3. Disaster Response
In 2006, Latin Americ and the Caribbean were spared major disasters of the magnitude of Tropical Storm Stan (2005) or Hurricane Ivan (2004). However, many other emergency situations posed serious concerns and required substantial technical support from PAHO/WHO. A review of these situations in which PAHO worked with member states to respond to pressing health issues is provided below.
Unusually high seasonal rainfall at the end of 2005 caused widespread flooding in several Regions of Guyana in early 2006. The government declared Regions 2 (Pomeroon/Supenaam) and 5 (Mahaica/Berbice) as disaster areas and an international appeal was launched to secure support and assistance. PAHO/WHO worked with the Ministry of Health to conduct disease surveillance and manage health and environmental issues in the shelters. Medical teams from the Ministry worked closely with the Civil Defense Commission and in the flooded areas to deliver health care daily. There was an increase in the number of persons admitted to the Georgetown Public Hospital with a suspected diagnosis of leptospirosis. The appropriate treatment, prophylactic doxycycline, was administered in the flooded areas and in other areas where cases were detected.
Virtually every year, Bolivia experiences a cyclical pattern of intense rainfall, hail, mudslides and floods. In the early months of 2006, major rivers overflowed and the rains triggered landslides and obstructed roads, isolating some communities. The most affected departments included Santa Cruz, Beni, Cochabamba, Trinidad, Pando, Potosi and La Paz. A population of 200,000 was affected and 21,000 were left homeless and were housed in shelters. Although there was no major damage to health services, the number of cases of respiratory and digestive illnesses and conjunctivitis rose among the population in shelters. Local health authorities managed the situation. The health thematic group, led by PAHO/ WHO in coordination with the Ministry of Health, stepped up epidemiological surveillance, vector control and vaccinations and assessed the need for medicines. The supply management system (LSS/SUMA) was used to manage donations.
Along Ecuador's Pacific coast, rainfall that began in January caused major flooding and affected 150,000 persons in six coastal provinces (29,115 families). More than 1,100 families were evacuated to shelters (schools and other municipal buildings that were improvised for this purpose). The MoH and PAHO/WHO focused on activating emergency operations centers; the assessment of damage and needs; vector control (spraying and fumigation); mobilizing medical brigades to provide health services to the population in flooded areas of the country; stocking health facilities with medicines and delivering safe drinking water and chlorine for water treatment in affected communities. International aid was mobilized to improve public health measures and reduce the risk of communicable diseases. The result was that the outbreaks were controlled, thanks to surveillance, detection and opportune treatment; access was improved to safe water and sanitation; and appropriate community actions were taken to control vectors.
The department of Nariño, Colombia was put on high alert when seismic activity increased around the Galeras volcano (which had been active again since mid-2004) and the alert level was raised to level II. The volcano threatened seven municipalities with a population of almost 8,000. The population closest to the volcano-some 2,500 people-was evacuated to shelters. Health facilities in the at-risk area were also put on alert and hospital emergency and contingency plans were activated for a potential volcanic eruption. Some health programs in the area were interrupted because the level of staffing decreased. PAHO/WHO supported the departmental and municipal health authorities by designing clean, healthy temporary shelters and a module for triage and stabilization of the injured. The Organization also supported other public health actions, including psychosocial and mental health support and communications. A simulation exercise was carried out, a health crisis situation room set up and the LSS/SUMA system was put in place to manage humanitarian aid.
Following torrential rains in May, Suriname declared the southern region of the country a disaster area and requested international assistance. PAHO/ WHO deployed five experts to support the Country Office to assess health needs and mobilize resources. A Supply Management team was also deployed and the LSS/SUMA system put in place. A sanitary engineer, already on the ground, provided technical support. Experience has shown that in this region of the country, flooding is generally followed by malaria outbreaks. Therefore, PAHO/WHO procured and distributed insecticide-impregnated bed nets and malaria testing kits and conducted training on the use of the latter. Water tanks were installed in affected communities to allow the population to collect rain water and thus prevent outbreaks of diarrheal disease. PAHO/WHO held a lessons learned exercise and began developing a contingency plan for the health sector, as Suriname did not have one.
