South Asia: Tsunami & Health Situation Report # 40

Report
from World Health Organization
Published on 04 Mar 2005
As most tsunami-affected regions enter the second phase of the post-disaster health program, they are focusing on rebuilding their infrastructure, increasing capacity and assessing and rehabilitating their health systems. Medical supplies, their storage and tracking systems are being strengthened in these countries.

Summary

In India, the National Institute of Communicable Diseases, Delhi, has established a comprehensive network for epidemiological surveillance in the tsunami-affected areas of the Andaman and Nicobar islands.

In Indonesia, a repeat measles vaccination campaign has been launched in Banda Aceh.

In the Maldives, WHO experts, along with a government team, are assessing the surveillance systems at health centre and regional hospital levels.

In Calang, in Indonesia's Aceh Jaya district, health authorities, in consultation with WHO, announced that their priorities will be the areas of communicable disease control, primary health care, maternal and child health and nutrition, in three puskema (health center) sites.

Communicable Diseases

India: The National Institute of Communicable Diseases, Delhi, has established a comprehensive network for epidemiological surveillance in the Andaman and Nicobar islands. There is a Central Unit at Port Blair and six mobile peripheral teams, to monitor water-borne and vector-borne diseases. The laboratory at the GB Pant Hospital has been strengthened to provide rapid laboratory surveillance. Oral Rehydration Salt (ORS) depots have been established at various camps, and ORS is being distributed to diarrhea cases to prevent dehydration.

Indonesia: A measles vaccination campaign is being repeated in Banda Aceh from 28 February - 5 March 2005, due to the low coverage attained during the initial campaign. 3066 children were vaccinated in the first morning.

Seven cases of clinically diagnosed measles were reported from Samalamga in Bireuen district, and case investigations are currently underway.

A new case of acute jaundice syndrome was reported in Meulaboh. The onset was two weeks ago, and hepatitis testing is currently pending.

An intensive campaign along the west coast of Aceh has ensured the delivery of thousands of bednets to protect from vector-borne diseases. In Bakornas, indoor residual spraying has been done in 47 barracks.

Myanmar, Sri Lanka, Maldives, Thailand: No communicable disease outbreaks or unusual events have been reported.

Health System and Infrastructure

India: Eleven additional doctors are now working in the Andaman and Nicobar islands. Laboratory facilities have been set up at Car Nicobar for bacteriological examination of drinking water.

WHO, in collaboration with the government of Tamil Nadu, organized a symposium on the management of health emergencies in disasters, on 23 February 2005. This was attended by the Deputy Regional Director, WHO Regional Office for South East Asia (SEARO). WHO officials also discussed the post-disaster disease surveillance situation with the National Institute of Communicable Diseases (NICD) in New Delhi on 1 March 2005.

WHO India and the Department of Health and Family Welfare, Tamil Nadu, are currently discussing the possibility of establishing a resource centre for data warehousing. WHO also plans to assist in an extensive survey of all public and private health care facilities available in 13 affected districts in Tamil Nadu, to create a database of the available health care facilities and their services.

WHO India will provide technical assistance in developing health financing plans of the Tamil Nadu government, for financial protection of below-poverty-line (BPL) families in the case of catastrophic illnesses, and for the development of state health accounts. The Organization will also explore the possibility of involvement of the private sector in the provision of health care in cases of tuberculosis, malaria, immunization, and disease surveillance.

Indonesia: In Meulaboh, WHO and the District Health Authorities have initiated a planning exercise with health partners working in primary health care to address issues of access to essential health care services and the assistance needed by the Tsunami affected population. Three health centers (Samatiga, Meureubo and Kaway XVI) have been affected by the tsunami and Medicins Sans Frontiers Belgium has already started physical rehabilitation through two year and five year strategies.

WHO and Pharmaciens Sans Frontiere (PSF) are assessing the pharmaceutical situation in the region around Meulaboh. The warehouse of the District Health Office, which serves all the Primary Health Care Centers in the 11 sub-districts of Aceh Barat, has been affected by the Tsunami. A large quantity of drugs needs to be destroyed and the rest identified, sorted and the warehouse system reorganized. Humanitarian drug donations are currently taken directly to the health center or health post by the mobile teams working at the site. Therefore an assessment should be done at the sub-district level also. In the hospital, a large quantity of humanitarian donations is stored in at least five different places, with no tracking system in place. Experts in the Supply management System (SUMA) have done assessments of warehouses within Banda Aceh to pre-classify supplies and assist in warehouse management.

WHO, UNICEF and Mentor will work together to develop a protocol to correlate test results from Malaria Rapid Diagnostic Test (RDT) with blood films from patients with fever.

Seventy hospital and healthcare leaders, ministry of health officials and partners attended a workshop held in Medan, from 21-24 February 2005, to discuss ways to revitalize medical care services in NAD and North Sumatra province.

In Calang, Aceh Jaya district, health authorities, in consultation with WHO, announced their district's priorities in post disaster health programming, following their first health coordination meeting for international and domestic agencies on 23 February 2005. These priority areas will be immunization and communicable disease control, outpatient clinical care with an emphasis on primary health care, maternal and child health, as well as nutrition.

Seven of the eight puskesmas (health centers) in Aceh Jaya were destroyed and 16 of the 53 district health office staff lost their lives. The puskesmas will be reconstructed in Calang and Teunom, and improved in Lamno, on a priority basis, to form a platform for local health services. It is expected that the reconstructed puskesmas, in conjunction with planned residential barracks, will draw back local health staff displaced by the disaster. The return of local health staff will then accelerate the process of health services expansion and outreach planned by local health authorities.

Maldives: A WHO epidemiologist and data manager left for a two-day visit to Meemu Atoll with a team from the Maldivian government. They will investigate four mumps cases that were recently notified, as well as assess the existing data system, the capacity available at the different health facility levels and the surveillance systems in operation at health centre and regional hospital levels.

Sri Lanka: The WHO laboratory expert has presented the list of laboratory equipment prepared by the Ministry of Health. An initial estimate of the reagents and consumables requested is approximately 600 000 USD. The estimate for equipment is expected to be completed shortly.

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