In November, this writer left his aesthetic practice behind to lend a badly needed medical hand among those affected by Typhoon Haiyan.
ON Nov 8, 2013, Typhoon Haiyan made landfall in central Philippines. The most powerful storm of the year caused almost 6,000 deaths and affected more than 14 million people there*.
Once I heard of the extensive damage caused by this natural disaster, I wasted no time in contacting Mercy Malaysia (Medical Relief Society Malaysia), a non-governmental organisation dedicated to providing medical relief and humanitarian services locally and abroad. I wanted to offer my time and expertise as a medical doctor.
On Nov 26, I and my long-time medical assistant friend, Daniel, met up at the airport with obstetrician Dr Helen, anesthesiologist medical officer Dr Melvyn, medical equipment specialists Mr Guna and Mercy Malaysia coordination staff Badlizan. We were the seventh batch of volunteers to be dispatched by the organisation to help in this disaster of unprecedented scale.
We travelled to Ormoc district in Leyte province where we would serve for two weeks. From Cebu airport, it was a three-hour hour ferry ride to the Ormoc pier, which was a hive of activity when we arrived. Porters buzzed about carrying large boxes and the bulky luggage of those who just disembarked from our ferry. Many people had brought supplies and necessities for themselves and their families from unaffected Cebu into disaster-struck Ormoc.
We had brought along 10 boxes of foods, Mercy Malaysia T-shirts and other items for the team’s use but it was extremely difficult to secure a porter as they were very busy. As I later learned, the typhoon had brought increased business to porters, hotels, restaurants and laundries, as scores of relief workers from all over the world had descended on Ormoc. One man’s poison is another man’s meat, they say....
We were picked up by Mercy Malaysia staff in one of their four rented vehicle and whisked to our makeshift tent on the grounds of Ormoc District Hospital. This was where we would be attending to patients on an outpatient basis for the next two weeks.
We then met up with other Mercy Malaysia volunteers who had been there for nearly two weeks. They would be leaving in two days’ time and would soon hand over their duties to us. I could see the physical toll that the mission had taken on them, but, despite appearing tired and obviously lacking sleep, they were still cheerful and treated patients with gusto.
On average, our volunteer doctors, nurses and medical assistants saw an average of 500 to 600 patients a day, seven days a week in the outpatient department in a makeshift tent that Mercy Malaysia had set up.
The organisation provided medicines and treatments free of charge, which is why many people took the opportunity to see us. In the Philippines, all patients, except for those over the age of 60 years, have to pay for consultation, medicines, blood investigations, X-rays and ward admission, even at government hospitals. The fees are not steep, but many could not even afford such low fees as they are in dire poverty and became even worse off after the typhoon.
We were introduced to Brenda, the friendly Ormoc District Hospital administrator, who took us on a tour of the hospital. Much of the hospital’s equipment, such as intensive care unit ventilators, baby incubators and operating theatre equipment, was damaged beyond repair. Mattresses, beds and whole sections of the wards were drenched in rain water. Most – 80% at least – of the hospital roof was damaged or simply missing. Mercy Malaysia had funded and completed the repair of sections of the roof, but there was still much to be done almost a month after the disaster struck.
We heard how, dramatically, five babies were delivered by flashlight on the night of the typhoon after the electricity supply was cut off. Power and water had been restored to the hospital and other critical buildings since then but most areas of Leyte province were still without electricity.
I could easily see that the hospital staff were overwhelmed by the sheer number of patients. Some of the local doctors, nurses and administrative staff had not reported back to work as their houses had been damaged or they were back in their own provinces looking after their own families. This has taken a huge toll on the staff who have chosen to remain. The doctors would be on call for 24 hours for four days in a row and then they would work regular office hours for the next four days.
As for us Mercy Malaysia volunteers, we would have a mission debriefing among ourselves at the end of each day to discuss the goings-on that day, and lay out plans for the next day. This was followed by dinner at our base camp, a 10-minute drive to the Ormoc Senior Citizen centre which had been taken over by the Leyte Department of Health as the command centre of the typhoon relief efforts.
