POST-DISASTER: WHAT ROLE FOR HEALTH PROMOTION?

[francesca.ramondetti]

Haiti is reeling. 200,000 or more people are thought to be dead. Many more, are internally displaced, hungry, thirsty, and maybe thinking the dead are the lucky ones.

The world has risen to help. Aid in the form of food packs, water, medicare (drugs and medical personal) are slowly getting to the people that need it. Money has been promised for the massive rebuilding effort that mill be needed.

As a Health Promotion Practitioner (HPP), I can’t help thinking what possible role Health Promotion can play in the ameliorating the suffering and pain of people experiencing this massive catastrophe. I believe the possible role(s) Health Promotion can play in responding to calamities and disasters are not fully employed early enough by Aid Agencies and Donor Countries. Attention is majorly given to the evident and pressing need for food, water, sanitation, and medicines. All these are very important. Without them, may more lives that may be saved may end up to be lost. In that sense, we could say such efforts are health promoting.

Having said that, it is pertinent to note that these aid efforts are mostly carried out without a framework of Health Promotion (empowering people to be able to be WELL in their whole being: BODY, SOUL. AND SPIRIT) in mind.

I think as HPPs, we should start to make a case for the consideration of aid efforts to be carried out with Health Promotion principles in mind. Attention should be given early in relief efforts to counselling and other mental health support services. After being fed, and rehydrated, survivors have the terrible memories they have to live with. Support can be instituted early.

Weaning people from aid is a difficult thing. I think if from the start, the true goal is to get survivors back to a start of HEALTH rather than just helping them survive the disaster, the process will be much easier and pleasant for all.

Look forward to responses.

Dr Gbenga Adebayo MBChB Ife

Livinghealth International

Lagos, Nigeria

Waiting for your comments on the topic,

Francesca

[francesca.ramondetti]

Dear colleagues,

I've been thinking upon the topic, and I was wondering about the management of chronic diseases after disasters and devastating earthquakes such as the one which struck Haiti. Inadequately controlled chronic diseases like diabetes mellitus, cancer, cardiovascular diseases - only to mention a few of them- may present a threat to life and well-being. The needs of this portion of population have been ignored by Haiti's own leaders and government. Haiti is not only one of the poorest countries in the world, but it is also one of the most unequal in its disparities in wealth and access to political power.
What do you suggest a health promoter could plan to find a solution to the above mentioned problem?
It would be great to hear any contribution from you!
Francesca

[Torill.Bull]

Yes, the tragic situation in Haiti certainly calls for the attention of health promoters! As I am writing there has just been an earth quake in Chile as well. Another situation during the last year was the floods in the Philippines.

When I sit here thinking about these situations, I start wondering about the words 'acute' and 'long-term'. Is there an acute form of health promotion? Or is health promotion always long-term efforts? I suspect it might be both, but I would love to hear examples of excactly the acute initiatives that are appropriate at the highly chaotic times of catastrophic events. So, people, please chip in here!

I know at least one way in which health promotion can make valuable contributions to disaster situations, but it is a long-term approach: many areas are simply 'disaster prone', meaning they have a great risk of reoccuring disasters. It might be annual floods, annual droughts, earth quakes or other. In such areas health promoters contribute to 'disaster preparedness'. This is about building local capacity for handling the acute situation, to reduce harm both in the actual situation and long-term, to pull the community together. One example can be to provide secure places for communities during floods, and to train everybody in right reactions when catastrophes threaten.

Looking forwards to hearing from others,

Best wishes,
Torill Bull

[francesca.ramondetti]

Health promotion interventions may be both acute and long-term in my opinion too. Disease prevention involves different actions from fluoridation of public water to immunization for infectious communicable diseases to cancer screening programs.
Post-disaster health promotion should focus on encouraging people to take part into protecting their health and make the best use of facilities and services provided by the community. Communities in post-disaster areas should encourage improved hygiene practices in each population group (women, men, elderlies, children, those with disabilities).
Acute areas of health promotion intervention may be: use and maintenance of toilets, lack of hand-washing with soap, unhygienic storage of public water and unhygienic storage and preparation of food. I see these ones as priorities.
Then all the messages should be given in a positive way, because people and especially those who suffered a disaster don't like to be taught. Using humour wherever it is possible might help.
As long as I'm concerned, only after planning acute health promotion we can start caring about long-term actions.
Do you agree? I'm looking forward to hear further ideas.

