Stetoscorp 5th Edition

WHAT DO SCORPIONS SAY?

DISEASE OUTBREAKS IN POST DISASTER SETTING

Refugee is a common terminology used for people affected by a disaster (natural or mankind) which force them to stay outside their home either because of their home is broken or for safety reasons.

UNHCR defines refugee as someone who owing to a well-founded fear of being persecuted for reasons o race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to usch fear, is unwilling to avail himself of the protection of that country (refugee convention, 1951). The survivors who are affected by disaster commonly then called as internally displaced persons (IDP). Unlike refugee, IDPs have not crossed and international border to find sanctuary but have remained inside their home countries. In this article, refugee means IDPs. Refugees are considered as vulnerable group because their rights tend to be violated.

Indonesia is a supermarket of natural disaster. Every month, 200 disaster hit Indonesia. Respect to this fact, having ability to handle refugee for scorpion as an ambassadors of human rights, is crucial.

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STETSCORP | 5th Edition 2016

by Dhiya Khoirunnisa

What medical student can do? Outbreak of disease are commonly occurred following a disaster. In many post-disaster, 60 to 90 percents of death of the refugees are due to communicable diseases. Thus in doing humanitarian action, refugee’s health are some of the main concerns. The risk of outbreaks following natural disasters is closely related to the health status and living conditions of the displaced population. The refugee’s camp are often crowded, has poor sanitation, inadequate health services and worsen by the unsufficient food supply. These factros contribute to the quick and rapid of spreading out communicable diseases.

Diarrhea, acute respiratory infection or measles are the common outbreaks affected refugess/IDPs. As stated in SPHERE project, which is the book of emergency response guideline, the first potential case is diarrhea particularly if clean water and latrine are not adequate provided. This outbreak will be happened after three days. Particularly for children, diarrhea is a killer even in not disaster situation.

SCORP CIMSA | Stetoscorp 5th Edition

WHO really concern about this, and has initiated to develop and do trial of oral cholera vaccine when tsunami affected Aceh in 2004. A little bit different case was happened in Yogyakarta after the earthquake in 2006. Even though number of death directly caused by the earthquakes was not as many as in Aceh, but a second ‘disaster’ was occurred in 1-2 weeks after it because of tetanus when survivor back to their home, save their asset and tried to rebuild their house without proper protection. Children and men are the most vulnerable group. It seems that girls and women in Indonesia are more protected as an impact of TT for girls at 6 grade, TT for married to be, TT for pregnant women and TT for women in reproductive age. One of UNICEF core commitment for emergency response is to providing measles campaign for all children aged 0-15 years old grouped in one shelter. This program is implemented by assuming the measles immunization coverage in the area is less than 90%. Measles is very infectious and can very quick spread out. Its fatality rate is very high.

Pregrant women and children under five are the most vulnerable group to be sick or even died due disaster. Their immunity is lower compare to adult men.

This situation is even worse because they sometimes inferior to have adequate drinking water and food supply too when they need is higher. The unsifficient food supply that can lead to undernourished can also affect the immunity of the refugees. There are a few activities to prevent communicable diseases:

1.

Safe water, sanitation, site planning. It should be based on standard. This will ensure that the refugee’s are given good living condition. This may prevent diseases such as diarrhea, leptospirosis or hepatitis A and E. 2.

Primary health-care services. It is used to provide early diagnosis and treatment for diseases. Primary health care also has a role for vector and environment control. Aside from that, they need to give health education to the refugee’s in order to promote refugee’s health.

3.

Surveillance/early warning system.

It should be quickly established to detect outbreaks and monitor priority endemic diseases.

4.

Immunization.

Measles immunization is the most common vaccine given in post-disaster setting. This program is combined with vitamin A supplementation 100,000 IU for children 6-11 months and 200,000 IU for children above 1 year.

From the description above, three outbreak of communicable diseases associated with immunization which commonly happened in post disaster area are cholera, measles and tetanus.

5th Edition 2016 | STETOSCORP

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WHAT DO SCORPIONS SAY?

Except for cholera, other two diseases have immunization program in Indonesia. Based on scorecards, Indonesia GVAP Routine Immunization Goal is NOT ACHIEVED and DTP3cv <80%. DTP3cv is the third dose of diphtheria toxoid, tetanus toxoid and pertussis containing vaccines. This figure is actually cannot be tolerated knowing that the DTP1cv national coverage has already achieved. What does it mean? It means, most of children in Indonesia has access to get vaccine but the quality of immunization service is not good which imply to the failure of some children to receive the third dose. While for the tetanus toxoid, it clearly showed the immunization program gap for men and school aged boys.

It is concluded, the disease outbreaks post disasters must be considered as a risk. Immunization program during the disaster must be put as an important of preparedness plan. That means provision of vaccine, ensuring the cold chain and skilled health providers need to be calculated and budgeted. Scorpion can play important role on this by working together with the ministry 840,89 of health to contribute â&#x20AC;&#x153;Build Back Betterâ&#x20AC;?.

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STETSCORP | 5th Edition 2016

SCORP CIMSA | Stetoscorp 5th Edition

CONGRATULATION

UNIVERSITY OF YARSI Local of SCORP CIMSA started from February 2016

UNIVERSITY OF JEMBER Observer of SCORP CIMSA started from May 2016 5th Edition 2016 | STETOSCORP

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