Our breakfast and dinners here consisted of convenient, easy-to-prepare meals such as canned sardines, instant chicken curry, bread with jam and peanut butter, and the occasional round of fresh fruits and vegetables bought when available from the nearby market. We slept three to a room meant for two in a budget hotel; but we were luckier than the previous batch of volunteers, as we had power and so could enjoy air-conditioning and hot showers – which were very welcome indeed after our very long days.
On the first day at work, I was rather overwhelmed by the sheer number of patients. By the time we arrived at the hospital early in the morning, a long queue had already formed outside the tent, snaking all the way to the main road. Women with their children in tow, the elderly with walking sticks and the injured were waiting patiently in line to see us.
Assisted by local translators, I quickly discovered that most patients had injuries sustained during the typhoon as well as skin diseases, musculoskeletal aches, coughs and colds, diarrhoea and abdominal upsets, most of which were related to the disaster and its aftermath.
Some had difficulty sleeping and were struggling with anxiety and feelings of hopelessness after losing family members and their belongings and homes. These patients we referred to our volunteer clinical psychologist. (Mercy Malaysia was also providing mental health care for those who needed it.)
A huge number of people were symptomatic of tuberculosis, and I had to refer them for chest x-rays at the hospital, which was just behind our tent. Tuberculosis is an epidemic here, and many people afflicted with this disease go undiagnosed and untreated.
Out of the 150 or so patients that I saw a day, a disproportionately high number had enlarged thyroid glands. Goiter seems to be very common here, due to a lack of iodine. I also found many people with undiagnosed and untreated high blood pressure, diabetes mellitus and heart disease. As I mentioned before, healthcare is not free in the Philippines even at government facilities, so most of the poor cannot afford to see doctors; compliance with long term medications for chronic diseases is also poor due to financial reasons.
The patients and local healthcare staff that I spoke to were amazed that we Malaysians were willing to come all the way to the Philippines to treat their citizens for free. I feel proud that Malaysians embrace the spirit of altruism and giving.
When nothing can help
My third day at work was uneventful in the morning at the outpatient tent. In the afternoon, however, I noticed there was a lifeless body in the hospital’s Emergency Department. An elderly man lay motionless on a stretcher with a shirt covering his face. It seems that he had been lying in full view of all the other patients for the whole day. I wondered what he had died of, and why the hospital staff didn’t place him elsewhere, out of sight of the other patients.
The next day, I was horrified beyond words as I stepped into the Emergency Department again: I noticed a smell of decay and saw that the body of the elderly man was still lying in the exact same spot as the previous day. His body was starting to decompose; it was bloated and pale. Flies were swarming about him while the patients in the room tried their best to look away.
Why was he still there? Perhaps he didn’t have any contactable next of kin. The sight left me saddened that whole day.
The next day, another sad experience: A middle-aged man with a damaged right eye came in. His eye had been injured by flying debris during the typhoon three weeks ago. He had no money to seek treatment and had only come to see us today when he heard that Mercy Malaysia was providing free medical aid.
The eyeball was lacerated and very red. His cornea had started to form opaque scar tissue, which was hindering his vision. I realised that, if not treated aggressively, he could end up with irreversible blindness.
But the Ormoc District Hospital does not have an eye specialist. And while there were at least three private opthalmologists in town, they were expensive and this patient had no money. So I sought out Brenda, the administrator, and asked if the hospital could sponsor a consultation at the nearest private opthalmologist. With the go ahead given, Brenda drove the patient in her own car to the private clinic.
The man was saddened to learn that his eyesight could not be saved as the injury was too extensive and he had come too late for treatment. The eye doctor suggested enucleation surgery, which is the removal of his entire eyeball, and replacement with a non-seeing prosthesis that looked like a real eye. But that would cost 35,000 pesos (RM2,500) and the patient certainly could not afford it. He gave a weak smile and went silent.
I’ve never felt so helpless before.
