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Malaysian Journal of Medical Sciences, Vol. 15, No. 2, April 2008 (29-33)

SHORT COMMUNICATION

HEALTH MAJOR INCIDENT : THE EXPERIENCES OF MOBILEMEDICAL TEAM DURING MAJOR FLOOD

Rashidi Ahmad, Zainalabidin Mohamad, Abu Yazid Mohd Noh, Nasir Mohamad, Mohd SaharudinShah Che Hamzah, Nik Ariff Nik Mohammed, Kamarul Aryffin Baharudin, Tuan Hairulnizam Tuan

Kamauzaman

Department of Emergency Medicine,School of Medical Sciences, Universiti Sains Malaysia, Health Campus

16150 Kubang Kerian, Kelantan, Malaysia

Disaster is a sudden event that associated with ecological changes, disruption ofnormal daily activities, destruction of infrastructures, loss of properties, andmedical disabilities. In disaster, there is a mismatch between available resourcesand patients need for healthcare service. During flood disaster, the victims werepredisposed to different type of illnesses for various reasons such as inadequatesupply of clean water, poor sanitation or drainage system, unhealthy foods, andover-crowded relief centers. Mobile clinic is an option for delivering medical carefor the disaster victims who often have a difficulty to access to the medical facilities.In this article we would like to share our experiences during the provision ofhumanitarian services for flood victims at District of Muar Johor. Common illnessesamong the flood victims at visited relief centers and advantages of Mobile MedicalRelief Team were also highlighted and discussed.

Key words : flood disaster, health disruption, mobile medical team

Introduction

On 19th December 2006, continuously heavydownpour occurred in Johor. Many towns such as“Muar” Muar, “Kota Tinggi” Kota Tinggi and \o“Segamat” Segamat were seriously flooded withwater levels as high as 10 feet above ground levelrecorded in some areas. (1) Flood victims wereevacuated to the unprepared designated reliefcenters. (2)

The sudden occurrence of unexpected floodsin State of Johor creates varying degrees of chaos tothe affected community. From health perspective,such events can result in immediate medicalproblems, as well as long-term public health andpsychoemotional disruptions. (3) Usually there willbe a mismatch between available health resourcesand patients needs. In addition, medicalinfrastructure and common roads may be totallydisrupted during a disaster, and to reestablish themto normal function needs time and money. (4, 5) As

a consequence, some of the flood victims may havepoor accessibility to the nearest health facilities fora common treatment. Furthermore, continues routinemedical care also may not be available to survivorsdue to damaged healthcare facilities. Bothgovernment and private clinics were badly affectedby the floods. The doctors and paramedics wereflood victims themselves. Beside an obligation tothe public health they also have to ensure the safetyof their own family The factors mentioned abovemay affect patient’s health status. It is noteworthythat the restoration of an affected society back to itspre-event status requires detailed evaluation andextraordinary efforts.

Providing medical care in a disaster setting isalways a challenge to the healthcare providers. Theobstacles include varying amounts of resources,varying type of acute illnesses that may associatedwith mass event, and for varying periods of time.(6, 7) The success of medical care in such events isdetermined by various factors including appropriate

Submitted-20-02-2005, Accepted-03-12-07

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Table 1: Schedule of mission

Rashidi Ahmad, Zainalabidin Mohamad et. al

Day 103/01/07Wednesday

08301730

2230

0045

Team departef from Kubang Kerian, Kelantan to Kuala LumpurBriefing by Dato’ Ahmad and Medic Asia personnel nearMac Donald Restaurant at Jalan Sungai Besi, Kuala Lumpur.Meeting together with Muar District Officer Tuan Haji Abdul RahmanJaafar.Team reached Kampung Raja, Pagoh.

Day 305/01/07Friday

080008300930130014451515

Briefing and breakfast at a food stall at PagohExtra supply received from Lenga Health ClinicFourth medical clinic: Balai Raya Kampung Tulang Gajah, Lenga.Extra supply received from Pagoh Health ClinicFifth Medical Clinic: Kampung SentosaDebriefing and dinner at Kesang Muar.

