HEALTH CLUSTER Situation Report No 17 • The / Typhoon Bopha (Pablo)

A. Cluster Details 1. Lead Organization: Department of Health / World Health Organization

2. Cluster Website:

3. Focal Point Contact Details: Dr Gerardo P Medina Technical Officer Emergency and Humanitarian Action WHO Mobile # 0908 863 3163 Landline 02 528 9765 Email: [email protected]

B. Reporting Period 1. Report Number: HC Sit Rep No. 17

2. Report Date: 4 March 2013

3. Time Period Covered: 18 February to 3 March 2013

C. Humanitarian Situation

 From the DOH Health Emergency Alert Reporting System (HEARS) Update as of 4 March 2013, the casualties from Typhoon Pablo remain at 1,146 deaths, 2,956 injured, and 834 still missing. No new fatalities were added to the official list of the DOH for this reporting period.  In Compostela Valley: All rural health units are functional and rendering routine health services. Some of the reported totally damaged BHS in Compostela (1), (3) and (3) are now temporarily repaired and partially functional. In the past weeks, births were attended only in RHUs. But in this last week, majority of births are now delivered in BHS attended by assigned midwives. Aside from deliveries, other routine health services are increasingly being rendered again in BHS by local health staff like medical consultation, immunization, vitamin supplementation, and pre- and post- natal checkups. Referral system continues to function as patients needing higher level of care have been taken in from the BHS to the RHU and to the Compostela Valley Provincial Hospital as needed. Some barangays, though, in the municipalities of Compostela, Montevista, Monkayo and New Bataan were flooded due to the effects of Tropical Depression Crising. Road conditions remain the hindering factor in the regular provision of health services in hard to reach areas in the municipalities of Laak (Kidawa and Limot), Compostela (Panasalan, Bagongon, Ngan, New Alegria). Previously scheduled medical outreach mission in these were postponed and rescheduled.  Health services in the Boston-- (BBC) area continue to be steadily rendered more and more by local health staff, augmented by the DOH. Mobile health teams still play a big role in rendering healthcare in more far-flung areas. A number of key health facilities are undergoing repair supported by the LGU, DOH, and cluster partners like MERLIN and ICRC. The RHUs will go back to rendering OPD consultations only at the beginning of March, which most likely increase the demand for in-patients services at Cateel District Hospital. Improved road conditions from the capital Mati City to Caraga to Boston should improve further health service. However, the recent tropical cyclone “Crising” has caused flooding and displacement anew which may affect the health status and health service delivery in the areas, especially the municipality of Caraga (pop 36,464 individuals/ 6,855 families/ 4,970 children aged below 5 years), which has not been a recipient of any major Pablo assistance, unlike its three neighbours to the north.  Since Surveillance in Post Extreme Emergencies and Disasters (SPEED) reporting as started in December, the top health conditions prompting consultation in Compostela Valley and Oriental have been acute respiratory infections, fever, wounds and bruises, high blood pressure, and acute watery diarrhea. Partners likewise report other reasons for consultation which include myalgia, UTI and skin infections, among others. Health conditions reported via SPEED warranting special attention include acute malnutrition, suspected measles, suspected acute hemorrhagic fever, and measles-like symptoms with joint pains in .  For the reporting period, the three leading causes of admission in the Cateel District Hospital are acute gastroenteritis with dehydration, acute respiratory infections, and normal spontaneous vaginal deliveries (NSVD).

