Joy and Hope

By Lilia G. Hernandez, M.D.

To all those I know or have met: There is very little I can do; I can at least write about them and the people who dedicate their lives to help them.

Many donors, local and international, have expressed the desire to direct their aid to rehabilitation, even only a few days after Typhoon Haiyan, called Yolanda locally. There seemed to be adequate international emergency response. Many however were aware that the rehabilitation of the people will take months, if not years. 

On the first 2 weeks of March, I went with a team on medical missions to Burauen Leyte, ravaged by Yolanda in Nov, and visited Tacloban City on my own; then to Inabanga Bohol, destroyed by an earthquake a month earlier. On March 22-23, I went with the same team for psychosocial follow up visits to Daan Bantayan and San Remegio, both at the northern tip of Cebu mainland. Part of the team proceeded to the island of Quinatarkan. All these were hard hit by Yolanda.

Dr. Lilia Hernandez examines a patient during 

the medical mission in Burauen, Leyte on March 8, 9, 2014.

What I came away with these experiences were joy and intense sorrow and some confusion. Joy and hope with the dedication and focus of the community workers. Joy and hope at the resilience and Faith of the people, many whom described themselves as "malampuson ug naningkamot" (persevering and keeps trying).

When I returned to the Holy Spirit Convent to spend the night, before I took the ferry home, I knelt before the Blessed Sacrament and cried. Tears could not have burned hotter in my confusion: why O God do so many have so little, suffer so much, yet thank God first of all for their survival; and why do those who have so much, pay so little, think of the poor as lazy? Why are the nations so responsible for pollution that changes the climate, not bear the brunt of its tragic effects? Where is justice? How can modern youth keep Faith, seeing this so universal unfairness: the 1% vs the ninety nine? Is the parable of the rich man and the beggar Lazarus at his gate really believable?

Donors need not be concerned. In the over 36 years I have been away from the Philippines, many sectors have achieved pride in their nationality and identify with its people, the majority of whom still remain poor or live very remotely. The "1% vs the ninety nine" cannot be owned by any country. Many Americans already claim this.

What I had the privilege of witnessing and working with were groups of citizens who have coalesced to be relief workers in disasters; community organizers, teachers and conduits of aid from international agencies during recovery and "normal" times. Most are young who have spent part or much of their lives, part time or full time, trying to realize their idealism: health professionals or graduates of the Arts, farmers, fisher folk, housewives or school dropouts.

When I discussed with a Washington psychiatrist about training the community workers on the psychosocial aspect of disaster response and rehabilitation, I was very happy thinking it was a novel idea. But they were on the 3rd year of intermittent training, which started when they realized the need after a medical mission following the 2012 earthquake in Guihulngan Negros Oriental. The workers were grateful for the present funding, as it allowed the hiring of professional speakers to train more workers and give updates to those previously trained.

VPHCS psychosocial team poses with residents 

in Barangay Mohon, Daanbantayan, Cebu, during their second 

psychosocial session this March. 

Dr. Lilia Hernandez is seated on the extreme right.

The Visayas Primary Health Care Services is the team I have worked with for decades, and for whom the FilAm Center for Community and Development (FACCHD) has given financial support since 1995. The "development of relevant, effective, affordable, and accessible health care" is its goal. Over the years, it has linked with many other privately funded groups: CERNET (funding from Germany); FARDEC (funding from Bread for the World); MAGNA (funding from a Protestant group) etc. Some of the organizations they link up with (MAGNA for example) worked through the DOH or DSWD during this disaster, such as in the psychosocial training. So I am hopeful that with the same training given to governmental agencies, they too will conscientiously conduct the psychosocial sessions I have seen being done on my trips.

These psychosocial interventions happen after the initial relief services of food and temporary shelter distribution and response to immediate health care needs. As one community leader aptly put it "after a natural calamity always follow health problems." (Human sa katilingban, musonod gyud ang problema sa panglawas.")

There are at least 3 sessions lasting half to a full day each. The first session is allowing the community to unload; very emotional, many express grief, some express anger; children sessions apart from the adults. The teams bring the food which the communities prepare or cook so everyone can eat until the session is over. Sessions are facilitated initially by psychologists in the presence of those trained in disaster responses. Subsequent sessions are conducted by the trained community workers.

