Return to Leyte Part 3: Tears and Joy

Read part one and part two.

The tile floor that was all that remained of the old house and clinic building is still visible in front of the new clinic.

We got to the Cumpio’s place around 4:00 pm, where everything was set up for the ribbon-cutting ceremony and reception. I got a few photos while we still had daylight (sun sets early in the tropics!) and then we hung out on the beach while waiting for the festivities to start. (Naomi swam again.)

The beach across from the newly rebuilt Cumpio Clinic.

It’s hard to express how much it meant to be able to be there for this celebration. When I arrived in Leyte in March and met Nerissa, the site of the Cumpio family home was still covered with debris from the typhoon and it was difficult to see how the clinic would ever be rebuilt. When I left Leyte in April, the debris had been cleared, funds for building materials had been secured and the first supplies had been purchased, and I had committed to finding the money to pay the laborers until the project was completed.

This photo is from April. The white tiles under the cement blocks are the same ones in the photo above of the completed clinic in September.

As the rebuilding project picked up steam, more people became involved: last month, a new grant was secured to help finish the inside of the building so that it could pass the health department inspection, and an ambulance vehicle was donated as well. This was truly the work of many hands and hearts.

With Nerissa beside one of several signs erected for the opening, thanking the many donors who helped in the rebuilding.

Looking around the clean, bright, spacious clinic building, I couldn’t help but remember the many nights Nerissa and I had spent attending births together in a hot, stuffy tent. What a contrast! What a significant step, not just for the Cumpio family but for the whole community, in recovery, rebuilding, and restoring local capacity! The first baby expected to be born in the new clinic is due this last week of September, with many more to come thereafter.

Ribbon across the front door all ready to go!

By the time the celebration began, it was too dark to get good photographs. My heart was so full, it was hard to imagine how much more momentous this occasion must be for the Cumpio family. Lots of tears through the smiles. It is impossible to forget the loss and devastation that preceded this event, the lives that were shattered by Yolanda. I am in awe of the resilience and strength of the people of Leyte and so very, very blessed to be able to count Nerissa as a friend and colleague.

Trying to put my heart into words.

Having learned our lesson on Monday, we left the party before it was really over to start driving back to San Ricardo ferry. I needed to be back in Davao on Thursday and could not afford to spend all day Wednesday waiting at the ferry terminal. So much for my original plan to avoid night driving! We arrived safely to the port a little after 1 am and were told that the scheduled 3 am sailing was full already but that we would be on the next boat at 8 am. Grabbed a few hours sleep in the car. The “8 am” boat finally left, with us on board, around 11:30, and we were home by 10 pm on Wednesday night. I’m already scheming about another visit, with a less tight timeline, when Matt and the kids have a school break. To quote the t-shirt depicting the MacArthur Landing Memorial which I brought home for Ezekiel, “Once you see Leyte, you will return!”

 

 

Return to Leyte Part 2: In Imelda’s Bedroom

Waiting for breakfast at the Haiyan Food Stop, refreshed after a good night’s sleep and ready for another day!

After our two long days of driving, we slept late on Tuesday morning. The grand opening of Cumpio Midwife Clinic was not taking place until evening. We ate a delicious breakfast and set out for Tacloban, about half an hour away. Our delays the previous day meant that we would not have time to see all the places that I’d hoped to visit with Naomi and Gabriela, but we meant to make the most of the time we had. Driving to Tacloban, I was amazed at how many changes there had been in the 5 months since I had left. It was so encouraging and heartwarming to see shiny new roofs where six months ago there were weather-beaten tarps. The recovery and rebuilding had clearly come a long way!

Morning refreshment — fresh buko juice (coconut water) and tiny single-serving pineapples, eaten off the stem like a lollipop.

Naomi and Gabriela agreed that of the various landmarks that we could visit (the scenic Leyte-Samar bridge, the MacArthur Landing Monument, the several large ships that had been washed into town by typhoon Yolanda) they were most interested in the Sto. Nino Shrine and Heritage Museum, built as both a museum and one of the 29 residences of President Marcos and taken over by the Philippine government in the 1980s after Marcos was ousted. Tacloban is former first lady Imelda Marcos’ hometown, and the museum was built on her family’s property. The mansion suffered extensive flooding and damage during Yolanda (link goes to a news site photo slide show) but has since re-opened. Our tour guide, who told us she was already part of the staff in the days when the Marcos family still used the residence on their visits to Leyte, was clearly devoted to the building and grieved over the damage caused by the typhoon. Despite the storm damage, the girls were impressed by the grandeur and opulence.

