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2015, SPECIAL EDITION, JOURNAL OF HEALTH MANAGEMENT
JOURNAL OF HEALTH MANAGEMENT
SPECIAL EDITION VOL. I: AUGUST 2015
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supplement-flood disaster.pmd
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ADVISOR
Dr Shahnaz Binti Murad
Deputy Director General of Health
(Research and Technical Support)
EDITOR IN-CHIEF
Dr Nor Izzah Binti Hj Ahmad Shauki
Director, Institute for Health Management
MD (USM), MCommHealth (H&HM) (UKM)
EDITORIAL BOARD
Dr Nor Filzatun Borhan
MD (USM), MPH (UM)
YBhg. Datin Dr Noriah Bidin
MBBS (DOW), MPH (UM)
Dr Nor Haniza binti Zakaria
MD (AIR LANGGA UNIVERSITY)
MANAGING EDITOR
Dr. Pangie anak Bakit
Dr. Munirah Ismail
Siti Zubaidah Ahmad
Mohd Idris Omar
Nooreyzan Manangin
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ACKNOWLEDGEMENT
The Editorial Board of Journal of Health Management (Special Edition) would like to thank
Director General of Health Malaysia for the permission to publish the articles in this journal. We
would like to convey our gratitude to all reviewers for their time and contributions in the
publications of this special edition. We also would like to extend our sincere appreciation and
gratitude to YBhg. Datin Dr Ang Kim Teng and Dr Harvindar Kaur Gill for their contribution in this
publication.
We also dedicate this special edition to all the Ministry of Health Malaysia teams who have
provided excellent service during the flood disaster.
Dr. Tahir bin Aris
Institute for Public Health
Ministry of Health Malaysia
Dr. Noormawati Ahmad
Institute for Health Behavioral Research
Dr. Mohd Azahadi Omar
Nazirah Gulam Mohd
Institute for Health Behavioral Research
Dr. Jasvinder Kaur
Dr. Amal Nasir Mustafa
Institute for Medical Research
Dr. Roslinah Ali
Institute for Health Systems Research
Dr. Ahmad Faudzi Yusoff
Institute for Medical Research
Datin Dr. Siti Haniza Mahmud
Adilius Manual
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Impact of The Big Flood on Blood Donation Pattern
Ailin Mazuita M, Noryati AA, Norasrina I, Rosalind Choo PY, Suriani O
National Blood Centre
ABSTRACT
The big flood that hit our country during the end of December 2014 until January
2015 had touched the public nationwide. A tremendous response from the public to
assist the flood victims was witnessed and this included blood donation. The pattern
of blood donation during this period was studied which included the demographic
distribution of blood donors who attempted to donate blood and the outcome of
donations.
This study was conducted in National Blood Centre, Kuala Lumpur. It was a
retrospective observational study based on data collection from Blood Bank
Information System. Data of all donors who attempted to donate blood during the
big flood period, 28 December 2014 until 11 January 2015 was collected. Another
group of all donors who came in the same period one year earlier was taken as the
control group.
A total of 11,637 (85% increment) donors attempted to donate blood during the big
flood period of which 9,979 (85.78%) donors were eligible to donate. Majority of the
donors were male, Malay, Malaysian, aged between 21-30 years and either from
managers or professional workers group. There was no significant difference in the
rate of donations which were screened reactive for Transfusion Transmitted Infection
and deferral rate compared to control group.
Keywords: flood, disaster, blood donor response, blood donation
Sabah in East Malaysia[1]. The season
starts in early November and ends in
March, causing floods in the regions
mentioned during this period. The last
Northeast Monsoon was exceptionally
wet, bringing floods tomost states in
the country. It started at the end of
December 2014 until early January
2015. According to the expert of
Climatology
and
Physical
Oceanography, Professor Dr Fredolin
Tangang from the National University
of Malaysia, the overwhelming rain
during that period wasthe result of
Madden-Julian
Oscillation
phenomenon, combined with the
annual Northeast Monsoon. MaddenJulian Oscillation is the variation of
weather in the tropics which originates
INTRODUCTION
Malaysia is made up of two
geographical
regions,
Peninsular
Malaysia which is part of the Asia
continent and East Malaysia in the
Borneo Island, separated by the South
China Sea. Being surrounded by the
ocean, rainfall is largely influenced by
seasonal wind flow in the region.
There are four distinct seasons
according to the wind flow patterns
namely the Northeast Monsoon, the
Southwest Monsoon and two shorter
inter-monsoon periods.
The Northeast Monsoon brings heavy
rainfall to the east coast of Peninsular
Malaysia, and western
region
of
Sarawak and north-easterncoast of
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from the Indian Ocean and passes
Malaysia four times a year[2].
is also experienced at the start of the
year as the population settle in to their
jobs and other activities after the long
year end break.
This was one of the worst floods in
many decades, paralysing social
functioning of the affected areas with
Kelantan, Terengganu, Pahang and
Perak being most affected states.
Health
services
including
blood
transfusion
services
were
badly
affected. Some hospitals including
blood banks were inundated with
water, while many staffs were
stranded in their homes due to the
flood. Blood collection was badly hit
because donors were not able to
come, and hospitals were not able to
hold any blood donation campaigns.
This study looks at the response in
blood donation after the big flood
disaster at the end of 2014 to the
beginning of 2015. It analysed the
demographic profile of blood donors
who responded to the disaster. By
doing this study, blood transfusion
service hope to identify and target
potential blood donors from among
disaster-driven donors to increase its
blood donor pool.
Blood donors who came to donate
blood during the same period one year
earlier were taken as a control group.
The pattern of donation, deferral rate
and screened reactive donation rate
between these two periods were
compared.
The impact of the great flood touched
the hearts of many and caused a
tremendous response from the public
in unaffected states to donate blood.
There was a surge in the number of
walk-in blood donors at the National
Blood Centre and other hospital blood
centres that were not affected by the
flood. This experience is not unique, as
post-disaster surge of blood donors
had been reported elsewhere including
China after a severe earthquake hit
Sichuan
Province[3],
the
great
earthquake in East Japan in 2011[4]
and in the United States of America
after the coordinated terrorist attack
on September 11[5].
MATERIALS AND METHODS
This was a retrospective observational
study using secondary data from the
Blood Bank Information System (BBIS)
which provides donors’ demographic
profile, contact number and donation
history.
The study was conducted at the
National Blood Centre, Kuala Lumpur
(NBC). NBC is fully Government funded
Institution under the Ministry of Health
Malaysia. It is the centre for blood
donation, processing and distribution
of blood and blood components to all
government and private hospitals in
the central region (Klang Valley, Negeri
Sembilan and West of Pahang).
Catchment areas for blood collection in
NBC include the Federal Territory of
Every year, seasonal variations are
seen in the number of blood donations
in the National Blood Centre. Seasonal
blood shortages usually occur during
the school holidays, term breaks and
long festive holidays, for example
during Aidilfitri and Chinese New Year
where most of the regular blood
donors return to their home towns
outside the Klang Valley.This shortage
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Kuala Lumpur, Federal Territory of
Putrajaya and some parts of Selangor.
For the state of Selangor, NBC’s
catchment area overlaps with other
collection centres namely Hospital
Tengku Ampuan Rahimah Klang,
Hospital Banting and Hospital Kuala
Kubu Bharu. Therefore, the statistic for
blood collection as shown in Fig. 1
combines the data for NBC and these
other collection centres. NBC alone had
managed to collect 166,787 units of
blood which accounted for 25.54% of
blood units collected in the whole
country for the year 2013. Blood
donation services were organised at
the centre and in mobile blood
collection clinics which operated for a
certain number of hours in various
public places, offices and etcetera.
Figure 1: Total Number of Blood Collection in 2013 according to state. (* total blood
collection for Federal Territory of Kuala Lumpur, Selangor and Federal Territory of
Putrajaya)
Study population
The study population comprised of two
groups of donors at NBC. The study
group comprised of all donors who
came to donate blood during the big
flood, from 28 December 2014 to11
January 2015 while the control group
were donors who came to donate
blood over the corresponding period
the year before.
All allogeneic blood donors in NBC are
voluntary non-remunerated donors. No
replacement donations are allowed in
NBC. Donors come to the blood
donation centres on walk-in basis.
Information regarding the site and
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schedules of mobile donation clinics
are available online at the NBC website
www.pdn.gov.my,
NBC
official
facebook and information booth at the
NBC. In addition, NBC also gets help
from co-organisers of blood donation
drive campaigns by promoting the
upcoming campaigns through their
social media networks.
RNA and Hep B DNA. Serological test
for TTI markers are done to detect the
presence of HBsAg, anti-HepC virus,
anti-HIV and RPR for Syphilis. Blood
units that are screened reactive will
then undergo confirmation test for the
relevant
infection.
If
confirmed
positive, the blood unit will be
discarded and the donor will be called
to NBC for counselling.
There are two types of blood donation
in NBC, namely whole blood donation
and plasma or platelet apheresis
donation. Regular whole blood donors
are eligible to donate their plasma or
platelet through apheresis method.
However, this type of donation is only
available at the centre. Whole blood
donors are encouraged to return 3
months after their last donation date
while apheresis donors can donate
again after 14 days from the last
apheresis donation.
Variables
Variables collected for each donor
include demographic data of the donor
(age, gender, occupation, race, and
nationality),
data
regarding
the
donation (place of donation and
number of donation), result of the
donation attempt (succeeded to
donate or deferred), result of TTI
screening for donors who were eligible
to donate (reactive or non-reactive)
and whether donor return to donate in
the future (yes or no).
Donor screening
All potential donors are screened to
check for eligibility to donate blood.
Pre-donation screening tests done at
the site of donation include donor’s
blood group and haemoglobin level.
Trained medical officers or nurses are
responsible for conducting medical
interviews to determine eligibility by
evaluating the donor’s health history,
risk behaviour against transfusion
transmitted infections and physical
screening prior to blood donation.
Donors who do not fulfil the criteria
are deferred either permanently or
temporarily from donation.
Age was analysed as both numerical
and categorical variable. The minimum
age for giving informed consent in
Malaysia is 18 years old while the
minimum age for donating blood in
this country is 17 years old. For donors
who are between 17 to 18 years old, a
guardian consent form must be
produced by these donors during
donation. The maximum age for blood
donation in Malaysia is 60 years old.
However, regular donors who are
above 60 years old and are certified as
healthy by their physicians are eligible
to donate. The rest of the donors are
categorised into 20s, 30s, 40s and 50s
age cohorts.
Transfusion-transmitted
infections (TTI) screening
At NBC, all donated blood units must
undergo TTI screening. Nucleic Acid
Amplification Test is carried out to
detect the presence of HIV and Hep C
Gender was a categorical variable and
divided into male and female. Race
was also a categorical variable and
divided into Malay, Chinese, Indian and
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Others according to the data given by
donors in their donor registration form.
There were also donors who did not
state their race and this group was
categorised as race not stated.
the control group because data
collection was done only 3 months
after their visit.
Not all donors who attempted to
donate were eligible to donate. Donors
who were not eligible to donate were
deferred for various reasons during
pre-donation testing or interview. In
this study, total number of donors who
attempted to donate during the
studied periods was taken to reflect
the actual response to the big flood
and the total number were then
broken down into donated and
deferred donors.
Donor’s occupational status was taken
from their registration form as stated
by the donor in the form. Donor
occupations were then categorised
according
to
the
International
Standard Classification of Occupations
version ISCO-08 published in 2008[6].
It
is
an
International
Labour
Organization classification structure to
organize information regarding labour
and jobs. The major groups in this
structure
were
managers,
professionals,
technicians
and
associate professionals, clerical support
workers, service and sales workers,
skilled agricultural, forestry and fishery
workers, craft and related trades
workers, plant and machine operators
and
assemblers,
elementary
occupations
and
armed
forces
occupations.
Additional
categories
added from data compiled were
students,
housewife,
pensioners,
unemployed and others. There were
also donors who did not state their
occupation and these were categorised
as occupation not stated.
Among the donors who were able to
donate their blood, a small proportion
were tested reactive for TTI markers.
Therefore, the donors who were able
to donate were further subcategorised
into non-reactive to TTI markers and
reactive to TTI markers.
Data analysis
Data were statistically analysed by
Statistical Package for Social Sciences
(SPSS) version 20 for windowsoftware[7]. There were numerical and
categorical variables in this study. The
distributions of numerical variables
were explored and the mean and
standard deviation were checked. The
difference of mean between the
numerical variables with the groups of
donor from 28 December 2014 until 11
January 2015 and one year earlier
were tested by independent t-test.
Other categorical variables were
nationality where donors were divided
into Malaysian and Non-Malaysian
while place of donation were either
centre (NBC) or mobile. Donors were
also categorised into first time attempt
to donate or repeat donors. The
donors’ return behaviour were also
analysed and categorised into return or
not-return to donation. For the donors
who came in during the big flood
period, their return rate was taken
within a shorter period compared to
For
categorical
variables,
the
frequencies
were
explored
and
percentages were calculated. Chi
square test was used to determine the
association between the categorical
variables
with
the
outcome.
Significance was taken at a P-value of
<0.05.
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RESULT
the same period a year earlier where
only 6,264 donors attempted to donate
blood at the NBC. During the big flood
period, 9,979 (85.78%) donors were
eligible to donate, either whole blood
or plasma and platelet through
apheresismethod, whilst the number of
eligible donors during the same period
one year earlier was 5,438 (86.81%).
Descriptive Analysis
A total of 11,637 of donors attempted
to donate blood with National Blood
Centre during the big flood period from
28 December 2014 until 11 January
2015. The total number of donors
showed an 85% increase compared to
a. Socio-demographic distribution
Table 1: Socio-demographic distributions of donor who attempted to donate blood
during the big flood period (28 December 2014 – 11 January 2015) and the same
period one year earlier as a control group.
28 Dec 2014 –
28 Dec2013 –
11 Jan2015 (Big
11 Jan 2014
Characteristics
flood) n (%)
(Control) n (%)
Age
(years)
mean (s.d.), range (min,max)
< 18
18 - 20
21 - 30
31 - 40
41 - 50
51 - 60
> 60
Gender Male
Female
Race
Malay
Chinese
Indian
Others
Not stated
Occupa- Managers
tional
Professionals
status
Technicians and associate
professionals
Clerical support workers
Service and sales workers
Craft and related trades workers
Plant and machine operators, and
assemblers
33.09 (9.56),
(17-61)
52 (0.45)
688 (5.91)
4650 (39.96)
3648 (31.35)
1896 (16.29)
695 (5.97)
8 (0.07)
6562 (56.39)
5075 (43.61)
6628 (56.96)
3583 (30.79)
1149 (9.87)
182 (1.56)
95 (0.82)
1626 (13.97)
2060 (17.70)
924 (7.94)
33.39 (9.77),
(17-64)
22 (0.35)
378 (6.03)
2428 (38.76)
1877 (29.96)
1182 (18.87)
375 (5.99)
2 (0.03)
3957 (63.17)
2307 (36.83)
3706 (59.16)
1849 (29.52)
535 (8.54)
118 (1.88)
56 (0.89)
1350 (21.55)
693 (11.06)
561 (8.96)
1400 (12.03)
1152 (9.90)
98 (0.84)
444 (3.82)
395 (6.31)
675 (10.78)
56 (0.89)
433 (6.91)
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Characteristics
Nationa
-lity
Elementary Occupations
Armed forces Occupations
Student
Pensioner
Housewife
Unemployed
Others
Not stated
Malaysian
Non-Malaysian
Table 1 shows the mean (SD) age for
blood donors during the big flood
period was 33.09 (9.56) years old
(range 17 – 64), whilst the mean (SD)
age for blood donors during the same
period one year earlier were 33.39
(9.77) years old (range 17 – 61).
Majority of the blood donors in both
groups aged between 21 to 30 years
28 Dec 2014 –
11 Jan2015 (Big
flood) n (%)
28 Dec2013 –
11 Jan 2014
(Control) n (%)
171 (1.47)
472 (4.06)
797 (6.85)
37 (0.32)
389 (3.34)
102 (0.88)
676 (5.81)
1289 (11.08)
11538 (99.15)
99 (0.85)
97 (1.55)
285 (4.55)
330 (5.27)
22 (0.35)
174 (2.78)
48 (0.77)
258 (4.12)
887 (14.16)
6206 (99.07)
58 (0.93)
old (38.76% and 39.96% respectively)
(Figure 2). Male, Malay and Malaysian
donors were the majority of donors
who came forward to donate blood
during both periods. Meanwhile, based
on occupational status, majority of the
donors
were
managers
and
professional workers (Figure 3).
Figure 2: Donor distribution according to age group
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Figure 3: Donor distribution according to occupation
b. Donation characteristics
Table 2: Donation characteristics distributions during the big flood period (28
December 2014 – 11 January 2015) and the same period one year earlier as a
control group.
Characteristics
Place of donation
Centre
Mobile
Previous donation history
No
Yes
Return for next visit
Return
No return
28 December 2014 – 11
January 2015 (Big
flood) n (%)
28 December 2013
– 11 January
2014(Control) n (%)
2824 (24.27)
8813 (75.73)
1814 (28.96)
4450 (71.04)
4444 (38.19)
7193 (61.81)
1793 (28.62)
4471 (71.38)
1,292 (11.10)
10,345 (88.90)
2,982 (47.61)
3,282 (52.39)
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Figure 4: Donor distribution according to place of donation
Among those who attempted to donate
during the big flood period, 4,444
(38.19%) had no history of previous
blood donation. The percentage of
these donors increased in comparison
to the same period one year earlier
where only 1,793 (28.62%) donors
who never donated before attempted
to donate (Table 2). Out of the 4,444
donors who come to donate regardless
of any experience of previous
donation, 3,570 (80.33%) of them
were eligible to donate blood while 874
(19.67%) were deferred due to various
reason during the pre-donation test or
interview (Figure 5). This percentage
of eligible first time donors increased
compared to the same period one year
earlier where only 1,393 (77.69%) first
time donors were eligible to donate
(Figure 6).
Table 2 and Figure 4 show that
majority of the donors (75.73% during
the big flood period and 71.04%
during the period one year earlier)
came to our mobile collection clinics
(mobile) compared to our static blood
collection centre in the National Blood
Centre.
Table 2 also shows that majority of
donors who attempted to donate blood
during both period had previous
experience with blood donation
(61.81% among those who came
during the big flood period and
71.38% among those who came at the
same period one year earlier).
However among those who attempted
to donate blood during the big flood
period only 11.10% had return to
donate on the next visit. Meanwhile
the control group showed 47.61% of
return rate (Table 2).
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Donor with NO previous
history of donation,
eligible to donate
Donor with
previous history
of donation
history of donation, NOT
eligible to donate
history of donation
Figure 5: Outcome of donors with no previous history of donation who attempted to
donate during the big flood period from 28 December 2014 - 11 January 2015.
Figure 6: Outcome of donors with no previous history of donation who attempted to
donate from 28 December 2013 - 11 January 2014.
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c. Outcome of donation
Table 3: Outcome of donation based on total donated during the big flood period (28
December 2014 – 11 January 2015), n=9,979 and the same period one year earlier
as a control group, n=5,438.
28 December 2014 – 11
January 2015 (Big flood)
Outcome
n (%)
Screened reactive donation for TTI markers
Yes
33 (0.33)
No
9,946 (99.67)
TTI: transfusion transmitted infection
Table 3 shows out of the 9,979 donors
who were eligible to donate during the
big flood period, 33 donations or
0.33% were screened reactive to
transfusion
transmitted
infection
28 December 2013 – 11
January 2014 (Control) n
(%)
13 (0.24)
5,425 (99.76)
markers. The percentage is higher
earlier where 13 (0.24%) donations
out of 5,438 were found to be reactive.
STATISTICAL ANALYSIS
a. Socio-demographic distribution
Table 3: Difference of socio-demographic distributions between the big flood period
(28 December 2014 – 11 January 2015) and the same period one year earlier as a
control group.
28 December 2014
28 December 2013
– 11 January 2015
– 11 January 2014
p-value
Outcome
(Big flood) n (%)
(Control) n (%)
Age (years)
< 18
52 (70.27)
22 (29.73)
0.001*
18 - 20
688 (64.54)
378 (35.46)
21 - 30
4650 (65.70)
2428 (34.30)
31 - 40
3648 (66.03)
1877 (33.97)
41 - 50
1896 (61.60)
1182 (38.40)
51 - 60
695 (64.95)
375 (35.05)
> 60
52 (70.27)
8 (80.00)
Gender
Male
6562 (62.38)
3957 (37.62)
< 0.001*
Female
5075 (68.75)
2307 (31.35)
Race
Malay
6628 (64.14)
3706 (35.86)
0.003*
Chinese
3583 (65.96)
1849 (34.04)
Indian
1149 (68.23)
535 (31.77)
Others
182 (60.67)
118 (39.33)
56 (37.09)
Not stated
95 (62.91)
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Outcome
28 December 2014
– 11 January 2015
(Big flood) n (%)
28 December 2013
– 11 January 2014
(Control) n (%)
Occupational status
Managers
1626 (56.64)
Professionals
2060 (74.83)
Technicians and
924 (62.22)
associate
professionals
Clerical support
1400 (77.99)
workers
1152 (63.05)
Service and sales
workers
Craft and related
98 (63.64)
trades workers
Plant and machine
444 (50.63)
operators, and
assemblers
Elementary
171 (63.81)
Occupations
Armed forces
472 (62.35)
Occupations
Student
797 (70.72)
Pensioner
37 (62.71)
Housewife
389 (69.09)
Unemployed
102 (68.00)
Others
676 (72.35)
Not stated
1289 (59.24)
Nationality
Malaysian
11538 (65.02)
Non-Malaysian
99 (63.06)
Place of donation
Centre
2824 (60.89)
Non-Centre
8813 (66.45)
Chi-square test *Significant if p-value < 0.05
Based on Table 3, there were
significant
differences
in
sociodemographic distributions between the
two groups of donors based on age
group (p=0.001), gender (p<0.001),
1350 (45.36)
693 (25.17)
561 (37.78)
16
< 0.001*
395 (22.01)
675 (36.95)
56 (36.36)
433 (49.37)
97 (36.19)
285 (37.65)
330 29.28)
22 (37.29)
174 (30.91)
48 (32.00)
258 (27.65)
887 (40.76)
6206 (34.98)
58 (36.94)
0.617
1814 (39.11)
4450 (33.55)
< 0.001*
race (p=0.003), occupational status
(p<0.001) and place of donation
(p<0.001). However, there was no
significant difference for nationality
(p=0.617).
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8/6/2015, 2:32 PM
b. Outcome of donation
Table 4: Difference of outcome of donation between the big flood period (28
December 2014 – 11 January 2015) and the same period one year earlier as a
control group.
28 December
2014 – 11
January 2015
(Big flood) n (%)
28 December
2013 – 11
January 2014
(Control) n (%)
Screened reactive
donation
Yes
No
33 (71.74)
9979 (64.78)
13 (28.26)
5425 (35.22)
0.324
Deferral
Yes
No
1658 (66.75)
9979 (64.73)
826 (33.25)
5438 (35.27)
0.052
Outcome
p-value
Chi-square test
*Significant if p-value < 0.05
Based on the outcome of donation,
there were no significant difference
intherate of screened reactive donation
(p=0.101) and deferral rate (p=0.052)
for donors in the period of big flood
and the control group (Table 4).
