Christina Naula 00:00

Okay.
Oh, so now I need to find you. Oh, there
you are. Hi, Ram. Sorry I was just looking
through, the camera slides keep moving
about.
So
welcome, Ram. So we've got our next
speaker.
And I've just also lost sight of my
timetable, which is here oh okay yeah I
should know that really. So Dr. Ram Vadi is
going to talk to you today about health
needs assessment and flexible
approaches.
So just really
well, I'll let him explain and introduce
himself, because I'm sure he'll do a much
better job than I do.
So off you go, Ram. And again, if you have
any questions you can talk
or you could put your hand up, or you can
write in the chat, and I can pass the
messages on to Ram.

Unknown Speaker 00:59

Excellent. Okay, thanks very much,
Christina. Let me just share my screen
here.

Ram Vadi - UK-Med 01:12

That whole screen.

Christina Naula 01:15

Oh, that just stopped sharing. Did I take it

off?
Yes, I think you did.
Although you did press on the slideshow
button.
 Ram Vadi - UK-Med 01:24
Let's see.
let's try again. Here.
right? Share.

Christina Naula 01:33

Yup.

Ram Vadi - UK-Med 01:40

Excellent! I'll apologize in advance I have
some construction happening next door
so that always seems to be the case they
start right when you have to do a
presentation. So hopefully won't be too
disturbing. But yeah, no thanks again for
having me, and nice to see you, Christina.
So I'm Ram. I'm the health director at
UKMED. I'm sure, David, gave a very nice
introduction on who we are as an
organization so I'll probably skip that part.
What I'm going to talk about today is
health needs assessments and flexible
approaches.
I'm not aiming to teach everyone what
health needs assessments are, I'm sure
many people know what those are, but I
wanted to approach it a bit in terms of how
we look at that in terms of being
humanitarian organization.
And also one of the most globally
deployed emergency medical teams.
And how that informs a lot of our
responses and equally the ways we adapt
our programming during or post
responses as well. I'm just gonna
minimize this so I can see my screen.
So essentially with health assessment,
what is it that we're looking to provide? Or
what are we looking to gain essentially?
And for us is a humanitarian organization
where we look at assessments so the
need for an assessment is whether we
decide to intervene very often, and it's
quite evident these days with the amount
of needs globally in terms of conflicts, in
terms of disasters and equally outbreaks,
so it's a way to decide for ourselves
whether there's a need to intervene and if
we provide any additional value to that
context or to the needs that are being
seen. It's also to understand a bit more on
the nature and the scale of the
intervention that maybe needed to
respond. And I'll come onto that a bit later
as well.
Equally the prioritization allocation of
resources, program design and planning.
For a smaller organization like ourselves
that has very little in terms of overhead
costs. So we work, and I'm sure David
explained it, primarily through a register
based mechanism.
We tried to allocate the resources best we
can, so we can provide more in terms of
on ground support as opposed to HQ
level, but equally for bigger organizations
like UN organizations, the World Health
Organization, ICRC, and others
prioritization and allocation of resources
is extremely important, given in the level
of needs across the globe and big
programs that are taking place. So it's
another question that we seek to answer
during assessments.
And the last one isalso and I think it's one
that people tend to kind of

neglect in some ways, is that the

assessment is not only for us, it's also in a
way to influence potentially the decisions
of others. So other organizations that may
be going in, others who are already in
country governments, donors, etc., and
equally to verify/justify the decisions that
are been made to date. So there may be a
request for responses that have come up
 Unknown Speaker 04:39
but in many cases we often see that the
assessment has been done by other
actors and can quickly change, and the
scope of what we aim to deliver. And I'll
give an example later on of a response
that we had in Beirut that was kind of a
good example of that. How an actual on
ground assessment really informed a
different set of programming than what
was actually requested to start with.

