Disaster Medical Assistance in Super Typhoon Haiyan: Collaboration with the Local Medical Team That Resulted in Great Synergy
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SHORT REPORT Disaster medical assistance in super typhoon Haiyan: Collaboration with the local medical team that resulted in great synergy Hoon Kim, M.D.,1 Moo Eob Ahn, M.D.,2 Kang Hyun Lee, M.D.,3 Yeong Cheol Kim, M.D.,4 Eun Seok Hong, M.D.5 1Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea; 2Department of Emergency Medicine, College of Medicine, Hallym University, Chuncheon, Korea; 3Department of Emergency Medicine, Wonju College of Medicine, Yonse University, Wonju, Korea; 4Department of Trauma Surgery, National Medical Center, Seoul, Korea; 5Department of Emergency Medicine, Ulsan University, Ulsan, Korea ABSTRACT BACKGROUND: On 8 November 2013, Typhoon Haiyan made landfalls over the center of the Philippines and devastated the region. Soon aftermath of the disaster, many foreign medical teams (FMTs) headed toward the site, and the Korean team was one of them. METHODS: This study described the experiences of the team during the initial phase of response, focusing on collaborative efforts with the local medical team. RESULTS: The Korean team was capable of providing primary care, and the Filipino team provided incomplete secondary care which was insufficient for covering the patient load. Not only did the Korean team provide electricity for hospital operation and various materials, but also supplemented medical personnel, who covered the emergency and outpatient departments. Collaborative efforts filled in each other’s gap, and resulted in great synergy. CONCLUSION: Disaster medical relief mission of FMTs should be cooperated with a coordination mechanism. Collaboration with the local resources can be a great opportunity for both parties, and should not be overlooked in any disaster situations. Key words: Collaboration; disaster; typhoon. INTRODUCTION million households. Nearly one million families lost their houses while four million people were displaced.[1] Category 5 tropical cyclone Yolanda, known as Super Ty- phoon Haiyan, devastated the Philippines on November 8, Most hospitals and health facilities in the typhoon-hit areas 2013. As of January 29, 2014, the death toll had reached 6201 were seriously damaged, and in Tacloban, only one public hos- with 1785 missing according to the Philippines National Di- pital remained functional following Haiyan.[2] saster Risk Reduction and Management Council (NDRRMC). The report of the agency revealed that 28.626 were injured. Soon after the tragedy, international aid mechanism was op- The typhoon affected fifty-seven cities and more than three erational, but suffered many difficulties due to logistical prob- lems. The geography of the Philippines produced several simi- Address for correspondence: Moo Eob Ahn, M.D. larly affected regions that could not be reached easily. Not 77, Sakju-ro, Chuncheon-si, Gangwon-do 200-704, Republic of every island was covered by aid agencies in a timely fashion due Korea 200704 Chuncheon, South Korea to tackled logistics. World Health Organization (WHO) set up Tel: +82 - 10-9719-7119 E-mail: [email protected] a coordination center for medical aid agencies in Tacloban and Cebu. Korean Disaster Relief Team (KDRT) was one of the Qucik Response Code Ulus Travma Acil Cerrahi Derg 2015;21(2):143-148 foreign medical teams (FMT) that provided medical service in doi: 10.5505/tjtes.2015.54770 Tacloban. KDRT was deployed on November 15, and started to provide medical service as of November 16 in St. Paul’s Copyright 2015 TJTES hospital, Tacloban City. St. Paul’s hospital was also severely damaged and partially operated by the Filipino medical team Ulus Travma Acil Cerrahi Derg, March 2015, Vol. 21, No. 2 143 Kim et al. Disaster medical assistance in super typhoon Haiyan deployed from Davao. They treated about two hundred outpa- Table 1. Human recourses of KDRT and Filipino team tients per day, provided minor surgical services while running thirty patient beds at the time of KDRT’s arrival. Four terms of Occupation Specialty KDRT Philippines Total KDRT provided seamless medical services for six weeks there- after, in cooperation with the Filipino healthcare workers. Doctor Emergency medicine 1 1 2 This article highlighted initial cooperation efforts from both General surgery 1 8 9 sides and its effect in hospital function which was greatly en- Surgical oncology 1 1 hanced with cooperation. Orthopedics 1 5 6 MATERIALS AND METHODS Anesthesiology 1 3 4 Internal medicine 1 1 2 The capacity of KDRT and the Philippines medical team was Pediatrics 1 1 [3] classified using WHO guidelines and described accordingly. OB-Gynecologist 1 1 Each team’s role in the hospital was described and hospital General physician 1 1 functions were measured using Inter-Agency Standing Com- mittee (IASC) health service availability checklist form, and Sub total 5 21 26 the status of before and after collaboration was compared. Supporting Nurses 7 12 19 [4] Operational information including daily reports from both Healthcare Nursing aide 3 3 sides