Case Study Local

8/9/2019 Case Study Local

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R E C A PRegional emergency collaboration, action and preparedness

Save Lives!

Make Hospitals Safe in Emergencies.

EMERGENCY and HUMANITARIAN ACTION

EMERGENCY and HUMANITARIAN ACTIONpage 1

In the early morning o

17 January 1995, a magnitude

7.3 earthquake struck the

Hyogo preecture in Japan.

Known hence as the Great

Hanshin-Awaji Earthquake

or the Kobe Earthquake, the

quake aected 1.7 million

people in its immediate

atermath and let 6533 dead

and 43 792 injured. More

than hal a million homes

were damaged

or destroyed,

and evacuees

numberedmore than

300 000. Direct

damages

amounted to

about 50% o

the preectures

GDP.

Hospitals were not

spared the devastation. O

the 180 hospital buildings

in the aected area, 45%required major repairs, 6.7%

required rebuilding, and 2.2%

were completely destroyed.

Loss o water supply,

telecommunications, electrical

supply, as well as shortage

o medical manpower and

damage to equipment led

to an overwhelming ailure

o hospitals and health care

delivery services.

The earthquake exposed

the vulnerabilities and

limitations o the existing

disaster response and

preparedness eorts o

the Region.

Recognizing

that saety

and security incommunities is

the oundation o

progress, Hyogo

ormulated

and adopted a

comprehensive

approach to disaster

prevention and reduction,

as part o their creative

reconstruction eorts.

Central to this approach wasthe designation o Disaster

Medical Centres (DMC),

which will play the leading

role in disaster management.

Other advances were the

renewal o the Emergency

Medical Information System

(EMIS), establishment o a

Disaster Medical Assistance

Team (DMAT), education and

training o medical sta on

disaster medicine, amendment

o the National/Local

Disaster Response Plan and,

mutual cooperation among

neighbouring re departments.

The Hyogo Emergency

Medical Center (HEMC) was

established as the main DMC

in Hyogo in August 2003. As

o January 2008, there were

15 DMCs in Hyogo. Sitting at

the core o the disaster health

management system, these

centres have the capacity to

provide health services non-

stop, utilize the EMIS, support

Special Issue | World Health Day 2009

Hyogo, JapanA Model Approach to Disaster Risk Reduction

Lao Peoples Democratic Republic:]

Enhancing Emergency Management for

the Health Sector, p.2

Malaysia: Communication is Vital to]

Ensure Hospitals are Safe from Disasters, p. 3

continued on page 2

Fiji: New and Impending Challenges]

Re-emphasize need for Support for Safe

Hospitals, p. 4

Philippines: Safe Hospitals Start with]

Safe Buildings, p. 4

Cambodia: Revitalizing Health Centres]

by Learning from Past Experiences, p. 5

Philippines: A Safe Hospital Surviving]

A Major Typhoon, p. 6

Nonga General Hospital, Papua New]

Guinea: A Call for Policies to Ensure Safe

Hospitals, p. 7

Viewpoint: Are YOU prepared for]

Hospital Disasters? p. 8

Loss o water supply,

telecommunications,

electrical supply, as well

as shortage o medical

manpower and damage

to equipment led to an

overwhelming ailure o

hospitals and health care

delivery services.

Viewpoint

From Quality Patient Care to Patient

Safety to Safe Hospital

The battle cry o hospitals has always

been, We provide quality patient care!

We have state-o-the art modern

sophisticated medical equipment. We

have very competent physicians! I

have yet to hear hospitals with slogans

o, We provide sae patient care! We

are a sae hospital to go to even during

times o emergencies and disasters.

The paradigm at present is still ocused

on quality patient care with the

assumption that quality encompasses

continued on page 3


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R E CA P Regional emergency collaboration, action and preparedness page 2

a high patient load (including

long-distance transers), treat

serious emergency cases (such

as multiple trauma), store

emergency relie goods and

materials, and train medical

sta in disaster medicine.

Doctors acting as Disaster

Medical Coordinators are

nominated or each centre. In

addition to these unctional

requirements, DMCs are

required to possess anti-

seismic structures and other

reinorcements to maintain

structural integrity in the ace

o uture disasters.

