Hurricane

This week’s blog is from Rachel Alsop, one of our colleagues in our strategy consulting team who spends some of her own time volunteering with the humanitarian mapping charity, MapAction. The importance of this work is evident from the blog and so I’m leaving Rachel to explain, in her own words.

In some of my spare time I volunteer with the humanitarian mapping charity MapAction.i The charity is made up of a group of volunteer Geographical Information Systems (GIS) professionals who are ready to deploy rapidly to natural disasters and conflict-related emergencies. The charity’s first emergency deployment was in 2004 in response to the Boxing Day tsunami in the Indian Ocean, and since then it has responded to a number of large scale disasters such as the 2015 Nepal earthquakesii and its 2014 deployment to Iraqiii in response to widespread conflict. My experience has highlighted that there are three essential components that help with the delivery of healthcare in a humanitarian response: information, accreditation and communication.

Information
When MapAction deploys to a disaster, the aim is to assist the humanitarian community by creating a shared operational picture that aids in decision making. In essence, it makes maps that provide people with information to help them make decisions effectively. For example during the 2010 Haiti earthquake, the team created maps to divide the affected areas into the sectors that search and rescue teams would need to cover, as well as providing co-ordinates and directions to reported locations of people caught up in the disaster. This information had to be gathered and collated from many sources including the government of the affected area, other NGO’s on the ground and even from SMS messages from trapped individuals. The aim is to collate, visualise and disseminate this information in an easy to use format. Making sure this information is available quickly can have a positive impact on the outcomes of those people affected, ensure that the response is targeted to where it is most needed and that access to healthcare is as timely as possible.

Accreditation
In the immediate aftermath of a disaster, the desire to help is strong, but concerns do arise that individuals may sometimes respond to the situation with inadequate training or preparation. In some circumstances this could lead to inappropriate delivery of care and poor patient outcomes. Medical teams responding to a disaster are usually working in resource poor settings, where infrastructure could have been seriously affected and with limited access to equipment they might commonly use to diagnose and treat, such as x-ray machines. Additionally, there are a number of other complexities that come with treating patients in disaster zones, firstly the size and speed of onset of a disasters, for example in the 2010 Haiti earthquake 222,570 people were killed and over 300,000 people were injured with orthopaedic trauma being the most common diagnosis and surgery needed.iv Secondly a lack of medical records and challenges keeping track of patients given an inevitably chaotic environment increases the complexity of the response needed. These challenges create huge difficulties for the humanitarian effort. In recent emergencies incoming teams have been unaware of local or international facilities, and there have been reports of teams attempting to deliver care without adequate supplies or expertise.

The World Health Organisation (WHO), many of the international/national medical teams and Government Ministries of Health have recognised this and have introduced accreditation initiatives aimed at putting quality of care at the centre of any response. For example, the WHO introduced the Emergency Medical Team Minimum Acceptable Standards in mid-2013, which aims to ensure that teams are self-sufficient so as not to place a burden on already strained national systems, and that they are able to provide appropriate quality of care in a disaster setting.v Moreover, teams are expected to arrive with sufficient personnel, equipment and supplies to meet the needs of a disaster affected community. Although classification by the WHO to become a quality-assured medical team that meets their minimum standards is not mandatory, it is widely encouraged and accredited teams may be more likely to be requested to respond to a disaster.vi This is particularly important as teams need to be prepared for a range of potential presentations including trauma, post disaster infectious disease outbreaks (such as cholera) and people with long term illnesses such as diabetes. Teams are working within increasingly complex emergencies with both natural and man-made hazards at play.vii Accreditation through this system helps raise the standards of the health response and ensures health professionals are as well prepared as possible for whatever they may find when they arrive in response to a disaster.

Communication
I recently attended Triplex 2016, one of the world’s largest humanitarian training exercises.viii Over 300 people from the humanitarian community across 86 countries came together to train in conditions as close as possible to a true disaster response.

