Disaster

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Choose a disaster that has occurred in the last 10 years (in the United States or internationally). Research the event online. Blog your report about the event specifically addressing the healthcare perspective. What were the barriers for providing and/or accessing healthcare? Who responded? How long did it go on? How did socioeconomics and environment impact the event and environment? Imagine being a healthcare provider during that event. Are we better prepared for the next disaster?

In 2011, a magnitude-9 earthquake caused a huge tsunami and tremendous damage to northeastern Japan. In addition, the tsunami caused a cooling failure at the Fukushima Daiichi Nuclear Power Plant which resulted in a nuclear meltdown and leak causing release of radioactive materials into the Pacific Ocean.

Although Japan was prepared for earthquakes, they were not prepared for the tsunami – which caused most of the damage and deaths. More than 18,000 people were killed in the disaster, mostly to drowning (Oskin, 2013).

The damage impacted the country’s utilities, transportation, and healthcare facilities. Electricity, water, and gas were cut off during the disaster and were not restored for coastal areas for up to one-four months after the disaster (inland areas were restored within 3 days) (Nohara, 2011). The rural coastal areas did not have public transport, and many of the roads were damaged or blocked making access to the disaster areas difficult. In addition, initial lack of gasoline made health and medical support activities difficult (Nohara, 2011). Three hospitals in the coastal areas had been completely destroyed and half of the other clinics/health facilities were damaged, adding to the difficulty of providing medical services. Fortunately, other hospitals designated for disaster base medical care were able to provide emergency care (triage, emergency response, and transport of patients to inland areas/hospitals). A total of 28 Disaster Medical Assistance Teams (DMATs) were able to provide care from the day of the disaster (March 11, 2011) until July 2011.

 

 

References:

Nohara, M. (2011). Impact of the Great East Japan Earthquake and tsunami on health, medical care and public health systems in Iwate Prefecture, Japan, 2011. Western Pacific Surveillance and Response Journal, 2011, 2(4). doi: 10.5365/wpsar.2011.2.4.002.

Oskin, B. (2013). Japan earthquake & tusnami of 2011: facts and information. Retrieved from: http://www.livescience.com/39110-japan-2011-earthquake-tsunami-facts.html

Haiti Natural Disaster

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In 2008 Hurricane Gustav affected Haiti. It is important to understand that Haiti is one of the poorest countries in the Western Hemisphere and have original problems in respect to health (AmeriCares, 2009). Moreover, Haiti has high infant and maternal mortality rates, high malnutrition, and the inhabitants have a high rate of having HIV/AIDS too (AmeriCares, 2009). To make matters worse, Hurricane Gustav struck the area and destroyed about 10,000 homes and up to 90% of crops were lost as a result (AmeriCares, 2009). This original incident of malnutrition could have been aggravated by this natural disaster. One of the organizations that managed to send medical and disaster supplies within a few days was AmeriCares (AmeriCares, 2009). This organization supplied about 80,000 people with medical supplies and brought food to this country as well (AmeriCares, 2009). The only barrier to access healthcare was through the hopes that other countries would send over food and medical supplies to the area because they had lost everything by the disaster. Money was raised through different organizations and that also helped buy food and supplies that these individuals needed. Before the disaster struck, it was known that three out of four Haitians were living in poverty (AmeriCares, 2009). Lack of money can affect their health because of the lack of money to pay for health care costs. The disaster helped everyone regardless of their socioeconomic status, which  helped these individuals get some type of care health wise. The health services lasted for many months because these individuals living in Haiti were under environmentally unhealthy conditions.

If I were to have been a healthcare provider for this event, I feel that adequate help arrived for this natural disaster. Other countries cooperated by sending food and medical supplies as well, which was great. The first organization to respond was AmeriCares and its warehouses are located in Miami and New York City in order to rapidly respond to Haiti and nearby regions (AmeriCares, 2009). I feel that Haiti is best prepared for another natural disaster if it were to occur because their experience with hurricanes and earthquakes allows them to estimate the amount of supplies they need to have for an emergency situation.

