PULSE The Asia-Pacific IFMSA Magazine April 2014 Issue
Dear Asia-Pacific Family, In the last few months a number of natural disasters have significantly affected our region. Most recently, the Philippine Islands have been devastated by Typhoon Haiyan. Relief efforts are still taking place there, and will continue into the foreseeable future. Natural disasters are likely to increase in frequency and become more severe as man-made climate change advances. Now, more than ever, we need to realise the impact of human activity on health, and work towards reducing our carbon footprint. More responsibility for our actions is needed. To help achieve this goal, we need greater awareness and education on the impact of climate change and natural disasters on health. This Pulse magazine is meant as a capacity building tool to improve medical students' knowledge on the aforementioned issues. It is also meant as a tribute to the thousands of AMSA-Philippines members who were affected by the recent disaster. To our Family members in the Philippines, please know that your Asia-Pacific Family is with you in spirit and that we are always here to help so please do not hesitate to ask us for assistance at any time.
RCmessage
With my love and best wishes always,
Bronwyn.
Asia-Pacific Regional Team SCOME Regional Assistant SCOPH Regional Assistant SCORA Regional Assistant SCORP Regional Assistant SCOPE Regional Assistant SCORE Regional Assistant Advocacy, Policy and Education Development Assistant Publications and Communications Development Assistant NMO Development Assistants
Yameen Hamid (BMSS Bangladesh) Shela Putri Sundawa (CIMSA-ISMKI Indonesia) Tsukasa Watanabe (IFMSA Japan) Ayaka Ishihata (IFMSA Japan) Rizki Meizikri (CIMSA-ISMKI Indonesia) Adelia Rachman (CIMSA-ISMKI Indonesia) Aghnia Putri (CIMSA-ISMKI Indonesia) Theodora Caroline (CIMSA-ISMKI Indonesia) Ann Jeong (KMSA Korea) Joshua O'Reilly (AMSA-Australia) Rimi Maehara (IFMSA Japan)
2
On the cover
PULSE IFMSA Megazine The Asia-Pacific April 2014 Issue
source: www.thena
tion.com
Typhoon Haiyan, known as Typhoon Yolanda in the Philippines, was a powerful tropical cyclone that devastated portions of Southeast Asia, particularly the Philippines, on November 8, 2013
2 RC Message 4 ACTION 2013 Summer Camp 5 Gamacoaster 6 International Climate Change Negotiations 7 Bringing Think Global to the IFMSA Network in Asia-Pacific 9 Chronicles of Yolanda 11 "THE MOST VULNERABLE" 12 Haiyan In The Phillipines: A Grade 3 Disaster 13 Health workers after Typhoon Haiyan: shaken, but not broken 15 Health at Your Doorstep 16 Working with Project Child 17 SCOPE Weekend Training 2014
CONTENT 3
ACTION A New Wave of Action
By Mariko Kondo ACTION (Asian Collaborative Training on Infectious disease, Outbreak, Natural disaster and refugee management) is the only transnational project in the Asia-Pacific Region. We belong to SCORP, and our vision is to spread the idea of disaster medicine to health-related professionals around the globe. As medical students, we should be trained to be ready to face disaster situations and provide proper management in order to reduce the level of damage and prevent infectious outbreaks at disaster sites.
The Goals Our goals are: 1. To raise awareness of healthcare students towards disaster management; 2. To train future healthcare professionals who can work to relieve disaster victims; 3. To motivate trained healthcare students to spread their knowledge on disaster medicine within their NMOs; and 4. To cultivate medical field workers who have international perspectives in dealing with disaster medicine.
The package Every year, ACTION organizes a week-long summer camp hosted by one of our member countries. In 2013 the camp was held in Bangkok, Thailand with the courtesy of Mahidol University. Over 40 participants from 9 NMOs spent the week learning the ideas and skills of “Outbreak Investigation” from experts of the field. Every year, local university faculty members and governments support ACTION’s academic content, and last year’s summer camp was supervised by Mahidol University and the Thai Bureau of Epidemiology. ACTION believes that our program should not end in a mere week of
fun and friendship (although they are just as important), and thus we put great effort into our follow-up activities. During our summer camp, we gain fundamental knowledge on disaster medicine based on the current global standards. However, every country has different issues and styles when it comes to the management of disasters and infection. In order to make our knowledge more useful, each NMO organizes follow-up activities based on their local needs. For example, ACTION-Japan is planning to organize a study tour in Fukushima. As the chronic phase of the East Japan Earthquake and Tsunami extends, we would like to raise awareness amongst those that stay in Fukushima as well as those who have evacuated to other prefectures. This will be a Japanese-based program, but we are planning on sharing what we learn with others from around the region.
