On unfateful morning yesterday, Himalayan kingdom of Nepal, sharing border with China and India , suffered earthquake of magnitude 7.8. Last major esrthquake in Nepal was reported in 1934. It is true that we hardly have any control over the natural calamities like Tsunami,or earthquake. We merely can do anything to avert it. Forecasting of such dangers are still not accurate. Only perfect scientific invention and technology, if discovered in future, might help in preventing human lives from it, if people are given pre warning about it. But to tackle emergencies stemming from such natural disaster is one of the big challenges for public health professionals. Patterns of natural calamities can help in understanding and responding to deal with it. For example , Bangladesh is well prepared for cyclones and flood, because it faces any of these calamities every three four years.
2011 earthquale in Japan resulted in loss of $365 Billion US dollars. Hurricane Katrina of 2005 was 45Billion dollars loss for United States. Because of lack of insurance, the loss might not be that huge when compared with US and Japan loss. However, in confrimance with the Nepal economy, this loss might be more difficult for Nepal to meet. Other health priorities, such as achieving millennium goals take backside, because of such emergencies,which have long run consequences. First and foremost challenge before government remain for the government is providing basic needs to affected people and then rehbiliating them. Nepal like country whose GDP is $ 67Billion and which depend largely on international aid(especially India), would completely fall if international agencies community do not come forward to provide assistance.
I witnessed two natural calamities so far, first was Mumbai deluge in 2005 and then Sandy in New York. Mumbai deluge was complete administration failure , most of the portion of city was submerged in water , and thousand of people lost their lives in few hours , and unfortunately, I don’t think any lesson were learnt from it. On the other side, Sandy was effectively handled. Though I was in San Fransisco, I observed it very closely. One major difference observed was that how quickly administration responded to calamity. Then Mayor Bloomberg gave warning signs and evacuated major areas to make sure that Sandy loss is minimized. And then once Sandy passed, Bllomberg administration wisely managed the quick response in all asoects. But again, it was emergency response in difference setting (developed vs developing).
To survive an earthquake and reduce its health impact, three Ps Preparation, Planning, and Practice are required. Mortality stems from trauma, asphyxia, burns, and dust impacting in the Lungs. People are left with disabilities. Surgical need are very important in first few weeks . Sufficint supply of suturing materials, instruments and disinfectants is need of hour. Severe cases of burns were also reported from previous earthquakes. All wounds and burns should be carefull checked as clostridium titani spores are present int the soil and can infects wounds and burns. Adequate stocks of tetanus vaccines for children is important to prevent tetanus related morbidities. Case fatality rate of tetanus is very high if left untreated. Dysphagia and trismus are few of first symptoms of tetanus, hence, cases with these symptovs should be reported to epidemiologists and surveillance officers. Good surveillance and collection of data helps in any future disasters. Few studies have reported increased cases of HIV/AIDS, perhaps because of faulty blood donation or unprotected sex (since unavailability of condoms and other barrier methods). Overcrowding of people cane xpose peole to scabies like infectious diseases. Surgical team, equipments, well trained CPR team, and blood availability (blood bank with standard storage facility) is the cornerstone of saving human lives in medical point of view. If people are given CRP training and for genral wound management, in emerncy situation, physician and nurses can handle cases on priority bases ,and over-burdened health professionals can be used judiciously to give adequate timely treatment to patients. Infectious dieseases (waterborn like cholera , diarrhea), food born diseases such as dysentery become rampant. Timely measure to remove dead bodies animal corpses , and cleaning and applying disinfectiong methods can help
Earthquake survivors are exposed to post traumastic syndrome, hypertension , insomnia and depression. It is worth to mention one movie I watch recently, based on tsunami (I watched Spanish version), in which one married couple of Germany visited Phuket of Thiland with their two gorgeous kids.Tsunami stuck just after two days of their stay and wife lost her husband and children. She wanders one hospital to another, she couldn’t, but only thing she could see the dead body of one of her kids. Her life was devastated in minutes, natural calamity changed her life totally. Eventually she returned Germany, her family gave her support and she was provided psychiatric help. Finally she was able to get over the trauma. This is very nice movie to know how to treat patients with post traumatic stress syndrome (one of therapies). Distruction of homes and inappropriate living condition add up their stress level.
Linnen et al study, conducted in Harvard medical school (2011) vividly describe how fear and pain are affected in post traumatic stress syndrome. It implied that putamenand caudate activity is increased in post traumatic syndrome when subjected to heat pain, in addition, Biologically point of view speaking. Prefrontal cortex and amygdala is involed with emotion and behaviorVery few studies of its kind, Khachadurian (2015) et al reported that earthquake related loss and concurrent psychopathological stress affect adversely on their quality of life. Rwanda was exposed to terrific war in 1990s and their were huge human lives. Boston massachusset depaArtment sent few of their psychiatrist to help people to deal with post traumatic stress syndrome stemming from war. Talk therapy, cognitive behavioral therapy and support from family friends also can be useful Sometimes antidepressant (though black box sign by FDA) can be sueful innot all patients though.. But question crops up, do they have those resources, do they have human resources and experts to tackle it, do they have trained peole , and more importantly money. Here timley international help can make wonder.
International agencies like UNICEF, World Health Organization and World Bank have big role to play. For example, world bank helped Pakistan (project:P099110) to build 80,000 houses under team leader Raja Arshad. It was possible with the assistance of US $ 400 millions. I was reading tweets from Alex Gavan , mountaineer, who has pleading for immediate help for Nepal to avoid further damages. It is scary to imagine rock and ice falling on the mounaineers. I am worried about rurtal pockets aroung Kathmandu. Media, government officials and international agencies focos on big cities, but I think, rural help should be managed through effective measures. Technology is again going to be blessing here. Gis role in earthquake: Google use in finding the person.Facebook and twitter are part of emergency preparedness.Facebook can creates pages for earthquake survivors to connect with each other.
Public health communication plays very important role in first few weeks of earthquakes. People should be educated about emergency preparedness. It also included educating them about safe water and food preparation. They should be stressed on maintaining hygience . Since Nepal is zone for malaria and dengue, use of mosquito nets should be emphasized.
