bonddonraj
Par 100 posts (V.I.P)
PLANNING FOR NATURAL DISASTERS
GUIDING PRINCIPLES FOR HEALTH SECTOR FLOOD MANAGEMENT
Natural calamities like flood are regular phenomena in India. Some parts of the country are more prone than others. With scientific development, flood forecasting is made much in advance. Therefore, public health measures can be well planned in advance in a systematic and scientific manner.
Public Health Risks
The health problems relating to flood can be either due to direct impact on human population and on existing infrastructure and resultant effects due to combination of these factors.
A. Direct impact : Resulting in drowning.
B. Damage to existing infrastructures :
(i) Direct effect on water, power supply and sanitation facilities, forcing the community to consume polluted water and stay in unsanitary condition.
(ii) Damage to existing health infrastructure resulting in ineffective functioning of available facilities.
(iii) Destruction houses : The affected population is exposed to adverse climatic conditions leading to disease particularly respiratory infection and fever.
(iv) Damaged ration shops and other shops providing food may lead to shortage of food in affected community leading to starvation conditions.
C. Combination of factors : The above factors may change the living conditions of the community temporarily till they are finally rehabilitated. Sudden change in environment leads to following factors, each contributing to health problems.
(i) Population displacement : there are two ways by which population displacement may affect the health of the affected community :
(a) Movement of population results in overcrowding at new places with possibility of transmission of diseases from moving population to local population of new places.
(b) Health problems in temporary shelters : When the affected community is shifted temporarily to a new place, existing water supply system, toilet, cooking space becomes inadequate leading to insanitary conditions resulting in different types of diseases specially diarrhoeal disease. Epidemic may be a possibility.
(ii) Population Density : Density of population increases proximity, resulting in spread of communicable diseases.
(iii) Work pressure on existing health infrastructure : The existing health centers may suddenly start getting large number of patients which may be more than their absorbing capacity. Additionally, if these centers are also affected by floods, it may be difficult for them to discharge their responsibility.
(iv) Psychological manifestation : Loss of property or loss of lives of relatives produce tremendous tension and pressure on mind of people resulting in anxiety, neurosis or depressions.
List of common ailments / diseases found after floods
Types of ailments Due to
1. Water-borne diseases Diarrhoeal - Non-availability / Inadequate availability
diseases (cholera, gastroenteritis, of drinking water due to :
dysentery, etc.) Infective hepatitis, (a) Flooding of wells with polluted
poliomyelitis drinking water
(b) Breakdown of piped water supply
(c) Inaccessibility of available water sources. Insanitary conditions in villages / evacuation camps due to :
(i) accumulation water;
(ii) lack of excreta disposal;
(iii) blockage/disruption of normal drain;
(iv) slush with increase in breeding space for flies;
(v) overcrowding;
(vi) dumping of compound dry refuse;
(vii) dumping of animal excreta;
(viii) dumping of carcasses
2. Malaria / Filaria - Increase in mosquito breeding space.
3. Skin disease / Eye diseases / - Lack of personal hygience and
Respiratory diseases overcrowding.
4. Respiratory diseases - Adverse condition of living.
5. Snake / Insects bite - Water entering into their shelters.
6. Injuries (not very common) - Collapse of houses / standing structure
SPECIFIC PUBLIC EHALTH ACTIVITIES FOR FLOOD
A. Preventive Measures
Water-borne diseases are one of the most common phenomena during flood. Diarrhoeal disease is one of the earliest manifestations but diseases like typhoid and infective hepatitis are usually seen after about a fortnight. Therefore, emphasis is given consumption of safe drinking water and sanitary waste disposal.
(i) Safe drinking water : Safety of drinking water has to be ensured at the point of storage and distribution. Various methods are :
(a) Boiled water : Water could be boiled for 10 to 15 minutes and then stored in clear and covered containers. From large container water can be drawn by a long handle utensil.
(b) Use of chlorine tablets : Nascent chlorine makes water safe for drinking : 1 tab (0-5 gm) can be used to chlorimate 1 bucket (15-20 l) of water.
