health implications of disasters in the philippines

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HEALTH IMPLICATIONS OF DISASTERS IN THE PHILIPPINES JOFRED M. MARTINEZ, MAN, RN 2 ND ANTIQUE HEALTH CONGRESS ST. ANTHONY’S COLLEGE, SAN JOSE, ANTIQUE FEBRUARY 26, 2015 Faculty, Nursing Department

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HEALTH IMPLICATIONS OF

DISASTERSIN THE PHILIPPINES

JOFRED M. MARTINEZ, MAN, RN

2ND ANTIQUE HEALTH CONGRESSST. ANTHONY’S COLLEGE, SAN JOSE, ANTIQUE

FEBRUARY 26, 2015

Faculty, Nursing Department

PHILIPPINE DISASTER RISK PROFILE

20 earthquakes per day

22 active volcanoes

36,289 kms. of coastline

20 to 30 typhoons a year

Assessment of Disaster and Risk Reduction Management at the Local Level, 2014

PHILIPPINE DISASTER RISK PROFILE

"EM-DAT: The OFDA/CRED International Disaster Database www.em-dat.net – Université Catholique de Louvain - Brussels - Belgium"

8

28

18

136

314

25

0 50 100 150 200 250 300 350

Drought

Earthquake

Epidemic

Flood

Storm

Volcano

Natural Disaster Occurrence in the Philippines from 1900 to 2014

Super typhoon Haiyan

YOU HAVE JUST ARRIVED HERE.YOU ARE IN CHARGE!

WHAT WILL YOU DO?

EFFECTS OF DISASTERS

• Death, injury, illness and disability

• Damage/loss of essential life support services

• Damage/loss of facilities, services, infrastructure

• Displacement of populations

• Psychosocial stress

• Environmental pollution

• Economic and social impact

EFFECTS OF DISASTERS

• Risk of infection or contamination for response and relief personnel

• Breakdown in communication networks and information flows

• Breakdown in security

• Delay or lack of access to routine services

HEALTH EFFECTS OF DISASTERS• Increased number of deaths and injuries

• Population displacement, including missing persons

• New cases of disease and disability

• Increased number of cases of psychological and social behavioural disorders

• Possible food shortages and nutritional deficiencies

HEALTH EFFECTS OF DISASTERS• Contamination or injury of relief personnel

• Environmental health hazards

• Damage to healthcare facilities and other health infrastructures

• Diversion of development resources to emergency relief

• Disruption of routine disease surveillance

• Disruption of routine health services

HEALTH SERVICES IN EMERGENCIES• Mass casualty management

• Management of the dead and missing

• Health information and communication

• Communicable disease control measures

• Environmental health

• Psychosocial services

• Reproductive health

• Feeding and nutrition

VulnerabilitiesCapacities

EMERGENCY INDIRECT IMPACTS

DIRECT IMPACTS

HEALTH RESPONSE

search and rescuefirst aidtriage

medical evacuationprimary care

disease surveillance and controlcurative careblood bankslaboratories

referral systemspecial units (burns, spinal)

evacuation centresshelterwater

food and nutritionenergysecurity

environmental healthprimary health care

care of the deadpsychosocial care

disability care

recoveryreconstruction

ASSOCIATED FACTORS

Climate/weather/time of dayLocation

Security situationPolitical environment

Economic environmentSocio-cultural environment

Morale, solidarity, spiritCompetence, corruption

COMMUNITY

Damageand

Needs

EMERGENCIES & HEALTH

ROLES OF NURSES IN EMERGENCIES

PLANNING• meeting with national/local coordination bodies

• planning/implementing command systems

• planning for logistics and administrative arrangements

• planning for safety and security arrangements

ROLES OF NURSES IN EMERGENCIES

COORDINATION• with military

• with private sectors

• with professional associations

• with international assistance

• with forensics and mortuaries

• with social and welfare services

ROLES OF NURSES IN EMERGENCIES

ASSESSMENT• conducting inter-sectoral damage analysis and

needs assessment

• conducting community risk assessment

• conducting patient assessment

ROLES OF NURSES IN EMERGENCIES

PROVIDING IMMEDIATE CARE• search and rescue

• victim identification and reporting

• evacuation

• first aid

• triage

• transport of victims

• trauma/primary care

ROLES OF NURSES IN EMERGENCIES

PROVIDING ACUTE CARE• treatment of disease or injury

• laboratory services and blood bank products

• medical supplies

• essential drugs

ROLES OF NURSES IN EMERGENCIES

PROVIDING REHABILITATION CARE• orthotics and prosthetic

• dental care

• disability care

ROLES OF NURSES IN EMERGENCIES

PRIMARY HEALTH CARE• emergency shelter

• water safety and quality

• food safety and nutrition

• food supply and food security

• energy, protection and security

• recovery of PHC activities (EPI, MCH, CDD, ARI)

