Sora’s month in Leyte – Part 2 – Rebuilding Local Capacity

(See Part 1 here.)

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Midwife Maricel with her youngest daughter.

Of all the Filipina midwives I worked with in Dulag, Maricel was one of the hardest to get to know. I saw quickly that she was extremely hardworking and responsible as well as being one of the most knowledgeable and experienced midwives on our team, but she was shy and a little mistrustful of foreigners. After several weeks of working together, she opened up and I learned more about her family and her experiences during the disaster. Like the other residents of coastal Leyte, which is no stranger to typhoons, Maricel was taken by surprise by the force of Yolanda. (Back in November, Philippine president Aquino told reporters “nobody imagined the magnitude that this super typhoon brought on us” and this was certainly true of everyone I spoke to.) Maricel, her husband and her daughters were in Dulag when Yolanda made landfall but her teenaged son, who attends school an hour away in Tacloban, was not with them. Communications were cut off after the storm and the roads were impassable. It would be more than a week before the separated members of the family knew that all had survived. Maricel and her family were among the fortunate: there were no fatalities in the immediate family and they lived far enough inland that they did not lose everything they owned. Even so, picking up the pieces and putting their lives back together was a daunting and difficult task.

The “birth camp” where I volunteered was funded and directed by outside (foreign) donors. In the immediate aftermath of supertyphoon Yolanda, numerous NGOs came to provide temporary health care services in the affected areas, and these services were desperately needed. The local clinics and hospitals had been damaged or destroyed, medical supplies and equipment were washed away, and the local doctors, nurses, and midwives were themselves typhoon survivors who had lost homes, possessions, and family members. However, foreign assistance for necessary health care is a temporary, immediate-post-disaster-relief strategy that becomes much less appropriate in the recovery and rebuilding phase. Restoring locally directed health care services is necessary for a community to return to normal.

During my time in Leyte, I saw firsthand some of the detrimental unintended consequences of having foreigners providing (free) health care. Prior to typhoon Yolanda, every barangay (village or district) had a Rural Health Unit providing midwifery care for low-risk births as well as other health care (each RHU also had an ambulance for transport to a higher level facility (hospital) when needed). In most barangays, there were also several privately owned “lying-in clinics” (birth centers) accredited by PhilHealth, the national health care plan. In the aftermath of the disaster, the Philippine government adopted an “all-avail PhilHealth” policy for citizens affected by typhoon Yolanda. This meant that everyone in the disaster area was eligible to receive PhilHealth coverage for needed services, regardless of whether they had previously paid the premiums normally required for coverage. Prenatal care, birth, and postpartum and newborn care at any PhilHealth accredited facility (either a hospital or lying-in clinic) was among the covered services.

Because our organization gave out “freebies” to patients both at prenatal checkups and when they gave birth (food and vitamin supplements, baby clothes and blankets, tarps), patients came to us to get prenatal care and give birth in our tent-clinic even when they had to pass multiple functioning birth centers on the way to our facility. In fact, on more than one occasion pregnant women arrived who had traveled up to two hours or even more, sometimes from areas that were not even affected by the typhoon. Midwives who had run privately-owned PhilHealth accredited birth centers in the area prior to Yolanda were losing patients and income because their patients were coming to us. In some cases, the patients were not aware of the PhilHealth “all-avail” policy and believed they would have to pay for care at the local clinics; in other cases, they just didn’t want to miss out on the “freebies” that we were giving away.

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Maricel’s clinic building after the typhoon. The clinic is on the first floor; the second story was where her family lived. They are now living in the kitchen area behind the clinic. In addition to the wall and roof damage, their water-pressure tank was destroyed when a neighbor’s wall collapsed.

Maricel, owned her own birth center in another barangay of Dulag about 20 minutes away. Maricel’s clinic was still open for business despite the building having sustained significant damage from Yolanda. She came to work for the birth camp in San Jose school because “all her patients were coming here” and without patients she had no income to pay for the operating costs of her own birth center (professional fees, business license, etc.)

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Maricel’s youngest daughter “out back” at the laundry/kitchen area behind her clinic.

After discussing the issue with the project manager for the birth camp, we encouraged Maricel to talk to patients from her barangay who came for prenatal care at the birth camp, making sure that they knew her clinic was open and that care there was free under the “all-avail PhilHealth” policy, and encouraging  them to transfer their care to her much closer birth center. Before Yolanda, Maricel’s clinic had usually had 8-10 births every month. She had had only four deliveries total during the first three months of 2014, but after she started “recruiting” patients from the birth camp, there were four births at her birth center in the first two weeks of April (before I returned to Davao… hopefully there have been more by now!) She is hoping to continue to increase her patient load to the point that she can stop working at the birth camp and focus on her own clinic.

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Maricel with a new mother at her clinic.

When I visited Maricel’s clinic I was impressed at how clean, organized and inviting it was despite the typhoon damage. She had obviously worked very hard to keep her clinic open and functional after losing the top half of her building (which served as her family’s living quarters.) However, every time it rained water would leak from the roofless second story into the clinic in numerous places, requiring buckets in the hallway and causing significant ceiling damage.

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Water damage and mold on the ceiling of the delivery room in Maricel’s clinic.

The estimated cost to repair the roof and damaged second-story walls and replace the water-pressure tank is a little over $2000 USD. Maricel has struggled to keep her clinic open since typhoon Yolanda and coming up with the funds for the repairs is completely beyond her family’s means. Aside from the ongoing damage to the clinic ceiling every time it rains and the loss of the family’s living space, the obvious damage to the outside of the building has been a deterrent to potential patients who were not aware the clinic was still open. (Maricel’s husband has since erected a large sign making clear that the clinic is open for business and also advising residents that they can get free care at the clinic due to the “all-avail PhilHealth” policy.)

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With Maricel outside her clinic building.

Contributing to the repair of Maricel’s clinic will both directly help a family return to an independent livelihood after typhoon Yolanda and also ensure ongoing maternal-child health services in a low-resource area of rural Leyte. To give online, click this link and select “Special Project.”  100% of donations received will go toward either Maricel’s clinic repair or to the second clinic repair project (Cumpio clinic in Tanuan, Leyte) which I will post about shortly. I intend to post “after pictures” of the clinic when repairs have been completed.

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