Fourteen years

ater the Great Hanshin

Earthquake, due to the

massive reconstruction and

remodeling eorts, Hyogo

has already ar exceeded

pre-disaster development

levels. It is clear that Hyogo,

has learnt a valuable lesson.

On the tenth year anniversary

o the disaster, Hyogo hosted

the World Conerence on

Disaster Reduction during

which the Hyogo Framework

or Action (HFA) 2005-

2015, a blueprint to guidedisaster risk reduction eorts

worldwide, was drated.

One HFA key activity is

integrating disaster risk

reduction planning into the

health sector and promoting

the goal o hospitals sae

rom disasters.

The experience o Hyogo

is an excellent paradigm or

the vulnerability o hospitalsto disasters, the impact o

hospital ailure in disasters

and emergencies, and o the

need to approach disaster risk

reduction in a comprehensive,

multi-disciplinary manner.

The reconstruction o the

aected areas and the

remodeling o the disaster

health management system

highlighted the key roles

o health services, health

human resources, health

inormation systems,

and training in disaster

preparedness and response.The creative reconstruction o

Hyogo received tremendous

legislative and nancial

support, and sparked debates

on how to urther increase

advocacy o stakeholders and

hospital administrators to

hospital saety.

Presented by Takashi Ukai,

MD, PhD, o the Hyogo Emergency

Medical Center, HumanitarianMedical Assistance, during the

Regional Meeting on Sae Hospitals,

8-10 December 2008, Phnom Penh,

Cambodia

Hyogo, Japan: A Model continued

Lao Peoples Democratic RepublicEnhancing Emergency Management for the Health Sector

The landlocked country o

the Lao Peoples Democratic

Republic is sometimes seen as the

least aected by disasters when

compared to other Member States

in the Western Pacic Region.

Yet the rise o water levels in

the Mekong River last August

2008 revealed the importance

o preparedness and emergency

management in all situations.

Abundant rains in northern

Thailand, northern Lao Peoples

Democratic Republic and north-

east Viet Nam last year resulted

to increases in water levels in the

Mekong River on 12-20 August

2008. The foods destroyed roads

and armlands in 11 provinces,

aecting more than 200 000 people

(26 000 households) rom 866

villages.

Health acilities were not

spared rom the foods. Nineteen

health centres were fooded orcing

health sta to take emergency

actions and secure valuable medical

supplies and stocks. Health workers

who had previous training in

preparedness, contingency planning

and stockpiling and management o

drugs were able to apply their skills.

The quick action o the

government, the military and

concerned groups and individuals

to put up sand bags was eective

and reduced the drastic eects o

fooding, especially in Vientiane City

and other high-risk areas.

Prior to the foods last year,

the Ministry o Health o the Lao

Peoples Democratic Republic

organized the rst national-level

training course on Public Health

and Emergency Management in

Asia and the Pacic (PHEMAP). This

course was designed specically

or emergency managers in order

to increase their level o awareness

and technical expertise by providing

them with a holistic understanding

o the whole range o emergency

management.

This year, more PHEMAP

training courses are planned to

strengthen disaster preparedness,

management and response

capability among health personnel,

particularly among hospital sta.

Inclusion o sae health acilities in

the training will increase awareness

among the health workorce,

ensuring that they will remain

unctional during times o disasters

and emergencies.

Presented by Dr Sibounhom

Archkhawongs and Dr Phisith

Phoutsavath, Lao Peoples

Democratic Republic Ministry o

Health during the Regional Meeting

on Sae Hospitals, 8-10 December

2008, Phnom Penh, Cambodia


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sae patient care, that best eort

is enough in emergencies, and that

disasters rarely aect hospitals.

I I were a patient, I would ike

to be provided quality medical care,

one that is associated with a correct

diagnosis and accurate and eective

treatment with minimal side-eects.

I would also like to be provided with

a sae management regimen, one

that will NOT subject me to a high

risk or complications and death,

and not to say, medical

errors. Furthermore, I

would like to be treated

in a sae hospital, one

that will NOT collapse

during earthquakes

which may occur whenI am in the hospital

and one that will NOT

burn me to death when

there is an accidental re. I suppose

any human being, regardless o

position in the society, would want

the same things that I wish or in a

hospital.

