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SK Learning Hub - First-Aid training and basic life support for youth - December 17, 2022 | By SK Calumpag General Santos City | Facebook

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URL: https://www.facebook.com/SKCalumpang9500/posts/pfbid02hi11KdBKemCmUbGcqF3oc7kgePfHwGnBeSep9bdgTCxkYWUeasDMR3MbH2BW8Qhgl
TITLE: Fierce Responders: First-Aid Training
AUTHOR: SK Calumpag General Santos City (Facebook page)
DATE: December 17, 2022
KEY INFO: This program was held in order for the Calumpang Youth and SULKAR scholars to train and learn the basics of emergency training, particularly first-aid. Ms. Ina O. Dela Cruz, President of MSU-SHS First Aiders, spoke about the importance of first aid in times of emergency and adversity along with her is the Mindanao State University First Aiders, demonstrating the basics of First-Aid. A short demonstration and assessment were also carried out to ensure that participants understood the training.
(Chrezvel Kate Tejero)

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Davao City sends aid to areas hit by Typhoon Odette - City Government of Davao | 

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URL:
https://www.davaocity.gov.ph/good-news/davao-city-sends-aid-to-areas-hit-by-typhoon-odette/
TITLE: Davao City sends aid to areas hit by Typhoon Odette
AUTHOR: administrator
DATE: January 3, 2022
KEY INFO: The City Government of Davao has given financial assistance and sent responders to several areas in the Visayas and Mindanao that were gravely affected by the onslaught of Typhoon Odette in mid-December. Duterte said that the entire Davao team focused on providing medical missions, debris clearing in barangays, as well as psychological first aid and medical post and evacuation centers.
(Chrezvel Kate Tejero)

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URL:
https://www.philstar.com/lifestyle/health-and-family/2022/09/01/2206125/psychological-first-aid-key-battling-mental-health-crisis-industry-leaders
TITLE: Psychological first aid key to battling mental health crisis, industry leaders say
AUTHOR: Philstar.com
DATE: September 1, 2022
KEY INFO: In Manila, PhilCare and Johnson & Johnson Philippines Inc. (JJPI) are collaborating to make psychological first aid (PFA) accessible to more Filipinos. This can help the Mindanao community to become more resilient facing the after math of natural disasters.
(Chrezvel Kate Tejero)

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MANILA, Philippines - Due to the increasing number of mental health cases in the Philippines, two leaders in the country's health and personal care industries, PhilCare and Johnson & Johnson Philippines Inc. (JJPI), are collaborating to make psychological first aid (PFA) accessible to more Filipinos.

Results of a recent study by the Department of Health (DOH) indicates that around 3.6 million Filipinos found themselves battling mental disorders during the pandemic.

PFA is about comforting someone who might be in distress and helping them feel safe and calm by applying three basic action principles - look, listen and link.

To look is to assess the situation of the individual seeking help; to listen is to pay active attention to what they're experiencing and helping them find solutions to their problem; and to link is to address their basic needs like food, water and medicine or to connect them to loved ones or to social support when needed.

Empowering patients and helpers

"Learning PFA and understanding reactions to crises empowers all of us as helpers," said Dr. Edgardo Juan Tolentino, former president of the Philippine Psychiatric Association, during the recently held online forum Let's Talk About Psychological First Aid organized by PhilCare and JJPI.

"PFA is not anything far from physical first aid where you put a bandaid on the shallow wound of an individual, but if the wound is deeper and you can't control the bleeding, you may have to call the ambulance or bring the person to the ER," he said.

Through this joint effort, PFA training, facilitated by JJPI, will be incorporated into PhilCare's Mindscapes program for mental wellness. This will allow PhilCare's mental health professionals to use PFA to treat their patients battling anxiety and depression brought on by the pandemic, economic uncertainties or personal issues.

Mindscapes provides customizable and scalable programs to companies that wish to support their employees' mental wellness journey. PhilCare also created three prepaid plans to make mental health counseling more accessible and affordable to Filipinos.

The PFA that PhilCare and JJPI have adopted is the version that the International Red Cross has been using since March 2020. It specifically targets concerns arising from the COVID-19 pandemic and is more of an evidence-informed intervention.

More than an effort to enhance its well-rounded mental health and wellness initiatives, the collaboration is also part of PhilCare's 40th-anniversary celebration. It signifies the HMO trailblazer's continuous journey in improving the lives of Filipinos through new and innovative healthcare products and services.

Bring back control

"If we can put a theme to the pandemic, it would be 'we have lost control.'" Dr. Tolentino shared. "When it began in 2020, our days were predictable. We have a schedule. Then suddenly, we find ourselves confined in our homes, with no schedule."

"The idea is to bring back control by supporting good personal choices. Draw people out by asking them 'What did you do to help yourself during this time?' then pick up their positive coping mechanism," he added.

Dr. Tolentino pointed out that just being by the side of someone who's going through a crisis, encouraging their existing coping skills and not pressing them to give details of their ordeal is already practicing PFA.

