"Recovering, not recovered" Hospital disaster resilience: a case-study from the 2015 earthquake in Nepal.

BACKGROUND: Disasters are an increasing threat to human health, but we know little about their impact on health services, particularly in low and middle-income settings. 'Resilient hospitals' have been increasingly recognized as a cornerstone of disaster management. While various frameworks of hospital resilience exist, they emerged from pre-disaster considerations, and do not incorporate evidence from post-disaster settings. OBJECTIVE: This dissertation investigated the impact of a large-scale sudden onset disaster in a tertiary hospital in Nepal, and explored its resilience mechanisms. METHODOLOGY: This consists of an in-depth case-study combining quantitative data from routinely generated hospital records and qualitative data from semi-structured interviews with hospital staff. We used both advanced statistical methods and mixed inductive and deductive coding to analyze the data. RESULTS: Most of the admitted earthquake victims required surgical interventions and long hospitalizations, considerably straining the hospital. For six weeks, the average number of daily admissions decreased. During this period, the share of injury-related admissions was particularly high, and such admissions were particularly long compared to the baseline. Admissions due to other conditions relatively decreased and were shorter. We found that the hospital's resilience was highly dependent on emerging adaptations, in addition to the pre-existing disaster plan. Individual resilience of staff also played a major role, and was influenced by senses of safety, meaningfulness, and belonging. CONCLUSION: Hospitals should prepare resources and plan for their known disaster risks, but should also allow for a certain flexibility to innovative adaptions to emerging, unforeseen challenges. Challenges faced by hospital workers should not be undermined, and addressing them will increase hospital resilience

Road Safety is No Accident: Challenges facing the Healthcare Sector

No ano de 2018, ocorreram em Portugal 34 235 acidentes com vítimas e morreram 675 pessoas. Mais de 10 pessoas por semana, o equivalente a 66 mortes por cada milhão de habitantes - a União Europeia registou uma média de 49 óbitos por milhão no mesmo período

Fostering hospital resilience to disasters : lessons from a tertiary hospital in Nepal

Resilient hospitals are essential to reduce the human impact of disasters. The evidence on the disaster impact on hospitals is limited, and research on hospital resilience is mostly from pre-disaster phases, and does not portray post-disaster realities. This dissertation investigates the impact of a high-magnitude earthquake on a tertiary hospital in Nepal and explores resilience mechanisms, using a combination of quantitative and qualitative methodologies. The key findings are: i) the earthquake produced resource-intensive conditions that required lengthy in-hospital treatment; ii) the hospital’s function was affected and the provision of elective care was disrupted; iii) the hospital’s resilience was highly influenced by emerging adaptations and on resilience of individual staff, which depended of meaningfulness, sense of safety, and sense of belonging. We finish the dissertation with recommendations to improve resilience of health facilities and reduce the human impact of disasters.(SP - Sciences de la santé publique) -- UCL, 202

The Syrian Crisis: Refugees. Thematic Group C: Contribution from the Centre for Research on the Epidemiology of Disasters (CRED)

The current Syrian conflict has caused a massive population displacement, reportedly the biggest since the Second World War. Six years after the beginning of the war, experiences of these Syrians who fled conflict have been long and diversified. However, information has been scarce until recently. We aim to assess the impact of the current Syrian crisis on health and well-being of people who have fled war to neighbouring and transcontinental countries. Many aspects must be taken into account to understand the current health status of Syrian refugees. The demographic and epidemiological situation before the war determines the frequency of different diseases; but disruption of public health services has enabled the spread of previously rare conditions. Violence has increased the burden of injuries and mental diseases. Finally, a sudden disruption of daily routine to undertake uncertain and perilous journeys also determines the patterns of disease

Clinical Characteristics of Refugees in Greece

In 2015 Europe experienced over 1 million arrivals of migrants and asylum-seekers (1). Greece was the main entry for many people fleeing from civil war and in the Middle East and south Asia (2). Several delegations of Médecins du Monde (MdM) collaborated in a project to deliver healthcare to refugees in Greece from April 2016 until July 2017 in a total of 21 sites. The aim of our study is to explore the utilization of health services by the MdM Field teams during the Greek Refugee Crisis with a view to improve the evidence for operational planning and decision-making in the future. Anonymized routinely generated data from the consultations were extracted, containing patients' sociodemographic and clinical information. Physician diagnoses were adapted from the 2nd version of the International Classification of Primary Care (ICPC-2), and grouped into 13 categories. We undertook a descriptive analysis using R software (version 3.3.2) to calculate proportions, -test for equality of means, and χ2 test for independence. We included 30,983 consultations and 8,564 individuals in our analysis. About 55% of the consultations were performed on women, and mostly on Afghans (48%) and Syrians (43%). Children under 10 represented 25% of all consultations (n= 7729). The number of individual Syrian patients consulted (n=4215) was higher than Afghans (n=3447). The most common diagnosis was upper respiratory tract infection (n=5430), followed by musculoskeletal and skin diseases (n= 2359 and n=2106, respectively). The proportion of consultations with a communicable disease was 35% (n= 9083). Consultations of Afghans had 1.45 (CI95% 1.38-1.54) times higher odds of being done for a communicable disease compared to consultations of Syrians. The proportion of consultations for respiratory diseases was significantly higher if the patient was younger than 15 years (p<0.01). There were significantly more consultations on Syrians for reproductive health than on Afghans (p<0.01). This is the first study to report clinical findings on thousands of consultations performed during the Greek refugee crisis. Our results show that the demographic and epidemiological characteristics of patients consulted reflect the pre-existing profile in their home countries. Respiratory infections and skin diseases are also frequent, reflecting the home country realities

PALTEM: What Parameters Should Be Collected in Disaster Settings to Assess the Long-Term Outcomes of Famine?