All hospital managers will one

day most likely be a patient seeking

treatment in a hospital and wishingthe same things. As early as now, we

should start expanding and shiting

the paradigm to include patient

saety and sae hospital, not only or

our uture and our amilys uture,

but also or the sake o our client-

patients, the raison detre o our

hospital. Making our hospitals sae

should also be considered part o

our personal citizenry, our hospitals

social responsibility. Making our

hospitals resilient in order to be able

to handle victims o mass casualty

incidents and prevent massive loss

o lie and limb will contribute to

a aster post-disaster economic

recovery.

Being both a hospital

manager and a medical

practitioner in government

and private hospitals, I have

expanded quality patient

care to patient saety to

sae hospitals rom 2003to present. Thanks to the

campaign o the World

Health Organizations global

alliances on patient saety and sae

hospitals which have opened my

eyes and which have acilitated this

expansion and shiting o paradigm.

On the disaster aspect, I started with

continual development o disaster

preparedness plans ocusing on

response plans and drills on patientsurge, re and earthquake. Lately, I

am now ocusing on the structural

saety o the hospitals with which I

am connected.

In this early stage o my

experience with the sae hospital

campaign, in both private and

government hospital settings, I eel

there must be commitment and

ull support rom top management

to get the sae hospital initiative

implemented. In private hospital

settings, once there is commitment

and ull support rom top

management, resources needed

to ulll the requirements or sae

hospital development are relatively

easier to procure than in government

hospital settings. In public

institutions, however, budgetary

constraints, administrative protocols

and organizational behaviour have

always been challenges. With lack o

nancial resources, the structural andnon-structural requirements or a sae

hospital development are the hardest

to comply with. A well-organized

and collaborative emergency and

disaster committee is essential in

ullling the unctional requirements

or a sae hospital development. No

matter what the constraints are in

a hospital setting, whether public

or private, as long as there is ull

appreciation o the importance o

a sae hospital initiative by all sta,

ull commitment and support o

the leaders, ull cooperation and

collaboration o the sta, and a sense

o social responsibility, a sae hospital

can be developed, gradually and in

due time. One can start complying

with the unctional requirements o a

sae hospital and placing mitigating

measures or the structural and non-

structural requirements i they cannot

be remedied at once.

Needless to say, sae hospital

development will reduce the

probability o a building collapsing

during a disaster and will allow the

hospital to continue to unction

during emergencies. Sae hospitals

will avoid loss o properties, lives opatients and sta, and increase its

surge capacity to unction in times

o need. In short, hospital managers

should look at the benets o the

sae hospital initiative in terms o

reducing risk, protecting health

acilities, and saving lives. I hope in

the near uture I will be using and

seeing slogans like Our hospital is

sae.

Viewpoint: From Quality Patient continued

11 March 2009

Reynaldo O. Joson, MD

Assistant Medical Director, Manila Doctors Hospital

Chairperson, Department o Surgery, Ospital ng Maynila Medical Center

Making our

hospitals sae

should also be

considered part

o our personal

citizenry, ourhospitals social

responsibility.

Malaysia

Communication is Vital to Ensure Hospitals are Safe from Disasters

Malaysias topography and location

predispose the nation to a number

o natural hazards that may lead to

disasters. Not surprisingly, a good parto its emergency and preparedness

programmes is geared

towards dealing with

typhoons and foods. The

peninsula is constantly in

the pathway o numerous

tropical storms, and over

the past our decades

Malaysia has suered more than US$ 80

million in total estimated damages due

to foods.

Health acilities should remain

operational even in the ace o disasters

to continue to provide or those aected,

but at times nature proves to be too

overwhelming or these services. In 2004,

the Kota Bharu hospital was unable tocope with rapidly rising water levels,

leading to fooding o

some o its major sections

and rendering them

nonunctional. Torrential

rains in 2006 caused

major fooding in several

provinces, making health

centres inaccessible. The foods aected

more than 500 relie centres, disrupting

much-needed medical services in areas hit

by typhoons. The nancial cost or repair

and restoration o these health acilities

to unctional status amounted to US$ 1.5

million.

Malaysias eorts are currently

directed towards preventing repetitionso these said occurrences. Citing rom

its past events, It is more expensive to

learn rom bad experiences. The nation

has recognized the need to strengthen

its disaster preparedness programmes

and has thus invested in mitigation and

disaster risk reduction. Risk analysis and

vulnerability assessment o all health

acilities is currently under way in order

to identiy those acilities in need o

reinorcement.

