Assisting devastated communities after the Philippines typhoon
The Central Philippines was hit by the most powerful typhoon recorded in history, Typhoon Haiyan, on 8 November 2013. More than 6,000 people died, 28,000 were injured and over 1.2 million homes were damaged or destroyed by the winds, which reached more than 300 km/h. In January 2014, Dr Sarah Miller MAPS accepted an assignment with the Australian Red Cross to work with the International Committee of the Red Cross (ICRC) in one of the worst affected areas of the Philippines. She was appointed as the Clinical Psychologist and Mental Health Technical Advisor to the delegation providing assistance after Typhoon Haiyan. Dr Susie Burke FAPS interviewed Sarah while she was still in the field in the Philippines.
Where are you undertaking your work?
I'm based on the island of Samar which is in the area significantly affected by the Typhoon Haiyan. Whole villages have been wiped out, cars can be seen on the top of house rooves and palm trees have been ripped up at the roots and displaced hundreds of metres away. Many people are now living in tents, or with tarpaulins and makeshift repairs to their simple wooden house structures.
The locals from this area are predominantly fisherman and they live by the coast consuming a diet of mainly fish. Sadly, many will not eat fish now as they believe the fish have been eating the corpses of their loved ones who were washed away. Many speak of fear and terror as the rising water engulfed their homes and caused destruction, loss of possessions, and loss of equipment such as boats and fishing gear on which they relied for their livelihood.
What is the Red Cross delegation tasked with doing in the Philippines?
In the 100 days following the typhoon, the ICRC has provided, jointly with the Philippine Red Cross, large-scale emergency assistance in the island of Samar. The activities are now transitioning into the recovery and capacity building phase to support communities in rebuilding their lives.
The ICRC delegation consists of medical staff, engineers, logisticians, shelter specialists, and development personnel from all over the world, as well as local Filipino counterparts. They are passionate, professional and like-minded in humanitarian attitude. It always feels like being at home amongst Red Cross people.
In the early days, ICRC established two emergency hospitals in tents to support the local facilities of Samar, which were badly damaged by the typhoon. The teams treated people with surgeries and other medical conditions, especially respiratory problems from the unsanitary and damp conditions they have been living in for the last two months of heavy rain. The engineers are repairing water systems and creating access to fresh drinking water for the villages via mobile water treatment plants and water stations. The shelter specialists have been rehabilitating local facilities such as the hospitals and providing technical advice to communities, along with tools and building materials so they can build safer houses. An ICRC distribution team manages emergency relief items like food, tarpaulins, cooking equipment, mats and blankets, as well as seeds, fertiliser and cash grants to farmers and fishermen to enable them to restore their livelihood.
What are your living conditions like?
The ICRC delegation was living in tents at first, however the water levels crept up again when the low depressions and tropical storms hit in late January, and we were moved from the tents for safety reasons. We are now living in a dilapidated 'resort'. There are tarps where the windows and doors should be and my hut leans sideways due to cracks in the stumps and foundations from the floods. There's no hot or drinkable water and we bathe using a bucket. The plumber just got the toilet working so a flushing western toilet will be a luxury. Food began as rice for breakfast, lunch and dinner or army ration packs due to the destruction of crops and livestock limiting the availability of produce. We began getting very creative with combinations of food supplies, and very over rice! Fortunately this improved over time and we could supplement our rice with some fish, pork or eggs.
What is your role?
My role is to deliver mental health and psychosocial support to the affected communities. In humanitarian emergencies such as natural disasters, the number of people with mental health disorders is estimated to increase by about 10 per cent. Beyond mental health disorders, people also often experience psychosocial problems such as family separation, disruption of social networks, destruction of community structures, services, resources and safety, and increased vulnerability to violence. Children often experience more behavioural problems and emotional changes such as sadness, and fears of rain and wind. The level of these psychosocial effects is difficult to quantify.