Have a nice weekend,

Francesca

[Torill.Bull]

Hi,

I see that you point to at least three important topics in your post, Francesca:

Providing water and sanitation
Teaching about practices for hygiene in disaster situations
Being sensitive in communication with a stressed population

Just the other day I heard an emotional interview with a Chilean who commented on the robberies that are going on from stores and businesses after the disaster. He understood people so well, stating that people were stealing to live, and that all the government did was to send police to chase people, not provide the essential food and water. I think all this goes to confirm the need for extreme sensitivity in post-disaster situations; people make judgments according to new sets of criteria because the world has been turned upside down...

Has any of the readers been involved in acute relief work?? I feel a bit awkward posting opinions not having any practical experience here myself, and would love to hear from someone who has!

Best wishes,

Torill

[francesca.ramondetti]

Hi,

I see that you point to at least three important topics in your post, Francesca:

Providing water and sanitation
Teaching about practices for hygiene in disaster situations
Being sensitive in communication with a stressed population

Just the other day I heard an emotional interview with a Chilean who commented on the robberies that are going on from stores and businesses after the disaster. He understood people so well, stating that people were stealing to live, and that all the government did was to send police to chase people, not provide the essential food and water. I think all this goes to confirm the need for extreme sensitivity in post-disaster situations; people make judgments according to new sets of criteria because the world has been turned upside down...

Has any of the readers been involved in acute relief work?? I feel a bit awkward posting opinions not having any practical experience here myself, and would love to hear from someone who has!

Best wishes,

Torill

I agree with you, Torill. I feel a little awkward posting opinions upon a situation where I never had a practical experience myself...
What I was doing during the past few days is reading through many articles upon the topic, and my conclusion is that in Haiti and Chile they happen to be at that uncomfortable stage where the immediate intensity of the early disaster response was passing by, but it is still inappropriate to fully transition away from relief interventions.
The main problem in such emergencies is that as long as the cameras are rolling and the world’s attention is focused on the drama, it seems that everyone wants to give help and that it's really possible to begin those longer-term community development programs. The question is what happens when the world's attention is falling down...That concerns me.
People are not so sensitive to disasters as they were used to be once. We're not completely aware that life in some countries is not easy even before or without a disaster such as earthquakes, floods, landslides, or other situations caused by natural phenomena.
In my opinion the government and the other various groups – professional, skilled experts, and the general public - should make their interventions before that disasters take place. Starting from the structure of the houses...they all collapsed because they were never built respecting the antisismic norms, even though it's well known that the area is subjected to quakes from time to time.
Vital infrastructure necessary to respond to the disaster was severely damaged or destroyed. This included all hospitals; air, sea, and land transport facilities; and communication systems. Of course it'll be very hard to build everything new and to assure that such a disaster is not going to happen again.
International organizations such as WHO and UN are already providing a lot of help to countries affected by natural disasters. But it's clear that the aid in the form of medical care, food and food preparation, clothing, money is not enough to help those countries to guarantee a good quality of life within a short term. This will take ages.
The important thing is to begin. And that's what Health Promotion should assure in developing and third world countries. The aim should be to improve the quality of life by strengthening cooperation among international organizations and to challenge each other to be truly committed to sustainable development and equity.

Awaiting for more comments!

Francesca

[gbenga]

Glad at the response my topic has been eliciting.

While an argument might be made that the role of HP in disaster efforts starts pre-disaster(unhealthy/sub-healthy individuals may be more likely to become casualties as well as succumb more easily to the harsh conditions such disasters may cause), i will like to dwell on post-disaster possible efforts only.

In the early post disaster period, in addition to the issues already identified, I think HP can may be useful in building mental fortitude and hope amongst survivors. Counseling services and support groups may help people reject despondency and embrace hope. As we know, there is great power in the sense of hope for a better life. This early support may help in preventing future Post-Stress Traumatic Disorder (PTSD) and help promote mental health and future quality of life.

