AFTER THE TSUNAMI – HARNESSING AUSTRALIAN EXPERTISE FOR RECOVERY
Canberra, 31 March 2005

Follow-up group reports and case studies
Group 3: Health systems

Background

The earthquake and tsunami in the Indian Ocean in December 2004 had a major impact on the health system of affected countries. In the Aceh province of Indonesia, around 50% of the provincial health centres were seriously damaged or destroyed and over 50% of health care professionals were killed or displaced. Australia’s response in assisting in both the immediate recovery and with the following relief effort immediate aftermath tested our health system resources and emergency management protocols. Through a partnership with the Government of Indonesia, Australia now has been given the opportunity to extend this assistance into the rehabilitation phase. What is our capacity and capability to do this?

The working group focusing on Health Systems as part of the National Academies Forum noted the willingness of the Australian health community to respond to call for assistance in meeting the immediate need in the affected countries. Our capacity to readily harness that expertise and resources from the wealth of offers received represented a real challenge to effectively managing the response in this case, and any similar event in the future. The lack of real knowledge about the capacity and capability of Australia’s health workforce to operate in our region is compounded by our diminishing knowledge-base in Asian languages, culture and politics, as well as a loss of knowledge on how to manage tropical diseases and ‘old’ diseases (such as measles and tetanus), especially in a compromised setting as might be expected in any country in the aftermath of a major natural disaster.

In the affected countries, the loss of many of the health professionals and much of the health infrastructure, compounded by the scale of the physical and psychological trauma experienced by the local population was recognised as a major challenge for rebuilding. It was recognised that any rebuilding effort should aim to not just restore the national health infrastructure and human resources, but should do so in a way that empowers the people of Indonesia (and other affected countries) to materially improve the health and welfare of their population, in a sustainable manner. Our capacity to effectively assist in the rehabilitation of the health system in the affected countries will be dictated to a great extent by our knowledge of the region.

It was felt that any rehabilitation program should consider the impact on public health (both physical and psychological), as the public health status will in turn impact on the speed and scope of economic and environmental recovery in the region.

Recommendations

• Critical mapping of resources, maintaining the database and matching resources with need (knowing ourselves and our region)
  • In Australia
    • Health care professionals (who they are, what they do, where they are)
    • Maintaining our knowledge of tropical diseases ‘old’ diseases that are prevalent in the developing world (recognition and treatment, especially in the context of developing countries)
    • Knowing the teachers
  • In our region
    • Population data (immunisation status, epidemiology, mental health, population resilience factors)
    • Who (who are the health care workers)
    • Where (geographic distribution)
    • What skills (surgeons, primary care, nursing, public health)
• Indonesia and region recovery
  • Decisions should consider the long term impact on mental and physical health, these have an impact on population health and capacity, which impacts on cultural and economic as well-being.
  • health must be part of the planning
  • Work with the GoI MoH plan for recovery
  • Do no harm, don’t return to status quo – real development. Reduce vulnerability and improve robustness of the community.
• Centres of excellence
  • Establish linkages: physical institutes, collaboration and twinning (DoHA (Australia) to MoH (Indonesia), university to university, hospital to hospital)
  • Training of trainers, exchange programs
  • Helping Indonesia and the region to help themselves (improve public health research, meeting their own needs).
  • improve communication, building ‘bridges’ linkages = improve trust
• Improve our awareness of the region
  • Language
  • Culture
  • Politics
  • Burden of disease (tropical, emerging, old diseases)

The population around the Sissano Lagoon near Aitape in Papua New Guinea lived in a tropical paradise. They lived on and around a sand bar that protected the lagoon. They fished from the sea and the lagoon and had a vibrant fishing industry. They enjoyed good health, with a low incidence of communicable diseases, brought about by a combination of healthy environmental factors, such as walking in the sand (reducing the likelihood of contracting hook-worm), living by the sea (sea breezes blowing away malaria- and dengue-carrying mosquitoes, and regular bathing in the sea/lagoon (reducing incidence of skin disorders). In July 1998, their tropical paradise was inundated by a tsunami triggered by an undersea earthquake and landslide. This was a one-in-200 year-event that killed 2,200 people and left over 10,000 people homeless. In response to contamination of the lagoon and the threat of future tsunamis, the people were resettled in-land. Settlements were built, including houses, schools and churches. The effect of this was that people started seeing diseases that their previous lifestyle had protected them from (mosquito-borne diseases and skin diseases). This also caused family tension because the men had to travel distance to fish in the ocean and social unrest because of land-ownership issues.