Slide 2:
In the modern world today, we face as a global culture the inclination of civil wars and political crises and displacement of peoples. The quote mentioned above refers to the displacement of people due to natural and political disasters. When these disasters transpire, individuals are typically living in sub-standard living conditions. What ends up happening as a result is that people are exposed to living conditions with lower sanitation that were seen many centuries ago. This subjects these populations to diseases that they may have not been subject to previously.
In order to combat this epidemic, we have to act collectively as a society that goes beyond the political borders that define the sovereignty of nations. Where this debate gets tricky is when governments are reluctant to allow health care professionals to treat those who need help and also, when the government simply does not have the proper resources to treat the sick. In these situations, there has to be an organization that is higher up in the global pecking order in order to treat the needs of this nation’s sick in order to prevent the spread of disease. This presentation will be exploring a plan for this prospective non-governmental organization to combat the spread of disease with or without the government’s help or permission.
Slide 3:
There are many misconceptions about how Tuberculosis is spread. The initial bacteria that spreads Tuberculosis is found in areas that do not have proper sanitation. This is precisely why the aftermath of a political crisis or natural disaster is the perfect environment for the weaker citizens to catch this bacteria. Particularly those citizens who are elderly, children or HIV positive are at risk. What this means is that when these global crises occur, the weak are the ones who get sick first from the new exposure to bacteria specimens that were not previously a threat within that given population. What ends up happening is that Tuberculosis is spread through close proximity. This close proximity can occur between many different locales to include: hospitals, homeless shelters, refugee camps, and jails. One cannot get Tuberculosis unless they are exposed for an extensive period of time; however, it is clear that refugee camps, for example, are an ideal place to contract Tuberculosis because they have people close together and the weak members of the population exposed to bacteria that is dangerous and unsanitary. Thus, in order to combat Tuberculosis in these extreme situations, there has to be an international organization involved in many cases that does not have political interests. There needs to be an international organization involved that is merely worried about public health.
Slide 4:
The tsunami in Southeast Asia is a sensational example of a situation that is a natural disaster that happened in developing countries. What makes this example so relevant is that yes, there were issues with Tuberculosis involved in the sanitation and where the WHO had to make efforts was in the 1) Pre, 2) Post, and 3) Post – Post Operational Strategy to try to eliminate the exposure to Tuberculosis as much as possible. The WHO did this by serving as a support to the local government rather than a burden. This strategy worked in the case of Southeast Asia because the governments both welcomed and wanted their help. This does not always happen in the case of political crisis and civil wars. This is an important difference to understand in that natural disasters tend to inspire a more team effort between local, federal, state, and international organization effort. Here, the countries affected made a collective effort to band together and help people, which is why they had a very successful operation overall.
Slide 5:
The main operational framework of the strategy for the WHO to implement is to provide more technologically advanced support to those countries who simply do not have the infrastructure. The reason that this support is so essential is that the countries affected by crises such as these just do not have a first world standard of living many times. For this reason, their already dire situations are worsened by the harsh natural disasters. These conditions are caused by lack of preparation, but also, lack of resources to implement the proper plans of preparation. This is why the strategy by the WHO is one to provide resources that are not there prior to an incident if it can be forecasted. If the incident cannot be forecasted, then the strategy then becomes how the WHO can get the maximum output in the minimal amount of time in order to prevent the spread of disease. Typically, the target areas for diseases such as TB are targeted in an effort to get the technology there to avoid the spread of bacteria to the weak. Hospitals, jails, and elderly homes, for example are ideal places to start because they protect those who could be the pathogens to spread the disease to others.
Slide 6:
When there is a crisis imminent, there is a tendency to poorly manage personnel and not work collectively as a team, (Karadag, C., 2012). Three of the main decision making issues that affect ethics are rush, poor planning, and poor crisis management. While on the surface, these methods do not appear to affect crisis management decision making problems, there is surely a correlation. Many times when there is a natural disaster, ethics become compromised relating to medical ethics of the individual and the collective, (Karadag, C.). The reason that these medical ethics become imperative in the rush, poor planning, and poor crisis management is that health professionals have to at times, act without the authority of a collective manager in order to make difficult decisions that change the impact of lives. Relating to rushing, there is usually not a great deal of warning for a natural disaster, thus, there is little time to properly organize the medical personnel and establish authority. Poor planning comes in when the WHO sectors at the local level, for example, are not trained in or do not follow protocol. Poor Crisis Management comes into play when those who are put into managerial positions are no properly trained on how to handle those positions. This poor planning can greatly affect the response and spread of infectious diseases such as TB. Thus, it is critical to take these ethical decision making problems quite seriously in drilling in order to be able to implement effective practices with short notice on future global crises.
Slide 7:
At times, there is an inclination to start in the big cities; however, in the developing world it is imperative to start the strategy at the target areas that are “critical” pertaining to risk for the citizens to contract disease. The WHO would ideally achieve this by reaching out to the local, state, and federal governments in order to target where the high risk areas are. The best way to do this on short notice is to divide and conquer. What is meant by this is to target those local poorer provinces that have the lowest standard of living at the outset. This is where a disease such as TB will originate. Additionally, within the bigger cities in hazard areas and moderate areas like elderly homes, hospitals, and jails. Then, once those areas are secured, it is recommended to reach out to the lower risk areas to secure those citizens. Many times, the wealthy are helped first, which is a great mistake. Regardless of status, the WHO has to target the disease and a disease like TB knows no class or rank. It infects the weak and unfortunately, this is usually the sector of the population that has the lowest quality of life and resources. The federal, state, and local governments need to distribute resources to the critical areas and work their way down the pyramid mentioned above in order to be effective.
