Editor’s note: In early November, Typhoon Haiyan, known as Typhoon Yolanda in the Philippines, was an exceptionally powerful Category 5 tropical cyclone that devastated portions of Southeast Asia, particularly the Philippines, killing 5,260 people and causing many more injuries.
Apalachicola resident Larry Applebee, a physician assistant who currently works as a hospitalist for IPC, took leave from this job to volunteer with Clarion Global Response, formerly IMAT (International Medical Assistance Team) as part of a crew of medical professionals from around the world who flew to the devastated region to help. He has done work like this in Haiti and other places, so he knew some of what to expect.
Applebee’s team started out as with a PA, a nurse, and two paramedics, and later added four physicians and two RNs. The last two days Applebee’s team was back down to him and the RN, so he “freelanced,” traveling to Tacloban and Dagami with other groups, who provided needed medications in appreciation.
Applebee found himself working with professionals from Malaysia, Finland, Germany, the Netherlands and Israel. During his work there, he kept notes with the help of his iPhone which he worked into a journal on the plane trip home.
He describes his writing as “ADHD –like,” but it is startlingly clear in its detail and moving in its impact. The Times is grateful to be able to share it with our readers
Day 1: Travel. Left Tallahassee at 5:40 a.m., which made for a busy day, leaving from Apalachicola at 3 a.m. I had not much sleep as I worked the day before in Ocala, driving home and arriving at 12:30 a.m. The flights have gone smoothly, transfers without difficulty. The airport in South Korea was very modern with all the conveniences. Asiana Airlines was great, service was superb, food tasty.
I'm on the final leg from Incheon to Cebu, wondering what to expect. As I fill out my customs declaration I feel nervous, an anxious anticipation as I remember previous volunteer trips. I remember a very old woman in Haiti, who adopted us and lived on a cot in our field hospital. Of the locals, no one knew who she was, she was obviously demented. She swept and kept the hospital clean-ish . Mostly, she slept.
I remember a little girl; around 10, she came in with her baby brother, an infant. She and the baby were clean, well dressed and healthy in appearance. None of our translators could not get a complaint from her. Yet she hung out with us. I asked her about her parents and I found they were both killed in the earthquake, leaving her to care for the infant. After some questioning, I held her hand and told her that she was doing an excellent job taking care of her brother and he was very healthy. She was all smiles, I think this validation is what she needed.
Now, I wonder what this trip will bring. Hotel tonight, tomorrow back to airport to pick up the rest of the team, then a ferry to Ormoc City.
A quick meet and greet , then to Ormoc district hospital to help in ER. Then we were dispatched to Palompon. This is a level 1 hospital , they had critical care needs.
We bought them meds when we arrived. We found they had docs coming in the next day, but no help the next 24 hours. I arranged to stay. I worked the ER, they gave me a sleep room, I stayed the night and saw a variety of illnesses and injuries. I met a woman there who was having trouble breathing. She had pneumonia, she had a small mixed breed dog at her side, she would not be separated from this mutt. I found out that she lost all of her family and was homeless and alone. I worked the night, the German docs arrived at 8 a.m. and took their transportation back to Ormoc City.
I met a friend from my Haiti mission: Tim, a surgical PA, he needed help in Dagami. They left me in charge of minor surgery, patients with infected wounds, and the medical needs. Me and a nurse saw 20 wound infections. I sutured 12. I saw my first tetanus. I saw a child with measles, three children with chicken pox, one with infected pox. I am amazed at the resilient, homeless, sick but always smiling. They are working hard at rebuilding their homes, but in the process are lacerations are common. The Germans docs arrived and I took their transportation back to Ormoc City, 100 kilometers away.
The next day we went together as a team and manned the ER at Ormoc district hospital. Truly an international affair. The ambulance (manned by Japanese docs) brought us patients, many tuberculosis, dehydration, etc. Here we delivered babies. More wounds, burns. It is interesting to note how this hospital functions. They write prescriptions when they admit the patients, they give the orders to the patient and the patient buys the meds and theses meds are used during their stay.
It was her that I encountered a 21-day-old infant in respiratory in distress. This baby was intubated the day before with a presumed RSV (respiratory syncytial virus), now with a secondary pneumonia. The tube had advanced and had to be repositioned. The baby died the next day as we were unable to transfer her to the Chinese hospital ship. This ship has ventilators, intensive care docs, and is state of the art. We had arranged the parents to do so; they had a room on the ship. Sadly, due to politics we were unable to transfer and the baby died the next morning
At our first clinic at a local church where we were assigned, we saw about 75 patients in a shortened day. There were some injuries from the typhoon and a lot of illness from the contaminated water and the smoke in the air from burning debris (intentionally burned for disposal). There were also several with chronic illness and a significant number of those who were severely stressed by their circumstances who can’t sleep or who somaticize (Note: Anxiety converted into physical symptoms).
