The story was written more than two years ago, kept on file, remembered so often—every time someone poor becomes seriously ill in the boondocks, when poverty limits the choices and predicts the outcomes, when economics always determine the quality of dying, and where death is the final unaffordable burden.

mpoñgan was a 15-year old kid from the boondocks. His name derived from his father, Ompong, but in keeping with the comic nicknames of his friends—Buaya, Kurapoy, Bulate, Atotay, Ogag, Negro—with whom he shared a life severely circumscribed by poverty and abandonment. He grew up in Region 6, about 100 square meters at the end of a dirt road, with its cluster of squatter-type houses—so called because it was the poorest and most crowded in a street lined by low-income housing, a place of day-to-day survival, Isang-kahig isang-tuka, where jobs are scarce and seasonal, where role models are just as scarce, where going to bed hungry was not uncommon.

This was Ompoñgan's world. A place difficult to dream a future from, only to wonder what there is to do the next day—other than bingo, tong-its, pusoy-dos, kara-kruz, tex, or betting on the thrice-daily hueteng. No one cared that he quit school at third grade, it was just a matter of time anyway—no one in his clan has ever come close to getting a high school diploma. He left home often, to the next pook or barangay, coming back soon enough, and no one really cared—one less mouth to feed when he was gone. He took up the commerce of the wayward life, surviving with street smarts and delinquent skills. He drank some, gambled often. He stole from neighbors' fruit trees to sell for cigarette money. He would gamble away in a few minutes what he had put together from a few days of odd jobs. And when the days were idle, and there were many such days, he loved going to the river with his friends, to swim, fish, and drink.

They call it the Lagnas River. Some call it by another name, Ugong, for the sound it makes when an eddy forms at the river's edge, when myth warns it will soon claim another life.

That life would be Ompoñgan's. As he has done many times before, he did a back flip from a rock ledge, hoping to land on his feet on shallow waters. He slipped and landed on his head. He didn't surface for quite a while. Friends thought he was jesting, until he started to surface feet-first. He was limp and lifeless when he was pulled out of the water. Blue around the lips, he was slapped and rocked, and eventually revived. His arms and legs were noticed not to be moving. Even in the boondocks, they knew it was a bad neck injury. Tests would later show his cervical spine was shattered in places. He would die in two months time, his illness, dying, and death consigned to the realities of poverty.

An odyssey
They carried him to the house, a short walk from the river, with no neck injury precautions. He complained of a headache; his arms and legs, limp. The neighborhood hilot was called. He said: Bali na ang leeg. Dalahin na ninyo sa Manila.

For rural folk, Manila is always a daunting destination—expensive, unfamiliar, intimidating, inhospitable—a last resort thing. The family opted for the provincial hospital instead. It took several hours of soliciting and borrowing to put together the 500 pesos the barangay office required for use of the patrol/ambulance to cover fuel and driver expenses.

Barely out of Candelaria, the barangay patrol/ambulance overheated and stalled. By the time the vehicle got fixed, It was starting to get dark. The driver suggested that the patient be taken Mayabo, Candelaria, to a local healer specializing in bone problems.

After a circuitous ride through rural dirt roads, they arrived at the healer's place -- a bamboo hut with four cots to accommodate patients who might need overnight stays. Despite his obvious quadriplegic state, the healer took him in. Ompoñgan stayed for 3 days, went through the gamut of alternative healing -- bulong, tapal, orasyon. Cigarette papers were licked while prayers were being whispered, and applied to the upper back, ankles and wrists. He was spoon-fed water, coffee, bread and rice. On the third day, his stomach started to distend. Another tapal was applied to the puson. He had no urine output, and started vomiting coffee-ground stuff. The healer said: Hindi ko na kaya iyan. Dalahin na ninyo sa ospital. (I can't handle him anymore. Take him to the hospital.)

At the Lucena Memorial Hospital ER, after IV fluids were started and xrays taken, his family was advised to take him to Manila—his condition was far too serious and complicated for provincial hospital care. For the third time in five days, they arranged for an ambulance transport.

There was desperate need for money. Since the accident, family members have been hurry-scurrying trying to raise funds. No relative or neighbor could advance a loan. Their credit rating so bad, a 5-6 loan was impossible to get. No cow, goat, gun, or anything of value to sell or pawn. With a barangay endorsement letter in hand, an aunt went soliciting door-to-door, receiving five- to twenty-peso donations, coming up with about 2000 pesos after two days and about a 100 houses.

