Emergency response to natural disasters

Kèren Zaccai

Over the past decade, millions of people have been affected by natural disasters worldwide. The tsunami in Japan in 2011 and the earthquakes in Chili and Haiti in 2010 are just a few of the disasters that shook the world in the past years. What happens directly after a disaster strikes? Who are the people who go to the place everyone runs away from? What is it like to be there and help people who lost everything?

First response

Dr. Muhammad Shoaib is a 35-year-old doctor who has worked for Médecins Sans Frontières (Doctors Without Borders) in Pakistan since 2004. When the 2005 earthquake struck northern Pakistan with a magnitude of 7.6 on the Richter scale, the official death toll from the quake surpassed 76 000. More than 80 000 people were injured, many with serious, life-changing injuries. Nearly 3 million people were displaced from their homes, and most of them were obliged to live in tents. Rebuilding schools, hospitals and houses presents one of the greatest challenges following a natural disaster. Dr. Shoaib was member of the MSF medical team who responded to the 2005 earthquake.

“You need to do everything you can to help people within your role.” says Shoaib. “During the earthquake in Pakistan the road was broken and the ground was so muddy that the helicopter could not land. We had to jump out while the helicopter was hovering at low altitude and throw out the supplies. We set up the clinic right there and were able to perform small surgeries and treat various injuries and infections. Because of the condition of the roads, the more seriously injured patients were taken to different locations by helicopter.” Shoaib and his colleagues were the first responders to the disaster. The local community had no means of transportation and was very thankful for their presence. After their intervention Shoaib says he felt proud to be a doctor, being able to help others in such a situation.

After Shoaib became an MD, he received a master degree in Public Health and worked for MSF in Pakistan. In 2010 he decided to expand his field of experience and moved to Uganda, where he has been working for the past ten months. He was involved in landslides and responded to an outbreak of an unknown disease which turned out to be yellow fever. “These experiences form you in a way that you become less dependent.”

“Fast decision making is essential when being a first responder to a disaster, and that is what you become eventually: a fast decision maker. There are a lot of people involved in emergency responses. Within all disciplines - nurses, doctors and other medical staff-, experience is the most important factor in decision-making. You can be a great medical doctor, but you must be a manager as well, especially in these kinds of situations, as you have to manage other people of variable capacities.”

At mission level MSF has a country management team in which Shoaib works as a medical coordinator in Uganda. In this role he is responsible for monitoring the health needs in the area and in case of emergencies he is involved in the decision making. In this process, a level of emergency preparedness is always required. “We must be ready for various emergency scenarios depending upon the prevalence and likelihood of various emergencies in the area. This emergency preparedness includes ensuring the access to medical supplies, development of an area specific emergency preparedness plan and training of staff.  Lastly, very important, every response is evaluated so that we can learn from our experiences.”

Medical instinct

“Sometimes it’s necessary to do consultations under a tree when nothing else is available. It is important to try to be creative and innovative. When you first arrive at a scene you sometimes have to deal with patients that need extraordinary care while you do not have all supplies, infrastructure or relevant skills: open skull surgery for example or patients with femur fractures when transportation is not available. In those cases you just try to innovate and “do no harm” or prevent further damage prior to referral to an appropriate medical center.” Setting up priorities in the emergency service delivery centers and triaging of sick patients is very important in these situations.

According to Shoaib, security issues are most frustrating of all. “When it is not possible to get a patient transported to the right facility because it is not safe to travel at night, you know it is not possible, but your medical instinct tells you that this person needs help.”

Disasters have a big impact on each person involved, including casualties, as well as health workers. Hence, the tasks of first responders should not be taken lightly. Even when you are well prepared and have a lot of experience, there are various risks you take while working in an emergency situation: the post earthquake shocks in Pakistan, for example, or the possibility of contracting an illness while responding to an outbreak. This, combined with an increased workload can increase the stress levels of the health workers involved. MSF does practice precautionary measures where applicable and psycho-social support is available where needed. “Even during a mission, psychological support can be contacted online or by telephone. In some first-responding teams a psychology expert is even part of the team. After a mission, this support is available at the headquarters. Shoaib finds this a very necessary aspect of MSF.

“For all doctors in various fields of medicine it is important to have at least basic trainings and education in emergency medicine. This knowledge should be refreshed periodically to maintain the capacity to manage emergencies regardless of whether you are in a modern city hospital or somewhere out in the desert.” Shoaib can only encourage young doctors to get adequate training and exposure to manage various medical emergencies. “However, you still learn best through experience.”

Imagine… a disaster strikes your hometown: what would YOU do? Got interested in the world of disaster management after reading this article? Do you want to know more about it?

Dive into the topic this autumn and join the 8th IFMSA-NL Conference on “S.O.S.; Crisis- and Disaster management,” a breathtaking theme! During the day other experts will share their knowledge and their experiences.

Date: 15 October, 2011

Time: 10 AM-6PM

Place: Academic Medical Centre, University of Amsterdam

Price: €7.50 (including lunch and coffee breaks)

Register now and book your tickets at www.ifmsa.nl/congres

About the author:

Kèren Zaccai is a fifth year medical student at the Erasmus University in Rotterdam and Public Relations coordinator of the 8^th IFMSA-NL conference.

References:

Data according to the National Plan of Action of the Islamic Republic of Pakistan