Health Care Provision and Health Systems in the Immediate Phase of Mass Population Migration: Field Experience in Sri lanka

Author(s): l. dassanayake*1, A. Karunarathne2
Affiliation(s): 1Department of Orthopaedic Surgery Teaching Hospital Anuradhapura and Disaster prepairedness and resp, MInistry of Health, Colombo, 2Department of Neurosurgery, Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka
Keywords: Mass population migration, disaster, health
Background:

Provision of an optimum health care services determine the survival during disasters. Especially when the community had being on migration for a considerable time ,poor quality water, poor sanitation reduced food supplies and overcrowding may aggravate the health issues and demands for the health system to function on it’s full stretch. Scenario discussed will be the ground level experience of establishment of the health care system and provision of primary health care during the initial disaster phase in zone 4 of Menik farm relief villages with the sudden influx of 44,000 internally displaced population on the days of 15th and 16th of May 2009. This population had being on migration for months.

Methods:

Identification and predicting the health issues of the community, assessing the capacity of the existing health facilities, prioritizing the services carried out before and on arrival of the IDP’s. First 24 hours spent on preventing the mortality among IDP’s by treating the life threatening conditions and launching the existing heath facility to its fullest extent. With the progress of the time services were expanded and consolidated. Special attentions were paid to health education,early detection and prevention of infectious outbreaks and strengthening the primary health care.Mobile health clinics were used to access the population in the peripheries of the zone until the proper primary health care centers are established. A Close coordination was established between the ground level and the central level to facilitate the smooth flow of logistics,human resources and enabling ground level to contribute efficiently in decision making.

Results/Conclusions:

A. Identification of the nature of health issue: On migration for a long period of time; Large number of unattended medical and surgical problems; Dehydration; Sub-optimal antenatal care compared to other areas; Came with epidemics of Hepatitis A, diarrhea and Chicken pox.
B. Identification of Main Issues in managing the health: A population with a very high morbidity; Limited man power; limited amount of logistics; Minimal infrastructure; Language barrier; Extreme stress in all levels of the staff; No emergency or disaster medicine physicians.
C. Prioritizing the Health services for the first day: Prevent deaths during the initial phase; Only life threatening conditions treated in first 24 hours; ORT to all patients with diarrhea under direct observation; Provision of bottled water with ORT to patients; Majority of the selected patients forresuscitation and treatments within first 24 hours were having diarrhea or severe chest infections; Provision of Water and food as a secondary objective.
D. Second Day: Started treating the other cases; Started collection of the vital demographic data; Finding volunteers from the community; Starting the antenatal clinics with mid wives; Starting nutritional center, feeding center, children’s clinic and health education programs.
E. By first week: Initiation of the EPI program; Start maintaining the health records; Acquisition of Mobile lab; Negotiating with NGO’s to expedite the construction of Primary Health Care Centers. Coordination of the resources and planning to provide a much comprehensive primary health care was started by the end of the first week.

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