In its activities towards emergency

preparedness and

Health acilities

should remain operational

even in the ace o

disasters to continue to

provide or those aected

continued on page 7


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The development o a

society, region or country

is closely intertwined withthe occurrence o, and

vulnerability to, disasters. Fiji is

an independent island nation

in the southern Pacic Ocean.

Fiji experiences maximum

rainall between the months o

January and March. Between

the months o November and

April, Fiji is prone to tropical

cyclones, o which there are 10

to 15 ravaging the country perdecade.

Starting 8 January 2009,

the Western and Central

Divisions o Fiji were hit by

two consecutive tropical

depressions, resulting in heavy

rainall and strong winds.

The resulting foods mostly

aected the low-lying areas

o Rakiraki, Nadi, Ba, Nadroga

and Wainibuka in the Western

Division. At the height o the

disaster, more than 11 500

people were displaced in 169

centres.

Crops were damaged

and over 100 roads, crossings

and bridges in the Western

and Central Divisions were

closed due to foods. Water,

electricity and communicationlines were also damaged.

Total cost o damages was

estimated at FJD36 million

(US$ 23.8 million). Access to

and restoration o clean water

supply, provision o ood

supplies, and prevention o

waterborne and vectorborne

diseases were priority areas o

concern in the relie eorts.

Fortunately, no majordamages to health acilities

or casualties among health

personnel were reported.

But hospitals in Ba, Nadi

and Sigatoka had to rely on

backup power and water

supply or several days, and

had to operate on skeletal

sta. Health centres in the

Central and Western Divisions

were also fooded.

Fiji is no stranger to

environmental hazards. The

country has experienced more

damaging natural disasters

in the past and will continue

to do so in the years to come.

Perhaps more importantly,

South Pacic island countries

such as Fiji are among the

most vulnerable to theconsequences o climate

change, specically, more

requent seasonal cyclones,

landslides and storm surges,

and rising sea levels leading

to foods. In

addition to

injury and

drowning,

health risks

associatedwith these hazards are

malnutrition, scarcity o resh

and sae water resulting in

higher rates o diarrhoea,

dengue, typhoid, and other

waterborne, oodborne

and vectorborne diseases.

Psychosocial concerns also

arise as increasingly larger

populations are threatened

with displacement.

Gaps previously identied

on the activities concerning

sae hospitals in the country

were: (1) lack o emphasis on

the issue o sae hospitals,

(2) absence o building

maintenance plans, and

(3) absence o analysis o

existing health acilities saety.

These recent foods serve as areminder that these gaps still

need to be addressed.

The challenge is to make

hospital administrators,

policy-makers, and other

stakeholders

more aware

o the need to

ensure sae,

unctional

and resilienthealth acilities. Indeed, the

goal o disaster risk reduction

and o sae hospitals and

health acilities should be

approached with more ervor

and urgency in regions with

an inherent and, as is the case

o Fiji, increasing vulnerability

to natural hazards.

For more inormation visit

http://www.wpro.who.int/sites/

eha/disasters/2009/fj_tropical_

depression/list.htm. The report on

Fijis Sae Hospitals was presented by

Dr Eloni Tora, Ministry o Health o

Fiji, during the Regional Consultation



FijiNew and Impending Challenges Re-emphasize Need for Support forSafe Hospitals

Island countries are

among the most vulnerable

to the consequences o

climate change.

The Philippines has a long

history o natural and human-

generated disasters. Major typhoons

and heavy rains bringing foods,

earthquakes, landslides and volcanic

eruptions aecting amilies and

communities are expected every so

oten. To add to these, we hear o

armed conficts, mass gatherings,

environmental emergencies, andother human-generated and

technological emergencies with

their share o casualties.

One aspect o providing saety

in disasters and emergencies is to

create buildings that can withstand

these hazards. Awareness and

education on creating sae buildings

is an important step. Sae hospitals

start with architects and engineers

who understand and can design

buildings with disaster reduction in

mind. What is a sae building? Howdo natural hazards aect buildings?

What actors should be considered

to build sae

Philippines

Safe Hospitals Start with Safe Buildings

continued on page 5


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inrastructures? Does climate

change have any impact on thesaety o buildings?