Day 406/01/07Saturday

0900

10002000

Meeting with Yang Berhormat Tuan Haji Samat Aripin - cancelled.Travel back to Kuala Lumpur.Debriefing with Dato’ Ahmad and Medic Asia team at Jalan Ampang,Kuala Lumpur.

Day 507/01/07Sunday

0730 Travel back home to Kota Bharu, Kelantan.

Day 204/01/07Thursday

08300900

0930

1000

1430

1530

17002000

Meeting and briefing at Seri Pekembar complexTeam met Dr. Nizam, medical officer in-charged of Pagoh area.Extra supply received from Pagoh Health ClinicFirst location: Kampung Tulang Gajah, Lenga. Reseheduled as no villagersat the location.First Medical Clinic: Flood Relief Centre - Kampung Sungai Berani, Lenga Mosque.Team mer Yang Berhormat Tuan Haji Samat Aripin.Second Medical Clinic: Flood Relief Centre - Balai Raya KampungJawaThird Medical Clinic: Flood Relief Centre - Kampung Jawa MosqueVisit Kampung Sentosa.Debriefing at KEMAS office, Pagoh Jaya.

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strategies, well distribution of resource matrix,trained health personnel, physically and mentallyprepared staffs, as well as a great leadership. Alogistic difficulty is another major issue that needsto be tackled wisely during disaster. The mobilemedical relief team may work best during the flooddisaster. The idea was to bring health care to thosesick and disable victims who had difficulty accessingto medical facilities. Mobile clinic is also a viableoption for victims who need routine medicalrequirements such as obtaining and administeringcardiac or diabetic medications. Mobile medicalrelief teams that offered by the non-governmentalorganizations and private sectors are advantage forthe local health authority.

Mobile Medical TeamDisaster and Emergency Medical Team

(DEMAT) of Hospital Universiti Sains Malaysia(HUSM) together with a non-governmentalorganization called Medic Asia took an initiative toform a team with a primary objective of provisionof medical and humanitarian assistance to floodvictims at remote area. The selection of relief centrewas made by Medic Asia Reconnaissance team whomade the health disaster assessment earlier on priorto the mission.

The team composed of four medical officersfrom HUSM and the other four were representativesfrom Medic Asia organization, which is based in

Kuala Lumpur. Medical equipments andmedications were donated by HUSM and extrasupplies were provided by Health clinics of Pagohand Lenga. The visited villages were KampungSungai Berani, Balai Raya Kampung Jawa,Kampung Jawa Mosque, Kampung Tulang Gajahand Kampung Sentosa. In this mission, the mode oftransportation was four wheel drive vehicles,provided by Medic Asia organization. Their missionstarted on 3rd January 2007 till 6th January 2007.Their tentative program was illustrated in table 1.

Within three days, a total of 170 patients weretreated in their clinic. Sixty-five (38%) were malesand 105(62%) were females. Among these victims,123(72%) were adults and 47(28%) were children.Upper respiratory tract infections (URTIs), includingviral URTIs, laryngitis, and pharyngitis presentedmost frequently (34.1%). Other illnesses weremusculoskeletel problems (22.9%), headache(10.6%), hypertension (8.8%) and dermatologicalproblems such as dermatitis and fungal infection(8.2%). Eleven victims were referred to the nearesthospital due to uncontrolled hypertension. Onevictim was referred for arthritis with a severe jointpain. Above data were summarized in table 2, 3 and4. The volunteers from Medic Asia assisted thedoctors by taking part in providing health educationto the public and deworming to the children. Someof them conducted a drawing class and games anddistributing presents to the children.

Table 2: Distribution of victims according to place and gender

Table 3 : Distribution of victims according to place and age group

HEALTH MAJOR INCIDENT : THE EXPERIENCES OF MOBILE MEDICAL TEAM DURING MAJOR FLOOD

Place

Total

Sg. BeraniBalai Raya Kg JawaMasjid Kg JawaTulang GajahKg Sentosa

1023

292165

Male FemaleGender Total

1173

2163

105

2196

5084

170

Place

Total

Sg. BeraniBalai raya Kg JawaMasjid Kg JawaTulang GajahKg Sentosa

211

162747

Paediatric(<12 years)

AdultAge Group Total

1985

3457

123

2196

5084

170

50

Even though this mission was very tiring, butthe volunteers were very happy for the nicewelcoming by the flood victims and the localauthorities. They had morning briefing sessioneveryday. The purpose of the session is to ensureeverybody is in a good condition, all the equipmentsare ready and available and nevertheless to informany changes made from the previous plan. At nightthe volunteers attended the debriefing session. Adebriefing or also known as psychological debriefingis a one-time, semi-structured conversation with anindividual who has just experienced a stressful ortraumatic event. The purpose of debriefing is toreduce any possibility of psychological harm bysharing their experience or allowing them to talkabout it. (8) The debriefing session was led by theteam leader who is usually the most senior andexperience person in the group.

