Typhoon Lawin Health Assessment – Illocos Norte, Cagayan, Kalinga

MSF Team – 2 MDs, 2 RNs, 2 Logistics Managers, 1 Pharmacist

MdM Team – 2 MDs

Super-Typhoon Lawin (international name HAIMA)

made landfall early on Oct 20th

, then lost power

going over the mountainous (and sparsely

populated) East Coast of Northern Luzon. It

continued as a category 4 Typhoon, West across

the predicted path through Isabella, Cagayan,

Apayao and Ilocos Norte provinces. Central Luzon

was affected as well, but to a lesser degree.

MSF + MdM arrived October 21st

to Tuguegarao in

Cagayan Province and Laoag City in Illocos Norte

Province. MSF + MdM aided in the initial

assessment of Medical structures in collaboration

with the DoH.

Despite the widespread damage across several regions, there were no immediate major health emergencies that

required MSF or MdM operations. Many Health structures did suffer damages. However, very few resulted in the

structure being incapable of continuing to provide services to the affected populations. Structures that did become

‘non-functional’ were able to refer patients to near-by functioning structures.

NDRRMC Situation Report (No. 07 dated 24 October 2016), noted 12 (twelve) deaths as a result of the typhoon.

Most injuries were treated by existing medical structures and most were non-life threatening in nature

(lacerations, puncture wounds, etc.) with patients being released the same day.

The major concern would be the lack of electricity in most structures. Most Medical structures possessed only 1

generator for back-up power and most were not in optimal condition. These systems remained under-tested and

under-dimensioned (too small for running the hospitals). There also appeared to be no standard for back-up power

supplies, leaving each Health structure in a potentially precarious situation. It is recommended to complete an

inventory of all back-up electricity systems in medical structures and implement routine testing and upgrades.

The lack of electricity also affected important Municipal water systems. Back-up generators were being used to

restore some water pump stations, but generator problems continued to be a major obstacle in providing

adequate quantities and quality of water. This should be monitored closely as the proper treatment and provision

of water could not be guaranteed at the time of assessment.

There was no official request for foreign assistance by the Philippine Government. Therefore, any response had to

be handled by in-country resources.

List of Acronyms

ANC ……………………………………………………………………………….Antenatal Clinic

AFP ……………………………………………………………………………….Armed Forces of The Philippines

BEmONC ……………………………………………………………………….Basic Emergency Obstetric and Neonatal Care

BHS ………………………………………………………………………………Barangay Health Station

CAR……………………………………………………………………………….Cordillera Administrative Region

CT ………………………………………………………………………………..Computerized Tomography

DoH ……………………………………………………………………………..Department of Health

DPWH ………………………………………………………………………….Department of Public Work and Highways

ECG……………………………………………………………………………….Electrocardiogram

EPI………………………………………………………………………………..Expanded Program on Immunization

ER…………………………………………………………………………………Emergency Room

HEMS……………………………………………………………………………Health Emergency Management System

KVA …………………………………………………………………………….Kilo-Vol-Amper

LGU……………………………………………………………………………..Local Government Unit

MdM…………………………………………………………………………..Medecins du Monde

MSF ……………………………………………………………………………Medecins Sans Frontiers

NDRRMC ……………………………………………………………………National Disaster Risk Reduction and Management Council

OCD…………………………………………………………………………….Office of Civil Defense

OPD…………………………………………………………………………….Outpatient Department

OR……………………………………………………………………………….Operating Room

PHO ……………………………………………………………………………Provincial Health Office

POD…………………………………………………………………………….Postnatal clinic

RDRRMC …………………………………………………………………….Regional Disaster Risk Reduction and Management Council