(c) Bleaching powder : Bleaching powder is used to disinfect usually large amount of water. Usual dose (with 35% chlorine) 2 gms for 5 litres of water : 1 table spoon (5 gms) of bleaching powder for 80 litres of water. The quantity of a water source can be estimated as :
(1) For rectangular = length breadth height (meter) 1000 = quantity in litres
(2) For cylindrical = height radius in m2 3140 = quantity in litres
(d) Monitoring : Chlorine content of water is estimated by chlorinometer. 0-5 mg/l of free residual chlorine should be available in water after 30 minutes of contact for safe drinking.
(e) Bacteriological examination of water should be done at frequent intervals. (Facial coliforms per 100 ml should be below 10 for reasonable quality).
(ii) Disposal of waste water and excreta : Existing infrastructure is likely to become infective. Therefore, adequate arrangements for disposal of wastes should planned in advance, so that it can be executed immediately.
Minimum numbers of toilets at public places and institutions in disaster situations
Short Term Long Term
1 toilet to 50 stalls
1 toilet to 20 beds or 50 out-patients
1 toilet to 50 adults
1 toilet to 20 staff
Children – 1 toilet per 50
3:1 female to male
1 toilet to 30 girls, 1 toilet to 60 boys 1 toilet to 20 stalls
1 toilet to 10 beds or 20 out-patients
1 toilet to 20 adults
1 toilet to 10 children
1 toilet to 30 girls, 1 toilet to 60 boys
1 toilet to 20 staff
VACCINATION IN CASE OF DISASTER
A decision regarding vaccination should be taken by concerned authorities at higher level based on the following principles:
The health authorities are usually under considerable pressure by local media, public & politician to begin mass vaccination usually against tetanus, cholera & typhoid. The situation should be handled by educating concerned people about the role of these vaccines in such scenario. World health organization does not recommend typhoid & cholera vaccine routinely in endemic areas.
The mass vaccination against tetanus is unnecessary. The focus should be on correct case management including wound cleaning. The injured who had received full TT immunization in last five years should receive only one dose in previously unimmunised person two doses of TT is required.
Currently available cholera & typhoid vaccines are multi dose & these do not have proven role in stopping outbreak.
Measles vaccination is of specific importance in areas where measles vaccination is low. All the children between 6months to 5 years of age (irrespective of their previous immunization status) who are housed in either camps/ make shift arrangements, should be administered a dose of measles vaccine as soon as they arrive in the camps. Vaccination may not have substantial impact on the outbreak control as children are likely to have been exposed by the time vaccine is initiated.
1. The surveillance system for vaccine preventable disease should be strengthened at disaster sites. Routine vaccination, specifically against, measles need to be strengthened in disaster affected areas.
2. Some other vaccine may be considered in such scenario with specific indications.
• Diptheria: close contacts should be given erythromycin while other contacts may be given vaccine.
• Influenza: Priority should be given to patients with chronic disease & immunodeficiency.
• Plague vaccine may be given for individual protection.
3. Natural disaster may have negative impact on ongoing national programmes viz. measles control & polio eradication. Their disruption should be closely monitored.
4. Any decision to conduct mass vaccination programmes in such scenario should be taken only after considering following issues –
• Vaccination programmes require large number of workers who could be better employed elsewhere.
• To maintain proper sterilization & injection techniques may be difficult resulting in more harm then good.
• Mass vaccination may give false sense of security resulting in neglect of other effective control vaccines.
(iii) Fly proofing : Areas including houses / shelters should be disinfected regularly by spray of bleaching powder.
(iv) Health education : Use of mass media like radio, newspaper, pamphlets, leaflets containing small repeated message on following points should be transmitted to the population :
- personal hygiene
- water consumption
- use of boiled water and chlorine tablets
- food consumption – avoid use of food prepared and stored in the open.
- Cheap ice creams, stale and overnight food should not be consumed
(v) Surveillance : A close watch is required to be kept so that any rise indisease can be detected at very early stage. This can be done with a careful watch at the peripheral level, viz. village in rural area and ward in urban area respectively.
