Training Community Health Workers in refugee camps: A case study from Pakistan

In October 1983 a training programme for refugee community health workers was begun as the major part of a primary health care programme for Afghan refugees in Pakistan. The programme began with a pilot period in Badaber camp, situated near to Peshawar. The general issues involved in training auxiliary health personnel were answered by the use of a "knowledge, attitudes and practices survey" and involvement of the refugees from the beginning of the programme. The development of the training programme is discussed with reference to these issues and the constraints arising from the special circumstances of the refugees, in addition to those common to most national training programmes, are reviewed.     

Ocean waves and roadside spirits: Thai health service providers' post-tsunami psychosocial health

A massive earthquake off the west coast of Sumatra in Indonesia triggered a tsunami on 26 December 2004. At least five million people around the world were affected, and the total number of deaths exceeded 280,000. In Thailand, the tsunami struck six southern provinces, where the disaster's immediate impact was catastrophic. Based on ethnographic fieldwork in Phang Nga Province (2007), this paper provides an overview of the disaster's psychosocial consequences for Thai health service providers, the vast majority of whom were bypassed by regional post-tsunami mental health initiatives. The available tsunami literature only briefly attends to health providers' experience of professional 'burn-out', rather than explores the tsunami's wide spectrum of psychosocial effects. This research aims to remedy such oversights through 'critical medical' and 'interpretive phenomenological' analysis of the diverse and culturally-situated ways in which health providers' experienced the tsunami. The paper concludes by arguing for disaster-related psychosocial interventions to involve health providers explicitly.     

Training refugees as primary health care workers: Past imperfect, future conditional

Many problems have been encountered in the planning and implementation of health care in refugee camps, and more specifically in the training of refugees as primary health care workers. A review of the published literature and a "survey" of the opinions and experiences of refugee, national and international health personnel regarding training has therefore been undertaken to provide an overview of what has been done and to make recommendations for future work.
The review highlights the need to reallocate resources away from high visibility emergency aid to development activities, such as training, that will create an infrastructure for primary health care and promote self-reliance.     

Prisoners of armed conflict: Nicaragua an ICRC survey

This paper examinee the role of the medical delegate of the ICRC. Part I outlines the diseases and conditions found during a survey of three Nicaraguan rural prisoner of war camps. This information should enable medical delegates to formulate better plans for the treatment of prisoners in future. Part II suggests an alternative health care system which relies on the use of medical kits and manuals In the hands of medical auxiliaries. Dividing responsibility in this way would leave the medical delegate free to perform tasks which make more use of his more sophisticated skills.     

Rebuilding and strengthening health systems and providing basic health services in fragile states

The international community has compelling humanitarian, political, security and economic reasons to engage in rebuilding and strengthening health systems in fragile states. Improvements in health services and systems help to strengthen civil society and to restore legitimacy to governments. Effective engagement with fragile states to inform the design of health programmes and selection of interventions depends on donor coordination and an understanding of health system challenges. Planning requires consideration of allocation (services to be delivered), production (organisation of services), distribution (beneficiaries of services) and financing. The criteria for selecting interventions are: their impact on major health problems; effectiveness; the possibility of scale-up; equity; and sustainability. There are various options for financing and models of engagement, but support should always combine short-term relief with longer-term development. Stakeholders should aim not only to save lives and protect health but also to bolster nations' ability to deliver good-quality services in the long run.     

Using evidence to improve reproductive health quality along the Thailand-Burma border

The Mae Tao Clinic, located on the Thailand-Burma border, has provided health services for illegal migrant workers in Thailand and internally displaced people from Burma since 1989. In 2001, the clinic launched a project with the primary aim of improving reproductive health services and the secondary aim of building clinic capacity in monitoring and evaluation (M&E). This paper first presents the project's methods and key results. The team used observation of antenatal care and family-planning sessions and client exit interviews at baseline and follow-up, approximately 13 months apart, to assess performance on six elements of quality of care. Findings indicated that improving programme readiness contributed to some improvement in the quality of services, though inconsistencies in findings across the methods require further research. The paper then identifies lessons learned from introducing M&E in a resource-constrained setting. One key lesson was that a participatory approach to M&E increased people's feelings of ownership of the project and motivated staff to collect and use data for programme decision-making to improve quality.     

Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work

Expatriate health care professionals frequently participate in international responses to natural disasters and humanitarian emergencies. This field of practice presents important clinical, logistical and ethical challenges for clinicians. This paper considers the ethics of health care practice in humanitarian contexts. It examines features that contribute to forming the moral landscape of humanitarian work, and discusses normative guidelines and approaches that are relevant for this work. These tools and frameworks provide important ethics resources for humanitarian settings. Finally, it elaborates a set of questions that can aid health care professionals as they analyse ethical issues that they experience in the field. The proposed process can assist clinicians as they seek to establish their moral bearings in situations of ethical complexity and uncertainty. Identifying and developing ethics resources and vocabulary for clinical practice in humanitarian work will help health care professionals provide ethically sound care to patients and communities.     

