Consultation to Integrate Indigenous Traditional Knowledge in Disaster Risk Reduction for Health, Mexico, 30 July to 1 August 2018

News and Information for the International Community

Perspective 4 Spotlight 5 Interview 6 Member Countries 8 ISASTERS Information Resources 14 Upcoming Events 16 Preparedness and Mitigation in the Americas September 2018 Issue 127 Photo: Alex Camacho PAHO/WHO

Participants in the Consultation to Integrate Indigenous Traditional Knowledge in Disaster Risk Reduction for Health, Mexico, 30 July to 1 August 2018.

Consultation to integrate indigenous traditional Editorial knowledge in disaster risk reduction for health What we know about the salud carried out in Mexico impact of volcanic ash in the respiratory system

n 2014, within the framework of a con- of their Plan of Action for Disaster Risk Isultation in Canada concerning disaster Reduction 2016-2021. The inclusion of he health impact of volcanic erup- risk reduction in the health sector in indig- indigenous populations also plays a vital Ttions is of major significance, and enous communities, 20 delegates from ten role in the PAHO/WHO Strategic Plan and the effects of volcanic ash on the respi- countries in the American hemisphere in a number of national mandates in areas ratory system and on general health are issued a number of recommendations for including but not limited to the Ethnicity especially important. national and international action, but with and Health Policy, the Health Research Pol- Several volcanoes are currently in a special focus on indigenous populations. icy, and the Strategy for Universal Access to eruption in the Region of the Ameri- In 2016, the Member States of the Pan Health and Universal Health Coverage. cas, including, among others, Kilauea, American Health Organization incorpo- For this purpose, in fulfillment of the in the United States (in the state of rated ethnicity as a cross-cutting aspect 2014 recommendations, PAHO/WHO held (continued on page 2) >> (continued on page 5) >> PHOTO Agung Santoso Agung PHOTO

(from page 1) Editorial What we know about the impact of volcanic ash in the respiratory system

Hawaii); Popocatépetl, in Mexico; Volcán vides, some of the main lessons learned up of particles under 10 microns in diam- de Fuego, Pacaya, and Santiaguito, in Gua- about protecting health in the face of volca- eter (PM10), and especially those of less temala; and Reventador, Cotopaxi, and nic eruptions can be outlined today. than 2.5 microns in diameter (PM2.5), can Sangay, in Ecuador. It has become clear that the breathable exacerbate preexisting respiratory diseases The Volcán de Fuego eruption in Gua- particles produced by eruptions are not as and increase premature mortality among temala in June 2018 took the lives of over acutely dangerous for respiratory health as patients with chronic diseases. Longer 100 people and left 197 missing, a number the smoke from fossil fuels. One of the dis- exposure, perhaps as little as a few years, injured, and hundreds in shelters. In addi- coveries of research on the eruption of the has been shown to contribute to increased tion, the emission and fall of volcanic ash Mount Saint Helens volcano in 1980 is that mortality from respiratory and cardiovas- have been continuous since the eruption. volcanic ash can contain unusually high cular diseases and cancer. The volcanic Although volcanic eruptions are much quantities of a mineral called crystalline sil- ash from eruptions normally includes a less frequent than other natural events that ica that is present in breathable particulate, large proportion by weight of PM2.5. The cause disasters, such as earthquakes and and that can reach the lungs. Substantial concentration of these particulates in the floods, most volcanoes do have the poten- exposure to this compound may lead to the air can greatly exceed the air quality limits tial for dangerous eruptions that release development of silicosis, a pulmonary dis- recommended by the World Health Orga- large quantities of gases and ash in the ease that is normally diagnosed in workers nization (WHO) and can do so for months space of a few hours, sometimes followed by with severe exposure to silica powder in in the case of short eruptions, and for years intermittent activity lasting weeks or even mines and quarries. following longer eruptions. Symptoms in months. These gases normally disperse in Advances in epidemiology in the last people with asthma or other chronic pul- the atmosphere and pose little risk for local decade on the health effects of air pollution monary diseases are also seen to recur after populations. An ash plume, however, can in the middle- and high-income countries acute exposure to the ash, as observed in affect extensive areas. have shown that the finest particles play a the Mount Saint Helens case. Most of the communities in volcanic fundamental role as the most toxic of all When erupting volcanoes continue regions are not prepared for these events. components in traffic-related emissions. emitting ash for months, concerns about Given the examples that history pro- Short-term exposure to fractions made (continued on page 3) >>

