Rapid Assessment Survey of Earthquake Affected Bhuj Block Of

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The effect of talking, reading and silence on the professionals from the subcommittee of RAPID ASSESSMENT SURVEY OF EARTHQUAKE AFFECTED BHUJ “White coat” phenomenon in hypertensive patients. professional and public education of the american BLOCK OF KACHCHH DISTRICT,* GUJRAT, INDIA Am J hypertens 1998;11:203-7. heart association council on high blood pressure 13. Scriven AJ, Brown MJ, Murphy MB, Dollery CT. research. Circulation 2005;111:697-716. A. T. PAWAR, S. SHELKE, V. A. KAKRANI Changes in blood pressure and plasma 21. Décio MJ, Geraldo Pierin AM, Ines L, Fernando N. catacholamines caused by tyramine and cold Devices and Techniques for Blood Pressure ABSTRACT exposure. J Cardiovasc Pharmacol 1984;6:954-60. Measurement and Criteria for Hypertension 14. Potter JF, Watson RD, Skan W, Beever DG. The Adopted by Brazilian Physicians. Explorat Study RESEARCH QUESTIONS: How much human loss would have caused by the earthquake pressor and metabolic effects of alcohol in Arq Bras Cardiol 2002;1:79 in Bhuj block? What is the environmental sanitation status? OBJECTIVES: (1) To assess normotensive subjects. Hypertension 1986;8:625- 22. Canzanello VJ, Jensen PL, Schwartz GL. Are human loss and injuries after the earthquake in Bhuj block.(2) To study the status of 31. aneroid sphygmomanometers accurate in hospital some relief activities.(3) To study the environmental sanitation status of the earthquake 15. Neeta RT, Smiths P, Lenders JW, Thein T. Does it settings. Arch Intern Med 2001;161:729-31. affected Bhuj block. STUDY DESIGN: Cross-sectional study. SETTINGS: Bhuj block. matter whether blood pressure measurement are 23. Kantola I, Vesalainen R, Kangassalo K, Kariluoto A. PARTICIPANTS: All villages excluding Bhuj city of Bhuj block. STATISTICAL ANALYSIS: taken with subjects sitting or supine? J Hypertens Bell or diaphragm in the measurement of blood Proportions, chi-square test, chi-square for trend. RESULTS: Survey was done in 144 1998;16:263-8. pressure? J Hypertens 2005;23:499-503. villages; there were total 541 deaths with death rate of 3.18 per 1000 population. 16. Wall manning HJ, Pauline JM. Effect of arm position 24. McKay DW, Campbell NR, Parab LS, Chokalingam Death rate was significantly associated with distance of village from epicenter (chi- and support on blood pressure reading. J Clin A, Fodor JG. Clinical assessment of blood square for trend significant, P < 0.001). Among victims, majority were children 171 Hypertens 1987;3:624-30. pressure. J Hum Hypertens 1990;4:639-45. (45.4%) and women 107 (28.4%). Relief work was significantly associated with 17. Russel AE, Wing LM, Smith SA, Aylward PE, Ritchie 25. Prineas RJ. Measurement of blood pressure in the accessibility of village (P < 0.001) and few interior pockets were deprived of help. RJ. Optimal size of cuff bladder for indirect obese. Ann Epidemiol 1991;1:321-36. Total 56 (38.9%) villages were entirely dependent on water tanker for water supply measurement of arterial pressure in adults. J 26. Jamieson MJ, Webster J, Philips S, Jeffers TA, and in 61 (42.4%) villages drinking water was used without chlorination. In 142 (98.6%) Hypertens 1989;7:607-13. Scott AK, Robb OJ, et al. The measurement of villages open-air defecation was practiced. Diseases such as URTIs, diarrheal diseases, 18. Neufeld PD, Jhonson DL. Observer error in blood blood pressure: sitting or supine, once or twice? J fever and conjunctivitis were commonly observed in the field area. pressure measurement. Can Med Asso J Hypertens 1990;8:635-40. 1986;135:633-7. 27. Ali S, Rouse A. Practice audits: reliability of 19. Baily RH, Bauer JH. A review of common errors in sphygmomanometers and blood pressure recording Key words: Bhuj block; earthquake; rapid assessment the indirect measurement of blood pressure. Arch bias. J Hum Hypertens 2002;16:359-61. Intern Med 1993;153:2741-8. 28. Kay LE. Accuracy of blood pressure measurement 20. Pickering TG, Hall JE, Appel LJ, Falkner BE, in the family practice center. J Am Board Fam Pract. Graves J, Hill MN, et al. Recommendations for 1998;11:252-8. On Friday, 26 January 2001, around ravaged the state of Gujarat. The earthquake blood pressure measurement in humans and 29. Reevs RA. Does this patient have hypertension? 8.46 a.m., when Indian Republic Day of intensity 6.9 Richter scale flattened Bhuj experimental animals: part 1: blood pressure How to measure blood pressure. JAMA celebration was underway, one of the most city and badly struck Bhachau, Anjar, Rapar measurement in humans: a statement for 1995;273:1211-8. devastating natural calamities of our time and Gandhidham blocks of Kachchh district and spread over radius of 200 km.