I've been working in the hospitals and in the field doing therapeutic work with affected people. They have presented with posttraumatic stress symptoms, acute stress disorder, cumulative loss and grief, depression, anxiety, substance misuse, suicide and self harm attempts, medically unexplained somatic complaints, and several cases of psychotic episodes triggered by the disaster. I have spent a lot of time training local medical staff to recognise signs of trauma, provide psychological first aid and basic counselling skills, conduct outreach to affected villages, and recognise referral thresholds. This will hopefully leave behind a greater capacity for the community to respond to their own needs. The Philippines is after all one of the top ten most disaster prone areas of the world. Rather than the international community reacting each time a disaster happens, hopefully having locally trained people will enable them to prepare and mobilise to assist their people when needed. I'm enjoying the community development elements of my task.
The other day, I did a group session in an elementary school which had been washed out. The students had no books or materials and were wading through a metre of water to reach the front door. We did some narrative work to help them make sense of the frightening events of the last months and the students shared their stories with me. It's always tear jerking. We also participated in therapeutic and psychosocial strengthening activities and it was nice to see their spirits lifted by the distraction from loss and destruction.
I have been working intensively with a child patient in the emergency hospital named 'Mar'. He is 13 years old and suffered extensive injuries to his legs eight months ago when he was hit by a car. His family can't afford the medical treatment required to give him surgery to assist with his rehabilitation. Then the typhoon occurred and his family home was destroyed. He was afraid, had become incontinent, did not attend school or socialise with other children, and reported worry about his situation and future. Our surgeon operated on him and he began to recuperate in the hospital. I worked with him on his trauma effects, pain, fear and incontinence. Yesterday, he walked out of his room and into the corridor. The look of pride and joy on his face was indescribable. In that moment we forgot the rain and bucket showers, and remembered why we were here.
How is psychological support perceived and understood in the Philippines?
It is my impression that psychological support is more understood in the Philippines compared with many other south-east Asian countries. This is likely due to the Western influence of colonisation by the United Sates in the earlier part of last century. People present with elements of individualistic and collectivist beliefs and thus recognise individual (as well as family and community) coping as important for recovery. There is still some mental health stigma, mainly due to lack of awareness or availability of practitioners.
The Philippines has around 800 psychologists, only one of whom actually lives in the disaster affected area and there are none on the island of Samar where I am based. There is next to no government funding for psychosocial recovery programs, so disaster affected communities rely on access to mental health and psychosocial support programs through international organisations like the Red Cross.
On the whole people are receptive to interventions, make self-referrals for assistance, and report gratefulness for support to treat and assist them to cope. I have found my position to be well perceived and almost revered, with long waiting lists and many word of mouth referrals.
What have you learnt about disaster work on this assignment?
I have previously been deployed by Red Cross to provide disaster assistance after the floods in Pakistan in 2010 and to Norway shortly after the massacre in 2011, and have worked in Australian domestic emergencies such as the floods in Queensland, and the bushfires in Victoria and Tasmania. It’s hard to compare emergencies as each are different in terms of their psychosocial impact. People’s ability to recover depends on the characteristics of the event, the crisis and post-crisis environment, individual characteristics, and family and community resources. Cultural and religious factors also affect the way in which people make sense of and process the event. In all, an average of 80 per cent recover from any traumatic event over time using their own individual and community coping resources and psychosocial support, with a smaller percentage needing mental health assistance.
As you find with many people living in difficult circumstances, the Filipino people are incredibly resilient, grateful and determined. The Philippines is a strong catholic country so faith, community cohesion and hard work reconstructing their homes is assisting in recovery. If only we could switch off the rain for a few days to help them dry their belongings and lift their spirits. Unfortunately my psychology skills don't extend that far!
However, I'm really pleased to be here, can see the strength and growth in the people and villages, and feel blessed that people share their stories and journey to recovery with me. It’s a truly privileged position to be a psychologist.