Stories From the Field:

TYPHOON HAIYAN

Mass General Supports Typhoon Haiyan Recovery Efforts with the International Medical Corps

Dr. Miriam Aschkenasy recently led a disaster response team of seven nurses, doctors and pharmacists from the Massachusetts General Hospital to support medical relief efforts in the Philippines. The team returned to Boston on 9 December 2013.

5 December: Final day in the field!

We went to the municipality of Panay (again) and the barangay of Agojo. We traveled with the new team made of up of 3 young Filipino physicians from Manila and 4 nurses - some from Manila and some local. We paired up and worked with them closely to show them how we were running the clinics. We saw a total of 119 patients and had several very sick patients that needed urgent/emergency transfer to the hospital including an acute abdomen in a young man, and leukemia patient with pneumonia who looked ill, and two cases of moderate malnutrition.

The clinic was right by the ocean so for at least one day we did not sweat our body weight in water. We returned and continued to do everything partnered up with our new team. This included preparing pharmacy, medical boxes, paperwork, reporting, food, team function, safety and security and leadership. Roel is now doing a review with the MD's on common diseases and treatments and what we have in our cache for treatment. Heather and Keely had to head out tonight so I will get up with the new team tomorrow morning to make sure they got out the door ok.

We completed a two page "debrief" form and had a group and then individual debriefs with IMC. We are still also going to debrief in Cebu.
 
We are now busy packing and turning things over to the new team. We are having dinner at 6 and early team meeting so we can retire to our rooms early. ETD for tomorrow am has been moved earlier per the recommendation of our driver.

4 December: Only a few days left to go!

Today we went as one team to Panitan Municipality to the barangay of Tinigban where we saw patients from Tingban and Quios. We saw a total of 243 patients. It was a great barangy - very organized and great nurses and midwives. Again: a lot of primary care but a well taken care of population in general.

We are starting to prepare to sign off. I completed the sign off document and each team member had a chance to give input. The new team arrives tomorrow - I believe it is 3 Fillipino MD's and 4 nurses.

Tomorrow we are going to Panay municipality to the barangay of Agojo. We are only planning on staying until noon as there is quite a bit to do at the command center to turn over to the new team. The new team is coming with us and we will partner up so they can work with us as we go through our roles and how things are set up. When we return we will also have them do the preparation with us for the next day (data entry, SPEED surveillance forms, MUAC reporting forms, preparation of pharmacy and medical boxes for next day, etc.)

We have paperwork to do for tomorrow as well. A two-page debrief questionnaire and we are going to meet for a debrief both as a group then 10 min as individuals. We are also going to have a debrief in Cebu with the Field Program Coordinator.

We have donated our bed nets to the Project Hope team. I have done an inventory of the back packs and will type it up tomorrow. We are also collecting books, resources, portable Internet, local phones and other things to give them they might find useful (pyrethrin spray, work gloves, etc.)

3 December: Update from IMC Team

Well what a day! We had the exciting news at the Health Cluster meeting tonight...but I will keep you in suspense a few more lines.

We went as one team today to two barangay:

1. Lanigpa - we saw 131 patients .... drum roll... and 8 cases of CHICKEN POX
2. Tico - we saw 126 patients and two just recovered cases of chicken pox.

We reported the chicken pox cases to SPEED (the Philippines surveillance system) and at the Health Cluster meeting tonight. Apparently there was an isolated case in Iloilo last week or so but nothing here until now.

We have managed to coordinate with Project Hope and their team will pick up both first aid backpacks. I am so happy we were able to do this.

We have two great Filipino nurses working with us and I am going to write general letters of recommendation for both of them.

Tomorrow we are stretched thin - two teams working apart and each team in two barangays. We are going to have a few extra hands but it will be a long day.

24 November

We arrived a week ago today and so much has happened. We are a team of seven (2 doctors, 4 nurses, and a pharmacist). Two of our team members are from the Philippines and one of those is from the region we are working in.

We have power almost all day and when there is power we have internet and AC - a true treat! We usually head out in the morning with several plastic bins full of medical supplies and travel by car and boat (then we climb under trees, walk across wood planks, and over downed power lines) to remote locations that have not yet received any services. We set up a clinic for the day and, working with the Filipino midwives and nurses from the borangy (village), we see patients.

Yesterday our two teams saw nearly 300 patients - I alone saw 62 children! We are mostly doing primary care but just our presence, I think, is helpful - some peace of mind that they are not being ignored or passed over. People are already hard at work rebuilding (I have never seen rebuilding happen so fast) and it means so much to them to have someone reach out to their community. We have seen 500 patients since we started and will continue to do mobile clinics to hard-to-reach locations for the time being.

The contrast between the areas that have been struck by the Typhoon and those that are not is startling: The areas hard hit have been totally devastated. You can drive along a road and suddenly every single telephone pole is down - broken, bent in two, swaying on its side or laying in the road.  There is a park near here with these huge fat trunked trees and it looks as if someone took a hand and just knocked them all over - every tree in the park is on its side with its entire root bulb pulled up from the ground.

