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Disaster Epidemiology Lessons From Bam
Earthquake Dec 26, 2003 Iran
Part 7: Health sector in Bam
earthquake A. Ardalan MD, MPH, PhD student in
Epidemiology1
Learning objectives:
To view the structure of health system in Bam
To understand the barriers of efficient health
services delivery in Bam
To learn about mental health interventions in Bam
To learn about surveillance system in Bam
To learn about health related concerns in Bam
2
Health
service
structure
Geographic
classification
Physical space
Instruments
Workforce composition
Duration of activities
Workforce tasks
Strategies for
service delivery
Workforce training
Volunteer peoples 3
Population movement after the earthquake
Zones
Earthquake-stricken area
4
Population Movement
Major concern and barrier for effective services delivery in Bam
1) Invasion of poor people from neighboring
areas to Bam
110,000
Population
before the
earthquake
40,000
Number of
death
90,000
Population at
the 1.5
months after the
earthquake
- = (?)
5
The most important reasons:
Poor environmental health condition of previous living
zone (85%)
Lack of accessibility to latrines (73%)
Recurrent referral of health personnel for census
(54%)
Being interested in being in front of their own
damaged house (49%)
Lack of sufficient environmental space for living (26%)
Population Movement
2) Changing living places inside the bam
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Water forsanitaryusage
Bath room Latrine Detergents
1th day
2nd day
3-5 days
> 5 days
7
Cumulative percent of the first time health services delivery to the earthquake-stricken households in Bam
till 20th days of post-disaster period
The overall satisfaction of the earthquake-stricken people from health services delivery
0%10%20%30%40%50%60%70%80%90%
Water forsanitaryusage
Bath room Latrine Detergents
High Moderate Low 8
The needs (expressed demands) of Bam earthquake-stricken households on 19th and
20th days of post-disaster periodBath room
74 %Food 69 %
Clothes 68 %
Heaters 62 %
Security 60 %
Latrine 49 %
Money 47 %
Others
9
10Addiction
10Irregular menstrual bleeding
13Movement disability
15Nausea / Vomiting
20 Oral & teeth problem
51Depression
60Acute respiratory infection
%IllnessIllness %
Suicide thought 5
Pregnancy 3
Low back pain 2
GI bleeding 1.5
Bloody diarrhea 1.5
Suicide attempt 1
The frequency of illnesses in the earthquake-stricken households till 19th and 20th days of
post-disaster period
10
29%26% 25%
23%20%
14%12%
0%
5%
10%
15%
20%
25%
30%
11
The needs (expressed demands) of Bam earthquake-stricken householdson19th and 20th days of post-disaster period
22%
15%
12%
9%7%
0%
5%
10%
15%
20%
25% Transportation
Unavailability of required servicesUnfamiliarity with health and medical centersDissatisfied from
previous servicesInappropriate
time
12
Main barriers in health services delivery in Bam earthquake-stricken households,
during first 20 days of post-disaster period
Some points about accommodation status of population
Determinants of aggregation places
Distances of tents
Risk of injuries
Cultural values
13
Social problems of earthquake-stricken households
in Bam till 20th days of post-disaster period
67%
56%
3%
0%
10%
20%
30%
40%
50%
60%
70%
Steeling Violance Sexual violance
Violence: Physical or psychological aggression 14
67%
14%9%
4%0.50%
6.00%
0%
10%
20%
30%
40%
50%
60%
70%
15
Substance abuse in Bam
Opium abuse
Prevalence before the earthquake: 30 % male, 5% female (anecdotal evidence)
Norm culture
A major problem in the treatment
of hospitalized patients
16
Opium odor
High price of
opium
Heroin
Injection
Low price of heroin
Lack of money
Security concern
Psychological
consequences
of earthquake
Unemployment
Inadequate withdrawal
services
17
Changing the pattern of substance abuse in Bam
Psychological Problems in Bam earthquake
A major consequence of disaster:
40% PTSD
Comprehensive Mental Health program by
Office of MH at MOH
MH and Social Working interventions
by State Welfare Organization
18
Mental health interventions in Bam
Office of Mental Health at Iranian MOH has
valuable experiences on MH interventions
in disaster situations, based on previous
earthquakes in Iran.
They are covering all population in Bam
by holding “Relief groups” to deal with
PTSD, Depression and Suicide.19
20
21
22
Between families had asked for news
about their relatives after the
earthquake and used from provided
list by governmental organization,
23% had found their response.
Public address system: Psychological importance
23
Mass Graves in Bam Myths and Realities
Political environment
Bad odor
Cultural beliefs
24
Current response
Modify the
system
Collection of additional
data
Additional analyses
Disseminating the result
Further action
Evaluation the action
Iterative process
Surveillance System
25
Evaluation of Designing Steps of the Surveillance System in Bam
Establishment of objectives
Development of case definitions
Determining data sources
Development of data-collection instruments
Testing the field
Development and testing of analysis strategy
Development of dissemination mechanism
Usefulness assessment of system 26
Pre-requirements of Surveillance System in disasters
Stable health management in crises
EpidemiologicKnowledge
Well-trained field-team
Network communication system
27
28
Some comments on the Disease Surveillance System in Bam
Necessity of effective training program
Improving effective communication system, especially internet
Surrounding area should not be missed
Integration of a JIT Outbreak Investigation System
Using available data on referrals to clinics and health centers instead of the population for denominator of the indicators accompany by providing necessary information on referral pattern of people. 29
Future Potential Risk Factors of Outbreaks in Bam
Hot weather
Re-establishment of pipe-water supplies
Low access to bathing facilities and risk of pediculosis and other cutaneous diseases
Past history of epidemics of typhoid fever and cholera
Endemicity of malaria and coetaneous leshmaniasis 30
Final Conclusion of the lecture:
Bam earthquake was a major disaster,
resulting in mass destruction and a very
high toll on human lives and health.
These losses cannot be justified in light
of existing scientific knowledge and
expertise in disaster management. 31
Final Conclusion of the lecture:
The necessity of research-based
information and better multi-disciplinary
coordination was evident for more efficient
service deliveries to poor people.
Most of what can be done to mitigate
injuries must be done before an
earthquake occurs. 32
Final Conclusion of the lecture:
Because structural collapse is the single
greatest risk factor, priority should be given to
seismic safety in land-use planning and in the
design and construction of safer buildings.
The reconstruction of buildings according to
modern standards will take decades to
accomplish and will absorb a considerable part
of the country's resources.33
Final Conclusion of the lecture:
In disaster-prone areas, training and education in
basic first aid and rescue methods should be an
integral part of any community preparedness
program.
Better epidemiologic knowledge of risk factors
for death and the type of injuries and illnesses
caused by earthquakes is clearly an essential
requirement for determining what relief
supplies, equipment, and personnel are
needed to respond effectively to earthquakes. 34
Final Conclusion of the lecture:
The integration of epidemiologic studies
with those of other disciplines such as
engineering, architecture, the social
sciences and other medical sciences is
essential for improved understanding of
consequences following earthquakes. 35