1. Healthcare Technology Aspects of Disaster Planning – based on the post Tsunami Experience
Authors: Dr S B Gogia, Dr M R Surwade
Organization S.A.T.H.I. (Society For Administration Of Telemedicine and Healthcare Informatics)
Correspondence Address: 28/31 Old Rajinder Nagar New Delhi 110060
Telephone Number +91-11-25853090, 25852291, Fax +91-11-25860163
Presented by Dr S B Gogia
1.1 Summary :
S.A.T.H.I. has been involved in implementing the Healing Touch Project which has been sponsored by OXFAM Trust India. This Project was started after the Tsunami disaster in Tamilnadu to bring the fruits of Telemedicine, a new thrust technology in Healthcare Informatics to the victims. Being a new field, more than expected problems were faced. However despite a delayed start (in May, this year), the project has managed to provide mental health support to the victims while they were at home.
This pilot project can show the way forward to extending the fruits of technology in post Disaster Management. For that to occur, this technology should be more widely based, awareness should be present. The systems should be existing and available for immediate use as and when disasters occur.
1.2 Introduction :
Healthcare Informatics is a new and upcoming specialization. It holds the promise of improving the healthcare scenario of our country through
- Increased Efficiency
- Better monitoring of health status of the community
- Upgrading the skills of Existing Health workers
We from SATHI have been working to provide a Telemedicine based Healthcare support system for the Tsunami victims. The project though still incomplete and under implementation shows promise in showing the way forward to managing disaster.
1.3 The Project :
Owned and conceived by
OXFAM TRUST INDIA
Consultants, Technical Inputs and Implementing Agency
Our basic guiding principle was that “More people die of after-effects of natural disaster than the disaster itself”. We felt that Telemedicine can and should provide a solution to control the “Disaster after the disaster”
President SATHI, 28/31 Old Rajinder Nagar, New Delhi.
Tsunami Project Coordinator, c/o SATHI, Address B9/108, Pharma Apartments, 88 IP Institutional Area, Patparganj, New Delhi.
After signing an MOU, SATHI proceeded to do a Needs Assessment through a field visit to the affected areas in 2 nd half of January 2005. Our Survey showed that As far as healthcare is concerned, The First and Second phases of the disaster were well managed by the Government at least in Nagapattinam District. However there was a need for Mental Health Support due to high incidence of
Sense of Loss and bewilderment
Survivors still in grip of fear & shock
Loss of Family members and loved ones
Anxious & depressed
Displaced & unemployed
Inability to get back to work
Ignorant about tsunami
What was it ?
Will it strike again ?
How to be prepared ?
How to cope with the after effects
The occurrence of this problem was articulated by WHO and also accompanied by the Realization that the steps taken by the Government for up gradation of mental health of the victims were inadequate as well as wrongly directed. There was a
Mismatch between needs and services
Inadequate number of mental health specialists
Increasing trend of psychosocial effects – depression and alcoholism
Stress and fatigue among relief workers
No community participation
80 – 90% Of the population had a lowered mental Health status. A situation which would improve in most but would sink to the level of requiring specialist help in around 4 –5%.
Telemedicine was felt as the right solution to the problems as it would
- Allow the specialist to identify the 4-5 % population who require help
- Ensure access to specialists’ services
- Ensure quality of services
- Treat the health workers too who might themselves be affected
- Enable people
- to articulate their needs
- participate in interactive sessions with experts
- Enable service provider to be need specific
- Strengthen the health care delivery system
- Increased efficiency of service provider -more coverage
Village level operable
Integrated with present health system
- vertically: primary - secondary – tertiary
- horizontally: among the networked units
Empowering the community
–between Government, NGOs, Community and development support agencies
Processes followed were :
Health needs assessment
Designing of telemedicine network
Advocacy & Orientation of all stakeholders
Capacity building of community mental health team (frontline workers of Government, NGOs and community)
Advocacy and social mobilization of IMA, Indian Association of Psychiatrists) Sensitization of women self help groups
The network would provide Counseling (through Video Conferencing for the victim) in the presence of the health worker. As we were aware that the Health Worker may be a victim too and suffer himself herself from stress overwork . Expert Backup would be provided for the mental Health Support with Individual and group sessions possible. No traveling would be required by the victims with the volunteers provided Continuous learning and supervision on the job as well as on the spot. Thus it was adaptable to all needs.
A Tele conference based training module was developed which was
– Based on assessed needs
– Considered Human Rights perspective
– Incorporated WHO guidelines –Some separate suggestions for relief worker and affected people were present in these guidelines
– It provided on the job and continuous training using an innovative interactive and participatory training methodology
– Supported by audiovisuals
1.4 Outcomes :
A model of telemedicine network has been developed. The design of this model is specific to the needs and integrates the service providers with field level facilitators.
Despite the late start of the project, over 140 psychiatric tele visits and were organized from one centre in the periphery of 49 patients with at least 2 being brought back from near suicide.