Slide 8:
If we were to measure the allocation of $100,000 increments to a country such as Thailand in the tsunami relief, consider the scale above. Granted, there is a higher dollar amount, but the principal is the same when the amount is lessened or increased. The reason for this is there needs to be an 85% investment in the poorer citizens and a 15% in the rich. This is often not practiced because of political unethical spending. This is why the ethics comes into play because in these situations the rich are seen as more valuable to help. What is not realized is that by not allocating the proper resources to the poorer communities, we are allowing the source of the disease to spread. This allocation of $100,000 demonstrates how the WHO has to be a support system to the local, state, and federal governments in the sense of how to adequately distribute resources so that the citizens who need those resources do in fact get them. By doing this the WHO and local governments are practicing social and medical ethical responsibility to treat those who will inevitably be susceptible to disease first.
Slide 9:
The key to this strategy is to allocate resources effectively and systematically. If the WHO were to send all personnel to the impoverished, they would still have an enormous problem. The idea, once again, is to divide and conquer. By allocating the vast majority to the critical and hazard areas, the personnel are distributed efficiently to attack the major threats of disease. By allocating the remaining 15% of personnel to the moderate and low risk, this mitigates the risk of these areas developing into a critical or hazard area due to lack of medical attention. More often than not, this is not organized well and what ends up transpiring is that areas that were low risk then become susceptible to TB in developing countries and had this been planned better, the personnel could have helped the whole population collectively and effectively.
Slide 10:
The saying the “Devil is in the Details,” absolutely applies to the preparation of personnel and prospective facilities. Beginning with the personnel, the WHO and the countries prospectively anticipating disasters such as these should have manuals and training programs in place for emergency response. The country who is planning this should consider it an insurance policy for their public health. By doing this, the country is eliminating the prospect of unnecessary disease in the wake of a crisis. There is a three prong strategy that relates to personnel and the facility because those preparations go hand in hand. The first step is to educate. By educating and training WHO professionals in Geneva or in the local offices, these personnel can be readily training locals even when crises are not set to happen. This will increase awareness and efficiency should a crisis present itself. The next step of this education is to practice. Practices should occur regularly around the world so that in the event of an emergency, personnel can be brought in to lend a hand. Lastly, there should be a drill and implement phase that can be experienced from visiting the high risk areas even if there is not a crisis. This could be useful in preventing the spread of TB in the assistance of local hospitals to keep the standard of care higher than previously before. That way, if there is a crisis, this sector of the population will not be at risk. These steps will lead to a proper execution should an emergency arise. It will allow for a great increase and preparation in combating a disease such as TB in the wake of a natural or political disaster.
Slide 11:
This ecosystem listed above can be applied to the prospective disaster by focusing on TB prevention in a developing country. WHO personnel and local doctors should be studying as much as they can to be ready for such a crisis. These personnel should be applying the techniques that they learned in order to keep them fresh in their minds. Then, in order to reinforce their knowledge, these professional should be training local doctors and nurses in order to give another individual a chance to contribute to the effort as well. This has a great affect when required to mobilize because then we have double the man power in the event of a crisis. Then, the surplus in trained professionals can attack the high percentage needed in the critical masses even when we are not in crisis mode. This is a great way to remain aware and to be simultaneously promoting more knowledgeable prospective staff that speak the local language to really make a difference should a horrific event arise.
Slide 12:
Let’s return to the previously mentioned quote. Now that we have established the connection between the cause of TB and natural/political disasters, the debate comes regarding what we do to change the status quo? The reality is that this debate goes beyond the power of states. A nation or a state needs a strong non-governmental organization such as the WHO to step in and lend a handing in training and preparation in the name of public health. Consider the methods presented and contribute other relevant ideas that you though of during the presentation. How would you operate differently? Additionally, how would you structure personal manuals to implement training programs? The key to remember with this is that planning for disaster relief is a collaborative process that is need of a cohesive management structure. Without this, we have good faith individuals trying to help, but not achieving the end objectives that the local population desperately needs in order to combat disease.
References
Coninx, R. (2016). Tuberculosis in Complex Emergencies. World Health Organization. Retrieved from: http://www.who.int/bulletin/volumes/85/8/06-037630/en/
Karadag, C. (2012). Ethical Dilemmas in Disaster Medicine. Iranian Red Crescent Medical Journal. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518976/
Tuberculosis Symptoms, Causes & Risk Factors. (2016). American Lung Association. Retrieved from: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/tuberculosis/tuberculosis-symptoms.html?referrer=https://www.google.com/
Watson, J. (2007). Epidemics After Natural Disasters. Center of Disease Control and Prevention. Retrieved from: http://wwwnc.cdc.gov/eid/article/13/1/06-0779_article
Wook, L. (2016). Strategic Approach to Maintain Appropriate Tuberculosis Control Activities in Countries Affected by Asian Tsunami Disaster.” World Health Organization. Retrieved from: http://www.who.int/tb/features_archive/tsunami/en/