 

Reference: AmeriCares. (2009). Health and hope in Haiti. Retrieved from       http://www.americares.org/who-we-are/newsroom/news/health-hope-in-         haiti.html

Earthquake!

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Haiti Earthquake

The disaster I chose to discuss is the earthquake that occurred in 2010 in Port Au Prince, Haiti. It was a 7.0 magnitude earthquake that affected the southern part of Haiti. Haiti is considered a third world country where poverty and limited resources are very common. Although it occurred over a great distance, the impact was felt internationally. On the date of January 12, 2010, and the following weeks and months, the death toll estimate ranged from 230,000-316,000, 300,000 were injured, 85,432 individuals were displaced, and help from all around the world was centered on this country. A review on the event by CNN five years after the earthquake determined that billions of dollars have been utilized in efforts to restore their country. Many organizations including The Red Cross, the Peace Corps, the U.N., Habitat for Humanity, and more played a role in the restoration of Haiti either by traveling there and providing support or by raising funds. Personally, the reason I chose this disaster is because I was fortunate enough to travel to Haiti in 2012, two years after the incident as part of a medical group with International Service Learning (ISL). Although we did not travel into the city for safety purposes, it was evident how much of an impact the earthquake had on the rest of the country. Our group traveled to little villages on the border between Haiti and the Dominican Republic, and everyone we spoke to was affected by the earthquake, just about every family knew someone that lived at the capitol since many family members migrate there with hopes of finding jobs and more opportunities that the little villages do not provide. While we talked to the villagers on occasion, it was evident that they were distressed about not knowing where their family members that had moved to the city were or whether they were still alive. It was interesting to observe how different their life style was compared to ours in the U.S. we might have the luxury of contacting hospitals, police stations, or even fire stations to look for our loved ones in case of an emergency, these individuals did not even have a phone or any form of communication or transportation to go and look for their loved ones that possibly were affected by the earthquake. Through our work with this country, we observed the great impact of cholera post the earthquake incident. Individuals were banned from using water from local streams and rivers due to the great possibility of obtaining cholera, a deadly bacterial disease that may cause dehydration and diarrhea. In the U.S, we may think how hard could it be to treat cholera? Well, in a third world country such as Haiti, sometimes their only source of fresh water is from these cholera-infested streams. Then, when its times to get treatment, there is no access to health care (such as in these small villages), or when there is access there is no money to pay for treatment, so as a result many people ended up dying as a result of cholera after the earthquake.

An impactful story I heard from one patient we were treating in Haiti was that her child had become infected so she attempted to travel to the nearest medical center, which was across the border in the Dominican Republic (3 hours away). She traveled on foot to the border, which is identified by a large river, a bridge, and a chain blocking the entrance into Haiti at the end of the bridge, guarded by a heavily armed military man. She begged and pleaded to the guard to let her cross as her child was sick and she had been traveling on foot for many hours. The guard was not compelled. She contemplated crossing the river, but knew it would make it worse since it was probably infested as well and the guards would probably catch her anyways. She returned every day, but ultimately her child ended up passing, probably from dehydration. It is sad to think that no matter how many billions of dollars were donated from many countries, it was not enough to help the residents of Haiti.

Some barriers identified that prevented Haiti from obtaining help were lack of resources, lack of proper money handling from the superiors of this country, and no proper infection control. Although I would like to say that we would be better prepared for the next international disaster, it is a difficult situation when we are 100% prepared but the resources from the country that needs relief are minimal. I believe the United States is very prepared for most situations, but when the number of people needing help surpasses the amount of supplies and providers, it is evident that many individuals will die or suffer terrible consequences resulting from inadequate resources.