Suffer the little children
Besides covering the outpatient department at the hospital, Mercy Malaysia had also been tasked by the local Department of Health to help out at the rural health clinics in nearby Valencia district. Two of our volunteer doctors, assisted by a nurse and medical assistant, and a large team of Valencia rural health centre staff, would take turns to set up and run a mobile clinic at one of the 17 barangays (villages) in Valencia.
It was my turn to go to a place called Conception. Most interesting name, I thought. We quickly set up our registration counter, doctors’ consultation table and medicine dispensary counter before attending to the 180 villagers who had come to see us.
A mother brought her ninth child to see us. The child was the younger of a pair of identical twins. While her older sibling was fairly healthy, this one-year-old had a huge, bloated abdomen, pale complexion, sunken face and bony limbs.
Her mother explained that the child refused to eat and her tummy had been expanding in girth rapidly for the past two months. I immediately recognised the gravity of her condition, suspected liver disease, and told the mother in no uncertain terms that her child must be admitted to the nearest hospital immediately for further tests and treatment. Failure to do so would certainly result in death.
The poor woman burst into tears upon hearing that. She confessed that one of her other children had just died a few months ago from a similar condition. She had no money to admit this child or buy any medicine. I could only prescribe some antibiotics and painkillers, while futilely hoping for the best.
And then there was the morning on which a woman cradling her child rushed into our outpatient tent while we were still in the midst of setting up for the day’s clinic. She was in her late 30s, tears were streaming down her face, and she looked flushed and flustered. I thought her child must be very ill.
“Help me, doctor! Help me! My dog is dying!” she wailed.
I thought I had heard wrongly.
“Did you say ‘dog’, ma’am?”, I asked, bewildered.
The lady frantically explained that her pet dog was in her car, that it was dying, and the veterinary clinics were not open at this hour. She had rushed to our clinic to seek help as the dog was lapsing in and out of consciousness and not breathing well.
I understood that many people treat their beloved pets as part of their own family, so I politely explained that I have no knowledge or experience in treating animals. I don’t even own a dog and would be clueless about what to do. We only have doctors for treating people here, I said.
She didn’t give up and pleaded for us to give the dog some oxygen. While we didn’t have any oxygen supplies in our tent, the emergency department of the Ormoc Hospital did.
However, they too would only treat human beings as all their resources are stretched. There are many patients who needed the oxygen there and animals were nowhere on their list of priorities. The woman’s body trembled in exasperation before she rushed out of our tent to seek help elsewhere.
A prayer for healing
On the last working day for members of this seventh batch of Mercy Malaysia volunteers, I woke ill – I had been vomiting and having diarrhoea since the night before. Perhaps it was the food, coupled with the lack of rest that had brought down my immune system. A number of our volunteers had come down with tummy aches and flu over the course of their stay here but none of it stopped anyone from carrying out their duties.
So I gulped down some pills and rested for a few hours before making my way to Sicularay barangay with Dr Thomas, a nurse, a medical assistant and two local geriatric counsellors. As before, we were assisted by the nurses and midwifes of Valencia Rural Health Centre.
Sicularay was a remote village with bumpy gravel roads and no clinics. A local midwife and a nurse visit the village monthly to perform simple check-ups, but proper healthcare facilities were not available at this isolated barangay. We set up the clinic in a half-completed chapel, whose roof has been partially blown away by the typhoon. A huge crowd was already waiting for us by the time we arrived, as the last time they have been visited by doctors was ages ago.
I was most amused when mangy dogs ran in between our legs and under our consultation tables while chickens clucked about while I was attending to patients! In the late afternoon, it started to rain heavily and water started to seep in through the damaged roof. We had to see patients while people held umbrellas over us! Despite the conditions, though, two doctors saw a record 271 patients on that day.
As I took my last photos with the local children, with a blazing orange sunset and gorgeous sugarcane fields in the background, a tear trickled down my cheek as I realised that there was so much more to be done for these people. While they have experienced much hardship and misfortune, I found them to be always ever-giving and hospitable.
I will always cherish this experience that has made me grow emotionally and mentally, and the new friends I made here. I hope that my presence made a difference even if it was only a small one. As I left, I said a silent prayer for healing for the Philippines.