Overview
St. John’s National Academy of Health Sciences (SJNAHS) has a robust and experienced Disaster Relief Unit (DRU). This unit was set up based on frequent requests for disaster relief, which required a single channel to streamline our response to the situation. The Unit usually meets and gets activated when a call for disaster relief comes.

The Unit is currently constituted by
a. Dr Pretesh R Kiran – Convener
b. Dr Meryl Anthony – Member
c. Dr Bobby Joseph – Past Convener and Advisor
d. Dr Sanjiv Lewin – Past Convener and Advisor
This unit has been set up based on frequent requests for disaster relief, which required a single channel to streamline our response to the situation. The Unit usually meets and gets activated when a call for disaster relief comes

Services
Some of the major disasters where the unit has provided relief include
Cholera in Post War Refugee Camps, 1972
Andhra Pradesh Cyclone, 1977
Bhopal Gas Tragedy, 1984
Bangladesh Cyclone, 1991
Lathur Khillari Earthquake, 1993
Orissa Super Cyclone, 1999
Gujarat Earthquake, 2001
South Asia Tsunami, 2004
Floods – Bihar, Orissa, 2006, 07, 08, 11
Riots in Kandhamal, Orissa, 2008
Floods – Karnataka and Andhra Pradesh, 2009
Earthquake – Sikkim, 2011
Floods – Assam, 2012
Floods – Uttarakhand, 2013
Floods – Kashmir, 2014
Earthquake – Nepal, 2015
Floods – Tamil Nadu, 2015

□ When a call comes for assistance, a meeting of the cell is called for by the Convener, presided by the Director to be able to decide on whether to send in a team or not, and if yes, then where to send in the team to for assistance in the disaster hit area.
□ Notices put out in the institution inviting volunteers for the relief mission. Contact is established, if needed, with donors to fund travel, drugs and equipment. Attempts are made to contact local health authority/ relief agency to assess the ground situation in the affected area. The core team meets to prepare logistics with the objective of self sufficiency during response and no additional pressure on local health agencies.
□ Volunteers are listed out. Look to the “old faithfuls”. Depending on the type of the disaster, the teams are constituted with persons of required expertise, with emphasis being laid on primary health care that can be delivered even by specialists in the situation. In making the teams, more than 1 team for sequential deployment is constituted, keeping in mind that the situation may demand the same. Teams should be prepared to be away for at least 2 weeks before being replaced by the next team.
□ The teams are briefed by the core team regarding what to expect in the situation and how to respond to special situations if any. Common protocols for Primary Health Care, food and water hygiene including water disinfection, environmental hygiene including temporary shelter and waste disposal, and Psychosocial care are familiarised to the teams. Each team should have a designated leader who is responsible for communication and co ordination. When teams are broken into sub teams, it is good to have sub leaders who will report to the leader who will report to the organization.
□ The teams carry material pertinent to the WHO Essential Drug List, if needed, apart from basic clinic and minor OT equipment. Material needed for Chlorination (safe drinking water) is also carried along with standard medical protocols/procedures, self protective equipment and supplies including anti-malarials, insect repellants, food and water. Teams should carry money, not too much, not too little; ideally each person should have the money to return to base. Baggage is restricted to minimal. The teams are advised to be careful in taking relief material – old clothes, utensils, drugs and medicines – these can be a burden and may not serve the intended purpose
□ On arrival, the team reports to the local Disaster Mitigation Office/ organization. The team is advised to be diplomatic in initial dealings, as many times, the expectations of the relief teams are at variance with those of the host organization.
□ Teams are advised to be clear about the teams logistics at all times – teams who have a clear idea as to how they travel and where they stay are more effective in what they do. When the time comes for departure to Disaster Zone, teams are advised to split into sub-teams as necessary. Upon reaching the sites of disaster, the teams meet the formal/ informal local leaders at the sub sites, set up camp and initiate relief activities

□ Morbidities on site, all of which are not necessarily directly related to the disaster, may include
• Infections – Respiratory, skin and intestinal
• Exposure – Heat or Cold
• Malnutrition
• Vulnerable populations
• Psycho-social problems

□ Teams may be involved in
• Medical curative/ palliative services
• Surgical curative/ palliative services
• Preventive measures – chlorination, sanitation
• Education
• Surveillance for disease outbreaks, especially in vulnerable groups
• Feedback, periodic health reports
• Miscellaneous – food distribution, shelter, disposal of bodies
□ Additional Public Health issues that teams may be involved in include
• Health Education
• Hygiene
• Sanitation
• Safe Drinking water
• Shelter
• Psycho-social assistance
• Re-establishing Health facilities
• Rehabilitation of disabled

□ Departure of teams from the affected areas is planned in advance, as early as possible, generally 10 - 14 days after arrival in the region. The teams report to the local organization/ governmental authority about the work done, and then return to base, A detailed report follows this after return of the team to St John’s in order to assist the local authority to respond better to the situation. In some cases, then teams report also to teams replacing them in providing subsequent relief activities.

□ In the course of past relief operations, several lessons have been learnt:
• Need for a core team at the institution
• Need for sponsors to support travel and team costs – setting up a disaster fund into which people can contribute helps
• Have a local partner with whom you must work directly, be clear about the bonafides, local presence, logistic capability of the partner organization
• Do not get fooled by some “Good Samaritans”.
• Have a clear communication channel with the local partner, let the team leader communicate directly with the partner
• Upon reaching, communication and good relationships are very important. Allow for single channel communication through the leader
• In the field you do not require sophisticated equipment or fancy drugs
• Beware of rumors
• Be aware of epidemics – disease surveillance
• Prioritize activities – no unnecessary surgeries, no mass vaccinations
• If you sense you have done enough in one location move on to the next
• Plan exit early
• Report back to local Disaster Mitigation Office to suggest next steps
• From a Public Health point of view, learning includes prioritizing health services, supporting national and local health systems, coordination between groups, Primary Health Care, providing clinical services and establishing Health Information Systems