First National level workshop on 'Hospital Disaster Preparedness' in the North East India
organized by: Emmanuel Hospital Association in partnership with GeoHazards International and UNICEF

Hospitals Safe from Disasters
The price we pay for the failure of hospitals or health facilities due to disasters is too high. In comparison, the cost of making hospitals safe from disasters is tiny. Disaster damage to health systems is a human tragedy, results in huge economic losses, deals devastating blows to development goals, and shakes social confidence. Making hospitals and health facilities safe from disasters is an economic requirement, and also a social, moral and ethical necessity.

Background of high-seismic risk zone of NEI & the role of healthcare institutions
The entire northeast of India is in the highest risk zone of seismic hazard in India, and its seismic hazard primarily results from massive earthquakes along the Himalayan front to the north. India’s seismic risk received relatively little attention until the 2001 Bhuj earthquake killed thousands (medical, nursing, other hospital staff & patients and their relatives). Since then, a number of efforts to improve earthquake safety have begun, but the needs are massive and much work remains.

The northeast is part of lower Himalayan region of India that has experienced large and devastating earthquakes throughout history, and will continue to do so in the future. The Indian building code (I.S 1893:2002) contains the seismic zoning map for the country. The map includes most of the northeast region is in the highest risk zone V.

Despite this region’s high hazard, most of the lifeline infrastructure critical for the government, economy, and public welfare–such as health, education, water supply, power, main administrative buildings, command and control centers, transport infrastructure–have not been sited or designed considering this hazard in accordance with modern building codes, and are thus especially vulnerable to the effects of earthquakes.

The role of the public as well as private health sectors in the response to disasters is rapidly emerging, both in terms of operational and training issues. This was revealed starkly when the sole major hospital in Kachch district—the Jubilee Hospital, Bhuj—collapsed in the Bhuj earthquake putting immediate medical response to the earthquake in disarray.

Disasters have negative impacts on the community's health, and health administrators, healthcare professionals, first responders, and community volunteers must be well-prepared and trained to assure an effective and sustained public health response during an emergency. The National Disaster Management authority highlighted the importance of Medical Preparedness by releasing National Guidelines on Medical preparedness and Mass Casualty management in November 2007.

Global campaign on 'hospitals safe from disasters'
International Strategy for Disaster Reduction (UN/ISDR) and the World Health Organization (WHO) has launched a world-wide campaign on 'hospitals safe from disasters' in January 2008 and planned to partner with governments, international and regional organizations, non-governmental organisations and individuals worldwide to raise awareness about why and how to redouble efforts to protect health facilities and ensure they can function during and in the aftermath of disasters.

EHA & GHI taking the campaign a step forward
Emmanuel Hospital Association (EHA) and Geohazards International (GHI) is committed to take the hospital disaster safety campaign a step forward by launching its national level campaign in the Northeastern region the reason being the seismic zoning map of India includes most of the northeastern states in the highest risk zone V.
On 10th March 2008, Emmanuel Hospital Association in partnership with Geohazards International and United Nations International Childrens' Education Fund (UNICEF) organised a one-day regional level workshop on “Integrating Earthquake Risk Mitigation with Hospital Facilities Planning” at Brahmaputra Ashok Hotel, Guwahati, Assam.

Emmanuel Hospital Association is one of the largest rural healthcare & community development NGOs with its 20 hospitals and 30+ projects in 15 states and Union Territories of India. Most of EHA hospitals are located at the most high disaster prone zones of north, east and northeastern zone.

Disaster Management & Mitigation Unit (DMMU) is the nodal agency for EHA for designing, promoting and implementing strategies and programmes on disaster risk reduction, hospital and general preparedness, rapid medical response and recovery including relief & rehabilitation work in any major disasters in India with the main aim in building a safer world begining with the communities we work.

GeoHazards International is a non-profit organization dedicated to reducing death and injury caused by natural hazards in the world's most vulnerable communities.
This is first such national level campaign initiated and launched by any NGOs in India for creating awareness on hospital disaster safety forming a common regional platform addressing leaders of both public as well as private healthcare sectors

The Participation
The workshop was attended by about 100 participants from healthcare institutions and their leaders, medical specialists (surgery, orthopaedic, dentistry, anesthetia and trauma management), administrators, civil and biomedical engineers, HR executives, security heads, community development as well as faith-based leaders and students from government medical and engineering colleges etc.

44 organizations (including government and private sectors) participated ranging from CEOs, medical superintendents, nursing superintendents, administrators and unit heads from Army hospitals, NE Railway hospitals, from government medical and engineering colleges to high profile corporate & mission hospitals and top notch NGOs from 6 states and 11 districts.

The workshop
The workshop brought together International experts in seismic safety from Geohazards International, California, USA, who have already assisted important Hospitals in India and abroad in assessing the risk to their facilities and taking measured steps towards reducing the risk posed by earthquakes to them.

Experts from Assam and Delhi highlighted the risk and raised an alarm to work on the war footing to prepare joint action plan with the respective state government nodal agencies for disaster management, as a part of disaster preparedness plan to reduce risk and vulnerability. They highlighted that both private and public sectors together developing joint action plan during peace time would only ensure better prepared. Emergency medical experts addressed the need of training in mass casualty, trauma management and basic life & first aid programmes. Experts also informed that with the help of technological advancements 'golden hour' can be reduced significantly that could save the lives of accident victims.