Department of P. S. M., B. J. Medical College, Pune, Bhuj, once a historical town and vibrant India market, became a death trap, neither the Correspondence A.T. Pawar, 8/B-1, Sawantnagari Co-op Housing Society, military station nor the air force camp Bopodi, Pune-3, India, escaped quakes fury. Hundreds of NGOs and E-mail: [email protected] thousands of volunteers from India and *Paper presented at 31st Annual National abroad traveled a great distance to help Conference of IAPSM, 27–29 March 2004, victims and assisted thousands of people in Chandigarh. rebuilding their lives.

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Along with many deaths and severe injuries local guide, who were familiar with local considering emergency situation of while 28.4% were adult females and 10% requiring medical intensive care increased language and locality by ‘Kachchh Navnirman earthquake; it was not practically feasible to were adult males. Thus, children and females risk of communicable diseases remains a Abhiyan.’ Each team carried a kit of essential approach any ethical body. comprised 81.6% of deceased. potential risk following natural disasters. This medicine with them. is mainly due to overcrowding and Collected data were presented in tables and Relation of human loss against distance from deterioration in environmental hygiene Each team was allotted a defined geographic graphs and analyzed by using appropriate epicenter shows attenuation tendency as particularly affecting water supply and area. A map of Bhuj block compiled by statistical tests. Data generated in the present distance from epicenter increases death rate disposal of human wastes. This again CMAG-EPC earthquake technical assistance study were qualitative data. To test the goes on decreasing [Table 2, Figure 1]. Death depends upon previous sanitary levels of cell was given to each team. A proforma was association between two qualitative variables rate in villages, at a distance 30–35 km from area.[1] Diarrheal diseases are a major cause prepared for recording data from each village chi-square test was used. To test the trend epicenter, was exceptionally high, i.e., 8.52 of mortality and morbidity in emergencies; regarding human and animal deaths and of death rate along with increasing distance per 1000 population. This was due to town hence continuous check on water supply and injuries, available water sources, chlorination from epicenter chi-square for trend was used. Sukhpar, which was urban area with disposal of human wastes are of utmost of water, sanitation facilities, illness if any, population of 10 000, with many multistory importance.[2] necessities of villagers, status of relief RESULTS building and reported 165 deaths at death activities, etc. rate of 16.5 per 1000 population and hence The process of assessment is as essential Total 144 villages, 128 from Bhuj block and death rate in this category was high. in relief work as in developmental work, A team approached each village and 16 from adjacent blocks, were surveyed. We though in emergency we cannot wait to find identified key informants such as local came across nine uninhabited villages during To assess status of relief activities, three out all available information before leaders (Sarpanch) and teachers. Data were our survey. Population of these villages was parameters, i.e., restoration of electricity, responding.[3] Rapid initial assessment to collected by interviewing key informants as approximately 170 000. Total deaths reported identify immediate problems in affected area well as through group discussions. Data from these villages were 541, giving death Table 2: Effect of distance from epicenter on death rate should be done.[4] So rapid assessment regarding environmental and water sanitation rate about 3.18 per thousand population. Total Distance from No.of survey of earthquake affected Bhuj block was conditions were collected by exploratory walk. 1412 injuries were reported from these 144 epicenter Population No. done, to assess human loss and injuries after People with disease if any were examined villages, while five persons were missing. 0–5villages 8 deaths rate 5952 81 302 13.6 of Injuries D earthquake, to study environmental sanitation and given medicines. There were 769 animal deaths. 