physical, emotional, and mental. The positiveenergy that we cultivate everyday results in decreased
feelings of loneliness and increased resilience to any
hardships that we encounter in life. Thus, people
experiencing negative experiences stop thinking about
them, and can find blessings and lessons in any situation
they confront. Those teachers who chose to be positive are
the ones standing still and gaining positive synergy amidst
the pandemic. A positive mindset helps find opportunities
in the midst of difficulty. This might somehow become partof a teacher’s way of consoling him- or herself in order toEubios Journal of Asian and International Bioethics 31(2) (February 2021)

get through hard times in the field of teaching especiallyduring the pandemic.
Furthermore, some teachers said they were watching
Korean drama (K-drama) to relive their stress. They also
gained a network of K-drama enthusiasts which became
their support system during the pandemic. According to Dr.
Ellis (2020), watching TV or anything that is enjoyable orinterests the person provides opportunities for storytellingto teache valuable lessons about empathy, friendships,
kindness, respect, justice and hope. This could be an avenue
for the individual to see the positive and negative sides oflife and be given a chance to explore and appreciate thedifferent experiences of life.

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Living a positive and healthy lifestyle
Living a healthy lifestyle is very much important in all
situations. It becomes a necessity during the pandemic
when people really need to have a strong immune system toight the virus. But for some public schoolteachers in
Mindanao, living a healthy lifestyle is needed not only toboost their immune system to ight the coronavirus but also
other viruses that they encounter in Mindanao. Aside fromthe many demands they have to endure in making, printing,sorting, distributing and checking the modules, they have toalso deal with lack of budget in the materials needed as wellas in the attitude of some parents who thought they havedone nothing and are not teaching the kids and it is theparents who have the responsibility of monitoring andteaching their children in the modular mode of education.
The Department of Education in Southern Mindanao has
geared up to an alternative mode of education with ablended learning approach and a combination of modular,
radio-based and television-based instruction to educate thechildren despite the threats of the pandemic. As to theattitudes of some parents who thought that the teachers did
not do their job and just left the responsibility to theparents to do the monitoring and teaching of their kids, it
can also be seen as a valid complaint because of the newmode of curricular delivery in the new normal demands a
lot of time from the parents to really monitor and supervise
their children while they learn at home (Bayod, C. and
Bayod, R., 2020). All these circumstances have caused
additional stress to the already stressful situations of manyteachers who are assigned in different public schools in
Mindanao. Yet there are many teachers who chose to rise
above their internal and external predicaments by living
and practicing a healthy lifestyle. In fact, one teacher who isassigned in Butuan City said: “With the very stressful
situations that I am into today as a teacher, I make sure tocontinually take care of my mental health through thefollowing ways… getting physically active, getting enoughsleep, and developing coping skills.” This was af irmed byanother teacher when he said: “We may face challenges andbaggage from the call of our duties, but self-care by living ahealthy lifestyle is still a valuable aspect in considering ourmental and psychological health. We still need to balance andvalue our time, have rest, take a nap and most importantly, I
see to it that I can manage my time well.” For many teachers

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living a healthy lifestyle is a form of self-care that includes
proper time management and staying away fromnegativities.
This is beautifully captured in the shared experience of astudy participant when she said: “Teaching is one of thehardest yet noblest jobs in the world especially in this time ofpandemic. I admit I felt a bit anxious during the irst two
weeks of this new normal mode of teaching. It's
overwhelming and exhausting but I cultivated a (healthy
lifestyle) and positive mindset. This is the way things work
now and I have to deal and make the most out of it. Though
we are bombarded with so many tasks still I make time tounwind, to relax and to take care of myself. I also avoid fromexposure to social media. Social media feed is now looded
with news and information which can trigger uncertainty,
anxiety and restlessness.”
Another teacher also shared: “the new normal mode ofeducation is truly challenging. Despite the challenges I've
encountered, I always keep in mind the goals I have to achieve
not only for myself but also for my pupils. To preserve mypsychological and mental health, I instill positive thoughts
every time I feel like things aren't going the way I wanted it tobe. Also, having a conversation with people with the same
mindset is a great help.” Still another teacher shared howliving a positive and healthy lifestyle helps in the pandemic:“to stay in good mental health, I tend to eat well, keep intouch with people who inspire me, read motivational books,
focusing on positive things… and the most important thing I
do is to take a break.”This is also con irmed by a teacher through these words:“to ensure that I am mentally and psychologically healthy
despite the challenges we encountered with this new normal
mode of education, I maintained my psychological and mental
health through keeping a healthy living such as eating
healthy foods and drinking a lot of water, getting enough restand sleep and I also do light exercise at least three times aweek for relieving my stress at work.”
Another way of living a positive and healthy lifestyle is tofocus on gratitude for having a job in this pandemic. This is
beautifully captured by one teacher when she said: “As an
educator, a public servant and a classroom adviser, it isindeed challenging to cope with the new normal especiallythat the learning modality has changed from face to face toblended learning. Our school focuses on ADM (Alternative
Delivery Mode) modules, where I as a teacher do thefollowing: printing, sorting, and binding. After that, I willconsolidate all the 8 subjects/ modules, disinfect the learners'
envelopes, insert all the consolidated modules, call/inform theparents and learners and many more. All these things are new
to me and to all the people around me. It is very tiring, timeconsuming and monotonous but I still maintain mypsychological and mental health by telling myself that I am
blessed to have a job in the pandemic and to stay healthy inspite of what is happening; by enjoying the monotonous stuff
with music; by reading positive quotes in the social media.”
It is evident from the sharing of these teachers that theychose to live a positive and healthy lifestyle in order tomaintain their psychological and mental health amidst

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

different trials, pressures and dif iculties that the new
educational set up brings to them. Indeed, life is a matter ofchoice to stay mentally and psychologically healthy. This
also means giving up all excuses and victim stories thatmany people cling to most of the time which makes them
unhappy and unsuccessful. Systems and administrative
failures, unjust laws and policies, unfair distribution of
burdens and opportunities of course have to be dealt within a proper venue. But all that matters now is to have theright choice in terms of what, when and how to act andrespond to the situations. These teachers are on the right
direction.
Jensen (2019) cited John Bargh’s famous saying: “Wehave a single, uni ied mind that operates in both conscious
and unconscious modes, always using the same set of basic
machinery, ine-tuned over the course of evolutionary time.”
This means we can control our mindset and we can evenchange our outlook on things. A positive life is one we cantake control of and change from within because we can live
a positive life no matter where we are, who we are and what
we do in life. According to MacIntyre et al. (2020), balancing
personal and professional roles is a challenge for manyteachers, but online delivery of courses with work-at-homeprotocols and ubiquitous online work-related activity
creates a lack of physical, temporal and/or psychologicalboundaries between school and home. There is now a greatchallenge of choosing to be positive or to be affected by somuch stress that are brought about by the pandemic. Someof the ‘normal’ (i.e., pre-pandemic) stressors that teachers
in general suffer from include pressure in licted by heavy
workloads, time constraints, unbalanced work-life
integration, limited autonomy, excessive administrative
obligations, strained relationships with colleagues andschool leaders, role con lict/ambiguity, managing
innovation and change, emotional labor, dread over losing
control of the class, fear of evaluation, and low professional
self-esteem, among others (Mercer and Gregersen, 2020).
To be able to maintain their wellbeing and still ind
positivity in the midst of adversity is a choice that perhaps
not all are able to achieve because of varied life dispositions.

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Talking to God and to someone they trust
Another important way for these teachers to maintain andmanage their psychological and mental health is spendingtime to talk and pray to god and to share their feelings andemotions to someone they trust. For instance, one teacher
said: “Every time I am anxious of everything that has been
happening, I talk to god and to someone close to me about it,
it is either my family or friends.” Another teacher also shared
how his spirituality helps him in this of pandemic: “Incoping to such pressure, I spend a moment of silence andprayer. Sometimes a cup of coffee under the tree, be withnature, keeping away from social media, and chatting withfamily or friends is in fact a quality time for me.” Still anotherteacher shared, “In this pandemic, I keep myself calm,surround myself with my family, share my feelings to others,

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re lect on what this pandemic has brought to me in a positive
way… and pray to god.”
The concept of prayer and talking to someone you trust
and pausing for a while to re lect were very common among
the study participants. Indeed, these teachers do havestrong spirituality which has allowed them to ind beauty inthe midst of many dif iculties. This is beautifully capturedby the sharing of this teacher: “Despite the challenges that I
have encountered in this time, I have maintained mypsychological and mental health by thinking positively.
Whenever there are dif iculties encountered, I pause for a
moment, pray for god's guidance and then continue what I
am doing but if I feel so tired and discouraged, I listen tomusic (since music is my remedy). Some of this music is
Christian and love songs. Also, I tried to do some breathing
exercise (watch it on YouTube and repeat doing it).
Sometimes, I go to a beach or pool and have a dip so that I
can breathe fresh air as well.”Connecting to the source, talking to god, sharing their
feelings to their families and friends and spending time tore lect have helped these teachers to stay positive despite
encountering various problems as teachers during this timeof crisis. Prayer and talking to someone they trust are themain source of strength for many people in the Philippines.
In the study of Arnado and Bayod (2020) college students
said that their source of strengths are god and their families.
Although, they are open for guidance services if needed,
they still ind it less important compared to the presence of
god and their families and loved ones. Spirituality and its
many expressions like focus on meaning and staying
positive is also mentioned by Bayod (2020) to be very
important especially in dealing with different forms oflosses during the pandemic. In fact, Studnicki (2020)
uttered in one of her prayer journals: “This current
pandemic has been one of the most dif icult things I’ve had
to go through. I’ve never felt so unsure of what tomorrow
will bring. But this has been a reminder that I truly neverknow what tomorrow will bring, let alone the next minuteof my life. It really has put things into perspective for me
and given me the opportunity to place my trust in god morethan ever before”.

Their advice to fellow teachers who’ve experienced
dif iculties
These teachers have shared their insights and also advice totheir fellow teachers especially those who experienced
dif iculties and are at the brink of giving up. Their advices
are the following: be compassionate with yourself andpractice self-care, focus on positive things and also talk tosomeone you trust.
Be compassionate with yourself and practice self-care
On top of their advice and insights to fellow teachers, theseteachers send a strong message to be compassionate withyourself and to always practice self-care. “To all the teachersout there who have experienced different psychological andmental health problems, please be compassionate with

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

yourself. Don't deprive yourself from actions that can makeyou forget the stress and struggles, have fun on weekends or
during your free time. Have someone to talk with you, be
optimistic, let us be reminded that we are only having a bad
day but never a bad life”, advices one teacher.
This was supported by another teacher when she said:“the advice I wanted to share with my co-teachers who
experience the same feeling is that we have to learn to deal
with the stress that surrounds us. Don’t be too hard on
yourself. We should value ourselves most of the time. Wheneverything doesn't seem right, take a break. Work, but don't
forget to take good care of your mental health. Indeed, themost important requisite to have mental health is to becompassionate and not to be too hard and harsh withourselves. Self-care is very important during this trying
time. Self-compassion is empirically correlated with
reduced anxiety and depression, as well as greater life
satisfaction, psychological wellbeing, and social connection(Allen and Leary, 2014; Barnard and Curry, 2011). Thismeans loving oneself and nurturing the gift of life. If there isself-compassion, a person tends to look at the positive sideof circumstances and still choose to feel worthy in a given
situation whether it is good or an unlikely predicament.

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Focus on positive things
Since these teachers continue to focus on positive things in
the midst of many negative events, they want to admonish
their fellow teachers to do the same. For example, a teacher
from Davao Occidental said: “my advice to other teachers
who have experienced psychological and mental problems
caused by this pandemic is to stay strong minded, open
minded and goal minded. We, educators, should be proactivein the change of our educational system. If we put ourselves ina negative way, worse consequence will appear not just to us
but especially to our students. Strive hard and stay positive.”
Another teacher assigned in Butuan City said: “to my fellow
educators, let us be open-minded and stay positive.
Everything will fall into place someday. Trust in yourself andpray. All of these will be over soon in God’s time.” A teacher
from Davao del Sur also shared her advice: “Give ourselves abreak from everything that gives us stress, learn to say nosometimes to people. Take a rest if tired. For me, it’s perfectly
okay not to be productive all the time. Focus on the things we
can control and leave what we can't. There's nothing we
could do but to accept the reality and see the bright side of it
like I still have the job the I earnestly prayed for. I believe thatsometimes, the problem is within us; it's the way we think, theway we see things or the way we handle the situation.
Working smarter, not harder also helps. Making complicatedwork/things simple and have your own strategies in doingtasks easy. For me it saves time and energy to the things thatreally matter.”
Teachers are normally confronted with a lot ofchallenging situations and obstacles but to some, they
consider these experiences a part of life. Most of them
become resilient to stress and pressures because they learn
how to focus only on the good things, no matter how small
or insigni icant they seem. They can ind the proverbial

silver lining in every cloud even if it’s not immediately
obvious. This is what other teachers do in handling theirwork. These thoughts would relate to Legg (2019) about thebene its of thinking positively and how to do it. According tohim, positive thinking is not magic, and it will not make allof our problems disappear. What it will do is make problems
seem more manageable and facilitate the approach tohardship in a more positive and productive way.
Talk to god and someone you trust
These teachers encouraged their fellow teachers to be open
to their emotions and talk to god and to someone they trust.
For instance, once teacher said: “…you need to stay connectedwith your social and family networks even if sometimes it isvia technology. You also need to exercise regularly andpractice habits that you enjoy and ind relaxing. It will also
help if you seek practical, credible information at speci ic
times of the day.” Another teacher said: “my advice to otherteachers is to continue to pray. Never cease praying and ask
for god's guidance. Also, ind a company whom you can trustand share what you are feeling. In these ways, you will be able
to ease the pain and unload your heavy feelings if there areany.” One teacher from South Cotabato shared his advice tohis fellow teacher: “my advice to my co-teachers is to always
pray and stay connected to god and to your families and loved
ones. Spend quality time with them and with the people you
trust. Share your feelings and doubts as well as frustrations tothem. This way, you will be relieved.”
Prayer is considered a strong support system through achallenging life journey. This is the way to navigate many
challenging situations particularly nowadays that we areconfronted in the battle to save ourselves from invisible
enemies. Chaplain Major Doug Hedrick once said: “Why is a
support system important? One reason is this—it’sbiblical. God created humans with the innate need to be
in relationship with others, said in another way, to bepart of a support system.” This would mean that no one
has everything they need or has all the answers to life
successfully by themselves. Therefore, we must
remember to support, to give assistance, and it can takemany forms regardless of time, place or conditions. We
need to strengthen our connections to god and to others
in order to survive and be happy. Frankl’s concept on
logotherapy emphasizes that humans are motivated bysomething they believed in (Frankl, 1977). According toFrankl, our life can have meaning even in the mostmiserable or difficult times and the desire of the person
to live comes from finding the meaning or reason tosurvive. Looking at the situation of teachers, theycannot change the circumstances or conditions of theworld; thus, they are forced to change themselves inorder to meet the demands of times.

Conclusion
It is essential to know that the teachers are the prime
facilitators of education and are the irst to adjust to thetransition brought about by the impact of the COVID-19
pandemic. As it impacted every aspect of the humanEubios Journal of Asian and International Bioethics 31(2) (February 2021)

experience, teachers in the public schools ind beauty in themess, as in the form of unavailability of academic resources,
connectivity and many others that cause discomfort andrequire a period of adjustment to cope with the demands ofthe pandemic. Their ways of maintaining psychological andmental health is to do more bene icial activities including
the things that they enjoy, to relieve stress, like gardening,watching K-drama and selling lowers from their gardens.
These teachers are living a positive and healthy lifestyle bygetting physically active, getting enough sleep, anddeveloping coping skills by eating healthy foods anddrinking a lot of water, getting enough rest and sleep anddoing light exercise at least three times a week, enjoying
music and reading positive quotes in the social media.
They also emphasized that talking to god and tosomeone they trust are essential to staying positive and formental health: keeping oneself calm, surrounding oneself
with family, sharing feelings to others, re lecting on what
the pandemic has brought them in a positive way and mostimportantly praying to god.
The advice of the teachers especially those who haveexperienced dif iculties is to be compassionate with oneself
and practice self-care. They emphasized not to deprive
oneself from things or actions that can help forget the stressand struggles. It is best to have fun on weekends or during
free time. It is also helpful to focus on positive things inorder to stay strong minded, open minded and goal minded.
And above all, never cease praying and asking for god’s
guidance to ease the pain and unload heavy feelings ofuncertainty and discomfort brought about by the pandemic.
Indeed, these teachers have found beauty in the midst of
the different mess they have experienced. Their stories willserve as inspiration to others, especially those who continue
to wallow in pain and negativities in life.

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positive-energy/

COVID19 and Challenges invaccination programs in Bangladesh
Md Rijwan Bhuiyan 1, Tandra Saha, Nazia Islam 2, Tamsila
Taramun 2, Yousra Siddiquee1, Maisha Ahsan Momo1,
Mahmuda Momtaj2, Shahanaz Chowdhury 3
1. Dept. of Noncommunicable Disease, Faculty of Public
Health, Bangladesh University of Health Sciences
2. Dept. of Reproductive & Child Health, Faculty of Public
Health, Bangladesh University of Health Sciences
3. Dept. of Community Medicine, Faculty of Public Health,Bangladesh University of Health Sciences
Email: dr.shahanazch@gmail.com

Abstract
The article tries to explore the current situation andchallenges faced by the health system in Bangladesh
regarding child immunization and also present thealternative methods adopted to make it functional. Data
were collected from various secondary sources along with
key informant interviews (KII) over the phone. The
vaccination program is largely disrupted due to COVID-19
pandemic in Bangladesh. All static clinics remained open,
but satellite clinics needed to be closed due to transport
restriction and shortage of health workers. Overall, theEubios Journal of Asian and International Bioethics 31(2) (February 2021)

attendance rate is low in both types of facilities. Expertssuggested to open the centers by maintaining physicaldistancing and frequent hand washing by health workers.
The EPI division of the Directorate General of Health
Sciences (DGHS) releases guideline. Vaccine shortage may
create problem. Initiatives have taken place like solidarity
lights, allocation of more funds and awareness building by
developing partner. The reasons include transportation
problems, health workers being affected by COVID-19, lackof PPE supply and awareness. The shortage of stock isanother problem. A guideline has been prepared by theministry, several strategies have been taken, like solidarity
lights ly to import the vaccine. Effective action is needed toovercome this situation. Otherwise, the giant successes thathave been gained over a long time in the country withtremendous effort may be ruined due to the COVID-19
pandemic.

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Introduction
The coronavirus outbreak was irst detected in Wuhan,
China in December 2019 with unknown origin. This is ahighly infectious disease and symptoms include fever,cough, fatigue, shortness of breath, and loss of smell andtaste. On 30 January 2020, World Health Organization(WHO) declared a Public Health Emergency of International
Concern worldwide.1 Although the cause is unknown, it isassumed to have come from animals and now it is
con irmed that the virus has been transmitted human tohuman. Within less than 5 months from its irst detection,nearly two million people from almost 188 countries areaffected with this virus.2 On March 7 the irst COVID-19
patient was identi ied3 and as of 09 June 2020 there are
71,675 con irmed cases of them; 975 are died4 and thedeath toll is continuing to rise.
To reduce community transmission initially thegovernment of Bangladesh banned most lights on 15th
March.5 On March 26, country enforced lockdown includedbans on travel on water, rail, and air routes and roadtransportation was suspended. All non-essential
organizations, businesses, and educational institutions areclosed, except for pharmacies, groceries, and otherunavoidable necessities.6
The immunization program in Bangladesh is a successfulprogram and has been impressive in coverage.7 In
Bangladesh the Expanded Program on Immunization (EPI)
was launched on April 7, 1979 in a small scale and gradually
was made available to all target groups (infants andpregnant mothers) by 1990.8 According to Bangladesh EPI:
Coverage Evaluation survey 2016, from 1995 to 2016 thevaccinated rate reached from 76.0 percent to 95.1 percent.9
However, due to COVID-19 pandemic, the immunization
activities are interrupted. Recent review of WHO andpartners mentioned that this could put the lives of nearly 80
million children under the age of 01 at risk. Moderate,
severe or total suspension of vaccination services wasreported during March and April 2020 in more than half of
129 countries where immunization data are available. The
director-general of WHO stated that “Disruption to

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immunization programs from the COVID-19 pandemic
threatens to unwind decades of progress against vaccinepreventable diseases like measles.”10
The aim of this paper is to explore the current situationand challenges facing in immunization program during
COVID19 pandemic, and to identify the alternative methods
to continue the services and limitations that need to be
overcome.