Ram Vadi - UK-Med 05:02

So in in summary, really, what is a needs
assessment seeking to answer? Just
going quickly through it, I mean in terms of
what it should cover and a good needs
assessment that's kind of holistic
really should cover essentially the
spectrum of needs and risks. That's risk
either for the team or risks in terms of
delivery. So it can be financial risk, security
risks, logistics risk, etc.
Ideally the geographical distribution of
needs and severity. We recently
responded into Turkey, and also
Northwest Syria, and the geographical
distribution of the needs was a essentially
equivalent to the size of Germany. So you
can imagine sometimes the scope and
scale of these responses is extremely
enormous. Ukraine is another case in
point, an enormous country with needs all
across
and trying to understand that can take
days and weeks. But we try to get as much
of a picture as we can, and we use others
assessments equally to feed into that, to
have a better understanding of needs and
severity, because each location and
context is quite different.
The temporal duration of needs. And this
can be quite flexible as well in terms of
how long we expect the need to continue.
And that changes, conflicts are a very
good example of this in terms of needs
waxing and waining. So a lot of locations
again, Ukraine, that we assessed in the
beginning as not having needs have now
become apparent for needs, because the
areas have been liberated and newly
liberated
and people are behind those front lines
for some period and needs don't reach
them. We can see those in kind of similar
situations to what is happening now in
Israel and Gaza as well.
The severity of the conditions. That's
conditions to operate but equally the
conditions on ground. So in certain
countries the weather can prove that can
prove to be quite a challenge in terms of
delivering care. So we try to assess that as
well, and the feasibility of deploying into
those countries, or what we need to bring
out if we decide to deploy.
Any existing capacities and resources that
are in country.
We tried to get the information in terms of
also desegregating by any genders, age,
minority groups, vulnerabilities. And I'll
come onto that a bit later as well. And all
of this is to form some form of a baseline
data, one to measure our progress when
we do decide to respond but equally to
inform any future assessments that we
may seek to do as well.
Another one that, I think, is kind of key to
us and for other actors, and I think it's
become much more apparent in the past
few years is the is the need for
coordination, not only coordination for
assessments, but also coordination
amongst actors.
For those who probably worked in the
humanitarian sector they can remember
that it's very much siloed many years ago
in terms of how people worked and in
terms of how people responded. And
there's been a bigger need and a
requirement in many instances to work
together, to deliver care and also to avoid
duplication.
So coordinating on assessments, using
standardized tools so that information is
shared across and it's easier for others to
understand. And that includes
international and also national actors.

Unknown Speaker 08:03

Allowing others to benefit from those
findings. Again, coming back to making
the best use of resources, avoiding
assessment fatigue

Ram Vadi - UK-Med 08:10

and also providing a broader picture of
needs that others can respond to and
delivering responses which communities
can benefit from in the greatest way.
In terms of the assessment fatigue that's
something we often see in a lot of context,
in that many organizations come and are
assessing either communities or facilities
and there is a general fatigue from local
communities. And I think most people can
imagine that
when you come into locations, if your
home area was affected and you have
various international organizations
coming and asking you the same
questions at some point you get a bit
fatigued or tired of answering the same
questions, especially of care or support is
not immediately coming. So it's one thing
that we, as an organization and others
often try to avoid doing responses.
In terms of how to plan assistance
properly. I mean, I'll not going into it in
great detail. But this is just kind of a
picture of one kind of standardized
planning that it's been done by WHO
and the IASC which is the Interagency
Standing Committee. So various UN
organizations in terms of how can
assessments effectively be done in a
robust, simplified, and logical process.
Again, coming back to saving time for
individuals and communities, but equally
allowing resources to be allocated in an
appropriate way, and it comes down to,
you know, planning and designing, so
effectively planning what it is that you want
to do the scope, I mean,

the design of your assessment, who you

need to engage with, and also the
resources required.
Then an implementation phase, and then
comes back to the cleaning of all of the
information gathered, analyzing in an
effective way so that it can be shared with
donors, home institutions, and other
actors, and sharing those findings widely,
coming back to the part of coordination
with other actors, disseminating
knowledge, and ensuring that others get
those findings, but that they can be read
and understood in a logical manner and
avoiding duplication again.
When we're doing these types of
assessments. And I can say this from
ourselves, because we try to really,
even in large scale responses, and we've
got a lot of learning for the past few years,
is trying to ensure that one of the people
that are going on, but also the questions
that they're asking are appropriate and
fitting what we need to understand, both
from an HQ perspective but also for other
organizations. And we want to ensure that
all groups are being heard within those
responses. So when we're deploying
people, are questions being asked in the
local language?

Unknown Speaker 10:41

So, for example, we would hire
interpreters or would work with local
partners to ensure that we're
communicating effectively and getting the
information needed and that it's being
communicated back to us effectively.

