After the Storm: Yolanda in the Eyes of Doctors to the Barrios

While I sat in front of the TV in the comfort of my apartment as Yolanda (Haiyan) unleashed her fury in Central Visayas, these doctors to the barrios (DTTBs) decided to stay at the forefront instead of going back home when the super typhoon hit their respective municipalities.

Rather than point fingers and waste time ranting on what should have and could have been done, allow me to share the first-hand stories of my colleagues, so that the Filipino medical community and the rest of the nation can focus all effort instead on what can be done right here and right now, to create meaningful impact on the people who have been hardest hit by this catastrophe.

Hernani, Eastern Samar

Dr. Ezra M. Valido
University of the Philippines College of Medicine Class of 2012

I was at the area during the typhoon. We experienced high-speed winds coupled with the storm surge. We currently have 67 dead and 13 missing as of November 14. Four of my barangays are totally wiped out. We expected the winds but not the surge. Before this, nobody has experienced seeing the ocean that high. An evacuation system was in play but one of the evacuation centers was also affected.

Currently, only two barangay health stations are functional. One rural health unit (RHU) is damaged and the other is destroyed. We are running low on medications like pain medications and basic antibiotics. We are in dire need of oral rehydration solution (ORS) and water purifiers like Hyposol.

Aside from medications, we need food. The relief operations have been slow and minimal. We need gasoline for transporting the goods. We need shelter. This is the amihan season in the east. We experience heavy rains almost daily. We need hygiene kits and temporary latrines. We are trying to prevent open defecation around the communities.

San Roque, Northern Samar

Dr. Dante B. Salvador, Jr.
University of the Philippines College of Medicine Class of 2012

Our municipal mayor activated the municipal DRRMC (Disaster Risk Reduction and Management Council). We had a meeting and planning. For health, I suggested we utilize our existing area assignments for reporting of casualties and service provision; the nurses/midwives assigned to a particular area will be stationed there to man the barangay health station or barangay hall. I requested for purchase of essential medicines and supplies like paracetamol, amoxicillin, ORS, mefenamic acid, anti-tetanus vaccine, iodine solution, gauze, and syringes, among others.

The families near rivers and those with unstable houses were evacuated preemptively. I checked the evacuees to see if there’s anyone with an illness, to prevent spread of disease in the evacuation centers. The local government unit provided meals and bottled water to the evacuees. I stayed at the RHU for at least 48 hours from Thursday to Saturday, to make myself available at the time when I expected a surge of injured individuals.

We expected the typhoon to be worse, because the projected path of the typhoon was towards us. As it turned out, the typhoon changed its path. We had minimal damage in our municipality. Zero casualty and zero incident related to the typhoon. But our problem after the typhoon is electricity. The entire region is powerless, and initially with no cell phone signals. Our census was status quo: no unusual increase in a certain disease. Medicines are accessible, but most need to be bought by the patient outside.

Presently, the most pressing concerns are not biomedical. We are having problems because of electricity and communication. Referral systems are hampered. The LGU cannot provide diesel for the generators 24/7. We have patients who need to be nebulized but they have to wait until we can ask for diesel for the generator.

Last Wednesday, November 13, we had 4 deliveries during the night. One particular baby was born uneventfully that night, even though we only used flashlight to deliver the baby. The following morning, only then did I see rashes on the baby and the mother. I had to immediately refer them to the provincial hospital for management. The baby died a day after. Had I seen the rashes that night, I would have referred them earlier, the baby might have been treated on time, and he might have survived.

What we need most at this time is electricity. Our generators are run by diesel. Problem is, you can’t ship diesel. It may be difficult to ask for cash for the purchase of diesel, and I’m not comfortable receiving money as assistance to buy diesel, but if it’s the only way to go about it, then fine. Medicines are welcome, as the initial purchase is already almost depleted.

Hopefully, relief efforts will be well coordinated. Just like our present health situation, there might be inequity in relief provision. I hope the foreign assistance that the Philippine received be utilized now. Start with the ones not covered by non-governmental organizations (NGOs) and volunteers: infrastructure. I believe there’s sufficient number of relief goods for the victims coming from local donors, volunteers, and NGOs, but unless the government starts rebuilding the backbone of a well-structured society (like the city of Tacloban), that society will remain fractured, or form “pseudo-arthrosis.” (LOL)

Villareal, Western Samar

Dr. Iris Conela A. Tagaro
West Visayas State University Class of 2011
Philippine General Hospital Intern 2012

Two days before the typhoon, we had an emergency meeting (Disaster risk reduction team composed of heads of offices). I was one of the members of the rescue and medical emergency management as part of the Department of Health (DOH). We identified needs for emergency response such as personal protective gears and rescue equipment.

We identified hazardous areas and imposed forced evacuation to assigned evacuation areas. We did bandillo and used the radio station of the Armed Forces of the Philippines (AFP) to inform everyone to prepare for the typhoon and possible worst-case scenarios such as storm surge, flooding, and strong winds that may cause injuries due to high-momentum sharp debris.

We set up an operational center at the municipal hall. We gathered food and water and packed them for relief operations. We assigned duty teams from fire and police departments, AFP, and Department of Social Welfare and Development (DSWD), and health department for pre- and post-typhoon management.

I set up an RHU-Villareal emergency management desk for emergencies. I had been on perpetual duty at the RHU since one day prior to Yolanda’s landfall. And I transferred the RHU’s important equipment to a higher area in the mayor’s office, just in case the water levels would rise, especially since the RHU is just adjacent to the coast line.

We had no mortalities. The most significant damage the typhoon did was on the roofing of light-material houses. Monitoring and search for the injured commenced immediately when the weather calmed down. The AFP, police and fire departments, and Department of Interior and Local Government (DILG) immediately commenced clearing of roads and helping out DSWD in distributing relief goods.