Methods
This study has combined primary and secondary data
sources. The electronic databases PubMed, MEDLINE and
Google Scholar were searched. A keyword search was also
conducted in the Google server. We initially screened alltitles and abstracts identi ied by electronic search andpotentially eligible free articles were obtained in full text
and abstracts for paid articles. Additionally, all online
newspapers, documentaries, online/ television interviews,
social media and blogs were included as data sources. All
selected authentic articles and information were reviewed
and addressed in this article with reference as secondary
source of data.
Key informant interviews (KII) over phone and datafrom a few centers were collected as a primary source ofdata. As a written consent from the respondents was notpractical, the interviewers’ identity and opinions arepresented anonymously.
Findings
The challenges faced by the vaccination program in
Bangladesh during COVID19 outbreak have become anational concern. Stakeholders are trying to overcome theseissues as a top priority and have started a dialogue. The
indings are addressed based on data sources obtained
below.
United Nations Children's Fund (UNICEF)
They expressed that the stock is running low and there is aneed to import immediately. Manufacturers also warned
about the shortage from their side and a double shortage.
UNICEF expressed that there will be no harm if frontline
workers maintain proper distancing and hand washing
during vaccination. Bangladesh has postponed national
measles and rubella campaigns where 34 million children
aged from 9 months to 9 years were targeted.
The DGHS has released a guideline to continue routine
immunization during COVID-19 pandemic in line with
UNICEF and WHO global and regional advisories. They
mentioned the services should continue both in ixed andoutreach sites as an essential service. UNICEF proposed tobuild knowledge, motivate, support and empower thehealth workers to protect themselves with frequent handwashing and other personal protection precautions so thatthey can continue their work. Additionally, there is a need tobuild trust in communities so that parents understand thatwith proper protective measures they can immunize theirchildren safely. Also, it is needed to begin rigorous planningEubios Journal of Asian and International Bioethics 31(2) (February 2021)

to intensify suspended activities once the situation is undercontrol.11
UNICEF released a warning on their website under thetitle “Disruption of child vaccination in South Asia poses anurgent threat to children’s health”. Around 4.5 million South
Asia’s children miss out on routine immunization due to
COVID-19 situation.11 The UNICEF’s executive director,
Henrietta Fore said: “We cannot let our ight against one
disease come at the expense of long-term progress in our ight
against other diseases; we have effective vaccines against
measles, polio and cholera. While circumstances may require
us to temporarily pause some immunization efforts, these
immunizations must restart as soon as possible, or we risk
exchanging one deadly outbreak for another.10
World Health Organization (WHO)WHO reported that more than 116 million infants are
vaccinated globally. But there are still more than 13 million
children who miss out on vaccination. However, thisnumber will increase because of COVID-19.12 The DirectorGeneral of WHO, Dr Tedros Adhanom Ghebreyesus says
“Disruption to immunization programs from the COVID-19
pandemic threatens to unwind decades of progress against
vaccine-preventable diseases like measles.”Around 14 vaccination campaigns supported by GAVI
against polio, measles, cholera, human papillomavirus,
yellow fever and meningitis have been postponed, which
would have immunized more than 13 million people andthe tragic reality is that children will die as a result. WHO
urged countries to support Gavi’s “ambitious goal” of
immunizing 300 million more children by 2025, which will
require $7.4 billion in funding.
“GAVI” the vaccine alliance“GAVI” along with WHO and UNICEF warned that COVID-19
pandemic disrupts vaccination efforts so nearly 80 million
children are now at risk worldwide. Their report shows, outof the 129 countries, more than half (53%) reported
moderate-to-severe disruptions, or a total suspension of
vaccination services during March-April 2020.
They
explained the reason of disruption as parents unwilling toleave home, lack of information of the infection of COVID-19
virus and other health workers are unavailable due torestriction and in some cases shortage of PPE.
Dr. Seth Berkley, GAVI CEO stated: “More children in morecountries are now protected against more vaccinepreventable diseases than at any point in history, but due to
COVID-19 this immense progress is now under threat, risking
the resurgence of diseases like measles and polio. Not only
will maintaining immunization programs prevent more
outbreaks, it will also ensure we have the infrastructure weneed to roll out an eventual COVID-19 vaccine on a global
scale.”13 However, they called for joint effort to safely deliver
routine immunization and proceed with vaccination
campaigns against deadly vaccine-preventable diseases.

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Online newspapers and other media

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The issue has been publicly disseminated through theonline newspapers. Before that it was under the discussionof concerned authorities. The Financial Express reported on
26 may, 2020 the headline “Pandemic halts vaccination fornearly 80 million children”. 10 The Newage Bangladesh
reported on April 30 that “Two million newborns andtoddlers are on the risk of missing the schedules of 10
vaccines schedules”. 14
The famous Bangla newspaper Prothom Alo reported
that about 1.9 million children are deprived fromvaccination program due to COVID-19 situation in a Barisal
division of Bangladesh. 15 The United News of Bangladesh(UNB) reported from UNICEF that over 28,000 children
under the age of ive may die in the next six months as anindirect result of coronavirus pandemic in the worst-casescenario.16 The service utilization for children under ive inMarch 2020 was down 25 percent compared to March
2019.16 This is due to nationwide lockdown, and delayed
vaccine deliveries10; Parents are not bringing their children
to the clinic for COVID phobia although the government has
opened the static clinics.15 26 thousand health workers
related to EPI activities are providing services without PPE
during COVID-19 pandemic. Till April 2, 2020 thegovernment did not provide any instructions on how toprovide service during the lockdown situation. 17
Therefore, health workers have become anxious andagitated. Their association leaders proposed to stop the
program unless suf icient protective equipment is provided
by the government. Frontline health workers related tovaccine program in Moulovibazar district of Sylhet divisionwere not provided PPE; therefore, they were at risk andsome were not willing to provide services.17 Nearly 6 to 7
thousand static centers all over the Bangladesh are open
except on Friday. Almost 1 lac 20 thousand satellite centersprovide services throughout the country and these centers
are in different houses, schools, etc. Some of the owners ofthese places were not willing to allow public gatherings
during this situation, hence the health workers got introuble whether to continue or open the center. 18
Health worker reports
They have reported that although they attend the satellite
clinics 4 days per week but less than one third did notpresent to receive vaccines.15 They also said that fever ispost symptom of some vaccine, therefore, parents also
become unwilling to take vaccine for their child as thissymptom is similar to COVID-19 and may be taken as asocial stigma. One reported even calling the parents fromdoor to door they are not attending the clinics. Additionally,
the place owners of satellite clinics don’t want to allow thegatherings. Another health worker said she did not even get
one child in the last two weeks under her 8 centers which isalarming.15 Health workers also said that due to thissituation they are not able to ful ill their target and backlog
is going high.19

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

Of icials of EPI, Directorate General of Health Services(DGHS), Bangladesh
They said: “It has been a dif icult task for us to run routine
vaccinations in the current situation’’. The report concluded:
They are about to run out of their stocks and arranging for achartered light to bring vaccines from abroad. Additionally,
whether women aged 15-49 years and adolescents between
16-17 years are vaccinated with tetanus and measles, andrubella, respectively, is uncertain. The postponed measles
and rubella campaign which targeted millions of children
aged between 9 months and 9 years is in danger. DGHS
issued guidelines to continue routine immunization during
COVID-19 pandemic in line with UNICEF and WHO global
and regional advisories.14
Key informant interviews (KII) over phone:
Information from various key informants was presented in asummarized way as we were not able to take formal consent
and no one wanted to provide information other than in ananonymous manner. The overall indings are that thesatellite clinics may open depending on condition. But the
problem is that suf icient number of PPEs have not been
provided to the health workers. Health workers reported
that parents are not coming to the centers for service.
A few health workers reported that they got very
successful result in terms of response. They would even callthe mothers to con irm the vaccination schedule. The
surveillance medical of icers (SMO) reported that although
the response rate is low in city corporation areas, in rurallevel presence is a little better.

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Conclusion
The national vaccination program is largely disrupted due
to COVID-19 pandemic in Bangladesh. Although static
clinics are open, but the satellite clinics needed to close due
to countrywide lockdown. The reasons are transportation
problem, health workers are affected by COVID-19, lack of
PPE supply and awareness. Overall, the attendance rate is
low in both types of facilities. The shortage of stock isanother problem. Healthcare facilities need to be ready fortreatment, besides prevention of diseases, even during the
pandemic. Also, it is a duty of the health system in general to
make sure the panic caused by the pandemic is notoutgrowing the demand for vaccination among parents ofthe target age group of EPI.
The health system needs to gain back the trust of parents
and to encourage them to cooperate in executing the EPI bybringing their children to the facilities maintaining
schedules. Awareness has been created through TV andsocial media for continuing the schedule with precision to
make the parents bring their children. If needed extra campand manpower should be added. Effective action is needed
to overcome this situation immediately. The health systemneeds to gain back the trust of parents to encourage them tocooperate in executing the EPI by bringing their children to
the facilities maintaining schedules. Otherwise, the successthat has been gained over a long time with tremendous
effort may be lost due to the COVID-19 pandemic. 22, 11

References
1. WHO. (2020). Retrieved June 10, 2020, from World HealthOrganization: https://www.who.int/emergencies/diseases/
novel-coronavirus-2019/events-as-they-happen
2. Dong E, Du H, Gardner L. (2020). An interactive web-based
dashboard to track COVID-19 in real time. Lancet Infect Dis.
3. Perera W. (2020). Perera W. Bangladesh Government Downplays
COVID-19 Threat as Job Losses Mount. (2020). Available online
at: https://www.wsws.org/en/articles/2020/03/16/bangm16.html (accessed March 26, 2020). Retrieved June 10, 2020,
from Bangladesh Government Downplays COVID-19 Threat as
Job Losses Mount: https://www.wsws.org/en/articles/
2020/03/16/bang-m16.html
4. Institute of Epidemiology, Disease Control and Research.
(2020). Retrieved June 10, 2020, from Bangladesh COVID-19
Update: https://www.iedcr.gov.bd/
5. Javed HAl. (2020). Retrieved June 10, 2020, from Passengers
From Europe Land in Dhaka Despite Ban: https://www.dhakatribune.com/bangladesh/dhaka/2020/03/16/
defying-bar-european- light-lands-in-dhaka
6. Anwar S, Nasrullah M, Hosen MJ. (2020, April). COVID-19 and
Bangladesh: Challenges and How to Address Them. POLICYBRIEF ARTICLE .
7. Jamil, K; Bhuiya, A; Streat ield PK; Chakrabarty, N. (1999). The
Immunization Programme in Bangladesh: Impressive Gains in
Coverage, But Gaps Remain. Health Policy and Planning , 14 (1).
8. Sharker, P., Sharker, N., Doulah, S., and Bari, T. (2015). Expanded
Programme on Immunization in Bangladesh: A Success Story.
Bangladesh J Child Heallth , 39 (2).
9. MoHFW. (2016). Bangladesh EPI: Coverage Evaluation survey
2016. DGHS, Dhaka.
10.AP. (2020). Retrieved June 10, 2020
11.UNICEF. (2020). Retrieved June 11, 2020, from Disruption ofchild vaccination in South Asia poses an urgent threat tochildren’s health: https://www.unicef.org/bangladesh/en/press-releases/disruption-child-vaccination-south-asia-posesurgent-threat-childrens-health-unicef
12.https://news.un.org/en/story/2020/04/1062712
13.GAVI. (2020). Retrieved June 14, 2020, from At least 80 million
children at risk of disease as COVID-19 disrupts vaccination
efforts, warn Gavi, WHO and UNICEF: https://www.gavi.org/
news/media-room/least-80-million-children-risk-diseasecovid-19-disrupts-vaccination-efforts
14.Maswood, M. (2020). Retrieved June 10, 2020, from The New
Age: 2m children in Bangladesh likely to miss schedules of 10
vaccines: https://www.newagebd.net/article/105433/2mchildren-in-bangladesh-likely-to-miss-schedules-of-10-vaccines
15.Uddin JM. (2020). Retrieved June 10, 2020, Prothom Alo:https://www.prothomalo.com/bangladesh/article/1653843/
UN. (2020). Retrieved June 14, 2020, from UN News: https://
news.un.org/en/story/2020/04/1062712
16.https://unb.com.bd/category/Bangladesh/covid-19over-28000-children-could-die-in-6-months-without-urgentaction/51543
17.Daily Kalerkantho. (2020). Retrieved June 11, 2020, https://w w w. k a l e r k a n t h o . c o m / p r i n t - e d i t i o n / n e w s / 2 0 2 0 /04/02/893626
18.Rahman Z. (2020). Retrieved June 11,2020,https://
samakal.com/bangladesh/article/200420483/Sarabangla.
Retrieved June 11, 2020, https://sarabangla.net/ post/
sb-430354/

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19.The Dandee Barta. (2020). Retrieved June 10, 2020, https://dundeebarta.com/site/
20.Islam MA. (2020). Retrieved June 11, 2020, from The Daily
Checkpost: http://dainikcheckpost.com/archives/49628
21.Daily Noyadigonto. (2020). Retrieved June 11, 2020, https://www.dailynayadiganta.com
22.The Daily Star. (2020). Retrieved June 11, 2020, https://www.thedailystar.net/bangla

Reviving the ancient businessmodel: The case of the Digos Barter
trade during COVID-19 pandemic- Fatima M. Chinfatimamchin@gmail.com (Corresponding author)
Asia United Bank, Digos City, Philippines- Raymond K. Hastings
hastingsraymond1@gmail.com
Cor Jesu College, Philippines- Randy A. Tudy
randytudy@g.cjc.edu.ph
Cor Jesu College, Philippines

Abstract
Barter is an ancient charter before the advent of the cash
economy wherein individuals and businesses use cash as a
medium of exchange. During the height of the COVID-19
pandemic, the barter system, driven by social media's
in luence, suddenly resurrected. The purpose of thisqualitative case study is to explore on the success of theresurgence of bartering in Digos City during COVID-19
pandemic. The case focused on the Digos Barter, a populargroup of Digoseños with a strong presence on Facebook
through its page named "Digos Barter Trade." Five
individuals, including the administrator of the Facebook
Page, participated in the Key Informant Interview (KII).
Secondary data, such as comments and reviews on
Facebook page and reports, were other sources of data.
Results showed the drivers of the success on the resurgenceof the Digos Barter Trade are unemployment, lack of cash,
and a sense of community. Based on the results, the Digos
Barter Trade members were driven by the loss of income
and their need for socialization. The resurgence of theancient business model during this recent pandemic
showed how this model could ill in the people's
physiological, social, and psychological needs in distress.

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Introduction
The irst form of commerce in human history was bartertrading, a simple exchange where people could freely swap
goods and services. With civilization, people needed more
and more economic advances to meet their social needs.
Hence, barter was not enough to meet the requirements(Rotolo, 2013). During the Great Depression in the 1930s,

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the scarcity of money led to a revival of cashless deals(Kaikati and Kaikati, 2013). Consequently, people beganbartering again; they exchanged work for food, goods forother goods (Rotolo, 2013). Barter is said to be on the riseagain worldwide.
The Universal Barter Group (2008) reported that in2004, 30% of all world trade came from barter trading; 65%of the fortune 500 irms engaged in barter trading in one
form or the other. Almost one-third of all small businesses
in the United States of America used some form ofbartering. The Small Business Association (2008) statedthat all indications show it increasing by the year. Barter
trade is one of the tools individuals and irms use to survive
during dif icult times (Bazar, 2008). However, as commerce
has become more complicated, slowly the barter system
was fading away. But, when the COVID-19 pandemic hit theentire world, the idea of bartering goods resurrected.
The world is in the midst of the most severe pandemic
that has led to increasing concerns and uncertainties(Ataguba, 2020; Weible et al., 2020). Nations responded
differently, but with one common goal of ighting the virus.
In the Philippines, this was by community quarantine. As
the community quarantine dragged on for a while,
individuals began to feel the burden of an acute shortage ofgoods and services that even led to hunger (Dutta, 2020).
Businesses and individuals are thinking of ways how toaddress the problem. One of these is bartering of goods.
In the Philippines, bartering has been practiced long
before the Spaniards colonized the country. During the
COVID-19 pandemic, because of its impact on business andemployment, it appears that bartering is back in time with amodern twist. A growing online community in Iloilo,
Philippines has rediscovered the practice of barter or
exchanging goods without money (CNN Philippines, 2020).
In the process, many other cities followed, speci ically in
Digos City. The Digos Barter has about 44,000 members todate. Not only has bartering become a fresh way of securing
goods, but it has also become fun.
The present study is our contribution to the literature on
the resurgence of barter system, particularly during the
COVID-19 pandemic. As this phenomenon is stilldeveloping, not much has been written about it. In thispaper, we discuss the drivers of success for the Digos Barter
Trade, facilitated by its strong presence in Facebook, apopular social media platform in the Philippines.

COVID-19 pandemic and the economy
The recent crisis, according to the World HealthOrganization (WHO), was declared a pandemic. Given therise in the recurrence of pandemics, numerous researchers,
including Garrett (2007), Keogh-Brown et al. (2008),
Madhav et al. (2017), and Fan et al. (2018) argued that alargescale global pandemic was unavoidable. The Imperial
College of London Coronavirus Response Team argued that
COVID-19 is the most severe episode since the 1918
Spanish In luenza pandemic (Ferguson et al., 2020).
Kuckertz (2020) stated that the COVID-19 pandemicEubios Journal of Asian and International Bioethics 31(2) (February 2021)

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Sampling: This study used purposive sampling, which istypically used in qualitative research to identify and selectthe information-rich cases for the most available resources(Patton, 2002). This involves identifying and selecting
individuals or groups of individuals who are pro icient andwell-informed and interested (Cresswell, 2011). It wasitted for this study since we used the key informant
technique. This study involved ive (5) individuals who
engaged in barter during the COVID-19 pandemic.

fOnline barter
The government restricted people’s movements to theminimum and the most essential ones. As they stayed homemost of the time, online usage increased. A new
phenomenon was born, online bartering. According to
Stodder (2020), bartering is a natural occurrence during an
economic crisis. Historically, it has been the form of trade inancient civilizations when money did not exist. Orme
(2004) de ined barter as trading goods or services for othergoods or services and is believed to be the world's oldest
form of exchange. Researchers have often concluded thatbarter trade can be bene icial in some situations, mostly due
to dif icult economic or business times (Crest, 2005; Lecraw,1989). Online bartering emerged during the COVID-19
pandemic. People have been turning to swapping, trading,and bartering as a form of entertainment or a way of getting
or exchanging goods. With economic uncertainty looming
and anxiety levels soaring, barter is becoming an emerging
alternative solution (Jones, 2020).
Current trends indicate that bartering frequency is on
the increase worldwide, with a major increase in internet
barter transactions. A signi icant contributing variable tothis development is the utilization of existing and rising
electronic business advances (Rise, 2003). In today's harsheconomic climate, Ortutay (2009) asserted that online
bartering is becoming a way of getting rid of old things andshopping without opening wallets. The number of bartered
goods posted on Kijiji, one of the leading barter websites in
Taiwan, had almost quadrupled in the latter half of 2012
(CommonWealth Magazine, 2013). In the Philippines, 85
popular Facebook barter groups with 2,150,448 Filipinos
are members of these groups (iPrice Group, 2020). We

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could say that Filipinos are getting into barter much as we
did back in the old days (Mendoza, 2020). The purpose ofthis qualitative case study is to explore the success of Digos
Barter Trade during the COVID-19 pandemic.

ftriggered a twofold crisis: an exceptional weight on
numerous health systems worldwide; and an economiccrisis when the infection control measures brought aeconomic activity to a sudden end.
The COVID-19 pandemic has wreaked havoc on the
lives of people. For example, Gourinchas (2020) discussed
about its effect on the economy, which disrupted the normaltransactions of employees, irms, suppliers, consumers, andinancial institutions. According to Carlsson-Szlezak et al.
(2020), there are three main transmission channels. The
irst is the direct impact, which is related to the reduced
consumption of goods and services. Prolonged lengths ofthe pandemic and the social distancing measures might
reduce consumer con idence by keeping consumers at
home, wary of discretionary spending, and pessimistic
about the long-term economic prospects. The second one is
the indirect impact of working through inancial market
shocks and their effects on the real economy. Household
wealth will likely fall, savings will increase, and consumer
spending will decrease further. The third consists of supplyside disruptions as COVID-19 halts production, negatively
impacts supply chains, labor demand, and employment,
leading to prolonged periods of lay-offs and rising
unemployment. Indeed, the economy is hugely affected, andthe people suffer.

