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Experience sharing of flood relief health activities at Sangli, Maharashtra

2020; Medknow; Volume: 9; Issue: 1 Linguagem: Inglês

10.4103/jfmpc.jfmpc_963_19

2278-7135

Prasad Tukaram Dhikale, Balkrishna Adsul,

Disaster Management and Resilience

The flood ravaged parts of western Maharashtra mainly along the bank of river Krishna and Panchaganga in August 2019.[1] As there was no prior experience of flooding of such a larger intensity in this region, people were not prepared for it. In some Indonesian islands where there are frequent floods, people are prepared for it thereby reducing casualities.[2] Before us, some health relief teams were working mainly for the medical care of the displaced population living in emergency shelters like schools. When our relief team comprising doctors of different specialties from Municipal Corporation of Greater Mumbai went to Sangli, flood water had just receded. Most of us were posted by District Health Officer (DHO) at the flood-affected primary health centers (PHCs) and subcenters in Sangli. Most of the PHCs and subcenters were flooded with water, so we were having OPD in nearby Gram panchayat office/other rooms. The number of patients at these centers was around 100 per day. Most of the cases were upper respiratory tract infections, Tinea, boils, minor injuries, and wounds; there were some cases of acute gastroenteritis. The morbidity pattern was similar to that seen in flood-affected Thailand in a cross-sectional study in 2013.[3] Surveillance of the infectious cases was done for early detection of the outbreak. Surveillance continued for at least 6 weeks which is the incubation period of hepatitis A. No outbreak was detected. Gastroenteritis outbreak was considered if the number of gastroenteritis cases was more than 5 per 1000 population. Doxycycline prophylaxis for leptospirosis was given as per national guidelines. Daily surveillance was kept at PHCs and subcenters about the number of people affected by the flood, displaced by flood, returned home after the flood, received chlorine tablets/liquid, and received doxycycline prophylaxis. Also, surveillance was done for water sample testing for microorganisms, bleaching powder testing for chlorine concentration, and mosquito control measures. It was an intermediate phase of disaster where the focus was on mediating disruption to the provision of the basic needs of the affected people.[4] Health education of people about water purification, mosquito breeding prevention, and sanitation was done. People were dumping their household goods which were immersed in flood near roads, and also there were bodies of dead animals and urgent requirement of sanitation. The sanitation workers from different parts of Maharashtra and volunteers were continuously doing this Herculean task of cleaning. Piped water and electricity supply was stopped during the flood. Gram panchayats were given a letter for super chlorination of water tanks, that is, using a double dose of bleaching powder and announcement was made not to use that water for drinking and to use bore water only after the addition of chlorine tablet (75 mg) per 20–25 L of water or liquid chlorine. House-to-house distribution of chlorine tablets was done. Preventive disinfection helps in reducing the health risks associated with contaminated water.[5] Container survey for mosquito breeding was done. Doctors and health staff from other places of Maharashtra were deputed in flood-affected areas. Many teams of doctors from nearby places, medical colleges, Indian Medical Association, and nongovernment organizations were also providing medical care in these areas. The collector had given an order that all teams of doctors should take permission from the DHO so that there will be better coordination. DHO office was insisting not to give intravenous fluids and unnecessary injections in villages as it was not needed, not sustainable, and would increase people's expectations. The morbidity profile of patients checked by other private doctors was also collected by the surveillance system. Prompt mobilization of manpower was done with good coordination by local health authorities. There were some specialty doctors in the team but they had to use their MBBS knowledge to manage patients. Relief materials like packaged drinking water, food grains, clothes, fodder for cattle, and so on were distributed by different organizations in the affected area. Experience of health staff The medical officer (MO) of a PHC told that after the flood had receded, people started returning to their village and then local leaders with a big mob of villagers approached PHC and demanded mask and glows for all villagers. The MO tried to explain to them that it was not needed and still she has put a demand to the DHO office. The MO said “I escaped manhandling because I was a female.” After listening to this, our team did not use masks as it was not needed and would create demand for masks among villagers. Most of the local health staff's houses were also affected by the flood. The frustration and scarcity caused by the disaster increases the chances of a conflict.[6] The disaster-affected people often feel that assistance will not come or is delayed. Disaster workers are also stressed emotionally, psychologically, and physically exhausted from coping with long working hours, fear and worry, and a lack of resources. Conflicts can be avoided by providing adequate resources, giving correct information, encouraging people to use healthy coping mechanisms, and avoiding overwork of disaster workers.[6] When the villages were flooded, some patients with diabetes and hypertension were not able to get their regular medications. When the water receded, the health department provided the stock of antidiabetic and antihypertensive medications. In a village, an elderly patient died of pneumonia as he was not evacuated early by the NDRF teams. The DHO office instructed the health workers to keep a list of seriously ill/bedridden patients so that they can be given preference for evacuation with other vulnerable populations. Overall, there was no outbreak, good surveillance, focus on water, sanitation and vector control, and good coordination by local authorities of the external help. Providing antidiabetic and antihypertensive medications post disaster is important. Post-disaster conflicts can be avoided by giving correct information to people, providing adequate resources, and avoiding overwork of disaster workers. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Ackowledgement The authors acknowledge the Municipal Corporation of Greater Mumbai and District Health Office Sangli for their support and their employees who worked for disaster relief and shared their experiences.