Disaster : Emotional Effect

The impact of disaster is beyond what we can imagine. What's more is that it does not only affect physical, but mental as well. No one who experiences a disaster is untouched by it. Losing their loved ones and the properties they own (house, vehicle, livestock) in just a blink, has shattered their lives.

• Warning and Threat Phase : The length of this phase varies, depends on the event. For an instance, in flooding case, there are usually several days of warning that give people time to prepare.

• Impact/Inventory : . Disaster victims may be stunned or confused after the disaster occurred. Yet, they somehow quickly recover and start focus on protecting themselves and their family.Reactions to the impact of the disaster depend on warning and preparedness activities, the level of destruction and the success of the local and state emergency response. The inventory phase follows the event immediately as people start forming a preliminary picture of individual and community condition.

• Heroic : During this rescue or heroic phase, the victims work together to save lives and property. For those who have not lose their loved ones, this may be a period of euphoria and boundless altruism. They are willing to put forth energy to help others. However, this phase also likely to be a time of shock or denial, protecting the person from intense emotions.

• Honeymoon : For a brief time, a week to several months later, those who have experienced disaster are likely to share feelings of common purpose and mutual support. Relief efforts are in full swing and hope recovery run high.

• Disillusionment : This phase can range from two months up to two years. People experience feelings of frustration, disappointment, anger and bitterness especially if the promises for assistance and help are not fulfilled or are seen as too little or too late. The "shared community" feeling may gradually be lost as people concentrate on rebuilding their own lives and solving individual problems.

• Reconstruction/Recovery :For several years after the disaster, people start focusing in rebuilding their homes. businesses and life patterns although support systems may have helped them cope with their immediate needs and emotional responses.
  

The local condition should be assessed ; the victims' cultural aspect, local wisdom, their perception towards disaster and illness and their priorities. The evaluation of the mental status of the people who are affected need to be done regularly. Every single psychiatric symptoms finding should be considered as important and should be given a prompt treatment.

Dealing with one's emotions, is part of all health care workers' duty; be it doctors, nurses, or paramedics. It is important aspect need to be pointed out when handling disaster victims. A simple communication might boost the victims and help them to recover even better, with minimal emotional impact.


References :
1. Back to Business : Health Recovery - Stress Management

2. Psychosocial Issues for Older Adults in Disasters

3. Disaster Mental Health Primer : Key Principles, Issues and Questions

4. Lecture Note : Disaster Management in Mental Health by dr. Bambang Hastha Yoga, Sp. KJ

Disaster : When it strikes

• February 2010, Ciwidey - West Java landslide :

• October 2010, Tsunami in Mentawai :
  

Photo from Kompas

• October 2010, Merapi eruption :
  

photo from Detik

• November 2010, Bromo eruption :

photo in The Jakarta Post

The year 2010 has not been a great year for Indonesia after all. Indonesia reels from earthquake, landslide and flood, tsunami, and volcanic eruption. The impact is not only limited to its local people, but to the country as well. The massive damages have been an economic burden to Indonesia, to recover and stand again on its own.

Now now, let's google up the meaning of 'disaster'.

"sudden ecological phenomenon of sufficient magnitude to require external assistance" - WHO.

"Bencana adalah peristiwa atau rangkaian peristiwa yang mengancam dan mengganggu kehidupan dan penghidupan masyarakat yang disebabkan, baik oleh faktor alam atau non-alam maupun faktor manusia sehingga mengakibatkan timbulnya korban jiwa manusia, kerusakan lingkungan, kerugian harta benda, dan dampak psikologis" - UU Republik Indonesia no 24 tentang penanggulangan bencana.

A disaster can be classified into natural and manmade. However, these two types sometimes can be overlapping. Earthquake, tsunami, volcanic eruption, cyclone are some of the examples of natural disaster. Manmade disaster, on the other hand, is a consequence of their own activity, for an instance deforestation, setting of fires and war. Either natural or manmade, both situations need to be tackled wisely to minimize its impact.