Final Reflection

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tumblr_mrfvgwWntE1s938rio1_500I cannot believe that pinning is just around the corner. It feels so unreal. I cannot believe I will be walking down the line for graduation, my goals are slowly being accomplished. Such an amazing feeling. When I came back to the program after taking a break due certain reasons, I was nervous because there was no time to fool around since I would not be getting a second chance. I knew I had to do well. To be very honest, I was also nervous about going into a new cohort and I knew I would miss my old cohort very much; but, everyone in 2015 are very friendly and I felt like I was part of their cohort. I want to state how lucky I am to have been part of two amazing nursing cohorts (2014 and 2015). I enjoyed the supportive and friendly nature of both cohorts. My motivation to finish this semester strong is my son because I want to be able to provide a future for him.

 

Since I haven’t done patient care for over a year, I knew I had to slowly merge into what it meant to be a nurse again. The first day, I made sure I could handle the care of a patient, documentation, and looking at the patient as a whole. I gained some very valuable experiences during the critical care rotation and when I got into the swing of things again, I knew that nursing is what I am meant to do. Not only was I able to practice my nursing skills such as Foley insertion and IV insertion, but I also wanted to assess other aspects of my patients by providing holistic care even just for a day. One of my patient’s thanked me for listening to his story and for not assuming that he was a chronic smoker. This patient had a permanent tracheostomy and people would always asked if he smoked; which was not the case. This clinical rotation enforced therapeutic communication and the importance of just listening even for 10 or 15 minutes. Also, I always told my patients when I would be back to check on them and I stuck by my word. I think it’s very important to assess the patient’s other needs when their physical needs are being met, or assess the physical needs that are not being met outside the home. Our reaction to our patient’s slight physical chance in vital signs, mental status, or other body system changes really do pave the road of recovery for our patient.

 

The assignments provided for critical care were valuable because it allowed you to dive into how you think and how you process the information. We also got to see how our peers would handle the situation. I want to be the type of nurse that provides safe, effective patient-centered care by focusing on my patient as a whole, looking at aspects on them and being mindful of thchanges in the patient’s status.

 

Overall, this semester has been a great experience. I am really happy about the path I chose to take and the obstacles I had to overcome; I have no regrets. I will truly miss cohort 2015, but I know we will all flourish and become great nurses. Not only were my peers supportive, but all the instructors who helped us grow as nurses and taught us to follow our own path. I want to take all the instructors because they helped us spread our wings and fly; they did all that they could to help us keep our wings from being damaged along the way. The nursing program has become another family for me that I will truly miss.

 

 

 

 

Earthquake in Nepal

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Nepal Earthquake

This past Saturday, a 7.8 magnitude earthquake hit Nepal, India. To date, more than 4,800 people have been found dead and more than 9,200 people are injured. Nepal’s weak healthcare system, terrain, and whether are some identified barriers for providing and accessing healthcare. According to the 2011 World Health Organization report, Nepal has a population of 28 million people, only has 2.1 million physicians, and 50 hospital beds for every 10,000 people. One trauma center, Bir Hospital’s Trauma Centre has 200 beds. However, doctors need more than 1,000 more beds to treat patients. Families and children are sitting on hospital floors and tents posted outside the hospital. Patients are being discharged prematurely to make room for more injured survivors that come into the hospital. Outside major cities have limited access to healthcare facilities and only have basic medical centers that aren’t equipped to handle the injuries sustained by survivors. Additionally, the rugged terrain and poor whether have made it difficult for relief parties to reach these hospitals via helicopters. The Kathmandu International Airport has one runway and space for a limited number of aircraft to part, which has hampered the delivery of relief materials.

Aside from the response from Nepal’s local hospitals, the United Nations (UN), various aid groups and at least 16 nations have rushed aid and workers to Nepal. This catastrophic event happened less than a week ago and residents of Nepal continue to feel aftershocks from the initial earthquake. The day after the earthquake (Sunday), a 6.7 magnitude aftershock, struck east of Kathmandu; which further destroyed homes, buildings and surrounding areas. As far as socioeconomics and environment, the few medical centers present and the few number of physicians and healthcare providers has impacted how patients are seen and treated. As mentioned above, farther regions from the major cities don’t have the proper medical services to treat these severely injured patients.

As a future nurse, it is important to remember that a catastrophe can happen anytime. I believe that no amount of preparation can really truly prepare us for major traumatic events such as this one. However, we can learn from events such as the one in Nepal and prepare supplies and beds in case we were to encounter a similar situation.