PFA can be helpful to people coping with everyday stress and challenges. These people could include healthcare workers and social welfare responders, COVID-19 survivors, families who just lost a loved one, older adults who feel alone, and those with vulnerabilities like mental health and substance abuse problems.

"The goal of PFA is to provide safety, calm and comfort, and connectedness to a person. As well as to promote self-empowerment by giving them back their sense of control," Dr. Tolentino concluded.

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Psychological first aid key to battling mental health crisis, industry leaders say

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MANILA, Philippines - Due to the increasing number of mental health cases in the Philippines, two leaders in the country's health and personal care industries, PhilCare and Johnson & Johnson Philippines Inc. (JJPI), are collaborating to make psychological first aid (PFA) accessible to more Filipinos.

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URL:
https://www.who.int/philippines/news/feature-stories/detail/philippines-pioneering-psychological-first-aid-
following-crisis
TITLE: Philippines pioneering psychological first aid following crisis
AUTHOR: World Health Organization
DATE: July 12 , 2017
KEY CONTENT :
The article is about Filipinos frontline workers practicing psychological aid to help people affected by natural disaster such as earthquakes. As the article said, not only physical first aid is important , as well as psychological first aid because taking care of mental health is also very important. This information can help us practice psychological first aid as well here in Mindanao, especially when more people are accepting and taking notice that mental health is important. It will greatly help our brothers and sisters in our community to cope from the after math of natural disasters that may happen.
(Chrezvel Kate Tejero)

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"The psychological damage left in the wake of natural disasters in the Philippines has proven to be as devastating as the physical damage", said Dr Gundo Weiler, WHO Country Representative in the Philippines. "WHO and partners developed a guide on psychological first aid to ensure that standards and best practices are consistently applied in humanitarian settings in order for us to do better for the mental health of disaster affected populations".

World Mental Health Day is observed on 10 October every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. The theme of this year's World Mental Health Day covers "psychological first aid". Efforts in support of the day will focus on basic pragmatic psychological support by people who find themselves in a helping role whether they be health staff, teachers, firemen, community workers, or police officers.

Despite its name, psychological first aid covers both psychological and social support. Just like general health care never consists of physical first aid alone, similarly no mental health care system should consist of psychological first aid alone.

In 2013, following Super Typhoon Yolanda (Haiyan), WHO together with the Philippine Department of Health worked with its teams in the provinces of Leyte, Cebu, Capiz, Samar, and Northern Palawan to provide information on psychological first aid to partner organizations, teachers, police and others who can help in extreme life experiences, both man-made and natural, like the typhoon aftermath. To date, most, if not all, of the frontline workers in almost all regions of the country are capable of providing psychosocial support.

"Filipinos, in general, grow up in a caring environment, caring for and being cared of by others. This is where resilience comes from. We have long been practicing psychological first aid even before the term was officially coined. This makes giving of psychological first aid an inherent trait among us." explained then Assistant Secretary who is now Secretary of Health Dr Paulyn Jean Rosell-Ubial.

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Philippines pioneering psychological first aid following crisis

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"The psychological damage left in the wake of natural disasters in the Philippines has proven to be as devastating as the physical damage", said Dr Gundo Weiler, WHO Country Representative in the Philippines.

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URL: https://www.youtube.com/watch?v=x1oo76Y_87A&t=94s
TITLE: First Aid for Open Fracture | LIFESAVER
AUTHOR:  UNTV News and Rescue
DATE: October 17, 2021

KEY INFO: This National news video talks about how to apply first aid for an open fracture injury. During a natural disaster such as an earthquake, fractures are a common injury. This knowledge will help people in the Mindanao community to be prepared with first aid knowledge for open fracture injuries.
(Seanlei Angliongto)

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8) Public service message or promotional video

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8) Public service message or promotional video

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URL:
https://www.youtube.com/watch?v=9_zS0ZVcvu4
TITLE: First Aid Campaign Promotional Video
AUTHOR: Rotract Club of Greater Chittagong
DATE: August 25, 2022
KEY INFO: This promotional video in Bangladesh talks about how first aid can help you save the lives of others so that many people will be motivated to join their first aid training. This can encourage the people in the Mindanao community to also try expanding their knowledge and learn more about fist aid so that they may be equipped with such necessary skill especially when facing emergencies.
(Seanlei Angliongto)

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URL: https://www.gmanetwork.com/lifestyle/news/91024/what-to-do-before-during-and-after-an-earthquake/story
TITLE: What to do before, during, and after an earthquake
AUTHOR: Ron Lim
DATE: July 27, 2022
KEY CONTENT:  The posters in the link shows how to prepare for a natural disaster like earthquake. It tells us to not forget to pack our necessities especially a first aid incase of emergency. Learning how to prepare, what to do during and after the earthquake will be beneficial for the people of the Mindanao community to be prepared when facing natural disasters.
(Seanlei Angliongto)

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URL:
https://www.youtube.com/watch?v=tZTX99t2TKg
TITLE: Doctors encouraging more people to learn CPR
AUTHOR: NBC News
DATE: January 11, 2023
KEY INFO: This American broadcast television network demonstrates the proper way of performing CPR step by step. During a natural disaster, some people's breathing or heart stops, and learning CPR can potentially save their lives. This can become a good reference for the community of Mindanao in learning CPR which can greatly help in situations such as natural disasters.
(Seanlei Angliongto)

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Doctors encouraging more people to learn CPR

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URL:
https://fliphtml5.com/lajub/kujj/basic
TITLE: First aid e-magazine
AUTHOR: ebarolanadine018
DATE: May 2020
KEY INFO: In this magazine, it discusses how to treat different kinds of injuries, and what to do in medical emergencies. It is very crucial to know how you will handle situations, especially natural disasters.
(Jam Lopez)

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No Text Content!

