Going Mental

Help me :(

During disasters, no one can anticipate the level of stress and burden that comes with it. Sure, the logistic team can handle everything that the victims may need, but at times what should really be a matter of concern is the mental state of the victims. There are a few mental problems that may accompany different stages or phases after disaster:

• Critical Phase
• Acute stress disorders: this usually occur less than one month after an extreme stressor.
• After critical phase
• Post-Traumatic Stress disorder (PTSD): This can occur more than one month after an extreme stressor. It can also occur immediately for those who has had some sort of traumatic experiences previously.
• Prolonged Stressors
• After a catastrophic experience, the patient can endure unwanted personality change which is caused by his/her way of dealing with the disaster.

Lets us look into detail what PTSD is all about

Based on experience, i have encountered a few cases where some of my friends and family members are traumatized by a gruesome incident they ever encountered in their lives. For example, when one is involved in an accident, it will take them a very long time to actually get in another car ride ever again. The following are the main symptoms of PTSD:

• "Flashbacks" about the traumatic event
• feelings of estrangement or detachment
• nightmares
• sleep disturbances 
• impaired functioning
• occupational instability
• memory disturbances
• parenting or marital difficulties

The patients may withdraw themselves from doing some activities that they think may cause them to have the same experience and are terrified for everything. When things like these happen, there are two possible route on how one can individually deal with their problem. 

They can either have healthy coping mechanisms or maladaptive coping strategies. Its these maladaptive coping strategies that we have to be very careful and clever to detect. 

Examples of maladaptive coping strategies are like:

• An increased use or abuse of alcohol, coffee, drugs, gambling, tobacco, etc.
• A compulsion to work more than usual
• A temptation to make hasty major life-decisions (e.g., a job change, a divorce)
• A tendency to completely avoid any feelings or thoughts about the event.

When an event of disaster happens, it can certainly cause very complicated mental health and psychosocial problems. The effect of the disaster varies from people, country and also economic backgrounds. For example, in developing countries, life problems and secondary disaster following the disaster is even prominent than the trauma primarily faced.

Therefore, prompt evaluation of the mental status of the people who deals with disaster should be done regularly and no "simple" sign should be taken lightly. Regular support groups in which survivors can discuss their feelings and experiences are also very important so that all their negativity can be transformed into effective and positive communication.

References:

1.     Lecture Note: Disaster Management in Mental Health (by Dr. Bambang Hastha Yoga, Sp.KJ)

2.     Medicine.net. Search on Post-Traumatic Stress Disorder

Blood Banking in Disaster

In a disaster, some or all of the following scenarios may materialize:

• Damage to health facilities at a time of increased demand for their services
• Disruption of social networks and the operations of health care and support entities.
• Environmental degradation leading to the proliferation of vectors and other sanitation problems.
• Human displacement leading to radically increased or decreased population density, affecting food supply and hygiene and precipitating the outbreak of communicable diseases.
• Damage and partial or total loss of basic services (transport, communications, water, electricity).

Only a comprehensive strategy comprising vulnerability assessment, mitigation, and closely-knit organization at the local, regional and national level will ensure an adequate response in disaster situations and guarantee the timely and cost-effective recovery and reconstruction of the affected facilities. A national blood bank system, including a central reference facility should be established for the handling of emergencies. The system should take into account the capacity and vulnerability of each centre, both from the point of view of infrastructure and the services it should provide in an emergency.

The organization and hierarchy of the blood bank network should be established in advance as part of the overall development and management of the system. An inventory of human and physical resources should be carried out, including the precise definition of roles and responsibilities.

The vulnerability assessment of laboratories and blood banks should uncover at

least the following information:

• Expected structural and non-structural behavior of the laboratory or blood bank facilities.
• Expected characteristics of the damage: location, causes, magnitude and consequences.
• Likely operational capacity after each type of disaster.
• Recovery time for full operational capacity.

