On July 26, 2014, International Medical Corps and AAR Japan, in partnership with the local PWD-support organization Iwaki Jiritsu Seikatsu Center, conducted an emergency shelter simulation focused on the needs of PWDs, the first exercise of its kind in Japan. Over 70 people took part in this exercise, including 21 PWDs (11 visually-impaired, 9 physically disabled, and 1 hearing-impaired), 20 caregivers, and 11 junior high and high school students. The event took place in the gymnasium of Iwaki City’s Nakoso Second Junior High School, as school gymnasiums are the typical venue for an emergency evacuation shelter in Japan.
The day was divided into morning and afternoon sessions. The morning session, themed “Discovery,” split the PWDs, their caregivers, and non-PWDs into 4 groups and had them take turns participating in separate activities at 4 “checkpoints”. Each group had a “navigator” to explain the rules of each activity and to encourage the PWDs to take the lead in identifying problems and brainstorming solutions.
Checkpoint 1: “Barriers” – finding the various obstacles in a typical emergency shelter: People with different disabilities often experience obstacles in different ways. The participants explored the gymnasium and listed all the different barriers they found. They also discussed the various obstacles they faced in order to reach the gymnasium, such as navigating an extremely steep staircase and having to walk on slippery gravel. Those in wheelchairs had to be carried up the stairs by four people.
Checkpoint 2: “My Own Space”: A small-scale cardboard mockup of a “typical” emergency shelter was created in the center of the gymnasium, complete with narrow pathways, cardboard separations, etc. PWD participants were encouraged to explore the space and think about which spot in the gymnasium would be the best place to set up their living space. Individuals with visual impairments chose spaces near walls so that they could use them to feel their way as they walked around the gym, while individuals in wheelchairs tended to choose spaces near exits and toilets.
Checkpoint 3: “Items Available and Unavailable”: This exercise challenged participants to think about what necessary items they need depending on their particular type of disability, and check whether they could fulfill that need in the shelter. A selection of various objects and materials were then placed on a table in front of the participants, and they were encouraged to be creative in thinking how they would use different items to suit their needs.
Checkpoint 4: “Communicating”: PWDs were asked to think about what kind of assistance they would need (e.g., medication, specific assistance, dietary restrictions, etc.) and to practice conveying vital information at a mock registration desk. Additionally, participants wrote notes to check the status of loved ones, and taped them to a message board, which was a form of communication commonly used during the Tohoku disaster.
After the morning session, all the participants enjoyed a simple lunch consisting of “alpha-rice”, which is instant rice that can be made with either hot or cold water and often stored as emergency rations in places designated as emergency evacuation shelters. The participants commented that the rice tasted better than they expected.
In the afternoon, three additional activities were held:
Creating an “SOS Card”: All participants created their own SOS cards with their vital information, including emergency contact numbers, the names of their medication, allergies, illness or handicap, prosthetics, needed medical equipment, etc.
Making My Own Space: PWDs created their own “living quarters” in the gymnasium using various material available, such as gym mats, chairs, cardboard, etc. Other participants assisted the PWDs with using duct tape, cutters and scissors.
Supporting the Visually-Impaired: Mr. Wataru Murai, president of the Iwaki Social Welfare Association for the Blind, taught non-visually-impaired participants some pointers on how to guide visually-impaired individuals. A 30-foot obstacle course was also set up so that participants could use a blindfold and walking stick to experience a little of what it is like to be visually-impaired. In turn, visually-impaired participants borrowed the wheelchairs of those with physical disabilities and experienced what it is like to not be able to walk on their own.
At the end of the session, a final discussion was held where all participants could share their thoughts and lessons learned from the day’s activities. The lessons learned during this exercise will be utilized in the second emergency shelter simulation for PWDs that will be conducted in early October, 2014.
Mental Health Care After a Disaster: The World Health Organization (WHO) estimates that rates of common mental disorders, such as anxiety and depression, double during humanitarian emergencies - affecting up to 20% of the population - while people with severe mental disorders are especially vulnerable in emergency situations. After Typhoon Haiyan struck the Philippines, the WHO estimated that 10–15% of the affected population would suffer more serious psychological problems as a result of the crisis, and that 3–4% would suffer from severe mental disorders.
Mental health support systems are critical for populations affected by conflict and crises, because the survivors are not only faced with stressful experiences such as violence and loss, but also often have to adapt to the challenges of new environments such as displacement and loss of property and livelihoods. Distressing experiences and fragmented or insufficient medical services can lead to unaddressed mental health and psychosocial issues, impacting the welfare and functioning of individuals and families.
