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10 June 2005

Disaster Management Moving from Response to Prevention

Early warnings also needed for diseases, injuries, CDC doctor says

By Cheryl Pellerin
Washington File Staff Writer

Honolulu – Critical components in the creation of early warning systems for hazards such as earthquakes and tsunamis include deep-ocean buoys, tide gauges and robust communications systems. Along with these technical elements, however, is the need to consider the human element, the people threatened by disaster.

Both are being discussed in Hawaii at the June 6-10 international Asia Pacific All-Hazards Workshop, where more than 175 people from 18 countries have gathered to discuss the issues and challenges involved in developing an early warning system for a range of hazards in the Indian Ocean region.

The workshop is sponsored by the National Oceanic and Atmospheric Administration and the U.S. Trade and Development Agency and is being held in cooperation with the Asia-Pacific Economic Cooperation forum.

One of the attendees knows a lot about people and disasters. Dr. Mark Keim is a medical officer in the National Center for Environmental Health at the U.S. Centers for Disease Control and Prevention (CDC) in Georgia. He has worked with teams in 30 to 40 disasters around the world.

“The main goal of early warning or disaster warning systems is to protect lives and property,” Keim said in an interview during the workshop. “At CDC, our core mission is [to ensure] safer, healthier people, so when it gets down to lives and health, that’s our job.

“We’re the people who become directly involved with the population. We work on the ground [with the victims] and at upper levels [with officials] to coordinate and assess and improve health and lives,” he said, “either preventing people from becoming injured or ill or responding to illness or injury after the fact.”

After the December 26, 2004, tsunami devastated the Indian Ocean region, killed hundreds of thousands of people and left millions homeless, Keim led the first U.S. government health assessment team into the most severely affected areas in Indonesia.

He and his team, whose members included experts from the Indonesian Ministry of Health and the Indonesian military, completed health assessments for 25 cities in five days.

“What we do at CDC teaches us what kind of preparedness measures are necessary,” he said.

An assessment team determines whether people have clean water and adequate food and shelter, whether living conditions are adequate to support health, and whether injuries are being properly treated.

“One of the reasons we’re here [at the workshop] is that even if the early warning system works perfectly and 100 percent of the people are evacuated, they’ll still come back to no water, no food and no home,” Keim said. In that situation, "you have displaced populations that are highly vulnerable to risk.”

Preparedness also involves communicating risk to a population in a way that allows people to accept the risk without feeling overly concerned, paralyzed or helpless, he said.

Early warning means much more than a siren going off, he added.

“We have to be willing at community, state and national levels to listen to people, to empower them to take responsibility and bring stakeholders together to facilitate the process of public health preparedness, as opposed to imposing that on them from outside,” Keim said.

Since it was founded in 1946 to help control malaria, CDC has led public health efforts to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. It is recognized globally for conducting research and investigations and responding to health emergencies around the world.

Keim’s environmental health center at CDC is engaged in the same kind of outreach. The center offers a range of services related to people and disasters. These include education and training for populations, training for medical providers and public health officials, disaster planning for hospitals at national and state levels, and technical assistance.

The center has helped many countries with disaster- and public-health-related planning.

In the late 1990s, Keim said, “We received a request from the U.S.-associated Pacific island nation, the Republic of Palau. They asked for an assessment of their disaster management plan. We did the original assessment and then received further requests from other U.S.-associated nations.”

In 2000, CDC established the Pacific Emergency Health Initiative to strengthen the capacity for emergency preparedness and response among Pacific island countries and territories. The initiative is now working with 22 Pacific islands.

The center also developed planning software -- the Automated Disaster and Emergency Planning Tool (ADEPT) -- that is used to write public health plans. Participating Pacific islands have tested ADEPT and used it to produce six national plans and 10 hospital plans.

The center’s five-year goal is to offer such assistance to the Pacific basin and to all small island developing states, Keim said, “because they’re extremely vulnerable. There are meteorological and coastal hazards, and earthquakes and volcanoes are predominantly in these areas. They’re also economically challenged and relatively geographically isolated.”

Natural and human-generated disasters have occurred more often in recent years and with increasingly higher costs, according to statistics and studies reported on by the United Nations and generated by CDC, Keim said.

“There will come a time – and we’re already at that point in many areas of the world – when we can no longer respond,” he said. “What we need to do is to prevent the disasters or at least lessen their impact when they occur.”

At CDC, the Center for Environmental Health is moving in that direction, Keim said. The stages of disaster management are planning, preparedness, mitigation (reducing the intensity of a situation), response and recovery.

“We’re trying to move into prevention and mitigation in the same way that the infectious disease group moved into prevention and vaccinations in the past century,” Keim said.

Today, most of the center’s work involves disaster preparedness and mitigation, he said. Ten years ago, the work focused mainly on disaster response.

“It’s the most cost-effective thing, preparing and lessening the chance of that injury as opposed to taking care of it after it’s done,” he said. “Immunization is a good example -- immunizing children rather than waiting for the measles epidemic and then dealing with the lingering health effects.”

Tsunamis and earthquakes cannot be prevented, but communities can be strengthened and made resilient through planning and preparation.

“We responded in 2002 to landslides in Micronesia when a typhoon dropped 24 inches of rain in 24 hours on one area, killing 49 people and injuring quite a few more in a health care system that was really bare bones to begin with,” Keim said.

Micronesia is in a typhoon belt that generates 18 typhoons a year, so the likelihood that the same storm devastation could occur in the future is high.

“We started thinking in terms of very low-tech solutions,” Keim said. A geologist from the U.S. Geological Survey told Keim that the landslides depended solely on a certain amount of rainfall. To measure the rainfall, the team turned Coca Cola cans into rain gauges that could warn residents when the rain was reaching critical levels.

Most of the villages already had church bells. With the proper community education, the bells became an instant early warning signal.

For evacuations, the team used hazard maps that had already been developed for the area and that showed high- and low-risk zones. The team went door to door and helped residents in high-risk zones figure out where they would go – typically to stay with relatives who lived in low-risk zones – and how they would get there.

“Those are the kinds of simple processes that can save lives and that basically just take manpower and personnel to put together,” Keim said.

Additional information about the CDC National Center for Environmental Health is available on the center’s Web site.