Immediately after a disaster has struck, damage to each facility and to the system as a whole should be assessed from the point of view of both security and operational capacity. Then an assessment must be made of the need for blood, supplies, and other physical and human resources. If donations are required, one should ideally accept first of all people who have previously donated blood, and process the units of blood in accordance with national safety standards.

Emergency communications should be carefully planned and tested in advance. This includes redundant channels and alternative modes. Transportation of blood and other supplies and equipment to the affected areas should also be planned with care, including alternative routes in case roads have been blocked by landslides, debris or flooding. Simulations and drills should be carried out in normal times to test the efficacy of the system.

References:

1. www.unisdr.org
2. Disaster Bloodbanking lecture by Dr Teguh Triyono

World AIDS Day 2010 Slideshow Project

World AIDS Day 2010 falls on the 1^st of December 2010. Where is it celebrated and remembered? All over the world. HIV/AIDS has become a global crisis and an old friend to the human race. Who else will care, if not us and who else will act, if not us.

For this memorable day is no joking matter, we should always understand the role that we need to play and the mindsets about AIDS that we need to change. For every prejudice destroyed, comes with it the ultimate benefit. And that moment starts now.

Especially for this day, I’ve put together some photos easily accessible from Google and did some research on our national AIDS organizations (both Malaysia and Indonesia) before arranging it into a slideshow via windows moviemaker. Hopefully some of the info and words shared in the slideshow will spark a little bit (if not much) of understanding among us to combat this global enemy.

Enjoy.

Managing Donations for Disasters

Donations and relief aids for Tsunami Disaster Victims (2004)

“Uncoordinated, uncontrolled masses of donated goods and volunteers can interfere with disaster operations and cause a secondary disaster”

Innocent thoughts ran through my mind as I hear about the amount of generous donations that came from an insane number of parties all over the world as well as local NGOs every time a disaster strikes in Indonesia. Little that I know, these resources without the proper management and coordination between the organizations that are involved can impose severe effects later for the respective country or area. 

There are two problems that may arise regarding poor donations and national volunteer management. Too many, and too little.

A good example that I got from Prof. Sulanto’s lecture was how thousands of help or medical aids received by local and international organization during the Acheh Tsunami, indeed caused billions of rupiahs to be spent by the government to assist in waste disposal in result of this. From this example, we know that a balance or regulation regarding this occurrence needs to be developed.

The National Volunteer and Donations management strategies stressed on a few key elements:

1.   Donations activities may begin before a disaster declaration: Coordinative efforts needs to be made to prevent difficult problems and misunderstandings later. Donations planning, coordination and management are necessary to avoid chaos, waste of time and effort that large shipments of undesignated goods can cause. This is also necessary towards addressing spontaneous, unaffiliated volunteers who arrived on-site at a disaster, ready to help. Because they are not associated with any part of the existing emergency management response system, their offers of help are often underutilized and even problematic to professional responders.

2.   Shipment of undesignated goods may be affected by state policies: During a catastrophic disaster, the state may impose policies that affect the transportation of all vehicles include shipments of goods. These policies should facilitate and not interfere with the shipments of the designated goods.

3.   State and local governments are in charge of donations operations: The government should address critical issues such as what procedures should be established at weigh stations, toll booths and other point of entry. The government also has a role in addressing a massage to the public regarding donated goods and volunteer services.

4.   State should make full use of existing voluntary agency capabilities: State and local donations management personnel should be very familiar with the strengths and interests of the voluntary organization, and other non-governmental organizations have a wide variety of abilities that can be fully used during a disaster.

5.   Use flexible strategies: Flexibility must always be used in disaster operations. There is no single correct way to manage unsolicited goods and spontaneous volunteers for all disasters. Other factors determining the appropriate approach will depend on the types of working relationships that are made between government emergency management personnel and voluntary agencies prior to a disaster.

6.   Use a team approach: While the government is responsible for certain critical issues, the leading voluntary agency representatives can be involved actively in day-to day operations.

