Impact Assessment – Emergency Wheelchair Response in the Philippines by Cheryl Ann ‘Tchai’ T. Xavier 1. Background beneficiaries and (7) impact it had made on people’s lives. 1 When Typhoon Haiyan hit the Philippines in This study was conducted in two phases: a desk November 8, 2013 it left a trail of devastation in its research and field visits to beneficiaries in Ormoc wake. The National Disaster Risk Reduction Management Council (NDRRMC)2 reported 6,293 and Tacloban. In an attempt at triangulation, the deaths, 28,689 injured and 1,061 still missing. In the following methodologies were used: desk research, Province of Leyte (Tacloban is the capital city), 5,262 interviews (skype and face to face) and field visits to individuals were reported dead and 15,609 injured. beneficiaries (observation and interviews through th On 9 November, the Government accepted the UN questionnaire). The beneficiaries for home visits and offer of international assistance. interviews were randomly selected in both Ormoc and Tacloban. A standard questionnaire (Satisfaction Handicap International (HI) and Johanniter and outcomes at time of follow-up of assistive International Assistance (JUH) were among the technology4) was used during the interview. The humanitarian agencies that responded to the sample size was 34% of the total beneficiaries5. disaster. In line with responding to an emergency, Motivation has implemented a project to develop and This report is divided into five general sections: (1) trial an emergency response wheelchair package. A Background (2) Summary of Findings (3) wheelchair design was developed and 300 Conclusions (4) Recommendations (5) Appendices. wheelchairs were produced with the intention of The summary of findings is subdivided into six using them in a suitable emergency during the categories to reflect the specific questions evaluated project. A limited emergency wheelchair service was in this assessment: (2.1) need for emergency designed and a training package to train emergency response wheelchair service (2.2) wheelchair users responders how to prescribe and fit the wheelchair in emergency (2.3) transitional use of wheelchairs was developed.3 In the aftermath of Typhoon Haiyan, (2.4) emergency response training and service (2.5) HI and JUH used the wheelchairs as part of their wheelchair user follow up (2.6) impact on people’s response. lives. 2. Summary of Findings This report looked into the impact of the provision of the wheelchairs as part of the emergency response 2.1 Need for wheelchairs after the emergency of HI and JUH. Specifically the impact assessment evaluated the (1) need for wheelchairs after the The statistics released by NDRRMC reported 28,626 emergency (2) wheelchair users in the emergency injured, 55% of these injuries (15,609) were from the (3) transitional use of wheelchairs (4) the emergency province of Leyte. By November 16, 2013, the World response service and (5) training (6) follow up of Health Organisation (WHO) identified major trauma and injuries as one of the major risks to public health 6 1 post Typhoon Haiyan. As predicted, early As Typhoon Haiyan reached the Philippine Area of Responsibility, the typhoon is locally known as Typhoon Yolanda. 2 Situation Report 108 dated 3 April 2014, NDRRMC is empowered with policy 4Draft version of the WHO Wheelchair Service Training Package Management making, coordination, integration, supervision, monitoring and evaluation Module. 5 functions linked to developing and implementing the country’s National Risk 15 people out of total of 44 beneficiaries. However, of the 15 individuals Reduction Management Framework. visited, it was not appropriate to have 1 individual answer the questionnaire as he only used the wheelchair once. 3 Sheldon, S. Emergency Response Wheelchair Programme – Philippines 6 Draft Document – Public Health Risk Assessment and Interventions – Implementation Monitoring Report Typhoon Haiyan Philippines, 2nd edition, 16 Dec 2013. WHO 1 surveillance systems reported that trauma was the a. By Dec 15, China's navy hospital ship Peace top cause of mortality and morbidity in the affected Ark concluded its humanitarian medical aid areas during the first 2 to 3 weeks following the mission in typhoon-hit areas in the Philippines. During the mission, the ship typhoon. A lack of functioning health facilities in the treated 2,208 patients, conducted 44 areas of maximum impact meant that treatment of operations, and offered medical treatment many of the injuries was delayed. and medicine to more than 450 households. (reliefweb.int/report/Philippines/chinas-peace- By December 11, 2013, the focus of the disability ark-hospital-ship-returns-home) and rehabilitation stakeholder meetings headed by WHO (under Health Cluster) has been how