PHILIPPINE PHYSIATRIST IN TYPHOON HAIYAN THE PARM EXPERIENCE Joint Congress of the 5 TH Asia Oceanian Conference of Physical Rehabilitation Medicine 26 th Philippine Academy of Rehabilitation Medicine Radisson Blu, Cebu, Philippines February 20, 2016 Filipinas G. Ganchoon, MD

The Role of the Philippine Physiatrist in a Large-Scale Natural Disaster Provide descriptive epidemiology of Typhoon Haiyan Describe the strategic development of PARM’s disaster rehabilitation program (PARM CARES) Summarize the lessons learned in developing Rehabilitation Disaster Relief Program Summarize aid missions conducted by PARM members in the primarily-affected Visayas region Present rehabilitation injury data from two affected populations Elaborate the roles of local physiatrist in large scale natural disaster using the example of Philippine Physiatrists in Typhoon Haiyan.

Highest -intensity of a Category 5 tropical cyclone with sustained winds of 315 kph (above the 252 kph threshold for a Category 5 hurricane, the highest category on the Saffir-Simpson scale) -Reference: Meteomedia -storm surge recorded in East Asia of 9.14m due to strong winds, resulting in the majority of deaths due to drowning and catastrophic damage

ANIBONG, TACLOBAN, LEYTE REUTERS/ROMEO RANOCO IMPACT Significant national impact: 6,268 confirmed deaths, 28,689 injured, and 1,061 missing, with 3.4 million families (over 16 million persons) affected in 44 provinces, 57 cities, and 591 municipalities. Reference : National Disaster Risk Reduction & Management Council (NDRRMC)

PARM Philippine Academy of Rehabilitation Medicine Membership: 340 PMR Centers: 412 Chapters  North Luzon (46)  National Capital Region (178)  Visayas (22)  Mindanao (20)

THE BIRTH OF PARM REHABILITATION DISASTER RELIEF Haiyan hit the central or Visayas region of the Philippines. The PARM Physiatrists in the Visayas Region were the first responders. Within 24 hours Dr. Jeanne Flordelis and Dr. Rhoel Dejano in Cebu Dr. Filipinas G. Ganchoon in Bacolod were contacted by friends in affected area asking for help. They set up their mission teams with their rehab center staff and friends in the community to affected areas

THE BIRTH OF PARM REHABILITATION DISASTER RELIEF After 2-3 days Post Haiyan when they came back from their missions. They saw the devastation in the Haiyan hit areas in their respective areas. They documented what they saw and sent the pictures to PARM National president Dr. Romil Martinez asking for help. The worst hit area is Tacloban. Most of the hospitals were destroyed, those who were severely injured were air lifted to Villamor Air Base in Manila. They were then transferred to Philippine Orthopedic Center and cared for by PARM Physiatrists headed by Dr. Ma. Eulalia Beredo. They were not able to get any contact with 3 PARM Physiatrists in Tacloban so they planned a mission going to Ormoc and Tacloban Day 5 Post Haiyan. Due to security reasons, they only made it to Ormoc and they were able to contact Dr. Raymund Balverde who gave them inputs on the status in Tacloban. Dr Balverde and his family relocated to Cebu. The 2 Tacloban Physiatrists Dr Liezel Calina and Dr. Rommel Bugho stayed and headed the PARM disaster relief programs in Tacloban,

THE BIRTH OF PARM REHABILITATION DISASTER RELIEF The Haiyan survivors admitted to Philippine Orthopedic Center and were cared for by PARM Physiatrists headed by Dr. Ma. Eulalia Beredo. PARM gave financial assistance for one month to cover their medical treatment as well as food for their family members who were with them. PARM National set up a team of Physiatrists in Villamor Air Base to welcome and care for those who have physical disabilities from Haiyan hit areas. PARM Physiatrists in Visayas (PARM Visayas) continued their mission trips to disaster hit areas with their teams.