Architects and

engineers who

can build sae

health acilities

must adhere to the

countrys building

codes, considering

the integrity o the structural and

roo rames with the types o

disasters that occur in a particularlocality.

But saety o hospitals in

disasters extends beyond the

design. Other considerations

include the choice o location,

types o materials to be used,compliance to

building and

occupancy permits,

and the capability

o construction

companies and

individual workers.

The choice o

location is crucial or a hospital to

survive foods, earthquakes and

strong winds. The auxiliary whobuild the oundation, prepare the

concrete mixture and complete

the rest o the building must be

aware and understand that the

inrastructure they build should

withstand disasters.Building sae health

inrastructures covers a variety o

existing concerns in our society.

These include policies on the part o

government ocials and hospital

administrators, implementation o

laws, regulation o proessionals,

awareness and training o the

construction sector, nance and

resource management, close

monitoring o projects and humanresource development.

Inclusion o sae hospitals in

academic and training programmes

is an essential element in

the campaign but in order to

achieve resilient acilities, theentire spectrum o construction

rom policies to design and

implementation must be taken

into consideration. This is why

collaboration among government

agencies, academic institutions and

the private sector is crucial.

Based on the presentation

o Arch Cristopher Espina o the

University o the Philippines, College

o Architecture, during the RegionalMeeting on Sae Hospitals, 8-10

December 2008, Phnom Penh,

Cambodia

Sae hospitals

start with architects

and engineers who

understand and can

design buildings with

disaster reduction in

mind.

Over the past decade,

Cambodia has dealt with

more than its air share oemergencies brought by

natural hazards. In the last

10 years, the nation has

weathered major tropical

storms resulting in foods that

have taken hundreds o lives

and displaced thousands more.

The recent emergencies

have brought to light the

importance o having acilities

that can remain operationalin times o emergencies.

During recent tropical storms,

several key health acilities

were fooded, rendering some

only partially unctioning and

others totally inoperable.

Faulty drainage systems in

some health acilities resulted

in urther damage to hospital

equipment during fash

foods. Health workers aced

the challenge o extending

quality care in spite o limited

supplies and acilities. During

these emergencies, the

nation was unable to address

the increase in demand or

essential drugs and necessary

equipment. The provision o

health services was blocked or

interrupted due to damagedor destroyed inrastructure,

disrupting access to much-

needed lielines during these

emergencies.

In light o these

problems, Cambodia has

taken advantage o this

opportunity to learn rom

its past experiences. Some o

the health centres that were

damaged or destroyed in thepast have been redesigned

to withstand hazards such

as typhoons and foods. Six

health acilities have been

elevated to address the

problem o fooding, while

health centres located in

areas prone to landslides have

been relocated. All necessary

equipment and drugs now

have their own designated

areas or sae placement and

storage. Training has also

been done to upgrade the

capacity o health managers

in managing situations in

which they were previously

overwhelmed, such as those o

mass casualties.

Despite these

achievements, Cambodia

realizes that there is still much

to be done or its emergency

preparedness and response

programmes. There is a

need or a comprehensive

vulnerability analysis to

classiy and prioritize acilities

according to their saety

and risk. Standards or the

construction o sae hospitals

and health centres as well as

or guidelines hospital disaster

plans in times o emergencies

must be set and implemented.

The denition o hospitals

sae rom disasters should be

clearly understood at all levels,

and guidelines need to be

developed or the assessment

and monitoring o the

construction o these health

acilities. With the assurance

o quality health acilities,

these centres will also

hopeully be able to provide

quality health care beore,

during and ater disasters.

Presented by Dr Khuon Eng

Mony and Pro Chhuoy Meng o

Calmette Hospital, Cambodia,

during the Regional Meeting on

Sae Hospitals, 8-10 December 2008,

Phnom Penh, Cambodia

Philippines: Safe Buildings continued

CambodiaRevitalizing Health Centres by Learningfrom Past Experiences


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The Bicol Regional

Training and Teaching

Hospital (BRTTH) is a 250-bed

acility designated as a heart,

lung and kidney centre, in

Legazpi City, Bicol Region, inthe Philippines.