Cultural experience One of the highlights of ACTION is our unique multicultural experience. For our 8th annual summer camp, we were honored to welcome a new member NMO - Oman. The Omani delegation introduced us to Arab culture and the current situation of disaster and outbreak management in the Middle East.
4
GAMACOASTER
Role of Medical Students in Disaster Preparedness
by Ardys Safira Indonesia is a country located at the meeting in the form of lectures and focus group discussions. point of the Indoaustralian, Eurasian and Pacific Furthermore, in order to pass on practical skills and techtonic plates, and is therefore prone to natural knowledge, skills trainings, role plays, and disaster disasters such as earthquakes, volcano eruptions, management simulations are organized. Through and tsunami waves. Casualties and death tolls are these sessions, participants learn how to manage always high whenever major disasters happen in natural disasters; and are empowered to educate this country, leaving a haunting terror for those and inform people in their home countries about who survive and who may witness the death disaster preparedness. of loved ones, or the destruction of homes and livelihoods.
The Activities
Under risk Certain cities are more prone to disasters than others. Among these is Yogyakarta, a city blessed with fertile lands and natural beauty – however, being “fenced in” by a fortress called Merapi volcano in the north and Parangtritis beach in the south, has put Yogyakarta under risk of natural disasters. As one of the most renowned institutions in Indonesia, Gadjah Mada University realizes that health professionals play a vital role whenever disasters happen. Through the Gadjah Mada Course on Disaster Management, the university hopes to provide young health professionals with a comprehensive training course on how to deal with natural disasters. Each year, over the course of a few days, “Gamacoaster” educates students on topics in disaster management through interactive methods
In 2013, fourteen undergraduate medical students from Austria, Egypt, Germany, Indonesia, Japan, Malaysia, Slovenia, Taiwan, and the Czech Republic took part in “Gamacoaster”. The students were all very nice and got on well with each other. After ten days, all the participants were successfully able to obtain the required knowledge and expertise on disasters, how to prepare for them, and how Indonesia and other countries around the world cope with them. The students had the chance to practice the skills that they learnt from the simulation sessions during a field trip where they visited local communities, teaching them how to prepare themselves before, during and after disaster situations. Last but not least, the participants were able to savor the beauty of Yogyakarta - the splendid views, the friendly people, and the unique culture seemed to astonish many of them in a way they had never before imagined.
Take part in 2014's GAMACOASTER, GAMAMORSE (Gadjah Mada Medical Summer Course) on infection and neglected tropical disease! Check out www.gamamorse.com for more info and registration. Isn't it exciting?
5
i
INTERNATIONAL CLIMATE CHANGE NEGOTIATIONS By Rachel Purcell In November 2013 I was a member of the IFMSA delegation attending the 9th Conference of Youth (COY 9) and the 19th United Nations Climate Change Conference (UNFCCC COP 19) in Warsaw, Poland. Attending COY 9 and COP 19 was an enlightening experience. Â A long way from university study back home in Australia, being able to witness the negotiations has provided valuable insight into high level decision-making processes regarding climate change at an international level.
COY COY 9 was an inspiring way to lead up to COP 19. Held over four days preceding the COP, it gave participants the opportunity to network with similar-minded young people from around the world. Youth from the international community joining together to prepare for the upcoming climate negotiations is symbolic of the intergenerational equity challenge that climate change poses. Passionate about climate justice and equity, the youth perspective offered a passionate perspective on climate change. From different backgrounds, cultures and experiences; the enormous challenge which climate change poses to our generation transcends barriers of language and unites participants in forming a platform of solidarity in preparation for the upcoming negotiations.