The city of Tacloban in Leyte Province was the epicenter of the 2013 typhoon, and one of the worst-affected areas. International Medical Corps’ teams in Tacloban reported that almost 100% of patients they saw had suffered the loss of home and livelihoods, and that approximately 75% of patients at clinics in affected areas reported psychological distress.
As one of the very few international relief organizations to make mental health care a priority, International Medical Corps has the capacity to respond to mental health and psychosocial needs during a disaster like Typhoon Hiayan; build the capacity of mental health systems in disaster-affected areas while delivering services and supporting recovery; and help develop national policies to ensure these systems will remain resilient in the face of future disasters. In post-tsunami Aceh and Sri Lanka, International Medical Corps’ mental health guidelines were cited by the WHO as examples of “building back better” and creating sustainable mental health services. International Medical Corps also delivered integrated mental health programs after Hurricane Katrina, in post-earthquake Pakistan, post-earthquake Haiti and in numerous post-conflict settings in Africa. Further, International Medical Corps has been one of the pioneers of combining psychosocial support with its nutrition programs to enhance infant development and improve maternal mood.
International Medical Corps’ Response in the Philippines: International Medical Corps was on the ground in the Philippines within 24 hours of Typhoon Haiyan, and began supporting a comprehensive emergency response. Rapidly implementing a network of mobile medical units, International Medical Corps was able to reach remote communities cut off from health care and basic services, providing over 14,625 health consultations in more than 80 villages. As local capacity recovered and the need for direct humanitarian service delivery decreased, International Medical Corps shifted towards early recovery efforts in 17 municipalities in late December 2013. As part of this work to “Build Back Better” in the Philippines, International Medical Corps is coordinating with national, local, and international agencies to combine mental health care with the delivery of primary and secondary health care.
In order to create a more permanent solution to addressing mental health concerns in the Philippines, International Medical Corps trained 34 primary health workers in 17 municipalities throughout the Leyte Province to identify and manage priority mental health conditions according to national and global WHO guidelines.
In addition, 17 health care workers were trained under the WHO’s more advanced training program that consists of three modules given as 2-3 day sessions (totaling 7-9 days of training) for doctors and nurses working in primary care centers at the community level. Ultimately, this program provides participants with specialized training to identify mental illness and provide the proper medications and psychosocial care to properly treat them. These advanced training sessions also provided opportunities for health care providers to examine the existing mental health referral systems, and fill gaps to serving patients with more severe needs. This training program adds to a broader effort to promote mental and psychological well-being at the community level that includes training over 600 community leaders to recognize some of the symptoms of mental illness and refer them to the appropriate place to seek treatment.
Moving forward, International Medical Corps will work with the Philippine Department of Social Welfare and Development to train social workers as part of multi-disciplinary health teams to follow up with patients, connect people to needed services, and help reduce the stigma related to seeking mental health care. Further, International Medical Corps will expand its training program to include health care workers in municipalities that have not yet received training, and provide mentoring visits after the workers are certified to help ensure they put into practice the techniques and lessons learned during the training sessions.
Success Stories: Two women who had participated in International Medical Corps’ advanced training program, Evelyn Cabanero, a lead nurse and Dr. Eugenie Nicolas-Ortega, a primary care physician, shared their insights on how mental health services within their hospital are evolving after Typhoon Haiyan and International Medical Corps’ trainings. Through education for health care workers and community outreach programs to reduce the stigma of seeking help for mental health issues, International Medical Corps has given health care workers and families a new level of comfort which will lead to more people getting the treatment they need.
Evelyn and Dr. Ortega spoke about their increased comfort with approaching patients who may exhibit signs of mental illness, “We are no longer afraid of them. Before now, we were afraid of them because they may be violent. Now we are not afraid to approach or even touch the patient. We talk to them, make eye contact, and build rapport.”
Another benefit of International Medical Corps’ mental health training are the shifting attitudes in the community regarding suicide, which has led to more patients being referred for mental health treatment instead of only treating the damage done by suicide attempts: “…Now, we provide more follow-up appointments including psychological advice and referrals to a psychiatrist in Tacloban.”