63 (2) 911-1406 DSWD PAGASA BFP (02) 8856-3665 (02) 8284-0800 (02) 8426-0219 (02) 8852-8081 (02) 8426-0246 (02) 8931-8101 to 07 0918-912-2813 PHIVOLCS LTRFB Red Cross (02) 8426-1468 to 79 143 1342 (02) 8527-8385 to 95 (02) 8790-2300 local 604 (02) 8426-2515 (02) 8527-0864 MMDA (02) 8426-2534 DILG 0921-448-7777 (02) 8876 3454 136 PNP local 337 (Rescue) 117 local 1096 (Metrobase) (02) 8722-0650 0917-847-5757 local 1135 Road Safety) local 1168 (Public Safety) local 1169 (Road Emergency) local 1162/ 1163 (Flood Control) local 1070 (Anti-Jaywalking) 26 \"The safety of the people shall be the highest law.\" - Marcus Tullius Cicero

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URL: https://open.spotify.com/episode/6qQf4JnL5gqGzn2mrktW45?si=5f7d794ac0a143f4
TITLE: Chapters  1 & 2 First Aid Basics
AUTHOR: JP
DATE: October 2020
KEY CONTENT:
This podcast is about a talk regarding basic first aid. Regarding how to respond to situations especially these times where we face COVID. This is will inform the people in the Mindanao community more understanding regarding first aid and how to do it while taking precautions to also avoid getting infected with COVID.
(Allyza Capistrano)

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Listen to this episode from All Things First Aid on Spotify. In this episode we discuss my background with healthcare, podcast disclaimers, preparedness, legal aspects of first aid, EMS system, infection control and post emergency support.

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URL:
https://mbhte-tesd.bangsamoro.gov.ph/ptc-basilan-on-basic-first-aid-training/
TITLE : PTC- Basilan on Basic First Aid Training
AUTHOR: Nurjihad Abdullah
DATE:  December 7, 2022
KEY INFO: In partnership with the Local Government of Isabela City, The City Disaster Risk Reduction Management (CDRRM) conducted a one-day basic first aid training for the PTC Staff to extend assistance on how to improve emergency situations as the need arises in Basilan.
(Allyza Capistrano)

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In partnership with the Local Government of Isabela City, The City Disaster Risk Reduction Management (CDRRM) conducted a one day training for the PTC Staff to extend assistance on how to enforce emergency situation as the need arise.

With the presence of the Chief Administrator Allan J. Pisingan, who actively involved himself also in the process of learning and enhancing basic knowledge on Basic First Aiding, the training becomes a success as this allow staff to be vigilant and ready in case of emergency either way for the needs of the people in and outside office premises.
#TESDAAbotLahat #nobangsamoroleftbehind #PTCBasilan
Basic First Aid Training, Disaster Risk Reduction Management (CDRRM), MBHTE-TESD PTC Basilan, MBHTE-TESD TTI, No Bangsamoro Left Behind

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PTC- Basilan on Basic First Aid Training

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In partnership with the Local Government of Isabela City, The City Disaster Risk Reduction Management (CDRRM) conducted a one day training for the PTC Staff to extend assistance on how to enforce emergency situation as the need arise. With the presence of the Chief Administrator Allan J.

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URL:
https://www.freepik.com/free-vector/first-aid-techniques-guide-infographic-poster_3796729.htm
TITLE: First aid techniques guide infographic poster
DATE: January 24, 2019
KEY INFO: This infographic provides different but helpful procedures for conducting first aid rules and regulations. Through the visual illustration , short and concise information, more people will be intrigue to take a look and read . Therefore it helps spread information regarding first aid much easier and to a wider audience.
(Jam Lopez)

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Free Vector | First aid techniques guide infographic poster

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Download this Free Vector about First aid techniques guide infographic poster, and discover more than 45 Million Professional Graphic Resources on Freepik. #freepik #vector #infographicposter #cprtraining #cpr

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14) Non-Government organization or academic institution article

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14) Non-Government organization or academic institution article

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URL:
https://reliefweb.int/report/philippines/ph-red-cross-provides-psychological-first-aid-more-700-following-north-luzon-earthquake
TITLE: PH Red Cross provides psychological first aid to more than 700 following North Luzon earthquake
AUTHOR: Philippine Red Cross
DATE: August 1, 2022
KEY INFO: Four days after a 7.0 magnitude earthquake hit Northern Luzon, the Philippine Red Cross (PRC) provided psychological first aid to more than 700 persons in Abra and Ilocos Sur. Trained PRC facilitators give psychological first aid to affected children through activities such as games.
(Allyza Capistrano)

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Four days after a 7.0 magnitude earthquake hit Northern Luzon, the Philippine Red Cross (PRC) provided psychological first aid (PFA) to more than 700 persons in Abra and Ilocos Sur, 216 of them children. PFA is given by trained individuals to people who have just experienced a serious crisis event. The World Health Organization says it "involves humane, supportive and practical assistance for people who are distressed, in ways that respect their dignity, culture, and abilities."