References:

“Nepal earthquake: Death toll rises above 3,000.” (2015). BBC News. Retrieved from http://www.bbc.com/news/world-asia-32475030

Reuters. (2015). Earthquake overwhelms Nepal’s weak healthcare system. IBN Live. Retrieved from http://ibnlive.in.com/news/earthquake-overwhelms-nepals-weak-healthcare-system/542403-2.html

Watson, I., Mullen, J., & Smith-Spark, L. (2015). Nepal earthquake: Death toll passes 4,800 as rescuers face challenges. CNN. Retrieved from http://www.cnn.com/2015/04/28/asia/nepal-earthquake/

Picture: http://whatstrending.com/news/18953-earthquake-devastates-nepal

Earthquake in Nepal

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The earthquake that occurred in Nepal this past Saturday, April 25, 2015, impacted this country significantly. This event especially struck home for me, because I have friends who are Nepali refugees; otherwise, I may not even have heard of this very small country that is tucked between India and China. As I researched this event in more detail, I became increasingly aware of the tremendous need for healthcare providers to respond; this country is very poor with approximately 25% of the population living below the poverty line, and consistently experiences economic imbalances (CIA, 2015). In addition, many regions of the country are rural, transportation is difficult and unpredictable, and power outages occur frequently. So far, the death toll as of today, Tuesday morning, is over 4,300 confirmed (CNN, 2015). Again, due to the difficulty with communication from the more rural areas, which were actually closer to the point of greatest impact associated with the earthquake, officials cannot yet determine deaths/injuries in these regions. Due to the fact that the structure and function of several healthcare facilities were compromised, CNN reported that there is a lack of facilities for necessary medical and surgical operations, which prompted providers to use locations that are not normally intended for surgery…which then increases the risk for infection (2015).  Earthquakes cause a significant loss of resources, with typical results being loss of electricity and water. Over 8,000 individuals so far are reported injured, and existing facilities are overwhelmed (CNN, 2015).

Typical injuries include TBIs, upper and lower extremity fractures, and pelvic fractures; due to the possibility of delayed care and insufficient personnel (responders are still retrieving victims from the rubble), there is the potential for hemorrhage and infection to cause death even if the initial injury is not fatal (CBS, 2015). Surgical equipment and antibiotics to combat infection are necessary supplies that are in severe shortage currently. A lack of sufficient water not only increases the risk for dehydration in the absence of injuries, but also can make crush injuries worse (renal dysfunction) and exacerbate medical comorbidities. Inhalation injuries from smoke/debris, tetanus infection, and communicable diseases (from lack of sanitation and crowded makeshift housing) are expected to be a significant concern as well.

Initial international responses to Nepal were actually delayed due to concern of possible aftershocks. Over 16 other countries have demonstrated aid with both financial means and sending people to help the existing structure. India, being in close proximity and also affected by the earthquake, has demonstrated particular initiative in sending aid to Nepal (CNN, 2015).  So far, organizations who have responded to this crisis, besides the national providers, include Red Cross, UNICEF, and various international search/rescue teams, with more aid expected.

The expected outcome is currently unknown, but Nepal will likely struggle to recover from this event due to the country’s pre-existing insecure economic and healthcare condition.

References:

Cable News Network (CNN) (2015). Nepal earthquake’s victims overwhelm hospitals. Retrieved from http://www.cnn.com/2015/04/27/world/nepal-earthquake-bir-hospital/index.html

Cable News Network (CNN) (2015). Nepal earthquake: India leads massive aid effort to help survivors. Retrieved from http://www.cnn.com/2015/04/27/asia/nepal-quake-india-aid/index.html

CBS News (2015). Medical crisis in Nepal in earthquake aftermath. Retrieved from http://www.cbsnews.com/news/medical-crisis-in-nepal-in-earthquake-aftermath/

Central Intelligence Agency (CIA) (2015). The World Factbook: Southeast Asia: Nepal. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/np.html

