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DISASTER MANAGEMENT AND PUBLIC HEALTH EXPERIENCE IN THE AFTERMATH OF THE EARTHQUAKE AT BHUJ IN INDIA Dr HS Ratti, MD India.

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Presentation on theme: "DISASTER MANAGEMENT AND PUBLIC HEALTH EXPERIENCE IN THE AFTERMATH OF THE EARTHQUAKE AT BHUJ IN INDIA Dr HS Ratti, MD India."— Presentation transcript:

1 DISASTER MANAGEMENT AND PUBLIC HEALTH EXPERIENCE IN THE AFTERMATH OF THE EARTHQUAKE AT BHUJ IN INDIA Dr HS Ratti, MD India

2 DATELOCATION MAGNITUDE 1819 JUN 16 KUTCH,GUJARAT JAN 10 NEAR CACHAR, ASSAM MAY 30 SOPOR, J&K JUN 12 SHILLONGPLATEAU APR 04 KANGRA, H.P JUL 08 SRIMANGAL, ASSAM JUL 02DHUBRI, ASSAM JAN 15BIHAR-NEPALBORDER JUN 26 ANDAMAN ISLANDS OCT 23 ASSAM AUG 15 ARUNACHAL PR – CHINA BDR JUL 21 ANJAR, GUJARAT DEC 10 KOYNA, MAHARASHTRA JAN 19 KINNAUR, HP AUG 06 MANIPUR-MYANMAR BORDER AUG 21 BIHAR-NEPAL BORDER 6.4

3 DATE LOCATION MAGNITUDEDEATH INJURED 1991 OCT 20 UTTARKASHI, UP HILLS SEP 30 LATUR MAY 22 JABALPUR,MP MAR 29 CHAMOLI DIST, UP SIGNIFICANT EARTHQUAKES IN INDIA AND ITS NEIGHBOURHOOD ( )

4 ANTICIPATED PUBLIC HEALTH PROBLEMS IN DISASTERS 1Disruption of Water supply and Sanitation 2Large scale migration 3Overcrowding due to emergency housing situations with poor personal hygiene 4Mass feeding without adequate food handling, storage and sanitary facilities 5Disposal of Dead Bodies and Caracas 6Rodent and Stray dog/animal problems 7Relaxation of sterilization precautions and emergency use of unscreened blood 8Psycho-social and Mental health problems

5 COMMUNICABLE DISEASES HAVING DISASTER IMPLICATIONS (HAVING POTENTIAL FOR OUTBREAK) 1.Amoebiasis 2.Camplyobacter Enteristis 3.Chicken Pox 4.Cholera 5.Coccidiomycosis 6. Dengue fever 7.Diptheria 8.E. Coli Diarrhoea 9.Food Poisoning 10.Rotavirus Enteritis 11.Hepatitis A, B & E 12.Hanta Virus Disease 13.Influenzae 14.Leptospirosis 15.Malaria 16.Measles 17.Meningitis 18.Pertusis 19.Plague 20.Pnuemococcal Pneumonias 21.Rabies 22.Relapsing Fever 23.Salmonellosis 24.Scabies 25.Typhoid Fever

6 26 Jan 2001 at 0856 AM (IST), Bhuj in western India and its surrounding areas were struck with severe earthquake, measuring 7.9 on the Richter scale

7

8 CRATER FORMED AT THE EPICENTRE AT DHORI

9 LINEAR CRACK AT THE EPICENTRE AT DHORI

10 LAVA LIKE MATERIAL SPROUTED AT THE EPICENTRE

11 DESTRUCTION LEFT BEHIND BY THE EARTHQUAKE

12 Mortality and Morbidity Dead19727 Injured1,66,000 Homeless6,00,000 House Destruction total : 3,48,000 House Destruction partial : 8,44,000 Total cattle Killed :20,000 Direct Estimated Economic Loss :USD 1.3 bn

13 Large scale migration of inhabitants Large scale scale influx of relief workers & material

14 International NGOs :55 National /Local NGOs :26 Government Bodies :8 Donor Governments :18 Inter Governmental Organisations:8 Red Cross and Red Cresent :6 Total Organisations (2 weeks) :125 Relief Agencies at work

15 Immediate hrs Relief and Rescue provided by Indian Army Teams and the Indian Army Hospital surgical operations performed in makeshift Military Hospital within first 60 hrs of the Disaster

16 Situation Assessment Public Health Measures –Water Borne disease –Air Borne infections –Vector borne diseases –Biomedical wastes –Disease Surveillance –Dead Bodies and Animal Caracas Disposal –Disinfecting of Rescue Sites and Teams –Mental Health Public Health Measures

17 CLIMATIC CONDITIONS PREVAILING IN BHUJ IN FIRST WEEK OF FEB 2001 MaxMin Day Time33 0 C22 0 CAvg Temp 21 0 C Night Time 19 0 C09 0 C RH7261 RainfallNil Gujarat State has experienced Drought Conditions since 1998

