Disaster Health Care Services in the Lens of

Injury Care in Bangladesh: An experiential

Analysis of tropical Cyclone SIDR

Dr. AKM Fazlur Rahman, PhD., Dr. Aminur Rahman, Dr. Saidur
Rahman Mashreky and Md. A. Halim Miah

Centre for Injury Prevention and

Research, Bangladesh (CIPRB)
Introduction
Bangladesh is one of the leading disaster-
prone countries in the world
Increasing global warming and
environmental degradation contribute to
climate change
Bangladesh is becoming more vulnerable
to various disasters
The country tops the list among 170
countries of the Global Climate Risks
Index (German Watch,2009)
Introduction …..
Disasters affect human health and cause property
damage
Injuries are the major causes of death, disability
and illness due to disaster
Snake bite
10%
Diarrhoea
10%
ARI/Pneu
Drowning 3%
77%
Flood, 2007
Source: DGHS Control Room, 2007
Sidr
 Sidr at a glance
Formed 11 November 2007

Dissipated 15 November 2007

Wind speed 215 km/hr (3 min sustained)

Highest wind 250 km/hr (1 min sustained)

speed
Tidal surge 15 – 20 feet

Duration 3.5 hrs (7:30 p.m. to 11:00 p.m.)

Impact of Sidr

Total affected districts 30

Worst affected districts 12
Affected Upazila 200
Affected Union /Municipality 1950
Population affected 8,923,259
Total families affected 2,064,026
Death Toll (Injuries) 3,363
Injured survivors 55,282
Estimated economic loss US$ 3 billion
Impact of Sidr contd….

Government figures showed that Barguna

district was at the top of the casualty list
(1277 deaths) which was followed by
Bagerhat, Patuakhali, Pirojpur, Barisal and
Gopalganj.
20,000 kms of power supply lines of REB
was damaged
Road and telecommunication disrupted
 Study Objective

To improve Health Service Delivery, particularly

in injury care preparedness and response
during disaster – lessons learnt from Sidr
Understanding the Disaster Health
Care Services in the Lens of Injury
Care in Bangladesh: An experiential
Analysis of Tropical Cyclone Sidr
 Goal and objectives
Goal
Reduce consequences of injuries due to
disasters.
General Objective
To facilitate optimum preparation for
management of injury care in the disaster
affected area through providing information and
policy recommendation to the concerned policy
and decision makers.
Specific objectives
– Explore health seeking behavior related to injury as
a result of SIDR
– Explore the constraints and predicaments faced by
the Health Care Providers at the upazila and
community level (human resource, equipment etc.)
regarding injury care
– Formulate a policy recommendation for better
management of injury illness due to natural disaster
 Research Methods
Research Design
Cross-sectional survey: Magnitude and type
of injuries
Qualitative study: FGDs, in-depth interviews,
free listing and case studies
Review research: A desk review was done to
analyze the existing policy and strategies
regarding injury management during disaster
 Study Area
Barguna Pirojpur

Patharghata Zianagar

30 clusters 30 clusters
 Sample size
Barguna
– 20 cases/cluster X 30 cluster = 600 cases
Pirojpur
– 20 cases/cluster X 30 cluster = 600 cases

Cases occurred within 7 days of Sidr

Cases = Injury mortality & morbidity
RESULTS
 Injury mortality & morbidity
Injury mortality - 34
Injury morbidity - 1210
Household – 1187
Sample population – 5165
Proportion of types of injury
deaths
Others Cut
6% 9% Neck fracture
3%

Limbs fracture/
sprain
9%
Chest injury
3%

Abdominal injury
3%

Drowning
67%
Proportion of types of injury morbidities
Others
15% Cut
26%

Near-drowning
10% Head injury
3%
Abdominal injury
1%

Chest injury Neck fracture

12% 1%

Pelvic fracture Limbs fracture/

6% sprain
26%
 Place of injury
Open place
On the boat
6%
12%
Open place
8%

Cyclone shelter
Others
4%
21%

Under tree
Own/other's home 4%
78%
Own/other's home On the boat
61% 2%

Others
4%

Mortalities Morbidities
11% of the injured were permanently
disabled
Of the 5165 pop. 132 permanently
disabled
Care received immediately after injury
Medicine
shopkeeper
34%

Others
9%

Traditional healer
4%
Kabiraj
8%
Homeopath
2%
Allopath
43%

12 out of 34 injury mortality cases received care from

Allopathic practitioners and medicine shopkeepers
Distance of the nearest health facility
Within 200 yds
10 m iles & m ore 4%
17%

Within 1 m ile
25%

6 - 10 m iles
14%

2 - 5 m iles
40%
 Community priority issues immediately after
the Sidr (Barguna)
Priority Items Frequency Smith Salience

Habitat 13 0.436
Cattle 10 0.163
How to survive 8 0.167
Rest of the family 5 0.163
members
Husband 3 0.115
The assets 3 0.058
To search those 1 0.058
who alive
Everything destroy 1 0.038
Emergency Preparedness by the
Communities before Sidr
Community people
– heard the announcement of Sidr through miking
– but they did not believe it
– flood, cyclone, storm, etc. are regular features of
coastal belt
– they were reluctant and did not have any emergency
preparedness
– they could not imagine the how devastating Sidr could
be
“Truly speaking, we did not have any kind of
preparation as we never even think about it!”
uttered the boys in FGDs.
 Emergency Preparedness by the
Communities before Sidr
Teacher
“When we were warned about Sidr, people
were laughing at us and did not believe us
as just two months before a tsunami signal
was proved wrong……… People left their
homes only when the tidal surge reached
to their home yards.”
 Emergency Preparedness by the
Volunteers before Sidr
Red Crescent Society did some limited
activities
– Informing people by miking
The upazila (Pathorghata) team was not very
active for the last few years
There was no logistics support for the teams
except a hand mike
A few trained volunteers – rescue and first aid
Lack of coordination with the volunteers and the
team leader and with the central body
Emergency Injury Care Preparedness by
the Communities before Sidr