Trained PRC facilitators give PFA to children through activities that are appropriate to their age, such as games. PRC's Welfare Services Team set up Child-Friendly Spaces (CFSs) in areas affected by hazard events as a standard component of PRC's disaster responses. "Tinutugunan ng Red Cross hindi lang ang pisikal na pangangailangan ng ating mga kababayang naapektuhan ng malakas na lindol sa Northern Luzon kundi pati na rin ang kanilang mental health needs."

The PRC continues to provide other much-needed aid to people affected by the 7.0 magnitude earthquake that struck Northern Luzon mid-morning of July 27. As of July 31, it has distributed around 16,000 liters of water through its water tankers, 3,180 hot meals, 1,200 bottles of water, 970 face masks, 762 hygiene kits, and 262 sleeping kits, among other forms of humanitarian aid.

The National Disaster Risk Reduction and Management Council reported that the 7.0 magnitude quake affected more than 1.7 million people in Abra, Ilocos Sur, Kalinga, Mt. Province, Benguet, Baguio, La Union, Ilocos Norte, Pangasinan-Dagupan, Aurora, Cagayan, and Nueva Ecija. More than 600 families, or around 3,000 persons, are still in evacuation centers. More than 4,500 houses were damaged.

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PH Red Cross provides psychological first aid to more than 700 following North Luzon earthquake - Philippines

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Four days after a 7.0 magnitude earthquake hit Northern Luzon, the Philippine Red Cross (PRC) provided psychological first aid (PFA) to more than 700 persons in Abra and Ilocos Sur, 216 of them children. PFA is given by trained individuals to people who have just experienced a serious crisis event.

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Disaster Preparedness Plan: What to Do in Case of an Emergency - Blogs - Makati Medical Center |  July 29, 2021

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URL:
https://www.makatimed.net.ph/blogs/disaster-preparedness-plan-what-to-do-in-case-of-an-emergency/
TITLE: Disaster Preparedness Plan: What to Do in Case of an Emergency
AUTHOR: Makati Medical Center
DATE: July 29, 2021
KEY INFO: This article aims to educate people on what to do in natural disasters or emergencies. It includes that people should prepare basic emergency kits such as food, water, flashlights, medicines, batteries, and whistles, among others, and also include basic first aid items to treat people in the event of an injury.
(Jam Lopez)

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Disaster Preparedness Plan: What to Do in Case of an Emergency - Blogs - Makati Medical Center

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​Due to its geographical location, the Philippines has always been prone to typhoons during the Monsoon season. On average, there are around twenty (20) typhoons in a year, where at least five of them are considered severe and destructive. As a result, Filipinos often brace themselves during this season to prevent significant injuries and losses.

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URL: https://www.youtube.com/watch?v=F_B_--bsikA
TITLE: DIARRHEA: First Aid, Food Poisoning -- Doctor Willie Ong Health Blog #13b
AUTHOR: Doc Willie Ong
DATE: February 13, 2019
KEY INFO: Doctor Willie Ong, a health blogger, gives some tips on how to apply first aid to food poisoning.  This is helpful, especially during natural disasters here in Mindanao, where there is a possibility that food is limited or scarce during the situation. This is why people might resort to or accidentally eat expired food.
(Jam Lopez)

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DIARRHEA: First Aid, Food Poisoning -- Doctor Willie Ong Health Blog #13b

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URL: https://www.youtube.com/watch?v=yv5m25jZHF8
TITLE: Philippines | Typhoon Haiyan: The Killer Storm | 101 East
AUTHOR: Al Jazeera English

DATE: December 6, 2013
KEY CONTENT: In Tanauan Leyte, an international rescue team has set up a clinic on the top floor of the town hall to apply first aid to the affected people of Typhoon Haiyan who were desperate for medicine and treatment for severely infected wounds.
(Allyza Capistrano)

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🇵🇭 Philippines | Typhoon Haiyan: The Killer Storm | 101 East

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URL:
https://www.facebook.com/watch/live/?ref=watch_permalink&v=464877791451748
TITLE: Webinar on Psychological First -Aid - May 11, 2021
AUTHOR: DepEd Tayo South Cotabato
DATE: May 11, 2021
KEY INFO: This webinar discusses how to address the emotional reactions of people to natural disaster such as stress, grief and anxiety. Their aim is to educate about Psychological First Aid to the people, particularly in South Cotabato, that is very useful to promote safety and stabilize survivors of disasters.
(Rex D. Escaño Jr.)