The community is then allowed to process and come to grips with their loss and new situation: lost means of livelihood or crops, homelessness, etc. The team returns several weeks later for a follow up session. This time the facilitator tries to evoke responses by allowing each to draw the Tree of Life: the roots are his/her name and Barangay, the trunk how the person perceives her or himself; the leaves are his/her dreams; the fruit what gives happiness and to write on the side who he or she wish to thank. The third session is brainstorming and planning with the people on what they can do for disaster preparedness, with the trained facilitator giving pointers/ideas that the community might decide they can adopt.

In the Barangays I went to, the families decided to form into a cohesive group. FARDEC or Farmers’ Development Center will supply materials for reconstruction; labor will be "bayanihan" or community effort.

I reviewed the drawings before they were returned to the people. Their self-perception was encouraging: malampuson or persevering; maloloyon or compassionate, matinabangon or helpful. Their dreams were so universal; except for "makatindog akong balay" or reconstruction of my house, many wrote the education and prosperity of their children. Who they felt grateful to had one consistent answer: God. Then came family and the relief workers.

There is much more that need to be done; many more resources needed from government and private sectors. But I feel hope that with a little material help, these people shall rise again. Their lives are simple; their needs are the basics of life. 

Come to think of it, maybe the wealthy need our prayers more, "kay ang mga pobre kanunay nga dunay malampusong pangandoy". (For the poor always have their persevering hope").

-----------------------------------------------

March 24, 2014

Lilia G. Hernandez, M.D. is a very good friend of the VPHCS and an ardent advocate of community-based health programs in the Philippines. She practices pediatrics in California and visits the Philippines regularly to render her services in the communities served by the VPHCS. She is the President of the Board of Trustees of the Fil-Am Center for Community Health and Development (FACCHD) in Pleasanton, California which has supported the VPHCS since 1995. 

She is a graduate of the University of Santo Tomas, Class 1974 and a Silver Jubilarian Awardee for Community Service in Philly (1979). She wrote these reflections to her classmates in the USTMedicine1974@yahoogroups.com on Mar 24, 2014. 

Psychosocial support services for survivors of Typhoon Yolanda in Northern Cebu

The Visayas Primary Health Care Services, Inc. (VPHCS) conducted a series of psychosocial support services missions in February and March in 20 barangays in nine municipalities and one city in Cebu which were affected by Typhoon Yolanda. 

VPHCS staff Irish Grace Ramirez discusses 

about disasters in Malbago, Daanbantayan. February 16.

The missions sites were as follows, namely: Barangays Kampinganon, Lipayran and Patao in Bantayan, Barangays Kaungkod, San Agustin, Bonacan in Madridejos, Barangays Bateria, Malbago and Tominhao in Daanbantayan, Barangays Bitoon, Langub and Hagdan in Kinatarcan island, Sta.Fe., Barangay Tambungan in San Remegio, Barangays Pulambato and Gairan in Bogo City, and Barangays Cagcagan, Northern Poblacion, Puertobellow, Kawit and San Juan in Camotes Island.

 A children's play therapy in Lipayran, Bantayan, February 23.

 In Lipayran, Bantayan, Feb.23

In Camotes, March 2.

The weekly missions started in February 8 and shall last until end of April.

The services are part of the rehabilitation project, Building Resilient Communities In Facing Natural Calamities – Phase I, implemented by the Central Visayas Farmers Development Center (FARDEC) with the support of the Action Aid.

The six-month project aims to provide relief, housing materials, livelihood assistance, and rehabilitation services to families in the 20 barangays that were affected by the typhoon. It also aims to organize people’s organizations that shall become resilient in facing future calamities including formation of working committees on disaster preparedness. 

The psychosocial missions of the VPHCS are part of the rehabilitation services for the affected families.

VPHCS volunteer Pearl Templado 

in a psychosocial session, Camotes, March 2.

Each psychosocial intervention started with a disaster education which mainly consisted of information regarding the scientific explanation of the occurrence of earthquakes, typhoons, landslides, and floods and other calamities, and basic information on disaster preparedness and management. This information would not only increase knowledge of the affected communities but would also ease their tensions as they can now explain scientifically the causes of disasters. Even the basic knowledge on what to do during disasters is a form of healing for the affected communities. 

After the lecture on disaster education, discussion on the “Impact and reaction to trauma” was held which deepened the different effects that typhoon Yolanda had on the people, including economic losses, emotional, social, mental, behavioral and physical ailments. This was followed by a discussion on the “Five steps for psychosocial support” which outlines the five role of a psychosocial caregiver in the community, namely: active listening, relive and regrieve, recreation, rebuild and referral. 

Mothers in Camotes island share their stories, March 3.