Ram Vadi - UK-Med 10:52

That we respect all cultural norms when
asking questions.
In certain societies the way that we
approach certain beneficiaries has to be
extremely sensitive to the culture and the
practices there. So we try to inform the
teams that are going to do the
assessments of that, but equally
understand local knowledge through our
stakeholders that we work with and also in
getting consent from anyone we
communicate with. And that's particularly
key from vulnerable groups and children,
etc.
We try to have discussions with any kind of
affected group and make it as wide a
group as possible so women, children,
people with disabilities, elderly views,
LGBTQ, minority groups, etc. So we have a
holistic picture of groups that are affected
and the needs that they may have,
because across these groups and other
groups, we can obviously see that pre-
existing differences may have happened
before any assessment or any kind of
incident
and we try to account for that as well in
terms of what we deliver.
The collaboration part as well, that I spoke
on, which is key to working with not only
other actors, but also local NGOs and
community based organizations who
often have a good understanding of the
community and may have pre-existing
relationships that can help to inform our
assessments and eventually what we try
to deliver. And in many circumstances
we've often worked with those local
organizations, not only in the assessment,
but equally on the longer term care that
we deliver. So in Turkey, for example, we
worked with a local organization that
provided mental health and psychosocial
support to victims, or not victims sorry,
people that were affected by the
earthquake and trying to make that
culturally appropriate, but also within the
language. So the mental health services
provide to the affected communities were
delivered by actual Turkish
Nationals who both spoke the language
and understood better the context and
the needs of the people.
And the other one is that very often
assessments are, especially if we go to
health actors and primarily focus on
health, but we, you know,
we know that health is a wider spectrum of
needs, and it's not only medical but also
includes, essential elements like the
water, the sanitation,
the hygiene, food security, shelter,
protection, and other needs that people
may have. And all of these kind of
determine the requirements of the
population in that country, and how that
affects their physical and mental health.
So we try to deploy a team that is both
wide spectrum in terms of looking at
these assessments, but also
incorporating these requirements into
their needs assessments as well.
The other one is also of being
accountable. In the last few years there
has been a big focus within the
humanitarian community of being
accountable to beneficiaries both in terms
of how we respond, but also in terms of
what we deliver and how we assess
communities.
And I think it's quite key that when we look
to deploy out as individuals or as
organizations, that we look at those
affected by a crisis or disasters as
beneficiaries of our services and not
victims. So they're people who are
affected by crisis, and we need to provide
accountable care to them, and something
that's appropriate, and that they require.
And how we try to do that ourselves is to
involve the community wherever possible.
So right from the needs assessment to
the delivery of care, keeping them
informed, seeking out various members of
the community. So all kinds of local
stakeholders, not only authorities, but
local partners and local community
leaders at the various age groups and
gender groups, etc., that should inform
what we aim to deliver and understanding
their particular needs. And ensure that
we're seeing the communities and
potentially any hidden populations. And
often those hidden populations are
communities that people haven't
assessed or haven't accounted for.
The other one is about seeking feedback
or guidance wherever possible, to inform
our assessment, and that comes from all
of the various stakeholders that you may
work with, or that we may work with.
And providing that broader contextual
understanding and building of
relationships. And we've seen that in a lot
of our responses that the ability to either
respond or stay in country has been
driven a lot by local stakeholders and
requesting
additional forms of support, or keeping us
informed of what is being required for
populations that may be needing
additional help. One case in point, coming
back again to Turkey is when we delivered
a response to the earthquake. We sent out
a fixed facility, so a large tented fixed
facility where patients had to come
but local stakeholders informed us of a lot
of populations who were remote and
hadn't received care so we started to do
mobile clinics
So essentially vehicles of teams going out
and delivering care. And we understood
that through working with local
stakeholders and also building of
relationships, and then providing care to
those communities as well.
The other one is about not building
realistic expectations. So when you're
working with the communities actually
informing them of what you can actually
deliver, what is realistic within your
organizational mandate or the funding
that you have
and what your assessment will lead to. It
comes back to the fatigue part. If you don't
plan to do something or they're requesting
something, it's to be truthful and
accountable for what you want to do and
what you can deliver, or who you may
connect them with to provide that
response.
give a case example on this a bit later.
I'll