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Research question
What are the drivers to the resurgence and success of thebarter system amidst the COVID-19 pandemic?

Methods
Research design: This qualitative study was conductedusing a single-case study approach. It was used to explore
the drivers of success of Digos Barter Trade during the
COVID-19 pandemic.
Participants: Five (5) members of Digos Barter Trade,
comprising of two men and three women, who quali ied on
the criteria set for this study, willingly participated in the
key informant interview. The criteria were as follows: (1)they must be a member of Digos Barter Trade; (2) they must
be residing in Digos City regardless of their age and gender;and (3) they must have at least ive (5) successfultransactions in barter. For the purpose of triangulation, we
also got reviews on the page of Digos Barter Trade to
analyze important information that con irmed its success.

Data sources and data collection: The main source of thedata came from the informants and the reviews on the
Facebook page. Interviews were conducted from August to
September 2020. All interviews were noted and transcribed.
Data were gathered through Key Informant Interview (KII).
Since the participants are accessible online, text-based
instant messaging (e.g., Messenger) was used for data
generation. The principal advantages of the key informant
technique relate to the quality of data obtained in a
relatively short period (Marshall, 1996). The KII technique
was suitable because the participants represented people
directly related to the case study.

Analysis and interpretation of data: To analyze andinterpret the data, we followed Colaizzi’s (1978) distinctive
seven-step process that provides a rigorous analysis witheach step staying close to the data. We also used thetechnique utilized by Tudy and Tudy (2020), like using
tables for analysis. First, we familiarized ourselves with thedata by reading through all the participants' responses intheir interviews several times. Second, we identi ied
signi icant statements that were of direct relevance to thecase study under investigation. Thus, we created a tablewith three columns consisting of signi icant statements,
sources, and formulated meaning. Third, after theidenti ication of the signi icant statements provided by the
respondents, we formulated meanings. We identi iedmeanings relevant to the study that arise from a carefulconsideration of the signi icant statements. Fourth, since
formulated meanings were given, the process of grouping allthese formulated meanings into categories that re lect a
unique structure of clusters of themes was initiated. Eachcluster of themes was coded to include all formulated
meanings related to that group of meanings. After that,groups of clusters of themes that re lect a particular vision,
was incorporated together to form a distinctive theme. Fifth,
at this stage of analysis, all emergent themes were put into
an exhaustive description. We wrote a full and inclusive
description of the study, incorporating all the themes
produced at step four. Sixth, we began the reduction ofindings that did not it the themes in the overall structure.
Lastly, we veri ied the fundamental structure through themember-checking technique.
Trustworthiness refers to the degree of con idence indata, interpretation, and methods used to ensure the qualityof a study (Pilot and Beck, 2014). Amankwaa (2016) statedthat researchers should establish protocols and procedures
necessary for a study considered worthy of consideration byreaders.
Credibility: Pilot and Beck (2014) asserted that thecredibility of the study, or the con idence in the study and,
therefore, the indings, is the most important criterion.
Credibility is achieved through reliability, replicability,
consistency, and accuracy of a study's indings (Tracy and
Hinrichs, 2017). Lincoln and Guba (1985) stated that it isthe equivalent of internal validity in qualitative researchand is concerned with truth-value. We ensured that the
research indings represent plausible information drawn
from the participants' original data. Before we conducted
the interview, we made sure that the participants know the
purpose of the study so that they would be comfortableenough to share their experiences with us. Also, theparticipants must be quali ied to give the relevant
information needed. In the interview protocol for the Key
Informant Interview, the experts validated the questions.
We applied the member-checking method, wherein theparticipants validated the correctness of their answers.

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Transferability: For credibility or authenticity, thequalitative research projects' indings should betransferable (Curtin and Fossey, 2007). Transferability
refers to the degree to which the results of qualitative
research can be transferred to other contexts or settings
with other participants (Korstjens and Moser, 2018). In caseof using different terms for techniques to establish
transferability, Lincoln and Guba's (1985) recommendation
is to provide a detailed description of the phenomenon. In
this study, we shared our indings to the participants andff

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121

also the bigger audience hoping the phenomenon would betransferrable in other contexts.
Dependability: We explained how the data gathering wasdone. Dependability includes the aspect of consistency(Lincoln and Guba, 1985). According to Shanton (2004),
dependability is dif icult to measure where there is a needto facilitated future investigation to obtain consistency ofstudy. We discussed thoroughly the methods we used to
conduct the study so that others who would want to know
about the study and would like to replicate it in othercontexts would be guided.
Finally, con irmability requires the researchers todemonstrate how conclusions and interpretations havebeen reached. It is concerned with establishing that indings
are clearly derived from the data (Tobin and Begley, 2004).
Con irmability is usually established when credibility,transferability, and dependability are achieved (Ryan et al.,2007). In this study, we provided an audit trail to make sure
we can trace and connect how we journeyed from data
gathering to analysis, and interpretation.
Ethical considerations: At the beginning of the research,
we clearly disclosed the purpose of the study and made surethat the respondents voluntarily participated. Moreover, we
explained that they have the right to withdraw from thestudy at any stage if they wished to do so. Ethics has always
been an important consideration when doing research andare regulated by law and ethical standards. Creswell (2013)
suggested that ethical concerns need to be consideredthroughout the process of doing research. Creswell (2013)
noted that it is important to be aware of cultural norms andthe needs of any vulnerable populations that may be part of
the research. We secured the participants’ informed
consent. Mandel and Parija (2014) pointed out that
informed consent is the bond of trust between the
researchers and the participants. It is the single mostimportant aspect of any good research because it assuresthat participants’ wellbeing will be protected and that they
have self-determination in terms of participating in the
research. Rose (2009) stated that the informed consent
process must be a dialogue of the study's purpose, duration,
experimental procedures, alternatives, risks, and bene its.
Hence, before the interview, we asked them to read and tosign the informed consent form.

Results
Drivers of success of the resurgence of the barter systemamidst of pandemic: When the participants were asked
how they ended up engaging in barter during the COVID-19
pandemic, the following themes emerged: unemployment,
lack of cash, and sense of community.
Unemployment. Millions of inhabitants of the archipelago
have lost their jobs due to the COVID-19 pandemic; many
got unemployed and some of them ventured into bartering
because there was an opportunity, as expressed by the122

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

participants. They had to stay at home because of thequarantine protocols. Hence, they could not work.
In the case of Ms. Ana, she shared: “We participated inbartering because we had a hard time when the Enhanced
Community Quarantine was implemented. My father lost his
job as a tricycle driver. He cannot go out and work since he isa senior citizen.”
Like the irst participant, Mrs. Mary who also joinedbarter, mentioned: “My relatives are struggling with
unemployment. Their workplace was closed due to thepandemic. They have nothing to eat so I bartered my personal
belongings in exchange for groceries and rice”.
Struggling to make ends meet, Mrs. Arlene offeredoptical services to Digoseños in exchange for groceries. She
said: “I started to barter last June. I bartered a complete one
eyeglass for eight kilos of rice and groceries. Since I cannot goback to Palawan (around 900 kilometers apart) and my clinicis there. It was even closed due to pandemic.”
Lack of cash. Lack of cash was another driver cited by theparticipants. Many people talked about the health crisisbrought on by the outbreak of the COVID-19 pandemic. It is
not the only challenge causing stress. They were also
worried about their inances, both short-term and longterm. Thus, they responded by bartering as a natural
solution when there was no money. For instance, in the caseof Ms. Ana, her family suffered inancially due to her father's
unemployment because of the pandemic. She shared: “It’s so
dif icult nowadays. We do not know where to get money tosettle the bills for groceries.”
She added, “I bartered my mother's snake plant. It's easier
to convert them into food with bartering, especially when we
don't have a source of income.”
Mrs. Arlene maximized her skills since she also needed
food for the family. She shared: “During the pandemic, manybene ited from my services as I was offering complete
eyeglasses to those who could not afford it or had no money
to spend for their eye problem. Truly, many have availed myservices. In return, it also helped me like providing food andmilk for my mother while we were waiting to return to
Palawan where my livelihood is.”Based on the sharing of our participants, the lack ofmoney or cash prompted people to consider bartering justto get food. Also, they realized that while they had nomoney, they had accumulated material things which they
could swap for other needed goods like food.

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Sense of community. At a time of extreme isolation,bartering makes the participants feel they are a part of acommunity that looks out for one another. It is not justabout the goods that they get but that feeling of solidarity
amid a crisis. Mr. Benjamin revealed: “I learned more about
how to improve public relations through bartering. That isexactly one of the reasons why I like barter. You get to know
people you are dealing with.”
In the case of Mr. Franklin, who is the administrator of
the Facebook group, he explained how the Digos Barter
went beyond just bartering. He shared: “As the administrator

of Digos Barter Trade, I posted a request to solicit help toseniors who cannot get out of this pandemic. They requested
to barter their 200 bundled irewood in exchange for a sack ofrice and groceries.”
Somehow, just knowing that someone out there isexperiencing the things the same way you do brings
comfort. Hence, bartering had brought not only sharing or
exchange of goods but it also created a sense of community
and an expression of compassion for those in need.

Discussion
The results of this study revealed that the resurgence ofbarter succeeded in times of COVID-19 pandemic because of
the different drivers. When the participants were asked why
they ended up bartering, one reason was unemployment.
The COVID-19 pandemic has caused an exponential
increase in unemployment. To provide a lifeline, Digoseños
started online bartering. During the pandemic, however,scarcities of items and a high unemployment rate areforcing people to think outside the box. Birch and Liesch(1997) indicated that the barter system is the most
attractive to the unemployed and those with low householdincomes. Hence, those who do not have much inancial
resources are most likely to indulge in bartering.
Another reason for the revival of barter was lack of cash
during the pandemic. While many Digoseños talked about
the health crisis brought on by the outbreak of the
COVID-19 pandemic, that is not the only challenge causing
stress. They are also worried about their inances, both
short-term and long-term. For them, barter is a natural
solution when there’s no more money. Bartering became
popular during the Great Recession in 1930s. Ozgul (2017)
explained that bartering can contribute to the country’s
economy by relaxing companies even in times of crisis. In atime of pandemic, most people are affected by the inancial
crisis due to loss of income. With no more cash to buy
necessities, the barter allows people to trade their unused
or used items. It is a welcome relief for cash-strapped
individuals and families, especially during a pandemic.
Sense of community is also indicated as a driver to theresurgence of bartering. Sometimes it is not just about the
goods we get but that feeling of solidarity amid a crisis. At atime of extreme isolation, bartering makes people feel they
are part of the community that looks out for one another.
Marmarosh et al. (2020) found that human beings arefundamentally social, and the need to gather with others isextremely important, especially during times of distress.
The need to belong and the importance of reducing
loneliness during uncertain times often encourage people toconnect, despite recommendations to remain sociallydistant. It takes more energy to barter, but it also builds a
sense of community.
Implications of the study: For local barter trade, there isno clear prohibition. But these are still subject to regulation,must be registered and are subject to tax if done again in thecourse of trade or as regular business. In fact, there wasalready an attempt to tax bartering. Nevertheless, theindings of the study provided a glimpse of how government
can support barter in times of pandemic. How can it support
or tolerate when people in need can bene it from it?

Concluding remarks
Indeed, bartering is becoming very helpful, especially for
those who have lost their jobs due to the pandemic withlittle money left to buy daily essentials. The economic
hardships people are coping with are driving therediscovery of bartering. Many community members may
have begun to barter not so much for economic but social
reasons, as bartering can reinforce social connections,express kindness, or secure essential supplies for neighbors
suffering hardship. Moreover, the barter group has
expanded its reach by serving those in need. This is anotherarea for future research worth investigating.
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The evaluation of public healthethics, individual, collective andstate with institutional,
responsibilities and obligation
during the COVID-19 pandemic
through online media reports in
Turkey- Sukran Sevimli, M.D.
Department of Medical History and Medical Ethics, Dursun
Odabas Research Hospital, Faculty of Medicine, Van Yuzuncu
Yıl University, Turkey
Email: sukransevimli@gmail.com
Abstract
Qualitative content analysis of Turkish Medical Association,
Turkish Public Health Association, and online newspaper
articles and videos using keywords was made. After that,
related online reports and interviews have been classi iedand analyzed according to the context between May 22,2020 and November 16, 2020. The Turkish COVID-19
scienti ic committee and the Ministry of Health havesuggested a new way of normal life called controlled social
life for all places in Turkey. In the frame of theserecommendations, with the Google research engine many
articles of online media including announcements ofmedical and legal associations, interviews, and calls madeby the authorities were selected and analyzed. These
articles and interviews containing each problem and pieces
of information provided for the common understandings ofthe society were selected and evaluated for three topics
individual, collective and state and institutional
responsibility and obligations.
Although the warnings of associations, health authorities,
and scientists are mostly about personal-civil responsibility,
some occurring practices have caused violations. The
research found that the level of education, perception
capacity, and habits that include existing social-cultural andreligious rituals have prevented people from adapting tothis controlled social life. Therefore, besides the original
national culture and customs, universal ethicalresponsibilities and obligations should teach starting from

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

primary school and should consist of whole life
understanding as a higher perspective.
Key words: Public health, public health ethics, ethicalresponsibility, COVID-19, Turkey

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Introduction
The COVID-19 pandemic has shown the importance of
public health ethics (PHE). PHE is assisted by many-ethicak
approaches, utilitarian, deontology, social contracts, andvirtue ethics. Utilitarianism and consequentialism in the
19th century, seriously affected public health. The classicalutilitarian’s, Jeremy Bentham (1748- 1832), and John Stuart
Mill's (1806-1873) views were adopted as a public healthapproach as "the greatest good for the greatest number andthe least harm for the fewest”. Macer (1998) stated that thisp h i l o s o p hy i s i n te r n a l ly c o h e re n t , s i m p l e , a n dcomprehensive and can be effective to resolve dilemmas. In
this utilitarian context, PHE constraints should be for thebene it of the individual and/or the bene it of thecommunity. In this perspective quarantine and isolation
practices are provided to protect the greatest people.
A second ethical approach is deontological or duty ethics(e.g. Immanuel Kant). This theory includes ethical rights
and duties, both actions and the intentions of those whopractice the actions. These are bene icence, nonmale icence, idelity, reparation, gratitude, selfimprovement, and justice (Etkin, 2016; Zack, 2009) . Thisapproach has played an important role in the preparation of
the Universal Declaration of Human Rights (Etkin, 2016).
Two articles of The Universal Declaration of Human Rights
are “Everyone has the right to life, liberty, and security of
person” and “Everyone has the right to a standard of living
adequate for the health and well-being of himself and of his
family… and the right to security in the event of…
circumstances beyond his control.” (The Universal
Declaration of Human Rights (UDHR), 1948; UNESCO,2005). Although the deontological approach is criticizedbecause it is not a gray area, it is important in terms ofevaluating the four basic measures created during the
pandemic period within the scope of responsibilities andobligations towards individuals own themselves and society.
Virtue ethics (e.g. Plato and Aristotle) is concerned withliving well (Etkin, 2016; Zack, 2009) . The person is pleased
to behave virtuously, s/he does not do the virtuous behavior
to get praise from others, and that is, person only chooses tobe virtuous. It considers each person should have moral/
ethical values to act and to attitude. This approach leads tomoral autonomy as a person’s self-determination, howeverat the same time; it brings also an individual's individual
ethical responsibilities and obligations.
According to social contract theory there is a contract
between the public and the government. This contract has
involved legal rules, social-ethical responsibilities, andobligations towards the public (Zack, 2009). The public cangive up some freedoms in return for the health bene its.
Therefore the government's duty is to prepare programs,
plan, and facilities for all health issues, and so it can

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mitigate, respond, and recovery. In this context, it takes
measures to prevent people from harming themselves andothers by adopting a paternalistic attitude if necessary. The
concept of responsibility and obligation has also
determined in "The Universal Declaration on Bioethics andHuman Rights" in Article 14 “Social responsibility andhealth": The promotion of health and social development for
their people is a central purpose of governments that all
sectors of society share” (UNESCO, 2005).
The social justice theory of John Rawls described social
justice's main aim is fairness and egalitarian principle andprevent "the veil of ignorance” (all human persons are equalin fundamental worth or moral status) and convenient for
democracy which based on human rights. In other words, toremove "veil of ignorance" is to protect human dignity, equal
right for human beings, and societal peace. Correspondingly,
PHE prioritizes the health problems of society as thesalience of population health, safety, and welfare; fairness
and equity in the distribution of services; and also respect
for the human rights of individuals and public, (Daniels etal., 2000; Gostin, 2001)”; and “Justice is Good for Our
Health” (Daniels N et al., 2000).
Therefore the main jobs of states and institutions is tohave a two-kind of plan as a preparation plan and response
plan. These plans may help produce peaceful and effective
solutions to panic, fear, preventing disinformation withviolation of human rights and con licts. Firstly, thepreparation plan aims to save the greatest number andrestructure the conditions of response, so that, adequate
responses mitigate ethical violations. And the second planshould be prepared as a response plan to save all people.
Because pandemic usually created some societal justiceproblems because of limited resources in terms of numbersof hospital beds, tests, ventilators, antiviral medications,and the number of healthcare personals. These ethicalapproaches are important for public health because theactions of collective ethical responsibilities and obligations
may occur in a society consisting of both external
experiences and individuals performing internal
evaluations. Preliminary preparations, plans, and practices
made by taking into account science, legal and ethicaltheories also contribute to the awareness of the society
about responsibilities and obligations of the individual,
collective, and the state.
The COVID-19 pandemic has entailed responsibilities andobligations at a global level. Some measures include
institutional, collective and individual responsibilities.
These responsibilities and obligations have required somecommon restrictiveness in both individual and societal levelin every nation. As a matter of fact, in the irst months of thepandemic, countries around the world implemented not
only quarantine/isolation but also lockdown and restrictedtravel (human mobility from in city to the whole country or
beyond the country). However, as the economic problems
deepened, these measures were loosened, and the new
return to normal movement was initiated within theframework of the determined rules; (1) using of face masks;

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(2) using hand sanitizers to be clean; (3) observing social
distance (protection distance) between people; and (4)staying home as much as possible. However, theeffectiveness of these border measures can only be possible
with the participation of the individual, collective and state
institutions. In short, these three responsibilities mentioned
above have involved the eclectic combination of the four
ethical approaches.
1. Individual ethical responsibility and obligations:
Ethical responsibility is an indicator that the individual'sability to recognize, understand, interpret, and act
autonomously on multiple principles and values, according
to standards within a given ield and/or context (Cemal,
August 1 2016; Neves, 2005). Medical ethics includes theindividual's fair use of medical services within theframework of their autonomy and their acceptance orrefusal of treatment. However, since PHE aims to protect
and maintain the health of society, it requires certain
measures that restrict the autonomy of the individual(Giubilini, 2019). Therefore, PHE includes collective
responsibilities and obligations.
2. Collective ethical responsibility and obligations: This
ethical responsibility and obligations have included some
restrictiveness of individual autonomy partially orcompletely (Giubilini, 2019). This situation occurs
especially in extraordinary situations such as pandemics
and disasters. When there are serious health problems suchas a pandemic, PHE may require restrictive measures suchas quarantine, isolation, and vaccination, as well as lessrestrictive measures such as protective equipment, social
distancing (contagious protection distance), which include
collective responsibility. However, these obligations do notmean that total removal of ethical values. Therefore theseobligations should involve some ethical principles, called
the principle of less restrictive alternative (PLRA) measures
become more vital (Giubilini, 2019).
3. State and institutional ethical responsibilities andobligations: The implementation of public health policies
and ethical values is only possible if the state, relevant
institutions, public health workers and society ful ill theirlegal and ethical responsibilities. The state is obliged toprotect and improve human rights, provide necessary
assistance and proper management of institutions andservices, according to clear and transparent eligibility
criteria and rights. Relevant state institutions are obliged totake measures to protect the health of individuals, namely
society. PHE does not ignore the ethical principles of
medicine, but in extraordinary situations such as apandemic, it may limit some individual rights (autonomy)such as quarantine/isolation, or lockdown and PLRA suchas vaccine or using mask and so on.
The purpose of these obligations of public health scienceand related institutions has protected public health and has
also maintained state public policy. Therefore public healthpolicy should involve public health measures but also be
careful with these restriction measures; while theserestriction measures include principles such as non-harm,
utility, and justice, they should not completely eliminate theprinciple of autonomy. The majority of restrictive measurestaken within the framework of public health policies
followed during the COVID-19 pandemic are in line withindividual ethical responsibilities. Of these, only quarantine,
isolation, and lockdown have put a serious restriction on
individual autonomy. However, using protective items ofclothing (mask, social distance, and hand washing, and stayat home as possible as etc.) is convenient with the principleof less restrictive alternative (PLRA) (Giubilini, 2019).
There needs to be implementation of two kinds of plans
as short and long term. These may be detailed as: irst
adapted to the conditions involving various parameters andprepared clear intuitional policies; second, themaintenance obligation of healthcare professionals serving;
third, resource allocation and priority setting during
emergencies; fourth imposing restrictive measures;quarantine, lockdown/curfew, and up to PLRA (Giubilini,2019) such as social distance, using protective equipment,
hand washing and vaccine; ifth, consider international
public health obligations; sixth calculate risk perception foreach level and seventh is to inform the public to adapt tothe existing conditions and ensuring good communication,and public health research.
In this study, I have found examples of theunderestimation and even total lack of attention of PHE
measures that less constrain people's democratic-social andeconomic life in Turkey. Turkey's government had loosened
COVID-19’s type of isolation measures to stimulate theeconomy, which was adversely affected by the irst wave of
the pandemic like other governments. However, while
economic activities returned to normal with social andpolitical meetings (e.g., weddings, engagements,
condolences, funerals, political meetings, the opening ofmosques and shopping centers, private Quran courses,
restaurants, and education) the number of cases increased
sharply in the whole country as a result of people notpaying attention to speci ic pandemic measures. For thesereasons and the aim of the study, the researcher collected
some online reports and videos to evaluate in terms of PHE
speci ic restrictive and less restrictive measures. And allreports were evaluated to explain why some measures are
not followed by some people.
Research Questions
Why do people not pay enough attention to less restrictive
measures that will protect and sustain their lives healthsocially and economically? What are the factors of the nonful illment of personal, social, and corporate responsibilities
here?