In Iran, the great earthquake in Bam
also caused a very huge increment in
blood donors of over 600% compared
to the control [8].
There were significant differences in
the pattern of donors who attempted
to donate during the big flood period
compared to the same period the
previous year for age group, gender,
race, occupational status and place of
donation.
DISCUSSION
This study showed that there was a
spontaneous surge of donors who
attempted to donate blood in response
to the big flood disaster in Malaysia,
with an increase of 85% compared to
the same period a year earlier. The
influx of blood donors in response to
disaster were also seen in other places
in the world. Guo et. Al. reported an
increase of 38.14% in whole blood
donors post Sichuan earthquake
compared to the control period[3];
while Glynn et. al. reported an increase
of about 145% of whole blood
donation after the September 11
terrorist attack in the United States[5].
The majority of donors (39.96%) who
attempted to donate blood during the
big flood period were from the 21-30
years old age group. This could be due
to the “snowball” effect among the
young where one donor can strongly
influence other members in his/her
peer group to donate blood[9]. The
increase in number of young blood
donors is actually in tandem with WHO
campaign to increase recruitment and
17
17
8/6/2015, 2:32 PM
retention of donors from this age
group projected during the World
Blood Donor Day celebration for the
year 2010 with the theme “New Blood
for the World”[10].
likely to return to donation if they felt
uncomfortable
during
donation.
However, their motivation to donate
blood was not lost[12]. Therefore, it is
important to follow up on female
donors who temporarily deferred from
donation to increase their return rate.
Reassurance and making them feel
comfortable during donation are
essential to encourage them to return
in the future.
This finding also corresponds to the
population census in Malaysia whereby
the biggest population in Malaysia in
2010 were aged between 20-24 years
old, followed by 15-19 and 25-30 years
[11].
This study also found that the majority
of donors who attempted to donate
blood were from the managerial and
professional
occupation
group.
However, it was the professional and
clerical support groups that showed
the biggest increase during the big
flood period. A study done by Michel
on the prosocial behaviour and
volunteerism after Hurricane Katrina
concluded that education was one of
the significant positive factors in
exerting
feeling
of
personal
responsibility for helping victims[13].
This study did not look at the
education background of donors.
However, donor occupational status
does usually reflect their education
background. Therefore, the finding of
this study is consistent with the study
done by Michel.
This study showed that majority of
donors who came forward to donate
blood during the big flood period were
male, corresponding to the population
sex ratio in Federal Territory of Kuala
Lumpur and Selangor. However,
population sex ratio in Federal
Territory of Putrajaya actually was the
reverse. The population in Federal
Territory of Putrajaya was very small
compared to the other two states (F.T.
Putrajaya 0.07 million, F.T. Kuala
Lumpur 1.67 million, Selangor 5.46
million)[11].
Nonetheless, the percentage of female
donors increased in comparison to the
same period a year earlier. Female
donors appeared to attempt to donate
more in response to the big flood. This
finding is similar to the study done by
Dr Kasraian on characteristics of blood
donors post great earthquake in Bam,
Iran[8].
The majority of donors (75.73%)
during the big flood period and
71.04% of the control group donated
through mobile collection clinics
(mobile) compared to our static blood
collection centre in the National Blood
Centre. The mobile collection clinics
appeared to be more convenient for
donors as these were held in public
places such as shopping complexes,
public transport stations, community
centres and also in corporations with
big employee numbers.
The reasons why women were less
represented in long term blood donor
pool in Oslo, Norway were studied by
Misje, Bosnes and Heier. The authors
found that young female donors were
associated with a higher deferral rate
mostly due to low haemoglobin level,
low body weight, pregnancy and
lactation. Female donors were also less
18
18
8/6/2015, 2:32 PM
respectively)[8]. The finding of our
study echoed their findings. This study
showed a return rate of only 11.10%
among all donors for the post-big flood
period while the control group showed
a higher rate of 47.61%. However,data
collected on this was for only three
months after the big flood. Amore
correct picture on the return rate
would require a fulll year evaluation
after the big flood.
As described by Kapuchu in his article
on Non-Profit Response to Catastrophic
Disaster, non-profit organizations play
important roles in strengthening the
response operation to the disaster
victims. For example, non-profit
organizations teamed up with the
public in the recovery efforts, and in
offering aids to victims of the
September
11
attack[14].
This
collaboration was also seen in
response to the big flood in Malaysia.
Many non-profit organizations or nongovernment bodies came forward and
organize blood donation drives with
the National Blood Centre. This
resulted in a tremendous response
from the public who came to donate
blood during that period.
From the analysis of donors who had
no experience of previous blood
donation, 19.67% were deferred from
donating blood during the big flood
period and the percentage was higher
in the control period at 22.31%. These
donors who were temporarily deferred
need to be followed up by sending an
invitation message after the deferral
period is over. Donors who donated in
a busy mobile clinic especially during
the big flood period might be turned
off due to long queues for donation
during such periods. A special
appreciation message should be sent
to these donors, especially first time
attempted donors to entice them to
attempt donating again in the future.
Analysis on donation characteristics of
this study showed that 38.18% of the
donors who attempted to donate blood
during the big flood period had no
previous experience on blood donation.
This category of donors showed an
increment compared to the control
group (28.62%). This finding is
consistent with a meta-analysis done
by Bednall and Bove who reported was
that 73% of 2,615 first time donors
would
donate
blood
following
catastrophic event[15]. The awareness
to donate blood all year long should be
propagated as the need for blood and
blood component does not arise after
disaster period only.
Although the number of donations that
were confirmed reactive to TTI
markers was higher for the big
floodgroup, the difference was not
statisticaly significant. This finding is
consistent with studies by Guo et. al.
and Kasraian[3, 8].
Guoet. al. had shown that the return
rate of first time donors who donated
in response to disaster was low
compared to the control period (8.00%
and 13.00% respectively)[3]. Similar to
this, Kasraian found the same pattern
of return rate of first time donor postBam earthquake compared to control
group
(14.80%
and
32.1%
Deferral rate during the big flood
period was about the same compared
to the same period a year earlier
(13.19% and 14.25% respectively)
and was not statistically signicant. This
finding suggests that there are
potential eligible blood donors who
only donated in response to disaster.
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19
8/6/2015, 2:32 PM
This group of donors should be
targeted to become regular blood
donors to ensure adequate and safe
blood supply all the time. Voluntary
non-remunerated blood donor pool
should be increased to achieve a state
of self sufficiency with the rate of 5%
donation per population.
REFERENCES
1.
Ministry of Science, T.a.I.;
Available
from:
http://www.met.gov.my/index.p
hp?option=com_content&task=
view&id=75&Itemid=1089.
2.
Malaysia, U.K.; Available from:
http://www.ukm.my/lestari/en/
banjir-20142015/.
3.
Guo, N., et. al.., First time
CONCLUSION
Influx of blood donors in response to a
national disaster is common[3-5, 8].
This finding is also shown in this
study. Demographic analysis showed
that the majority of donors who
attempted to donate during the big
flood period were male, Malay,
Malaysian, aged between 21-30 years
and from managerial or professional
workers group. The majority of these
donors donated through mobile clinics
and had previous donation history.
This
information
is
useful
in
strategising blood donation promotions
to the targeted group as a means of
increasing the blood donor pool.
donors responding to a national
disaster may be an untapped
resource for the blood centre.
4.
Vox Sanguinis, 2012. 102 (4): p.
338-344.
Nollet, K.E., et. al.., The great
East Japan earthquake of March
11, 2011, from the vantage
point of blood banking and
transfusion
medicine.
5.
Transfusion Medicine Reviews,
2013. 27(1): p. 29-35.
Glynn, S.A., et. al.., Effect of a
national disaster on blood
supply
and
safety:
the
September
11
experience.
There were significant differences in
pattern of donors who attempted to
donate during the big flood period
earlier based on the age group,
gender, race, occupational status and
place of donation. However, there
were
no
statistically
significant
differences in the rate of screened
reactive donation to Transfusion
Transmitted Infection and deferral rate
which means no increase in safety risk
in the donated blood in response to
national disaster.
6.
Jama, 2003. 289 (17): p. 22462253.
Organization, I.L. International
Standard
Classification
of
Occupations. 2008; Available
7.
8.
from:
http://www.ilo.org/public/englis
h/bureau/stat/isco/isco08/.
IBM
SPSS
Statistics
for
Windows, V., (2011). 20.0. IBM
Corp., Armonk, NY., 2011, IBM
Corp: Armonk, NY.
Kasraian, L., National Disasters
in Iran and Blood Donation:
Bam Earthquake Experience.
ACKNOWLEDGEMENT
The authors would like to acknowledge
the Director General of Health Malaysia
for his permission for this article to be
published.
9.
Iran Red Crescent Med J, 2010.
12(3): p. 316-318.
Symvoulakis,
E.K.,
C.I.
Vardavas, and P. Fountouli,
Adverse
reactions
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to
blood
after a natural disaster: The
case of Hurricane Katrina.
donation among adolescents.
10.
11.
Jama, 2008. 300 (15): p. 17591760.
Organisation, W.H., World Blood
Donor Day 2010, 2010.
Population
Malaysia,
D.o.S.
14.
to
Distribution
and
Basic
Demographic
Characteristic
Report
2010
(Updated:
05/08/2011). 2011.
12.
Misje, A.H., V. Bosnes, and H.E.
Heier, Gender differences in
15.
catastrophic
Disaster
Prevention
and
Management: An International
Journal, 2007. 16(4): p. 551561.
Bednall, T.C. and L.L. Bove,
Transfusion Medicine Reviews,
2011. 25(4): p. 317-334.
Sanguinis, 2010. 98(3p1): p.
e241-e248.
Personal
Michel,
L.M.,
responsibility and volunteering
21
21
disasters.
Donating Blood: A Meta-Analytic
Review
of
Self-Reported
Motivators
and
Deterrents.
presentation rates, deferrals
and return behaviour among
Norwegian blood donors. Vox
13.
Sociological Spectrum, 2007.
27(6): p. 633-652.
Kapucu, N., Non-profit response
8/6/2015, 2:32 PM
Hospital as a Disaster Relief Centre for Staff and Community in a Flood
Disaster
Ngah B, Nyak Abdullah N, Lim F, Nicholson MA, Ahmad A
Hospital Sultan Haji Ahmad Shah
ABSTRACT
From the 25th December 2014 to the 4th January 2015, the District of Temerloh was
hit by a major flood which resulted in 29,204 flood evacuees of which 6,450 were in
the Mukim Perak II, where Hospital Sultan Haji Ahmad Shah (HoSHAS) was located.
Seven hundred and thirty (730) hospital staff were also affected, of which slightly
over half (383 staff) had their houses flooded while the rest were cut off by floods.
A hundred and twenty eight (128) staff moved to stay in the hospital, bringing with
them 124 family members. Thus, the hospital became a relief centre for its own
staff. This unintentionally, helped to ensure the hospital was not short of staff during
this critical moment as otherwise, those affected might not have been able to come
to work.
Due to over-crowding in the designated relief centres, some evacuees also used the
hospital a relief centre. This paper shows the need for a hospital to be prepared to
take on the role as a relief centre during a serious flood disaster, beyond its
traditional role of patient care service.
PURPOSE OF THE STUDY
Hospital Sultan Haji Ahmad Shah’s
disaster plan was geared towards
responding to the sick and injured in a
disaster but not as a relief centre
during a flood. This paper presents
the need for a hospital’s flood disaster
response plan to include an additional
function as a disaster relief centre,
especially for its own staffs who are
victims, and the community around it.
hospital is situated on a small hill,
about 5 km from the major Pahang
River. The surrounding areas of the
hospital are low lying and are flood
prone. Many of the staff stay in
housing estates in these areas. The
hospital employs slightly over 2,000
staff of various categoriesand provides
living quarters for 330 staff and their
families. There are five schools
designated as flood relief centres in
the area.
INTRODUCTION
Hospital Sultan Haji Ahmad Shah
(HoSHAS) is located in the state of
Pahang in the district of Temerloh. The
550 bedded specialist hospital was
opened in 2005, as a replacement for
the old Mentakab Hospital. It is a main
referral centre for six other districts,
namely
Jengka/Maran,
Jerantut,
Bentong, Raub, Lipis and Bera. The
Pahang River, which is 435km long, is
the longest river in West Malaysia.
The river starts from the hills in the
District of Lipis and is joined by the
Kuala Tahan. Tembeling River also
forms the Pahang River. It is joined by
the Semantan River at Temerloh town
before flowing towards the sea. This
River drains three-quarters of land
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Data for the study were collected from
the
Malaysian
National
Security
Council, Temerloh Disaster Operation
Control Centre, Ministry of Health
Malaysia (MOH), Pahang State Health
Department and HoSHAS hospital
census.
water in the State of Pahang. When
water levels are high in all the three
tributary rivers, major flood will occur
in the District of Temerloh and its
downstream region.
Major flood
disasters were recorded in this District
in 1926, 1971 and 1988.
In recent years, there has been rapid
development in Temerloh town with
many new housing estates being
developed around the river bank,
which are flood prone areas. Thus,
the impact of the latest flood is more
severe as the number of houses and
people affected are much higher as
compared to previous floods.
RESULT
1.1. Pahang River Water Situation
On the 22nd December 2014,
Kuala Lipis town was hit by flood.
Water levels reached its town
area.
On the 23rd December
2014, Kuala Tahan reported that
flooding has occurred in its areas.
The water level in Temerloh was
still below its warning stage.
Table 1 shows the river water
levels of three main tributaries to
Temerloh (Lubuk Pasu) area.
METHODOLOGY
This is a retrospective study using
secondary data documented by various
Government Departments during the
recent major flood between 25th
December 2014 and 4th January 2015.
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Table 1: Pahang River levels from 24th December 2014 to 6th January 2015
Tembeling
Yap
LubukPasu
Semantan
(Kuala
Date/River
(Jerantut)
(Temerloh)
(Temerloh)
Tahan)
(meters)
(meters)
(meters)
(meters)
Normal
60.00
44.00
26.00
49.00
Alert
64.00
48.00
29.00
51.00
Warning
66.00
50.00
31.00
52.00
Danger
68.00
52.00
33.00
53.00
th
24 Dec 2014
77.52
59.12
32.90
47.99
25th
NA
55.40
35.80
48.49
26th
NA
55.39
36.01
49.05
th
27
NA
55.09
37.92
50.54
28th
NA
55.09
38.08
50.98
th
29
NA
55.40
37.91
62.55
th
30
NA
50.24
37.88
62.55
st
31
55.28
48.63
37.86
62.55
1st Jan 2015
49.86
48.23
38.02
62.52
2nd
NA
48.07
37.50
62.37
rd
3
NA
47.94
35.50
62.19
th
4
NA
47.89
31.89
62.08
5th
NA
47.83
29.61
62.04
th
6
NA
48.05
28.56
62.00
Source: Web Portal Department of Irrigation and Drainage Malaysia
1.2.
The Pahang River at Temerloh
rose rapidly at about 1 meter/day
from the 25th December 2014.
This resulted in many of the
population
being
caught
unprepared.
From the 25th
December 2014 to the 2nd
January 2015, all major roads
were affected except for the old
trunk road from Temerloh to
Kuala Lumpur, making most
towns and villages inaccessible by
road. A total of 29,204 people
were displaced by the flood to
relief centres in the District of
Temerloh.
Immediate Flood Contingency
Plan
The Hospital Flood Committee
met on 23rd December 2014 to
look at its flood preparedness
plan.
Blood products, food,
water, petrol and medication
were at the required levels as
specified in the Standard
Operating Procedure (SOP) for
patient care.
All elective surgeries were
cancelled.
Three
hospital
quarters were designated for
staff evacuees and additional
beds were placed in the nursing
hostel to cater for nurses.
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1.3. Community Evacuation
the area were inaccessible by
road, leaving the Seberang
Temerloh Secondary School as a
relocation site for the community
surrounding the hospital area.
During the flood, 3,000 evacuees
were placed in the school leading
to over-crowding. Many of the
evacuees stayed with relatives or
friends to avoid the congestion.
Ten families were evacuated to
the hospital while many used the
hospital facilities such as toilets
and power supply.
There were five flood relief
centres in Mukim Perak II, where
HoSHAS is located with a capacity
for 4,200 evacuees. However,
there were a total of 7,020
evacuees which was 67% more
than their capacities (Figure1).
The nearest relief centre to
HoSHAS was Seberang Temerloh
Secondary School.
It could
accommodate 2,000 evacuees.
The other four relief centres in
Figure 1: Disaster Relief Centre (DRC) in Mukim of Perak II
(Source: Temerloh Disaster Operation Control Centre)
1.4. Hospital Staff Affected By
Flood
able to come to the hospital
(Figure 3) by lorry, boat and
Multipurpose
Vehicle
(MPV).
Throughout the duration of the
flood, the hospital was able to
maintain it clinical staffing
numbers, enabling the hospital to
function without staffing problem.
Figure 2 shows the number of
hospital staff affected by the
flood. Of the 730 staffs that
were affected, 128 moved into
the hospital with 124 family
members (Figure 3). However,
1,855 (90.3%) staffs were still
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Figure 2: Number of HoSHAS staff whose houses were affected by flood
(Source: Hospital Census)
Figure 3: Overall staff attendance to work and stayed in hospital hostel/quarters
from 25thDecember 2014 to 5thJanuary 2015 (Source: Hospital Census)
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1.5. Impact on hospital services
was also use for evacuees from
old folk homes, resulting in its
bed occupancy exceeding 100%
in some days (Table 2). Two
temporary wards were opened
to meet the increase demand
for beds (Figure 5). Some
patients had to be transferred
to other accessible hospitals in
the west of Pahang as
temporary measures to reduce
congestion at HoSHAS.
1.5.1. Hospital Bed Occupancy Rate
(BOR)
In line with the flood SOP,
residents in the flooded areas
who were bed ridden, pregnant
women in their third trimester
and end stage renal failure
patients were evacuated to the
hospital (Figure 4). The hospital
Figure 4: Number of patients admitted or not discharged due to flood from
24thDecember 2014 to 5thJanuary 2015 (Source: Hospital Census)
Table 2: Number of inpatients and BOR of Hospital Sultan Haji Ahmad Shah
from 25th December 2014 to 3rd January 2015
Date
No. of Inpatient
BOR
th
25 Dec 2014
441
80.18%
th
26
434
78.90%
th
27
446
81.10%
28th
472
85.80%
th
29
563
102.04%
th
30
573
104.10%
st
31
559
101.60%
1st Jan 2015
514
93.50%
nd
2
439
79.80%
rd
3
417
75.81%
Source: Hospital Census
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27
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Figure 5: Number of patients in two temporary wards from 24thDecember
2014 to 5thJanuary 2015 (Source: Hospital Census)
Patients are usually evacuated
with at least one family
member, as it is the culture of
the community to fend for their
sick relatives. With the failure
of utility supply in the town and
nearby districts, end stage renal
patients were transferred to the
hospital, thus there was a need
to work at maximum human
resource capacity, especially for
nursing staff (Figure 6). Patients
discharged were also kept at
minimal
numbers
as
surrounding
disaster
relief
centres were congested and the
roads were inaccessible to send
patients back to their homes.
Newly delivered babies and
infants were kept in the hospital
in accordance to the directive.
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28
8/6/2015, 2:32 PM
Figure 6: Number of renal patients admitted due to flood (Source: Hospital
Census)
1.5.2. Outpatient Services and
Emergency
Specialist outpatient services
were cancelled.
Emergency
attendances were minimal due
to flooded roads and hence
services were directed to
communication and dispatch
operations with other flood relief
agencies.
This
allowed
resources to be redirected to
the wards and the formation of
more medical teams to help
with the flood relief evacuation
centres.
1.5.3. Food and Medication
As a standard flood preparation
procedure, food and medication
were stocked for inpatient
services for three months.
However,
food
was
only
stockpile for patients. Staff
evacuees
and
relatives
accompanying patients were not
provided with food. As the
hospital was not gazetted as a
flood relief centre, supply from
central agencies for flood
evacuees
were
also
not
provided to them. There was
temporary shortage of food in
the town due to electricity
supply disruption in the town
and panic buying. However,
electrical and water supply to
the hospital were unaffected.
1.6. Hospital As A Disaster Relief
Centre For Volunteer From
MOH
During the flood, there was
shortage of medical and health
personnel in the District to attend
to the relief centres. Emergency
relief staff were mobilised from
unaffected States. The hospital
was used to house these relief
personnel (Figure 7).
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Figure 7: Number of relief staff staying in HoSHAS from 25thDecember 2014 to
January 2015 (Source: Hospital Census)
2. DISCUSSION
be prepared for such a role during a
disaster.
2.1. The Need For Hospital As A Relief
Centre
This study showed that Hospital Sultan
Haji Ahmad Shah was used to its
capacity during the flood.
Bed
occupancy rate increased by about
20% - from 80% to 102% within three
days.
Hospital services are labour
intensive, especially nursing personnel.
Hospitals with intensive care units
require even higher number of nurses.
Thus, there is a need to ensure they
have a place to be accommodated
during a disaster to ensure their
availability for critical patient care
service. In the Temerloh flood, HoSHAS
staffs were also affected by the flood –
both material loss as well as emotional
distress. It is therefore essential that
emotional needs of affected staff be
properly managed in a disaster where
staffs who are victims continue to work
during this moment of need.
When disaster happens, members of
the community look to the hospital as a
safe place for refuge.
With the
availability of basic amenities, hospital
inadvertently becomes a relief centre
for the community during a major
disaster, in addition to providing its
own patient care service.
The role of hospital as a relief centre
during disasters is not something new.
For example, hospitals had been
designated as conflict free zone in
times of war. However, the September
11th (2001) attack on the World Trade
Centre was an eye opener to this role.
St. Vincent’s Hospital New York, for
instance, treated only 800 victims at
that time, but housed a crowd of close
to 25,000 people who were unsure of
where to go(7). Thus, hospitals need to
As there was over-crowding designated
Disaster Relief Centres (DRCs), the
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30
3rd
8/6/2015, 2:32 PM
volunteers together with the staff
evacuees helped ensure the
hospital operated at its optimal
level without disruption of services.
community turned to the hospital for
shelter and used the hospital facilities
for their daily needs such as toilet and
bathing facilities. This will create
sanitation and cleaning problems for
the hospital if no forward planning is
done. Hospital security was an issue
as the security services were also
affected by shortage of manpower.
Measures were taken by HoSHAS
to ensure the well-being of these
volunteers, staff and their families
together with the volunteers by
providing them with all the basic
necessities.
The Hospital Disaster Plan by the
American Hospital Association on
Hospital
Preparedness
for
Mass
Casualty and WHO Hospital Emergency
Response Checklist do not appear
address the use of hospitals as a relief
centre for staff or for the community
during a disaster(8,9). Their approach is
still oriented towards caring for the sick
and communities are directed to
designated relief centres. But in our
case, the DRCs were already congested
and could not handle the load
themselves.