COP 19 Intergenerational equity was also a featured component in some of the discussions at COP 19.An inspiring panel aimed at youth
discussed the impacts of climate change on future generations across the globe. UNFCCC Executive Secretary, Christiana Figueres, shared her vision inhoping for a future which connects the 1.3 billion people currently without access to electricity to electricity efficient cooking stoves for women in developing countries; and where access to meetings such as COP 19 is possible using technology which is available to everyone across the globe. Figueres stated that the quest for intergenerational equity when it comes to climate change is a marathon not a sprint, and that there is a responsibility to advocate strongly in communities back in our home countries. The transformation from high-level carbon use must be a complete wave, and that as youth we need to send a strong signal that low carbon needs to be the norm heading into the future, “Make no mistake, the quality of energy
6
on this planet determines the quality of life.� Ahmad Alhendawi, the UN Envoy on Youth, urged us to be patient and stay motivated, that intergovernmental negotiations take time, and that reaching consensus is the only way to move forward. Attending the 19th United Nations Climate Change Conference was an incredibly valuable experience. Not only did I learn about climate change and health, but also how health may or may not be a priority in international negotiations.
"
I would encourage all medical students from the Asia-Pacific region to try and take advantage of opportunities afforded by being a medical student and member of the IFMSA to attend meetings like this in the future.
"
I consider medical student participation at COP 19 as a valuable way to experience the politics of climate change in a global setting. The benefits of translating this into public health practice and advocacy in our home countries are clear. Â Attending COP 19 affords the opportunity to share our experiences with student colleagues back home.
Bringing Think Global to the IFMSA Network in Asia Pacific
By Claudel Desrosiers & Anya Gopfert Think Global is the IFMSA's premier global health initiative working to educate and empower youth around the world to make a change in global health. Over the next year, Think Global will be providing workshops, webinars and blogs supporting IFMSA in its work on the post2015 development agenda, climate change and advocacy to name but a few examples, with the over-arching aim of the initiative being to "bring Think Global to the local level." Think Global aims to educate and provide forums for discussion through webinars and blogs. Webinars will be available reaching out to the IFMSA network and beyond to discuss topics ranging from global health diplomacy to sustainable development, featuring both youth leaders in their fields and international experts. To complement these webinars will be monthly Think Global blogs on the IFMSA website providing insight into topical global health debates and issues. The first blogs are up, with the latest discussing climate change, health and Typhoon Haiyan.
Future global health leaders need to be knowledgeable in global health. And they need the skills in advocacy and diplomacy to enact this knowledge in a productive way. Think Global will be working to build capacity amongst the youth generation to develop change makers Most of all the Think Global capable of creating the coordinators and international world we want. This year team want to meet the needs of the we aim to introduce IFMSA network. So please do get involved a formalized global and get in touch by e-mailing us at: health advocacy training thinkglobal@ifmsa.org. that will increase the All ideas are welcome! availability of training for youth around the world.
7
H
eadline
TYPHOON HAIYAN Jonathan share his first-hand experience of Typhoon Haiyan
8
The Chronicles of Yolanda By Jonathan Panghubasan
After a straight 32 hours of hospital duty, I had fallen asleep for a few hours only to be woken up at 3am by the sound of a howling wind and driving rain. An hour later, I noticed that the wind was getting stronger. I turned on the radio, which had started issuing reports that the waves hitting the nearby coastline were getting bigger and that water had started to flood the radio station. Then the radio broadcast went off air. I looked out the window of my boarding house and saw people on the street, shouting at each other, “Hold your hands together and walk carefully because the sea water will rise!” Despite the warning signs I was not overly concerned as I believed that a storm would be unlikely; the only thing I knew about Yolanda before then was that it was possibly going to be the strongest typhoon to hit the Philippines and that it might hit my city, Tacloban. I went back to bed but at around 7 am I noticed water entering my room. And just a few minutes later, water started coming in through the sides of my door. On getting up I was shocked to see that the water outside was already thigh-high and that the wind had ripped off the roofs of some of my neighbours' houses. My immediate thoughts were, “Should I go out? Where should I go? Will I die today?” When I tried to open my bedroom door it did not budge, so I forced it open and was suddenly thrown back by the torrent of water rushing in. I fought the water and made my way towards the gate. Outside, I saw a man with a plastic pail over his head. "At least I'm not alone", I thought. Reaching Magallanes Road, I could see in the distance a huge wave approaching the shore. I quickly sought shelter behind a wooden barrier which served as a temporary dyke against the wave - a miracle in my time of need. Then I saw a second wave approaching. I was sure it would break the wooden barrier, so I swam through the neck-deep water with all my might. The current was very strong and I battled to keep my head above the water. Just a few yards from my boarding house was a small coconut tree. I grabbed one of its palms and pulled myself and another man onto a concrete wall. From this vantage point we could see people climbing to the second floor of a unit
nearby. We decided to follow them as this seemed the safest option. There were at least 25 of us there, crowding in such a small space. The windows were broken and we could feel the strength of the wind and rain. All of the women and children were placed in a small room in the interior of the apartment while we, the men, stayed on the outside to fend off flying debris. We were on constant lookout for rising water levels and deliberated on alternative escape routes. We all prayed; I held on to my rosary tightly and prayed silently.