MethodThis study was conducted as qualitative research on online
media reports and interviews to explain public health ethics
individual, collective responsibilities between 30 June to 16
November 2020. For this purpose, I then collected somerelated events from online reports and YouTube interview
videos. The review reports and videos were assessed
according to the pandemic, PHE and individual-collective,Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

and institutional responsibilities and obligations. I thendetermined keywords and searched on internet web sites
and YouTube’s into consideration. After that, pieces ofreports were collected, associated, and separated according
to their subjects.
And, all results were collated andevaluated with a framework of the values of public healthethics (PHE) and their individual, collective andinstitutional, responsibilities, and obligation.

Results and Discussion
The COVID-19 pandemic differs from other diseases interms of the risks they pose for others, as well as its
emergence processes due to the social determinants
included in the concept of health. An effective response
against the pandemic requires measures to be taken at theindividual, collective and institutional levels.
This study is important because it includes cases, legal
regulations, and emerging problems at the national level.
Each country should put its issues to determine a common
path around the world. In addition, it seems, organizations
such as the World Health Organization, Control Disease
Center, and Public health organizations and government
need to study more to prepare more functional programs
about the situation. The pandemic cannot be prevented only
by healthcare professionals and facilities; in order to control
and eliminate the pandemic problem, each individual
should ful ill their ethical responsibilities and obligations;and therefore, collective participation and institutional
support are required.
However, there is no speci ic case-based qualitative or
quantitative study on this subject in Pub Med, Google,
Google Scholar, and Science Direct studies, however, only afew studies were related to individual, social andinstitutional responsibility. For this reason, this study data
were evaluated and discussed within these studies.

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1. Individual ethical responsibilities and obligations:This includes steps of protection of each individual(protective equipment, social distance, hygiene and stayhome as much as possible), individuals applying thesebehaviors with the same meticulousness, that is, accepting
them as a collective ethical responsibility. In this context,
when we examine the news and interviews in the media, it
is seen that there are serious problems regarding individual
responsibility and obligations. Evaluating the reasons of
those who do not want to ful ill individual responsibilities
and obligations will make a signi icant contribution to thesolution of the problem in question. For this reason, news
and interviews including the reasons of those who do notcomply with the existing measures were selected.
The online media reports collected as an example
under 4 subheadings regarding these responsibilities andliabilities have not clearly understood the pandemic
problem at the individual level (Appendix A). The cases are:
1. Some Turkish customs such as hugs, condolences (takedays), wedding ceremony, home visits (e.g., guests came tothe house, we couldn't say no) hand or face kissing tradition127

and practices of religious holidays contributed signi icantly
to the increase of the pandemic. 2. Some of the Covid-19
patients have tried to escape from the hospital orquarantine. 3. The spoiled sel ishness of famous people not
to take precautions. 4. Some people refuse to use masks andsocial distance for personal reasons (e.g., “I should attend
political or social meeting”, "I am not affected by the
pandemic", “my working conditions, eating together in thejob, and my transportation problems force me”, or I havemore serious problems than pandemics (e.g., hunger, bills to
be paid, rent, children's needs and so on). 5. Those whostrongly respond to the doctor's mask warning.
Some YouTube Street Interview videos were analyzed(İlave TV, 2020; Media, 2020; Sarı mikrofon, 2020; Sor kaç,
2020; Street interviews, 2020; Tolga Taştemel, 2020).
Topics from these interviews were: 1. Some people do notbelieve in the presence of COVID-19, 2. Some people put
faith over the pandemic situation in thinking this sent by
God/Allah, 3. Some think that COVID-19 will not seriously
affect them, 4. Some indicated that the data show that themortality rate is low; so, if they get infected they will betreated in the hospital, 5. Some indicated that in any case,we will be infected by COVID-19, maybe it is a destiny, andthere is no need for panic. However, all of these negative
attitude 6. Some of them think that pandemic is not only agovernmental issue but also on individual, collective andstate- institutional responsibility.
When we consider these events, it is seen that there is aserious problem regarding individual ethical responsibility
and obligations; it is seen that people escape fromquarantine, celebrities see themselves as special, strongly
disagrees to doctors and people who warn of wearing
masks, and not obeying the social distance rule, they do nothesitate to ignore both themselves and other people, andeven endanger their health. However, health authorities
have stated that protection from the short and long-term
consequences of the Covid-19 pandemic is only possible ifevery individual in the society acts with a sense of
responsibility towards others. In addition, they stated that
despite their explanation that protection from the short andlong-term consequences of the epidemic is possible only ifevery individual in society acts with a sense of
responsibility towards others, and the messages
emphasizing the understanding of total solidarity in theprocess, unfortunately, it has not been understood enoughyet by people.
While evaluating these cases, we can accept that the stateof fear and anxiety caused by being under threat of possible
death is normal to a certain extent. People know only as
much knowledge as they can understand, and make sense of
it and apply it. However, we can only allow the uncertainty,
confusion and despair brought about by the pandemic todominate human life to a certain time. This period should
be short; people must take into account the direction andmanagement of institutions as a social entity andunderstand the importance of solidarity in order to protect
their own existence. Otherwise, we cannot control and128

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

mitigate the harm of the pandemic, individual ethicalresponsibilities, and obligations really play an importantrole. However, in this process, the feeling that security andhealth institutions can protect people from everything
started to disappear, "With the COVID-19 pandemic, people
have dif iculties in being tested for COVID-19, the right to bediagnosed and treated from the state, and they have been
disappointed on their thought and expectation that theycannot receive suf icient health, security and economic
support (Üstün & Özç ftç , 2020). Therefore, people also
developed some feelings such as anger, anxiety and fear
(Bozkurt, Zeybek, & Aşkın, 2020; Yıldırım, 2020).
In addition to all of this, another important reason is that
health literacy, health news and health warnings are
ignored. Sensational, tabloid-type news is in focus, while life
issues are not. These show why a serious study is needed onhealth literacy and watching-listening to health news.
Perhaps it would be bene icial for the media to present
health news in a more striking way, to take part in thiscontext, and to include in discussion programs. The
inclusion of all institutions providing secular and religious
education from kindergarten to health education programs(such as children's games, social activity planning games,
and cartoons) and continuity in these programs can makethis issue more effectively.

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2. Collective ethical responsibilities and obligations:
The organization and realization of collective movements
are dif icult, because people should share common aim andapproaches. Therefore, for economic purposes, it is easy forpeople to come together and embrace joint action; we caneasily see this in companies (Lewis, 1948). Businessorganizations do not ignore their ethical responsibilities inorder to maintain their own existence and increase the rateof pro it, and develop different standards by which
members of the organization can be judged for personalfaults. Ethical and legal responsibilities and obligations areclearly stated in these organizations (Smiley, 2005).
Members are limited in their powers or judged due to their
unethical and illegal behavior, and therefore they faceserious material and moral damage (Smiley, 2005).
However, that situation is different in public health.
Especially during a pandemic, the way to break the chain ofcontamination is to block the contact chain. For that reason,collective understanding-attitude is important to break the
chain of contamination. The spread of the virus will be
prevented by inding and isolating the contact. People
should follow voluntary or compulsory determined
pandemic restrictions for two reasons both for the bene itof the individual and the bene it of the community. This
study evidence stated that the common consciousness inthe continuation of the spread of the pandemic; the effect ofPH and PHE awareness is not suf iciently developed insociety (Appendix B).
These ive themes described the results: 1.People's
failure to comply with COVID-19 new normalization ruleswith hugs and hand kissing where at funerals, weddings,
engagement ceremonies, continuing home visits between

friends/relatives, frequent home visits, religious holidays
and soldiers' farewell ceremonies; 2. Companies do notreport cases due to economic concerns; 3.Koran courses(private religious education courses ignored the pandemic);
4. Of icial education institutions to start education (despite
the measures taken, COVID-19 positive cases emerged); 5.
Unfortunately, the society does not take into account the
new normal living conditions in the natural disasters andimportant opening or meeting (Hagia Sophia opening,
political meetings, lood disasters in Giresun, and anearthquake in İzmir and its districts etc.).
In the light of the data in Appendix B, we can clearly saythat public health requires each individual to be selfconscious about health and public health, and their actions
should be in line with the existing measures and associate
this with their individual ethics. For that reason, the publichealth ethics organization and realization of collective
movements are not easy, because people should sharecommon aims and approaches. Therefore, for economic
purposes, it is easy for people to come together andembrace joint action; we see this in companies. Businessorganizations do not ignore their ethical responsibilities inorder to maintain their own existence and increase the rateof pro it and develop different standards by which membersof the organization can be judged for personal faults (Lewis,1948). Ethical and legal responsibilities and obligations areclearly stated in these organizations. Members are limitedin their powers or judged due to their unethical and illegal
behavior, and therefore they face serious material and moral
damage. For that reason, if people don't tangible bene it isdemonstrated, people don't care to act together and follow
rules.
In this context, each individual is important, especiallyemployees who are in contact with too many people for
their job can spread COVID-19 without symptoms, children
and teens should also be evaluated as a super-spreadergroup by authorities. Therefore, the authorities need to plana serious child-adult education in order to increase publicawareness and public consciousness about the knowledge
and results that will enable joint action. In the program,individuals should be self-conscious about health and publichealth, and their actions should be in line with existingmeasures and associate this with their individuals' ethicalresponsibilities and obligations. Thus, it can be ensured thatthey stop the behaviors that are a part of society's traditions
and customs and have now become a habit during apandemic.
In this context, it is stated that in the study conductedwith 533 villagers in China, the villagers collectively
followed pandemic measures with inform, control, publichealth leaders, and its committee and legal reasons (withpenalty fear). However, the study in question is about
villagers and it is undoubtedly much easier to control thelimited population and area (Yang & Ren, 2020). However,
population and area size constitute two serious barriers incities. Therefore, reports in the media about the village andthe villagers in Turkey is quite limited and seems to befocused on the city of these problems.

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As a conclusion, the shortcoming in this context becamevery evident in the COVID-19 pandemic, and some of thepeople ignored the new normalization rules and returned totheir pre-pandemic behaviors and meetings. This attitude
prevented the pandemic from being brought under control,causing serious damage to the whole country. Taking action
to create collective awareness among people in the
pandemic requires a special effort to ensure health literacy
or media and health authorities should put extra effort todevelop at least providing good listening and understandingof health-related information.
3. State and institutional ethical responsibilities andobligations: The responsibilities of the state and related
institutions can be addressed from both an ethical and legal
perspective. Because, taking into account the values of PE
a n d P H E a re p o s s i b l e by e s t a b l i s h i n g s t ro n g ,understandable, and traceable policies and clarifying the
ethical and legal dimensions of these policies. The duty ofthe state is to improve the lives of people in every condition,and so, the ethical approaches, social contract, and social
justice theory in the introduction part of the article,
pandemic preparedness plan, and response plans are ofvital importance. In this framework and speci ic to thepandemic necessary legal-ethical-social measures are;active case- inding studies by the application of screening
tests of the relevant institutions of the state, de initive
diagnosis, and treatment of suspicious cases, quarantine/
lockdown practices, tracing of the contacts, and practices
the less restrictive four measures: 1.Legal precautions andits penalties, 2. Con licting statements by governmentof icials, 3. Lack of multi-sectoral organizations. 4. Seasonsin pandemic planning, and inally 5. Preparation for natural
disasters every time (before-during-after) to prevent
pandemic disseminate.
1. Legal precautions; penalties and incentives (Violating
the measures regarding infectious diseases): According
to the justi ication of the crime of violating the measures
regarding infectious diseases, the protected legal value is"protection of public health". The relevant sanctions are
determined as "crimes against the public health” (Bayzit,
2020; Yenerer Çakmut, 2014).
In the event of entering or escaping a place underquarantine despite being unauthorized, or in case of otheractions that may be contrary to the measures taken by thecompetent authority, the following penalties are given topersons (Appendix C) within the framework of the laws indetail. The ine to be applied according to the 282th articleof the General Hygiene Law (789-3180 TL), the penalty to
be applied according to the 32nd article of theMisdemeanor Law (100-392 TL) and the 195th article of
the Turkish Penal Code. According to the opinion,
imprisonment from two months to one year may be
imposed (Bayzit, 2020). However, these legal rules do not
involve or mention "using a mask", therefore, in the casetitled "The court canceled the mask penalty! Striking 'social
state' emphasis" in Appendix C, it was revealed that thisissue could not be evaluated legally. This is undoubtedly due

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129

to the fact that this pandemic has different characteristics
than other pandemics. Therefore, legal regulation needs tobe reevaluated.
Besides that, in accordance with these legal regulations,
The Ministry of Interior issued various circulars to ensure
controls during the pandemic process; on 11 September
2020 a circular regarding the Imposition of a Dormitory
Charter to Avoid Isolation was issued and the relevant
practices were provided by the security forces; on 12
September 2020, "Circular on HES Code Obligation inIntercity Buses with 81", on 15 August 2020 "Circular on
Public Rest and Entertainment Places Sent to 81 Provincial
Governorships; On 24 September 2020, a Circular on
Correctly Informing the 81 Provincial Governorships wassent and; on the date 30 September 2020 "Turkey
Coronavirus General of the Comprehensive Audit to perform",and the 81 Provincial Governors (Life is often home) HPP
Code Theme 2 Circular (Türkiye Cumhuriyeti İç İşleri
bakanlığı, 2020).
Although with these legal regulations and penalties somepeople still haven't followed the new normalization rules.
The very high risk of transmission of COVID-19, people arestill continuing to act within normal living customs andrules, and the lack of incentives as well as prohibitions have
led to the pace of the pandemic.
Would incentives be more effective? Identifying low andhigh-risk professions in the pandemic and implementing
inancial incentives accordingly will make a serious
contribution to the control of the pandemic. For example,
the bus driver who is not allowed to take standing
passengers will abide by this rule, because the government
has prepared an incentive package to support his earnings.
Hazard pay during a pandemic and providing incentives
within new laws for essential workers such as signi icant
inancial incentives should be given to freelancers,
tradesmen, unemployed people (including those who workin daily work) and those who disclose their duties such ascollective looding; rewarding the businesses-shop owners
that obey the rules (Parkhurst and Faulkner., 2020; Hecker,2020).
1. COVID-19 Turkey government aid; the government
decided to provide social assistance for unemployed peopleor limited work allowance for those who are at risk of being
unemployed or losing their jobs. In accordance with theAdditional Article 2 of the Unemployment Insurance Law
No.4447, it has been decided to pay premiums to those whomeet their working periods and premium payment
conditions at the start of the short-term employment of theworkers. 2. On the other hand, inancial support should be
provided for all healthcare workers due to the high-risk
group and recognizing COVID-19 as an occupational disease
and providing continuous inancial support to thehealthcare professionals and other hospital staffs, children
and spouses of those who died from COVID-19. And
healthcare workers all over the country took action with thecry "We are running out, we are dying". Because the disease
and death caused by the COVID-19 makes working

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conditions more oppressive and harder. Indeed, HCW felt
this pressure the most. In addition, Turkish Medical
Association and Turkish Mental Trauma and Disaster
Psychiatry Working Unit had an explanation. “Coordinator
Dr. K. Laçiner pointed out that the burden of healthcare
professionals is increasing day by day: “Healthcare
professionals caught Covid-19 disease 14 times more often
than society” (Birgün/Ankara, 2020).
In summary, the importance of inancial incentives forbetter execution of the pandemic process should not be
overlooked by the authorities and incentives should also be
evaluated more among the measures.
2. Con licting statements by government of icials, World
Health Organization (WHO) and scientists: 1.This
con lict is seen in both explanations and some applications.
In this regard, the limitations made in the data announced
daily by the Ministry of Health or not disclosing thosediagnosed with Covid-19 positive, but disclosing thosediagnosed with Covid-19 and having severe symptoms
played an important role in not knowing the total number of
COVID-19 positive cases. Scientists make different
explanations. Con licting statements of the WHO aboutmasks and medicines used for treatment (Ashley Yeager,
Feb 28, 2020; Bayram Altug, 2020; Editorials, 2020; Mark
Sableman, 2020). 2. Lack of consensus on all meetings:
While the meetings regarding weddings, condolences,engagements or national holidays were limited, politicalmeetings such as party congresses or mosque openings
seriously affected people's decisions regarding COVID-19.
Pneumonia rate of patients: 4.20%
Number of severe patients (red line): 3.439
Total number of healed patients (blue line): 414.278
Total death number: 11,507(Türkiye Bilimsel ve Teknolojik Araştırma kurumu(TÜBİTAK), November 15, 2020.)