18 Water Borne disease Threat potential –Breakdown of distributed piped water supplies and water requirement being met from alternate sources –Drinking water available only from 4 to 5 deep bore wells scattered over the whole town and nearby villages in the Public Health Engineering Department. –Drinking water is highly salty and at places turbid (due to earthquake). –The water is collected by water truck/water bowsers/tankers and distributed manually

19 Intervention –The bore well water is collected in sump. –Flocculation and sedimentation in the sump was carried using Alum for a period of atleast 4 hours –It is followed by super chlorinating at 2 ppm with liquid chlorine and/or bleaching powder with a contact period of minimum 20 minutes –All water bowsers/tankers leaving the water point were checked for free chlorine levels and due records were kept. Water Borne disease

20 Outcome – 70 to 75 percent of population was getting chlorinated water supply. – A 8000 litre desalination plant received as gift from USAID was installed for exclusive issue of drinking water. –There were no cases of Gastro Intestinal diseases among population in 3 week post disaster period. –A close monitoring has been instituted combined with disease surveillance

21 Threat potential –All pers and families living in tentage and makeshift arrangements –Inadequate supplies of tentage resulting in overcrowding by a factor of 80 to 100 percent. –Sharp and high difference in max and min temp (max daytime temp of 34 to 36 degrees centrigade while min night temp was 8 degrees centigrade) –Season ideal for Chicken pox, measles and meningitis outbreaks –Potential of outbreak of Bubonic plague was kept in mind in view of earthquake disaster Air Borne disease

22 Intervention –Health education campaign was undertaken to ensure that there was minimal over crowding in tentage accommodation. A minimum distance of 3 feet was advocated –To adopt a head-foot alternate bed positions –Adequate ventilation of tentage and exposure to sun during daytime was adovacated –Provision of adequate warm clothing –Field and Hospital based Passive Disease surveillance –Active surveillance by random interviews was carried out in select areas of high density. Every day, a new area was visited. Health advice was given. Air Borne disease

23 Outcome –There were 4 cases (all adult males) of chicken pox reported between 7 to 8 Feb in military areas and 31 cases among civil population in samkhayali village near Bachao. Of these, 28 were children under 12 years of age and 3 adults –Outbreak control measures included segregation and symptomatic treatment of the affected individuals –All cases recovered and no secondary outbreak of communicable diseases was reported in military and civil areas till 3 weeks after last case Air Borne disease

24 Threat perception –No piped distribution of water supply leading to places with water point collection –Inadequate disposal of liquid and solid wastes leading to fly nuisance –Inadequate disposal of Bio Medical waste Vector Borne disease

25 Intervention –Spraying operations using 0.1 % NUVAN (Dicholorvos) solution in the areas where solid waste were disposed –Daily sprinkle of Lime Slaked powder over and around the Deep Trench/Shallow Trench latrines used for excreta disposal in temperory shelters put up for living –‘Smoking’ of the Deep trench latrines to prevent and fly breeding –Spray water collection pockets with anti larval measures - Baytex 1000 Conc and/or Baytex granules or Abate (Temephos 0.5%) –Space spraying of tentage accommodation with Baygon and /or Malathion 50 % EC (in 0.5 % solution) Vector Borne disease

26 Large quantity of Biomedical waste was generated in the areas in military hospital and other places in whole of district of Bhuj following disaster. No incineration facilities are available except in the military hospital where rudimentary and sufficient facilities are available only for routine workload The waste was segregated into open pits at a distance from the hospital and burnt in the beehive incinerator over a period of 7days Other non biodegradable waste like plastics, IV Sets, were disposed by deep burial in open ground Biological medical waste generated in other areas including animal dead was strewn all around in Bhuj district and posed a potential public health problem Bio Medical Waste

27 Disease Surveillance Active Disease surveillance in 10 relief centres were established in and around Talukas of Bhuj district - Khavda, Anjar, Baccaho (2 centers), Samkhyali, Ratanpol, Modvadar, Dhori, Dharan and Mandvi. Passive Disease surveillance launched in consultation with WHO Teams and the State Health authorities

28 Each relief centre had a team of one Medical Officer and Two Nursing Assistant. Besides, additional Mobile Teams from each centre were sent out daily to cover different villages. No mass immunisation was recommended. However, UNICEF promoted mass vaccination against measles for all children 9 mths - 5 yrs was undertaken in the the Kutch areas by the state health authorities

29 Disinfection of Rescue Sites and Teams Personal Protective Measures –Gloves, Face Masks and Head Protection Disinfecting The Dead Bodies with 40% Formalisn and 10 % Creosol Solution Deodourisation of the work are at the relief site

30 MENTAL HEALTH A much relieved lady rescued after 96 hours. Acute Post Stress Disorder In need of Post Traumatic Counseling

31 REHABLITAION & RECONSTRUCTION First steps towards future ?


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