We hit the ground running and had a wonderfully productive day. Our team split into two mobile teams for clinic. Dr. Rob, JB and I left early and visited two different municipalities. The first stop was the Degami Municipality. Municipalities are rated according to their affluence on a 1-6 scale with 1 being the most affluent. Degami is a category 3. They have 65 barangays (villages) 16 of which are in the mountains. There are about 35,000 people which make up about 7,000 families. After the typhoon, they had an influx of an additional 2,000 families (mostly made up of women and children) that came from either the coast or the mountains. There was a severe flash flood that was caused by water coming down out of the mountains. In the Philippine culture, if someone is even closely related, they will take them in and provide for them to the best of the ability. In Degami, there are a total of six health clinics. One is located in the municipality and five are outlying. However, even before the storm, only one of the remote clinics was fully functioning. They were in the process of remodeling the other four. Then the storm hit and the clinics were all completely destroyed (except the one located in the main municipality). Therefore, they recalled all of their midwifes, that run the clinics, to work in the main clinic. The regional hospital is located in Barauen, located about 14 KM away and it serves five municipalities. The roads, however, are a story in and of themselves so a trip to the hospital is a major undertaking at this point. Mayor Delusa and his Municipal Health Officer, Dr. Nemie, are doing an outstanding job of meeting the needs the best they can. They were delighted to hear that we wanted to do a clinic later that day in one of the outlying barangays where the clinic had been destroyed.
The second municipality that we visited was TabonTabon. It is a much smaller municipality with a population of only 12,000. They didn't experience an influx of people but they certainly had an influx of water! There are a total of 16 barangays and only two medical stations. The outlying clinic in San Pablo was completely destroyed and they have been serving their entire population out of their barely remaining clinic at the municipality headquarters. They have done 10 deliveries since the storm even though they still don't have any power (nor will they have power anytime soon). Mayor Brando met with us and was eager to have us return later in the day to do a clinic.
Shortly after we returned from our reconnaissance mission, we returned to the guest house, loaded the truck and took off for the remote rural clinics. First we dropped off Nora and Rob (our Paramedic) with half of the Philippine medical grads in the TabonTabon municipality. They worked out of church since the clinic was demolished. Then Dan and I took the other half of the grads and headed on to San Pablo. The midwife went to the barangay several hours before we arrived to put the word out that we were coming so there was a huge crowd when we arrived. It was raining in sheets of water and fortunately we were able to set up clinic under some very large tarps that had been donated by USAID. We backed our mini-truck under one end of the tarp and used the bed and one small round wooden table as the pharmacy. Our team saw over 250 people and the other team saw over 180. We saw people with a variety of issues. Most of what we saw were cases of upper respiratory illnesses. We saw a few people with very significant infections related to injuries from the typhoon. We did the best that we could to take care of the wounds but our supplies were limited. I would have loved to take care of these folks on a daily basis until they were well but they may not receive care again for at least a week. We loaded them up with a supply of antibiotics and hope that they will do OK. Unfortunately, the Health Clinics do not have fuel for their generators so their vaccines have gone bad. The national Department of Health and the World Health Organization are in the process of setting up a massive immunization program for the city of Tacloban but they will not be getting to these rural areas in the first wave. These rural folks are really at risk of some serious infections. In the world of disasters, there are multiple waves. The first wave is the acute phase of the disaster itself. Then there is a honeymoon phase where things start to get better. Unfortunately, that is often followed by a horrific phase of infectious disease and malnutrition. Disaster organizations approach this phase with a intense effort called WASH (water, sanitation and health). We are now transitioning to incorporate these strategies. We will continue treating the sick and other specialists will focus on the water, sanitation and health. The hope is that we will avert a major secondary disaster with illnesses such as cholera and typhoid.
While the clinic was going on, the men from the community were trying to keep the water from accumulating on the tarps over our head. They would use long bamboo poles to lift up the centers of the tarp and a massive wall of water would come splashing down at the ends or in between the tarps. On an occasion, they dumped about 5 gallons of water on top of one of the medical grads. The whole crowd erupted in laughter and then quickly covered their mouths in shock. It would have been a fantastic YouTube moment.
As the clinic was wrapping up, I had a wonderful time doing some magic for the kids. They were eager to play and laughed hysterically as I pulled coins out their ears and wiggled their arms. I sewed up one boy earlier in the clinic and gave him the toy slingshot helicopter that I brought. The adults absolutely loved watching their kids smile, laugh and play. The whole community was smiling when we left. We accomplished our goal: to bring some medical care, hope and love to this community that had not received medical care since the typhoon.
We then went to Tacloban and met Philip the owner of RTR Hospital. They doing an outstanding job of reaching people without care. They brought in two helicopters and they have been flying and trucking teams out to those that need help. What they have accomplished is a logistic miracle. I was impressed by Philip's compassion and ability to get things done. They are coordinating several teams in the area. We are exploring working with him in the future of this response. He invited us to his brother's home where we had a wonderful dinner. His brother is the congressman for the district. They are doing a fantastic job of mobilizing resources to provide for the people.
Earlier in the day, the other team found an 11 year old girl with a fractured hip. A wall fell on her during the storm. She has not had any medical care since the storm 14 days ago! We were able to take her back to Tacloban to the main hospital. Later this evening, we made arrangements for her to be evacuated in one of Phillip's helicopters first thing in the morning to Cebu where she will have her hip fixed.
We piled into the trucks and went back "home" to our base. A day well spent.