"I experienced the longest wait I have ever had in my life. My legs were aching from constant standing and thirst consumed me." I counted the minutes, and hours. While waiting, we saw people forcing open their roofs because their doors were blocked by debris. Men, women and children were climbing out — in shock, wet and terrified. We did our best to help those within our reach. At around 10am the wind and driving rain died down and we stayed in the building until the water gradually subsided to knee level. We wondered what would happen after the typhoon. I felt intense fear at the thought of losing my loved ones, and of having nowhere to go. I almost cried; I was so afraid of what would happen next. In the aftermath of the storm one of those that I was with pointed out a person lying underneath a car and told me that he was dead. Upon scanning my surroundings more closely I noticed that there were dead bodies everywhere — under the rubble and half-buried in mud. Scenes of people struggling to swim and survive flashed back in my mind. I decided to make my way to St. Niño Church because I knew that some of my friends had taken shelter there in preparation for the calamity. As I walked towards the church, I saw from afar that the roof was almost completely destroyed. At the convent however, I was relieved to find that all of my friends, the priests, and many evacuees were safe. I ate the food offered to me and drank lots of water. At 1 pm, my friends and I decided to go to our homes to check on our families. On our way we walked amidst dead bodies on the streets. After confirming that my family was safe, I returned to St. Niño Church as I knew many of the evacuees needed help in cleaning and suturing their wounds, and that they would require consultations with medical personnel. My friends and I assisted them as fully as possible.
9
After the storm As time went on I learnt that all of my classmates had been affected by the calamity. Every one of us at the University of the Philippines, Manila-School of Health Sciences has our own share of stories to tell - from trying to hold on to whatever we could while the walls of our houses were being swept away, to climbing on roofs to escape the flood. We all experienced what we thought would be the end of us; we are grateful that there weren't any casualties from our school. After the typhoon, my classmates and I carried on volunteering, going on duty for 24 hours, 32 hours and even 72 hours straight. Sleepless nights; food, water and electricity shortages; and scarce resources made the experience even worse. I volunteered in the church, heading the disaster and relief operations for the Vicariate of Tacloban. My work consisted of conducting medical consultations and treating wounds in the church grounds. Some of my classmates volunteered with the Red Cross, taking part in medical missions and relief operations. Some went as far as Samar Island to
Medical consultations soon after the typhoon had struck
help other affected towns and municipalities. During those initial few days, my classmates and I felt the need to really practise what our school had been teaching us all along - to reach out and serve the underserved, evaen at the expense of our own comfort. I commend my classmates, colleagues, faculty members and staff for upholding the mandate and mission of our school. I believe that I was spared because I am meant to help others — that I should share the life given to me so that it may give life to others. Although I lost many dear possessions, I am able to better appreciate the best gift God has given me — my life — which I had so often taken for granted. And this is why I continue to volunteer in the church, and with the Red Cross and other relief operations. All these experiences will forever be etched in my heart and mind — a significant period in my life’s journey. Yolanda has been a life-changing event. I hope and pray that, through this experience, we will grow more to become better people.
Medical mission team from the University of the Philippines
One of the damaged buildings at the University of the Philippines
One of the medical mission teams
Some of the relief efforts taking place in Tacloban City
Tending to wounds in the aftermath of Typhoon Haiyan
One of the damaged buildings at the University of the Philippines
"
Jonathan is a medical intern from the University of the Philippines-Manila School of Health Sciences Center in Tacloban City. He is the president of Doctors for Social Responsibility, a local member organization of AMSA Philippines. Together with his fellow students, he assisted in typhoon relief efforts in his community.