THE BIRTH OF PARM REHABILITATION DISASTER RELIEF Help from other PMR National Societies and organizations came: International Society of Physical Rehabilitation Medicine (ISPRM) Japan Association of Rehabilitation Medicine (JARM) Korean Academy of Rehabilitation Medicine (KARM) Royal College of Physiatrist of Thailand (RCPT) Philippine American Physiatrist Association (PAPA) World Rehabilitation Fund (WRF) United Auburn Indian Community Tribe (UAICT) Philippine National Day Association (PNDA) Philippine Chinese American Medical Association (PCAMA) Their invaluable help made it possible for PARM to continue its Rehabilitation Disaster Relief programs

THE BIRTH OF PARM REHABILITATION DISASTER RELIEF Dr. Romil Martinez and PARM Executive Board established PARM CARES (Compassionate Advocacy for Rehabilitation Education & Service) Dr. Filipinas G. Ganchoon was appointed to head the program.

Medical Missions Conducted by PARM CARES (Nov 2013 – Dec 2015) NCR (Manila) Philippine Orthopedic Center Villamor Airbase Region VI Antique Capiz Iloilo Lakawon Island Northern Negros Occidental Region VII Northern Cebu Bantayan Island Region VIII Leyte Ormoc 31 MISSIONS 31,859 kits distributed 7155 patients served

PM & R CONDITIONS EVALUATED IN PHILIPPINE ORTHOPEDIC CENTER (POC) (NOV 10, 2013 – DEC 18, 2014)

TABLE 1: PM & R Conditions Evaluated at Philippine Orthopedic Center (POC) (November 10, December 18, 2013) DiagnosisNumberTotalPercentage of 79 Persons Percentage of 125 Conditions MSK 7392%58% Fractures 6886%54.4% Upper Limbs16 Ribs8 Spine18 Pelvis4 Lower Limbs22 Amputations (Traumatic) 22%1.6% Other MSK Conditions 34%2.4% Soft Tissue Injuries 1924%15.2% Wound/Skin Infections 1519%12% Neurological 1823%14.4% TBI2 2.5% 1.6% SCI15 19% 12% Ulnar Neuropathy1 1.3% 0.8% Total125

31 RELIEF & MEDICAL MISSIONS OF PARM CARES (NOV 10, 2013 – DEC 12, 2015)

TABLE 2: PARM CARES Missions (Nov.10, 2013 – Dec 12, 2015) DateLocationMission TeamRelief KitsPatients Served November 10 Brgy Tapilon, Daan, Bantayan; Northern Cebu PARM(V)/Cebu (40 MDs, AMRO) November 12 Brgy (4), Cadiz City; Brgy (4), Sagay City; Northern Negros PARM(V)/Bacolod (1MD, 30 Volunteers) 3000 November Brgy Libertad, Cagbuhangin,Mabato, Linao, Valencia; Ormoc City; Leyte PARM(V)/Ormoc (3 MDs, 5 nurses, 12 HWs, HELP for Ormoc) (Brgy Libertad) November Villamor Air Base, Manila; Luzon PARM National420 December Brgy Marasbaras, RTR; Tacloban, Leyte PARM CARES (National) ISPRM (12MDs, 30 HWs) 2000 (Brgy Marasbaras, RTR ) 50 (children (ASP, Tacloban) 400 February 17 Tent City, San Jose; Tacloban, Leyte Abuog General Hospital, Abuog; Franciscan Clinic, Baybay; Leyte PARM( CARES (National) (6 MD, 40HW, ISPRM, PAPA) ISPRM, PFP, PSPO (basic needs/medical screening survey) 16 (P&O evaluations) February 18 Burauen, Leyte RTR, Tacloban, Leyte PARM CARES (National) PAPA ISRPM, PFP, PSPO 288 (basic needs/medical screening survey) 283 (344 diagnoses) 1 (P&O) Total Missions31 31,859 kits distributed 7155 patients served

PARM CARES MEDICAL MISSION TO BURAUEN, LEYTE

THE DEVELOPMENT OF PARM REHABILITATION DISASTER RELIEF On their February 17-18, 2016 Mission (100 days post Haiyan) The team assessed that there are more mission teams coming to help with basic needs and common medical conditions but there was none that help those with disabilities. After 100 Post Haiyan, after doing base need analysis, PARM CARES decided to have its base of operations in Tacloban and focus on providing rehabilitation services. Tacloban was chosen since it is worse it and we have local Physiatrists on the ground who will be able to follow- up the patients

THE DEVELOPMENT OF PARM REHABILITATION DISASTER RELIEF PARM CARES came up with these projects: 1.Rehabilitation Center Project in Partnership with World Rehabilitation Fund. 2.Legs for Life Project for Haiyan amputee survivors in partnership with Philippine Orthopedic Center, Tzu Chi Foundation and Physicians for Peace. 3.Mobility Clinic in partnership with Loving Rose Foundation.