ROLES OF NURSES IN EMERGENCIES

COMMUNICATION AND REPORTING• emergency reporting system

• disability and infectious/outbreak surveillance

ROLES OF NURSES IN EMERGENCIES

RECOVERY AND REHABILITATION• compensation of victims

• recovery, reconstruction and rehabilitation of community

• post-event evaluation

• research and documentation

• community risk reduction programmed

ROLES OF NURSES IN EMERGENCIES

PROVIDING TRAINING IN EPR• emergency drills

• risk communication

• mass casualty management

NURSE COMPETENCIES INDISASTER MANAGEMENT

PRE-INCIDENT PHASEA. Assist in the assessment of communities to

determine pre-existing health issues and health care resources in a given community

B. Contribute to the planning of health care needs of individuals and communities in an emergency/disaster

C. Mobilize community for health and intersectoral plan on health emergency management

NURSE COMPETENCIES INDISASTER MANAGEMENT

PRE-INCIDENT PHASED. Collaborate with other health care professionals

to develop measures to reduce vulnerability of populations

E. Support health policy and organizational preparation for emergencies

F. Develop health education and advocacy materials and provide training on health emergency management

NURSE COMPETENCIES INDISASTER MANAGEMENT

PRE-INCIDENT PHASEG. Demonstrate application of professional, ethical,

legal, cultural and gender considerations

H. Demonstrate leadership and management skills in health emergency management

NURSE COMPETENCIES INDISASTER MANAGEMENT

INCIDENT PHASEA. Perform situation and needs assessment and

prioritize care and management in the field and health facility during emergencies

B. Provide initial relief and care during emergencies

C. Provide nursing care of individuals, especially the vulnerable groups

NURSE COMPETENCIES INDISASTER MANAGEMENT

INCIDENT PHASED. Support and implement public health

interventions

E. Provide safety and security of patients and personnel

F. Provide psychosocial support to patients and staff

NURSE COMPETENCIES INDISASTER MANAGEMENT

INCIDENT PHASEG. Facilitate coordination and communication

H. Supervise/support management of logistics and supplies

NURSE COMPETENCIES INDISASTER MANAGEMENT

POST-INCIDENT PHASEA. Provide long-term care to individuals and

families B. Support recovery - reconstruction efforts in the

hospital and communityC. Evaluate the impacts of nursing intervention and

utilize these results to develop evidence-based decisions

PSYCHOLOGICAL

FIRST AIDJOFRED M. MARTINEZ, MAN, RN

Faculty, Nursing Department

HOW SOMEONE RESPONDS DEPENDS ON THESE FACTORS

• the nature and severity of the event(s) they experience;

• their experience with previous distressing events;

• the support they have in their life from others;

• their physical health;

WHAT IS PFA?PSYCHOLOGICAL FIRST AIDA humane, supportive response to a fellow human being who is suffering and who may

need support.According to Sphere (2011) and IASC (2007)

WHAT IS PFA?• providing practical care and support, which does

not intrude;

• assessing needs and concerns;

• helping people to address basic needs (for example, food and water, information);

• listening to people, but not pressuring them to talk;

WHAT IS PFA?• comforting people and helping them to feel

calm;

• helping people connect to information, services and social supports;

• protecting people from further harm.

WHAT IS PFA IS NOT• It is not something that only professionals do.

• It is not professional counselling.

• It is not “psychological debriefing”.

• It is not asking someone to analyse what happened to them or to put time and events in order.

WHAT IS PFA IS NOT• Although PFA involves being available to listen

to people’s stories, it is not about pressuring people to tell you their feelings and reactions to an event.

WHO NEEDS IT?PFA is for distressed people who have been recently exposed to a serious crisis event.

