Emergency Health Management in Emergency Health Management ...

Emergency Health Management in
Nargis Cyclone Affected Areas
DR. SOE LWIN NYEIN
DIRECTOR (EPIDEMIOLOGY)
DEPARTMENT OF HEALTH

Cyclone Track

Early Warning
•Since 30-4-08 morning
By Radio, TV Channels, Newspaper, phone,
Fax to high risk areas for community alert
and preparedness
• Ministry of Health also sent early warning
information and instructions on
preparedness of disaster through
respective State and Divisional Health
Department to high risk townships

•Population affected - 2.4 millions
•The death and missing – 138,373
•Injuries – 19,359

Sr.
No
Animal losses
Species Losses% Head (nos.) Value
(kyats in
million)
1 Buffaloes 45 136631 20494
2 Cattle 16 91297 23694
3 Sheep/ goat 15 7084 142
4 Pig 15 67903 3395
5 Chicken 15 2404344 3607
6 Duck 32 533856 801
Total 42134

National Disaster Preparedness and Response Committee
Ministries
Central Level
Central Committee for Disaster
Preparedness and Response
If necessary
UN Agencies
and ASEAN
Countries
Sub Committees
Period
Early Warning
During Disaster
period System Period Period period
Pre-disaster
period
Post disaster
period
Emergency Period
Governments and
non- governmental
Organizations
Emergency Response
Headquarters
Committee from
Ministries
Governments and
non- governmental
Organizations
Governments and
non- governmental
Organizations
State/ Division/ Township/Wards and village Disaster Preparedness and Response
all Areas
All disaster area and
resources form related area
necessary for help
All areas concerned with
rehabilitation programme

National Disaster Management Committee
After Tsunami (2004), the Government of Union of Myanmar had organized
the National Natural Disaster Preparedness Central Committee in 2005
chaired by the Prime Minister and comprised of (10) sub-committees.
Ten Sub-committees
1. News and Information
2. Emergency communication
3. Rescue and relief
4. Transport and clearance of passage
5. Health Care Sub-committee
6. Rehabilitation and resettlement
7. Security
8. Preliminary information on destruction and emergency relief
9. Reduction of dangers and construction of emergency shelter
10. Confirmation of destruction

Search and Rescue

Under the guidance of Prime Minister, Chair of the
National Natural Disaster Preparedness Central
Committee the teams visited Mawlamyinegyun, Pyapon
and Bogale on the 4 th
of May and provided emergency
medical care and referred severely injured patients to
Yangon General Hospital and Yangon Kyimyindaing
i i
Orthopedic Hospital by military helicopters.

Emergency Medical Care

Emergency Medical Care
• Emergency Health Management Office at YGH, managed by Minister,
Deputy Minister and senior officials from DOH
• Providing emergency medical and surgical management for the people in
shock and injured
• Immediate management of functioning of operation theaters, labour room,
and X-ray machines etc..
• 24 - hour clinics were opened at the every camps for emergency medical
care – supervised by senior medical officer
• Senior epidemiologists/specialists immediately assigned in affected areas

Relief Camps

Established early warning
surveillance and response system
• Focus on the communicable disease of
public health significance, (severe
diarrhoea, measles, tetanus, DHF, etc.)
• Daily reporting system
• Daily monitoring of disease morbidity and
mortality
• Immediate feedback mechanism
• Monitoring of response and outcome

EWARS – Information flow
Health Facilities
Camps/clinic
S/C
RHC
Station Hosp
Temporary
camps
INGO
Data collection
compilation
and analysis
Lab confirmation
TMOS
NGO/INGO
at Yangon
Divisional
Health
Department
Health
Cluster
Agencies
MOH
National Surveillance
System
Response and feedback

Weekly Diarrhea Cases in Nargis-hit Yangon and Ayeyarwaddy Division
2500
ses
ber of Ca
Num
2000
1500
1000
500
0
Wk19* Wk20 Wk21 Wk22 Wk23 Wk24 Wk25 Wk26 Wk27 Wk28 Wk29 Wk 30 W31 W32 W33
Epidemiological Week Number
Yangon Ayeyawaddy Total

1600 Comparasion of Incidence of DHF cases in Yangon Division
( from 2003 to 2008 As of July- 22)
1400
1200
1000
800
600
2003
2004
2005
2006
2007
2008
400
200
0
Jan Feb Mar Apr May Jun Jul
month
As of July 2008

Comparasion of Incidence of DHF cases in Ayeyarwaddy Division
( from 2005to 2008 As of July- 19)
1400
1200
es
Cas
1000
800
600
400
2005
2006
2007
2008
200
0
January February March April May June July
month

Comparasion of Incidence of DHF Cases in Ayeyarwaddy Division
(Affected 7 Townships, 2005-2008 2008 as of July 19)
350
300
250
Cases s
200
150
100
2005
2006
2007
2008
50
0
January February March April May June July
month

Specialist teams were formed
and sent to the frontier camps in
groups of (20) in rotation, fully
equipped with medicines and
supplies.
Specialist teams include-
- Physician
- Surgeon
- Orthopedic surgeon
- Pediatricians
- Anesthetist
ti t
- Psychiatrist
- Eye surgeon
- Dental surgeon
- Medical doctors and nurses from
general hospitals.

