(introductory text...)

Cecelia Santos-Acuin, A. Troy Gepte IV and M. Justiniana Dedace

The Vitamin A problem in the Philippines

Vitamin A continues to be a leading cause of micronutrient deficiency, blindness, and eye disorders in the Philippines. Among children six months to six years of age, the prevalence of nightblindness is 0.7% and of Bitot's spots 0.2% (UNICEF, 1992). Certain communities (remote rural barangays or villages, urban slums) and population groups (children from large families, with poorly educated mothers, from unlanded farms or small/hired fishing households) are considered at higher risk than others. The Aetas possess a number of these factors and their children are considered at high risk for vitamin A deficiency.

The current management strategy of the Department of Health is to provide 200,000 IU of vitamin A in a capsule every six months to children suffering from or at high risk of developing the deficiency (those who are mildly, moderately, or severely malnourished; those with chronic diarrhea or recent measles). However, this policy is more curative in approach, seeking to correct the deficiency when it already exists. Recently, a campaign was launched to administer vitamin A capsules to all children and pregnant women, with or without the deficiency. As in other interventions of this nature, problems of supply and distribution influence its effective implementation. Moreover, administration of large doses of vitamin A must be adequately supervised because of the danger of toxicity.

The Aetas of Canawan, Morong

Geography of Canawan, Morong, Bataan

Morong is a municipality in the province of Bataan, about 150 kilometers northwest of Manila (Map 2). It lies at the foot of the tail end of the Zambales mountain range that extends from the north of the province of Zambales down the western side of the island of Luzon to end in Bataan. Morong has a population of about 19,000 living in five barangays or villages. It is bounded on the north by the Subic Naval Base forest (that was an American territory until 1992), on the west by the Subic Bay (that opens into the South China Sea), on the south by the municipality of Bagac, and on the east by Mt. Natib (a dormant volcano). Morong's barangays are laid out so that a portion of each lies along the coast and flat land, with larger areas at the foothills or mountain slopes. This is typical of many coastal towns in the country.

Canawan (also Kanawan) is a sitio or hamlet of barangay Binaritan, about eight kilometers from the town proper at approximately 200 meters above sea level, along a mountain slope denuded of forest cover. Its nearest neighbor is the Philippine Refugee Processing Center (PRPC).

MAP 2. The FES Protocol was Tested in Canawan, Morong, the Philippines

A single dirt road leads from the PRPC to a hanging bridge about thirty to forty meters in length spanning the Batalan River. This road and foot bridge serve as the only link between Canawan and the lowlands. From the bridge, a trail of caked mud and loose stones slopes upward (the average slope is forty-five degrees), leveling off on a grassy plateau where the Aetas have built most of their houses. The entire climb from the hanging bridge takes about thirty minutes. Other houses, that are situated in the hulo or in places farther from the center of the sitio or village, are built near the fields they cultivate. To get to the hulo requires another thirty to sixty minutes of hiking through rolling hills.

There are no official census records, but unofficial estimates place about thirty families living in Canawan that are of Aeta origin and five families from intermarriages between Aetas and lowlander Tagalogs.

Climate

Canawan's climate is typical of a tropical forest fringe with temperatures from 25°C to 350° C. There are roughly two seasons, dry and wet, although some would add a cold season (December to February), called taglamig by the Tagalogs, when temperatures may drop to the high teens. In terms of food availability, however, this cold season does not vary considerably from the dry season and is considered part of the latter in this discussion.

The dry season is from March to May or June and is characterized by a warm, humid climate with temperatures reaching as high as 38°C to 40° C. Since many plants that are not cultivated in irrigated fields die, food can become scarce. These months are considered taghirap (times of difficulty or hardship). This is the time when young men of the village go into the forest to look for game or honey.

Once the rains come in June or July, it rains heavily almost daily, usually from mid-morning to late afternoon and evening. All of Canawan becomes covered by clouds and travel is difficult. Vegetables and tubers are plentiful at this time. This is the rice planting season so that this staple becomes scarce. Harvest will not take place for another six months or so given the elementary agricultural skills of the Aetas.

