Disaster relief and recovery after a landslide at a small, rural hospital in Guatemala

Reducing patient surge: community based social networks as first responders

A major challenge for health services worldwide is in providing adequate medical care during mass disasters. The ongoing COVID-19 pandemic highlights this difficulty. Patient surge, a consequence of most types of disasters that contribute to trauma experiences, is a primary factor in disrupting such care as it is composed of worried well persons and those experiencing psychosocial trauma that can severely disrupt and overwhelm effective acute hospital based health care. We review the literature and propose a potential solution framework to reduce such a surge that relies on exploiting community social networks as first responders. We utilize and integrate literature based evidence on patient surge, community disaster behaviors and community based informal social networks to examine reasons for patient surge to hospitals. We then propose that leveraging community based social networks as a potent deterrent for non-critically injured, especially those who have experienced psychosocial trauma or the worried well, from seeking hospital care during ongoing disasters. By emphasizing the social capital inherent in community based social networks, this perspective posits an alternative cost-effective means of reducing patient surge.

Sri Lanka's post-tsunami health system recovery: a qualitative analysis of physician perspectives

Background

The 2004 Indian Ocean tsunami caused significant damage to the health system in Sri Lanka. Rebuilding infrastructure and improving the mental health system were targets of recovery policies. Retrospective analyses of the post-tsunami health system recovery in Sri Lanka lack the perspectives of local stakeholders, including health care providers.

Methods

In 2014 we interviewed 23 Sri Lankan physicians from the Eastern and Southern regions. Participants were recruited with snowball sampling. We used a content analysis approach in analysing the transcriptions.

Results

Sri Lankan physicians critiqued governance, sustainability and equity in the health system recovery. They held leadership roles as facilitators and sustainers of specific projects but were rarely formally consulted in recovery strategic planning. They identified instances of poor coordination among partners, corruption trends, local resource mismatches, regional resource disparities and the influence of the Sri Lankan civil war.

Conclusions

Post-tsunami health system recovery planning and implementation in Sri Lanka did not involve local physician stakeholders in ways that have been prioritized more recently in other recovery frameworks. Despite limited formal inclusion, local physicians developed significant leadership roles that have informed their critical perspectives on the health system recovery.

A systematic review of the health impacts of mass Earth movements (landslides)

Background. Mass ground movements (commonly referred to as 'landslides') are common natural hazards that can have significant economic, social and health impacts. They occur as single events, or as clusters, and are often part of 'disaster' chains, occurring secondary to, or acting as the precursor of other disaster events. Whilst there is a large body of literature on the engineering and geological aspects of landslides, the mortality and morbidity caused by landslides is less well documented. As far as we are aware, this is the first systematic review to examine the health impacts of landslides. Methods. The MEDLINE, EMBASE, CINAHL, SCOPUS databases and the Cochrane library were systematically searched to identify articles which considered the health impacts of landslides. Case studies, case series, primary research and systematic reviews were included. News reports, editorials and non-systematic reviews were excluded. Only articles in English were considered. The references of retrieved papers were searched to identify additional articles. Findings. 913 abstracts were reviewed and 143 full text articles selected for review. A total of 27 papers reporting research studies were included in the review (25 from initial search, 1 from review of references and 1 from personal correspondence). We found a limited number of studies on the physical health consequences of landslides. Only one study provided detail of the causes of mortality and morbidity in relation a landslide event. Landslides cause significant mental health impacts, in particular the prevalence of PTSD may be higher after landslides than other types of disaster, though these studies tend to be older with only 3 papers published in the last 5 years, with 2 being published 20 years ago, and diagnostic criteria have changed since they were produced. Discussion. We were disappointed at the small number of relevant studies, and the generally poor documentation of the health impacts of landslides. Mental health impacts were better documented, though some of the studies are now quite old. Further research on the health impacts of landslides needs to be undertaken to support those responding to landslide disasters and to aid disaster risk mitigation advocacy.