2/19/20072/19/2007 11

Dr. M.A.L.R. Perera, MB; BS, M.Med.Sc & MD (Community Medicine)

Health Systems Management Specialist

Senior AssociateHealth Policy Research Associates (Pvt) Ltd.

DirectorInstitute for Health Policy

Former SecretaryMinistry of Health, Nutrition & Welfare,

Sri Lanka

2/19/20072/19/2007 22

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2/19/20072/19/2007 33

Serious disruption of the Serious disruption of the functioning of a community functioning of a community causing widespread human, causing widespread human, material, economic or material, economic or environmental losses which environmental losses which exceed the ability of the exceed the ability of the affected community or affected community or society to cope using its society to cope using its own resources. own resources. A disaster results from A disaster results from the combination of the combination of hazards, conditions of hazards, conditions of vulnerability and vulnerability and insufficient capacity or insufficient capacity or measures to reduce the measures to reduce the potential negative potential negative consequences of risk.consequences of risk.

Ex. Land slides

2/19/20072/19/2007 44

A potentially A potentially damaging physical damaging physical event, phenomenon event, phenomenon (volcano) or human (volcano) or human activity activity (deforestation) that (deforestation) that may cause the loss may cause the loss of life or injury, of life or injury, property damage, property damage, social and economic social and economic disruption or disruption or environmental environmental degradation. degradation.

2/19/20072/19/2007 55

The probability of The probability of harmful consequences, harmful consequences, or expected losses or expected losses (deaths, injuries, (deaths, injuries, property, livelihoods, property, livelihoods, economic activity economic activity disrupted or disrupted or environment damaged) environment damaged) resulting from resulting from interactions between interactions between natural or humannatural or human--induced hazards and induced hazards and vulnerable conditions. vulnerable conditions. (settlements in land (settlements in land slide prone slopes)slide prone slopes)

2/19/20072/19/2007 66

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2/19/20072/19/2007 88

84125121Partially damaged

152112Completely damaged

TotalOtherPreventiveCurativeType

Source: Ministry of Health website.

2/19/20072/19/2007 99

1001008.78.722.822.845.745.720.020.02.82.8PercentPercent

3535338816167711NumberNumber

TotalTotalStudent Student nursesnurses

Non technical Non technical staffstaff

Technical Technical staffstaff

MO / DSMO / DSSpecialist Specialist MOMO

CategoryCategory

Source Ministry of health

Total affected 689

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2/19/20072/19/2007 1111

oo Economy / industryEconomy / industryoo 1,615 km of roadway 1,615 km of roadway

(including 1,137 km of (including 1,137 km of National Roads) with 25 National Roads) with 25 bridges and Causeways bridges and Causeways damageddamagedSchools Schools -- 3,5473,54759 fully, 102 partially 59 fully, 102 partially damageddamaged

2/19/20072/19/2007 1212

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2/19/20072/19/2007 1818

1201 1201 -- Egypt & Syria Egypt & Syria -- deadliest earthquake in history deadliest earthquake in history -- 1.1 million 1.1 million people killedpeople killed13471347--1350 1350 -- bubonic plague bubonic plague -- 25 million killed (25 25 million killed (25 -- 33%of population of 33%of population of Europe + millions in Asia and North Africa died)Europe + millions in Asia and North Africa died)16th16th--18th centuries 18th centuries -- Western Hemisphere Western Hemisphere -- millions of lives of millions of lives of American Indians lost through various sicknesses brought over frAmerican Indians lost through various sicknesses brought over from om Europe (lacked previous exposure & resistance)Europe (lacked previous exposure & resistance)1769 1769 -- India India -- 10 million people died from a famine in Bengal.10 million people died from a famine in Bengal.1876 1876 -- 1879 1879 -- China deadliest drought in recorded history China deadliest drought in recorded history -- 9 million 9 million dieddied19181918--19 19 -- Influenza pandemic 35 Influenza pandemic 35 -- 75million lives75million lives1935 1935 -- China, Yellow River flood China, Yellow River flood -- 3.4 million victims ( lives lost not 3.4 million victims ( lives lost not estimated) estimated) 19581958--61 61 –– China China -- famine 20 million died famine 20 million died 19951995--98 98 –– North Korea North Korea -- famine and floods three million died famine and floods three million died 19811981--1984 1984 -- Africa (20 African nations) Africa (20 African nations) -- drought drought -- During one season, During one season, about 20,000 were starving to death each month. Some 150 millionabout 20,000 were starving to death each month. Some 150 millionfaced starvation.faced starvation.

