Disasters and development: Part 2: Understanding and exploiting disaster-development linkages

This lesson is a continuation of Disasters and Development: Part 2: Understanding and Exploiting Disaster-Development Linkages published in Prehospital and Disaster Medicine in Volume 17, Number 3. It identifies the goals of a specific damage mitigation project that can be incorporated into a regular development project and the mechanisms for obtaining the mitigation component of such a project. Mechanisms for assessing the success of such a project are discussed. It stresses the importance of the application of building codes, associated training programs, and more extensive use of zoning regulations in urban development that decrease the population at risk and the likelihood of damage to industrial facilities. Disasters can elevate the development potential of a society at risk for damage from a hazard. The political impact of damage and disruption can be a catalyst for change. Development opportunities often are compromised because of an excessive focus on relief assistance. Interventions designed to mitigate the damage from a given hazard are particularly effective when they focus on areas at particularly high risk for actualization of the hazard. Support from the private sector, including the non-formal sector, is a key element of successful reconstruction management. The period of recovery is an opportunity for general assistance to government with administrative procedures, including enhanced management training programs.     

Disaster medicine in the 21st century: future hazards,vulnerabilities, and risk

The prediction of future disasters drives the priorities, urgencies, and perceived adequacies of disaster management, public policy, and government funding. Disasters always arise from some fundamental dysequilibrium between hazards in the environment and the vulnerabilities of human communities. Understanding the major factors that will tend to produce hazards and vulnerabilities in the future plays a key role in disaster risk assessment. The factors tending to produce hazards in the 21st Century include population growth, environmental degradation, infectious agents (including biological warfare agents), hazardous materials (industrial chemicals, chemical warfare agents, nuclear materials, and hazardous waste), economic imbalance (usually within countries), and cultural tribalism. The factors tending to generate vulnerabilities to hazardous events include population growth, aging populations, poverty, maldistribution of populations to disaster-prone areas, urbanization, marginalization of populations to informal settlements within urban areas, and structural vulnerability. An increasing global interconnectedness also will bring hazards and vulnerabilities together in unique ways to produce familiar disasters in unfamiliar forms and unfamiliar disasters in forms not yet imagined. Despite concerns about novel disasters, many of the disasters common today also will be common tomorrow. The risk of any given disaster is modifiable through its manageability. Effective disaster management has the potential to counter many of the factors tending to produce future hazards and vulnerabilities. Hazard mitigation and vulnerability reduction based on a clear understanding of the complex causal chains that comprise disasters will be critical in the complex world of the 21st Century.     

Disasters and development: Part I. Relationships between disasters and development

This module introduces a paradigm for understanding the disaster/development interface. Specifically, the module asserts that disasters and development are linked closely in that disasters can both destroy development initiatives and create development opportunities, and that development schemes can both increase and decrease vulnerability. The module consists of four parts: Part One introduces these concepts and discusses how disasters can vary from one type of hazard to another, as well as from one type of economic condition to another. Part Two develops the paradigm in depth, and provides case examples to amplify the points made in the text. Part Three describes and discusses different methods and tools for analyzing decisions for potential investment of resources, and should enhance the reader's capacity to analyze the mitigational benefits of development alternatives in both the pre- and post-disaster context. Part Four conceptualizes the role of UN agencies, NGOs, and the affected communities in promoting development based on the concepts discussed in the module. This training module, Disasters and Development, initially was designed to introduce this aspect of disaster management to an audience of UN organization professionals who form disaster management teams, as well as to government counterpart agencies, non-governmental organizations (NGOs), and donors. The educational process has been designed to increase the audience's awareness of the nature and management of disasters, in order to lead to better performance in disaster preparedness and response. The content has been written by experts in the field of disaster management and in general follows the UNDP/UNDRO Disaster Management Manual and its principles, procedures, and terminology.     

Current extent of disasters in Africa

The people oFf Africa are exposed to a wide range of disasters that seriously have aggravated the Continent's economic situation. Economic losses and human sufferings from drought, desertification, locust infestation, infectious diseases, epidemics, and armed conflicts are the dominant disasters that the people in the African countries face, and they have rendered the population utterly vulnerable. Disasters have aggravated Africa's economic situation. The cumulative effect of disasters include loss of property, injury, death, mounting food import bills, health hazards, environmental degradation, backward economic development, displaced people, refugees, and nutritional deficiency. Today, 175 million Africans out of a total population of 744 million people (23.5%) are suffering from chronic hunger; this is an increase of 50% from 25 years ago. In many African countries, up to half of the population suffers from absolute poverty. It is projected that Africa will be the only Continent to continue with the current level of poverty for another decade.     