After clinic, we took a tour of the still mass of wreckage and debris. There were children playing and laughing, although the smell of rot was pervasive. The smells, an order hard to describe, a combination of diesel fuel, human and animal wastes and death.
The views were stunning but after a while, you just felt a waterfront. One of us commented that it was sad that the parents had lost a baby and didn’t know where the body was. The bystanders said that the parents were probably dead too. I no longer felt numb, I felt a little sick…
Then we moved on to Ormoc, a functioning city. The economy is turning back on and the health of the people isn’t too bad. The streets are bustling with activity. Tacloban, on the other hand, has disintegrated. There are many internally displaced persons from Tacloban in Ormoc despite the 100 kilometer distance.
Seems the more tired I got, the less clear my journal became.
I love this kind of work, wanted to stay longer. The destruction, loss of family, etc. is horrible. The peeps are noble, gracious, humble and very hard working. I especially liked working the fishing villages, As I saw a parallel between them and our community. The 14-year-old who lost all her family and clinged to her small dog for comfort, sad, heartbreaking.
In the Philippines, a great miracle happened. First came the once-in-a-century typhoon of such ferocious strength. Next came the demonstrated resilience and faith of the Filipino people. A smaller miracle, perhaps; the effect on my own heart, filled with so many testaments of hope.
As I return home from the Philippines at this Christmas season. I think how the messages of the holidays are so relevant: wherever we are in the world, we have reason to be thankful, and wherever we are, we can triumph over something that seems more powerful than we are. In this case Typhoon Haiyan. I do have a sense of guilt for not staying longer.
I am warmed by the light of these stories.
This story was told me from another group in a nightly get-together. We used these as a nightly de-stressing. Also a few beer.
Perla, the girl with the violin: A 14-year-old girl emerged from the clinic after being treated for a minor wound, she had a violin in hand. She was reportedly reluctant to accept any assistance because she had to allow someone to hold her violin. She finally let a nurse hold her violin. Finally, someone asked if she felt like playing something. She stood up and played the Philippine national anthem to applause and hugs from those around her.
Reyna: I tried to engage this young lady in conversation, getting info on her present illness. She had a bronchitis. Seeing she didn’t want to talk, I didn’t make further attempts. It was near lunch, so we gave her something to eat. After she ate she gave me her name and said, “I’m sorry I can’t talk now. I’m still in mourning – I lost six family members.” At that point, I couldn’t talk either.
We reached remote Guiuan, a village of about 45,000 that was among the first areas hit by the full force of the storm. The situation here is bleak. The village has been flattened -- houses, medical facilities, rice fields, fishing boats all destroyed. People are living out in the open; there are no roofs left standing in the whole of Guiuan. The needs are immense and there are a lot of surrounding villages that are not yet covered by any aid organizations. We set up our clinic in what used to be a church with makeshift tarps to keep the rain out and set about seeing patients.
Saw 300 today, a variety of injuries, illness, diarrhea, upper respiratory illnesses.
Today we came across a young Mary Anne Moraleta who survived the storm surges of Super Typhoon Yolanda. While hopping from house to house, however, she got her foot trapped between ripped off roofing from her neighbor's home. The wound has been bandaged but not cleaned. She's scared to have it cleaned at a nearby because of the language barrier.
"Siguro kung Pilipino, okay ako, at least p'wede kong sabihin na dahan-dahanin," she said. (I'd be okay if medical workers were Filipino. At least I can tell them, please be gentle.)
"Resilient" is an overused word to describe Filipinos when disaster strikes, but it's what Matsuda would use for the victims of Yolanda. "May mga ngiti pa sa mukha nila, so medyo relieved na ako," he said. (There are smiles on their faces so I'm a little relieved now.)
But amid the widespread grief and despair, it was the extraordinary courage of the Filipinos that struck me most.
On my final day in Ormoc City , I saw a group of people walking back to town. It started to rain, a man looked up to the sky and asked out loud, "How much longer? How much longer?" I wished I had an answer for him. There was little I could do, little that I could give. I only had some cereal bars and crackers in my backpack. I gave these and my beef jerky and he graciously said thank you and smiled.