Conclusion

Mobile Medical Relief Team is a great optionin providing a medical care to the sick and disablesflood victims who are unable to access the healthservices due to logistic difficulties and damagedhealthcare facilities. In fact, volunteered mobile teamis capable to assist the health teams organized bythe local Health Department. Government and non-government agencies that provide such assistanceshould work together and have a communication-link for the benefit of the affected population. Thiskind of service should be coordinated betweenMinistry of Health and non-governmental bodies ina more organized manner without compromisingregulatory and ethical requirements. The

contribution of this team in such mission may notbe that much. However, it can reduce the burden ofthe local health authority. We hope, in the future,this kind of rendered service can be offered not onlyto the community in a disaster area but also to thosewho live at the remote areas where health facilitiesare almost not accessible.

Acknowledgements

The author is grateful to the all the emergencyphysicians, master candidates of Emergencymedicine, paramedics of HUSM, Hospital Directorof HUSM and Medic Asia organization for theirdirect and indirect assistance in formulating thispaper.

Corresponding Author :

Dr. Rashidi Ahmad, MD, MMed (EmergencyMedicine) USMDepartment of Emergency Medicine,School of Medical Sciences, Universiti SainsMalaysia, Health Campus, 16150 Kubang Kerian,Kelantan, Malaysia.Tel: +609 766 3244Fax: +6097663370Email: shidee_ahmad@yahoo.com

References

1. Anonymous. Johor. Wikipedia: The Free Encyclopedia.Available at: http://en.wikipedia.org/wiki/Johor.Accessed May 15, 2007.

Table 4: Distribution of medical problems among visited flood victims.

Rashidi Ahmad, Zainalabidin Mohamad et. al

1. URTI 2. Musculoskeletal pain3. Headache4. Medical Check up5. Hypertension6. Skin disease7. Trauma8. Dyspepsia9. Abdominal pain10. Asthma11. Others Total 21 9 6 50 84 170(100)

Sg.Berani

Medical conditions Balai rayaKg Jawa

MasjidKg Jawa

TulangGajah

KgSentosa

N(N%) Place Total

69012101001

22001310000

11101200000

1816133501003

31111612

8310111

58(34.1)39(22.9)18(10.6)16(9.4)15(8.8)14(8.2)2(1.2)2(1.2)1(0.6)1(0.6)4(2.4)

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2. Anonymous. 2006-2007 Malaysian floods. Wikipedia:The Free Encyclopedia. Available at: http://en.wikipedia.org/wiki/2006-2007_Malaysian_floods.Accessed May 15, 2007.

3. Auf der Heide E. Disaster Response: The principlesof preparation and coordination. St. Louis: CV Mosby1989

4. Dova DB, del Guercio LRLM, Stahl WM and et al. Ametropolitan airport disaster plan: coordination of amultihopsital response to provide onsite resuscitationand stabilization before evacuation, J Trauma 1982;22:550-559

5. Noji EK: Flood. Noji EK (ed). The Public HealthConsequences of Disaster Oxford University Press,New York, 1997, pp 287–301.

6. Kongsaengdao S, Bunnag S, Siriwiwattnakul N 2005,‘Treatment of survivors after the tsunami’, EJM, vol.352(25), pp. 2654-2655

7. Axelrod D. Primary Health care and the Midwest flooddisaster. Public Health Rep 1994;109:601-605

8. Anonymous. Debriefing. Available at: http://en.wikipedia.org/wiki/Debriefing. Accessed May 15,2007.

HEALTH MAJOR INCIDENT : THE EXPERIENCES OF MOBILE MEDICAL TEAM DURING MAJOR FLOOD