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The Royal College of Psychiatrists Improving the lives of people with mental illness

Philippines - Typhoon diaries by Dr Lynne Jones

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06/01/2014 14:50:29

Cebu City

Saturday 7 December 2013


Definitely a very good idea to arrive at any disaster a few weeks late. Marin has got everything super-organised down to the point where, instead of fielding containers in and out of airports at 2 am, he is available to designate vehicles to take our out-going Volunteer doctors to nail salons, massage parlors and the beach. Cebu, second city in the Philippines, is quite unaffected by the Typhoon.  After 3 weeks in Tacloban with toilet facilities well below Sphere standards, the Docs apparently need it.  And a new seemingly very effective Country director has arrived and is both charming and on top of things at the same time.

For those of you wondering what I am doing here rather than attending to my duties as a new child and adolescent consultant in West Cornwall, I can only say I am a little bewildered myself.  On my induction day in October I did mention to my new boss that  if there was a Mega Emergency I might ask for unpaid leave to go, but those sort of things only happen every four years or so I reassured her,  quite forgetting that the Haiti earthquake was 2010. Of course she had said.


They wanted tarpaulin, cash, food or a flight out…


So  after the Typhoon struck and 3 days of listening to news and getting emails asking if I was available I rang up: 'um sorry, but I do think that really I need to go and wonder if I could take some leave and  unpaid leave now?'  My Colleagues and bosses were all extraordinarily supportive. So here I am for eight weeks.

Have  not been near the disaster area yet - these last two days have all been briefings and meetings and proposal writing while feeling half asleep in the day time and energetic and wakeful at night. At the local health cluster, the assistant head of the Regional Department of Health announces that she wants every affected family Debriefed in the next three months.  ‘Stress Debriefing’ which the Philippines call psychosocial processing is the flavour of the hour here.  Health Departments in every stricken municipality have deployed a team of volunteer ‘processors’ who gather people into groups and encourage them to tell their stories and ventilate their emotions.  This is actually critical incident stress debriefing by another name and there is a WHO guidelines saying that this should not be done for everybody in the aftermath of a disaster because at best it does nothing, and at worst it may do harm.  So it’s a bit of a problem. However some of the Processing Volunteers at the Evacuation Centres complained to my predecessor that they were failing as processors, because, guess what, the affected people just did not want to talk to them about what had happened or ventilate their feelings. They wanted tarpaulin, cash, food or a flight out… The volunteers were so relieved when Margriet said, well actually helping them with just that and not forcing them to talk about traumatic events if they don’t want to, is a very good idea. Apparently in the last few days in Manila, after discussions with WHO, the DOH has agreed to change its practice and substitute debriefing with Psychological First Aid. What’s that you might ask?  Common sense: would be my answer, comfort people, make them safe, help them get the things they need and connect them with others.  If people WANT to talk, always stop and listen, but don’t force talking…Yes there is a manual…

These are quite the loveliest people. Along with proposals and briefings and debriefings, I have spent every day being thanked without having done anything yet. The local business community organised a ‘thanksgiving dinner’ for all the international NGOs, where speeches were made, songs were sung: religious, secular and the national anthem, and people repeatedly hugged us and thanked us and gave us tee shirts and shell necklaces. Then the following morning a large crowd of students arrived at our hotel with gift baskets for outgoing volunteer doctors…

 

06/01/2014 16:32:07

Roxas City, Payan Island

Monday 9 December


Roxas, in the Western Visayas lies at the tail end of the Typhoons path, the last large island to be hit. The central red band marking the path of Hurricane devastation skims across the top NE corner of the island. The winds and the storm surge that followed flattened coastal villages, threw rubbish into all the fish farms and mashed the crops.  Inland it was mainly wind and, just like the Wolf in the story of three little pigs, highly discriminatory. I drive along a track between emerald green rice fields where the coconut palms are all bent or broken in the same direction and see that all the stone villas remain intact and standing except for their roofs.  But anything made of cane or bamboo has been squashed, knocked sideways or in some cases reduced to a pile of sticks. As in every disaster, it’s from those that had little in the first place that much has been taken away.


Why don’t you give it to her every day as prescribed, then these episodes might not occur?

…We cannot afford the medicine …


But the extraordinary thing is that this damage is already half hidden under the quickly put up tarpaulins and bits of cardboard and tin. New bamboo frames are already being built over the old ruins. Yesterday a family carefully laid down planks of wood across small ponds in their yard so that I could walk, princess like, into the shattered remains of the living room, and sit above another small lake, on the raised cane platform, talking to a 25 year old girl with possible bipolar disorder.