History

It is believed that the Aetas were the first people to live in the hills of Morong, and were there before the Spaniards arrived in 1521 (Rahmann, 1963). Living independently by hunting wild animals and a slash and burn method of land cultivation, the Aetas occupied the valleys, knolls, and dense rainforests of Bataan. The Aeta settlements gradually receded to the more remote reaches of Morong, driven by the progress of lowlander civilization and abetted by their own destructive techniques of farming (personal communication, E. Mendoza, Jr., 1992).

At the behest of a local chieftain, Pablo Sulangi, in the 1930s, the Aetas dispersed throughout Morong and resettled together in one hillside community by the Morong River. They remained there until 1942 when they were forced to hide from the Japanese invaders during World War II. Unable to practice their slash and burn method of farming (kaingin) for fear of being found and captured, the Aetas suffered hunger and deprivation.

The Hukbalahap uprising, a local rebellion in the mountain and plains of Central Luzon, prevented the Aetas from completely retaking their prewar settlement until the late 1950s. In the late 1970s, they were forced to relocate again because the government claimed their land for construction of the PRPC'.

The Aetas chose Canawan, a piece of land situated a few kilometers from the site of PRPC. Eventually, the government, through the issuance of Proclamation #192, allotted 165 hectares of land from the Bataan National Park Reservation for the creation of the Canawan Negritos Reservation Area. It ordered the exclusive use of this land for the benefit of the Negritos (the racial group to which the Aetas belong) living within the area. The Department of Environment and Natural Resources (DENR) and the Office of the Northern Cultural Communities (ONCC) administer and manage the land.

The Aeta way of life is considered the most primitive among the various ethnic groups existing in the Philippines. With the objective of exploring indigenous vitamin A-rich foods, they were deemed ideal for this qualitative research because of their closeness to nature and their remoteness from the existing healthcare delivery system.

The Aeta's way of life

The life of the Aetas of Canawan revolves around the extended family. Aeta families freely intermarry so that almost all members of the tribe are related in some way and often share the same family names (e.g., Malunik, Quitain, Cayetano, Alejo). Community members are thus closely knit and mutually supportive.

Most traditional Aeta culture (agriculture, working tools, manner of dress, decorative ornaments), has been influenced by the lowland Tagalogs. The Aetas' capacity to selectively accept change, cherishing some aspects of their culture while abandoning others, has been influenced largely by their interactions with the Tagalog unat (meaning straight-haired, in contrast to the Aetas who are called kulot or curly-haired).

Agriculture

The Aetas have practiced slash and burn agriculture (kaingin or gasak) for many generations. Produce is mainly root crops (mostly sweet potatoes or kamote), bananas, and a variety of vegetables. Rice is not planted extensively and is usually bought to supplement their insufficient stores. Planting starts in May when the rains come. The vegetable harvest takes place after four to five months; the harvest of rice four months later. The bounty of produce depends on adequate rain since there is no irrigation system, and on vigilant protection from rats and other wild animals. With better tools, rice stock, and field management, lowlanders have managed to plant and harvest two to three rice crops a year. The Aetas barely manage one crop per year.

The Aetas do not seem to practice any system of crop rotation. Most of their produce is sold through a cooperative market in the town. Like all other co-op members, they supply certain kinds of vegetables or fruits predetermined by an agreement with the traders in the cooperative and the market. Most of the foods they consume are bought from the same market with the money earned from selling their produce.

With the ban on gasak farming, in order to preserve the few remaining trees in the already denuded forests of Morong, the Aetas have been forced to make do with whatever cultivable lands have been allotted to them. This increases the intensity of land use and heightens the urgency to improve methods of cultivation to maximize production.

Hunting and Gathering

Unlike the Aetas (a related racial and ethnic group also found in Luzon), the Aetas of Canawan seldom hunt for wild deer, pigs, monkeys, and lizards, as they did previously. Likewise gathering is rare and usually limited to honey. The honey-gathering process, (namumukyutan or namumuay) is generally done on dry, non-windy days. The bees are driven away by smoking the hive and the whole hive is obtained. The honey is collected and sold for about 1000 Phillipine Pesos ($40 US dollars) per gallon. The Aetas regard this as one way to generate income, especially during the difficult dry season. This and other traditional skills in procuring wild food are gradually being neglected as forest resources dwindle, and the Aetas rely more and more on the market for their needs.