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2/19/20072/19/2007 2121

Sri LankaSri Lanka 7.1%. 7.1%. India 18.1 %India 18.1 %Indonesia 17.7%Indonesia 17.7%Maldives 5.4%Maldives 5.4%District severity District severity ranged from 0.2% in ranged from 0.2% in Puttlam to 60.6% in Puttlam to 60.6% in Batticaloa Batticaloa

12.8

8.4

24.4

41.3

60.6

49.4

12.9

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4.6

21.3

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2/19/20072/19/2007 2222

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2/19/20072/19/2007 2323

31,187 perished, 31,187 perished, 4,280 missing (total 4,280 missing (total 35,467). 35,467). Children, womenChildren, womenMortality rate 2.67%. Mortality rate 2.67%. Injured 23,189 Injured 23,189 (injured to deaths (injured to deaths ratio 1:1.53). ratio 1:1.53).

2/19/20072/19/2007 2424

5.53%5.53%1629116291294494294494TotalTotal16.43%16.43%371037102258022580MulaitivuMulaitivu0.28%0.28%3310651065KilinochchiKilinochchi8.72%8.72%175717572015620156JaffnaJaffna2.44%2.44%188118817702977029BatticaloaBatticaloa2.56%2.56%6476472524525245KalutaraKalutara3.97%3.97%142314233586235862TrincoTrinco0.88%0.88%22228228PuttalamPuttalam

13.48%13.48%1168116886678667HambantotaHambantota7.58%7.58%205220522708827088MataraMatara1.83%1.83%4484482452424524ColomboColombo2.32%2.32%10010043074307GampahaGampaha6.49%6.49%310031004774347743GalleGalle

Rate Rate (%)(%)

Injured, sick, Injured, sick, disableddisabled

Affected Affected populationpopulationDistrictDistrict

Source Department of Census & Statistics

2/19/20072/19/2007 2525

100100488488TotalTotal0.610.6133

Infective Wounds (Existing wounds contaminated Infective Wounds (Existing wounds contaminated tsunami tidal water)tsunami tidal water)

43.6543.65213213***Near drowning***Near drowning0.410.4122All other burns All other burns –– (Electrocutions)(Electrocutions)25.8225.82126126**Other injuries of specified and multiple body regions**Other injuries of specified and multiple body regions1.841.8499Crushing injuries and traumatic amputationsCrushing injuries and traumatic amputations0.410.4122Injury of other internal organsInjury of other internal organs1.021.0255Dislocations, sprains and strainsDislocations, sprains and strains10.2410.245050*Fractures*Fractures

16167878Superficial injurySuperficial injury%%No:No:Nature of injuryNature of injury

Source TH Karapitiya

2/19/20072/19/2007 2626

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Cases & carriersCases & carriers

PathogensPathogens

VectorsVectors

SuseptiblesSuseptibles

2/19/20072/19/2007 2828

Cases & carriersCases & carriers

PathogensPathogens

VectorsVectors

SuseptiblesSuseptibles

2/19/20072/19/2007 2929

2215152525303090901,5381,5382,1632,1633,0833,083IncidenceIncidence

MeaslesMeaslesMalariaMalariaMumpsMumpsChicken Chicken poxpox

DysenteryDysenteryDiarrhoeaDiarrhoeaRespiratory Respiratory infectionsinfections

Viral feverViral feverDiseaseDisease

In welfare centres up to 18th. March, 2005 (population as of 04.03.05, 123,298)

Reflection of the usual endemic back ground morbidity exacerbated by the over crowded conditions in welfare centres.