The ballroom with its enormous, octopus-like chandeliers.

Naomi was particularly fascinated by the dioramas depicting Imelda Marcos’ life, from her childhood in Leyte to her benevolent good works as First Lady of the Philippines, in each of the downstairs guest bedrooms.

Example of one of the dioramas: a youthful Imelda is crowned beauty queen.

The second-floor rooms had sustained less damage than those on the ground floor, as they had not been flooded (apparently the mud was knee-deep after the waters receded.) These included the ballroom, the larger of the two dining rooms, and the family bedroom. Our guide insisted I take a picture of the girls sitting on Imelda’s bed:

This picture does not do justice to the size of the room. The luxurious ensuite bath was quite a big larger than my bedroom.

Our tour complete, we left Tacloban and headed south to Dulag, where I had spent four weeks in the spring volunteering at Bumi Wadah’s “birth camp” clinic, which at the time was located in San Jose elementary school. We drove past the school, which is in session but still under construction (a Japanese NGO began repairs to the school shortly after I left Dulag.) Bumi Wadah has a lovely clinic building now which they share with the rural health unit. We visited there and were treated to a delicious lunch (eggplant salad, pumpkin soup, rice, vegetable lumpia, and fruit salad – yummy!) Because our lunch visit was a day later than planned, most of the midwives were attending a seminar and I would not get to see them until later that day at Nerissa’s opening, but it was great to see the new clinic building and see old friends again.

Lunch at Bumi Wadah.

One of the things I enjoyed most about my time in Dulag was the beach right across the street, where I went walking almost every day unless it was pouring rain or we were extremely busy with patients. In Davao, it’s easy to forget we’re on a tropical island since the city is so built up and the water so polluted — to get to a beach from Davao we have to drive a long way down the coast, or first drive and then take a boat to Samal Island. So after lunch we walked across the street to enjoy the fresh ocean breezes and the lapping waves.

Naomi enjoying the beach in Dulag.

On the beach, as well, signs of recovery were evident. Though the debris of ruined houses remained in many places, the surviving coconut trees, which had been almost bare of leaves in March, were green again and new fishing boats lined the beach. Naomi splashed in the waves while Gabriela and I visited with a new Bumi Wadah midwife volunteer who had just arrived from Australia. All too soon, it was time to head back toward Tanuan, for the most important event of our trip: the grand re-opening of Cumpio Midwife Clinic.

Return to Leyte

A few weeks ago, I got a message from Nerissa Cumpio. “Good morning Sora, the opening will be on September 16th, I hope you are available that day.” For several months, I’d been getting updated photos of the building project progress and finally, the date was set for the (re)opening celebration of Cumpio’s Midwife Clinic! I immediately started to plan my trip.

Rather than fly into Tacloban airport, I decided to make it a bit (more) of an adventure and drive to Leyte. I figured that the cost for gas and the ferry would be comparable to flying and that this plan would allow me to see more of the Philippines, and bring Naomi and Ezekiel with me. Unfortunately, I had a very tight schedule for when I needed to return to Davao, requiring some very long days of driving! Ezekiel decided the long days in the car did not appeal to him, and Matt had classes to teach in Davao, but Naomi came with me, along with Gabriela, one of our friends from Davao.

We set off on Sunday afternoon, well-provisioned with snacks and water bottles. The plan was to drive from Davao to Surigao City on the north-eastern tip of Mindanao, spend the night there, and take a morning ferry, reaching our final destination in Leyte in time for lunch. I had not been able to find a working phone number for the port or the ferry company in order to confirm schedules, but I had the all-important copy of my vehicle’s OR and CR and I had found what looked like a fairly recent ferry schedule on a travel website so I wasn’t too worried.

Our route.

The drive from Davao City to the ferry terminal in Surigao City is estimated at just over 5 hours by the google maps app. All I can say, is, whoever created the algorithm for the google maps travel times must never have driven in the Philippines. Our trip was on the Pan-Philippine highway the entire way, but most of the Pan-Philippine highway (outside of the major cities) is only two lanes, and there are frequent landslides and bridge repairs requiring constant maintenance.

Road works ahead.

When road construction limits the two lanes to one, there are never any flaggers directing traffic nor lights at night. And when passing through the numerous small towns the road becomes full of slow-moving tricycabs, bicycles, pedestrians, motorcycles laden with anywhere from four to six passengers plus cargo, dogs, chickens, carabao, etc. (Most of these also have no lights at night.)

Small-town traffic!