2.2.
i)
Housing for the Staff
Evacuees and Volunteers
Fortunately Hospital Sultan
Haji Ahmad Shah was newly
built in 2004. Hence, there
was ample spare space to be
converted into temporary
bedding areas. Most of the
evacuees
were
female
nurses, thus nurses hostels
were used to house them.
Extra
beddings
were
provided and bought using
the Hospital’s Social Society
Fund. The three quarters
allocated for disaster were
used to house families.
Some of the male staffs
were allowed to use their
working place, single rooms
in wards and the on-call
rooms to stay. Volunteers
were housed in converted
seminar rooms.
Hospital Sultan Haji Ahmad
Shah Experience
2.2.1. Hospital Staff and Relief Staff
The issue of human resource
availability of medical personnel
was dealt with by the Ministry of
Health by sending volunteers from
its various facilities to Hospital
Sultan Haji Ahmad Shah. These
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ii)
Clothing
Some of the staffs were
working while their houses
were flooded. They were
left with only the clothes on
their back. Donation drives
were carried out among staff
to help them and some of
the clothes were also
donated to the community
evacuees.
iii)
iv)
Stress Management
Several
measures
were
taken to help reduce stress
for the staff.
a) Temporary Nursery Centre
For Staff’s Children
An ad hoc nursery service
was setup by the staff from
Medical
Rehabilitation
Department for children of
staff while their parents
were at work. Hence, the
staff could focus on their
work without having to
worry about the welfare of
their children.
Food
The hospital disaster manual
only addresses availability of
food supply for patients.
With the occupancy reaching
100%, there was hardly
enough food supply for the
2,000 hospital staff and
families of those that stayed
in the hospital.
As the
hospital
was
not
a
designated
flood
relief
centre, it was unable to
source help from flood
agencies. Food was initially
bought from nearby towns
using
emergency
funds
available.
b) Communal Cooking
Due to the flood, almost all
shops near the hospital were
closed. To enhance the
feeling of hospital oneness,
all
daily
meals
were
prepared
and
cooked
together.
Staffs
were
assured of at least one full
meal a day.
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8/6/2015, 2:32 PM
c)
Daily Trip to Nearby Town
ensure staff with highly
stress
behaviour
are
detected early and managed
properly.
The hospital management
also provided scheduled
transportation for staff to
visit nearby towns daily. It
enabled staff take a short
break from the stressful
working environment.
d)
f)
Daily Updates
Briefing for staff and Heads
of Department were carried
out daily on the flood
situation.
Worst case
scenarios, river water levels
and recovery planswere
discussed.
These daily
briefings enabled staff to be
updated as well as voice
their
opinions
and
suggestions
to
the
management.
Monitoring of Double Shifts
Double
shifts
were
monitored so that the same
staffs were not put in an
unbearable
stressful
situation. With the help of
relief staff, no staff were put
on double duty during this
period.
e) Monitoring of Stress
Behaviour
2.2.2. Community
The hospital had developed
a stress protocol two years
earlier for detection of staff
with stressful behaviour,
especially those working in
the emergency and critical
care area. It was developed
with the Psychiatry and
Mental Health Department to
Ten displaced families had used the
hospital lobby as their temporary
evacuation area.
The hospital
allocated an area and set up four
temporary tents for their use
through the Hospital social club.
Foods and clothing donated to the
hospital were also distributed to
these victims.
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33
8/6/2015, 2:32 PM
The hospital facilities were also
used to conduct Friday prayers as
most of the surrounding mosques
were flooded. Designated washing
facilities were allowed to be used
for the public.
The hospital’s
helipad which is normaly used for
patient evacuation became a
distribution despatch facility to
transport supply to victims in other
flood relief centres.
2.3. The Recovery
in the post-flood
expected to be high.
Four hospital voluntary groups were
formed to help in the cleaning of
staff’s houses that were flooded,
health clinics, schools and mosques
that were similarly flooded. With the
help of the hospital’s social club,
high power water jets were
purchased. The aim was to get the
staff and community to return to
normalcy as soon as possible, and
allow the hospital to function
effectively as the number of patients
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34
8/6/2015, 2:32 PM
period
was
CONCLUSION
ACKNOWLEDGEMENT
Although the main function of the
hospital is to provide treatment for
the injured in a disaster, its role as a
relief centre for its own staff and the
immediate community should not be
over-looked. This would ensure
adequate staffing during such critical
period where workload would be
higher. Caring for your own staffs
who are victims is as important as it
promotes loyalty and motivates the
staff to work harder. Many of the
actions taken by HoSHAS at the
recent flood were impromptu. With
better planning and preparedness,
staff welfare and patient care service
can be further improved. One
missed opportunity was in helping
staff to evacuate as part of the
Hospital’s staff mobilisation plan
before the flood occurred. In
conclusion,
Hospital
Disaster
Management
Plan
should
incorporate contingencies for its role
as a relief centre for its affected staff
as well as the local community who
may seek refuge in the hospital.
published.
REFERENCE
1. Report and Statistics, Malaysian
National Security Council. 2014-2015
2. Report and Statistics, Temerloh
Disaster Operation Control Centre.
2014-2015
3. Report and Statistics, Ministry of
Health Malaysia. 2014-2015
4. Report and Statistics, Pahang State
Health Department. 2014-2015
5. Report and Statistics, Hospital Sultan
Haji Ahmad Shah. 2014-2015
6. River Water Level. Department of
Irrigation and Drainage, Malaysia.
2014-2015
7. Meyer, Susan. Disaster Preparedness:
Hospitals Confront the Challenge.
Trustee Magazine. February 2006
8. Hospital
Emergency
Response
Checklist: An all-hazard tool for
hospital administrators and emergency
managers. WHO. Europe. 2011
9. Hospital Preparedness for Mass
Casualties. Final Report. American
Hospital Association/U.S. Department
of Health and Human Services. August
2000
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8/6/2015, 2:32 PM
Challenges of Logistical Management During The Flood Disaster in Malaysia
Lim KK, Jasvindar K, Chong ZL, Abdul Aiman AG, Mohamad Naim MR,
Azli B, Muslimah Y, Faizah P, Cheong SM
ABSTRACT
Institute for Public Health Crisis Preparedness and Response Centre (CPRC-IPH) was
established and given the task of logistic management during the major flood disaster in
Malaysia on the eve of 2015 new year. The objective of this paper is to share the
experience and challenges faced in the process. Upon establishment, CPRC-IPH recruited
its members, set up a designated flood operation room, created an inventory of stand-by
vehicles, deployed them to flooded areas for aids, monitored their activities thoughout,
devised the idea of vehicle-day to quantify the intensity of involvement of the stand-by
vehicles provided by different parties, and submitted feedback daily to Ministry of Health
Malaysia Crisis Preparedness and Response Centre (CPRC-KKM) in Putrajaya. The result
wasa 22-member team running CPRC-IPH for 20 days, different tasks outlined in the terms
of reference. Eighty-seven (87) vehicles were on stand-by, of which 55 were from various
agencies under Ministry of Health (MOH) Malaysia, 15 from concessionaries, and 17 from a
private rental company. In total, 281 vehicle-days were completed throughout the period;
out of which 39 vehicle-days were contributed by MOH vehicles, 124 by concessionaries, and
118 were rented. On average, around 14 cars were deployed each day with two from
MOH. This greatly reduced the impact to the exisiting core business of the participating
MOH agencies. Three challenges faced by CPRC-IPH in the process were shortage of
vehicle supply, communication breakdown, and difficulties in monitoring. Governmentprivate partnership, establishment of standard operation procedure for disaster
management, prior structured training for CPRC members, utilisation of diverse information
systems, and creative simplification of quantifying measurement were the keys in solving
the problems faced. In conclusion, CPRC-IPH fulfilled the logistic management successfully.
It is hoped that its experience may help to improve the logistic management for flood
disaster in the future.
Keywords: Logistic management, flood disaster, CPRC, Malaysia
Introduction
weather disaster in the world and the
costliest in terms of economic losses (1).
Flood disasters have been reported in
many regions and countries. In many
cases, the observed magnitude and
frequency of the floods have been
Flood takes place when water from heavy
rainfall exceeds the flow capacity of the
river system and happens more frequently
worldwide due to a variety of human and
environmental factors. It is the commonest
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8/6/2015, 2:32 PM
CPRC-KKM in management of this flood
disaster. Institute for Health Management
(IHM) was responsible for the deployment
of medical and health personnel from nonaffected States to the flooded ones, whilst
Institute for Public Health (IPH) was given
the task of logistic management, i.e. to
create an inventory of stand-by vehicles
and to plan their deployment according to
needs. Accordingly, each of the Institutes
established their flood operation room on
31st December 2014, known as CPRC-IHM
and CPRC-IPH respectively. Apart from
logistics, CPRC-IPH also provided hostel
facilities for medical and health staff who
were deployed to flood areas by CPRC-IHM
for their duties. In addition, individual
experts from other Institutes of NIH were
involved in the flood operation in various
ways, especially in CPRC-KKM. Experts
from Institute for Medical Research (IMR)
were also called to study the soil in flooded
areas for communicable diseases agents,
such as meliodosis.
found to be more severe than expected
(2). Flood brings casualties, destroys
infrastructures, annihilates crops, and
negatively impacts human health physically as well as psychologically. On
average, more than 196 million people are
affected by disastrous floods each year
globally (3).
The victims always need
prompt attention in several areas such as
health care, food, water, safety and
childcare (4).
Malaysia is among the countries that
experience negative influences of floods
yearly. Based on the existing reports,
40% of the total damages in Malaysia
were brought by floods (5). In 2006, the
state of Johor was hit by one of the worst
floods in Malaysian history with about
160,000 populations being displaced (6).
The record was renewed in December
2014, when Malaysia suffered an even
worse flood disaster which affected
several States simultaneously. Many of
the areas affected were not considered as
flood-prone prior to this. Health care
providers faced many challenges in
delivering their services to flood victims
due to devastation of healthcare facilities
and other infrastructures. The Ministry of
Health (MOH) Crisis Preparedness and
Response Centre (CPRC-KKM) was
mobilised to provide short-term relief
responses and interventions by deploying
additional medical and health personnel to
restore the health services to the affected
states.
Many disaster studies have their focus on
documenting the ways disasters affect
individuals, households and communities.
However, documentationon transportation
problems and vehicle management for
disaster response operations is very
limited. The aim of this paper is to provide
a general overview of the issues and
challenges experienced by CPRC-IPH in the
management of vehicles and transportation
during this major flood disaster. Data and
informations were obtained from CPRC-IPH
reports and through observations made
during the flood period in various the flood
operation rooms.
Following the decision of the CPRC-KKM
meeting on 31st December 2014, two
research institutes were selected to assist
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8/6/2015, 2:32 PM
Materials and Methods
other stakeholders. CPRC-IPH was to
fulfill the needs by deploying vehicles with
or without drivers from its inventory of
stand-by vehicles according to requests.
Following instructions received in the
meeting at CPRC-KKM, a techincal
committee for CPRC-IPH was formed
immediately. Members were recruited
from among staff based on availability
and willingness to participate.
Each
member was given a task according to
the terms of reference outlined later on.
A meeting room equiped with necessary
facilities within the main block of IPH was
converted into the flood operation room.
It was staffed according to pre-arranged
rosters. Meetings were held regularly in
the flood operatioin room to update
members on the latest developments.
Upon deployment, the vehicles were
monitored
daily
by
CPRC-IPH.
Information such as schedule, tasks and
locations were obtained from the drivers
or responsible officers and updated each
morning. Communications were carried
out using landline, mobile network and
internet. Among them, the most used
was instant mobile messaging application,
in
particular,
which
WhatsApp®
contributed to rapid information updates
between all the stakeholders. Besides,
photos sent by the drivers also provided a
glimpse into the latest condition of the
flooded areas.
As soon as it was established, CPRC-IPH
created an inventory of stand-by vehicles
by contacting various agencies under
MOH in States which were not affected by
floods, such as State Health Departments,
Hospitals, Allied Health Colleges, Research
Institutes, and various Divisions within the
head office at Putrajaya. These agencies
were requested to identify and set apart
idle vehicles and drivers, if any, for flood
rescue operation purposes.
Contact
persons were also appointed by each
participating agency. On the other hand,
the MOH Engineering Division in Putrajaya
was given the mandate to coordinate with
various
hospital
support
service
concessionaries for vehicle contribution,
whilst the Administrative Unit in Putrajaya
was to hire appropriate vehicles in case of
shortage.
In order to measure the amplitude of
involvement of the stand-by vehicles from
the three main providers, CPRC-IPH
devised and proposed the idea of vehicleday. When any one vehicle was deployed
for any activity in a day, regardless of the
number of trip it made during that
particular day, it was counted as one
vehicle-day. For example, two vehicles
deployed in a day was counted as two
vehicle-days; one vehicle deployed for
two days was also counted as two
vehicle-days.
Vehicle-day represents
neither the exact number of vehicle
deployed nor the exact number of day a
vehicle was deployed. It merely quantify
the intensity of vehicle usage over a
particular period. This means the higher
the number of vehicle-day, the higher the
number of vehicles deployed and the
longer the time these vehicles were away.
At the same time, CPRC-IPH started to
receive
transportation
and
vehicle
requests from CPRC-IHM and CPRC-KKM,
which in turn received them from the
affected State Health Departments and
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8/6/2015, 2:32 PM
Results
Further more, by dividing the vehicle-day
with the total period of operation, one will
get the number of deployed vehicle per
day.
The CPRC-IPH technical committee
consisted of 22 members, 14 of whom
were officers and the rest were support
staff. For smooth operation, each member
were given a position with specific terms
of reference (Table 1). Two duty shifts
were formed, which were morning (8.00
am – 2.30 pm) and afternoon (2.30 pm –
9.00 pm) shifts. The members were
rotated to go on duty according to prearranged roster to prevent fatigue. In the
end, CPRC-IPH operated for 20 days in
total between 31st December 2014 and
19th January 2015.
All information on CPRC-IPH activities, in
particular the logistics were updated on a
daily basis and recorded in both hard and
soft copies. These informations were
summarised into a daily reportwhich was
submitted through email to CPRC-KKM.
Table 1: Terms of reference for CPRC-IPH members
Position
Terms of reference (TOR)
Liason officer
(LO)
Attend CPRC-KKM meetings in Putrajaya
Coordinate activities in the flood operation room
Coordinate and colloborate with other stakeholders
Head
Assist LO in coordinating the activities in the flood operation room
Communicate with other stakeholders in daily operation
Prepare and submit daily report to CPRC-KKM and LO
Operation
officer
Establish the flood operation room for usage
Maintain the flood operation room daily
Staff the flood operation room by preparing duty roster
Update daily record of duty officer
Document
officer
Record all the activities of the flood operation room according to
chronological order
Keep a record of all documentation and forms
Ensure all the documentation and forms are updated
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8/6/2015, 2:32 PM
Duty officer
Update the inventory of stand-by vehicles
Monitor the movement of deployed vehicles
Record all incoming/outgoing calls in the record book.
Check the CPRC-IPH official email ([email protected])
Update the contact numbers of relevant organizations andpeople
Liase with other stakeholders when needed
Record all the informations received and decisions made
Receive and pass-over shifts from and to the other duty officers
Drivers
Be eveready for deployment
Update the flood operation room with informations on activities,
working schedule, and location of the vehicle
A total of 87 vehicles comprised the
inventory of stand-by vehicles.Among
them were 55 vehicles of different classes
such as 4-wheel-drive (4WD), multipurpose vehicle (MPV), van, sedan car,
and bus from various agencies of the
MOH Malaysia (Table 2); 15 4WDs from
concessionaries; and another 17 rented
4WDs from a Car Rental Company. Out
of the 15 4WDs contributed by the nine
concessionaries, 5 were from Radicare; 2
each from Medivest and AVP; and 1 each
from Continental, Technohouse, Alshem,
KBE, George Kent, and Besta.
Table 2: Total vehicles available from various agencies under the Ministry of Health
Malaysia
Type of Vehicles (in number)
Contributors
4WD
MPV
Van
Car
Bus
Ministry of Health (MOH)
Research Institutes
9
1
1
3
1
National Blood Centre
1
1
Allied Health College
1
State Health Departments
26
4
6
1
Total
36
6
7
3
3
There were two guiding principles
in the selection of stand-by vehicles for
deployment. Concessionary and rented
vehicles were the first to be deployed to
reduce the impact on exisiting core
business of the participating MOH
agencies. Secondly, whenever a MOH
vehicle was deployed, it was preferably
for short distance day trip. As a result,
throughout the 20 days of operation, the
MOH agencies contributed merely 39
vehicle-days out of a total of 281 vehicle-
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8/6/2015, 2:32 PM
days. The rest were evenly distributed
between the concessionaries (124 vehicledays) and private car rental company
(118 vehicle-days). This means that on
the average, around 14 cars were
deployed each day; out of which two
were from the MOH, and six each were
from concessionaries and rental company.
Figure 1 demonstrates the number of
daily deployed vehicles according to
different parties in details. The number
rose steadily, peaking on 6th January
2015, and plateauing on the 17th day
from the start. The area below each line
represents the number of vehicle-day
contributed by the respective providers.
Number of Vehicles
35
30
25
20
15
10
5
19-Jan
18-Jan
17-Jan
16-Jan
15-Jan
14-Jan
13-Jan
12-Jan
11-Jan
10-Jan
9-Jan
8-Jan
7-Jan
6-Jan
5-Jan
4-Jan
3-Jan
2-Jan
1-Jan
31-Dec
0
Date
Total
MOH
Concessionaries
Rented
Figure 1: Daily deployed vehicles
Discussion
Most of the logistic systems are designed
to operate under regular conditions.
When a disaster takes place, the means
to deliver aids are usually disrupted and
hence, the logistic operation faces
difficulties in accomplishing the tasks (4).
However,
with
improvements
in
information communication technologies
and preparedness, logistic plans to reach
the affected areas with all the urgent
needs have been proven to be successful
(7). Logistic management during flood
disaster involves dispatching commodities
such as medical materials, equipments,
rescue teams to the affected areas as
soon as possible(8).
The damage caused by the recent floods
was unprecedented to the residents as
well as infrastructures, especially roads
and health facilities. The MOH Malaysia
responded immediately through CPRCKKM during the flood disaster to restore
the services of medical care in the
affected areas by mobilization of
emergency supplies, equipments and
personnel. The workload was enormous
as additional flood-related emergency
medical services were urgently needed,
on top of the regular day-to-day medical
services provided.
Since logistic
management is one of the most important
elements of disaster management itself,
CPRC-IPH was established to focus only
on this task and do it well.
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8/6/2015, 2:32 PM
In fulfilling its calling, CPRC-IPH faced
many challenges. Although most of the
problems were solved promptly, three
underlying key issues that gave rise to
them must be addressed here to improve
the
efficacy
of
disaster
logistic
management in the future. These three
issues are shortage of vehicle supply,
communication
breakdown,
and
monitoring difficulty.
when most of the trips were completed by
concessionary and rented vehicles.
Apart from that, multi-party involvement in
disaster management with no training or no
standard prior training and experience led
to a common mistake – communication
breakdown.
Throughout the operation,
CPRC-IPH received conflicting instructions
from different parties through different
channels, which greatly affected the
arrangement and monitoring of the
vehicles. Most of the mis-informations were
sorted out properly prior to decision
making.
Unfortunately, one incident
happened towards the end of the operation
where two buses departed forthe airport to
fetch 90 returning health staffs but returned
with only one person as the rest of them
dispersed upon landing following their own
family or department vehicles (11). This
problem can be solved by improving the
communication channels under existing
standard operating procedures (12). Proper
training for CPRC staffs may also enhance
their efficacy in future as most of those
involved were first-timers. Nevertheless, the
decision to allocate three vehicles and two
drivers fully to CPRC-IHM for its use from
the beginning helped to prevent the
mistake from happening earlier. Despite all
efforts, effective communication between
various agencies remained a persisting
issue in logistic mamagement and is still
being cited as the main area that needs
attention in disaster or crisis management
(13).
The flood left affected areas with limited
availability of all resources, for example,
transportation,
supplies,
manpower,
hospital
capacity
et
cetera.
The
communities and agencies depend heavily
on transports from non-affected areas to
fill up the gaps. The transportation system
is the most important lifeline system,
because damage to it imposes extra
burden on their other lifelines (9). In
addition, these disruptions are costly and
it is crucial that authorities take
appropriate measures of response to
reduce it’s negative effects (10).
CPRC-IPH attempted to minimize these
problems by requesting standby vehicles
from various health agencies not affected
by floods directly. However, many State
Health Departments and Hospitals had
already deployed their own vehicles
voluntarily to the flooded areas, and thus
were unable to provide extra vehicles for
standby. In addition, the remaining
vehicles were just enough for their
exisitng daily core activities. However,
some State Health Departments, Research
Institutes under MOH, National Blood
Centre and Sungai Buloh Allied Health
Colleges were able to spare some vehicles
for stand-by. Fortunately, the fear of
disturbing the core business of various
MOH agencies was alleviated eventually
As an extension of the communication
issue, difficulty in monitoring the activities
of the deployed vehicles troubled CPRCIPH. Lack of coordination and poor
telecommunication
network
in
the
affected areas were identified as the main
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8/6/2015, 2:32 PM
culprits of this
issue.
Prompt
communication between CPRC-IPH and
the drivers was crucial as timely and
accurate informations were crucial in
logictic management (14). Fortunately,
this issue was minimised with the
availability
of
information
and
communication technology. The existence
ofinstant mobile messaging applications
provided
a
reliable
communication
platform for stakeholders to converse with
each other. These information system
provided timely access to comprehensive,
relevant
and
reliable
first-hand
informations. Therefore, it is not a suprise
that social networks are becoming more
attractive for agencies in addressing
communication issue during a disaster
(15).
standard operation procedure for disaster
management, prior structured training,
utilisation of diverse information systems,
and creative simplification of quantifying
measurement proved to be a lifeline in
the time of need. By raising the issues
and
recommending
steps
for
improvement, it is hoped that the logictic
management for flood disaster may be
perfected in the future.
Acknowledgement
The authors would like to thank the
Director-General of Health, Ministry of
Health Malaysia for permission to publish
this paper. We are grateful to all the
members of CPRC-IPH, CPRC-KKM, and
CPRC-IHM, who together contributed to
the country during this disaster. Last but
not least, we extend our deepest
condolence to the flood victims and
sincerely hope for them to recover from
the lost soon.
As part of vehicle monitoring issue, it was
realised that to quantify the intensity of
involvement of stand-by vehicles from
different parties, information on mileage
covered and time spent by each vehicle is
necessary. This will require a methodical
checking mechanism and an effective
feedback loop, which is time-consuming
during a disaster. A more accurate
method would be through installing a
global positioning system in each vehicle,
but this is expensive and needs additional
funding. The idea of vehicle-day might be
a solution to this due to its simplicity in
contrast to the widely used conventional
measurements (16).