After the forum, a pre-test was conducted on the assessment of the feelings during the disaster and a post-test of the feelings felt at present. The two tests were filled up by all the survivors that would identify those who needed psychosocial therapy.

This was then followed by stress debriefing through group therapy. Here, the residents were grouped into groups of 10 to 20. Each group had a therapist who facilitated the survivors to express their experiences and their feelings before and during the typhoon, and how these affected them . They narrated their flashbacks of what happened during the typhoon. They shared symptoms they had after the disaster that included headaches, difficulty of sleeping, feelings of anxiety, irritability, inability to concentrate, lack of appetite, depression, nervousness, symptoms of numbness of feet, pounding of the heart, and stomach problems. 

The residents said they didn’t expect Typhoon Yolanda to be that strong. There was extreme fear that another typhoon would occur again which could even be stronger than Yolanda. 

They also answered the facilitators’ questions on what they did to conquer their fears, what keeps them to move on with life and what are their coping mechanisms. It was heart warming that the people clinched to their hopes with the consolation of being still alive. 

Most of them said that they need to move on since they have families, and that their peoples’ organization was actively looking after the welfare of the members, especially in the orderly management of relief operations being extended by many civic and charitable organizations. 

Residents in Bogo City pose 

with the psychosocial team, February 23.

Many also said that they have attributed their strength in their conviction and belief that there was still the existence of God and this faith would alleviate their emotional and psychological burden. 

At the end of each session, the facilitator identified those who really needed psychosocial and psychiatric treatment for them to fully recover from their trauma.

The children had psychosocial activities. In play therapy, the facilitator engaged groups of children in play in order to draw out their feelings of fear and anger. The facilitator then processed the emotions expressed during the play. In art therapy, the children expressed their feelings through drawings after which the facilitator processed the projections of the children. The children enjoyed their play and art therapy as they shared their drawings to everyone. They also shared experiences during the disaster. The team didn’t see any abnormal behaviour during their play and drawing sessions. 

Two follow-up psychosocial sessions were expected to be held per barangay after the initial session, in order to ensure full recovery of the affected individuals.

When disaster hits home

By Lilia G. Hernandez, M.D.

I arrived in the Philippines March 1st and I would like to share very powerful experiences in the past 2 weeks.

I had not been to Aceh Indonesia after their tsunami or to Haiti after their destructive earthquake. But in the past 10 days, I have been to Leyte and Bohol. The damage here may have been on a lesser scale, the earthquake in Bohol; the typhoon in Leyte. But the disaster cannot be less for the residents.

Tacloban has never been “home” in my heart. However, my father was born there and there grew up a “canto boy” till self-awareness and love brought him to Manila to better himself. To Tacloban he returned on the last 4 years of his life. And there I lived and studied my Pre-Med. All of us emigrated, but 3 nieces and a nephew still live there. So, after a medical mission in the remote barangay Dinaayan in Burauen, Leyte, I went to Tacloban City.

The devastation seen as one drives through the streets, now open but not quite repaired, is so mind numbing, one either gets used to the sight and cease to be affected, or gets so distressed one has to have a sense of humor to stay sane. Some of the highway center islands were made into burial ground with crosses and mourners visible still. Even the coconut trees tell the story: like a woman with disheveled hair blown by the wind from her back, the coconut palms are in one direction, telling of the force and direction of the wind. Many stand like amputated arms reaching out from the ground, probably wailing with the people when the storm passed. Wailing could still be heard where people are trying to rebuild. The day I arrived, people talked of 4 more dead bodies found in San Jose, 4 months to the day after the killer typhoon.

CNN showed a powerful image of a huge red and black cargo ship beached by Yolanda. There is not one but 2 ships, however, one slightly smaller to the right of the well-publicized one. Imagine the people killed when the ship plowed over the houses on its way up the slope of the hill to its current location. Today shanties of tarp and recovered materials have been hastily rebuilt between the shore and the ship. I saw men working on the hull, and one lowering a pail to get water from a well beside the ship. Possibly, that was the community well long before the ship changed the landscape.