Gabriela had been working day shift at the clinic so we did not depart Davao until 2:00 pm. We reached Surigao City around 10:00 pm, completely exhausted. I had planned to go to the ferry terminal before we slept to confirm the ferry schedule and find out how early we needed to show up to secure our place on the ferry, but we were so tired we by the time we were approaching Surigao City that we chose to just check into a hotel and set our alarm for 5:30 am, figuring the ticketing office was probably closed already and that getting to the ferry at 6:00 ought to be enough for an 8:00 am departure. (Rookie mistake!)

We slept well and arose bright and early, headed for the ferry about 10 minutes away. As we got closer, the lines of parked cargo trucks on both sides of the road led me to suspect I might have made a tactical error in not taking the time to visit the port the night before. My inquiries at the port quickly confirmed my suspicion. I was permitted to hand in a photocopy of my vehicle registration to secure my place in line, but not to buy a ticket yet. I was told the morning ferry was already full and the noon ferry was “probably” full as well. The driver of the first car in line to board informed me that he had arrived at the port a little after midnight. Ooops! I texted my friends at the birth camp in Dulag to let them know we would not be there for lunch after all (“Maybe supper, then?”) and we decided to make the best of it by driving around Surigao to see the sights and maybe finding a (more pleasant than the ferry terminal) place to relax for a few hours.

The Surigao beach where we spent most of Monday morning.

We bought some pandesal at a local bakery and found a place where we could rent a beach cottage (picnic table with a roof) for 100 pesos. Naomi played in the water and Gabriela took a nap. We’d been told to check back in at the ferry terminal at 11:00 am, so right on time, we headed over. The ticketing agents were clearly overworked and stressed. When I finally got their attention, I was told my name had been called half an hour before! (I protested that I had left my cell phone number… but that was with a different agent, who had gone off duty in the meantime.) It was okay, we still had our place in line for the next ferry and were allowed to buy our tickets — a multi-step process involving no less than 5 different people all in different offices. I continued to hope for a lunchtime departure though there was no sight of a ferry yet, we parked our car where we were directed… and waited.

The ferry showed up around 2 pm and unloaded. Then the loading process began, and I realized this was going to take a while. The order of priority for ferries is passenger buses (which get on the next departing ferry after they show up), private vehicles (like mine, which apparently usually need to wait a while!) and finally cargo trucks, which explains the lines of trucks on the side of the road leading to the port. And all of these vehicles, crammed as tightly as possible in order to fit as many as possible, are required to back into their place on the ferry… the ramp only works on one side of the boat.

Finally, the ferry’s here!

The crossing itself was pleasant and uneventful, taking a little over an hour. The sea was calm and by leaning over the side into the breeze we could avoid the smell from the large truck full of pigs directly below us. Though there was some nervousness in certain quarters due to the unfortunate ferry accident that had occurred just two days before, I saved all my anxiety for the night driving.

Naomi, enjoying the fresh sea breeze and avoiding the smell (though not, alas, the sound) of the pig truck.

As the San Ricardo ferry terminal came into view, we enjoyed the beautiful views of the sunset over the mountains (the sun sets early near the equator!)

The welcome sight of the Benit (San Ricardo) ferry terminal, late afternoon on Monday.

Unfortunately, we still had 170 km to drive, mostly in the dark, on winding mountain roads. Again, we pulled into our destination around 10:00 pm, tired from a long day of travel. Nerissa and her husband Alex were waiting to meet us at the Haiyan Foodstop, a restaurant built after (and named after) the typhoon. The Haiyan hotel is still under construction but two guestrooms are open, and that was where we were staying for the night. A joyful reunion and a good night’s sleep (with no 5:30 am alarm this time!) and we were ready for the next day’s adventures.

 

Sora’s Month in Leyte – Part 3 – Cumpio Clinic

(Click to read Part 1 and Part 2.)

Nerissa standing next to the sign that used to hang above her family’s birth center.

Nerissa Cumpio is one of the bravest women I know. She is loved by all who know her for her ready smile and cheerfulness. Everyone who has worked with Nerissa can testify to her dedication, industriousness, and eagerness to learn new things. Even after an exhausting night with many births and no sleep, Nerissa was always ready to make the rest of us laugh with her quick sense of humor. And the fact that Nerissa was there in Leyte and working at the birth camp at all is evidence of her incredible courage and resilience.

Nerissa didn’t originally plan on becoming a midwife, but went back to school at her mother-in-law’s urging in order to be able to work together with her in the family clinic. The family property in Tanuan (just south of Tacloban) includes a beautiful strip of beach and used to house both their home and Cumpio Clinic, a PhilHealth accredited birth center. The night before Typhoon Yolanda was due to make landfall, Nerissa and her two young daughters evacuated to her grandmother’s home, 2 km inland. Her husband Alex and her father-in-law had planned to stay at the house but around midnight they changed their mind and decided to join the others — a decision that saved both of their lives.

