Briefly Noted is a short PAHO/WHO monthly bulletin containing disaster news and notes. Please feel free to share this message with colleagues. To subscribe, send your name, organization and email address to disaster-newsletter@paho.org.

Our print newsletter, Disasters: Preparedness and Mitigation in the Americas is now published twice a year in September and March, allowing time and space for in-depth articles, interviews and other forms of technical support for disaster management. Back issues are online at www.paho.org/disasters.

Toolkit Being Developed to Deal with
Pandemic Influenza

PAHO/WHO has been working with Caribbean countries to coordinate a number of activities designed to prepare for an influenza pandemic. The main thrust has been the development and testing of a National Influenza Pandemic Plan, advocacy for the participation of non-health actors in these activities—particularly national disaster and uniformed forces—and strengthening the readiness of health institutions by developing and training in various protocols designed to promote hospital and health center capacity to respond to emergencies.

Among the novel approaches taken by the project is the collaboration, with partners working on avian and pandemic preparedness activities, to develop a toolkit aimed at mayors or civic leaders who may find themselves having to deal with a panicked community and with little additional help from outside. This collection of guidelines gives the non-technical reader enough information to prepare a small community for the pandemic. It is designed to complement national pandemic plans and while it does not include hospital or health center arrangements which would be covered in the national plan, it does have information for the householder on how to prepare for a pandemic including what to do with a sick person at home.

All the English and Dutch-speaking countries of the Caribbean have developed a national plan for pandemic and most have trained outbreak response teams to investigate suspected human cases of avian or pandemic influenza. At present, countries are looking to strengthen their hospital safety plans by including provisions for a pandemic.

The Loss of a Health Center is a Social
as Well as an Economic Issue

Nationwide, most hospitals and health facilities in Costa Rica were spared massive damage from the January 8th earthquake. However, several small health centers did suffer severe structural damage and are beyond repair. The village of Poasito lost its community health center, where an integrated health team labored to improve access to primary care. Similar centers in the small towns of Cinchona and Vara Blanca were also destroyed or seriously affected.

The loss of these health centers has had an enormous social impact on the affected population, as they were built with the communities’ own efforts and resources.

Close to the epicenter of the earthquake, other health facilities that were well built and had received proper maintenance withstood the impact and suffered very little damage, showing that it is possible to make health facilities disaster-resilient.

The silver lining of this earthquake is that Costa Rica now has the opportunity to build new health facilities in safe areas that were not affected, using “safe hospital” norms and rules, so that the communities can have access to health services when they are most needed. It is also the time for hospitals and other health facilities to revise and update their emergency plans, and conduct courses and simulations to train their personnel in disaster and emergency management. The window of opportunity will close in a few weeks; disaster memories are short, and the (very human) trend is that everything is forgotten, and nothing is done until the next earthquake occurs.

The Earthquake in Poas, Costa Rica:
Has it Been Forgotten Already?

It has only been 20 days since a magnitude 6.2 earthquake shook Costa Rica on 8 January, and already it’s old news. It was one of those “minor” disasters that is profiled in the news for a few hours or days and soon disappears. The social and economic impact of the earthquake, however, will undoubtedly be felt for several months to come.

The earthquake once again proved that Costa Rica is highly vulnerable to natural phenomena and, therefore, cannot get complacent with preparedness measures, particularly prevention and disaster risk reduction. The country has estimated the economic losses at over US$ 100 million. According to official information, confirmed on 22 January by the National Emergency Commission (CNE), the earthquake’s toll was 23 deaths, 100 injured, seven missing, more than 100,000 affected, 71 communities with serious damage to vital lines (housing, water, roads): 71 and approximately 423 houses completely destroyed.