Nepal Earthquake: April 25, 2015

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Nepal Earthquake Rescue DogJust this past Saturday (April 25, 2015), the country of Nepal has experienced what has been deemed the worst natural disaster in Nepal’s history for more than 80 years. The Nepal earthquake was a 7.8 magnitude quake that has, so far, resulted in 5,000 deaths and over 9,000 injuries. Eight million have been affected by this disaster, so its effects are dramatic and far reaching. The earthquake has resulted in several offshoot disasters, including aftershocks, landslides and the well-publicized Mt. Everest avalanche. As tragedy strikes, 16 nations have hurried in to come to Nepal’s aid, including India, China, and Israel. The United States has sent several disaster relief teams as well as provided $10 million in assistance.

Nepal Earthquake Mt Everest Avalanche

Despite these international efforts, barriers remain to providing relief to Nepal and surrounding areas devastated by the earthquake. Barriers include unreliable means of communication, the terrain, badly damaged roads, weather (heavy rains), lack of supplies (food, drinking water, electricity, gas, etc.), unsanitary conditions and a continually rising number of injured. Hospitals in Nepal are overflowing with patients and healthcare professionals are running low on medications and surgical supplies. The relief efforts are ongoing for the country of Nepal at this time. They continue to require international assistance as they continue searching for survivors and cleaning up the rubble. The country of Nepal is dependent on income from tourism so this disaster will greatly affect their economic status.

Nepal Earthquake Relief Effort

I can’t even begin to fathom what it would be like to be a healthcare provider during this crisis. The overwhelming number of those affected and the destruction of homes and buildings is difficult to imagine. I have yet to participate in a disaster effort, let alone one of this magnitude, but it is essential that we learn from this disaster to better prepare for future disasters. Previous earthquakes and other international disasters have better equipped the world for more efficient and effective response to save lives and minimize devastation. With each new disaster, new obstacles are encountered and hopefully overcame and/or provided a learning experience that will improve the world’s preparedness for the next disaster.

References

Watson, I., Mullen, J., and Smith-Spark, L. (2015). Nepal earthquake: Death toll passes 4,800 as rescuers face challenges. Cable News Network. Retrieved from http://www.cnn.com/2015/04/28/asia/nepal-earthquake/

Shapiro, E. (2015). Nepal earthquake resucue teams en route in wake of devastation. Good Morning America. Retrieved from http://abcnews.go.com/International/nepal-earthquake-rescue-teams-en-route-wake-devastation/story?id=30609810

Mai-Duc C. (2015). Nepal earthquake: 8 million affected, 4 Americans dead; how to help. Los Angeles Times. Retrieved from http://www.latimes.com/world/asia/la-fg-asia-nepal-earthquake-what-you-need-to-know-20150427-htmlstory.html

Pesta, J. and Bhattacharya, S (2015). Rescuers struggle to reach outlying villages hit by Nepal earthquake. The Wall Street Journal. Retrieved from http://www.wsj.com/articles/nepal-rescuers-struggle-to-reach-quake-victims-1430113791

 

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Nepal: The Disaster Response

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Image: http://i1.wp.com/www.kollytalk.com/wp-content/uploads/2015/04/Nepal-Earthquake.jpg

This past Saturday, April 25th, a 7.8 earthquake struck Nepal that has led to over 4,600 deaths and 9,000 injured people (CNN, 2015). A disaster this large in size with so many people injured requires a significant international response to provide needed supplies and care. Countless buildings and homes have been destroyed, people have have lost their families and are in dire need of food, shelter, and medical care.  The United States Agency for International Development (USAID) has assisted by deploying a search and rescue team to Nepal, along with a Disaster Assistance Response Team (DART) to identify and prioritize needs (The White House, 2015). Humanitarian organizations such as Doctors Without Borders and the Red Cross have also responded to the incident to provide care to those affected by the earthquake and subsequent aftershocks (The White House, 2015).

