Hurricanes: 5 Years After Katrina Are We Any Better Prepared?

(Source: http://www.nhc.noaa.gov/index.shtml)

(Source: AP/NASA)

Currently, in the Western Hemisphere, three hurricanes are active with Hurricane Karl already making landfall near Veracruz, Mexico and affecting central Mexico.  Igor and Julia are approaching land in the next few days.  What began as a relatively quiet Hurricane Season has now picked up activity rapidly.  What are the key factors facing populations and public health officials this year and what lessons have been learned during the past 5 years?

• Communications: Technology has allowed public health officials to provide messages and information about impending storms through multiple venues such as internet, text messages through mobile phones, and traditional outlets such as TV and radio.  Although after the hurricane makes landfall and disrupts power supplies, prior to landfall government officials have many options to provide warnings and preparedness instructions to local populations.
• Evacuations: Communities at risk for hurricanes have become more attuned to evacuation preparations and routes.  When Katrina and Rita struck 5 years ago, the media showed stark images of people stranded in long lines attempting to evacuate cities.  Through dedicated evacuation lanes and plans to evacuate communities in a staggered pattern will assist evacuations this year.
• Response Resources: Localities are beginning to regionalize resources so that smaller, adjacent municipalities can share resources with larger cities.  In addition, improved communications and interactions among local, state, and national officials will assist in future responses.  

Although public health officials and governments can assist at the macro level with preparedness and response, ultimately, individuals and families will have the final responsibility in how well they endure a hurricane.  Hurricane Ike just over 2 years ago showed that some people continue to remain complacent in the threat of a disastrous storm.  

Eyjafjallajokull Volcano: Remote Natural Phenomenon Impacts Global Health and Travel

(From www.huffingtonpost.com)

(From www.examiner.com)

On Wednesday April 14th, the Eyjafjallajokull volcano in Iceland erupted and deposited large quantities of volcanic ash in the earth's upper atmosphere.  The ash contents include approximately 25% Fine Particulate Matter that are less than 10 microns in size, and these small particles can reach the lower respiratory tract and cause respiratory irritation, especially in individuals with chronic respiratory diseases such as asthma or emphysema.  Currently, the European Air Quality Monitoring Network with stations all across the continent is tracking air quality measurements. No elevated particle levels have been recorded, but fore-casted rain may affect these levels.  

  (From www.nytimes.com)

Of large concern is also the impact the ash cloud has upon global travel through Europe.  Eurocontrol, based in  Brussels, coordinates air-traffic management across the continent and reported that by the end of Tuesday April 20th, 95,000 flights will have been canceled due to the ash cloud.  In addition to mainstream commerce and leisure travel, this ban on flights throughout Europe has had enormous consequences on the delivery and transportation of health supplies and materials in and out European cities. For example, the German Foundation for Organ Transplant has had to alter scheduled deliveries of hearts, lungs, and livers, and is working with Eurotransplant to coordinate ground deliveries of vital organs.  

The threats of the volcanic ash upon aircraft are real and not merely hypothetical.  An article published April 19th in the New York Times states:

From 1953 to 2008, just 89 planes were reported to have encountered an ash cloud, said Denis Chagnon, a spokesman for the International Civil Aviation Organization in Montreal.

But the real perils were demonstrated in June 1982, when a British Airways Boeing 747, flying to Australia from Malaysia, flew directly into an erupting volcano’s ash cloud.

One after the other, all four engines shut down within minutes, turning the aircraft into a overweight glider. After 15 harrowing minutes, the plane had dropped about 20,000 feet, enough for the plane to fly under the ash cloud and allow for clean air to feed the jet turbines. At that point, the crew was able to restart the engines, which allowed for an emergency landing.

Another Boeing 747, belonging to Singapore Airlines, lost power in three of its four engines when it hit ash from the same eruption. And in December 1989, all four engines of a three-month-old KLM Boeing 747 shut down when the plane encountered ash from Mount Redoubt. The plane descended to 12,000 feet from 25,000 feet before the crew was able to restart two of the engines.

After the Quake: Reconstruction

(Example of earthquake resilience technology.  Source: esciencenews.com)

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.

Effectiveness of Emergency Response Efforts

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.

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

(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.