A hydroelectric plant, hotels, crops, schools, houses, health centers, highways and bridges suffered damage or were destroyed in the Poas area, considered one of the most important tourist destinations in the country. Specialists from the Costa Rican Volcanic and Seismic Observatory, after a reconnaissance flight, observed that the ecologic and environmental impact has been huge. In addition, approximately 1250 hectares of agricultural and livestock land has been affected. In economic terms, the most affected areas are tourism and agricultural exports, which represent a considerable portion of the Costa Rican income.

A Test for the National Response System

Costa Rica has a strong national structure for the management of emergencies and disasters. From the start, the CNE took control of response measures, activated an Emergency Operations Center, and deployed focal points to the affected areas. Other agencies in the national disaster response network also got to work in rescue operations, care of victims, and evaluation of damage and needs. In general, and despite some minor coordination problems at the beginning, the response was quick and efficient.

The Costa Rican Red Cross y National firefighters activated their search and rescue teams, and performed an admirable job in the care of the injured and rescue of hundreds of people who were left isolated due to the damaged roads. Electricity, water, and communications were reestablished very quickly in most of the affected areas. The cleanup and reopening of roads and highways was also very efficient. Only those areas closest to the epicenter remained without access seven days after the earthquake, due to the magnitude of landslides.

Regarding humanitarian supplies, national solidarity filled warehouses set up in locations where assistance was provided to the affected population. Food, used clothing and shoes piled up in warehouses Donations could have been handled better if, from the start, the public had been encouraged to make monetary donations.

Health Situation

The health sector activated its emergency mechanisms to provide assistance to those injured and control sanitary conditions in shelters. The Costa Rican Social Services treated approximately 1.100 injured people in their Basic Health Clinics (EBAIS), health centers or areas reserved at the shelters. Only 81 people had to be evacuated to hospitals in other cities.

In general, epidemiological surveillance and health control have been carried out efficiently, and health services during the emergency were satisfactory. After the first few days, psychosocial intervention became a priority. The Costa Rican Social Security strengthened their psychosocial service teams, and special units were deployed to shelters.

The management of dead bodies was performed according to existing protocols and guidelines available in the country. A temporary morgue was created in the San Miguel de Sarapiqui school, where forensic experts from the Judicial Investigation Agency examined, identified, and delivered the victim’s bodies to family members.

In search of a new destiny

Although the earthquake affected a rural, sparsely populated, area, several communities were severely affected. Cinchona became a ghost town, where practically all buildings were destroyed. The population was evacuated, leaving all their possesions behind.

At least 25 temporary shelters were habilitated for 3700 people. The Ministry of Health took charge of sanitary surveillance and control; initial reports indicated problems due to lack of latrines, access to safe water and waste disposal in several of those shelters. These problems, however, were quickly taken care of. By 22 January only 1500 people remained in the shelters at Poasito, Fraijanes, Heredia and Sarapiqui. Authorities are making plans to establish temporary settlements for these families, where they can stay at least six months, until a more permanent solution is found.

‘Safe Hospitals’ the Theme of Next World Health Day

World Health Day is celebrated each April 7 to mark the founding of the World Health Organization. This year, World Health Day’s theme is When Disasters Strike: Safe Hospitals Save Lives.
On this day in Latin America and the Caribbean and worldwide, countries will mark the celebration with a variety of events and activities that focus on the importance of safeguarding all health facilities—large or small, urban or rural—from the impact of disasters.

World Health Day is an opportunity to focus global attention on this important issue through media attention, outreach to other sectors and the wide dissemination of information. The ultimate goal is to ensure that everyone can count on the fact that hospitals and health services will be able to function in disasters and emergencies, when they are most needed.

This broad theme will focus primarily on three important messages:

	All health facilities must be able to withstand the physical impact of disasters.
	Critical health services must continue to function in all emergency situations.
	The health workforce must be trained and ready to deal with the particular challenges these situations impose.

PAHO/WHO is preparing a special website with a variety of materials related to World Health Day, including posters, FAQ sheets, a reading library, case studies and more. Watch for the announcement of this website soon!