Around me, suspended from the ceiling beams were sports bags and plastic bags all stuffed with personal possessions while others were slung over the fence to dry them out.  The girl got sick again a few days ago and became wild and angry as she quite often does. So they had to tie her.  She showed me the bruises round her wrists and ankles, and the one on the side of her face where her mother had slapped her to calm her. She was untied and quite calm and well again, because they had then given the medicine prescribed by the province’s one practicing psychiatrist. They showed me the script: haloperidol (an anti-psychotic drug) to be taken every day.

 …Why don’t you give it to her every day as prescribed then these episodes might not occur?

…We cannot afford the medicine …

They wait until she gets violent, then give the drug until she calms down, and then they stop it again. That at least I can address. As they already had a prescription I gave them three months’ supply from our emergency drug kit and begged them to see the effect of taking it every day.  Medicine is private in the Philippines. There is some kind of help for some impoverished families. But this is only for some chronic illnesses like diabetes and hypertension.  People with mental illnesses get nothing.


…What’s to be done?
I asked the Director of the Hospital when I visited him that afternoon?

…We need Obama here he laughed. He told me they did not see much result from giving psychotropic drugs, so they did not invest in them.

So it’s not about disasters, it’s all about poverty, what a surprise. The Disaster Community, that flock of storm chasing swallows with which I flit about the World, is already discussing this. I went to the interagency meeting tonight. It is held very conveniently in the Provincial governor’s office, where the Main hall has been entirely taken over by different humanitarian organisations and all the Cluster leads.  Up at the Stage end large maps have been hung on the curtains to show the Typhoon path. Down one side appropriately positioned under the massed portraits of earlier town Dignitaries are the Filipino military. Down the other end large numbers of Canadian military sit at computers typing up DART (Drug and Alcohol Recovery Team) assessments, and scattered about are various NGOS using this as office space.  

As the meeting made clear the acute emergency phase is already ending. We are now discussing ‘early recovery and building back better.  The Filipino military are scaling down and going home to rebuild their base; USS Illustrious has already steamed  off to Manila. The OCHA lead is suggesting the meetings go down to once a week rather than every other day and that at beginning of January we give the town their office back. But some are concerned that it is too soon to scale down transport as there are still remote communities whose needs have not been assessed. I only grasped when I got here that this is a country of 7000 Islands….

This discussion takes place against a background of intense loud rhythmic drumming coming up from the main square outside. Today is ‘Roxas’ day, yesterday it was the Feast of the Immaculate Conception and the Filipinos are not ones to let a Typhoon get in the way of a good party. So we have had 48 hours of Fiesta. Last night two flower bedecked  life sized  Madonnas were being carried round and round the square with accompanying priests,  choir boys, school girls in frilly white dresses holding candles, youth playing guitars. At the same time large groups of young men with homemade drums of various sizes gathered in groups in different areas and then also processed about banging out competing quite different rhythms. The Madonnas finally went home to bed inside the Main church, but the boy bands are still drumming and processing under the multi coloured flashing stars and flowers, and the coloured fountain and fairy lights that bedeck the area for Christmas. There are numerous balloon, candy floss and snack sellers, and happy families and partying and giggling girls and boys.  It could be Mexico or Guatemala…

 

Tuesday 10 December,  Roxas

Ate dinner in a café with three brightly lit life-sized plastic Santa’s waving at me. This might be a disaster zone but I do on occasion feel like a clunky giant that has wandered into a giant Children’s party. It’s not just the flashing fairy lights, the Santas and the life-sized Jesus Crib with pastel coloured plaster shepherds and kings in front of our hotel; or the toy village of plaster houses placed outside the municipal headquarters. The bikes with side cars that everyone uses for riding around are candy coloured,  as are many of the uniforms which everyone seems to love wearing.  Hotel gardens all have plaster bambis and rabbits and squirrels planted in the undergrowth and lagoons are fenced in with toy boats on which to ride about. There light pop music playing everywhere and  everything, meat cheese and bread seems to come with added sugar and added salt...

 

08/01/2014 14:03:19

Clinic in the Church

Wednesday 11 December 


It is impossible not to be impressed by the way people take care of each other here.


