Typhoon Haiyan After Action Report: Local Physicians Give First-Hand Findings

Published on May 8, 2014
The devastation left in the wake of Typhoon Haiyan was unprecedented. To get a sense for how successful healthcare relief efforts fared on the ground, EPI sat down with two physicians from the initial wave. Dr. Evangeline “Banggi” C. Cua is a general surgeon from Iloilo, Philippines and Dr. Ma. Rowena Alcido worked as a general practitioner in a remote municipality in Samar Island.

Dr Banggi Cua (in blue scrubs) directs her team of volunteers with distribution of medical supplies in Tacloban City.

EPI: What were your first thoughts or feelings upon hearing about the storm’s devastation?

Dr. Cua: “I feared for the safety of my siblings and relatives who were residents of Tacloban. My mother decided to go there and look for my siblings when we didn’t hear from them a day after Typhoon Yolanda. Imagine my 65-year old mother walking alone from San Juanico Bridge to my aunt’s place, which was about 16 kilometers away! I was crying the whole time because my brother’s last message was he was on duty in an evacuation center (he’s a policeman) then I heard in the news that all the evacuees in an evacuation center drowned during the typhoon surge. I never felt so helpless in my whole life. When I talked with my mother, after 3 days of not hearing anything from them about the devastation, and that they were all okay, I decided to go there and do something. My sister initially asked me to abort my plans of volunteering in Tacloban because of security issues but I felt guilty. I mean, how could I go on with my life when I know that people are suffering and I could actually do something to help and not go there? I thought, at that time, that it’s our moral obligation as a human being to extend help.”

Dr. Alcido: “A chill ran down my spine. This was a major disaster and it happened in a place very familiar to me, where I spent growing up and where I chose to serve as a remote area physician. I knew I just couldn’t stay glued to the TV watching how slow [the] relief efforts were. There was a pull to be on the ground.”

Dr Alcido (2nd from left) and her fellow physician-volunteers who joined a local NGO-Agape Rural Program to serve the remote and less-known affected areas.

EPI: Did you have any doubts when you made the decision to volunteer and organize your team?

Dr. Cua: “None. I started calling DOH (Department of Health) and the (Philippine) Red Cross to ask for volunteer opportunities starting on the 2nd day after typhoon Yolanda”.

Dr. Alcido: “There was no doubt as to the team’s safety or whether the team goes or not. There was a pressing need to go on the ground but it was just a matter of when and where. People were more than willing to volunteer, but they need to be informed beforehand as to the dates involved and as to what they need to prepare.”

EPI: Were there any the barriers or hindrances while preparing for and during the actual mission?

Dr. Cua: “There was total lack of coordination among organizations involved in the relief and rescue missions. I called Red Cross and they were asking me to submit a CV, updated Professional License ID and my board certificate! I was asked to call a certain number only to be told that they’ll call me at a later time. I emailed someone from PRC and they just told me to be in Tacloban and bring my own resources. The DOH central office also did the same. I was referred back to the provincial DOH but I was so angry I didn’t bother to call again. When I was arranging for transportation, the AFP personnel in charge of the C130 plane manifesto in Cebu could not give me assurance that my team could get a ride on the plane even if I told them that we are a medical team. We were given the round about between Cebu and Villamor Airbase. I only had 4 volunteers at this time because almost all the people I’ve asked to go with me were afraid of the security issues in Tacloban at that time and they thought it was too dangerous for a medical mission. Three doctors who initially volunteered backed out at the last minute. I had to promise one volunteer that I’d pay for her fare so she would go with the team. I only had one day of preparation for the mission - from collecting funds to buying medicines and picking up donated medical supplies from donors’ homes. We had limited medical supplies. Airlines who were supposed to give free cargo allowance containing medical teams asked us to pay enormous amounts for our cargo. We ran out of supplies while in Tacloban because half of our supplies got lost in Cebu during transit. The [government] red tape was worse. One retired AFP [military] general asked us to pay for “consultancy fee” for arranging our inclusion in the list of people who could ride the C130 plane and this was not an AFP plane, but for a Sweden C130 plane.”

Dr. Alcido: “Contact on the ground was difficult to establish especially in Samar areas so we skipped that area. Then transportation problems ensued, the contact we had with the C-130 plane bailed us out on the day of the trip [sic]. We anticipated this by psyching ourselves into spending for plane fares even before our slot was cancelled. Then there was the issue of how much cargo we could carry on board or whether we should transport the supplies ahead. There was also the challenge of how much food and water we could carry with us. Eventually we arrived in Ormoc and all our challenges were put to rest when our host contact on the ground took care of our food & lodgings. We had a roof, beds (we stayed at the hospital ICU), electricity from the hospital standby generator and a bathroom. “

EPI: What about the foreign aid organizations? International media reports said they bypassed the local government and went directly to the people?

Dr. Cua: Some of the foreign aid went directly to the people because the organizations that brought them were the ones who distributed the goods. Those that were directed to the local government didn’t reach the people. We were able to enter one of their warehouses while we were looking for our missing supplies; there was so much waste [translated]. Mineral water bottles were on the floor while people outside the streets were asking strangers to give them water.

EPI: Where did you first set up? How did you choose the location?