D. Humanitarian Response

Coordination and Information Management:  Cluster coordination continues to be decentralized at the local government unit level. o In Compostela Valley: . Health and MHPSS clusters have been organized at the provincial level, with cluster meetings undertaken every two weeks or as needed. . Information management and sharing has been enhanced with the community health data boards updated weekly at the RHU, detailing key information including presence of mobile teams and delivery of routine health services. o In Davao Oriental: . MHPSS cluster has been organized and strengthened at the provincial level while health clusters have been organized locally specifically in the three municipalities, namely – Boston, Baganga, and Cateel. Local/municipal health clusters meet regularly for updates and concerns. . Quad-cluster meetings (Health, MHPSS, Nutrition, and WASH) and MHPSS cluster meetings have been scheduled weekly. o The WHO continues to support the Department of Health and respective Provincial Health Offices in the coordination and information management work related to health and MHPSS clusters. Essential Health Services and Supplies  Essential health services and supplies support continue to be rendered to local government health personnel by mobile health teams (composite teams rendering medical, MHPSS, WASH, and/or nutrition services) from the DOH central office, other DOH regional offices, DOH and LGU hospitals and health cluster partners like WHO, UNFPA, MERLIN, IOM, the Philippine Red Cross and its partners, among others.  The WHO provided a tent to Cateel Rural Health Unit which will serve as the temporary consultation area/OPD area while the RHU repair is ongoing.  MERLIN teams continue to provide medical consultation, antenatal and postnatal care, nutrition assessment, distribution of RUSF, health/hygiene promotion, breastfeeding promotion, and measles immunization to 21 barangays in the BBC communities. MERLIN has three mobile team clinics that provided services to 3,300 in these areas for the reporting period.  Furthermore, MERLIN has completed rehabilitation of the Cabasagan BHS in Boston and the Taytayan and San Rafael BHS in Cateel. They are currently supporting the rehabilitation of three other BHS in Cateel, two BHS in Boston, and one in Baganga. The rehabilitation of the BHS also includes refurbishment of medical and non-medical supplies.  The Philippine Red Cross, continue to provide health services through its Emergency Health Stations, setup in Lucod, Baganga. They are also providing psychosocial interventions to children through play and art therapy. Health services are also being rendered by PRC is New Bataan at the Tent City and Bantacan Elementary School.  ICRC continues to provide basic health care services through its health post. Furthermore, they also provide assistance in the provision of food for the watcher in the hospital.  IOM supports the ongoing MHPSS Basic Training for BHWs and community leaders in Davao Oriental. They have also deployed health staff (nurses) starting 20 Feb 2013 to augment the RHU staff in Baganga. Transportation support for patient referral from Baganga to Cateel District Hospital has likewise been provided by the organization.  In Compostela Valley, IOM continues to render medical services in their established health station in Compostela Tent City.  Save the Children has finished with the series of CMAM-IYCF Training for BHWs and BNSs which will then be followed by trainings on outpatient treatment program for RHU health personnel for MAM cases and inpatient treatment program for Cateel District Hospital health personnel for SAM cases.  Ateneo de Davao COPERS Team conducted mental health and psychiatric interventions to patients from Cateel and Baganga, They have identified patients needing further psychiatric interventions and will be referring the patients to Psychiatric Pavilion in for OPD consultation.  From the UNFPA: Two RH medical missions were conducted in Compostela Valley – one in New Visayas, Montevista on 20 February and another one in Mangayon, Compostela. The two missions served a total of 122 pregnant women, 144 lactating women and 322 other women of reproductive age. Fifty-six (56) of the women were indigenous people while 37 of the clients are aged 15-19. They were provided with pre- and post-natal services, medicines, pediatric consultation for pregnant women, FP counseling including FP commodities, health information sessions and hygiene kits. There were 588 dignity kits distributed, 48 cycles of Exluton, 63 cycles of Microlutons and 36 pcs of condoms.  In Davao Oriental, a total of nine (9) RH medical missions were conducted by UNFPA during the period 18-28 February 2013, serving a total of 295 pregnant and lactating women from 5 barangays in the municipality of Caraga and 4 barangays in Baganga.  The Philippine Red Cross, supported by partners like the Spanish Red Cross and the ICRC, continue to provide health services through its Emergency Health Stations in New Bataan, Compostela, Monkayo, and Baganga.  ACF continues their Psychosocial Support Services in Monkayo (Brgy Pobloacion and Banlag); Montevista (Tapia and Poblacion); Bantacan Elementary School, New Bataan, and; Compostela (Poblacion, San Miguel and Gabi). A total of 1,042 from January 1- March 1, 2013 among pregnant, lactating women, mothers and children below 59 months old were able to avail this service. Mental health and psychosocial condition of the community whom they serve are manageable and there is no need for higher level of interventions.