Each morning we load up the minibus with boxes of meds and two teams of volunteer doctors and nurses from Manila drive out of Roxas to another village. There is always a cluster of buildings: day nursery, Church, Barangay Captain’s house all around a basketball court.  Today the Clinic was in the Church, and the waiting mums and babies filled up the pews while Jesus and the Madonna looked down on us all. The patients complain of coughs and colds in the children, and aches and pains and high blood pressure in themselves.  I was asked to see an old man with Dementia. His wife complained that he often went for long walks without any problem, but since their house had fallen down he could not recognize the place when he came home and repeatedly asked where it had gone. She has to help dress him and feed him but is completely uncomplaining. So is another worn looking woman whose husband has had paranoid delusions for the last 15 years. The Mayor told us he speaks to himself all the time and is often aggressive and argumentative without cause. But the man himself, sitting tense, angry and suspicious looking, told me he was fine and had no complaints- I am the surveyor for all the land in the area – and sometimes there are disputes .  His wife shook her head and smiled- this is a fantasy she said.  Apparently he started to change over the years, becoming more and more obsessed over a land deal, writing reams of notes that made no sense, talking to himself and ranting, often he was wild and had lost his mind  but they have never persuaded him to see a psychiatrist or go to the Hospital. His wife said she and her daughter worked around him, being careful not to stir up his anger. Anyway if he did go to see someone they could not afford the drugs.  And the mayor has given him a job - switching on the town lights in the morning. It is impossible not to be impressed by the way people take care of each other here. It is just so much harder to do when the House has fallen down. In fact the man seemed completely unaware that the walls and ceiling around him were all askew. He never mentioned it.

I am still sleep disordered and dozed off at the Health cluster meeting this evening waking to hear my name called to discuss mental health. I hope I made up for it by being passionate and not too inarticulate about the need for community based services for those with severe mental illness, and advocacy for free medication. As usual, everyone else, apart from a couple of agencies, is  running counseling programmes or making child friendly spaces. One of our donors was there and he nodded and smiled.  I am hoping he will give me 100,000 to start a programme. In 2009 the Philippines Government came out with a very nice national plan. It said  What is ideal is to assimilate mental health into primary health care, provide mental health care in general hospitals and develop community-based mental health services. …The purpose of this bill is the comprehensive addition of Mental Health in the national system. It is to render available, accessible, affordable ·and equitable quality mental health care and services to the Filipinos especially the poor, the underserved and high risk populations. That would be the families I saw this week then…

08/01/2014 15:42:12

Pontevedra

Thursday 12 December


'The worst thing is the rain...'five elderly women told me this morning, ... if there’s rain and a strong wind we are terrified. And we feel lonely and sad because we don’t know how we will make a living.


We were sitting in the Barangay office while they explained their current difficulties: no electricity, roofless houses, patched up with plastic but still leaking, no kitchens, very little food  and no way to make a living. This is a ‘Nipa’ area where people grow straw (Nipa) and weave it for material used in housing and other things. I have discovered that Nipa is a kind of Mangrove. It actually looks like the top of a palm tree growing in the mud and produces a useable crop of leaves every four to five months. But the last harvest was soaked, and the plants destroyed so they have none to weave and new plants can take one to five years to reestablish.  And the food support that was coming from the Red Cross and other families has stopped, so people are beginning to go hungry.  Everyone is affected:  a young man told me his farming parents were laid off and their stored food supplies, that would normally see them through, were destroyed. Another woman told me she and her husband worked in a hotel but it had been destroyed and they had nothing. Food, cash, shelter and the means to work, that’s what everyone wants.

Friday 13 December, Pontevedra

Pontevedra lies right in the red band on the disaster map and you can see the difference when you drive into the area – almost every house, stone and straw, is affected, while the coconut palms all have an odd starfish appearance: the eastern side blitzed and all the fronds pushed to the West.

This morning I saw Isobel, a young mother who has been sick for three years. She lived with an abusive husband who brought her home with her younger children when she became ill, and left her with her mother. Since then she has scarcely spoken, just stares and mutters sometimes. Some days she stays in one position for hours at a time. She seems to understand people around her and washes and dresses herself, though she eats very little and is often incontinent. Sometimes she brushes her children’s hair, other times she does not know who they are. When the Typhoon came she was terrified, shaking and soiling herself. The house was completely destroyed and they took shelter at a neighbour’s. Now they are back living under plastic in a quickly constructed room.  It took some 20 minutes to persuade Isobel to move very slowly up the stairs to the consultation area. Once there she sat completely still staring into space, sometimes whispering to herself. I made brief eye contact but she would not answer any question.

… Why have you never taken her to the Doctor? I asked?

…' We have no money for medicine' the usual answer, but now I have a better reply. I have worked out an arrangement with Roxas’ single handed psychiatrist, whom I met yesterday. She runs a private practice for a population of 800,000 in the Province.  She has agreed to see the impoverished patients we refer, and if appropriate will use psychotropic drugs from the WHO interagency emergency drug kits that we have donated to her, so at least some patients can have free medication. It’s not a long term solution for everyone. I don’t think medication will help the homeless woman they asked me to see later in the afternoon, but it might get Isobel  out of her catatonic state.   When we got up to go Isobel’s mother threw her arms around and hugged me tightly. She is tiny and thin, and her head came up my chin, she would not let go.