The Tungurahua volcano in Ecuador has been active for the last six years and in mid-2006 eruptions killed five persons and affected almost 450,000 in the provinces of Tungurahua and Chimborazo (to put this in perspective, the total population of these provinces is 915,588). In the high-risk areas, more than 14,000 people were evacuated either to shelters or to the homes of family or friends. Many of these families returned home once the level of volcanic activity diminished, however, these was a substantial impact on health centers, agriculture and livestock and mudflows destroyed homes. In the affected provinces medical teams were deployed to shelters and regular follow up was conducted through a health situation room. The LSS/SUMA system was set up in both affected provinces to manage humanitarian aid. Months later, some 2,500 persons from five communities in the most at-risk area still remained in temporary shelters pending the relocation of their homes to safer sites.
In Haiti, heavy rains caused by Hurricane Ernesto in August hit the coastal areas of the departments of Sud, Sud-est, Ouest, Grand-Anse, L'Artibonite, and the Northwest; however, no major flooding or significant damage to infrastructure were reported. Two people died and 200 had to be evacuated. Nineteen houses were destroyed and 134 damaged. Several localities in Port-au-Prince (Martissant, Gressier and Mariani) along southbound roads were flooded. WHO/PAHO pre-positioned essential medicines (kit 10,000) in Port-au-Prince (2), Le Cayes (2) and Jeremie (1).
In early October, the Chaparrastique volcano, near the town of San Miguel, El Salvador, began to show increasing signs of activity. Prompted by this threat, the disaster office of the Ministry of Health organized training sessions for health personnel on damage and needs assessment. These workshops which took on a more realistic character, given the risk conditions in the area. The health sector was encouraged to step up coordination with other sectors, particularly the municipal civil protection system; a health emergency committee was organized and made operational. Health and environmental conditions in the Isidro Menendez Institute, which had been designated as an emergency shelter were evaluated and a stock of medial supplies was replenished in the at-risk area.
In late November, Haiti once again experienced extreme weather due to a cold front in several parts of the country. The unusually heavy rainfall caused serious flooding in Grande-Anse and in the North-West region. Seven persons died and more than 4,000 families were directly affected. At least 335 persons were temporarily sheltered in Jeremie (Grand Anse). Two hospitals and their pharmacies, which were already in precarious conditions, were flooded, severely affecting the population at large. PAHO took the lead in coordinating the health response, and together with the Ministry of Health, pre-positioned medicines and distributed medical supplies to the health sector in the affected areas, either to replace the losses or to strengthen the capacity to treat the injured and ill. An emergency assessment showed that eight potable water distribution systems were destroyed or severely damaged in Grand Anse and Nord-Ouest. PAHO/WHO coordinated with partners on the ground to facilitate distribution of water while repairs were made to the affected water systems.
In the latter part of November, intense rainfall devastated much of Panama, leaving 11 dead and 1,300 displaced persons that required support from local authorities. Five health facilities were damaged (one health center and four health posts which provide only primary care). The disaster office of the Ministry of Health coordinated the sector's response. PAHO/WHO coordinated the assessment of damage to health facilities and helped to set up a health situation room for information analysis both in Panama City (the capital) and in the affected departments. Working together with the UN Emergency Team, national authorities in Panama initiated the use of a single form to capture information on an ongoing basis. As a result, authorities determined that no external aid was required, although neighboring countries provided some donations.
Other Health Crises
Forty-eight persons died and 15 were blinded by the toxic effects of methanol in an incident of mass poisoning in Nicaragua. Between 2-20 September, 801 people were treated for methanol poisoning following the ingestion of home-brewed local alcohol known as "guaro," which had been contaminated by methanol. Most cases occurred in the departments of León and Chinandega.
The Network of Toxicology of Latin America and the Caribbean (RETOXLAC) played a critical role by providing information to Nicaragua's Toxicology Reference Center on case management, identifying a new antidote and making a network member available for on-site technical assistance. A U.S. drug company, Jazz Pharmaceuticals, donated the antidote medicine-1,200 vials were delivered to Nicaragua and put to immediate use.