5–10 9 10 085 80 241 7.93 10–15 7 6700 21 43 3.13eath status of earthquake affected Bhuj block and 15–20 15 7490 21 37 2.8 20–25 8 8878 10 17 1.12 status of some relief activities. Present study was planned in emergency at Out of total 541 deaths in area, age, and sex 25–30 11 14 170 15 16 1.05 head office of ‘Kachchh Navnirman Abhiyan’ composition of 376 was available; [Table 1] 30–35 12 21 120 180 532 8.52 35–40 17 33 453 6 14 0.17 MATERIALS AND METHODS one of the nodal NGO involved in relief work. age and sex composition of 165 deaths from >40 57 62 208 127 210 2.04 Along with team members, representatives of Sukhpar town was not available. Among Total 144 170 056 541 1412 3.18 χ2 A rapid assessment survey was done in Bhuj ‘Kachchh Navnirman Abhiyan’ actively deceased, majority of them, i.e., 171 for trend = 386.5; df = 6; P < 0.001, highly significant. block of earthquake affected Kachchh district participated in planning present study. Social (45.4%), were children below 14 years of age, during a period of 6–10 February 2001. scientists of Tata Institute of Fundamental 15 ‘Kachchh Navnirman Abhiyan’ one of the Research approved the study design. As Table 1: Age and sex composition of deceased 10 nodal NGO involved in relief work provided present study does not consist any kind of Group Male (%) Female (%) T 5 all essential assistance throughout study. intervention or procedure that ethically cannot death rate Children (0–14) N.A. N.A. 171 (45.5) Survey was done by a group of 18 people (15 be approved. Planning committee decided to Adolescent (14–19) 12 (3.2) 29 (7.7) 41 (10.9) 0 Adult 38 (10.1) 107 (28.4) 145 (38.6) otal (%) 0- 5- 10- 15- 20- 25- 30- 35- >40 doctors and three paramedical workers from go with study without any ethical approval. Old 6 (1.6) 13 (3.4) 19 (5.0) dit f i t Pune), who were divided into five teams. Each Also due time constraint and lack of facilities Total 376 Figure 1: Relation of death rate with distance from team was provided one volunteer and one to approach any ethical committee *Percentage in each cell shows percentage to grand total. epicenter

Indian J Med Sci, Vol. 59, No. 11, November 2005 Indian J Med Sci, Vol. 59, No. 11, November 2005 INDIAN JOURNAL OF MEDICAL SCIENCES 491 492 EARTHQUAKE IN BHUJ, GUJARAT help provided by NGOs and food distribution was shortage of tent and blankets. While assessing environmental sanitation with epicenter 20 km northeast of Bhuj hited from public distribution system (ration) were status of villages, it was observed that the the western state of Gujarat. Total 7906 considered [Table 3 & 4]. Villages with State government of Gujarat was supplying practice of open-air defecation was almost villages from 182 blocks from 21 districts kachha (mud) approach road were considered food materials to earthquake victims through universal in the area. In 109 villages, there were affected taking death toll of 20 005.[5,6] as hard to reach interior pockets. It was its public distribution system. About 15 (68%) was no concept of sanitary latrines. In 17 Kachchh district alone reported 18 416 observed that relief activities in interior villages with kachha road had not received villages, sanitary latrines were provided by deaths, which was almost 92% of total villages were inadequate. food from public distribution system till the NGOs prior to quake but 90% of them were human loss.[5] time of survey. All these relief activities were damaged in quake. In 142 (98.6 %) villages, Of the total 144 villages surveyed 90 (62.5%) significantly associated with condition of majority of people were practicing open-air In the present study, 541 deaths were villages had pucca (tar) approach road, while approach road to village (P < 0.001). defecation. In most of temporary settlement reported from 144 villages giving death rate 54 (37.5%) were having kachha (mud) camps, there was no provision of sanitary of 3.18 per 1000 population. According to approach road. In 28 (51.8%) villages with Of these 144 villages 21 (14.6%) villages latrines and people have to go for open-air Japanese agency, death rate in Kachchh kachha approach road, electricity was not were depending entirely on local sources defecation. Authors were like to throw light on district was 12.1 per 1000 people. Bhachau restored. While, in only 16 (17.8%) villages such as well, tube-well, and lake for water. very alarming and surprising fact that most taluka suffered highest ratio of human loss with pucca (tar) approach road electricity was In 51 (35.4%) villages, water was provided by of the volunteers and even doctors working amounting to 6.47%.