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Webinar on Psychological First -Aid - May 11, 2021 | Online Training on Psychological First-Aid - May 11, 2021 | By DepEd Tayo South Cotabato | Facebook

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1,194 views, 72 likes, 36 loves, 129 comments, 6 shares, Facebook Watch Videos from DepEd Tayo South Cotabato: Online Training on Psychological First-Aid - May 11, 2021

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URL: https://books.google.com.ph/books?id=u8RWDwAAQBAJ&printsec=frontcover&dq=first+aid+book&hl=en&sa=X&ved=2ahUKEwii-f-8yIj9AhV5sVYBHTsGCPQQ6AF6BAgJEAI#v=onepage&q=first%20aid%20book&f=false
TITLE: The Complete First Aid Pocket Guide: Step-by-Step Treatment for All of Your Medical Emergencies Including • Heart Attack • Stroke • Food Poisoning ... • Shock • Anaphylaxis • Minor Wounds • Burns
AUTHOR: John Furst
DATE:  November 13, 2018
KEY INFO: This E-book is almost the same as the Philippine Red Cross first aid manual book here in Mindanao. It provides you with simple instructions on how to treat wounds and other common injuries in a variety of emergency situations, especially in a natural disaster scenario.
(Rex D. Escaño Jr.)

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From minor cuts and burns, to heart attacks and strokes, this handy, take-anywhere guide gives you the knowledge and advice you need to recognize and respond to any medical emergency.Be prepared for any medical emergency and handle it safely and efficiently with The Complete First Aid Pocket Guide.…

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URL: https://conflictandhealth.biomedcentral.com/articles/10.1186/1752-1505-5-3
TITLE: Integrating mental health into primary care for displaced populations: the experience of Mindanao, Philippines
AUTHORS: Yolanda Mueller, Susanna Cristofani, Carmen Rodriguez, Rohani T Malaguiok, Tatiana Gil, Rebecca F Grais & Renato Souza
DATE: March 7, 2011
KEY INFO: In 2011, This research shows the feasibility and success of implementing Psychological First Aid into primary care in Mindanao, specifically for displaced persons with mental health or neurological disorders such as psychosis or epilepsy. These displaced persons are people who were forced to leave their homes due to war and natural disasters.
(Rex D. Escaño Jr.)

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Abstract

Background

For more than forty years, episodes of violence in the Mindanao conflict have recurrently led to civilian displacement. In 2008, Medecins Sans Frontieres set up a mental health program integrated into primary health care in Mindanao Region. In this article, we describe a model of mental health care and the characteristics and outcomes of patients attending mental health services.

Methods

Psychologists working in mobile clinics assessed patients referred by trained clinicians located at primary level. They provided psychological first aid, brief psychotherapy and referral for severe patients. Patient characteristics and outcomes in terms of Self-Reporting Questionnaire (SRQ20) and Global Assessment of Functioning score (GAF) are described.

Results

Among the 463 adult patients diagnosed with a common mental disorder with at least two visits, median SRQ20 score diminished from 7 to 3 (p < 0.001) and median GAF score increased from 60 to 70 (p < 0.001). Baseline score and score at last assessment were different for both discharged patients and defaulters (p < 0.001).

Conclusions

Brief psychotherapy sessions provided at primary level during emergencies can potentially improve patients' symptoms of distress.

Background

During the acute phase of an emergency, mental health interventions to reduce traumatic stress are often put in place. In addition to syndromes often associated with conflict such as post-traumatic stress disorders [ 1], other disorders also occur, such as depressive or anxiety disorders [ 2]. Further, in a context of limited access to health care, patients with mental health or neurological disorders not directly linked to the conflict, such as psychosis or epilepsy, may be neglected by vertical interventions related to the conflict or natural disaster [ 3]. Descriptions of treatment models and research about the outcome of interventions in emergencies are rare [ 4]. Much of the existing research focuses on post-traumatic disorders, often to the exclusion of other disorders. Less attention may be given to the needs of those with disorders unrelated to the conflict. Vertical trauma-focused services are often juxtaposed against the importance of the integration of trauma-focused care and the treatment of pre-existing mental disorders into general mental health and primary care [ 5].

Humanitarian organizations now recommend that psychological first aid be provided as part of medical care for victims of violence or natural disasters and that care for people with severe mental illness is integrated into primary health care due to the extreme vulnerability of such patients [ 4, 6, 7]. Medecins Sans Frontieres (MSF) has integrated mental health into medical activities in order to respond to mental health needs of people with common and severe mental disorders [ 3]. Following international recommendations [ 7], MSF developed a model for mental health care provision where psychological first aid and brief psychotherapy is provided to patients with common mental disorders by trained psychologists working at primary health care level. The diagnosis and treatment of severe mental illness are either provided through a referral system to existing psychiatric care structures or directly if no such structures exist. Here, we describe a model of mental health care adapted to protracted conflicts and the characteristics and outcomes of patients attending mental health services. We discuss lessons learned and the need for continued research on mental health in humanitarian emergencies.

