33. Tindog Tacloban! – Intro

This blog is mirrored from the MSF site. Pictures are added. Date of initial publication: February 18, 2014. 

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This blog is mainly to get word out to friends and family regarding this mission.  There are a lot of questions coming my way, the answers to which may be of interest to some and not others. From conditions on the ground involving lodging, food and security on to the impact of physical and psychological trauma on the local population, and how the project is addressing these needs. Somebody asked me how I brought enough toothpaste for 2.5 months, given that I had a strict 10k checked-luggage weight limit. That’s ok. I’m posting this openly as others may be interested in what an MSF mission to the Philippines is like for a rank-and-file forensic psychiatrist from Toronto.

Happy reading, whoever you are. Your time is appreciated.

But please keep in mind that this blog is personal, and in no way is meant to represent the views or organizational values of MSF.  I wholly support the MSF that I know to be an independent, politically neutral organization that provides medical care irrespective of race, religion creed or political conviction.  If you walk in the door, and are in need of help, MSF does its best to help.  This is my third mission with this organization, and it is a pleasure and an honour to work with them again.


Human-caused climate change likely had something to do with the “super-typhoon” on November 8, 2013 that tore a strip off of regions of the Philippines. Winds of over 300km/h, and gusts well higher, made this the most powerful such storm ever recorded to make land-fall. And it did. It was as if not a single building was left standing in some regions, by reports, photos, and remaining carnage evident. Tacloban was one of those hard-hit regions.  A city of about 200,000 people, it is on Leyte Province, in the Visayas. I arrived on February 8, three months afterward the typhoon.

Filipinos are accustomed to storms with high winds, but this was something new.  Not only were the gale forces well in excess of the near-monthly storms that come through, it was the unexpected rise in sea level, 4 metres high in some regions, that caused so much loss of life and other damage. Tacloban is at the crux of an inlet, so the water brought by the typhoon was amplified.  The death toll is not clear, but it is over 7 thousand. Millions were affected.

MSF was on the ground in in the Philippines within several days, but as is the case in calamities, putting resources on the ground is only half the battle.  Distributing them is the other.  Infrastructure (roads, communications, water and sewage, power sources and lines) were wiped out.

The Wikipedia site describes the scene as follows:

According to estimates on November 13, only 20 percent of the affected population in Tacloban City was receiving aid. With lack of access to clean water, some residents dug up water pipes and boiled water from there in order to survive. Thousands of people sought to evacuate the city via C-130 cargo planes, however, the slow process fueled further aggravation. Reports of escaped prisoners raping women in the city prompted a further urgency to evacuate. One resident was quoted as saying “Tacloban is a dead city.”[61] Due to the lack of electricity, planes could only operate during the daylight, further slowing the evacuations. At dawn on November 12, thousands of people broke through fences and rushed planes only to be forced back by police and military personnel. A similar incident occurred later that day as a U.S. cargo plane was landing.[92]

 On November 14, a correspondent from the BBC reported Tacloban to be a “war zone,” although the situation soon stabilized when the presence of government law enforcement was increased. Safety concerns prompted several relief agencies to back out of the operation, and some United Nations staff were pulled out for safety reasons. A message circulating among the agencies urged them to not go into Tacloban for this reason.[93]

MSF has set up services in a hospital that was previously damaged.  They are fixing the structure so that is is usable and safe for MSF staff, and have hired many who were in its employ prior to the typhoon.  Functioning six days a week, they saw over 2500 patients last week in the outpatient department.  There are about 50 inpatients, which include surgical cases and maternity. Last week there were 57 admissions on the maternity ward, which was over capacity, so several new beds were added.  MSF provides free care and medicine,,so the numbers of people using our services are swelling.