What they had:

■ Torch
■ Da (A kind of chopper)
■ Microphone (Red Crescent)
■ Bicycle
■ A few of them had Life jacket (Red crescent)
■ A few of them had water containers
(household level)
 Emergency Injury Care Preparedness in
the Community level
What they did not have:
■ Rescue training
■ First aid box even among the community
volunteers
■ Stretcher
■ Training on Primary Injury care
■ Transport
■ A referral point
 Injury Care Preparedness at
Govt. health facilities
Emergency meeting with staff to treat casualties
Challenges:
– Lack of relevant logistics including
Dressing materials - gauze, bandage, cotton,
needle, thread, antiseptic
Emergency medicines including tetanus toxoid
Equipments
Ambulance
– Lack of trained manpower on Emergency Injury Care
 Injury Care after Sidr

Huge number of Injured people started

coming to the Pathorghata Upazila Health
Complex from 11pm, immediately after the
cyclone weakened on that night
The major injuries were
– Cuts from tin
– Injury from blunt objects
– Fractures
(FGD with doctors, Pathorghata).
SACMO
“We did not have any idea that so many injury
patients would come just after Sidr. After a
tropical storm we usually get 2 or 3 injury
patients. A situation like this was unimaginable
to us and we were not prepared for them.”

Health Assistant
“We did not realize that the situation could be so
devastating. We do not have training on injury
care. We could only use antiseptic to wash the
place of injury and then apply bandage. Our
office did not undertake any preparation to
tackle the situation.”
 Situation of Injury Care after SIDR

Patients were unable to reach hospitals due to

communication problems
People did not pay attention to their injuries at first as
they were busy with collecting food and rebuilding the
houses. They came for treatment after 3 or 4 days, even
after 8 days, by this time their injuries were already
infected
Women and adolescent girls did not visit to male HCP
(in-depth interview with Upazila Health Complex personnel,
Pathorghata, Barguna).
Injury Care preparedness By others
HCP
After Sidr some NGOs provided treatment to
injured patients:
– Gonosastho Kendra
– Dak Die Jai
– Family Health Clinic
These people have no training on emergency
health care. They had no idea about what
kind of health hazard they might face after a
super cyclone.
Injury Care by medical teams after Sidr

A doctor stated, “I could not imagine

that we would find so many injury
patients. Our team had enough ORS
and water purification tablets. But
these people needed treatment for
their injuries first.”
 Conclusion
People were not prepared
Communication disrupted
Health facilities had not enough materials
for injury care
Lack of trained community volunteers
HCPs were not trained on emergency
medical care
 Recommendation from different
Stakeholders
Community

to appoint trained health personnel on emergency

care at union and upazila level;
to provide first aid materials for injured patients;
to include a chapter in school books on disaster
preparedness, early warning system and injury
care
to evaluate disaster related activities after any
disaster to revise the action plan;
to include community people in causality
management;
 Community
to provide unemployed youths with first aid training
and to pay them accordingly;
to provide financial support to severely injured poor
patients
provide free treatment and care at proper time to the
poor patients
to strengthen the medical teams for providing care
at the scene
to keep emergency medical facilities like first aid
boxes at schools, religious centers, clubs, offices of
the local government
To formulate a Community Safety and Protection
strategy in disaster preparedness considering local
customs, religion and gender
Recommendations from different
Health Care Providers
to include causality management as an integral part of
health related preparedness;
to provide HCPs, especially FWAs and HAs, as well as non-
medical persons with first aid box and hands-on training
to provide HCPs with enough washing material, needle,
thread and TT injection in first aid box;
to provide HAs with training on medical stitching;
to appoint HAs and HIs with diploma degrees on health;
to ensure enough trained workforce to tackle a post-disaster
situation;
to train doctors on emergency medical care including injury
to send medical teams to vulnerable areas before a disaster
to keep reserve of enough blood for emergency patients
 CIPRB Recommends
– Develop integrated plan to handle injuries
during disasters
– Adequate and planned financing on disaster
preparedness
– Developing human resources
Training of volunteers on first response
Training of paramedics on Basic Life Support
Training of doctors on emergency medical care
– Keep a supply of ready emergency medicines
and other necessary logistics to manage
injuries during disaster preparedness
 CIPRB Recommends
– Ensure emergency transportation facilities
– Ensure long term medical support for severely
injured people/follow up
– Include injury care in the rehabilitation
programs taken after a disaster
– More consultation and discussion on disaster
preparedness and injury care
 Acknowledgement
TREE- Senwalia, Savar, Dhaka
UPACAR- Pirojpur
Multi Tasks-Pathargata, Barguna
Professor Dr. Khondhaker Md. Shefyetullah, Director Medical
Education &HMPD, DGHS
Civil Surgeon, Barguna
UHFPO, Pathargata
Mr. Joyanta Adhikari, Executive Director, CCDB
Mr. Mahmudul Islam PhD, UNDP
Mr. Khurshid Alam
Salma Rahman, Research Coordinator
Bithi, Research Associate
Hasina Akter, Research Associate
Nadimul Haque Mandal, Research Associate
All the participants in the SIDR affected area
THANK YOU