More in :
1. Natural Disaster in Indonesia

2. Discovery Channel - Southeast Asia

3. What is Disaster

4. Psychosocial Issue For Older Adults in Disasters

5.Lecture note : Conceptual Framework of disaster and Disaster Management by dr Hendro Wartatmo

Share and Care

As you can see on top of the right column in my blog, there's a link where you can click and donate some money to Merapi's victims.

Just copy this link to your blog and help us to spread the words :

http://dl.dropbox.com/u/2501888/HTML%20code%20for%20PKPMI-CY%20Merapi%20Eruption%20donation.txt

"We can't help everyone, but everyone can help someone" - Dr. Loretta Scott

A simple action might means the world to them. Let's share and care :)

Getting Accessed

Picture : Motor Sehat Ibu & Anak

Motor Sehat sponsored by SIKIB (Solidaritas Istri Kabinet Indonesia Bersatu). It is somekind of extension of Mobil Sehat. Even a motorbike can deliver health care to the community. Talking about accessibilty? :)

Chronic Disease Management

Diabetes, hypertension, congestive heart failure and asthma are some of chronic diseases that are familiar to us. Nowadays the number of people who suffer from these diseases increased. Imbalanced diet, less physical activity and other bad habits such as smoking are major contributors to such diseases.

A guideline for chronic disease management therefore is essential.



Based on British Columbia's Expanded Chronic Care Model, there are several important aspects to manage chronic diseases.

• Community System
  

Its goal is to build healthy public policy, strengthen community action and create supportive environment.

• The Health System

In health system there are international CDM conference, CDM program information days, national chronic care network and CDM quality improvement. All of these programs work to create a culture, organization and mechanisms that promote safe, high quality care as well as to promote collaboration.

• Self-management Support

Each patient need to prepare themselves, set their minds

• Delivery System Design

Delivery System Design includes; living well with a chronic condition, chronic disease management for diverse population, nurse care management, complex chronic patients, targeted interventions (aboriginal populations, homeless populations and hutterites), health/illness and spirituality.The goal is to assure the delivery of effective, efficient clinical care and self-management support that suits with patient's cultural background.

• Decision Support

The aim of decision support is to promote clinical care that is consistent with scientific evidence and patient preferences. The academic detailing, physician education and disease management accreditation influence the decision making.

• Information System

This element focus on multiple sources in delivery of effective and efficient clinical care.

The main points of CDM are :

1. Comprehensive care : Multiprofessional, multidisciplinary, acute care, prevention and promotion
   
2. Integrated care, care continuum, and coordination of different components
3. Population orientation (defined by a specific condition)
   
4. Active client-patient management tools (health education, empowerment, self-care)
   
5. Evidence-based guidelines, protocols and care pathway
6. Information technology and system solutions
7. Continuous quality improvement

However, it is not that easy to implement the chronic care program. Many problems arise, complicate the success of the program. First and foremost, of course regarding the financial flow and incentives. Lack of incentives demotivate health professionals to get involved with CDM program. Research suggests that one of the central obstacles to improved care for patients with chronic disease is the lack of coordination in health care provision. Poor coordination will affect the continuity of care. Another problem is due to lack of efficient use of information and communication technology (ICT), maybe due to high costs and budget-overruns. Not every country can afford ICT iniatives to be put in all of the health care system. A proper evaluation is noteworthy to evaluate effectiveness and cost-effectiveness of various preventive and treatment interventions. If the evaluation is not well established, the policy makers thus are not optimally equipped to make informed decisions to form the future of CDM.


Read more :
1. Chronic disease management and remote patient monitoring - Eurohealth Vol. 15 No. 1, 2009

2. Are disease management programs (DMP) effective in improving quality of care for people with chronic condition? [August 2003]

3. The expanded chronic care model : An integration of concepts and strategies from population health promotion and the chronic care model

Being Insured

I was watching an English drama series, 'The Good Wife' where it discuss about laws, family and political issues. One of its episode has caught my attention. It was about a 23-months-pregnant woman who was trying to get her insurance company to cover the surgery cost of her fetus. The fetus need a balloon catheter to be inflated in the heart to keep it alive or else it won't survive. Well, it's not about the case that I'm going to write a review on, instead it's more about health insurance.