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3. Lack thereof multi-institutional organizations:
Turkey's health system, hospital and medical staff at the
beginning of the pandemic quite successful because of
employment. Besides it, the irst important organization is
the Coronavirus Scienti ic Advisory Board which is a groupof medical scientists set up on 10 January 2020 by the
Ministry of Health. A COVID-19 guide was prepared tocollect information about the disease from a single source
on January 14. However, as known that an open dialogue
includes basic elements such as the right of all decisionmakers to access information (transparency), enabling all
scientists to take a more active role, and so on. This also
plays an important role in the trust, love, compassion,understanding, solidarity, cooperation, and sharing of
dif iculties between the society and the institutions andtherefore the state.
In a pandemic situation, continuous decisions are madeat international-national, organizational/ institutional andindividual levels. The sum of all these decisions constitutes
the response to the epidemic. These decisions are based on
scienti ic and correct information. Therefore to thisimportant and necessary board, the establishment of acommittee consisting of professional organizations,ethicists, and social scientists, along with this council, could
be a signi icant contribution to the development of social
common understanding against the pandemic. Considering
the country in general, it is seen that “a common
understanding and common attitude” against the pandemic
has not been realized yet. Unfortunately, there is ade iciency in this regard. Because creating public awarenessof Turkey in taking these measures can provide thecontinuation of social and economic life. For this reason,with the participation of every professional, social, and artorganizations, wider cooperation will make a very
important difference. This team can evaluate risks fromdifferent angles and reach society by using many different
resources such as pictures, movies, verbal narratives,
drama, or understandable /simple scienti ic information ofdifferent people.
4. Seasons in pandemic planning: It is also important toevaluate seasonal factors in measures against pandemics(Academy of Medical Sciences, 2020). What kind of
measures should be taken for this issue, especially the
special conditions brought by the winter season, and winterpandemic measures are still not determined. Healthcare
professionals expect Covid-19 infections to increase thiswinter, as the virus that causes corona comes from thecoronavirus family and other types of coronaviruses spread
more during the winter months. In winter, virus-carrying
particles can stay in the air longer, even in less humid air
due to cold weather. In this context, besides the lu vaccine,
it is important to provide basic winter requirements(clothes, warm house-of ice, food and lu medicines etc.)
ventilation, and economic support.
5. Preparation for natural disasters: Indeed, naturalman-made disasters and pandemic processes have similar
and different aspects. The sudden severity of natural
disasters (e.g., earthquakes, tsunami, storms and loods. andso on) caused people to forget about the pandemic.
Therefore, in any case, it is important to bring these
extraordinary conditions under control and to ind
solutions to these problems. Otherwise, societal anxiety
increases, insensitivity in society also appears as a problem,the struggle capacity of health workers decreases, problems
in the use of resources increases and routine health services
disrupted. Consideration of democracy and human rights
has become one of the basic requirements while taking
sharp measures to protect public health.
According to the data of the US Geological ResearchCenter (USGS), a total of 105 earthquakes of 6 or higher
magnitude occurred in the world in 2020. Furthermore, inthe earthquakes that occurred in the world in 2020, a totalof 198 people died and it is seen that 160 are Turkish.
Turkey has experienced three natural disasters which were
occurring in different parts of the city (e.g., 24 January 2020
6.8Mw Elazığ earthquake 41 people died and 1466 mild tomoderate injuries, a lood occurred in Giresun on 22 August2020 11 people died and 12 were injured and a 7.0 Mw
earthquake and Tsunami occurred in Izmir on 2 November

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

2020, 114 people lost their lives, 1036 people were
injured).
However, the main harm was not derived fromearthquakes, tsunami and lood, that is, the main harm wasderived from weak buildings or city ground control error or
creeping and sand withdrawal from streams brought
disaster’. It is because of the fact that the opening of theseareas to construction has caused the current damage to begreatly increased. Due to the rescue efforts in these serious
natural disasters and the panic in society, people havesigni icantly ignored the pandemic protocols. In this case,the number of COVID-19 positives has increased
signi icantly. These painful situations revealed that the
prepared plan should not only be for pandemic but also fornatural or human-induced disasters, taking into account all
natural, social, and economic and number of population
characteristics of the cities.

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Conclusions
The pandemic is a global problem and requires some
restrictive measures on a global level to protect andmaintain health. A code of PHE which is evaluated from avery wide and high perspective in a multi-disciplinary area,
for a pandemic is necessary because ethics generally
considers human life, human dignity, and well-being,
whereas a pandemic threatens life and these values.
Therefore PHE involves all ethical approaches such asutilitarianism, duty ethics or deontological perspective,
virtue ethics, social contract, and social justice theory.
Many pandemics have occurred throughout world
history; these past experiences have pointed out that the
pandemic can be controlled or eliminated with measures tobe taken in all areas affected. For that reason having the
pandemic under control is needed on individual, collective,
and states, and related institutions and they should act in aframework of common understanding, common effort (i.e.,
policy and institutional plan and program on health, tradeeconomy, transportation, and education, etc.). All measures
should also involve natural-man-made disasters, seasonal
conditions, or some private conditions such as other socioeconomic and health issues (e.g., chronic diseases,
disabilities, refugees as special conditions as well as
poverty, the unemployed, and those who have lost their job).
Providing PH and PHE needs some restrictive measures'
under four basic ethical approaches whose main aim isproviding healthcare professionals with more effective
healthcare, preventing the spread of the pandemic at thecommunity, and maintain health at both national andinternational levels.
The basic principle of healthcare ethics is to determine
the ethical responsibility and obligations aspects ofdecisions involving the whole society while improving,protecting, saving, and providing herd immunity for thehealth of the society, thereby protecting and maintaining
human dignity, human rights, integrity, and legal-ethicalrights of society. Correspondingly, public health precautions
lead to a decrease or increase in the pandemic, namely the131adequacy or insuf iciency of the measures taken at theindividual, collective, or state and institutional levels of
people play an important role in controlling the pandemic.
As known, in the pandemic, there are no good days for anyof us unless each person takes their own responsibility asmuch as everyone else.
As seen in this study, Turkey has taken into accountpandemic measures to protect public health convenientinternational rules. These measures are seen as quarantine/
isolation/lockdown which is more restrictive measures andon the other side the less restrictive measures, tailored tothe state of the pandemic. However, at the same time,
violations of these rules have occurred in many countries
like Turkey. This situation reveals that not only legal
measures are suf icient regarding the pandemic, but alsothat efforts should be made to achieve a common
understanding, common behavior, and therefore a common
attitude within the framework of common values andincluding human rights. However, in this case, there may be
a struggle in accordance with the framework of publichealth ethical values.
In short, the real struggle against the pandemic can berealized in a short time with the public health ethics values
such as the importance and integrity of human dignity,
human rights, responsibility, solidarity, herd immunity, andcommon rights. International ethics code and declarations
should a part of education for all countries to develop ahigher and holistic understanding, conscience, and attitude
against a pandemic.

Limitations
This study is limited to the events and interviews that took
place during the pandemic between 22 May 2020 and 16
November 2020 and were featured in newspapers andYouTube videos. In addition, the mentioned news is limited
due to a large amount of news, and only a small part of thenews is included in the Appendices. However, the news inquestion is a summary of the many events that happened.
Also, there was a possibility of some unreachable incidents
or resources. Another important circumstance is that only a
few articles explaining the behavior of people during the
pandemic could not be reached.
References
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Ashley Yeager. (Feb 28, 2020). Government’s Mixed Messages on
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Appendix A. PHE, Quarantine practices and Individual
responsibilities and obligations
1.Some of the Covid-19 patients have tried to escape from thehospital or quarantine.
a.The person who tried to go to his wife in the hospital by violating
the quarantine rules in Gümü?hane was caught at the police
application point. Y.Ç, who was taken into custody at theapplication point and imposed an administrative ine of 3
thousand 150 TL, was taken to Ahmet Ziyaüddin Gümü?hanevi
Dormitory, which was prepared for those in quarantine under thesupervision of the 112 Emergency Service team. It was learned
that Y.Ç. left his residence in Bayburt to go to his wife who wasbeing treated at Trabzon Karadeniz Technical University (October
9, 2020).
https://www.trthaber.com/haber/turkiye/karantinadan-kactipolise-yakalandi-522015.html
b. He escaped quarantine, went to have an eye examination. Whenthe coronavirus test was positive in Beyo?lu, M.Ö., who decided tobe quarantined at his home, went to the hospital because of theredness in his eyes. M.Ö. began to argue with the doctor who did
not treat him because he saw that he was carrying the virus in thesystem. Thereupon, the police were informed. BC disappeared
until the teams arrived. He was later caught at home and placed ina quarantine dormitory (October 06 2020).
https://www.milliyet.com.tr/gundem/karantinadan-kacti-gozmuayenesi-olmaya-gitti-6323079

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

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c.The patient, who was infected with the virus in Zonguldak andshould be in quarantine at home, was caught betting at the game ofchance dealer (?HA September 06, 2020)
https://www.ntv.com.tr/turkiye/bahis-oynamak-icinkarantinadan-kacti,VzLDBkBEBEuISQMURBM_6Q
d.A Covid-19 patient with corona virus contact in Denizli escapedin violation of the quarantine rule. The person who went to the bus
station to change the province was caught by the police teams(DHA August 30, 2020).
https://www.ntv.com.tr/turkiye/corona-hastasi-karantinadankacti-otogarda-yakalandi,jvP7MKfFIUSYgy3d18bLyQ
e.M.F. whose test was positive and yesterday's test turned negativein the recovery process. named party tickets to go to his city with
the idea that the cut will be discharged escaped from quarantine
grounds (September 12,2020).
h t t p : / / w w w. y e n i d u z e n . c o m / k a r a n t i n a d a n - k a c t i yakalandi-131417h.htm
f.It was determined that Osman S., who had a positive coronavirus
test in Suhut district of Afyonkarahisar, violated the quarantine
and went to the market. Police resettled Osman S. in the dormitory
after criminal action (September 29,2020).
https://www.olay.com.tr/karantinadan-kacti-marketteyakalandi-628014
g. The person who got on the bus from Aksaray while he was
supposed to be in quarantine and who was found to have pierced
the quarantine in the inspections carried out by the teams in
Sakarya became the irst quarantine penalty in the city. The person
who is placed in the KYK dormitory and will stay in the dormitoryfor 9 days will meet all his expenses(September 17,2020).
https://www.bizimsakarya.com.tr/guncel/karantinadan-kactisakarya-da-yakalandi-h124560.html
h. According to the information received, S.G. in Seyitgazi district
was quarantined on the grounds that it was corona virus contact.
Not waiting for the end of the quarantine period, S.G., who wentout, was caught by the police teams. Legal action was taken against
the citizen on the grounds that he did not comply with the ban(November 11,2020).
http://www.anadolugazetesi.com/eskisehir-de-karantinadankacti--139631.html
i. U.G. (37), who was taken to home quarantine by the ilming
teams for visiting her mother-in-law with coronavirus, left herhome and went to Didim by failing to comply with the measures.
U.G. caught by the police teams (September 15, 2020).
https://www.aydinkulis.com/genel/karantinadan-kacti-didim-deyakalandi-h20900.html
j. ?.Y. had a positive record from the Covid-19 test and should beunder home isolation. However, he did not, the police teams found
him at the street, contacted with 112 teams. Taken to theambulance by health teams, ?.Y. He was later taken to Malatya
Training and Research Hospital (August 30, 2020).
https://www.haberler.com/karantinadan-kacti-denetimlerdeyakalandi-13554886-haberi/k. Bursa Provincial Health Director Dr. Halim Ömer Ka?ıkçı statedthat they encountered striking examples in the radiation studies
during the pandemic process and said, "When we called a casewhose coronavirus test was positive, we learned that he had hishair done at the hairdresser as part of the wedding preparations.
Our teams immediately went to the hairdresser and we took thepatient into isolation" (October 9, 2020).
https://www.mygazete.com/gundem/karantinadan-kacti-oylebir-yerde-yakalandi-ki-h49490.html

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l. The woman should be under quarantine at Taksim First Aid
Hospital , escaped from the hospital. The woman was caught bypolice teams in Taksim/?stanbul (March 23, 2020).
https://www.veryansintv.com/taksim-ilkyardim-hastanesindekarantinadan-kacan-kadin-yakalandi
m. The person who should have been in quarantine at home due tothe corona virus (Covid-19) in the Sandıklı district ofAfyonkarahisar was caught by the gendarmerie teams while
traveling with a tractor. He was placed in the KYK dormitory,
where he was quarantined after he applied a ine of 3 thousand
180 TL (September 26,2020).
https://www.cnnturk.com/turkiye/karantinadan-kacti-traktorleseyahat-ederken-yakalandi
2. The spoiled sel ishness of famous people not to takeprecautions.
a. Korona EB. escaped from quarantine! He was closed to thequarantine dormitory with his lover (September 18, 2020).
https://www.youtube.com/watch?v=6N5rlF8be5E
b It was noteworthy that actress M. Bolu?ur did not persistently
wear a mask wherever she was seen. Upon this, Bolu?ur said, “I ama person who prefer distance. I am born as a socially distantperson, therefore I shouldn't use a mask 29.9.2020.
https://www.internetgundem.com/merve-bolugur-ben-zatendogustan-sosyal-mesafeliyim-dedi-3557h.htm
3. Those who refuse to use masks and social distancea.Salih Ergün, who runs a clothing store in Gölcük, warned Yunus
E., who came to the store with his family for Eid shopping, aboutwearing a mask. However, Yunus E., who rejected this proposal,
attacked the business owner Salih E., who warned him to wear amask. Salih Ergün, who was hit on the head with a hanger iron,
remained on the ground in blood (28.07.2020 ).
https://www.haberturk.com/son-dakika-haberler-masketakmayi-reddedip-is-yeri-sahibini-darp-etti-2757499
b. A woman warned at the market for not wearing a Mask. She
threatened market employees (August 5,2020). https://
onedio.com/haber/maske-takmadigi-icin-gittigi-marketteuyarilan-kadin-bana-bak-lan-dort-goz-benim-canimi-sikmakafani-gozunu-patlatirim-913314
4. Those who strongly respond to the doctor's mask warninga.A doctor working at the Family Health Center in Karaba?lar
district of Izmir was battered in an argument after he asked people
who came for examination to wear a mask. Another doctor who
was trying to break the ight by intervening was injured as a resultof being hit on the head with a hard object 30.6.2020.
https://www.sabah.com.tr/yasam/2020/06/30/maske-takindiyen-doktoru-darp-ettiler
b. After the treatment of G.B, who came to the emergency room of
Bornova Türkan Özilhan State Hospital due to heart disease,doctor M.B warned of a mask. Two people, one of whom was awoman, beat the doctor who gave the warning and threatenedwith a knife on October 11, 2020.
https://www.medimagazin.com.tr/ozel-saglik//tr-maske-uyarisiyapan-doktoru-once-bicakla-tehdit-etti-sonra-darpetti-9-681-91731.html
c.At the Istanbul Çapa Medical Faculty Hospital, a person battereda health worker who told him to wear his mask correctly. It wasstated that the health worker who was injured in his eye wasoperated (25.09.2020). https://www.birgun.net/haber/maskeuyarisinda-bulunan-saglik-calisanina-saldiri-ameliyataalindi-316914

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

e.Violence to mask warning: A 10-year-old girl who played hideand-seek with her friends in the gaming room of the site yesterday
evening in Esenyurt, Istanbul. She irst warned them for not
wearing a mask, and then took videos on her mobile phone to
inform the authorities about the Hayat Eve Sı?ar (HES). Therefore
she was battered by foreign national women (30.09.2020).
https://onedio.com/haber/istanbul-da-maske-uyarisi-yapan-10yasindaki-cocugu-darp-ettiler-924679

Appendix B. Super-spreader events and collective
responsibilities and obligations
1.People's failure to comply with COVID-19 new normalization
rules at funerals, weddings, engagement ceremonies, and soldiers'
farewell ceremonies.
Failure to comply with the bans imposed on weddings,
engagement ceremonies, and condolence tents within the scope of
the Coronavirus epidemic in many cities such as Diyarbakır,
Gaziantep, ?anlıurfa, Adıyaman, Mardin, ?ırnak, Batman, Elazı?
caused an increase in the number of cases. Finally, in Diyarbakır, acoronavirus patient who attended a Mevlit dinner infected 37
people with the virus. In the normalization process that started onJune 1, it is worried that such gatherings may increase the numberof cases. Dicle University Infectious Diseases and ClinicalMicrobiology Department Lecturer and Covid-19 Intensive Care
Coordinator Prof. Dr. Recep Tekin pointed out that the newnormalization is mixed with the old normalization. Prof. Dr. Tekinsaid the following:
Our people perceive this process as the old normalization process.
It was perceived that we would not use masks, we would makecontact at close range, we would go to mass meals. Since we did
not pay attention to these, our number of cases increased. We
de initely need to know that what we mean by normalization must
be the new normalization. The new normalization also has certain
standards, masks, social distancing, and cleanliness. (03 June2020).
https://www.milliyet.com.tr/gundem/son-dakika-i-dugun-vetaziyeler-corona-virus-vakalarini-artirdi-6225932
2. Companies do not report cases due to economic concerns
a.Governor of Kırklareli, Osman Bilgin, announced the big mistake
made in the corona Kırklareli Governor Osman Bilgin invited all
institutions and citizens to comply with the measures taken
against the corona virus and announced that they detected 30 new
cases due to the hiding of the case (October14, 2020).
Kaynak Yeniça?: Governor of Kırklareli, Osman Bilgin, announced
the big mistake made in the corona.
b.Living in the district of Emet, ?.E. Covid-19 test was applied toÇ.E. The pair, whose test results were positive, were taken to hometreatment. The radiation teams of the District Health Directorate
also identi ied the people with whom 2 patients were in contact.
However, ?.E. and Ç.E. did not report the names of some of theircontacts to the ilming team. Emet District Governorship also ileda criminal complaint to the prosecutor's of ice. The Prosecutor's
Of ice launched an investigation against the couple for "making
false statements to a public of icial who has the authority to issue
an of icial document" (October 16, 2020).

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3. Private Quran courses
a. Cases are increasing in children attending Quran boarding
courses. When the capacities were increased in the Koran courses,
where education has been allowed since June, coronavirus cases
started to be seen. Dr. M. Yıldırım, from the mobile medical team,stated that although the children should spend the quarantine in

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the dormitory, positive cases were sent to homes by public
transport with the decision of the mufti and the provincial healthdirector (by A. Özbek, September 29, 2020)
https://bianet .org/bianet/toplum/231763-yatili-kurankurslarindaki-cocuklarda-vakalar-artiyor.
b. It was learned that the coronavirus test of a mosque imam who
worked as a temporary instructor in the Central Male Quran
Course af iliated to the district mufti in Camikebir District ofMente?e District was positive. While the imam, whose coronavirus
test was positive, was hospitalized, the Quran course wasquarantined (September 15, 2020).
http://www.mugladevrim.com.tr/haberler/mugla-haberleri/mentese-de-kuran-kursunda-koronavirus-sokuc. The corona virus test of the female teacher and two students in
the Kaynarca Central Girls' Quran Course was positive. While theteacher and the students were quarantined at home, the course
suspended education until a second order (September 28, 2020).
https://t54.com.tr/haber/5517023/kuran-kursunda-koronapanigi
d. Scandal in the Koran course: 40 children who continued to stayin bed were caught with coronavirus. In the Koran Course, where
they continued to study despite the coronavirus epidemic,
coronavirus were detected in 9 children. After the children werequarantined in the course, the number of cases increased to 40(October14,2020).
https://www.birgun.net/haber/kuran-kursunda-skandal-yatilikalmaya-devam-eden-40-cocuk-koronaviruse-yakalandi-319187
4.Of icial Education
Samsun Governorship announced that the test results of 2teachers and 3 students in Baruthane Secondary School located in
irst step district were positive. The Governorship stated that it
was decided to quarantine students and teachers who may be incontact and that distance education was started (October 18,
20209).
https://www.cumhuriyet.com.tr/haber/2-ogretmen-ve-3ogrenci-pozitif-cikti-1774231
5. COVID-19 is forgotten in special openings and natural disastera.Hagia Sophia has been a museum for 86 years; it will be
converted into a mosque in 24.07. 2020. 350 thousand people
attended the prayers in Hagia Sophia. Unfortunately, the crowd inquestion did not pay attention to the pandemic rules with theexcitement of praying (July 25, 2020).
https://tr.euronews.com/2020/07/24/ayasofya-n-n-ibadete-aclmas-n-dunya-medyas-nas-l-gordu.
b. Flood disaster in Giresun: Loss of life increased to 8. Floods
occurred in Giresun, Samsun, Rize and Trabzon. Vehicles driftedalong the roads, retaining walls collapsed. The number of people
who lost their lives in the lood rose to 8. Secretary of State forHome Affairs Minister Soylu stated that the search for 8 people
continues. According to the statement made by AFAD, 157 citizens
were rescued in the ongoing intervention works with a team of988 people and 288 vehicles after the lood in Giresun (August 24,2020).
https://www.ntv.com.tr/galeri/turkiye/giresunda-sel-felaketi-7kisi-hayatini-kaybetti,7WvlFT_7p0u63Oc
c. As seen in the video, attention was not paid to covid-19
measures at the political meeting held later (August 31,2020).
https://www.msn.com/tr-tr/video/unluler/erdo%C4%9Fancorona-salg%C4%B1n%C4 %B1na-ra%C4%9Fmen-giresundamiting-yapt%C4%B1-%C3%A7ay-da%C4%9F%C4%B1tt%C4%B1/vp-BB18yKvC