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Pre-deployment Flood Disaster Volunteer Activities in Crisis Preparedness Response
Centre of Institute for Health Management (CPRC IHM): Our Maiden Experience
Pangie B, M Fairuz AR, Noriah B, N Filzatun B, N Izzah AS
Institute for Health Management
ABSTRACT
Flood disasters are closely related with the states that lie on the East Coast and Northern
parts of Malaysia. The flood that occurred recently in December 2014 and January 2015
was regarded as one of the worst crisis that Malaysia has ever experienced in recent
decades. It affected more than 250,000 people and disrupted the services of many
hospitals and clinics. The serious impact on healthcare services in the three affected states
(Kelantan, Pahang and Terengganu) has necessitated the Crisis Preparedness Response
Centre (CPRC) in the Ministry of Health (MOH) to mobilize other healthcare professionals
from non-affected states to provide services at these affected areas. During crisis, human
resource management plays a vital role which includes the deployment of volunteers. This
article is mainly about workflow and process in CPRC Institute for Health Management
(IHM) as a transit centre for deployment of healthcare volunteers to the affected area.
CPRC IHM was established on the 28th December of 2014 and headed by the Director of
IHM. Several teams have been formed, namely the operational room, logistic, predeployment registration, post-deployment registration, data management, Non-MOH
volunteer registry, Information Technology and catering teams. All the teams had
synergistically worked together throughout the deployment process. CPRC IHM in
collaboration with other divisions like CPRC MOH, CPRC Institute of Public Health (IPH),
Disease Control Division particularly Environmental Health Section and Mental Health
Section, MOH were working hand in hand in providing the services. As this is a maiden
experience for IHM managing such a crisis, many lessons were learnt which were valuable
for future preparation. As this was a new experience for IHM, standard operating
procedures (SOP) and guidelines needed to be developed which cover all aspects of
deployment for future preparedness. This spans initiation of the operational room to
deployment of healthcare volunteers to the disaster area with better coordination from
CPRC MOH.
Keywords: Flood disaster, CPRC MOH, CPRC IHM, pre-deployment volunteers,
transit centre
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Introduction
Malaysia is blessed as she is located
outside the “Pacific Ring of Fire”.
However, Malaysia encounters other
disasters such as floods, man-made
disasters and haze annually. Flood
disasters are associated mainly with
states that lie on the East Coast and
Northern part of Malaysia. Based on the
Department of Irrigation and Drainage
Malaysia, about 29 800 km2 or 9% of land
in Malaysia is prone to flash flooding. It is
due to the cyclical monsoon which usually
peaks from October to January annually.
However, no states in Peninsular Malaysia
are totally spared from experiencing the
flood phenomenon.
Building experience and exposure
of the staff
Preparedness for disaster
Fast response towards disaster
Assessment of severity and effect
of any disaster
Evacuation, rescue and relief
Recuperation and rebuilding
In disaster and crisis management,
human resource management plays a
vital role especially in the deployment of
volunteers. The coordination to meet
demand of human capital during the crisis
is important in response to the shortage
of functioning healthcare providers in the
affected area. Alerted by this paralysis of
health services in all three states, CPRC
MOH had to mobilize other healthcare
providers from non-affected states to
provide relief to already exhausted
healthcare workers in the area.
The flood that Malaysia experienced in
December 2014 till January 2015 was
regarded as one of the worst flood crisis
that ever happened in recent decades. It
had affected more than 250,000 residents
and adversely affected many health
services including hospitals and clinics.
Background of CPRC IHM
CPRC IHM was established on the 28th
December of 2014 based on the mandate
given during the CPRC MOH Meeting
which was held on the previous day. In
view of the availability of accommodation
and training facilities, IHM was appointed
the transit centre for MOH healthcare
volunteers. Two main tasks for CPRC IHM
were the pre and post deployment of
healthcare volunteer management. This
article mainly discusses pre-deployment
activities in CPRC IHM.
Lesson learnt from this experience is the
disaster and crisis management need to
be strengthened. Arora (2013) discusses
about
the
process
of
disaster
management which involves a continuous
and integrated process of planning,
organising and implementing measures
which are;
Prevention of potential danger or
threat of any disaster
Migitation or risk reduction of a
disaster of the severity or
consequences
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During the 20-day operation from the 28th
December of 2014 until the 16th January
of 2015, CPRC IHM had managed and
deployed 494 volunteers mostly consisted
of MOH healthcare providers from West
Coast, Peninsular Malaysia to Kelantan,
Pahang and Terengganu. The breakdown
of the volunteers by job position is shown
in Table 1.
Table 1: Number of pre-deployment volunteers in transit at CPRC IHM by job
position
No
Job Position
Total
Volunteer
1.
Specialist
15
2.
Medical Officer
40
3.
Dental Officer
3
4.
Nurse
163
5.
Assistant Medical Officer
30
6.
Assistant Dental Officer
4
7.
Counsellor
12
8.
Engineer
25
9.
Penolong Pegawai Kesihatan Persekitaran
50
10.
Social Worker
1
11.
Laboratory Technician
4
12.
Pembantu Kesihatan Awam
18
13.
Driver
61
Pembantu Perawatan Kesihatan
14.
20
Pembantu Rendah Awam
15.
20
Grand total
494
The CPRC IHM Operation Structure
CPRC IHM task force was formed which
comprised the IHM administration,
financial department and technical
officers. It was led by the Director of IHM
and assisted by a dedicated officer
heading the CPRC IHM Operation Room
and supported by seven teams with
various functions and roles (as in figure
1).
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Figure 1: The Functional Structure of CPRC IHM and the Respective Teams’ Responsibility
Pre-Deployment CPRC IHM Team Scope of Work
the affected areas. To ensure efficient
and quality services were given to the
volunteers, the workflow illustrated in
Figure 2 was developed and adopted by
the pre-deployment team.
As a transit centre during the flood
disaster, CPRC IHM was tasked to
facilitate the deployment of volunteers to
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Figure 2: The workflow for the CPRC IHM pre-deployment team
Pre-deployment Volunteers
Management
iii.
iv.
In general, the management of the predeployment volunteers in CPRC IHM was:
i.
Volunteer registration;
ii.
Pre-deployment Psychological First
Aid (PFA) briefing;
Accommodation
and
facilities; and
Logistic arrangements
All pre-deployment volunteers were
required to follow the process flow as set
by CPRC IHM as shown in Figure 3.
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Figure 3: Pre-deployment Volunteer’s Process Flow
1.0 Volunteers Registration
Once the volunteers arrive at IHM, they
will be registered promptly. All volunteers
were registered using standard format
provided by CPRC MOH. For those who
were not on the list, CPRC IHM contacted
CPRC MOH via a Liaison Officer (LO) for
further action. Once registered at IHM
and the details received from CPRC MOH,
the CPRC IHM officer-in charge will notify
the volunteer of their flight schedule. The
main purpose of the complete and
detailed registration was for inclusion in
the daily census report and MOH
volunteer registry database.
Essential information such as contact
person at affected states, return flight
details (if available), flood or water-borne
related disease such as leptospirosis,
meloidosis and typhoid and precaution or
safety practice during flood were also
conveyed to the volunteers during the
briefing
session.
The
protective
equipments which were supplied by the
Occupational Safety and Health Unit,
Ministry of Health were distributed to the
volunteers.
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Photo 1: The volunteers were given safety jackets and sleeping bags before deployment
Photo 2: The Secretariat of CPRC IHM updating the daily census of the pre-deployment
volunteer
2.0 Psychological First Aid (PFA) and
Pre-Deployment Briefing
Based on National Guidelines for Mental
Health and Psychosocial Response to
Disaster, the mental health needs of
disaster response workers should be given
priority. This should include appropriate
training and surveillance during and post
deployment. All volunteers who registered
to volunteer underwent a session of PFA
by a trained counsellor. The purpose of
the PFA session was to provide
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psychological support and to ensure
preparedness for the volunteers so that
they were mentally well prepared to serve
in the affected area. The content of PFA
was based on the national guideline which
comprised information on emotional and
psychological impact (short and long
term) disaster on individuals. It includes
the recognition and management of
distressed feelings, anxiety, depression,
post traumatic stress disorder and other
mental health issues that may occur. This
guideline also outlined how the volunteers
manage their mental health needs and
simulation exercise. The PFA sessions
were conducted in groups or face-to-face,
depending on the number of volunteers
present during the session or the
particular time before their departure to
the affected areas.
Photo 3: PFA trained counsellor giving PFA in Delima Hall to the group of pre-deployment
volunteers
3.0 Accommodation and Catering
Facilities
Upon registration in IHM, the volunteers
were provided with accommodation
according to their flight schedule. Food
and beverages were also provided
throughout their stay in IHM. A total of
151 volunteers were lodged at IHM
accommodation during their transit. The
hostel supervisors were responsible in
managing and arranging the room for
volunteers. The Catering Unit was in
charge of providing food for all volunteers
who transit in CPRC.
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Photo 4: The Catering team monitoring the catering service at the cafeteria
4.0 Logistics Arrangements
deployment volunteers who were using
CPRC airport transfer were notified early.
They were asked to gather at the IHM
lobby before the departure. The logistic
officer in charge would ensure that all the
listed volunteers embarked on the
provided vehicle. The volunteers were
also reminded to bring all of their
belongings. Other than that, CPRC MOH
also had allocated one liaison officer at
every airport to facilitate the process of
check in of the volunteers at the airport
counter.
For logistic arrangements, CPRC IHM
collaborated with CPRC IPH and other
institutes namely Institute for Health
Behavioural Research (IHBR) and NIH
Secretariat to provide more drivers for
this task. IHM has also provided 1 bus
with maximum of 25 passengers, 1 sixseater four-wheel-drive and three cars.
CPRC IHM arranged the transport
accordingly i.e by number of volunteers
and type of airport locations. Pre-
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Photo 5: The Logistic Officers assisting the volunteers into the bus before they departed for
Subang Airport
Challenges and Recommendations
Flood disaster management involved
inter-organisational commitment and each
organisation has their chain of command,
information and communication resources
(Sufiza, 2012). The synchronization
between these organisations and the units
within the organisation affect the
efficiency of overall disaster management
country wide. Centre for Public Policy
Studies (2015) reported that there were
weaknesses in disaster management such
as lack of coordination, dissemination of
information and inadequate standard
operating procedures. Being assigned as
the transit centre for flash flood, CPRC
IHM faced many challenges as this was
our first experience involved in disaster
management.
this timing, many of the volunteers were
not physically and mentally prepared.
Realising this, CPRC MOH reminded
respective departments that volunteer
recruitment
must
emphasise
the
importance of physical and mental
preparation. In the light of disaster, each
volunteer should be briefed on the
expectations, adequate and suitable
belongings. Foods, medical supplies and
personal belongings should always follow
these two criteria; ready-to-go & easy-tocarry.
As a transit centre, IHM has displayed the
related information on its official website.
Other medium of dissemination was
through MOH official website and DG’s
official
Facebook
page
which
announced IHM as a transit centre and
invited volunteers to visit the IHM website
for further information and clarification.
Relevant information was available on
display boards at IHM.
1.0 Preparation and Information for
Pre-deployment Volunteers
As this was a big scale flood disaster,
MOH had to send extra healthcare
volunteers to the affected area. Due to
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Early notification should be given to the
volunteers prior to their departure to the
affected area. However, during this crisis,
some of the volunteers were informed by
their superior late e.g the night before
their departure. During PFA briefing,
volunteers who were not ready to go
were asked to return to their workplace.
Experiences of earlier batches of
volunteer were also shared during PFA
briefing. This would help volunteers to be
prepared on what to expect when they
were in affected area.
number of volunteers that will transit at
IHM, there will be either inadequate or
excess food preparation. Normally, early
information from CPRC MOH helped to
overcome this issue and food will be
prepared based on number of volunteers
at particular time.
Conclusion
Effective and efficient communications are
the main pillars in any effective disaster
management. The networking and
excellent teamwork among those involved
had benefited others in ensuring the
smoothness of transiting volunteers, thus
the credit should be given to CPRC MOH
as the main recruiter and managed the air
transport, CPRC IHM as the main transit
for MOH volunteers and CPRC IPH which
was in-charge of the land transportation
for MOH vehicles. At the beginning, there
were a few hiccups especially in
conveying the volunteer profile to the
relevant department, flight schedules and
logistic arrangements. However, once the
Liaison Officers were appointed as the
contact person between CPRC MOH and
CPRC IHM to convey all the information,
suggestion and queries, the process went
smoothly. Based on this valuable
experience, it is recommended that a
standard operating procedure (SOP) and
guidelines should be developed which
consists of the setting up of an operation
room
with
a
clear
functional
organisational structure with responsibility
and work process for a transit centre.
2.0 Short Period of Time for Logistic
Notification
The major issue in the logistics
management was when CPRC IHM
received late flight itinerary from the
CPRC MOH. The shortest notice was 3
hours before the departure time especially
during the first three days after the
establishment of CPRC IHM. It was
extremely short notice considering the
time required for transport to the airport,
current traffic conditions and the flight
check-in time. As an immediate solution,
a liaison officer from NIH was appointed
as focal person in CPRC MOH. As a result,
many issues were solved and overcome
such as the itinerary of the volunteers
was sent a day before they were deployed
to the affected state.
3.0 Issues on Food Preparation
Other issue faced was the food
preparation for the volunteers. When
CPRC IHM does not receive the correct
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Acknowledgement
We would like to acknowledge the
Director General of Health, Malaysia for
permission to publish this article.
Mental Health Unit, Non-communicable
Disease Section, Disease Control Division,
Ministry
of
Health
Malaysia
in
Collaboration
with
World
Health
Organization (2013). National Guidelines
for Mental Health and Psychosocial
Response to Disaster. Kuala Lumpur.
Mental Health Unit, Non-communicable
Disease Section, Disease Control Division,
Ministry of Health Malaysia (2013).
Manual on Mental Health and Psychosocial
Response to Disaster in Community. Kuala
Lumpur.
Mohd Sukeri K, Shazwani S. (2015). Flood
Disaster Management: An Evaluation of
Effectiveness Flood Delivery System.
Reference
Arora P. (2013) Leveraging Human
Resource
for
Effective
Disaster
Management: Comparative Lessons from
the 2011 Tohoku and the 2004 Indian
Ocean Tsunami. Visiting Researcher
Report submitted to the Japan Institute
for Labour Policy and Training (JILPT),
Tokyo, Japan, p. 90.
Centre for Public Policy Studies (2015),
CPPS Policy Fact Sheet: Malaysia’s Flood
Management.
Chan, N. W. (2012), ‘Impacts of Disasters
and Disasters Risk Management in
Malaysia: The Case of Floods’, in Sawada,
Y. and S. Oum (eds.), Economic and
International Journal of Social Science
and Humanity, 5(4):398-402.
Safiza Suhana KB, Abdul Samad S,
Zahriah O. (2009). Disaster Management
in Malaysia: An Application Framework of
Integrated
Routing
Application
for
Emergency
Response
Management
System. International Conference of Soft
Computing and Pattern Recognition.
Third AIPA Causus Report (2011), ASEAN
Inter-Parliamentary Assembly.
Welfare Impacts of Disasters in East Asia
and Policy Responses. ERIA Research
Project Report 2011-8, Jakarta: ERIA.
pp.503-551.
Harpal S. Shamala S. (2009), Health
Emergency and Disaster Preparedness in
Malaysia. South East Asian Journal of
Tropical Medicine of Public Health,
40(1):11-15.
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Collaboration Via ‘Smart Partnership’ in Flood Disaster Assistance
Alzamani MI, Hafiz S, Abu Hassan AA
Hospital Kuala Lumpur
Abstract
In any disaster, resources are limited. Various agencies have different resources and
strengths. The major floods that swept across the East coast from late December 2014 to
early January 2015 caused a population displacement of more than 200,000 people and
enormous property destruction. We describe a strategy of engaging ‘smart partnership’ via
collaboration with various organizations for the common purpose of humanitarian
assistance. Our ‘smart partnership’ had enabled us to unite resources and strengths and
distribute them based on victims needs in Kelantan and Pahang. An assessment team was
dispatched and based on findings; strategy was laid out to provide effective and relevant
form of assistance to meet there needs. A total amount of RM 295,711.10 worth of goods
was channeled to victims effectively and systematically. The ‘smart partnership’ via
multiorganization collaboration is a good working model in uniting effort, resources and
strength in providing assitance during and after disasters. Such a working model is
recommended for future assitance efforts for disasters.
Introduction
organizations
partnership.
In any disaster, resources are limited.
Various agencies have different resources.
Massive floods struck the East coast areas
of West Malaysia affecting mainly the
states of Kelantan, Terengganu and
Pahang from 15th December 2014 to 3rd
January 2015. More than 200,000 people
were displaced and 21 people died during
this disaster. A lot of property was lost or
damaged and the total loss was estimated
to be worth more than RM500 million.
About 200,000 individuals were displaced
by the floods in the East Coast with
Kelantan having the higher number.
Critical patients from affected hospitals in
Kelantan had to be evacuated. In an
attempt
to
provide
humanitarian
assistance to affected people, the
Emergency Department of Hospital Kuala
Lumpur collaborated with different
through
57
‘smart’
Method & Materials
We describe a strategy of smart
partnership through multiple organizations
in galvanizing an effective response for
assistance during the flood. ‘Smart
Partnership’ is a concept introduced by
Steven R. Covey through his book, 7
Habits of Highly Effective People (Covey,
2013). Value and respect are attained by
people understanding a ‘win’ for all is
ultimately a better long-term resolution
than if only one person or one
organization in the situation had got his
way. This was the basis of our partnership
for this project.
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The smart partnership was established
among three main parties:
Emergency Department of Hospital
Kuala Lumpur (EDHKL)
The committee of ‘Projek Banjir
‘Aids’ HKL (Projek BAH)’
The National Welfare Foundation
set up by the Hospital Director to pool
contributions from the whole hospital. The
EDHKL also collaborated with the National
Welfare Foundation to provide assistance
for the floods victims in Kelantan and
Pahang.
Results
The objectives of our ‘smart’ collaboration
are as stated below:
To provide medical assistance
based on needs at selected
evacuation centres in Kelantan &
Pahang
To assist in getting affected
medical centres like Health Clinics
affected by floods into working
conditions
To provide mental support for
affected victims
To provide care and psychological
support for children
To identify needs and provide
appropriate and relevant assistance
To work with multiple agencies for
relief care
This strategy of collaboration is the first of
its kind applied to our hospital. The
strategy of engagement of this smart
partnership is described below.
From the initial meetings, the modus
operandi for this project was determined
and the following were exercuted:
Deployment of expert analysis
team to Kelantan and Pahang for
needs assessment
Deployment of HKL medical team
to evacuation centres for medical
support as well as mental and
community support
Establishment of medical centres
which included clinic/ sickbay/
treatment corners for evacuation
centres.
Provision of water tanks and water
purifier
Support for drugs replacement for
chronic illnesses
Provision of ‘healthcare walkabouts’
at evacuation centres
Engagement of counselors for
mental support
Profiling of family members at
evacuation centres
Children psychological support
programme institution like ‘art
therapy’ etc
Provision of health talks on waterborne diseases in anticipating
infectious
disease
contraction
during recovery phase
Wellness Kit distribution for victims.
Health clinics clean-up
Postfloods aboriginal settlement
humanitarian assistance
Strategy of Assistance
A smart partnership was established via a
series of meetings with stakeholders.
These meetings were initiated by the
Emergency
Department
of
HKL.
Subsequently the stakeholders agreed to
assemble each organization’s resources to
meet the demands of victims. Emergency
Department of Hospital Kuala Lumpur
(EDHKL)
collaborated
with
‘Projek
Bantuan Air Banjir HKL (Projek BAH)’
which consisted of a committee specially
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o Planning and strategy
o Logistics and planning
Resource 2 : ‘Banjir Aids HKL’ Project
(Project BAH)
o Collection of donations from
all HKL staff
o Manpower resources
Resource 3 : National Welfare
Foundation
o Logistics support - vehicles
o Equipment to be purchased
o Wellness kits for family
members
o Support of food and shelter
for assistance providers
o Engagement of councillors
and psychologists
Resources from ‘smart partnership’
The
‘smart’
partnership
enabled
assistance to be provided and through
this collaboration multiple resources were
combined for a workable function of
assistance strategy (Figure 1). The
various resources attained are listed
below:
Resource 1 : EDHKL resources
o Emergency Medicine and
Disaster
Management
consultation expertise
o Risk assessments
o Trained personnel as field
medical responders
Figure 1 : ‘Smart Partnership’ via collaboration with multiple organization
Total Expenses
logistics purpose such as transport and
food for volunteers.
Through this ‘smart partnership’, the
project managed to raise and distribute a
total of RM 295,711.10 to flood victims in
Kelantan and Pahang. This excludes more
resources which were obtained for
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Transport & Logistics
and hence the paralysis of the community
safety system including local National
Security Council personnel, police, fire
and rescue services and ambulance
services. Many affected victims lost
belongings and houses were swept away.
An oversupply of volunteers was noted in
Kelantan in the week following the
flooding.
HKL established contacts and cooperation with the Air Force and Fire &
Rescue
Department
for
transport
assistance. The HKL Transport Unit
provided land transport for closer areas
such as Temerloh, Pahang.
Assessment in Kelantan
The Intervention in Kelantan
An expert analysis team was sent to Kota
Bharu Kelantan on 30th-31st December
2014. The assessment team despatched
consisted of a Senior Consultant of
Emergency Medicine, 2 Emergency
Physicians,
an
Emergeny
Medicine
Registrar, an Assistant Medical Officer and
3 officers from the National Welfare
Foundation. The floods had brought
strong currents in certain areas like Kuala
Krai where travel by boat was risky.
Helicopters could not land in certain
areas. A ‘third wave’ of rain was expected
according
to
the
Metereological
Department (but did not occur in the
end). Certain areas were not accessible
by medical teams due to deep floods on
the roads. A sizeable number of clinics
were damaged. Hospitals like Kuala Krai
became an ‘island’ and were not
accessible via land vehicles. The floods
brought mud which required a lot of clean
water for the cleaning-up process. Piped
water and electricity were not available.
Many public workers were also victims
The team established a medical centre at
the Sultan Ismail School which housed
about 4,000 evacuees. 2 water tanks and
a purifier were donated to the centre. An
assessment was also performed at
Sekolah Kebangsaan Pengkalan Kubor in
Tumpat Kelantan with a view to establish
a medical center there as well. A 24 hours
Emergency
Medical
Service
and
Observation Ward was established in both
side. At the time of assessment, there
was already an excess of medical
volunteers in Kelantan. Water had
receded and most evacuation centres
were being closed. In view of this, the
reconnaissance team decided to switch
attention to Temerloh, Pahang to optimize
assistance in areas needed.
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Donation of Water Tanks for Relief Centre Use
Aborigines Medical & Humanitarian
Assistance
Krau were damaged by flood which left
mud and dirt with a strong stench which
rendered medical services there not
feasible until a full proper cleanup. Most
furniture was not usable. The floods
brought mud which required a lot of clean
water for cleanup. Many affected victims
lost belongings which were damaged in
their houses.