Supply of Drugs/ Logistics for
Emergency Management
Ministry of Health
• Emergency Health Kits
• Vaccines (Measles and Tetanus)
• Bleaching powder for chlorination of water
• Fogging machines, insecticides
• Other essential drugs requested from
affected areas

Water and Sanitation
• Chlorination of all water
sources in affected area
to get safe drinking water.
• Testing of water samples
•By the support of INGOs and
UN agencies, sanitary latrine
and proper waste disposal
system at all camps.

Water Purification Plant provided by INGOs

Nutrition & Food sanitation
• Also supervised the food sanitation, food
safety and also advice special arrangement for
the infants.
• Management of child nutritional emergency
• Coordinated with NGOs, INGOS and UN
agencies

Immunization
• Measles immunization
activities was carried out all
children (9 months to 15
years).
• Tetanus vaccination was
indicated d for injuries i and AN
care.
• Routine EPI plus Activities

Vector control and Waste Management

Public health measures implemented
at the storm-hit areas
• Health education
• Chlorination of drinking water
• Construction of sanitary latrines
• Proper waste management
• Fogging with insecticide to
control vector borne diseases
• Immunization particularly polio
and measles to children under
15 years
• Vitamin A distribution
• Moral support
• Mental health care
• Surveillance of disease outbreak

Psycho-social Support

Mental Health Care
Mental health services are being provided at
affected areas.
6 Teams (4 Psychiatrists for each team) are based
at Myaungmya rear camp to provide counseling as
well as curative services to storm-hit victims.
Psychiatrists were also included in floating hospitals
to Ayeyarwaddy division

Mobile Hospital Ships
Four Floating Hospitals visited
to Pyapon, Bogale, Labutta and
Mawlamyaingkyun townships
Anchored at the townships,
give treatment on board for
medical care, dental and
mental care.
Daily visit nearby villages along
the river creeks and streams by
motor boats and give treatment
to the people residing there.

Floating Hospital
• (7) batches of 129 doctors and nurses had been deployed d to
storm-hit areas by Double Deckers
• Curative services, disease control and public health measures
provided on the ships.
• Mental health was also taken care of by psychiatrists on board
• Refer patients that need further medical care to base camps

Traditional medicine i services
• Provided since 6
th May, by mobile teams in Ayeyawady and Yangon
Divisions.
• Traditional medicine clinics were opened at storm-hit areas.
Si 11 th J hi i ti f T diti l M di i P titi h d
• Since 11 th Juneaship consisting of Traditional Medicine Practitioners had
visited to affected areas for provision of traditional medical care.

Health Care Provision at Relief Camps by local NGOs
MMA contributed altogether (160) doctors in Yangon and (266)
doctors in Ayeyawady Division for provision of medical care.
MNA visited Ayeyawady Division and provided nursing care
MHAA visited Yangon Division and support public health
MRCS also contributed by first-aid management at front camps

Veterinary special teams
•Eighteen teams which included three
veterinarians organized from other State and
Division cooperation with local veterinarian
stationed at six veterinary camps alternatively.
• All veterinarians were facilitated with a
veterinary use and field use equipments, drugs,
medicine and vaccine.

Veterinary Coverage of LBVD
Head (nos.)
Division FMD HS Total Treatment Total
Yangon
Ayeyarwady
848 13299 14147 1246 15393
11870 22106 33976 8130 42106
Total 12718 35405 48123 9376 57499

Private sector Involvement
Doctors , nurses and pharmacists from Asia Royal private
hospital visited to Kunchangone on 7 th May (21 persons) and
9 th May (27 persons).
23 Health personnel form Pan Hlaing private hospital had
been working at Ngaputaw and Haingyi-Kyun since 21 st May.
19 health personnel from Pinlon (SSC) private hospital had
been stationed at Hlaingphone in Labutta and provided
medical care for two times since 3 rd June.

Team from Royal Kingdom of Thailand
f( )
Two teams of (30) members each stationed at
Myaungmya and Labutta.

Medical Team from
People’s Republic of China
Team of 53 members stationed at Kunchangon
township, field trip to Dedaye and Kawhmu.

Medical Team from
Republic of India
A team of 47 members organized at Pyapon and
A team of 47 members organized at Pyapon and
Bogalay townships

Medical Team from
People’s Republic of Bangladesh
33 members positioned at Maubin and Wakema.

Medical Team from
Republic of Singapore
Two teams of 23 members stationed at Twante
Two teams of 23 members stationed at Twante
township.

A team of 30 members visited Pathein, Dalah & Seikkyi
Kanaungto townships.

Medical Team from French Republic
A team of 24 members stationed at Kawhmu
A team of 24 members stationed at Kawhmu
township and Pyinkhayaing Frontier Camp.

Medical Team from Japan
A team of (23) members based at Labutta town

Medical Team from
LAO People’s Democratic Republic
23 member team located at Kyauktan township.

Medical Team from Republic of Indonesia
Organized at Kawhmu township.

Medical Team from
The Socialist Republic of Vietnam
A team of 15 members stationed at Twante township

Medical Team from Republic of Korea
Two teams positioned at Kunchangone township.

Revitalizing of health services
• Mobilization of health personnel to affected areas
• Reconstruction and renovation of damaged health facilities
• Restoration and replacement of health staffs
• Replenishment of equipment, logistics, medicines and supplies to health
facilities
• Early detection and rapid response of disease outbreaks
• Immunization
• Dengue Prevention and Control
• Protein Energy Malnutrition Control
• Reproductive Health Project
• School Health
• Restore and maintain programmes such as TB, HIV/AIDS and Leprosy
• Mental Health Plan
• Water and sanitation