"
10
THE MOST VULNERABLE By Renzo Guinto Charlotte Holm-Hansen Lucas Scherdel
It seems no coincidence that the UNFCCC Conference of Parties (COP 19) unfolded in the midst of environmental disaster once again – affecting, unfortunately, the Philippines for the second time in as many years. In November 2013, the land mass of the central Philippines was struck by a typhoon regarded as the most powerful in recorded history – reducing an entire city to rubble, and causing severe destruction in dozens of Filipino towns. Roughly 10 million Filipinos were affected, with a death toll exceeding 6000. At present, food, water, and health care are limited, while relief operations remain delayed due to impassable roads, destroyed airports, disrupted telecommunication lines and lack of electricity. This story is reminiscent of the typhoon in 2012, which happened during the final phase of COP 18 in Doha, claiming nearly 2000 lives in the Southern Philippines. Despite the Filipino negotiator’s pleas and cries, nothing meaningful came from the COP. Whilst we know that in a warming planet, every country is vulnerable, this recent tragedy serves as a reminder that some can be more vulnerable than others as a result of their geography, economic status, and other influencing factors. Evidence has taught us that climate change is the biggest threat to global health in the 21st century, but it has also demonstrated that the effects of climate change on human health can be varied and often unevenly distributed.
From Asia to Africa At present, sub-Saharan Africa is at great risk to the impacts of climate change – with risk of food scarcity as a result of crop failure, minimal sources of clean water and changes in precipitation that cause flooding and droughts. One should also consider the coupling of such with higher rates of
vector-borne diseases. Similarly, Southeast Asia’s coastal cities are also among the mostvulnerable, exhibiting susceptibility to sea-level rises and flooding, as well as saltwater corrosion of crops and extreme weather events. What’s more, increasing ocean acidification can lead to a loss of coral reefs, subsequent declines in fish habitation and the loss of corals’ natural protection against storms. Small island states are recognised by the Intergovernmental Panel on Climate Change (IPCC) as being particularly vulnerable to the adverse effects of climate change, with many of the small island states already suffering reduced adaptive capacity. The Pacific is one of the most vulnerable regions when it comes to risks of extreme weather events and the effects of climate change, especially the low-lying coral islands.
Time to act Youth participation, education and awarenessraising on issues related to climate change and health are at the heart of what is required here. There is an especially vital need for activism in the more vulnerable countries of the developing world. It may be true that student-led projects are undertaken all over the globe, but the tendency for youth participation can often lean towards the Global North. The gap that this then presents in the minds of those most vulnerable to climate change is something that needs to be addressed. The questions then, are how do we mobilise the Global South? How do we facilitate sustainable projects, build on participation and better capacity building? How do we encourage and ensure the inclusion of youth from those countries most at risk?
11
HAIYAN IN THE PHILLIPINES A GRADE 3 DISASTER
Everybody s Rights Health is a human right, not just a civil right. It is the moral duty of civil societies worldwide to assist in order to maintain health in disasterstruck areas of the world. In the Philippines the healthof many people has been severely affected, and currently numerous actors (such as the World Health Organisation, the Red Cross and medical field hospitals) work there towards health goals. The acute response has now passed, but the current situation of rebuilding has also proven challenging.
By Fabian Falkenbach Thilo Rattay Moa M Herrgård In the early morning of November 8th 2013, the strongest tropical cyclone in history (Haiyan, also known as Yolanda) started to move over the Philippine Islands. The cyclone was born six days earlier in an area of low aerial pressure several hundred kilometres South-East of Pohnpei in the Federated States of Micronesia. There began a period of rapid intensification, after which Haiyan moved over the Atlantic, reaching the Philippines where it brought devastation to 44 provinces. As of January 2014, 6 190 deaths, 28 626 injured and 1 785 missing persons have been reported (1). More than 10 million people have been affected; and of these almost 4 million have been displaced
The Damage Typhoon Haiyan also resulted in severely damaged infrastructure (3), which has impaired access to water, power, fuel and communications, amongst other things. This has caused significant repercussions for the health industry as many hospitals were rendered dysfunctional, and hospital security became a cause for concern (2). Due to the widespread damage, the disaster is categorised as Grade 3 - the highest internal emergency category under the World Health Organisation’s (WHO) Emergency Response Framework (ERF) (2). As a consequence of climate change created largely by man's activities, extreme weather events are expected to happen more frequently, commonly affecting the poorest countries in the world. Myles Allen, Head of the Climate Dynamics Group at the University of Oxford, states that current evidence points to an increased risk of more intense hurricanes (5), such as Haiyan, in the future.