A team was sent to Gua Musang, Pahang
for humanitarian assistance for the
aborigines at Kampung Liggi, Kuala Betis
and Tohoi. The team provided a mobile
medical team as well as wellness kits,
mattresses, pillows and food to the
affected community.
The immediate needs were clean water,
basic survival items to restart life such as
cooking stove, personal hygiene kits and
cleaning up of the health clinic. A follow
up meeting was held the next day at HKL
with the Projek BAH committee member
and it was decided to send assistance the
following day. At the time of assessment,
there were 62 evacuation centres in
Temerloh with about 23,000 evacuees.
Many areas were not reachable due to
access issues. There were also family
members not contactable or whose fates
were uncertain.
Assessment in Temerloh, Pahang
An expert analysis team was despatched
on 2nd December 2014 to Temerloh
Pahang. The team included a senior
consultant, 3 Emergency Physicians, a
Matron and three staff nurses and a
dietitian. The team visited the Hospital
Sultan
Ahmad
Shah,
the
Floods
Operations
Room
at
the
Health
Department, and the Evacuation Centre at
Sekolah Sukan Pahang in Temerloh which
housed about 4,000 evacuees, evacuation
centres in Kuala Krau and a Health Clinic
at Kuala Krau. Certain areas were not
accessible to medical teams due to deep
floods on the roads. Clinics like Kuala
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The Intervention in Pahang
College volunteers and the Tzu Chi
organization. The clinic was in very bad
shape and the stench from the mud made
its function not feasible. The National
Welfare Foundation provided cleaning
equipment like shovels, spades, wheel
barrows, mops, brushes, 2 water jet
machines and 2 generators. The teams
removed all damaged and tainted
furnitures, equipment and drugs from the
clinic and started cleaning. The Fire &
Rescue provided water. Later in the day
the water jet was used as there was
running pipe water. The team also
salvaged valuable and useable equipment
and stored them in a safe room. A
‘microcleaning’ where equipment were
cleaned was planned for the next day and
another team was sent on 5th December
2015.
This intervention was executed via a
smart partnership earlier established for
Kelantan floods response with the
collaboration between Projek Banjir Aids
HKL 'BAH', Emergency Department HKL
and National Welfare Foundation. A
hospital bus, a large truck and four 4WDs
were engaged for logistics support.
Distribution of family wellness kits, gas
stoves, water tanks and water purification
systems were carried out at to relief
centres. Human resources were pooled
for health facility major clean up. Cleaning
equipment were purchased. A 24-hours
Emergency
Medical
Services
and
Observation Ward was established at the
Relief Centre at the Temerloh Sports
School where the team, made up of 1
Emergency Physician, 2 Registrars, 2
housemen, 2 Assistant Medical Officers
and 3 Staff Nurses stayed in for a week.
Pyschological aid for children was also
provided as a service embedded within
the clinic.
Establishment of 24-hour Emergency
Medical Services and Observation
Wards
On 3rd January 2015, a team of 9
volunteers made up of a specialist, 2
doctors, 33 assistant medical officers, 2
staff nurses ran the medical centre at
Sekolah Sukan Temerloh on 24 hours
basis. They treated on average of
between 30-40 patients a day which
included emergency cases such as acute
coronary syndrome.
Health Clinic Major Cleaning
Based on the needs assessment, on 4th
January 2015, a team of 44 volunteers
from HKL was sent by HKL bus to Klinik
Kesihatan Kuala Krau for clean up works.
Assistance was sought from Fire & Rescue
Agency to provide a water tanker. The
Family Medicine Specialist of Kuala Krau
received the volunteers who immediately
started work. The cleaning up team was
also joined by volunteers from National
Welfare Foundation, Jerantut Nursing
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Distribution of Goods and Donations at evacuation centre at Sekolah Sains
Pahang and Sekolah Kuala Krau
A truckload of donations
Distribution of goods at relief centre
HKL through Projek ‘BAH’ and the
National Welfare Foundation joined
together in distribution of donations in the
form of 260 cooking stoves and donations
of 200 family wellness kits.
forming this partnership which enabled all
the
objectives
to
be
achieved.
Collaboration with external and local
organizations was shown to be effective
in providing care during disaster.
Following Typhoon Haiyan which affected
the Philippines in 2013, Kim H et al (2013)
asserted that collaboration with the local
medical
team
resulted
in
great
synergy. The assisting team then was able
to function by focusing on collaborative
efforts with the local medical team. The
Korean team was capable of providing
primary care, and the Filipino team
provided incomplete secondary care
which was insufficient for covering the
patient load. The Korean team provided
electricity for hospital operation and
various materials, but also supplemented
medical personnel, who covered the
emergency and outpatient departments.
Collaborative efforts filled in each other's
gap, and resulted in great synergy. Kim et
al suggested that disaster medical relief
missions should be cooperated with a
systematic coordination. Collaboration
with the local resources can be a great
opportunity for both parties, and should
not be overlooked in any disaster
situations.
Discussion
Responding to disaster requires a lot of
resources which may be in the form of
manpower, equipment and money. A lot
of resources may be obtained by
combining
strengths
from
various
organizations with varying strength and
capabilities. A synergistic result would
ensue through such endeavours. Frank
Covey introduced the concept of ‘win-win’
strategy via his principles embodied in his
book,7 Habits of Highly Effective People,
which was first published in 1989 (Covey,
2013). Covey advocated an approach to
being effective in attaining goals by
aligning oneself to what he calls ‘true
north’ principles of a character ethic that
he presented as universal and timeless.
The book introduced the seven habits in a
proper order. The fourth habit was called
‘think win-win’. This habit promotes
genuine feelings for mutually beneficial
solutions or agreements in relationships
whether personal or organizational. Smart
partnership such as that we described
based on our experience following the
east coast floods is the first of its kind in
our hospital. We found a lot of benefit in
Smart partnership as in this project
provided
a
win-win
phenomenon.
Synergistic outcome was achieved in this
project where Emergency Physicians in
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the Emergency Department provide their
expertise in co-ordination, planning,
analysis
and
recommendaiton
of
assistance. Human resources and central
collections were garnered by the ‘Project
BAH’ committee for all donations at our
hospital. The National Welfare Foundation
provided what we did not have in the
form of logistics support, monetary
resources, wellness kits, transport as well
as equipment needed for assistance.
service responses, especially during crisis.
Interlocal collaboration too contributes to
disaster preparedness. Errett et al (2014)
studied
the
impact
of
interlocal
collaboration
and
emergency
preparedness
via
semistructured
interviews. The study showed interlocal
collaboration was found to impact
preparedness by promoting the perceived
dissolution of geopolitical boundaries,
developing self-reliant regions, developing
regional capabilities, promoting regional
risk identification and creating an
appreciation of the importance of
interlocal
collaboration.
Interlocal
collaborations contribute to overall
national preparedness. Apart from smart
partnership, coordinated collaboration
with operation centres of the State Health
Department enabled us to function
effectively.
The
operation
centres
provided us with vital information of areas
covered or where help needed.
In establishing a smart partnership,
common ground interests were a powerful
unifier for collaboration. This partnership
worked because of similar interests that
all parties had. Work was made much
easier with the contribution of each
organization’s expertise. Kuziemsky et al
(2015) believed that common ground was
necessary for developing collaboration as
part of building resilience for public health
preparedness. While the importance of
common ground as an essential
component of collaboration has been well
described, there was a need for studies to
identify how common ground develops
over time, across individual and group
dimensions, and the contexts that
influence its development.
A working collaboration framework should
be outlined by extracting the expertise of
each organization. Lu and Xu (2015)
analyzed on NGOs collaboration in
community post-disaster following 2008
Wenchuan earthquake in China. Nongovernmental organisations (NGOs) that
attend
community
post-disaster
reconstruction were often unable to
deliver all requirements and have to
develop
cooperative
approaches.
However, this collaboration can cause
problems because of the complex
environment, the fight for limited
resources
and
uncoordinated
management, all of which result in poor
service delivery to the communities,
adding to their woes.
Collaboration
framework was proposed for interrelated
Collaboration with the community helps in
mobilizing and integrating knowledge and
skills during crisis. In establishing
emergency medical services and an
observation ward, our team collaborated
with the managers of the relief centres for
better reception apart from effective
services. Kotarba et al (2014) applied the
constructive relationship management
model which was found to be an
appropriate strategy for mobilizing and
integrating the knowledge and skills
needed for comprehensive science and
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components of organisational structure,
operational processes, reconstruction
goals and implementation areas.
organizations to develop a dualintervention model of capacity-building for
public mental health preparedness and
community resilience.The collaborative
model was found to be an effective
approach for promoting public health
preparedness and community resilience.
Crowd psychology should be
considered in handling patients at relief
centers. The attitude of the victims should
be taken into consideration. Safety should
be observed. Carter H et al (2015) applied
crowd
psychology
to
develop
recommendations for the management of
mass decontamination of a major
incident. This approach emphasized that
crowd
events
are
characteristically
intergroup encounters, in which the
behavior of one group can affect the
perceptions and behavior of another. In
this partnership, the sending of expert
team enabled the crowd psychology
especially at relief centres be studied and
relevant strategies outlined.
In our
experience, we spent a shorter time in
Kelantan as there was already an
overflow of volunteers. We then shifted
focus to Pahang. This enabled us to
channel our resources more effectively
where they were needed most or at
places where help was still required. We
found that needs such as clean water was
of utmost importance. Water filter of
purification
system
was
essential.
Through this partnership, water tanks and
water purification system costing RM
32,100 were donated.
Conclusion
Smart partnership via collaboration
among EDHKL, Projek BAH and National
Welfare Foundation enabled a good
synergy of assistance. The assistance
provided much needed help effectively. It
is hoped that future co-operation could be
formed to provide similar services in times
of need. Resources can be sought from
external agencies via this model of smart
partnership whereby parties with different
resources can join hand and contribute
respective strengths.
Acknowledgement
published.
References
1. Steven R. Covey. 7 Habits of Highly
Effective People. Simon & Shuster
2013.
2. Kim H(1), Ahn ME(2), Lee KH(3), Kim
YC(4), Hong ES(5).Disaster medical
assistance in super typhoon Haiyan:
Collaboration with the local medical
team that resulted in great synergy.
Ulus Travma Acil Cerrahi Derg. 2015
Mar;21(2):143-8.
doi:
10.5505/tjtes.2015.54770.
Partnership of various organizations would
improve community resilience as well.
McCabe et al (2014) described the
collaboration of academic-governmentfaith as
partnership for community
resilience. Johns Hopkins Preparedness
and Emergency Response Research
Center partnered with local health
departments
and
faith-based
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3. Kuziemsky CE(1), O'Sullivan TL(2).A
model
for
common
ground
development to support collaborative
health communities. Soc Sci Med.
2015
Mar;128:231-8.
doi:
10.1016/j.socscimed.2015.01.032.
Epub 2015 Jan 20.
4. Kotarba JA(1), Croisant SA(2), Elferink
C(3), Scott LE(4).COLLABORATING
WITH THE COMMUNITY: THE EXTRATERRITORIAL
TRANSLATIONAL
RESEARCHTEAM.
J
Transl
Med
Epidemiol. 2014 Dec 5;2(2):1038.
5. Lu Y(1), Xu J.NGO collaboration in
community
post-disaster
reconstruction: field research following
the 2008 Wenchuan earthquake in
China. Disasters. 2015 Apr;39(2):25878. doi: 10.1111/disa.12098. Epub
2014 Nov 28.
6. Errett NA(1), Frattaroli S(1), Resnick
BA(1),
Barnett
DJ(2),
Rutkow
L(1).Interlocal
collaboration
and
emergency preparedness: a qualitative
analysis ofthe impact of the Urban
Area Security Initiative program. Am J
Disaster Med. 2014 Fall;9(4):297-308.
doi: 10.5055/ajdm.2014.0181.
7. Carter H, Drury J, Rubin GJ, Williams
R,
Amlôt
R.
Applying
crowd
psychology
to
develop
recommendations for the management
of mass decontamination. Health
Secur. 2015 Jan-Feb;13(1):45-53.
8. McCabe OL(1), Semon NL(2), Lating
JM(3), Everly GS Jr(4), Perry CJ(5),
Moore
SS(6),
Mosley
AM(7),
Thompson CB(8), Links JM(2).An
academic-government-faith
partnership to build disaster mental
health preparedness and community
resilience. Public Health Rep. 2014;129
Suppl 4:96-106.
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lesser but nonetheless, as serious as it
was of longer duration.
minimise adverse health impact. We had
learnt from the history of previous floods,
local or international, of major public
health impacts resulting from damage to
homes and subsequent displacement of
occupants which led to compromised
personal hygiene, contamination of water
sources, disruption of sewage service and
solid-waste collection, injuries sustained
during clean up, stress-related mental
health and substance abuse problems,
and even deaths due mainly to accidental
drowning(4).
The responsibility to manage health and
medical
emergency
response
was
delegated to Health District of Kemaman,
as one of the team of District Disaster
Management and Relief Committee
(DDMRC).
This article describes
Kemaman’s flood disaster plan and shares
its experience in operationalising the plan
for the benefit of those who are involved
in flood management, whether locally or
other parts of the world.
Realising the magnitude of such potential
devastations, a team from the Kemaman
Health District Office, led by the Medical
Health Officer, deliberated and came out
with a comprehensive Flood Management
Plan. The plan was developed and
completed in April 2014, before the 2014
floods which came at the end of the year.
Experience from the previous flood in
2013 had been a great help in
strengthening the plan.
Methodology
This is a case study, using secondary data
from its documented records and
interviews with those who were directly
involved in the management of flood.
Data and reports during the 2014 flood
were retrieved and analysed descriptively.
Senior officers of the District Health
Department such as the District Health
Officer, epidemiological officers, medical
officers, and Health District staff who
experienced the flood were interviewed.
This plan was created based on the Risk
Control
Management
model
which
comprised of risk analysis, maintenance
improvement, preparedness and disaster
response (Figure1). It is a comprehensive
plan, catering for the pre, during and
post-flood periods.
Flood
Management
Plan
In
Kemaman 2014
Handling flood disaster is not an easy
task. It is a big responsibility which
requires outstanding performance to
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Figure 1 : Risk Management Operation (Adapted from Eikenberg, 1998)
Risk Analysis
Risk
analysis
involves
hazard
determination, vulnerability analysis and
risk determination. The aim of this step is
to identify potential risks, either those
that lead to flood itself or harms that can
occur during the disaster. This is crucial in
order to plan for counter-measures to
overcome or reduce the flood hazard.
DIS had earlier taken steps to expand the
river capacity by upgrading trench and
drainage system of the area to make sure
Kemaman could cope with large amounts
of water in the face of torrential rains.
Vulnerability
analysis
is
identifying
persons, places or things that are more
susceptible to hazard when disaster
comes. Health Clinics which are located in
the risky (prone to flood) areas were
determined, and preparation were made
to mitigate the risks. This included
relocation of valuable portable assets such
as ultrasound machine, x-ray machine,
vaccine refrigerator, laboratory equipment
and documents such as patients’ records
and medications to safer places. These
had to be planned and executed before
the floods, including transporting them to
other locations. Health clinics must
Heavy rainfall, poor and insufficient
drainage, low river holding capacity and
back water phenomenon are potential
hazards that can lead to flood formation.
Thus, indicators for these components
such as weather forecast and sea level
conditions were gathered and monitored
through a Flood System Surveillance
system (Infobanjir) as well as direct
information from the Drainage and
Irrigation Department (DIS).
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develop alternative plans to continue with
their services if they are affected by flood.
Of
equal
importance
are
risk
determination on communication system,
transportation issues, power supply, food
and medical supplies.
The plan also covered identification of
vulnerable patients such as elderly and
bed-ridden persons, pregnant mothers
who were close to their due dates,
patients with chronic illnesses who
required
uninterrupted
care
or
medications such as those with end stage
renal
failure,
diabetes
mellitus,
hypertension and psychiatric patients and
those on anti-coagulants. All health clinics
had to list and identify their vulnerable
patients, and planned for their relocation
before an impending flood.
Maintenance Improvement
Having been made aware of the possible
risks explained above, the next step was
to
work
towards
maintenance
improvement, which can be categorised
as structural and non-structural.
Structural maintenance improvement
Structural maintenance improvements
include preparation of medications and
food supplies, as well as establishing
sufficient crucial utilities such as water,
electrical and communication facilities.
Medications to be used by visiting medical
team to relief centres were reviewed to
ensure their availability and adequacy.
These medications were pre-packed and
put in specific containers. Storage was
upgraded and updated to ensure they are
easy located when needed.
Risk determination is listing all possible
risks associated with flood which could
impact on the flood victims. The impacts
could be directly through contact with
flood water, or indirectly through damage
caused to natural and human-built
environment. The impact of floods on the
human habitat is related directly to the
location and topography of the area, as
well as human demographics and
characteristics of the environment.
Contingency plan for power supply
shortage include getting in place electrical
generator for hospitals and relief centres
to when the need arise. This part of the
plan is essential as some patients in
hospitals are dependent on life-saving
machine such as ventilators in the
Intensive
Care
Unit
(ICU)
and
haemodialysis machines in the other
critical units. For the same reason, the
National Power Supplier (Tenaga Nasional
Berhad) had made earlier efforts to
upgrade their substations to a higher level
at flood risk areas.
For example, contamination of water
sources, disruption of sewage service and
solid-waste collection during flood would
increase the probability of communicable
diseases
transmission
such
as
leptospirosis,
typhoid,
cholera
and
meliodosis. Thus, preparation had to be
made to ensure health promotion and
education is conducted in flood relief
centres. Besides, all flood relief centres
must undergo cleanliness and sanitation
assessment to ensure safe water supply,
adequate and functioning sanitation
facilities as well as checks on food
preparation and handling practices.
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each health clinic. Their names were
listed together with contact numbers.
There were two teams (Table 2), one to
deliver medical care, and the other, public
health service. In order to strength the
teams, continual medical education and
updates were given to them prior to the
flood.
Non-structural maintenance improvement
Non-structural improvements include the
management and updating the staff list,
and recruiting possible non-governmental
bodies that could be called upon when
they were needed. Designated medical
and health teams were recruited from
Table 2: Staffs of medical and health team
Medical Team
Health Team
Medical & Health Officer
PPKP
Medical assistant
PKA
Staff Nurse
Driver
PPK
PRA
Driver
No
1
2
3
4
5
Medical team would function in mobile
and static clinics in the relief centres,
while the health teams would do
environmental
assessments
and
preventive measures such as fogging and
checking for other vectors.
These training were not limited to the
health staff alone, but extended to staff
from other agencies, such as District
Office, Fire Service and Public Defence
Department as well as community
leaders. This simulation ensured that all
members in the rescue team were wellprepared and able to perform well during
a disaster. On the other hand, participants
from the community had a better
understanding of the evacuation plan. In
addition, training for food handlers during
disaster, handling boat and psychological
first aid team were carried out.
Preparedness
Based on previous evidences, it is
proposed that good preparedness plan is
mandatory to be prepared in any areas
that are likely to experience disasters (57). Preparedness is defined as “activities
and measures taken in advance to ensure
effective response to the impact of
hazards”(8). The purpose of Kemaman
Health District Office’s preparedness plan
was to reduce the risk through early
warning systems and measures which can
be taken to mitigate the effect of a flood
disaster.
Logistic
A list of transportation assets from the
health team and other agencies were
made in ready for mobilisation during
flood disaster. These include ambulance,
4x4 wheel drive, boats and lorries. Access
to flooded areas and relief centres had
already been established.
Training
Acknowledging the challenges that would
be encountered, table top training and
simulation exercises for the rescue team
and evacuation plan were carried out.
Food Supply
Food supplies were sent prior to the flood
to the relief centres. Taking cognisance of
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Disaster Response
The flood disaster in Kemaman in the
year 2014 started on 16th December 2014
until
4th
January
2015.
Disaster
Operational Room for Kemaman Health
District Office was activated on 16th
December as soon as floods were
reported in upstream areas of the
Kemaman River. At the beginning, two
flood relief centres were opened with 65
casualties recorded. The flood operation
office was headed by the Kemaman
District Health Officer. The role of the
control room include – coordination of
health teams (mobile, static and
emergency relief teams from nine
community health centres, one district
hospital and medical volunteers), stock
indenting
and
management
for
medication and food supply for health
staffs and volunteers, distribution of flood
disaster equipment (technical and nontechnical), coordinating safe transport and
vehicles for the use of mobile teams and
medical emergency relief teams as well as
arrangement for the relief of health staff
affected by flood. It also functioned as a
call centre for medical emergency needs
from the Kemaman District Disaster
Operational Room or the Head of Flood
Relief Centres as well as calls from
individuals requiring medical aid.
the 2013 experience on supply-shortage
due to inaccessibility, more food stock
were allotted in the centres with the help
of the Social Welfare Department. A
newly prepared helipad ensured adequate
and continual supply to all the relief
centres, as more pre-packed foods were
stored near to it. In all health facilities,
food supply had been distributed early
and can only be used during the flood
emergency.
Inspection And Examination Of
Relief Centres Pre-Flood
All gazetted relief centres were inspected
and examined for safe water supplies,
toilets, place for food preparations and
waste disposal systems. Suggestions were
given to authorities to improve the
facilities if needed. Health education and
promotion with regards to hand hygiene,
dangers of flood and standing waters,
common disease outbreaks in the postflood period such as typhoid and
diarrhoea, safe food preparation and
drinking boiled water were given to the
community as soon as relief centres were
opened. Posters and pamphlets were also
distributed prior to event.
Warning System And Evacuation
Memo was circulated to the communities
in potential flood areas which consist of a
list of gazetted relief centers where the
flood victims could go according to
designated areas to avoid over-crowding
if left to choice. Warning sirens were
installed in mosques to announce updates
on flood situation, as early information to
the communities and for early evacuation
to non-flooded area.
Kemaman District Health Office
Disaster Operational Room (DOR)
The daily activities of Kemaman District
Health Office Disaster Operational Room
(DOR) were as follows:
1.
Risk Based Surveillance
The main activity of DOR is performing
risk evaluation based on situational
analysis
from
daily
surveillance
assessments. The risk analysis was
performed daily based on weather
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forecast (rainfall, river water level and sea
tides), manpower availability, medication
supply, number of flood victims and flood
relief centres as well as updates on roads
and routes accessibility. The data source
of risk surveillance include the weather
forecast from the national Meteorology
Department, daily health report from
medical teams, latest updates on flood
relief effort from Kemaman District DOR
(number of flood victims and food relief
centres) as well as information from the
local people. Updates were given during
daily morning briefing held at the District
Health Office DOR, attended by the
control room personnel and representatives
from the medical team, health team as
well as volunteers.
the same time attempting to minimise
team exhaustion.
During the peak
disaster, 38 medical teams (mobile and
static teams) consisting of medical
officers, paramedics, nurses and drivers
were deployed in one day to all flood
relief centres, providing medical aid and
relief. Unresolved medical emergencies
were informed directly to DOR to arrange
for emergency evacuation and hospital
referral via inter-agency collaboration.
All medical teams were equipped with a
standard set of medical equipment as well
as medications which was developed
based on the medication needs during the
flood disaster of 2013. It consisted of
medications for symptomatic relief of
common ailments,
medications for
common chronic diseases and injections.