The Tagalogs regard the hunting and gathering way of life as evidence that the Aetas tend to be lazy and resistant to change. True or not, the Aetas have remained remarkably isolated from improvements in farming technology that have been of immense benefit to the lowland Tagalogs.

Water, Sanitation' and Hygiene

The recent installation of a water system (steel pipes, rubber hoses, and faucets) through the assistance of the World Relief Corporation (WRC) has facilitated the delivery of water from a nearby spring to the center of the village. Although the Aetas now have running water to use for bathing and laundry, it has not changed the way they maintain personal hygiene. They change their clothes only after several days of wear. Children are allowed to play on the ground barefoot and clad only in dirty shirts. Food is handled without handwashing, and soap is rarely used.

The few material possessions of the Aeta family consist of some clothing, cookware, utensils, plates, and homemade furniture, such as benches and tables. Their trash usually consists of organic wastes from food preparation. Cigarette cartons and candy wrappers are seldom found in the trash because these items are beyond the reach of most members of the community. Since the Aetas have a minimal amount of waste, garbage disposal is not much of a problem.

Toilets are nonexistent in Canawan. Aetas defecate and bury their stools in nearby fields. Remarkably, there have been no reported major outbreaks of diarrhea! diseases in the area, the local perception being that they have become immune to diarrhea-causing germs. As one Tagalog remarked, "Sanay na ang mga iyan sa marumi!" (They are used to being dirty!)

Health Status and Practices

The Aetas believe that evil spirits are the usual cause of illness. They still practice a ritual called kagon, a form of spirit healing performed with dance, song, and guitar music to exorcise the dimonyo from ailing individuals. It is customary to wear a necklace of stringed pieces of sticks to ward off bad spirits like lamang-lupa, inhabitants of the earth believed to enter the body and cause disease.

When an illness persists, the Aetas seek medical help at the local clinic built by the WRC, an evangelical organization based in the United States, in the Canawan Village. Other health facilities include the PRPC hospital and the Rural Health Unit (RHU) in the town proper. Generic drugs are given free of charge at the clinic by a nurse who comes once a week. A weighing and feeding program for the underweight and malnourished is also undertaken by the WRC. However, lack of resources and appropriate health education hinder effective delivery of healthcare to the Aetas. The RHU staff come to Canawan about once a year, usually on a vaccination campaign. They claim that the remoteness of the village precludes more frequent visits with the limited available resources and manpower.

Malnutrition is a problem, particularly among children. It is common to find reddish or yellowish hair, a sign of protein deficiency, among children three to eight years old. In fact, this is considered karaniwan or normal by the Aetas. This age group is no longer breastfed, but they are unable to successfully forage for their own food. Readily available sources of animal protein are scarce. Except for a few chickens, no other livestock is raised, and they seldom hunt for animals such as wild deer and pigs. As a result, the Aetas are dependent on plant protein sources.

Cases of diseases related to malnutrition (diarrhea, measles, pneumonia) have been reported occasionally. Proximity to the forest has also led to outbreaks of malaria. In the course of our fieldwork during the dry season, there was one month in particular when almost every household had a member sick with malaria. During the wet season, a wave of upper respiratory infections swept through the community.

Although there are records of patients consulting at the RHU for eye symptoms, no signs indicative of vitamin A deficiency were documented.

Concepts of food and deficiency

We asked the oldest man in the village, (Mang Aquino Malunik, estimated to be about ninety years old, but appeared thirty years younger) what he wanted to eat. He replied, "Kung ano man ang ipagkaloob ng Diyos" ("Whatever God provides.") The response captures the entire attitude that most Aetas have toward food. They eat to survive and will take whatever is available. According to Mang Aquino, this attitude enables them to survive during difficult times. Another belief that influences food consumption is that of "makasanayan ang isang bagay" ("getting used to something"). Aetas are afraid to eat too much food or partake of what they consider to be "rich" foods, like meat, because they do not want to get used to them to the extent that they will "pine" for them.