The risk reduction measures will not only include earthquake vulnerability reduction of the hospital structures itself and anchoring the contents of a hospital building including critical medical and general hospital equipment that can be damaged in an earthquake, but also developing capacities of healthcare leaders, hospital staff and the community at large in being able to handle large scale emergencies through rapid medical response and in mass-casualty management.

Dr. Dhruba Hojai, the Director, Health Services, Government of Assam, inaugurated this important event. He also released the “Hospital Safety Check list for Hospital Administrators” in the first session of the workshop. The check-list was jointly prepared by GHI and EHA for hospital administrators.

Dr. Hojai further stated that the region falls in High Seismic Risk Zone and stressed that the damage can only be minimised by taking mitigation measures and through careful preparedness and constant alertness. He suggested that each hospital should form a disaster preparedness advisory group to discuss the preparedness in case of any disaster. He called upon the medical professionals to build a robust system of prevention, mitigation and preparedness to reduce the risks of natural disasters.

He emphasised the need for the public and private hospitals together to have an interface with local communities so that everyone has clarity of roles in the eventuality of a disastrous event.
He congratulated EHA and GHI for their pioneering work in bringing in the public and private healthcare sectors together in this common platform. He also appreciated that the workshop is participated by a very important group i.e, the general community and development NGOs of the region.

The day long workshop was stitched through 3 main technical sessions –

Session- I addressed the Context and Assessing Seismic Risk in life line buildings, which gave participants a general understanding of the earthquake hazard in Northeast India and also the factors that affect the Risk to health facilities.

Session- II addressed the Fundamentals of Managing Earthquake Risk. This session gave hospital administrators an overview of the various earthquake risk mitigation solutions that they can initiate to reduce the earthquake damage risk to their health facilities.

In the IIIrd session GHI expert shared important outcomes of the case study on GTB Hospital, Delhi and elaborated the practical steps that have been taken by hospitals around the world in integrating mitigation solutions into planning and action.

The experts from premier engineering colleges in Assam as well as UNDP representative have elaborated the diagnostic steps taken by the goverment of Assam as part of the mitigation plans for lifeline buildings and highlighted the new building codes and standards that the nodal agency of the state is contemplating to bring in. Ms. Nandita Hazarika, the SPO/UNDP briefed that the state nodal agency is taking steps in assessing lifeline buildings, providing training and awareness programmes specially focussing on public sector undertakings.

L. Thomas Tobin, Chief Operating Officer of GeoHazards International said that GHI has worked for years with scientists and engineers from India and other countries, helping communities threatened by earthquakes to reduce death and suffering, so that they are able to develop and prosper.

He said that EHA, as partners in India has been working closely with GHI and acknowledged their able leadership in taking risk mitigation plans forward. He said that this successful workshop is a good example of public private sectors and NGO coming together to address earthquake risk in the region. Mr. Tobin said that today’s workshop was a first step in a long journey towards improving the performance of hospitals in future earthquakes. He said that the rich quality printed materials and workshop CD passed on to each participants include information that would help hospitals taking first step.

Achievements

• The workshop achieved its objectives in bringing leaders of healthcare institutions from both public as well as private sectors to a common platform for sharing the experiences and the urgency for hospitals to be prepared for disasters.
• The workshop created awareness among the leaders and representatives of 44 organisations of this high seimmic risk region, on the risk and vulnerability of lifeline buildings and the need to proactively plan for mitigating them.
• The workshop also highlight the need of building capacity of the healthcare professionals, engineers, NGOs and community volunteers in basic life supports and first aids, mass casualty and trauma management.
• EHA could rope in international experts from GHI, California, USA with its huge experience and credit in this field abroad and in India as its main partners in India which gave a major technical inputs in the workshop.
• EHA could also link local inputs from the region including both private and public sectors which presented its current experiences and information on disaster preparedness in the region.
• The workshop highlighted the need of coordination, networking and participation from both the sectors through an active private public partnership.
• Participants could take away with them the most updated and researched materials with them in the form of CD and printed materials. The 'Check-list for Hospital Administrators on Hospital Disaster Preparedness' was released and provided to each participants would be a handy ready materials for hospital administrators to start with.
• Hospital administrators and key health sector emergency-management personnel together in understanding the threats posed by earthquakes affecting the region need to take proactive steps to address the risk.

Charting the way ahead

The one-day workshop laid the foundation for taking 'hospital disaster preparedness' a step forward in a long journey towards improving the performance of EHA hospitals as well as other hospitals in future in prepariing for disasters esp. earthquakes.

The participants across the northeastern region, both private and public healthcare sectors, were sensitized and many hospitals have shown their interests to take the message forward. We are in touch with several large hospitals which have shown interest in taking up our capacity building programmes as well as engineering consultations for structural issues.

This workshop has given us tremendous opportunies of networking with the government hospitals as well as corporate, mission and private hospitals.

We do hope that we would be able to chart our way ahead from this workshop travelling across the country's most high risk seismic hazard region by identifying potential strategic hospitals to develop a model seismic safe hospital working alongside the state governments and international development agencies.

“The time to repair the roof is when the sun is shining.” - John F. Kennedy