The medication supply was constantly
evaluated and medication boxes were
continuously refilled by the pharmacy
teams at DOR. Medications required that
were not available will be obtained from
the district hospital and transported to the
patient as arranged by DOR.
2.
Medical and Health Teams
Coordination and Response
Planning of mobile teams and static
health team routing and shift schedule
were done daily under the control of the
Chief Medical Officer of DOR. The mobile
health teams were scheduled to visit and
provide medical care and treatment to all
flood relief centres with victims less than
1000 people on a daily basis whereas
static medical teams were rostered to
provide 24-hour medical treatment at
static clinics in major flood relief centres
with flood victims of more than 1000
people.
The number of teams was
decided based on the daily updates on
the number of flood victims as well flood
relief centres. There were 29 medical
teams registered as flood relief medical
teams during the flood preparedness plan.
However, team deployment was being
reorganised by the Chief Medical Officer
of DOR as nearly 30% of health staff
were also flood victims. Duty rosters were
updated daily to cater for needs, while at
Medical and health team activities were
reported daily to DOR based on a
standard reporting format which includes
types of diseases treated (communicable
or non-communicable diseases), disease
outbreak occurrence, hospital referral or
death. This report became the source for
daily
risk
surveillance,
providing
information for the next disease control
activity plan to prevent disease outbreak.
For example, water source testing and
treatment was performed at flood relief
centres
when
cases
of
acute
gastroenteritis were noted to be rising.
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3.
Transportation and Logistics
Coordination
Transportation
as
well
as
driver
requirements were controlled centrally by
the DOR commandant. Vehicles available
include ambulances and 4-wheel drives
(FWD) which were provided by the
community
health
centres,
district
hospital, dental office as well as
volunteers from the community. Need for
truck or boat to access certain areas for
emergency relief were requested through
the Kemaman District DOR. However,
standard safety measures were of utmost
priority in providing relief and only
gazetted boats equipped with safety life
jackets were utilised at every level of
operation.
4. Inter-agency Coordination
Based on risk surveillance, the most
challenging period during the disaster was
from 24th to 28th December 2015. The
rain was ferocious and the river water
level kept rising above its danger limit. In
addition, sea tide was also recorded to be
at its highest level, rendering the city of
Kemaman paralysed and at great risk.
Electricity and several telecommunication
service provisions were cut off. The
number of flood victims increased
dramatically.
Flood
centres
were
concentrated in the city area with 10
major centres being opened and each
requiring 24-hour medical cover. The
majority of housing areas in the city were
submerged by the flood and most major
roads were totally cut off.
Communication was badly affected as
several telecommunications were cut off
at several severely impacted areas,
especially in the upstream region of
Kemaman. Attempts to enter those areas
were made daily based on risk
surveillance updates obtained from the
Kemaman District DOR. Therefore, any
emergency medical need must reach
Kemaman Health District Office DOR in a
timely manner. For example, an antenatal
mother who experienced premature
contraction at Felda Seberang Tayor was
successfully evacuated using a 5 tonne
army truck, the only vehicle that could
access her area, after it was informed to
the Kemaman District DOR by the local
people via text message. Medications
supplies needed by the medical teams
were delivered successfully to ensure
continuity in medical relief provision
service.
Issues of road accessibility continued to
become a challenge as the main road to
get to the upstream region was severely
damaged, cutting off the access to several
flood relief centres. One of the major
relief centres, the Sekolah Kebangsaan
Bukit Mentok, which was accommodating
up to 1,900 flood victims, was only
accessible by boat or air transport.
During this period, the number of medical
teams available was not able to cater for
the needs at the relief centres as both the
flood victims and flood relief centres kept
on rising.
Call for help was sent out by the head of
Kemaman Health District Office DOR 3
days prior to the situation, based on the
weather forecast and the worsening flood
trend. It became the centre for receiving
medical volunteers from government and
non-government organisations. These
volunteers were incorporated into the
local medical relief teams schedule and
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Malaysia (ATM), Majlis Keselamatan
Negara (MKN) and MIMPA. Their efforts
their help had been commendable. During
the period, 38 medical teams were
deployed to all flood relief centres daily
using transportation arranged by DOR in
collaboration with other agencies such as
had been truly commendable and greatly
contributed
to
the
successful
management of medical emergency
evacuation and relief work during the
flood disaster in Kemaman in 2014.
Pejabat Daerah Kemaman, Jabatan
Bomba Kemaman, Jabatan Pertahanan
Awam Malaysia (JPAM), Angkatan Tentera
Figure 2: The Kemaman District Health Office’s Disaster Operational Room Activities
1.
Post Flood Activities
Post-flood period is as crucial as the after
effects of flood could be as devastating as
the flood itself. Again, risk analysis and
assessment had to be repeated. Some
potential disease transmission did exist,
and affected communities remained under
close surveillance. Kemaman Health
District Office continued to be vigilant in
the post-flood period. The activities
carried out were as follows:
Evaluation of damage and loss
in affected health facilities
Health facilities which were affected by
flood were assessed on loss and damage
of assets, infrastructures and building.
Any stolen or damaged asset had to be
reported within 24 hours of detection.
Health facilities with minimal damage had
to restart operating as soon as possible,
or at least within three days after the
flood subsided in order to provide
continuous
health
care
to
the
communities.
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8/6/2015, 2:32 PM
2.
Prevention
of
post
flood
diseases
Flood waters and standing waters posed
various risks. These include infectious
diseases, chemical hazards, and injuries.
Larviciding, fogging and environmental
assessment were continued by health
team in the relief centres and post-flood
areas. Food premises and factories were
visited by the inspectorate unit for food
sampling and monitoring of food safety
compliance.
Health
education
and
promotion continued with emphasis on
post-flood management measures.
3.
Surveillance of outbreaks and
other health related illness
post flood.
Disease surveillance and analysis were
carried out continuously to monitor for
any disease outbreak for early and rapid
response.
Additionally,
psychological
assessment for flood victims was made
through psychological first aid teams
which were led by trained Family Medicine
Specialist. Health education regarding
post-traumatic
stress
disorder
and
depression were highlighted to the flood
victims and identified cases were referred
to
the
psychiatrists
for
further
management.
The
surveillance
for
diseases is presented in Figure 3 and 4.
Figure 3: The number of cases of notifiable diseases during 2014 flood
.
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8/6/2015, 2:32 PM
Figure 4: Total number of patients seen during 2014 flood
77
77
8/6/2015, 2:32 PM
Discussion
comprehensive
and
well-structured
plans, it was impossible to sustain the
“business”. As proven by the census
(Figure 1), there were no outbreak of
common communicable diseases such
as typhoid, cholera, leptospirosis, and
dengue during/post flood occurred.
Floods are a common disaster and have
led to extensive morbidity and mortality
throughout the world (9). The health
impacts of flood are wide ranging, from
immediate to medium and long term
(2). However in the 2014 flood, these
impacts were minimised in Kemaman
due to its outstanding flood hazard
management plan.
Nevertheless, attempt should be made
to determine the long term impacts of
flood to the victims such as disability,
mental
health
problems,
social
disruptions and other health relate
diseases. A study had shown the
prevalence of psychological distress in
survivors could be as high as 53% two
years post-flood and it could also
exacerbate their physical illness(1).
Even though a Psychological First Aid
Team (PFAT) was established, the role
was limited to during and immediately
after the flood period. This kind of
support should be extended longer to
ensure
a
comprehensive
risk
management process (4).
According to Matthew (10), effective
health response to disasters will depend
on three important lines of action:
disaster
preparedness;
emergency
relief; and management of disasters .
In our setting, these entire components
were executed and supplemented with
risk analysis (Figure 1). Based on this
assessment,
simple
steps
like
developing facility specific preparedness
plans which detail out standard
operating procedures during floods and
identify clear lines of command had
strengthened the response to the flood
(11). Thus, it is proven that early
detection of an impending flood and the
availability of counter-measures to deal
with them can significantly reduce the
health consequences (9,11).
The strong partnership of the District
Health Office and other stakeholders as
well
as
NGOs
expedited
social
mobilization. Every team managed to
play their respective roles during the
flood and was successful in reducing
human
vulnerabilities
in
social,
economic, health, and cultural aspects.
It allowed for the use of both structural,
for example canalization of rivers, helipad construction; and non-structural
flood management, for example flood
forecasting
and
warning
system,
removal of medical assets from risky
area. This collaboration had managed to
reduce the susceptibility to flood
hazards among stakeholders and
victims. Chan (3) advocated on the need
Daily activities during the flood which
included
risk-based
surveillance,
coordinating medical and health team
response,
transport,
logistic
and
interagency coordination enabled the
activities to run smoothly and carried
out as planned, alleviating the hazard
and health impacts. The long duration
of flood (more than 2 weeks) was a
great challenge, while maintaining
service and activities during the flood
period was demanding. Without proper
78
78
8/6/2015, 2:32 PM
Acknowledgement
published.
for multi-agency collaboration for
disaster management, and suggested it
as one of the most important
component in flood disaster risk
management. This was tested and
noted to be true in the Kemaman flood
in 2014.
References:
1.
Alderman K, Turner LR, Tong S.
Floods and human health: a systematic
Environment
international.
review.
2012;47:37-47.
The benefit of inter-agency approach
extends to capacity building for
stakeholders as well as the victims.
Simulation exercise on flood scenario
increased the awareness and alertness
of the victims to be quickly mobilised
during flood situation. Mobilisation of
health staff and medical team, boat
handler competency, and food handling
at the distribution centre had improved
significantly and proceeded smoothly
during the real disaster event, which
could have contributed to saving many
lives.
2.
Du W, FitzGerald GJ, Clark M,
Hou X-Y. Health impacts of floods.
Prehospital
and
4.
Keim
ME.
Building
human
resilience: the role of public health
preparedn
ess and response as an adaptation to
climate change. American Journal Of
Preventive Medicine. 2008;35(5):50816.
5.
Haines A, Kovats RS, CampbellLendrum D, Corvalán C. Climate change
and
human
health:
Impacts,
vulnerability and public health. Public
Health. 2006;120(7):585-96.
6.
Ziegler AD, Lim H, Tantasarin C,
Jachowski NR, Wasson R. Floods, false
hope, and the future. Hydrological
Processes. 2012;26(11):1748-50.
79
79
medicine.
3.
Chan NW. Impacts of Disasters
and Disaster Risk Management in
Malaysia:
The
Case
of
Floods.
Resilience and Recovery in Asian
Disasters: Springer; 2015. p. 239-65.
Conclusions
The experience of Kemaman Health
District in the 2014 flood had enriched
us greatly in executing a Flood Disaster
Plan and flood hazard management.
This
real
life
participation
and
experience is invaluable to many who
were involved, and made us resilient to
respond to future flood disasters,
including providing help to other parts
of the country. Early risk assessment,
good preparedness and contingency
plan had ensured continuous public
health care delivery to the community.
It helps to reduce the negative impacts
of flood disaster. High level of
commitment
and
inter-agency
collaboration are crucial elements in
successfully managing a flood disaster.
disaster
2010;25(03):265-72.
8/6/2015, 2:32 PM
7.
Plate EJ. Flood risk and flood
management. Journal of Hydrology.
2002;267(1):2-11.
8.
Nation U. UNISDR Terminology
on Disaster Risk Reduction 2004.
9.
Ahern M, Kovats RS, Wilkinson P,
Few R, Matthies F. Global health impacts
of floods: epidemiologic evidence.
Epidemiologic reviews. 2005;27(1):3646.
10.
Mathew
D.
Information
technology
and
public
health
management of disasters—a model for
South Asian countries. Prehospital and
disaster medicine. 2005;20(01):54-60.
11.
Phalkey
R,
Dash
SR,
Mukhopadhyay A, Runge-Ranzinger S,
Marx M. Prepared to react? Assessing
the functional capacity of the primary
health care system in rural Orissa, India
to respond to the devastating flood of
September 2008. Global health action.
2012;5.
80
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Communicable Disease Control in The 2014 Pahang Flood
Sapian M, Sharifah Mahani SMA, Akmalina H, Shahidan H, Aznita Iryany MN, Hafeez I
Pahang State Health Department
ABSTRACT
Pahang, an east coast state in Peninsular Malaysia encountered its worst flood on 22nd
December 2014 to 18th January 2015. Medical and health teams were mobilized to carry
out preventive and control measures at Disaster Relief Centres and flood affected areas.
This study describes the pattern of communicable disease occurrence, as well as preventive
and control measures taken during the flood period. Data from the Disaster Operation
Room of Pahang State Health Department and CDCIS E-Notification system were reviewed.
Ten districts in Pahang were affected by the flood. A total of 81,927 people were
evacuated, of which 5,974 (7.3%) were found to have communicable diseases. Five most
common diseases encountered were Acute Respiratory Infection (64.9%), skin infection
(16.3%), fever (11.9%), Acute Gastroenteritis (4.4%) and conjunctivitis (0.8%). Five food
poisoning outbreaks and one HFMD outbreak were reported. Overall, there was no
significant increase in the number of notifiable communicable disease related to the flood
except for leptospirosis, melioidosis and food poisoning. However not all of the
leptospirosis (5%) and melioidosis (56%) cases were directly caused by flood.
Communicable diseases were well under control during the flood period and this was
attributed to due diligence by all health districts in carrying out their flood preparedness
plan effectively.
Keywords: Pahang, Flood,
Preventive and Control
1.0
Preparedness
INTRODUCTION
Plan,
Communicable
and 2013 in terms of the number
of districts affected and extent of
infrastructure damage. This recent
flood started from 22nd December
2014 till 18th January 2015 and
involved ten districts.
Flood is a yearly occurrence in the
east coast of Malaysia where the
state of Pahang is located. Flood
phenomenon
is
due
to
climatological
factors
like
temperature, rainfall, evaporation,
wind movement and the natural
topography of the place.1
Those affected by the flood are
normally placed at Disaster Relief
Centres (DRCs). These relief
centres are located in designated
public places such as schools and
community halls. These facilities
are equipped with basic amenities
The 2014 flood in Pahang was the
worst, compared to the previous
floods in 1926, 1971, 2001, 2007
81
81
Disease,
8/6/2015, 2:32 PM
the transmission of food and
water-borne diseases such as
typhoid fever, cholera, hepatitis A,
dysentry, food poisoning and acute
gastroenteritis, as well as vectorborne diseases like dengue and
malaria, and other diseases like
leptospirosis and melioidosis.
such as portable water supply,
electricity and sanitary latrines.
However, during the floods, these
places
may
experience
environmental risk factors such as
overcrowding, sanitation issues and
issues related to food handling and
preparation. Further, foods for the
flood victims housed in these relief
centres
are
prepared
by
volunteers, some of whom had
never been briefed on proper food
handling practices.
Since flood is a yearly event and
usually occur at the end of the year
in Pahang, all government agencies
at the state and district level start
their preparation early. The Natural
Disaster Management and Relief
Committee (NDMRC) at the state
and district level are headed by
State Secretary and District Officer
respectively.
Inter-agency
collaboration and communication
are important to ensure smooth
and efficient execution of the state
and district disaster preparedness
plan. For the PSHD, DHOs and
hospitals
have
their
own
preparedness plan which includes
assisting the District Officer in
identifying suitable places for DRC,
providing logistics support, medical
and health teams during the flood
(refer to Annex 1 for Summary of
The State Preparedness Plan).
Health education materials are also
produced
adequately
to
be
disseminated during all phases of
flood to increase awareness among
the public on steps to be taken to
prevent diseases related to flood.
Medical and health teams from
District Health Offices (DHO) are
responsible for monitoring flood
victims’ health status and health
related activities at DRCs and flood
affected areas. Medical teams
comprising doctors and paramedics
are tasked to provide medical
treatment
and
psychological
support to flood victims. Health
teams carry out preventive and
control measures for disease
outbreaks such as ensuring food
safety, water quality, vector control
and proper refuse disposal.
Flood situations increase the risk of
infection
and
communicable
disease transmission. Standing
water cause by heavy rainfall or
overflow of rivers can act as
breeding grounds for mosquitoes,
putting affected population and
rescuers at risk to infections
transmitted by mosquitoes. Overcrowding at DRC facilitates the
transmission of diseases like acute
respiratory infections (ARI), skin
infections
and
conjunctivitis.2
Hence, floods potentially increase
This study describes the pattern of
communicable disease occurrence,
as well as preventive and control
measures taken during the flood
period.
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8/6/2015, 2:32 PM
2.0
METHODOLOGY
other diseases. Data on notifiable
communicable diseases for the
whole state during the flood
period were taken from the
Ministry of Health’s web-based
Communicable Disease Control
Information System (CDCIS),
namely E-Notification and EDengue.
This is a retrospective review of
communicable diseases data and
activities during the 2014 Pahang
flood. The flood period was
divided into three phases, preflood period (23rd November 2014
- 21st December 2014), during
the flood (22nd December 2014 18th January 2015) and postflood period (19th January 2015 18th February 2015). Following
the epidemiological week (epid
week) reporting system for
disease surveillance in the
country, the period of study was
from epid week 48/2014 to epid
week 7/2015.
Melioidosis is not a gazetted
notifiable disease by law in
Malaysia. However, it was made
compulsory to notify this disease
administratively by the Ministry of
Health (MOH), Malaysia in 2015.
In Pahang, melioidosis is not
uncommon. Hence, all medical
practitioners in Pahang had been
instructed to notify melioidosis
administratively since 2011 and
this is captured in the Pahang
Melioidosis Registry. Additional
information on leptospirosis and
melioidosis were also obtained
from daily returns which were
specifically collected during the
flood period by the Pahang State
Communicable Disease Control
(CDC) unit.
Data on flood victims from DRCs,
medical
and
health
teams
reports, disease surveillance data,
preventive and control activities
at DRCs and flood affected areas
were gathered from daily returns
submitted to the PSHD Disaster
Operation Room (DOR). Some
victims complained of only fever
without other symptoms. As
such, data on fever alone were
captured to differentiate it from
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8/6/2015, 2:32 PM
3.0
RESULT
3.1 Flood Victims and Disaster Relief Centres (DRC)
Table 1: Flood victims and DRC's during 2014/2015 flood by districts in Pahang
District
Number of
Number of
Number of Mean duration of
DRC
Families
Flood
DRCs’ operation
Affected
Victims
(days)
Kuantan
61
6,326
23,549
4
Jerantut
59
1,161
4,418
10
Lipis
34
1,173
4,442
7
Pekan
85
3,912
15,298
12
Rompin
6
122
471
2
Maran
44
1,629
6,788
10
Temerloh
77
5,978
22,865
11
Bera
19
869
3,327
10
Raub
16
200
668
1
Bentong
2
20
101
1
Total Pahang
403
21,390
81,927
8
Source: State Disaster Operation Control Centre (SDOCC)
Table 2: Medical and Health Team by districts in Pahang during 2014/2015 flood
District
Pre-flood
During flood
Medical Health
Medical
Health
Within
Within
Within District Outside Within District Outside
NGO/
district
district district within state, district within state,
other
MOH/ (team) state
KKM
(team)
(team) (team) state
agency
(team) *MAF
(team) (team)
(person)
(team)
Kuantan
Rompin
Maran
Jerantut
Lipis
Pekan
Temerloh
Bera
Raub
Bentong
C.Highlands
Total
Pahang
16
9
12
11
12
8
8
13
6
6
4
13
8
9
9
9
12
11
6
12
4
4
24
9
12
11
12
11
8
13
6
6
4
10
2
13
5
1
-
3
6
3/2
20
-
13
8
9
9
10
12
11
6
12
4
4
1
1
6
13
1
-
2
6
21
6
-
10
51
12
73
60
-
105
97
112
31
34
98
22
35
206
MAF - Malaysian Armed Forces
84
84
8/6/2015, 2:32 PM
3.2. Communicable Diseases And Outbreak Reported
Figure 1: Type of notifiable communicable diseases related to flood during flood period
by epid week in Pahang
Figure 2: Leptospirosis and melioidosis during flood period by epid week in Pahang
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8/6/2015, 2:32 PM
Table 3: Type of communicable diseases at DRC’s by districts during flood period
Communicable Diseases
District AGE
ARI Conjunctivitis
Skin
Fever HF
Infection
MD
Typhoid
Total
Food
Lepto- Chicken Dengue Cases
Poisoning spirosis Pox
Kuantan
39
655
11
36
0
0
0
27
1
0
0
688
Jerantut
73
640
2
93
111
0
0
22
0
0
0
775
Lipis
7
285
4
120
0
0
0
0
0
1
0
369
Pekan
66
1384
24
321
272
0
0
0
0
5
0
1882
Rompin
1
38
0
10
5
0
0
0
0
0
0
47
Maran
24
123
1
270
224
3
0
0
0
2
1
643
Temerloh
26
107
5
100
62
0
0
39
0
0
0
339
Bera
Raub
24
0
643
1
2
0
26
0
38
1
0
0
0
0
0
0
0
0
0
0
0
0
628
2
Bentong
0
0
0
0
0
0
0
0
0
0
0
0
Total
Pahang
260
3876
49
976
713
3
0
88
1
8
1
5974
86
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8/6/2015, 2:32 PM
Figure 3: Distribution of communicable diseases among flood victims at the DRC’s by
day.
Figure 4: Type of communicable diseases during flood period at DRC’s by day
87
87
8/6/2015, 2:32 PM
Figure 5: Distribution of communicable diseases at the DRC’s by day.