RESU ………………………………………………………………………….Regional Epidemiological Surveillance Unit

RHU…………………………………………………………………………….Rural Health Unit

RN ………………………………………………………………………………Registered Nurse

List of Medical Structures Assessed physically

Region Province Structure Beds GenSet Notes

1 Illocos Norte Pagudpud RHU 1 Needs back-up GenSet

2 Cagayan Cagayan Valley Medical Center 600 +4 Needs 625 kVA back-up GenSet

2 Cagayan Peoples General Hospital 75 2 GenSets OK

2 Cagayan City Health Office 0 Needs 2 GenSets

2 Cagayan Penablanca RHU 0 Birthing Clinic, Needs 2 GenSets

2 Cagayan Alcala RHU 20 1 Needs back-up GenSet

2 Cagayan Lol-la RHU 1 Needs back-up GenSet

2 Cagayan Mathilde Olivas Hospital 25 1 Needs back-up GenSet

2 Isabela Elvine Masigan Hospital 10 0 heavily damaged, 2 ambulances

2 Isabela Milagros Alvano Hospital 50 1 Needs back-up GenSet

CAR Kalinga Tabuk City Hospital 100 1 Needs back-up GenSet

CAR Kalinga Lubuagan RHU 1 0 damage

CAR Kalinga TInglayan RHU 1 0 damage

Region 1 – Illocos Norte Province

The health situation is under-control in all 4 provinces (Ilocos Norte,

Ilocos Sur, La Union and Pangasinan) in Region I. There were minimal

damages in health facilities and infrastructures. As a result, a few number

of people sustained injuries; but none of them was life threatening. No

reported typhoon-related death in the region. Cellular lines were restored

in the region, except for landlines and internet services. Electricity took

longer time to be restored; but at the time of our arrival at the Regional

DOH Office in San Fernando, La Union, 70% were already restored. And

on the 21st of October, almost all of the affected places were reportedly

restored. Access to road networks is restored by the time of our trip.

There were floods caused by typhoon but they had subsided by the time

of our visit. Rain leakage and broken glasses were also reported by a few

health facilities.

The Regional Disaster Risk Reduction Management Council

(RDRRMC) and the regional and provincial health authorities were found

active in the preparedness, monitoring and response. Regional and

Provincial officials categorically said that Ilocos region does not need

international help, not even national help, where local resources and

capacities are enough to cope with the current situation.

Key contacts:

Dr Rosario Pamintuan, head of Regional Epidemiological Surveillance Unit (RESU) and Health Emergency

Management System (HEMS)

Mr. Melchito M. Castro, Regional director, Office of Civil Defense Region 1, RDRRMC.

Dr Edwin Sanchez, Assistant Director, DOH Regional Office 1

Provincial Health Team Leader/DOH Officer of Ilocos Norte, Dr Fanny Carmelita Domingo

Provincial Health Officer, Dr Josephine A. Rueda

San Fernando, La Union, Region 1

Regional Health Office, Region 1

• Met with Dr. Rosario P. Pamintuan, head of Regional Epidemiological Surveillance Unit (RESU)

and Health Emergency Management System (HEMS)

• Met with Dr. Edwin Sanchez, Assistant Director of Region 1 who arranged for our team to join in

the DOH assessment team the next day in Ilocos Norte.

Regional Disaster Risk Reduction and Management Council, Region 1

• Mr. Melchito M. Castro, regional director, Office of Civil Defence Region 1, RDRRMC who

categorically said that the Region is able to address the situation using local resources.

International and even national help is not needed.

As of 21st October morning:

• Winds were “Moderate to Strong” in Ilocos Norte and “Light winds to Fair Weather’ in La Union

and Pangasinan;

• In Pangasinan Province, flooding was as high as 1-2 feet. (San Roque Dam went above the

spilling level and four gates were opened to release 4 meters of water from the dam);

• Pre-emptive evacuation was done in the whole region led by the Armed Forces of the

Philippines (AFP)

• There were 107 evacuation centers opened the day before and during the onslaught of Typhoon

Haima, wherein 3320 families or 12012 individuals sought temporary shelter. As of 21st October

2016, 7pm, there were as much as 23,500 people affected in Ilocos Norte itself when we’ve got

there.

• By the end of our assessment, all evacuation centers were closed as individuals have all gone

back to their respective homes.

o Total Injuries in the Region (as of 21st Oct)_ One case was reported from Brgy San Pedro,

Agoo, La Union, hit by a fallen branch of a tree and 5 cases were reported from Ilocos

Norte (2 cases of head injury due to fallen tree branches, 2 cases of lacerated wound,

and one case of hematoma of 1st digit). However, with the following report in the

evening, in Ilocos Norte, there were reportedly 10 injuries _ 1 head injury and others

were minor injuries.

o Total Casualties in the Region (as of 21st Oct)- zero (0)_ There was a person from Ilocos

Norte whose cause of death was previously reported on the news as typhoon-related.

