 or the Philippine disaster risk reduction and management system states in its declaration of policy, it shall be the policy of the state to uphold the people's constitutional rights to life and property by addressing the root causes of vulnerabilities to disasters. Adhere to and adopt the universal norms, principles and standards of humanitarian assistance and the global effort on risk reduction. Incorporate internationally accepted principles of disaster risk management, adopt a disaster risk reduction and management approach that is holistic, comprehensive, integrated and proactive in lessening the socioeconomic and environmental impacts of disasters, including climate change and promote the involvement and participation of all sectors and all stakeholders concerned at all levels. Develop, promote and implement a comprehensive national disaster risk reduction and management plan. Adopt and implement a coherent, comprehensive, integrated, efficient and responsive disaster risk reduction program, mainstream disaster risk reduction and climate change in development processes such as policy formulation, socioeconomic development planning, budgeting and governance, provide maximum care, assistance and services to individuals and families affected by disaster, implement emergency rehabilitation projects to lessen the impact of disaster and facilitate the resumption of normal, social and economic activities. This is Dr. Teddy Herbosa, your host for health issues. In this episode, we tackle disaster risk reductions in health. We have as our guest Dr. Ronald Law, Chief of the Preparedness Division of the Health Emergency Management Bureau, the Department of Health. He is responsible for policies, plans and programs on health and disaster resilience. He's also a faculty in the UP College of Public Health and is also a Fulbright scholar on health security and an author of several articles on health emergencies and disaster management. Ron, welcome to health issues. Thanks for having me here, Dr. Ted. So what was this Fulbright scholarship that you went to? Which part of the US did you visit? I've been hosted by the University of Washington, based in Seattle, Washington. I was there for four months to investigate the topic of health security. So I was there to look into the US best practices in terms of the health aspect of disaster risk management. Any new things that you can share with our viewers on health security and disasters? Not really so much. However, in terms of my experience there, I saw how, in particular, the state of California was addressing the health concerns of the wildfire, which was ravaging some parts of California. So their disaster hazards are different from ours, because we address volcanic eruptions and typhoons, and they do nothing. Let's get down to it. My first question is, you belong to the Health Emergency Management Bureau of the Department of Health. It's called HEMB for short. What does the HEMB do and what is its mandate and how does it help the Filipino people? Okay, Health Emergency Management Bureau, or short for HEMB, is an office in the Department of Health. Its primary mandate is to manage the health consequences of disasters through a comprehensive and systematic approach that we call disaster risk reduction and management in health. So it entails a lot of programs so that during disasters we are able to manage or reduce mortality and morbidity that are preventable, and this is very important to look into. And during actual disasters, we act as the coordinating office. So we represent the DOH to the National Disaster Risk Reduction Management Council, which is provided for in the Republic Act 10-1-1. Yes, so you have a seat, you sit on the health seat of the National Disaster Risk Reduction and Management Council. So anything related to health, it is the HEMB that will address it, correct? Yes. What are the basic and common public health issues that we handle in every disaster? Are there principles that we follow, that HEMB follows, so that there will be a standard approach to the people affected by disasters? Okay, first in terms of issues, the usual health issues will always arise. So some have to do with public health medical aspects, so the usual communicable diseases, this may surface, along with that, of course, non-communicable diseases, of course, trauma is important. It depends on the kind of hazard. When you put displaced people in the evacuation centers, these usual health problems might come about, other than that, sometimes there are impacts on the mental health aspect of people. We also have to look into the nutritional aspect and very importantly, water sanitation and hygiene, because this is important in order to prevent outbreaks of diseases, which are common. So let me repeat that. The first one was public health concerns, spread of communicable diseases in evacuation centers. The second is essential and emergency care, trauma cases, the needing care that you need to address. The third you said was communicable, the third you said was psychosocial, mental and psychosocial illnesses. The fourth you said is wash, water, sanitation and hygiene. We're still missing one more. Nutrition. Correct, very good. So we're missing the nutrition. So let's start with wash, because I know for a fact that in disasters, for the first 24 hours, if you don't have water, you will have problems. So what does wash, wash is the short for? It stands for water, sanitation and hygiene. So basically those are important components that we are looking into. First, during disasters, we must ensure access to safe water that people can drink. So it's important, portable water, because most of the time diaries may happen and it arises because of so many things, but having safe water to drink is an important component of the response. And we need to make sure this is made available, especially