Yolanda: Impact and future direction

I have asked Ernesto Garilao, president of Zuellig Family Foundation (ZFF) to be my guest columnist.  I have asked him to give an “on the ground “ description of what happened in the partner municipalities of the Zuellig Family Foundation in the aftermath of Typhoon Yolanda as well as his comments on how to handle disasters in the future.  As chairman of ZFF, I would like to express our profound gratitude to the US-Philippines Society and its donors for having provided to date $400,000, of donations from more than 300 individual donors as well as from Hank Greenberg of CV Starr and the Direct Relief Group. I am equally delighted and grateful that my former colleagues from Naspers (of South Africa) and partners of Sulit.com.ph have contributed $100,000.00.

The path of Super Typhoon Haiyan (local name Yolanda) affected thirteen partner municipalities of ZFF in Samar, Northern Negros, Capiz, Romblon, Masbate and Northern Palawan.

Hours after the typhoon struck, ZFF immediately activated its Community Disaster Response Program to respond to the emergency health needs of the municipalities. While the Foundation has responded to disasters in the past, the days that followed highlighted the need to shift paradigms to ensure that local government units are able to sustain improved health outcomes even in the face of major disasters.

ZFF response to Yolanda

 The first priority was to establish communications with our partner LGUs. Since power and communication lines were down, we had to send staff on the ground and coordinate with the DOH and the DSWD. The first information came from affected municipalities in Capiz. Upon the request of Mayor Bo Escutin of Dao and Mayor Ipe Yap of Ivisan, ZFF provided relief assistance to more than 9,000 households in their towns, which are two of the hardest-hit areas in the province. ZFF also conducted a medical mission, treating more than 1,800 patients.  Subsequent reports from Romblon, Masbate, Western Samar, and Northern Palawan came in, but the damage was not as severe.

Eastern Samar at risk

Since communications with Eastern Samar was difficult, a team was sent to the municipalities of Giporlos, Salcedo and Gen. MacArthur. These three, together with ten others in the province, were among the hardest hit by Yolanda. Accompanied by Mayor Mark Biong of Giporlos, the team saw a heartbreaking picture. Coastal barangays were wiped out. Sources of livelihood were destroyed. Health facilities were severely damaged and health workers themselves were victims of the calamity. In Salcedo, Mayor Melchor Melgar pointed to a small space in the municipal building that has been converted into a temporary birthing facility.

The ZFF response was immediate. Medicines and supplies were airlifted to augment dwindling stocks in the RHU of these LGUs, as well as relief goods for more than 8,000 households.

The larger picture of Eastern Samar is grim. Information provided by Governor Aklan Nicart and his health team showed that the two district hospitals in Balangiga (covering Lawaan, Giporlos, Quinapondan, and Balaginga) and Guiuan (covering Guiuan, Mercedes, Salcedo, Gen MacArthur and Hernani) were totally destroyed, together with the municipal hospitals of Quinapondan and Gen MacArthur. This means that if you need hospital care, you need to go to Borongan Provincial Hospital, which is the nearest functional health facility.

Even in normal times, life is hard in Eastern Samar. With a population of 425,000 (2010), poverty rate is 60 percent (2010). While the situation has improved in recent years, maternal mortality ratio (MMR) is still high at 110 (2010). While 66 percent of maternal deliveries are facility-based, most maternal deaths come from home deliveries (34 percent) with traditional birth attendants since mothers are too poor to seek facilities based care. In cases of high-risk pregnancies, however, hilots cannot handle obstetric emergencies, often resulting to maternal deaths.

To make matters worse, Yolanda caused the destruction of the hospitals whose catchment population represents a third of the total population of the province.  Since sources of income from fishing and agriculture were also destroyed, poverty rates are expected to increase. As a result, more poor mothers will be at risk since their default behavior will be to deliver at home with a hilot. Since hospital care will now be in Borongan, which entails higher costs of transportation, accommodation and other out-of-pocket expenses, even high-risk mothers will opt to deliver at home and take the risk.

Unless major interventions are put in place, more mothers will die from childbirth in Eastern Samar.

Typhoon Yolanda is a game changer

The recent ZFF experience necessitates a change in its approach towards disaster relief, which should now be framed within the overall goal of a resilient rural health system that provides health services to the vulnerable population, even during times of emergencies.

Our new interventions must enable partner LGUs to be able to do the following:

Local hazard mapping, risk assessment and identification of vulnerable communities/populations

Local government units must be aware of potential hazards in their municipalities, whether the danger is from flash floods, storm surges in coastal barangays, landslides or earthquakes in upland communities, or volcanic eruptions. The health facilities must be in safe areas. The number of families and their needs in these dangers zones must be assessed (including those for pregnant women, children and the sick and the elderly), evacuation routes and centers must be identified, supplies and materials (including medicines) ensured.

Planning for disaster preparedness and response

LGUs must ensure that adequate resources are allocated for disaster response. Aside from emergency equipment, supplies and materials (which should include vaccines and medicines for identified morbidities), proper training must be given to first responders. Planning must also take into account available technology.

Specific to public health systems, LGUs must have emergency power supply, water purification and/or emergency water supply, sufficient medical equipment and supplies (including drugs and medicines), and communications satellite phones.

Execution of post-disaster plans: relief, recovery and rehabilitation

Leadership and governance in disaster preparations and response must be evident not only prior to an event, but must be quickly manifested at the onset of and immediately after the disaster strikes. This requires, first of all, the presence of the local leaders to quickly organize and lead the LGU response. Training in disaster management will come in handy as the mayor and members of his/her response team are able to assess the situation, get information on the extent of the damage on both human and material assets of the municipality, deploy resources to affected communities and sectors, and re-establish services, utilities and vital infrastructure to help their constituents better cope with the disaster.

Challenge for the private sector in health

If there is one thing Yolanda has taught all of us, it is now necessary, now more than ever, to invest in disaster preparedness and mitigation to make health services more resilient in the face of more violent typhoons. Other than responding with disaster relief, the private sector must now look into increasing the resiliency of rural health systems especially in disaster prone areas. With climate change, this is now an imperative that ZFF will operationalize. We welcome partners to join us in this endeavor.