This evening I discussed Psychological first Aid (PFA) to the team. The Provincial Health Office have given me two handouts they use for training: one on PFA which ends with the instruction: Do not debrief by asking what happened. And pinned to it there is a second on Critical incident Stress debriefing, which tells you to do exactly that!  I would be fascinated to see how these two lectures are actually taught in combination! As we only had an hour I sat them down and asked them to make a list of the three things that had helped them most when something terrible had happened in their lives.  They all listed: being with family, friends and colleagues who were available and able to listen, who could provide a comforting shoulder on which to lean, who could advise, encourage them to restart their lives and who could give financial support. These were the most important things, followed by being able to pray, to do something altruistic, being diverted, getting entertained and distracted. When we added up the whole list it looked remarkably like the Checklist for PFA, which it always does. No one had listed talking to a counselor, or getting debriefed. I once went to a talk by a Glaswegian psychiatrist who had gone down to Lockerbie a year or so after the plane fell out of the Sky. He systematically asked people what had helped most in the immediate aftermath. And in spite of the fact that the Town had been flooded with counselors who had rushed in to do debriefing  etc. the most helpful intervention was apparently the Salvation Army Tea Van, handing out cups of tea, a chat and a familiar shoulder to weep on… I do worry that by manualising PFA and saying it  needs to be ‘taught’  and should be delivered by ‘frontline health workers’ backed up by a psychiatrist, we are undermining peoples  trust in their own common sense empathic response to helping disaster affected people in distress.  We have again created a technology that must be learned and delivered by professionals rather than empowering people to do what seems natural and right in helping others.

 

 

22/01/2014 10:53:41

Back in Cebu City

13 December

'...F***king  ********* '   someone has scrawled on the graffiti covered walls of the men’s ward at the psychiatric hospital. They sleep three to a bed or not on a bed at all. In the Woman’s ward they are stretched out on plastic chairs and tables. The women crowd round me, touching, friendly smiling. The ward still has the vestiges of the TB hospital that once occupied these large high ceilinged rooms: big netted windows looking on to a veranda and empty dusty gardens below. The two story building was built in 1936 and has all the elegance of that period. A wide open reception area, carved curving wooden bannisters up steps with brass treads tiled patterned floors. But a whole ward fell down in the earthquake two months ago. (Remember the Earthquake?)  And the reception area is now the emergency assessment ward where 25 patients sprawl on 10 shared sheet-less cots

'… We do rapid tranquilisation with haloperidol and assess them here over 2 days.' Marx my guide and Senior nurse explains.  'If they are better we send them home otherwise they get admitted…'  There are currently 170 patients in a 60 bed facility. All the nurses are kind and caring, trying at some point to spend individual time with each patient, doing some group music activities, but it is one to seventy with no other support. If a patient becomes violent and needs restraint, they are put in a three foot cage with hole in the floor…  F***king  ******** indeed.

 

 

22/01/2014 11:12:51

Tacloban and Tanauen, Leyte

17 December  

This is another country.  How to describe this? I don’t have the words. The town and all the surrounding communities have been gutted. No house is untouched. Windows and doors blown, piles of rubble and twisted metal, cables and wires in great tangles. Rubbish heaped up everywhere. It looks like a war zone: Sarajevo in the mid 90’s, or old pictures of the East End of London during the Blitz. And the same astonishing sight of people conducting normal life amidst it all: motorbikes and pedal bikes with side cars driving everywhere; blown apart shops have signs up saying OPEN for business. And while my first impression is devastation, Tom, our site manager keeps pointing out how much better things have got: the rubbish no longer fills the streets; people are patching up their homes

No house is untouched

Tom gives me a list of the mental health contacts I need to see and when I call, each one of them says do come now. We would be delighted to see you? I am constantly astounded at the welcome Filipinos give to this extraordinary invading hoard of do-gooders..

 

 

Everywhere I go people interrupt exhausting, never ending days simply to talk to me. Like Dr. Verona, head of the psychiatric department at the Eastern Visayas Memorial hospital. She is one of four public psychiatrists available for the entire region (there are eight including the one in private practice). She runs the forensic service doing assessments and court reports; is the point of referral for child abuse and domestic violence; teaches medical students at the university after work; and is involved in the Government plans to train doctors in the Community. This is in addition to running psychiatric outpatients here on the second floor of the hospital

Good idea she said, when I discussed our plan to help the government train rural health unit doctors in mental health ...  just don’t ask us to help  at the moment, I have lost my roof, my colleague her house and the third, her relatives… Devastated house in Tacloban


The Hospital stands right next to the Sea front and it is extraordinary that no one within it died as initially patients and doctors had prepared themselves for wind and sheltered downstairs. The TV warned No house is untouched...a ‘Storm surge’, but no one in the Philippines knows what that word means - if they had said tidal wave, or mini tsunami it would have been different.