Who needs more immediate advanced support:• people with serious, life-threatening injuries who need

emergency medical care• people who are so upset that they cannot care for

themselves or their children• people who may hurt themselves• people who may hurt others

PFA TARGET OUTCOMESPhysical health:

RESTORE SAFETY

Psychological health:

FACILITATE FUNCTION

Behavioral health:

EMPOWER ACTION

PFA DO’S Be honest and trustworthy.

Respect people’s right to make their own decisions.

Be aware of and set aside your own biases and prejudices.

Make it clear to people that even if they refuse help now, they can still access help in the future.

PFA DO’S Respect privacy and keep the person’s story

confidential, if this is appropriate.

Behave appropriately by considering the person’s

culture, age and gender.

PFA DONT’Sx Don’t exploit your relationship as a helper.

x Don’t ask the person for any money or favor for helping them.

x Don’t make false promises or give false information.

x Don’t exaggerate your skills.

PFA DONT’Sx Don’t force help on people, and don’t be

intrusive or pushy.

x Don’t pressure people to tell you their story.

x Don’t share the person’s story with others.

x Don’t judge the person for their actions or feelings.

PREPARING FOR PFA• Learn about the crisis event.

• Learn about available services and supports.

• Learn about safety and security concerns.

ACTION PRINCIPLES OF PFA

LOOK LISTEN LINK

LOOK• Check for safety.

• Check for people with obvious urgent basic needs.

• Check for people with serious distress reactions.

PEOPLE WHO ARE LIKELY TO NEED SPECIAL ATTENTION

• Children – including adolescents – especially those separated from their caregivers

• People with health conditions or physical and mental disabilities

• People at risk of discrimination or violence

LISTEN• Approach people who may need support.

• Ask about people’s needs and concerns.

• Listen to people, and help them to feel calm.

LEARN TO LISTEN WITH:• Eyes ›› giving the person your undivided attention

• Ears ›› truly hearing their concerns

• Heart ›› with caring and showing respect

KEEPING PEOPLE CALM• Keep your tone of voice calm and soft.• If culturally appropriate, try to maintain some

eye contact with the person as you talk with them.

• Remind the person that you are there to help them. Remind them that they are safe, if it is true.

KEEPING PEOPLE CALMIf someone feels unreal or disconnected from their surroundings, it may help them to make contact with their current environment and themselves. • Place and feel their feet on the floor.• Tap their fingers or hands on their lap.• Notice some non-distressing things in their environment,

such as things they can see, hear or feel. • Encourage the person to focus on their breathing, and to

breathe slowly.

LINK• Help people address basic needs and access

services.• Help people cope with problems.• Give information.• Connect people with loved ones and social

support.

FREQUENT NEEDS• Basic needs, such as shelter, food, and water and

sanitation.

• Health services for injuries or help with chronic (long-term) medical conditions.

• Understandable and correct information about the event, loved ones and available services.

• Being able to contact loved ones, friends and other social supports.

FREQUENT NEEDS• Access to specific support related to one’s culture

or religion.

• Being consulted and involved in important decisions.

POSITIVE COPING• Get enough rest.• Eat as regularly as possible and drink water.• Talk and spend time with family and friends.• Discuss problems with someone you trust.• Do activities that help you relax (walk, sing, pray,

play with children).• Do physical exercise.• Find safe ways to help others in the crisis and get

involved in community activities.

NEGATIVE COPING• Don’t take drugs, smoke or drink alcohol.• Don’t sleep all day.• Don’t work all the time without any rest or

relaxation.• Don’t isolate yourself from friends and loved

ones.• Don’t neglect basic personal hygiene.• Don’t be violent.

CRISIS AND SPIRITUALITY

CRISIS AND SPIRITUALITY• Be aware of and respect the person’s religious

background.• Ask the person what generally helps them to feel

better.• Listen respectfully, and without judgment, to

spiritual beliefs or questions the person may have.

CRISIS AND SPIRITUALITY• Don’t impose your beliefs, or spiritual or religious

interpretations of the crisis, on the person.• Don’t agree with or reject a spiritual belief or

interpretation of the crisis, even if the person asks you to do so.

ENDING YOUR HELP• Use your best judgment of the situation, the

person’s needs and your own needs.

• Explain to the person that you are leaving, and if someone else will be helping them from that point on, try and introduce them to that person.

• If you have linked the person with other services, let them know what to expect and be sure they have the details to follow up.

THANK YOU VERY MUCH!

For more information:

Psychological First Aid. Guide for field workers.www.who.int/mental_health/publications/guide_field_ workers/en/