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Earthquakes, Fuel Crisis, Power Outages, and Health Care in Nepal: Implications for the Future
- Bipin Adhikari, Shiva Raj Mishra, Sujan Babu Marahatta, Nils Kaehler, Kumar Paudel, Janak Adhikari, Shristi Raut
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 11 / Issue 5 / October 2017
- Published online by Cambridge University Press:
- 18 April 2017, pp. 625-632
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Earthquakes are a major natural calamity with pervasive effects on human life and nature. Similar effects are mimicked by man-made disasters such as fuel crises and power outages in developing countries. Natural and man-made disasters can cause intangible human suffering and often leave scars of lifelong psychosocial damage. Lessons from these disasters are frequently not implemented. The main objective of this study was to review the effects of the 2015 earthquakes, fuel crisis, and power outages on the health services of Nepal and formulate recommendations for the future. The impacts of earthquakes on health can be divided into immediate, intermediate, and long-term effects. Power outages and fuel crises have health hazards at all stages. It is imperative to understand the temporal effects of earthquakes, because the major needs soon after the earthquake (emergency care) are vastly different from long-term needs such as rehabilitation and psychosocial support. In Nepal, the inadequate and nearly nonexistent specialized health care at the peripheral level claimed many lives during the earthquakes and left many people disproportionately injured. Preemptive strategies such as mobile critical care units at primary health centers, intensive care training for health workers, and alternative plans for emergency care must be prioritized. Similarly, infrastructural damage led to poor sanitation, and alternative plans for temporary settlements (water supply, food, settlements logistics, space for temporary settlements) must be in place where the danger of disease outbreak is imminent. While much of these strategies are implementable and are often set as priorities, long-term effects of earthquakes such as physical and psychosocial supports are often overlooked. The burden of psychosocial stresses, including depression and physical disabilities, needs to be prioritized by facilitating human resources for mental health care and rehabilitation. In addition, inclusion of mental health and rehabilitation facilities in government health care services of Nepal needs to be prioritized. Similarly, power outages and fuel crises affect health care disproportionately. In the current context where permanent solutions may not be possible, mitigating health hazards, especially cold chain maintenance for essential medicines and continuation of life-saving procedures, are mandatory and policies to regulate all health care services must be undertaken. (Disaster Med Public Health Preparedness. 2017;11:625–632)
What Happened to Our Environment and Mental Health as a Result of Hurricane Sandy?
- Shao Lin, Yi Lu, John Justino, Guanghui Dong, Ursula Lauper
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 10 / Issue 3 / June 2016
- Published online by Cambridge University Press:
- 18 April 2016, pp. 314-319
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Objectives
This study describes findings of the impacts of Hurricane Sandy on environmental factors including power outages, air quality, water quality, and weather factors and how these affected mental health during the hurricane.
MethodsAn ecological study was conducted at the county level to describe changes in environmental factors—especially power outages—and their relationships to emergency department (ED) visits for mental health problems by use of a Poisson regression model.
ResultsWe found that many environmental hazards occurred as co-exposures during Hurricane Sandy in addition to flooding. Mental health ED visits corresponded with the peak of maximum daily power blackouts, with a 3-day lag, and were positively associated with power blackouts in Bronx (prevalence ratio [PR]: 8.82, 95% confidence interval [CI]: 1.27–61.42) and Queens (PR: 2.47, 95% CI: 1.05–5.82) counties. A possible dose-response relationship was found between the quantile of maximum blackout percentage and the risk of mental health in the Bronx.
ConclusionWe found that multiple co-environmental hazards occurred during Hurricane Sandy, especially power blackouts that mediated this disaster’s impacts. The effects of power outage on mental health had large geographic variations and were substantial, especially in communities with low sociodemographic status. These findings may provide new insights for future disaster response and preparedness efforts. (Disaster Med Public Health Preparedness. 2016;10:314–319)
The Impact of a Large-Scale Power Outage on Hemodialysis Center Operations
- Mahshid Abir, Sophia Jan, Lindsay Jubelt, Raina M. Merchant, Nicole Lurie
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 6 / December 2013
- Published online by Cambridge University Press:
- 22 August 2013, pp. 543-546
- Print publication:
- December 2013
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Introduction
On June 29, 2012, mid-Atlantic storms resulted in a large-scale power outage affecting up to three million people across multiple (US) states. Hemodialysis centers are dependent on electricity to provide dialysis care to end-stage renal disease patients. The objective of this study was to determine how the power outage impacted operations in a sample of hemodialysis centers in the impacted regions.