to those that who are vulnerable. Correct, water is life, right? And if you don't drink for 24 hours, you start to thirst, you start to have problems. If you have a small child or you have an elderly and they have no water for 24, 48 hours, you're going to have medical problems of dehydration. So it's very important to be able to provide safe, when you say safe, not infective, potable, people can drink it. So how do you do this? How do you provide safe, potable drinking water? So first, we must ensure that the standards are being followed. We do regular water testing to make sure these are things. Of course, we have to mobilize. You bring test kits, right? Test kits. In the disaster site, you bring test kits and if the water being given is coming from a source, you test for microbiology. Yeah, that's right. If there is bacteria that can infect the people. What else? So we must ensure also. I see these plastic blue cans that you give away. What is this? They're called jerry cans. Jerry is spelled like Jerry. Tom and Jerry. Jerry cans, yeah. Yeah, that's right. So it's a storage. So we provide that so that people store it properly. And that's drinking water, right? Yeah. But if the source isn't safe, what do you provide? You provide something there. Yeah, yeah. Some disinfectants. Disinfectant, a chlorine tablet, right? So you have the jerry can. What's the size of that? How many liters of water does a jerry can have? It's supposedly for a family. We do the necessary. So a jerry can will be good for a day, for a family. How many? At least four or five people, right? So they will have potable drinking. So the Department of Health distributes this during a disaster to the homeless, right? They are given a jerry can. And some other water source is given. And then you give the chlorine tablets. You put it in the jerry can. And then it has like a faucet so that the people can drink safe water immediately, correct? What else? The other part of WASH is you send out filtration systems, the DOHS machines that can convert floodwater to drinking water. Oh, sometimes it remains to be a good option. But yeah, but the basic, a domestic of water is still in. But sometimes that is an option, but we don't usually recommend doing that, converting, yeah. And so that's one. And what is the sanitation and hygiene? Maybe I'll start with the hygiene. You also give away a pail for taking a bath inside there is a sanitary napkin. So what do you call that hygiene kit? That's the hygiene kit, yeah. So why are you giving away water, jerry cans, hygiene kits? Can you explain what are, what is the public health consequence of a hygiene kit? Okay, so sometimes a hygiene can be compromised during emergencies and disaster. So we have to make sure people have the means. Of course, water is also essential in taking care of hygiene like the daily use of water for bathing. So we have to make sure people take a bath and then let's say our reproductive each group of women would have to have access to sanitary napkins. For their monthly menstrual cycles, right? Which are very important. And we also know that in public health, the most common cause of diarrheal gastrointestinal disease is hand to mouth or fecal oral root, we call it. So it's very important to have hand washing. So we provide soap, we provide clean water so that people can wash their hands often. And today even respiratory illnesses can be spread by unclean hands. So you give the hygiene part. How about the sanitation part? Sanitation is about toilets, right? The toilets, yeah. Can you explain what the department- So toilets are important. They have to be made sanitary. Of course, again to prevent transmissible diseases that can be transmitted through the fecal oral. So we need to make sure toilets are also sanitary and people don't just defecate anywhere. And we have to make sure that waste management is being followed. In fact, I see this in all the different evacuation centers. There are so many people using one toilet and if you go to the toilet, you're the first one to run away because it's so unsanitary. Yes, yes. So you provide, I've seen the department of health provide portable. The portlets, yeah. Portlets or sometimes they are able to dig and do latrines. Yeah, latrines, yeah. So the latrines are noticed has to be designated away from water sources. Yes, it has to be, yes. Why? Why does it have to be away? So of course, there's a possible risk of contaminating water that people use for drinking. So that's- Especially the the fossil, the groundwater. If you just defecate and urinate anywhere, the groundwater that is shipped underwater and it will contaminate with the groundwater. Exactly. And then you promote illness. So that's very important. What about water? Hygiene kits for taking a bath, washing your hands and then also your sanitary latrines and your toilets. Let's go to nutrition. We have to provide nutrition to the evacuees. After 24 hours, they'll all be hungry. Yes. So what is the role of the department of health in terms of nutrition and what is the role of DSWD in terms of nutrition? Okay. So as you know, malnutrition is an important aspect to look into. So there are areas that are affected by disasters. Sometimes malnutrition is a concern. Correct. So and on top of that, sometimes agriculture is affected. So it leads to problems in terms of food availability, quality and quantity. And of course, DSWD takes care of the food. But ensuring the new to the value that people have access to nutrients that they need. So they are able to prevent the occurrence of diseases is important. So we have to make sure people, especially in belonging to the vulnerable groups in specific terms. For example, pregnant and lactating women, they need to continue having the type of nutrition that they need. Correct. So they can produce breast milk because we all know that the