36. Tindog Tacloban! – An 11 Year-Old Boy

The names and some details of the case have been changed to ensure anonymity. Melan provided permission to write about his story, with the understanding that it would be potentially read on the internet by people all over the world, and would describe some of his experiences of the previous several years. His mother provided written permission.

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At around 11am on Saturday, I was asked to see an 11 year-old boy, Melan, who had been brought to the MSF Outpatient Department for a fever and sneezing.  The physician who saw him was advised that since the typhoon, Melan has been more isolated and played less with friends, and thus made the referral to mental health services.

Melan looked like any boy his age.  He had a mop of shaggy hair, jeans, and avoided eye contact most of the time.  He peered up now and again, and had a sad look that wouldn’t shake.  I told him that he didn’t have to be here, that he could leave and come back another day, but it might be good for him to talk given the sadness his mother described.  He thought it best to continue, despite his hesitancy.  He wouldn’t speak for a little while, but eventually said that he has been “feeling down because of the storm.”  Regarding his experience of the typhoon, he said that “the winds tore the roof open and trees fell down… tidal wave… many things happened.”

Melan’s mother watched with an uncomfortable anguish as he spoke through his tears, remaining silent yet present as he expressed himself. 

He was in the family home, with his mother and cousin (age 6).  He awoke around 5am when the roof-top ripped off his house.  He had heard that a big storm was coming, but he thought it would be like the many other storms that he had witnessed, so he was not worried when he went to sleep.  The first floor of the house flooded, and Melan joined his mother and cousin for the next four hours.  He spoke with his mother throughout the storm, and he felt that she and he “were fine.”  When the winds died down, he walked outside, and found that “many things were destroyed… electrical posts, houses, almost everything in the house, roads.”  He thought that his house could have collapsed, as many others had.  Melan did not see any dead bodies, but heard of casualties, and of others seeing bodies in the street. 

Melan had no close friends or family who died in the storm, nor was anyone in his school injured or killed. 

After the Typhoon, like so many others, Melan and his mother went to Manila to stay with family.  He felt safe in Manila, and thought of the storm “sometimes.”  He returned to Tacloban five days prior to having presented to the MSF hospital.  He was sleeping relatively well, and had no nightmares, but thought of the storm during the daytime “sometimes.”  He could go many hours without any thoughts of the storm.  As he said this, however, tears washed down his cheeks.  I asked where the tears were from, and he answered, “the people who were killed in the destruction.”  He could not identify who, just that they were people from his city. 

At this point his mother was crying quietly, and I was quite taken with his story.  It was becoming less clear, however, what was driving his sadness and self-isolating behaviour three months after the incident.  Melan had no psych history, was on no medications and had an unremarkable medical history.  Nobody in his family had ever been seen by psychological services of any kind. 

I asked Melan if the darkening clouds, rain and winds were worrying to him, and he said that they were not.  When asked what he would say to a younger child if they were frightened in a storm, he responded: “calm down, there is nothing to be afraid of.”  And he reiterated that this was his belief, not simply the consolation of an innocent.  Melan did not recall having been frightened by a storm or any other act of nature prior to or since typhoon Yolanda. 

The most difficult part of the memory of the typhoon was “the part where many people died… the part that friends or family could die… I could be alone.” 

This could be called existential angst.  Death and loneliness drive many symptoms, but as the discussion continued, it did not seem to be the generator of his almost palpable terror.  And then it came out.  When asked if there was any time in his life when Melan felt alone, powerless to what could happen next, he started to cry more forcefully, sometimes gulping air as he spoke. It was wrenching to me, and his mother put an arm around him as he continued. He spoke of the time when he was 7, and a 10 year-old male student “punched him” once and taunted him several times.  This bullying behaviour took place at and around school-time, and lasted about 1-2 months. 

Melan refused to go to school a few times, but his parents and teachers were, to his recollection, unaware of the problem.  The bully did not target Melan specifically, as he was known to bully the younger kids. On direct questioning, Melan said that the bully probably did not even know his name, and the bullying stopped because the older boy forgot about Melan. 

We spoke about feelings of helplessness and fear given circumstances out of our control.  Melan cried a fair bit, but decided to continue. 

We spoke of his father who had been a migrant worker in Dubai for 8 years, and how he has a good relationship with him, speaking on the phone every week, and seeing him once a year for a week. 

Melan’s plan for the near future was to “be with friends this week… try to forget about the past… not think of bullying.”  We set up an appointment for the following week. 

This story hints at many things.  I want to underscore something that has become glaringly apparent as time goes on in my career and life: that a sizeable chunk of human misery is perpetuated by factors within someone’s control, often discretionary.     

35. Tindog Tacloban! – The Outpatient Program

jeepney inside (1 of 1)

The jeepney sets out at about 8:15am. It looks like a battered old short-bus, but instead of back seats, it has two long bench seats along the sides, and an open back and sides. If there is no air conditioning, this is the most comfortable way to travel.

jeepney red (1 of 1)

Three counsellors. One of whom is an MD, the other two have an undergraduate degree in psychology. All have had previous training with another MSF project in the Philippines. We’re constantly bantering and discussing cases along the way.

tent city

First we attend Tanauan Central School Evacuation Centre. There had been a planned time for follow-up sessions with some persons identified as having difficulty adjusting to post-typhoon conditions, whether above the threshold for a diagnosis of mental illness or not. The tent city locale was empty. Almost completely empty, in that there were even no kids about, which is a rare thing out here. Turns out that the whole camp had gone to a place called Pago to work on the more permanent structures to where they would be moving eventually.

tent city 2

We moved on to a small displaced persons camp, mostly made of up tents. We met with the Captain of the local region, and he warmly greeted us, but advised that there was a food distribution going on, which clearly took priority over the planned psycho-education session that we had arranged. We rescheduled for that afternoon, and hopped in the Jeepney toward the next stop.


