Transformative Education
for Health Professionals

Mainstreaming Disaster Health Education

Background

Disaster Health has often been a reactionary approach for policy makers and Governance in India. In the year 2014, India witnessed a massive flood in Jammu and Kashmir region which was the costliest natural disaster of 2014 causing a loss and damage of US$ 16 Billion. Cyclone Hudhud in Visakhapatnam caused a loss of US$ 7 billion. [1]

The recent Chennai floods of 2015, created a significant socio-economic impact on India’s economy with an estimated loss of over $3 billion (Rs 20,034 crore), according to Aon Benfield. [2] Disasters strike anywhere and anytime, disaster awareness and preparedness remains the key. Human settlements are often located near river banks with illegal settlements wide spread, so the need take a social determinants of helath approach remains imperative. [3]

Health-work force have not been oriented towards practices of disaster risk reduction and even less about disaster resilience. Medical education in India is less inclined to prioritize the need to promote disaster health literacy.

                                                                                

A high level stakeholder meeting organized by Center for Health and Development, Mangalore, International Institute of Health Management Research, Delhi and Alliance for Adaptation and Disaster Risk Reduction, Delhi with Yenepoya University, Mangalore being the Knowledge Partner and Corporation Bank, the Banking Partner recently concluded in New Delhi which focused on “Building India’s Disaster Health Infrastructure.” In the proceeding report addressing future directives, it was unanimously agreed upon that present day medical education is highly insufficient and does not orient medical students towards Disaster Risk Reduction. It says, “We teach them to inspect, palpate, percuss and auscultate but we do not teach them to be disaster prepared, disaster resilient and disaster trained. It was thought about that community medicine departments in medical colleges should play an active role in orienting and sensitizing medical students towards the practical components of disaster management. The report also spoke about the need for medical college hospitals to offer courses and fellowship programmes in Disaster Management and Humanitarian Emergencies.[4]

Private sector organizations and registered humanitarian organizations like Help Age India, Action Aid International, SEEDS India, AMDA International, Save The Children, Doctors Without Borders and of course UN agencies like UNICEF and WHO have been pioneering relief and response in humanitarian emergencies. India has largely been relying on the goodwill of such organizations to manage mass casualties, medical relief and re-build crumbling infrastructure post-disaster.

But from the perspectives of health, we lack capacity building, skills and orientation of doctors towards practicing medicine with limited resources. How to set up field hospitals, how to identify and manage dead bodies, how to dispose the dead, protecting women from rape and molestations and ensure children are not trafficked need to be addressed more deeply and guidelines that are already laid out, need to be followed and reinforced. During disasters, in the quest for saving their souls, people often leave their medicines, their id cards and just escape to safer havens. Re-establishing primary healthcare remains of utmost priority in any humanitarian emergencies, channels for procuring other medicines should be open an those suffering from chronic diseases should get the medicines immediately.

The Paris Agreement on climate action has put significant political pressure on member nations to act. But disaster health has never been seen as a political priority since 1947. Indian sub-continent is among the world’s disaster prone areas, yet our indifference on such aspects is extremely shameful. Year after year, floods, earthquakes and cyclones continue to hit different regions in the country. People die, families are broke and the socio-economic loss, simply enormous. Post disaster, the politicians visit, promise to sanction some amount to the victims and beneficiaries and the episodes are then forgotten.

Disaster Management Act 2005

The Disaster Management Act was passed in 2005 which structured an action plan at different levels for execution, but history will record that ever since 2005 we have had numerous disasters which as a nation we could do nothing about. Aspects of classifying disasters, declaring disaster prone zones, streamlining responsibility and involvement of local communities are neglected in the Act. Medical education curriculum does not highlight the act to undergraduate students of medicine. [5]

Doctors & Diseases in Disasters

Disaster Health is a missing link in the India’s Disaster Resilience story. The number of doctors engaged in Mainstreaming disaster health is very minimal. As per the WHO’s Global Atlas of the Health Workforce (WHO 2010b) data, India ranked 52 of the 57 countries facing human resources for health (HRH) crisis.