THE RESULTS OF PARM REHABILITATION DISASTER RELIEF PARM CARES came up with these projects: 1.Rehabilitation Center Project in Partnership with World Rehabilitation Fund. This project has helped provide Rehabilitation Equipments to 3 Rehabilitation centers in Tacloban: Remedios Trinidad Romualdez Hospital, Divine Word Hospital and Eastern Visayas Medical Center. These centers has helped Haiyan survivors with disabilities by providing rehabilitation consult and physical therapy services. 2.Legs for Life Project for Haiyan amputee survivors in partnership with Philippine Orthopedic Center, Tzu Chi Foundation and Physicians for Peace. This project as project free protheses to 96 Haiyan amputee survivors. 3. Mobility Clinic in partnership with Loving Rose Foundation. This project has provided free mobility aids to 70 Haiyan amputee survivors.

THE RESULTS OF PARM REHABILITATION DISASTER RELIEF Total Missions: 31 Kits Distributed: 31,859 Patients Served: 7,155 Rehabilitation Centers/Hospitals Rehabilitated: 3 Haiyan Amputee given prosthetic legs: 96 Haiyan amputees given mobility aids: 70

THE RESULTS OF PARM REHABILITATION DISASTER RELIEF Total Missions: 31 Kits Distributed: 31,859 Patients Served: 7,155 Rehabilitation Centers/Hospitals Rehabilitated: 3 Haiyan Amputee given prosthetic legs: 96 Haiyan amputees given mobility aids: 70

DISASTER REHABILITATION CONTINUUM

Clinical  First Responder  Triage/ER  Inpatient and Outpatient Rehabilitation  Medical Mission Volunteer Provider  Trainer Physiatrist Roles in Disaster Response Non-Clinical  Rehabilitation Needs Assessor  Medical Mission Volunteer: leader, coordinator, relief distributor  Trainer  Disaster Rehab Program Developer  Researcher  Community Advocate Disaster rehabilitation calls us to treat patients beyond the confines of our clinics. We are called to rehabilitate our cities and our communities and to use new skills and tools.

LESSONS LEARNED PARM REHABILITATION DISASTER RELIEF 1.Our local physiatrist is a trained team leader. Our practice is team approach so Physiatrist and his/her rehab center team can be trained to be first responders. 2.Physiatrists are natural community leaders. We gain the trust of our community when they know we care and we respond to their needs and concerns. 3.We have to find a safe and secure base of operations before we conduct our mission. 4.We have to do base need analysis before going to the mission site and do mission assessment after mission trip. 5.A rehabilitation disaster relief team can grow organically. PARM CARES started with a few local leaders and became a national and international movement. 6. We have to go with a team that has already worked together and each one has developed trust and understanding how each team member works. 7. In the case of foreign medical team members who joined us, we had a buddy system where a local Physiatrist is assigned to look after one or two foreign team member. 8.We need to invest in training our local Physiatrists in disaster prepareness. 9.We need to organize and form networks with other local and international government, non governmental, medical and non medical associations in order to enhance cooperation and coordination of our disaster response teams.

FUTURE CONCERNS OF PARM REHABILITATION DISASTER RELIEF 1.We need to find ways to make the program sustainable financially. 2.We need to invest in training our local Physiatrists in disaster prepareness. 3.We need to form networks with other local and international government, non governmental, medical and non medical associations in order to enhance cooperation and coordination of our disaster response teams.

International Society of Physical Rehabilitation Medicine (ISPRM) Japan Association of Rehabilitation Medicine (JARM) Korean Academy of Rehabilitation Medicine (KARM) Royal College of Physiatrist of Thailand (RCPT) Philippine American Physiatrist Association (PAPA) World Rehabilitation Fund (WRF) United Auburn Indian Community Tribe (UAICT) Philippine National Day Association (PNDA) All Donors and Volunteers

MARAMING SALAMAT (Thank You) MERON BA KAYONG TANONG? (Questions?)