As the country’s armed forces deal with the evacuation of pilgrims and residents of Uttarakhand’s flood ravaged districts, their comrades-in-arms from the Armed Forces Medical Services (AFMS) are already seeing the first signs of an impending public health crisis. While the first priority was rightly given to the evacuation of survivors, the delay in clearing bodies of flood victims from water sources has had a devastating consequence: contamination of springs used for drinking water purposes. Medical teams at various sites are already reporting that signs of gastrointestinal infections (fever, diarrhoea, nausea), even among the Indo-Tibetan Border Police (ITBP) personnel were on the rise by June 28.
This is but one of the hard lessons we are left with as we grapple with the aftermath of arguably the worst natural disaster of recent times. As teams of doctors, nurses and paramedics help out in the flood-ravaged areas, they are bound to return with suggestions of what public health infrastructure can be put in place in these areas to prevent or at least lessen the toll in future.
First on the list will probably be a better communication network between the various groups involved in disaster relief: be it the government, the military or volunteers ranging from hospitals, NGOs, etc. For instance, though hospitals based in the region were only too willing to provide medicines, first aid kits as well as doctors to help out with the relief work, there were media reports that medical personnel were left cooling their heels in Dehradun, far from the affected areas. The flip side of this criticism, of course, is that with limited means of transport, the state government’s strategy was to bring patients to the doctor rather than the reverse. Which makes sense because these cities were anyway better equipped to be the treatment base for the influx of patients.
Maybe these reports reflected a temporary impasse and the government, with help from the armed forces, were ultimately able to iron out the logistic kinks. But, delays during disasters of this scale cost lives and on a larger scale, deepen the public health crisis by the day. Both the centre and individual states are reportedly revamping their disaster management plans and one hopes that hospital managements will be consulted for their expertise in emergency medicine and trauma care. Of course, implementing these plans will require intense public scrutiny and media oversight to translate plans from paper to reality faster.
The truly sad part of this tragedy is that it is bound to recur; not just in the ecologically fragile Uttarakhand region, but in other regions as well. Disasters come in various shapes: tsunamis, earthquakes, as well as more new age threats like radiation leaks and chemical/biological warfare. Express Healthcare has covered the efforts of some state governments to roll out centralised emergency medical response services, like the Mumbai Emergency Management Exercise (MEMEX) and the Chennai Emergency Management Exercise (CEMEX).
These have evolved into good examples of synergies between the state and the corporate sector. (See story: Defence Against Disasters, Express Healthcare, February 2012: http://healthcare.financialexpress.com/201202/criticalcare01.shtml)
What’s required is to strengthen these public-private partnership (PPP) efforts and scale them up to the national level. Express Healthcare will be collating a detailed analysis of the learnings from this disaster in an forthcoming issue and we invite comments and suggestions from our readers.
As the politicians continue to pass the buck, each state is still counting missing victims and so the demand to label it a national calamity is gaining force. But will India’s citizenry allow them to get away with it this time? With elections around the corner, it is time for the electorate – both on the individual as well as corporate front – to take an active part in ensuring that the next time Mother Nature vents her fury, we at least have the infrastructure in place to limp back to normal.
Viveka Roychowdhury
Editor