Anyway no one panicked. When doctors saw the water in the streets they moved everyone higher up, very efficiently and quickly- even ICU patients cooperated.  There was no food or water or power. Even so within the first 48 hours 2000 patients arrived…

How did you cope, I asked the colleague who was telling me the story.

…It was just a relief to be a doctor and contribute something… the first help arrived from a neighbouring island on Sunday morning.

 

 

 

29/01/2014 11:40:41

Southern Leyte

18 December

...they get food parcels once a week from the Department of Social Welfare, but nothing else. I am beginning to realise that these inland remote scattered agricultural families are in many ways worse off than people concentrated and very visibly destitute in the main cities and coastal areas


It is the Christmas tree that catches my attention, driving back to ‘home base’,   I see an unlikely flash of glitter among the felled and devastated coconuts. Then I see it is a scrappy tinsel tree placed on the deck of a small put-together shack.  So I ask the driver to stop and walk over to take a picture. I am always nervous of taking pictures in disaster areas. Is it disaster tourism? Am I causing offence? I want the pictures for what I believe is the good purpose of using for teaching and sharing at home. All the same, if people are around I always ask.  On one unforgettable occasion a man rushed up to me on an empty tsunami-devastated street in Eastern Sri Lanka. I thought he was angry and I began apologizing. NO NO he said I WANT YOU TO TAKE THIS HOUSE!  MY MOTHER DIED HERE…  He was shouting and there were tears in his eyes, and I suddenly realized that for him, this random white woman on the empty road with her digital camera was at least one way of memorialising his mother, turning her from a washed away statistic of mass death, just one in 10,000 on that coastline alone, into someone of significance: his mother.  And we sat down on the road side and he told me all about her.

So that experience has made me slightly more confident that photography might have value, and here the response has been overwhelming.  People smile, wave, pose and beckon me over to take this or that… I always show the pictures and ask how they are, and they never ask me for anything!  And when I leave they always call out Thank you ma am, thank you ma am, thank you for coming!  As if I had just dropped by for tea or at least done something. 

A very elderly white haired lady emerges from the shack. Her name is Adila, she is 88. Her daughter comes out and her grandchild. Their house was entirely destroyed - they'd just made this one.  No they have no money, no means, and her husband is a labourer who picks rice but has no work at present.  But they found the tree in the rubbish and they want to show they are celebrating, as it gives them hope. 

 

They have neighbours: an elderly couple in a triangular-shaped structure that they too built from scraps of their old home, and across the way a family of five who have rebuilt their house and replanted their garden in small pots.   All of them lived in traditional houses before - beautiful structures of woven straw, which did not stand a chance.  Apparently they get food parcels once a week from the Department of Social Welfare, but nothing else. I am beginning to realise that these inland remote scattered agricultural families are in many ways worse off than people concentrated and very visibly destitute in the main cities and coastal areas.

Came home and found we were having Karaoke in the yard!  We are all camped out on the top two floors above the general store belonging to the Barangay Mayor. We look out on a washed away office and health post but this stone building survived and has become a kind of NGO hub with various medical missions keeping their vehicles in the yard.  Tomorrow is the last day of mobile clinics. The DOH asked for all the voluntary agencies to stop doing them because the acute health needs have subsided and it understandably does not want existing health structures undermined or duplicated. All local staff were asked to come back to work at the end of last month. Most  municipal clinics  are functioning now even if under canvas or plastic. The volunteers are leaving on Friday so they are partying. So All by myself echoes out repeatedly across darkened rice fields…

 

 

29/01/2014 12:13:25

Tanauen

19 December

Grave on the traffic island, Southern LeyteThis Evening went round to see Dr Arlene. I met her at the psych department and while we were just chatting she suddenly burst into tears and then told me about her aunt who had died in her arms and  how she had almost drowned herself.  Then she asked if I would come and visit her at the house where it happened so she could show me. Of course I said yes, so that’s why we are picking our way across to the chrome balustrade which Arlene says saved her life.