These concepts regarding food availability affect the consumption of vitamin A-rich food as well as other food. A number of Aeta fruit and vegetable crops are rich in vitamin A and are available throughout the year. The problem the study team identified is not an inadequate intake of vitamin A-rich food, but what appears to be deficient vitamin A absorption and storage in the body. A review of actual intakes from food frequency tables and 24-hour recalls shows that the Aeta diet does not have a regular source of fat, whether animal or plant-based. As a result, those who have increased needs, such as pregnant and lactating women or children with illness (measles or diarrhea), may develop vitamin A deficiency.

From key-informant interviews, nigh/blindness appears to affect women only when they are pregnant, and the only memory they had of a person who manifested what may be Bitot's spots involved a young child who had other signs of malnutrition as well, and subsequently succumbed to infection.

Factors affecting food intake

Vitamin A in Breastmilk

Although no interviewee could recall any eye signs of vitamin A deficiency in infants, this group may be at risk for vitamin A deficiency, since Aetas exclusively breastfeed until about eight months of age. If the breastfeeding mother is deficient herself or has minimal vitamin A stores, it is likely that her child will not get sufficient vitamin A from her milk, since vitamin A in breastmilk is largely a product of maternal intake. Bongga's study of the nutrient content of breastmilk of Filipinas showed a mean retinol content of 36 mg/dL (Bongga, 1986). This is far below estimates made from U.S. mothers of 67 mg/dL (NAS, 1991). While it has been observed that infants who consume as low as 100 to 151 mg of RE per day do not show signs of vitamin A deficiency, the Filipino values are still a cause for concern. While Bongga did her work among urban poor Tagalogs, and the retinol content of the Aetas' breastmilk may vary, it raises the possibility that breastmilk as a source of vitamin A for infants may be less adequate in populations with marginal vitamin A intake.

It was difficult to elicit responses from the Aetas suggestive of micronutrient deficiency, other than that of vitamin A. The strongest evidence of nutritional deficiency seems to be the well-recognized observation that during times of hunger and inadequate intake, people get thinner and children get sick more often. However, a more specific link between an illness and a deficiency state cannot be made. This results from the concept that illness is caused by evil spirits. Signs of vitamin A deficiency were therefore elicited by showing pictures and describing the eye signs of deficiency, rather than by asking about deficiency states as a whole.

Food Availability

Among Aetas, three factors affect the availability and absorption of vitamin A-rich food: cost, season, and the site of the procurement (whether food is purchased, homegrown, gathered from the wild, etc.).

Most plant sources of vitamin A are homegrown and available throughout the year. Except for carrots, that they do not grow and are very expensive, the Aetas frequently have leafy vegetables such as talbos ng kamote (camote tops), or malunggay (horseradish tree leaves) with their rice. Animal sources of vitamin A, such as liver, are rarely eaten as these are usually bought from the market or caught in the wild. Except for chickens, few animals are raised for food. Recently, the government distributed piglets to some families. This was a gift with which the Aetas were not entirely happy, because the breed of piglets given to them are perceived to be prone to disease and selective in feeding.

The abundance of a particular nutrient source at any given time may vary. For instance, kalabasa (squash) is a wet season crop and may be unavailable or expensive during the dry season; mangga (mango), on the other hand, is a dry season fruit and can be had for the asking at this time, yet is exorbitantly priced the rest of the year. Year-round sources are also abundant, such as malunggay, papaya, and kamote tops.

The nearest market, about thirty minutes by foot, was the PRPC market which closed in mid-1994. This market was important, not only as a source of food, but also because it was where the Aetas sold their produce. It was here that crops commissioned by the cooperative were brought for selling and where foods such as rice, meats, fish, canned produce, candies, snacks, and tobacco were purchased. To get to the next nearest market, the town market, the Aetas either have to ride a tricycle (which costs about five pesos per person) or walk an additional forty-five minutes. Another option, especially with a lot of goods to carry, is to ride in a caribou-driven cart, which is difficult given the narrow mountain trails; the trails could be widened to accommodate the carts. Unfortunately, there are very few caribous, and these are used in the fields. Thus, this option would probably not be used often. Given the market cost of vitamin A-rich animal sources, it is unlikely that the Aetas would spend much on these foods, even if an easier (and cheaper) way to town could be found.