[7] Fewer death rates not restored. This difference is statistically pipeline of these 13 (9.0%) villages were in the area had no other option than open-air were observed in our study this can be significant (P < 0.001). having local sources of water in addition to defecation. This can be attributed to the fact attributed to fact that, majority of deaths were pipeline [Figure 2]. In 22 (15.3%) villages that most of the teams of doctors, who in Bhuj city and we surveyed rural area. In Among villages with kaccha (mud) approach water-carrying pipeline was damaged due to visited the area, were without public-health rural area people had left for their work in field road nine villages received inadequate help quake and now these villages have to depend experts and sanitarians. Fortunately due to in early morning and many people were from NGOs, while two villages received no on water tanker for water. Of these 144 scarcity of water in Kachchh region of attending Republic day celebrations in help at all. In this study, adequate help was villages only 65 (45.1%) villages were Gujarat, there was no breeding of mosquitoes. schools. UNDP reports similar finding. defined as supply of one tarpaulin per family, receiving adequate water so as to take daily According to this report, in Kachchh district, two blankets per family and food materials bath. Separate pipelines for high caste and During survey 169 cases of upper respiratory 69% of human loss occurred in urban area for 15 days for family. Ideally tent per family low caste people were unique picture tract infections, 36 of diarrheal diseases, 57 and 31% in rural area. The cause of more and blanket per person was required but there observed in few villages. When asked about cases of fever, and 46 of conjunctivitis were fatalities in urban areas can be explained by the chlorination it was revealed that in 61 identified and treated [Figure 3]. multistory dwellings and apartments Table 3: Effect of road status of village on electricity (42.4%) villages chlorination was not destroyed in urban area and streets filled with Electricity restoration practiced. Most of the organizations providing DISCUSSION enormous amount of debris which made Road status Yes No T [8] Pucca road 74 16 90 relief materials were distributing chlorine search and rescue more difficult. Kachha road 26 28 54 tablets but they were not insisting on the use In the morning of 26 January 2001 an Total 100 44 144 otal of these tablets. earthquake of intensity 6.9 Richter scale, Children and females comprised 81.6% of χ2 = 11.17; df = 1; P < 0.001. deceased. Among deceased 45.4% were Table 4: Effect of road status on relief activities children and 36.2% were females thus

Road No. of voluntary Help agencies* from Govt./ received** Food from PDS local sources 15% together they formed 81.6% of deceased. 35% URTI 35% tanker 19% According to 1991 census, in total, they status Diarrhea 51% tap Fever [9] villages 54% comprise (64.4%) of population. The quake Pucca road 90Inadequate 2 88 83 7 15% tap damaged Conjunctivitis Kachha road 54 11Adequate 43 Yes No 39 15 12% struck at 8.46 in the morning, when women Total 144 13 131 122 22 15% have engaged themselves in ‘care sector’ *χ2 = 11.41; df = 1; P < 0.001; H.S. **χ2 = 8.94; df = 1; Figure 3: Pie diagram showing diseases observed in P < 0.001 H.S. Figure 2: Pie chart showing sources of water community activities such as preparing meals, washing

Indian J Med Sci, Vol. 59, No. 11, November 2005 Indian J Med Sci, Vol. 59, No. 11, November 2005 INDIAN JOURNAL OF MEDICAL SCIENCES 493 494 EARTHQUAKE IN BHUJ, GUJARAT clothes and house cleaning. Under five year cases of diarrhea, 49 cases of fever, and 71 3. Public health team, emergencies department, 7. Hirosaki.org [homepage on the internet] Outline of olds were with them; therefore, there was of conjunctivitis in Bhuj on 14 March 2001 Oxafam. Oxafam Guidelines for hygiene promotion Damage survey. In Comprehensive Survey of the incidence of more fatalities among women but no case of URTI has been reported.[10] The in emergencies. Suzzane Ferron: February 1998. 