Fredricks Karla, Dinh Hao, Kusi Manita, Yogal Chandra, Karmacharya Biraj M, Burke Thomas F, Nelson Brett D
1Division of Global Health and Human Rights,Department of Emergency Medicine,Massachusetts General Hospital,Boston,MassachusettsUSA.
3Dhulikhel Hospital,Dhulikhel,Nepal.
Prehosp Disaster Med. 2017 Dec;32(6):604-609. doi: 10.1017/S1049023X1700680X. Epub 2017 Aug 8.
Introduction The Nepal earthquake of 2015 was a major disaster that exacted an enormous toll on human lives and caused extensive damage to the infrastructure of the region. Similar to other developing countries, Nepal has a network of community health workers (CHWs; known as female community health volunteers [FCHVs]) that was in place prior to the earthquake and continues to function to improve maternal and child health. These FCHVs and other community members were responsible, by default, for providing the first wave of assistance after the earthquake. Hypothesis/Problem Community health workers such as FCHVs could be used to provide formal relief services in the event of an emergency, but there is a paucity of evidence-based literature on how to best utilize them in disaster risk reduction, preparedness, and response. Data are needed to further characterize the roles that this cadre has played in past disasters and what strategies can be implemented to better incorporate them into future emergency management.
In March 2016, key-informant interviews, FCHV interviews, and focus group discussions (FGDs) were conducted in Nepali health facilities using semi-structured guides. The audio-recorded data were obtained with the assistance of a translator (Nepali-English), transcribed verbatim in English, and coded by two independent researchers (manually and with NVivo 11 Pro software [QSR International; Melbourne, Australia]).
Across seven different regions, 14 interviews with FCHVs, two FGDs with community women, and three key-informant interviews were conducted. Four major themes emerged around the topic of FCHVs and the 2015 earthquake: (1) community care and rapport between FCHVs and local residents; (2) emergency response of FCHVs in the immediate aftermath of the earthquake; (3) training requested to improve the FCHVs' ability to manage disasters; and (4) interaction with relief organizations and how to create collaborations that provide aid relief more effectively.
The FCHVs in Nepal provided multiple services to their communities in the aftermath of the earthquake, largely without any specific training or instruction. Proper preparation, in addition to improved collaboration with aid agencies, could increase the capacity of FCHVs to respond in the event of a future disaster. The information gained from this study of the FCHV experience in the Nepal earthquake could be used to inform risk reduction and emergency management policies for CHWs in various settings worldwide. Fredricks K , Dinh H , Kusi M , Yogal C , Karmacharya BM , Burke TF , Nelson BD . Community health workers and disasters: lessons learned from the 2015 earthquake in Nepal. Prehosp Disaster Med. 2017;32(6):604-609.
引言 2015年尼泊尔地震是一场重大灾难，给人类生命造成了巨大损失，并对该地区的基础设施造成了广泛破坏。与其他发展中国家类似，尼泊尔在地震前就建立了社区卫生工作者网络（社区卫生工作者；称为女性社区卫生志愿者[FCHVs]），并继续发挥作用以改善母婴健康。默认情况下，这些女性社区卫生志愿者和其他社区成员负责在地震后提供第一波援助。假设/问题 像女性社区卫生志愿者这样的社区卫生工作者可用于在紧急情况下提供正式的救援服务，但关于如何在减少灾害风险、备灾和应对中最佳利用他们的循证文献很少。需要数据来进一步描述这一群体在过去灾害中所发挥的作用，以及可以实施哪些策略来更好地将他们纳入未来的应急管理。
2016年3月，在尼泊尔的卫生设施中使用半结构化指南进行了关键信息访谈、女性社区卫生志愿者访谈和焦点小组讨论。录音数据在一名翻译（尼泊尔语 - 英语）的协助下获得，逐字转录为英语，并由两名独立研究人员（手动和使用NVivo 11 Pro软件[QSR国际公司；澳大利亚墨尔本]）进行编码。
在七个不同地区，对女性社区卫生志愿者进行了14次访谈，对社区女性进行了2次焦点小组讨论，对关键信息提供者进行了3次访谈。围绕女性社区卫生志愿者和2015年地震这一主题出现了四个主要主题：（1）女性社区卫生志愿者与当地居民之间的社区关怀和融洽关系；（2）地震后女性社区卫生志愿者的应急响应；（3）为提高女性社区卫生志愿者管理灾害的能力而请求的培训；（4）与救援组织的互动以及如何建立能更有效提供援助的合作关系。
尼泊尔的女性社区卫生志愿者在地震后为其社区提供了多项服务，很大程度上没有接受任何特定培训或指导。除了改善与援助机构的合作外，适当的准备可以提高女性社区卫生志愿者在未来灾害发生时的应对能力。从这项关于尼泊尔地震中女性社区卫生志愿者经历的研究中获得的信息可用于为全球各地不同环境下的社区卫生工作者的风险降低和应急管理政策提供参考。弗雷德里克斯·K、丁·H、库西·M、约加尔·C、卡尔马查里亚·BM、伯克·TF、尼尔森·BD。社区卫生工作者与灾害：从2015年尼泊尔地震中吸取的教训。院前灾难医学。2017；32（6）：604 - 609。