She and her husband lived with two elderly aunts and an uncle. The aunt had just invested her life savings in doing up house for them all.  They took the Typhoon warning seriously and chose the downstairs bedroom as the safest place.  Because it was stone built house they even invited in two neighbours. It was the same story I have heard repeatedly:

…We did not understand storm surge we heard that on CNN but we don’t know what it means ... so when the water came in we were really shocked and then we were struggling to stay alive. Arlene is quite determined to play the whole thing out for me- showing where her mother grasped electricity cabling and held on, and where her aunt drowned and she was unable to resuscitate her and then her husband had plucked her out of the rising waters.  Her uncle had drowned outside.  The shell of the house is full of broken timber and wrecked Christmas decorations including baubles, plastic green trees and a headless Santa. Arlene has retrieved the small figures from a Christmas crib and places them in a row along a windowsill. The baby Christ is still covered in mud and on the floor is a lit candle where she tells me she placed the bodies. They were absolutely determined their relatives would not end up in a mass grave so they walked for four hours the next day to find an embalmer and walked another four hours to bring him back. What happens to bodies matters. Just up the road from here, the grass covered island that lies between two highways has been turned into a small informal grave yard because there is no room left in the main one cemetery. Each one is carefully made with named cross, pots of flowers, neatly laid gravel and small tokens. Someone has put a child’s trumpet on one, on another there are a small pile of still wrapped chocolate bars.

 

December 20th

I am still chasing up cases. In the  last 10 days I have been told about at least 37 people with severe mental illnesses half of whom have either never  had care or only intermittently because they cannot afford it. I am getting used to the shaking heads when I first ask: No there’s no one like that here… and then oh yes - so and so, he talks to himself all the timethat Lady who walks naked in the Street- her children throw stones at her… There’s a woman who never leaves her house…  Sometimes I am referred someone who is not mentally ill at all- like the woman I saw today – who had apparently lost her mind because of  the storm, but actually the fact that she was sad and mute after hearing of the death of  a relative a few weeks ago, seemed less relevant to me than her current physical state: when I examined her was semi-comatose with a racing pulse, high blood pressure and fever. The Family had actually called in the traditional healer the previous day but agreed there was no improvement. I persuaded them to send her back to the district hospital for investigation.

December 21st

I should be writing up my notes something but I am so tired when I get in I cannot write anything. My head is full of cold, combined with endless pictures of devastation, how many ways to wipe out a home, a job, a community, and the area is so vast. We drive up and down the devastated highways- today to a fishing community on the Coast. I was accompanying Michael doing his livelihoods assessment. The Barangay Secretary, friendly and welcoming as everyone always is, said she would gather a group of men for us to meet. So we walked on the beach beside a line of quickly put up shacks, then we came back to find them putting up an extra awning to shelter some thirty people crowding round. They thought it was a ‘distribution’ but even when Michael explained it was us gathering information from them, they still wanted to stay.  They have almost all lost their boats- damaged by the Storm- and none of them have the means to repair them or to make a living at the moment, every one of them has been washed out of their homes. At least they are getting food, indeed there are 6 NGOs delivering various things to this Community in addition to the weekly delivery by the DSW, so they are not hungry at the moment, unlike my three families living in the field of coconut trees. But no one is certain how long this largesse will continue. No one has information.  

I am struck by the arbitrariness of aid - for all our efforts at coordination it’s still patchy, and inexplicable to those on the receiving end. The other day a Barangay captain bitterly complained to me that in his municipality there were 78 Barangays, 17 of them had a long standing relationship with a particular NGO so they were all getting shelter kits, water bottles tools, etc. etc., while neighbouring communities were just getting food and he could not understand it- why in this situation did that NGO not deliver to them all? On another day last week the mobile clinic team had arranged to do pre natal checks in a community. We turned up to find a great crowd of women and children waiting under umbrellas in a roofless church- but not for us. The Archdiocese was also sending a mission from neighbouring church- food, a medical mission and a psychosocial processing team…

 

We also called in on a farming Community. According to Michael this is one of the lucky ones because they have an agreement to only pay one third of the actual crop…  So if there is no crop they don’t pay.  As they have lost 90% of the harvest this is fortunate. But many other Communities are not so lucky: if you are a tenant farmer here- and most people in these villages are- you must give a rent to the Landlord of between 15 and 44 sacks of rice every harvest. The amount varies according to the area and landlord, but it has to be paid, regardless of your actual harvest. So if everything is wiped out, as it has been this year, you still have to pay.

I ask Jo our interpreter, if he thinks it’s a good system.

… Actually yes. It’s always been like that …for 1000s of years

… Does that mean it can never change?

… Why should it?  And the landlords also suffered losses, you know, they have to get them back.

… But that means some people will just pile up increasing debt and never escape, Michael gently interjects. He is Ethiopian and knows something about land poverty.