breast code of the Philippines doesn't allow distribution of milk formulas during disasters. In fact, in the recent Tal volcano, we saw many lactating mothers donate their frozen breast milk to the children because I think the mothers are unable to produce milk because of the stress. So very important to provide nutrition, lactation for the babies and nutritious food. Very important to have nutritious food, especially targeting those that are predisposed to severe malnutrition. Are you identify children who are in a moderate or severe malnutrition and make sure they are fed with high protein, high calories for food? What the DOH doesn't really feed, right? It's actually the DSWD, the Department of Social Welfare and Development, provides the food. So if you want to donate food, you give it to, what does the DOH do? DOH does the micronutrient supplementation, which is part and parcel of our nutrition programs. And assessment of the children's nutritional status. Yes, exactly. So you seek out, in the evacuation centers, who are the kids that are moderately malnourished or severely, if they're severely, you hospitalize them, right? If they're moderate, you make sure they are given priority in terms of the food. So they're very interesting. In the recent Tal volcano eruption, even so, LGUs provide food through catering. Do you advise this catered food with all the evacuees in an evacuation center? It's an interesting approach. It's the first time I've seen that. Definitely it's interesting, but we have to look into the practices. Yeah, the nutrition. Because the food itself, we prefer ready to eat. Because sometimes in the area, there is no cooking facility. So if there's no cooking facility, the handling of the food can be the source of gastrointestinal epidemic or outbreak. So it's very important that the food is also safe, just like the water. They must not be contaminated. If they've been prepared elsewhere and brought there, they could have been messed up somewhere during the... So it's very important to have this. So nutrition is a big aspect. And then we go to public health, right? So the vulnerable groups are the women, of course the women and the children. So when you put all these people in evacuation centers, the first thing that spreads is someone has a cough and the next family has a child and they have a cough. And what are the programs of the Department of Health to prevent the spread of illnesses? So wash and clean food will prevent gastrointestinal illness or diarrhea. But how about the respiratory infection? Okay, so respiratory infections are very common. Acute respiratory infections are usually the top cost of morbidity. So the common way of preventing it is being done. And on top of that, we need to do very good surveillance. So an evacuation center is usually congested, cramped. And sometimes it can have issues in terms of having the basic amenities. So we need to look into surveillance. So hygiene promotion is equally important and we need to go back to the prevention and control measures. Like if people are, for example, wearing masks. Isolating someone who's ill. So issues on isolation. So if someone is sick, remove him from the evacuation center so that they will not contaminate the other kids. I saw a recent one. Some of the LGUs now have this foldable type divisions. You've seen that? They say it isolates a family so that the spread of respiratory illness also is controlled. Are you for that type of evacuation center? It's a good option, but the ventilation is poor. So the air is stagnant in those cubicles, which are usually filled up by six to eight people. Our family levels are not the same as Japan. In Japan, there's one or two people in the family. In the Philippines, it's six to eight. So you put them in three square meters of space and they're about six to eight people. Sure, families may have privacy, but we have to look into, of course, distancing and then looking at the engineering aspect of that to make sure for isolation, distance is important. And that's what I've seen. We use school buildings of elementary of the Department of Education. And they fill one classroom with so many families and it's really like, to me, a culture medium for bacteria to go from one person to another. They need to decongest this somehow and build actual evacuation centers with more space. I think some LGUs are beginning to do that. Are there any other measures to prevent spread of measles, spread of rubella or other preventable diseases? Of course, a key there is education. So educating people about the health hazards of different disasters, especially those occurring in the evacuation center is important. So communicating risk is an important strategy that we need to do. So risk communication. Yeah, yeah. But we also have a preventive measures when we had Typhonion, we vaccinated everybody who was six years old and below against measles. Can you tell me about the role of vaccination or immunization during disasters? Okay, so vaccine preventable diseases are also equally common in the aftermath of disasters. So the only thing that we can have to counter that is a very good coverage for the immunization. So during peacetime, we must ensure that the coverage rates are high enough to prevent them. So measles is very common and there are other diseases that we really can prevent if the vaccination coverage is good. So if you're, like for example, when we had Typhonion, the people are actually the cost, the immunization rates in those regions were low. So we did mass vaccinations. So Ron, what are the actions of the Department of Health or HEMB to prevent contagious communicable diseases like measles and other preventable communicable diseases? First, during peacetime, even before disasters happen, we need to make sure vaccine preventable diseases is a concern, especially measles. So we need... Our