On 30 November 2006,

Typhoon Durian (local

code name Reming), with

a maximum wind speed o

280 kilometres per hour, hit

the region. The typhoon

destroyed much o the

hospitals medical acilities

and equipment and cut

o electricity, water and

communication systems.

Inaccessibility and closure

o stores made it dicult

to replenish supplies. Even

hospital personnel were

injured because o the

typhoons rage. In spite

o these misortunes, the

hospital remained unctional.

Prior to the calamity,

the hospital had trained

and developed its health

emergency management sta

(HEMS). It also had established

a hospital emergency

preparedness response and

recovery plan (HEPRRP)

that covered preparedness

during the pre-impact

phase, response during the

impact phase, and organizedactivities during the post-

impact phase.

When the coming typhoon

was rst announced, the

administration declared Code

White, mobilizing the HEMS

and advising unit heads to

secure their respective areas.

Necessary personnel including

surgeons, anaesthesiologists,

emergency and operating

room nurses, and medical

interns, remained within the

hospital premises.

Code Red was declared

ater the astronomical agency

announced increase wind

speed to 280 kph. The hospital

emergency incident command

system (HEICS) was activated.

The HEMS, doctors, nurses,

and duty sta identied

possible problems and drew

out contingency measures

to minimize damages. The

personnel were willing to

extend their duty hours. They

transported patients to saer

areas and secured medical

equipment and ood. Within

the rst eight hours, 200

additional patients arrived

at the emergency room

creating the need to augment

Emergency Room sta.

When the storm cleared,

damages and the medical

status o in-patients were

rapidly assessed.

There were no

major casualties.

The hospital

administration,

government and

nongovernment

organizations collaborated

to achieve rapid restoration

o electricity, water and

communication systems.

Management o logistics was

emphasized. The national

government provided unds

or the renovation o hospital

inrastructure.

Now, BRTTH remains active

in taking care o the health

needs o the people in the

Bicol Region. Renovation o

major areas made sure that

the building can withstand

uture typhoons that occur

more than 20 times a year.

The organized hospital

sta ensure

that services

can remain

unctional

during and ater

a disaster.

This report is

based on the case presented by Dr

Rogelio Rivera, Chie o Hospital,

BRTTH, during the Third Asian

Ministerial Conerence on Disaster

Risk Reduction in Kuala Lumpur,

2-4 December 2008.

Philippines

A Safe Hospital Surviving a Major Typhoon

Dedicated sta and a unctional emergencymanagement system were keys to continuing

essential hospital services during and ater a

major typhoon.

Now, BRTTH remains

active in taking care

o the health needs o

the people in the Bicol

Region.


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Papua New Guinea, with its

uniquely diverse natural landscape

and topography, is host to an

equally diverse array o natural

hazards, making it the most

vulnerable to natural disasters

among the Pacic island Member

States. Papua New Guinea is

situated on the boundary between

the Pacic and the Australian

tectonic plates and has eight active

volcanoes. Hazards that continually

plague the country include volcanic

eruptions, earthquakes, tsunamis,

tropical cyclones, large-scalelandslides, fooding, sporadic

droughts, rosts in highland areas,

and rising sea levels brought

about by climate change. Tsunamis

and landslides occur secondary

to earthquakes that occur with

regularity throughout the year. There

is also a high risk o technical and

human-generated disasters, such

as oil spills, industrial pollution and

unregulated and destructive land-use practices.

In 1994, the Nonga General

Hospital was closed due to damages

inficted by the eruption o the

Rabaul volcano, one o the countrys

most active volcanoes. Immediate

damages, such as structural

collapses, were noted due to the

weight o volcanic dust and debris.

Over time, volcanic dust and toxic

emission o sulur dioxide gas

resulted in corrosion o

building materials and

air-conditioning units,

as well as corrosive

damage to hospital

equipment. Beds were

reduced rom 450 to

a mere 30 beds or

emergency use. Having

its operating rooms

closed, the hospital

also lost its capacity to

conduct major surgeries.

The depth o

damage to the hospital

extended beyond the resulting

structural ailures. Health personnel,

as much a pillar o the health

system as the elements that keep

the hospital standing, are equally

vulnerable. Many hospital sta

with chronic respiratory problems,

such as asthma, were orced to

transer. With structural damage

and unctional losses, as well as loss

o health personnel, the remaining

hospital sta suered rom very low

morale.