However, further verification showed that the patient’s cause of death was post-

stroke.

• Total Damaged Health Facilities in the Region as of Oct 21: 6 health facilities

o 1 in La Union- Ilocos Training and Regional Medical Center in La Union (leaking

roof/ceiling in the following areas: kiosk, Pedia ward, Ortho ward, Neuro ward, Uro

ward, OPD, Surgery Building, ECG and Treatment Room, waiting area, Optha-ENT ward,

ER, HEMB, Gaiter proble/damaged CT scan and dietary; but the hospital is still functional

o 5 in Ilocos Norte (see succeeding report on Ilocos Norte)

• Functionality of the Health Facilities: As of Oct 21 reports, all of the health facilities are

functional and are able to see patients in their respective catchment areas.

Ilocos Norte

As Ilocos Norte has reportedly been the most affected area among 4 provinces in Region I, the team

decided to do the assessment in the Province. This was also the priority area of DOH Regional Office and

RDRRMC for assessment. During the team’s visit at the Regional DOH Office, it has been agreed that the

DOH, together with MSF and MdM will conduct a joint rapid assessment in Ilocos Norte Province on

October 22, 2016. The Provincial Health office, with the support of the Regional DOH office found to

make all necessary preparations before the typhoon. They did pre-emptive evacuation of population

situated in hazardous areas. They had also re-stocked medicines in RHUs. Such collaborated efforts

could have contributed in zero casualty and only minor injuries after the typhoon.

Local resources appear to be adequate to address the current situation. Health needs are minimal

compared to other sectors that sustained majority of the damages, such as the agriculture, housing and

infrastructure. Damages to health facilities are minimal and the provincial and regional government

should be able to address them.

Office of the Provincial Health Team Leader/DOH Officer, Ilocos Norte Province

The team met Dr. Fanny Carmelita Domingo, the Provincial Health Team Leader/DOH officer in Ilocos

Norte. She gave us information about the health situation of the province and functionality of the health

facilities. She stated that the local capacity is enough to cope with the situation. During the said

meeting, it was planned that MdM and MSF teams together with the DOH team would go for

assessment in the next day. The PHO shared recent updates about the health situation in the province.

Information collected for Ilocos Norte province as of 7pm, 21st

October 2016

1. No. of affected Local Government Units: 23

2. No. of affected barangays: 254

3. No. of affected families: 6,139

4. No. of Affected persons: 23,525

5. No. of damaged houses: 3,968 (Totally: 367; Partially: 3, 601)

6. No. of evacuation centers: 7 (All evacuation centers were vacated since

the people had already gone back to their homes)

7. No. of Hospitals: 7 (all are functional)

All of the hospitals are functional and there is no increased influx of patients post-typhoon. We

were able to see the Provincial Hospital in Ilocos Norte, Sr. Roque Ablan Memorial Hospital, and

the hospital was functioning well.

8. No. of Rural Health Units: 23 (all are functional)

Health human resources (HRH) in the Province have started reporting to work and the health

facilities are able to resume back to normal. Despite of the minor damages of some health

facilities, service delivery has been restored.

9. Damaged Health Facilities due to Super-typhoon Haima:

a) Marcos Elizabeth Barangay Health Station (BHS)- partial damage to roof and ceiling

b) San Nicolas Rural Health Unit (RHU)- partially detached roof

c) Gabu BHS- some broken windows

d) Paoay RHU- cracked glass window at the ER

e) Bacarra RHU- damaged to RHU storage facility

With the minor damages sustained by few health facilities, the Provincial Health officials said that the

provincial and regional government will be able to deal with the repair of the damaged health facilities.

The team also joined DOH and Provincial Health Office (PHO) briefing the next day, October 22, 2016

before the joint assessment.

Pagudpud RHU, Ilocos Norte

Pagudpud RHU is supposedly one of the health facilities

that sustained major damages during the typhoon.