The health team immediately received patients post-typhoon for emergency management as identified by the search and rescue team. At about two hours prior to landfall, I already received one critical patient at 3 am. Since I had intravenous (IV) medications and an oxygen tank, we stabilized the patient first and prepared for transport anytime. When the AFP gave signal that we could already transport the patient, I was shocked when the ambulance came back with the patient and gave the news that the ambulance was not allowed to pass through San Juanico bridge due to the dead bodies blocking the road towards Tacloban City.

This is a catastrophe for us, since the referral center of Villareal is Eastern Visayas Regional Medical Center (EVRMC). Our supplies come only from Tacloban City. We rarely refer to Samar Provincial Hospital since the availability of critical patient management is not reliable. They have no respirator, or even an on-duty obstetrician and anesthesiologist. Our pool of blood donation is also in EVRMC.

The most pressing problem we have right now is the loss of a referral center, especially for emergency, obstetric, and surgical cases. Since all hospitals in Tacloban are non-functional, patents come to the RHU instead for medicines. We have patients coming from St. Paul’s Hospital, considered a premier hospital in Tacloban, referred to the RHU for IV antibiotics.

RHU-Villareal is the only health institution in the municipality, and it has been the only health facility that manages all emergencies, and cares for patients who are not able to go to the hospital. More or less, it is equipped to function as an infirmary or a primary care center. Now, with the loss of all referral hospitals in Tacloban, and the uncertainty whether our patients will be adequately managed in Samar Provincial Hospital, we have to be prepared for the more severe cases that we may receive in the coming days.

We are prepared to attend to Villahanons, but since the typhoon, we have also been receiving survivors who were rescued from disaster areas (We are only 40 km away from Tacloban). And we are running out of medicines and IV fluids fast.

One baby who was delivered thickly meconium stained in the birthing facility of the RHU was the second-to-the-last recipient of ampicillin and gentamicin IV antibiotics. Even private pharmacies are now depleted of medical supplies, and the drugs are very expensive. What we immediately need are medicines, especially IV medications and anti-tetanus vaccines for typhoon victims, and patients who will not be able to receive secondary or tertiary care.

San Sebastian, Western Samar

Dr. Alberto M. Ong, Jr.
University of the Philippines College of Medicine Class of 2012

I was in the my municipality’s health center when the typhoon struck. We were on-duty 24/7 while Yolanda was on its path to the province. Our local DRRMC, along with Red Cross Philippines/Red Cross Australia (NGO with a 3-year partnership with our municipality), organized the preparation for the upcoming typhoon. We were able to pack relief goods and acquire enough medications just before Yolanda made its landfall. We also tapped the Red Cross community volunteers (who were trained by Red Cross) in the preparation. Preemptive evacuation was also done.

Our municipality was not affected as badly as Tacloban City. Only the weak structures (houses made of pawid) were destroyed. Health facilities are still intact. As stated above, we were able to acquire our medicine beforehand.

The major hospitals, where we send our patients needing hospitalization, are located in Tacloban City. After Typhoon Yolanda destroyed the city, including these hospitals, we are left with no choice but to refer our patients to Samar Provincial Hospital, which also has limited capability, or to manage the patients in our RHU.

Another concern is that most of the supplies for our health center are acquired in Tacloban City. Most of what we have in our health center also come from the regional office of the Department of Health (Center for Health Development – Eastern Visayas or CHD-8). In the next coming months, we are expecting difficulty in ensuring the availability of medicine and medical supplies for our constituents. For example, we are expecting a drop in our expanded program for immunization (EPI) coverage because the vaccines come from CHD-8 (In addition, the current absence of electricity in the region adds to the burden of maintaining these vaccines).

We currently augment the medical services in the southern areas in Samar badly affected by the typhoon, specifically the municipalities of Basey and Marabut. Furthermore, the municipal health officer of Marabut, who was in Tacloban City when the disaster happened, is still considered missing, hence there is a need to deploy a health service provider to this municipality. We also share our meager resources to them.

Consequently, our time spent for our constituents are reduced in order to provide needed service to these areas. I would appreciate additional health manpower, or relievers, for our province who can be temporarily deployed to these municipalities. Medicine and medical supplies for these areas will also be very much appreciated.

Matuguinao, Western Samar

Dr. Jeremiah S. Calderon
University of the Philippines College of Medicine Class of 2012

I was in Matuguinao when Yolanda struck. Prior to landfall, I was able to regroup my staff after the municipal emergency meeting and I gave a brief overview on basic life support. We put up a first aid station in the municipal hall, and an emergency response team was organized to respond to the health needs of Matuguinao, 24/7.

A significant area of agricultural land and a number of establishments were damaged, including the main health center, where a portion of the roof was detached. Although still awaiting confirmation, water supply in one of our barangays (9 hours away by foot) is believed to be contaminated based on reports of increasing prevalence of diarrhea.

Our most pressing health problems include the rise in diarrhea and pneumonia cases, as well as bronchial asthma attacks. Because of the lack of medications and supplies in the RHU, we have to refer patients to the nearest municipality, which is 2 to 5 hours by boat and/or habal-habal. Power outage is another problem.

Aside from rehabilitation of our RHU, we need medicines and supplies. Our local government cannot purchase these as of the moment due to difficulties in logistics. Although our municipality also suffered damages from Yolanda, I feel that areas more severely affected by the typhoon like Tacloban, Hernani, Marabut, and Basey, should be prioritized.

In this crucial time of relief and rehabilitation, help in whatever form is most welcome. If you want to offer assistance, please do not hesitate to post a comment or send a message so that we can coordinate the delivery of aid to our colleagues.

Detailed instructions on how you can help are on this page.

All photos used with permission.