Methods

Setting

The Mindanao conflict in the Philippines first flared in the 1960s when the Moros, the Muslim minority, began an armed struggle to regain their ancestral homeland in the southern island [ 8]. Since then, periods of peace have alternated with periods of short but ferocious clashes between the Bangsamoro rebel forces and the Armed Forces of the Philippines (AFP), displacing tens of thousands of civilians. In August 2008, the peace agreement between the Government of the Philippines (GRP) and the Moro Islamic Liberation Front (MILF) disintegrated and an estimated 700,000 persons were displaced [ 8]. Most of the fighting between the government and MILF secessionist group took place in the Autonomous Region of Muslim Mindanao (ARMM).

During that time, many had to evacuate under fire, saw their homes destroyed, or witnessed people being wounded or killed. Since, some displaced returned to their homes, facing the risks associated with shelling and fighting during the night. By December 2009, 125 278 people were still estimated to be internally displaced in Central Mindanao [ 9]. These informal settlement sites, called evacuation centers, were made of local material and plastic sheeting and located in public spaces and on roadsides. Some centers were transformed into semi-permanent resettlement areas because of the persistence of the armed conflict in the home communities of the displaced population. In these confined spaces, the population still encountered fighting and the surrounding presence of armed forces. Relatives in the community hosted nearly half of the displaced.

MSF started to work in Mindanao in November 2008, with the aim of ensuring medical care for the displaced population. Within this framework, the organization set up activities with the authorization of the Ministry of Health. At primary health care level, mobile clinics provided curative and preventive care at the level of the evacuation centres. In addition, the Ministry-of-Health-supported Rural Health Units received additional support in terms of medical supplies, human resources and logistics. Secondary level care was supported by establishing a referral system to the regional hospital. All individuals, whether displaced or members of the host community were eligible to receive care provided free of charge.

Mental health intervention

At the community level, community health workers (CHW) were trained by the psychologists to identify and refer cases of mental disorders and epilepsy to the MSF mobile clinics, where the mental health team provided proper diagnosis and treatment (Figure 1). The mental health team consisted of three national psychologists, one national psychologist supervisor, and one expatriate psychologist coordinating the team. At the rural health unit level and in mobile clinics, medical and paramedical staff were trained to suspect potential mental health disorders when faced with a patient presenting with at least two medically unexplained physical symptoms (MUPS). In this case, they performed the self-reporting questionnaire (SRQ20)[ 10]. In the absence of a cut off score validated for the local population and due to the impossibility to conduct such studies during a humanitarian emergency, we applied a cut off score of equal or superior to six based on the results of a previous study conducted in the same region [ 11]. Identified patients were then referred to the mental health team. If the score was below six, the patient was usually not referred, except in the presence of other symptoms and signs that led the clinician to consider the patient still in need of mental health support. The mental health team filled the SRQ20 again, to corroborate the score done by the medical staff. The Trauma Scale Questionnaire (TSQ) was used to detect post-traumatic stress disorder [ 12- 14]. Subsequently, the Global Assessment of Functioning score (GAF) was administered in order to assess levels of disability. The psychologist, after making a diagnosis, also provided psychological first aid and structured psychotherapy. All patients were advised to come for follow-up consultations with the mental health team. Patients that did not present to follow-up consultations were reminded to do so by the CHW covering their area. The CHW also collected information about the reason of the default through the community.

Within this model, psychologists located at primary health care level provided psychological first aid and structured psychotherapy to people with common mental disorders [ 15- 18]. Brief psychotherapy sessions consisted of psychoeducation, breathing and relaxation exercises, problem solving counseling and cognitive behavioral techniques for the management of anxiety and depressive symptoms. This choice of psychotherapeutic interventions was based on the existing evidence of its effectiveness and feasibility in primary health care settings in low-income countries [ 4]. The first follow-up visit was usually planned after 1 week, and from then on every second week. The usual treatment plan consisted of three to four follow-up consultations, although it was possible to add more sessions, taking into consideration the evolution of symptoms of the individual patient. The primary health care psychologists also assessed cases of severe mental illness, before referring them to a psychiatrist working at the secondary level. MSF covered all transportation and psychiatric treatment costs and for referred patient for a minimum of 6 months up to two years of treatment.

Scores

The self-reporting questionnaire (SRQ20) is a scoring system used to assess levels of distress. It has been endorsed by WHO to be used in primary health care settings for detection of probable cases of mental health disorders. The SRQ20 includes 20 items related to somatic signs, depressive/anxiety factors, and a more cognitive/decreased energy factor [ 10]. It has been used previously in the Philippines in a population-based survey about the impact on mental health of partner violence [ 19]. The SRQ20 has also been used in conjunction with other scales to asses outcome of patients undergoing psychotherapy in Brazil [ 20]. The final score of an individual patient can vary between 0 (no distress) to 20 (maximum distress).

The Global Assessment of Functioning scale (GAF) is a widely used scale that measures overall levels of functionality of an individual. It corresponds to the fifth axis used to organize mental health diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) [ 21]. The scale ranges from 01-10 ("persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death") to 91-100 ("superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms"). For simplification purposes, categories 01-10 are reported in this article as 10, 11-20 as 20, 21-30 as 30, etc.

