Department of Medicine

What One Doctor Did When Disaster Struck

Last November when a typhoon struck the Philippines, just one month after an earthquake had happened there, many people in the United States reacted with dismay. Some resolved to help, sending money to charities that would supply blankets and shelter and food. Others took it more personally, packing up themselves and their colleagues and traveling to Tacloban to render medical care onsite.

Julieta Gabiola, MD, Clinical Associate Professor in the
julieta gabiola in Tacloban
Julieta Gabiola, MD, tending to a smalll child in Tacloban
Division of General Medical Disciplines, belongs in the latter group. As a native of the Philippines and one who leads medical missions there every two years, she was uniquely positioned to render aid to the people in Tacloban.

The call came early after the November 8th typhoon. As Gabiola recalls, “When the disaster occurred, I was asked by Amir Rubin, CEO of Stanford Hospital and Clinics, to look into putting together a response team, for many of our Filipino staff  were asking what Stanford was doing to help. At about the same time, SEMPER (Stanford Emergency Medical Program for Emergency Response) was approached by Medical Team International to go to the Philippines. Dr. Colin Bucks from SEMPER asked me to join them as I had conducted a medical mission in Tacloban just 9 months prior.”

The team arrived in the Philippines on November 22nd, landing in Cebu where they immediately sought transport to Tacloban. They spent a day waiting, planning, and strategizing in Cebu before they moved to an airfield at 3 AM to be ready when a C130 could fit them in. Eight hours later they flew about 100 miles to Tacloban only to find that most hospitals were not operational.  As Gabiola recalls, “There was a Chinese hospital boat anchored out in the ocean where some patients were being treated. It was well equipped and staffed by specialists and surgeons.”

One hospital in Tacloban (RTR- Remedios Trinidad Romualdez – owned by the Imelda Romualdez Marcos family) was partly operational but already had a full complement of medical professionals from different countries. The Stanford team changed course to better meet the needs of the other communities not yet reached by multinational medical teams. Six people from Stanford went to the outskirts of Tacloban and the other four went to Guian in Samar, also badly affected by the typhoon.

The injuries they cared for were not what they might have seen had they arrived earlier. “We saw musculoskeletal injuries like wounds, lacerations, hematomas, not as many acute injuries as you’d expect. There were more chronic primary care illnesses.”

Their living accommodations were barely adequate: “Eighteen of us stayed in a house that had a leaking roof, which I called “Philippine snow,” one bathroom but no running water, and electricity provided by a generator. Every other day supplies came in from UNESCO, WHO, and the Philippine Department of Health. We were able to avail ourselves of all of those resources, but it was still tight, so we had to carefully figure out what we could give out to patients.“ The Guain team seemed to have fewer resources than the team in Tacloban.

According to Gabiola, the days were long: “We would get up at 6 AM and leave at 7. Within about 30 minutes of reaching a site, we were able to put together a clinic with the help of the community. We would see patients from about 9 AM to 5 PM. We would get home about 6:30 PM, unload, restock for the next day, and enter data into the computer.  Dinners and meetings went on until about 9 PM, and then we went straight to bed totally exhausted.”

For two weeks, the Stanford team treated every patient who came through the doors of the clinic. Gabiola recalls, “I was inspired by my SEMPER colleagues and what they were able to do with very minimal resources. There were no complaints. They would jump up and do anything that could be done for anybody. We celebrated Thanksgiving with teams of Filipino doctors and nurses who helped us. We were all thankful for our families, our health, our roofs and livelihood.  The ducks and roosters we purchased from the community for our dinner complemented the celebration. The celebration partly helped fill the void of not having our families that day.  I cannot imagine, though, how the people of Tacloban felt losing all their families, homes, and sources of livelihood. Yet they were hopeful, appreciative of people’s help, and ready to rise and rebuild.” After two weeks, SEMPER returned to Stanford exhausted but fulfilled.

But Gabiola felt a need to go back, so after one week in the US she took her scheduled Christmas vacation and returned to help again in Tacloban. This time she brought medications she thought were more needed, such as those used to treat fungal infections, antibiotics, medications for blood pressure and diabetes, and vitamins (which she found to be popular in almost all communities). She also had the luxury of spending time with the people, hearing their stories, their hopes, and the sadness of losing everything.

These two trips have encouraged Gabiola to think differently about how to best help her fellow Philippine citizens in the future. After her previous medical mission to Tacloban in January 2013, she said, “I was thinking about putting together a program whereby medical mobile vans would go to remote areas in the Philippines. It seemed to me that medical missions were a “band aid” for chronic diseases and that medical mobile vans going to communities on a more consistent schedule throughout the year may lead to better outcomes both in medical and surgical cases.”

“On a medical mission, we typically give patients a one - or two-month month supply of a blood pressure or diabetes medication. When they run out, medicines are not refilled due to non-affordability and lack of access. There was minimal or no follow up until another medical mission or until they presented to a hospital with a stroke or heart attack.

The medical mobile vans would also support the research from Stanford led by Gabiola, supported by Mark Cullen, MD, Chief of General Medical Disciplines. The research is looking at prevention of hypertension and diabetes through education and lifestyle modification.

Stanford plays an important ongoing role in the health of the citizens of Tacloban, quite apart from the emergency last November. Says Gabiola, “Stanford has been very generous in terms of donating surplus office and hospital furniture and supplies: IV poles, dialysis chairs, examination tables, sutures, catheters etc. I drive a truck to the loading dock about twice a month, collect whatever excess supplies they have for me, take them to a warehouse in Fremont, fill up a 40-cubic yard container, and send it to the Philippines. This goes on all year round.

“Others help out as well. Our Filipino nurses at Stanford have been collecting disposable surgical equipment like clamps, scissors, sutures, and outdated supplies for me for the past eight years. They bring me boxes of these items to go with me to the Philippines. My office sometimes looks like a warehouse.”

Asked about the most difficult adjustment when fitting back into life at Stanford, Gabiola says, “This experience reawakened in me how I started in my journey. It helped me define where I came from, where I am now and connected all those dots. It was a striking reminder that one can live and survive with very, very minimal resources. Coming back it is striking to see what luxury we have in this country, the waste, and how fortunate we all are. I admired the resilience of the Filipino people, their hopes and them bonding together to rebuild. I was also struck by how generous Stanford is, the staff and the leadership.  For every one of us who went, about 10 people and many patients were affected by the changes they had to accommodate in our schedules.  SEMPER is appreciative of how colleagues helped cover their absences from work.  The letter to the staff from our Chief Executive helped the process immensely.”

 

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