Health Management after Natural Disasters REHABILITATION/RECOVERY OF DISASTER VICTIMS

Dr. M.M. Prabhakar, Medical Superintendent Director, paraplegia hospital, Ahmedabad.

Definition-Disaster
A serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources.

One of the most widely held myths regarding earthquakes, hurricanes, floods, and other natural disasters is that they are "great equalizers." They bring to mind the wrath and power of an untamed nature that hits men and women, young and old, rich and poor alike.

In fact, natural disasters are not great equalizers. There is sufficient evidence by now to demonstrate that they affect populations selectively: the poor are the most vulnerable, the least prepared, the hardest hit.

Natural Disasters Human-caused Disasters
•Accidental •Malicious

Disaster classification
Natural disasters
– Meteorological disasters – storms (hurricanes, tornados, twisters, cyclones), cold spells, heat waves and droughts. – Typological disasters – avalanches, landslides, and floods. – Telluric and Teutonic disasters – earthquakes, volcanic eruptions. – Biological disasters – insect swarms, and epidemic of communicable diseases.

The Four Phases of “Emergency Preparedness & Response”

Preparednes s

Prevention

Response

Pre-event

Municipal & F/P/T Capacities
EVENT

Post-event

Recovery

Mid-term Review of IDNDR held at Yokohama in May 1994.
Those affected most are the poor and the socially disadvantaged in developing countries as they are the least equipped to cope with the situation. Disaster Prevention, mitigation and preparedness are better than disaster response. Disaster response alone yields temporary relief at a very high cost. Prevention contributes to lasting improvement in safety.

With its vast territory, large population and unique geoclimatic conditions, Indian sub-continent is exposed to natural catastrophes traditionally. Even today the natural hazards like floods, cyclones, droughts and earthquakes are not rare or unusual phenomenon in the country. While the vulnerability varies from region to region, a large part of the country is exposed to such natural hazards which often turn into disasters causing significant disruption of socioeconomic life of communities leading to loss of life and property

Hazard Vulnerability in India
Indian Subcontinent: among the world’s most disaster prone areas 54% of land vulnerable to Earthquakes 8% of land vulnerable to Cyclones 5% of land vulnerable to Floods > 1 million houses damaged annually + human, social, other losses

Earthquake in Kutch
16th June, 1819. 1st noted earthquake in Kutch. 26th January (Republican Day), 2001. “most devastating earthquake in the last 180 years in India” 6.9 Richter scale. Epicenter located about 20 kms. From Bhuj in north-east direction.

Earthquake 2001
About 1.59 crores occupants in the affected area About 13,811 died (12,221 in Kutch only) About 1.66 lac people injured 3.55 lac houses collapsed totally 8.68 lac houses damaged

A Paradigm shift from Postdisaster reconstruction & relief to Pre-disaster Pro-active approach.

concept of "Self-help rather than welfare dependence,"

The goal of appropriate disaster response is to support the positive qualities of the affected community while working as an agent of positive change in regard to its disasterprone elements.

Agencies responding appropriately to a disaster often create a second, or aftershock, disaster within the community. An intervener's humanitarian aid after a disaster can, in fact, be harmful to the beneficiary. The intervener refers to any agency from outside the disaster community's own resources to respond to the disaster.

Effects of Intervention on Coping Mechanisms
Interveners frequently have no understanding of the resources existing within a community that can cope with disasters. Nor do they have an understanding of the role these coping mechanisms play within a community. lack of familiarity with the social and anthropological background of the country and their desire to respond to short-term needs which overshadow the long-term implications of their actions.

Therefore any intervener must learn to identify the coping mechanisms that exist in the society and how they relate to outside help. The intervener must learn to work with these built- in disaster response systems and to encourage a collective response.

The objectives of India’s National Policy for natural disaster reduction is to reduce
loss of lives property damage economic disruption

Post-disaster reconstruction and rehabilitation is a complex issue with several dimensions. Government, nongovernmental and international organizations have their own stakes in disaster recovery programs, and links must be established among them, as well as with the community. In other words, post-disaster rehabilitation and recovery programs should be seen as opportunities to work with communities and serve local needs.

The standard time frames for rescue, relief and rehabilitation are defined as seven days, three months and five years respectively. The rehabilitation/reconstruction phase typically starts at the end of the relief phase and may last for several years.

The short-term plans for the recovery process are clearance of debris, building housing units, and restoration of lifelines and infrastructure, while the long-term objective is to build a safer and sustainable livelihood.

Process of Reconstruction and Rehabilitation had three major stages
I: Principles and Planning II: Implementation and III: Ensuring Sustainability.

