Chan E Y Y, Sondorp E
London School of Hygiene and Tropical Medicine, Health Policy Unit, Department of Public Health and Policy, Keppel Street, London WC1E 7HT, UK.
Asia Pac J Public Health. 2007;19 Spec No:45-51. doi: 10.1177/101053950701901S08.
Although natural disasters may cause massive loss of human life and destruction of resources, they also present affected populations with a rare opportunity to access external resources. Nevertheless, many post-disaster medical relief intervention programmes only focus on the provision of acute medical services and the control of communicable diseases. Currently, no specific study has examined why chronic medical needs seem to be insufficiently addressed in disaster relief interventions. This paper review current knowledge about how natural disasters affect people with chronic medical needs, assess possible factors in disaster preparedness and response that pre-empt addressing chronic medical needs and suggest possible ways to overcome these barriers. Unawareness and insensitivity of relief workers towards chronic medical conditions, the practice of risk rather than need-based assessments, a focus on acute needs, the lack of reliable indicators and baseline information, and the multidimensional characteristics of chronic medical problems all pose serious challenges and probably deter the government and post-disaster relief agencies to deal with diseases of a chronic nature. It is important to increase the awareness and sensitivity of the stakeholders towards chronic medical problems during all phases of planning and intervention. Relevant assessment tools should be developed to rapidly identify chronic medical needs in resource deficit settings. Community partnership and collaboration that promote local ownership and technical transfer of chronic disease management skills will be essential for the sustainability of services beyond the disaster relief period. Potential programmes might include the technical training of local staff, establishment of essential drug and supply lists, and the provision of a range of medical services that may address chronic health needs.
尽管自然灾害可能会导致大量人员伤亡和资源破坏，但它们也为受灾民众提供了获取外部资源的难得机会。然而，许多灾后医疗救援干预计划仅侧重于提供急性医疗服务和控制传染病。目前，尚无具体研究探讨为何在救灾干预中慢性医疗需求似乎未得到充分解决。本文回顾了当前有关自然灾害如何影响有慢性医疗需求人群的知识，评估了在备灾和应对过程中可能阻碍解决慢性医疗需求的因素，并提出了克服这些障碍的可能方法。救援人员对慢性疾病状况缺乏认识和敏感度、采用基于风险而非需求的评估做法、专注于急性需求、缺乏可靠指标和基线信息，以及慢性医疗问题的多维度特征，都构成了严峻挑战，可能阻碍政府和灾后救援机构应对慢性疾病。在规划和干预的各个阶段，提高利益相关者对慢性医疗问题的认识和敏感度非常重要。应开发相关评估工具，以便在资源匮乏地区快速识别慢性医疗需求。促进当地自主权和慢性病管理技能技术转让的社区伙伴关系与合作，对于灾后救援期之后服务的可持续性至关重要。潜在的计划可能包括对当地工作人员进行技术培训、制定基本药品和物资清单，以及提供一系列可能满足慢性健康需求的医疗服务。