On the same note of mental health, HP Practitioners (HPPs) can synergize with aid agencies to help reunite broken or separated families. Whilst noting that this is usually one of the goals of aid agencies post-disaster, i am drawing attention to it so that it is not viewed just as an isolated aid activity, but a vital part of the strategy by HPPs to promote the health of a population ravished by a disaster.

Also i the early phase, i think HP practitioners, should develop programs and initiatives aimed directly at women and children. These group suffer the most in any troubled population. Vaccination services, sexual health and rights education (women may be vulnerable to sexual exploitation in these extraneous conditions), make-shift schools may be some of these programs.

In the mid to late phases, HP programs may be useful to look at possible factors that may help mitigate future disasters. Studies may be done to see if there are fallout conditions as a result of the disaster and how such fallout conditions may be controlled.

Look forward to responses and more contributions.

Dr Gbenga Adebayo
Livinghealth International
Lagos, Nigeria

[bolajokoaina]

I have gone through the different postings to this topic they are all interesting. I appreciate the person who started this topic. It is quite important to give attention to counselling, psychology support and other mental health support services because living with the terrible memories can be devastating to health at the end of the day such that the food and water support may not yield any meaningful effect.

[Torill.Bull]

This morning I read a newspaper article about children in Haiti being reunited with their parents after having been separated by the earthquake. It is such a shattering situation, the dispair of the parents, the helplessness of the children. Some of these children had been 'given away' by their parents to other caregivers in order to give the children better protection during the highly health-threatening conditions in post-disaster Port-au-Prince. This is believed to have protected the children's physical health, but to have been a threat to their mental health. I think keeping families together and supporting parents in caring for their children mentally in these situations could be an important role for health promoters. How could it be done? Maybe by setting up local groups for parents to meet and discuss, and receive advice? By play groups, taking the minds of the problems for some minutes? By make-shift schools, as suggested by Dr.Adebayo?

I also agree that women's needs must receive special attention. Not only are they more vulnerable, but they are also keys to family and child health (of course not to underestimate the role of men, but this is what research tells us...).

There is one practical issue I think needs consideration, though: Who are the health promoters we are discussing, and how do they work? Do we imagine health promoters going to do short time efforts as part of an 'aid' effort, or should the main responsibility be on locally sustained efforts? I guess local health promoters could be hit hard by disasters themselves? As far as I have heard, there is a strong need to orchestrate help efforts (one of the learnings after the 2005 tsunami). Do we work with the large organisations, volunteering?

Really appreciating the contributions of you all!

Best wishes,
Torill Bull (PhD student, Norway)

[francesca.ramondetti]

I appreciated reading through all of your comments very much.
So far the aid agencies which have been involved in the establishment of many hospitals in Haiti are also focusing on the population’s urgent medical needs, but not only: they're caring about preventing the Post-Stress Traumatic Disorder too. Some of the emotional and physical responses in the post-disaster include confusion, fear, hopelessness, sleeplessness, crying, difficulty in eating, headaches, body aches, anxiety, and anger. People may be feeling helpless.
I agree with the point that one of the major health promoters' aim should be to help vulnerable groups including children, pregnant women, the disabled and the elderly on one hand and to deliver psycho-social support to all the population on the other hand.

These group suffer the most in any troubled population. Vaccination services, sexual health and rights education (women may be vulnerable to sexual exploitation in these extraneous conditions), make-shift schools may be some of these programs.

I agree with all of written above, and I would suggets a screening children for malnutrition and vaccinating against communicable infectious diseases.It would be useful to develop an integrated programme of school rehabilitation and child health clubs, where to involve their parents too. Friendly spaces for children should be provided and health promoters should help to make them safe and keep them so, working together with the aid agencies.

I think keeping families together and supporting parents in caring for their children mentally in these situations could be an important role for health promoters.

What it has not been said so far it's the need to start an adoption process for children who survived their parents after the disaster. Keep in mind that in addition to losing homes and families, in a post-disaster situation children are required to stay in centres with strangers and they loose contact with surviving siblings and relatives. Despite our best efforts, orphanages are often non-stimulating, regimented places which are not the optimal environment for the natural growth and development of children. Helping children find surviving family members and relatives, and facilitating foster care would be for more beneficial than to be placed in institutions. These options should be explored first.