The economic impact o this

disaster was due to loss o expensivehospital

equipment

and high

maintenance

cost or

buildings,

equipment,

and vehicles. For the hospitals

remaining sta, the cost o living

became increasingly burdensome,

and hardship allowance was thusintroduced as part o their benets.

Over the next years, Nonga General

Hospital would be closed and

reopened several times due to the

volcanic eruptions.

Ater more than a decade, the

government nally granted the

request or hospital relocation to a

saer zone. However, several other

hospitals in the country continue

to stand in hazardous areas which

make them prone to damage or

destruction rom natural disasters.

To name a ew, Wewak Hospital

stands on a tsunami risk area while

Kimbe Hospital is fanked by not

one but two active volcanoes. Lae

Hospital, the only national reerral

hospital or cancer patients, stands

on a tectonic ault which puts it at

constant risk rom earthquakes that

can cause spillage o radioactive

material.

Thus, there is a need to

strengthen policies on site selection,

construction and development ohealth acilities

in Papua New

Guinea. Similar

to the experience

o Fiji, past

experiences and

ever-present

hazards in Papua New Guinea

continuously emphasize the

pressing need or new policies to

ensure hospitals sae rom disasters,as well as policies on minimum

standards or hospital saety. As a

prerequisite to these, there exists

the need to increase advocacy and

awareness o politicy makers, health

proessionals and the communities.

Presented by Dr Victor Golpak,

Papua New Guinea Ministry o

Health, during the Regional Meeting



Nonga General Hospital, Papua New Guinea: A Call for Policiesto Ensure Safe Hospitals

response, Malaysia has

taken a more proactive

stance, rather thanits reactive approach

rom beore. Hospitals

serve as vital centres o

communication during

disasters. Inormation

in times o crises is an

essential resource and

hospitals are a critical part

o the communication

network that must be

in place in times oemergencies. Hospitals

need to establish and

maintain ecient and

eective communication

with all agencies involved.

In Malaysia, emphasis

has been placed on

establishing swit and clear

communication during

disasters; the nation is

strengthening its intra-

agency communication

(seamless bottom-to-top

transer o inormation

and vice versa) as well

as improving its inter-

networking (establishment

o medical emergency

call centres nationwide

with direct links to lead

government emergency

agencies). Malaysia is

currently updating its

emergency response

plans in order to provide

equitable access to health

care both in and out o

disasters. An ounce o

prevention is still worth

more than a pound o cure.

Presented by Dr Ahmad

Tajuddin Mohamad Nor and Dr

Mohd Safee bin Ismail o the

Ministry o Health o Malaysiaduring the Regional Meeting on

Sae Hospitals, 8-10 December


Malaysia: Communication is Vital continued

Past experiences and ever-

present hazards continuously

emphasize the pressing need

or new policies to ensure

hospitals sae rom disasters.


8/8


World Health Organization

Regional Office for the Western Pacific

United Nations Avenue, PO Box 2932

1000 Manila, Philippines

E-mail: [email protected]

Phone: +632 5289810

Facsimile: +632 5289072

EMERGENCY and HUMANITARIAN ACTIONDr Arturo M Pesigan

Dr Lester Sam Geroy

Dr Rene Andrew Bucu

Dr Paul Andrew Zambrano

Ms Glessie Salajog

Mr Zando Escultura

The Regional Roll Out of the Safe Hospitals Campaign

is supported by the European Commission

Humanitarian Aid department

For more information about Emergency and Humanitarian Action in the Western Pacific Region,contact:

RECAP Regional Emergency Collaboration Action and Preparedness is the Newsletter of the Emergency and Humanitarian Action Program of the Regional Office for the Western Pacific of the World Health Organization.The reported events, activities and programs do not imply endorsement by WHO-WPRO and the statements do not necessarily represent Organization policies.

Editorial Staff:

The scenario above may sound

like something rom a movie, but it

could just as easily happen in your

hospital. Or, in some similar ashion,

just as easily happen to you. In this

scene, you could be the scrub nurse,

the rst assist, the surgeon-in-charge,

or possibly even the patient. Have

you ever considered

whether your hospital

is prepared or

disasters? And more

importantly, are you?