But you know, changes in views is another

key one is that we need to be open and
informed about the needs and also the
responses that are required. All of these
humanitarian responses are quite flexible
in terms of what the immediate picture
may show and what eventually will come,
and how we respond.
And other actors may have already
assessed these areas or be in country,
and can probably help you or anyone to
avoid the duplication of these efforts. It's
about engaging with the various
stakeholders to understand what is really
needed, and that can even happen before
one is deployed. So for us, when we send
out international teams, we try to engage
with the Ministry of Health and the WHO
country offices
to get a wider picture of what is the actual
reality on ground, we try to engage with
existing stakeholders and countries so
people we may know through pre-existing
relations, or the ones that we seek to
develop at that time.
So that we're sending out a team and or a
response that fits what is actually
required. I mean, again, coming back to
the best use of resources.
Working with the communities and liaising
with them, ensuring that what we're
offering is something that they realistically
want. And again sharing those findings
with others. So we may have deployed into
an area, the situation may have changed,
and it's about informing others and
working in coordination and collaboration
with others as well.
Just on the assessment team itself. I
mean, I think it's quite apparent and I
mentioned it said, the needs that we look
to do during an assessment ensuring that
the right profiles are there, and that the
people within the team are adaptable,
informed of what they're doing, given full
briefs on what is the requirements on
ground and that includes not only the
requirements of what they're looking at,
but also the requirements in terms of
security, management of the team
finances, etc., and so that they have the
available resources to be
a semi-autonomous team, but equally
doing so in a safe and sound manner on
the ground.
And the assessment team is really the
most important resource, because they're
actually the people who go out and do
that.
The more qualified and experience the
team is, obviously the better but there's
ways that we equally train our people to be
able to do assessments, to be able to
engage with communities and
understanding how to engage effectively
and appropriately with communities on
the ground.
Where possible, we try to ensure that the
team has a range of backgrounds. So this
includes ethnic and religious backgrounds
and appropriate balance of both males
and females. Again, coming back to the
cultural norms and cultural context. That
may go one way or the other and
depending on what we're looking at or
planning to look at.
The people are trained in how to do the
assessments. So we're not just sending
people out blindly; that they have the tools
and the resources needed, and they've
been trained effectively how to do that
and how to also engage with communities
in a safe and appropriate way
and ensuring that any engagement with
the community is done without causing
any additional harm. Every team member
that we send out, either on assessment
team or on a response, has a full job
description or a ToR (terms of reference)
which outlines what is expected of them
and
what is the duties and how they're
supposed to do that. And that is
developed by our health team, which is my
department, the operations team which
leads a lot of the responses and other
departments as well, human resources,
finance if required, and we have a full
briefing with them. So even in surge
responses where we're expected to have
a team on the ground within 24 hours

we still aim to do
a fullbriefing with the team. And that it
covers all matters of security, health so
their personal health, so things that they
need to be aware of,
and also their travel logistics. And we've
done this with teams in all various time
zones having briefings with people in in
Australia, the UK sub-Saharan Africa,
North America, etc.
So it's a key part because we don't want to
send people in blindly. We want to provide
them with enough information that we
have to date and keeping them informed
equally during the response with any
information that comes through,
sharing of resources and sharing of
stakeholder information and ensuring that
when they come into country they can in
some ways hit the ground running and
have the locations of where they're meant
to go. But a lot of that else has to be
worked out on the ground, and so we train
them on how to effectively do that as well.
So I've mentioned a few times throughout
the lecture and it's one key one for us that
we've learned over the past 30 or 40
international deployments we've done in
the past few years is the need to adapt.
We saw throughout Covid, that having the
right people in the right place at the right
time is not always feasible. So we talked,
as I mentioned the last slide, about having
the right team and the right profiles,
there's always, you know, issues with
being able to do that, logistics of getting
people in, visa issues, etc., so we can't
always have the ideal team as much as
we'd like to there's also challenges to it.
And Covid was a clear case example. We
would have teams lined up, at the last
minute we would have to withdraw people
because they couldn't get the clearances
from the country to come in
or restrictions would change, or they
would need specific covid testing, which
wasn't available at the time because of
shortages. So lots of challenges.
And some of that is obviously gone down
now with the pandemic kind of seizing. But
there's still obviously challenges with
getting people out and moving them
across the world. So, being adaptable
during a deployment is key, and the terms
of reference will be agreed

usually post assessment which informs

what we aim to deliver can obviously
change on ground. So we may seek to
develop one type of programming but
needs may change, the community needs
may change, or the views on what they
want may change, and local stakeholders
or international stakeholders equally may
change of what they hope to deliver on
ground.
So we really need to be adaptable as an
organization in terms of what we need to
scale up. So over the past few years, we
brought on lots of additional people at HQ
and equally onto our register, which has
reached just over 1,000 people, the skill
sets and expertise so not only individuals
that go out for things like assessments,
but also on deployments. So we can have
a much more holistic picture.