2 September 2018 Issue 127 Editorial (from page 2) age exposure to PM2.5 rose significantly in silica and quantify the size of the particles. the entire range of non-respiratory health this arid environment during the months Effective respiratory protection is also impacts related to PM2.5 particulate mat- and even years following the eruption. necessary in any heavy ashfall, especially ter increase, and this prompts as much or Nevertheless, studies were not conducted for people with pre-existing respiratory and more anxiety in terms of public health as to monitor the health of the population, or cardiovascular diseases, who should remain crystalline silica has in the past. An import- children’s health in particular. indoors to the extent possible. As to types of ant example highlighting the caution that More research is needed to determine protection, recent research has shown that should be exercised in events of this type is whether PM2.5 particles in volcanic ash light high-efficiency masks are most effec- the eruption of the Cordón Caulle volcano are as toxic as similar fractions of the same tive in reducing the inhalation of PM2.5 in Chile, in 2010, with ashfall extending size in traffic-related air pollution. In the from volcanic ash, and that they are prefer- into Argentina, in particular the dry areas past, it was assumed that volcanic emis- able to the household protective measures of the Patagonian steppes. It was only three sions were less dangerous since they consist that people normally use to cover the face. months later that conditions in some of of natural mineral particles. However, we In addition, children should be prevented the area’s cities improved enough to allow cannot guarantee that today. For this and from playing in places where ash has been normal life to resume. However, some very other reasons, populations and authorities deposited, or near dusty roads. thick deposits of ash remained on the land in areas with ashfall are advised to reduce for many months and were then born aloft exposure as much as possible, starting Peter J. Baxter, MD, Cambridge University, by strong winds, in some cases produc- with withdrawal from inhabited areas and United Kingdom. E-mail: pjb21@medschl. ing powerful ash storms that temporarily protection for workers. Also, ash samples cam.ac.uk. reduced visibility to zero. Although that should be analyzed in experienced labora- ash did not contain crystalline silica, aver- tories to rule out the presence of crystalline

PAHO recommendations on ashfall and protection of the respiratory system

The health impact of volcanic eruptions, spe- Respiratory Protection cifically the effects of volcanic ash on the respiratory system and on general health, is of major importance. People should know that breathing ashes can be harmful and that protec- In consultation with various experts, PAHO offers rec- tion is recommended for everyone. ommendations for the general public on what to do For people in general who have to leave home for short periods, any type of common surgical mask can be effective. when volcanic ash begins to fall or is ongoing, on how Care should be taken to adjust the mask to the face properly people can protect themselves if they need to go out- by adjusting the clips and nose straps. doors, what to do if ash is in the home, and on how to Two types of populations should receive special advice on respiratory protect the respiratory system, both for members of the protection: general population and for those who are most vulner- People who work outdoors and are much exposed to the ash (such as cleaning teams, emergency and rescue teams, and able to ash particulate. police). PAHO also explains the principal health effects of ash fall in terms of the respiratory system, toxicity, and People who are particularly vulnerable to ash particles (for example, patients with serious illnesses, asthma patients, the eyes. children, and the elderly). For complete information, visit: http://bit. ly/2CwS462.

Editorial September 2018 Issue 127 3

The Emergency Medical Teams (EMT) initiative moves forward in the Americas

26 professionals trained as EMT coordinators to bolster capacity during emergencies and disasters

he Pan American Health During the course, the partici- TOrganization held the IV pants were required to work with the Regional Meeting of Emergency response coordination mechanisms Medical Team Coordinators, on that bring together national and inter- 16-20 July in Virginia (United national efforts, to understand and States), with 26 participants from harmonize the guidelines of the Med- Haiti, Brazil, Uruguay, Canada, the ical Information and Coordination United States, Jamaica, Barbados, Cell (CICOM) with national emer- Puerto Rico, and Panama. gency operations centers procedures, Led by a team of eight experts from their own EMTs at the national level. After and to understand the best practices for Costa Rica, the United States, Anguilla, finishing the course, the professionals join supporting their own countries’ national Barbados, and PAHO itself, the course the roster of coordinators available for implementation of the Emergency Medi- trained disaster response professionals on mobilization by PAHO/WHO to perform cal Team initiative and the development of the mechanisms for requesting, receiving, this function as a part of the coordination national EMTs. and coordinating international Emergency of national response to emergencies and Medical Teams, as well as on managing disasters.

United States’ Team Rubicon classified as a Type 1 EMT

The United States Team Rubicon, a patients a day during a maximum of 14 receive this designation and is the third disaster response organization made up of days. It also has triage capacity, clinical care Emergency Medical Team in the Region to armed forces veterans, received a verifica- areas, a basic laboratory, and pharmacy qualify, after the Type 1 fixed EMT of the tion visit for the classification of its Type capacity, in coordination with the interna- Costa Rican Social Security Fund (CCSS), 1 Mobile Emergency Medical Team. The tional disaster response network. and the Type 2 inpatient surgical cell EMT visit took place on 27 and 28 June at the Team Rubicon is the first nongovern- of Ecuador’s Ministry of Health. It is also team’s National Operations Center in Dallas mental organization in the Americas to the 18th team in the world to classify. (Texas), and was led by a team of international experts headed by PAHO. The team concluded that this EMT meets the international standards for classification as a Type 1 Mobile Emergency Medical Team on the WHO roster.