7.   Cash donations to voluntary agencies are preferred. Cash donations to the voluntary agencies experienced in disaster relief help the agencies purchase precisely what the affected community needs, such as food items for the food bank. Cash donations to voluntary agencies help the local economy affected by the disaster because money is spent in the local area. Cash donations also eliminate the difficult transportation and logistics requirements necessary for the donations of goods.

8.   Information management IS essential: During a large-scale or catastrophic disaster, several thousand calls can be anticipated. A phone bank us the backbone of a successful donations management operation. The public should know where to call to discuss and coordinate their offers before they collect and send goods and volunteers to the disaster area. A volunteer and donations phone bank must be adequately staffed to give the caller accurate and timely information about the need for donations of goods and volunteers.

These key elements needs to be of high attention during each phase of disaster management. The elements of the volunteer and donations management system establish a consistent flow of information and goods to help manage operational activities.

References:

1.   Points of Light Foundation & Volunteer Center National Network: Managing Spontaneous Volunteers in Times of Disaster:  The Synergy of Structure and Good Intentions  www.PointsofLight.org/Disaster

2.   FEMA Materials:  “When Disaster Strikes … How You Can Help” (L-217 English and Spanish – FEMA Publications

Human Resource in Health Care

Human resource is a term used to describe the workforce of an organization. It is one of the three major principle of health system input, the other two being physical capital and consumables.

The concept of human resource management has been a topic of wide debate. It basically means, the strategic and coherent approach to an organization most valuable assets, and that would be the people working together to achieve a similar cohesive goal. 

In general, human resource management function to employ people, develop their maximum capacity, utilizing, maintaining, and compensating their services in tune with the organizational requirements.

In health care, human resource can be defined as the different kinds of clinical and non-clinical staff responsible for public and individual health intervention. The target of human resources in health care not only comes from the direct caregivers of health services but also other individuals that are involved in working together to ensure a efficient working health organization, for example, administration, public relation, security, catering, laundry, electronics, civil, electrical and air conditioning maintenance.

In a hospital setting, the human resources can be divided to medic and non medic; technical and administrators, and all have a rather similar crucial role to ensure the accessibility and efficiency of an organization.

***

When we talk about human resource in health care, several issues easily comes to mind:

1.      Composition and distribution of health care workforce. This issue is considered one of the key indicators or a country’s capacity to provide delivery and intervention of health care services.

2.      Workforce training issues. Some of us may wonder, where actually some doctors get their medical certificate judging from their performance in the field and quality of care, thus stereotypes are often being put forward. Truthfully, in my opinion, prior education is as vital as the in service training for health care workforces. The HRM (short for human resource management) should really develop ideas on how they can provide new options for education to cater for the country’s current and future needs.

3.      Migration of health workers. An issue addressed like an old friend. A problem that has been on top of everyone’s concern. Research has indicated that regardless of any country, migrations to urban area are common. This coincides with globalization of health care and issues of brain drain both external and internal. With regards to this issue, actions and planning needs to be generated as there might be an imbalance in the human resource in the urban and rural areas, thus jeopardizing health care deliveries at places where the attraction is less (in a working environment perspective).

4.      Level of economic development. One must admit that the richer and more developed country (higher gross domestic product per capita), the more money is being spent on health care as compared to countries with lower gross domestic products per capita.

5.      Sociodemographic, geographical and cultural factors. An example for this is regarding the age distribution of the population in an area. Where there is an ageing population, there is a high demand for human resource regarding a certain particular field. Training should also be given to younger populations so that they can fill in the shoes of doctors which will soon be retiring.

The management of human resource certainly has its difficulties and challenges. We, as soon-to-be 'human resource' involved in an organization has a big role to play in order to maintain the balance and efficiency of the system, therefore should always be prepared for the challenges ahead of us. This is because the whole organizational operation depends crucially on it and any mistakes and flukes can indeed impose severe effects to the system.

References:

1. Lecture by Dr. Andreasta Meliala : Human resource management in health and Medical Doctor career.

2. Human Resource Management in Health Care, Principles and Practices by L.Fleming Fallon, Jr; and Charles R. McConnell.

3. Human Resource Planning in health Care, B. Ray.