26 January 2001 Earthquake (Mw7.7) in the State relative to males. It means that during WHO reported that at the onset of disaster p. 2-6. of Gujarat, India, 117 p. 51-5. Available from: http:/ emergency this group is at more risk. epidemic, a concern but no major epidemic 4. Savic S. Principles of Post disaster evaluation. In: /www.st.hirosaki-u.ac.jp/~tamao/Gujaratweb. Disaster Management Report of workshop 8. UNDP.Org[homepage on the internet] UNDP Bhuj had occurred, although, some expected cases organized by Director general of Health services, site, Available from:www.undpquakerehab.org/ - There was inverse relationship between the of diarrheal diseases and acute respiratory Ministry of Health And Family welfare, Government 9. Census of India. District census handbook of distance of village from epicenter and death tract infections had been noted.[11,12] Of India: Nagpur; 1986. p. 88-107. Kachchh district. Govt. of India: 1995. rate. The same observation has been reported 5. Government of Gujarat. Org [homepage on the 10. United Nations Disaster Assessment and [7] by the Japanese agency. It can be From this study, it can be concluded that internet] A preliminary report on the earthquake Coordination (UNDAC) team. Bhuj, Gujarat, India: concluded from this observation that in early rapid assessment survey is important tool in damage in Gujarat presented to Joint assessment Final report; 17th February 2001. days of emergency village near epicenter providing information for planning relief mission of the world bank and Asian development 11. Weekly situation report No. 74. Government of need more attention. In the villages at a activities and rapid assessment survey bank. February 2001. Available from: http:// India. Ministry Of Agriculture. Department of distance more than 45 km death rate should be done within first 2–3 days of www.gujaratindia.com/ agriculture and cooperation. 20th March 2001. observed was little high. These included emergency. From observations in study, it is 6. UN.org [monograph on the internet] Gujarat 12. WHO.org [homepage on the internet]. WHO mainly villages from Khavada area of Bhuj recommended that there should be co- earthquake- Fact sheet. Available from: activities following the earthquake from 26 Jan-30 block. In this area due to cold people were ordination between NGOs/agencies providing www.un.org.in/UNDMT/states/gujarat/ June. Available from: http://w3.whosea.org/gujarat/ at home in the early morning at the time of relief work and each NGO should shoulder updates.html finalreportf.html earthquake, also this region the houses were specific responsibility in specific geographic made of mud, which totally collapsed in region to avoid duplication of services and earthquake. missing some interior pockets.

In the early days of emergency, there were ACKNOWLEDGMENT many gaps and overlaps in providing relief work. Due to difficult roads, many hard to Authors express their sincere gratitude to authorities of reach interior pockets were deprived of help Janpath citizen’s initiative and Kutch Navnirman Abhiyan while few villages on high ways received help or providing all essential help for present study. The co- in excess. Some of volunteers and NGOs operation extended by Dr. Prasad Rajhans (team were in so hurry of providing help that they leader), Secretary Emergency Medical Services, Pune, in study and preparing paper is also acknowledged. really dumped the relief material in villages. Thanks are also due to all our team members, NGO representatives for their participation in study. URTI, diarrheal diseases, fever and conjunctivitis were commonly observed REFERENCES disease during survey. After earthquake, houses were either collapsed or damaged and 1. Chandra S. Disaster and Disaster warning system. people were living in temporary shelters. Essentials of community medicine. New central There was overcrowding hence there may be Book agency: Kolkata; 1997. p. 106-12. more cases of URTI and conjunctivitis 2. Park K. Park’s textbook of Preventive and Social especially in children. National disaster Medicine.17th edn. Jabalpur: Mrs. Banarsidas management cell of India had reported 32 Bhanot Publishers; November 2002. p. 569-73.

Indian J Med Sci, Vol. 59, No. 11, November 2005 Indian J Med Sci, Vol. 59, No. 11, November 2005