So we've also scaled up in areas in terms

of community engagement,
research, nursing and physician profiles,
and also the people that coordinate the
deployments so medical coordinators and
team leads. We've also scaled up and also
brought in additional experience from
people who have worked for other
organizations to be able to provide a
much faster set of responses, but also
much safer and more holistic type of
responses.

Unknown Speaker 22:29

Another

Ram Vadi - UK-Med 22:30

way that we've kind of mitigated some of
these logistical issues, either for
assessments or when we're developing
responses, is through remote support.
We've seen huge technological advances
over the past few years. I think this is case
in point. Now, we're able to give lectures
and teaching online, where you know
many years ago is very much being based
around in person communications. So it's
a cost effective way of both maintaining
support and relationships, but equally
starting a response. So it's happened
before in certain responses where we've
sent out an assessment or an advance
team, and we've started some form of
remote support.
So hospitals or facilities may tell us that
they receive a set of guidance, or they
receive certain sets of equipment, and
they're not sure how to set it up
so we would connect them with remote
technical support specialists that would
come from our register, that will work as
either a supplement precursor or follow-
up to the in-person interventions.
So it provides some immediate support to
the country but equally allows us to have
some engagement when the response
may end. So we've had a lot of responses,
especially during Covid, where the
facilities requested that we maintain some
kind of guidance and support
to them as guidelines continued to
change as they receive large amounts of
patients during surge. More recently we've
sent a team into Armenia after a huge
Burns incident, and some of the surgical
teams that went in
has still maintained relationships with the
hospital. So they are exchanging over
Whatsapp or Zoom calls about some of
the patient cases, and how to effectively
treat those patients. So it does provide a
high level of support when you either can't
get people in the country, or when the
people have exited the country.
And allows us equally to adapt to needs
on the ground so even when there's a
team in country
we can also provide some additional
support. So if the team in country is
requesting some level of additional
support, we have people that we can draw
on to provide that support to the team and
the national actors as well.
This is just an example of one way that
equally when
we've used learning from responses. So
during the Covid period we had a lot of
various requests for assistance, some
requests for assistance were for direct
clinical care but some were simply for
capacity building and training teams. So
what we did was we developed a
standardized package of teams that could
go out
which met most of the needs. So using
learning from responses to inform future
responses, and so it allowed us to
negotiate with the countries when there
was request for assistance, to be able to
offer them some immediate support in
terms of what would target the biggest
areas of need or the biggest areas of
need that we had seen from responses
and make a conditional offer to those
countries of how we would enter and the
types of profiles we would bring in, and
what they would aim to target. So for the
direct clinical care teams, they'd focus on
wards and patient care and also
community level care, but also where they
would task themselves with some of the
biggest gaps that we saw in many
responses.
But then, during the capacity building
responses, it was very much focused
around training programs and what
resources we would need and also the
requirements that we would need from the
country. So for direct clinical care, we
needed the countries to provide us with
licenses to practice so these people
could provide that direct care and support
the local clinicians. In the capacity
building and training which was much
more hands off, and was much more
focused on supporting national actors in
terms of how to engage.
And
so I'm just gonna go through a quick case
study, which was the Beirut port blast
response, which we responded to in
August of 2020.
For those that will remember the Beirut
port blast happened
at a time when
the during the peak of Covid in many
countries. This was August in 2020, it
happened in the port. So Beirut was going
through a large financial and economical
crisis at the time, and had a fair amount of
lockdowns during the Covid.
The port blast injured, well the reported
deaths, it's probably a bit higher, was
about 200, there was about 6,000 people
injured, and around 300,000 people in the
immediate area of the blast
lost their homes.
The port of Beirut is right in the city center,
there being the capital of Lebanon so
quite a big area and many major hospitals
after the blast were either destroyed or
had to discharge patients. Primary
healthcare centers equally affected, and
this was on top of both Covid, a political
and economic crisis.
Where you can see the red line there is
just about roughly the day that the blast
happened.
So up until this period Lebanon had very
strongly managed Covid prior to this
incident, partially because the numbers
were fairly low, Lebanon was a fairly small
country, so most of the cases were
managed in one hospital in Beirut. So
from all across the country most patients
were brought to one facility.
There's quite a strong private healthcare
sector it still is today in Lebanon but the
public sector was fairly weak and often for
many period
quite underfunded.
So what happened after the blast was the
large amount of casualties were moved
into private and public hospitals. Patients
who were Covid positive were moved out,
and obviously, during the ensuing chaos of
the blast, many people were discharged
or there was no kind of social distancing
measures, all measures went out and the
Government dropped all covid
restrictions. So the immediate request,
and we sent out an assessment team, was
to look at trauma