Team Rubicon is equipped with tem- Team Rubicon providing porary shelters, supplies of medication for medical aid after Hurri- outpatient care, and technological support cane Maria at a Federal Medical Station in Puerto for lifesaving care in austere environments. Rico. Team Rubicon can provide care for 100

4 September 2018 Issue 127 Perspective

Photo: Alex Camacho PAHO/WHO - September 2018 Issue 127 2018 September Jesús Guadalupe Fuentes, an expert expert an Fuentes, Guadalupe Jesús tral knowledge and practices as well as as well practices as tral and knowledge strengthened have experiences that share in disasters and emergencies resiliencyto populations. indigenous populations. Permanent Nations the United of member underscored Issues, Indigenous on Forum in a network forming of the importance disaster the on Americas of the Region populations indigenous and reduction risk ances share to possible it make would that

- For the first time, an innovative “mir an innovative time, the first For hypothetical methodology The at looks ror scenarios” methodology was tested. methodology tested. was scenarios” ror methodology This is designedto identify - manage risk disaster of critical elements the health make sector where can ment improve to adaptations and adjustments the well-being guarantee and interventions populations. indigenous of perspective the classical scenarios both from the theindigenous perspective of from and simulation/construction Two worldview. involving once conducted, were exercises eruption, volcanic a by caused disaster a resulting crisis humanitarian a theother indigenous by movements migratory from - map to led These exercises communities. will serve that actions input as priority ping and health on guidance developing for in indigenous management risk disaster The working day included a review a review included day working The thisinitiative that agreed group The Spotlight of the proposal and of the foundations of of the foundations of and the proposal of tradi - indigenous integrate to initiative an reduction risk disaster in knowledge tional working ongoing an created health,and for proposal in the modifications make to team the participants. by suggested as network a regional establishing requires information expertswith share who can indigenous and reduction risk disaster on populations. a consultation to integrate indigenous tradi- indigenous integrate to a consultation reduction risk disaster in knowledge tional 2018. in August City, health, in Mexico for experts management risk in disaster Twenty peo- indigenous with along participated, Canada, leaders from indigenous and ple Guatemala, States, the United Ecuador, Peru. and Mexico, Honduras, held in Mexico held in health for (from page 1) page (from reduction risk knowledge disaster in traditional indigenous integrate to Consultation Carlos Soto Menegazzo, Minister of Health of Guatemala, visiting people affected by the eruption of Volcán de Fuego. Photo: JMinistryPhoto: Guatemala of Health

Carlos Soto Menegazzo, Minister of Health of Guatemala

“It is necessary to continue strengthening sectoral capacities for timely and adequate response to the population in emergencies”

n 3 June of this year, Guatemala expe- The Ministry of Health addressed the assistance, with support from the Risk Man- Orienced one of the worst catastrophes emergency in three phases. The first was to agement Unit of the Ministry of Health and of recent years. The eruption of Volcán de provide hospital care for 58 people who had the Health Cluster. The third phase pro- Fuego, in the country’s south central region suffered burns. They were initially treated at vided medical and mental health services, (one of the country’s four active volcanoes), the Escuintla hospital and then transferred plus psychological care in shelters and com- left a toll of 113 people dead, 197 missing, to the national referral hospitals (Roosevelt munities that were affected or at risk, and 58 injured, 4,175 in shelters, 12,800 evacu- Hospital and San Juan de Dios Hospital). the continuity of health services has been ated, and 1,702,130 affected, in addition to Due to the severity of the burns in some ensured by continuous monitoring of sup- destroying 186 dwellings, damaging three cases, arrangements were made for 13 of the plies in hospitals and health areas. health centers, and affecting five roads. In patients to be taken to centers specializing What was the greatest challenge this interview, Minister of Public Health in burn treatment, thanks to collaboration during the first 72 hours of the emergency? and Social Welfare (MSPAS), Carlos Soto with the governments of Mexico and the As a Ministry, our challenge was Menegazzo, shares his experience at the United States. In the second phase, lead- to ensure immediate care for burn vic- head of one of the key ministries during the ership and oversight was coordinated by tims and other injured people, as well as emergency response: the Health Directorates in collaboration strengthening coordination with people, What was the response of the Ministry with institutions, agencies, and nongovern- organizations, and missions that provided of Health in this emergency? mental organizations that provide health (continued on page 7) >>

6 September 2018 Issue 127 Interview (from page 6) support for the health sector. But coordina- the Health Cluster that we lead jointly with tion needed to be strengthened at the local PAHO/WHO. This served to bolster the and national levels. health response for the affected population What role has health sector leadership through measures for medical care, psycho- played in the response? logical support, nutrition, water quality, and The Health Area Directorate repre- appropriate health conditions in the tempo- sented our Ministry in the departments rary emergency shelters. Those entities are