Recent priorities since the earthquake hit have included search and rescue operations to find survivors and relief efforts (CNN, 2015). Even with the help that has arrived through international aid, however, there have been significant barriers preventing the provision of adequate medical care. Hospitals in Nepal have been overwhelmed and lack needed medical supplies, survivors remain buried in building wreckage, and rural areas are not easily accessed by rescuers (CNN, 2015). One hospital is operating at over 3 times its normal capacity with over 1,000 patients (CNN, 2015). Difficult terrain creates difficulty for surface transport to more rural villages in Nepal, while storm weather conditions preclude access via helicopters (CNN, 2015). However these villages are seeing serious damage. One village in particular saw about 70% of homes destroyed with trapped people inside, especially children and the elderly (CNN, 2015). Another cited barrier has involved the small Kathmandu airport becoming jammed with incoming aid workers, which prevents the ability of all needed aid and supplies to enter the country (CNN, 2015). The supplies highly prioritized currently are food, which approximately 1.4 million people need, and tents to withstand monsoon weather (CNN, 2015).

I believe that there are some aspects of a disaster response such as this that are difficult to control for. Earthquakes are unpredictable and as such are difficult to plan relief for as the size and magnitude cannot be know beforehand. However, in 2009 the Nepal government launched a Nepal Risk Reduction Consortium, which raised awareness of the imminence of a large disaster in addition to retrofitting hospitals to withstand an earthquake (United Nations, 2015). This act has potentially saved many lives in this earthquake as the hospitals are still standing and able to treat patients. The United Nations also plans to assist Nepal in reconstructing the country to be more resilient to disasters (United Nations, 2015). Hopefully other countries will learn from this event to strengthen their own disaster preparation.

References:

Asia News. (2012). For World Bank, Nepal is Asia’s third poorest country. Retrieved from: http://www.asianews.it/news-en/For-World-Bank,-Nepal%27s-is-Asia%27s-third-poorest-country-24668.html.

CNN. (2015). Nepal earthquake: Death toll passes 4,600 as rescuers face challenges. Retrieved from: http://www.cnn.com/2015/04/28/asia/nepal-earthquake/index.html.

The White House. (2015). America’s response to the earthquake in Nepal: What we can do to help. Retrieved from: https://www.whitehouse.gov/blog/2015/04/27/america-s-response-earthquake-nepal-what-we-can-do-help.

United Nations. (2015). UN allocated $15 million in emergency funds for Nepal earthquake response. Retrieved from: http://www.un.org/apps/news/story.asp?NewsID=50708#.VUAfI5Ozl2A.

Final Reflection

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It is almost unbelievable that I am sitting here writing my “final reflection.” In fact I am sitting in the exact spot in which I have done most if not all of my assignments in the last three years with my pug by my side. I am still very unsure about how I feel about this “graduating” thing. I have many emotions flood over my as I have been reflecting for the last month or so. I am filled with happiness, sadness, anxiety, fear, and hope. Happiness because I am finally finished with school after 8 very long years. Sadness because I have met amazing faculty and students that I will not be seeing on a weekly basis anymore. Anxiety because I am unsure of where I will end up in the next few weeks, months, and years. Fear because I will not have my instructors and peers holding my hand through it all anymore. And finally, hope, I have hope that I will succeed in everything that I will do here on out.

Critical care was the first rotation where I actually felt that I could do this nursing thing and be successful at it. I don’t know if it is the staff at West Hills or if you receive more respect and trust from the nurses in your last semester. When asked by the nurses, “What semester are you in?” and the reply of “My last” and the excitement of them letting you have so much more autonomy. I actually felt like they trusted me to care for a patient competently. Of course if something went wrong you had them there as your number one resource. I feel blessed to have had critical care in our last rotation. I feel like a learned more in one day in the ICU than I did in an entire semester in Med-Surg. This has by far been my most favorite rotation out of the entire program.

As we close on our last days I can’t help but think about all the memories I have with many of my peers and wondering where the nursing professional will take them. I can’t say right now that I will miss nursing school and don’t think I ever will say that, however, I will miss many of the experiences I had with my peers and faculty.