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

Appendix C. State and institutional ethicalresponsibilities and obligations

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1.Legal sanctions: Regulations on communicable diseases are
generally included in the Public Health Law [7] and TCK numbered
5237, article 195.
a.Article 195 of the TCK: the purpose of the Criminal CodeARTICLE 1- (1) Purpose of the Criminal Code is to protect therights and freedoms of individuals, public order and security, therule of law, public health and the environment, public peace, and toprevent crime. The law regulates the basic principles of criminal
responsibility, crimes, punishments, and types of security
measures in order to achieve this goal. Within the framework ofthis legal regulation, those who do not comply with the quarantine
measure are punished (October 20, 2020).
https://www.mevzuat.gov.tr/MevzuatMetin/1.5.5237.pdf
b. Public Health Law (UMUMI HIFZISSIHHA LAW)
Law Number: 1593; Acceptance Date: 24/4/1930;Published in
Of icial Gazette: 6/5/1930 Issue: 1489; Code of Publication: Series:
3 Volume: 11 Page: 143
Aim: Improving the sanitary conditions of the country and struggle
against all diseases or other harmful agents that harm the health of
the nation, ensuring the healthy upbringing of the future
generation, and making the people receive medical and social
assistance are among the general government services.
https://www.mevzuat.gov.tr/MevzuatMetin/1.3.1593.pdf
c.Law on Misdemeanors:
Law Number: 5326; Acceptance Date: 30/3/2005; Published in the
Of icial Gazette: Date: 31/3/2005 Number: 25772 (Duplicate):
Code of Publication: Series: 5 Volume: 44
Purpose Article 1- (1) In this Law; to protect the social order,
general morality, general health, environment, and economic order.
https://www.mevzuat.gov.tr/MevzuatMetin/1.5.5326.pdf
d. Turkish Criminal Law
Article 138 related that intentional manslaughter and so, people
who don't follow the pandemic rules can be trial with this article.
e. The court canceled the mask penalty! Striking 'social state'emphasis
The administrative ine of 392 TL imposed on E.N. ? for travelingwithout a mask in Bolu was canceled by the court. The reason forthe decision was that "both the principle of being a social state andthe imposed obligation bring inancial burden, the state is obliged
to provide 3 masks per person every day (13.07.2020).
* Article 19 of Turkey Constitution - it is regulated that nobody's
freedom and security can be restricted without a court decision,and that they should be submitted to the approval of a judge
within 24 hours, even if restricted in case of necessity.
* Article 23 of our Constitution stipulates that the freedom ofresidence and travel can only be restricted by law.
The 64th article of the General Hygiene Law regulates themeasures regarding epidemic diseases. There is no obligation towear a mask in any of these measures.
* Moreover, even while we agree that such a requirement, Turkey
Constitution Article 2 of the Republic of Turkey is envisaged thatthe social state of law, when you bring economic as a liability if theprinciple of the social state, it was clear that should be borne by
the state's obligations.
* It has been decided to abolish the administrative ines, which do
not comply with the law, because of the principle of being a social
state and the necessity of being a inancial burden, that the state is
obliged to provide 3 masks per person every day, as required by
the above-mentioned Constitution and laws. DHA

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https://www.sozcu.com.tr/2020/gundem/mahkeme-maskecezasini-iptal-etti-dikkat-ceken-sosyal-devlet-vurgusu-5928646/
2.Con licting statements by government of icials
a. Turkish Medical Association “If we do not show the picture
clearly, we cannot run the process well. Due to the epidemic, our26 physician friends lost their lives by paying serious costs. We areconcerned that these efforts will go to waste. Why is there adifference between the igures announced by the governors andthe igures of the Ministry of Health, the Minister of Health should
explain this? (August 7,2020) https://www.enpolitik.com/guncel/
turk-tabipleri-birligin-den-bakan-koca-ya-cagri-celiskininnedenini-aciklayin-h323185.html
Health Minister Fahrettin Koca made a statement after theCoronavirus Scienti ic Committee meeting held today. Stating thatthe number of healthcare workers who tested positive for
Kovid-19 has exceeded 40 thousand, Koca explained that the
number of healthcare professionals who died due to coronavirus
reached 107. Explaining that there was a 50 percent increase incoronavirus cases in the last month in Istanbul. However, Minister
Koca said that they did not think of restrictions in the city (October
14,2020). https://www.evrensel.net/haber/416516/fahrettinkoca-testi-pozitif-olan-saglik-calisani-sayisi-40-bini-gecti
Among the number of coronavirus cases, the data announced by
the ministry and by independent health professional organizations
are generally inconsistent. In the press release made on September
30, Health Minister Fahrettin Koca said that not all cases are
considered patients and that only people with Covid-19 symptoms
are included in the coronavirus data announced daily. While Koca's
statement caused reactions, the former president of the Turkish
Medical Association, Prof. Dr. S. Adıyaman said, "Every case is a
Covid-19 patient (October 10 2020 by E.Akgül). https://www.sozcu.com.tr/2020/saglik /prof-dr-adiyaman-her-vaka-bircovid-19-hastasidir-6062416/
b.Health Minister Dr. Fahrettin Koca's announcement that thepatient-case distinction has been made to the public since July 29
2020, people who do not show symptoms even though the
COVID-19 tests are positive, are not included in the tables, andonly those who show symptoms are explained under the title of'patients', which created a new situation. This situation has
increased the anxiety in the society because not all igures aredisclosed.
https://www.enpolitik.com/guncel/turk-tabipleri-birligin-denbakan-koca-ya-cagri-celiskinin-nedenini-aciklayin-h323185.html
c. Prof. Dr. A.Saltık stated that approximately 40 thousand beds
allocated for the pandemic in Istanbul are full, intensive care units
are even more full. How is our hospital beds illed with so few daily
new diagnoses? (November 16, 2020)
14 DAYS CONCURRENT CLOSING AROUND THE WORLD BY UN
CALL! http://ahmetsaltik.net/

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

The untold stories of front-liners
working under threat during the
COVID-19 Pandemic: Bases forpolicy and program formulations- Erikka June D. Forosueloerikkajunedecrepito@gmail.com (Corresponding author)- Rogelio P. Bayodroger.bayod@gmail.com- Nickle S. Male icio
drnmale icio18@gmail.com
Cor Jesu College, Philippines

Abstract
The COVID-19 pandemic has resulted in a worldwide publichealth crisis causing additional burden to poor countries interms of health programs and services, especially to theirpoor and vulnerable populace. While medical health experts
and scientists in different countries have been studying how
to treat people and to uncover more information on thevirus, it has become more evident that nobody is immune tothis virus. However, some groups such as the poor andvulnerable front-liners who continue to work despite thethreat carry a bigger risk of infection and even an increased
chance of dying from COVID-19. Thus, it is crucial to identify
these vulnerable groups to better protect them from thisvirus. This study aims to present the different stories,
experiences and challenges of frontline workers in Southern
Mindanao, Philippines who continue to work and to ensurethat their families will live despite the threat to their lives
because of COVID-19. The ultimate goal of this paper is topresent irsthand data from these ordinary but essential
workers on what policies and programs government must
consider for supporting them, while they continue toprovide vital services to the society.

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Introduction
As the COVID-19 cases in the Philippines continue to rise,
the government is doing its mandate to prevent the further
increase of the infected by the virus. The more people whowill be hospitalized, the more budget it needs from thegovernment which is already suffering inancially becauseof the effect of the COVID-19 pandemic as well as othercalamities that have hit the Philippines.
Based on World Health Organization 2020, thePhilippine government mounted a multi-sectoral responseto the COVID-19, through the Interagency Task Force (IATF)
on Emerging Infectious Diseases chaired by the Department
of Health (DOH). Through the National Action Plan (NAP) on
COVID-19, the government aims to contain the spread of
COVID-19 and mitigate its socioeconomic impacts. It is more
dif icult if the ones affected by the virus, hospitalized and/or isolated, are front liners such as medical doctors, nurses
and other medical practitioners because it will result in lossof manpower in the medical ield to take care of patients.
Indeed, COVID-19 has revealed that some essential jobs

such as medical doctors, nurses, medical technicians andother hospital staff are needed in the time of pandemic.
Thus, they are called the front-liners in the country’s battle
against the virus. However, workers outside of thehealthcare sector like tricycle drivers, food vendors, foodlaborers, security guards are also on the front lines in the
country’s ight against COVID-19. While the medical fontliners have health insurance and hazard pays, most otheressential workers do not have health insurance and do notreceive any hazard pays.
According to Abellanosa, (2020), people’s responses to
the government’s policies varied depending on their socialand economic location. It is easy for some to stay at home
but not for those whose consumption depends on daily
earning of an income. Lack of savings is a reason whywholesale shopping of groceries is not a practice amonghouseholds in slums or poor urban areas. This is the main
reason why the so called “front-liners” have no choice otherthan to work to earn a living. Income-poverty thinking canlead to neglect vulnerability when seeking to raise income
as stressed by Abellanosa (2020). Families’ sustenance may
be more important than the danger the Covid19 pandemic
poses, which is due to their highly exposed nature of jobs
speci ically going out to earn money to buy basic needs.
Hence, humanitarian partners providing cash
interventions help that cash transfer programs are designed
in cognizance with government protocols for the ECQ andother COVID-19 measures, including avoidance of mass
gathering, physical distancing and disease prevention. The
following measures will be considered in planning for Cash
and Voucher Assistance (CVA): a) Coordinate plans andactivities with the barangay and municipal authorities toavoid people being confused by different activities. If
possible, the local government should be given the list ofbene iciaries of the implementing organization; b) For cash
grants, organizations will apply government rates as thebasis for the amount. If the cash grant amount is lower than
the government cash grant rate in the area, organizations
are encouraged to discuss with the concerned local
governments to arrive at options that will not marginalize
the organizations’ bene iciaries; c) Whenever possible,
complement CVA activities with appropriate informationand education products and services that promote key
COVID-19 messages; d) Organizations will explore CVA
activities that lessen face-to face interaction, promote
physical distancing, and decentralize markets to avoid
crowding (COVID-19 Humanitarian Response Plan
Philippines, 2020).
The aim of this paper is to present and expose thedifferent challenges that these ordinary but essential
workers or front-liners have been experiencing as well as
their desires in terms of government support. It is our hopethat through this study, we can bring the voice of theseworkers who are at the margins of the society but have been
rendering essential services to all during the crises.

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)
Study participants and the research questions
In this research project, we chose the following essential
workers or front-liners: tricycle drivers, food vendors,
laborers in the market, and security guards. We chose themon the basis of the following criteria: that their works aremuch needed during the pandemic, that they have to workin order to sustain their needs and the needs of theirfamilies and that they belong to the category of “no work, no
pay or no money”.
We were able to do an interview, following theprescribed health protocols, with four security guards, ive
tricycle drivers, six food vendors, three food servers, twolaborers, one housekeeper and one working student who
works as an assistant to the ish vendor who delivers ish todifferent barangays and houses. The place of our study is
Digos City, the capital city or center in Davao del Sur andMalita, the capital town or center in Davao Occidental. All inall, we had twenty-two participants for this study. We
conducted one-on-one interviews with these persons after
they agreed to be part of this study. In our interview withthem, we were guided by the following research questions:
1. What are your stories and experiences as front-liners
working under threat during the covid-19 pandemic, 2. How
did you manage the many challenges you encountered in yourwork as front-liners during the covid-19 pandemic, and 3.
What actions in terms of policies and programs you needfrom the government as front-liners during health emergency
situations?

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Stories and challenges of non-medical front-liners
This study gave us the opportunity to listen to the stories
and experiences of front-liners who continue to work
despite the threat of COVID-19. The stories and challengesof these front-liners are mostly on the following: they chose
to work in order for them and for their families to live, they
have mingled with different groups of people which might
have been infected by the virus, they have braved the virus
and negotiated with authorities to allow them to operate
even during lockdowns and community quarantine.
Indeed, despite the imminent threat of COVID-19 virus,
these workers have no other option but to continue theirwork so that they can provide for the basic needs of theirfamilies. They are aware that there is a deadly virus, butthey would rather brave the virus than allowing them andtheir family members to die from hunger.
In the case of the tricycle drivers, they said that they
continue to drive and bring different passengers to theirdestination so that they will have money to buy food fortheir families. A tricycle driver from Malita, Davao
Occidental said: “I continue to drive my tricycle even if there
is a pandemic in our place because it is very dif icult to havefood if I won’t drive”.
The same comment was shared by many tricycle drivers
in Digos City. They said that they just have to be careful but
have no other choice but to continue their work becausethat is their only means of having money to buy food. A
tricycle driver in Digos City said: “It’s really scary but I don’t

137

have any other choice if got swayed by fear, I am sure that wewill all die in hunger. What will happen to my family and mychildren if I will not drive. They said that if you have a strong
immune system, you cannot be easily infected by the virusthat is why I just make sure that I have a strong immune
system by drinking calamansi juice and eating vegetables andthen I also sleep well during nighttime because we havecurfew by 8:00PM and I cannot be driving after that.”
On the part of the poor: (1) being exposed to a greater
probability or chance of infection, and (2) stressful
experiences due to the impositions of the government suchas but not limited to monetary ines and imprisonment for
probable violations should be considered. Survival may
overpower the fear of getting sick; after all, death is aconsequence of both hunger and disease. The elderly(senior citizens) had to risk lining up in barangay centersjust to get their subsidies; and vendors have to sell theirgoods every day because for the marginalized members of
the society, there is a trade-off between income and security.
Income-poverty thinking can neglect vulnerability inseeking to raise income (Chambers, n.d). It is like the race oflife and survival of the ittest at the same time. It is common
for these “front-liners” to say that their families’ basic needs
matter more than thinking about safety and homequarantine.
In the case of ish vendors and those who work in thefood industry, they shared the same sentiment that despite
fear, they have no choice but to continue working in order tolive and survive. For instance, a female ish vendor shared:“what I experienced with the arrival of COVID-19 is that thesituation is very dif icult, but I need to work to ind food for
my family.” Our participant who works as a food server,
shared that her challenges involve people who are
hardheaded and do not follow the health protocols: “For me
it is really between life and death experience because I am
serving food and there are customers who are hardheaded,
they still come inside without wearing masks despite theannouncement that “no mask no entry”. It’s us who have towear the masks instead.”A working student who also works as a ish vendor indifferent barangays and houses shared his unforgettable
experience during the pandemic: “an unforgettable momentfor me is when we went to one village and then the one whobought our ish was the father of a person who was positive of
COVID-19. We were so anxious for the whole week with myuncle. I am afraid to have the virus because we do not havemoney, I just worked so hard together with my uncle so that I
can buy the need stuff for my schooling and also the needs ofmy family. What will happen to us if I get sick? We do nothave money. We even do not have Philhealth insurance and
SSS and others”.
When people are confronted with a pandemic which is
new and untreatable as of the moment, they are often
gripped with fear and anxiety (DeJean et al., 2013). The
presence of fear and the thought of not being secure if
contaminated with the virus are shared feelings of thesemarginalized people. If they get sick, it means they would

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

stop working which would mean no income and no food to
eat in their households. Among other reasons, the fear was
being driven by the absence of treatment and no clear
strategies to protect them from COVID-19 (Ho, Chee and Ho,2020).
The security guards also shared their fear because every
day they are facing people who are really hardheaded. Thisis beautifully captured by the sharing of this security guard:“I work as a security guard in a money remittance agency, weclosed our agency in a while, yet we are needed to open forpeople need to claim money sent to them, but my work is very
scary since I am really the one who faces irst the clients. I
really need to work so that I can feed my family. My daily
work is very risky specially that we accommodate more that
50 clients every day. I can really say this is risky since I cannot
control the client to approach me even though we have thelogbook and alcohol for them to sanitize still it is very
dif icult, I just pray a lot, since I don’t have a choice because if
I will not work all of us in the family will die of hunger”.
It is obvious that these ordinary workers under the “nowork no pay or no money” category have no other choice
but to work despite the threat. For rich people who have theluxury to stay in their airconditioned houses and gatedcommunities, these people who continue to go out despite
the government’s call to stay at home, are troublemakers
who continue to be threats to public safety (Bayod, 2020).
But they fail to realize that these people are also afraid of
the virus and afraid to die but because of their situation
they choose to gamble in order to have a chance to live.
In fact, as mentioned by the Philippine President on his
State of the National Address, dated July 27, 2020: “when the
pandemic struck, I decided to prioritize life over otherconsiderations. According to experts, the interventions thatthe government had put in place prevented as much as 1.3 to
3.5 million infections. To me, even if the numbers were much
lower, it would still be and would have been worth thesacri ice[s] we made.” The government will intensify its
efforts to help businesses, especially our micro, small andmedium enterprises or MSMEs, by providing responsive
government assistance and services, capitalization, andbusiness operations support as we adapt to the next
normal. It is important that health and social care
workplaces follow viable pandemic control andmanagement policies to protect both workers andindividuals they look after (Roberts et al., 2007). This isvery important not only in hospitals and health institutions
but also to the poor people who rely on blue collar jobs to
get through life on a daily basis.

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Their ways of managing their challenges
It is also important to note that these people have followed
strict health guidelines and protocols while they work suchas wearing face masks and face shields, following social
distancing and washing their hands with alcohol. However,on top of these standard guidelines, they have their own
way of managing their challenges like staying positive,
praying to god and boosting their immune system. A tricycle
driver shared: “I put cellophane in the vehicle sir, it is theordinance in our municipality, and we should wear mask andface shield. I am really following the law sir, what is theordinance of the municipality specially in putting cellophane,face mask, face shield, I am really following it, because I havea child, it is dif icult, yet I just pray that the almighty protects
me from the virus and I think always positive ideas, since if wehave stress it will make our resistance weaker.”
Having a sense of connectedness with the superpower
promotes a feeling of bonding. In this case many people
believe that faith makes them part of something greaterthan themselves. It can happen by prayer or meditation, orby engaging in religious activities or simply doing things
like listening and brisk walking (Park, 2017). When humanbeings are put in a dif icult situation and it seems like there
is no hope, tendency to an ever loving and merciful god is animmediate resort. Our spirituality is tested especially intimes of trials and dif iculties. But the spirituality and belief
systems of the people can also be an important resource tokeep them going despite pains, challenges and uncertainties(Bayod, 2020).
Since they work basically for their families, they also
make sure that their families are safe when they arrive
home. Measures for protecting workers from exposure to
infection with SARS-CoV-2, the virus that causes COVID-19,
depend on the type of work and the exposure risk, including
potential for interaction with people with suspected orcon irmed COVID-19 and contamination of the work
environment. Employers should adopt infection control
strategies based on a thorough hazard assessment, using
appropriate combinations of engineering andadministrative controls, safe work practices, and personal
protective equipment (PPE) to prevent worker exposure.
Some OSHA standards that apply to preventing occupational
exposure to SARS-CoV-2 require employers to train workers
on elements of infection prevention, including PPE,
Occupational Safety and Health Administration (OSHA)
2020. A security guard shared: “I do not enter the houseautomatically since I have a child, I have to take a bathoutside and my wife prepares my new cloths. At work I wear
mask, face-shield and social distancing. But aside from that, I
am praying to our heavenly father for he is the only one who
can solve this problem.”
These people are not really hard-headed. In fact, they arefollowing the strict health protocols of the government.
They might have de ied the ‘stay at home’ call because ofnecessities and even negotiated with the authorities toallow them to operate and work despite the pandemic, butthey have followed the healthy standards of thegovernment. Since they are aware of the risks, they even go
beyond the minimum health standards. In fact, a ish vendor
shared: “I always buy vitamins and wear face mask, that is
the law here sir. No Facemask No Entry, I just wonder whysome can enter, that it is the ordinance here. We have tofollow what is mandated by the government, we should not be
hardheaded on the process, we should not be too stubborn. In
this time, we need to help each other.”Indeed, this person shared many valuable data. Asidefrom ensuring that the immune system is strong by taking

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

vitamins, he talked about following government protocols
and a sense of cooperation for the common good. In times of
any infectious pandemic, social distancing is important inpreventing infection in the population (Fong et al., 2020).
Social distancing is especially important in preventing
infections in enclosed spaces like buildings and workplaces.
Taking part by being sensitive to the welfare of others isvery important in this pandemic. The informant stressed on
the importance of the fairness and equity, saying that if all
people just help each other, there will be no one who will
experience dif icult times. But sad to say, some people takeadvantage of the situation through hoarding goods andpro iteering. News spread about certain of icials who took
advantage of the situation. There were reports that somebarangays would require a voter’s identi ication (ID) card as
requirement for government assistance. This is an exampleof the poor being used to further political advantage(Chambers, 2006). This is where the government must work
to ensure that people have equal access and opportunities
to basic goods and services.