When the storm surge came, it was worse than anyone had imagined or predicted. The grandmother’s home that the family thought would be far enough inland to be safe was swamped and they were trapped for hours in cold, filthy water, holding their children to keep them above the surface, in terror for their lives. After the water receded, the roads were so blocked with debris that it was impossible to return to their home for three days. And when they reached it, nothing was left of the beautiful house and clinic but tile floors covered with rubble.  Everything they had owned, from furniture to fruit trees, was gone. When the Cumpios searched the rubble they discovered that their surviving neighbors had already taken anything of value that had survived the storm.

With the rubble now cleared away, the tile floors that are all that remains of the Cumpio’s former house and birth center are visible.

After a desperate week — without communication with the outside world, waiting in relief lines for food and water — a brother-in-law came from Manila to find the family and evacuate them. At that time, they were certain that there was nothing worth coming back for in Tanuan because nothing they owned had been spared Yolanda’s fury. Their lives there had been destroyed by the storm, and they would start over again in Manila.

But when Nerissa was offered a job at the birth camp, she and Alex came back to Tanuan — ready to endure hardship to provide much-needed care for others who did not have the option of leaving Leyte. They came back to live in a UNHCR tent surrounded by rubble and debris and work to rebuild their home and community. They came back to a place where they would be surrounded every day by reminders of all they had lost and endured.

Nerissa showing me around the property just before I left Leyte — construction had already begun. She’s holding the rechargeable fan that I brought with me in order to make sure I wouldn’t be too hot to sleep at the birth camp (’cause I’m a wimp) and passed on to her when I left — their tent-home has no electricity.

When I met Nerissa, she and Alex and their children were still living in the tent and there were as yet no immediate plans, and no source of funding, to rebuild her Tanuan clinic. Then Mercy in Action (the organization that initially started the birth camp in December 2013 before turning it over to Robin Lim at the end of January) was given a significant donation for Leyte relief work and decided to dedicate it to rebuilding Cumpio clinic. Plans were drawn up and approved, and a Mercy in Action volunteer came to oversee the purchase of materials and the hiring of construction workers. There was only one problem… the funds available from Mercy in Action were enough to buy the building supplies, but not sufficient to see the project through to completion or even to pay the construction workers to begin building.

Construction workers making re-bar supports for the posts of the new clinic — even a light rain didn’t stop them. The workers are all local men with families so donations to help with construction are also helping the recovery of the local economy.

Before I left Leyte, I was able to give Nerissa money to cover the salaries of the construction workers for the first month of the project. I also committed to find the funding to complete the project — an estimated total of $5000USD. (Matt’s jaw dropped a little bit when I told him about this. I replied that after staying in Leyte and working with Nerissa for a month, I was going to make sure her clinic was completed even I had to use every penny of our personal savings to do it. She deserves this.)

With Nerissa and her husband Alex at the build site.

This project will only rebuild the birth center, not the Cumpio’s home. (Nerissa insists, “I really don’t mind living in a tent.”) As I discussed in Part 2 of this series, the Cumpio’s new clinic will be able to provide free care to local residents under PhilHealth’s post-disaster “all-avail” policy. An investment in this birth center (and this inspiring young midwife) will bless the community in Tanuan for many, many years to come. Please consider helping with a donation to our special project account.

Prayer request – immigration paperwork

Being a missionary requires filling out lots of forms and always having a large supply of 2×2 headshots…

UPDATE: Thank you for praying! Everything has worked out. (May 7)

One of the less pleasant realities of living overseas is dealing with the bureaucracy and paperwork for immigration. Before we moved to the Philippines, in preparation for applying for our missionary visas, we needed to have all of our birth certificates and our marriage certificate “authenticated,” first by the local civil authority where each document was issued and then by the Philippine consulate with jurisdiction over the area where each document was issued. For our family that meant spending several months gathering paperwork from two states, two Canadian provinces, the District of Columbia, and four different Philippine consulates. Then when we arrived in the Philippines, a few more months were spent gathering and notarizing the additional paperwork (in triplicate) needed to apply for our “9g” missionary visas and then waiting for the visas to be approved. While waiting, we needed to pay a fairly hefty fee to renew our visitor visas every two months. Everything went smoothly, if not as quickly as we might have hoped, and our 9g visas were approved last May 3 and stamped in our passports in June.