Principles and Planning
The first task was setting up the basic principles for planning the rehabilitation intervention. The intervention had to be participatory, with a gradual increase in the involvement of the community.

The Project Team would not,and should not, remain with the community forever. In such a case, the community who were the first responders should be sufficiently equipped to cater to their immediate needs. A well-planned rehabilitation exercise could significantly increase the capacity of the community for a more effective response.

Stage II: Implementation
Consisted of three steps:
– (1) Need Assessment – (2) Capacity Building – (3) Implementation.

In Step 1, emphasis was placed on the following features:
– (1) recognizing the community’s needs – (2) prioritization of needs as per the available resources – (3) translating needs into appropriate action jointly with the community.

The role of government at this stage of the exercise provided a recognized legal basis for working in the community.

Step 2 aimed to translate the plan into action. Step 3 focused on joint implementation. Project implementation components include reconstruction of houses and infrastructure as well as training programs. One significant part of the training program was the half-size shake-table testing with different building materials, which aimed to increase people's confidence in earthquakeresistant construction practices.

Stage III: Ensuing Sustainability
The effort initiated by the Project Team needed to be sustainable long after the interventions were over. In effect, intervention should be designed to ensure that the community was able to take care of its development needs and was resilient against future disasters. For this, strengthening local institutions was necessary.

Change attitudes that treat relief and development as isolated activities
Relief should always consider the medium- and long-term needs of beneficiaries and seek to increase the capacities of communities in disaster-prone areas. Relief should lay the foundation to rehabilitate livelihoods in such a way that they emerge as more resistant to shocks in the future.

Use relief as an opportunity to enhance local capacities.
Identify and build upon coping mechanisms, use local material and resources and take measures that regenerate livelihoods and local economies. There is a need to adapt programming to the socio-economic, cultural and environmental context as well as to understand gender-related needs.

Ensure that relief does not inadvertently reinforce tension or conflict within or between communities. In unstable and post-conflict situations design programmes that contribute to co-operation and reconciliation by building upon shared needs and common beliefs.

Use disaster preparedness programmes as an essential link between relief, rehabilitation and development that build capacities at the community level as well as in the National Society to better cope with future disasters, reduce vulnerability and thus enhance development prospects.

Contribute towards more systematic co-ordination, improved working methods for joint assessments and planning and the exchange of data and information between all actors in the international aid community.

Rehabilitation
restoration of the patients to their fullest physical, mental and social capability”.
“The

Rehabilitation
It includes
– Prevention of disability – Retaining functional activities – Appliances to compensate for loss of function – Resettlement in the community – Vocational training and placement – Restoration of physical and mental health

“Physical exercise alone is not rehabilitation.” “It is not enough to have specialist for physical disease and specialist for psychological disease; the same man must in a sense , be both.”

Rehabilitation team
Medical, paramedical staff. Local authorities. NGOs Prosthetists and orthotists Relatives and neighbors, last but not the least; patient himself

Rehabilitation
“With the right attitude of mind, a surgeon can practice rehabilitation in a barn; without it he will fall in the most lavishly equipped gymnasium.”

Return to living

Care in Kutch

Rehabilitation
According to the severity (Triage) the patients with
– Spinal injuries, head injuries – Compound fractures and fractures requiring internal fixation Shouldbe tranferred to higher centers by air or road for definitive treatment

Care for the injury
• • • • • 1,67,000 patients treated 720 Spinal Injury cases 109 Paraplegia 268 Amputations 8256 Total aids and appliances given

“Injury compensation given to 100% patients”

Rehabilitation Phase
Focus on Paraplegic patients
Comprehensive Rehabilitation o Infrastructure Reconstruction o Health Training o Community Mobilization & Coordination with the Government for strengthening Medical Services o Psychosocial Support
o

Rehabilitation Phase
The main activities undertaken were  Physiotherapy  Prosthetic support  Damage Assessment  Tracking patients with post-operative complications  Camps for handling post-operative complications

Premila/18 yrs, Bhachau Flag hosting day 15th August 2001 at Paraplegia hospital, Ahmedabad

Orthopedic team from civil hospital Ahmedabad operating at prefabricated hospital, Jubilee ground, Bhuj

Distribution of assistive devices Joint project of
–Ministry of Social Justice & Empowerment –Paraplegia hospital Ahmedabad –Blind people’s assoc. Vastrapur, Ahmedabad. –NGOs etc.

Vocational rehabilitation

Mental Health
Psychosocial Rehabilitation and Therapeutic support 1000 Teachers trained for Mental Rehabilitation. 10 UNFPA mobile vans with counselors delivered Mental Health services at door step. 6500 persons given psychotherapeutic intervention.

THANK

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