Role of Medical Students and Interns in Disater Management

Role of Medical Students and Interns
in
Disaster Management


Dr. R.S. Dahiya


Introduction:

Hardly a day now passes without a disturbing news about a major or complex emergency happening in some part of the world. Disasters continue to strike and cause destruction in developing countries specifically and the developed countries as well, raisin peoples concern about their vulnerability to occurrences that can gravely affect their day to day life and their future.

There is no doubt that remarkable progress has been achieved not only in the field of science and technology but in all spheres of human activity particularly during the current century. But unfortunately the same progress has been exploited to produce agent of mass destruction such as nuclear, chemical and biological weapons, capable of wiping out all the achievements made so for with in a matter of minutes. The floods and the draughts are also many times because of mismanagement. Even the science and technology has developed to a level where the houses can be made to bear with the earth quakes and cyclones.

There is a growing trend of various forms of disasters in the world. Number wise in 1998 alone, there were 74 major floods, 5 cyclones, 17 earth quakes, 18 draughts and 162 major accidents the world over. During the period of 1960 to 1989, our own country experienced a total of 191 disaster events of various types resulting into 1, 51, 179 deaths; 2,11,535 injured persons and 174,28,72,678 people were affected one way or the other.

All disasters can be broadly classified into two major categories.

A. Natural disasters such as earth quakes, floods, draughts, cyclones and volcanic eruptions etc.
B. Man made disasters which may be
· Intentional (Unconventional war fare, Civil strife, floods, droughts, etc.)
· Non intentional (industrial accidents eg. Bhopal gas Tragedy, Chernobyl Nuclear Plant disaster etc.)
The man made disasters are totally preventable provided there is will and the non intentional disasters can be prevented to a long extent .


C. Ecological disasters

v Oil Spills
v Air, water and soil pollution
v Desertification
v The green house effect
v Environmental degradation
v Refugees besides nuclear, chemical ,and biological catastrophes
These are man made and require determined, concerted efforts to prevent them.

Objectives are:
Ø To visualize preventive measures
Ø To reduce the loss of property
Ø To achieve international solidarity
Ø To achieve inter- sectoral cooperation
Ø To achieve community participation
Ø to achieve greater involvement and dedicated participation of medical and health personnel

This paper deals with the last objective.

How to really involve medical and health personnel with dedication during and after the process of disaster is over, is a serious issue. There are certain riders in the way of active and participatory involvement of these sections. Without addressing these challenges, the real involvement will be a far distant dream.

You can force a horse to go to the pond but you cannot force him to drink. The basic challenge is that they might not have been exposed to such situations earlier. Their orientation to deal with such situations may be weak. Many a times their motivation may be weak. Their working conditions may be worst etc. because of which their sensitivity towards human beings in general is eroded. Many times the interns are having a self alienation. Overall erosion of human values and domination of market values is a big rider. This cannot be inculcated overnight. Hence a selection is required. Those who volunteer for the job should be considered first.
Many times the things are expected from the private sector health personnel where has they have left this role in the market driven society.
The basics of disaster preparedness and management should be included in the under graduates syllabus. The involvement of undergraduates and interns in tackling various emergencies and in post disaster relief activities of health should be well planned and also be included in the curriculum.

While providing medical relief to disaster affected people under graduates and interns learn many things. They observe and treat cases; know about the principle of Triage while handling mass casualties; learn how to treat cases with optimal drugs and limited facilities; how to deal with the psycho-social- cultural problems and their impact on health; how the records of various activities are maintained and what is their significance in regular surveillance and monitoring of information to higher authorities.

They also learn that medical relief is integral to general disaster management. They see themselves that the disaster however imposes a sudden unexpected burden on the existing health services which prove incompetent to tackle such emergencies effectively since they are basically meant to provide the routine medical/health care to the community under their care during peace time/normal time. The communication channels are disrupted miserably and they learn how to reach the people who are under distress. They learn that outside medical assistance during disaster and in post disaster period is must. The assistance can be from within the district/state/ country and even international assistance depending upon the degree of damage caused.

Usually at a district level the Civil Surgeon and the District Health Officer along with their subordinate staff i.e. Medical Officer Incharge PHC/dispensary of affected area, implement the District Relief Plan, prepared and kept ready always in advance.

When the existing health infrastructure cannot cope with the extra workload, staff from adjoining health centers as well as state health services has to be mobilized for the medical relief work. Even this may not prove sufficient sometimes and extra help may be required from the nearby medical colleges and hospitals during different situations eg. Floods, famines, earthquakes, refuge relief work etc. The involvement of medical undergraduates, interns and P.G students including lady medical interns proves invaluable at many occasions. The floods of 1995 in Rohtak are a relevant experience where about 100 junior doctors of PGIMS Rohtak participated in medical relief work organized by Haryana Gyan Vigyan Samiti, a non governmental voluntary oraganisation.

The Medical relief work involves various activities such as :

1. Running an OPD for the patients
2. Attending indoor patients in temporary hospitals in schools/chopals/tents.
3. Rendering First Aid.
4. Treating of various kinds of emergencies.
5. Immunisation.
6. Keeping a watch on food and milk supply.
7. Ensuring supply of safe drinking water.
8. Imparting of health education.
9. Motivating people to participate in the relief work.
10. Make amendments and adjustments according to specific local needs.
11. They are exposed to experience of different preventive measures.

Hence it is strongly recommended that disaster management should become the part of undergraduate curriculum so that the under graduates and interns have a theoretical backup in this field when they are exposed to manage any disaster (during and post disaster period).