IN THE SHADOW OF THE VOLCANO HUMAN HEALTH AND COMMUNITY RESILIENCE Linda M. Whiteford, Graham A. Tobin, Carmen Laspina, and Hugo Yepes September 2002 CENTER FOR DISASTER MANAGEMENT AND HUMANITARIAN ASSISTANCE Blank Page IN THE SHADOW OF THE VOLCANO HUMAN HEALTH AND COMMUNITY RESILIENCE FOLLOWING FORCED EVACUATION AND PERIODIC ASH FALL TECHNICAL REPORT LINDA M. WHITEFORD GRAHAM A. TOBIN Department of Anthropology Department of Geography University of South Florida University of South Florida and CARMEN LASPINA ARELLANO HUGO YEPES Ministerio de Salud Publica Instituto Geofisico Del Ecuador Escuela Politecnica Nacional September 2002 CENTER FOR DISASTER MANAGEMENT AND HUMANITARIAN ASSISTANCE Tampa, Florida – USA A report on research conducted in communities in the vicinity of Mt. Tungurahua, Ecuador during 2001 – 2002 TABLE OF CONTENTS Acknowledgements………………………………………………………………………i Executive Summary……………………………………………………….……………iii Chapter 1: Overall Description of Project Aims……………………………………..1 Chapter 2: Literature Review and Theoretical Framework………………………..…7 Chapter 3 Research Strategy and Methodology……………………………………21 Chapter 4: Research Sites: Descriptions…………………………….………………31 Chapter 5: Tungurahua Volcano: Eruptions, Lahars, and Ash Falls……….………..47 Chapter 6: Epidemiological Review: The Cantons of Baños, Penipe, and Pelileo….59 Chapter 7: Questionnaire Results: Descriptive Statistics And Frequencies………....89 Chapter 8: Data Analysis: Testing the Research Hypotheses……………………....179 Chapter 9: Conclusions……………………………………………………………..289 Chapter 10: References………………………………………………………………295 Appendices: A Questionnaire Survey Instrument Spanish………………….305 English………………….317 B Penipe Descriptive Statistics……………………………………329 C Banos Descriptive Statistics……………………………………399 D Pelileo Descriptive Statistics……………………………………479 The Research Team………………………………………………………….………….547 ACKNOWLEDGEMENTS The authors are grateful to the Center for Disaster Management and Humanitarian Assistance at the University of South Florida for its financial support for this research. The research would not have been possible without this help. In addition, the Principal Investigators would like to thank the graduate students and independent researchers for their assistance on the project, in particular, Lucille Lane, Juan Luque, and Wendy Hathaway from the University of South Florida, and Natalia Bonilla, Jahzeel Buitrón, Dana Platin, and Sandra Salazar from Ecuador. Their dedication to the project in some very difficult circumstances was outstanding. Fredericka Williams and Debbie Roberson also helped us handle the myriad of administrative details. We are extremely grateful for the support provided by Adela Vimos and Nancy Benitez, in Ecuador, who helped in many different ways. Finally, this research would not have been possible without the help of all those respondents who participated in this study: the volcano and all those whose lives she touches. We thank them all. EXECUTIVE SUMMARY After approximately 80 years of quiescence, Mount Tungurahua entered a new eruptive phase in October 1999. The research findings described in this report focus on three communities in Ecuador close to Mt. Tungurahua, Penipe, Baños, and Pelileo. The primary focus of this study was to determine how community resilience was affected by exposure to volcanic ash and forced evacuation. Specifically the research looked at infectious disease patterns, respiratory illnesses, perceptions of risk, economic losses, and various socio-economic factors in the context of long-term community recovery. Residents of Penipe had experienced heavy ash falls, Baños had suffered from limited ash falls but had been evacuated, while Pelileo had a little ash but had not been evacuated. An inter-disciplinary research team was assembled in early 2001. Dr. Linda Whiteford, an expert in anthropology and public health and Dr. Graham A. Tobin, an expert in natural hazards, were team leaders. They were joined by two Ecuadorian counterparts: Dr. Carmen Laspina, of the Ministry of Health, a physician with extensive experience in epidemiology and public health issues; and Ing. Hugo Yepes, the Director of the Geophysics Institute of the National Polytechnic, Ecuador’s lead agency on volcanic and seismic hazards. Graduate students in Anthropology, Geography and Public Health from the U.S. and Ecuador rounded out the research group. To develop the data and other necessary information to undertake the study, a variety of methodologies and research techniques were employed. These consisted primarily of the following: • On-site evaluation to determine project feasibility and demographics. • A structured questionnaire survey administered to 314 participants: 105 in Penipe; 103 in Pelileo; and 106 in Baños. • Formal in-depth