(1) Early detection of unexpected increased occurrence
The unusual rising pattern of any disease can be detected easily be keeping a watch at sub-centre and PHC levels and in urban areas by noticing more number of cases with similar symptoms coming from a particular village of locality (say more than 5 persons / locality).
(2) Immediate investigation
In case of rising trend of diseases. Investigation should include the following points :
(a) Assessment of the situation by the health official;
(b) Detection of the source of spread of infection by identification of house, persona and locality;
(c) Investigation of diseases like in case of diarrhoeal diseases by stool examination, stool culture, etc.;
(d) Immediate isolation of the source;
(e) Requisition of special medical team for investigation from the District or medical colleges, if required.
(3) Preventive measures against diseases
Specific points are :
(a) Disinfection of water sources by chlorination at intervals;
(b) Distribution of chlorine tablets to local population with necessary instructions for its use;
(c) Immunization against diseases for high-risk group population;
(d) In case of municipalities and notified areas, arrangements for proper disposal of water and human excreta;
(e) Publicity and health education with pamphlets, newspapers about do’s and don’ts;
(f) Health check up for high-risk group like children below 5 years, pregnant and lactating mothers and old persons in anganwadis, Balwadis, Chaupal, schools, etc.;
(g) Close surveillance.
(4) Immediate action in case of rising disease patterns
(a) Arrangement for extra manpower / doctors, paramedicos and other staff;
(b) Arrangement for quick mobility;
(c) Sufficient drugs, vaccines and other medical stores;
(d) Establishment of evacuation / isolation camps;
(e) Close supervisiona nd periodical evaluation and reporting;
(5) Feedback at various levels
Feedback is extremely essential to keep close watch at different levels for timely action. Information from the field should be small and specific.
(a) From sub-centre to PHC.
(b) From PHC to District.
(c) At the District, between Public Health Officials and District Medical Colleges authorities and District Collector.
(d) From the District to the State Headquarters.
(e) From the State Headquarters to the Centre (EMR Section – Tel. No. 23061955).
(f) Establishment of control rooms at PHC, District and State Headquarters.
ADMINISTRATIVE ARRANGEMENTS
1. Identification of Target Groups
In flood prone areas, villages and PHCs should be identified which are commonly affected by flood. Having done so, attention to be paid to target groups like children, pregnant and nursing mothers, old and infants, as they pose special health problems.
2. Procurement of Medical Stores
There is no need to stock a large quantity of a number of medicines. It is expected that only about 10% of the affected population may require medical treatment. Most common diseases are diarrhoeal diseases including gastroenteritis, dysenteries and cholera, typhoid and infective hepatitis. Other common diseases are respiratory infections, skin diseases, malaria and snake bites. Medical stores should include disposable syringes / AD, ORS and other important drugs.
3. Disinfection of Drinking Water Sources and Frequent monitoring at Storate and Distribution Points
Necessary administrative measures may be taken to distribute chlorine tablets, bleaching powder and estimate chlorine content of water at distribution points.
4. Immunization
It is better and cost effective to start immunization against certain diseases like polio and DPT much earlier, specially of children. In case of suspicion of rising pattern of diseases, immunization should be initiated only in valnerable groups in endemic areas.
5. Establishment of Medical and Health Camps
In addition to the existing establishments like dispensaries, PHC, taluka, district and Medical College hospitals, arrangements for mobile and fixed camps may be planned in advance to render medical aid in flood affected areas where existing infrastructure is likely to be ineffective. Arrangements for transport facilities should be make for every medical health camp to transport critically ill persons to higher level referral centers.
6. Setting up of Epidemiological Surveillance
Epidemiological surveillance should be set up through PHC and incidence of epidemic prone diseases should be notified to the health authorities regularly.
7. Publicity and Health Education
Adequate publicity should be given to inform the people about thelocation of various medical and health camps and other medical units. People should be informed from time to time about the public health measures to be practiced by them.
8. Monitoring and Review
(a) A cell should established under the charge of senior officer in the Directorate of Health Services to exclusively monitor and review the public health measures in the affected areas in the State.
