Earthquake poses hard questions
Aliya Q Khan, MD, a public health specialist and Technical Officer for Health and Development Services at The Network*, Islamabad, says the recent earthquake has posed many questions in need of answers – and many lessons for handling future disasters
(21 Oct 05)
Health, information and research – could they help minimize the trauma of our earthquake victims??
The recent earthquake in Pakistan and Azad Jammu Kashmir has left 47 000 dead, more than 60 000 injured and more than 2 500 000 homeless. This part of the world has never seen such a devastating tragedy in its recent history – despite all its political instability, poverty, lack of education, high infant mortality rates, high population growth rates, low immunization coverage, and internal conflicts.
Fear is still bright in people’s eyes, and hearts are aching for the victims. This tragedy has affected a whole generation and it will remain in the memories of those who survived, for the rest of their lives.
Apart from being a national (and even regional) tragedy, it has also given rise to a number of questions. Are we prepared for such natural disasters? Do we have the necessary skills, equipment and infrastructure to help people in these disasters? Do we have the necessary information in case of disaster? What would be the immediate health problems? Do we have the necessary structures to tackle these before foreign aid arrives? All these and many more questions are coming to peoples’ minds.
The government at national level lacks a national disaster management strategy, and thus there is no formal training for disaster tackling, neither at the health care personnel level, nor at the local administration level.
Probably most important is the coordination of search and rescue. Disaster management does not mean using the army alone; it’s the responsibility of all government agencies, NGOs and organizations that can help. All these bodies and individuals need a common forum for information sharing and for better coordination, which was very much lacking here in Pakistan in the first few days of relief work. Properly coordinated, the NGOs and other organizations could provide a helping hand to the government agencies in search and rescue and relief operations.
Timely information and especially health information would have helped many to survive and saved many more from serious injuries or infections.
The world has witnessed many disasters, like the recent tsunami and continual hurricanes, and we must learn from them that a rapid, clear assessment of death and injury helps to set up relief camps in the geographical areas where they are most needed. The human resources and supplies required for such activities can also be estimated immediately.
Different services need different information, which could be provided rapidly if information distribution was well-organized:
Emergency curative services: The emergency staff treating injuries need to know rapidly the estimated number and type of injuries and patients (in the case of Pakistan, 90% of injuries were orthopaedic and it was mostly children who were affected as they were in their schools at the time of the earthquake).
Curative services: Once emergency cases are treated, these patients can be shifted out to other base hospitals or nearby hospitals to leave room for incoming cases - but information is needed on what vehicles are available and what human resources to shift patients and to continue with their medical care after they leave.
Preventive services: Patients in the emergency and base hospitals need prevention from wound infections, communicable diseases, epidemics of diarrhoea, measles, tetanus, water borne diseases, contamination from decomposed human and animal bodies, etc. They also need warm clothing at this stage because of the change in weather and approaching winters. So information on needs and numbers and the changes in these numbers as the disaster develops is required as rapidly as possible – for those who can provide the needed material.
Health promotion services: The above is possible only if everyone is well trained and well aware of health promotion, including good patient care and preventive measures.
Rehabilitation services: And lastly, there is rehabilitation, which is the longest phase of a disaster. It is not the physical rehabilitation of the injured but more importantly the treatment of their mental trauma, vocational rehabilitation, rehabilitation of their businesses and livelihoods. Again, numbers and the rate of flow of patients is essential so that those down the line can plan and provide for the services that will be needed.
The two most important cadres, who can benefit from – or provide - such information, are the health-care providers and local administration.
The role of local administration is greatly neglected – but they are the ones who can organize up-to-the-minute information flow and coordinate activities in terms of the geographical distribution and severity of the disaster.
Apart from these, volunteers and the general public should also be engaged as part of the information gathering and distribution system.
This disaster has revealed some weakness in all systems but here I will concentrate only on health systems. The most important weakness (I would call it criminal, if you would allow) is in the provision of vaccines, especially TT/ATG/ATS (tetanus toxoid, antitetanus sear, and antitetanus globulin). The need should have been estimated from day one of the disaster. It was clear that the injured would need these vaccines along with others.
Yet yesterday, 20 October, six children under treatment died because of the non-availability of ATG. With this disaster of course the local market is totally depleted of many life-saving medicines. There should be some immediate alternative to solve this situation, be it in the form of import or donations.
The other issue is the lack of surgical and orthopaedic supplies and prostheses. These are needed now and will also be needed in the rehabilitation phase, as already appeals have already been made for the provision of artificial limbs for these victims.
There are also certain items which are still under the country’s Central Board of Revenue’s list of imports – meaning that customs duty has not been waived despite the urgent need.
This earthquake has not only been a terrible human tragedy, it has been compounded by all these ongoing and avoidable human errors.
Disasters like this need operational research on the responses as they take place, in real time, to solidify these hard lessons into hard facts. After one disaster comes another; we cannot always wait to learn.
*The Network for Consumer Protection, commonly known as “The Network”, is a national, public interest, not-for-profit organization, which began in 1992 as the “Association for Rational Use of Medication in Pakistan” in the wake of a drug tragedy. For some years it focused on advocating the rational use of drugs and the concept of an essential drugs list, in order to optimize the use of drugs and to “help bring equity in their access”. In its watchdog role, The Network has also kept an eye on problem drugs, non-available essential drugs and drug prices. Later, The Network began a project to protect breastfeeding against unethical marketing of baby food. Building on this experience, The Network has become a wide-ranging national consumer protection organization.
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