Posted in Issue 107 - June 2007 Editorial
Medical treatment and public health interventions are generally based on evidence. Methods and procedures are critically reviewed, often with control groups; side effects or errors are tracked and corrected; finally, original results are published with peer review to ensure scientific quality. The benefit of this process is that errors and long-held misconceptions are discarded, allowing medical and public health strategies to evolve.
In the aftermath of sudden onset disasters, the laws governing information management seem to be changing. The premium is on immediate action, while evidence and information play a secondary role. The myths of humanitarian response identified 25 years ago by PAHO/WHO remain unchanged. Errors identified in “lessons learned” exercises or in evaluations are repeated from crisis to crisis. To understand the cultural peculiarities in information management in major disasters, one has to look at what information is needed, what sources are available, how to access the information, and, finally, how the use of this information differs from that of routine public health and medical requirements.
Types of disaster information needed
In “non-disaster” periods, the need for hazard and vulnerability data, guidelines, models, case studies, evaluations, new methods, and results are comparable to those of any social or public health field. The range of scientific fields is broad and increasing. However, we are still hampered by a lack of data and information on risk reduction (for example, economic and cost-benefit aspects of mitigation measures).
In the post-disaster period, needs change dramatically. The premium is no longer on elaborate comparative studies and general guidelines, but on highly time- and place-sensitive issues; on operational information about what is needed where and how it will get there. The clientele is also different. Those using the information are not planners or experts who value scientific accuracy. Instead they are predominantly first responders and emergency decision makers and coordinators unwilling or unable to devote the time necessary to secure reliable information before taking action. Speed and visibility compete with effectiveness.
The sources of information
In medicine and public health, most of the knowledge comes from scientific articles or books that undergo a demanding process of preparation, analysis, and conclusions submitted to the scrutiny of peers. In the disaster field, much of the knowledge still comes from the so-called “gray literature” which is not subject to review requirements for formal publication. Lack of independent editorial and peer scrutiny places the burden of quality control on the reader. This gray literature is likely to remain an important source of knowledge in disaster management.
Often in the acute emergency phase of a major crisis, the real-time information required for decision making is just not available. Yesterday’s information or information from another disaster obviously will not meet urgent needs of responders. The health response is also taking place in a multi-sectoral context requiring an inter-agency approach to needs assessment. Data collection mechanisms established by the U. N. or individual countries fail to generate large amounts of information that can translate into meaningful decisions by actors with distinct operational responsibilities and their immediate needs for information.
Often, a lack of funding is given as the reason why data on needs are not collected or available in the first days and weeks of a disaster. But good information was also elusive in the response to the tsunami in Asia and Hurricane Katrina when funding was not an issue. In spite of considerable commitment from the humanitarian community to the principle of evidence-based action, the existing mechanisms to generate this operational information (for example, UNDAC, FACT) were no match for the complexity and compressed time-frame of the task at hand.
Access to needed information
Facilitating access to information is the raison d’être of librarians. They know how to compile large amounts of existing information and guide users to the small subset relevant to their needs. In the medical arena, the U.S. Library of Medicine (NLM) or PAHO/WHO Center on Health Science Information (BIREME) compile information using databases such as Medline and LILACS. In risk reduction and preparedness, the “gray” literature is unregistered in those databases, but CRID and similar facilities provide access to this type of documentation. However, these systems were not designed to provide the ephemeral data and information required for operational field decisions in an acute emergency.
While operational data are lacking, considerable information is produced in the aftermath of the disaster that has an intrinsic scientific value for future disasters. Projects to disseminate this information in larger disasters, such as OCHA’s Humanitarian Information Center, often have a short life expectancy that does not exceed that of a specific humanitarian relief effort.
The Central American Network for Disaster and Health Information (CANDHI), established jointly by CRID, NLM, and PAHO, is an example of how individual, national centers, which are well positioned institutionally, are particularly well suited to ensure long-term safeguards for and access to the large amount of gray and otherwise perishable information (situation reports, evaluations, needs assessment analysis, after-action debriefing reports, appeals, and progress reports). The trained librarians in these centers should concentrate on locating and preserving this valuable post-disaster documentation before it is lost.
Today, information is electronic and therefore ubiquitous. Sorting out the relevant documents is increasingly difficult. Many centers, like CRID, the CANDHI network, or Civil Protection information centers, increasingly have on-line access to the same publications, while authors of studies and reports are also routinely posting their documents on the web. Users require well-designed search engines that “understand” their special field and needs, and guide them past the overwhelming mass of irrelevant or unreliable references. That is the domain of excellence of information centers like CRID. Their strength—as well as their limitation—is the fact that their scope of application is limited to their own carefully selected database and not to the web universe.
Searches with Google and other commercial search engines provide access to hundreds of thousands references; most are utterly irrelevant to user needs. The challenge for librarians and users alike is to ensure that most, if not all, of the highly pertinent and reliable information is displayed in the first pages of a search. Again, the skills of competent modern librarians will be required to attach the necessary labels, attributes, and keywords to a web document to optimize its accessibility.
Librarians can contribute by preserving, organizing, and disseminating the irreplaceable and perishable data and documents generated by relief and recovery efforts. Unfortunately the main challenge will continue to be that of ensuring that this evidence and knowledge are actually used and put into practice by disaster managers. A more proactive effort from information experts is required to translate information into knowledge and avoid the repetition of errors and myths. Affected populations would benefit greatly if the pressure for immediate and visible action were balanced by a willingness to use available information and experience.
This issue of the newsletter includes notices on other initiatives to improve access to disaster information, such as Redhum (from OCHA) or PreventionWeb (from ISDR).