Our WHO and Department of Health (DOH) colleagues set up a fantastic orientation for us this week. We met with WHO offices at both the Western Pacific Regional and the Philippines Country Office, as well as with National DOH staff, including the people responsible for surveillance, routine immunization, and laboratory testing. We heard about the measles outbreak of 2010-2011 (which is still causing cases across certain regions of the country), about Philippines's 'high risk' status for polio importation, about the challenges of administering an immunization program (or a surveillance system) in this very geographically diverse nation, about workforce issues and dedicated staff working on immunizing the nation's children, and about exciting plans for pneumococcal, rotavirus, and pentavalent introduction here.
We spent the day on Friday gearing up for next week's adventure--a countrywide assessment of the surveillance system for monitoring adverse events following vaccination. Adverse events following immunization (AEFIs) are any problems following an injection, including those resulting directly from the vaccine (e.g., fever after DPT vaccination, which is normal, but can cause anxiety for parents, or an allergic reaction), those resulting from administration errors (say an abscess developing because of poor injection technique), as well as those that are purely coincidental (maybe the child was already infected with another illness, or just happened to develop symptoms that were linked in time to the immunization). Good systems for tracking AEFIs are important for ensuring vaccine safety and monitoring the quality of the immunization systems in a country, and are especially important for maintaining the public's confidence in immunizations.
So a team of about 16 of us are splitting up across the country tomorrow to complete site visits assessing the surveillance systems for these events at health centers and at the provincial and regional level. I'm headed up north, about 6-8 hours north of Manila, to Region I, Ilocos, where I'll be traveling with a colleague from the Department of Health and a local representative from the region. I'm excited to see more of the country (though less excited about the long bus ride), and about the project. We will all return to Manila next Friday to debrief and discuss our findings. It will be good, after a week of theoretical introduction to the health system here, to see its strengths and challenges up close.
In between all of the work introductions, the team and I have also done a good job of exploring the Manila neighborhoods around our hotel. I'm struck by the bustling crowded streets--there is no rush hour in Manila, because it's all rush hour!--but also by the respectfulness of people on the street. No leering, no street harassment, nothing but warmth and friendliness (so far!) toward the four of us as foreigners. We have ridden the LRT (light rail transport) train to and from work most mornings, and despite having to push through truly incredible seas of people, it's actually quite comfortable and navigable. It's also a funny experience to suddenly be *tall*! The average Filipina woman is just 4'11", so at 5'5" I'm nearly a giant. I've thought often of my dear friend who is a 6'2"-tall woman, and how very much she would tower over these crowds!
The four of us went on a guided morning tour of Manila this morning. We saw the monument and cemetery for WWII dead, which is a gorgeous green expanse of grass and lovely gardens commemorating the more than 45,000 Americans and Filipinos who died in the Pacific Theater. We also toured the thriving financial district, Makati, which felt like driving down Wall Street, and, in contrast, the ancient walled city of Intramuros, which was built in the 1500s during Spanish colonial times. It was nice to get a sense of this sprawling, vibrant city. Because Chinese New Year is tonight, there was a lot of activity all over the city. We saw fireworks and lion and dragon dancers last night, and the city feels abuzz with activity.
Sunset over Manila Bay
Early morning view from my hotel balcony
The WHO Regional Office
Monument and Cemetery to WWII Deaths
Cathedral of Manila, in Intramuros, the walled city
Manila traffic. That's a pedi-cab and a horse cart in front of us, and a "jeepney" shared taxi beside. Also note the Jollibee franchise on the right--it's the Philippines's answer to McDonald's.
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