Special report: silent disasters

Disasters occur not only in war and conflict or after natural events, such as earthquakes or floods. In fact, the death of hundreds of thousands of children in Niger every year, often for treatable conditions, could just as well qualify as a disaster situation. A lack of funding for health care and health-care staff and user fee policies for health care in very poor or unstable settings challenge international agreements that make statements about the right to health and access to health care for all people. This paper argues that although sustainable development is important, today many are without essential health care and die in the silent disasters of hunger and poverty. In other words, the development of health care appears to be stalled for the sake of sustainability.     

Disasters and development: Part 3: Assessing trade-offs in investing in vulnerability reduction

This lesson describes how a government decides whether and how much it should spend on vulnerability reduction. There are techniques and methods by which decision-makers compare development alternatives. The differences between the risk that a potentially catastrophic event will occur and uncertainty are described, with uncertainty providing greater difficulty in economic analyses. There is a range of methods for identifying the complex mix of competing costs and benefits associated with any restructuring of investment priorities to accomplish disaster mitigation. The possibilities are described in terms of the opportunity costs and present value. Impact and consequent losses include: (1) direct monetary effects; (2) indirect monetary effects; (3) direct, non-monetary effects; (4) indirect, non-monetary effects; and (5) loss of non-renewable natural resources. The difficulties in assigning values to these effects are described, as well as the means of judging the cost-effectiveness of such interventions. An advantage of screening projects using a framework of analytical methods is that it can assist in focusing on a variety of possible outcomes and make the factors influencing these outcomes quite explicit.     

Disaster care: psychological considerations

Disasters are tragic events that disrupt the normal functioning ofa community and overwhelm personal and community resources. The people who experience or simply witness traumatic events can be affected emotionally and develop a range of physical and emotional responses, which in turn can produce psychological, social, and physiological dysfunction. The challenge for health care providers is to recognize the range of emotions and to be able to identify when professional help is indicated. This article provides an overview of the human stress response and describes sources of stress that follow disasters, acute stress disorder, post-traumatic stress disorder, and interventions and resources used to care for victims after disasters.     

Poverty and development: pulling forces and the challenges for nursing in Africa

In September 2000 the United Nations Millennium Declaration was adopted and endorsed by 189 countries, translating into eight Millennium Development Goals (MDGs) to be reached by 2015. At the midpoint between the MDG adoption in 2000 and the 2015 target date for achieving the goals, Sub-Saharan Africa (SSA) is not on track to achieve their MDGs. Poverty and development are pulling forces and impact on the ability to achieve the MDGs in SSA, thus the main purpose of this article is to participate in the debate concerning the global theme of poverty and development and the challenges for the nursing profession. In this article the concepts of poverty and development are explored, and the existing trends with specific reference to SSA are investigated. An evaluation of the present status of SSA in reaching the MDG's is examined and the article concludes with a discussion of the challenges for nursing in Africa.     

International emergency medicine: How to train for it

This article provides background information about the emerging field of international emergency medicine (IEM) and how emergency physicians in Australasia can participate in its practice and development. It reviews the seven key areas of knowledge and skills involved in the practice of IEM as put forward by US fellowship programmes: (i) Emergency Medicine Systems Development; (ii) Humanitarian Relief; (iii) Disaster Management; (iv) Public Health; (v) Travel and Field Medicine; (vi) Programme Administration; and (vii) Academic Skills. Current obstacles to the development of similar programmes in Australasia are explored and identified as primarily financial. Means by which individuals can fund and engage in IEM activities are proposed. This article provides a reference of domestic and international IEM training resources that can be obtained by Australasian emergency physicians and trainees today.     

Forestry for rural development,poverty reduction and climate change mitigation: we can help more with wood