Water borne, based & washed diseases are usual in welfare centres.

No epidemics

2/19/20072/19/2007 3030

oo No consensus on main No consensus on main problems / no sense of the problems / no sense of the scale / prevalence of thesescale / prevalence of these

oo Evidence of tension between Evidence of tension between hosts and displaced people. hosts and displaced people.

oo Pressure from hosts to have Pressure from hosts to have displaced persons removed displaced persons removed from shelters (Schools or from shelters (Schools or public buildings)public buildings)

oo Harsh treatment of displaced Harsh treatment of displaced children in host schoolschildren in host schools

oo State has registered orphans, State has registered orphans, encouraged care within encouraged care within extended family and extended family and provided them with financial provided them with financial assistanceassistance

2/19/20072/19/2007 3131

The role of hospitalsThe role of hospitals

Experience of the National Experience of the National Hospital of Sri LankaHospital of Sri Lanka

2/19/20072/19/2007 3232

Site arrangement:Site arrangement:Forward Command Post Forward Command Post –– Operations are Operations are directed and controlled from this point.directed and controlled from this point.Casualty Collecting Area Casualty Collecting Area –– Casualties are Casualties are initially assembled & triaged.initially assembled & triaged.Patient Treatment Post Patient Treatment Post –– Triage treatment of Triage treatment of all casualties.all casualties.Ambulance Loading Point Ambulance Loading Point –– Patients are Patients are loaded at this point.loaded at this point.Ambulance Holding Point Ambulance Holding Point –– Vehicles are Vehicles are marshaled here.marshaled here.

2/19/20072/19/2007 3333

ACTIVITIES:ACTIVITIES:

Receiving information about the disaster.Receiving information about the disaster.Activation of the disaster plan.Activation of the disaster plan.Disaster stocks.Disaster stocks.Ambulances to the site.Ambulances to the site.Bay to receive patients.Bay to receive patients.Strengthen the security.Strengthen the security.Alert different sections of the hospital.Alert different sections of the hospital.

2/19/20072/19/2007 3434

Receiving patients Receiving patients -- Admitting & treating large Admitting & treating large number of patients within a short period of number of patients within a short period of time time –– Most difficult task.Most difficult task.Triage & sorting out dead bodies.Triage & sorting out dead bodies.Taking care of belongings of the patients.Taking care of belongings of the patients.Crowd control.Crowd control.Seeking assistance from other hospitals Seeking assistance from other hospitals agencies.agencies.Registration of patients & identification of Registration of patients & identification of dead.dead.

2/19/20072/19/2007 3535

Refreshments to the staff & other Refreshments to the staff & other volunteers.volunteers.Statistics.Statistics.Dissemination of information to the Dissemination of information to the superiors & public.superiors & public.Handling visits of VIPs & media Handling visits of VIPs & media personnel.personnel.Infection control.Infection control.RehabilitationRehabilitation

2/19/20072/19/2007 3636

TRIAGETRIAGE

It is the process by which disaster It is the process by which disaster casualties are sorted, prioritised, and casualties are sorted, prioritised, and distributed according to the need for first distributed according to the need for first aid, resuscitation, emergency aid, resuscitation, emergency transportation, and definitive medical transportation, and definitive medical care.care.

Continuing process Continuing process –– Begins in the field Begins in the field and continues into the hospital.and continues into the hospital.

2/19/20072/19/2007 3737

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2/19/20072/19/2007 4141

Dug wells still appear to Dug wells still appear to be contaminated with be contaminated with salt watersalt waterGOs & NGOs have GOs & NGOs have attempted to clean attempted to clean thousands of private thousands of private dug wells by pumping dug wells by pumping out salty water in the out salty water in the wells, often several wells, often several times.times.