PAHO/WHO's role included identifying experts to review protocols for poisoned patients; coordinating the health response and implementing contingency plans. It also organized epidemiological surveillance at the local and national level, and supported the Ministry of Health in active case detection at the grass roots level by helping to train 533 Nicaraguan health staff. PAHO/WHO also assisted in the coordination and management of the donation and importation of the antidote (Fomepizole) and the local purchase of other essential drugs and supplies.
In Panama, 91 patients suffered acute renal insufficiency syndrome caused by the accidental ingestion of cough syrup contaminated with diethylenglycol (DEG). Forty-five people died and some patients who received treatment were left in critical condition. A national campaign was launched to identify the causal agent, ensure that patients received medical treatment and destroy the adulterated medicines. PAHO/WHO assisted the Ministry of Health in the investigation and control of the outbreak, with the help of international experts in epidemiology, toxicology, and communications. Once the diethylenglycol was identified, PAHO/WHO also helped to acquire the recommended antidote (Fomepizol) and the clinical support for its use.
In 2006, PAHO/WHO coordinated the installation of two Emergency Operation Centers in Les Cayes and Jacmel. Equipping these centers and staff with computers, satellite Internet access and other office equipment allowed them to play a more active role in managing disaster alerts, evaluating needs and responding to natural disasters.
PAHO/WHO supported the participation of three Haitian medical doctors (trainers in mass casualty management) in a regional training in Martinique and Guadeloupe, organized by the University of Bordeaux, France. The purpose of their participation was to improve their technical capacity to review the existing curriculum in Haiti and develop new training materials and workshops. Subsequently, several specialized courses/activities were carried out:
- In March, emergency room personnel (30 people) from the department of Sud were trained in the management of medical/surgical cases. The same course was replicated in Jacmel, Sud-est department in June.
- Thirty first responders (police, fire brigade, Red Cross volunteers, hospital staff, etc.) were trained in mass casualty management in May. In addition to practical training on health contingency planning, mass casualty management, psycho-social care, epidemiological surveillance and humanitarian supply management, two simulation exercises were carried out. The course was repeated in another department in June.
- Haiti's Civil Defense (DPC) carried out courses in general disaster management and contingency planning in April. These courses were the result of joint efforts between PAHO/WHO and UNDP to ensure that the departments had improved and updated contingency plans for disaster management at departmental level. In May, the department of Sud-est finalized and disseminated its plan; the department of Sud finished its plan in August. Both plans were used for Hurricane Ernesto and the departments agreed to evaluate them to determine future needs for disaster preparedness at departmental level.
Prior to the start of hurricane season, shelters (churches and schools) in isolated areas were prestocked with supplies and the Local Disaster Committees in the Departments of Sud and Sud-est received other material support to conduct minor infrastructure repairs. Local Disaster Committees also were outfitted with vests and caps to properly identify community and departmental Committee members. When health facilities and services were affected by flooding, PAHO/WHO supported the public health system with essential medicines and supplies. In 2006, six WHO Emergency Health Kits were distributed throughout Haiti, enabling a population of 60,000 to be treated over a three-month period.
PAHO/WHO continued to provide technical cooperation to health authorities in Colombia to improve access to health care for the internally displaced population (IDPs), the vulnerable population in the receptor communities and refugees crossing borders from neighboring countries. In 2006, PAHO/WHO managed these activities through eight field offices in Nariño, Valle, Chocó, Cordoba, Norte de Santander, Santander, Antioquia and Cundinamarca. The IDP target population in these departments is 732,000 persons.
By including the variable "displaced" in data collection surveys, health information and statistics on IDPs was improved. This allowed health authorities to better plan and execute specific programs. Nationally, funding was increased for health care and health promotion programs for the displaced population. Some of the specific achievements of 2006 include:
- In Valle, the SIGA software was field tested and used to track the execution of funds earmarked for health expenditures for IDPs. Set up in hospitals that provide health care to IDPs, the software collected information on their health status and prevalent diseases, medical procedures performed and the cost of treatment. Hospitals reported this information to the Departmental health authorities and to the Ministry of Social Protection. This previously uncollected information was used to track the use of allocated funds, determine the number of beneficiaries, and plan specific interventions according to the epidemiological information available. It yielded morbidity and mortality data, disaggregated by gender, age, ethnicity and disability. The Colombian Ministry of Social Protection will now use this software at thenational level.