Evelyn explained how the Burauen District Hospital plans to open a new room with three beds reserved for patients in need of mental health care. They also discussed the plans for a greater integration of mental health treatment and awareness across hospital services. “We’re now able to give treatment to depressed patients, whose final action is sometimes suicide. The hospital staff will work to prevent the progression of depression and other forms of mental illness,” Dr. Ortega added.
Evelyn ended the discussion with a statement that gets to the root of the issue of treating mental illness in the Philippines, “there’s a stigma attached to mental health issues because families lack knowledge regarding mental health.” Through education initiatives, and with your support, such as the training programs, International Medical Corps is helping to eliminate these types of stigma and build the capacity of local health care systems to properly care for those who suffer from mental health issues.
With the rainy season in full swing, nutrition and food security issues in South Sudan have become ever more important to address. The torrential rains in this region during the months of July and August make roads and rivers impassible, making it even more challenging for aid agencies to provide necessary services. This season comes on the heels of six months of war that has uprooted 1.1 million people. While men, women and children leave their homes in search of safety from violence, they face further dangers such as hunger, disease and other medical concerns. Displaced persons have been unable to plant crops and therefore the country is unable to feed itself. Humanitarian assistance is crucial to the survival of the people of South Sudan; however, funding is dwindling for the crisis.
International Medical Corps has been working in South Sudan since 1994, 10 years before the peace accord was signed. Today, we deliver health services in six of South Sudan’s ten states to nearly half a million in South Sudan and work to address maternal health, HIV/AIDS, nutrition, food security, water and sanitation. International Medical Corps emphasizes its nutrition and feeding programs in South Sudan. These programs are progressively growing, especially during the current rainy season where we support five outpatient treatment programs, six blanket supplementary feeding programs, four target supplementary feeding programs and three stabilization centers across six different counties in Upper Nile, Jonglei, Central Equatoria and Lakes State. We work in both rural and urban areas through 46 health facilities, including two hospitals. We provide approximately 20,000 consultations per month through these facilities.
MALAKAL: Following the outbreak of heavy fighting in early 2014 in Malakal, capital of Upper Nile State, at least 30,000 Internally Displaced Persons (IDPs) sought refuge at a UN base and in the grounds of churches in Malakal. International Medical Corps leads the nutrition programs in Malakal and is the only health partner providing Community-based Management of Acute Malnutrition (CMAM) services to Internally Displaced Persons.
International Medical Corps addressed the immediate needs of the local population by treating more than 460 injuries resulting from the conflict. Since January 28th, we have provided more than 10,000 health consultations in clinics at the United Nations’ compound in Malakal. In addition, 25 International Medical Corps-trained community nutrition volunteers and health promoters have provided routine nutritional screening and treatment referral of both children under 5 and pregnant and breastfeeding women. Community outreach to mothers has resulted in the establishment of 120 mother care groups, which hold two sessions per week on infant and young child feeding practices.
Since January 29th, International Medical Corps has screened more than 6,900 children for malnutrition. Our teams organized training for health professionals in cholera prevention and treatment. Community health volunteers and national staff were also trained on the importance of vaccination for measles and polio.
AWERIAL: Across Awerial County, an estimated 31,000 people are displaced, having been forced from their homes by fierce fighting in the town of Bor. Since January 6, International Medical Corps has conducted 2,789 health consolations in the county, with focus on smaller, isolated communities that have received little or no access to services. Mobile medical clinics, providing basic primary health care, maternal health, and nutrition screenings, are reaching IDPs living in in the villages of Yelakot, Kalthok and Wun Tua.
International Medical Corps has also been providing mobile health and nutrition services by boat to the islands of Mathiang, Matoro, Nyindeng and Malual, where few other humanitarian actors are operating. The nutrition programs also cover outpatient treatment for severe acute malnutrition without medical complications, as well as targeted supplementary feeding for children under five and pregnant and lactating women. Our services have ensured approximately 1,200 children and 500 pregnant and lactating women have been screened for malnutrition and admitted to the appropriate treatment programs.
JUBA: In Juba, International Medical Corps is providing primary health care and reproductive health services at the UN House and Tongping camps in Juba, where it serves as the co-lead in health programs in coordination with the World Health Organization. More than 4,000 health consultations have been conducted since January 6. International Medical Corps is also working alongside the World Health Organization and UNICEF to vaccinate children under five, as well as supporting the Ministry of Health in mass vaccination campaigns at the UN House camp. Additionally, International Medical Corps is in the process of setting up an operating theatre in Juba, to serve as an emergency surgical unit focused on complicated deliveries.