Forests are a renewable resource and wood is a valuable and sustainably useable product that contributes to national economies. This value from the forests can be realised in harmony with the functions of forests in the global carbon cycle and as long-term carbon repositories as well as providing other environmental values. This important understanding is missed or ignored in many global forestry forums. After more than two decades of so-called ‘pro-poor’ forestry policies backed by large amounts of research preferentially targeted to advance non-timber forest products and payment for ecosystem services including Reducing Emissions from Deforestation and Forest Degradation, it is difficult to find evidence to back any contention that in any tropical region they have advanced the economic status of forest-dependent or rural communities enabling them to come out of poverty in an enduring way. It is argued here that the sustainable management of native and planted forests, including wood production and processing in rural regions, and greater use of wood products by all of us, can play a much greater role than has been recognised so far for dealing with two major interrelated global challenges. These are poverty reduction in rural forest landscapes, notably in the subtropics and tropics, and to make modest contributions to climate change mitigation globally, especially by recognising the roles of both forests and wood products in the carbon cycle. It is time for a revised narration in the global agenda to raise the potential role of forests as a sustainably manageable resource, free from overzealous calls for forest conservation, but with a more balanced and holistic recognition of the contributions that forests, forestry and the wood-products sector can make to economic and social development. This should be brought effectively into the deliberations of the forthcoming UN Sustainable Development Goals. This would require efforts by the UN and other bodies to bring the private and public sectors into symbiotic partnerships, not as opposing forces as has often been the case.     

Your blues ain't like mine: considering integrative antiracism in HIV prevention research with black men who have sex with men in Canada and the United States

Evidence‐based interventions have been developed and used to prevent HIV infections among black men who have sex with men (MSM) in Canada and the United States; however, the degree to which interventions address racism and other interlocking oppressions that influence HIV vulnerability is not well known. We utilize integrative antiracism to guide a review of HIV prevention intervention studies with black MSM and to determine how racism and religious oppression are addressed in the current intervention evidence base. We searched CINAHL, PsychInfo, MEDLINE and the CDC compendium of evidence‐based HIV prevention interventions and identified seventeen interventions. Three interventions targeted black MSM, yet only one intervention addressed racism, religious oppression, cultural assets and religious assets. Most interventions' samples included low numbers of black MSM. More research is needed on interventions that address racism and religious oppression on HIV vulnerability among black MSM. Future research should focus on explicating mechanisms by which multiple oppressions impact HIV vulnerability. We recommend the development and integration of social justice tools for nursing practice that aid in addressing the impacts of racism and other oppressions on HIV vulnerability of black MSM.     

Sharing Pacific-Rim experiences in disasters: summary and action plan

INTRODUCTION: The discussions in this theme provided an opportunity to address the unique hazards facing the Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 3 and Theme 7 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) communication, (2) coordination, (3) advance planning and risk assessment, and (4) resources and knowledge. DISCUSSION: Action plans were summarized in the following ideas: (1) plan disaster responses including the different types, identification of hazards, focusing training based on experiences, and provision of public education; (2) improve coordination and control; (3) maintain communications, assuming infrastructure breakdown; (4) maximize mitigation through standardized evaluations, the creation of a legal framework, and recognition of advocacy and public participation; and (5) provide resources and knowledge through access to existing therapies, the media, and increasing and decentralizing hospital inventories. CONCLUSIONS: The problems in the Asia-Pacific rim are little different from those encountered elsewhere in the world. They should be addressed in common with the rest of the world.     

Poverty as a practice issue for learning disability nurses

People who have a learning disability are vulnerable to poverty. Given that poverty has a negative impact on mental and physical health, this should be an area of concern for learning disability nurses. Historically, however, this is an area of practice which has not received much attention. It is important that learning disability nurses are aware of the impact which poverty can have on the lives of their clients and that they incorporate this understanding into their practice. Interventions which can be implemented at the level of individual clients, groups and society to tackle poverty and its effects are proposed. It is concluded that, at present, little is known about the extent to which such a perspective underpins practice or about the extent to which poverty is addressed in pre- and post- registration educational courses. The need for further research and development is noted.     

Working during pregnancy: psychological stressor or asset?

Nearly half of women continue working during at least part of pregnancy. Health promotion for the pregnant client includes a focus on the impact of work on her health and the health of her fetus. Concerns about environmental hazards in the workplace, workplace stressors, and a non-supportive work environment contribute to the psychological vulnerability of the pregnant worker. However, working can also provide the pregnant woman with important health resources. Because of the potential of work during pregnancy to be both a stressor and a benefit, individualized assessment and counseling for each pregnant woman is indicated.     

Organization-based incident management: developing a disaster volunteer role on a university campus.

BACKGROUND: Catastrophic events are an ongoing part of life, affecting society both locally and globally. Recruitment, development, and retention of volunteers who offer their knowledge and skills in the event of a disaster are essential to ensuring a functional workforce during catastrophes. These opportunities also address the inherent need for individuals to feel necessary and useful in times of crisis. Universities are a particularly important setting for voluntary action, given that they are based in communities and have access to resources and capabilities to bring to bear on an emergency situation. METHODS: The purpose of the study was to discern how one large private organization might participate and respond in the case of a large scale disaster. Using a 2-phase random sample survey, 337 unique respondents (5.7%) out of a sample of 6000 replied to the survey. RESULTS: These data indicate that volunteers in a private organization are willing to assist in disasters and have skills that can be useful in disaster mitigation. DISCUSSION: Much is to be learned related to the deployment of volunteers during disaster. These findings suggest that volunteers can and will help and that disaster preparedness drills are a logical next step for university-based volunteers.     

