SAMAR, Philippines – It was in the middle of the night when Cathy Navilla, 17, began to go into labor. That was when they found out her baby was too big and required a delivery via cesarean section – a medical procedure that is not available in her municipality of Balangiga, Samar.

Navilla was rushed to the International Committee of the Red Cross (ICRC) field hospital in the neighboring town of Basey, about 20-30 minutes away, for an emergency cesarean section (c-section).

On the early morning of December 8, Navilla gave birth to a health baby boy, weighing in at more than 4 kilos (close to 9 pounds). She named him Miggy.

Navilla is one of the first 3 women to receive a cesarean section in Basey. The sole municipal hospital in Basey could only cater to normal deliveries and would refer cases requiring a c-section to Tacloban, which is about 1 hour away. But when super typhoon Yolanda came, it damaged the hospital and completely destroyed the hospital’s one and only ambulance.

Extensive damage and poverty incidence

According to a recently released Multi-Cluster/Sector Rapid Assessment (MIRA), a cooperative survey involving more than 40 agencies across the affected area, including 92 municipalities, there was extensive damage to healthcare facilities across the affected provinces. Health experts warned about how this would impact the continuance of reproductive healthcare services and force more women to give birth at home without the supervision of a skilled birth attendant.

In Samar, where poverty incidence is estimated to be between 40-60%, in some areas the highest of 60-80%, even before Haiyan, access to healthcare and medical procedures was out of reach for many women.

The ICRC field hospital is a 20-bed hospital set up in the Basey basketball court equipped to treat minor injuries and medical conditions. Currently, the most common reported medical conditions treated were urinary tract infection and upper respiratory tract infection, which are common during a disaster like Super Typhoon Haiyan. The field hospital includes a sterile surgical theatre where simple surgeries and c-sections can be performed. Sixteen ICRC medical specialists run the hospital, which includes one surgeon and one anesthesiologist. They are assisted by 50 locally hired staff.

Daunting tasks ahead

The United Nations Population Fund (UNFPA) estimates that about 1,000 births per day are expected in the typhoon-hit areas. Out of this number, almost 150 mothers may experience life-threatening complications. A total of 90,000 births are projected within the next 3 months.

The task of rebuilding the healthcare systems to ensure these services remains to be one of the most daunting tasks one month after Haiyan. The Department of Health (DOH) estimates at least 117 health facilities in 7 provinces were damaged by the category-5 typhoon.

Other experts point out to the need to think of sustainability of improvements such as access to c-sections.

“We have to be mindful about future pregnancies since once delivered via c-section, all deliveries will have to be done via c-section,” said Gunnel Nocdlander, an ICRC mid-wife currently on mission to the Philippines.

Contraceptive use

Municipal Health Officer Danilo Fami admits that the contraceptive prevalence rate (the number of women of reproductive age who are using a contraceptive method) is very low in the province of Samar. “Our contraceptive prevalence rate is low. Acceptability to contraceptive use is hampered by a lot of factors like religion and superstitious beliefs. Some women still believe that contraception can cause infertility or is harmful to your health.”

According to Fami, the local health workers of Basey informed the women about their family planning options. Women, who had given birth through a c-section were being cautioned about the dangers of getting pregnant without waiting for the prescribed minimum 3-year gap in between deliveries.

However, the new mother Navilla, who was getting ready to go home, said that no one had spoken to her about family planning yet. “Syempre, gusto ko mag family planning pero wala pang kumakausap sa akin.” (Of course, I would like to go on family planning but no one has talked to me yet about my options.) – Rappler.com