…Everyone has an equal chance. My parents were tenant farmers like that but they made a small business, got some loans and now they are doing well. If people want to, they can escape, it’s up to them. Mrs. Thatcher would be very proud. Jo trained as a nurse in Manila but now works as a real estate agent: nurses work too hard and earn too little, but he is also trained in search and rescue and after the Typhoon, he came down with the team and has stayed to help his family.

 

10/02/2014 09:42:11

Mayorga, Southern Leyte

Christmas Day


You know you are into  the ‘early recovery ‘  phase after a disaster, when you stop camping out in someone’s yard or attic and move into  a large rented house  owned by  a family with enough income to build something that did not get knocked  down,  and  who has enough space, or a second home of their own  to rent out to a passing INGO.

So we have vacated the Barangay Mayor’s top floor. His entire family had arrived for Christmas and all the neighbourhood children were coming round to get free flip flops, so it was time to go. We have moved into a palatial two storied villa near the devastated coast. It is a White house. There are two wings around a central portion with colonial looking pillars in front of a large carved front door holding up a pillared and balustraded   ornate balcony, where I sit writing. I do believe that middle class families in Iraq, Aceh and Pakistan and Haiti are all shopping from the same Home and Gardens Catalogue, as I always end up living in what feels like the same house. They all have almost identical interior design: Marbled floors throughout, chandeliers in all the main rooms, heavy ornate carved furniture with a baroque feel, gilded mirrors, jacuzzis and ornate Italianate fountains in the garden! The curving glass windows that surrounded the stair case were all blasted out.  There is no power and we get our water from a hand-pump outside then carry it in buckets to wash in the beautifully tiled shower rooms.    But there is propane gas stove. Haakon, our amazing logistician has got small generators running for short periods. The guys are all sleeping under nets in the extensive living room. As the only woman I have a room of my own upstairs for the moment.  The only alarming things are the two life size Santas standing, arms raised, at the bottom of the stairs: fully dressed, white haired, bearded and bespectacled, they startle me every time I come down the stairs.

I am writing up my notes. We have been funded to train for three months. The DOH asked me when we could start.  Yesterday the Monsignor in Buraeun said I could use his large Church meeting room. We begin in January….

 

More later.

 

10/02/2014 16:02:17

Some kind of wilderness - Bohol


2 January, Bohol


Bohol, Phillipines: Dr Lynne Jones blogOn the last morning of my R and R we kayak up the wild river: I call it that because on my first day here, having kayaked along the coast accompanied by the constant sound of traffic, I begged Ray to take me to some kind of wilderness. He laughed and said no one had made that request before, but he gave it some thought and today we are paddling upstream on flat water between Nipa palms.

 

The last sign of a road was at the broken bridge. This is Earthquake country and half the houses around the nearest town were destroyed by the 7.2 quake in October last year, along with 200 lives lost.  I notice that it is the Nipa houses that have survived intact, while the ornate stone villas and the ancient churches have collapsed. There are no good architectural choices in the Philippines.

 

Ray has not been up here since the quake and wants to see how it has changed. Renato a local fisherman leads, pointing out a raised sandstone platform that only emerged thee months ago. As we go higher the river closes in, coconut palms give way to beautiful, unnamed, branching deciduous trees with mottled trunks and heavy leaves. Vines hang down and strangler figs crawl up. There are kingfishers perched on branches and martins dipping and weaving over the water. At one point we come to a washing station where whole families launder and bathe in the river. Then there is a series of clear pools between which we have to portage the kayaks over rocky ground.

 

Finally we leave them on a small beach and walk and scramble up more rocks and boulders to the Tank. It holds the water for the village and stands with four clean outflows above two deep green pools – perfect for swimming.

 

For an hour I cannot tear myself away, floating and gazing up through the green leaves, sitting in the natural Jacuzzis created by the small falls, with the  water pounding my shoulder and back; nothing but the sounds of river and forest. Ray says he will call this Lynne’s trail in his publicity material. Forget mental health programmes, this is a real honour, a trail named after me!

 

 

Connecting dots

Monday 6 January, Manila


Manila: Dr Lynne Jones blogI hold the green pools in my mind staring out at the skyscrapers opposite. There is a swimming pool here; bright blue and long enough for laps surrounded by Epsteinesque, heavy bodied female sculptures, next door to a fully equipped gym complete with TV screens. As you float on your back you can choose which shaped scraper to look at: the one with tilting floors, or the oval one with white trimming or perhaps at the green of the golf course that bizarrely edges between them.

