Chapter 16
In the News: Health Effects of Tsunamis/Natural disasters
On December 26, 2004 a strong earthquake occurred off the west coast of Northern Sumatra, Indonesia. A subsequent tsunami hit Southeast Asia and East Africa causing hundreds of thousands of deaths and widespread destruction. At the present time more than 228,000 people are dead or missing including many doctors and nurses. Eigel Sorenson, special envoy of the World Health organization, said there could be up to as many as one million people affected.
Initial response of health care workers after a natural disaster occurs should be:
· Assess the scope of the damage and set up a plan of action.
· Determine the extent of useable facilities and the number of health care professionals available.
· Organize staff, supplies, and information to provide the greatest aid to people in the most immediate need of services.
· Join with worldwide multiple agencies to coordinate the complex response effort.
The immediate health concerns after a disaster are:
- After the rescue of survivors, the primary health care concerns are clean drinking water, sanitation facilities, food, shelter, and medical care for injuries.
- Flood waters often pose health risks from contaminated water and food supplies.
- Loss of shelter leads to insect exposure, heat, and other environmental hazards.
- Other traumatic injuries are a major concern. Injuries such as broken limbs and head trauma are common due to the physical impact of debris.
Secondary effects may be infectious diseases such as cholera, malaria, and diarrhea.
Immunizations
Health care workers who travel to the disaster area should consult with a travel medicine specialist to be certain they have all the necessary immunizations. Ideally there should be 4-6 weeks before travel, however this is generally not possible. Vaccination is not recommended for imminent travel.
Recommended immunizations are the following: tetanus/diphtheria vaccine or booster (if the most recent vaccine or booster was five years ago), hepatitis A and hepatitis B, influenza, typhoid, polio, measles, rabies (which is endemic throughout the affected areas), and cholera vaccine. The cholera vaccine is not available in the U.S. A person may be able to obtain it at an intermediate destination however it requires some time for the antibody protection to occur. Also, there is no immunization against malaria. When serving in a malaria-prone area all health care workers should take anti-malarial drugs. Health care workers who have fever or flu-like symptoms either while in the area or after retuning home (for up to one year) should seek medical attention.
Risks for Health Care Workers
· Infected wounds. Wear sturdy footwear to protect the feet. Have up-to-date tetanus immunizations. Cleanse any wound immediately with soap and clean water. Be familiar with basic first aid for any injury.
· Electrocutions. Prevent electrocutions by avoiding downed-power lines. A portable generator improperly installed or operated can send power back to the downed electrical lines which can seriously injure or kill workers who may believe the power is off.
· Unsanitary water supplies. Because of disruption of water supplies and sewage systems diarrhea, typhoid, or hepatitis A can possibly occur. Food should be thoroughly cooked; salads and ice cubes avoided. If known pure water or bottled water is not available, water should be boiled, or disinfected with iodine, chlorine, or water purification tablets. Have medication for diarrhea such as Imodium. Hydration is the key to effective treatment in cases of any diarrheal diseases. Handwashing is one of the most important preventive practices.
· Risks from insect bites. Health care workers should take measures such as insect repellent and sleeping under insecticide treated bed nets to prevent insect bites.
Standing water increases the insect population which can transmit malaria, Japanese encephalitis, and dengue. In addition to all other anti-malaria measures wear long-sleeved shirts to protect from insect bites.
· Risks from snake bites. Wear boots and long pants when outdoors especially at night. Seek medical attention any time a bite breaks the skin.
Psychological/ Emotional Risks
The effects of a natural disaster are extremely stressful. Keep family photos, favorite music CDs, or religious material nearby to offer comfort in such situations. Check in frequently with other family members.
Techniques for Handwashing with Alcohol-Based Products
If soap and water for handwashing is not available use alcohol-based products for washing your hands. When using an alcohol-based product apply product to the palm of one hand and rub hands together to cover all surfaces of hands and fingers. Rub until hands are dry.
Long Lasting Effects of a Tsunami or Any Other Natural Disaster
· Health care workers should survey and monitor for infectious, water, or insect transmitted diseases.
· Divert medical supplies from nonaffected areas to meet the needs of the affected regions.
· The restoration of normal primary health services, water, and sewage system is essential.
· Assist the community to recover physically, mentally, and socially when the crisis has subsided.
Reference
Centers for Disease Control. (2005). Tsunami disaster: Health information for
humanitarian workers. Retrieved March 16, 2005 from http://www.bt.cdc.gov/disasters/tsunamis/humanitarian.asp.