From Vivian Reyes, MD: Update from the Field – Cebu, Philippines

Editor’s note: Vivian Reyes, MD, is an emergency room physician at Kaiser Permanente San Francisco Medical Center. She is leading a team of Kaiser Permanente caregivers on the ground in the Philippines in the wake of Typhoon Haiyan, which killed at least 4,000 people and left millions homeless. Reyes and her team are in the Philippines at the request of Relief International.

November 20, 2013

I would say the team hit the ground running, but that would be inaccurate. The team actually began running before the plane even hit the ground!  After departing SFO on an overnight flight on November 16, heading to the Philippines, a request for medical assistance was announced on the plane’s overhead system.  The KP/Relief International team responded immediately.  Dr. Nina Chicaroen took the lead and assessed and treated the patient.  Needless to say, the flight crew and surrounding passengers were impressed and grateful to have a medical response team on board and attentive to the passengers’ needs.

The Kaiser Permanente emergency medical response team, working with Relief International, has begun its mission to provide medical relief care to people in the Visayans region of the Philippines, which was devastated by Typhoon Yolanda/Haiyan.  The team of volunteers from Kaiser Permanente includes Dr. Nina Chicaroen (Emergency Physician from Kaiser Permanente Santa Clara Medical Center), Robert Durand (Emergency Management Planner, The Permanente Medical Group, for Kaiser Permanente San Francisco Medical Center), Glen Encarnacion, RN (Emergency Department Nurse from Kaiser Permanente San Rafael Medical Center), and myself.  The team is currently based in Cebu as we work to determine which affected area may most benefit from the ongoing efforts we plan to provide. The second half of our initial deployment team will meet us here tomorrow, and the second team will arrive on December 3.

The first part of any disaster response is always a bit chaotic and fluid.  Upon arrival to Cebu, we learned that medical teams were no longer being allowed into affected areas, for at least a week. While this may seem surprising at first, it actually makes a lot of sense.  In the first week after the typhoon, many small medical relief teams flocked to affected areas.  However, as assessment results came back it turns out that many people who survived the typhoon did not have great medical needs, which is fortunate.  For those who had, the early medical teams were able to address their needs.  Given this, coupled with the more pressing need for food, water, and shelter, medical teams were asked to stand down.  Awaiting the go-ahead, our team quickly began our assessments.

Part of our team assessed the need for medical care in Cebu, the receiving area for many evacuees.  The other part of our team went into the affected areas to determine where our team and our plan for a longer term, capacity-building mission could be most beneficial.  Travel to affected areas has been difficult and time consuming.  We discovered that most information received has been inaccurate. This is likely due to outdated information as well as “the telephone game” phenomenon, where information changes slightly each time it is passed on to someone new.

The good news is that the health of victims is overall better than expected, and acute care issues have greatly been addressed.  I suspect there are areas that are yet to be discovered and will require medical services. However, our greatest concern now is getting medical care in place for when secondary illnesses, such as diarrhea, respiratory infections, and mosquito-borne illnesses become more prevalent.  Untreated chronic medical conditions will also need to be addressed.  The medical infrastructure in most places has been destroyed and this is a gap that we can help address.  Once we process the results of our assessments and collaborate with the Department of Health and the World Health Organization to determine where to base our team I will update you.

On a more personal level, the destruction that we witnessed during our assessments is indescribable.  The best way to describe it is to picture the destruction of the Joplin tornado, and then apply that level of destruction to entire large islands, which include both large and small cities, as well as miles and miles of farmlands.  (Editor’s note: See this gallery in for images of the devastation.) I am not sure that I saw a single building that was not destroyed or severely damaged.  There are trucks on top of houses and in trees, the river is filled with so much debris that you cannot even tell that it was a river, and not a single power line is up.  Anywhere you look will be similar to the photos shown on television.  Despite this destruction, however, the people have proven amazing resilience.  Catching a ride on a military plane transporting evacuees I sat next to a little girl about 3 or 4 years old who was playing games and laughing with her sister the entire ride.  People look amazingly healthy and remain pleasant and thankful for aid coming in.  Some have blank stares and it always makes me wonder how many loved ones they may have lost.

I will continue to update you as our medical relief mission progresses.  Sometimes communication is limited and time is short, but I will do my best to update  regularly.

Maraming Salamat,

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