Disease Surveillance  SPEED reports continue to come in from Compostela, Laak, Monkayo, Montevista, and New Bataan in Compostela Valley and from Baganga, Boston, and Cateel in Davao Oriental with the participation of partners like MERLIN and PRC.  Health conditions reported with outbreak potential are continuously referred to the surveillance unit of the PHO and CHD XI and concerned program managers for epidemiologic investigation and appropriate interventions. o Compostela Valley: High number of consultations due to acute watery diarrhea were reported from Montevista Municipal Hospital, Laak Municipal Hospital and Compostela RHU. Other health conditions that need immediate attention reported under SPEED include suspect measles, suspect acute hemorrhagic fever, suspect acute flaccid paralysis, acute malnutrition and suspect leptospirosis. Referral to the CHD XI and program managers of these reported consultations were done to be followed by augmentation of relevant medicines and supplies o Davao Oriental: The Regional Epidemiology and Surveillance Unit collected 30 samples (25-blood samples, 5-nasal swab samples) from patients with suspected measles-like cases with joint pain in Barangay Batawan, Baganga. They noted clustering of cases in Purok Tambis, Batawan. Samples were sent to the Research Institute for Tropical Medicine (RITM) for confirmation and the timeline for the results will be in 1-2 weeks.  Reported health conditions which need other cluster interventions are also disseminated with other partners such as NUTRITION, CCCM, and the WASH cluster which cross- references the WASH-related diseases in SPEED to the current WASH activities.  There was no outbreak of any disease nor any death attributable to the 21 health conditions SPEED is monitoring reported during this period.

E. Needs, Gaps & Constraints

Coordination:  Continuous coordination needed among the DOH, LGU and cluster partners to facilitate immediate repair of damage health facilities and replenishment of damaged medical/non-medical equipment without duplicating efforts. Essential Services and Supplies  Inadequate supply of drugs and medicines were raised due to the increasing number of consultations particularly in the municipality of Compostela, New Bataan and Montevista. They need to regularly replenish their allocation to the Barangay Health Station to be able to provide a more regular health services especially in hard to reach areas. Current services are provided through a scheduled medical outreach mission.  Cateel District Hospital has seen a decrease in its number of admissions. However some challenges remain: o Baganga RHU will temporarily terminate their inpatient treatment because the DOH ended the augmentation to their local health staff. Cases needed for inpatient treatment will be referred to Cateel District Hospital which may lead to increase again in hospital admissions. o Cateel District Hospital has no available vehicle for emergency transfers as it is no longer receiving ambulance assistance from Philippines Red Cross. o Support for food for watchers in Cateel District Hospital is currently being provided solely by ICRC. o Cateel District Hospital needs manpower to manage the laboratory needs of the patient. They are currently utilizing the medical technologist from Cateel RHU.  Vulnerable population among the affected communities, especially in Caraga, Davao Oriental, continues to be in need of providers of specialized RH care and medicines, in particular, the provision of pre-natal, post-natal check-up and supply of dignity kits for pregnant and lactating women, with special consideration for teenage mothers in affected communities.  MHPSS cluster needs to be further strengthened in the local level. o MHPSS government leads (DOH, DepEd, and DSWD) and NGOs providing MHPSS interventions need to consolidate data and continue work with cluster partners to enable equitable access to MHPSS services. o MHPSS referral pathway need to be established in the communities, evacuation centers and RHUs. o Adolescents are a missed age-group in the provision of MHPSS in Compostela Valley. o There were already noted cases of psychosis in Davao Oriental. However, the closest psychiatric center for referral in the zone is located in Davao City. Such referral has proven to be very difficult for affected families primarily because of the distance of the facility and the financial capacity of the family of patient to bear the cost of referral. Disease Surveillance  Intermittent internet connection (eg in Baganga RHU) and mobile phone signal (eg in Monkayo and Laak) still affect disease surveillance reporting. Capacity Enhancement  A number of BBC local health staff especially the field health personnel who have started to provide consultations in the BHS level need capacity enhancement on programs like IMCI (Integrated Management of Childhood Illnesses).  While health service delivery continues to improve, local health officials need to build their capacity on implementation of Minimum Initial Service Package on Reproductive health (including Adolescent Sexual and Reproductive Health. Intercluster Concerns  There were already cases of malnourished children (MAM/SAM) with medical complications admitted in Cateel District Hospital. Cateel District Hospital (stabilization centre) staff has already received training on the management of SAM/MAM cases with medical complications, from Save The Children but the emergency supplies (therapeutic milk) have not yet been delivered.  Immediate restoration of safe water through rehabilitation of water source and or availability of water storage was highlighted during the Health Cluster meeting as one of the gaps in the municipality of New Bataan and Monkayo. Some water sources and top water were restored but most of these are found to be contaminated with E. coli. Residents in Barangays Siocon, San Jose, Aurora and Maparat of Compostela have resorted to buying their water in New Alegria of twelve pesos per gallon.  Overcrowding of bunkhouses in the BBC area might increase the possibility of the occurrence of communicable diseases. In addition, water supply, sanitation, and latrines are not enough for the population in bunkhouses.