However, through inspection, only minor problems were

found: leakage in the delivery room and EPI cold chain

area and broken glass door at the entrance. In general,

the RHU looked squeaky clean and there were several

staff (about 10) present during the assessment

considering that it was Saturday. Conduct of EPI and

normal deliveries were still functional. There were no

typhoon-related mortality in the area and only 3 patients

sustained minor injuries.

Adams, a fifth class municipality situated in the northern coast of Ilocos Norte near Pagudpud

and one of the remotest areas in Ilocos Norte is also reportedly safe. Pre-emptive evacuation was done

on a timely manner that saved the people in the municipality.

Medical assessment of Pagudpud RHU

Type of Health Structure: Municipal Health Office with Primary healthcare center with

BEmONC facility

Number of Staff: 7 nurses, 7 midwives, 1 general practitioner and other staffs

Catchment Area: Municipality of Pagudpud with 6 barangays with estimated total

of population of 22, 000 people.

Average number of consultation

per day: 100 patients (not related to typhoon); no increased

influx of patients post-typhoon

Average number of deliveries per month: 10 - 12 deliveries. Complicated

cases needing higher level facility of care are referred to

Bangui District Hospital (45 mins from Pagudpud) or in

the provincial hospital in Ilocos Norte (about 1 hour from the

place)

Doctor-to-patient ratio: 1: 22,000 approximately

Nurse-to-patient ratio: 1: 3,143 approximately

Midwife-to-patient ratio: 1: 3,143 approximately

Pagudpud Rural Health Unit (RHU) is the main health facility in the municipality with a catchment of 6

barangays (one Barangay Health Station each) covering a population of approximately 22,000. The

facility has a doctor, 7 nurses, 7 midwives, a medical technologist and a dentist. The facility, like all other

RHUs in the country provides the following services:

• OPD

• ANC, PNC

• Basic Emergency Obstetrics and Neonatal Care (BEmONC)

• Family planning consultation and provision of commodities

• Nutrition screening

• Immunization

• TB-DOTS

• Laboratory for TB-DOTS and basic blood tests

• Open 24/7 to attend emergency cases

• All other national health programs that need to be implemented at the municipal and barangay

level

Logistics assessment

1. Water:

- Source: Local water district (Not Chlorinated)

- Storage: none

- Quality: Clear, no sediments observed. No odor

- Concerns: Water untreated, also source of drinking water for community

2. Electricity:

- Source: Local power Grid (Currently on Generator after Haima)

- Back-up Power: Generator Set

o Size of Genset: Undetermined

o Status of Genset: Not well maintained

o Fuel Allocation: bought by hospital funds & LGU

o Average run per day: Undetermined

o Electrician available to maintain: None (security guards to check)

- Protection:

o Average protection using standard size circuit breakers, no earth grounding and

differential breakers observed.

o Currently installed convenience outlets are not three-prong (no grounding)

o Some electrical wiring connections observed to be open, connections not enclosed in

junction boxes.

3. Waste Management:

- Available hospital cleaners: undetermined

- Waste Segregated: NO

- Sharps pit: available but almost full

- Placenta pit: undetermined

- Waste water treatment: None

- Infectious Medical Waste: disposed along with general waste in municipal landfill, no

treatment done.

- Status of Latrines/ toilets: available at hospital for patients and office ,

- Water available in every tap, pressure found sufficient.

4. Facilities:

- Ambulance: 1 unit available and in standby. Condition undetermined

- Laundry: Undetermined

- Kitchen: available but without proper equipment, standard protocols and strict

food handling not observe. Also observed to be near the TB-DOTS sputum collection area.

- Pharmacy: available and functional but storage is not temperature controlled and

exposed to heat with 1 unit cold chain with assorted vaccines, temperature monitoring done

on regular basis based on temperature monitoring guide but found 2 days without

monitoring entry. Possible cold chain breaks due to no available electricity.

- Laboratory: Will open soon but for now TB-DOTS is being done. Waste not properly handled.

(Containment and disposal procedures not followed.)

- Sterilization: None found

- X-ray: None found

- ER/OT: available and functional but not complete in terms of equipment.

Routine IPD and OPD procedures done.

