UPDATE ON TYPHOON RECOVERY, THE PHILIPPINES–Typhoon Haiyan (also known as Yolanda) was the deadliest natural disaster occurring worldwide in 2013. More than 6,000 deaths have been reported among 5 million individuals in the directly affected areas. Pediatric illnesses include gastroenteritis, malnutrition, leptospirosis, measles, and meningitis in the severe damage zone. It is too early to find publicly available data informing lessons on the matching of needs and relief efforts in the Philippines: food, water, sanitation, shelter, immunizations, medical and mental health care, and family reunification. Destruction of schools has interfered with normalizing children’s lives. The loss of running water and transportation makes it difficult to repair and rebuild critical infrastructure.
MASS TUBERCULOSIS EXPOSURE– Tuberculosis continues to be a threat and cutbacks in public health services leave us vulnerable. Infected infants are at high risk for severe tuberculosis. A TB infected mother gave birth to premature twins in Las Vegas in May 2013. The mother and both infants died, with postmortem evidence of TB infection in the mother and one of the infants. Because the infection was not recognized until after the mother died, 977 individuals were potentially exposed, many at a neonatal unit caring for the infants. The Southern Nevada Health District is recommending treatment for the 59 who tested positive for tuberculosis.
FLOOD MAPS – Mapping technology has improved over decades, but published flood zone maps do not always include important revisions to guide safety. For example, FEMA maps of New York City understated the number of structures actually at high risk by half. In 2012, Hurricane Sandy damaged buildings well beyond the area predicted by old methods. New maps were released in December 2013.
HOSPITAL DRILLS INVOLVING CHILDREN– A survey conducted in a sample of community hospitals described disaster drills in the Cincinnati, Ohio region. Only 18% of hospitals included children in simulated major emergencies. Those hospitals not practicing for pediatric emergencies might be more likely to expand their organizational learning if more published guidance was available describing pediatric scenarios integrated into disaster exercises.
ONLINE COURSES– Two online courses (including continuing education credit) have been released by the National Center for Disaster Medicine and Public Health at the Uniformed Services University of the Health Sciences.
- “Psychosocial Impacts of Disasters on Children” addresses behavioral health needs and interventions. The course is aimed at all health providers caring for children.
- “Radiation Issues in Children” reviews basic concepts of ionizing radiation, describes the unique pediatric implications, and develops clinical management plans for exposed children.
- CHRONIC INFECTIOUS DISEASE – Dr. Paul E. Farmer reviews opportunities to improve the management of chronic infections, based on successes in treating tuberculosis and human immunodeficiency virus. Key points: 1) Development of drug resistance can be delayed. 2) Effective treatments must be given robustly but ineffective treatments are not worth using at all. 3) After rapid diagnosis, distinguish between those interventions that are best provided in hospitals versus those better delivered in a community based setting. 4) Financial mechanisms must be developed to provide equitable treatments in resource poor settings, otherwise we will pay to treat the preventable infections when they spread to resource rich settings (see news story above, Massive TB Exposure). 5) Distinguish between “untreatable” and “difficult”.
DEVICES FOR LOW RESOURCE SETTINGS – Innovations are beginning to provide effective medical technology in austere settings limited by inadequate financial resources, electricity, clean water, replacement parts, and technical experts. Sustainable devices must be simple, inexpensive, easily cleaned, and compatible with unreliable electrical power sources. Examples: neonatal resuscitation tools, continuous positive airway pressure machines, and rapid diagnostic testing. While prototypes have generally been developed for daily use in countries with economic constraints, it is worth remembering that any community recovering from a major disaster is underserved, whatever its baseline services. Disaster planners may have something to learn from these simple, reusable technologies.
COMMENTARIES ON ADAPTATION AND DISASTER SCIENCE– Two recent commentaries provide useful perspectives for disaster researchers and policy makers. Moss and colleagues call attention to climate “adaptation science”. Many “natural” disasters are associated with extreme weather events. Debate about the causes of climate change sometimes distorts into ideological polemics. While we attempt to better understand the causes of climate change, a scientific approach is also necessary to adapt to environmental change, to find interventions that diminish “natural” disasters into less dangerous disruptions. Likewise, Dr. Kristi L. Koenig challenges us to avoid the distraction inherent in trying to distinguish “natural” and “manmade” disasters. The reality often involves a complex combination of the two. An all-hazards consensus approach to disaster mitigation, preparation, response, and recovery will anticipate some dangers while we develop evidence. Climate adaptation and disaster interventions are both difficult to study because they involve rare events affected by multiple variables. In both fields we must aim to go beyond anecdote and strive to conduct hypothesis driven studies leading to empirical evidence about interventions that work. Scientific progress will depend on the availability of grant funding.
Edited by: Dr. Bob Kanter