(b) The epidemiological cell of the Directorate of Health Services should be alerted and asked to keep itself ready for any eventuality if any epidemic disease breaks out. The unit should also be asked to take anticipatory preventive measures in the form of obtaining information in respect of epidemic prone diseases, immunization of preventable diseases, etc. the emergency drugs, vaccines etc. should be procured and kept ready.
(c) Similarly, one officer should be identified at the District level to coordinate and monitor all public health measures for flood affected areas in the district.
(d) The Directorate of Health Services in State should send regularly information to the Directorate General of Health Services.
CHECK LIST OF POINTS FOR MONITORING ARRANGEMENTS FOR PUBLIC HEALTH & MEDICAL PROBLEMS IN FLOOD-PRONE AREAS
1. General
(i) Have all the villages which are affected or are likely to be affected by flood been identified?
(ii) Has the requirement of medical and paramedical staff for attending to the health needs of flood-prone villages during the period been assessed?
(iii) Have the medical and paramedical personnel who may be required to be deployed been identified?
(iv) Have such personnel been given special training to attend to medical and public health problems which may arise in flood areas?
(v) Have surveillance teams consisting of bacteriologists to conduct on-the-spot random stool examination been constituted?
(vi) Has the requirement of drugs, disinfectants like bleaching powder / chlorine tablets and vaccines etc. been worked out?
(vii) Has the availability of existing stocks been estimated?
(viii) Have arrangements been made for the procurement of additional stocks required?
2. Action
(i) Has adequate publicity been given in the flood-prone areas on how to use the disinfectants and take other precautionary measures?
(ii) Have the anti-fly and anti-mosquito measures been taken?
(iii) Have the treatment centers been identified?
(iv) Do the villagers of each village know which treatment center to go to in case of need?
(v) Has the adequacy of the existing treatment centers been assessed?
(vi) If the additional treatment centers are required to be temporarily set up, have their locations been identified?
(vii) In case additional treatment centers are required, have the sources from which additional staff would be obtained been identified?
(viii) Has the availability of various drugs, vaccines etc. at such treatment center been assessed?
(ix) Have arrangements been made to supply additional drugs and vaccines etc. in treatment centers where existing stocks are not adequate?
3. Monitoring
(i) Has a senior officer in the Directorate of Health Services been identified to look after exclusively the problems of flood-prone areas during the flood session?
(ii) Have such officers been earmarked at the District and the Block levels?
(iii) Have such arrangements been made for feedback information from Health Centres to the Block, District and State Headquarters for periodical assessment of the situation and the availability of staff and stock position?
(iv) Do arrangements exist to report from the treatment centers to higher levels about any rise in the incidence of gastroenteritis, dysentery, cholera and jaundice?
GUIDING PRINCIPLES FOR HEALTH SECTOR DROUGHT MANAGEMENT
Drought, whatever the cause, has continued unabated to ravage many states in India. Drought is a protracted emergency, which invariably leads to shortage of food. The problem gets multiplied if poverty, illiteracy and backwardness are also associated. The impact is thus most in the sphere of nutrition in general and especially among children, lactating and pregnant mothers. Vitamin A deficiency occurs and in its mildest form causes night-blindness or at its worst blindness and death.
Many more come into contact with diseases such as malaria which easily prove fatal as resistance is low. During the prolonged and severe famine situation, the following communicable diseases are rampant and rapidly reach epidemic proportion; Measles, Meningitis, acute Diarrhoea and Dysentery; Viral hepatitis and Typhoid.
CONTINGENCY PLAN FOR MEDICAL CARE DURING DROUGHT
A cell should be established under the charge of a senior officer in the Directorate of Health Services to exclusively monitor and review the public health measures for the drought affected areas in the State.
The epidemiological cell of the Directorate of Health Services should be altered and asked to keep itself ready to meet any eventuality if any epidemic disease breaks out. Similarly, one officer should be identified at the district level of coordinate and monitor al public health measures for the drought affected areas in the district.
The Directorate of Health Services should send regularly information to the Directorate General of Health Services, where an officer will be earmarked to receive all the information and process the same for onward transmission to the Department of Health.