Everyone I met in Tacloban had a story to tell. The one that hit closest to home was about Michelle, my niece, who but for a wire attached to a fence, could have drowned. She, her 16 yr. old daughter and 1 yr. old son and the son’s father, Rodel, all live in a squatter area close to the sea, the area swept by the 30 ft. storm surge. She described early morning of Nov 8, 2014, when all of a sudden, the water was up to her neck. She and her daughter tried to cross the street to a fenced park on the slope of a hill. They were able to stand on the fence, holding on to a “wire on the fence” to keep their heads above the water. Rodel and their infant son were helped by the neighbors to cross to the hillside. Mercifully, she said, the water did not stay long, “it was sucked back by the sea”. They then walked higher up the hill towards the City Hall where there were other government buildings. Together with the other survivors they stayed there for over 36 hours, wet and cold, with no food or water. On Sunday (the typhoon hit Friday morning) they started walking to Quarry, the district where her sister and Rodel’s family lived. Michelle and her family suffered the trauma of near death experience; their house, all the food kept in preparation for the typhoon, all their clothing and belongings swept by the storm. What remained was buried in mud. Still hopeful, she retrieved her and her daughter’s uniforms, and tried to wash them back to some decent appearance. All employees and students go to work or school in uniforms. Talk of the resilience of Filipinos! And there are many more sad stories told by the residents but also of compassion and heroism.

Bohol is the island where I live when in the Philippines. Last weekend, I joined a team for a medical mission to Barangay Cambitoon, in Inabanga, close to the epicenter of the 7.2 quake in October. Along the way were the ruins of Bohol’s pride: the 17th century Catholic Churches. Made of cut limestone, the beautiful Loon and Clarin Church were literally pulverized. What remains are mounds of whitish sandy material! I have not seen the ruins of the other churches. Quite visible from the highway are the damaged homes; a few 2 -3 story structures sunk into the earth, with only the top floor visible.

As I sit to meditate on the events of the past 2 weeks, it only helps me to realize again and again, there is a Force greater than man. And there is an inherent goodness in the human heart.

Pediatrician Dr. Lilia Hernandez serves during the medical mission

in Inabanga, Bohol on March 15, 2014.

------------------------------------------------------

Lilia G. Hernandez, MD

March 17, 2014

Lilia G. Hernandez, M.D. is a very good friend of the VPHCS and  an ardent advocate of community-based health programs in the Philippines. She practices pediatrics in California and visits the Philippines regularly to render her services in the communities served by the VPHCS. She is the President of the Board of Trustees of the Fil-Am Center for Community Health and Development (FACCHD) in Pleasanton, California which has supported the VPHCS since 1995. She is  a graduate of the University of Santo Tomas, Class 1974 and a Silver  Jubilarian Awardee for Community Service in Philly (1979).  She wrote these reflections to her classmates in the USTMedicine1974@yahoogroups.com on Mar 24, 2014.  

Homeopathy services

The Visayas Primary Health Care Services (VPHCS) continues to render homeopathy services for indigent patients under the tutelage of German homeopathic doctor Norbert Enders.

In its recent mission Jan. to March this year, Dr. Enders, a member of the French organization Solidarite Homeopathie (SH) saw and treated more patients coming from urban poor communities in Cebu City. Dr. Enders also rendered his services for poor farmers during medical missions in Barangay Dinaayan, Municipality of Burauen in Leyte, Barangay Cambitoon, Municipality of Inabanga in Bohol, and Barangay Planas, Guihulngan, Negros Oriental. These are mountain barangays that were affected by the past typhoons and earthquakes. 

Dr. Enders sees patients in a medical mission 

in Burauen, Leyte on March 8, 2014.

Dr. Enders who is practicing in France has been training the staff of the VPHCS staff on the practice of homeopathy and treating indigent Cebuanos with homeopathy since 2008. He has given the staff systematic, comprehensive and quality trainings on the basic theories and practice of homeopathy, different remedies and indications, common illnesses and remedies, making a patient profile and arriving at a remedy, and other topics on homeopathy. Actual patients were also seen and treated during the trainings aside from lectures. 

Clinics of the staff with Dr. Enders were held during his recent mission in Sitio Lawis in Barangay Pasil and Sitio St. Mary Grace in Barangay Talamban, both of which are poor communities in Cebu City More than 200 patients were seen, treated and managed properly with homeopathy. Records and pictures of each patient were properly taken and kept in the office computers for documentation and file purposes. The trained staff actively treated the patients with Dr. Enders. Most of the patients who were also seen the past years claimed improvement of their symptoms with their treatment.

A pose with children in Dinaayan, Burauen, Leyte.

Homeopathy is a non-toxic system of medicine used to treat illness and relieve discomfort of a wide variety of health conditions. It is practiced by health care providers including medical physicians, chiropractors, homeopathic physicians, midwives and many others throughout the world.