affected, primarily Escuintla. In close coor- also now coordinating with all the institu- of Health, Guatemala Photo: Ministry dination with the National Hospital, the tions and entities of the Guatemalan state, departments were responsible for respond- helping to meet the new challenges involved ing to the emergency and ensuring medical in building temporary camps to house those care for victims of burns and other injuries who have lost their homes. Carlos Soto Menegazzo, Minister of Health of Guatemala. during the first hours of the disaster, and What lessons learned or issues for subsequently for providing care in the shel- improvement did this emergency bring to ters and affected communities to ensure the light for your Ministry? activate the Medical Information and Coor- provision of medical care, public health sur- Considering that the country is highly dination Cell (CICOM) along with the veillance, and control of risk factors for the vulnerable to various natural events, it is Risk Management Unit of the Ministry of population. necessary to continue strengthening sec- Health. PAHO/WHO has also offered tech- What sorts of coordination has toral capacities for timely and adequate nical support in the Escuintla Health Area the Ministry had with other entities for emergency response, timely management to strengthen leadership and coordination response to this emergency? of information for decision-making in with national and international institutions There was coordination with countries emergencies, and risk communication to and organizations. that sent medical brigades to provide health the population. We also need to continue a Once the population’s needs in the care, primarily the United States, Israel, training program to strengthen regulations emergency phase are met, what path will Mexico, and El Salvador, plus the Cuban and procedures for prehospital advanced your Ministry take to maintain access to medical brigades already established in life support in emergencies like the current health for the affected population? Guatemala, whose temporary relocation to one, and to bolster triage capacity in hospi- We must guarantee access to health the affected areas helped provide coverage tals. In addition, facilities and capacities for services for the people in shelters and of medical care and control health hazards. critical care management of injuries associ- communities through primary health care There was also coordination with other ated with burns must be strengthened. teams and public health teams mandated to ministries through the National Emergency What coordination has there been identify and control risks. In particular, it Operations Center of the National Disaster with PAHO/WHO in this emergency? is important to provide mental health care Reduction Coordination Office (CONRED) We enjoy close communication and and psychological support in coordination to coordinate the government response to coordination as a natural counterpart. This with other institutions. It is also necessary the population’s needs. facilitates technical assistance in the form of to strengthen intersectoral work and pre- Finally, there was coordination with specialists, supplies, medicines, and water paredness for new emergencies that can international, national, and nongovernmen- quality monitoring. With PAHO/WHO, have health impacts on the population. tal organizations, among others, through we also lead the Health Cluster and jointly

Interview September 2018 Issue 127 7

Countries of the Americas bolster their response to address yellow fever

Between December 2016 and June Brazil, public health authorities in the coun- Ministries of Environment and Sustainable 2018, 2,045 confirmed cases of yellow fever tries of the Americas where the disease is Development. Experts from the Institute of were reported to PAHO/WHO, including endemic have prioritized addressing the Subtropical Biology, the Dr. Julio Maiztegui 677 deaths in confirmed cases in seven risk of infection and the rapid transmission National Institute of Viral Diseases, and countries of the Americas: Bolivia, Brazil, of the yellow fever virus in large unimmu- the National Institute of Tropical Medicine Colombia, Ecuador, French Guiana, Peru, nized populations, and have worked with (INMET) also participated. and Suriname. Additional confirmed cases PAHO/WHO support to improve their sur- Collaborating as facilitators were pro- involved international travelers who had veillance systems. fessional staff from the Brazilian Ministry of traveled to endemic areas of Argentina, Coordinated by the PAHO Health Health, as well as from the state secretariats. Chile, and several European countries. Emergencies Department, the Organi- The State Center for Health and Surveil- In the context of a major epizootic zation’s Infectious Hazard Management lance (CEVS) of the state of Rio Grande do wave in nonhuman primates at a level of Unit (PHE/IHM) and Health Emergency Sul, the National Primate Center and the magnitude unseen since the 1940s, Brazil Information and Risk Assessment Unit Ministry of Health’s Evandro Chagas Insti- experienced an outbreak of yellow fever (PHE/HIM) are collaborating with the tute and the Zoonosis Control Center of the starting in late 2016 in the southeastern endemic countries to enhance prepared- state of Alagoas. part of the country. It was characterized by ness for possible outbreaks of yellow fever The agenda stretched over four days propagation to geographical areas that had by strengthening surveillance systems and and familiarized the participants with the not been considered at risk since the 1960s. diagnostic capacity. context of the epidemiological yellow fever Brazil responded aggressively to control the Workshops on yellow fever situation in the Americas, covering the 2016-2017 outbreak through vaccination prevention, control, and environmental patterns associated with yel- activity in the affected areas, monitoring surveillance low fever and their use in risk assessment. that was better integrated (humans, vec- Argentina It also presented the yellow fever situation tors, and nonhuman primates), clinical case With coordination by the PAHO/ in Brazil and the country’s epidemiological management, and vector control activities WHO Representative Office in Argentina surveillance system, in particular as regards in at-risk urban areas. Since the beginning (Tamara Mancero, Health Emergencies the constituents of epizootic surveillance of of 2017, over 57 million doses of vaccine Focal Point) and support from the Organi- nonhuman primates and in relation to ento- have been administered in affected and zation’s Department of Health Emergencies mological surveillance. at-risk areas. Given the situation manifest (Enrique Perez Gutierrez, PHE/HIM Unit As a result of the workshop, the inte- in the 2016-2017 and 2017-2018 outbreaks, Chief, and Roberta Andraghetti, Advisor for gration of the health and biodiversity however, Brazil has announced its intention the Country Health Emergency Prepared- conservation agendas was consolidated. It to expand yellow fever vaccination to the ness and International Health Regulations was suggested that there is a need to consol- entire country. Unit), a theoretical and practical workshop idate the provincial technical rapid response In addition to vaccination, effective was held in Posadas (Argentina). Partici- teams to deal with epizootics, and that their early detection and the reporting of yellow pating were the Ministry of Health and its technical capacities need strengthening. fever cases is essential in order for risk man- representatives in the provinces of Chaco, Along a similar line, the Zoonosis Coor- agement to reduce the impact and spread Corrientes, Jujuy, Formosa, and Misiones, (continued on page 9) >> of outbreaks. Alerted by the outbreak in as well as representatives of the nation’s

