So here I am in darkest Tacloban, having taken a slow drive and a walk through its streets. The damage is truly astonishing. Quite how any population can recover from something so big, so devastating, I have no idea.

There are Marine Police boats lifted into the centre of main highway, ships tilted dangerously on the shore. There are bodies still rotting at various points and dogs crazy with hunger, scavenging for anything they can find. There are young boys, old men, and women too, begging for a gift from this passing stranger. Tacloban is not a place you would wish your worst enemy to be.

Yet while I am surrounded by evidence of nature's cruelty to mankind, I am also surrounded by a most impressive attempt at reconstruction. Streets that were blocked only three days ago have now been cleared. Operating theatres in one of the city's main hospitals are scheduled to start work again within the next few days. The theatre staff have been sweeping, mopping and cleaning within an inch of their lives. The Philippines the world once knew and loved are already beginning to reappear.

One significant issue is affecting our theatre activity at the moment. There is a significant lack of disposable items. We have undertaken so much surgery that there is almost nothing left.  We are improvising as best we can - we have recycled the paper wrappers for gloves and have turned those into drapes, as drapes are lacking.  We no longer scrub our hands as far back as the elbows as there are no towels available to dry our hands and arms. Consequently we wash our hands thoroughly, finish off by washing them in spirit and then wave our hands about in the air for two to three minutes until they are dry.

There was, however, an especially challenging case today. Our Theatre Sister, Geraldine, an Irish girl of some repute, had stubbed her toe on a rock that was securing her tent from the high winds and rain. The thing had bled and the toenail had started to lift.  It was not going to re-attach, that much was clear, so the nail had to come off.  I could see Geraldine hesitating as to what she should do but in the end she plucked up courage. A surgeon was selected, the patient was anaesthetised - local anaesthetic of course - and the entire theatre team stood round with cameras. 

Poor girl, that must have been the most photographed toe in history, but the nail came off with ease. Geraldine, being the tough individual she is, kept away from work for precisely one hour. After that she was back at the operating table as if nothing at all had happened, a motivated aid worker if ever there was one.