The areas that were not hit as hard are back to regular commerce - supermarkets, restaurants, and mall traffic going on as usual. They sell T-shirts that say Bangon Philippines - which means "Rise Philippines" and reminds me of "Boston Strong".  We are able to purchase water and food and today the team took a break and had a fish lunch by the ocean. Again - the contrast is stark and startling, as usually the impoverished are exponentially more affected by the storm then others. We went to one island and they said all they need are fishing nets. Before the storm they would buy fresh water from the mainland but now they can't fish and therefore can't buy water. If they have nets, they have a livelihood, and they have a means for survival.

The local and national government is also very organized when it comes to the response and they are doing a good job of coordinating the many different organizations. It won't be long until there is a move from the response phase to the recovery phase, you can see it (and hear it) happening all around. I can hear someone working on their house as I type.

The team is now doing pharmacy inventory. The medical director and I are planning a surprise thanksgiving dinner for everyone with chicken, mashed potatoes, sweet potatoes, green beans, coconut pie, and coconut wine. We have much to give thanks for!

We arrived a week ago today and so much has happened. We are a team of seven (2 doctors, 4 nurses, and a pharmacist). Two of our team members are from the Philippines and one of those is from the region we are working in.

We have power almost all day and when there is power we have internet and AC - a true treat! We usually head out in the morning with several plastic bins full of medical supplies and travel by car and boat (then we climb under trees, walk across wood planks, and over downed power lines) to remote locations that have not yet received any services. We set up a clinic for the day and, working with the Filipino midwives and nurses from the borangy (village), we see patients.

Yesterday our two teams saw nearly 300 patients - I alone saw 62 children! We are mostly doing primary care but just our presence, I think, is helpful - some peace of mind that they are not being ignored or passed over. People are already hard at work rebuilding (I have never seen rebuilding happen so fast) and it means so much to them to have someone reach out to their community. We have seen 500 patients since we started and will continue to do mobile clinics to hard-to-reach locations for the time being.

The contrast between the areas that have been struck by the Typhoon and those that are not is startling: The areas hard hit have been totally devastated. You can drive along a road and suddenly every single telephone pole is down - broken, bent in two, swaying on its side or laying in the road.  There is a park near here with these huge fat trunked trees and it looks as if someone took a hand and just knocked them all over - every tree in the park is on its side with its entire root bulb pulled up from the ground.

The areas that were not hit as hard are back to regular commerce - supermarkets, restaurants, and mall traffic going on as usual. They sell T-shirts that say Bangon Philippines - which means "Rise Philippines" and reminds me of "Boston Strong".  We are able to purchase water and food and today the team took a break and had a fish lunch by the ocean. Again - the contrast is stark and startling, as usually the impoverished are exponentially more affected by the storm then others. We went to one island and they said all they need are fishing nets. Before the storm they would buy fresh water from the mainland but now they can't fish and therefore can't buy water. If they have nets, they have a livelihood, and they have a means for survival.

The local and national government is also very organized when it comes to the response and they are doing a good job of coordinating the many different organizations. It won't be long until there is a move from the response phase to the recovery phase, you can see it (and hear it) happening all around. I can hear someone working on their house as I type.

The team is now doing pharmacy inventory. The medical director and I are planning a surprise thanksgiving dinner for everyone with chicken, mashed potatoes, sweet potatoes, green beans, coconut pie, and coconut wine. We have much to give thanks for!

23 November

Started the morning with our daily brief. Then went to Pointeverde by car and meet the mayor. There we were joined by local police as local law requires all foreign national visitors be accompanied. The police and each respective team them headed by boats (with life jackets!) to their respective borangy to set up medical clinics for the day. We could not get the midwives to join is as it is Saturday.

Team 1 went to Gabuc and served the population of Gabuc as well as the neighboring island of Cabugao. The local police actually helped out quite a bit and acted as translators. We also had the help of a Canadian military officer named Chris who is Filipino. We saw 140 patients and saw everyone who came to be evaluated.

Team 2 went to the island of Ameligan and saw 157 patients - they saw patients until they ran out of supplies.

[Please note there is an island and a inland region that has the name Ameligan as well as Cabugao.]

In total our teams saw 297 patients - in one day!  I think everyone was very happy and had a very satisfying day. A few wounds, some asthma, chronic illness and in kids a lot of URI's.

Tomorrow we plan to:

1. Data entry from the clinic docs
2. Inventory our own supplies and label what we are donating
3. Inventory and breakdown of the WHO essential drug kits
4. Purchasing of vitamins (people love to get vitamins and they don't come in the WHO drug kits)
5. Briefing on certain disease we might see such as leptospirosis, meningitis, etc.

In total with three days of mobile clinics we have seen 513 patients!

22 November

The coordination in Roxaus is much better and it is the humanitarian hub for this area. There are daily cluster and OCHA meetings and our team members are invited to attend when possible. There is a very strong health system in this area with good capacity and they are very organized. Our short-term strategy is to reach out to regions no one else is accessing. The Department of Health is leading the response and our partners are trying to link-up with the municipal health officers to help create longer-term plans with a focus in mental health, rebuilding infrastructure, and primary care.

Arrangements were made for us to go, by boat, to two small islands with about 400-500 people. We were able to travel with several nurse midwives by paton boat to run clinics today. We had a short time since we could only stay as long as high tide to get back but the team was VERY happy to be doing something and felt they made a difference.