5. Transportation

o Planes/Airport - None

o Road Conditions - Good

- Police response and visibility: Police station very near the hospital, mobile/ cars available in

case of police response needed.

6. Supplies:

- All open and available stocks: Food Market, Hardware, Groceries, Pharmacies, Fuel Stations

7. Communications:

- Mobile Phone Signal - Yes (stable in hospital location)

- Data Internet Connection - Yes (but not really reliable)

Region 2 – Cagayan and Isabela Provinces

Information is slow to come out, as communication to many isolated

areas remains cut-off. Information from government aerial surveys

indicated that Tuguegarao (pop. ~140,000) in Cagayan Province is the

‘worst affected’ area from Typhoon Lawin. The NDRRMC stood up an

Emergency Operations Center in Tuguegarao. They are the authority

for the disaster response.

MSF and MdM are working directly with the DoH and their Health

Emergency Management Bureau, represented by Assistant Secretary

Myrna (0908 881 0048) in the DoH Region 2 Office.

Additional contacts from Region 2:

IMT Briefing (October 22, 2016)

Fire Supt. Roderick B. Ramirez, MD (Bureau of Fire Protection)

- 09255571865 / 09178871865

Ronald L. Villa (OCD) – 09055467367

DOH Regional office 2

Leonardo Rodney Ramirez, RN (Development Management

Officer) – 09179648334

Infrastructure damage

Roads were mostly cleared but had obvious signs of recent damage in many areas, including landslides,

flooding and structural (bridge) damage. As of Friday Oct 21st, all major routes in and out of Tuguegarao

were opened, as well as airport service.

For approximately 50 kilometers South of Tuguegarao hundreds of power line towers were broken,

fallen, or otherwise damaged. Repair crews were active, including with heavy equipment, trying to

repair the lines. Different sources report different repair times, from 3 weeks to 2 months.

Water – Tuguegarao Metropolitan Water District

Contact: Engineer Miller C. Tanguilan, CESE – General Manager – 0917 854 4830

Not a big concern for most as municipal water is available in most places. Diarrhea outbreaks are not

common to the area and cholera/shigella/E. Coli has not been noted in the Province historically.

There are 13 pump stations in Tuguegarao that function normally on City electricity. All pump stations

must now run on generators.

Of the 13 pump stations, 3 are currently not functional:

• Buntun - (furnishes 90 Liters per second) – 165kVA Generator damaged, in process of being

repaired = 8 Barangays affected (low pressure or no water)

• Linao - 75kVA Generator (furnishes 40 Liters per second) – main power cable damaged, in

process of repair = 5 Barangays affected (low pressure or no water)

• Annafunan – 100kVA Generator – damaged, in process of being repaired but parts are hard to

find. A 65kVA is being used instead, but only able to deliver 20Liters per second. = 4 Barangays

affected (low pressure or no water)

Engineer Tanguilan is in the process of establishing a water trucking system with the Bureau of Fire

Protection (BFP) to be able to distribute water the 17 affected Barangays.

The Water Bureau has a credit line with Petron and Maxx fuel stations, who are currently able to

provide all fuel needs to run the generators as well as the Fire Bureau water tankers.

The price of diesel was between 28 and 31 pesos per liter in Tuguegarao (normal price). ***note: in

Tacloban in 2013 diesel prices rose 5 times the normal price***

Chlorination usually occurs at the level of the Pumping stations. However, all water bureau staff are now

allocated to repair works. Therefore, no chlorination is currently happening for the City water supply.

They attempted to contact the Radio but the Radio station is not functional. Messages are being

distributed through Facebook that all water must be boiled before consumption.

Evacuation Centers

There were 15 evacuation Centers in Tuguegarao City. Most stay there during the night, as they repair

their houses during the day. At the time of visiting, there were only 3 evacuation centers still in

operation, the largest being ‘People’s Gym.’

A medical team from Cagayan Valley Medical Center was sent to the Evacuation Center and around 50

consultations were given.

Hospitals – There are 10 hospitals in Cagayan Province and 2 in Tuguegarao City.

