This is a slightly edited extract from a ‘de-briefing’ letter Siobhan wrote to a friend post Tacloban.
Please be aware that there are some graphic medical details.
Apologies but this one’s going to require a glass or two, even if you skim read. I freely admit that even more on this occasion it’s mostly about my therapy. There is however the additional intent of having a humanised version of events recorded somewhere. I actually drafted this on paper at the end of Jan – en route to stay with Tom and Jason in Japan. I even started typing it in mid Feb. But then it sat on the desktop and, given the differences between the three versions, I think only now I have enough emotional distance to finalise in print:
I never made it to Ormoc City.
En route there I flew in to Tacloban in the evening and as chance would have it agreed to stay one more night to help plan some communicable disease training with a GOARN colleague who had arrived a few days before. The following day she told me that at breakfast some Australians had waylaid her in her WHO flack-jacket in our hotel Lobby (the unofficial UN hub) and had asked ‘why wasn’t the WHO doing something about the dead bodies?’. Then later that day I overheard the Tacloban WHO logistician being very Gallic in a response to a call from another UN agency asking if we knew anything about management of dead bodies, as the local government unit (LGU) were asking for assistance in putting some tarpaulins around a field of them and the agency wasn’t sure it was quite the thing. I piped up at this stage and said that I’d heard this issue mentioned in the morning, but I understood that the forensic pathologist Professor Stephen Cordner had already been out as an advisor in the Philippines, and as I had seen his photo on the noticeboard in Manila, knew that it had been with the WHO. (One keeps an eye on one’s heroes as you know, and Prof Cordner is one of mine. He’s from a famous Melbourne football family, but being congenitally deaf he studied medicine and founded VIFM instead. He was already high in my esteem prior to the day that he convinced a full staff meeting in front of my very eyes the value of a new internal auditing software system, based on the simple, gently-put argument that if we wanted to set the standard we needed to know that we were meeting our own.)
Anyway, being just before New Year communication was limited: the health cluster coordinator had been sent on leave the day before and couldn’t be contacted. Nor could we reach anyone higher up in the WHO food chain, nor the ICRC. So I instead called a senior in clinical forensics in Melbourne and asked is she minded calling Prof Cordner about the issue and checking if it was okay to contact him. Next thing I know he had called back and I tried to connect him to the mayor’s office. Twelve hours later I was asked by the acting-in-charge of Philippines WHO (Ben Lane) to stay and provide a realistic update of the situation, so I met with LGU staff and eventually the mayor, Alfred Romauldez (Tacloban is a ‘highly urbanised city’ which means the mayors of such are directly under the national government, bypassing the regional level). This led to a rapid field tour that afternoon which revealed an open mass grave of more than 1000 corpses in an outer public cemetery and 700-800 further water-logged bodies in decomposing bodybags scattered over the land next to the Suhi community medical centre, where there was evidence of mauling by dogs. The latter site was open to a commuting road and surrounded by rice-paddies and poorer villages, and there were a couple of disheartened junior police officers stationed in the otherwise abandoned clinic building.
It was a tragic situation: a combination of grey areas in management-of-the-dead policies between the Department of Justice and the Department of Health; an unforseen disaster affecting a disproportionate number of middle class Catholics (in the city of Tacloban); a highly litigious country; the belief that the National Bureau of Investigation could do the impossible (i.e. provide full disaster victim identification (DVI) including sampling for DNA on that type of scale); mixed messages from international bodies such as Interpol re the same; and lots of ego, and lots of fatalism due to the enormous amount of surrounding corruption. The DOH had initiated a pretty realistic ‘partial DVI (clothes, scars, fingerprints etc.) and get them buried approach’ a couple of weeks after the tragedy, hashed out with Prof Cordner and a reluctant NBI. Unfortunately the latter’s (real) fears re litigation (writs were already being filed when I was there in terms of where bodies ended up in Tacloban if they had over-flowed from funeral parlours!) and the lack of any frameworks or international consensus to fall back on for this type of scale meant that when the NBI elite decided to change tactics to something more comprehensive, and the DOH went off in a huff, circumstances were ripe for one big messy stand-off that no-one could back down from and save Face.