Founded by German doctor Samuel Hahnemann in the 1790s, homeopathy is the art and the science of healing the sick by using substances capable of causing the same symptoms, syndromes and conditions when administered to healthy people, treating like with like (Similia similibus curentur), aiming to stimulate self-healing processes. 

 With local residents in Dinaayan, Burauen, Leyte.

It is a form of complementary and alternative medicine (CAM).

Homeopathy uses over 2,000 different remedies which are chosen to suit a patient's characteristics, as well as to treat his symptoms. Information on such remedies has been collected for nearly 200 years. Clinical cases and recent scientific trials using these remedies have been documented.

Medical mission in Bohol

In its continuing response to the October 15 earthquake and Typhoon Yolanda disasters, the Visayas Primary Health Care Services, rendered another medical and psychosocial support services mission for survivors of the calamities. 

Geriatric patients wait for their turn to be checked up.

 Dalaguete MHO Dr. Jose Edgar Alonso examines a patient.

The mission was held last March 15 in Barangay Cambitoon, a far-flung barangay in the town of Inabanga, Bohol where the epicenter of the earthquake hit. More than 250 patients availed of medical check consultations and medicines and psychosocial counseling. Some patients came from neighboring mountain barangays. 

The medical and psychosocial services mission was supported by the Fil-Am Center for Community Health and Development (FACCHD), Task Force Carabao, and Action Medeor. It was held in coordination with the Nagkahiusang Mag-uuma sa Inabanga (NAMAINA), the local government unit of Inabanga, and the Barangay Council of Cambitoon 

Cebu Institute of Medicine medical intern 

Giancarlo Bascon sees a patient.

Velez Hospital PGI Dr. Nikko dela Cruz and 

Cebu Institute of Medicine medical intern 

Karina Borromeo see patients.

 Cebu Velez Hospital PGI Vaughn Cesar Edulan 

explains to a patient her treatment.

The medical and psychosocial team was composed of VPHCS staff and volunteers Dr. Petty Orbeta de Castro, Dr. Lilia Hernandez, Dr. Norbert Enders, Dr, Jose Edgar Alonso, Dr. Erlinda Posadas, Dr. Grace Molina, Irish Grace Ramirez, R.N., Cebu Velez General Hospital post-graduate interns Dr. Vaughn Cesar Edulan, Nikko dela Cruz and JP Sepe, Gullas College of Medicine medical interns Irving Grecia and Stacey Lape, Cebu Institute of Medicine medical interns Karina Monica Borromeo, Giancarlo Bascon, Christine Escarpe and Charles Mark Loquere, and nursing students belonging to the Student Alliance for Community Health Services (SACHS) based in Tagbilaran City. 

A pose of the medical team.

Medical mission in Leyte

As it expands its medical services for families affected by Typhoon Yolanda outside the Cebu province, the Visayas Primary Health Care Services, conducted a medical and psychosocial support services mission in Barangay Dinaayan, a far-flung mountain barangay in the municipality of Burauen last March 8, 9.
 

Barangay Dinaayan is a rural community in Burauen, Leyte 

which was affected by typhoon Yolanda.

More than 250 patients from Dinaayan and neighboring mountain barangays of Damulo-an, Villa Corazon and Buenavista availed of free medical check-ups, consultations and medicines and psychosocial counseling.

Medical interns of the Cebu Institute 

of Medicine examine patients.

Burauen is a first class municipality in the central part of Leyte, about two hours travel time from Tagbilaran. It was badly hit by Typhoon Yolanda; coconut trees and crops were destroyed and houses were damaged. There were however no reported deaths.

More than 250 patients from the four 

mountain barangays were seen.

The mission was supported by the Fil-Am Center for Community Health and Development (FACCHD) and Action Medeor. It was held in coordination with the Tabang Sinirangang Bisayas and Health Empowerment and Action in Samar and Leyte, two non-government organizations based in Eastern Visayas. 

The medical and psychosocial team was composed of VPHCS staff and volunteers Dr. Petty Orbeta de Castro, Dr. Lilia Hernandez, Dr. Norbert Enders, Dr, Jose Edgar Alonso, Dr. Erlinda Posadas, Dr. Grace Molina, Dr. Oliver Gimenez, Irish Grace Ramirez, R.N., Lourdes Geolin, Crescenciana Labitad, Angelie Marangga, Boy Tamundo, Katrina Buena Balansa, Jade Ann Vega, Pearl Angeli Templado and Cebu Institute of Medicine medical interns and Gullas College of Medicine medical interns.