Hunting wild animals, as the Aetas ancestors did, will probably become rarer as the forest diminishes. During the time of the fieldwork (about half of the year), there was only one occasion when two wild pigs were caught. There may have been other instances when the adults who tend their remote fields have eaten food from the wild, but these would not be available to the children, or the lactating women who usually stay in the village, and are the most at risk for deficiency.

Food Beliefs

Food beliefs would be a secondary consideration in deciding what to eat. If food were abundant, concepts, perceptions, and personal preferences might prevail. For example, a lactating woman would probably opt to take malunggay leaves rather than take pechay (Chinese cabbage) if both were available, because she believes the former would increase her milk supply. A man with loose stools might choose a latundan banana (a variety of banana believed to cure diarrhea) over a mango because he thinks the banana will cure his diarrhea. However, a child would select mangoes over vegetables because fruits are more delicious, even if vegetables are believed to be mas masustansiya (more nutritious). Other food items perceived as masustansiya are meats, fish, eggs, and rice. But being masustansiya alone will not guarantee that the food would be eaten. Carristel, a masustansiya fruit abundant during the dry season, is rich in vitamin A and calories, but is seldom eaten because people do not like its taste. During taghirap (pert oafs of difficulty) when only vegetables would be available, they would be eaten regardless of beliefs and taste preferences. Beliefs would take a major role in food selection only in times of plenty and can therefore be considered independent of seasonality. However, they may play a bigger role in food selection during seasons of abundance.

The perceptions of food seem to be independent of season. The most important food for the Aetas is rice, referred to as gatas ng langit (milk from heaven). During times of scarcity, all remaining resources (i.e., cash) would be directed towards its procurement.

The desire for wet season tubers, such as kalot and boloy, was expressed during the dry season phase of the field work. Food for taghirap, such as batong-patay (literally dead stones) and sisila (grubs), are readily recalled without regard for season. The only effect seasonality may have is to affect the hierarchy or preference, as some foods may be more abundant than others at a certain time. For example, during the rainy season a wider variety of fruits and vegetables is available, so that year-round vitamin A-rich food such as malunggay and papaya may be ignored in favor of tubers like boloy or kalot that are low in vitamin A, but considered delicious. The Aetas might prefer the tubers because these are available only during this time of the year and thus take on the attributes of a delicacy.

Food Supply and Acquisition

The Aetas eat whatever is available from their environment. They harvest most fruits and vegetables from their fields and gardens (see Table 4.1). However, there are plants in the wild that produce fruits like bananas and carristel, and vegetables like pako (a fern).

Although much of their food consists of homegrown vegetables, there is an increasing proportion bought from the markets. These include rice (the staple), as well as eggs, meat, fish, canned goods, milk (including powdered infant formula), coffee, snack foods, and alcoholic beverages (beer, gin). Most of these market products are not affected by seasonality, however, travel becomes more difficult during the rainy season. The cost of these items is dictated by middlemen, who in turn blame typhoons, the oil crisis, the distance from Manila, and the residues from Mt. Pinatubo eruptions (which threatens critical bridges on the highway to Manila) for the high prices and the irregularity of supply.

Rice is especially crucial since the Aetas consider this the center of their food world. Many of them say that as long as there is rice, they are satisfied. Unfortunately, none of the families are self-sufficient in this staple. The Maluniks, who seem to be the most self-reliant, only plant about a two month supply and buy the rest from the PRPC market. Other families do not even plant rice. They say that the land is not suitable for planting rice, and when they try, the yield is not enough. Attempts to introduce better methods of farming and better varieties of rice have not been successful. The farmers say that representatives from the DENR and the Department of Agriculture (DAR) do not visit often enough. However, the DENR and DAR claim that the people are uncooperative and lazy.

Food from the wild is still an important, though unreliable food source, particularly of animal protein. Aside from honey and wild pig, other foods obtained are: bananas, coconuts, alupag (a kind of fruit), bulaig (a tuber also used as pig feed), ferns (pako, lagulo, and bago), lima-lima (a tuber), ubod ng yantok (rattan trunk), fresh-water shrimps and fish, birds, monkeys, deer, labuyong gubat (forest chicken), abaw (beetles), and bayawak (forest lizard). Two interesting foods that Mang Aquino recalls eating during times of extreme want are sisila (grubs), and batong-patay (dead rock). The latter has been described as a stone that looks like bread and is edible. It is said to "pampatigas ng tuhod" ("strengthen the knees") and is considered good for the body. Food from the wild is more likely to be sought during the dry season when other sources are not available. There is, however, some food from the wild (such as kalot, boloy and buli), that is available only during the wet season. Most of these items do not have species identification or food composition information.