I’ll be speaking about the mental health project more, but briefly, there are three components:

  1. Outpatient department (OPD): referrals from other services and our own follow-up
  2. Outreach: counsellors attend evacuation centres, hard-hit regions (baranguays) and other places where mental health needs are concentrated, and provide individual assessment and therapy on-site; we refer complicated persons to our OPD.
  3. School Program: Set up by child psychiatrists and psychologists, this ambitious project works with teachers and caregivers in elementary schools hard-hit by the typhoon.  Just to provide the scope of the destruction caused by the storm, one school which I attended last week had 63 students (30 male, 33 female; and one teacher) killed.  This was from a census of 430 students (grades 1-6) and 17 teachers. (Correction, there were 67 students killed at the school… the final count changed as more bodies were discovered since this number was first written.)

We have one psychiatrist, one psychologist, 8 counsellors and two translators.  Individual assessment and counselling are offered, which makes MSF, I’m told, perhaps the only NGO (non-governmental organization) to offer such services in the region.

When I was at the elementary school, the skies darkened and it started to rain. The winds picked up ever so slightly. A fright that I have never seen before en masse in children set in quickly.  They jumped up and huddled in the corner and cried; school teachers and our staff attended some of the more distraught ones.  One child ran toward her house, inconsolable.

It is hard to transition from such anguish.  But this post is to capture a brief snapshot of the project, and then return to mental health and some other issues more fully.

I’ve never seen an MSF project that was not ambitious.  This project is ambitious.  Some details.

There are, now, around 15-20 expat staff (like me who have been brought in from outside the country), and a much larger number of local doctors, nurses, midwives, pharmacists, etc. I should get numbers, but suffice it to say that this is fair-sized facility.

The logistics of putting so many supplies on the ground, navigating the decimated infrastructure, and arranging these medical services, is nothing short of staggeringly impressive.

Two quick examples.

The hospital’s electrical system was shot through when the typhoon hit.  In addition to the electrical grid in the city going down, and all the hospital damage, the water level hit the second floor of the hospital.  MSF rigged a complete second system of wiring and outlets within days of being in the building.

Second example: a few days ago I wrote on a requisition form that Mental Health Services (MHS) could use a flipchart and second whiteboard for teaching purposes, in addition to the markers, erasers and such that go along with this.  Within less than 24 hours, a flipchart and 2 paper rolls, as well as a whiteboard, were set up in our group meeting room.  The flipchart stand was constructed after the requisition was put in.  That this is seen as standard service is, I say again, hellava impressive.  Logistics is the unsung hero of MSF (at least from the outside; inside the NGO world and by all who work for the organization, their praises are sung).

The MSF project expat staff now live in a structure that used to be a hotel.  Everybody except for the 4-5 staff (surgeon, anaesthesiologist, midwife, obstetrician, emerg doc; they’re on call, so that’s the rationale) share rooms.  It’s a pretty swish location for MSF standards, with the local generator providing power for several hours in the morning and evening.  We have people who cook, clean and provide security, so food is pretty healthy and plentiful, the house is safe, and so on.

Most of the staff are out of the house by about 7am, and arrive at the hospital within 15 minutes or so.  We have several vehicles that provide transport, some of which are larger buses with open bench seating in the back, and more modest rickshaw-type units.  The end of the day seems to be around 5-8pm, depending on the need.  I’ve not left before 7pm, despite some messy jet-lag (it’s 13 hours ahead of Toronto).  This was not really my desire, but things have been busy.

So there it is.  I’m going to try and attach pictures, but internet is really spotty.  We don’t have it at the house, but seemed to have had it for several hours yesterday at the hospital… narrow bandwidth.  Not having internet is like having phantom limb discomfort.  You just feel like that appendage should be there.

It must be said early on that the Filipinos have been a warm, welcoming, and generally wonderful population with whom to work.  This is not the case everywhere, really.

OK. Toothpaste. I brought 50ml, assuming that since this was a large-ish city, I could find some here when I ran out.  This is true now, but for the first month that MSF staff were on the ground, this was not the case.  Finding food, clean water and other basics was a challenge for the first wave of MSF staff on the ground. I don’t know what they did.  An emergency relief mission is a different thing than what we’re doing now.  I greatly respect the efforts of the many staff (expat, local, distant) that carved out the project that allows me to fly in and immediately focus on mental health work.

À bientôt.