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.
On November 8, 2013, Typhoon Haiyan passed through the Visayas Region of the Philippines with wind speeds equivalent to a Category 5 hurricane. The strongest storm of 2013, Typhoon Haiyan devastated parts of the provinces of Leyte, Eastern Samar, Capiz, and Cebu, affecting 14 million people and killing over 6,200. 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, and established four programs in the areas of: health; nutrition; mental health; and water, sanitation, and hygiene (WASH) in schools. Through all of these programs, the goal is to support underserved and rural communities to “build back better. International Medical Corps was able to achieve the following in typhoon-affected areas from January until March 31, 2014:
The typhoon caused large-scale damage to local water and sanitation infrastructure, threatening the health status of vulnerable communities, and putting children, in particular, at risk for communicable diseases. To respond to this need, International Medical Corps launched an effort to repair or replace damaged toilets and hand-washing systems in over 100 local schools and reach more than 57,000 school children with improved WASH services. To date, International Medical Corps has rehabilitated the sanitation and water supply systems at 10 targeted typhoon-affected schools in 7 target municipalities in Leyte Province, including of Burauen, Dagami, Julita, La Paz, MacArthur, Mayorga and Tabon Tabon.
At San Roque Elementary School in Tanauan Municipality, only one classroom was left standing after the typhoon, and the devastation to San Roque Elementary resembles many schools in the area. “Our school was devastated; many of the roofs and walls of our buildings were destroyed. We have 11 classrooms of students and no toilet” says Patricia Andrin, the Principal of San Jose Elementary School. International Medical Corps has since rebuilt the roofs on the bathrooms and installed a new hand-washing station at San Roque Elementary School.
In addition to physically rehabilitating sanitation and hygiene infrastructure, International Medical Corps is also focused on training and educating local communities about proper hygiene practices to ensure optimal health. Through its comprehensive water, sanitation and hygiene (WASH) program, International Medical Corps is providing information and education on WASH and related health issues.
International Medical Corps recently sent nurses to San Roque Elementary to teach the 150 students about the importance of using their new hand-washing station. This was the first training session on hygiene promotion that will eventually reach over 130 schools in Western, Central and Eastern Leyte.
“As a nurse, I can see the benefits of the WASH program because it helps prevent the spread of water-borne pathogens,” said Priscilla, a member of the International Medical Corps’ hygiene promotion team. “A big concern of our program is to involve every child, because they are prone to illness. I know it is not easy to change these daily routines, but I am excited to make a difference.”
International Medical Corps – Typhoon Haiyan Emergency Response Update:
One of the most powerful typhoons on record, Super Typhoon Haiyan has left widespread devastation, affecting an estimated 16 million men, women and children, including displacing some 4.4 million people. International Medical Corps was on the ground within 24 hours of Typhoon Haiyan making landfall, providing emergency medical services to some of the most remote communities, many of which had yet to receive relief or health care. Rapid needs assessments revealed that Typhoon Haiyan severely damaged infrastructure, including homes, buildings and power lines; disrupted water supplies; and destroyed livelihoods, especially fishing and agriculture. There was substantial structural damage in rural health centers and village health offices and the storm destroyed stockpiles, creating a severe shortage of supplies and medicines critical to delivering health care.
Rapid Deployment of Mobile Medical Units: To meet urgent medical needs, International Medical Corps deployed rotating teams of international and local medical professionals to the Philippines. International Medical Corps’ first responders rapidly mobilized supplies and began spreading out to heavily affected areas not yet reached by other organizations. In six weeks of operation (from November 15 – December 19), mobile medical teams reached more than 80 villages (barangays) in 21 municipalities throughout Leyte, Eastern Samar, Cebu, and Capiz provinces – providing 14,625 health consultations.
Key services included health care and treatment for injuries, infections and chronic conditions; mental health and psychosocial support for survivors; monitoring diseases of epidemic potential; and nutrition screening for children under the age of 5. A total of 2,171 children were screened by the Mobile Medical Teams, with a total of 120 acute malnutrition cases treated in Leyte and Capiz Provinces. Out of the total consultations, 65% of new consultations (9,349) were women and girls, often some of the most vulnerable in the aftermath of a disaster. Further, in coordination with the government of the Philippines, International Medical Corps’ teams also delivered and distributed $1.8M worth of medicine and medical supplies to health care facilities.