Cagayan Valley Medical Center (DOH): 600 bed tertiary hospital

Contact: Engineer Meninga – 0915 801 6776 – expressed need

for additional Generators

+100% Bed occupancy rate (normal for this hospital).

There was minor to moderate damage to the roof and ceiling

of about 30% of the hospital buildings.

Only one patient care area was affected resulting in the

relocation of several patients.

Electricity is provided by a 625kVA generator and 313kVA generator for the majority of the hospital.

Though the hospital electrician stated that the 625kVA is actually only producing 75% (460kVA). The

Blood-bank has a separate 25kVA generator and the ER and OR both have 2kVA generators that are

used independently of the main generators. They have 3 solar panels (40watts) that were damaged

during the Typhoon. The hospital is forced to time certain services (Surgery, X-ray, CT Scan, Laundry, O2

generation) to avoid overconsumption. They have completed a bidding process for a new 625kVA

generator but it should take 1-2 months more to have it delivered and operational. 625kVA generators

are available in Manila for 2.8M pesos ($58k USD).

Water is normally provided by the City. Since the Typhoon, there has

been no supply reaching the hospital. They have been using their own

protected, deep well which has a 5HP and 3HP submersible pump. They

pump into a 15000L water tower, which then runs into the hospital. The

water is not considered drinkable from the tap.

The Hospital has a brand new oxygen generation plant

that has not yet been certified for patient use.

Emergency situations such as this, they may use it for

life-saving activities. They are able to produce/refill H

cylinders and could be a resource for other hospitals

that need oxygen. They have around 3 days’ worth of

Oxygen at any given time for their patients.

The Administration of the hospital has cancelled all holidays for staff to ensure proper staffing.

Regarding medical services, the facility is fully functional although all elective surgeries have been

postponed. They plan to restart elective surgical service on Monday Oct. 24th (under generator power).

The hospital use to be over 100% of bed capacity, so with the reallocation of patients from damaged

sections, the situation of overcrowding in some areas has been aggravated. ICU is full and portable light

ventilators are not available, resulting in new patients needing ventilation need to be ventilated by

manual bag ventilators. No any patient surge typhoon related reported by now.

A plan should be developed for the hospital to run on the generator power for at least 2 months

Peoples General City Hospital (LGU): 75 bed hospital

Contacted: Dr. Ramses Salvanerra – no expressed needs

They currently have 80% Bed occupancy rate. They’ve seen around 115 patients with wounds related to

the typhoon (puncture, lacerations, etc.). They do not report being overwhelmed.

Electricity provided by 165kVA generator and 250kVA generator operated alternatively.

Water is provided by their 40M well with submersible pump to 4000L tanks on the roof. Water is not

considered drinkable from the tap.

Ronald P Guzman Medical Center, Divine Mercy Wellness Center and St Paul Hospital of Tuguegarao

all requested treated water for dialysis patients. Estimated 100L needed per patient/per day. Usually 3

treatments are needed per week per patient. Cagayan Valley Medical Center has offered to furnish the

needed water.

The City Health Office The clinic normally functions Monday through Friday (closed during our visit). This

could be explored if needed to be open 24/7 to decongest Cagayan Valley Medical Center, or be used

as a back-up facility. The City Health Officer was busy with evacuees in the evacuation center.

Penablanca RHU: Penablanca is located 15 km south west from Tuguegarao. There is a RHU with a

birthing clinic. RHU runs from Monday to Friday 9AM – 3PM and the birthing clinic is functional 24/7

with midwife on call. RHU new building is under construction, planned to be inaugurated in November.

Temporally, they run OPD in the City Hall. The structure presented light structural damages, mainly

broken windows and broken glass main entrance. Some boxes of medicines stored on the floor got wet.

Supplies requested to DoH. The old birthing clinic was almost intact, part of ceiling of a room down. It is

operational during daylight but no generator back-up, and getting water from a well nearby and bringing

it by jerrycans. They refer patients to CVMC in Tuguegarao by ambulance. They have two municipal

ambulances fully operational 24/7. Americares NGO running OPD consultation there (1 MD, 1 RN, 1 Log)

Elvin Masigan Integrated Memorial Hospital: Santa Maria is located 25 kms away from Tuguegarao

City. MMC serves Santa Maria mainly but it receives patients from Enrile and Quezon too (25k people)

It’s an infirmary running as BEmONC. 10 bed capacity with an average of 2-3 deliveries per day and 10-

15 patients daily seeking for urgent medical attention (mostly at night) 1 lab for basic tests. Typhoon hit

the hospital quite strongly, and it has resulted seriously damaged, not operational at all. Patients are

referred to CVMC. They have 2 operational ambulances. Need of total rehabilitation and reconstruction.

