Cuban Disaster Preparedness: Lessons Learned

Guest blogger: Joe Vargas

The California Disaster Medical Services Association, in conjunction with the Medical Education Cooperation with Cuba (MEDICC), provided an opportunity for 17 health care professionals to be part of an exciting research team to examine Cuba’s acclaimed public health system, including its renowned disaster preparedness and medical response systems. The research group traveled to Havana, Cuba in December 2010 for nine full days of lectures, educational presentations and interchange with Cuban medical professionals and public health response teams. Although the United States has not had diplomatic relations with Cuba and travel is restricted, the group was allowed permission under the US treasury’s general license for professional research that includes full-time health and emergency response professionals doing research in Cuba.

During the visit, the group examined Cuba’s elaborate yet unsophisticated system for population protection during disasters. Given their limited physical, technical and transportation resources, the Cuban people, including school children, are taught at an early age about their role and responsibility in a disaster. Education is compulsory up to the 12th grade. Cuba’s hurricane-prone geographical location has necessitated an efficient and coordinated approach with an emphasis on accurate, early and frequent communication information. These internationally recognized measures include prioritized evacuation procedures for vulnerable populations that include high-risk seniors, pregnant women, disabled and individuals living in remote areas where flooding occurs. Transportation is prearranged using city buses to evacuate large communities to safer ground until the storm diminishes. Other preparatory efforts include frequent meteorological reports, monitoring and the shutdown of power and utilities days before the storm arrives. Cuba is one of the few countries that offer early advisories and information phases as preludes to the hurricane watch. Historically, very few deaths and injuries have occurred as a result of the many powerful hurricanes (Charlie, Wilma, Ivan) that have struck Cuba using this preparation approach.

The group also toured several medical facilities including Havana’s polyclinics (neighborhood clinics). At these facilities, the research team was able to view Cuba’s robust primary prevention-focused medical system and understand its critical ties to civil defense teams and meteorological and information sharing systems. Highlights included meeting with grassroots organizations in disaster preparation, response and recovery, including neighborhood organizations and the neighborhood-based physician medical team. The Ministry of Public Health directs all health sectors to support a comprehensive system of healthcare specifically oriented to prevention activities and primary care. Family physicians work in residential neighborhoods where they are provided a home and a functional clinic. Working alongside a nurse, they are responsible for approximately 80-130 families in their community. This closeness allows healthcare professionals to provide immediate emergency and personal care to their neighbors. Physicians develop an overall understanding of all their community needs, which contributes to their overall wellness and whose population health indicators are comparable to developed countries like the US and Canada.

Team members will be sharing their experiences throughout the country at conferences and workshops. To schedule a presentation or for further information you may contact Joe Vargas at jvargas [at] ochca [dot] com.

Cholera Lifts the Painted Veil over Haiti (and elsewhere)

Imagine yourself in the day-to-day in a crowded, dirty tent camp as a refugee somewhere. You have to stand in line for bottles of clean water, your health care comes from a medical charity with a trailer, and you never know whether your next meal will come from UN trucks or your own resourcefulness to scrounge something that your neighbors have not already found. You do the best you can, though, and you look forward to the good days when you can turn a nice big bag of beans or something into a meal to divide with your family in a tent that is inevitably too small for you. On bad days, though, your water might be tainted with Vibrio cholerae, a nasty little bug with a very short incubation time. You might not feel so good a few hours after that meal – and by the same time the next day, you could be dead.

Cholera is an aggressive water-borne disease that is currently running rampant through the world, the news, and the global health blogosphere. An outbreak reared its ugly head in Haiti last week when five cases were detected in Port-au-Prince. The disease has since spread through the population: 284 people have died so far, and over 3,600 people have been infected. Despite so many people living in high-density refugee camps with little to no sanitation, many are still surprised: it is the first time the island has seen cholera in 100 years, and after nine months I guess people were beginning to entertain the optimistic notion that the earthquake-ravaged nation might be able to avoid it. The debate over whether or not the outbreak (which some are already calling an epidemic) is contained rages on. Meanwhile, a much larger epidemic is running rampant through Nigeria  (though I suppose having eleven times as many cases and five times as many deaths will still not make you more noteworthy than Haiti – after all, Nigeria sees cholera every year). It has already appeared in flood-affected areas of Pakistan and in the aftermath of the mostly-ignored floods in West Africa. Basically, where there are floods, natural disasters, and/or refugee camps, there is cholera.