expanded program of immunization has to be well done. Yes, so we have to make sure that the vaccine coverage, immunization coverages are so high. So that is the main... If it was like Yolanda were in the FIC, fully immunized child was low. That means the immunization program wasn't implemented well. What do you recommend for that affected community? Okay, so as part of the response, we often do what we call outbreak response immunization. Outbreak response immunization. So what's outbreak response immunization? It's a way to, of course, to supplement the efforts to increase the vaccination and to help sustain that herd immunity, which is important to maintain so that any outbreak of vaccine preventable disease can be prevented, which is very true for measles. You did this during Typhoon Haiyan. But we had a measles outbreak in Manila because, and then we found the source in Tondo to be relatives of people who came from Tacloban, who moved to their relatives. And the outbreak was in Metro Manila, but we had no measles outbreak in the Tacloban area and the Visayas area. So this is one important aspect of prevention of outbreaks and epidemics during times of disaster because measles is like RO, the rate of progressions like 16, right? Yeah, it's very contagious. So one person can infect 16 people. So immunization is the key to stop that. That's just one. On top of that, of course, the duration is important. And then apart from that, of course, it's all about strengthening the immunity. So usually children and immunocompromised people usually would contract or get the measles. So we have to make sure those things are also being addressed, yeah. And there are other at risk groups aside from the children, women. Women can be pregnant or can have reproductive health issues. What are the programs during disasters? Okay, so we have what we call minimum initial service package for sexual reproductive health. So maternal mortality is something important to look into. So when you say maternal mortality, it's about a pregnant mother who evacuated to the center and then suddenly goes into labor, right? So what services do they need? They need to be delivered well, right? So if they're not delivered well, they can die from childbirth. Yes, yes. So we have to ensure safe pregnancy can happen. So ensuring that there's no infection. So we have to make sure we provide clean delivery kits. We have to make sure people who are trained are doing it and complicated ones are being sent to hospitals for referrals, especially those with the pregnancy complications. So identifying the women with high risk, making sure their nutrition is continuous, maybe making sure they get a tetanus shot as well. It's part of their prenatal. So all the public health issues for women are continued and you need to bring them to evacuation centers. So let's go to the next one. Emergency and essential care. Part of what people look for is injuries. They got injured because of the disaster. They have a fracture. They have a wound that's infected already. So how is this addressed by DOH? So aside from communicable diseases, trauma is an important group that we should focus on. So trauma is injury, right? Okay, so injury, yeah. So it depends on the hazard, but during, after common natural disasters, injuries are also very common. So we have to make sure these things are addressed properly following basic life support should be there. First aid is... So first aid, emergency care, some kind of intervention. Intervention. Stop the bleeding, stop the bleeding, immobilize the fracture, cover and clean dirty wounds and then be able to bring them to a surgical center for repair or treatment. Otherwise they get neglected, right? And if they get neglected, they can develop into complications. Infections, complications. So we go to the, probably the last part, which is really the psychosocial aspect of disasters. It creates a lot of trauma to all the victims of the, they become homeless, some of their relatives die. How is this addressed by the Department of Health? Of course, we acknowledge that it's an important aspect to look into and sometimes the effect is not clearly seen. Correct. So we follow different phases. So first, we have what we call psychological first aid, yeah. Explain that. So we do this to manage the immediate acute, the immediate reactions of people. So especially those who have lost their loved ones, who have their houses destroyed. So it's an immediate way of... So you need training to be able to identify the person and provide some sort of psychosocial support, correct? Yes, yes. So who do you train? The doctors, the nurses, the providers, the health personnel? We train a wide range of service providers. And the Department of Health is also in coordination with other agencies. So sometimes we need to tap social workers. Okay. And then of the day, it's all about some social needs being met. So most of the... So making sure anxiety, depression, and all these psychological issues happen and prevent them from getting into clear mental illness. So this is what the psychological first aid does. Yes. Do you provide psychological first aid to the rescue people, to the responders? Yeah, rescuers are what we call invisible victims. So yeah, they need to receive some form of psychological first aid as well. We've seen that with our young nurses and doctors that we sent to the front lines. They come back affected by what they see. So they need to be processed as well. So do you have a process where your team can identify the person that needs to rest or needs to be processed? Yeah. So we use some tools and then of course we do some activities that are especially if when we deploy people, so we have to make sure that the team leader knows how to assess and everyone should make their... And then there's self-care. Everybody should self-care. Because sometimes