Emergency Health Management in Emergency Health Management ...
Emergency Health Management in Emergency Health Management ... Emergency Health Management in Emergency Health Management ...
Emergency Health Management in Nargis Cyclone Affected Areas DR. SOE LWIN NYEIN DIRECTOR (EPIDEMIOLOGY) DEPARTMENT OF HEALTH
- Page 3 and 4: Cyclone Track
- Page 6 and 7: •Population affected - 2.4 millio
- Page 8 and 9: National Disaster Preparedness and
- Page 10 and 11: Search and Rescue
- Page 12: Emergency Medical Care
- Page 15: Relief Camps
- Page 19 and 20: EWARS - Information flow Health Fac
- Page 21 and 22: 1600 Comparasion of Incidence of DH
- Page 23 and 24: Comparasion of Incidence of DHF Cas
- Page 25 and 26: Supply of Drugs/ Logistics for Emer
- Page 27: Water Purification Plant provided b
- Page 30 and 31: Immunization • Measles immunizati
- Page 32 and 33: Public health measures implemented
- Page 34 and 35: Mental Health Care Mental health se
- Page 36 and 37: Floating Hospital • (7) batches o
- Page 38: Health Care Provision at Relief Cam
- Page 42 and 43: Veterinary Coverage of LBVD Head (n
- Page 45 and 46: Team from Royal Kingdom of Thailand
- Page 47 and 48: Medical Team from Republic of India
- Page 49 and 50: Medical Team from Republic of Singa
- Page 51 and 52: Medical Team from French Republic A
<strong>Emergency</strong> <strong>Health</strong> <strong>Management</strong> <strong>in</strong><br />
Nargis Cyclone Affected Areas<br />
DR. SOE LWIN NYEIN<br />
DIRECTOR (EPIDEMIOLOGY)<br />
DEPARTMENT OF HEALTH
Cyclone Track
Early Warn<strong>in</strong>g<br />
•S<strong>in</strong>ce 30-4-08 morn<strong>in</strong>g<br />
By Radio, TV Channels, Newspaper, phone,<br />
Fax to high risk areas for community alert<br />
and preparedness<br />
• M<strong>in</strong>istry of <strong>Health</strong> also sent early warn<strong>in</strong>g<br />
<strong>in</strong>formation and <strong>in</strong>structions on<br />
preparedness of disaster through<br />
respective State and Divisional <strong>Health</strong><br />
Department to high risk townships
•Population affected - 2.4 millions<br />
•The death and miss<strong>in</strong>g – 138,373<br />
•Injuries – 19,359
Sr.<br />
No<br />
Animal losses<br />
Species Losses% Head (nos.) Value<br />
(kyats <strong>in</strong><br />
million)<br />
1 Buffaloes 45 136631 20494<br />
2 Cattle 16 91297 23694<br />
3 Sheep/ goat 15 7084 142<br />
4 Pig 15 67903 3395<br />
5 Chicken 15 2404344 3607<br />
6 Duck 32 533856 801<br />
Total 42134
National Disaster Preparedness and Response Committee<br />
M<strong>in</strong>istries<br />
Central Level<br />
Central Committee for Disaster<br />
Preparedness and Response<br />
If necessary<br />
UN Agencies<br />
and ASEAN<br />
Countries<br />
Sub Committees<br />
Period<br />
Early Warn<strong>in</strong>g<br />
Dur<strong>in</strong>g Disaster<br />
period System Period Period period<br />
Pre-disaster<br />
period<br />
Post disaster<br />
period<br />
<strong>Emergency</strong> Period<br />
Governments and<br />
non- governmental<br />
Organizations<br />
<strong>Emergency</strong> Response<br />
Headquarters<br />
Committee from<br />
M<strong>in</strong>istries<br />
Governments and<br />
non- governmental<br />
Organizations<br />
Governments and<br />
non- governmental<br />
Organizations<br />
State/ Division/ Township/Wards and village Disaster Preparedness and Response<br />
all Areas<br />
All disaster area and<br />
resources form related area<br />
necessary for help<br />
All areas concerned with<br />
rehabilitation programme
National Disaster <strong>Management</strong> Committee<br />
After Tsunami (2004), the Government of Union of Myanmar had organized<br />
the National Natural Disaster Preparedness Central Committee <strong>in</strong> 2005<br />
chaired by the Prime M<strong>in</strong>ister and comprised of (10) sub-committees.<br />
Ten Sub-committees<br />
1. News and Information<br />
2. <strong>Emergency</strong> communication<br />
3. Rescue and relief<br />
4. Transport and clearance of passage<br />
5. <strong>Health</strong> Care Sub-committee<br />
6. Rehabilitation and resettlement<br />
7. Security<br />
8. Prelim<strong>in</strong>ary <strong>in</strong>formation on destruction and emergency relief<br />
9. Reduction of dangers and construction of emergency shelter<br />
10. Confirmation of destruction
Search and Rescue
Under the guidance of Prime M<strong>in</strong>ister, Chair of the<br />
National Natural Disaster Preparedness Central<br />
Committee the teams visited Mawlamy<strong>in</strong>egyun, Pyapon<br />
and Bogale on the 4 th<br />
of May and provided emergency<br />
medical care and referred severely <strong>in</strong>jured patients to<br />
Yangon General Hospital and Yangon Kyimy<strong>in</strong>da<strong>in</strong>g<br />
i i<br />
Orthopedic Hospital by military helicopters.
