Health services are casualties too / by John Ash and Mike Gomez

Health senices are casualties too by John Ash and Mike Gomez t 4.26 pm on Monday 16 July 1990, the Executive Committee of the Philip- pine Department of Health was in full session. Then the earth began to move. For an eternity, in fact no more than a minute, buildings swayed and cracked, roads undulated like waves on the sea, and literally millions of people panicked. They poured into the streets, desper- ate to get away from high buildings. They hurt each other more in the stampede than if they had stayed put as the manuals advise, crouching under a strong beam or even a heavy piece of furniture. But panic sows its own seeds, and it takes less than seconds for people to realise how · small and vulnerable they are when faced with the full force of nature. The Secretary of Health, Dr Alfredo Bengzon, did not panic. Power and telephone communications were the first to go down. Leaving a dazed Executive Committee behind, he rushed to his car outside with its radio telephone. Within minutes he had found an open line and was speaking live on national radio, appealing for calm. It was the Department's first intervention in the worst Philippine earthquake for 22 years. How bad the quake was would only become known later. In fact , it measured 7. 7 on the Richter scale. Manila, 137 km from the epicentre to the north, was badly shaken, and many buildings were seriously cracked. The real drama was elsewhere. In Cabana- tuan, provincial capital of Nueva Ecija, and only 40 km from the epicentre, tragedy struck the crowded six-storey Philippine Christian Colleges, burying 274 of its high school students under tons of concrete rubble; 154 of them died. The city of Baguio is the summer capital of the Philippines, famed as a tourist resort with its . pine trees and cool climate, and home to over 150,000 people. For 48 hours, Baguio was completely isolated. Electricity, water and communication lines were Racing against time, volunteers and soldiers look for survivors in the ruins of the Philippine Christian Colleges_ 22 destroyed and all roads cut by land- slides, often from deforested hills and mountains. Luxury hotels, schools and private homes lay in ruins. Terrified by after-shocks, people left their damaged houses to seek shelter in open spaces, without food or fuel, and drenched by the season's cold and unremitting rain. Hospital patients had to be moved from unsafe wards to tents in the open air. Only after three days was a main road cleared to allow supplies to begin to pour in. By that time, nearly 400 people were dead and 700 injured. Mr John Ash is Acting Public Informatio n Officer with WHO's Regional Office for the Western Pacific and Mr Mike Gomez is I nforrna- tion Director of the Philippine Department ''of Health . Despite dramatic rescues from the rubble up to two weeks after the disaster, the final toll was a heavy one for the nation: over 1,600 dead, thousands more injured, and billions of dollars needed to repair the damage. Health services are casualties of disasters too. Twelve hospitals would require "total reconstruction". Medical equipment is destroyed, especially breakable items like oxygen gauges, anaesthesia machines, microscopes, clinical glassware and laboratory equip- ment. Health personnel lose their homes. Their own children and rela- tives are trapped or injured. Two midwives were buried in mountain landslides and departmental vehicles stranded on blocked roads. Yet all hospitals and medical centres managed to operate throughout the chaos of the acute emergency stage, even with reduced staff levels. One rare piece of good fortune was the relatively high level of available stocks, since a substantial delivery of supplies had just been made. Medical teams under senior officials were mobilised from the capital to assist their prov- incial colleagues. Fear lent powerful energy to rumours of epidemics among the thousands of people displaced from WORLD HEALTH. J anuary-February 1991 their homes, cold, wet and hungyy before supplies managed to get through. Most of the affected areas already enjoyed high immunization coverage, officials pointed out, and many health personnel were already trained in case management of diar- rhoea and acute respiratory infection, the two likely candidates for epidemic outbreaks. The Department's strategy for epidemic prevention included sanitary latrine construction, water supply disinfection, disease surveil- lance at health centres and constant public information to allay fears and avoid panic. Unfounded fears Recent earthquake experience shows that, with proper application of current knowledge of the transmission and prevention of diseases, epidemics do not break out. But frightened people were convinced otherwise, and there was concern that unfounded fears would divert attention and resources from urgent relief measures and the normalisation of power and water supplies. Supplies and their delivery are crucial to the success of relief opera- tions, the Department acknowledges, and much can be done to improve systems in anticipation of future emer- W ORLD HEALTH, J anuary- February 1991 gencies. Better, stronger communi- cations lines are vital. Phones and many radio antennae are especially vulnerable. Priority transport for the health sector must be anticipated as a necessity, especially where, as in Baguio, helicopters and their limited space are the only option. Low-tech supplies are needed most: tents, cadaver bags, water purification chemicals, portable emergency genera- tors. Low-tech help, too. Foreign teams poured into the country in the after- math of the July quake, some with the most sophisticated search equipment on earth. While all efforts were appre- ciated, most highly praised were the medical team from Singapore who, amid everything else, were not afraid to get right down to digging latrines. WHO responded too with emer- gency funds, used p1incipally to re- stock depleted medicines. Other agen- cies helped generously in their own fields. Yet the most useful help was to be well prepared on the ground. No one in the Philippines speaks of earthquake prevention. Tremors will come again, as will other natural disasters, causing their terrible burden of damage. Being better prepared is what will mitigate the scale of loss, and that, as everyone agrees, is a process of development. • Relief supplies pile up at Baguio airport - the only way in or out of the city For several days. Below: Despite his pain and shock. a survivor in Baguio City signals bravely to reporters. WHO/WPRO/E. Usapdin 23