I did not think there would be more to this. I thought I had seen everything. I thought I would be immune to anything else I saw. But that was before I climbed the mountain.

I accompanied a visiting journalist to our Tondo project. He wanted to see our work on tuberculosis (TB), and he wanted to see the community, he said. I took him to the active case-finding activity, so he could see our setup, our x-ray truck, how we diagnosed people with TB. But it was still early in the day, and there were few people. So we decided to join the team of nurses who were visiting the homes of patients, and checking on children who were on preventive treatment.

Someone had already mentioned that the nurses were at Smokey Mountain. For some reason, I thought they meant that the nurses were visiting patients in the tenement houses around the mountain. The van picked us up, and dropped us off at the health center, where the two nurses were waiting for us. As we walked, I realized where our feet were taking us. “Aakyat tayo?” I asked, pointing. “Yes po,” they said.

I hope I did not shudder visibly. Inwardly I panicked. I was not prepared for this to happen on this day, and I did not know what to expect. Perhaps an overwhelming stench of rotting food and other garbage. Perhaps mountains of paper and plastic. Perhaps hostile people glaring suspiciously at us. I suppose I imagined the worst.

We walked past stores and stalls along the street, and ducked into a gap which led to a path up the mountain. I noticed a distinct smell despite my tight mask, and I thought for a moment, this is it. But I quickly forgot about it as I scrambled up what steps had been worn into the ground by years of foot traffic. I was so grateful that I’d worn my hiking shoes. I stepped carefully, wondering about the ground under my feet, worried that it would collapse under my weight, fearful that I would slip and fall. I thought about how many people had gone up and down those steps, and what happened if it rained. In some spots the steps were steep, and I had to climb high. There were no railings, nothing to hang on to, and I worried about losing my balance. Worse, sometimes people would walk down as we were going up, and I wondered if one of us would fall as we passed one another. But of course, this was their home, and they knew these steps so well that they did not have to think carefully about their footing, as I had to.

My sweat was dripping by the time we reached the top of those steps, and I was surprised to see a rather large plot of leafy vegetables, neatly planted. Clearly people tended these crops, and all I could think of was what their nutritional value could be, growing in such soil that was densely packed with decades of garbage. I recognized papaya plants, and asked one of our nurses what the other leaves were. “Talbos ng kamote,” she told me. I looked around and saw the roofs of the tenement buildings, and in the distance, commercial buildings in some business district I could not recognize. There were trees here, and flowers.

The nurses led the way to a small dwelling, which looked much the same as others we’d passed along the way: fragile, temporary, small and dirty. Nothing here looked permanent. Everything looked like a storm would wash it all away. Here and there were some cement structures, but most looked like they had been cobbled together with thin planks of wood, old tarps, and whatever else could be scavenged from nearby.

We met a woman named Mary Ann, whose baby was on TB preventive treatment (TPT); her father had tested positive at one of our screening activities. The baby was almost done with TPT, having started in May. They interviewed Mary Ann, checked her weight and the baby’s weight. The nurses cheerfully told me that the baby had gained so much weight that they needed to increase the dosage of his medicine; apparently the TPT drugs included vitamins and increased one’s appetite. To the journalist they explained the treatment, the challenges in their work, the family’s situation.

It was the journalist’s interview with Mary Ann that broke my heart. He asked her about her biggest challenges in life, in her living situation. She said, “Parang OK lang naman kami dito. Minsan wala pera, pag walang trabaho, walang makain. Pero OK lang naman kami.”

I did not cry then. I think I was too shocked by my surroundings. I cried later, when I’d had time to rest and eat, and I was on my way home after a dinner date with my best friend.

In my mind were ten million laments, about poverty and corruption, about the lack of education and terribly insufficient healthcare services, our botched economy and fractured society, about systemic greed and collective apathy, about years of neglect, all of which conspired to keep Mary Ann and her family living on a mountain of garbage. I was torn between anger and despair, frustration and hopelessness.

But to Mary Ann, 36 years old, with her small home, her husband who had TB, and her baby who was on TPT, things were not so bad.

Oh, and her baby? He’s named Miracle. A Miracle on a mountain of garbage in Manila.