The number of doctors, nurses and midwives, put together as a health workforce is less than 25 health workers per 10,000 populations which is below the threshold laid down by the Joint Learning Initiative of the World Health Organization in 2004. [6] The number significantly reduces when the topic to mainstream disaster health and further health education crops up.

Disasters usually see outbreaks of many communicable diseases like Measles, Diarrhoea, Cholera, Leptospirosis, it also aggravates non communicable diseases like Chronic Kidney Diseases, Diabetes and Hypertension mainly due to inability to procure medicines immediately. Pregnant mothers suffer due to poor access to health services post disasters and the vulnerability they face is enormous.

Shaping Disaster Health through resilience and education

The time has arrived where disaster health needs to be shaped by creating disaster resilient communities and empowering more Community Medicine physicians to address the global concerns of Disaster Risk Reduction and mainstreaming health in humanitarian emergencies. High degree of sensitization needs to be created through IEC activities promoting disaster preparedness and health work force needs to undergo mock drills on a regular basis.

Newer health challenges threaten human security. There are infectious diseases, environmental problems like vector breeding and other behavioural risk that affect health in disasters. Rapid demographic and epidemiological transitions which lead to changing landscape and changing disease dynamics adds greater challenges to address the problems. Disaster health has to be achieved by engaging in people’s participation through behaviour change communication and by protective motivation theory where communities understand that there is risk sufficient enough to warrant concerns. Only a culture of safety and culture of prevention can promote disaster health and help communities anticipate ahead of their times.

Localizing Sendai Framework

Among the seven targets enlisted in the Sendai Framework, it remains important for medical doctors and health workers to echo target D, which speaks about, “Substantially reduce disaster damage to critical infrastructure and disruption of basic services, among them health and educational facilities, including through developing their resilience by 2030.”[7]

Local District hospitals should table this for discussion and District Disaster Management Authority meetings should form a comprehensive plan to address the same. A task force committee can be created which involves 2 members each from civil society, doctors, social scientists, engineers, police to deliberate and bring in convergence of Disaster Health.

Conclusion

Disaster Health education needs to become a national priority and it should be integrated into medical education also as an exam subject for MBBS students. It is essentially through disaster health education that health workers will anticipate and be prepared for likely disasters. There is paucity of effort being put into enhance knowledge base in disasters and climate related factors. With Goal 13 of Sustainable Development focusing on Climate action, we might as well get inspired. More-so disaster response forces should involve public health doctors and further health as a priority development agenda. Regulatory authorities like Medical Council of India should call for a situation review to Mainstream Disaster Health and create resilient communities.

Dr Edmond Fernandes, MBBS, PGDip - PHSM

Edmond Fernandes is CEO, Center for Health and Development, (CHD-India). He can be reached at edmondvirgo@gmail.com

References:

  1. Guha-Sapir D, Hoyois Ph. Below. R. Annual Disaster Statistical Review 2014: The Numbers and Trends. Brussels: CRED; 2015
  2. Aon Benfield (2015) Global Catastrophe Recap, Aon Analytics.
  3. Smitha TK (December 11, 2015) Human Negligence Cause Chennai Flood Carnage, Say Urban Planning Experts, Available at: http://www.ndtv.com/chennai-news/human-negligence-cause-chennai-flood-ca...(Accessed: 29th April, 2016).
  4. Fernandes E, Center for Health and Development (March, 2016) Building India's Disaster Health Infrastructure, Mangalore/New Delhi, India: Center for Health and Development (CHD-India).
  5. Disaster Management Act 2005, A Disaster In waiting? Subhradipta Sarkar,Archana Sarma, Economic and Political Weekly September 2. 2006. 3761-63.
  6. Joint Learning Initiative (2004): “Human Resources for Health: Overcoming the Crisis,” Global Equity Initiative, Harvard University, Boston, http://www.who.int/hrh/documents/JLi_hrh_ report.pdf, accessed on 19th January 2016.
  7. Sendai Framework for Disaster Risk Reduction 2015 – 2030. Available online on http://www.unisdr.org/files/43291_sendaiframeworkfordrren.pdf. Last Accessed 20th January, 2016.