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12/26/2013

Philippines typhoon: A relief worker's small victories, lingering concerns

In late November, we met Toronto nurse Sherri Grady, who is currently helping with post-disaster relief in the Philippines with Médecins Sans Frontières. We last heard from Sherri one week after her arrival in the city of Ormoc, where she settled into her new surroundings and treated survivors of the devastating typhoon Yolanda.
 
Here is Sherri's latest update.
 
The last time we heard from you, you were based in Ormoc. Where have you been since and where are you now? Tell us about the journey and the logistics involved.
 
For the last two weeks, I have called the municipality of Carigara, Leyte home. Moving here was pretty painless for me, requiring little more than for me to pack my bags.
 
It did, however, require extensive logistical planning for my non-medical colleagues: a home and office were located, generators were put in place, food was organized for a team of 20-plus, cold chain for vaccines, staff were hired and trained on said generators... Typing this now, the list seems endless but as I hung my mosquito net that first night, I was most impressed by how organized these “logs” seemed. They made the impossible look easy.
 
It was only after a few days in our new home that I learned of our new Philippino/American benefactor who had temporarily rented two properties to us free of charge, out of respect for MSF’s work and reputation. The generosity that I have witnessed in this country continues to inspire me. 
 
Being able to live in Carigara provides our team with proximity to the population affected by Yolanda, and the hours previously spent driving now go towards consultations in some of the most isolated barangays of Leyte.
 
What is something that has really surprised you?
 
My medical team comes from all over the Philippines and when a nurse on my team commented on how you could hear Yolanda’s wind in Cebu, another replied, “You may have heard it, but in Ormoc we could see it.”

I remember being constantly aware of Yolanda’s destruction during my first week -- and newly amazed with each new piece of evidence of her wrath. However, at some moment near the end of my second week, I was surprised to realize that I had stopped noticing the devastation. Could I possibly be that callous, that hardened by the disasters I have seen? 

I spent the next few days focusing on the little details as we drove down now-familiar roads and onward to distant villages. I saw it then: improvement, clean-up and rebuilding. That stack of palm wood there used to be a tree that our car would have to drive around on the road. That house has a new roof built out of scrap metal and plastic sheeting, where last week there was a gaping void screaming up at the clouds, daring it to rain. Those choking evening fires that have us racing to roll up the car windows before yet another coughing fit ensues -- those are from people burning the debris that they have cleaned from around their homes.

It wasn’t that I had stopped noticing how bad things were. Instead, I had failed to recognize how much better they were getting. Now every day, I celebrate the small victories we come across: a new roof, fresh lumber being cut from downed trees, coconut plantation workers drying their lost crops for oil instead of food. It is here that I find hope, embodied in the men and women who keep pushing forward.

What are the most common health issues you are dealing with now?

Primary health care here in Leyte is not that different from most places I have practiced. I see a lot of coughs and colds, hypertension and skin diseases in my work here -- just like I do when working in the Canadian Arctic.

But what the medical teams are always monitoring for here, amongst these common complaints, are signs of outbreaks, dengue, cholera and meningitis, to name a few. These are precarious times for the people of Leyte and current conditions make them a population at risk when discussing health. 

Happily, I can report that the wounds we see are getting smaller and the infections less severe as people's access to health care improves. I had an interesting discussion with my project coordinator, in which he managed to put to words the sentiments I have been struggling to articulate: “Sherri, it’s not just about treating the common cold, it’s about restoring dignity."

What has been the most frustrating moment from your first few weeks in the Philippines?

The most frustrating part of my job is when we find a patient who needs more help then I know how to give. 

MSF’s emergency intervention in the Philippines has been appropriately focused on post-typhoon health needs. But what do I do when in a remote barangay, I find a psychotic man whose father has had to lock him up in his room for years to prevent him from running away and hurting himself? A one-year-old the size of a two-month-old baby with an unrepaired cleft palate? A little girl suffering from an unknown disease causing progressive paralysis and pain? Or a little boy with an eye deformity that I worry is a retinoblastoma?

In these moments, I depend on my colleagues and the partnerships we have formed with other organizations and the Department of Health. Together, we try to find the most appropriate places to refer these individuals, we advocate on their behalves, and we do everything we can -- but our time here is so short. We have already begun talking about the end of our emergency activities here: finding long-term partners to hand over projects to, donating supplies/equipment to the already-existing health structures, providing trainings as needed and making sure that the transition goes as smoothly as possible. 

While the plan for our departure has been well thought out and organized, and I am confident we will leave no gaps in the care for the local population, I can’t help but worry about these four innocent people. While not victims of Yolanda, life’s unfairness has caused them suffering nonetheless. 

Anything else you would like to share?
 
There are these surreal moments here where I drive around a bend or over a hill and suddenly, I find myself in this moment of suspended reality -- like time has stood still in the midst of Yolanda’s fury and if I listen I might still hear the wind. All the trees are leaning in the same direction, with the palm fronds still pointing straight out, suspended as if the wind is still blowing them. The houses on the hills are tilted, too, and for that split second, it seems to me as if someone has pressed pause on the world in the midst of Yolanda and if they dare hit play again it will all fall over.
 
Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar

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