Risk Assessment of Indonesian Satellite Health Clinics Caring for Displaced Survivors of the December 2005 Tsunami

Tuesday, 13 July 2010: 9:10 AM

Mary Lou Manning, PhD, CRNP
Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA

Learning Objective 1: Describe short and long term disaster relief efforts following the December 2005 tsunami.

Learning Objective 2: Apply lessons learned to local, regional, national and global disaster planning and management efforts.

Background: On Sunday, December 26, 2005 a massive earthquake struck off the western coast of Sumatra, Indonesia triggering an explosive tsunami. More than 175,000 died and over 1.7 million people were displaced and relocated to temporary homes, shelters or camps. Many villages were completely destroyed and the community infrastructure, including health care services, was decimated. Disaster relief funds supported the construction of small prototype satellite health clinics to care for those displaced. Objective: In 2007 significant numbers of people remained in “temporary” shelters and the clinics continued to provide their health care needs. Clinic surveys, including an infection risk assessment, were conducted to determine quality of care. Methods: A team of American and Indonesian nurses and physicians conducted surveys in 10 health clinics in the Aceh Baret and Nagan Raya districts. A health clinic assessment tool was developed and piloted prior to use. The survey included on-site observations, record reviews and staff interviews. Results: Three areas for immediate improvement/intervention emerged. 1) Many nurses and physicians died during the tsunami, so it was not unusual for clinics to be staffed by individuals with little medical training; 2) Following the disaster, medical care supplies and equipment poured into the region with little attention to need and use; 3) Each clinic incinerated its own medical waste, including sharps; and 4) There were few policies or procedures guiding clinical care. Conclusions: Disaster relief is a complex process measured not in months but years. Rebuilding the health care system to care for people who have experienced catastrophic loss of life and property is a slow, deliberate process requiring extensive resources. It was shown that even small improvements could help improve care and prevent infection. Lessons learned from previous disasters must be applied to disaster planning and management at the local, regional, national and global levels.