It didn’t of course help that the information reaching Manila about the scale of the tragedy (both in real and emotive terms) was being enormously downplayed by a media reacting to the concurrent War of the Roses-like political situation that potentiated this entire mess: basically that Mayor Romauldez is a Marcos (Imelda’s nephew), which of course in the president’s eyes make him an enemy by definition. The practical implications of this situation can be read in the popular press but I do believe that this meant that a lot of the Manila power-players refused to ‘see’ the extent of tragedy that had occurred in the South. There are wonderful individual doctors in the NBI but there can be no other reason why so many people from both the DOJ and the DOH looked the other way for so long, and the fact that the NBI were rostered on holiday from field DVI on the 18th and December and hadn’t returned by the time I got there. Of course what the media initially supressed the media also later drew attention to, so that the body issue at least was blowing out exactly at the time that I arrived. In terms of the rest of the tragedy the country still remains somewhat in the emotive-dark, with little realisation of just what ‘the biggest storm in history to ever hit land’ really meant. Ben told me just last week that he meets people in Manila and says where he’s been, and they give him a fixed look and ask him what it’s really like? And when he tells them they nod sagely and then shake their heads in the manner of those who realise that they’ve been duped.
Anyway, back to the story, fortunately my rather frank assessment found grip at the Manila meeting between the squabbling DOH and DOJ the following day and forced them to finally hear what was going on, and (in tears apparently) to come up with some sort of interim solution – which was to close the mass grave and temporarily bury the ‘unprocessed’ bodies to be exhumed for ongoing DVI at a suitable pace. Next thing I know I’m helping to project manage this dictated but un-resourced mass burial with the Mayor and his employee Dr Bubi, the latter a guitar-playing, did-medicine-for-his-father-but-in-reality-prefers-youth-work kindred whom I met on the day of the Manila decision: He had been the one trying to sort out some sort of framework for collection and preliminary identification of the dead until it became a successful operation and the leadership was subsequently squabbled over by more authoritarian players in the fire-brigade and police. Bubi was still living in a tent next to City Hall when I met him, his own house at that point remained uninhabitable having been under water with the storm surge (and he’d given all of his time to the dead in the interim), although the walls of his place were still intact due to being built by his grandparents to last. He’d lost a number of neighbours too, who had believed their own concrete walls would protect them: He told me more than once about the ones across the road who had been pressuring him to join them on their balcony and have a beer whilst he was rounding up stragglers for the evacuation centres he was overseeing. Those neighbours died with the others.
And the job itself, well I have described bits of it to others in the midst of it all, but in retrospect it essentially amounted to three things:
Firstly there was the messy, unpleasant, front-line, slightly medical bit where Bubi and I initially demonstrated how to re-bag the heavily decomposed bodies, some of which were in a number of pieces, and in such cases try and match the bits. And then later on solving other practical challenges, such as showing the workers how to retrieve and slit open bloated bladders of other bodybags in flooded pits, so that non-essential inflated and soft bits could drain away and the remaining body then be light enough to lift by a half-dozen men. It was the little things that hit me there: a young girl’s bracelet and watch next to a tissue-free ulna in lush grass: the dogs had obviously been cleaning her skeleton, which was spread over several feet amongst the odd grazing chicken. A scrap of underwear reading ‘Jockey’ also sent me reeling one time. The stench was of course horrendous, but worse were these visuals, and the other reminders of pain, such as the knife-slits to bags where desperate relatives must have surreptitiously combed the corpses lying in the field, remembering that theirs was carted off in a particular brand of bodybag: PCRC or DOH or whoever. Bubi had been exposed enough, so we agreed that he’d move on to managing the simultaneous temporary burial of the re-bagged bodies. In the end it took me and between 20-30 men three days to complete the re-bagging. It was the most unpleasant thing I have had to do in my life, but it had to be done. And this situation should not come to pass again.
