South-East Asia Regional Conference on Epidemiology

<strong>South</strong>-<strong>East</strong> <strong>Asia</strong> <strong>Regional</strong> <strong>Conference</strong> on Epidemiology | 149
• Needs against an existing gap (e.g. not enough oral rehydration salts (ORS) supply to address
this potential increase in diarrhoeal cases);
• Needs with a humanitarian perspective (e.g. population affected by floods needs supplies/
medicines as aid to counter the potential increase in diarrhoea cases).
Then and only then can rapid health assessments, surveillance and surveys be considered as
intelligence and meaningful.
However, in an emergency situation it is not so simple as several questions will arise: How much
ORS is needed? Who will provide the funds? Where will this be bought? How will this be transported
to the affected area/people? Who are the others who can act on this information? Are there health
workers who can distribute ORS properly? Who else might have already bought ORS as part of
preparedness or response?
Challenges
From the questions presented above, it is clear that discussing epidemiology in emergencies without
describing the chaos of the environment in which it will be applied reduces the topic to an academic
exercise. A few challenges are mentioned below:
Coordination
In any emergency, numerous NGOs and agencies are usually present and work on health issues.
In Aceh, Indonesia, for instance, there were over 250 NGOs in the health sector alone; during the
cyclone Nargis in Myanmar in May 2008, over 80 NGOs were engaged in health work, and in the
recent earthquake in Sumatra, Indonesia, in September 2009, there were around 40 NGOs providing
assistance.
A part of the agenda or main work of all agencies is to gather information and conduct rapid
assessments and surveys; they also participate in surveillance systems that are in place or set them up.
As such, information-gathering is often duplicated, resulting in varied interpretations. These can also
lead to gaps in actions/interventions.
Post-tsunami (December 2004), an effort to reform humanitarian practice was set in place by the
United Nations. Since 2005, the international response is done through the cluster approach and WHO
is the lead agency for health. The emergency of cyclone Nargis specifically had a subgroup which
coordinated participation in joint surveys and surveillance so that the methods were consistent and
analyses meaningful. The post-Nargis Recovery Plan Survey remains as the template in joint postemergency
assessment - where over 100 agencies and thousands of volunteers drew up a plan, method
and training, and the analysis for the survey was achieved and implemented. The health cluster is a
way to coordinate information-collection in such a way that it is implemented in a structured manner,
with cooperation from all agencies involved.
Changing context
The setting in a crisis is always in a flux and this brings challenges to information- collection, affecting
application of epidemiology. The following changes can occur:
• Expansion of the emergency area from local to regional or countrywide or can extend outside
camps as the case may be;
• Field conditions such as lack of security and accessibility and problems of logistics which can
hinder access to information;