Refugee health care: Similar but different?

The present review sets out to identify differences between refugees and other more stable communities living in less developed countries: demographic, mortality, morbidity, nutritional and selected epidemiological data are discussed. Although generalizations are difficult because of the variability of refugees and their differing circumstances, the health problems and diseases do not appear to differ qualitatively, although they may be quantitatively more severe.
The areas of particular concern lie not so much with the problems but with approaches to their solutions: the need to respond rapidly and appropriately to emergencies, the importance of attending to the priorities of nutrition, shelter, sanitation and water; and the necessity of providing services which are sufficiently flexible and sensitive to the changing needs of the refugees as they move from the acute emergency to the long-term settlements.
The review highlights certain areas where insufficient information is currently available, notably mental illness and the long-term issues of health and development, and outlines the implications of the conclusions for policy makers, with particular reference to training and research.     

Quality design: a planning methodology for the integration of refugee and local health services,West Nile,Uganda

In an emergency, the international community responds to the immediate health needs of refugees through the establishment of action-oriented, life-saving services. Healthcare delivery is often managed with limited, if any, coordination with local health management structures. In situations where refugees remain in the host country for many years, sustainability issues inevitably arise. Refugee-hosting governments may ultimately be called upon to assume the management and funding of refugee services. Planning for service integration, while protecting against declines in service quality, is a challenge in the typically resource-poor host environments. This paper discusses these issues by presenting the experience of the West Nile districts in northern Uganda, and describes quality design as a relevant planning methodology. Quality design is a systematic planning approach that documents and directly incorporates the service users' self-defined expectations and needs.     

城市供水管网健康监测与诊断:Ⅲ.既有局部漏损识别方法之二

城市供水管网是城市最重要的生命线工程,相对于地上结构,地下供水管网具有更高的易损性。由于供水管网多埋于地下,管道的早期破坏难以及时发现。本文提出了既有供水管网局部漏损识别的第2个方法:假设在管网的不同位置存在不同程度的局部漏损,计算监测管段的流量,以监测管段流量的计算值和监测值之间的误差最小为目标来识别出局部漏损的位置和程度。通过算例分析对本文方法的有效性进行了验证,并与既有供水管网局部漏损识别的第1个方法进行了比较。结果表明,本文方法在准确率和分辨率两个方面均优于第1个方法。本文解决了供水管网健康监测和诊断中的一个基本问题。     

Brief description of the effects on health of the earthquake of 3rd March 1985 – Chile

Chile is one of the most seismically active countries in the world. Earthquakes are periodic phenomena that test the quality of construction, as well as the capacity of the population to adapt to sharp changes in socio-environ-mental conditions.
Experience in this regard has demonstrated the desirability of being prepared, at the institutional level and at the level of the general population, to carry out investigations and to begin measures to cope with these catastrophes, in order to reduce damage and the interruption of normal life to a minimum.
In this paper some general aspects of the social and health impacts of the earthquake of 3rd March 1985 are examined. The shock affected the central area of Chile which contains 61% of the total population.
The earthquake occurred at 19:50 hours on Sunday, 3rd March, and was of magnitude 7.8. Recorded personal losses included 180 dead and 2,575 injured, and around 200,000 damaged or destroyed dwellings. The destruction also affected the infrastructure of the public services, such as energy, road, telecommunications and water supply, giving rise to an emergency in the provision of assistance.
Special reference is made to the effects, on the health care infrastructure, drinking water supply and, less important, on the behavior of some communicable intestinal diseases that are highly endemic in the area under study.     

There's nowhere to go: counting the costs of extreme weather to the homeless community

People experiencing homelessness are vulnerable to extreme weather in unique ways. The entrenched inequalities that underpin disaster vulnerability are compounded by extreme isolation and the stress of transient living on mental and physical health. However, the impacts of extreme weather on the homeless in Australia are largely undocumented and rarely incorporated in emergency planning. Interviews with and surveys of emergency and homeless services and service users revealed that the primary ramifications of losing shelter and worsening mental health deepen the cycle of homelessness and trauma. Consequently, homeless shelter losses, such as tents, should be included in pre‐ and post‐event impact statistics and subsequent recovery support. Extreme weather response plans should include early triggers and strategies for ‘non‐severe’ weather events, as the homeless community is affected earlier and by a wider range of meteorological conditions. Moreover, this study also explores the benefits of a trauma‐informed response to extreme weather when working with the homeless.     

Health and social impacts of a flood disaster: responding to needs and implications for practice

Carlisle in northwest England suffered its worse floods for more than 180 years in 2005. A study, reported here, was undertaken to assess the health and social impacts of these floods via in‐depth, taped individual and focus‐group interviews with people whose homes had been flooded and with agency workers who helped them. Respondents spoke of physical health ailments, psychological stress, water health‐and‐safety issues related to the floods, and disputes with insurance and construction companies, which they felt had caused and exacerbated psychological health problems. Support workers also suffered from psychological stress. Furthermore, it was found that people had low expectations of a flood and were not prepared. The findings are presented in five sections covering flood risk awareness, water contamination issues, physical health, mental health, and impact on frontline support workers. The discussion focuses on the implications of the findings for policy and practice vis‐à‐vis psychological health provision, contamination issues, training and support for frontline support workers, matters relating to restoration, and preparation for flooding.     