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88
8/6/2015, 2:32 PM
Table 4: Outbreak of communicable diseases reported during flood period
26.12.201
4
Type of
Disease
Outbreak
Food
Poisoning
Kuantan
27.12.201
4
Food
Poisoning
13
Outside food is
suspected
Jerantut
28.12.201
4
Food
Poisoning
22
Outside food is
suspected
Temerloh
29.12.201
4
Food
Poisoning
20
Food is
undercooked
Temerloh
31.12.201
4
Food
Poisoning
19
Poor food
handling
Maran
5.1.2015
HFMD
2
Involved siblings
(contracted the
disease before
moving to DRC)
Locality
District
DRC Youth
Complex
(Wisma Belia)
DRC Pahang Sport
Complex
(SUKPA)
DRC Advanced
Technology
Training Centre
(ADTEC)
DRC National-type
Tamil Primary
School Mentakab
(SJKT Mentakab)
DRC Malaysia Civil
Defence
Department
(JPAM)
DRC UMNO Hall
Pekan Tajau
Kuantan
3.3
Date Of
Outbreak
Number
Comments
of
Case
14
Outside food is
suspected
Prevention and Control Activities
Table 5: Dengue Control Activities at DRC’s and flood affected areas
No. of
No. of
No. of
No. of
Total pesticide used
DRC/
DRC/
container container
(1/kg)
flood
flood
inspected positive Larvicide Adulticide
area
area
inspected positive
During
1225
11
20216
29
524.84
36.42
flood
Post2482
7
8636
11
11.31
14.6
flood
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8/6/2015, 2:32 PM
No. of
DRC/
flood
area
fogged
224
1286
Table 6: Flies Control Activities at DRC’s and flood affected areas
No. of locality
No. of locality
No. of control
No. of
inspected for
positive for
activities
premises
disinfected
Maggot
Adult Maggot Adult Larvicide Adulticide
During flood
3343
3116
133
1344
866
394
1628
Post-flood
1156
1308
0
10
340
218
1953
Table 7:
Rats &
Cockroaches
Control
Activities at
DRC’s and
flood affected
areas
No. of locality
inspected for
Rats
Cockroaches Rats
2643
1064
During flood
Post- flood
No. of locality
positive for
2538
1064
Cockroaches
No. of
locality
disinfected
7
0
1254
506
4
0
Table 8: Safe water supply monitoring activities at DRC's and flood affected area
Pipe Water Supply
Well
No. of
pH
Chlorine
NTU
E.coli
No. of
No. of
Samples violation violation violation violation
Well
Well
(Colilert inspected Chlorinated
test)
During
840
0
81
59
0
13
13
flood
Post120
0
0
0
0
96
96
flood
Table 9: Environmental sanitation monitoring activities at flood affected area
Environmental Cleanliness
Villages
Postflood
108
Sanitation
Inspected Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory
solid
houses
houses
water
toilets
waste
sewerage
disposal
2394
314
90
269
90
90
8/6/2015, 2:32 PM
214
Table 10: Food Safety & Quality Activities for Food Handlers at DRC's
Briefing on Food Handling
Anti-typhoid
vaccine
given
No. of Briefing
No. of Food
conducted
Handlers involved
Before
14
574
329
Flood
During flood
815
5168
689
TOTAL
829
5742
1018
Table 11: Health Education Activities During Flood Period in Pahang
No. of health education session
Lecture Individual Demon- Small Public
Radio
counseling stration group announ- announdiscussion cement cement
During
flood
Post- flood
No. of materials
distributed
Gotong- Pamphlet Poster Bunting Banner
royong
523
16492
8585
2914
650
176
78
46197 3779
1
3152
2514
205
0
0
15
1403
4 DISCUSSION
43
The
major
causes
of
communicable disease outbreaks
in disasters can be categorized
into four areas; infections due to
contaminated food and water,
respiratory infections, vector and
insect borne diseases, and
infections due to wounds and
Various studies had shown that
following a disaster, there was
increased
incidence
of
communicable diseases in the
disaster affected areas. This was
contributed by over-population,
91
91
3
population
movements
and
economic
and
displacement,
environmental
devastation,
poverty, lack of sanitary water,
poor waste management, lack of
shelter,
malnutrition
as
a
consequence of food shortages,
and poor access to health care.3-7
The 2014 flood was the worst in
Pahang affecting 81,927 people
in ten districts. It lasted for 28
days from 22nd December 2014
till 18th January 2015. The victims
and districts involved were higher
compared to previous flood
disasters in Pahang.
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1024 105
8/6/2015, 2:32 PM
injuries.8 The most common
causes of morbidity and mortality
in this situation were diarrheal
disease and acute respiratory
infections.9
duration of DRCs’ operation, the
number
of
communicable
diseases reported from this
district was only 5.7% (339
cases). This was explained by the
fact that medical and health
activities were not in full swing as
many
of
the
staff
were
themselves affected by flood. In
addition, a number of DRCs were
inaccessible to the teams for a
few days during the flood.
In Pahang, 177 medical teams
were mobilized to render medical
aid to flood victims in 403 DRCs.
Only 7.3% (5,974) of the flood
victims from DRCs throughout
Pahang were detected to have
communicable diseases. Five
most common diseases were ARI
(3876 cases, 64.9%), skin
infection (976 cases, 16.3%),
fever (713 cases, 11.9%), AGE
(260
cases,
4.4%)
and
conjunctivitis (49 cases, 0.8%).
The pattern of communicable
diseases seen during the flood
disaster was similar to the Johor
flood in 2006-2007 as reported
by Badrul Hisham, A.S., et al.
(2009).10 The risk of ARI
increased due to over-crowding,
poor
ventilation
and
poor
nutrition
at DRCs during
disaster.11
The number of communicable
diseases reported daily at the
DRC corresponded to the number
of flood victims present the
centres. Only 91 cases (1.5%) of
all communicable diseases seen
at DRC were notifiable, of which
88 cases were due to food
poisoning and three cases were
Hand, Foot and Mouth Disease
(HFMD).
Six outbreaks reported from
DRCs during the flood period, five
for food poisoning and one for
HFMD outbreak. All the outbreaks
were under control and all were
treated as outpatients. For food
poisoning, three of the five
episodes
were
caused
by
consuming foods prepared and
brought in from outside the DRC.
The time these foods were
prepared and how they were
prepared were not known. For
the remaining two episodes, poor
food handling by food handlers at
the DRC was identified as the
cause for the outbreak. Most food
handlers at DRC were volunteers
and some had not been identified
Pekan district reported the
highest number of communicable
disease cases with 1,882 cases
(31.5% of total case), of which
73.5% were ARI cases. This
could be due to Pekan having the
highest number of DRCs and
longest DRC mean duration of
operation.
Although Temerloh district was
the worst hit district with the
second highest number of DRCs
and victims as well as mean
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and designated as food handlers
prior to the flood as flood was
not predicted to occur at their
areas. All designated food
handlers were briefed on proper
food handling and preparation
before the flood.
leptospirosis, melioidosis and
food poisoning during the flood
period as compared to pre and
post flood. During flood, the
incidence of leptospirosis and
melioidosis were expected to
increase especially after heavy
rainfall as it facilitates the spread
of Leptospires1 and Bulkholderia
pseudomallei bacteria, agents
causing
leptospirosis
and
melioidosis.
Although
leptospirosis
and
melioidosis
cases reported were higher
during
the
flood,
further
investigations showed that not all
leptospirosis (only 5% of cases)
and melioidosis (56% of cases)
were directly caused by flood.
The cases reported during the
flood was higher due to increase
awareness and notifications by
the
medical
practitioners
following instruction from the
Crisis
Preparedness
and
Response Centre (CPRC), MOH to
be on high alert for leptospirosis
and melioidosis which were
expected to increase during
flood.
A hundred and fifty five (155)
health teams were formed during
the flood period throughout
Pahang. One of the tasks was to
supervise and monitor food
preparation at the DRC. However,
some teams allocated to look
after certain DRCs were unable to
do so initially as they had to
monitor a few other new DRCs at
the same time. The number of
DRCs
that
were
opened
overwhelmed the number of
health teams, especially during
the peak period. The formation of
adequate health teams was also
hampered by the fact that some
health personnel were flood
victims themselves, especially in
Temerloh district. The situation
improved after mobilization of an
additional 34 health teams from
outside the district and state.
The HFMD outbreak reported
during the flood occurred in one
family. The cases developed
HFMD symptoms at home prior to
being evacuated to the DRC. In
the DRC, the cases were isolated
in a room to prevent transmission
to other flood victims.
Vector
borne
disease
was
expected to increase during flood
as a result of increase potential
breeding sites and expansion in
the number and range of vector
habitats. However, the expected
increase in dengue cases was not
observed during the flood period.
This could be due to intensive
and integrated control activities
done.
Overall, there was no significant
increase in the number of
notifiable communicable diseases
related to the flood except for
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8/6/2015, 2:32 PM
Prevention
Activities
and
Control
Prevention and control activities
were carried out by the state and
district public health teams prior
to the flood, during and post
flood. These activities contributed
to the low occurrence of
communicable
diseases
and
outbreak related to flood.
ii. Drinking Water Quality Control
(KMAM) and Rural Water Supply
&
Environmental
Sanitation
(BAKAS) Activities
Ensuring uninterrupted provision
of safe drinking water is the most
important preventive measure to
be implemented following a flood,
to reduce the risk of outbreaks of
water-borne diseases.2,12 During
the flood, 960 water samples
were taken from the pipe water
supplied by the Pahang Water
Authority (PAIP). The sampling
points include treatment plant
outlet, reticulations and also at
the DRCs. Only 8.4% and 6.1%
violation on residual chlorine and
turbidity were found respectively.
All violations were reported to
PAIP and remedial measures
were taken immediately. There
was no report of food water
borne cases from the area. A
total of 109 wells were also
inspected and chlorinated.
i. Vector Control Activities
Vector prevention and control
activities started prior to the
flood. Flood prone areas were
visited whereby search and
destroy activities were carried
out. Pamphlets and poster were
distributed. During the flood, a
total of 1225 inspections were
carried out at the DRCs, of which
only 11 (0.9%) were found to be
positive for Aedes breeding. This
was detected at the early phase
of flood period. Fogging and
larviciding were carried out and
no breeding were detected after
that. The activities continued
during the post flood period.
Apart
from
mosquitoes,
prevention and control activities
for
other
pests
such
as
cockroaches, flies and rodents
were also conducted at the DRCs
and flood affected areas. More
than
4,000
localities
were
inspected for the presence of
maggots and flies. Larvaciding,
adulticiding and disinfection were
carried out accordingly at the
premises.
To
ensure
environmental
cleanliness, 2394 houses were
inspected of which 314 were
found to be unsatisfactory. It was
also found that 269 latrines, 90
domestic water sewerage system
and 214 solid waste disposal
systems were in substandard
conditions.
Remedial actions
were taken immediately by the
health teams. These include
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8/6/2015, 2:32 PM
gotong-royong
disinfections,
activities and health. A total of 60
mobile
toilets
were
also
dispatched to the areas which
were badly affected.
carried out. The three most
frequent activities were individual
counseling
(47.1%),
demonstration on proper hand
washing (24.5%) and small
group discussion (8.3%). A total
of 52,821 educational materials
on various health topics related
to flood were distributed during
the flood. The topics include
hand hygiene, steps taken to
avoid disease during flood, food
and water borne diseases, vector
borne diseases, leptospirosis,
melioidosis and cough etiquette.
iii. Food Quality and Safety Activities
Before the flood, briefings on
hygienic and sanitary food
handling were given to volunteers
identified and designated to help
in preparing food at the DRCs.
Anti-typhoid vaccinations were
administered to 1018 food
handlers. However, not all food
handlers were given the briefing
and anti-typhoid vaccination as
some of them were recruited at
the last minute due to sudden
occurrence of floods at areas not
identified as potential flood areas
earlier. However, these DRCs
were
inspected
and
food
preparations were supervised for
every meal. Besides DRCs, 397
food premises in flood affected
area were also inspected to
ensure the quality and safety of
the food sold. Another 122
inspections were carried out at
the point of sale such as
supermarkets, hypermarkets and
sundry shops to ensure food that
were affected during flood were
not sold to the public. During the
operation, food items worth RM
1,360,723.58 were sealed.
These health education activities carried
out during the flood period had probably
increased
public
awareness
and
empower them to take actions which
prevent
them from contracting
communicable diseases.
5.0
CONCLUSION
There was no increase in the
prevalence
of
communicable
disease during the recent flood,
except
for
leptospirosis,
melioidosis and food poisoning.
However, the increase was not
directly caused by the flood.
A few factors contributed to the
success in keeping communicable
diseases under control in the
2014 flood. Firstly, all districts
had succeeded in carrying out
their preparedness plan (pre,
during and post flood period).
This was further enhanced by
good inter-agency collaboration
during the flood period. In
addition, DRCs were equipped
iv. Health Education Activities
During the flood period, 35,305
health education sessions were
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8/6/2015, 2:32 PM
DRCs are equipped with
facilities and personnel who
have been briefed on proper
food
handling
and
preparation. Further, they are
being supervised by health
teams.
with basic amenities such as
treated water supply, sanitary
latrines, uninterrupted electrical
supply and supervised food
preparation.
Moreover,
population displacement and
movement of victims which
usually lead to increase in
prevalence
of
communicable
diseases and outbreak did not
occur in Pahang since the flood
period was short in duration,
causing less impact on health.
6.0
iii)
RECOMMENDATIONS
i)
ii)
To further improve
the
management
of
communicable
diseases
related
to
flood,
Flood
Preparedness Plan has to be
reviewed. Alternative plan has
to be made to cater for
situations where health staff
themselves are affected by
the flood. Contingency plan
utilizing staff from unaffected
neighbouring districts within
the state and outside the
state should be put in place
so that this could be activated
at short notice to ensure
prompt and smooth running
of preventive and control
activities.
To prevent food poisoning
outbreaks occurring during
the flood period, it is
recommended that foods for
evacuees in DRCS should not
be prepared and brought from
outside as there is no proper
control on their quality. All
Health Alert Cards (HAC) were
distributed to monitor the
health status of MOH staff
and volunteers, especially on
Typhoid, Leptospirosis and
Melioidosis. However these
cards were distributed a little
late, and some well passed
the incubation period for
these diseases. In future,
HACs
should
be
made
available distributed to the
exposed staff and volunteers
early.
ACKNOWLEGEMENT
We would like to thank the Director
General of Health Malaysia for giving the
permission to publish this report. We
also would like to express our gratitude
to those who were involved directly or
indirectly in this study.
REFERENCES
1. Balek, J. (1983). Hydrology and water
resources
in
tropical
regions.
Developments in water science. Vol.18
2. World Health Organization (2005)
Flooding and communicable diseases
fact sheet: Risk assessment and
preventive measures cited 7 April 2015).
Available
from
http://www.who.int/diseasecontrol_eme
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rgencies/publications/who_cds_2005.35/
en/
OR
www.who.int/hac/techguidance/ems/
flood_cds/en/
Mohd Yusof, M., Adam, A.M. (2009).
Spectrum of flood-related diseases
encountered during flood disaster in
Johore, Malaysia. Journal of Community
3. Connolly, M.A., Gayer, M., Ryan, M.J.,
Salama, P., Spiegel, P., Heymann, D.L.
(2004). Communicable diseases in
complex emergencies: impact and
challenges. Lancet. 364(9449):1974–83.
[PubMed: 15567014]
4. Jensen, P.K., Meyrowitsch, D.W.,
Konradsen,
F.
(2010).Water
and
sanitation in disaster situations] Ugeskr
Laeger.
172(2):109–12.
[PubMed:
20074486]
5. Ivers, L.C., Ryan, E.T. (2006).
Infectious diseases of severe weatherrelated
and
flood-related
natural
disasters. Curr Opin Infect Dis.
19(5):408–14. [PubMed: 16940862]
6. Wilder-Smith, A. (2005).Tsunami in
South Asia: what is the risk of postdisaster infectious disease outbreaks?
Ann Acad Med Singapore. 34(10):625–
31. [PubMed: 16382248]
7. Lashley, F.R. (2003) Factors contributing
to the occurrence of emerging infectious
diseases. Biol Res Nurs. 4(4):258–67.
[PubMed: 12698918]
8. Ligon, B.L. (2006). Infectious diseases
that pose specific challenges after
natural disasters: a review.
Semin
Pediatr
Infect
Dis.
17(1):36–
45.[PubMed: 16522504]
9. Waring, .S.C., Brown, B.J. (2005). The
threat of communicable diseases
following natural disasters: a public
health response. Disaster Manage
Response.
3(2):41–7.[PubMed:
15829908]
10. Badrul Hisham, A.S., Shaharom Nor
Azian, C.M.D. , Marzukhi, M.I., Norli, R.,
Fatimah, O., Kee, K.F, Arbaiah, O.,
11. Isidore, K.K., Syed, A., Taro, K., Karen,
H., Hitoshi, O. (2012). Infectious
diseases following natural diasasters:
prevention and control measures. Expert
Health,Vol.15,15-23
Rev. Anti Infect. Ther. 10(1), 95-104
12. Najmeh, J., Armindokht, S., Mehrdad,
(2011). Prevention of
M. & Amir, L.
communicable diseases after disaster: A
review. Journal of Research in Medical
Sciences
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98
Food quality and safety
CDC Preparedness
notification, e-measles, MyTB, e-Dengue, e-wabak
Early warning signs (warning and epidemic level)
and response
Plan of action for disaster/flood available
Stock piling of supplies, operation room (Pahang
CPRC) standby
Rapid assessment team (RAT) and rapid respond
team (RRT)
Training of staffs and simulation exercise
Epidemiology of notifiable disease by enotification, e-measles, MyTB, e-wabak
Early warning signs (warning and epidemic
level) and response
Plan of action for disaster/flood available
Stock piling of supplies, operation room
(Pahang CPRC) standby
Rapid assessment team (RAT) and rapid
respond team (RRT)
98
8/6/2015, 2:32 PM
Data collection & monitoring
briefing, vaccination of food handlers
Food premises inspection, food sampling, food safety
Epidemiology of notifiable disease by e-
disease (ILI, sARI, AGE)
Training of staffs and simulation exercise
Surveillance of ILI, sARI, AGE, Dengue
PRE FLOOD
DISTRICT
Surveillance and trending of infectious
STATE
Pahang
Annex 1: Summary of Preparedness Plan for Communicable Disease Surveillance, Control and Prevention in
99
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8/6/2015, 2:32 PM
CDC Response
collaboration
Inter-agencies
Identify, mobilize, apply, and activate medical and
health resources. Resources include medical and
health personnel, equipment and supplies
required for district.
Identify, mobilize, apply, and activate
medical and health resources. Resources
include medical and health personnel,
equipment and supplies required for state
DURING FLOOD
outbreak
Meeting and update of communicable disease &
areas
materials
Inter-agencies meeting at state level
Distribution of health education material to flood prone
Inspection of identified DRC
Provision of latrines, databases of the population
Management)
by PAIP (Pengurusan Air Pahang or the Pahang Water
Preparation and distribution of health education
List of identified DRC
sanitation
Health Promotion
e-Vekpro)
Water sampling & monitoring of water treatment plant
and control activities, management of Dengue outbreak
Epidemiology of notifiable disease (eDengue,
Case notification and investigation, ACD/PCD, preventive
DISTRICT
Monitoring of E-Dengue
Environment and
Water quality and safety
Vector control
STATE
100
notifiable diseases, lab surveillance, TBIS,
vector/Vekpro, clinic-based continue and inclusive
of evacuation centres & flood areas
Early Warning And Response (EWAR)
RRT activated/standby for any outbreak
verification, confirmation and data collection for
outbreak investigation.
Disease outbreak(medical & investigation) team
Surveillance activities enhanced and
upgraded
Epidemiology of notifiable disease especially
diseases related to flood such as Typhoid,
Leptospirosis and Melioidosis
Early Warning And Response (EWAR)
Laboratory preparedness for testing of
samples for causative agent identification
Data collection & monitoring enhanced
Data collection & Surveillance, Epidemiology of
CPRC room activated
100
8/6/2015, 2:32 PM
inspection, food sampling inclusive of evacuation
Data collection & monitoring food premises
evacuation centres
Typhoid vaccination given to all food handlers at
for lab testing for causative agent identification
ACD/PCD, isolation of cases, swab/samples taking
activated
Operation room activated
DISTRICT
and district.
STATE
101
Need assessment of resources including human
resource
Distribution of HE materials and media statements
Environment and
sanitation
Health Promotion
CDC Response
101
8/6/2015, 2:32 PM
verification, confirmation and data collection
Report writing & lessons learned
Epidemiology of notifiable disease (enotification,e-measles, MyTB, e-wabak)
diseases related to flood
Weekly epidemiologic meeting focusing on
RRT activated/standby for any outbreak
Controlling Centre
Daily meetings at the district Disaster Operation
area
Distribution of HE material at DRC and flood affected
Larvaciding, temporary toilets & mobile toilets provision
points
on-site testing besides the routine water sampling
Water sampling & monitoring inclusive of DRC, additional
investigation of cases,
ACD/PCD, source reduction inclusive of DRC,
centres, holding samples
DISTRICT
Surveillance (ILI, sARI, AGE)
POST FLOOD
Controlling Centre for problem solving, updates &
collaboration
coordination of resources
Daily meeting at the state Disaster Operation
Inter-agencies
focusing on topics related to flood
Vector control
STATE
102
Need assessment
Environment and
102
8/6/2015, 2:32 PM
Documentation, report writing & dissemination
Inter-agencies
collaboration
Provision of health material on post flood diseases
Health Promotion
sanitation
Data collection & monitoring of any violation
Vector control
Report writing
respond team (RRT)
Rapid assessment team (RAT) and rapid
level) and response
Early warning signs (warning and epidemic
STATE
Documentation , report writing & dissemination
Health education continued
Inspection of latrine & rebuilding new ones
& chlorination of wells
Water sampling & monitoring of any violation, inspection
affected areas
ACD/PCD, source reduction inclusive of DRC & flood
services
Food sampling, Inspection of food premises that resume
DISTRICT
Pakat Pasca Banjir Kelantan 2014: Pendekatan Komunikasi Kesihatan
Kepada Mangsa Banjir Menangani Risiko Penyakit Berjangkit
Kamarul S1, Zanariah Z2, Affendi I2,M Nasir A1&Norrafizah J1
1
Institut Penyelidikan Tingkahlaku Kesihatan
2
Bahagian Pendidikan Kesihatan
ABSTRACT
Health Education Special Task Force Team (PAKAT) has been mobilized by the Health
Education Division to empower the flood victims in Kelantan in preventing infection
of post-flood communicable diseases. The objective of presentation is to share an
experience in delivering PAKAT health message to the target group.The PAKAT team
consists of 40 Health Education Officers from all the states in Malaysia. Those officers
divided in four groups and they were sent to the affected localities by stages. There
were 7 regions with 58 localities visited throughout the entire operating team. PAKAT
was divided into twoapproach; to provide the knowledge and perception as well as
skills to the flood victims. The main method used by PAKATwas delivering health
messages via house to house. A total of 14,151 leaflets, posters and bunting had
been distributed or displayed, 5584 individual advice was implemented, 720
demonstration, 527 small group discussions were conducted, 1678 public
announcements and 6 public talks.PAKAT teams managed to move along the current
operation covering seven districts in Kelantan which were Gua Musang (8 Localities),
Kuala Krai (17 localities), Tumpat (13 Localities), Machang (3 Localities), Pasir
Mas (6 Localities), Kota Bharu (4 Localities) and Tanah merah (7 Localities). The
PAKAT has successfully promoted and educated specific and tailored health
messages among community affected with flood disaster using multiple health
communication methods and approaches.
Keywords: PAKAT, flood disaster 2014, Kelantan
ABSTRAK
Pasukan Khas Pendidikan Kesihatan (PAKAT) ditubuhkan oleh Bahagian Pendidikan
Kesihatan, Kementerian Kesihatan Malaysia (KKM) bertujuan untuk menggerakkan
komuniti di kawasan bencana banjir di Kelantan. Strategi PAKAT pasca banjir adalah
menggunakan pendekatan komunikasi bagi menyampaikan mesej kesihatan kepada
mangsa banjir untuk mengelak daripada wabak penyakit berjangkit pasca banjir.
PAKAT pasca banjir Kelantan dianggotai oleh seramai 40 orang Pegawai Pendidikan
Kesihatan dari seluruh negara. Semua pegawai dipecahkan kepada 4 pasukan dan
setiap pasukan dihantar secara berperingkat ke lokaliti yang telah dikenal pasti.