<strong>Emergency</strong> Medical Care
<strong>Emergency</strong> Medical Care<br />
• <strong>Emergency</strong> <strong>Health</strong> <strong>Management</strong> Office at YGH, managed by M<strong>in</strong>ister,<br />
Deputy M<strong>in</strong>ister and senior officials from DOH<br />
• Provid<strong>in</strong>g emergency medical and surgical management for the people <strong>in</strong><br />
shock and <strong>in</strong>jured<br />
• Immediate management of function<strong>in</strong>g of operation theaters, labour room,<br />
and X-ray mach<strong>in</strong>es etc..<br />
• 24 - hour cl<strong>in</strong>ics were opened at the every camps for emergency medical<br />
care – supervised by senior medical officer<br />
• Senior epidemiologists/specialists immediately assigned <strong>in</strong> affected areas
Relief Camps
Established early warn<strong>in</strong>g<br />
surveillance and response system<br />
• Focus on the communicable disease of<br />
public health significance, (severe<br />
diarrhoea, measles, tetanus, DHF, etc.)<br />
• Daily report<strong>in</strong>g system<br />
• Daily monitor<strong>in</strong>g of disease morbidity and<br />
mortality<br />
• Immediate feedback mechanism<br />
• Monitor<strong>in</strong>g of response and outcome
EWARS – Information flow<br />
<strong>Health</strong> Facilities<br />
Camps/cl<strong>in</strong>ic<br />
S/C<br />
RHC<br />
Station Hosp<br />
Temporary<br />
camps<br />
INGO<br />
Data collection<br />
compilation<br />
and analysis<br />
Lab confirmation<br />
TMOS<br />
NGO/INGO<br />
at Yangon<br />
Divisional<br />
<strong>Health</strong><br />
Department<br />
<strong>Health</strong><br />
Cluster<br />
Agencies<br />
MOH<br />
National Surveillance<br />
System<br />
Response and feedback
Weekly Diarrhea Cases <strong>in</strong> Nargis-hit Yangon and Ayeyarwaddy Division<br />
2500<br />
ses<br />
ber of Ca<br />
Num<br />
2000<br />
1500<br />
1000<br />
500<br />
0<br />
Wk19* Wk20 Wk21 Wk22 Wk23 Wk24 Wk25 Wk26 Wk27 Wk28 Wk29 Wk 30 W31 W32 W33<br />
Epidemiological Week Number<br />
Yangon Ayeyawaddy Total
1600 Comparasion of Incidence of DHF cases <strong>in</strong> Yangon Division<br />
( from 2003 to 2008 As of July- 22)<br />
1400<br />
1200<br />
1000<br />
800<br />
600<br />
2003<br />
2004<br />
2005<br />
2006<br />
2007<br />
2008<br />
400<br />
200<br />
0<br />
Jan Feb Mar Apr May Jun Jul<br />
month<br />
As of July 2008
Comparasion of Incidence of DHF cases <strong>in</strong> Ayeyarwaddy Division<br />
( from 2005to 2008 As of July- 19)<br />
1400<br />
1200<br />
es<br />
Cas<br />
1000<br />
800<br />
600<br />
400<br />
2005<br />
2006<br />
2007<br />
2008<br />
200<br />
0<br />
January February March April May June July<br />
month
Comparasion of Incidence of DHF Cases <strong>in</strong> Ayeyarwaddy Division<br />
(Affected 7 Townships, 2005-2008 2008 as of July 19)<br />
350<br />
300<br />
250<br />
Cases s<br />
200<br />
150<br />
100<br />
2005<br />
2006<br />
2007<br />
2008<br />
50<br />
0<br />
January February March April May June July<br />
month
Specialist teams were formed<br />
and sent to the frontier camps <strong>in</strong><br />
groups of (20) <strong>in</strong> rotation, fully<br />
equipped with medic<strong>in</strong>es and<br />
supplies.<br />
Specialist teams <strong>in</strong>clude-<br />
- Physician<br />
- Surgeon<br />
- Orthopedic surgeon<br />
- Pediatricians<br />
- Anesthetist<br />
ti t<br />
- Psychiatrist<br />
- Eye surgeon<br />
- Dental surgeon<br />
- Medical doctors and nurses from<br />
general hospitals.