In closing we would just like to leave you with a quote. At the World Health Assembly in 2013, the WHO Director-General, Margaret Chan, stated, “We do not know when the next crisis will hit us, but we know that nature will continue to surprise us. I have never seen a country that is immune to disasters. Emergency Risk Management is an investment that no country can afford to avoid.” So let's be humanitarian - let’s take responsibility as global citizens and future doctors in maintaining health in areas of disaster. Let us never forget that, as medical students, we can make important contributions through a number of avenues, including trainings in disaster preparedness; advocacy campaigns and other awareness events; and being directly involved in disaster relief efforts.
i
AMSA-Philippines is currently working to assist affected members and communities in the sub-acute phase of the disaster. If you would like to assist, please contact them directly at: amsa-philippines@ifmsa.org
References: 1. World Health Organisation. Effects of Typhoon “Yolanda” (Haiyan): Report by the National Disaster Risk Reduction and Management Council, Republic of the Philippines. Manila: World Health Organisation; 2014. 2. National Disaster Risk Reduction and Management Council. Typhoon Yolanda. [Online]. Available from: http://www.ndrrmc.gov.ph/ attachments/article/1125 doc02494920131117083106.pdf [accessed 21 December 2013] 3. World Health Organisation. Typhoon “Yolanda” (Haiyan) in the Philippines. Manila: World Health Organisation; 2013. 4. World Health Organisation. Typhoon Haiyan. [Online]. Available from: http://www.who.int/hac/crises/phl/sitreps/philippines_ sitrep_17november2013.pdf [accessed 21 December 2013] 5. World Health Organisation. Public Health Risk Assessment and Interventions: Typhoon Haiyian, Philippines. Manila: World Health Organisation; 2013.
12
Health Workers after Typhoon Haiyan
SHAKEN BUT NOT BROKEN By Dr. Renzo R. Guinto
A public health consultant from the Philippines, Dr. Renzo Guinto is the former IFMSA Liaison Officer to the World Health Organization, Regional Coordinator for the Asia-Pacific, and founding Coordinator of the Global Health Equity Initiative. This article was written with generous research and technical support from doctors Ronnie Baticulon and Cecilia Acuin. For decades, the Philippines has been frequented by approximately 20 typhoons each year, but last November 8, 2013, its central islands were struck by what has been regarded as the world’s most powerful typhoon to hit land in recorded history. Nearly 16 million people from 44 out of 81 provinces were affected, including more than 6,000 reported dead and 4 million forcibly displaced from their homes. Infrastructure, livelihoods, and social services were severely damaged, including one-third of the country’s rice fields and more than 200 hospitals and local health centers. While the Philippine health sector, led by the Department of Health (DOH), and the rest of the international health community, headed by WHO, were getting their acts together to provide immediate response and assist in longer-term rehabilitation, hundreds of health professionals – not to mention my classmates at the University of the Philippines College of Medicine – who were deployed under the DOH’s “Doctor to the Barrio (Village)” program, experienced what it is to serve “in the eye of the storm,” extending health services as before, but facing harsher conditions, more constrained resources, and much greater challenges. In the province of Eastern Samar, the town of Hernani was one of the towns which were almost completely destroyed. “Four of my thirteen barangays (villages) were totally wiped out,” lamented Dr. Ezra Valido, Hernani’s municipal health officer. “We experienced high-speed winds coupled with the storm surge. We expected the winds but not the surge. Before this, nobody
had experienced seeing the ocean that high. An evacuation system was in play but one of the evacuation centers was also affected.” After the storm, only two local health stations remained functional, and stocks of essential medicines like pain relievers and antibiotics were running low. While relief goods such as food and medical supplies were slowly reaching his remote locality, Dr. Valido warned of the monsoon season that was about to come, which would further overwhelm the capacity of the already-wanting local health system and the rest of the community’s limited resources. He was also aware of the various public health risks that commonly arise postdisaster. “We tried to prevent open defecation around the communities,” he said. At the western side of the Samar peninsula, Dr. Alberto Ong may have been spared from the tsunami-like storm surge that wreaked havoc in Hernani, but he still felt the gravity of the typhoon’s aftermath nonetheless. “The major hospitals, where we send our patients needing hospitalization, are located in Tacloban City,” the capital of Leyte province. “After Typhoon Haiyan totally destroyed the city, including the hospitals, we were left with no choice but to keep the severely-ill patients in our local health center instead and manage them by ourselves," described Dr. Ong. Rural municipalities such as the one served by Dr. Ong were cut from their sources of medical supply. “Most of what we have in our health center also came from the DOH regional office in Tacloban City.” He expects that, in the coming months, the town will face difficulty in ensuring access to life-saving medicines for its constituents. “For example, we are expecting a drop in our expanded program for immunization coverage because the vaccines come from the regional office.” The absence of electricity in the entire region has also disrupted the vaccine cold chain.