Operasi PAKAT pasca banjir bergerak selama sebulan. PAKAT pasca banjir melakukan
lawatan dari rumah ke rumah untuk menyampaikan mesej kesihatan dengan
menerapkan ilmu pengetahuan dan perkongsian tentang penyakit berjangkit, serta
meningkatkan kemahiran cara mencegah penyakit kepada mangsa banjir. Pasukan
PAKAT pasca banjir berjaya digerakkan ke semua tujuh jajahan Kelantan iaitu Gua
Musang (8 Lokaliti), Kuala Krai (17 lokaliti), Tumpat (13 Lokaliti), Machang (3
Lokaliti), Pasir Mas (6 Lokaliti), Kota Bharu (4 Lokaliti) dan Tanah Merah (7 Lokaliti).
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Sebanyak 14,151 risalah, poster dan bunting telah diedar dan digantung di lokasi
yang strategik. Sebanyak 5,584 nasihat individu, 720 tunjuk cara, 527 perbincangan
kumpulan kecil, 1,678 hebahan awam dan 6 ceramah telah dilaksanakan. PAKAT
pasca banjir telah berjaya melaksanakan promosi dan pendidikan kesihatan kepada
mangsa banjir dengan menggunakan pelbagai kaedah dan pendekatan bagi
memastikan penyakit berjangkit tidak merebak di kawasan yang terjejas akibat
banjir.
Kata kunci: PAKAT, Banjir Kelantan
PENDAHULUAN
Pasukan Khas Pendidikan Kesihatan
(PAKAT) adalah gerak kerja (task
force) yang menggembling tenaga
Pegawai Pendidikan Kesihatan atau
Health Education Officer (HEO) dalam
melaksanakan mobilisasi komuniti.
Pasukan PAKAT digerakkan pada Ogos
2014
atas
inisiatif
Bahagian
Pendidikan Kesihatan Kementerian
Kesihatan
Malaysia
(BPKKKM).
Penubuhan PAKAT pada asalnya
bertujuan untuk memobilisasi komuniti
di lokaliti panas (hotspots) denggi di
negeri Selangor. Pada Disember 2014,
banjir besar melanda beberapa negeri
di Semenjung Malaysia terutama di
pantai timur. Kelantan adalah salah
satu negeri yang terjejas teruk di
mana
seramai
339,703
orang
penduduk
terpaksa
dipindahkan
(Sumber:
Jabatan
Kebajikan
Masyarakat 2015). Pada 29 Disember
Crisis
2014,
satu
mesyuarat
kerjasama BPKKKM dengan Persatuan
Promosi Kesihatan Malaysia (MAHEO).
Penulisan ini dilakukan bertujuan untuk
berkongsi pengalaman pasukan PAKAT
Pasca
Banjir
Kelantan
dalam
melaksanakan aktiviti promosi dan
pendidikan kesihatan untuk mencegah
penyakit berjangkit. Ia juga sebagai
salah satu platform bagi menambah
baik garis panduan pengurusan
komunikasi risiko semasa banjir serta
pelaksanaan PAKAT Pasca Banjir pada
masa akan datang.
MATERIAL DAN METODOLOGI
Tempoh operasi PAKAT
Pasukan
PAKAT
pasca
banjir
beroperasi selama sebulan bermula
dari 1 Januari hingga 30 Januari 2015.
Petugas PAKAT
Petugas terdiri daripada Pegawai
Pendidikan Kesihatan dan dibantu oleh
anggota sokongan dari BPK, Institut
Penyelidikan Tingkahlaku Kesihatan
(IPTK) dan Unit Promosi Kesihatan
(UPK) negeri di seluruh negara.
Preparedness and Response Centre
(CPRC) banjir yang dipengerusikan
oleh
Ketua
Pengarah
Kesihatan
Malaysia telah mencapai kata sepakat
untuk mengaktifkan semula PAKAT.
PAKAT kali ini dikenali sebagai PAKAT
Pasca Banjir kerana tumpuan diberi
untuk
menyalurkan
maklumat
kesihatan kepada mangsa banjir bagi
menangani masalah kesihatan selepas
banjir di pusat pemindahan serta
daerah terjejas teruk akibat banjir.
PAKAT Pasca Banjir adalah hasil
Bahan
Bercetak
Pendidikan
Kesihatan
BPK membekalkan pasukan PAKAT
Pasca Banjir dengan bahan bercetak
pendidikan KKM sedia ada yang
berkaitan dengan penyakit berjangkit
pasca banjir seperti risalah, poster dan
kain rentang.
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Strategi operasi PAKAT
BPK KKM telah menghantar surat
arahan bertugas bagi mengumpul
petugas PAKAT Pasca Panjir dan
keperluan logistik seperti kenderaan,
khemah dan peralatan memasak
minima. Petugas PAKAT Pasca Banjir
telah dibahagikan kepada 4 pasukan
yang mengandungi antara 15 hingga
16 orang petugas. Setiap pasukan
PAKAT Pasca Banjir telah menerima
jadual pergerakan secara berperingkat
dan senarai asas keperluan diri minima
yang perlu dibawa bersama termasuk
sarung tangan getah, penutup muka
dan but getah. Berdasarkan jadual
yang ditetapkan, pasukan PAKAT
Pasca Banjir diarah berkumpul di BPK
bagi mendengar taklimat penting
daripada ketua PAKAT Pasca Banjir
BPK KKM sebelum bergerak ke
Kelantan. Sesi taklimat tersebut
merangkumi maklumat keselamatan
ketika bertugas, mesej kesihatan,
kaedah penyampaian mesej, maklumat
ringkas lokasi yang akan dilawati,
pegawai bertugas dan tempat untuk
melapor diri. Sebelum berlepas, BPK
telah menyerahkan bahan pendidikan
kesihatan
dan
keperluan
asas
penjagaan kebersihan hasil pemberian
MAHEO untuk mangsa banjir seperti
gel pencuci tangan, cecair mandian
berubat dan cecair pembasmi kuman.
Setibanya di Kelantan, pasukan PAKAT
Pasca Banjir telah diberi taklimat
penuh berkaitan situasi terkini lokasi
bencana berdasarkan penilaian situasi
dan keperluan yang telah dilakukan
oleh pihak UPK Jabatan Kesihatan
Negeri Kelantan (JKNK). Pasukan
PAKAT
Pasca
Banjir
kemudian
dibahagikan kepada 3 kumpulan kecil
terdiri daripada 5 hingga 6 orang
petugas dan disediakan jadual logistik
bagi memudahkan pergerakan semasa
di lapangan. Sesi taklimat di lapangan
dan post mortem juga diadakan setiap
hari sebelum dan selepas aktiviti
PAKAT Pasca Banjir dijalankan di
lokaliti terpilih.
Pendekatan PAKAT
Petugas
PAKAT
Pasca
Banjir
bertanggungjawab
menyampaikan
mesej kesihatan dengan menerapkan
ilmu
pengetahuan
dan
persepsi
terhadap penyakit berjangkit, serta
membina
kemahiran
pencegahan
penyakit berjangkit kepada mangsa
banjir. Pendidikan kesihatan diberikan
bagi
membantu
individu
dan
masyarakat mengambil tindakan yang
bersesuaian
dalam
menangani
ancaman penyakit akibat banjir.
Petugas telah mengambil pendekatan
secara individu, kumpulan kecil dan
beramai-ramai
(mass)
mengikut
kesesuaian
keadaan
dan
emosi
mangsa banjir di lokasi. Rajah 1
menghuraikan pendekatan dan kaedah
komunikasi berkesan seperti nasihat
individu, tunjuk cara, perbincangan
kumpulan kecil, hebahan awam,
ceramah dan edaran bahan pendidikan
kesihatan
yang
digunakan
oleh
petugas PAKAT Pasca Banjir dalam
memastikan mesej kesihatan sampai
kepada mangsa banjir.
105
105
8/6/2015, 2:32 PM
Rajah 1: Pendekatan dan Kaedah PAKAT Pasca Banjir
Pendekatan & Kaedah
Kemahiran
Pengetahuan & Persepsi
Kumpulan
Kumpulan
Individu
Poster
Risalah
Ceramah
Bunting
Demonstrasi
Lawatan rumah
ke rumah
Lawatan ke
pusat
pemindahan
Hebahan awam
Advokasi
melalui
pemimpin
Demonstrasi
Perbincangan
Kumpulan Kecil
Demonstrasi
Lawatan
rumah ke
rumah
Lawatan ke
pusat
pemindahan
Perbincangan
Kumpulan
Kecil
Mesej kesihatan PAKAT
Terdapat 9 mesej kesihatan utama
yang disampaikan kepada mangsa
banjir mengikut kesesuaian mangsa
yang ditemui di lokasi. Adaptasi mesej
dilakukan
tanpa
menghilangkan
kepentingan mesej kesihatan yang
disampaikan
bagi
menghormati
keadaan dan emosi mangsa. Sebagai
contoh, mangsa banjir dinasihatkan
agar minum banyak air mineral
atau air suling dalam botol yang
dibekalkan jika tiada kemudahan untuk
memasak air minuman dan mesej
kesihatan tentang penggunaan cecair
pembasmi
kuman
ketika
106
Risalah
Tunjuk cara
Nasihat individu
membersihkan rumah dan
atau
peralatan di mana hanya akan
diberikan kepada mangsa banjir yang
masih mempunyai rumah dan atau
peralatan. Mangsa banjir turut diberi
penjelasan kukuh tentang kewajaran
mengapa setiap tindakan harus
dilakukan dengan betul berdasarkan
mesej kesihatan yang disampaikan
(WHO 2015 & Morgan O, 2004).
Dengan cara ini, petugas PAKAT Pasca
Banjir dapat mendekati mangsa
dengan mudah bagi menyalurkan
mesej-mesej kesihatan berikut dengan
berkesan:
106
Individu
8/6/2015, 2:32 PM
Kebersihan tangan (membasuh
tangan menggunakan guna
sabun atau gel pencuci tangan);
Minum air yang telah dimasak
sempurna;
Elak makan ulam-ulaman;
Guna cecair pembasmi kuman
ketika
bersih
rumah
dan
peralatan;
Memakai sarung tangan dan
kasut keselamatan;
Dapatkan rawatan segera jika
sakit atau demam;
Guna penutup muka;
Buang
sampah
domestik
dengan cara yang betul;
Menanam bangkai binatang
dengan cara yang betul.
HASIL
Seramai 61 orang pegawai telah
menyertai PAKAT Pasca Banjir yang
terdiri daripada 40 orang Pegawai
Pendidikan Kesihatan dan dibantu oleh
4 orang Juru Audiovisual, 8 orang
Pembantu Kesihatan Awam, seorang
Pembantu Rendah Awam dan 8 orang
Pemandu. UPK negeri yang turut serta
adalah Negeri Sembilan, Melaka,
Selangor, Kedah, Kelantan dan dibantu
oleh BPK serta IPTK. Pasukan pertama
telah digerakkan pada 1 hingga 4
Januari 2015 dan pasukan terakhir
pada 19 hingga 25 Januari 2015
seperti Jadual 1.
Jadual 1: Jadual Operasi pasukan dan jumlah kekuatan PAKAT Pasca Bbanjir
Kelantan
JUMLAH KEKUATAN PAKAT
PASUKAN
TARIKH OPERASI
KELANTAN (orang)
Satu
1- 4 Januari 2015
40 HEO &
Dua
5-11 Januari 2015
21
anggota
sokongan
Tiga
12-18 Januari 2015
Empat
19-25 Januari 2015
Aktiviti
pendidikan
kesihatan
menggunakan
pendekatan
secara
individu, berkumpulan dan beramairamai telah dilaksanakan di 7 jajahan
Kelantan; Gua Musang (8 lokaliti),
Kuala Krai (17 lokaliti), Tumpat (13
lokaliti), Machang (3 lokaliti), Pasir Mas
(6 lokaliti), Kota Bharu (4 lokaliti) dan
Tanah Merah (7 lokaliti).
Hasil
daripada aktiviti tersebut sebanyak
12,730 risalah telah diedar, 187 poster
berjaya ditampal, 1,234 bunting juga
telah
digantung
di
pusat-pusat
pemindahan banjir dan klinik kesihatan
serta sebanyak 1,678 hebahan awam
berjaya dilakukan oleh Unit Bergerak
Promosi Kesihatan (Jadual 2). Seramai
190 orang telah menghadiri ceramah,
3,925 individu mengikuti perbincangan
kumpulan kecil, 2,885 orang mengikuti
tunjuk cara dan 5,584 orang diberi
nasihat individu.
107
107
8/6/2015, 2:32 PM
Jadual 2: Aktiviti dan jumlah Pendidikan Kesihatan yang dilaksanakan oleh pasukan
PAKAT Pasca Banjir Kelantan
Aktiviti
Ceramah
Poster
Perbincangan Kumpulan
Kecil
Tunjuk Cara
Bunting
Hebahan Awam
Nasihat Individu
Risalah
Pasukan Pasukan Pasukan Pasukan
Jumlah
2
3
4
1
2
8
0
27
0
101
4
51
6
187
56
257
140
77
527
171
2
55
2
188
2429
42
499
410
4314
1431
52
570
178
5941
1553
28
554
130
2089
720
1,234
1,678
5,584
12,730
Gambar 1: Aktiviti-aktiviti yang dilakukan petugas PAKAT Pasca Banjir (Gambar
ehsan: Petugas PAKAT Pasca Banjir).
108
108
8/6/2015, 2:32 PM
Gambar 2: Cabaran yang dihadapi oleh petugas PAKAT Pasca Banjir ketika
menjalankan tugas (Gambar ehsan: Petugas PAKAT Pasca Banjir)
109
109
8/6/2015, 2:32 PM
PERBINCANGAN
Hasil kajian yang dilakukan oleh Pusat
Kajian
Kawalan
Banjir,
Fakulti
Kejuruteraan
Awam
Universiti
Teknologi MARA (UiTM) mendapati
terdapat peningkatan curahan hujan
yang tinggi direkodkan di stesen
Gunung Gagau di Gua Musang pada
21 Disember 2014 (302mm), 22
Disember 2014 (478mm) dan 23
Disember 2014 (515 mm). Keadaan ini
menyebabkan
terjadinya
bencana
banjir kuning besar di Kelantan (Berita
Harian 2015).
serta seterusnya, memperkasa mangsa
banjir untuk melakukan tindakan yang
disarankan.
Model
Kepercayaan
Kesihatan (Health Belief Model[HBM])
perceived
severity,
merangkumi
perceived susceptibility, perceived
benefits, perceived barrier, cues to
action dan self-efficacy (Rosenstock et
al
1988)
digunakan
dalam
menyampaikan 9 mesej kesihatan
pasca banjir. Penggunaan teori HBM ini
telah membantu petugas PAKAT Pasca
Banjir mendekati dan menyakinkan
mangsa
banjir
untuk
bertindak
mengikut tingkah laku dan amalan
penjagaan kebersihan serta kesihatan
yang betul bagi mengelak risiko
jangkitan penyakit berjangkit.
Pasukan PAKAT telah digerakkan ke
lokasi bencana terpilih di Kelantan
selama sebulan bertujuan memberikan
promosi dan pendidikan kesihatan
kepada mangsa banjir bagi mencegah
wabak penyakit berjangkit bawaan air
seperti
demam
tifiod,
kolera,
leptospirosis dan hepatitis A serta
penyakit berjangkit bawaan vektor
seperti demam denggi dan demam
denggi berdarah (WHO 2015, Gayer M
& Connolly MA 2005). Bermula pada 1
hingga 18 Januari 2015, dilaporkan
terdapat 458 kes Leptospirosis telah
berlaku di lokaliti terjejas banjir di
Kelantan,
namun
tiada
wabak
diisytiharkan
(KKM
2015).
Ini
menunjukkan bahawa, inisiatif PAKAT
Pasca Banjir dalam menyampaikan
mesej kesihatan kepada mangsa banjir
telah dapat membantu mencegah
berlakunya wabak penyakit berjangkit
pasca banjir.
Bagi menjayakan
misi tersebut,
pasukan PAKAT Pasca Banjir telah
menumpukan operasi gerakan dengan
mengadakan lawatan dari rumah ke
rumah atau lawatan ke tapak asal
rumah mangsa atau lawatan ke
khemah kediaman mangsa bagi
menemui mangsa banjir. Berdasarkan
analisa awal situasi yang dijalankan
oleh UPK JKNK, didapati nasihat
individu, perbincangan kumpulan kecil
dan tunjuk cara adalah antara kaedah
yang
paling
sesuai
dalam
menyampaikan
mesej
kesihatan
berkaitan tingkah laku kesihatan yang
perlu dilakukan untuk mengelak wabak
penyakit berjangkit. Kaedah nasihat
individu merupakan kaedah utama
yang
dilaksanakan
dalam
menyampaikan
mesej
kesihatan.
Kaedah ini sangat praktikal dan efektif
kerana lebih bersifat personalized
yakni individu didapati lebih mudah
menerima mesej kesihatan yang ingin
disampaikan. Kaedah perbincangan
kumpulan kecil pula dilaksanakan di
kalangan
mangsa
yang
tinggal
Penyampaian mesej kesihatan
PAKAT Pasca Banjir telah menekankan
penggunaan teori dalam merancang
pendekatan dan kaedah penyampaian
mesej kesihatan kepada mangsa banjir
bagi memastikan keberkesanan mesej
dan perubahan tingkahlaku berlaku
110
110
8/6/2015, 2:32 PM
bersama atau duduk berkumpul dalam
kumpulan kecil seperti di wakaf, rumah
dan khemah. Kaedah ini sangat
praktikal dan menjimatkan masa
kerana banyak mesej kesihatan dapat
disampaikan kepada mangsa banjir
dalam jumlah yang ramai (Declan T
Bradley 2014). Di samping itu, kaedah
tunjuk
cara
telah
dilaksanakan
bertujuan untuk memberi kemahiran
kepada mangsa banjir tentang cara
membasuh tangan yang betul, cara
membasuh
rumah
menggunakan
pembasmi kuman serta pemakaian
topeng muka yang betul. Kaedah ini
membantu mangsa banjir daripada
terdedah kepada risiko penyakit
berjangkit
ketika
banjir.
Aktiviti
hebahan awam menggunakan alat
pembesar suara yang dipasang pada
kenderaan jabatan juga antara kaedah
yang dilaksanakan bagi memberi
maklumat secara umum kepada
mangsa banjir. Kaedah ini sangat
praktikal
dilakukan
di
kawasan
bencana yang mampu diakses oleh
kenderaan dan mempunyai ramai
mangsa yang tinggal berselerak pada
skala yang lua. Ini kerana, hebahan
dapat didengari oleh ramai mangsa
banjir pada satu-satu masa. Pemberian
risalah
kepada
mangsa
banjir
bertujuan untuk dijadikan bahan
rujukan selepas semua aktiviti di atas
dilaksanakan ke atas mereka.
Walaupun
objektif utama PAKAT
Pasca
Banjir
adalah
untuk
menyampaikan
mesej
kesihatan
dengan menerapkan ilmu pengetahuan
dan persepsi terhadap penyakit
berjangkit serta membina kemahiran
pencegahan penyakit kepada mangsa
banjir, setiap petugas telah diberi
peringatan awal semasa taklimat agar
mengambil kira keadaan dan emosi
mangsa ketika menjalankan tugas.
Petugas
PAKAT
Pasca
Banjir
mengambil
inisiatif
memulakan
interaksi dengan bertanya khabar,
menyampaikan sumbangan barangan
MAHEO dan memberi kata semangat
kepada
mangsa
banjir
untuk
mewujudkan
kemesraan
sebelum
menyampaikan
mesej
kesihatan.
Setiap perjumpaan bersama mangsa
banjir diakhiri dengan kata-kata
semangat
dan
peringatan
agar
sentiasa menjaga kesihatan seperti
disarankan demi diri sendiri dan
keluarga untuk kelangsungan hidup.
Hasil daripada pemerhatian yang
dijalankan, mangsa banjir menerima
baik kehadiran petugas PAKAT Pasca
Banjir dan mesej kesihatan dapat
disampaikan dengan baik.
KESIMPULAN
PAKAT Pasca Banjir telah berjaya
melakukan promosi dan memberi
pendidikan kesihatan kepada mangsa
banjir di tujuh jajahan Kelantan dalam
masa sebulan. Pelbagai pendekatan
dan kaedah telah digunakan oleh
PAKAT dalam menyampaikan mesej
kesihatan kepada mangsa banjir.
Pendekatan PAKAT yang memberi
tumpuan kepada lawatan dari rumah
ke rumah atau lawatan ke tapak asal
rumah mangsa atau lawatan ke
khemah
kediaman
mangsa
menunjukkan
komitmen
pasukan
untuk memastikan mesej kesihatan
disampaikan terus kepada mangsa
banjir secara bersemuka supaya
mereka mendapat maklumat tepat
mengenai
amalan
yang
harus
dilakukan untuk mengelak risiko wabak
penyakit berjangkit.
PENGHARGAAN
Sekalung penghargaan dan ucapan
terima kasih ditujukan kepada Ketua
Pengarah Kesihatan Malaysia atas
kebenaran bagi menerbitkan artikel ini.
111
111
8/6/2015, 2:32 PM
Ucapan terima kasih juga ditujukan
kepada Timbalan Pengarah Kesihatan
(Penyelidikan dan Sokongan Teknikal)
atas
sokongan
dan
cadangan
penambahbaikan
yang
diberikan.
Sekalung perhargaan turut ditujukan
buat semua petugas PAKAT Pasca
Banjir 2014 serta individu yang terlibat
secara langsung dan tidak langsung
dalam penulisan artikel ini.
Kementerian
Kesihatan
Malaysia
(2015).
Siaran
Media
Tindakan
Kementerian Kesihatan Menangani
Banjir
19
Januari
2015.www.moh.gov.my
Morgan O. Infectious Disease Risks
From Dead Bodies Following Natural
Disasters. Rev Panam Salud Publica.
2004;15(5):307–12.
Rosenstock, Irwin M.; Strecher, Victor
J.; Becker, Marshall H. (1988)."Social
Learning Theory And The Health Belief
Model". Health Education & Behavior
15 (2): 175–183.
WHO. Flooding And Communicable
Diseases
Fact
Sheet.
Http://www.who.it/Hac/Techguidance/
Ems/Flood_Cds/En/[4 Mei 2015]
RUJUKAN
Banjir Kuning Bagai Tsunami Ancam
Kelantan.
17
Januari
2015.
http://www.Bharian.com.my/Node/297
43 [4 Mei 2015]
Bradley Dt, Mcfarland M, Clarke M.
(2014). The Effectiveness Of Disaster
Risk Communication: A Systematic
Review Of Intervention Studies. Plos
Currents Disasters. Aug 22. Edition
1.Doi:
Gayer M & Connolly Ma. Chapter 5:
"Communicable Disease Control After
Disasters"
In
Public
Health
Consequences Of Disasters, 2nd
Edition, Eds. Noji, Ek. Oxford: Oxford
University Press, 2005 (In Revision).
Jabatan Kebajikan Masyarakat (Jkm).
2015. Status Terkini Bencana Banjir Di
Pusat Pemindahan Tahun 2014/2015.
Bilik Gerakan Bencana, Bahagian
Kebajikan Produktif.
112
112
8/6/2015, 2:32 PM

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