Data Analysis

Data were collected by trained psychologists for all patients referred to the mental health team. At each patient's first consultation, information about socio-demographical characteristics, the experienced traumatic events, and syndromic mental health diagnosis was collected. The same scoring system was used at every subsequent visit to evaluate the patients. Translation of the instruments from English to the local language was performed using standard cross-cultural procedures [ 22]. The supervising psychologist entered the data into an MS Excel spreadsheet (Microsoft, Seattle, Washington). Retrospective analysis of the data was performed using Stata 9 statistical software (Stata Corporation, College Station, Texas). Analysis of outcomes focused on patients over 15 years of age with common mental disorders, in order to have a homogenous group of patients. Scores between first and last visit were compared using the Wilcoxon rank test.

Ethical considerations

We used routine monitoring data from the MSF program, which was conducted in coordination with the Ministry of Health via a memorandum of understanding, which is the usual procedure for NGOs operating in these contexts. No supplementary interventions were conducted for the analysis presented here. All electronic data were entered anonymously and identifiers were coded. No ethnic or identifying information was entered.

Results

Between March 4 and December 15 2009, the mental health team assessed 962 patients, totaling 2,242 visits. The mean age of patients was 35 years (SD 15 years). The male:female sex ratio was 1:3.9 for patients over 15 years. Out of the 962 patients referred to the team, 771 (80.1%) were considered to suffer from a mental health disorder after evaluation by the primary health care psychologist (Table 1). The remaining patients consisted either of persons referred to the mental health team for counseling for sexually transmitted infections or patients that were not judged to suffer from a mental disorder after assessment by the psychologist, although initially suspected by the medical teams.

Table 1 Type of mental health disorder among 962 patients referred to the mental health team in Mindanao, Philippines, March-December 2009

This paper focuses on the description and outcomes of patients aged over 15 years old and diagnosed with a common mental disorder. The majority of these patients (96%) experienced some traumatic event; the most frequently reported being evacuation of the home in a dangerous situation (54%), experiencing a combat situation (26%) or destruction of property (5%) (Table 2). Furthermore, 11% of the patients reported a death due to violence in the household. Four hundred and sixty-three patients (70%) were seen more than once (Figure 2). Median delay between the first and second visit was 14 days (IQR 7,28), and between subsequent visits ranged between 21 and 28 days. Over half (57%) of the patients did not come back for a scheduled visit (dropouts) before being discharged by the team. Data collected by the CHW showed that 35 to 40% of the dropouts had moved to another location or went back home.

Table 2 Characteristics of 661 patients over 15 years old with common mental disorder, Mindanao, Philippines, March-December 2009

We examined the evolution of the patients at consecutive visits according to the scores described above. Figures 3 and 4 shows the evolution of the individual patients on respectively the GAF and the SRQ20 score, for patients with at least two visits. Between first and last visit, median GAF score increased from 60 (IQR 60, 60) to 70 (IQR 64, 75; Wilcoxon rank test p < 0.001) and median SRQ20 score diminished from 7 (IQR 6,8) to 3 (IQR 1,7; Wilcoxon rank test p < 0.001). The difference between baseline score and score at last assessment was significant for both discharged patients and defaulters (p < 0.001). By analyzing the data (excluding the dropouts) we observed that 46% of the patients had sufficiently improved to allow discharge by the 3rd visit and 87% by the 4 th.

Discussion

The Mindanao project in the Philippines shows that simple mental health approaches such as psychological first aid and brief psychotherapy can be integrated into primary health care in an emergency humanitarian context. Furthermore, retrospective analysis of patient data suggest that brief psychotherapy sessions provided at primary level to patients with common mental disorders can potentially improve patients' symptoms of distress, within a few sessions.

Although there were a high number of dropouts from the program, it is important to note that patients did improve before they dropped out. This high proportion of dropouts could be linked to the volatile security context and regular displacements occurring in this population, which may prevent patients from attending consultations. We do not think that this reflects failure of care. Flexibility in the pattern of follow-up is a necessity in such an unstable environment, where regular attendance to appointments at fixed points in time cannot be expected. However, our data show that even a brief and sometimes irregular intervention can lead to substantial improvements in patients' conditions.

Whereas other case series conducted in violent contexts such as Darfur [ 3], Palestine [ 23] and Colombia [ 2] have already described characteristics of patients affected by mental disorders, our data have the advantage of having used standardized outcome measures and not only psychologist's opinion. Interestingly, our series consisted of a higher proportions of patients with common mental disorders when compared to the patients in Darfur [ 3], which showed a high proportion of severe disorders. This may be a reflection of the active case detection approach used in Mindanao, integrated into primary care, which allowed for detection of non-severe cases of mental disorders.