The project has shown that Mental Health Support for the victims is possible through Telemedicine and can result in significant savings as well as early recovery of patients
The capacity of the field level NGOs has been built in terms of the operation of the telemedicine network, skills to conduct counseling sessions at the community level.
Unified approach to respond to the disaster situation with application of the communication technology and network of health and other professionals has been developed. This would enable us in not only reducing response time to future disasters but also this professionals including service providers network will be readily available in future. This could prove to be the precursor for the National Network of Service Providers for Disaster Response.
The project has contributed to defining the modalities for disaster preparedness.
1.5 The project cycle :
The project was conceptualized in January. All initial processes, identification of Stakeholders, Operators, locations etc were ready by Mid February. 6 -7 units were planned in the periphery and one in the center. SCARF (Schizophrenia Research Foundation) was identified as the central unit, which would provide Mental Health Support. This selection was based on the aspects of willingness to do voluntary work as well as familiarity with language as well as proximity to the affected areas so that in case of need actual transfer and care should be possible.
Units in the periphery were to be located in various places depending on
How much affected the population was
Willingness of Local NGOs,
To run the system
To pay for the running costs
Proximity to the exchange (To allow ISDN Connectivity)
Access to government channels
The units were to be located in the PHC or Government Hospital and run by The Health workers with supervision and support by local NGOs. OXFAM had promised funding support for the Machines as well as for Maintenance and connectivity for the first 6 months
The project however could not start till middle of May due to the reasons outlined below :
- Funding was slow. It is still not fully released
- ISDN lines were promised within 2 days of application, but took a minimum of 2 months.
- In some areas as the exchanges are too old so the project had to be shelved after extensive preparation
- Satellite connectivity was promised (From the French Govt) in three locations but the antenna did not work
- ISRO connectivity was beyond the budget
- New type of technology, So
- Doubts about the project
- Delays meant that continues retraining of volunteers was required.
Currently there are three systems, 2 in the periphery and one in the center (SCARF). ISDN connectivity is till a problem at one place. The places where connectivity has been established and the system up and running, the results are gratifying. There have been thrice weekly sessions where inpatients were asked to come to the local Telemedicine center, they were seen online by Doctors from SCARF, Counseling was done, The medicines which were prescribed by the doctors at Chennai were provided to the patients by the attending volunteers – a separate stock of medicines used was kept locally as no chemists were available in the periphery.
By Mid 2006, the patients in Dharmakulam and surrounding areas requiring Mental Health support have been largely treated. The volunteers from Dharmakulam are now asking for online treatment for other specialties like General Medicine, Cardiology etc. SCARF our expert level partners have expanded the scope of activities and have added on more centres. So the project continues on its own steam
You can download a film of the telemedicine activities of scarf by clicking here
1.6 Discussion :
Telemedicine – literally medicine from a Distance – is a means of improving access to healthcare for far flung and remote communities by providing a virtual doctor at his doorstep. It is expected to be the next big leap in health care. It has a force multiplier effect in widening the reach and access of Medical Specialists. This will be the single most factor allowing India to reach the status of “Healthcare for All” by 2020, most probably earlier.
In Disaster situations, Health problems occur broadly in three phases. Use of IT can improve the outcome in all three. We from SATHI had endeavored to provide a demonstration of the expected benefits following the Tsunami. This paper is a preliminary report of this project - called ‘The Healing Touch”, which has just barely begun. Being a new technology, we faced many problems some of which are still unresolved, but despite that we do have evidence of the benefits possible. We have learnt some lessons on how to implement.
Based on these, we propose that to be ready for disaster, the following needs to be done
- Create awareness of telemedicine, make it popular so that projects like these do not have long gestation periods - A running system is more likely to work in Emergencies so Penetration of IT usage among the medical and healthcare community needs to be promoted.
- Information Technology should be used to create pre disaster statistics like
- General Information of Topology, Population Distributions, Health Needs etc (GIS)
- Database of Health service providers
- Database of other stakeholders like NGOs etc
- Simulation Techniques and testing of systems for disaster situations
- To obviate funding problems, funding for Healthcare and IT should be a part of the budge of any disaster
- Training and pre testing for disaster situations should be done for Healthcare facilities as well as NGOs and Government in all places specially Disaster prone areas
1.6.1 Acknowledgements :
Ms OXFAM TRUST INDIA , B-55 Shivalik, Malaviya Nagar, New Delhi who are the owners of the project for funding support and administrative help
The SATHI Team (www.sathi.org) for their continuing help and support the following NGOs /Organization are part of this running project :
SCARF (Schizophrenia Research Foundation, Anna Nagar, Chennai) who are providing psychiatric consultations and Mental Health Support ISED, who are running the project in Dharmakulam.
The following were contributors to the planning or shall be part of the project as it expands :
- PEDA, Kariakal
- Tamilnadu State Government
- Department of Public Health, Tamilnadu (Nagapattinam and Chennai Offices)
- PREPARE, Chennai
- FACE, in various places in Nagapattinam
- ARWEL, (Cheyyar)