Then things began to go wrong, though we remained in blissful ignorance of the fact for many months. Our application for alien certifiate of registration ID cards (or ACR I-cards) was sent from the Davao immigration office to the central office in Manila. We were told the cards would probably take about two months to be processed and arrive back in Davao. We waited… and waited… but each time we checked with the Davao immigration office, we were told the cards were still in process in Manila and that this delay was not unusual.

Then in December, Matt went back to Ohio for his ordination and Father Manto’s consecration as a Bishop. Leaving the country would have been a fairly straightforward matter if he had been in possession of an I-card at the time, but because his I-card had not yet been issued, when Matt returned to the Philippines after his short trip back to the US his 9g missionary visa was “downgraded” back to a 9a visitor visa.

It would take far too long (and would make extremely boring reading) to detail all that we have gone through in trying to correct this problem. To make a long story short, it involved many hours of stress and headaches, many many visits to the Bureau of Immigration by us here in Davao and the agent we hired to represent us in Manila, and up until this week it appeared that we had become stuck in a continuous loop from which there was no escape. Our I-card applications, sent from Davao to Manila, had mysteriously disappeared and never been entered into the computer system or processed. An I-card was required in order for Matt’s passport to be ammended from 9a visitor status back to 9g missionary status. Meanwhile, our one-year visas were going to expire on May 3. We had our applications for renewal (photo above) all ready to submit in March before I left for Leyte, but immigration would not accept them because the principal applicant (Matt) had had his visa downgraded…

Many of you have prayed faithfully for a solution to our paperwork woes over the last many months, for which we are very thankful. On Monday (yesterday), we had given up hope and resigned ourselves to the idea that we would have to start over from the beginning again… Then — wonder of wonders, miracle of miracles! — our agent in Manila texted incredible news. Our I-cards had been issued. Matt’s passport was being stamped with the correct stamp, and would be sent to us in Davao by courier that very afternoon.

This was amazing and unexpected news. But we’re not quite out of the woods yet. Our visas expire on May 3 — Saturday — and Thursday and Friday are holidays during which the Bureau of Immigration will be closed. The courier package with Matt’s passport in it just arrived this afternoon (Tuesday), and we plan to take all our renewal paperwork in tomorrow (Wednesday). Please pray that our renewal goes smoothly, with no lost documents, and that we’re granted the 2-year visas that we’re requesting. Also, Matt needs to travel again in June to go to the Reformed Episcopal Church’s General Council which is held once every three years. There is no chance that our new visas, much less our new I-cards, will be issued before he leaves, so he is applying for a “grace period waiver” to allow him to leave the country without an I-card. The waiver application must be submitted after our visa renewal application is received by the Bureau of Immigration but before our I-cards expire, so everything really needs to go smoothly tomorrow — the last day that the immigration office will be open before our visas expire. Please pray that the “grace period waiver” is granted in a timely fashion and that we have no further problems because of his travel! Thank you so much for your faithful prayer support.

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

(See Part 1 here.)

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.

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.)

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.

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.

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.)

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.

Sora’s month in Leyte – Part 1 – Introduction

Local children playing on the beach in San Jose, Dulag.

It’s been difficult to know how to begin to write about the month I spent volunteering at a makeshift birth center in the town of Dulag on the island of Leyte, ground zero for last November’s super-typhoon Yolanda (Haiyan). This first post will be a sort of introduction / overview and I’ll write later, in more detail and with more pictures, about specific events and people.

I’ve now heard many first-person accounts from survivors and relief workers who were there in the early weeks after the disaster. I’ve seen many photos and videos of the immediate aftermath. But it is still difficult for me to wrap my mind around the sheer scale of the devastation. By the time I arrived in Tacloban airport on March 15, more than four months after Yolanda, recovery and rebuilding was well underway. Evidence of the typhoon’s damage was everywhere, events were referred to as “before Yolanda” or “after Yolanda” and many people were still living in donated tents or under tarps with the donor organization’s name emblazoned in large letters. But the area had clearly settled into a “new normal.” New construction here and there denoted those who could afford to rebuild. A brisk new trade in the manufacture and sale of concrete blocks and the recycling of bent and damaged metal roofing was evident. Roadside stands offered an ever-increasing variety of produce, heaps of sprouted coconuts waiting to be planted to replace the thousands of lost trees could be seen by the roadsides, and some of the gardens that had been replanted “after Yolanda” were ready for harvest.

Many plants grow incredibly quickly in the tropics, but the coconut trees will take many years to replace.

