Health Information for Disaster Preparedness in Latin America
Jean Luc Poncelet
Pan American Health Organization, United States
Latin America is high risk in terms of disaster. Natural disasters include volcanic eruptions, such as Armero with 10,000 deaths in Columbia; earthquakes in Mexico and El Salvador; El Niño; and hurricanes, such as Hurricane Mitch. In October 1998 Hurricane Mitch impacted Guatemala, Belize, and part of Mexico, leaving 9,000 dead and 13,000 injured. These are large numbers for small countries that have less than 4 million inhabitants. The hurricane displaced 3 million people and caused $5 billion in damages.
Timely information is very important for disaster management. This information, however, relies mostly on a multitude of scientific groups that unfortunately do not communicate frequently among themselves. For example, Juarez hospital collapsed in a major earthquake in Mexico City in 1985, and was unable to function. The earthquake killed patients, surgeons, nurses, and the administrators who are needed to ensure that another collapse does not occur. Hospital construction needs input not only from architects, engineers, and builders but also from physicians, meteorologists, and volcano and earthquake experts.
Many specialties should work together; however the scientific community is working on a very isolated basis on very specific topics. Poor disaster management is in part due to inept collaboration. Thus, managing natural disasters is managing information. Reliable information is the most valued commodity before and after a disaster, because it allows us to save lives as efficiently as possible.
DISASTER INFORMATION IN LATIN AMERICA
The three main categories of users of disaster information in the Americas are academics and scientists, policy and decision makers, and disaster and risk managers. The disaster and risk managers influence the decision makers in taking preventive measures in a country.
The first issue that we have to deal with is the wealth of information of which little is accessible. In addition, the available information is not always applicable. Professionals in developing countries have a wealth of information that could be applicable to neighboring countries, but very little has been written down. Even when written, this information is often not circulated or when circulated often is not in a format that is useful for decision makers.
The availability of information is increasing, but often this information is of relatively poor quality and not always applicable to the developing country’s context. The best available written information in developing countries at the present time has not been peer reviewed. Researchers in developing countries prefer a non-peer-reviewed article written in their native language that is locally relevant to a peer-reviewed research article written
in a language they cannot easily read with conclusions that are not applicable to their country. While peer-reviewed publications are the most useful, less effort can be made in collecting and distributing them. Researchers in developing countries look forward to having better information and more scientific information, but they have to make use of what they have.
Little by little, limited access is becoming a myth. There is increasing access to the Internet in the Americas. The people who already have access to the Internet usually are extremely active, have a large influence on the community, and can communicate information. They are absolutely effective in their environment. It is the rest of the public that we have to work with.
THE REGIONAL DISASTER INTERNET NETWORK
Hurricane Mitch was the first Internet-dependent disaster in the Americas. It was the first time that a disaster was so influenced by communication through the Internet. Some information was reliable, some was not. The Internet was a powerful tool for coordination and provided extremely useful information for decision making. It was also a fertile ground for rumor. As a result, the Regional Disaster Internet Network was created to facilitate access to relevant and accurate information for decision makers.
Three organizations are working together on this project—the Pan American Health Organization (PAHO), the U.S. National Library of Medicine (NLM), and the Regional Disaster Information Center (CRID). PAHO is the regional office of the World Health Organization; it is 100 years old and has 2,500 staff members working throughout the Americas and the Caribbean. It has many contacts in all of the Latin American communities. That staff is not based in Washington; rather it is a very decentralized organization with approximately 2,000 people in the field. It promotes technical cooperation and knowledge sharing between countries.
NLM is a world reference health information center and offers free access to health information, including PubMed Central, the most consulted medical database on the Internet. NLM assists countries in obtaining access to the Internet and sharing expertise. That assistance is provided mostly in the United States, but NLM has worked outside of the United States in collaboration with PAHO.
CRID is a nongovernmental organization that was established in Costa Rica in the 1990s. It was originally funded by PAHO, but now is self-sustaining. CRID has 14,000 publications on disaster-related topics, mostly non-peer-reviewed. Collecting these publications on very specific health and disaster topics has been a major challenge. Quality is relatively good; it is not the highest quality in existence, but it is information people are looking for.
CRID has an average of 6,000 end users on a regular basis. The center is working with the support of many organizations and is multidisciplinary. It is the main source of documents in Spanish. At the present time most of the documents are based in Costa Rica for very practical reasons, but are being shipped to other countries. CRID also provides copies to users who do not have access to the main library in their country, which is likely located in the capital cities making it difficult for these users to access a hard copy.
CRID is also linked to a number of other Internet and library services and the different services are linked; one advantage of CRID is the ability to move directly from one database to another. For example, CRID is linked to LILACS, a CD-ROM that is distributed throughout the region. It is read by physicians and public health researchers, and hence is a system that can reach a large variety of people.
The result of the Regional Disaster Information Network is to increase the multisectorial access and use of the Internet. The use of the Internet by these disaster managers and health documentation specialists is increasing. It has been possible to set up six documentation centers in four different countries, increasing the coverage and number of fully digitized documents and making the Internet accessible to the population in the Americas. This has increased circulation dramatically and improved the document selection process, as well as the thesaurus. There was no thesaurus in disaster management until 10 years ago. Today’s thesaurus is the result of a significant effort in collaboration by a number of organizations.
The collaboration between NLM and PAHO has been a very interesting coordination effort. The partnership created a synergy between NLM’s good information technology capacity and PAHO’s knowledge about risk management and the regional network. There is also high motivation from the participating countries. That combination has made this project a great success.
Scientific information on disasters exists in developing countries, but there is very little access to that information. The most directly applicable scientific information is mostly unpublished and found within either that developing country or a neighbor. The project demonstrates that a simple arrangement between good partners can make information available to a large number of lower-income professionals in poor countries.
The active dissemination of good quality but free information is the main asset of the Regional Disaster Information Network. It is probably the most cost-effective disaster reduction activity that exists in the region. Providing technical information to people who are interested in the topic, especially if there is political will, has a huge impact in the countries. It also empowers nationals. The dissemination of information is a powerful means to reduce the gap between rich and poor by making data accessible, and is probably the best means to reduce the impact of a disaster.