Australasian Emergency Nursing Journal (2010)13, 4—6
a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / a e n j
GUEST EDITORIAL
Applying lessons learned to the Haiti Earthquake response
On the12th January at 4.53 p.m. (local time) the impover- ished Caribbean nation of Haiti was struck by an earthquake measuring 7.0 on the Richter scale. This was the largest earthquake to hit the island nation in over 200 years and the initial impact and subsequent aftershocks caused extreme damage and affected a population of over 3 million. The epicentre was approximately 17 km south-west of Haiti’s capital, Port-au-Prince. The nearby population centres and areas to the west and south of the epicentre were most severely affected. At the time of writing the numbers killed and injured are unknown and the dead are thought to number in the tens of thousands. Many were buried in the rubble of collapsed buildings in this desperately poor nation in which infrastructure, rescue and health capability and capacity are exceptionally poor. Damage to buildings and essential services such as power and water supplies, hospi- tals and government services was extensive, in part because of poor building standards and already overstretched ser- vices. Following the disaster many of the essential services necessary to support an effective response were too badly damaged to be used. Shipping was unable to berth and the airport control tower was destroyed severely limiting access by air. Both the main sea port and the airport were, as a result, left with very limited capacity to receive essential supplies and rescue personnel from other nations. The road network was in ruins severely limiting the distribution of aid. The extent of the damage and the already poor condi- tion of national infrastructure inevitably affected the speed and reach of the international humanitarian response.
It is estimated by the Centre for Research on the Epidemi- ology of Disasters1that in the past 50 years more than 10,000 disasters have occurred, more than five billion people have been affected, and more than 12 million persons killed at an economic cost of more than US$4 trillion. Disasters continue to occur and the frequency of these catastrophic occur- rences is increasing.1In addition, the impact of disaster is becoming more severe as more people live in close proxim- ity to possible impact zones (such as ‘sea change’ locations near to the coast), in more crowded situations and with greater reliance on the community for essential services.
In many countries population transitions and growth have not been accompanied by adequate development of infras- tructure and degradation of the environment has increased the impact of disaster. In addition we know that disaster does not affect populations equally and those with lower socio-economic resources are most severely affected. As a result poorer countries such as Haiti and poorer community members suffer disproportionately from disaster events.
For most of us our experience of disaster, and disaster health care, is limited to the media vision and reporting that we receive from disasters such as the Haiti earthquake. The television footage is often focused on the work of surgical teams and at the site of temporary field hospitals or on rescue teams digging for buried survivors. However, the international emergency medical and rescue response to disaster, generally arrives too late and has relatively limited impact on the survival and recovery of those affected, except of course at the level of individuals fortunate enough to receive life saving treatment in a timely way or the occasional extraordinary discovery of those who have been buried for extended periods. Surgical teams generally arrive a little too late to save life and generally cease to have much influence on survival and longer-term recovery a few days or weeks after the impact of disaster. Very early during the international response to the Earthquake Haiti was described as being ‘awash’ with doctors but desperately short of public health and nursing staff. This focus on providing acute medical care to disaster affected nations is a typical feature of the international response but is often of much less value than efforts to re-establish normal healthcare services and public health standards.
Nurses of course play a major role in this effort.
For the health services the coordination of the health response to disaster is the most pervasive problem. An extraordinary number of non-government (NGO) and human- itarian organisations and many national governments may become involved in responding to an event such as the Haiti earthquake. Coordination of this response to ensure that it is effective, that duplication is reduced and that the maximum possible benefit can be assured is a complex task. To this 1574-6267/$ — see front matter © 2010 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.aenj.2010.02.003
Applying lessons learned to the Haiti Earthquake response 5 end, following the Asian Tsunami disaster the United Nations
established the Global Health Cluster (GHC) comprised of key international organisations and led by the World Health Organisation. The GHC provides coordination of the inter- national effort and hopefully improves the outcome of the rescue and recovery effort.
It is common for health professionals to self-respond to disasters creating a major problem for affected nations requiring identification and credentialing of these respon- ders and the provision of resources to protect and to house them. Health and humanitarian organizations experienced in disaster response arrive in the disaster zone with a level of self-sufficiency, providing their own communications, logis- tics, supplies and the like. Well meaning self-responders generally do not have these resources and should be dis- couraged from travelling into disaster zones. Anyone wishing to volunteer as a responder should do so as a member of a multi-disciplinary contingent organised by a national gov- ernment or by a reputable non-government organisation experienced in disaster relief such as a member of the GHC.