TABLE 4. 1
List of Important Plant Foods by Seasonal Availability and Retinol Equivalents

Wet		Dry		Year-Round
Food	RE/100g	Food	RE/100g	Food	RE/100g
Taro leaves	1252.5	Cashew leaves	783.3	Chili pepper leaves	1860.8
Jute	1220.8	Mustard	270.8		1667.5
Bittermelon leaves	33.3	Mango, ripe	250.0	Carrots	1290.0
Carristel (Tiesa)	205.8	Melon	214.2	Horseradish tree leaves (malunggay)	516.7
Squash fruit	146.7	Papaya	75.0	Fern	429.2
Sigarilyas (goa/winged bean)	51.7	Spanish plum (Siniguelas)	37.5	Swamp cabbage (Kangkong)	63.3
Sitaw (yard-long leaves)	41.7	Watermelon	16.7	Bago leaves	90.0
Corn	35.0	Mungbean	13.3	Sweet potato	63.3
Bittermelon (ampalaya) fruit	33.3	Jackfruit	3.3	Tomato	11.7
Okra	24.2	Cabbage	3.3	Cassava	10.8
Eggplant	13.3	Cashew fruit	2.5	Guava	5.0
Taro Tuber	5.0	Pineapple	1.7	Banana	0.0
Lagulo (fern)	*	Star apple	0.8	Coconut	*
Buloy	*	Black plum (Duhat)	0.0	Rice	*
		Yam bean (Singkamas)	*	Babayan leaves	*

* Data not available

There is no division of labor as far as food acquisition is concerned. Both men and women are responsible for procuring food. However, because women become pregnant and need to take care of their infants, they may be confined to the village more often than men.

Aetas of all ages are involved in looking for food for the household. Children as young as five have been observed to dig their own camote while old women, like Aling Juanita (Mang Aquino's wife, one of the oldest and one of two women in the village who can still perform the kagon), are seldom found in the village because they are usually tending their fields.

Since almost everyone is family, the Aetas tend to share their food not only with household members but with neighbors as well. It is not unusual for a woman returning from the fields to be carrying a large bundle of string beans which she distributes to the houses she passes along the way. The whole village made a feast of two wild pigs caught by one of the young men, though a large portion was brought to town to be sold.

This generosity extended even to the study team, much to our discomfort, as we were aware of how limited their resources were. Yet it was a rare visit to Canawan that we would come down empty-handed. Someone usually pressed on us a few papayas, some camote, a bag of vegetables, or some bananas.

A typical meal

The typical meal of an Aeta would probably vary depending on the season of the year, whether he or she is at the village, near the fields, or in the forest. Age, of course, would also be a determinant, since all infants are breastfed. There was only one infant in the entire village who was not breastfed at the time of the field work, and this was because his mother became mentally ill soon after giving birth. Weaning takes place when the child begins to have teeth and begins to reach out for food ("nagsisimula nang umabot-abot ng pagkain"). Once the child starts raking solids, he is fed whatever the older members of the household are having.

The Aetas start the day by going to their fields. They may take a midmorning meal consisting of coffee made from burnt rice, and any leftovers from the previous evening's supper. The women, children, and older men who are left behind in the village have lunch at midday. This would consist of boiled rice and boiled or broiled vegetables, again usually leftovers. The main meal would be taken at dusk. The men and women who have returned from the fields bring home vegetables from their fields or plants growing in the wild (such as mushrooms) or, when lucky, birds or fish caught on the way. These are cooked by roasting or boiling and are eaten with rice. Meals are prepared with a minimum of utensils and little seasoning (usually salt, and occasionally bagoong or salted fish paste). There are times when a meal would consist only of rice and salt.