Milagros Albano District Hospital (Cabagan): 50 bed

capacity provincial Hospital serving 8 municipalities. Bed

occupancy rate is around 67%. The hospital sustained

structural damages, affecting mainly to roof and ceiling.

Some patients needed to be reallocated but as bed

occupancy is usually below 75%, they could be safely

accommodated. 125 kVA generator got damaged due to

heavy rain, but they got a generator from provincial government (75 kVA) so they are functional, able to

provide services although all elective surgeries have been postponed. They didn’t state any medical

surge till now. Water obtained from own well and pumped by submersible pump.

Alcala RHU:

Contacts:

1. Jay-Ar Q. Duruin, Nurse III : contact number 0917 513 1254

2. Dr. Gene Richmond R. Vergara, Medical Officer III : 0917 534 5435

3. Reynaldo C. Floria, MPDC : 0905 629 4707

New building and birthing clinic got damaged (roof). Not operational. Patients go to Alcala hospital

nearby. Hospital is a 20-bed infirmary running as BEmONC facility, with low occupancy rate (<50%) and

2-3 deliveries per day. They refer patient to CVMC by 1 municipal ambulance. There was damage to the

roof and ceiling. Fully operational by generator on demand (no back-up generator) Water from well

pumped by submersible pump. No medical surge.

Lol-la Rural Health Unit and Birthing Center

Contact: Dr. Concepcion B. Abang - Municipal Health

Officer/Pediatrician

There was a report being received by Office of DOH,

Region 2 that birthing center in Lol-la municipality was

not functional. Therefore, the assessment team,

together with 2 DMOs from the regional office went to Lol-la RHU. After finding that Lol-la RHU was

referring pregnant women to the nearest District Hospital, the team also decided to visit to the said

referral hospital.

• Lol-la RHU and Birthing Center is a BEmONC-certified health facility that caters to 44,000 population

located in a first-class municipality. The municipality has 35 barangays.

• The average number of deliveries conducted every month was 8 and there were approximately 20

cases of deliveries referred to Matilde A. Olivas District Hospital, which is about 15-20 minutes from

the RHU.

• The Health Human Resource (HRH) seems to be enough_ 1 doctor, 17 nurses (1 permanent, 3

contractuals, 1 casual, 12 NDPs), and 15 midwives (5 permanent, 4 casuals, 3 contractuals, 3

RHMPPs).

• In terms of medicines and supplies, RHU reportedly had adequate quantities

• Since the typhoon, conduct of normal deliveries had temporarily been stopped due to insufficient

supply of water. Since municipal water system being dependent on electricity, water supply was also

affected where there was a power cut. The facility has no water tank for storage. There was an old

5-KVA-generator but no back-up generator that may pose problems in storage of vaccines.

• During the visit, a private company was demonstrating on how to use a water filtration system in

the municipality. However, it did not look like a sustainable solution for the water problem in the

municipality considering the cost and limited volume of water being filtered.

• Based on observations, there was no major structural damage in the health facility. If the electricity

and water are restored, RHU and birthing center can regain functionality to its pre-disaster stage. If

the water shortage cannot be solved in a short time, it would an added burden for pregnant women

to travel to the District Hospital that may further cause congestion in the district hospital.

• The team had given the feedbacks from the assessment to DOH and recommended that the reason

for temporary non-functionality of the birthing center is something that can be addressed

immediately without waiting for the electricity to be restored (may take months to be restored). The

municipality can help in looking for ways to find sustainable water sources so that the operations of

the birthing center can be resumed as soon as possible.

• It was also recommended to DOH to make a standard protocol for cold-chain monitoring and

breakage.

