Thursday, January 28, 2010

After the Quake: Reconstruction

(Example of earthquake resilience technology.  Source:

People are still waiting for the basic necessities: food, water, shelter, medical care.  Relief workers on the ground are sending back desperate messages for more supplies, including items as simple as tents.  However, a conference was held earlier this week in Montreal discussing a new "Ten-year Plan" for Haiti.  What about all the prior reconstruction and relief plans the international community has attempted to provide for Haiti?  A commitment of financial aid alone will not suffice for actual reconstruction and future mitigation from another devastating earthquake.  These funds and plans will need to be backed by a commitment from the Haitian government at all levels (national to local) to use these funds directly for rebuilding that meets a new level of standards for structures.  Architecture and engineering and materials sciences have made vast progress in the past few decades in structural design and capabilities that can prevent the horrific scenes we are witnessing in Haiti.  Disasters do not strike low-income and high-income countries equally.  However, if the international community and the Haitian government agree to knowledge translation and the transfer of technology to Haiti, only then can we avert another crisis.  Haiti cannot be built back to the way it was; it needs to be built to the way it should have been before January 2010.

Friday, January 22, 2010

Effectiveness of Emergency Response Efforts

USAID: From The American People
File:UN emblem blue.svg

One of the primary challenges in a large-scale response to a public health emergency is measuring the effectiveness of external actors attempting to provide assistance to the population affected by the disaster.  Although almost all the players have altruistic intentions, each organization still possesses certain objectives or motives that need to be met.  Essentially, they each need to prove the organization's effectiveness in meeting the needs of disaster victims.  Professionalism has entered the domain of Non-Governmental Organizations (NGOs) (American Red Cross), bilateral government donor agencies (USAID), and the UN.  Historically, these aid and response agencies have had minimal oversight and plenty of funding.  Good intentions were not always met with good outcomes.  Donors have become more savvy, and they are now requiring information and data on organizational effectiveness when intervening in a disaster situation.  People who contribute $10 or foundations that donate $1,000,000 all want to know if their money was well spent.  Two of the main areas for evaluation are outputs and outcomes.

  • Outputs are "quantitative" measurable data.  How many blankets were distributed? How many meals were provided? How many injuries were treated?  These data are usually quantifiable with specific numbers, and they are easy to present to the public.  
  • Outcomes are "qualitative" data and frequently more difficult to measure.  This data usually comes from focus groups or interviews with disaster victims.  They are often descriptive and narrative rather than measurable.  They often focus on satisfaction, perceptions, awareness.
What are the challenges to monitoring and evaluating response to disasters?
  • Who will do the "counting?" 
  • How do you "measure" during a crisis (possibly diverting time and efforts away from delivery of aid)? 
  • What will be the universally recognized indicators?
Disasters and emergency situations are complex environments, and multiple expectations exist.  The affected people expect (and deserve) immediate and life-saving assistance.  The donors expect cost-effectiveness for their donations.  The aid agencies expect to "get the job done" so they can be invited back and continue to have longevity.

Wednesday, January 20, 2010

Disasters and Development

The earthquake in Haiti and prior disasters in low-income countries reveal that disasters affect nations differently based on the level of development in the country.  Risk reduction strategies and emergency preparedness planning can help mitigate the effects of a public health emergency on the local population.  Public health emergencies and disasters occur within a cycle.  In disaster-prone regions, governments, non-governmental organizations (NGOs), and the local population are always within one of the four phases of a disaster at all times: Preparedness, Response, Recovery, Mitigation.

Disaster Cycle
Process Graphic
(Source: FEMA)

The primary problem for most low-income countries is that the government and local population already has a limited source of public health funds to spend on a large number of public health issues, and most countries do not have the fiscal capacity to devote scarce resources for disaster mitigation or preparedness.  Therefore, disasters impact low-income countries disproportionately compared to the impact on high-income countries.

  • Mitigation:  High-income countries have building codes that regulate the physical structures in earthquake zones and allow these buildings to withstand strong earthquakes.  Most low-income countries have limited or no building codes and regulations, and even simple and low-cost structural engineering interventions could save 1000's of lives in the event of an earthquake.  In addition, many countries face challenges of  corruption and bribery, and builders may use low-grade materials or bypass standards and regulations. In the May 2008 Sichuan Province 7.9 magnitude earthquake in China, many government buildings remained standing, but many schools toppled.  This disparity raised concerns for different building standards between the two types of buildings.  
  • Preparedness:  High-income countries have the capacity to equip and train emergency responders such as firefighters and paramedics.  In addition, businesses often have contingency plans in the event of a disaster.  Also, both government agencies and corporations can conduct drills to evaluate their preparedness and response capabilities and make modifications based on the findings from these drills.  Low-income countries often have very limited pre-hospital care systems in place, and firefighting and search and rescue operations are frequently nominal throughout these nations.  
When faced with daily public health challenges such as malnutrition, clean water availability, immunization campaigns, and communicable diseases treatment, low-income countries cannot afford to spend limited funds on disaster mitigation or preparedness.  The international community must recognize that development assistance will need to focus on disaster preparedness disparities to prevent another devastating event such as the one that has occurred this past week in Haiti.

Tuesday, January 19, 2010

Haiti: Crisis in a Capital City

The devastating earthquake that damaged Haiti on Jan 12th is an enormous emergency public health situation on all accounts. Although many countries have been affected by earthquakes in recent memory, including China, Iran, India, and Turkey. None of these countries had to confront the challenges of the earthquake destroying the capital city and the center of both political and economic power for the country. Had those earthquakes occurred in Beijing or Tehran or Mumbai or Istanbul, those nations would have had a much different course to follow after the impact of the initial event. In addition to the immediate relief that is being ramped up daily, the people of Haiti face the daunting prospect of rebuilding fragile governments and economies. As the international community provides immediate assistance, donor countries will need to evaluate how they help Haiti rebuild the governance infrastructure and the local fiscal economy.

For the immediate aspects of the crisis, these are the key issues:
  • Coordination of delivery of assistance: Too many players are on the ground with little coordination of efforts, and certain populations are being underserved in the midst of cargo planes landing hourly at the Port au Prince airport.
  • Basic necessities: Food, shelter, water, clothing.
  • Personal security: So far, the local population has acted courageously and with little menace towards each other. If the situation remains severe for a prolonged period, security will become a more important factor.
  • Healthcare: The two major health issues will be treatment of acute conditions (fractures, internal injuries, wounds, burns) and the management of chronic conditions (diabetes, asthma, hypertension, etc).
  • Mental health needs: As the public health crisis continues to enter a protracted phase, mental health concerns will begin to emerge.