Nepal Earthquake Notes – 2 – Response

Our experiences their experiences

(This photo was taken from the Canterbury Public Health Response Document)

In 2011 February 22nd, Christchurch was struck with a 6.4 earthquake at about 12.51 PM in the afternoon. The epicentre of the earthquake was around a place known as Lyttleton. The city centre was badly affected, many buildings collapsed and particularly in the Eastern suburbs of Christchurch, the devastation was remarkable as hundreds of houses were immediately destroyed or were rendered useless for living. People were displaced and were accommodated in several shelters across the city and a massive restoration operation was launched. Immediately following the earthquake, the death tally stood at 185. Following the initial earthquake, the city suffered about 12,000 more aftershocks over the next three years. The citizens battled the aftershocks as they rebuilt the city. Four years later, Christchurch is again coming back to her former glory and plans are afoot for the renvewal of the city. But in the rebuild and reconstruction of the city of Christchurch hangs a tale that can have important lessons for everyone around the world.

In 2015 April 25th, Nepal, in Kathmandu suffered the result of a similar earthquake of much larger intensity 7.9 Richter scale epicentre located at Lamjang in the Kathmandu Valley and not far from Everest. This also led to massive damage, about 1900 lives lost in the first 24 hours itself, and massive losses of property. Several villages disappeared, and there were avalanches from Mount Everest and other mountains that added to the woe. At the time of writing this, rescue operations are underway and several aftershocks have already taken place.

At the time of writing this, a massive recovery operation is taking place, and you can learn more about the recovery operations here

I write this on the third day of the Nepal earthquake and would like to highlight some aspects of earthquake disaster management and strategies that I saw implemented in Christchurch. Some public health and disaster management measures certainly helped people of Christchurch and led to far fewer deaths and destructions that would otherwise occur. In no particular order,

  1. Immediately after the earthquake, the public health department issued warnings about boiling drinking water and restriction of the “flushing the toilet”. Which meant, the advisories were about conservation of water and keeping in mind that it was possible that the drinking water might be contaminated. It turns out that these two activities alone led to really less load of people with stomach related diseases that would otherwise occur.
  2. The city government formed a crisis management team and the mayor oversaw the operations. The control room effectively managed hundreds of visitors and worker bees who turned up to set up search and rescue operations that led to the recovery of bodies and clearing of people who were trapped in the debris.
  3. Several volunteer organisations set up shelters that allowed people to camp out and provided food, shelter, and clothing.
  4. In addition to medical services, several additional services such as mental health services and care were pressed into action.
  5. A thorough evaluation of every building was undertaken, and each building in each residential zone was “sticker”-ed, or colour coded so that the status of the building would be known.
  6. Fresh water was provided to the affected neighbourhoods
  7. Recovery operations were televised and tally of the deceased and recovered were made available to people.

A good description of the steps are available with the Wikipedia entry

The behavioural model, life span, arsenic toxicity and tying it all together


Initial thoughts on a model development explaining health care utilisation

While reading the 1987 classic text by Ronald Andersen on behavioural model of health care utilization and health care access, I wonder how he tied it all together in the sixties when he first drafted his behavioural model. The challenge in our times I guess is the issue around environment, and the new age of informaiton, technology and devices.

If one were to think of explaining how and why we use health services and pay for them, and indeed, what determine our access to health care throughout our life span, how would one go about it?

It boggles my mind what really goes on. What would be a reasonable way to explain the health care utilization pattern? From a purely health policy perspective, how does one tie together the concepts of health, the issues around who accesses healthcare and how, access to health care as health and illness develop across the life span of a person, and the role of physical environment.

  • What role does interaction with physical environment play in my access and utilization of health care services?
  • Does the pattern of my accessing health care services (rather utilization of health care services vary) over time as my life story evolves?
  • As my physical function changes over time?Does it matter how I was born, how I was raised, how I got my nutitional needs served in my infant-youth days the environment I was in?
    Does the utilization of health services, the health outcomes matter and depend on them?
  • Where are the evidences that they do?

At some point a novel model will emerge  to develop a model of health care utilization and identify a measure of access based on the role of environmental variables.

_That_ may well be the fifth phase of the health care utilization. However, there are other issues around. I think the current age is the age of information and I wonder if anyone has worked out a model that incorporates how information dissemination and informaiton technology and its usage has affected or impacted the health care utilization and how all of that affects and impacts health care usage and access?

Arsenic toxicity is a case in point. Being exposed to arsenic in groundwater definitely affects health care usage pattern and additionally it also explains to some extent how utilisation and access to care matters. I need to get my head around this for a while and come up with a dynamic model that:

1) Explains or predicts health care utilization
2) TAkes into account the issues around nutrition, diet, arsenic toxicity and arsenic metabolism and the role that elucidation of multiple variables take to explain usage

3) Extend the scope of the Andesen model to incorporate all of these features and more to show and extend the policy debates around them

Whose safety first?

Guy defusing a landmine

Whose life? Whose safety?

The picture above shows an official of a bomb disposal squad attempting to defuse a landmine that was booby trapped in a forest area of the West Bengal state of India. It was unfortunate that he died in the attempt as the landmine blew up on his face (for a detailed account and picture of how it all happened, read the page here:

Why was he doing what was he doing? Why was he prying open a potential live bomb with hammer and chisel with no safety equipment worn on him? It’s very unfortunate that our police forces are supposed to tackle issues like defusing live bombs and chase terrorists and people with guns, but more often than not, occupational safety issues are ignored.

It’s surprising that there is very little literature out there that addresses the issues of occupational safety for security personnel and police forces. I searched the Pubmed with the following keywords: “Occupational Health”[MeSH] AND “Police”[MeSH] to capture as much literature as I could. Here are the search results. I could retrieve about 53 articles, but none of them dealt with issues related to occupational hazards of police officials who disposed bombs, etc, or safety awareness among police officials, or intervention research to improve safety consciousness. No primary study, no secondary data analysis that could fit a systematic review. There may have been some research tucked somewhere, but at least Pubmed database did not archive any that could be retrieved by their generic keywords.

As police forces, particularly in countries like india, need to tackle problems of defusing bombs, and terrorist plots, there is a need for systematic training of these personnel in occupational hazards and safety awareness. This also needs to be reflected in research people do.

Journalists, particularly those who cover war and terror is the other very vulnerable group. In the blast that occured in West Bengal on the 21st September, 2006, several journalists got severly injured.

It’s sad, almost to the point of callousness that police officials and journalists paid so scant attention to their occupational hazards even as they deal with dangerous stuff day in and day out. There was clear lack of awareness; how do you explain the near Darwin award nomination style attempt to defuse a bomb with just chisel and hammers? The accidents and deaths yesterday were stark reminders of what could happen if you ignore safety.

There is an urgent need to set up studies on occupational safety and their awareness among security forces, police officials, and journalists. There is also a need for organizing regular training programs and training manuals for these occupational groups.

Anyone listening?