It is evident that

hospital personnel

respond to disasters

depending on how

amiliar they are with hospital

emergency plans, and how well they

were trained in implementing theseprocedures. When hospital sta are

unprepared and poorly trained, we

place not only ourselves and the

institution at increased risk, but also

the patients we take care o, and are

responsible or. Personnel training

and development must be an integral

part o any emergency preparedness

programme. No emergency plan

will work i no one knows how to

implement it.Over the past two months, I

have been involved in a Hospitals

Sae rom Disaster Campaign

Project that aims to come up with

guidance materials to assist hospital

and health acilities in conducting

emergency exercises.

What I have come to realize

in this endeavor is that plans are

only as good as the people who

use them. This pertains not only to

those who carry out these plans

during emergencies, but also to the

emergency management committees

that evaluate them, update them,

and teach them

to others. One o

the best tools in

accomplishing

these tasks is

through the use

o emergency

exercises.

Conduction

o these exercises is a venue or

training, assessment, evaluation and

improvement.Oten when we think o

emergency exercises, what

commonly comes to mind are re

or earthquake evacuation drills.

However, emergency exercise

activities also include orientation,

and tabletop discussions on

emergency operations plans, or

functional and full-scale exercises

which actually test and put these

plans in action. Each exercisetype has its own strengths and

limitations. Complex exercises more

closely simulate reality; however,

they are also more dicult to

organize and require more resources.

Although most hospital

administrators would agree on the

value o conducting these activities,

very ew are willing to pay the

price. Exercises are perceived as

cumbersome, labour intensive,

timeand resourceconsuming

activities. Even in hospitals where

specic standards or emergency

preparedness are already in place,

oten due to requirements or

accreditation, these standards oten

never extend beyond the written

page. Ironically, there is usually

only renewed or increased interest

in risk reduction practices ater the

experience o a recent disaster, only

to die down later.

Yet despite these challenges,

emergency exercises have been

identied as a critical component o

preparedness. Moreover, when doneproperly, the risk reduction and lie-

saving potential o these exercises

more than validate their necessary

place in routine practice or all

hospitals and health acilities.

In the midst o all this, what can

you do?

First, be amiliar with your

hospital emergency plans and

procedures. This is one o the best

steps or you to be able to personallyrespond to emergencies. It can

outline or you what the hospitals

policies are, as well as your role and

responsibility in emergency response.

For larger centres, this inormation

can usually be accessed rom the

hospitals emergency management

committee or similar bodies.

Second, ask when emergency

exercises are scheduled in your

institution. It may be that exercise

activities are in place, and you just

have not been inormed o them.

Taking part will not only let you learn

more about emergency plans, but

also provide a good opportunity to

interact with other individuals rom

your institution.

Third, volunteer to help the

emergency management committee.

By doing this you can actually have

a direct hand in shaping how your

hospital will respond to emergencies.

This will benet your institution, and

will also let you work with other like-

minded people.

Finally, join in the Hospitals Saerom Disaster advocacy. The general

population is only recently gaining

awareness o the importance o

hospital emergency preparedness.

Promoting these concepts can help

acquire support rom key decision

makers who can translate them

into policy, and allocate appropriate

resources. You can take part in this

movement.

In the end, what is ultimatelynecessary is sharing in the vision o

keeping hospitals sae. Do it because

it reduces risks or yoursel and or

your patients. Do it because these

simple activities can help save lives.

Cesar Vincent L Villauerte III, MD

Viewpoint

Are YOU prepared for Hospital Disasters?It is 11:26 AM.

You are in the middle o surgery. What was expected to be a routine procedure has turned into a difcult case. Hunger pangs subtly begin to creep

into your stomach. The patient has lost a lot o blood, but the anesthesiologist reports that vital signs are still stable. You continue with your work.

Suddenly, the ground begins to shake. You hear the instruments rattle violently on the metallic table. It does not stop, and seems to be getting

stronger with each vibration. Your team is suddenly quiet. There is rantic chatter rom the nurses outside. Without warning, electricity goes out. The

back-up generator does not turn on. Emergency lights create tall shadows in the operating room. There is a strong hiss growing rom the gas line. A

scream is aintly heard rom ar away. The worst has happened. Do you know what to do?

When our hospital

sta is unprepared and

poorly trained, we place

not only ourselves and the

institution at increased

risk, but also the patients

we take care o, and are

responsible or.

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