Matilde A. Olivas District Hospital

The health facility is a level- 1 hospital with

25-bed capacity. But in practice, it has to

accommodate up to 75 patients.

There are 8 doctors (1 ObGyn, 1

Pediatrician, 2, Anesthesiologists and 4

General Practitioners); 18 nurses (6

permanent and 12 contractual) and 1

midwife in the hospital. In every shift, there

are only 4 nurses manning the wards, ER,

OPD and OR.

The new building is supposed to be typhoon-proof since it was built in 2014, but it sustained

structural damages from the typhoon, particularly the ceilings of ER and business office. Even pre-

typhoon Haima, the facility was rehabilitated for floor tiling with just 2 years of turn-over. Observed

during the assessment was presence of live wires hanging from the broken ceiling in the new

building without turning off the circuit breakers which posed a safety hazard to the patients and

staff.

In the old building, there had been structural damages since before the typhoon that caused some

of the rooms dysfunctional (leakages from plumbing and toilet sewerage system, leakage in the

centralized oxygen supply and electrical circuit breakage inside the OT). Damages caused by the

typhoon were broken glass panes on the staircase (both sides of the building), and ceilings above

the stairs going to the 2nd floor).

The hospital has been doing proper waste segregation, but disposal is done in an open pit where

animals frequent. The open pit is also near the river. They do open-burning of general wastes near

the laundry area so that linens would be exposed to the smoke.

Generator condition is not good and there is no back-up. Fuel is subsidized by the Provincial

Government.

The hospital has continuous water supply from the stored water in the tank with the present power-

interruption.

Observed the vaccine fridge inside the pharmacy but not able to inspect the vaccines and the

monitoring sheet. Recommendation is made to DOH to do a standard cold-chain monitoring and

breakage.

Blood bank fridge was also observed in the pharmacy (right location be in the laboratory) but was

not able to be inspected inside.

The needs expressed by hospital staff were ultrasound machine, medicines especially antibiotics, IV

fluids and oxytocin

The team finally had provided feedbacks to DOH including the needs and gaps from the

observations and interviews with the staff.

Cordillera Administrative Region - Kalinga Province

MSF/MdM team was endorsed by DoH for continuing assessment in

Kalanga province in CAR, moving from Tuguegarao to Tabuk, Lubuagan,

Tinglayan, and Bontoc. Roads were mostly passable although there

were many parts still affected by landslides. Bridge in Bontoc was closed

for safety reasons after being damaged in the Typhoon. However, we

were able to discuss with Department of Public Works and Highways

(DPWH) who agreed to allow us to cross because of our medical

mission. The road from Bontoc to Bagguio was not passable according

to DPWH.

Regarding infrastructure, most roads, bridges and buildings were intact.

There was no network coverage in Tabuk and as afternoon 23 October

no electricity. In the evening of Oct 23 electricity was restored in part of

the province, at least municipalities close to Bontoc.

CAR seems to less affected than Cagayan in terms of damages to health facilities, although the lack of

electricity together with difficulties in communications and geography could be a risk regarding access

to health. Roads need to be cleared ASAP and plans for level 1 hospitals need to be implemented to be

able to run safely as long as normal power supply remains off.

Tabuk District Hospital

Persons interviewed:

1. Dr. Bernard L. Luandaga, Head of the Department of Surgery : 0920 955 2419

2. Dr. Josephine Abunalde, Anesthesia Department : 0916 372 5784

Level 1 provincial hospital. It was functional running on one 195 KVA generator. Also operational for

medical wards, obs-gyn, ER and emergency surgery (2-3 per day as average including cesarean section).

No backup generator. No network coverage. Light structural damages in roof.

Surgeon reported repeated interruptions during surgeries due to Generator overload. For this reason,

MSF donated one 2 KVA generator as backup for OR only.

A plan should be developed for the hospital to run on the generator power for at least 2 months

Lubuagan - RHU with birthing clinic not damaged.

No electricity. They have normal operations during daylight hours. They refer to Tabuk City Hospital.

Tinglayan - RHU with birthing clinic not damaged. No patients at the time of visit.

The electricity returned on the evening of October 23. They remain operational with 3 RNs. They refer to

Tabuk City Hospital and have an ambulance on stand-by.