Health Service Focus

Healthcare in disaster zones

NHE speaks to Professor Donna Mead, Dean of the Faculty of Health, Sport and Science at the University of Glamorgan, and chair of the second International Conference of the World Society of Disaster Nursing held recently in Cardiff, about the messages presented during the event and the wider principles of disaster healthcare.

The University of Glamorgan is one of the only institutions in the world to offer an MSc in Disaster Healthcare, and had a key role in establishing the World Society of Disaster Nursing (WSDN), which met for its second international conference in Cardiff in late August, hosted by the university.

Professor Donna Mead, Dean of the Faculty of Health, Sport and Science at the university, chaired the conference. She told NHE about the university’s own role in disaster healthcare, saying: “We have sent students now to over 40 countries where there have been disasters: either with the British Armed Forces, or with Merlin (Medical Emergency Relief International), Médecins Sans Frontières, Tearfund, Christian Aid, the Red Cross, or an Italian NGO called Emergency.

“Most of our graduates will work in the NHS, or the regular army or in the health service in their own countries. But when there are disasters, they deploy. For example, the Finnish Red Cross has got a fantastic track record of deploying for humanitarian reasons, and much like with the TA in this country, these people will be working away and they’ll get the phone call and they have to deploy: off they go, sometimes with quite short notice.

“When the Haiti earthquake happened [January 12, 2010] one of our graduates leading the International Red Cross humanitarian endeavour emailed us and said ‘you’ll never guess, I’m in Haiti, there’s four graduates of the Glamorgan course here’.”

During the MSc programme, students have a three-month deployment to a disaster or conflict zone. This follows practice sessions in a simulated environment, focusing on conflict situations in the UK, and on natural and environmental catastrophes during a trip to Finland, which has always had a large role in disaster healthcare and support.

The degree programme as it is today at the University of Glamorgan evolved out of conversations between nursing academics based across Europe in the mid to late 1990s, with initial European funding secured in 1996 and partnership working between universities in Finland, Sweden, Spain, Ireland, Northern Ireland, Scotland and Wales. The programme was developed and approved by the University of Ulster at the end of 1998. It is now delivered by the University of Glamorgan. Professor Mead explained: “As the years went by Ulster stopped being formal partners. But their staff continue to help us.” A book chronicling the backstory was published in 2010, called ‘Education for Disaster Healthcare: A Story of Humanitarian Endeavour’, with a foreword from Professor Mead.

There are now two pathways in the Glamorgan course – disaster healthcare (formerly disaster nursing), and an environmental hazards and management pathway.

The WSDN

Moves to found the society began around five years ago in Kobe, Japan, which itself was badly affected by the Great Hanshin earthquake in 1995. Members initially came from eight countries, which has since risen to 27, and the first international conference was held in Japan in 2010. The second conference in Cardiff in August attracted just over 200 delegates, “which for a niche area like disaster healthcare and disaster nursing, is very good”, Professor Mead said.

“We had people from 25 counties, which is fabulous. There were two types of people who came, with some overlap: those who live in counties where there have been very significant disasters, such as people from China, many of whom were involved in the [May 2008] Sichuan earthquake.

“There were also large numbers of people from Japan, involved either in Kobe or the more recent Fukushima earthquake, or the Philippines floods. The other half of attendees were people who deploy, from countries such as Britain, the US, Australia, Finland.”

Resilience and preparedness

Professor Mead continued: “Everybody tends to focus on the disaster when it happens, but disaster healthcare is very much grounded in public health. If all you do is restore that community to where it was before the disaster happened, you haven’t gained very much. You have to build resilience so that if there’s another disaster, they’re better equipped to deal with it: disaster preparedness, disaster resilience, and disaster management in the aftermath.

“If you think of Banda Aceh [the closest major city to the epicentre of the December 2004 Indian Ocean earthquake and tsunami], there’s no cameras out there now and nobody’s interested – but the health problems out there are huge. The children’s issues are very severe. That’s why we have the conference.”

Professor Mead said one particularly interesting session at the conference was about the role of the media, with speakers including the BBC’s Middle East editor Jeremy Bowen.

She said: “There’s been a long history of keeping the media at arm’s length, but then of course the media don’t pick up on other stories that we would want them to. The session was about the media being friends not foes.

“Jeremy Bowen talked about the way he deals with people on the ground. He was trying to get across that although it might seem very intrusive when journalists try to get stories about individual situations – and often healthcare professionals feel that’s very intrusive – to get the message back home it has to be packaged into a story to grab the attention of viewers. He was trying to help people to understand that balance: there is a code of conduct, there are ways that you go about it. Nobody seems to realise that the media are part of your armoury: that was extremely helpful and interesting.”

NHS attitudes

The NHS in each of the four nations of the UK has some kind of initiative to help assist those carrying out disaster healthcare abroad, while reservists employed by the NHS get help via the MoD’s SaBRE campaign (Supporting Britain’s Reservists and Employers).

Professor Mead said: “In Wales for example, we have Wales for Africa and there is a level of understanding and agreement about the commitment that people are going to be involved in humanitarian endeavour.”

She praised the work of Lord Nigel Crisp on developing the NHS in England’s role in humanitarian relief. She said most people going out to help in a disaster zone receive adequate help from their employers, adding: “Sometimes it will take a bit longer to sort out than you’d like, but we rarely get a ‘no you can’t go’.”

It is not just nurses and medical staff needed, but also those with other health-related specialisms and experience, especially in public health and epidemiology. She said: “You would be very foolish indeed to deploy without somebody with expertise on diseases, on bacteria, on how they spread, about environmental hazards – which is one of the reasons we morphed into including environmental health into our programme.

“We have also graduates who could be called medical support staff: paramedics, physiotherapists, other types of clinicians. We definitely need logistics, and often that’s about GIS (geographic information systems) – finding out where the population you’re trying to serve is, who has been displaced, often through mobile phone technology. If you’ve got the right computer experts you can tell where people are. We also need HR specialists and people with legal knowledge, especially the law of the land in the disaster zone.”

We asked Professor Mead whether there are universal principles of nursing, things the typical health worker in the NHS would share with someone working in the chaos of a disaster zone – or if the two worlds are too far apart for that.

She said: “There are universal principles – but they are a means to an end. Care of the patient and the family is paramount. That’s not going to be compromised.

“When you’re working in a disaster area you may be in a situation where you’re dealing with specific population concerns or a very specific community. You have to work within the cultural context of wherever you find yourself.

“For example, we were in Kabul in a hospital where people get promoted on the basis of patronage and not on expertise, so you’ve got people with senior jobs and influence who are not up to the job. But you can’t go in there and shout and scream about it. You have to say to yourself, my goal is that the people with the expertise have the power and influence. It can take you two or three months to get to that stage, so you can see what you would like to change but you can’t always change it overnight.”

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