Report from the Philippines: Day Clinics in the Province of East Samar

By Tim Tan, MD, MPH’14 in Population and Family Health with a certificate in Public Health & Humanitarian Assistance and a Columbia University International Emergency Medicine Fellow

Following the devastation caused by Typhoon Haiyan/Yolanda in the Philippines, I joined a medical team deployed by NYC Medics, a disaster relief NGO based in New York City, and provided emergency medical care to hard-to-reach, small communities. Overall, the work put my Public Health and Humanitarian Assistance classwork into context in a practical fieldwork experience, from collaborating with local and NGO partners, to participating in OCHA cluster meetings, to prioritizing needs and providing care.

Our Mobile Model

Administering emergency medical care.

Administering emergency medical care.

True to the mission of NYC Medics, our medical team focused on providing care to remote locations through mobile units. On of our first excursion, we worked in a village on Homonhon Island, a small island 2-3 hours by boat from Guiuan which had had no contact with the rest of the country due to shattered boats and damaged phone networks.  With transportation assistance from US Navy helicopters, we ran a one-day clinic out of an unused hospital, seeing over 170 patients.

As expected, the team treated patients with infected wounds, infectious diseases with a high incidence of acute respiratory illness and pneumonia, and exacerbations of chronic illnesses such as asthma or hypertension. The other health issues we saw ranged widely—on one occasion, I played the role of dentist to extract a young boy’s infected tooth. On another occasion, the diagnosis was all-too-clear when a small girl threw up an Ascaris worm (an intestinal roundworm). A patient whom we identified with life threatening conditions—renal failure and pulmonary edema—was evacuated off the island to a referral hospital run by partner NGOs.

For staffing, we had a surgical physician’s assistant, a nurse from NewYork-Presbyterian, several paramedics, and myself, an emergency medicine physician. In addition, two nurses from the Department of Health in Guiuan joined us and provided tetanus vaccinations to our patients. One of the DoH nurses stayed behind to provide follow-up wound care to patients that we treated.

The navy forgot to pick us up that night, so we ended up camping overnight on the island before returning to Guiuan the following morning. The locals were more than happy to have us as our guests, however, so the impromptu stay went smoothly. It was a quick introduction to life on the ground.

Expanding Care Around Guiuan

After that first trip out, we continued to work with the US Navy and USAID to plan additional mobile medical clinics for different sections of Homonhon Island.  During this first week, the NYC Medics medical team essentially split into two groups.  I was the physician for the mobile team, and together with anywhere from four to seven other team members—physician assistants (PAs), registered nurses (RNs), and paramedics (or EMTs, emergency medical technicians)—we made several additional trips to Homonhon Island, providing medical care to communities that had not been reached since the storm.

While one mobile medical unit served Homonhon island, NYC Medics formed a second “land-based” mobile medical unit providing care to small communities surrounding Guiuan, treating from 130 to over 250 patients per day.  Medical complaints and diagnoses were similar, with infected wounds, respiratory illness and diarrhea, and untreated hypertension, diabetes, and asthma commonly encountered.

The city of Guiuan itself had its medical needs covered by a Doctors Without Borders (MSF) clinic and field hospital.  This field hospital served as our referral site for patients who were especially ill and needed to be evacuated from Homonhon Island for inpatient care.

Relocating to Hernani

During the second week of the relief mission, NYC Medics learned that several communities northward along the coastline had not received the same level of attention from relief agencies.  The team thus relocated to the towns of Llorrente and Hernani, where we continued to work using the same model of mobile and land-based teams.  Though the destruction in these areas was less severe, medical needs were comparable due to damaged infrastructure and limited access to personnel and resources.  Since the international community had a smaller presence in this area, we mostly worked with the mayor and a local doctor to identify communities in which to work.

I continued to work with the mobile team. One of our roles was to deliver care to people on an island that was only accessible by boat, and another community that could only be reached by a mountain hike over washed-out roads.  We hiked with all drugs, medical supplies, and clinic gear, rushing to beat the high tide.  It showed me how out of shape I am compared to the EMTs!  Around Hernani and Llorrente, the patient mix included more primary-care issues, but we continued to encounter a large infectious disease burden, as one would expect post-disaster, including acute respiratory infections and diarrhea.

Throughout our stay, each team saw between 100-300 patients per day, with a final day clinic of over 550 patients (with both teams involved). In total, we treated over 2500 patients, all in remote areas.

The Power of Partnerships

NYC Medics works with numerous partners to set up the day clinics and serve communities located outside of the NGO centers. During my time in the Philippines, the U.S. Navy provided us with transportation, USAID helped coordinate between us and the Navy, and MSF was a valued referral partner in Guiuan.  Many other wonderful collaborators assisted in numerous ways.

AmeriCares stands out as one of the most valuable.  They provided a truckload of essential medications and supplies to our team, which enabled us to continue delivering emergency medical care.  In a video that AmeriCares made during one of our trips to Homonhon Island, an AmeriCares colleague, Alex explains: “We were the first people to come to the community since the typhoon struck.  The team treated more than 100 patients, including a diabetic woman who was on the verge of losing her foot from a cut she got during the storm.” Watch the video “Isolated Village Gets Crucial Medical Care” from AmeriCares on Vimeo.

To read more about the NYC Medics partnership with AmeriCares and the ongoing work to help meet the needs of families suffering in the aftermath of the typhoon, visit this Haiyan/Yolanda webpage.

Makita Mo Mamaya (Farewell) to the Philippines

I am leaving to return to New York soon, but the international response to Typhoon is only just beginning. A lot has happened since I first landed in the Philippines. I will carry this experience back to the classroom and forward as I continue my career after graduation.

Photo credit: NYC Medics Operations Director, Phil Suarez

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