Supply of Drugs/ Logistics for<br />
<strong>Emergency</strong> <strong>Management</strong><br />
M<strong>in</strong>istry of <strong>Health</strong><br />
• <strong>Emergency</strong> <strong>Health</strong> Kits<br />
• Vacc<strong>in</strong>es (Measles and Tetanus)<br />
• Bleach<strong>in</strong>g powder for chlor<strong>in</strong>ation of water<br />
• Fogg<strong>in</strong>g mach<strong>in</strong>es, <strong>in</strong>secticides<br />
• Other essential drugs requested from<br />
affected areas
Water and Sanitation<br />
• Chlor<strong>in</strong>ation of all water<br />
sources <strong>in</strong> affected area<br />
to get safe dr<strong>in</strong>k<strong>in</strong>g water.<br />
• Test<strong>in</strong>g of water samples<br />
•By the support of INGOs and<br />
UN agencies, sanitary latr<strong>in</strong>e<br />
and proper waste disposal<br />
system at all camps.
Water Purification Plant provided by INGOs
Nutrition & Food sanitation<br />
• Also supervised the food sanitation, food<br />
safety and also advice special arrangement for<br />
the <strong>in</strong>fants.<br />
• <strong>Management</strong> of child nutritional emergency<br />
• Coord<strong>in</strong>ated with NGOs, INGOS and UN<br />
agencies
Immunization<br />
• Measles immunization<br />
activities was carried out all<br />
children (9 months to 15<br />
years).<br />
• Tetanus vacc<strong>in</strong>ation was<br />
<strong>in</strong>dicated d for <strong>in</strong>juries i and AN<br />
care.<br />
• Rout<strong>in</strong>e EPI plus Activities
Vector control and Waste <strong>Management</strong>
Public health measures implemented<br />
at the storm-hit areas<br />
• <strong>Health</strong> education<br />
• Chlor<strong>in</strong>ation of dr<strong>in</strong>k<strong>in</strong>g water<br />
• Construction of sanitary latr<strong>in</strong>es<br />
• Proper waste management<br />
• Fogg<strong>in</strong>g with <strong>in</strong>secticide to<br />
control vector borne diseases<br />
• Immunization particularly polio<br />
and measles to children under<br />
15 years<br />
• Vitam<strong>in</strong> A distribution<br />
• Moral support<br />
• Mental health care<br />
• Surveillance of disease outbreak
Psycho-social Support
Mental <strong>Health</strong> Care<br />
Mental health services are be<strong>in</strong>g provided at<br />
affected areas.<br />
6 Teams (4 Psychiatrists for each team) are based<br />
at Myaungmya rear camp to provide counsel<strong>in</strong>g as<br />
well as curative services to storm-hit victims.<br />
Psychiatrists were also <strong>in</strong>cluded <strong>in</strong> float<strong>in</strong>g hospitals<br />
to Ayeyarwaddy division
Mobile Hospital Ships<br />
Four Float<strong>in</strong>g Hospitals visited<br />
to Pyapon, Bogale, Labutta and<br />
Mawlamya<strong>in</strong>gkyun townships<br />
Anchored at the townships,<br />
give treatment on board for<br />
medical care, dental and<br />
mental care.<br />
Daily visit nearby villages along<br />
the river creeks and streams by<br />
motor boats and give treatment<br />
to the people resid<strong>in</strong>g there.
Float<strong>in</strong>g Hospital<br />
• (7) batches of 129 doctors and nurses had been deployed d to<br />
storm-hit areas by Double Deckers<br />
• Curative services, disease control and public health measures<br />
provided on the ships.<br />
• Mental health was also taken care of by psychiatrists on board<br />
• Refer patients that need further medical care to base camps
Traditional medic<strong>in</strong>e i services<br />
• Provided s<strong>in</strong>ce 6<br />
th May, by mobile teams <strong>in</strong> Ayeyawady and Yangon<br />
Divisions.<br />
• Traditional medic<strong>in</strong>e cl<strong>in</strong>ics were opened at storm-hit areas.<br />
Si 11 th J hi i ti f T diti l M di i P titi h d<br />
• S<strong>in</strong>ce 11 th Juneaship consist<strong>in</strong>g of Traditional Medic<strong>in</strong>e Practitioners had<br />
visited to affected areas for provision of traditional medical care.
