Flood 2022 in Pakistan: Managing medical flood relief camps in a developing country

Abstract

Floods are the most common natural disasters in the world. Currently Pakistan is in an acute emergency situation due to the recent flood that occurred as a result of the monsoon rains in July–August 2022. Unfortunately, the country was already under an economic crisis and was just recovering from the COVID pandemic when this devastating calamity struck. Almost one-third of the country’s land was affected, with millions of houses damaged and property lost. As the victims are displaced and local health units are flooded, their medical needs are being met through medical flood relief camps arranged by public and private sector welfare organizations. Due to a lack of disaster preparedness and policies, most of the healthcare workers are untrained to manage medical flood relief camps and are hence learning from experience rather than following any standardized policy guidelines. We did not find any guidelines for organization and management of a flood relief camp in previous literature. As natural disasters continue to cause mass destruction every few years, there is a need to devise policies and procedures for disaster preparedness and hazard reduction. This paper is thus an effort to provide the best possible delivery of acute health services in a developing country during and after a flood in the transit phase, while the government and other non-governmental organizations (NGOs) help communities rebuild their health system.

Introduction

Just when the world was healing from the COVID-19 pandemic, Pakistan was hit by torrential monsoon rains that resulted in one of the most destructive floods in the country’s history. It has affected almost one-third of the land, with more than 1.3 million houses destroyed, 1700 casualties, and thousands of injured in all provinces of Pakistan.^[1]

Calamities like earthquakes and floods bring more chaos in an already unstable healthcare system in developing countries. The recent flood has displaced more than 30 million people in Pakistan, leaving populations of all ages vulnerable to communicable and non-communicable diseases. Unavailability of basic needs, clean water, and lack of sanitation has affected health of affected communities, causing an epidemic of communicable diseases. Around 10 million children are at risk of waterborne diseases and malnutrition. Almost 1.5 thousand public health facilities have been destroyed. Inaccessibility to primary care services translates to a delay in seeking medical care and thereby increased morbidity and mortality.^[2,3]

As the healthcare system of the country is disrupted, numerous international and local non-governmental organizations (NGOs) have come forward to provide medical assistance to flood victims and internally displaced people (IDPs). Hundreds of medical camps are being set up every day near flood-affected areas to provide medical help. These camps are being run through local healthcare workers available within the local community and health professionals from public and private sector institutions and organizations who are traveling to areas where the local health systems are non-functional. Through these camps, medical teams can target preventive and therapeutic aspects of health. This is also an opportunity to integrate other required services such as delivery of food, clean water, therapeutic nutritional supplies, and essential health kits.^[4]

Floods are the most frequently occurring natural disasters and require disaster management policies and strategic planning. This includes a health management plan for flood-affected communities, both during the acute phase and for the long-term. Timely provision of preventive and therapeutic services may save the cost of treatment, morbidity, and mortality. Yet low-quality and unplanned fire-fighting measures without any planning may lead to more harm than good. In an emergency situation, even primary care specialists such as general practitioners, family physicians, and paramedics are usually not trained for disaster management. Moreover, unavailability of a primary care specialist may result in another specialist taking on the role of a primary care provider. This calls for training of all primary care workers including family physicians, paramedics, other healthcare workers, and relevant stakeholders to organize standardized, efficient, and cost-effective medical flood relief services for the provision of medical assistance of best possible quality, and, at the same time, to conserve meager resources.^[5]

A set of clinical guidelines and strategies for planning, organization, and execution of a medical flood relief camp therefore needs to be developed by local experts who are well aware of the ground realities. Hence, this paper is useful for public and private healthcare organizations, workers, and various stakeholders who intend to provide effective medical flood relief services. A multidisciplinary team comprising of a family physician, pediatrician, infectious disease specialist, dermatologist, researchers, teachers, and trainers who are experienced in disaster management and are actively participating in medical flood relief camps in the current situation played a crucial role in developing the guidelines. A training module developed in the local language by the Indus College of Family Medicine and Public Health, Indus Hospital and Health Network is freely available on YouTube.^[6]

Organizing a medical flood relief camp

Scope of services

Table 1 shows the essential requirements for organizing a medical flood relief camp. The scope of services provided in a medical flood relief camp depends on an accessible site, characteristic of catchment population, available resources, and a need assessment of the community. This includes a survey about the state of functional services in regional secondary or tertiary care hospitals. The camp services must include consultations and provision of therapeutics for acute disease management; rapid diagnostic kits for anemia, blood sugar levels, and infections like malaria and dengue may be included if available. Minor procedures like wound dressing, nebulization, intravenous hydration, and administering injections may increase the scope of service but there may be issues of waste management. The services may also provide for the prevention of common diseases; for example, mosquito repellents, sanitary kits, deworming, and delivery kits for antenatal patients.

