Managing Health Related Problems in Disasters Effectively

1. Managing Health Related Problems in Disasters Effectively: Use of ICT from Pre to Post Disasters Presentation for IVth International Conference on ‘Transforming Health Care with IT’ Dr. Sunita Reddy Asst. Prof. Center of Social Medicine and Community Health, Jawaharlal Nehru University New Delhi sunitareddyjnu@gmail.com

2. Risk Society Anthony Giddens and Ulrich Beck have termed "Risk society", a society that is organized in response to risk, a society increasingly preoccupied with the future (and also with safety), which generates the notion of risk" (Giddens 1999: 3) With modernization comes a manufactured risk, with a significant level of human agency operating in the production and mitigation of it (Beck 1992: 21). It’s a Global World with Global Threats- Disasters ‘natural’ ‘man-made’- Biological, Chemical, Nuclear…

3. Have We learnt from Past Lessons? Bhopal Accident Methyl Isocyanides (MIC leak in 1984 in Bhopal) Deaths- around 16,000 Severely injured 5,58,000 Still birth rate gone up by 300% and Neonatal mortality by 200%. Shortage of hospitals and doctors. Medical staff were unprepared for thousands of casualties and were not even aware of treatment methods of MIC inhalation. Disposal of dead- concern- dumbed in Narmada along with mass burial.

4. Building ICT Services • Building critical ICT services, having a pre-planned response to any major disruption by invoking a Disaster Recovery Plan (DRP), and defining the procedures to recover fully is the need of the hour. • Prepare ICT based Disaster Reduction Planning in Health Care System. • Following figure gives a framework to plan ICT in heath care system at a community level.

5. Risk/Impact Assessment Recovery strategy Prepare DR plans Update plans Test Plans Educate Risk/Impact Assessment – Pre-planned list of critical systems to be recovered Recovery Strategy – DR contractor to assist the ICT Department with recovery of affected systemsDR Plans – ICT Security Specialist co-ordinates the implementation of the DR PlansEducate – Structured Test Programme to train ICT Systems staff in recovery proceduresTest Plans – Planned testing of nominated systems by ICT Systems staffUpdate Plans – Regular review of the DR Plan and training new staff

6. CBRN Disasters • History is witness to all kinds of Chemical, Biological, Radiological or Nuclear Disasters across the world. • Today we are able to take precautions and contained the disaster due to ICT- example in JAPAN, India etc. unlike in history. • In contrast to chemical, conventional, and nuclear weapons that generate immediate effects, biological agents are generally associated with a delay in the onset of illness (hours to days).

7. Biological Weapons • Moreover, illness from biological weapons are not likely to be recognized in their initial stages. With highly transmissible agents (eg. Plague and smallpox), the time delay in recognition can result in widespread secondary exposure to others, including doctors and health staff. • IT can enable to keep surveillance on any change in disease pattern- immediate or slow.

8. Disasters and Destruction of Health Services • Large-scale disasters also affect the public health personnel, in terms of lives lost- takes some time to restore to normalcy. • The destruction of health care centres and the equipment contained within is only a part of the problem because some of the members of the health care team may also lose their life during the disasters.

9. PH implications • Disasters have severe impact on Public Health • In Tsunamis, Floods etc. mosquitoes thrive due to large scale stagnation, leading to the spread of mosquito-borne diseases, respiratory problems, skin problems, like rashes, allergies and psychological problems such as anxiety, depression and post traumatic stress adds to the complexities post-disaster. • Ex. From ‘Clash of Waves’

10. Clash of Waves Post Tsunami Relief & Rehabilitation in Andaman And Nicobar Islands Dr. Sunita Reddy ‘Clash of Waves: Post-Tsunami Rehabilitation in Andaman and Nicobar Islands’ is located in anthropological discipline, based on longitudinal research covering five years of post tsunami rehabilitation. Often media and government focus on the disaster event, the emergency and relief period activities, but long-term rehabilitation are given a short shrift. What happens to people’s lives, livelihoods and shelters devastated in disaster, is not known and not documented. This book traces and documents experience of the effected people and the gaps emerging out of this long and arduous attempt to rehabilitate them. Most important being livelihoods and the most contentious issue is shelters. Above all, the top down rehabilitation packages on the Nicobarese have changed their culture forever… Book Released on 24 Dec 2012, NDMA Published by INDOS BOOKS F-4, ShaheenBagh,Okhla,New Delhi-25. Email:-indosbooks@gmail.com and anthroposif@gmail.com, Cont No. +91-9810521404

11. Public Health Implications • Public health implications of large-scale disasters are felt for months and years to come. Each disaster leads to immense public health problems, which varies from disaster to disaster. • Providing health care pre and post disaster is important. Preparedness to any disaster can be improved with prior planning. • ICT can be of immense value to plan, prepare and mitigate in disaster scenarios

12. Disaster Epidemiology • The primary concern of the disaster epidemiology is to improve decision–making, by emergency response personnel and reduce the adverse public health consequences of disasters. • IT can be of immense help to scientifically measure health effects of disasters, in order to assess the needs of the disaster affected populations, to match resourcesand needs efficiently, to prevent further adverse health effects, to evaluate programme effectiveness and to plan for contingencies (Noji 1992).

13. Pre and Post incident care check list using IT • Pre- Disasters- IT based Data base – base line survey of the disease profile, health services, availability of beds and specialists known to the DDMA and SDMA • prepared check list for Self Assessment by responders / Supervisors • After action review of successes and failures. • Community post incident responsechecklist. • Media & Public Relations and Documentation / Reporting using ICT. • IT surveillance for Unusual swarm or insects and Unexplained casualties. • ICT for identification and Disposal of Dead facilitated through technology

14. Community Involvement - IT Using Web, media, mobiles the community can be involved in pre- during and post disasters. Children fond of interesting video games- design games which teach a lesson/ build skills for disaster response and mitigation. IT based disaster management courses in schools be made compulsory. Interactive IT programs, where people can report any unusual cases of diseases to the hospitals .

15. Information to the Community Giving credible and need based information relating to hazardous biological / chemical elements. A regular system of information for accessing and recruiting a suitable nodal person called community information representative (CIR) to disseminate the information and create awareness in the community. Communication material in simple, local language, pictorial audio-videos. Various representatives of the communities can play an important role in training and awareness programmes (NDMA guidelines, 2007).

16. References Davis Lee. 2002. Man- Made Catastrophes. Checkmark Books. New York. BBC. ^"Bhopal: Could it happen again?". 16 Dec 2008. http://news.bbc.co.uk/2/hi/programmes/bhopal/4034829.stm. Retrieved on 7 January 2009. http://en.wikipedia.org/wiki/  Giddens Anthony  (1999) “Risk and Responsibility” Modern Law Review 62(1): 1-10. Beck Ulrich (1992) Risk Society: Towards a New Modernity. New Delhi: Sage. (Translated from the German Risikogesellschaft published in 1986 NDMA (National Disaster Management Authority) (2007) National Disaster Management Guidelines Chemical Disasters (Industrial). Govt. of India. Ronan R. Kevin and David M. Johnston (2005) Promoting Community Resilience in Disasters: The role schools, youth, and families. Springer.

17. Thank You