<strong>Health</strong> Care Provision at Relief Camps by local NGOs<br />
MMA contributed altogether (160) doctors <strong>in</strong> Yangon and (266)<br />
doctors <strong>in</strong> Ayeyawady Division for provision of medical care.<br />
MNA visited Ayeyawady Division and provided nurs<strong>in</strong>g care<br />
MHAA visited Yangon Division and support public health<br />
MRCS also contributed by first-aid management at front camps
Veter<strong>in</strong>ary special teams<br />
•Eighteen teams which <strong>in</strong>cluded three<br />
veter<strong>in</strong>arians organized from other State and<br />
Division cooperation with local veter<strong>in</strong>arian<br />
stationed at six veter<strong>in</strong>ary camps alternatively.<br />
• All veter<strong>in</strong>arians were facilitated with a<br />
veter<strong>in</strong>ary use and field use equipments, drugs,<br />
medic<strong>in</strong>e and vacc<strong>in</strong>e.
Veter<strong>in</strong>ary Coverage of LBVD<br />
Head (nos.)<br />
Division FMD HS Total Treatment Total<br />
Yangon<br />
Ayeyarwady<br />
848 13299 14147 1246 15393<br />
11870 22106 33976 8130 42106<br />
Total 12718 35405 48123 9376 57499
Private sector Involvement<br />
Doctors , nurses and pharmacists from Asia Royal private<br />
hospital visited to Kunchangone on 7 th May (21 persons) and<br />
9 th May (27 persons).<br />
23 <strong>Health</strong> personnel form Pan Hla<strong>in</strong>g private hospital had<br />
been work<strong>in</strong>g at Ngaputaw and Ha<strong>in</strong>gyi-Kyun s<strong>in</strong>ce 21 st May.<br />
19 health personnel from P<strong>in</strong>lon (SSC) private hospital had<br />
been stationed at Hla<strong>in</strong>gphone <strong>in</strong> Labutta and provided<br />
medical care for two times s<strong>in</strong>ce 3 rd June.
Team from Royal K<strong>in</strong>gdom of Thailand<br />
f( )<br />
Two teams of (30) members each stationed at<br />
Myaungmya and Labutta.
Medical Team from<br />
People’s Republic of Ch<strong>in</strong>a<br />
Team of 53 members stationed at Kunchangon<br />
township, field trip to Dedaye and Kawhmu.
Medical Team from<br />
Republic of India<br />
A team of 47 members organized at Pyapon and<br />
A team of 47 members organized at Pyapon and<br />
Bogalay townships
Medical Team from<br />
People’s Republic of Bangladesh<br />
33 members positioned at Maub<strong>in</strong> and Wakema.
Medical Team from<br />
Republic of S<strong>in</strong>gapore<br />
Two teams of 23 members stationed at Twante<br />
Two teams of 23 members stationed at Twante<br />
township.
A team of 30 members visited Pathe<strong>in</strong>, Dalah & Seikkyi<br />
Kanaungto townships.
Medical Team from French Republic<br />
A team of 24 members stationed at Kawhmu<br />
A team of 24 members stationed at Kawhmu<br />
township and Py<strong>in</strong>khaya<strong>in</strong>g Frontier Camp.
Medical Team from Japan<br />
A team of (23) members based at Labutta town
Medical Team from<br />
LAO People’s Democratic Republic<br />
23 member team located at Kyauktan township.
Medical Team from Republic of Indonesia<br />
Organized at Kawhmu township.
Medical Team from<br />
The Socialist Republic of Vietnam<br />
A team of 15 members stationed at Twante township
Medical Team from Republic of Korea<br />
Two teams positioned at Kunchangone township.
Revitaliz<strong>in</strong>g of health services<br />
• Mobilization of health personnel to affected areas<br />
• Reconstruction and renovation of damaged health facilities<br />
• Restoration and replacement of health staffs<br />
• Replenishment of equipment, logistics, medic<strong>in</strong>es and supplies to health<br />
facilities<br />
• Early detection and rapid response of disease outbreaks<br />
• Immunization<br />
• Dengue Prevention and Control<br />
• Prote<strong>in</strong> Energy Malnutrition Control<br />
• Reproductive <strong>Health</strong> Project<br />
• School <strong>Health</strong><br />
• Restore and ma<strong>in</strong>ta<strong>in</strong> programmes such as TB, HIV/AIDS and Leprosy<br />
• Mental <strong>Health</strong> Plan<br />
• Water and sanitation