Table 1: Checklist of essential requirements for organizing a medical flood relief camp

Camp location

The site of the camp should preferably be in a shaded area with clean water and nearby sanitary facilities for the staff. A shaded waiting area for patients, a registration/triage and assessment area, consultation area, an area for dispensing medicines, and an observation area for commonly required procedures such as intravenous (IV) hydration, nebulization, and administration of injections should be available. Tents may be used if a concrete site is not feasible. Moreover, it is also important to be culturally sensitive; for example, in the Pakistani context gender segregation with women and children separated from men through a screen or tent is desirable.

Caring for caregivers

The organizers need to plan a safeguard for the health of their staff. Providing them with essentials like accommodation, meals, clean water, sanitation, security, protection from extreme weather, and prevention from communicable diseases should be a priority. Caregivers also need to be vigilant and avoid becoming infected through implementing infection control practices like wearing masks, gloves, hand sanitizers, and mosquito repellents. Doxycycline 100 mg/day, 1–2 days before travel may be taken and continued for four weeks after return for Malaria prophylaxis.

Community acceptance

Involving the local community leadership would ensure smooth management, staff security, and acceptability of services, and at the same time prevent mobs from misusing and looting delivered goods. This would help an in an even distribution of offered services to the people in need. The local leadership may also guide for a feasible location of the camp, volunteers from within the community, and locally available resources.

Clinical management of common ailments in a flood situation

Tables 2a and 2b show the clinical guidelines for commonly reported adult and childhood ailments, respectively, during a flood situation.

Table 2a: Management of common infections in adults in flood relief health camps

Table 2b: Management of infections in children at flood relief health camps

Clinical management should be based on availability of resources yet in the best interest of the patient, weighing risk versus benefits. Broad-spectrum medicines like antibiotics should be used for empirical therapy as diagnostics may not be available. In case of a red flag sign, urgent care should be provided considering the distance of the nearest available secondary or tertiary care service. A referral system to the nearby healthcare facility should be established. Adult patients with red flag signs and any child with high-grade fevers, decreased responsiveness, and neck stiffness should be referred to the nearest hospital.

Simultaneous patient education on prevention of diseases may be provided in the patient waiting area. Doctors or consultants should encourage preventive behavior in patients and their immediate families and provide opportunistic care that may include administration of vaccines, deworming, and provision of nutritional, vitamin, and iron supplements, especially to women, children, and the elderly. For example, every child over the age of six months should receive vitamin A supplements and undergo deworming with syrup albendazole.^[5,25,26]

Medicine and preventive therapies checklist

Table 3 shows the essential medications that should be included for treatment of common flood-related waterborne, vector-borne, and skin diseases. Medications for chronic diseases like diabetes and hypertension may also be added for short-term cover till medication supplies are restored in the vicinity of the affected site. Doses of commonly used medications among children in a flood relief setting are shown in Table 4.

Table 3: Checklist of medicines and other medical supplies

Table 4: Doses of commonly used medications among children in a flood relief setting^{[ 27 , 28 ]}

The quantity of medicines should be based on the number of days the camp shall be conducted and the expected turnover of patients per day. This may be confirmed through local leadership and other relief-providing agencies that have worked recently in the region. At least 10% of reserve medicinal supplies should be added to account for an unexpectedly high turnover.

Conclusion

A medical flood relief camp is an effective way of providing short-term medical services to victims who are unable to access primary and sometimes urgent healthcare. However, the planning and execution requires a meticulous approach to ensure efficient service delivery of the desirable quality. As natural disasters continue to cause mass destruction every few years, there is a need to devise policies and procedures for disaster preparedness and hazard reduction. This paper is thus an effort to help provide the best possible delivery of acute health services in a developing country during and after a flood in the transit phase, while the government and other NGOs help communities to rebuild their health system.

Key points and take-home message

During an emergency situation, medical specialists and paramedics offering voluntary help in medical camps are usually not trained for the purpose.

No standard guidelines are available in the country regarding management and training of healthcare paramedics to cope with the situation of floods.

As natural disasters may cause destruction at mass level every few years, it is important to devise disaster management policies and procedures that may help reduce morbidities and mortality.

This paper provides a complete training module of disaster management of floods for healthcare workers.

We made an effort to set guidelines regarding basic healthcare needs and requirements of training health paramedics to combat a flood situation.

This paper is hence an effort to provide the best possible delivery of acute health services in a developing country during and after a flood in the transit phase, while the government and other NGOs help communities rebuild their health system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.