- PAHO/WHO supported the publication, by local health authorities, of basic health indicators on IDPs. In Nariño and Santander, a web site on health and displacement was created and local and national health authorities, UN agencies, NGOs and othersare using the information to plan and follow up specific health programs.
- The web site on Health and Displacement (created and managed by the PAHO/WHO Representation in Bogotá) continues to publish technical information and reports on health and displacement and emergency situations. The site, used by national and international institutions, NGOs, universities, and others, received 1.2 million hits in 2006. The site has improved collaboration among institutions, as it provides open access to studies, official statistics, NGO and UN information and links to other national and international sources on IDP health issues. See Annex 10 for the homepage of this website. (www.disaster-info.net/desplazados)
- PAHO/WHO collaborated in epidemiological surveillance efforts along the Colombia-Ecuador border to identify 35 common diseases and to develop a software application to analyze the health situation in border municipalities. This software will collect health information from official sources at the departmental, municipal and national levels and compile updated health information to improve decision making. The system will also improve municipal-level health surveillance and will be implemented in 2007.
- The allocation of funding for IDP health issues and the execution of projects improved at the departmental level in Santander, Valle, Cundinamarca and Cordoba. PAHO´s technical cooperation allowed health authorities to identify, access and manage specific national resources earmarked for IDP health care, of which they were formerly unaware. As a result, health authorities were able to integrate resources for health promotion, disease prevention and treatment into the local health budget (previously, resources earmarked for the poor rather than for IDPs were used).
- The "Healthy Homes" initiative was implemented in all Departments where PAHO has field offices. It aims to improve household conditions related to water quality, sanitation, refuse, food, and animals. National and local authorities, UN agencies, the private sector and NGOs worked together to implement and follow up the initiative. Demonstration projects were implemented in Nariño, Chocó, Santander and Norte de Santander as a low-cost solution that is quick to install and easily transportable for displaced population. It includes a toilet, clothes washing areas, a shower, domestic water filters, separate bedrooms for children and adults, kitchen, dining table and seats, trash container, closet, solar oven, and a rain water collection system. This home will help resolve some of the most pressing needs for shelter and sanitation for those who have lost their homes due to displacement and/or natural disasters. PAHO/WHO designed and installed the Healthy Home Family Shelter model with input of universities and IDPs.
The areas of Colombia with the greatest population of IDPs were also the site of floods and landslides in 2006. PAHO/WHO worked with national and local authorities in those departments to coordinate the primary health response, conduct epidemiological surveillance, implement basic sanitary measures in temporary shelters, provide psychosocial aid to the affected population and evaluate damage to health facilities. As a result, preventive emergency measures and surveillance systems helped avoid public health problems in flood-affected areas.
Regional Health Disaster Response Team
In response to the vulnerability of Latin America and the Caribbean to major sudden-impact disasters- some of which strike multiple countries at the same time, as was the case with Hurricane Mitch in Central America-preparations went forward to ensure that the PAHO/WHO Health Disaster Response Team is ready for deployment in emergency situations.
The initial identification and selection of team members was completed and to date, 80 team members have been selected from among PAHO's professional staff throughout Latin America and the Caribbean and from the Ministries of Health of selected countries. These experts possess a wide variety of technical skills: health services administration, medicine, general management, mental health, sanitary engineering, logistics, coordination, water and sanitation, epidemiology, damage and needs assessment, information and communications and toxicology.
For some time PAHO has maintained a small electronic Roster of health experts to identify candidates with a particular disaster-related skill set. Now, with the formal creation of the Health Disaster Response Team, the redesign of the Roster is almost complete. This will permit PAHO/WHO to centralize data on team members and rapidly select and contact individuals for deployment.