The creation of a strong network of community health workers was crucial to identify potential patients and to ensure good follow-up. CHWs also played an important role for adherence to psychological support and pharmacological treatment, by speaking with the patient about the importance of finishing treatment. Indeed, without the work done by the CHWs in this project, the proportion of defaulters would probably have been much higher. It was also important to find local psychologists able to speak and understand local languages and cultural issues. This gave patients the opportunity to express themselves in their own language, while receiving professional care from someone coming from the same cultural background. The good collaboration between the medical staff and the mental health team was also an important factor of success of the project. This was facilitated by previous sensitization and training of medical team on mental health issues.

It is worth noting that changes on median GAF scores reflected a progression from moderate symptoms to mild symptoms and good functionality. Although the GAF score has been used previously to measure patient outcome, the SRQ20 score was not validated as such for this purpose. However, we do find this scale useful in this situation, as it is referring to items related to distress not directly related to a specific diagnosis. Besides, it has been used in a number of different cultural contexts. Interestingly, GAF and SRQ scores showed a linear relationship in our dataset (regression coefficient -1.5; 95%CI -1.53, -1.41; p < 0.001), which strengthens our conclusions. Clinicians (doctors and nurses) also judged the SRQ20 to be a useful tool to perform screening of a suspected case before referring them for specialized assessment. Further research on the development and use of outcome measures that can be standardized, acceptable to primary health care practitioners and feasible for routine use in humanitarian settings is of the utmost importance [ 24].

One of the limitations of this work is the absence of a control group. Indeed, we cannot exclude that the positive outcomes seen in this project are not due to the intervention, but may only reflect the healing effect of time itself. The possibility of bias due to the fact that professionals providing mental health services were the same ones that measured outcome scores can not be excluded. We tried to minimize this by implementing continuous training and quality control on the use of the scales. Further, outside of a study context, inclusion criteria into the program were not strictly defined, allowing for the follow-up of some very paucisymptomatic cases. This inclusion of patients with light symptoms may have accentuated the positive impact of the intervention. This highlights the need for continued formal research in this area.

Conclusions

This project shows the feasibility and success of implementing mental health care into primary care, as recommended by WHO, even in an unstable context with a mobile population. Brief psychotherapy sessions provided at primary level during emergencies can potentially improve patients' symptoms of distress. The key to success in this project lies in the flexibility given by the mobile set-up, the integration of psychologists as part of the mobile clinic teams, the good network of CHW specifically trained in the identification and follow up of mental health patients, as well as the good collaboration between medical and mental health teams. This multidisciplinary approach should be promoted and widely applied in other humanitarian contexts.

Acknowledgements

We wish to thank the staff and the patients of the project. We also would like to thank the Ministry of Health for its collaboration.

This work was funded by the operational budget of MSFCH.

Author information

Authors and Affiliations

1. Epicentre, 8 rue Saint Sabin, 75011, Paris, France

Yolanda Mueller & Rebecca F Grais

2. Médecins Sans Frontières, rue de Lausanne 78, CP 116, 1211, Geneva 21, Switzerland

Susanna Cristofani & Renato Souza

3. Médecins Sans Frontières, N°01 Manara st, Rosary Heights 10, Cotabato city, 9600, Mindanao, Philippines

Carmen Rodriguez, Rohani T Malaguiok & Tatiana Gil

Corresponding author

Correspondence to Yolanda Mueller.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

YM analyzed the data and drafted the manuscript. CR, TG, RTM and SC conceived the data collection system, and contributed to the data interpretation and the revision of the manuscript. RFG and RS made substantial contributions to the data analysis and to the revision of the manuscript. All authors read and approved the final manuscript.

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Mueller, Y., Cristofani, S., Rodriguez, C. et al. Integrating mental health into primary care for displaced populations: the experience of Mindanao, Philippines. Confl Health 5, 3 (2011). https://doi.org/10.1186/1752-1505-5-3
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Keywords

# data[].attributes.attachment_link.title
Integrating mental health into primary care for displaced populations: the experience of Mindanao, Philippines - Conflict and Health

# data[].attributes.attachment_link.description
Background For more than forty years, episodes of violence in the Mindanao conflict have recurrently led to civilian displacement. In 2008, Medecins Sans Frontieres set up a mental health program integrated into primary health care in Mindanao Region. In this article, we describe a model of mental health care and the characteristics and outcomes of patients attending mental health services.

# data[].attributes.body
URL: https://onlineonly.christies.com/s/american-art-online/hy-hintermeister-1897-1972-44/95187
TITLE: "Be Patient, Gramps!" (First Aid)
AUTHOR: Hy Hintermeister
DATE: 1944
KEY INFO: This painting was created in America and it depicts how this child is acquiring first aid skills, specifically bandaging. Although he is a child, he already has the vital knowledge to handle any medical crises he may encounter. This shows the importance of equipping the youth in Mindanao with first aid skills because it is very useful in our daily lives, especially in case of emergencies that are unforeseeable.
(Rex Escaño Jr.)

# data[].attributes.attachment_link.description
Hy Hintermeister (1897-1972)“Be Patient, Gramps!” (First Aid)signed ‘Hy. Hintermeister./©’ (lower right)–inscribed and dated ‘©/Louis F. Dow 44’ (on the reverse)oil on canvas30 x 22 in. (76.2 x 55.9 cm.)Painted in 1944.