They arrived at government hospital, way short on funds, surviving on a meager food budget, with handouts from other patients' families in the ward. There were daily texts to the province pleading for money, which was wired whenever donations cumulated enough, and which were almost immediately used up for daily medication needs.

The mother and uncle said they got daily doses of scolding from the doctors and nurses for not coming up with the money needed for his medical care. No medical insurance to lighten the burden. No extra money for a neck brace or an egg-crate mattress. A resident attempted to fashion a neck brace from cut and taped pieces of cardboard, which was so ill-fitting it caused more discomfort than relief.

The family was informed a minimum of thirty thousand pesos would be needed for surgery . But before that, a neck spine MRI had to be done to establish actual surgical need, options, and prognosis. I was informed by a niece, a physician doing public health clinic at the hospital, that the family did not have the P5,000 needed for the MRI. I told her I would cover the cost of the procedure, to reassure the private diagnostic radiology clinic that a check will be given in 2 days. Despite her reassurances, they refused to do the MRI without some form of collateral—they said her cell phone would do.

The MRI confirmed the cervical spine injury. A doctor said: Luminsad na ang buto. Added: Maski maoperahan, hindi na lalakad. (Even if he gets surgery, he's not going to walk.) While they were contemplating the prognosis, someone said: Ano pa ang ginagawa ninyo dito. Baka mahawaan pa. Dito pa abutin. (What are you waiting for. He might catch an infection. He might die here.) They decided to take him home—back to Region 6.

He was wheeled to the transport ambulance in the same metal gurney that he was received, where he has lain during his whole hospital stay, in the same clothes, where he received no amount of nursing care, no quadriplegia precautions. His clothes and back stuck on the gurney as they lifted him, and left behind a putrid lump of rot to reveal a fist-size decubitus ulcer in the low back, releasing a sickening odor of decay that caused one of the ambulance helpers to throw up.

He spent the next three weeks in a dirt room, lying on a make-do wooden bed made of salvaged wood and bamboo slats, with fold-up hinges in the middle to allow him to be sat up. I showed the family how to clean the sacral ulcer, providing supplies for wound care. Malnutrition and infections hastened the dire prognosis. He would die in three weeks, sooner than later.

In the interim, when word went around that death was just a matter of time, contributions and compassion started pouring in. When death is imminent, generosity swells. A half-sack of rice. Coffee. Canned goods. Foodstuff he requested: grapes, champurado, juices. The till box of donation was never empty, and when it overflowed, the mother considered buying a cell phone, for which she got a well-deserved berating. An uncle dipped on it for personal use.

Soon Ompoñgan could take only liquids. For days, he sang Pusong Bato, a song of unrequited love, again and again. The family found out there was a girl named Grace, an infatuation, he was singing about, pining for. He called his brothers and sisters, one by one, whispered to them: Be good, don't be like me. Magpakabait kayo. Huwag kayong gumaya sa akin. For days before he died, Ka Berong, his grandfather stood by the end of this cot. Sinusundo na ako, he told his aunt. Ayaw ko pa. And he refused to go. He wanted to stay alive, struggled against the ghostly summons. Finally, one day, soon enough, his breathing became labored. He still tried to cling to life. His aunt said: Sumama ka na. Oras na. Go with him. it's time. Tears were flowing down his cheeks as he closed his eyes and died.

There wasn't enough in the donation box to buy a coffin. They had to borrow half the cost of the coffin from a barangay konsehal, promising to pay when the expected they received the municpal donations for an accidental family death. There was no cemetery plot. The poor do not have the luxury of prepaid planning. The cheapest plot would have cost more than thirty thousand. The coffin left nothing in the funerary coffers. The traditional cockfights happened, but the ten-percent from the palisadas pot money would add but a pittance. Desperate for a burial place, someone suggested sharing his grandmother's cemetery "apartment."

Actually, it was the only option. His grandmother's tomb, top chamber of a 4-high apartment niche, was opened, the fragments of more than 10-year old bony remains were put in a bag and pushed to the end to accommodate Ompongan's coffin. And there he lies, to rest in peace, sharing space in an apartment niche—death delivering the final indignity.