you cry or because you see someone really affected or suffering. It also affects you as a doctor or as a nurse, correct? So psychosocial really is a very important part of disaster, it's very important. In terms of disease surveillance, the Department of Health produced something that was very interesting. It's called speed. Can you tell our people what speed is? Okay, speed is an early warning and alert system. So outbreaks of diseases should be prevented. So speed is innovative in terms of it using, it uses SMS. So it... This is the phone. The phone. The hand phone, yeah. So we're the SMS capital. So with the help of health workers, they're able to report some of these symptoms. So it's called syndromic. So with those symptoms, we're able to... It's called syndromic surveillance. Yes, it is. So health workers in different evacuation centers would report to SMS, right? And the DOH central office, you in the central office will see these reports and then you see, oops, there is a very high incidence of measles. So maybe we should bring vaccines there. There is a high incidence of diarrhea. Then you start to bring potable water or water filtration units or whatever diseases they report, you are able to manage. So that's really the logistic side of disaster preparedness, right? Being able to bring resources to the people that need them most. We have currently a volcano that erupted, the Al volcano. Can you tell me some of the health issues that happens during volcanic eruption? Okay. So again, it depends on the hazard, but from our experience, the volcanic eruption was, it was not explosive. Yes. So it was a lot of a lot of a lot of a lot of ash. Steam ash. So the main health issue there is respiratory. Correct. So people run the risk of inhaling that ash particle and it can affect their respiratory function, their breathing. So those people with respiratory illness problems would have a hard time. So yeah, we need to also protect kids from inhaling those dust particles. There was a shortage of N95 masks in Metro Manila. And then the DOH announced, no, you don't need to wear N95 in Metro Manila. So it's very important that the correct information is also passed on. Because the first message was wear N95, which is correct for the affected area. But then everybody in Metro Manila started to buy N95. So the people that were affected now don't have N95. Whereas the ones there, they need that there. The responders, the volunteers, the workers correct. So this is very important. Now we're having an outbreak. It's called the N-Coronavirus Acute Respiratory Disease. What happens during outbreaks and epidemics? How does HEMB play in terms of a role? Because it's a different type of disaster. It's not like a volcano erupting, or a typhoon coming, or an earthquake happening. But it's still a disaster, right? So can you explain what happens in an outbreak or an epidemic? Okay, and then in relation to our role in HEMB. Yes. So an outbreak or epidemic, it's usually addressed by many offices in the Department of Health. So one aspect is surveillance, first detection and control. So we need to test the... Detection and control. The specimen, yeah. So one is preparedness and response. So HEMB plays a role in terms of emergency preparedness and response by helping out in the mobilization of resources. So you have the quarantine, the Bureau of Quarantine, which is in charge of blocking any disease from outside the country to enter the country. You have the National Epidemiology Bureau, which makes sure that they monitor certain diseases, that if there is an outbreak, what is an outbreak? Okay, an outbreak is an excess number of cases over a period of time. So that's just to limanize it a little bit. So we have common dengue, and then the DOH declared a dengue outbreak. That means the number of cases of dengue was higher than last year's in that same month and period. And what is an epidemic? Okay, an epidemic is almost anonymous with an outbreak, but what we must distinguish it from is a pandemic. Correct, so our... So outbreak is the start of an epidemic, right? So the epidemic is a full-blown, many cases. So they declared, first they declared an outbreak, then the Secretary of Health declared a dengue epidemic. What is a pandemic? Okay, a pandemic is, but we have to refer to the latest term being used by the WHO. It's public health emergency of international concern. This is for influenza, avian flu, Zika, Ebola, and now the end-coronavirus, interesting. So Ron, there are any things you'd like to say about what HEMB does and provide confidence or Filipino people that the Department of Health is indeed ready, prepared, and follows the mandates of the Republic Act 10121 that I described earlier, and give your message to the viewers. Okay, so the Department of Health along with other bureaus, and especially our bureau, is doing its best to manage all the effects of these emergencies and disasters, including the end-coronavirus ARD. So we are creating systems to allow us to prevent these things from negative consequences. So we call on everyone to make sure that accurate information, the right information is being propagated, and that is only by way of observing what the authorities are saying. Of course, the DOH always would observe or follow the recommendations of the World Health Organization. So with that, Ron, I'll have a fist bump because we are not allowed to do hand shakes because of the current outbreak. Ladies and gentlemen, disasters are common. The Philippines is a disaster-prone country. We have listened to Dr. Ron Law of the Health Emergency Management Bureau discussing the disaster risk reduction and management issues related to health. I hope we have educated you and informed you of what the government does in times of disaster. With that, thank you very much and see you in the next episode of Health Issues.