Dr. Cua: “Outside the Redemptorist church in Tacloban City. We were given 5 tables and a tarpaulin. A Redemptorist priest asked me to consider having the mission in their church in Tacloban where they had 2,000 refugees. “

Dr. Alcido: “The team that went to Ormoc was composed of remote area physicians previously affiliated with the Doctor to the Barrios program of the Department of Health (DOH). Through our tie-up with Agape Rural Program, we did a 5-day mission covering a private Ormoc hospital, and some towns of Isabel, Tacloban and Basey. After that, half of the team worked with an international humanitarian NGO (MSF-Holland) which provided medical and psychosocial services extensively in the towns of Leyte.”

EPI: Were there other individuals or groups that helped you and the team?

Dr. Cua: “Mostly, my Facebook friends who were able to read my post(s). One friend introduced me to his photographer friends in Thailand and Japan who, in turn, sent money. The Redemptorist community who provided our food and accommodation while we were in Tacloban.”

With no electric power, Tacloban survivors assist the Team Banggi volunteers with flashlights to continue giving medical treatment into the night.

EPI: What other social media besides Facebook helped? Twitter?

Dr. Cua: Just Facebook, I didn’t tweet at that time. I think most Filipinos use Facebook more because I saw some of my posts would be shared sometimes 300-500 times.

EPI: How did the mission trips affect your regular or daily responsibilities and those of your team members?

Dr. Cua: “I took a leave from work. I had to arrange the follow-up consult and elective surgery of my private patients to fall on dates that I am in Iloilo.”

Dr. Alcido: “Half of the team committed to a 5-day mission and went back to their usual business after the mission. The other half stayed in Ormoc to work for the international humanitarian relief group that was in need of doctors for 6 weeks.”

EPI: What were the common conditions that you saw during the missions?

Dr. Cua: “(On our) first mission (5-9 days after Yolanda)—mostly infected wounds. For the second mission (2 weeks after Yolanda)—respiratory and GI infections. On the third mission (6 weeks after Yolanda)—skin lesions (fungal), upper respiratory tract infections (URTIs)”.

Dr. Alcido: “URTIs, wounds suturing, skin diseases-scabies, impetigo and fungal infections, hypertension, acute watery diarrhea, a few bloody diarrhea, chronic malnutrition, parasitic worms, otitis media/externa.”

EPI: How consistent has the support been for your missions?

Dr. Cua: Donations from friends and strangers (continue to come in).

Dr. Alcido: We always had the help of our partner NGOs for the supplies and transportation.

EPI: What factors (besides social media and contacts) have also helped your team?

Dr. Cua: “(The) willingness of the members to go to remote places. There were 9 members for our first mission (only 3 are MDs, one chef, 1 law student,1 PT,1 nurse , 1 midwife and 1 social worker). The subsequent missions were composed of almost the same group of people- mostly MDs and nurses. We have scheduled medical missions until May 2014.”

Dr. Alcido: “We have been fortunate to work with NGOs with a good track record and extensive experience in doing disaster work.”

EPI: Who pays for the team’s travel and other expenses during the trips?

Dr. Cua: The arrangement is for first time members [who] pay a one-way fare. The rest of the expenses are shouldered by the team. After that, everything is free. I have to consider, too, that they will not have their usual income or salary if they are with us during missions.

EPI: From the beginning of the recovery effort, how have your responsibilities evolved? Was it all medical/surgical?

Dr. Cua: During the first mission, I was doing everything - supervision, marketing, accounting, etc., on top of medical consults- from general medicine to surgery. There were only three MDs in the team. Now I mostly supervise. (Later) I was able to recruit my med school classmate, an ophthalmologist, to the team. Beginning in March we will include cataract surgeries.

EPI: So the responsibilities have evolved beyond the disaster-related problems?

Dr. Cua: Yes, and we will also include places outside those affected by Typhoon Haiyan. We have one mission scheduled in April in Banaue (Northern Luzon).

EPI: What are your final thoughts on the overall disaster response?

Dr. Cua: I’d like to see a better system during disasters. Better coordination between departments involved in the relief and rescue is needed as well as more involvement from the private sector. Perhaps they could enlist MDs for mandatory service during disasters as they do in the army.

Dr. Alcido: We had almost everything: the basic medications, emergency drugs, access to emergency transport, emergency/transport assistance, referral center for acute, life threatening/emergency cases, a water-sanitation team for access to potable water, and a psychosocial team for the mentally distressed. We covered areas with no doctors, assisted rehabilitation of some structures, reached far-flung villages through mobile clinics, and distributed non food-item kits. For an emergency disaster response we have covered the essential and given more. But we have seen also the limitations of emergency disaster efforts. The problems we were seeing towards the latter part of the missions were poor access to health facilities, chronic medical conditions, surgical conditions requiring elective surgery, poor health-seeking behavior, problems in water access and sanitation, and lack of a psychiatric program in the region – all of which are problems inherent to the health system even prior to the disaster.

Evangeline "Banggi" C. Cua, MD, FCPS is a general surgeon practicing in Western Visayas. She feared for her siblings and relatives who were living in Tacloban City (several islands away in Eastern Visayas), an area with major damage and loss from the Typhoon. Dr Cua spontaneously organized her team members through colleagues and Facebook posts. Her eponymous "Team Banggi" group continues to organize medical missions to other affected areas.

Ma. Rowena Alcido, MD, MPM had just finished serving two years as a general practitioner in a remote, underserved municipality in Samar Island for the Department of Health when the Typhoon hit. Dr Alcido volunteered with two groups: a local nongovernmental organization that works with rural communities and an international relief group.

Maria Salud Loreen Sannoy-Cadiz, MD works in the Department of Radiology, Diagnostic Imaging Center, Negros Oriental Provincial Hospital, Philippines.

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