8 September 2018 Issue 127 Member Countries (from page 8) (biological features of the Cul- dination Office of the Ministry of Health and the Bureau of icidae family, with emphasis Wildlife and Biodiversity Conservation are working on an on yellow fever vectors and epizootic surveillance protocol that will apply to nonhuman collection techniques); and primates and insects and be oriented to yellow fever, and that the biology, ecology, and most will provide general guidance for the provinces. common diseases of nonhu- Ecuador man primates. In Ecuador, a PAHO/WHO mission has worked with The workshop also the national Ministry of Health to strengthen yellow fever devoted one full day to defin-

response. The Ministry of Health issued a yellow fever alert ing an action plan for the PAHO/WHO Perez Enrique Photo: last March and initiated a preparedness plan to respond to the development, structuring, and consolidation of entomological presence of cases in the country. and epizootic surveillance in Peru. A PAHO/WHO tool was A mission was conducted to strengthen yellow fever used for this purpose. preparedness, warning, and response activities by reviewing The national authorities present at the workshop provided surveillance, laboratory, and preparedness and response capac- strong technical and policy support. As was the case in Argen- ities. tina, there were seven experts from Brazil’s Ministry of Health, For three days, the PAHO/WHO team, made up of Jairo from the State Health Surveillance Centers, and from the Evan- Méndez, Regional Virology Advisor to the Infectious Hazard dro Chagas Institute, as well as from the Health Emergencies Management Unit, Joao Toledo, the unit’s consultant on clini- Department. This expert team was in charge of a 36-hour the- cal management, prevention, and control of infectious diseases, oretical and practical workshop that covered epidemiological and the technical staff of the Representative Office in Ecuador, factors, elements of environmental surveillance of both insects worked together in technical sessions with the health teams, and primates, and the development of a plan to be proposed addressing surveillance, strategy, and delivery of services. In for the implementation of such surveillance in the country. addition, there was a visit to the Eugenio Espejo Specialized The field work component of the workshop took place in the Hospital in Quito and to the laboratory of the National Public Pucallpa Nature Park, with surveillance actions demonstrated Health Research Institute (INSPI) in Guayaquil. and practiced in three working groups: the first conducting On the last day of the mission, conclusions and recom- entomological surveillance, the second capturing primates, mendations were presented to the Vice Minister of Governance and the third conducting sampling and necropsy in primates. and Health Surveillance, Carlos Durán, and PAHO/WHO reit- As a result of the activity, Peru now has a proposal for erated its willingness to provide support for processes, training, structuring a surveillance system that will target nonhuman and strengthening of yellow fever response. primates and insects in the yellow fever context from a subna- Peru tional perspective, and an expert group is in place composed A four-day workshop was coordinated by the PAHO/ of 14 professionals from the Ministry of Health and 16 from WHO Representative Office in Peru (Monica Guardo and elsewhere in the country and from other institutions relevant Edgardo Nepo), with 29 participants from the Health Bureaus to this work, such as nature parks, the National Agricultural of Loreto, Amazonas, Madre de Dios, Cusco, Puno, Huánuco, Health Service (SENASA), and the University of Ucayali, Pasco, Junín, and Ucayali, as well as from the central office in among others. The members are trained in this type of sur- Lima. The workshop included theoretical and practical sessions veillance and can act as facilitators to replicate the course in on surveillance of nonhuman primate epizootics (active and the future, building capacities in other regions of Peru where passive); environmental surveillance in yellow fever settings yellow fever is endemic.

