Emerald Group Publishing Limited
Copyright © 2000, MCB UP Limited
Disaster stricken countries have made progress
For this issue of the Journal I thought I would create an earth-shattering exposé of what disaster response is all about but, instead, two articles have come on to my desk which, in my opinion, deserve a wider publication than they have received.
I will let the readers judge for themselves whether or not they agree with the contents.
Disaster stricken countries have made progress
Why then does press coverage leave us with a sense of déjë vu?
The 1985 earthquake in Mexico City, Hurricane Mitch in Central America in 1998, Kosovo, 1999, and now the earthquake in Turkey. Aside from the hazard itself, can we clearly distinguish among these events, or is one disaster pretty much like another? If we are to believe press coverage of public health issues following large-scale disasters, the aftermath is so similar that one can almost cut the name of the city or country from one story and paste it into another.
Reading the accounts of major natural disasters, we cannot escape the feeling that the press paints a stereotypical portrait of the post-disaster situation for the benefit of the public in donor countries. And who in the Western hemisphere is not a donor?
The scenario often presented in the media leaves us with a sense of déjë vu ... images of helpless injured victims suffering from a lack of medical attention because the national authorities are not responding. Nurses, doctors or relief workers are interviewed and only their complaints about needing medical supplies and medicines are given high priority. The overall picture would lead one to believe that the health services are not responding at all.
Often international news teams claim to arrive at the site of the emergency in a remote area before any external rescue teams. That might sometimes be the case, but local health authorities and other health personnel can only dream of having an open-ended expense account that would let them hire aircraft or four-wheel drive vehicles regardless of the cost! Problems that are logistical in nature are translated as a lack of co-ordination and competence.
Once the work of the medical teams from donor countries has been widely covered, and the emergency medical situation is "in good hands", interest shifts to scenes of people deprived of food and drinking water in less-accessible areas, giving the impression that these items are scarce in the disaster-stricken country. In reality, the problem lies with getting the food and water where they are needed, when they are needed. The result of this misperception is an enormous amount of donated bottled water and household food - donated and amassed in major cities in the USA and other countries, which in fact could be purchased locally more quickly and at a fraction of the cost of airlifting it from overseas. Donations of this sort are still piled up in the warehouses of donor countries waiting to be airlifted, or are clogging the distribution channels in the disaster-affected country.
Haven't we heard, for at least the last 30 years, about the likelihood of catastrophic outbreaks and epidemics? Only a handful of doctors or relief workers warn the world of this secondary disaster. We still remember the unfulfilled prediction of a shigellosis outbreak following the earthquake in Nicaragua in 1972 that was supposed to claim more victims than the earthquake itself. Published in a prestigious medical journal, to this day, this prediction has not been revisited by the editors. These unsubstantiated fears (in many instances the predicted disease is not even endemic locally) pressure the authorities to take harsh measures like incinerating or burying bodies in mass graves, or purely symbolic gestures such as spreading lime or disinfectant on corpses. In the process, the rights and needs of local communities to properly honour and bury their loved ones are the casualty of this haste. No wonder that, when disaster response addresses the misconceptions propagated by the media, rather than the deeply felt priorities of the victims, mental health assistance quickly becomes an urgent need.
Why is public health "common sense" in such short supply under stressful conditions? Yes, people can be carriers or hosts of diseases such as cholera, typhoid fever and other feared plagues. But these people are much more dangerous alive than they are buried beneath a landslide or the rubble of a collapsed building. In all fairness, misinformation is less persistent in disasters occurring in Latin America and the Caribbean where the voice of reason can still be heard, although alarmist opinions continue to find their way into the press.
Disasters are chaotic. Management in crisis situations always implies decision making under a cloud of uncertainty. Emotions that are distorted by the moment may impair even the best judgement that otherwise would have relied on experience and training.
One factor that makes Latin America and the Caribbean stand out from other regions is its level of preparedness and disaster education for health professionals. PAHO/WHO's modest contribution of technical expertise, thanks to support from the governments of Canada, the USA and the UK, helps to improve disaster preparedness for national and local health authorities. This can only happen if it is part of an ongoing programme to strengthen local capacity before disasters strike.
Politicians and the media both mould and respond to the perceptions of public opinion. It is the responsibility of professional disaster managers and humanitarian organisations (NGOs and the UN) to break this cycle of misinformation. Let us join forces with highly professional and dedicated members of the mass media to provide the public in donor countries with a balanced and fair view of health needs and priorities in the aftermath of sudden-impact disasters.
The victims of these future tragedies can only benefit if the assistance so generously donated is based on fact rather than on rumours and myths.
Henry C. Wilson