The second bit was the practical, systems, side. Collecting equipment from around town; meeting Bubi’s generous friends in the Red Cross; asking, asking, and asking again for things to happen (nb. this was great therapy for my long term difficulty in expressing my needs!) Then making sure that things happened by having at least two back-up plans in place. It was a frigging mess. The DOH had left a lovely epidemiologist in charge over the holiday period who was trying to manage the whole outbreak response at the same time as this growing crisis. I valued her, and tried to protect her and give her time for the ‘real’ epi work, but her immediate bosses took much longer to gain my respect: the latter promised items or equipment that never arrived or arrived long after I’d swung into place a back-up for example. However to be fair the DOH response was merely representative of the whole picture. Each department or office was looking after itself and no one had the foggiest of how to work together, since they’d got to this mass standoff as a reflection of what had been going on in Manila. I remember at one time I wanted to give some soldiers who were a bit green around the gills a break from re-bagging some really messy corpses so sent them to help the NBI move ‘processed’ bodies for final burial. The NBI pathologists initially couldn’t understand what I was offering, they thought there must be some error. It took me some time to explain that there was no catch, and to push home the concept of sharing resources on the one work-site, since we all happened to be working on parts of a bigger project.
Of course the relevant squabble was only an example of a bigger, more systemic mess – fuelled by the awful corruption and an ingrained system of false promises. A good example of this was on the final day (five, I think) when the media was through the roof and an under-secretary of health had reassured a national broadsheet that she personally had mobilised much-need equipment to come from a neighbouring city to help finish the burial process, and the public works department had also promised the same thing, but the only reason we got actually got it done was via plan C: the South Korean army that had arrived in Tacloban the week before – and even that was through sweet-talking the local Philippine Colonel in charge to let the backhoes travel through the outskirts of town when a permit (A Permit!) hadn’t been approved yet.
The third component of the job was inter-related. This was the slightly dissimulating smiling me who ran around the whole time saying, ‘wasn’t it great how everyone was working So Well together?’, until in the fact, in the end, they did. I knew the universe had shifted slightly when one evening I saw some DOH and NBI doctors exchanging recipes at the end of a Management of the Dead Task Force meeting. And if the media had to be faced then I said the same thing. And also that it was a difficult job, but everyone was doing their best, and we would use the lessons from this for the future. Which of course was what we were discussing – the practicalities of algorithms for future disaster DVI attempts, perhaps with bar-coded bodybags, and single layer trenches versus pits etc. etc.
And then there were the vignettes:
The curtailing of a mass psychogenic illness in the surrounding poorer community of Suhi, whose residents spoke of spirits that were walking, and intractable nightmares, and that many of them were getting rashes and stomach sickness that could not be explained. These symptoms all resolved when the bodies were interred.
The wealthy Jorge in his black sports car, a friend of Bubi’s younger brother, whose friends were either dead or had left town and who drove aimlessly between the expensive coffee shop and ‘business’ appointments, wanting to leave, heavy with survivor guilt – in need of a project. We left him planning a community hub.
The day when I looked up and saw a new recruit taking a photo of me with his phone. I later asked Bubi what was going on (having no TV nor time to read the papers). He told me it was because I was burying bodies and I was pretty and that is what people needed at the time. And then for a day or two there people smiled at me in the streets, and crossed the road to shake my hand, and cars stopped to let us through, and the WHO amah insisted on charging me a reduced rate for my clothes washing, and it was for just long enough for me to feel the loss ever so slightly when it ceased to be, but to also realise that for my ego, if not my privacy, the temporariness of my hero status was a good thing!
The pragmatic middle-aged lady that lived over the stream behind Suhi, who, after the all the bodies were temporarily buried, walked past me as we were pumping surface water into a (non-potable) creek to improve the site for re-exhumation and ongoing processing. I looked up at her at one point and smiled, she looked at the water draining into the creek she was crossing, and then pointedly looked back at the site over the small ridge, and then looked at me again and smiled, and said, ‘Vitamins’. (!)
The appreciation of an artist at work: when we gave up on the pumping water for body re-exhumation in the torrential rains and decided to do some earth moving to drain the overflowing trenches into the creek. Leo was a backhoe operator extraordinaire, who could take my vision about what needed to be done and then add a little touch of his own. A minor double take in seeing just how large the unhappy frogs were that we disturbed in the process – but rather points to the sense of the vignette above.