so many people feared that this huge

blast that hit this big metropolitan area,
that there large amounts of trauma, and
actually was found that most of the trauma
was absorbed within the first day or 2 by
the private and public sector.
And the Government rightfully so
predicted that covid numbers would start
to peak because of all of the discharge of
patients and the fact that held measures
were dropped.
And I think it's quite clear on this
epidemiological curve here that
that's exactly what happened, that
numbers slowly started to peak and then
public hospitals which had never received
Covid patients were then requested to
then take on Covid patients to the existing
hospitals that were still remaining after
the blast could take in the trauma patients
that required additional care.
So we deployed a 5 person assessment
team immediately after the blast. In the
middle is David who just gave the last
lecture and a few other members. So we
sent out a surgeon, an ED nurse, a
logistician and a rehab specialist. So we
deployed out 5 people with the initial
thought being that it would be focused on
trauma and burns.
And the assessment team within a day or
2 it was quite clear, with conversations
and assessments of facility existing
facilities, that actually those needs have
been met and again, that Covid was going
to be the biggest need in country.

So very quickly we resourced a response

team. So some of the members went
back, and we brought out additional
professionals which was primarily focused
on an outbreak type of response.
And they began to work in 2 hospitals. So
2 public hospitals in Beirut. The initial
focus of our deployment was around
hospital preparedness so all of these
public facilities had never received Covid
patients, nor had they received any form
of training or support prior to that.

So there was very much a baseline focus

around infection prevention control,
patient flows and preparing facilities to
start to receive cases.
Inthe photos one of our register
members, an ICU nurse from Scotland,
who was giving a lecture here to some
nurses in the facility.
But there was quite a big apparent gap,
many of these facilities had never
received training, as I said, when we came
into the facilities that people weren't even
aware of what PPE was or what the
requirement was for PPE. So we had to do
a lot of baseline training around that and
preparing them for how to
essentially protect themselves, but also
protect the communities as well. We
deployed a mixture of NHS staff and
humanitarians
and at this point most of them had covid
experience, a lot of them had outbreak
experience, Covid most of them coming
from the UK had dealt with some of the
initial large waves in UK, but some also
came from our international part of our
register.
Itwas often mentioned that we were
experts in Covid, and I think that was
something we tried to push back on, and
that we were not experts, and I don't think
anyone, at especially this period, was an
expert, we simply just had a bit more
knowledge having had been from
respective countries and had dealt with
Covid. So we're a little bit ahead. So it was
a bit of shared understanding and shared
learning through this deployment. But
there were certain aspects that we felt
that we could effectively teach people in
terms of infection prevention, control and
patient flows as new guidelines started to
come online.
The response was extended twice. So we
ended up taking on 2 additional hospitals
after a few months because another
emergency medical team exited the
country.
And by the end we had 6 hospitals, so 2 in
the north of Lebanon, and 4 in Lebanon,
the greater Lebanon area. And the shift
over time went from supporting with the
baseline care for outbreak response to
much more focus on on the job
supporting clinical bedside coaching and
emergency departments, Covid boards
and ICU's. And this is one of our members
working in an ICU in a hospital just outside
of Beirut. We also included remote
support which I spoke on earlier, so we
couldn't get all of the specialists into
country
due to various restrictions globally so we
provided a lot of remote teaching,
especially on intensive care because
intensive care was extremely hard to bring
special set of countries due to the need in
everyone's other countries during the
pandemic. Biomedical technicians was
another one who provided support to local
facilities to help set up equipment that
was deployed out or donated.
And we also tried to provide a much more
holistic response.
As I mentioned, a lot of these facilities had
been underfunded for years, so we
provided much. They hadn't received even
baseline training pre-Covid so we provide
a lot of support and trainings in terms of
basic life support ALS and other support
mechanisms, ward care, nursing care,
things that people hadn't either been
trained on or had been trained many years
on, and due to the kind of neglected
public health care system hadn't been
focused on.
In the later phases covid vaccine started
to come out. We also provided support
and a request to provide support in terms
of setting up of the areas that would
provide the vaccines, the covid vaccines,

Unknown Speaker 33:10

and additional training on things like
anaphylaxis reaction, etc.

