jueves, 1 de mayo de 2014

Typhoon Haiyan and the Professionalization of Disaster Response — NEJM

Typhoon Haiyan and the Professionalization of Disaster Response — NEJM


Typhoon Haiyan and the Professionalization of Disaster Response

Hilarie H. Cranmer, M.D., M.P.H., and Paul D. Biddinger, M.D.
N Engl J Med 2014; 370:1185-1187March 27, 2014DOI: 10.1056/NEJMp1401820
When international medical response teams landed in the Philippines last November in the days and weeks after Super Typhoon Haiyan hit, it was immediately apparent that they needed to act as professional humanitarian responders. The top priority was not that they deploy their medical skills but that they support the plans that were already in place. Although there were posters directing foreign medical response teams to register with the Philippine government, the trucks loaded with bags of rice from the World Food Program being delivered to the Department of Social Welfare and Development should have tipped off the response teams that the humanitarian response was what was most needed — and was working.
Our medical teams reached their destinations with food, medications, and a plan (that the local minister of health helped to develop) to care for the population. Even in the remote areas where those teams were deployed, clinicians treated many patients with hypertension and found that medications were locally available. Typhoon-related medical problems were directly related to the loss of food, water, and livelihoods; people were spending their time finding food rather than refilling their prescriptions. The regional governments were coordinating with the United Nations (UN) so that local teachers could pick up bags of rice and distribute them to their students during school hours. Though the UN was present, the regional government and the Philippine Red Cross were coordinating the response. Lessons from past events about providing humanitarian care and reducing risk after a disaster had clearly been applied.
Unfortunately, the devastation in the Philippines is only one of many recent examples of destruction from weather phenomena, and not all these events have seen the level of coordination of medical and humanitarian resources that was observed in the Philippines. Hurricane Katrina, the Indian Ocean tsunami, the earthquake in Haiti, the tsunami in Japan, and Superstorm Sandy, among others, have caused wide-scale loss of life and suffering in the past 10 years. In addition, and of great concern, the number of severe weather events and the human toll they are exacting are indisputably on the rise.1 These increases probably result from a number of factors, including changing climate and increasing population density in urban centers, but it is clear that destructively severe weather is now part of our world. It is our responsibility to plan for, mitigate, respond to, and recover from these events.
With each such event, many people, especially physicians and other medical professionals, have asked the same questions: What can be done to prevent such loss of life? How might I help?
There are promising examples of models for disaster planning that can be effective regardless of what resources are available. When Cyclone Phailin struck India just 2 months before Typhoon Haiyan, nearly 1 million people were evacuated from the coasts and only 23 people died. This is especially striking given the limited resources available relative to the size of the population affected. Replicating such success, however, is challenging for many countries. Moreover, successful evacuations alone do not automatically prevent other downstream consequences of interrupted access to water, food, and basic medical care that can persist long after a disaster has passed.
The record of global responses to recent disasters has been mixed. Despite noble intentions, poorly prepared and poorly equipped responders have sometimes ended up depleting needed resources rather than providing solutions. In previous responses, some health care workers have worked outside their scope of practice and licensure. Many have been deployed without food, water, medical-supply chains, or even transportation. Their failure to secure basic logistic arrangements taxes already stressed and fragmented local systems that are attempting to deliver basic necessities to the locally affected population. Failure to coordinate with local response authorities or with international relief agencies results in either duplication of existing capacity or missed opportunities to fill gaps in delivery. After the earthquake in Haiti, for example, most responders were younger than 30 years of age and had no previous disaster-response experience. Some responder deployments lasted less than a week, provided limited benefit, and left postoperative patients without a plan for follow-up care. Unintended and significant consequences included the highest postdisaster rates of post-traumatic stress disorder and depression ever reported among humanitarian aid workers themselves, which diminished their capacity to care for the Haitian population they intended to serve.2
A Destroyed House near Tacloban on the Island of Leyte after Typhoon Haiyan.
Medical responders to disasters, no matter how honorable their goals, can help others best when they are well prepared and function as part of a coordinated and professional response. They should be trained using a competency-based curriculum to provide medical care in an austere environment, as well as informed about humanitarian standards and practices.3 When they are deployed, they must collaborate with local response leaders and coordinating systems. They should be physically and psychologically prepared for what are often severe and stressful environments. They should strive to deliver excellent medical care just as they would at home.
On the basis of a systematic review and analysis of past disaster responses, the World Health Organization formed a working group to address the need for improvements and consistency among disaster-response teams and produced guidelines for the minimal capabilities and support systems. The group's recommendations include classifying these teams into various tiers of response and personnel necessary for the disaster, strengthening the capacity of host countries rather than replacing it, providing technical support and advice as international agencies, and developing an international registry of foreign medical providers, categorized by skill sets.4 To address home organizations' poor accountability for these providers, which has been a criticism of previous responses, core standards are recommended: teams should be insured and cared for, arrangements should include provisions for their repatriation, and there should be an exit strategy for their return home should they become ill or disabled.
The Massachusetts General Hospital Center for Global Health deployed four professional teams of humanitarian responders to the Philippines. Our first team, working with International Medical Corps, included two doctors, four nurses, and a pharmacist. Two of the team members were Filipino American, and nearly all of them had previous disaster-response experience, whether domestic, international, or both. International Medical Corps soon replaced our international staff with a national staff who would continue to roll out surveillance and public health programming, working with the regional health officials. Our other three teams worked with Project HOPE, which launched a land-based mission to help rebuild the infrastructure that was devastated on one of the larger outlying islands, not only providing supportive health care but also helping local people who lack access to food, water, and assistance in rebuilding and supporting collapsed health care structures.
In the response in the Philippines, we have seen encouraging signs of progress. Teams are traveling for longer periods of deployment and coordinating their efforts with local and international partners. They are more likely than past response teams to be self-reliant and versed in the local language and culture, as well as in international standards for water, food, and health care delivery. The teams do not aim to replace health care workers but to support them. We should expect no less of our medical professionals when they are deployed to regions hit hard by disaster, whether inside or outside the United States. Good intentions in the absence of preparation, training, and coordination confer little benefit; providing a professional response to populations affected by disasters and emergencies is our next evolutionary step.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on February 19, 2014, at NEJM.org.


From the Department of Emergency Medicine (H.H.C., P.D.B.) and the Center for Global Health (H.H.C.), Massachusetts General Hospital; and the Division of Policy Translation and Leadership Development, Harvard School of Public Health (P.D.B.) — both in Boston.

No hay comentarios:

Publicar un comentario