In Indonesia there are several insurance policies to cover the health care cost of its citizen.

• Jamsostek - A social security based program for private employers and employees where it consists of; Employment Injury, Death, Health Insurance, and a provident fund type Old Age Benefit. It also covers their families, therefore the premium paid by the employer for unmarried employee is only 3% while for the married employee is double(6%). Not all of the private companies have to join Jamsostek. For those companies with at least 10 employees and a monthly payroll of over one million rupiah, with no or poor social security scheme, they are mandated to enrol their employees in Jamsostek.
  

• Askes - As for civil servants, their health insurance cover is Askes. The members of Askes contribute 2% of their monthly salary. All of members are entitled to comprehensive benefits considered medically necessary regardless of their rank and income. Askes pay the provider, which usually consists of public health centers and public hospital. Prospective payment method is used by Askes to pay the providers.
  

• Asabri - It is a counterpart fund for the armed forces and police. It provides similar lump-sum retirement benefits and pensions.

In 2005, a new health card system for the poor, Askeskin is introduced to replace Kartu Sehat. Askeskin is designed to increase access to, and the quality of, health services for the poor. For as low as Rp. 5000 per month per card holder, these people can receive basic outpatient health care and third class hospital care for free. Those who are less poor pay for their own premiums. Askeskin covers obstetric service package, mobile health services and special services for remote areas and islands, immunization programmes and medicines.

With these health insurance schemes, more and more people are now covered. However some measurements need to be taken to extend health care insurance for a wider coverage. The government should increase the budget for health care aspect for the benefits of all.


REFERENCES :
1. Indonesia : Providing Health Insurance For The Poor

2. Health care System Country Notes Asian Region - Indonesia

3. Social Health Insurance for The Poor : Targeting and Impact of Indonesia's Askeskin Program

Abbreviation :
Jamsostek = Jaminan Sosial Tenaga Kerja
Askes = Asuransi Kesehatan
Asabri = Asuransi Sosial Angkatan Bersenjata Republik Indonesia
Askeskin = Asuransi Kesehatan Masyarakat Miskin

Systemic Thinking

We were assigned to write a report after our Systemic Thinking practical session to be submitted, unfortunately my group has to resubmitted it again due to some lackings. We just reviewed and sent our report two days ago. Hopefully this time, it is much better than the previous one!*finger crossing*

We are surrounded by systems all around us, and we are actually apart of it. We work and collaborate with each other to finish our task ( in my group case, to get done with the report). Now let's define the word 'system'.

A system is an organized, highly integrated, purposeful structure regarded as a 'whole' consisting of interrelated and interdependent elements. These elements continually influence each other to maintain their activity and existence of the system, in order to achieve the common purpose, the 'goal' of the system (BusinessDictionary.com).

A system should have :

1. Input
2. Process
3. Output - primary purpose of any system
   

There are many types of system, ranging from simple to complex. A complex system consists of many subsystems and it is called as 'open system' since it interacts with the environments.


Do not confuse systematic thinking, systems thinking and systemic thinking as each of them carries different explanation. Systematic thinking is about methodological thinking. Systems thinking means to be thinking about how things interact with each other while systemic thinking is a simple technique for finding system focus.

Systemic thinking combines analytical thinking and synthetical thinking. For first step (analytical), list as many elements you can think of. Then later (synthetical) step, find the common theme or repeating pattern across those elements. Just like what we have done during our systemic thinking practical session.

Read more in :
1. Systemic Thinking

2. Systemic Thinking - a simple thinking technique for gaining system focus by Gary Bartlett

Simply

For this Block 4.2; Health System and Disaster, we were given an opportunity to help ourselves in boosting up our grade. Yes, who doesn't want an A in examination right? Besides, let's preoccupied ourselves as much as we can about health system before we enter our co-ass for the next semester!

Hopefully by blogging, we can learn more about the content of the block and help each other out by sharing information. Any comment are very much welcomed :)