Ram Vadi - UK-Med 33:13

You can kind of see that the evolution of
the response over time from going simply
to focus on trauma, to doing baseline
outbreak training to a much more holistic
wider response. It ended up being 8
months in total so it was one of the
longest responses we've ever done but it
was about maintaining relationships with
the stakeholders that we engaged with.
And also the constant
learning from the response and trying to
bring out additional specialists as and
when the teams identified those during
the response.
And I think that is it from my side. I'll stop
the share.

Christina Naula 33:51

Thank you very much, Ram, so let's open
up for questions. I see Don has joined us
as well. So morning Don.
Let's see if we have any questions.
Anyone wants to get this started?
So you can use the chat or you can also
use
well you can just use your microphone as
well.
maybe kick us
I'll off. So I was wondering
you kind of
you've been talking about
assessing the needs of a locality where
you have to go to so how does that work in
a timely it kind of

well I'm trying to say you know, what is the

timelines? So is your health needs
assessment team going out first?
And how quickly are these assessments
done?
Or do you just deploy at once, and you
assess while you're there, while you're
already trying to
establish a response?
 Ram Vadi - UK-Med 34:54
Ihope that makes sense. No, it does.
Yeah, I think it's more the latter actually.
We try to do that at the time of when the
team comes out. I mean, the timeline
depends a lot on the situation, and how
quickly we can get people in.
And the reality is often it's dependent on
passports so certain countries and certain
people coming from certain nations
obviously, it's much more challenging.
What should normally happen and how
the whole EMT mechanism is designed
with WHO is in a large scale response that
the government should waive entry
requirements, and also generally customs
requirements. So Lebanon was a good
example of that. After the blast the
Government dropped covid restrictions,
but also dropped the requirement for any
nationals that required visas to be able to
come in so declared essentially a
state of emergency and put in kind of
emergency protocols, meaning that
people could come in without visa
requirements.
In many countries that doesn't happen. In
Turkey, for example, it didn't happen.
Recently we had teams in Malawi. And,
interesting enough it was quite difficult. So
the Government, we've responded to
Malawi a few times and the Government,
has never dropped those requirements
during Covid, and recently, during a large
cholera outbreak that we responded to.
So sometimes we still need to go through
the whole visa process in home country.
Now saying that in best case, when that
does happen, or if we're able to get
people into country, we can normally
deploy people into country within 24 to
48 hours. Turkey we had people in country
in about
10 to 12, I think, and that was only held up
due to the flights, not anything to us. So
the logistical challenges are sometimes
outside of our per view best case we can
get people into contract within 24 hours.
We try to have a team of about 4 to 5. So
they cover, depending on the needs or
what the context is, we would send out
specific people so we also try to define
that team based on the needs. So if it's a
surgical team, obviously will include a
surgeon, a nurse, possibly a rehabilitation
professional.
If larger scale disaster we would
it's a
probably look to involve someone that
would look, at not only health needs but
also water and sanitation needs in the
community,
we may look to send out some one that
works with the community so an RCC
lead. So the profiles can change but best
case scenarios is that they're responding
in the background equally from our side
we're already starting to frame some of
the background work. So we maintain an
on call system. So we would already start
to look at specific profiles while the team
is assessing so we have a baseline team,
some of that can change. So the human
resources team is already contacting
people
based on the information we have to date
in terms of who may be deployed, the
logistics team is already looking at
infrastructure and pharmaceuticals that
may be deployed and from our side in the
health and operations, we're looking at the
technical parts. So how can we get in?
What's most likely required? Who may
need to go from HQ staff? So a lot of it is
happening, I guess, in parallel during that
time of the team, either mobilizing to
assess or while the assessment is
happening as well.

Christina Naula 37:59

Okay. So I guess you also have kind of
standard operating procedures in place
already from previous experience that you
can then adapt very quickly to a new
situation.

Ram Vadi - UK-Med 38:08

Absolutely yeah.