 

Everything around us was built in the last 10 years in an area of the City called the Fort. The pavements are immaculately clean; there is traffic, but no jams, doormen and security guards on every corner who salute you, a ‘High Street’ full of designer stores, and a tree-filled circle where you can drink cappuccino.  The whole place is full of bright young Filipinos shopping and eating, and presumably working in one of the Fortune 500 companies that built the tower blocks. No  jeepneys or street children here, and no visibly poor people,  except the ones who have donned immaculate uniforms  to serve us Italian pasta and Asian fusion and barbequed ribs at night; always, always smiling.


My Agency has an apartment here - as many do. It’s convenient and easy to get to many of the coordination meetings that are held close by. Anyway, I have done my duty in meetings: I have discussed mental health training curricula, and grief and mourning with WHO at the DOH, a two hour traffic jam across the city. I have eaten eggs Benedict in the café in the museum garden with the charming Head of the Philippine Psychiatric Association and the Head of the National Centre for Mental Health, both of whom share my frustration at people’s lack of access to care. They have given their blessing to our small venture in training primary health care doctors.


Doctors doing community mental health can apply to the medicine access programme MAP at the National Centre and they will be supplied. This is music to my ears


They have grander plans: they want to train one psychiatrist per region as a master trainer in the mhGAP curriculum and then support them in rolling that training out in all 16 regions. A great idea if someone will give them the money. Dr Vicente assures me that there is access to psychotropic drugs. Doctors doing community mental health can apply to the medicine access programme MAP at the national Centre and they will be supplied. This is music to my ears.

 

I tell him about Dr Verona, who has only had free medications since the disaster brought the NGOs to her hospital. He did not know that there was an outpatient psychiatric department at Eastern Visayas. Perhaps the most useful role I am playing here in this complex country of 7000 islands is connecting dots.

 

 I took three hours off to venture out of our genteel up market enclave into the older familiar Manila of stationary, foul smelling traffic jams and jostling streets, and crossed town to walk through Intramuros. The oldest part of the City was built by the Spanish half a millennium ago on the site of a palisaded fort, by a wide muddy river next to the ocean.

 

I wandered through the garden that now occupies the original Fort and eavesdropped as a Filipino tour guide stopped among  life-size bronze statues representing Spanish monks and  explained to a group of teenage Filipinos that: the Spanish unified us, before that we were a group of quarreling islands. They brought us together. Then I walked round the corner to the remains of the jail where those same Spaniards imprisoned  independence-minded Rizal before his final walk to his death by firing squad, now  carefully traced out in bronze footsteps. It is just across from the cells where the Japanese occupiers tortured other Filipino resisters half a century later.

 

Further down in the garden more young people photographed themselves, sitting on a bench next to the life sized bronze of General Macarthur, responsible for the costly liberation of the country and the reduction of most of this area to rubble.


As if the contemplation of all the paradoxes of colonization, occupation and conflict were not enough, just standing outside Manila cathedral is a lesson in either resilience and determination, or bloody minded stupidity, take your choice.

 

A helpful plaque explains how eight churches have occupied the same site since the first one made of nipa and bamboo in 1571. Earthquakes in 1599, 1600, 1621 and 1645 knocked down the two stone structures built in that period. Typhoons and earthquakes so badly damaged the next one that the people knocked it down themselves in 1751. An earthquake destroyed the fifth cathedral in 1852 and the sixth in 1863. Then another earthquake in 1880 severely damaged the seventh, which was finished off by the Americans in the Battle for Manila in 1945.

 

Just beyond the Cathedral is another memorial, to all the unknown civilians who died in that battle, having nowhere to flee.

 

 

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        About this blog


Dr Lynne Jones (photo by Asmamaw Yigeremu)

                Dr Lynne Jones
    (Photo by Asmamaw Yigeremu)

Lynne Jones is a child and adolescent psychiatrist, writer, researcher and relief worker. She has been engaged in assessing mental health needs and establishing and running mental health services in disaster, conflict, and post-conflict settings, since 1990 including Central America, Bosnia, Kosovo, Afghanistan, Iraq, Sierra Leone, Liberia, Aceh, Sri Lanka, Pakistan, New Orleans, Chad, Uganda, Ethiopia, the Middle East, Haiti and Mozambique. In 2001, she was made an Officer of the British Empire (OBE) for her mental health work in conflict-affected areas of Central Europe.

She is currently  a consultant in child and adolescent mental health for Cornwall Partnership NHS Foundation Trust.  The Trust gave her 2 months leave to provide emergency assistance in response to Typhoon Haiyan in the Philippine. 
 
Lynne is currently working with the International Medical Corps in the Philippines.  This is her diary for December.