The normalisation of adversity: in the 10 days after the burying project, when I was consolidating the sites and running around getting signatures on a request for the American Ambassador to fund cadaver-searching dogs back to the city (my promise to Bubi for his help in the burial process), and after having just obtained an un-looked-for signature, I heard the mass at the local Santo Nino Cathedral, so my driver (who turned logistican for me) and I went and sat in the back. And the rain was dripping down the colonades and through holes in the ceiling over some empty pews, and running over our feet, but the rest of the place was packed, and the choir-girls were nudging each other and making eyes at a couple of cute boys as they hit the high notes, just as usual.
And then there was a terribly glamorous House of Reps member whom I met on my last night, when I joined the Mayor and Bubi and some others for dinner at the really good local Italian restaurant. She had set up a collection in Manila to make up packs of lipsticks and ‘grooming kits’ to hand to school teachers, so that the kids going to school could see their teachers well groomed, as a signal that all was well again. And they had a point, although there were still bodies lying under all the debris, because a balance does need to be found, and sometimes being seen to be something does help, even if you’re churning up inside, because an example needs to be set.
I made mistakes of course. The one that I learnt the most from was when we started excavating the bodies that had undergone a partial DVI and were buried in layers at the Suhi site. After evidence of the first (very well preserved) body was revealed by the backhoe the workers (local men – no longer any soldiers) stood around not moving for a time. I asked the backhoe to stop and checked with the new NBI pathologist, a regional, senior doctor, what was going on. He suggested that we didn’t go into the pit, but I asked him how were we going to get them out then? In the end with much encouragement and me going into the pit a couple of workers and we retrieved the first body. But it was difficult, the mud was sucking and impossible to work in, and the workers were reluctant. We gave up and the machine went back to work. It was then that I heard the sound of a backhoe tine going through someone’s skull – which is something that I really don’t ever want to hear again. And that operator was Leo, and I’m sure that he doesn’t want to ever hear the same thing either. But in this situation machinery was our only option. In any case my real error was revealed when the NBI doctor later told me that the men had probably paused to make their own prayers to the spirits of the dead that we were exhuming, although a little bit of me realises that he was also testing me, since he could have told me so at the time. But I was the outsider, and his team had just arrived and I hadn’t proven myself to them yet. And he was also right, and it was my error, and I felt bad: I had simply assumed the reluctance to be like that of the squeamishness in the re-bagging process. So I asked if he translate an apology later, that I had meant no disrespect – and the workers with English said that it was fine ma’am, however when I felt the emotion behind their responses I knew it was something that I had needed to say. And after that the new pathologist and I got on just fine.
I also made a mistake in thinking that the Americans might play ball in funding the American cadaver-searching dogs back to the city. The dogs were vital as people were starting to try and rebuild but bodies were still literally everywhere under debris, and the old backhoe-though-the-body not the ideal way to find one. It was suggested by USAID that the ambassador had a discretionary fund that could be used for this if a convincing letter was written. So I drafted one and managed to get it signed off by the regional heads of the DOH; the NBI; the Police scene-of-crime-operations; the Bureau of Fire Protection; Bubi; the Mayor; the Red Cross and the state congressman, and in the end it was all for nothing. This I found out much later on of course. But too much politicking was happening at a higher level, so the UNDP had to cough up the funding at the final call. And as of last week, four months after the storm, the dogs were still finding 15-20 bodies a day in the confines of the city.
