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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 Epidemiology. 1. Learning objectives:

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slide1

Disaster Epidemiology Lessons From Bam Earthquake Dec 26, 2003 Iran

Part 7: Health sector in Bam earthquake

A. Ardalan MD, MPH, PhD student in Epidemiology

1

slide2

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

slide3

Geographic classification

Strategies for service delivery

Physical space

Instruments

Health service structure

Workforce composition

Workforce tasks

Duration of activities

Workforce training

Volunteer peoples

3

slide4

Population movement after the earthquake

Zones

Earthquake-stricken area

4

slide5

Population Movement

Major concern and barrier for effective services delivery in Bam

  • Invasion of poor people from neighboring
  • areas to Bam

110,000 Population beforethe earthquake

90,000 Population at the1.5 months after the earthquake

40,000 Number of death

= (?)

-

5

slide6

Population Movement

2) Changing living places inside the bam

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%)
slide7

Cumulative percent of the first time health services delivery

to the earthquake-stricken households in Bam

till 20th days of post-disaster period

7

slide9

The needs (expressed demands) of Bam earthquake-stricken households on 19th and 20th days of post-disaster period

Bath room 74 %

Food 69 %

Clothes 68 %

Heaters 62 %

Security 60 %

Latrine 49 %

Money 47 %

Others

9

slide10

Illness

%

Acute respiratory infection

60

Depression

51

20

Oral & teeth problem

Nausea / Vomiting

15

Movement disability

13

Irregular menstrual bleeding

10

Addiction

10

The frequency of illnesses in the earthquake-stricken households till 19th and 20th days of post-disaster period

10

slide11

The needs (expressed demands) of Bam earthquake-stricken

householdson19th and 20th days of post-disaster period

11

slide12

Main barriers in health services delivery in Bam

earthquake-stricken households,

during first 20 days of post-disaster period

Transportation

Unavailability of required services

Unfamiliarity with health and medical centers

Dissatisfied from previous services

Inappropriate time

12

slide13

Some points about accommodation status of population

  • Determinants of aggregation places
  • Distances of tents
  • Risk of injuries
  • Cultural values

13

slide14

Social problems of earthquake-stricken households in Bam till 20th days of post-disaster period

Violence: Physical or psychological aggression

14

slide16

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

slide17

Changing the pattern of

substance abuse in Bam

Inadequate withdrawal services

Security concern

Opium odor

Heroin Injection

High price of opium

Lack of money

Psychological consequences of earthquake

Low price of heroin

Unemployment

17

slide18

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

slide19

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

slide23

Public address system: Psychological importance

  • 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.

23

slide24

Mass Graves in Bam Myths and Realities

  • Political environment
  • Bad odor
  • Cultural beliefs

24

slide25

Surveillance System

Collection of additional data

 Modify the system

Current response

Additional analyses

Iterative process

Evaluation the action

Further action

Disseminating the result

25

slide26

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 assessmentof system

26

slide27

Pre-requirements of Surveillance System in disasters

Stable health management in crises

Epidemiologic

Knowledge

Well-trained field-team

Network communication system

27

slide29

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

slide30

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

slide31

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

slide32

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

slide33

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

slide34

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

slide35

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