Member Countries September 2018 Issue 127 9

Photo: PAHO/WHO 10 the nationalthe levels and for local conduct- transported to assist authorities health at Welfare. in disaster response Experts were ofof Public Ministry the Health and Social tor’s response capacity under leadership the on strengtheningfocused - sec health the shelters. ated, including were 4,175who relocated to Approximately 12,800 people were- evacu died, 58were injured, and 197disappeared. Some 1,702,130people were affected, 113 with pyroclastic flowsand ash columns. Intermittent eruptions continued for days, Chimaltenangotla, and Sacatepequez. volcanic dome departments inthe of Escuin- affectedthe communities located thenear clastic flows. The ash particleslahars and level andsea producing constant pyro- umns of ash reaching 10,000 meters above of Antigua, erupting, began emitting col- Fuego, located some 20kilometers west The response to the Volcán deFuego eruption Guatemala The support provided by PAHO On 3 June, Guatemala’s Volcán de September 2018 Issue 127

and health promotion. health and form of campaigns for prevention disease among communities affected the inthe psychological support for dissemination messageshealth about and practices good prepared with educational and public department of Materials Escuintla. were and field the insituation rooms inthe ting up emergency operations centers in as well as supplies and equipment for- set assistancetechnical on managing corpses, gavealso departmental health authorities patients department inthe of It Escuintla. shelters and hospitals with dealing burn monitoring kits, and sterile materials for tive equipment, hygiene kits, water quality shelters. PAHO distributed protec personal - includingvices, mental care, health inthe providing and medical other ser health responsehealth operations field, inthe and management of information, conducting ing damage assessment, coordinating the PAHO mobilized approximately US$ - • • • • four lines of action: impacted by eruption. the The was focus on rioration of communities inthe health emergency response health and avoid dete- Response Fund (CERF)to support the 310,000 from Common the Emergency

campaigns munication and health information and practices through good risk com- and promoting healthy environments Enhancing awareness of hazards health diseases; prevent water-borne and vector-borne vectorsifying control interventions to Increasing access to safe water and inten - ofvictims disaster; the andvices psychological support for Improving access to mental ser health munities; prevention inshelters and affected com- as well as disease surveillance, miological Strengthening public and health epide- . Member Countries - Peru The regional health directorates strengthen capacities for monitoring water quality

Those in charge of monitoring water Food Safety (DIGESA), the workshop ventions to enhance the efficiency of the quality programs in 12 of Peru’s regions was directed at those responsible for the health authority’s monitoring. took part in the Workshop on Monitoring water quality monitoring programs of the The workshop allowed the personnel Drinking Water Quality, which aimed to regional health directorates (DIRESAs) in of the DIRESAs to improve their capacities strengthen capacities and ensure adequate the southern section of the country (Tacna, and skills for health-related monitoring of conditions in the systems responsible for Moquegua, Cusco, Puno, Apurímac, Aya- drinking water quality, and thus ensure the supplying safe water to the population. This, cucho, Pasco, Huánuco, Huancavelica, presence of water supply systems that pro- in turn, will contribute to reducing diseases Junín, Madre de Dios, and Arequipa). vide safe water to the population, improving associated with poor quality water. The objective was to strengthen the people’s health by reducing the incidence of Organized by PAHO’s technical capacities and skills of human resources water-borne diseases. team for water and sanitation and Peru’s to formulate and implement water quality Directorate of Environmental Health and monitoring programs and tools for inter-

Honduras Workshop to assess the Hospital Safety Index

ican Technical University (UNITEC), the Fire Department, the Red Cross, and the Permanent Commission on Contingen- cies (COPECO) were also represented. The workers trained are now in a position to evaluate other hospitals and strengthen the capacity to respond to emergencies. The Hospital Safety Index is a tool for fast, reliable, low-cost evaluation that provides an immediate estimation of the probability that a health facility can continue to function in disaster situations. By The María de Tegucigalpa Hospital train evaluators to use the HSI tool. Pro- determining a hospital’s safety index, which (Honduras) served as headquarters for the fessionals from various of the country’s also considers the natural environment workshop on evaluating the Hospital Safety hospitals participated. These included the and the health services network to which Index (HSI), hosted by PAHO/WHO, from Mario Catarino Rivas Hospital, Leonardo the hospital belongs, countries and deci- 24 to 27 April 2018, and led by international Martínez Hospital, and María de Teguci- sion-makers will have a better sense of their experts from the Organization. galpa Hospital. Other institutions, such as ability to respond to major emergencies and The purpose of the workshop was to the Ministry of Health, the Central Amer- disasters.