Training workshops for team members have taken place in the Dominican Republic and Costa Rica to update and streamline the Organization's internal administrative procedures (to increase flexibility in emergency situations) and to foster teamwork among experts, most of whom share a common organizational affiliation but who previously had little opportunity to work together. The workshops focused on improving emergency-related skills including: the coordination of humanitarian supplies in the aftermath of disasters; conducting damage assessments; resource mobilization; developing recovery and rehabilitation plans and communications and information management. The agenda for the February training session in Costa Rica is attached as Annex 11.
Manual and Guidelines
The first draft of a Disaster Response Team Manual was written, translated from Spanish to English, and reviewed by several experts in the Region. The manual will be a living document and will be revised following a major disaster in orderto incorporate missing or other required information and to revise procedures. User-friendly web-based and print versions are being prepared. The manual will also be available on CDROM and will be widely distributed among team members and PAHO offices. Many of the Organization's internal administrative arrangements are being updated and reference to these is included in the Response Team Manual. This manual, parts of which are interactive, is housed on PAHO/WHO's Intranet site. A print version of the manual is available on request.
Equipment and Supplies
Experience following the December 2004 tsunami in south Asia helped the World Health Organization to develop the content of a "Survival Kit for One Person." Using this list as a guide, PAHO purchased and assembled 15 basic survival kits and pre-positioned them in the three subregional disaster offices: Barbados (for the Caribbean), Panama (for Central America) and Ecuador (for South America). The utility of these kits will be tested at the first opportunity and their content will be reevaluated. The pre-positioning of the equipment and supplies will at least facilitate the deployment of the team to an affected area. In the case of hurricanes, the pre-positioning of a team will be decided according to the each individual situation.
In summary, the makeup of the team is multidisciplinary and members have substantial experience in their area of expertise. All are now much more familiar with internal PAHO/WHO procedures and can therefore speed up the response by cutting through red tape. The creation of this Team and the inter-programmatic support it receives is an important indicator of the fact that humanitarian response to disasters in PAHO Member States is a collective responsibility of the entire Organization.
The United Nations humanitarian reform and the creation of the cluster mechanism have played a role in how PAHO/WHO has organized this team and selected members. In disaster situations, the Team Coordinator will also serve as the health cluster lead and will be tasked with liaising with all other agencies. In Colombia and Haiti, countries which are in complex emergencies, a system is already in place and PAHO/WHO is coordinating health issues. Read PAHO's newsletter editorials on the UN Cluster Approach in Annex 12.
The Logistics Support System
The LSS is a joint initiative of six UN agencies (WHO, WFP, OCHA, UNICEF, UNHCR, and PAHO) to consolidate the experiences of the UN Joint Logistics Centre (UNJLC) and the SUMA system in the Americas with regard to the management of humanitarian supplies. LSS combines the strengths of these two successful initiatives that have operated in different environments and have served complementary purposes.
The English and Spanish-language versions of the LSS software were finalized in 2006 and widely tested. LSS has its own web site www.lssweb.net where the software can be downloaded free of charge. The web site is also regularly updated with LSS activities and operations (in English and Spanish), a team of LSS members was formed and its members incorporated into the PED roster, the LSS was implemented in several locations following different disasters (floods in Colombia and Suriname, crisis in Lebanon), and a CD-Rom containing the LSS software, manuals in both languages, instructions for setting up the web application, PowerPoint presentation and other information was developed and is being distributed free of charge.
There was good reception of LSS in all the countries were training activities took place and there is even a request to translate it into Turkish after the training in Ankara. During 2007, it is expected that the software and manuals will be translated into French and Portuguese, so all PAHO member countries will be able to use the system in their national language. The availability of the French version will also facilitate its dissemination to other regions.
Meetings are held with NGOs, UN agencies and National Authorities of each country where the LSS is deployed or training take place. These meetings emphasize the importance of accountability and transparency in the management of humanitarian aid. The objective of promoting good governance is far more ambitious and perhaps important that the improvement of the software and its utilization as an inventory control tool. However, contribution to coordination and transparency will only be fully accomplished if a culture of collaboration and frank exchange of data among international agencies and national partners exists. The shortcomings are generally not software or system problems but a lack of willing to share data and lack of political support.
For the complete report, please see http://www.disaster-info.net/AnnualReport06/index.htm