September 24, 2017

Nepal Earthquake: Lesson for Safety of Hospitals and Health Centers from Disasters

Recently, a drastic earthquake of 7.9 in magnitude caused a huge destructive natural disaster in Nepal, resulting in loss of nearly eight thousand lives and properties, the cost of which could not be accurately estimated yet, followed by a series of after-shocks.
In 2008, Myanmar also encountered a natural disaster, not in the form of earthquake, but as cyclone Nargis and associated tsunami, which claimed nearly one hundred and fifty thousand human lives in fractures, buildings, livestock, cattles paddy fields, natural environments and so forth.
It is an economic as well as a political concern to keep health facilities functional and available in a disaster, which, of course, is utmost difficult in practical point of view. The concept of keeping health facilities safe from disaster initiates after the 1975 Mexico earthquake, when most of the health facilities collapsed in Mexico City and there was no way to provides needed health services to the mass of casualities.
Mexico earthquake was preceded by Bagan earthquake in Central Myanmar, which destroyed numerous unvaluable ancient national heritages of Myanmar, in addition to loss of human lives and basic structures.
A safe health facility constitutes some place that provides clinical and public-health services, which should have structures that are able to withstand the traumas from natural disasters. Non-structured elements consist of equipment that will not fail, such as related contingencies, constant supply of electricity and water back up. Conventional aspect of safe health facility in natural disaster is trained staff skilled according to disaster preparedness plans, who are aware of the consequences of disaster and brave enough not to run away leaving patients abandoned. Perhaps functional evacuation plan is also included in conventional elements of a safe health facility in disasters.
The health service outlets are not the priority items for governments and donors to fund, whether in peacetime or in disaster time. The social loss is also an important one. In a post-emergency situation, the hospital is a veritable meeting place for all to come together and feel a sense of shared plight and mutual comfort, or a common dwelling for those whose homes have been destroyed. If the hospital remains standing, it can give access to basic services such as water, sanitation, electricity and other social security measures. It houses the field hospital that will take care of the urgent and salvageable casualties of the early hours of the disaster. When a health facility is lost, it is a huge loss in investment, not just because of the absolute amount of money lost, but also because of the lack of opportunities to attract public or donor funds to such investments. The health sector is not the first priority of such investors or investments. In times of disasters, funds pooled go elsewhere, to seemingly more visible items such as housing, roads, bridges etc. In the scheme of governance, health is very underfunded. So it is all the more important and reason enough to help protect these investments a priority.
One example: The Global New Light of Myanmar, in its May 10 issue, published a news item quoting Reuters News Agency. It reads, Nepal’s prime minister pledged on May 8 to rebuild schools and roads within two years of quake. Telecoms, power stations and hospitals were mentioned only at the letter part of prime minister’s pledge and promise.
We have had several emergencies in these few years – the Asian tsunami, cyclones Cidr and Nargis, the Kosi river floods in Nepal, the West Sumatra earthquake, Vietnam and the Philippines typhoons, and other complex emergencies such as the conflict in Sri Lanka. Health workers risk their lives through all this and although all health services are supposed to be neutral even in times of war, there are crossfire causalities or collateral damage, as it is now sometimes called. Round about 60 percent of deaths from disasters were in South East Asia during recent past, World Health Organization says.
Lack of investment for keeping health facilities intact may have its basis in the lack of emotional attachment people have for these facilities to which one goes only when one is sick. Thus, health facilities do not have the backing or demand for protection as other entities. It is also a fact that hospitals do not have too many good feelings attached to them anyway because we prefer happy memories to the often gloomy memories of our illnesses. Structurally too, hospitals can be a difficult thing to plan consistently across all cultures and national boundaries. Neither do all countries have the same health systems nor risk reduction systems. And not all countries have similar architectural designs or constructional typologies. Therefore, an all-encompassing systemic programme is difficult to craft. There have to be national-level adaptations, and these take meticulous attention and time.
Since the 2009 WHO campaign to promote the movement for keeping health facilities safe in disasters, a lot of effort has happened. There were a lot of hits on this, and now global ambassadors such as the Chinese actor Jet Li, and Heikki Kovalainnen the F-1 speed ace, have endorsed the campaign. WHO has published a very popular pocket guide to disasters. The private sector also has contributed through the growth of health-care providers.
Urban dwellers must be taught the skills of how to respond in an emergency. This is the place where most casualties will be recorded if an emergency should strike like a major after-shock in Nepal on 11 May 2015. There are disaster risk reduction actions being taken in several nations including Myanmar. The Gujarat (India) project is one that uses the community in programme planning, drills and response plans. The Kathmandu valley also has a better plan now that will be more effective on these fronts. The Hospitals Preparedness in Emergencies programme in Nepal has engineers involved in the training course, and a similar project will also soon be rolled out in India. Furthermore, in India, there is an urban disaster preparedness initiative happening already. Risk mitigation and personal protection in schools and communities are included in this. There is a two-city simulation exercise also now being planned for Mumbai and Delhi, which would require that all new hospitals be seismically resistant. But quality professionals are also needed for assessing and reconstructing. These are unfortunately hard to come by, which may delay the work somewhat.
Private sector regulation is also a huge issue that must be addressed. With so many providers and hospitals, they must be also made to abide by building regulations.
May all planet citizens be safe from disasters.


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