Member Countries September 2018 Issue 127 11

PAHO has intensified its technical cooperation with Venezuela and neighboring countries. Photo: Sabina PAH/WHO Rodriguez Photo: Venezuela and neighboring countries Institutional regional response to the health situation The Bolivarian Republic of Venezuela, under stress as a result of a combination Regional Revolving Fund for Strategic Pub- a federal state of over 30 million inhab- of factors, including migration by health lic Health Supplies (Strategic Fund) and the itants, is dealing with a sociopolitical and workers and scarcity of medicines and PAHO Revolving Fund, which facilitates economic situation that has had a negative health supplies. This situation has affected vaccine procurement. This response was impact on its social and health indica- the general functioning of the health system strengthened in December 2017 by acti- tors. Outbreaks of diphtheria, measles, and its capacity to respond rapidly to emer- vating the Incident Command System (at and malaria have spread rapidly, affect- gencies and disease outbreaks. Despite this, PAHO headquarters and at Representative ing several states simultaneously. Other the health system does have some capacity, Offices in Brazil, Colombia, and Venezuela) areas of public health concern are HIV, which includes health infrastructure and and delivering resources from the PAHO tuberculosis, increased maternal and child human resources that can be mobilized Disaster and Emergency Fund and PAHO mortality, access to medicines, and ade- to implement immediate actions when Epidemic Emergency Fund, as well activat- quate health care for people with chronic necessary. ing administrative procedures internally health conditions. Population movements In response to the situation in the coun- to facilitate a rapid and flexible technical have increased both within the country try, the Pan American Health Organization cooperation response to countries. and toward other countries: Argentina, has substantially intensified its technical Furthermore, in response to the various Brazil, Chile, Colombia, Ecuador, Guyana, cooperation with the Ministry of Health of public health problems, PAHO has deployed Peru, and Trinidad and Tobago in partic- Venezuela to strengthen the management technical and multidisciplinary field mis- ular. In 2017, over 2.3 million Venezuelans of health systems, improve communicable sions since November 2016 that include migrated to other countries. This includes and noncommunicable disease prevention mobilizing over 60 employees and setting more than 1.53 million going to South and control, and improve disaster manage- up six field offices (five in Colombia and American countries, increasing public ment and the procurement of medicines, one in Brazil). The experience embodied in health concerns.1 vaccines, laboratory reagents, and other these country mission teams and field offices Venezuela’s health system is currently supplies for health programs through the encompasses a range of technical areas such

12 September 2018 Issue 127 Member Countries

Member Countries Member

13 127 Issue 2018 September

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the building more environment-friendly environment-friendly more building the higher resist to buildings modifying include These personnel. additional deployed has

events like this in the future, and to make make to and future, the in this like events toolkit this in recommended practices best it where areas, border in offices field lished

drew on the Smart Hospitals Toolkit. The The Toolkit. Hospitals Smart the on drew - estab has and Tobago), and Trinidad and the hope of limiting the harm caused by by caused harm the limiting of hope the

The notion of “rebuilding better” here here better” “rebuilding of notion The Peru, Guyana, Ecuador, Colombia, zil, rebuilding the nursing home’s facilities in in facilities home’s nursing the rebuilding

(DFID) and the Canadian government. Canadian the and (DFID) - (Bra countries neighboring Venezuela’s in gin Islands showed great commitment to to commitment great showed Islands gin

Department for International Development Development International for Department response its intensified also has PAHO - Vir British the of government The

cial support from the United Kingdom Kingdom United the from support cial Fund. Strategic and Fund Revolving PAHO water use as well. as use water

- finan with Organization Health American the through vaccines and medicines of tity aerators were also incorporated to reduce reduce to incorporated also were aerators

The rebuilding was done by the Pan Pan the by done was rebuilding The - quan significant a purchase to Venezuela LEDs. Low-flow toilets and faucets with with faucets and toilets Low-flow LEDs.

community and the elderly. the and community of Health of Ministry the authorized had

Islands and is very important for both the the both for important very is and Islands he that PAHO informed Maduro, Nicolás

facilities for the elderly in the British Virgin Virgin British the in elderly the for facilities President, Venezuelan the Etienne, F.

Adina Donovan nursing home is one of two two of one is home nursing Donovan Adina Carissa Director, PAHO by led Venezuela,

Virgin Islands on 6 September 2017. The The 2017. September 6 on Islands Virgin to mission high-level the During

of Hurricane Irma, which hit the British British the hit which Irma, Hurricane of Guyana. and Brazil, Colombia,

tained major damage during the passage passage the during damage major tained Venezuela, in levels subnational and

- sus facility The Tortola. in home nursing national the at missions cooperation nical

to rebuild and improve the Adina Donovan Donovan Adina the improve and rebuild to - tech 35 than more conducted has PAHO

This document is a case study of efforts efforts of study case a is document This Offices, Representative the through ground

to the solid presence established on the the on established presence solid the to

tion, and risk communication. In addition addition In communication. risk and tion,

- administra logistics, and coordination

prenatal checkups, clinical management, management, clinical checkups, prenatal

chain, infection prevention and control, control, and prevention infection chain,

Islands after Hurricane Irma Hurricane after Islands

vices management, immunization, cold cold immunization, management, vices

Donovan nursing home in the British Virgin Virgin British the in home nursing Donovan

health and laboratory services, health ser health services, laboratory and health -

reconstructing the Adina Adina the reconstructing better: rebuild to vector control, surveillance, epidemiology, epidemiology, surveillance, control, vector

as disaster management, entomology and and entomology management, disaster as PAHO/WHO publishes a case study of how how of study case a publishes PAHO/WHO The Information Management Toolkit for Emergency Operations Centers, a resource to improve Member States’ coordination and decision-making during emergencies Photo: Raul Argueta PAHO/WHO Raul Argueta Photo:

PAHO/WHO’s Emergency Operations Center at HQ, in Washington, D.C.