And thus I have an answer to my question that I wrote to you last time, about why I was meant to be there. Ironically I really believe it all worked out in the end because I didn’t really care if I ever worked for the WHO again, so I rather overlooked protocol for the most part because it appeared that protocol had been implicit in creating the problem in the first place! For example even Ben Lane one night, at all other times on spot in his support, expressed concern about me keeping as low a profile as possible so that it was not apparent that this issue needed external help to be solved. And of course I did when I saw that media was around, but I think that the initial grottiest bits would not have happened without further anguish, fractions and delays and god knows what larger repercussions if it had not been demonstrated to the local workers and soldiers that I, an apparently soft blonde western woman, but with a convenient title, could do those really unpleasant things: that they could be done, that this is what we were all going to do together because this is what needed to happen. At times I really felt I was channelling Tiffany Aching! Even on day one of the operation I received a text at four in the morning from the charming ... city administrator Tecson Lim lamenting the rain and asking if we could postpone. I replied that we needed to set an example, and, as it was, before we could start I had to do a run back to the army barracks to collect the promised Unit of soldiers as they had ‘slept in’. The Mayor was there of course, but he couldn’t be there all the time, he had a city to rehabilitate, and Manila powers on his back, so in the end I didn’t give a damn if occasionally it looked odd. Having just agreed before that sometimes it’s quite important to pay attention to appearing normal, I should like to clarify that at other times it’s frankly not worth it!
And Mayor Romauldez and his city are now one to watch. They have nothing to lose anymore. The Mayor is the feudal lord who saw his city suffer the most terrifying of assaults but it survived. Moreover in the aftermath he received no help from his overlord and had to suffer his own grief and trauma with that of his people whilst being called to account for it by the senate. He made mistakes of course about the scale of the storm, like everyone else. … But unlike many others I never heard that he was on the take. And I think that this storm, and its aftermath, was perhaps his nemesis. He was left out to rot, to be the scapegoat: equipment that might have helped him was left locked up just 10 km from his city, and yet in the end he and Tacloban contrived. There might just rise a phoenix there – he’s certainly not going to give up now in any case.
And I was lucky enough to meet some more kindreds. Bubi’s gone to ground now, poor emotive sod. But we had such an intense sibling-like connection that I reckon I’d know if there was anything seriously wrong. And then there was Dr Angie, an NBI pathologist who gave me a beautiful book of essays on well-being, opportunity/destiny and anguish that is edited by a prominent Philippines linguist. (She also gave me a much-loved copy from her own bookshelf of one on Philippine folklore medicine, which touched me enormously.) And a gorgeous Canadian girl, who is into rubbish disposal, and our paths will cross again some day. And finally there was Ben Lane, a beautifully bright angst-ridden American from the southern states, with a ripper of a take on the intricacies of his own country and countrymen, whose nightly debriefs enabled me to stay sane…
And there were also the not-quite kindreds, but rather interesting people, such as the American boy Mark who was representing the Cadaver dogs amongst other groups and had been involved in body collection. He was taking a break when I first arrived, and I met him via email as he thought the WHO might fund the dogs. His US-military-speak was incredible, which we had to get over, but there is a genuine heart there... (I recommended Mark to replace me)…
And there were also other inspiring people working for the WHO: A really good Philippine administrator seconded from Geneva; a very bright water engineer out from Karachi who had excellent thoughts on how the organisation could be restructured, and the seriously M-like Philippine WHO WR (…ex UK GP) – who could manage a room full of conflicting interests like it was nobody’s business. I could have worked for her – and if I hadn’t had plans and unfinished business here might have taken up the offer. Perhaps in ten years of so when my current projects are complete! Anyway by the end of it I really felt that the WHO fat was in the regional office, at least if the goldfish there were anything to go by. But perhaps also just poor patterns of communication and consideration that need a bit of shake-up… And there are good people there ready to act, and many of the others just need to experience some more of what it is they are part of in order to be able to assist in change also.
So to wrap up: I have processed well, this is really the last bit. I now know myself that much better than when I went to Pakistan, so that I knew in the Philippines when I was tired, when it was time to go, which in fact was when I had always planned to leave. I did go into sixth gear for some days there: I’m sure it scared a few people – but it got things done, and it’s probably good for me to let it rip once in a little while! I also spent the last days in the Philippines re-writing my ambivalent mid-20s memories of Manila by visiting the Binondo church during the festival when they bless all the mid-sized baby Jesus statues, and wandering the streets near the university, and soaking up the atmosphere of the beautiful Paco cemetery where Jose Ramos was interred.
And as I finish this there really is a smile on my lips… making plans of getting one’s backhoe certification in the next couple of months (and avoiding another Masters) is enough to put a smile on any girl’s face!
Sincere thanks for the therapy session!