The mental health of expatriate and Kosovar Albanian humanitarian aid workers

The mental health consequences of exposure to traumatic events and the risk factors for psychological morbidity among expatriate and Kosovar Albanian humanitarian aid workers have not been well studied. In June 2000, we used standardised screening tools to survey 285 (69.5%) of 410 expatriate aid workers and 325 (75.8%) of 429 Kosovar Albanian aid workers from 22 humanitarian organizations that were implementing health programmes in Kosovo. The mean number of trauma events experienced by expatriates was 2.8 (standard deviation: 2.7) and by Kosovar staff 3.2 (standard deviation: 2.8). Although only 1.1% of expatriate and 6.2% of Kosovar aid workers reported symptoms consistent with the diagnosis for post-traumatic stress disorder, 17.2% and 16.9%, respectively, reported symptoms satisfying the definition of depression. Regression analysis demonstrated that the number of trauma events experienced was significantly associated with depression for the two sets of workers. Organisational support services may be an important mediating factor and should be targeted at both groups.     

The role of natural disaster in individual and relational adjustment in Sri Lankan mothers following the 2004 tsunami

The purpose of this study is to examine the associations between maternal mental health distress symptoms, including depression and post‐traumatic stress disorder, the extent to which the presence of a child's disaster‐related physical health problem(s) have interfered with daily functioning, and family cohesion over time among Sri Lankan mothers who survived the tsunami on 26 December 2004. Study variables were measured using a self‐report questionnaire administered approximately four months after the event and three years later in summer 2008. Univariate, bivariate, and multivariate analyses were conducted. Path analysis was employed to assess the relationships between the key variables over time and the correlations in the study variables at each time point. Among other findings, the results of the path analysis indicated that post‐traumatic stress symptom distress four months after the disaster significantly predicted variance in family cohesion three years later. Clinical and empirical research implications are presented and discussed.     

浅析全球变暖的成因与人类健康

论述了全球变暖是当前人类所面临的一个最为严重的环境问题。这种日趋恶化的环境的产生与人类的各种活动是息息相关的, 环境的恶化必将给人类的健康带来最为严重的后果。     

桥梁结构健康监测的数据融合框架

大型桥梁结构健康监测系统需要安装大量各种类型的传感器,如何有效利用这些实时采集的信息以保障桥梁的连续安全运营是一个核心课题,而数据融合技术是解决这一问题的一个新方向。本文对近几十年来数据融合技术的发展做了全面综述,介绍了常用的数据融合模型,评析了各种常用融合算法。基于对健康监测系统的细致分析,在前人工作基础上,提出了桥梁结构健康监测的数据融合框架,对框架内的各个功能模块进行了功能定位,并给出了相应阶段适宜的融合算法。     

救援人员的主要心理问题、相关因素与干预策略

救援人员泛指在各种紧急情况中提供救助的个体,其心理健康风险得到越来越多的关注.研究发现救援人员的心理问题主要是应激相关障碍,消极情绪以及倦怠感.不利的救援工作条件、创伤暴露与非适应性的情绪调节策略是救援人员心理健康主要的危险因素;救援工作中的有利条件、社会支持、心理弹性以及适应性情绪调节策略是心理健康的保护因素.对救援...     

Displacement as a predictor of functional impairment in tsunami‐exposed children

Thirty months after the Indian Ocean tsunami of 26 December 2004, thousands of families in Aceh Province, Indonesia, remained in temporary barracks while sanitation conditions and non‐governmental organisation support deteriorated. This study sought to determine the factors associated with functional impairment in a sample of 138 displaced and non‐displaced Acehnese children. Using multivariate linear regression models, it was found that displacement distance was a consistent predictor of impairment using the Brief Impairment Scale. Exposure to tsunami‐related trauma markers was not significantly linked with impairment in the model. Paternal employment was a consistent protective factor for child functioning. These findings suggest that post‐disaster displacement and the subsequent familial economic disruption are significant predictors of impaired functioning in children's daily activities. Post‐disaster interventions should consider the disruption of familiar environments for families and children when relocating vulnerable populations to avoid deleterious impacts on children's functioning.     

窑洞民居防灾

黄河中上游广泛分布的窑洞民居常遭受种种灾害:有自然塌落、浸水损坏、滑坡崩塌和地震袭击。本文根据民间建窑经验、调查研究资料及试验结果,进行分析归纳,提出窑洞防灾措施:①选址;②合理选择窑洞跨度和断面形式,做好防水措施。并验算了民间一般明箍窑洞的抗震能力。