Some of the conditions in the exercise were not planned for but were realistic; a real storm hit the camp and the tent we were working in collapsed forcing us to evacuate. This environment in all its planned and unplanned extremes allows for experimentation and testing of processes in a safe space in preparation for a real disaster.

My experience of the exercise showed how important communication, co-ordination and collaboration are in an emergency response to a disaster. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) recommends a cluster based approach;ix where multiple organisations working within the same humanitarian sectors, such as shelter, water sanitation and hygiene (WASH) and health collaborate closely throughout the response.x This allows the delivery of aid in each sector to be coordinated and ensures resources are deployed effectively.

Even in a training exercise it was clear how vital it is to have good lines of communication between the different organisations in the field. These are built upon having clear systems within an organisation, so that others can rely on that organisation, even though they may never have worked with a particular individual on the ground. As a MapAction volunteer I was preceded by the organisational reputation my colleagues have built up in their past encounters in the field. These organisational principals and reputations help to deliver a more coordinated and effective response in a disaster.

In the UK we are in the privileged position of having access to the NHS, underpinned by the core principle that good healthcare should be available to all based on clinical need, regardless of ability to pay. It seems to me that healthcare in humanitarian disaster response abides by that same principle. However, the circumstances that teams operate under in a humanitarian disaster mean that there are challenges to effectively deliver quality healthcare. By applying the three essential components (information, accreditation and communication), the humanitarian response within a disaster zone has a greater chance of being better co-ordinated, efficient and effective; leading to a lasting and sustainable impact for affected communities.

Please note that Deloitte LLP do not have any associations with MapAction.

Rachel

Rachel Alsop - Consultant, Monitor Deloitte

Rachel Alsop is a Consultant in Monitor Deloitte’s UK Healthcare & Life Sciences practice. Rachel has worked with the charitable sector both within and outside of Deloitte, most recently developing a place based strategy for a healthcare charitable foundation. Her particular focus is around quality and outcomes research in healthcare and utilising data to inform effective strategies and interventions.

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i MapAction, [Online], Accessed 04/01/2017, Available from https://mapaction.org/
ii The United Nations Refugee Agency (UNHCR), Nepal: 2015 Earthquake, [Online], Accessed 04/01/2017, Available from http://data.unhcr.org/nepal/
iii MapAction, Iraq conflict, June 2014, [Online], Accessed 04/01/2017, Available from http://maps.mapaction.org/event/00229
iv Centres for Disease Control and Prevention (CDC), 2011, Post-Earthquake Injuries Treated at a Field Hospital – Haiti, 2010, [Online], Accessed 04/01/2017, Available from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5951a1.htm
v World Health Organisation (WHO), 2016, Emergency Medical Teams and World Health Organization, [Online], Accessed 16/12/2016, Available from http://www.who.int/hac/techguidance/preparedness/emergency_medical_teams/en/
vi World Health Organisation (WHO), 2016, Emergency Medical Teams: World Health Organization EMT Initiative, [Online], Accessed 04/01/2017, Available from http://www.who.int/hac/techguidance/preparedness/emt-info-nov2016.pdf
vii International Federation of Red Cross (IFRC) and Red Crescent Societies, Complex/manmade hazards: complex emergencies, [Online], Accessed 16/12/2016, Available from http://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/definition-of-hazard/complex-emergencies/
viii International Humanitarian Partnership (IHP), IHP trainings and exercises, [Online], Accessed 16/12/16, Available from http://www.ihp.nu/index.php/training
ix United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Cluster Coordination, [Online], Accessed 16/12/2016, Available from http://www.unocha.org/what-we-do/coordination-tools/cluster-coordination
x World Health Organisation: Health Cluster, Health Cluster participated in a major simulation exercise, [Online], Accessed 16/12/2016, Available from http://who.int/health-cluster/news-and-events/news/triplex2016/en/

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