The Assumption evacuation centre was similarly empty. Again, the inhabitants had gone to Pago to work on the housing structures there.

So we decided to do the most expedient thing and headed to Pago. There was a single concrete structure erected, and the start of many others. Building materials were stacked up in neat, organized piles. Large groups of people were working on different projects: moving wood, cleaning metal beams, concrete mixing, brick-laying, etc.




The MSF counsellors split up to find the persons with whom they had follow-up sessions planned, and they retreated under the shade of a tree to do their work. If possible, returning to work is almost always a good thing. It aids with depressive and anxious symptoms, of which post-traumatic distress is included. Work tends to be social and provides a sense of purpose, worth, and community-building.

The housing units are provided in order of need, and there is an equation that takes into account the size of the family, number of children, destruction of property, distance from shoreline, and other factors. My small poll suggested that most people thought that this was fair, and that they wanted to move in as soon as possible.

Next stop lunch.  We ate, discussed the cases, and planned the afternoon. Fish, rice, some meat stew that might have been pork. Like most prepared food here, there is too much sugar and salt. The fish was fantastic. The lunch room was a small open-air establishment that had been built mainly since the typhoon. On one side was the road with cars driving by, and on all other sides the visible debris from the storm. It had been arranged into piles of metal sheeting, wood that seemed to come from docks, and broken cars and other forms of transportation that had been destroyed. The region, Bislig, is one that was hard-hit, and is also being targeted by our Outreach team.

tree ripped up

We then returned to Magay for that psychoeducation centre. A bell was rung and the milling-about crowd grew from 20 to over 100 persons. It was a lively group. Many mothers holding babies, some who had been born since the storm. The Barangay Captain, a white-haired septuagenarian fellow who wore crisp jeans and a jean-shirt, curiously unaffected by the blistering heat and humidity, introduced our team. The counsellors launched into their routine, which was in the local dialect of Tagalog, called Waray Waray. One of the counsellors translated some of the on-goings, but more than anything I was fixed by the cadence and energy of the group. It was fast, interactive, and thoroughly engaging to the participants. The group called out answers to questions, made comments that struck home to easy laughter, and asked for clarification if the need arose. It was warm and intimate. I want to write that it had this tenor “despite” the setting, which was a slightly shaded area, 20 or so seats, with the rest of the people standing. But of course, it had almost everything to do with the setting.

Psychoeducation sessions are necessary here. It is very common to have people brought to the hospital by family for non-specific or unexplained medical symptoms such as bodily aches, irritability, sleep problems, and decreased functioning in the social, family or work sphere. No mention of sadness and anxiety is made, but on inquiry, there is significant concern in these areas. There are also more cases than I would have suspected involving persons who have been psychotic for years, and were never brought to the attention of a mental health professional. Some teaching of common symptoms of mental illness, and the availability of free MSF services, is a good thing. Of course, one wants to be aware of local ways of expressing emotions and behaviours associated with illness (idioms of distress and styles of reasoning), as we don’t want to prime people how to “properly” exhibit illness. But it seems that even moderate to severe symptoms may go unrecognized and unattended to by available health resources. There is much more to say on this topic, but I’ll leave it there for now. Something interesting happened.

At one moment during the 20-minute session, one of the counsellors asked the group if anyone had a family member or someone close to them who was killed by Typhoon Yolanda. There were many hands that went up. Then someone made a comment that got everyone laughing, and some were looking at a 60-ish year-old woman who was in the front row. She laughed, turned a bit red from the attention, and then started to cry. She covered her face, but motioned that she was ok, and for the talk to continue. The counsellor went to stand beside her, put a hand on her shoulder, as had several others who were sitting beside her or standing near her. The counsellor continued the session, and after a few minutes moved back to a central location. When the session was over, the counsellor sat down beside her and they spoke for 15 minutes or so. There were about three or four women who had pulled up chairs to take part in the discussion.

It was explained to me afterwards what happened. The woman’s name was the international call-sign name of the storm, and her husband died in the typhoon. When the group was asked if anyone was killed by “Yolanda,” someone joked that she had killed her husband. I double-checked that I heard that correctly. It’s hard to imagine a large setting in which humour like this wouldn’t be off-side back home in Canada.

I work at a Toronto hospital called the Centre for Addiction and Mental Health (CAMH). It’s one of the largest mental health institutions in the country. I could not even fathom humour such as this being mobilized in this way, but I started to wonder what it would take. I’m still wondering.

Here in Tacloban city and environs, in this most remarkable of places, humour is used with great deftness in the integration of psychologically traumatic events in a coherent and tolerable narrative. This is healing behaviour. It struck me that this was a shining example of the concept of resiliency.

z 365 store

(The winds hit gusts of 365km per hour; many stores that have reopened include the name Yolanda.)