were collected to access patient statistics. Workers EMT 3 3 RESULTS Pharmacist 1 1 Composition and Capacity of Both Teams Radiologic technician 1 1 2 Sub total 12 16 28 KDRT consisted of five medical doctors (two emergency Supporting staff physicians, one general surgeon, one orthopedic surgeon, one pediatrician, and one internal medicine specialist), sev- Administrator 2 2 4 en nurses, one pharmacist, one radiology technician, three Engineer 1 2 3 emergency medical technicians, and three medical administra- Logistician 25 25 tors. KDRT was type 1 FMT which could provide outpatient Sub total 3 28 31 emergency care according to the WHO classification. KDRT Total 20 65 85 lacked the capacity to provide maternal-child health care ser- vice and inpatient care, which was categorized as primary service in IASC checklist. KDRT brought various equipment was the post-event 6th day. They provided primary care and for hospital operations which far exceeded type 1 FMT’s ca- limited inpatient care for the victims and handled about pacity. Eight gasoline generators, two blood analyzers, X-ray two hundred outpatients and ten inpatients per day. KDRT machine, ultrasonography, and six patient monitors were in- started to work on November 16, and collaboration became cluded. Essential medicines and consumables covering more stable the next day. KDRT was mainly in charge of the out- than 10.000 patients were also included. The Filipino medical team was composed of twenty-one doctors, sixteen nurses, patient and emergency departments, and the Filipino team and twenty-eight logisticians. The Filipino team provided in- started to focus on inpatient care and surgical procedures. consistent primary and secondary health care services, but Daily number of outpatients increased more than twofold af- soon was overwhelmed by large patient load. Shortage of ter one week of collaboration, and the number of inpatients electricity and equipment like ultrasonography for prenatal was also doubled (Fig. 2, Table 2). Necessary surgeries were care hampered their activities again. After collaboration, performed without compromising outpatient department ca- stable provision of most primary and secondary health care pacity (Table 3). 24 h operations, including the emergency services was enabled 24 h per day. Some tertiary health care department, was enabled due to enough electricity provided services like advanced trauma care were also ensured. Total by the Korean gasoline generators. capacity was upgraded to type 2 FMT, which could provide stable inpatient acute care, general and obstetric surgery for DISCUSSION trauma and other conditions (Table 1, Fig. 1). Sudden onset disaster (SOD) in developing countries usually generate large number of sick and injured that overwhelms the Performance of Both Teams local capacity to respond, mandating international assistance. and the Collaboration Team [5] The Philippines suffer damages from typhoons annually, and The Filipino team started to work on November 14, which established National Disaster Risk Reduction&Management 144 Ulus Travma Acil Cerrahi Derg, March 2015, Vol. 21, No. 2 Kim et al. Disaster medical assistance in super typhoon Haiyan Type 3 DAY 10 17th, November (Inpatient referral care) DAY 7 14th, Type 2 November (Inpatient surgical emergency care) Type 1 (Outpatient emergency care) : Filipino medical team : KDRT : Collaboration team Figure 1. Capacity of KDRT and Filipino team, and collaboration team. Council (NDRRMC) in 2009, which is a working group of port network was hampered during the initial period after- various government, non-government, civil and private sector math of the disaster. After the initial assessment, Korean gov- organizations of the Government of the Philippines to tackle ernment decided to deploy consecutive small medical teams the detrimental effects of natural disasters. Although relative- rather than bulky field hospital unit. KDRT was the one of the ly well prepared to disaster among developing countries, the FMTs in Tacloban. As of November 15, KDRT started to par- intensity of Super Typhoon Haiyan was beyond the respond- ticipate in health cluster meeting held daily in Tacloban. KDRT ing capacity of the Philippines. Most hospitals and health care was assigned to St. Paul’s hospital to help the Filipino medical facilities in the affected regions were not working properly team which took over the hospital with markedly reduced due to structural damage and loss of human resources. Situ- function in terms of shortage of medicines, consumables, ation was worse in the Eastern Samar area, compared to Ta- equipment, and especially electricity. At the time of arrival, cloban in which many FMTs were in operation.[2] the Filipino team strived to accommodate flow of victims, and especially the outpatient and emergency departments Affected regions were scattered in several islands and trans- needed more resources for proper operation. KDRT took 600 100 90 507 500 80 408 417 402 392 402 70 400 361 60 52 300 293 286 304 50 259 261 44 41 39 40 241 232 35 33 34 213 200 173 161 30 24 185 177 161 98 20 100 94 93 90 12 10 0 0 8 0 0 14.