The town of Dulag is about an hour’s drive south of Tacloban, down the eastern coast of Leyte island. It was in the “eye of the storm” and while the incredible winds of the strongest typhoon to make landfall in recorded history did a lot of damage, Dulag did not experience the same devastating storm surge that caused thousands of fatalities in Palo, Tanuan, and Tacloban itself. The big wave (higher than the coconut trees, according to witnesses) went north up the coast rather than directly inland.

The clinic where I was volunteering was set up in early December. Tents were erected inside the large assembly room of a local elementary school because the building had lost its roof and a solar suitcase was used for lighting. By the time I arrived, we had electricity and the roof had been repaired, but we were still using tents because they were convenient room dividers and allowed a semblance of privacy. The volunteers slept in tents at one end of the long hall. There was a tent for medical supplies, a tent with two beds in it that served as the “delivery room”, and an L-shaped three-room tent with cots in it for mothers and babies to stay postpartum. If we had more patients than room in the tents, we set up extra cots for them wherever we could.

School canteen, battered by Yolanda and no longer in use.

Another damaged school building, looking out from the clinic toward the highway. The ocean is barely visible between the buildings and broken coconut palms.

In addition to volunteers from the US, New Zealand, and Europe, we had a great team of Filipino staff: six lovely midwives, a nurse who ran a sort of “urgent-care clinic” six mornings a week out of a Unicef tent set up outside next to the school playground, administration and support staff who took very good care of us. Most of these (except for the project manager) were local residents. The school building is right off the Pan-Philippine highway (more of a quiet country road at that point) and the beach is just across the road.

The Filipina midwives pose in our prenatal area (behind them is the tent for postpartum patients.)

School in the Philippines runs from June through March; April and May are the summer vacation months. So when I arrived San Jose Central school was still in session. The school administration was incredibly gracious about having a full-scale birth center on the premises and the children were charming, friendly, and extremely interested in us, peeking at us through the windows and doors from early in the morning until late in the evening. Despite the extreme damage to the school building and the surrounding community, there had been no fatalities in the student population during the typhoon (largely because the barangay of San Jose had been spared the deadly storm surge) and the students ended their year on time, having only missed a few days of school because of Yolanda.

In the doorway are Soichi and Tricia, two of our little friends whom we saw almost every day.

During some of my free-time while in Dulag, I reread When Helping Hurts (kindle edition on my phone) and sadly I saw more than one real life violation of the principles of “helping without hurting.” Immediate disaster relief work is stressful, intense, and difficult. Navigating the transition from relief to rebuilding is complex, challenging, and fraught with opportunities for unintended consequences. I learned a lot during my time in Leyte. While preparing for my trip, I solicited donations to help with buying supplies for the birth center where I would be working, and was able to use these to fill a suitcase, out of which much (especially baby hats and blankets) was distributed to the families of some of the 87 babies born while I was there. I quickly became convinced that, helpful as it was to the families we were caring for to have a place to come for a safe, gentle birth, it was more important for the community as a whole to work on restoring the health care infrastructure that had existed before the typhoon … and that our very presence as foreigners, giving away “freebies”, in many ways created a disincentive for that to happen. I realized that in order to make the greatest positive impact during my time in Leyte, my focus needed to be on supporting and assisting the local midwives I was working with in any way I could.

To be continued…

“My little finger shall be thicker than my father’s waist!”

Ezekiel shoots a jump shot in happier days. He’ll be sitting on the bench for the rest of the season.

Basketball is not intended to be a contact sport. Unfortunately, during team practice today Ezekiel’s little finger made contact with the ball and he came home with a swollen pinkie that was jutting out at an odd angle, which he could not straighten or move without extreme pain. After icing it and hemming and hawing a little bit we headed to the ER of one of the private hospitals in town (it was late enough in the evening that no clinics or doctor’s offices would be open.)

Who needs a lead apron for a little old hand x-ray?

The ER  experience was smooth, easy, and efficient, an incredible contrast to understaffed, overcrowded ER at the public hospital where we usually bring any patients who need transport for higher-level care. Ezekiel was unquestionably the healthiest patient there but we were still seen immediately. Within half an hour of arrival we had paid for our x-ray (in the Philippines, you pay first and then get treated: that’s why there’s no wait time in the ER) and Ezekiel was getting zapped. The radiology tech was surprised when I asked him to put the apron on my kid for just a hand x-ray.

Probable diagnosis: chip fracture. (They x-rayed the uninjured hand too to compare but I only got a photo of the first one.) No orthopedists in house at 7 pm so Matt’s going to take him back tomorrow.

