Jennie Abrahamson

1. Jennie Abrahamson Student Research at the University of Washington: NCHI Project, IBEC Research Team http://ibec.ischool.washington.edu LIS 528: Health Sciences Information Needs, Resources, and Environment

2. The Information Needs ofMedical Relief Agencies with a Focus on Doctors Without Borders(Médecins Sans Frontières)

3. Research Approach • Needs analysis based on survey of primary and secondary literature DWB literature Medline, CINAHL, EMBASE, ERIC, PAIS, PsycINFO, Sociological Abstracts, Library Literature, etc.

4. DWB Volunteer Teams • General practitioners/primary care • Specialists: general surgeons, anesthesiologists, OB/GYN, ophthalmologists • Registered nurses, NPs, PAs • Midwives • Public health and nutrition experts • Mental health specialists

5. DWB Volunteer Teams • Lab technicians • Pharmacists • Epidemiologists • Logisticians (innovation, c. 1981) • Water/sanitation engineers • Field coordinators/administrators

6. DWB Volunteer Teams • International network based in 18 countries • More > 2,500 volunteers and 15,000 local staff per year (http://www.doctorswithoutborders.org/)

7. Training and Educational Needs • Expertise in tropical medicine &/or infectious diseases helpful • Must be flexible! • Teaching & training skills • Ability to work with “limited technical resources” (make-do/can-do attitude) (http://www.doctorswithoutborders.org/)

8. Training and Educational Needs • DWB training program: • Specific health care issues • Mission related information • Advanced courses in epidemiology, nutrition, immunization, water and sanitation, logistics, coordination, and mission management (http://www.doctorswithoutborders.org/)

9. Training and Educational Needs • Medical ethics • Public speaking • Stress relief (post-traumatic stress disorder) • Languages • Cross-cultural sensitivity • Negotiation skills • Public health for “newbies” (Hakewill, 1997)

10. Training and Educational Needs • “Medical staff need to reorient their thinking from a purely clinical approach to a constant preoccupation with public health interventions” (Hakewill, 1997)

11. Training and Educational Needs • Must act fast to prevent deaths (most occur within first days and weeks) • Must learn to deal with more mortality than they perhaps ever have—many aspects—clinical, statistical assessments, prevention techniques, emotional coping skills) (Hakewill, 1997)

12. Additional Needs • DWB volunteers’ needs similar to other groups already studied: • Primary care practitioners • Rural practitioners • Emergency practitioners • Public health workers • Possibly, military field hospital workers & clinical teams • Not much library/info science research available?

13. Needs Studies to Consider • D’Alessandro, et al. (1999): “Information needs of naval primary care providers and patients at sea” • Dee, C. (1993): “Information needs of the rural physician: a descriptive study” • Gorman, P.N. (1995): “Information needs of physicians”

14. Needs Studies to Consider • Jerome, et al. (2001): “Information needs of clinical teams: analysis of questions received by the Clinical Informatics Consult Service” • Timpka, et al. (1989): “Information needs and information seeking behaviour in primary health care” • Toole, et al. (1989): “Measles prevention and control in emergency settings” • And others …

15. Additional Needs • Situational; Depends upon location and cause: • Wars and conflicts • Refugees and displaced people • Natural or man-made disasters • Long-term assistance • Build “stable and self-sufficient local health care structure” (http://www.doctorswithoutborders.org/)

16. Complex Humanitarian Emergencies (CHE) • Contemporary term • Describes “severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services,” usually found in populations affected by wars or other armed conflicts (Toole and Waldman, 1997)

17. Acute emergency phase (0-1 months) High mortality Communicable disease outbreaks Malnutrition Priorities: Food, water/sanitation, shelter Interventions: Feeding/nutrition programs Measles immunization CHE Phases(Burkholder and Toole, 1995)

18. CHE Phases • Late Emergency (1-6+months) • Declining mortality rates • Priorities: • Security • Fuel • Improve upon basic needs • Interventions: • Train Community health workers • Standardize treatment protocols • Develop drug supply • Begin disease prevention programs (STD’s, etc.)

19. CHE Phases • Post Emergency ( > 6 months) • Stabilize mortality rates • Priority • Expand self-sufficiency • Interventions: • Develop TB, mental health programs • Expand disease prevention programs (focus on primary health care) (Burkholder and Toole, 1995)

20. Other Needs • Ability to assess situation; determine needs rapidly • Technology: more & better (cast-offs, lack of infrastructure)

21. Other Needs • Drugs • “Access to essential medicines (needs to be) on the international agenda” • “Available drugs are archaic, ineffective, or toxic” to populations served • Need to improve funding and availability (some drug production stopped because not needed in developed world) • Access to Essential Medicines Campaign (http://www.doctorswithoutborders.org/)

22. Other Needs • Weather assessment & prediction • Blurring of personal and professional needs: • Communication (home and “office” –email?) • Stress relief • Address culture shock • Camping skills • Personal health monitoring

23. Meeting the Needs • Medical librarian for training, information resource development, and research support • Core medical library (kit-based), refer to MSF publications

24. Meeting the Needs Digitally • PDA for local info: • Medline—static databases if inet not available? • PrimeAnswers—targeted to population/area needs • Ethnomed and/or local profile • Tutorials • Drug information • Language help • Online clinical librarian (UK examples) -- United States?

25. Meeting the Needs Digitally • Weather tracking • Local and international news updates • Epidemiology: Disease tracking • Personal stress relief (guided meditation module, reading for pleasure, etc.)

26. Research Update • Need database to enable evidence-based relief policies and procedures and increase success rates (Toole, et al., 2001)

27. Research Update • Medical librarian as team member: CDC Director’s Emergency Operations Center • Importance of “skilled librarian” with training in finding information quickly • “Builds trust and instills confidence” (Swain, et al., 2004)

28. Research Update • Rural and nonrural clinicians rely most heavily on local, immediately available knowledge resources and human resources of information • Factors other than physical availability of information resources may serve as barriers to information access and patient care support (info behavior in context) (Gorman, et al., 2004)

29. Research and Possibilities for the Future • Further development of static and dynamic digital information tools • Digital Library: “A key technology for developing countries … They can assist human development by providing a non-commercial mechanism for distributing humanitarian information on … health, agriculture, nutrition, hygiene, sanitation, and water supply” (Witten, et al., 2002)

30. Research and Possibilities for the Future • Chat reference/decision support (volunteer corps of librarians, health care professionals) • Telemedicine consultation service

31. Into the Field …Information Needs and Use in Context “By showing each victim a human face, by showing respect for his or her human dignity, the fearless and selfless aid worker creates hope for peace and reconciliation” (Nobel Prize Citation for DWB, 1999)

32. Jennie Abrahamson, MLIS NLM Fellow Department of Medical Informatics and Clinical Epidemiology Oregon Health & Science University Portland, OR abrahamj@ohsu.edu