Sharing international experiences in disasters: summary and action plan

INTRODUCTION: The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives. DISCUSSION: The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories. CONCLUSIONS: Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.     

Health problems of Asian and Latino immigrants.

Many different circumstances influence Asian and Latino immigration to the United States, including poverty, war, educational opportunities, and protection of financial assets. Such varying circumstances point clearly to a different set of expected health problems. Immigrants often lack resources necessary to acquire quality health care. These resources involve language skills, knowledge of US health care and social services, and insurance. Risk factors to which immigrants may have been exposed include poor nutrition, lack of immunizations and vaccinations, inadequate or inappropriate treatment, and inadequate or inaccurate beliefs about illness and treatment. Frequent health problems among Latino and Asian immigrants are tuberculosis, hepatitis B, sexually transmitted diseases, cancer, diabetes, and substance abuse. The nursing care of immigrants involves not only attention to reducing risk and treating illness, but also attention to the provision of resources. Nurses face several ethical dilemmas in the health care of immigrants including a public anti-immigrant sentiment, and political attempts to limit health care and education to immigrants.     

Hospital evacuation; planning,assessment, performance and evaluation

ObjectiveMalfunction in hospitals' complex internal systems, or extern threats, may result in a hospital evacuation. Factors contributing to such evacuation must be identified, analyzed and action plans should be prepared. Our aims in this study were 1) to evaluate the use of risk and vulnerability analysis as a basis for hospital evacuation plan, 2) to identify risks/hazards triggering an evacuation and evaluate the respond needed and 3) to propose a template with main key points for planning, performance and evaluation of such evacuation.MethodsA risk and vulnerability analysis at two county hospitals along with a systematic online literature search based on the following keywords; “evacuation/closure”, “hospitals/medical facilities” and “disaster/hazards” alone or with “planning”, was conducted.ResultsWe found that although all hospitals have a disaster plan, there is a lack of knowledge and appropriate instruments to plan, perform and evaluate a hospital evacuation. Risk and vulnerability analysis can be used to reveal threats leading to an evacuation (e.g. on-going climate changes and terror actions). These key points can later be used to plan, perform and evaluate such evacuation.ConclusionThere is a need for an elaborated evacuation planning for hospitals. An evacuation plan should continuously be drilled based on a risk and vulnerability analysis. A general guide can be used as foundation to plan, perform and evaluate such plan.     

Living in Limbo: Latinas' Assessment of Lower Rio Grande Valley Colonias Communities

Community asset mapping (CAM) is the collective process of identifying local assets and strategizing processes to address public health issues and concerns and improve quality of life. Prior to implementing a community‐based physical activity intervention with Latinas in the Texas Lower Rio Grande Valley, promotoras [community health workers] conducted 16 interactive sessions in 8 colonias. The analysis of the transcribed CAM recordings and on‐site observational data resulted in the construction of Living in Limbo as the thematic representation of these Latinas' social isolation and marginalization associated with pervasive poverty, undocumented immigration status or lack of citizenship, their fears emanating from threats to physical and emotional safety, and the barriers created by lack of availability and access to resources.     

Recent progress in physical therapy of the upper-limb rehabilitation after stroke: emphasis on thermal intervention

Poor recovery of arm function after stroke can often have a negative impact on the patient and his/her family. These patients often need assistance from the society and may need to rely on government resources. Numerous therapeutic treatments are currently available for stroke rehabilitation. Traditional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, and motor relearning) have been used for many years. However, few of these interventions have been tested in clinical trials and are thus practiced on an empirical basis. Various evidence-based therapies (electric stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotic aided system, and virtual reality) have been added to classic rehabilitation approaches and seem to improve function. Recently, we demonstrated that a novel intervention, thermal stimulation, facilitated upper-limb functional recovery after acute stroke. In this review, we describe detailed thermal stimulation procedures and outcomes in stroke patients. We found that thermal stimulation in combination with other physiotherapies or chemotherapies was of great benefit to stroke patients. Development of a better rehabilitation paradigm that maximizes rapid recovery of arm function is a priority to help stroke patients and society.