The health response is frequently tainted by common misconceptions about disaster. We frequently have too lit- tle experience ourselves and can be easily fooled by public information sources when forming our understanding of what happens in disaster situations and what the health pri- orities should be. Often a relatively poor understanding of the heath impacts of disasters and the best evidence-based approaches leads to mis-guided and inappropriate health actions. These are complex events and difficult to manage even when responders are well rained, knowledgeable and experienced.
Very early in the response phase we hear about the risk of disease and the problem off decomposing bodies. Reports of looting and violence begin to emerge along with complaints about the delay in getting vital supplies to affected people, the delivery of health care to the injured and the exclusion of non-government and charitable organisations. For most of us these issues appear to be the expected sequellae of dis- aster but in fact they demonstrate how the lessons learned from disasters have failed to influence the understanding of the media, the average citizen and our own colleagues in health care.
We know, for example, that decomposing bodies are unlikely to be a risk to health. Mass burials are usually unnec- essary. The rush to bury the dead makes identification of the deceased very difficult and can deeply affect bereaved rel- atives who may find it more difficult to come to terms with their loss. Mass burial has severe psychosocial consequences and should be avoided whenever possible. Generally, the risk of infection arising from dead bodies is very low. Even if infectious diseases such as cholera, plague or typhus are present in the community it is far more likely that they will be spread by those who are still alive rather than by corpses.
The myth that bodies spread disease appears to arise from the infectious risk associated with handling the deceased wherein normal blood and fluid protective measures should be taken. People handling corpses have to be suitably pro- tected with masks and gloves to avoid infection by HIV and other blood-borne microbes. However there is no evidence that dead bodies spread disease even when in an advanced state of decomposition.2Indeed, a rush to pick up the dead may well be life-threatening. It can divert resources away
from rescue efforts for those who are alive and buried under rubble or in urgent need of medical care. In Haiti mass burial was once again an early feature of the response.
Another common myth associated with disasters is that they bring out the worst in human behaviour, when in fact, while people are shocked and wonder why they survived and others died, their resilience is generally extraordinary and the stories of goodwill and support that arise from disasters demonstrate the very best of the human spirit. We know, for example, that looting is rare3 although isolated cases are quickly reported in the media. Often, in situations where neighbourhoods are isolated and families are starving food may be liberated from markets and other locations, but of course this represents a rescue response rather than crimi- nality. Once again in Haiti reports of widespread looting risk placing too much resource into security and too little into responding to the very real needs of the population for food, safe water and shelter.
Another myth is that donations will arrive quickly and that donations of food, clothing and household goods con- stitute an effective response to relief in disaster-affected communities. It is common for well meaning groups through- out the world, including in Australia and New Zealand, to collect donations of clothing, food and other goods and to send these to disaster sites. However, not all donations are helpful, and at times large amounts of donated goods may worsen, or at least complicate, the disaster response effort.
Donations of items such as blankets, shoes or clothing may cause a secondary disaster, clogging up ports and consuming resources to sort and re-distribute these donations. Essen- tial resources such as food, shelter and clothing can usually be purchased effectively within the affected region or coun- try and this greatly assists local and regional economies in their recovery. Donations of cash to reputable humanitarian agencies or to governments constitute the best response.
Alexander3argues that these common mis-conceptions work against effective response and effective education of health personnel as responders.
Disasters will continue to occur and it seems likely that their impact will become greater as a result of chang- ing population demographics. Effective responses by health professionals and their organisations will require more edu- cation opportunities, good discipline and preparedness and an improved understanding of the health aspects of disaster.
To support this effort the International Council of Nurses, a member organisation of the Global Health Cluster, has accredited the Flinders University Research Program for Dis- aster Nursing. This program’s mission is to enhance research, development and the recognition of the nursing contribution to disaster preparedness and response.
Paul Arbon, AM∗ School of Nursing and Midwifery Faculty of Health Sciences, Flinders University World Association for Disaster and Emergency Medicine St John Ambulance, Australia
∗Correspondence address: School of Nursing and Midwifery, Australia. Tel.: +61 8 8201 3972.
E-mail address:paul.arbon@flinders.edu.au 17 February 2010
6 Guest editorial
References
1.Em-Dats emergency data base. Centre for Research on the Epidemiology of Disasters [CRED]; 2007. Available from URL:
http://www.cred.be/emdat.
2. De Ville de Goyet C. Myths, the ultimate survivors in disasters.
Prehospital and Disaster Medicine2004;22(2):104—5.
3. Alexander DE. Misconceptions as a barrier to teaching about disasters. Prehospital and Disaster Medicine 2007;22(2):
95—103.