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Government policies and programs for the essential,
non-medical front-liners
We asked them directly what actions they need from thegovernment as support while they continue work during
the pandemic; all of them shared that the government could
help them by giving them health insurance and hazard pays
as essential workers/front-liners. Some shared that the
government must have a program to support them bytraining, cash assistance and even free hospitalization. Hereare some of their wishes and desires from the government:“I am just hoping that there is a program in the governmentthat could be free like Philhealth specially that we areworking here in the public market, because even though theygive free rice and canned goods it will be consumed fast, andalso SAP the money will be gone, but god forbid if eversomeone gets sick, we are hoping that we have Philhealth.”“We the poor people, are hoping that the government willassist us if ever we get sick, we don’t have Philhealth and SSS
here in the public market. There should also be personal
assigned in the barangay to look into people, not that it isvery dif icult for them to be located, like in the barangay
health center there should be someone assigned or shifting 24
hours so that in terms of emergency we have faster help.”“Hoping that there is a program like SSS or Philhealth is ofvery big help among us tricycle drivers and our family, this isa great help if ever we get sick due with covid, and not just allabout food packs like rice and canned goods but also
vitamins.”“The help that our barangay gave was disinfecting thehouses and giving help to the community especially those who
had lost their jobs, life is so dif icult now. The government
gave us in time of pandemic food pack and the DSWD gave us
Php 6,000 which we call amelioration but hoping that they
will also look for some bene its like Philhealth or SSS to thosepoor people.”

139“Hoping that Philhealth and SSS are free for the Filipino
People. They give SAP and food packs but hoping they will
help if we or our family member gets sick like other places
having a health insurance.”
Indeed, aside from the food packs and the cash subsidy
during the pandemic, these people wanted that the
government have a long-term program for the health of theFilipinos especially the poor. They are more prone to abuse
due to lack of information or low level of literacy,
joblessness, and even poor health. Their lack of self-esteem
would be a form of disability for them to assert their rights(Abellanosa, 2011). Since they are not working in thegovernment or private companies, they do not have
Philhealth and SSS insurance. Thus, they want that the
government will have programs for them. If they haveenough money, maybe some of them will consider buying
health insurance for their families. However, they havebarely enough to support the basic needs of their families
such as food and others. This is where the government mustcome to craft proactive health programs for Filipino people.
According to Bayod, Forosuelo and Sanchez (2020),
Filipinos have experienced the care and concern of thegovernment and that is why they are happy. The SAP or theSocial Amelioration Program of the government for instancethat provides cash assistance to the poorest of the poor in
the Philippines, is indeed very helpful to combat theeconomic drawback brought about by the pandemic,
however, this cannot last for a long period of time.
Government should have long term initiatives to assist theless fortunate become independent in times of pandemic.

Conclusion
The pandemic has highlighted how the Philippine
government concretely exercised its initiatives for the
purpose of providing assistance especially in the aspect ofsocial and economic rights of every Filipino. In terms ofbasic services needed by people, it is not only lawed but
also lacking or not enough to sustain them in the long run.
The so-called front-liners like tricycle drivers, food vendors,
food servers, laborers, security guards who are working
under the threat of Covid19 pandemic need protection
while they are battling for survival.
It is true that these people are left with no choice otherthan to expose themselves to the danger of contamination
with the virus or else there is no food on their tables. It is
fair to say that there were efforts and to some extent help
for people over dif icult times in the current situation,
however, it is not enough to help them sustain and enable
them to be independent from assistance every time there isa pandemic. Their challenges result from choosing to workin order for them and for their families to live, mingling withdifferent groups of people which be infected by the virus, andhaving the initiative to ight the virus by negotiating withauthorities to allow them to operate even during lockdowns
and community quarantine. Their way of managing thechallenges are staying positive, praying to god and also
boosting their immune system. These are clear

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

manifestations that these non-medical front-liners have thedesire to thrive in the community where they are living.
Without resources it is true that the poor become evenmore powerless. If these low-income earners are displaced,
they could no longer feed their family and thus, largely they
will rely on the assistance from the government. In a trickledown economy as emphasized by Chambers (2006), any
crisis that would hit the main economic drivers would
automatically sacri ice the poor including low-income daily
wagers, or seasonal earners.
The ECQ due to COVID-19 has hit hardest the vendors,
tricycle and motor-cab drivers, and security guards. In effecttheir powerlessness has been highlighted in the face ofincome-less citizens who would be dependent on
government subsidies. In this time of crisis, it is the hopeand aspiration of these essential non-medical front-liners to
be given the assistance that they have been requesting fromthe government such as health insurance and hazard pay;some shared that the government must have a program tosupport them by capacity building, cash assistance and evenfree hospitalization. The Philippine government should have
holistic and proactive healthcare programs for all citizens
with special focus on the poor and vulnerable sectors. The
experiences of vulnerability and hopelessness of some of
our fellow Filipinos in the face of crisis should be given
utmost attention and priority through crafting of policies
and programs so they may feel that they too are truly
essential in the battle against the Covid19 pandemic.

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Social gathering in pandemic: A
blessing or menace for Pakistan- Naheed Feroz Ali, BScN Nurse, Student MScN,
The Aga Khan University School of Nursing,naheed.golanibscn786@gmail.com (Corresponding author)- Asma Amir Ali, BScN Nurse, Student MScN,
The Aga Khan University School of Nursing,
Asmaamirali1993@gmail.com- Sara Sheikh, BScN Nurse, Student MScN,
The Aga Khan University School of Nursing, Pakistan
Sara.sheikhhn@gmail.com
Abstract
The COVID-19 pandemic is a global health crisis which hasbrought streams of morbidity and mortality across theworld. The unprecedented outbreak has forced people
towards self-isolation and social distancing from their loved
ones, which has in licted detrimental physical,
psychological, and economic challenges in people's life. The
second spell of COVID-19 has started in Pakistan, so far
taking the national tally to 544,813 infected cases and 11,657
lives (Government of Pakistan, 2020; updated 30 Jan 2021).
The burden of mental health implication due to COVID-19
also rages across Pakistan, where anxiety, depression, fear,
sense of insecurity, and suicide are highly prevalent. The
sudden outbreak of COVID-19 has raised key ethicalchallenges for stakeholders after imposing stringent

lockdown and restricting people's movement for several
months. This paper aims to explore the ethics of restriction
on individual movement and social distancing, provide
arguments and counterarguments supported by ethicalprinciples and theories, to justify our stance and list
recommendations to address ethical challenges.

Case scenario
A 22-year-old girl presented to the clinic with a complaintof loss of appetite, feeling of hopelessness, and loss ofinterest in daily activity and was getting treatment for
depression. On further inquiry, her mother stated that she
was eagerly waiting for the convocation day, which wascanceled due to the implementation of stringent publichealth measures; soon after hearing this news, she wasprofoundly depressed and self-isolated herself from friends
and immediate family members.
This scenario raises several key ethical questions:
1. Is it ethically justi ied to limit the freedom of movementof people?
2. Is a limitation in a social gathering a blessing or a threat
to vulnerable people in the community?
3. In this unprecedented crisis, should social gatherings beallowed in Pakistan?
Our position
In our viewpoint, social gatherings should not be allowed inPakistan to limit the surge and spread of the fatal infection;
the worth of maximizing the bene its for the community ishighly essential in an unprecedented crisis. Mass gatherings
entail substantial health risks for the local community inwhich a vulnerable population is at higher risk of becoming
victim to COVID-19. Moreover, participation in social
gatherings can aggravate stress and disease burden on thealready crumbling healthcare industries of Pakistan, whichfurther in lict detrimental physical, psychological, andinancial consequences on people, and violate the ethicalprinciple of bene icence and non-male icence. Thus, social
gatherings should not be allowed in order to overcome theraging morbidity and mortality rate in Pakistan.

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Analysis of the ethical dilemma: liberal individualism
vs. authoritarian communitarianism
Liberalism endorses the core concept of personal autonomy,
uploads individual right to freedom of expression, thought,
and fosters liberal actions and practices without any
coercion (Wissenburg, 2019). In a pandemic, the liberal
outlook favors the idea that individuals have the autonomy
to freely move and savor their life without following any
proper social distancing and self-isolation guidelines
exacted by the governing bodies, which may override theethical principle of bene icence and Non-male icence.
Moreover, the liberalism approach promotes the notion of"International Human Rights Law" for privacy, freedom of
movement and expression with protection of fundamental
individual rights (Bredenoord, 2016). According to theconstitution of Pakistan Section 2d, the law “providesff

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

141

freedom of internal movement and uninhibited foreign
travel, emigration, and repatriation" to Pakistani citizens(Pakistan 2019 Human Rights Report, 2019). Conversely, a
restriction on freedom of movement is a morally wrong act
as it violates the human right of autonomy and liberty.
In contrast, the communitarian approach is centered on
the core concept of social goals, cooperative virtue, and thecommon good of the society, and the emphasis is given
more on community bene it rather than an individual(Callahan, 2003). It conveys the thought that in a pandemic,
individuals as members of society, are morally obliged tofollow the stringent guideline of social distancing andisolation to protect the health of the community. Moreover,stringent lockdown and limitations on social gathering are
ethically justi ied, which can curtail morbidity and mortality
rate and guarded the vulnerable population against dying
early due to the virus (Bredenoord, 2016). Furthermore, it
is a moral duty of every citizen to exercise virtue of ethics byreligiously adhering to standard operating measures, which
promote the safety and health of the community (Bellazzi
and Boyneburgk, 2020). Thus, social gathering is not a
viable option that could risk the lives of millions of innocent
souls.

Consequences of our position
Humans are social beings, shaped by social connections andphysical environment. Social gatherings such as thecommemoration of religious ceremonies and life events
such as birthday celebration, marriage, and convocation
ceremonies in lict a sense of inner happiness, excitement,social connectedness, and optimism, as well as nurture
resilience and positivity in people's life (Tewari et al., 2012).
The unprecedented pandemic has already wreaked havoc inpeople's mental health due to its devastating physicalimplications and economic fallout. Marroquin et al. (2020)
reported that the stringent mitigation measures weresigni icantly and independently associated with extreme
psychological symptoms like higher depression rate, stress,
and insomnia, and generalized anxiety disorders. In
Pakistan, most of the suicide cases were linked to thestringent lockdown measures and economic recession(Mamun and Ullah, 2020). Moreover, loneliness, decreasesocial interaction, and chronic stress also heighten the riskof suicide, emotional imbalance, and substance abuse
among high-risk groups (Thakur and Jain, 2020). Thus, thelimitation on social gathering in Pakistan poses an immense
threat to the mental health of an individual and can increase
the suicidal rate and mental health problems in the country.
Counterargument for justi ication
One of the core principles of bioethics is non-male icence,
which means do not harm (Smith, 2017). Allowing social
gathering may violate the ethical principle of "nonmale icence" by increasing the risks of developing COVID-19
disease in the vulnerable population. In Pakistan, the nonserious attitude, low socioeconomic status, and literacy rate
push people towards non-adoption of mitigation measures

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Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

like hand washing, wearing a mask, and maintenance of six
feet distance, which can augment the risks of raging
contagious infection across the country and cause an
overwhelming burden on the already crumbling healthcare
industries of Pakistan (Noreen et al., 2020). Moreover, theexponential disease burden and mortality rate in Pakistan
would further provoke neuropsychiatric illnesses in people
like post-traumatic stress, fear, anxiety, and depression(Hashmi and Saleem, 2020). Thus, permitting social
gathering can also signi icantly amplify the overallmorbidity and mortality rate across the country.
Autonomy vs. paternalism
In biomedical ethics, autonomy stands for individual liberty
to choose and implement their own decision, which is thedominant ethical principle and the most fundamental rightof the human being (Rathor et al., 2011). In a pandemic,
individuals have the autonomy to make their own
independent decisions, without any coercion andoppression by governing bodies, where the limitation on
freedom of movement such as travel ban, quarantine, andrestriction on social gathering is considered as an unethicaland morally wrong act. However, literature has suggested
that countries that dealt with pandemics in a liberal manner
had confronted more mortality and morbidity thancountries that chose the paternalistic approach (Hartmann,2020).
On contrary, paternalism broadly is de ined as selecting
an action, which limits a person's autonomy and liberty to
decide for their own (Drolet and White, 2012). Nations that
implemented a paternalistic approach in the pandemic haveresulted in successful containment of the COVID-19 virus.
For example, China, the epicenter of the outbreak, had
responded to the pandemic with a paternalistic approach byenforcing stringent mitigation measures like the travel ban,prohibition on social gathering, and self-quarantine to curb
the spread of the contagious virus, which have resulted indecreased infection rate in the country (Feng and Cheng,2020). Simultaneously, by paternalistic approach, thegovernment is also ful illing the principle of bene icence(doing good to others) and non-male icence (do not harm).
According to the international human rights law, restriction
on individual liberty should only be executed if it would
have evidence to show a reduction in the spread of the virus(WHO, 2007). It conveys the notion that in response to theraging outbreak of the disease, the paternalistic approachshould be exacted by the government to gain maximum
bene its for the community and save millions of innocent
lives in this emerging crisis.

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Consequences of this position
Although literature suggested that stringent mitigation
measures are signi icantly ef icient in containing a surge of
infection, it also heightens the unemployment rate, poverty,
and economic crisis across the world. Sha i et al. (2020)
reported in their study that the COVID-19 pandemic has
severely affected national and global economies. In
Pakistan, the pandemic has devastatingly impacted theurban and rural area business and employment rate due tostrict lockdown measures and ban on social gathering,which is a huge source of employment and income
generation in a country. Amid COVID-19 pandemic, loss ofjobs, poverty, and inancial constraint due to strict lockdown
increased fear, anxiety, and emotional toll among people,
which is signi icantly associated with negative psychologicalbehaviors and psychiatric suffering like substance abuse,suicide, anxiety, and post-traumatic stress disorder (Usher
et al., 2020). Thus, the mental health burden and increasing
death rate would further aggravate the already collapsing
economic and healthcare industries of the country.
Counterargument for justi ication
Implementation of effective mitigation measures is highly
essential to limit the spread of contagious infections andend the emerging pandemic earlier in the most effective
manner. Moreover, the resurgence of fatal diseases needs tobe restrained through stringent public health measures like
physical distancing and social isolation (WHO, 2020). The
government must place stern public health measures toreduce disease transmission and lower the mortality rate in
the country, which is the highest priority and need of thehour (Anderson et al., 2020).
Recommendations
Historically, pandemics last for several decades and in lictdetrimental long-term physical, psychological and inancial
crises on the people (Gelband et al., 2017). To achieve a winwin situation, social gathering would be allowed withstringent mitigation measures and standard guidelines torestrict disease transmission. Moreover, it would also
provide an opportunity for people to commemoratesigni icant life events with immediate family members,
which will ultimately curtail the mental health implications
among people.
Firstly, on an individual level, each member of thecommunity has the moral obligation to religiously comply
with standard operating procedures like hand washing,wearing masks, and physical distancing for six feet in thesocial gathering. Moreover, it is also a moral responsibilityof an individual to self-isolate him/herself if suffering fromany symptoms of COVID-19 infection and to not participate
in a social gathering. Furthermore, the individual issubjected to a limited number of gathering with only
immediate family members in the functions to minimize therisk of disease transmission on a larger scale in thecommunity.
Secondly, at the community level, stakeholders should
ensure the social gathering programs be arranged withstrict standard operating procedures and surveillancesystems, to detect COVID-19 infected persons with the helpof temperature checks. Moreover, the availability andutilization of sanitizer and masks in social gatherings
should be mandatory to stop disease transmission amongpeople. Online and open-air small distance-based seminars
could be organized at the community level to build
resilience and enhance the sense of social connectedness

and optimism in the people, which will signi icantly lessen
the disease burden in the community. Awareness sessions
could be organized to in lict insight in people about thecommon mental health implications faced by COVID-19
infected patients and educate them about the strategies toovercome psychological and psychiatric illness with more
resilience and inner strength. Furthermore, designated area
police and other of icials should be assigned to enforce,strengthen, and observe the implementation of strict
mitigation measures in social gatherings.
Lastly, at the national level, the government should issue
stringent guidelines and protocols for executing social
gatherings, and rigorous law enforcement should be
enforced on the violation of SOP during public gatherings.
Moreover, public functions should be allowed in outdoor
spaces with the limitation of guest number and number ofhours. Surveillance teams could be formulated to spot check
implementation of SOP during social gatherings, which cansigni icantly improve the utility of mitigation measures inpublic functions. The government could impose mandatory
regulations and employ the WHO risk assessment tools
before executing public gathering, which helps to assess therisk of transmission of the virus in gatherings and provides
an essential recommendation to improve the mitigation
measures. For this risk-based approach, training programs
could be organized to assist health authorities and event
organizers in their planning and executing upcoming mass
public events with minimal risk of disease transmission.
Surveillance software could be developed to trackpeople to analyze their health status and level of risk forcontracting COVID-19 virus, and designated color codes
which categorize people according to the health risk. This
strategy can also serve to provide recommendations to thehigh-risk groups to make them refrain from activities whichfurther enhance the risk of COVID-19 infection in them.
Moreover, this application also allows governing bodies toimpose a ban on social gatherings in particular areas, where
there is a relatively higher risk for spreading disease andcan also classify speci ic communities, which can executepublic gatherings with strict SOP. Furthermore, awarenessprograms could be broadcast on television, radio, and all
digital forums to increase the insight in people about theintensity and severity of the COVID-19 pandemic in the
country and the importance of observing mitigation
measures in a social gathering.

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Conclusions
A global health crisis has devastatingly hit every realm oflife and has enhanced the physical, psychological, andinancial suffering of the people. Due to its calamitouseffects on the health and economic sectors of the country, it
is very challenging for the stakeholders and national leaders
to deal with the unprecedented crisis in an effective manner.
Thus, a continuous multifactorial and comprehensive
approach at the individual, community, and national level isrequired to end human misery and pain swiftly andef iciently.

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The Philippine tax reform law foracceleration and inclusion (TRAIN):
The surrounding factual, legal andethical issues of the state’s taxing
power- Atty. Angelo Andro M. Suan, CPA
angelosuan143@gmail.com (Corresponding author)- Rogelio P. Bayod, PhD
roger.bayod@gmail.com
Cor Jesu College, the Philippines

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Abstract
Aside from its effort to rectify historical injustices done tothe poor and those at the peripheries, the Philippine
government under the Duterte Administration, aims tolevel-off the playing ield for people to pursue their desired

good life. Among the many programs it created to uplift theconditions of the worst-off in the country, the congress is
becoming pro-active in the passage of bills and enactment oflaws. With the attempt to elevate the state to a higher levelof independence, global competence and social andeconomic amelioration of Filipinos, statutes were passed,
and old laws were amended. One noted law that gained
public support as well as criticism from different sectors
and industries, is the Tax Reform for Acceleration andInclusion (TRAIN) as Republic Act (RA) No. 10963 which
took effect on January 1, 2018. This paper will attempt toinvestigate the ethical underpinnings, advantages anddisadvantages of TRAIN law. Further, this paper identi ies
salient features of the new law amending the old tax laws.
Moreover, the question of constitutionality and morality of
the TRAIN Law is discussed in this paper with a case inpoint in the implementation of the Unconditional CashTransfer (UCT) and the Social Amelioration Program (SAP)
during the outbreak COVID-19 in the country.

