Health care challenges during and after a natural disaster
Use technology to address some of the most pressing health care obstacles post disaster
Natural disasters evoke scenes of destroyed infrastructure, darkened cities, and long lines for food and water. But what’s less visible are the health issues that are exacerbated in the aftermath of these events.
Former U.S. Congressional Delegate Donna Christensen of the US Virgin Islands has seen firsthand the widespread and long-lasting health effects of natural disasters, which go well beyond the initial injuries and traumas.
“Our hospitals went down, so our hospital was really not functioning and we’ve been through that several times with hurricanes in the past,” Christensen said. “People were evacuated, some without medical records, some with medical records pinned to their clothing. In many instances, their families didn’t know where they were and they didn’t know where they were going at the time they were told to get on the plane or get on the ship.”
It is a harsh reality, but when a natural disaster disrupts a community, medical records and adequate care can be lost or difficult to access.
For this year’s World Health Day, the World Health Organization is focused on ensuring that everyone can obtain the care they need, and when they need it. This is particularly pressing during and after a natural disaster where infrastructure may be compromised and first responders are stretched to their limit.
There is good news, though. Technology-based solutions have an increasing role to play in helping communities better prepare for and recover from natural disasters. Through open technologies and cloud services, saving lives through code has never been easier and with submissions now open for the 2019 Call for Code Global Challenge, it’s a great way for developers to get involved and be part of a positive impact in the world.
Health care obstacles
Every year, natural disasters kill around 90,000 people, according to the WHO. The mortality rates alone are staggering, and unfortunately the health impacts don’t end with lives lost. The primary focus after a disaster is on helping people who sustained injuries or are at risk of health complications but damaged or destroyed medical facilities prevent timely access to emergency medical care — and that’s just one of the health challenges.
Medical supplies and records
“Getting medication into the territory was a major issue, both vaccines and medicines, especially insulin,” Christensen explains. Natural disasters can disrupt the medical supply chain and leave pharmacies low on critical medications that patients need to manage chronic diseases. For example, after Hurricane Ivan made landfall near Mobile, Ala., in 2004, pharmacies in the affected areas had depleted supplies by 53 percent within days, according to CDC research.
Medical records are also a challenge. Many developing nations still rely on paper systems, which are difficult to keep with a patient during an evacuation. For instance, Christensen remembers: “There was a case of a woman who came to Puerto Rico without a medical record. Luckily, she was a nurse. She was a dialysis patient but she had a very slow heart rate. The doctor wanted to put a pacemaker in and she said, ‘No, this is something I live with’ and they put her out of the hospital. She didn’t have her medical records with her. If she wasn’t a nurse, they wouldn’t have been informed.”
Electronic medical records are better than paper-based systems but they are not perfect. Without electricity, Internet or intranet after a disaster, a healthcare worker may not be able to access electronic medical records, creating a hurdle that could mean the difference between life and death for a medically-vulnerable patient.
“We really need a way to make sure electronically people can be traced to where they are going if they have to be evacuated and that the medical record is available to wherever they end up and that was not the case. That’s very, very important.” – Donna Christensen
Food and water
Disasters don’t just flood homes and destroy infrastructure. They also disrupt the supply chain and wipe out crops, magnifying the need for food security especially among the poor in developing nations. In 2017, extreme climate events, mainly drought, were a major trigger of food crises in 23 countries with more than 39 million food-insecure people in need of assistance, the Food Security Information Network’s 2018 Global Report on Food Crises states. Post-disaster food shortages can result in malnutrition while access to unspoiled food can be a challenge.
A lack of clean, available water is also a chief concern. During and after a disaster, water can become contaminated with microorganisms, sewage, agricultural or industrial waste, chemicals, and other substances that cause illness or death. For example, research by the WHO found contaminated water after flooding in Bangladesh in 2004 resulted in an outbreak of diarrheal disease, involving more than 17,000 cases.
Natural disasters are expected to displace nearly 4 million people in the next two decades, according to the Norwegian Refugee Council. This population displacement, along with cramped quarters and a lack of infrastructure, creates a breeding ground for diasese. The medically vulnerable individuals, such as those with immune system disorders, are especially at risk. For example, a measles outbreak in the Philippines in 1991 among people displaced by the eruption of Mt. Pinatubo involved more than 18,000 cases, according to WHO research. Other top concerns are West Nile Virus, malaria, influenza, and diarrheal disease.
“Extreme climate events – mainly drought – were also major triggers of food crises in 23 countries with over 39 million food-insecure people in need of urgent assistance in 2017.” – The Food Security Information Network’s 2018 Global Report on Food Crises.
Disasters can discriminate, disportionately affecting vulnerable citizens, such as children, the elderly, the disabled, and the impoverished. This is why experts stress that a community’s disaster response and recovery plan should be attentive to the needs of vulnerable populations. Such individuals may require medical supplies that can get damaged, lost, or be in short supply during or after a diaster.They may also rely on a caregiver or support network.
“When these individuals are suddenly ripped out of that environment, they don’t have a knowledge or awareness of how to get transportation to their doctor’s appointments, how to get food, or how to get medications,” said Joshua Barnes, the Disaster Recovery Director for the U.S. Department of Health and Human Services. “Technology could be really helpful in supporting patients and providers and finding the services that they need.”
Barnes recommends developers aim to create applications that can help bridge some of those gaps and restore support and a sense of independence to vulnerable individuals.
It’s not uncommon for natural disasters to yield mental health consequences. Research shows the incidence of depression, anxiety, post traumatic stress disorder, substance abuse and domestic abuse increases during and after these events. For instance, following Hurricane Katrina, a sample of survivors found one in six met the criteria for PTSD. The same is true for Puerto Rico, says Dr. Alexia Suarez, program manager, Americares.
“A year later we are finding results of post-traumatic stress disorder,” Suarez said. “More than despression is burnout, compassion fatique, difficulties managing your day-to-day work given the stress they are given by rebuilding and their own lives.”
Building up a community’s mental health resiliency prior to a disaster is key, she said. During an event, the WHO recommends at least one supervised health care staff member be available in ever general health facility during disasters to help assess and manage mental health problems. This goal can be difficult to meet, and all not all patients are able to make it into health facilities during or after a disaster. Virtual solutions could help fill the gap and technology could help connect individuals in need of support.
Erica Tavares, senior director of Institutional Advancement at the International Medical Corps encourages developers to not only be innovative, but to also think about maintenance.
“This whole idea of how do you use technology when you’re in a remote or offline setting is a real challenge for us,” Tavares said. “How can we empower healthcare workers to do surveillance, to collect data … when there’s no connectivity, and in a way that’s safe and secure.”
It’s not just about the technology, but about it being user friendly. “We can’t give people a solution that requires a lot of updates, that’s really cumbersome, that is going to fail on them,” Tavares said. “It has to be simple. It has to be intuitive. It has to be easy to translate into multiple languages, and it has to be something they can rely on and easy for them to share data back.”
Understanding community well-being and individual health before a disaster strikes can help improve overall resistance, experts say. Developers in particular can bring innovative ideas to the table and in the coming weeks, IBM Developer will share more information and ideas around these healthcare areas.
To get a better idea for inspiration on your Call for Code solution, please read the CTO’s letter to developers for resources to help you get started. You can also join the discussion, where you can interact with other interested developers.