Adhikari Bipin, Mishra Shiva Raj, Babu Marahatta Sujan, Kaehler Nils, Paudel Kumar, Adhikari Janak, Raut Shristi
1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine,Mahidol University,Bangkok,Thailand.
2School of Population Health,University of Western Australia,Crawely,Australia.
Disaster Med Public Health Prep. 2017 Oct;11(5):625-632. doi: 10.1017/dmp.2016.195. Epub 2017 Apr 18.
Earthquakes are a major natural calamity with pervasive effects on human life and nature. Similar effects are mimicked by man-made disasters such as fuel crises and power outages in developing countries. Natural and man-made disasters can cause intangible human suffering and often leave scars of lifelong psychosocial damage. Lessons from these disasters are frequently not implemented. The main objective of this study was to review the effects of the 2015 earthquakes, fuel crisis, and power outages on the health services of Nepal and formulate recommendations for the future. The impacts of earthquakes on health can be divided into immediate, intermediate, and long-term effects. Power outages and fuel crises have health hazards at all stages. It is imperative to understand the temporal effects of earthquakes, because the major needs soon after the earthquake (emergency care) are vastly different from long-term needs such as rehabilitation and psychosocial support. In Nepal, the inadequate and nearly nonexistent specialized health care at the peripheral level claimed many lives during the earthquakes and left many people disproportionately injured. Preemptive strategies such as mobile critical care units at primary health centers, intensive care training for health workers, and alternative plans for emergency care must be prioritized. Similarly, infrastructural damage led to poor sanitation, and alternative plans for temporary settlements (water supply, food, settlements logistics, space for temporary settlements) must be in place where the danger of disease outbreak is imminent. While much of these strategies are implementable and are often set as priorities, long-term effects of earthquakes such as physical and psychosocial supports are often overlooked. The burden of psychosocial stresses, including depression and physical disabilities, needs to be prioritized by facilitating human resources for mental health care and rehabilitation. In addition, inclusion of mental health and rehabilitation facilities in government health care services of Nepal needs to be prioritized. Similarly, power outages and fuel crises affect health care disproportionately. In the current context where permanent solutions may not be possible, mitigating health hazards, especially cold chain maintenance for essential medicines and continuation of life-saving procedures, are mandatory and policies to regulate all health care services must be undertaken. (Disaster Med Public Health Preparedness. 2017;11:625-632).
地震是一种重大自然灾害，对人类生活和自然环境有着广泛影响。发展中国家的人为灾害，如燃料危机和停电，也会产生类似影响。自然和人为灾害会给人类带来无形的痛苦，并常常留下终身心理社会创伤的印记。这些灾害的教训往往未得到落实。本研究的主要目的是回顾2015年地震、燃料危机和停电对尼泊尔卫生服务的影响，并为未来制定建议。地震对健康的影响可分为即时、中期和长期影响。停电和燃料危机在各个阶段都存在健康危害。了解地震的时间效应至关重要，因为地震后不久的主要需求（紧急护理）与康复和心理社会支持等长期需求有很大不同。在尼泊尔，周边地区医疗保健不足且几乎不存在专业医疗服务，这在地震期间夺去了许多人的生命，并使许多人受伤情况格外严重。必须优先采取诸如在初级卫生中心设立流动重症监护单元、对卫生工作者进行重症监护培训以及制定紧急护理替代计划等预防策略。同样，基础设施受损导致卫生条件差，在疾病爆发危险迫在眉睫的地方，必须制定临时定居点的替代计划（供水、食品、定居点后勤、临时定居点空间）。虽然这些策略大多是可实施的，并且常常被列为优先事项，但地震的长期影响，如身体和心理社会支持，往往被忽视。包括抑郁症和身体残疾在内的心理社会压力负担，需要通过为精神卫生保健和康复提供人力资源来加以优先处理。此外，尼泊尔政府卫生保健服务中纳入精神卫生和康复设施也需要列为优先事项。同样，停电和燃料危机对医疗保健的影响也不成比例。在当前可能无法找到永久解决方案的情况下，减轻健康危害，特别是维持基本药品的冷链以及继续进行救生程序，是必不可少的，必须制定规范所有医疗保健服务的政策。（《灾害医学与公共卫生防范》。2017年；11:625 - 632）