Children below 5 years, expectant and nursing mothers are the special victims of drought. Every effort should be made to reach these populations groups on a priority basis. In the entire drought affected areas they will be around 20-30% of the total population. In addition, the aged, the infirm, the disabled and the destitutes will pose special problems during drought. The health officials should be instructed to look after these categories of people.
During drought, diseases like gastroenteritis, dehydration, pneumonia, cholera, typhoid, dysentery, measles, parasitic diseases and others including nutritional disorders will pose special problems. Adequate provision for antibiotics, ORS, Vitamins and other essential drugs need to be made.
All drinking water sources need to be identified and every efforts made to disinfect the same wit chlorine or bleaching powder. Depending upon the resources and the nature of water sources, this could be done two or three times a week under certain circumstances.
Every effort should be made to provide adequate bleaching powder to disinfect the identified drinking water sources.
Immediate steps need to be taken to project children and the pregnant women with the protective vaccine used for the programme through a special drive. All primary health centers should be provided with adequate stock of vaccines and instructed to carry out special immunization programme in respect of the identified population on a priority basis.
In addition to the existing established units of dispensaries, primary health centers, sub-divisional hospitals, medical and health centers, sub-divisional hospitals medical and health camps need to be established to provide emergency medical care and other medicare services to the affected persons. Arrangements for transport should be made available for every medical health camps to transport critically ill persons to higher level referral centers.
During the drought a large number of cattle are likely to die because of non-availability of fodder. Special care needs to be taken to protect these animals from diseases and death. Animal husbandry and veterinary department should be involved in providing relief measures through establishment of camps. During drought there is every possibility of a outbreak of epidemic diseases because of scarcity of water and nutritional deprivation. Therefore, effort should be made to set up epidemiological surveillance for epidemic prone diseases should be notified to the health authorities regularly.
CHECK LIST OF POINTS FOR MONITORING ARRANGMENTS FOR PUBLIC HEALTH AND MEDICAL PROBLEMS IN DROUGHT AFFECTED AREAS
General
1. Have all those villages which are affected for acute drinking water scarcity during the drought period been identified?
2. Has the minimum requirement of water during the drought period for the population of these villages been worked out?
3. has the quantum of available water during drought period in these villages been estimated?
4. Top make up for the shortage, have alternative sources of water for supply to these villages been identified?
Planning
1. Has the requirement of medical and para medical staff for attending to the health needs of drought-prone villages during the drought-period been assessed.
2. Have the medical and para-medical personnel who may be required to be deployed been identified?
3. Have such personnel been given special training to attend to medical and health problems which may arise in drought areas?
4. Have surveillance teams consisting of bacteriologists to conduct on-the-spot random stool examination been constituted?
5. Has the requirement of drugs, disinfectants like bleaching powder, chlorine tablets, ORS and vaccines etc. been worked out?
6. Has the availability of stocks been checked?
7. Have arrangements been made for the procurement of additional stock required?
Action
1. Has adequate publicity been given in the drought-prone areas about how to usethe disinfectants and take other precautionary measures?
2. Have the anti-fly and anti-mosquito measures been taken?
3. Have the treatment centers been identified?
4. Do the villagers of each village know which treatment centers to go to in case of need?
5. Has the adequacy of the existing treatment centers been assessed?
6. If additional treatment centers are required to be temporarily set up, have their location been identified?
7. In case additional treatment centers are required, have the sources from which additional staff would be obtained been identified.
8. Has the availability of various drugs, vaccines, etc. at such treatment center been assessed?
9. Have arrangements been made to supply additional drugs and vaccines etc. in treatment centers where existing stocks are not adequate.
Monitoring
1. Has a senior officer in the Directorate of Health Services been identified to look after exclusively the problems of drought-prone areas during the drought period?
2. Have such officers been earmarked at the District and the Block levels.
3. Have arrangements been made for feed-back information from Primary Health Centres to Block, District and State Headquarters for periodical assessment of the situation and availability of staff and stock position?
4. Do arrangements exist to report from the treatment centers to higher levels about any rise in the incidence of gastroenteritis, dysentery, cholera, jaundice and polio?