The ER doctor offered to admit him so he could have first crack at the ortho in the morning rather than having to wait around in the outpatient clinic (Seriously? Seriously! “Since there is a fracture, we are allowed to admit him.”) This was obviously overkill so I said we’d just come back tomorrow. They settled for immobilizing the hand and finger (which Ezekiel considered excessive), telling us to keep icing, and writing a prescription for mefenamic acid which we probably won’t bother with since the swelling is fairly minimal (post title notwithstanding) and he’s not in pain unless he tries to move his finger.

The most remarkable part of the whole thing (besides being in and out and home in about an hour and a half, half an hour of which was spent driving?) Total bill for ER visit with x-ray: 823 pesos. (At today’s exchange rates, that’s USD$18.39.) Plus $0.65 for the bandage. Except… that this is at the expensive private hospital that very few families can actually afford to go to. It’s still hard to fathom that what seems like such a small amount to us is an insurmountable barrier to care to so many others.

Overseas Filipino Workers

image credit: the kaya collaborative

It is a truism that the Philippines’ biggest export is people. The number of Filipinos overseas is more than 10% of the Philippine population, and money sent from overseas workers to family members back at home represents more than 10% of the national GDP.

A few months after we arrived, one of the other missionary families asked if we’d be interested in a part-time cook — they loved the woman who was cooking for them but she really wanted full time work and they didn’t need her for that many hours. We agreed and soon grew to greatly appreciate Helen’s cooking and baking as well as her honesty, industry, and cheerful attitude. Helen was a grandmother and her income helped support an extended family including an aging father and a 10-year-old grandson for whom she was the primary caregiver. Some years before, Helen had responded to the recruiting advertisements and gone to Kuwait as a domestic worker on a two-year contract. It wasn’t long before she discovered that all was not as advertised. Her story is not an unusual one: overseas Filipinas working as domestic servants are frequently exploited and even abused. Helen left her first employer and was able to find another job “under the table” in order to keep sending money back to her family in the Philippines. She was reported for working illegally and spent months in a Kuwaiti jail before returning to the Philippines.

Helen eventually left us for a better job in Manila. A few months later, we learned that the sister-in-law of one of our apartment complex’s security guards was planning to go overseas to work, leaving her husband and two young children in hopes of better financial security for her children’s schooling and future. Her brother-in-law was trying hard to dissuade her: even if she were to get a “good” job with a reputable agency, she would not see her family for several years. It did not take much persuasion for us to offer her a job with our family. Of course, this solution is not generally available for the hundreds of thousands, perhaps millions of Filipina mothers who leave their children behind to work overseas, believing this is the best choice they can make for their families.

Getting a good job here in the Philippines is difficult. Because of an abundance of workers, the job market is saturated and even college-educated workers often struggle to find employment or make a liveable “middle-class” income. Employers can pick and choose and job specifications, especially for retail work, almost always list specifications that would be quite illegal in the U.S.: “Must be female, over 5’2″, and under 25 years old.” (To work at a grocery store check-out counter.)

Mary, one of my former patients, texted me today to tell me she was planning to apply to work overseas. She is 26 and had been working at the grocery store where I usually shop, so I saw her regularly. Her contract had expired and despite her experience and work ethic she was not going to be hired back again because she was “over the age limit.” She saw overseas work as her only option now.

“Maguol ko sa akong mga anak … wala ko trabaho wala sila makaon,” she texted. (I will be sad for my children but if I don’t work they are not able to eat.)

(She is still looking for a job here in Davao as well though she is running up against the “age limit” in many of the retail jobs for which she is qualified; please pray with me that she will find something.)

Just another ordinary day

Some days here can be challenging, frustrating even. The days you wake up with no power and no running water. The days your patient tells you she only took 3 doses of the antibiotic that was prescribed for 10 days because she couldn’t afford to buy more (yes, most medications here really are sold in single pill units.) The days you spend hours waiting in line and still haven’t managed to get all the required paperwork completed. But to make up for it, there are also days when I can hardly believe how lucky I am to get to live here and do the work I do.

Today I supervised swing shift at the birth center (2 pm – 10 pm.) As a supervisor I have more responsibilities and less time for direct, hands-on patient care but I get to do a lot more teaching, which I really enjoy. Seeing your student do something well is even more satisfying than doing it well yourself.

The shift started slowly: it had been a quiet morning without any births, and there was only one patient admitted, in labor with her second baby. Over the course of the afternoon, a few mothers brought their newborns in for scheduled check-ups. Most of these were uneventful — healthy mothers and healthy babies — but just before 4 pm a young couple came in with their new baby whose newborn screening test had just come back positive for G6PD deficiency. This metabolic disorder is not uncommon here and means that the baby lacks the enzyme glucose-6-phosphate dehydrogenase, and exposure to certain foods or medications may lead to hemolysis (destruction of red blood cells.) We spent a lot of time educating the parents about how to protect their baby and referred them for confirmatory testing.