MethodsThe sample consisted of all hemodialysis centers located in the District of Columbia and a total of five counties with the largest power losses in West Virginia, Virginia, and Maryland. A semi-structured interview guide was developed, and the charge nurse or supervisor in each facility was interviewed. The survey questions addressed whether their centers lost power, if so, for how long, where their patients received dialysis, whether their centers had backup generators, and if so, whether they had any problems operating them, and whether their center received patients from other centers if they had power.
ResultsCalls were placed to 90 dialysis centers in the sampled areas and a 90% response rate was achieved. Overall, hemodialysis operations at approximately 30% (n = 24) of the centers queried were impacted by the power outage. Of the 36 centers that lost power, 31% (n = 11) referred their patients to other dialysis centers, 22% (n = 8) accommodated their patients during a later shift or on a different day; the rest of the centers either experienced brief power outages that did not affect operations or experienced a power outage on days that the center is usually closed. Some centers in the study cohort reported receiving patients from other centers for dialysis 33% (n = 27). Thirty-two percent (n = 26) of the centers queried had backup generators on site. Eleven percent (n = 4) of the centers experiencing power outages reported that backup generators were brought in by their parent companies.
ConclusionsComprehensive emergency planning for dialysis centers should include provisions for having backup generators on site, having plans in place for the timely delivery of a generator during a power outage, or having predesignated backup dialysis centers for patients to receive dialysis during emergencies. Most dialysis centers surveyed in this study were able to sustain continuity of care by implementing such pre-existing emergency plans.
. ,Abir M ,Jan S ,Jubelt L ,Merchant R .Lurie N The Impact of a Large-Scale Power Outage on Hemodialysis Center Operations . Prehosp Disaster Med.2013 ;28 (6 ):1 -4
Impact of 2003 Power Outages on Public Health and Emergency Response
- James C. Kile, Stephen Skowronski, Mark D. Miller, Stephan G. Reissman, Victor Balaban, Richard W. Klomp, Dori B. Reissman, Hugh M. Mainzer, Andrew L. Dannenberg
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- Journal:
- Prehospital and Disaster Medicine / Volume 20 / Issue 2 / April 2005
- Published online by Cambridge University Press:
- 28 June 2012, pp. 93-97
- Print publication:
- April 2005
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Introduction:
In 2003, a major power outage occurred in the midwest and northeast United States affecting some 50 million people. The power outages affected multiple systems in state and local municipalities and, in turn, affected public health.
Methods:Semi-structured interviews were conducted using open-ended questionnaires, with a convenience sample of state- and locally selected subject matter experts from Ohio, Michigan, and New York. Respondents were interviewed in groups representing one of five areas of interest, including: (1) emergency preparedness; (2) hospital and emergency medical services; (3) municipal environmental systems; (4) public health surveillance and epidemiology; and (5) psychosocial and behavioral issues. The reported positive and negative impacts of the power outage on public health, medical services, and emergency preparedness and response were documented. Responses were categorized into common themes and recommendations were formulated.
Results:The amount of time that the respondents' locations were without power ranged from <1 hour to 52 hours. Many common themes emerged from the different locations, including communications failures, alternate power source problems, manpower and training issues, and psychosocial concerns. There was minimal morbidity and mortality reported that could be attributed to the event.
Conclusion:Power outages negatively impacted multiple municipal infrastructures, and affected medical services, emergency response, and public health efforts. Previous federal funding positively impacted public health and emergency response capabilities. Recommendations were made based upon the common themes identified by the respondents.
Recommendations may assist state and local health departments, medical service providers, and emergency responders in planning for future power outage problems.