Increasing Capacity Through Medical Training: True to its mission, International Medical Corps also provided training to build the capacity of local health care providers while delivering emergency services. International Medical Corps collaborated with the Provincial Health Office and UN agencies to conduct trainings for locally-based medical professionals to ensure that a broad range of health indicators were monitored and holistic health care was addressed in the aftermath of the typhoon. To date, International Medical Corps trained 11 people on SPEED (Surveillance in Post Emergency and Extreme Disasters) and with UNICEF trained participants on malnutrition screening of children under the age of 5. In collaboration with the United Nations Population Fund (UNFPA), International Medical Corps trained 21 participants from 5 different organizations on critical reproductive health care services designed to save lives and protect women, infants, and young girls during humanitarian emergencies (also known as the Minimum Initial Services Package or MISP). Furthermore, International Medical Corps’ Mental Health Specialist trained national doctors and nurses in Roxas on Psychological First Aid, which gives the skills necessary to support people immediately following extremely stressful events in ways that respect their dignity, culture and abilities.
Mobile Medical Team – The response in their words: Ivy Caballes, RN-- Mobile Medical Unit Team Leader, Leyte: “When we first arrived in Tacloban, I had mixed emotions as to how I would take it, because it would be my first time seeing the devastation. Because I was a part of the first Mobile Medical Unit, I was made team leader while we were still working in the evacuation center in Cebu. Working with the patients in the evacuation center in Cebu, we noticed that the patients had bad cuts and wounds. Dozens were coming to the evacuation center simply to list missing relatives and missing children. They told us their stories of the devastation. One woman told me, “We were chased by four big ships that were pushed onto land from the ocean.”
“Coming into Tacloban for the first time, I wondered what the devastation is going to be like. We arrived and saw that the airport was gone, and continued hearing stories about family members who had been lost on the coasts and loved ones who had been washed out to sea. It was really depressing and gloomy… on the road going to Tanauan, the devastation just broke your heart.”
“We were all excited to be part of the Mobile Medical Unit, because help does not often make it this far into Leyte. Working with International Medical Corps is a completely different experience. In the Philippines, when you do medical visits you often visit the place, do your assessments, provide your treatment, and then leave. With International Medical Corps, our Medical Director emphasized that we want to build up the existing healthcare providers -- the midwives and nurses -- and offer support where they cannot fill needs.”
“In some of these communities, many residents haven’t seen a doctor in years. After the typhoon, health care is finally beginning to reach the far-flung areas. It was a huge eye-opener for those of us Filipinos who didn’t know the extent of our country’s health concerns. During the crisis, the team was willing to sacrifice, everyone was willing to lend a helping hand. I really applaud the team for their patience and perseverance. It was a great feeling to be a volunteer for your own country.”
Today, International Medical Corps, in coordination with local authorities, is focused on recovery efforts including: building local capacity for mental health services, improving access to clean water and sanitation facilities in schools, and enacting an integrated treatment of malnutrition program. These activities will allow the residents of these storm-ravaged areas to become their own First Responders by making their communities more resilient in the face of any future disasters.
Yesterday (November 14th), an International Medical Corps team, including medical staff and water, sanitation and hygiene experts landed in Guiuan, on a remote island of the Philippines. They were met by hundreds of people on the tarmac, and immediately begin providing medical relief.
Typhoon Haiyan made landfall at Guiuan, knocking out water, power and communication. Two of the island’s three hospitals have been completely destroyed. Our teams have provided medical care for infected wounds from flying debris; upper respiratory infections; and complications from a lack of available medication for chronic diseases, such as diabetes. There have already been cases of diarrheal disease caused by a lack of clean drinking water, and local health officials fear an increase in cases of tetanus, dengue fever and measles in the coming weeks and months.
Just two hours after the team landed, we spoke to Margaret Aguirre, a member of our Emergency Response Team, and she noted "We were able to see the scope of the devastation. It was immense … Whole villages were flattened … We brought in food, water and medicine with us, and we’ve already begun treating patients … There are whole villages in Guiuan that have not been reached yet. That’s where we are going to be going.”
To meet the needs of the people of Guiuan, International Medical Corps is operating mobile medical units and providing access to clean water and hygiene promotion to thwart the spread of disease.
International Medical Corps has deployed a ten-member international Emergency Response Team that includes Medical and WASH professionals, and has recruited 40 local medical volunteers to staff mobile medical units in and around Tacloban and Tanauan. Mobile medical units will provide health care services, with a special emphasis on child and maternal health, including nutrition monitoring; medication; clean water, hygiene awareness and promotion; and psychosocial support and training in this area for frontline health care workers. In addition, International Medical Corps will provide a surgical team in Tanauan. As we begin delivering services, International Medical Corps will also continue assessing additional communities affected by the storm to provide health care and services to those who need it most.
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