Completely unprepared for disasters: the hospitals in Chennai — private as well as government — were particularly vulnerable, improvising solutions as the situation developed. At least 13 primary health centres in Kancheepuram and Tiruvallur districts were affected. The Tambaram Taluk Hospital in Chromepet ran outpatient (OPD) services from a wedding hall for two days after evacuating many of its inpatients to other hospitals.

Water had entered the ground floor of the ESIC Hospital in K.K. Nagar too.

Patients were shifted to a higher floor. But the worst affected was MIOT International, where 18 patients on ventilator support died on December 2 and 3, as per the Health Secretary’s press release. Within days, police registered a case under section 174 of the Criminal Procedure Code (Cr.PC) against the hospital. The post-mortem reports are likely to be submitted this week.

The floods in Chennai bring to the fore the need for stricter implementation of hospital safety standards. The last time this topic was debated was after what has come to be known as the ‘AMRI fire tragedy.’ In December 2011, around 3 a.m. a fire broke out in the basement of the seven-storey hospital in Kolkata — Advanced Medical Research Institute (AMRI) Hospitals. By morning, 90 patients had choked to death.

A few months before the AMRI tragedy, Kavita Narayan, a disaster management expert trained by the Federal Emergency Management Agency (FEMA), along with some of the best minds in the country — structural engineers, doctors and specialists in hospital design — had written a policy document that laid out in great detail what was expected of medical and non-medical staff in case of any disaster.

Every single one of the 111 pages of Hospital Standards Safety Committee had answers that could have saved lives. The document had exhaustive instructions to doctors, nurses, and management about how to plan and evacuate in case of emergency. It even laid out how and where to store which equipment; how to avoid flooding in critical units; the norms of fire safety, etc. The document has been gathering dust since December 2013, when it was submitted to the National Disaster Management Authority (NDMA).

In an ideal situation, the response begins soon as water levels start rising or, as in the case of AMRI, the fire was spreading.

In Tamil Nadu, the private sector currently caters to roughly 60 per cent outpatient services, and 40 per cent of in-patient services, as per the State Health Department. The Clinical Establishments (Registration and Regulation) Act, 2010 — enacted by the Central Government — which prescribes minimum standards to be followed has not been notified by Tamil Nadu because they already have a State Act. As of now, the Central Act is notified only in four States — Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim and all union territories except Delhi.

While the State has an Act in place to regulate private players, expecting any norms and standardised care from private hospitals is like building castles in the air.

Here is why: for nearly 18 years, the Tamil Nadu government has been sitting on The Tamil Nadu Private Clinical Establishments (Regulation) Act, 1997. The Act came into force in April 1997, the rules for it are yet to be notified.

The State government has three options: either adopt the Central Act, or enact its own or, lastly, make changes on the existing Act governing clinical establishments. Tamil Nadu has done none of this.

“We actually got the idea for the Central Act from Tamil Nadu. We were hoping it will pressure the State government to implement the existing law, if the Centre also passes it. Tamil Nadu passed the Act in the Assembly. Since then, it has been in animated suspension. We kept pushing for it but the lobby of private hospital owners is so strong that no progress has been made for nearly two decades.” said Sunil Nandraj, who was an adviser to the government as the Clinical Establishments Act was drafted.

Health Secretary J. Radhakrishnan said: “We are in the final stages of framing the rules for the Act. Several meetings have already been held with all stakeholders, and the rules will be notified shortly.”

With even minimal standards lacking, enforcing disaster preparedness is a far cry in India, Ms. Narayan said. “The draft hospital safety document has very specific rules — to the extent of specifying exact locations of storing emergency equipments. We do not follow any of this because India currently does not have a policy for this,” she said.

As the weather returns to normalcy in Chennai, the citizens should ask the question whether medical culture as well as governance in this country is willing to accept the virtues of regulation in the interest of patient safety.

Otherwise, this is the grim reality of Indian hospitals: they harm as much as they heal.

source: thehindu.com

2015 has been a formative year for climate change and disaster management efforts. The Sendai Framework for disaster risk reduction was adopted this year, and it culminates with COP 21 - which aims to attain a global climate agreement.

The UN World Conference on Disaster risk reduction took place in Sendai, Japan last March, which brought together government and civil society representatives from around the globe to discuss ways to achieve sustainable development by managing disaster and climate risks better. And UNFCCC's 21st International Conference of Parties (COP 21) is currently taking place in Paris with the aim of reaching a binding agreement for reducing emissions and keeping global temperature rise below 2 degrees.

It was only appropriate that these two events took place on the same year, as climate change and disaster risk are indispensably linked. A recent UNISDR study shows 90% of natural disasters are weather related. Climate change is exacerbating disasters - as evidenced by more frequent and intense climatic events such as floods, cyclones and droughts in vulnerable regions.

"It is important to bring the disaster agenda with the climate change agenda going forward," said Dame Julia Slingo, chief scientist at the UK Met Office. "Forewarned is better than forearmed," she said, adding that while prediction may not be possible, preparedness such as early warning can go a long way in improving resilience to disasters. She highlighted the importance of access to better information in the context of increasing frequency and intensity of disasters due to climate change.

"Climate change is an issue that is very much a part and parcel of the Sendai Framework," said Anote Tong, President of Kiribati, which is facing unprecedented floods, inundation and salt water intrusion. The islands on average are about 2 meters above sea level and many of the communities have to change their way of life to adapt. "Our experience this year with cyclone Pam represented that the most devastating risks would be from the changing weather patterns," he said. "We don't want to be duplicating the processes at Sendai and Paris, we want to make them as effective as possible".

To be effective in reducing the risks from disasters and climate change, inter-ministerial cooperation is required, according to Manuel Pulgar Vidal, Minister of Environment of Peru and the president of COP 20. "We are used to organize our public agencies by sectors in an isolated way," he says, "but we need a cross cutting way of governance to strengthen our government's ability to reduce disaster and climate change risks."

Abdullah Majeed, Minister of Environment and Energy, Maldives, stressed the importance of public funding for strong preparedness. "Disasters and climate change need to become priorities not just for disaster management and environment ministries, but for finance ministries as well," he says.

Given the scale of climate change impacts and disasters, efforts from the government or development organizations alone are no longer adequate. "National efforts need to be augmented by regional cooperation," says Majeed. His nation Maldives is in the Asia Pacific which is the most disaster prone region of the world and has faced over USD 200 billion worth of damage from disasters. The IPCC in its last two assessment reports have said that the poorest of the poor will be worst affected by climate change. Most small island developing states such as Maldives lack the capacity to address the disasters they are facing and are in dire need of international assistance and regional support.

"We agreed on 7 global targets [for disaster risk reduction] to be achieved by 2030 to reduce the impact of disasters. One of the targets is ready to be achieved by 2020," said Margarita Wahlstrom, Special Representative of the Secretary-General (SRSG) for disaster risk reduction, referring to countries having national and local plans for disaster risk reduction.

With the extensive loss of lives and property brought about natural disasters around the world, Sendai Framework's objectives are crucial to improving disaster preparedness and thus reducing risks in the short term. However, to reduce vulnerability and reach long term sustainable solutions, there needs to be increased focus on integrating disaster preparedness efforts with climate change mitigation and adaptation interventions. Sendai framework has been the first step towards doing so. And a strong agreement in Paris can give the finishing touch.

source: http://www.huffingtonpost.com