By Shawn D’Andrea, MD
Attending Physician, BWH Emergency Medicine
The week before Thanksgiving, the disaster medicine section of the American College of Emergency Physicians(ACEP) circulated a request for physicians to participate in ongoing humanitarian relief operations in the Philippines in response to typhoon Haiyan, also known as typhoon Yolanda. On Nov. 27, I arrived at Roxas City on the island of Panay, Philippines, to join a small group of physicians and nurses with a non-government organization engaged in relief efforts.
The group that had sent the request through ACEP, Remote Area Medical (RAM) is a small, all volunteer U.S. medical non-government organization which has functioned in several disaster settings and defines itself as an organization able to access and function in difficult-to-reach and austere settings. Following typhoon Yolanda, the group partnered with the Philippine Red Cross and later a regional health department on Panay island to support medical needs in the relief effort. When I arrived shortly before Thanksgiving, RAM, coordinating with the regional health department and other relief organizations, was performing daily missions to the rural areas of Panay island to provide direct medical care to patients in areas affected by the storm. While the regional health department has an extensive network of local health offices and clinics, the storm left the health infrastructure severely damaged. The role of medical relief organizations, under the direction of the regional health authority, was to assess the health needs of communities following the disaster, provide direct patient care during relief and recover phases of the disaster, and to provide ongoing disease surveillance.
On Thanksgiving Day, I joined a field team of doctors and nurses traveling to a rural community an hour or so from the regional center, Roxas City. When arriving to the local community, with members of the local health department functioning as interpreters, the team would set up an arrangement of tables and chairs to evaluate patients. Teams would evaluate between 50 and 300 patients per day, referring patients back to the local health services for stable chronic conditions, and monitoring closely for acute conditions or chronic conditions acutely exacerbated as the devastation of the health infrastructure had limited access to care.
While most patients remained in relatively good health following the storm (this population prior to the storm had variable access to care), teams regularly encountered patients with severe acute illness serving as alarming examples of how damage to the health care and overall infrastructure serves as a barrier to care. Obvious damage to the health infrastructure in the way of clinics with blown out windows or sheared roofs serve as visible evidence of the typhoon’s ongoing impact on access to heath care. Potentially more concerning, however, are the less overtly apparent effects on the population, such as impacts on livelihoods, food supplies, and strain on individual and family economic resources in the wake of a disaster which may present an ongoing challenge of access to care for the affected population.
Medical teams such as those working with RAM also play an important role in disease surveillance following a disaster. Numerous NGOs accessing several communities, with each team often seeing more than 100 patients per day, presents a rich opportunity for disease outbreak surveillance. Regions of Panay Island were reported to have variable and low childhood vaccination rates, a highly concerning feature for a population which could be placed in densely packed evaluation centers and at risk of food scarcity following a disaster. Medical teams were provided with lists of reportable conditions, and data was collected daily. The World Health Organization provides a rapid mechanism for submitting data by either text message or paper. Fortunately, evacuation centers were not required for a prolonged period of time following the typhoon.
Volunteer medical providers demonstrated variable response to the stress of experience of working in the Philippines following the typhoon, including early departures from the group. This highlights the importance of professional preparation for participation in humanitarian relief operations. While participating in disaster response can be a rewarding and fulfilling experience, it is, at a minimum, hard work, with long hours, and uncertain and frequently changing schedules and living conditions. On Panay island all of these features were present as well as intermittent water and power availability and nearly ubiquitous downed power lines. These environments are also inhabited by humanitarian professionals who have trained and worked long and hard to function effectively in these dynamic settings. One strong impression I am left with from this and other experiences in disaster response is how great a liability personal and professional unpreparedness is in a disaster setting. In the same way that being interested in medicine does not make one a medical professional, simply having an interest in humanitarian response does not alone prepare one for work in humanitarian operations. Fortunately training programs in humanitarian response now exist and are helpful in providing advanced preparations for medical professionals interested in participating in relief operations.
While immediate hours and days following a disaster are clearly the times of highest concentration of medical and surgical need, damage to the health infrastructure and a need for reinforced disease surveillance drive demand for medical organizations in days and weeks following an event such as typhoon Yolanda. Medical personnel interested in participating in disaster response can increase there own personal and professional preparedness for such operations by enrolling in a humanitarian response training course such as those taught by Brigham and Women faculty through the Harvard Humanitarian Initiative.
Shawn D’Andrea, MD, is a second-year International Emergency Medicine fellow. He also responded to the earthquake that devastated Haiti in 2010.