Information management during (IMTK) consists of a series of wall panels tems withstand the technological challenges emergencies continues to be a challenge that help at a glance to organize, visualize, that arise during emergencies, to provide for the health sector because the avail- and monitor natural threats or epidemi- better support for responses designed to able information can be limited and even ological situations that are unfolding. The meet the needs of affected populations. contradictory. Also, the information is toolkit also provides strategic day-to-day The PAHO Emergency Operations often difficult to organize, analyze, and information on response activities such as Center is promoting the use of the tool- visualize in a way that makes it useful for transportation of personnel to the field, epi- kit, initially distributing it to the countries decision-makers. In response to this prob- demiological surveillance data, laboratory currently confronting emergency health lem, drawing on practical observation and information, impact on people and health situations. The toolkit will gradually be dis- experience shared with ministries of health services infrastructure, and so on. tributed to all the Member States to support in the countries affected by emergencies The toolkit has been designed on the their operations and information manage- and disasters, PAHO has compiled and principle that “less is more” and that focus- ment during emergencies, outbreaks, and developed a toolkit for better management ing on what is basic and what is simplest is disasters. In addition, a series of workshops of information in both minor events and a practical way to analyze situations during is being planned to present the toolkit and more severe ones. health emergencies. It is expected to help train strategic personnel on its use. This Information Management Toolkit operational data collection and analysis sys-

14 September 2018 Issue 127 Information Resources NLM launches newly designed disaster information website

The United States National Library of Medicine (NLM) has launched a newly designed website for its Disaster Information Man- agement Research Center (DIMRC) and Disaster Lit® database. This new design facilitates access to key resources on both natural and anthropogenic disasters, as well as health emergencies. The Disaster Lit® database supplements the PubMed database with information on disasters and public health emergencies from hundreds of sources. Around 14,000 reports, training courses, web pages, etc., from government agencies, nongovernmental organizations, universities, and other sources, can be accessed here with a single click. Related links: • Disaster Information management research center: https:// disasterinfo.nlm.nih.gov. • Disaster Lit® database: https://disasterinfo.nlm.nih.gov/ disaster-lit. • PubMed database: https://pubmed.gov.

International Volcanic Health Hazard Network

The International Volcanic Health Hazard Network (IVHHN) samples for public health purposes: www.ivhhn.org/index.php. is an umbrella organization for all research and dissemination of information on the health hazards and impacts of volcanic eruptions. IVHHN represents academics and practitioners working across diverse scientific disciplines such as volcanology, epidemiology, environmental science, toxicology, public health, and exposure science, with a common objective of trying to determine the health impacts of volcanic emissions, and to protect exposed communities. The website of the International Volcanic Health Hazard Network has thorough information on the health effects of volcanic ash, advice on the most appropriate measures for respiratory protection, as well as methods for analysis and description of ash

Information Resources September 2018 Issue 127 15

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Disasters: Preparedness and Mitigation in the Americas is the Newsletter of the Health Emergencies Department of the Pan American Health Organization, Regional Office for the Americas of the World Health Organization. The reported events, activities and programs do not imply endorsement by PAHO/WHO, nor do the statements made necessarily represent the policy of the Organization. The publication of this Newsletter has been made possible through the financial support of the Office of Foreign Disaster Assistance of the U.S. Agency for International Development (OFDA/AID).

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Agreement.

Framework, in accordance with the Sustainable Development Goals and the Paris Paris the and Goals Development Sustainable the with accordance in Framework,

This meeting will discuss key issues to accelerate implementation of the Sendai Sendai the of implementation accelerate to issues key discuss will meeting This

https://www.unisdr.org/conference/2018/efdrr

21-23 November 2018, Rome, Italy Rome, 2018, November 21-23

European Forum on Disaster Risk Reduction Risk Disaster on Forum European

emergency preparedness, and antimicrobial resistance in hospitals will be discussed. be will hospitals in resistance antimicrobial and preparedness, emergency

agement in health. Issues such as quality of care for chronic diseases, accreditation, accreditation, diseases, chronic for care of quality as such Issues health. in agement

in collaboration with the League of Arab States and the African Union Commission. Commission. Union African the and States Arab of League the with collaboration in - man risk and quality facing challenges new the discuss to States United the and

the platform is organized by the United Nations Office for Disaster Risk Reduction Reduction Risk Disaster for Office Nations United the by organized is platform the HAC2018 will bring together health professionals and speakers from Latin America America Latin from speakers and professionals health together bring will HAC2018

Focusing on knowledge about disaster risk for inclusive sustainable development, development, sustainable inclusive for risk disaster about knowledge on Focusing http://hac.fiu.edu

1-2 November 2018, Cali, Colombia Cali, 2018, November 1-2 https://www.unisdr.org/conference/2018/afrp-acdrr

9-13 October 2018, Tunis, Tunisia Tunis, 2018, October 9-13 in health in

HAC2018 + 3rd Latin American Forum – ISQua. New challenges in quality and risk management management risk and quality in challenges New ISQua. – Forum American Latin 3rd + HAC2018 Reduction Risk on Meeting High-level and Reduction Risk Disaster on Platform Africa-Arab

Events Upcoming