2/19/20072/19/2007 4242

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2/19/20072/19/2007 4747

Object Object -- prevention, prevention, protect life & property, protect life & property, maintenance & maintenance & restoration of order, restoration of order, provide facilities for provide facilities for relief & rehabilitationrelief & rehabilitation

National council for National council for disaster management & disaster management & functionsfunctionsDeclaration of state of Declaration of state of disasterdisasterPresidentPresident’’s powerss powersPreparedness & Preparedness & mitigation plansmitigation plansNatural & human Natural & human disaster management disaster management centercenterDelegation of powersDelegation of powers

2/19/20072/19/2007 4848

1. Policies1. Policies2. Institutional arrangements2. Institutional arrangements3. Activation3. Activation4. Assessment of risks, 4. Assessment of risks,

hazards, response hazards, response capabilitiescapabilities

5. Mitigation5. Mitigation6. Preparedness, warning & 6. Preparedness, warning &

situation assessmentsituation assessment7. Response7. Response8. Recovery8. Recovery9. NGOs & private sector9. NGOs & private sector10. Public awareness10. Public awareness11.11. Guidelines for sub Guidelines for sub

national plansnational plans

2/19/20072/19/2007 4949

Rescue operationsRescue operationsThe local media "world The local media "world class" effortclass" effortPremises of TV stations Premises of TV stations inundated with relief inundated with relief material (Criss crossing material (Criss crossing the country)the country)Government machinery Government machinery kicked inkicked inInternational International community community

2/19/20072/19/2007 5050

Health system Health system responded immediatelyresponded immediatelyCasualtiesCasualtiesPHC to welfare centres PHC to welfare centres Mobile clinicsMobile clinicsLocalLocalForeign Foreign –– self sufficient self sufficient & reliant& reliant

Requirements in Requirements in websitewebsiteDisease surveillanceDisease surveillanceAnte natal & child Ante natal & child development recordsdevelopment recordsPsycho social supportPsycho social supportSanitationSanitation

2/19/20072/19/2007 5151

30% of the pharmaceuticals, & 30% of the pharmaceuticals, & biologicals unusablebiologicals unusableAbout 5% had passed expiry About 5% had passed expiry dates dates About 10% had package About 10% had package inserts in languages that inserts in languages that could not be read could not be read Another 5% were found to be Another 5% were found to be unregistered & had never unregistered & had never been used in the country been used in the country Another5% in strengths not Another5% in strengths not used in the country used in the country 22 lorry loads were sent to 22 lorry loads were sent to dumping sites for disposaldumping sites for disposalAnother 60 lorry loads to be Another 60 lorry loads to be disposed ofdisposed of

2/19/20072/19/2007 5252

oo Lost opportunity (plan)Lost opportunity (plan)oo Changing face of disastersChanging face of disastersoo Damage to health Damage to health

infrastructure (17.3% of infrastructure (17.3% of curative )curative )

oo Vulnerability Vulnerability oo Evacuation, alternativesEvacuation, alternativesoo Targeting services to Targeting services to

vulnerable population vulnerable population groups groups

oo Disease surveillance (Disease surveillance (gather gather intelligence )intelligence )

oo InterInter--sectoral coordination sectoral coordination (national, divisional)(national, divisional)

oo Civil society participation Civil society participation oo MIS (pyramidal)MIS (pyramidal)oo Visits by dignitariesVisits by dignitariesoo Need for hazard analysis & Need for hazard analysis &

mappingmappingoo Siting of temporary sheltersSiting of temporary sheltersoo Medico legalMedico legaloo Professional bodiesProfessional bodies

2/19/20072/19/2007 5353

Tsunami is a Japanese word for Tsunami is a Japanese word for "harbour wave"harbour wave““

From an entirely different perspective, From an entirely different perspective, anotheranother Japanese word for crisis Japanese word for crisis

(weichi) has two connotations. They(weichi) has two connotations. They are are danger and opportunitydanger and opportunity

Even in the midst ofEven in the midst of calamities there are calamities there are likely to be windows of opportunitylikely to be windows of opportunity

2/19/20072/19/2007 5454