Christina Naula 38:12

I'vegot a question here on the chat from
Harin.
So he says, you mentioned assessment
fatigue, how willing are other
organizations that have done previous
health needs assessments to share
theirs? And how do you navigate a
negative response to maintain good
relationships with other organizations?

Ram Vadi - UK-Med 38:33

I think it's a very good question. I would
say that majority of organizations are keen
to share their findings.

And I think there's a small contingent that

are generally not. The unfortunate reality
of these things is that we, especially when
there's large scale response to some
organizations or individuals feel that we
are maybe fighting over the same pot in
terms of donor funding, etc., so
oftentimes are not keen to share their
findings. But I would say in my experience
in UK-MED and other organizations about
90 to 95% of organizations are,
you know, technical individuals are keen to
share out the information. And oftentimes
they're keen to share that because we can
jointly approach it. So each organization
has a mandate so there's often types of
synergies that we can do if it's an
organization specialized in say, water and
sanitation we can look at jointly deploying
or jointly applying for funding.
So that would be one way we try to get
either try to get the information or try to
harmonize the information that we each
respectively have.
We also work within kind of a cluster
system so the health cluster system. So
oftentimes the health cluster is also
sharing these information out
so it's not necessarily that we need to
bilaterally request each organization but
the health cluster, or WHO in country will
share a lot of that information out or the
UN. So we can gain it through other
means. Whenever there's large scale
incidents there's often big blast reports
that have been kind of extrapolated from
other organizations or other UN agencies,
and we can take a lot of that baseline
information as well to inform what we do.
In terms of how do you navigate a
negative response? I think that's yeah. I
think that comes down to personalities. It
can be challenging some organizations
have their own specific mandates or the
way to view things.

Unknown Speaker 40:21

Ithink, from our side and for me as an
individual, it's about being open and
transparent about we're trying to deliver.

Ram Vadi - UK-Med 40:26

We're not trying to steal anyone else's
funding, we're not trying to go into
territories that aren't necessarily
where we provide any added value. And
then part of that also comes down to the
fact that we as an organization as an
emergency medical team, we work on a
request based system. So we don't seek
to enter countries or areas that we haven't
been requested either by national or local
authorities.
So almost every single response that
we've done as an organization has been at
the request of the Government, national
authorities, or WHO as a minimum. So we
have a specific request. Now, what can
change is what we deliver within the
request but we only come in invited
and we try to maintain that so part of, I
think, maintain the relationships is making
that clear to organizations that we have
been requested by the Government that
we're there to deliver something specific
and trying to explain that and be as open
and transparent as we can about what
we're trying to do.

Christina Naula 41:21

Okay, any other questions from the
audience? Remember, you can also
use your microphone if you want to.

Okay, just Harin says, thanks for the

answer. Anything else? I mean, we will
have a panel discussion
once we've done all the sessions. So you
know, if you think of something that you
forgot to ask, or you know you kind of been
digesting what you've been hearing, and
you have questions coming up take a note
and ask them in the panel discussion later
on.
Anything else?
Okay, so let's say, thank you to Ram for
sharing his expertise with us.
And we'll have a wee bit of a break now.
So we'll be back at 11:15

Antonia Mentel 42:12

with the...

Christina Naula 42:14

Oh, sorry there's someone coming.
Or has just someone got the microphone
on, maybe
Someone labelled Iphone wanted to say
something maybe? No.
Itwas just accidental. Okay, I've lost my
thread. Where was I? Okay, yeah. So David
Anderson is gonna just talk about
emergency responses for infectious
diseases
And then we'll have lunch break,
at 11:15.
and then we'll come back.
So I think, Ram, you've mentioned
risk communication and community
engagement already in your presentation,
so we'll have some one talking about that
in the afternoon, and also we'll talk about
sustainability
in a humanitarian health context. And then
finally, we'll finish with migration and
refugee health. And, as I mentioned
previously, a panel discussion.

Unknown Speaker 43:10

So we'll be staying on that same link for
the next session.

Christina Naula 43:14

So you can just or you can just leave it on
but then for the afternoon we will be
starting at a different link. So yeah, maybe
have a wee coffee and come back
refreshed. I realize some of you are from
time zones where it's probably barely the
morning or already late in the evening so
thank you for making the effort.
And thank you again, Ram, for your
informative presentation.
And see you again. Okay,
I'll I'll see you
later. Bye.
Okay, I'm I'm just gonna hang about here.
Let me just stop the recording.