13
From San Roque, Northern Samar, Dr. Dante Salvador realized from his experience the importance of addressing other needs beyond the health sector. “Currently, the most pressing concerns are not biomedical in nature,” he stated. “We are having problems because of electricity and communication… The entire region is powerless, and initially had no cell phone signals.” Dr. Valido agreed to the importance of the social determinants of health especially during times of disaster. “Aside from medications, we need food. The relief operations have been slow and minimal. We need gasoline for transporting the goods. We need shelter. This is the amihan season in the east. We experience heavy rains almost daily. We need hygiene kits and temporary latrines.” Governments of disaster-prone countries such as the Philippines have for years striven to strengthen their preparedness and early warning systems, as well as build capacity for immediate response and rehabilitation of affected communities. But it cannot be denied that it is the health workers on the ground who are first to bear the brunt of disaster, but who also do not waver in providing necessary health services to survivors.
Weeks after the disaster, the rhythm of care has shifted from infectious disease control, treatment of injuries and infected wounds, and reconstructive surgery to the management of non-communicable diseases, provision of psychosocial support, and health promotion and education. International organizations have done their part, such as UNICEF which helped restore drinking water supplies as part of its Water, Sanitation and Hygiene (WASH) response. Breast milk donation drives were also mobilized as babies continued to be born. The stories of Drs. Valido, Ong, Salvador, and countless others are proof of the persevering and resilient spirit of the Filipino health worker. These frontline health workers embody what the Philippine Secretary of Health, Dr. Enrique Ona, stated in a post-typhoon press conference: “The Philippine health system is shaken but it is not broken.”
14
HEALTH AT YOUR DOORSTEP
"ARIVU"
By Dr Naren Nallapeta, MSAI-India.
It all started two years ago when a senior of mine approached me to volunteer for a diabetes camp organized by a professor, to be held in one of the villages near my medical school. I initially thought this was one of those camps organized by physicians to promote business at their clinic. I was wrong. Dr Vishwanath is the pioneer of this brilliant idea of reaching out to the people (instead of waiting for people to approach doctors). He named this “Arivu” which means “Awareness” in the local Kannada language. My admiration for this amazing professor has moved me, and made me more committed to serve the community and make a difference.
rural community. We set out at around 8 AM to a village, usually situated on the outskirts of Davanagere, a town in Karnataka, India. The volunteers are divided into groups of four – with each group conducting house-to-house visits in a particular area of the village. Of the 4 volunteers in each group, one records the basic demographics of the patient and his or her blood sugar level; two check the patient’s blood sugar level; and another educates the patient and his or her family about the importance of prevention and early diagnosis. As of November 2013, 23 villages and more than 20,000 people have been screened. Out of those screened, around 2% were found to have blood sugar levels in the diabetic range – a truly alarming percentage. My involvement in 14 Arivu camps has touched, moved and inspired me. Often times I am still surprised by the fact that many people do not have a clue about diabetes. It is both my, and my professor’s, dream that people across the country and the world are more aware about this disorder. Let’s fight diabetes through awareness. Let’s make a difference at the grass-root level. Let’s start a transnational project to work on this issue. Let’s join hands. Let’s make a difference!
