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Hurricane Mitch was an event described as one of the most damaging recent natural disasters in our hemisphere. This study examined its effects on a community of 5,000 residents in northern Honduras.
Methods:
Survey responses of 110 attendants at an ambulatory clinic 4 months after the event were analyzed. Correlates were established between demographic and housing characteristics and morbidity and mortality.
Results:
The availability of food, water, and medical care decreased significantly immediately after the hurricane, but by four months afterward returned to baseline values. Residents reported emotional distress correlated with the loss of a house or intrafamilial illness or mortality. Diarrheal illnesses more commonly were found in households with poor, chronic access to medical care. The use of cement block housing correlated with availability of food or running water, with access to medical care and vaccinations, and with a reduced frequency of diarrhea or headaches in the immediate post-hurricane phase.
Conclusions:
Improvements in housing construction appear to be the most effective preventive measure for withstanding the effects of future hurricanes in tropical regions similar to northern Honduras.
Humanitarian medical assistance and intervention during the civil war in Bosnia and Croatia was felt by national health workers to be relatively ineffective (2.8 on a 5-point Likert scale), compared to other forms of humanitarian assistance such as medical supplies (4.4/5) and non-medical materials (3.9/5). Bosnian physicians treating civilians noted that the most helpful types of personnel were surgeons and emergency physicians. This study suggests that assessment of personnel needs at the recipient level, in addition to standard relief assessments, is required early in models of complex emergencies. This study supports existing epidemiological models of complex emergencies, especially when high trauma-related mortality and morbidity are likely to occur.
Since at least WWII, some open, contaminated wounds involving massive soft tissue injury and vascular damage have resulted in “irreversible shock,” despite prompt rescue, hemorrhage control, and blood and fluid replacement, without signs of clinical infection.
In animal studies, survival time was related statistically to the dosage of Clostridium perfringens in multicontaminated explosive wounds. Survival time was lengthened by the application of some topical antibacterial agents, but actual recovery was achieved only with topical mafenide hydrochloride solution aqueous spray, which resulted in negative clostridium. perfringens cultures. Although not related statistically to survival time, the mafenide hydrochloride spray also controlled the Pseudomonas aeruginosa in these wounds.
Mafenide hydrochloride had the American trade name of Sulfamylon from about 1942 until 1998, when another pharmaceutical company patented Sulfamylon as the trade name for mafenide acetate, a weaker antibacterial agent. However, mafenide hydrochloride still is available from chemical companies.
Mafenide hydrochloride solution spray has been used successfully in treatment of patients with severe by contaminated wounds and deep burns, and its use in initial care should be revisited.
Change in any organization is difficult. Relief organizations constantly are evolving and changing form to adapt to different needs, demands, and environment. As the phases of a disaster evolve, adjustments must be made by relief organizations to meet the changing needs. The sequential processes used to manage change include recognition and diagnosis of the problem, identification of alternatives, recognition of limiting conditions, selection of a strategy for change, and implementing and monitoring the change. The techniques used to effect change may be classified as structural, management, or technological. Changes can occur in division of labor, content of the work, relationships with other workers, supervisory and/or technical skills, operations, and decision-making hierarchy. Approaches can be mandated from the top, worked out jointly by management and personnel, or implemented by the affected personnel. Implementation of changes has two dimensions: timing and scope. Whenever changes are implemented, the impact of the changes must be monitored and the effects compared with what was expected.