Evidence suggests that nutritional status during fetal development and early life leaves an imprint on the genome, which leads to health outcomes not only on a person as an adult but also on his offspring. The purpose of this study is to bring forth an overview of the relevant parameters that need to be collected to assess the long-term and transgenerational health outcomes of famine. A literature search was conducted for the most pertinent articles on the epigenetic effects of famine. The results were compiled, synthesized and discussed with an expert in genetics for critical input and validation. Prenatal and early life exposure to famine was associated with metabolic, cardiovascular, respiratory, reproductive, neuropsychiatric and oncologic diseases. We propose a set of parameters to be collected in disaster settings to assess the long-term outcomes of famine: PALTEM (parameters to assess long-term effects of malnutrition)

A12 - Impact of the 2015 earthquake in hospital admissions at the Tribhuvan University Teaching Hospital: preliminary results

Background: In April 2015, Nepal was hit by a 7.8 magnitude earthquake, causing nearly 9,000 dead and 22,000 injured. The Tribhuvan University Teaching Hospital (TUTH) in Kathmandu received a high share of people affected. Literature on earthquake impact on hospitals is scarce, particularly in the mid and longer term. Methodology: To understand the effect of the earthquake in the functioning of TUTH, we gathered admission data from 1.5 months before to 3 months after the earthquake. We collected sociodemographic and clinical information (ICD-10 codes), and admission and discharge dates of patients. We defined 4 periods: Pre-Earthquake (PREEQ), Acute Earthquake Period (3 weeks after the first shake – EQ1), Post-Acute Earthquake Period (3 weeks after the acute period – EQ2), and Post Earthquake (POSTEQ). We performed descriptive analysis and logistic regression with period as outcome variable, taking sex and diagnosis in consideration. Results: A total of 9615 admissions were included. In EQ1, and compared to PREEQ, the odds of admission due to injury had the highest significant increase compared to other diagnoses (OR= 5.36, p<0.001). There was a significant decrease in the odds of admission of 0-4 age group compared to the 15-49 group (OR=0.68, p<0.01). In EQ2, the odds of being admitted due to respiratory diseases, and pregnancy-related issues were significantly lower relative to PREEQ (OR=0.770, p<0.05; OR=0.78, p<0.05 respectively). Finally, in POSTEQ, the odds were lower for injuries (OR=0.84, p<0.05), pregnancy (OR=0.72, p<0.001), and people aged 50 or more (OR=0.85, p<0.01), relative to PREEQ. Discussion: The higher odds of admission for injuries in the acute period is supported by the literature. The decrease in pregnancy-related admission implies that women’s access to this hospital was reduced. This study supports a conceptual model proposed of hospital needs after a sudden disaster, where trauma emergencies increase in a very short-term, leaving non-trauma emergencies and elective admissions for a post-acute phase. Keywords: earthquake, patient admissions, disaste

(Near) Future challenges for Public Health Professionals in Germany

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Hospital resilience after the 2015 earthquake in Nepal: a qualitative study with hospital staff

Background Research on hospital resilience is scarce and favours top-down approaches, and evidence from the field and operational levels is lacking. The aim of our study was to understand the mechanisms of hospital and individual resilience experienced by staff from a tertiary hospital in Kathmandu, Nepal, after the 2015 Earthquake. Methods We conducted semi-structured interviews with different professionals in May 2018; undertook a deductive thematic analysis of hospital resilience using the framework proposed by Bruneau et al; and used an inductive thematic analysis for individual resilience. Results The earthquake caused different types of burden to the hospital and individuals. Redundancy was mostly influenced by linkages with lower levels of care. Resourcefulness consisted mostly of spontaneous adaptations, with task shifting the most important for human resources. External provision of resources enabled the transfer of part of the burden but precipitated accountability-related challenges. The hospital's robustness depended not only on its physical resistance, but also on the functional capacity to provide life saving care, although routine services were interrupted and quality decreased. The hospital ensured rapidity in providing life saving care to the victims and re-start of routine activities, but recovery to a sense of normality was more conflicting and dependent on the individual. Individual resilience was dictated by safety, a sense of meaningfulness, self and external appreciation, and community support. Conclusions Our study shows the importance of staff experiences to improve hospital resilience. Disaster plans should acknowledge the role of task shifting, and basic care should be taught to all, not just those with clinical functions. Health workers are extremely overwhelmed during disaster response, and disaster plans should engage staff at an early stage to ensure they feel safe and sufficiently supported. Key messages Our work is one of the first to study hospital resilience with field data from qualitative interviews with hospital staff. Hospital resilience strategies should also address individual resilience of hospital staff