WHEN SHE chose to serve in Jipapad in 1993, Balanoba brought along her two-year-old son and her husband, a pastor who gave up his post in the city and continued his ministry among the rural folk.

	FAMILY CHORES. Marcelino Abu seldom does household chores, instead passing on domestic tasks to his eldest daughter while his wife is in Italy.

Because nobody else at the DOH's central or regional office had ventured there before her, Balanoba had to discover for herself what Jipapad was like. She found a poor mountainous town of 5,600 people, mostly coconut farmers. Eight barangays made up the town, four of them in far-flung areas accessible only by boat or a five-hour trek.

From Tacloban, Balanoba traveled by land for four hours to Borongan, Eastern Samar's capital. Then came another four hours by land to Oras town, from which. Jipapad was still some eight hours away upstream by passenger pumpboat. Later, Balanoba would sometimes log 12 hours on a cargo pumpboat, along with canned goods intended for the town. The downstream trip from Jipapad to Oras lasted a quicker five hours. "You had copra and abaca as companions," she says. There was only one trip a day.

A generator owned by an Italian priest supplied the town's electricity from six to 10 p.m. At first, the doctor stayed at the town treasurer's house, where drinking water was available. But when people hesitated to consult her, thinking she was allied with the politician, she moved to "neutral ground." Drinking water then became a problem.

There was no market in Jipapad. "You'd have to be on the lookout for itinerant vendors," says Balanoba. People didn't farm much because, they reasoned, the place was often flooded. Landowners, in turn, didn't let others cultivate their land because they were afraid that New People's Army rebels would steal the produce.

Lariosa's trip from Tacloban to Tagapul-an was a lot shorter, but still not quite pleasant. The road from Catlabogan to Calbayog is potholed while the banca ride from the Calbayog pier to the island municipality of 8,000 people takes some six hours because of numerous stops to unload goods.

Like Jipapad, Tagapul-an is mountainous, with only one barangay adjacent to the poblacion linked by cemented road. One could walk to the rest of the barangays, but it's faster to go by banca, Yet even the most skilled boatman gets intimidated by the waves whipped up by the gusty monsoon winds. "These are not Pacific waves, you can't ride them," says Lariosa. "The current is uneven and multidirectional." And, the doctor found out, one side of the island could be calm even as angry waves slammed the other.

Doctors assigned to Surigao del Norte's many island municipalities under the Leaders for Health program have their share of horror stories to tell. "They travel by boat and run into giant waves as tall as a church," says Labajo. "And they feel they're about to die."

THE WRATH of the elements is not the only threat. The river Balanoba used to travel to and from Jipapad has a history of encounters between NPA rebels and soldiers. On one occasion, a midwife was wounded when rebels attacked the soldiers who were with her on the pumpboat. Many encounters also took place on land. Balanoba counts herself lucky that she was never caught in the crossfire.

Not Phoebe de la Cruz, a doctor assigned to San Jose de Buan, an insurgent stronghold east of Calbayog in Samar. The military was accompanying de la Cruz on a medical mission when rebels attacked their convoy. The spirited doktora got off the vehicle to identify herself. The rebels then tried to take her with them but she stood her ground, insisting that she must treat the wounded.

Generally, the rebels consider the barrio doctors off limits. That's why they and other rural health workers are often the only government presence in some towns where Muslim or communist rebels operate. Bound by their Hippocratic oath, the doctors treat the sick and wounded among the rebels, as well as provide them the medicines and supplies they need.

Some barrio doctors are not bothered by the remoteness of their assignments or the risks. The challenge, they say, is trying to change people's ways and thinking. They have to deal with a dole-out mentality that has people expecting free medicine even when they're well. Nodora also says, "They don't see a doctor unless their illness is really severe. They believe that seeing a doctor and buying medicines are expensive. They don't know that the doctor at the RHU (rural health unit) is there to help."

Nearly all barrio doctors engage in health education soon after they arrive. In Jipapad, people descended on Balanoba as though an epidemic had broken out. It was their first time to be diagnosed. But they balked when she asked them to clean their wounds with soap and water. "They thought they'd get tetanus that way," Balanoba says.

She found people walking barefoot, one reason for the high incidence of parasitism. Many had also turned the river into a public toilet, giving rise to hygiene problems.

Balanoba involved village officials in a house-to-house campaign to have children immunized. They launched a contest on the cleanest barangay, emphasizing that every house must have a toilet bowl. Not all residents faithfully complied, as one councilor found out. In one home, he fell off the toilet bowl that toppled as he was using it. "It turned out to be just for display," says Balanoba.