to b. By December 4, Johanniter MERT team of 19 volunteers treated a total of 2,500 patients address the specific health, rehabilitation and (www.johanniter.de/die-johanniter/johanniter- assistive device needs of people with serious injuries unfall-hilfe/home/news). and disabilities. According to WHO, there were many people with disabilities living in the most affected c. MSF - Functioning six days a week, they saw areas and the vulnerability of people with disability is over 2,500 patients during the first week of particularly apparent in disaster situations. There December in the outpatient were also many people who sustained serious department. There are about 50 inpatients, which include surgical cases and maternity. injuries during the typhoon, many of these people MSF provided free care and medicine and the were referred to health facilities in Manila, Cebu and number of people using their services were Tacloban. Initial priorities were those with spinal cord swelling daily. (blogs.msf.org/Philippines) injuries, amputations, serious fractures and traumatic brain injuries.7 d. ARR Japan identified at least 57 individuals requiring wheeled mobility devices in Interviews with the Chief of Hospital and Chief Nurse Tacloban and Palo alone after conducting a in Ormoc District Hospital, confirmed referring those house to house survey. Majority of the cases who sustained serious injuries to Cebu City after the where of people who already had some form typhoon as they did not have the capacity to cater to of mobility disability prior to the typhoon, but major trauma. Major trauma cases were also did not have access to any assistive mobility device. referred to the foreign medical missions who had set- up within the hospital premises. An accurate These data are included to highlight that (1) there is estimate of the number of referrals was not available a need for the emergency wheelchairs (2) an as all records are now kept by the foreign medical untapped source of referrals can be explored by missions. 8 linking with the different foreign medical teams by sharing information about the emergency wheelchair As of December 11, 2013, there were eighty – five service or providing printed information materials. registered Foreign Medical Teams and 148 local Representatives from Humanitarian Aid medical teams operating in the affected area Organizations interviewed suggested that in coordinated by WHO in the Health Cluster. The comparison to an emergency brought about by an following is a review of a representative sample of earthquake, there is not the same degree of physical the summary of intervention of foreign medical injuries post typhoon Haiyan. This is confirmed by missions operating in Tacloban and Ormoc: interviews with three Barangay9 Leaders in Ormoc who were responsible for identifying wheelchair beneficiaries in their respective barangays (village). 7 Health Cluster Bulletin #7 December 11, 2013 – WHO and DOH They too reported that there were not a lot of post- 8 MERCY Malaysia is one of the first humanitarian agencies to have arrived at Yolanda injuries in their area that resulted to a need Ormoc District Hospital on 14th November 2014, a week after the super typhoon struck the central Leyte Island. MERCY Malaysia deployed its Emergency Response Unit consisting of tents, equipment and medical supplies 9 to run a temporary Outpatient Department which was in operation for two A collection of households is known as purok (zone). A collection of zones is months. Surgical teams comprising of orthopedics, anesthesiologists and known as barangay (village). A barangay is the smallest government unit in the nurses were also deployed throughout December and January to support Philippines. A collection of barangays make up a municipality or a city. Like any Ormoc District Hospital in its orthopedic cases. government officials, Barangay leaders are elected by the majority. 2 for wheelchairs in their area. They confirmed that to attend psychosocial support activities organised in most of the people requiring wheelchairs in their the community by humanitarian organisations. community had a disability prior to the typhoon. Another beneficiary reported the usefulness of the emergency wheelchairs during pre-emptive However, they also stress the need for wheelchair evacuation when their area was again hit by a services to address the pre-existing requirement for typhoon and there was fear of flooding around their wheelchairs prior to the typhoon. The provision of home. wheelchairs as part of the emergency response was greatly appreciated to remind them as community 2.3 Transitional use wheelchairs leaders of the difficulties of people with mobility The purpose of the emergency response wheelchair disabilities in the aftermath