Introduction
According to Oliver Wendell Holmes: “I hate paying taxes,
but I love the civilizations they give me.” This statement
speaks a lot on the attitude of people when left on their own
without government intervention. Thomas Hobbes says thatman is a beast, is barbaric and will do everything tooutshine others. Thus, it is important to have a governing
body that will decide on the laws and processes on how to
distribute the bene its and burdens when people come toagree and cooperate among themselves while living in thesame society. John Rawls used this concept in his theory ofjustice which will be the main theory to base our arguments
especially when we discuss in this paper the ethicalunderpinnings of the TRAIN Law in the Philippines.
Rawls argues that a society is just when its basic
structure is regulated by principles that would be selectedin the original position. The original position is a juststarting point where the contracting party is constrained by
the “veil of ignorance,” which denies them information that
could bias their selection of principles in ways that wewould normally regard as inappropriate, such as drawing
on one’s social, educational and economic status. The
principles of justice so selected will form the rules for
distributing what Rawls calls “primary goods”. These aregoods that any person with a rational plan of life would
want, such as rights, liberties, income, and wealth. These
goods include basic rights and liberties, freedom of
movement and free choice among a wide range ofoccupations, the powers of of ices and positions ofresponsibility, and income and wealth (Rawls, 2001).
To reconcile human freedom and equality, Rawls
proposes that each individual should be allowed to pursue
the good life while at the same time, the worst off or thepoor can bene it from those goods produced on the basis ofa property-owning socio-economic arrangement (Maboloc,
2018). What is the relation discussing John Rawls’ theory ofjustice in our attempt to explain the factual, legal and ethicalissues of state’s taxing power especially in implementation

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

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of the TRAIN law? This is very relevant in the sense thatJohn Rawls believes that the irst and most important dutyof social institutions is to promote justice. In fact, for him
justice is the irst virtue of social institutions (Rawls, 1971).
For John Rawls, the state plays a crucial role to ensuringthat each individual will have equal rights andopportunities. Thus, the state has the power and the
mandate to craft and implement laws and policies to ensurethat people’s rights and opportunities will be protected andalso fairly distributed.
There are three inherent powers of government bywhich the state interferes with the property rights, namely(1) police power, (2) eminent domain, and (3) taxation.
These are said to exist independently of the Constitution asnecessary attributes of sovereignty (City Government of
Quezon City v. Hon. Judge Ericta).
The power to tax is an incident of sovereignty and isunlimited in its range, acknowledging in its very nature no
limits, so that security against its abuse is to be found onlyin the responsibility of the legislature which imposes the tax
on the constituency that is to pay it (Mactan Cebu Int’l.
Airport Authority v. Marcos, 330 Phil. 392, 1996). It is basedon the principle that taxes are the lifeblood of thegovernment, and their prompt and certain availability is animperious need (Proton Pilipinas Corp. v. Republic of thePhilippines, G.R. No. 165027, October 16, 2006, citing
Province of Tarlac v. Alcantara, 216 SCRA 790, 798,1992).
Thus, the theory behind the exercise of the power to tax
emanates from necessity; without taxes, government cannot
ful ill its mandate of promoting the general welfare andwell-being of the people. (NPC v. City of Cabanatuan, 449
Phil. 233 ,2003). The welfare and the well-being of thedisadvantaged members of the society are the main concern
why the state has to impose taxes on people. In the TRAIN
law, those who have more income have higher tax to pay.
Some may call it unjust, especially if they have higher
income after starting from the bottom and through hard
work, talent, dedication and sacri ices, having elevated theireconomic status, and it would be unfair to just take awaysomething from the people who have worked so hard intheir lives and give it to the poor and those who may beconsidered lazy and free riders in the society. Rawls’
response to that argument is that there are factors that are
morally like our natural talents, skills and abilities. We do
not deserve all of those. Thus, at the very start, thedistribution of natural talents and skills and even family
membership is already unjust. But for Rawls, injustice isallowed as long as there is equality of opportunity andespecially if the worst-off in the society will have thegreatest bene it in this kind of arrangement. The worst-off
refers to the poor, the disadvantaged members in thesociety and that they should be considered as a priority interms of the programs and services rendered by the state(Maboloc, 2018). What about the rich and those who areborn with rich natural endowments or those who inherited
wealth and other social advantages because of family
membership? They can of course continue to pursue their

145

dreams and enjoy their lot, but they must contributesomething through taxes to serve the poor so that they canhave the opportunity to also improve their lives.
Tax laws are legislative in nature, legislature enacts
these statutes to meet the continuing necessity of the state
in raising revenue to defray the necessary expense(lifeblood theory). To meet such revenue raising objectives,
tax laws were continuously evaluated and amended toprogressively favor the taxpayer without prejudicing state’ssource of income. Part of the evaluation should be how thetax is being spent. Do the taxes increase the chance of thepoor to pursue their life plans? Are the tax laws fair to allconcerned?
The National Internal Revenue Code of 1997 (Tax Code)emanates from Republic Act (RA) No. 8424, otherwise
known as the Tax Reform Act of 1997, which was enacted on
December 11, 1997. From the Act’s effectivity on January 1,
1998, a series of laws have been passed to amend it.
Considering the signi icance of the amendments made,there are laws such as those introduced by RA 9337
(Reformed VAT Law), RA 9243 (Revised Documentary
Stamp Tax law), RA 9334 (Amended Excise Tax Law), andRA 9504 dated June 17, 2008 (amending Title II - Income
Tax). On December 19, 2017, President Rodrigo R. Dutertesigned into law Package 1 of the Comprehensive Tax Reform
Program (CTRP) also known as the Tax Reform for
Acceleration and Inclusion (TRAIN) as Republic Act (RA)No. 10963 which took effect on January 1, 2018.
The TRAIN aims to make the Philippine Tax System
simpler, fairer and more ef icient to promote investments,
create jobs and reduce inequality and injustice. Along withthis objective, the CTRP also aims to raise revenues that willfund the President’s Build Project to sustain high andinclusive growth of the country, and inance investments inpeople through enhanced education, health and social
services.

Tax reform for Acceleration and Inclusion (TRAIN) or
the Republic Act (RA) No. 10963
The Tax Reform for Acceleration and Inclusion (TRAIN) Act,of icially cited as Republic Act No. 10963, is the initialpackage of the Comprehensive Tax Reform Program (CTRP)
signed into law by President Rodrigo Duterte on December
19, 2017. The TRAIN Act is the irst of four packages of tax
reforms to the National Internal Revenue Code of 1997, or
the Tax Code, as amended. This package has introducedchanges in personal income tax (PIT), estate tax, donor'stax, value added tax (VAT), documentary stamp tax (DST)
and the excise tax of tobacco products, petroleum products,
mineral products, automobiles, sweetened beverages, andcosmetic procedures.
Important features of the tax reform are lower personal
income tax and higher consumption tax. Individual
taxpayers with taxable income not exceeding ₱250,000
annually are exempted from the payment of income tax. The
exemption for minimum wage earners is retained in therevised tax system; thus, these earners are likewise not146

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

liable for the payment of income taxes. Tax rates forindividual taxpayers still follow the progressive tax systemwith the maximum rate of 35%, and minimum rates of 20%(taxable years 2018 to 2022) and 15% (2023 onwards). On
the other hand, consumption taxes, in the form of higher
excise tax on tobacco products, automobiles, petroleum
products, tobacco, and additional excise tax on sweetened
beverages and non-essential, and invasive cosmetic
procedures were introduced.
The TRAIN Act is aimed to generate government revenue
to achieve the 2022 and 2040 vision of the President
Duterte administration, to eradicate extreme poverty, tocreate inclusive institutions that will offer equal
opportunities to all, and to achieve a higher income country
status. It is also aimed at making the tax system simpler,
fairer and more ef icient and effective to administer.
Regardless, contentions about the passing of this law havebeen present since the beginning and the subsequent
reception by the people since its rati ication has been
controversial. In the irst quarter of 2018, both positive andnegative outcomes have been observed. The economy saw
an increase in tax revenues, government expenditure and anincremental growth in GDP. On the other hand,
unprecedented in lation rates that exceeded projectedcalculations, have been the cause for much uproar andobjections. There have been petitions to suspend andamend the law, or even to declare it unconstitutional, so as
to safeguard particular sectors from soaring prices.

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TRAIN Law and John Rawls’ redistributive justiceJohn Rawls advances his two principles of justice andasserts that his two principles of justice are what thecontracting parties in the original position would choose.
The irst principle says that “each person has the sameindefeasible claim to a fully adequate scheme of equal basic
liberties, which scheme is compatible with the same schemeof liberties for all” (Rawls, 1971, p. 61). The irst principle isthe autonomy principle and suggests that the liberty ofpeople is supreme and cannot be violated even for the sakeof greater economic bene it.
The second principle states that social and economic
inequalities are to be arranged so that, a) of ices andpositions must be open to everyone under the conditions offair equality of opportunity and b) they are to be of thegreatest bene it to the least-advantaged members of society(Rawls, 1971, p. 61). The second principle has twocomponents. One is the fair opportunity principle and thesecond is the difference principle. These two components ofthe second principle suggest that primary social goods likeincome, wealth, opportunity, and social bases of self-respectshould be redistributed. It should be the worst-off in thesociety who must be favored primarily to make the sharingof social primary goods fair (Maboloc, 2018). The second
principle ensures redistributive justice. On the one hand,fair equality of opportunity ensures the poor their freedom
and autonomy to take advantage of the different programs
and services of the government for people to achieve thegood life. It also protects the poor and the weak against therich and powerful who want to dominate and control thesocial arrangement. On the other hand, the difference
principle ensures that even the poorest and those at themargins of society have access to the primary goods
necessary for their pursuit of the good life.
Here, we can say that Rawls’s theory of justice isegalitarian. For Maboloc (2018), egalitarianism is a doctrine
which says that persons must be respected as moral units.
He further asserts that no person can be sacri iced for thesake of another since each person has value in itself. Thus,
Rawls protects a great many liberties as strongly as he can.
But his list of liberties includes only two economic liberties:
the right to freely choose one’s occupation and the right toown personal property. That means that the state may notforce or order persons to perform jobs; neither may it
expropriate the personal or the non-capital goods of
persons. Therefore, in principle, Rawls can support different
schemes of government redistribution, regulation, and evensocialist economic production (Vallier, 2017).
Under the fair equality of opportunity principle, the only
reason the state may allow one to become wealthy,
in luential or powerful is that they do so under a system ofrules that promotes equal opportunity for everyone. Thus,
one’s unequal wealth, in luence, and power—no matter how
nobly and virtuously achieved or deserved—can beeliminated, even if it arises within a social system thatprovides great but unequal opportunities to everyone(Vallier, 2017).
The difference principle requires that inequalities ofprimary goods maximize the position of the least
advantaged members of society. This must occur within asystem of rules that maximize the position of the least
advantaged members of society (Vallier, 2017). The TRAIN
law is basically inspired or grounded by this principle ofjustice. The government arranges rules so that those whohave more in life are given the freedom to continue
pursuing their dreams and even bene it from them. But they
have to contribute something to the government throughtaxes and the government will redistribute this bene it to
the poor through different social services like theConditional Cash Transfer (CCT), Unconditional CashTransfer (UCT) and Social Amelioration Program (SAP) tothe poor when there is a calamity or pandemic like this
COVID-19. The Philippines was beset by plenty of natural
disasters last year that affected the lives of the poor. This
year, the COVID-19 pandemic has taken a lot of its budget
for SAP and UCT to help the poor. Without taxes, thegovernment cannot really ful ill its mandate to provide theneeded social services to the people. Thus, the TRAIN law isjust and ethical in the sense that it helps the least
advantaged in the society without curtailing the freedom ofpeople to pursue their life plans.

Criticism of the TRAIN law
Laban Konsyumer Inc., Makabayan bloc and other politicalparties iled a motion to the supreme court questioning thepassage and the implementation of the Tax Reform for
Acceleration and Inclusion law. “The continuing imposition

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

and increases of the fuel excise taxes exacerbates the adverse
effects to all consumers, more particularly to Filipinos from
low-income and poor consumers, who hardly have theresources to pay the excise taxes as prescribed by the Trainlaw and more so will pay more excise taxes in 2019 and 2020
but whose resources do not increase to be able to pay thehigher taxes in 2019 and 2020,” the group said in the motion.
Bayana Muna Party-list of icials are calling on theHighest Court to rule favorably on their petition to declarethe controversial Tax Reform for Acceleration and Inclusion(TRAIN) law unconstitutional. Included in the arguments
raised by the petitioners is the procedural defect,questioning the process in the passage of law. Accordingly,
TRAIN law had not been properly rati ied by the Lower
House of Congress. They said the deliberations on the then
TRAIN bill had no quorum, and that the majority did notgive other members of the Congress the chance to question
the proposal.
Petitioners were citing procedural lapses, its harsh
impact on the public, and violation of the constitution’s
provision on progressive taxation. petitioners said thatinstead of bene iting from the low prices of oil in the global
market, Filipinos would be burdened with arti icially highprices. Critics likewise contend that the reduction in income
tax is rendered meaningless by the tremendous increase in
the taxes to be imposed on consumer goods, primecommodities, medicines, electricity, and fuel. In particular,
the prices of gasoline and fuel products are expected to
substantially increase.
In turn, the marked increase in fuel prices will trigger acorresponding increase in the cost of transporting people
and goods, which will inevitably increase the prices ofpractically everything else. Moreover, the labor sector will
demand an increase in wages, which will also add to thecost of manufacturing goods and the delivery of services.
Since the additional tax will increase the selling price ofevery consumer product, the twelve percent value addedtax (VAT) currently imposed on all sale of consumer
products will be computed against a higher selling price,which will necessarily mean a larger VAT on the sale of what
is already very expensive, such as prime commodities tobegin with.
Critics of the TRAIN Act lament that the new tax
legislation not only increases taxes on prime commodities,
but also reduces the tax on the import of luxury vehicles.
The rationale for this manifestly pro-rich provision of the
TRAIN Act is a mystery.

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Is TRAIN on the right trail?
The tax reform program attempts to improve the lives ofFilipinos, especially the poor. It promotes equity such thatthose who have higher incomes will shoulder more of theburden compared to those with lower incomes. Thus,
Filipinos will contribute based on their capacity to pay.
TRAIN corrects and simpli ies the current tax system, as
well as make it fairer by lowering the PIT, reducing VAT
exemptions, and adjusting excise tax rates on petroleum

147

products and automobiles. Through this tax reform,
government will continue to increase spending in public
investment, such as by constructing school buildings, roads,
and bridges, and funding basic social services and social
protection. All these will stimulate the economy more andbene it the poor. This is a more inclusive way of spending
our shared resources, rather than merely boosting
individual consumption spending by lowering all taxes.
The proposed tax reform program will simplify
compliance through a single rate of 8% (in lieu of theincome tax and percentage tax) for small businesses, theself-employed, and professionals. To ensure compliance, tax
administration measures are included in the passage of thelaw such as relaxation of bank secrecy laws for fraud cases,
use of electronic receipts and connecting cash registers/
point of sale machines to BIR servers for simultaneous
reporting of sales and purchase data
The tax reform program is pro-poor and progressive. It
simpli ies the system and makes it fairer and more
equitable by restructuring the Personal Income Tax (PIT),
removing unnecessary Value Added Tax (VAT) exemptions,and adjusting the excise tax rates on petroleum products
and automobiles.
Through the reform, 83% of individual taxpayers
including minimum wage earners (P250k and below) will
be exempted from paying income tax. The revenues
generated from this reform will fund infrastructure, health,education, and social services for the poor which is basicallysupporting the Difference Principle of Rawls. Although theoverall goal of the tax reform is to address the inequity of
the current tax system, it will also help achieve thisadministration’s vision through additional investments insocial services, health, education, and infrastructure which
are believed to provide bene it to the worst-off in the
country.
The government through the solicitor general claimed
that the petitioners of TRAIN law failed to make a case of
unconstitutionality or invalidity strong enough to overcome
the presumption of validity of the TRAIN law. Furthermore,
it complies with the legal requirements set forth by theconstitution for it to be valid.
Below are some of the salient features of TRAIN LAW,
which are not present under the old tax laws:
1.Lowering personal income tax
2.Simpli ied estate and donor’s tax
3.Expanding value added tax (VAT) base
4.Increased excise tax on petroleum products
5.Increased excise tax on automobiles
6.Increased tax on sugar-sweetened beverages

Jurisprudence
In Estrada v. Sandiganbayan 421 Phil. 290 (2001), the courts
must assume that the legislature is ever conscious of theborders and edges of its plenary powers and has passed thelaw with full knowledge of the facts and for the purpose ofpromoting what is right and advancing the welfare of the
majority. Hence in determining whether the acts of the148

Eubios Journal of Asian and International Bioethics 31(2) (February 2021)

legislature are in tune with the fundamental law, courts
should proceed with judicial restraint and act with caution
and forbearance.
Furthermore, in the case of Gregorio Sarasola, plaintiffappellant, vs. Wenceslao Trinidad, Collector of Internal
Revenue of the Philippine Islands, defendant-appellee, GR No.
L-14595 (1919) the Supreme Court ruled that since theprompt collection of revenue depends on the very existenceof government itself, whatever determination shall be
arrived at by the Legislature, public policy decrees should
not be interfered with unless there be a clear violation ofsome constitutional inhibition.
On the other hand, courts, although zealous guardians ofindividual liberty and right, have nevertheless evinced areluctance to interfere with the exercise of the legislative
prerogative. They have done so early where there has beena clear, patent or palpable arbitrary and unreasonable abuseof the legislative prerogative.
To validate the exercise of the Supreme Court’s power tojudicial review, the words of Justice Laurel in the case ofAngara v. Electoral Commission, 63 Phil. 139, 158 (1936)
would be a good source of enlightenment, to wit: “And when
the judiciary mediates to allocate constitutional boundaries,
it does not assert any superiority over the otherdepartments; it does not in reality nullify or invalidate an
act of the legislature, but only asserts the solemn and sacredobligation assigned to it by the Constitution to determine
con licting claims of authority under the Constitution and toestablish for the parties in an actual controversy the rights
which that instrument secures and guarantees to them.”
The courts cannot just turn a blind eye and simply let it
pass. It will continue to uphold the constitution and its
enshrined principles. Furthermore, as cited in the case of
Biraogo v. Philippine Truth Commissions of 2010, GR No.
192935, December 7, 2010, the court held: “The Constitution
must ever remain supreme. All must bow to the mandate ofthis law. Expediency must not be allowed to sap its strength
nor greed for power debase its rectitude.”

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Conclusion
At present, the TRAIN law is already effective and income
wage earners are already experiencing the bene its of anincrease in take home pay while the poorest of the poor
who are also non-wage earners have already received theunconditional cash transfer which will assist them in theprice increase of commodities. Many employees earningcompensation income are now enjoying immunity from tax,
so long as their income does not exceed P250,000 or
approximately P20,833.33 a month. This is much moreadvantageous than the old tax law, where only minimum
wage earners were granted tax exemption. The exemption
granted by the government intangibly bene its the low andmiddle-income earners as they will receive the net pay
almost equal to the computed gross.
The TRAIN law is not arbitrary, oppressive, andcon iscatory, and does not result in the deprivation of life,
liberty or property without due process of law. It does not

violate the equal protection clause since it impacts mostly
middle to higher-income Filipinos.
Furthermore, it is settled that the law enjoys thepresumption of constitutionality. To overthrow thispresumption, there must be a clear and unequivocal breachof the constitution, not merely a doubtful or argumentative
contradiction. In short, the con lict with the constitution
must be shown beyond doubt. Where doubt exists, even if
well-founded, there can be no inding of unconstitutionality.
To doubt is to sustain. Thus, the TRAIN law should remain
valid unless otherwise declared by the Courts of Justice; assuch, everyone must uphold and respect the same, evenhow prejudicial it may seem to one’s perspective.
References
Maboloc, C.R. (2018). Applied Ethics: Moral Possibilities forContemporary World, SMKC PrintShoppe. 65 Salcedo Bldg,
Arellano St., Davao City.
Rawls, J. (1971). A Theory of Justice. Cambridge, MA: Harvard
University Press.
Rawls, J. (2001). Justice as Fairness: A Restatement, ed. E. Kelly(Cambridge, MA: Harvard University Press, 2001)
Direct Taxes Branches, Special Research and Technical Services
Branch and Fiscal Incentives Branch, NTRC (2020). Comparative
Matrix on Package 2 of the Comprehensive Tax Reform Program:Present vis-a-vis House Bill No. 4157 and Senate Bill No. 1357.
Sen, A. (2009). The Idea of Justice, 1 edition (Belknap Press ofHarvard University Press, 2009) - A. Kindle Edition. Location
217.
Tuaño et al. (2018). Get the data Created with Datawrapper.
Vallier, K. (2017). “A Rawlsian Case for Libertarianism”, retrieved
https://www.libertarianism.org/publications/essays/rawlsiancase-libertarianism November 3, 2020.

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