In the event of a disaster, the local health personnel must immediately become an active, reassuring and organizing force to which the community can refer. They will be more effective (even if they themselves or their families have suffered in the disaster) if they have been previously trained to play this role. They will be able to contribute not only by displaying a positive psychological and emotional attitude of readiness to help and solidarity but above all by reason of their professional qualities and methods of work. Some of those qualities are particularly useful at the time of the emergency and during the days that follow.
Experience has shown what professional qualities are important in the event of a disaster. The ability to estimate requirements and resources is the essential means of avoiding bewilderment and confusion. It serves to:
· select priorities for direct action by local staff in the emergency relief work and later in the management of health problems,
· determine the real and accessible resources available in the way of personnel, premises, medicaments, equipment and materials,
· ascertain what is missing and what must be obtained as a priority from outside assistance.
The evaluation of needs and resources is not a bureaucratic process: it is effective only if it results in good mental and operational organization of the local health personnel. Evaluation must seek to establish in every instance what must be done, who should do it, in what way and by what means. Obviously it is a tool that could be validly used in normal times, since it makes it possible to give clear answers to questions of fundamental importance for the health of the population in the event of a disaster.
In the situation following a disaster, even more than in normal times, health cannot be separated from the material, social and cultural conditions obtaining in a community: versatility is precisely the ability to take into consideration all the factors that have repercussions on the health of the persons or groups receiving care. This does not mean that local health workers must know how to do everything; but it means they must know how to bring into play the other technical or community resources needed to supplement health activities, while still performing their own specific professional tasks. This is not easy, for when confronted with the practical complexity and emotional tension involved in multisectoral work, health personnel often end up by confining themselves to repetitive tasks in their own sector, regardless of other community services.
A good knowledge of the area for which the local health personnel are responsible is essential in the event of a disaster and forms part of their professional qualifications. Some aspects are of fundamental importance:
· knowledge of the risks to health,1
· knowledge of resources useful in normal times and above all in the event of disaster.1
1 See the specific paragraph on page 48 and Annex 6.
It is important in disasters to have a knowledge of several aspects of the life and moving forces of the community, for example:
· the composition of the population by age, sex and family nuclei,
· the community’s institutions, services and administration,
· its social structure,
· its economic and productive activities,
· the forms of local political management, influential groups and persons, current conflicts, the influence of political factors on health,
· traditions, eating habits, the various aspects of the local culture.
Disasters often give rise to a sudden change in the strata and motive forces of society. The local health workers can expect everyone to be ready to cooperate and to show solidarity: it is knowledge of the community that will make it possible to bring about the participation and joint initiatives essential for managing health problems.
In the event of a disaster the local health personnel must become the focus for obtaining and imparting information on emergency relief, reuniting families, and evaluating needs and resources. They will be able to do this all the more effectively if they have developed and established a system for circulating and managing information on the community’s health problems. Among important professional qualities must be counted the ability of the local health personnel to select useful information, put it into circulation among the community in a constructive way, and dismiss false rumours. Information and communication form the basis of an ability to develop community participation and community activities. In the event of a disaster it becomes essential to coordinate health activities with:
· rescue work and the restoration of links with the outside,
· the local authorities, means of information and communication,
· public utilities (electricity, water, etc.),
· the social services,
· the transport services,
· the nearest health services to which the injured and sick who cannot be cared for on the spot will be evacuated,
· voluntary workers,
· outside assistance.
In fact, coordination implies paying close attention to the requirements of others and an ability to direct others towards the needs one is trying to satisfy. It will succeed all the better if clear information is available and if needs and resources can be correctly assessed. Coordination is dependent on two major conditions being met:
· clarity of the objectives,
· ability to deal intelligently and constructively with the conflicts that are often unavoidable in a community.
In all health activities methods of action should be chosen that interest and move people, encourage them to assume responsibilities, entrust them with clear and simple tasks, and promote cooperation, solidarity and mutual assistance. At the outset these methods involve more intense, difficult and prolonged work for the local health personnel but they produce better and more lasting results.