interviews with public officials, religious and social leaders, principally in the three communities. • Mapping of the three study sites to identify individual homes and other landmarks to facilitate sampling strategies. • Collection and analysis of geophysical data related to ash fall provided by the Ecuadorian Geophysics Institute. • On-site review of ambulatory care and emergency care health clinic records at the three sites in order to identify epidemiological trends. • Analysis of data on disease patterns and mortality at the regional and national level for comparison purposes. • Collection and evaluation of background information to provide political, social, economic and physical context for the hazard situation and evacuation. Results indicated: I. Community exposed to continuing ash falls experiences high levels of respiratory illness. • Three years of constant exposure to the deleterious effects of volcanic ash has had a significant impact on the residents of Penipe. The epidemiological data collected in Penipe indicate significant increases in outpatient consultation rates for acute respiratory infections during 1999 and 2001. During both of these years there were high levels of ash fall. In addition, in Penipe during 2000, pneumonia mortality rates in the less than one-year-old age group reached high rate. • Of the three cantons, Penipe was characterized as having the poorest health status. Penipe had the highest medical consultation rates for all three major illness categories, the highest mortality rates for children under five, as well as the highest overall mortality rates. • Despite the negative health outcomes in Penipe, the residents of the canton displayed remarkable resilience in the strengthening of local non-government organizations as well as community associations to meet the challenge of the disaster threat. II. Large-scale evacuation does not necessarily lead to high levels of respiratory illness. • The evacuation did not appear to have long-term consequences for incidence of respiratory illnesses in Baños. The epidemiological data do not demonstrate an increase in acute respiratory outpatient consultation rates in Baños after 1999, and consequently, do not support an association between evacuation experience and respiratory illness. • In Baños, the health of the community rebounded relatively quickly after the population returned in 2000, and, while economic conditions were difficult, there were still lower rates for respiratory illness, possibly due to the fact that Baños had not been exposed to major ash fall. • In addition to the epidemiological record, Baneños themselves have an optimistic and positive attitude about their health. Based on the data collected from the survey, 76 percent of Baneños expressed the belief that their health was no different than it had been before the evacuation. These findings point to a remarkable capacity for resilience among those interviewed in Baños. They were evacuated and suffered great hardships as a result of being forced to leave their homes and their community, but are still able to describe themselves and their health in positive terms. III. Community experiencing no evacuation and infrequent ash fall shows low levels of respiratory illness. The epidemiological data from Pelileo are more reliable than the other records examined in the study, because the hospital in Pelileo, unlike the hospital in Baños, was not closed at any time during the period of epidemiological review (1995-2001). • Analysis of rates of illnesses in Pelileo, such as upper respiratory illness, pneumonia, and diarrhea show they were relatively stable over the period under review. Additionally, in 2000, Pelileo had the lowest rate of acute respiratory illnesses of the three sites, suggesting an association between lack of exposure to ash fall and evacuation experience with fewer respiratory problems. • Residents of Pelileo, while neither evacuated nor exposed to continuous ash fall, can see Mt. Tungurahua and are aware of the volcano’s frequent eruptive activities. Sixty percent of the people interviewed in Pelileo expressed a belief that the volcano had affected their health, and a similar percentage felt that the volcano was a risk to their health. Although the residents of Pelileo have been spared the most direct effects of the eruptions of Mt. Tungurahua, the volcano’s activity has undoubtedly disrupted some of the traditional economic ties that connect Pelileo, as an important local industrial and agricultural center, with other communities in the hazard zone. Additionally, Pelileo became a place of safe haven for many Baneños during the evacuation and continues to harbor some families from the high-risk zones still on orange alert. In this respect as in many others,