As we were finishing up with this, another woman in labor walked into the birth room. She flashed me a big smile of recognition: I had been her midwife for her prenatal check-up earlier in the week. Her two adorable older boys peeked through the window from the waiting area outside. As J, one of our younger Filipina staff midwives, started checking the baby’s heart tones and the mother’s vital signs, we pulled out her chart and realized there was a problem: the baby was not due for another month. We try to avoid premature births at our clinic: as a birth center, we have everything necessary for normal births and full-term babies but we are really not equipped to provide respiratory support to babies whose lungs are not mature. We started to prepare for transport to the hospital but quickly realized there was not going to be time for that as her water broke and …ready or not, here comes baby! I made a snap decision that a late preterm baby here at the clinic was preferable to a late preterm baby in the ambulance van and we quickly got ready for the birth. A few minutes later a screaming baby boy was on mama’s chest and I was breathing a sigh of relief as I listened to him voice his annoyance with his untimely eviction: no resuscitation needed this time. At 2000 grams (4.4 lb) this little peanut was only half the size his next oldest brother had been at birth! He struggled a little with transitioning to using lungs that would really have benefited from a few more weeks inside, and there were a few moments when I thought we’d be sending him off to the hospital after all, but thankfully kangaroo care and close monitoring turned out to be all that was needed.

Once baby was stable the next step was sewing up his mama’s tear from the very speedy delivery. J needed a little help with her suturing technique — in fact, I had to tell her to pull out her first stitches and do them over again. I was proud of her for trying again instead of taking the easy way out and just having me do the repair, and by the time she finished she was proud of herself for a job well done and felt like she had really learned a lot.

By now the mother in the next bed was ready to push, so I left J to continue her postpartum watch and stepped over to the other side of the curtain to supervise the birth of another baby boy, a chunker by comparison at a week past his due date. He lost no time getting down to business with his new full-time jobs of eating and pooping.

At the same time that all of this was happening, one of the other midwives had been giving me regular updates about the young (teenaged) first time mother who had come in in very early labor shortly after our first birth of the shift. She was only 2 cm dilated and not having very strong contractions yet. Normally this would mean we would encourage her, explain the signs of active labor, and send her home. Unfortunately, this mother’s blood pressure was elevated — not to the point where we needed to transport to the hospital, but too high for us to just send her home. First, we instructed her to drink water and lie on her left side for a while, which often will normalize blood pressure — unfortunately, hers was actually a little higher when we checked it again. On hearing this, she started to cry and said she really did not want to go to the hospital. (Unlike our birth center, the hospital does not allow family members in the labor and delivery rooms and her mother who was doing a great job of supporting her would not be able to stay with her if she was transported.) I had her midwife quickly test for protein in her urine — all clear — and start an IV of D5W hoping to get her blood pressure to stabilize and buy her enough time to possibly be able to still deliver at the birth center. It worked — her blood pressure came back down to a more reasonable level — and she settled in to rest before labor really kicked in.

Our final patient of the night came in a little after 8:00. She was also a young first time mother, and also was not quite in active labor yet. Since there were no concerns about either her or the baby she was told to go home, eat dinner, and rest and instructed about when to return to the birth center. Later, the midwife who had checked her and sent her home was helping to clean up the birth room after our two patients who had given birth had moved to the postpartum area. She carried one of the big plastic trash cans we use for soiled linens out to the laundry area which is outside the clinic, behind the entrance hallway and family waiting area. She came back in laughing: “Remember the patient I sent home an hour and a half ago? I just found her hiding in the laundry area.” Like so many other first-time mothers, she was quite certain that her labor would be the exception to the norm and was deeply concerned that her baby would accidentally be born at home or in a taxi if she did not stay very close to the birth center! (While amused by this, I am also deeply sympathetic: when I had my first baby I was told “you’re not really in labor yet, go home” for three consecutive nights of non-stop contractions in a row until in desperation and exhaustion I finally dug in my heels and refused to leave the birth center.)

After giving report to the night shift team we all prayed together — for safety and normal, progressive labors for our two young mothers (the one with high blood pressure and the one who wouldn’t go home), for continued health and well-being for our little premie who was still struggling with breastfeeding, and with great thanksgiving for God’s mercies to us. Such a fun shift with a great team of midwives. I love my job.