This year’s floods are the worst Benin has seen since 1964. Photo taken by Salako Valentin/AP.

The extremely rapid spread of the disease through disaster areas underscores the extreme importance of prevention planning and education. In Haiti, for example, you would think that a nine-month lag would have allowed for ample time to have systems in place to deal with this kind of outbreak, but that unfortunately does not appear to be the case: Melinda Miles, director of Let Haiti Live, told UN Dispatch last week that “it is absolutely stunning that so little was in place to prepare for [the outbreak]…It is certain that many unnecessary deaths will be the result of poor planning and slow response.” On the other hand, Care has held hygiene awareness sessions for more than 10,000 people affected by the flooding in Benin. Even if cholera never appears, preparations for it are never in vain: having clean water, proper sanitation, and stocks of oral rehydration salts are always a good idea.

UN World Food Programme establishes regional supply hub in Asia to respond to natural disasters

Earlier this year, the UN World Food Programme announced that it would establish Asia’s first UN Humanitarian Response Depot (UNHRD) in Malaysia.1  Based in Subang (about 50 km west of Kuala Lumpur), the hub would provide storage, logistics support, and services to UN agencies and other non-profits operating in the region.  The government of Malaysia has agreed to build offices, warehouses, and a training center, and to contribute $1 million each year toward the cost of running the UNHRD network.

This hub is particularly important to Asia, as it has experienced a number of natural disasters in recent years.  In the past, international aid agencies have taken several days to bring supplies to people in need.  This hub, however, is designed to deliver humanitarian relief items within 48 hours of a crisis.   Other aid organizations will be able to stock goods and borrow supplies as well, and 39 different agencies have expressed interest in using the facility.  It is expected to be completed in 6-12 months.2

There are four other UNHRDs operated around the world to mobilize supplies in response to crises in Italy, the UAE, Panama, and Ghana.  While each base is designed for region-specific responses, they can respond to situations anywhere in the world: for example, all UNHRDs sent supplies to Haiti during the first days of the response. 1

A “Short Memory”: Devastating Earthquake in Haiti Brings Long-Standing Problems to Light

Blog contributor: Jessica M. Keralis

Bodies heaped on street corners.  Thousands aimlessly wandering the streets.  A once-busy port city strewn with rubble.  These are just a few of the images crowding the media coverage of the earthquake that leveled Port-au-Prince, Haiti.

Last Tuesday, a quake registering 7.0 on the Richter scale hit the Haitian capital with such force that it killed over 100,000 people in 60 seconds.1 It was the worst the region had seen in 200 years.   This, compounded with the country’s poverty, the poor construction quality and the underdeveloped infrastructure, left the region without power, shelter, or substantial medical response.2 Witnesses described mass chaos and mayhem as aftershocks rippled through the area.  The U.N. Headquarters, the National Penitentiary, and the presidential palace had all collapsed.3,4 As rescue and relief operations began, so did violence: by Thursday, gunfire could be heard in the streets at night.  The Red Cross estimates that one in three Haitians were affected. 4

The havoc wreaked by this most recent disaster, however, should draw significant attention to the Haitian government’s neglect of its own people.  Its land and resources have been repeatedly plundered, and its governance revolves largely around the U.N. relief agency.  The Caribbean nation is the poorest in the Western Hemisphere:  80% of its people live below the poverty line, and it has the highest rates of infant and maternal mortality.5 Its poverty and political instability have been repeatedly exacerbated by earthquakes, floods, and hurricanes; as such, it has been the recipient of substantial international humanitarian and financial aid. 2 Salvano Briceno, the director of the UN International Strategy for Disaster Reduction, has pointed out that the government seems to suffer from a short memory.  He said on Wednesday that while neighboring countries cope better with natural disasters, “the Haitian Government, once the relief effort is over, just wants to forget.”5 This time, however, there can be no forgetting: with the international relief effort must come a re-evaluation of the political and financial aid needed to best help the country.  The Haitian people deserve more than to go back to the status quo after the world helps them clean up the rubble.