After the Disaster: What Comes Next in the Philippines?
by Vicki Penwell

[Editor’s note: This article first appeared in Midwifery Today, Issue 113, Spring 2015.]

Photo provided by the author

Midwives with family who survived disaster

Vicki (far right) with a couple and their new baby ready to discharge from the birthing tent to go back to their own temporary homeless shelter. Volunteers: Tara Greeley, Michelle Pixianho, Jen Bunquin, Christy Martin, April Flores, Vicki Penwell

Last Christmas season, three of us Penwell midwives were living at ground zero of the Philippine disaster zone. From before Thanksgiving until the end of January, we were sleeping on the floor (when we did sleep), delivering babies round-the-clock in a temporary birth tent and caring for hundreds of wounded, sick and traumatized survivors of the November 8, 2013, super typhoon Haiyan, locally known as “Yolanda.” We were joined by loyal Mercy In Action Filipino staff from northern Philippines, as well as a few devoted international friends who are midwives and nurses. Eventually, my son, who is a doctor trained in emergency medicine, joined us as well.

Breech babies, twins and shoulder dystocia—we had it all in those tents, as well as too many hemorrhages to count and the occasional case where the woman arrived for a check-up with absent fetal heart tones. The situation in the early aftermath of the disaster created an overwhelmingly high-risk situation for women due to give birth, as their homes and lives were shattered by the world’s largest storm to make landfall in recorded history.

Maybe it is hard to fathom the extent of the disaster as you read this article in a comfortable chair somewhere. You may wonder how the pregnant women could become so high risk just by a storm. Let me try to help you understand. Just imagine if all of your pregnant clients were suddenly, violently, swept up in raging waters, pummeled and tumbled by cold waves, twirled as if in a washing machine for hours, filled with terror. They called them storm surges—series of monumental, tsunami-like waves that crashed into the ocean-side towns and villages, destroying millions of homes and drowning thousands of people. Every survivor we spoke to told us they were sure they were going to die that day.

Grief makes it hard to recover from physical wounds; grief affects the immune system. Grief plays havoc with all the body’s systems. Shock and grief were the norms for the survivors, including the heavily pregnant ones.

Some pregnant women lost family members. The worst stories were from mothers who told of having their children literally ripped from their grasp by the storm and washed away forever.

Grief makes it hard to recover from physical wounds; grief affects the immune system. Grief plays havoc with all the body’s systems. Shock and grief were the norms for the survivors, including the heavily pregnant ones.

There was not enough food, water or shelter for the stunned survivors for days after typhoon Haiyan. Lawlessness broke out in areas. Imagine that your pregnant clients have to go without any clean water; they fast for days and then eat only sporadically, as there is never enough food. And on top of that, they were all suddenly homeless, sleeping on the ground, in makeshift covers and eventually in tents provided by relief organizations. Security was non-existent; fear was constant.

The conditions were horrific, and all the more so for the pregnant women, who in different circumstances would have been nurtured, fed the best foods, kept hydrated, advised to avoid emotional duress and advised to rest and relax.

Now imagine if your birth center, with all your pregnant clients in this condition, suddenly began to be visited at all hours of the day and night with kids and adults suffering medical emergencies, so that you had to handle those as well as labors.

This is a little snapshot of what it was like in the immediate aftermath. For almost a month, we provided medical care with other midwives and nurses before any doctors showed up to volunteer.

In those first post-disaster months, when it felt true that we were living in what the press was reporting as an apocalyptical situation, it was hard to see past the immediate flood of humanity in need of urgent and immediate care. But eventually, and necessarily, we moved into the rebuilding and renovation process. From April until now, we have tried to follow the recommendations and guidelines of the World Health Organization, the Red Cross and other international groups who have called for aid workers and volunteers to begin rebuilding the local clinics, hospitals and birthing centers that were destroyed in the storm, helping local medical personnel get back on their own feet rather than inadvertently building long-term dependency.

Thanks to incredibly generous donations (many from midwives, doulas and other health care people in the USA, Europe, Australia and New Zealand) and a couple of grants (Global Giving and Center for Disaster Philanthropy) Mercy In Action was able to rebuild an entire clinic and birth center in the middle of one of the hardest hit communities in the disaster zone. The grand opening was in September, and in three short months, 37 babies had been born there.

We also worked on capacity building training for area midwives, which was in the form of five months of seminars using the International MotherBaby Childbirth Initiative as our guide. When the classes ended last December 2014, Mercy In Action gave each midwife who graduated a brand new birth bag, complete with Dopplers, blood pressure equipment, newborn resuscitation equipment, anti-shock garments and hemoglobometers to replace what they had lost in the storm.

Midwives are the first line of defense against maternal and newborn deaths in this country with very high rates of both. We need to see all of the midwives affected by last year’s disaster equipped with the tools they need, and we need to see their places of work rebuilt in order to help them help the most vulnerable population: the pregnant women and children.

How can you help? Donations can still be made towards disaster recovery work on this website.

Through all of us working together, we can see the Philippines recover, rebuild and re-equip their own midwives to serve the childbearing families. The scars are there, but they are slowly healing. I see smiles again on the faces of my friends from Leyte Island. The Filipino spirit is strong and resilient. They don’t need pity—just a compassionate helping hand. We are still here beside them, offering that hand.

Editor’s note: Midwifery Today offers “Midwives of Color” scholarships to Midwifery Today conferences. To inquire, please contact the Midwifery Today conference coordinator.

Vicki Penwell lives in the Philippines and commutes to the US twice a year to teach midwifery. She has been married to her one-and-only husband, Scott, for 36 years. Together they have worked in the Philippines helping improve birth services for the poor since 1991. They have three sons, two daughters-in-law and five grandkids. Vicki has been profoundly changed by her time in the disaster zone.


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