Seasonal variation would be reflected in the types of vegetables available for cooking. Those who stay near their fields with minimal cooking implements may opt to partake of foods from the wild (ferns, fruits, mushrooms) the availability of which will also be affected by the season.

More elaborate meal preparation is done during feasts, held to celebrate events, such as the opening of a new school or the Baptism of a child. On these occasions, noodles and meats with sauces may be prepared. The recipes, however, are of Tagalog origin.

Dry Season

The typical meal during the dry season would consist of rice (provided there is money to buy it from the market, or leftover grain stored from the previous harvest) and whatever vegetables are in season (mustasa, munggo, pechay). The vegetables would most likely be boiled. With luck, there could be freshwater fish or wild birds, either of which would be roasted. As their economy becomes more and more market-oriented, however, fish and birds when caught might well be brought to the market for cash to buy rice. Fruits like mangoes, carristel, cashew, black plums, Spanish plums, star apple, and pineapple are plentiful during the summer, so that it is common to see children walking about munching on some fruit.

Wet Season

Rice is scarce during the wet season that is also the planting season. When money is tight, or travel to the market impossible, the people turn to alternative staples, such as camote, kalot, and boloy (all tubers). Fortunately, vegetables are plentiful at this time, as are ferns and mushrooms. Fruits are limited to those available year-round, such as papayas or bananas. However, after a bad storm, even these are hard to find.

Suggested dietary modifications

Food intake is a complex behavior affected by a web of factors, only a few of which are mentioned above. It may seem that the Aetas would respond readily to suggested modifications as long as food is available. The perception of tiesa (carristel) should caution such optimism. People know that it is masustansiya (nutritious) and mabuti para sa mata (good for the eyes) and it is abundant in the summer months, but they would prefer not to eat it because they do not like its taste. There is need to experiment with recipes that would make tiesa more palatable, since this is in season during the dry months when not many food items are available. It is also rich in energy and vitamin C.

Our suggested modifications were directed toward improving the absorption of vitamin A and increasing body stores. We also recommended ways to improve the overall diet, keeping in mind other factors that could affect intake, such as taste and ease in preparation.

The first set of recommendations would help increase the fat in the diet. One way would be to use coconut milk more often. The Aetas already eat dishes in which vegetables are cooked in coconut milk. However, extracting the milk from coconut meat can be tedious and this may be the reason it is seldom done, even if coconuts are available. They would have to be convinced that the outcome would be worthwhile. Although coconut milk can be bought in ready-to-use form in Manila, it is unlikely that people from Morong and Canawan would buy it, given the availability of coconuts and the limited cash available.

A second way to add more fat in their diet is to encourage them to eat more nuts, such as peanuts, cashews, and sesame seeds. They, of course, need to be convinced to plant these crops. Cashew is already being produced, but peanut and sesame seeds could be introduced, both as cash crops and for personal consumption.

The Aetas also need to increase the amount of protein in their diets. One way would be use the nuts noted above. Another would be to eat more legumes, such as munggo (mungbean). Yet another would be to find ways to procure animal sources more readily. We proposed that more animals, such as chickens, pigs, and goats be raised.

Chicken would be a good source of nutrients. The eggs and skin are rich in fat, the liver in vitamin A, and the meat in protein. Pigs and goats would also be good sources of protein, and their livers of vitamin A. The Aetas would probably prefer the native breed of chickens and pigs, that are hardier and require little care. Goats will eat almost anything, so feeding should not be a problem, and their milk could be an additional source of fat as well. Perhaps, if the Aetas are hesitant to use goat or even caribou milk (they believe that this would make them behave like animals), they could be taught to make cheese from their milk and eat this instead. Cheese would be a good source of fat and protein.

A far more expensive way to increase vitamin A intake would be to fortify the foods that the Aetas eat often, such as rice and condiments like salt and soy sauce. However, marketing and distribution would be problematical for remote locations such as Canawan. On the other hand, this method could be implemented on a regional or national scale, which would require policy and legislative changes.

These suggestions could be implemented through a concerted effort involving community mobilization and health education. People like the Aetas have become wary of suggestions, even from well-meaning sources. It may be a good strategy to start with a few families who will adopt these changes by raising more animals, and planting a wider variety of crops. When this succeeds, other families will follow.