It is a known fact that diabetes is commonly asymptomatic in its initial stages, and that patients often present late to the clinic with untreatable complications. It is also well known that, in the quest to make money and profits, most pharmaceutical companies aim at treating diabetes rather than preventing it. And, in India, an interesting trend which we have observed is that more and more people from rural areas are being found to be diabetic. Keeping these aforementioned points in mind, Arivu was born, aiming to diagnose diabetes at its earliest stage; and to reach out to rural areas, spreading awareness about diabetes prevention, and the effects of urbanization and changing lifestyles on Indian communities. The Arivu camp is held on the last Sunday of every month, and over 60 volunteers (consisting of medical students, interns, residents and pharmacists) are involved in reaching out to the
15
Working with ild Project Ch
By CIMSA Indonesia
SCOPE is well known for its exchange programs, and every year National Exchange Officers from all over the world sign thousands of exchange contracts. However, SCOPE Indonesia is motivated to do something different aside from solely managing exchanges: Working with Project Child (WWPC) is a project run by the SCOPE team at Gadjah Mada University to address issues surrounding children’s education. In Indonesia, numerous children do not have the chance to go to school due to financial reasons. Such hardship forces children to help their parents earn money through begging on the streets and through child labour. As a result, the SCOPE committee at Gadjah Mada University, in cooperation with Project Child (an NGO focusing on children's health and education), provide hygiene classes in English to children through the WWPC project. In 2013, WWPC was commenced for the first time in Kricak, the home of Project Child. Children from low socio-economic status backgrounds
are divided into small groups, each one of which is taught about simple hygiene - including how to brush one’s teeth effectively; hand washing; and toilet hygiene, amongst other things. Through these tutorials, children are gradually introduced to the English language. The presence of international volunteers enhances the project experience for both the volunteers and for the children. To evaluate whether the children have learnt the required skills and knowledge, they are given a test towards the end of the course which requires them to repeat the correct procedures for brushing their teeth and washing their hands, and to complete a basic English exercise. We hope this collaboration with Project Child will give the children some new perspectives about how to live a healthy life; and will give them hope that, in spite of the hardships they have faced since early childhood, the future is still there for them to reach.
16
SCOPE Weekend Training 2014
By Anindya Prabasari, CIMSA-Indonesia
The Center for Indonesian Medical Students’ Activities (CIMSA) is famous for its tagline (which also happens to be its primary goal) of "Empowering medical students, improving the nation’s health". CIMSA has been working very hard to improve Indonesia’s health through advocacy work and projects. As one of CIMSA’s Standing Committees, SCOPE Indonesia will act to further realise CIMSA’s goal through the SCOPE Weekend Training 2014. The Weekend Training (WET) is an annual event by SCOPE Indonesia which was first held in 2012 in Malang, East Java. Another successful WET was held in March 2013 in Bandung, and we are optimistic the good work will continue in March 2014 in Surakarta. The purpose of WET is to give SCOPE members a deeper insight into SCOPE exchange management, and to provide a platform to discuss current issues within SCOPE Indonesia and what future plans need to be made. During this 2013/2014 term, we believe that SCOPE Indonesia needs more than mere exchange talks, and so we plan on giving our very best efforts to contribute more towards our goals. Based on this, we have reevaluated WET and are trying to reform it. We have arrived at the conclusion that WET should be able to create well-trained SCOPE exchange agents who will act as effective leaders in their local committees (LCs). To help achieve our goals this year WET 2014 will be organized around three pillars: SCOPE exchange program training; soft skills training; and global health lectures and discussions. The SCOPE exchange program training is undeniably important due to the fact there will be a lot of new
SCOPE members present, for whom it is important to provide the basics. For more experienced members we will have an “experts’ session” during which we will discuss more advanced topics. The soft skills training sessions are designed to educate students on SCOPE exchange management. In managing both incoming and outgoing students, we have to deal with external parties such as the faculty board, hospital directors, and doctors. Oftentimes the discussion outcomes don’t turn out as we expect them to, and occasionally they can even disrupt our exchange program significantly. Given these facts, we have started to assess each local committee’s needs, investigating what sort of soft skills training they would like to have in WET 2014. So far, the options vary from lobbying and negotiation skills, to advocacy and other skills that will come in handy in exchange management. The global health session is aimed at raising awareness about global health issues, and at stimulating SCOPEople to think critically about them. It is hoped that students will become global health trainers who will act to improve the general public’s awareness about global health issues, and who will encourage their LCs to initiate more projects on the topic. Through WET 2014, SCOPEople will have their own way of inspiring and helping CIMSA achieve the dream of improving the nation’s health through a well-educated society. WET 2014 will definitely provide a unique opportunity from, and a different atmosphere to, our beloved standing committee, SCOPE.
17