Books

The Journey of Latin America and the Caribbean

In the next several pages, you will find the book A World Safe From Natural Disasters, a comprehensive look at how the countries of Latin America and the Caribbean have dealt with the enormous and recurring impact of natural disasters on their lives and fragile economies. Published as a contribution from this Region to the World Conference on Natural Disaster Reduction in 1994, the book traces the transition from an era of improvised response and poorly coordinated international assistance to the more aggressive stance on disaster preparedness and prevention taken in many countries today.

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The major disasters that have taken place throughout history, despite their origin, have one thing in common: the enormous number of people killed. Hurricane Mitch in Central America, the floods in Venezuela, earthquakes in El Salvador, hurricanes in the Caribbean, and disasters caused by humans such as the Mesa Redonda fire in Peru, the supermarket fire in Paraguay, wars, plane crashes, among many others, have taught us important lessons about mass fatalities. Despite the efforts of experts, the lack of information and deeply held but erroneous beliefs continue to cause unacceptable practices in managing dead bodies in disaster situations.

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Practical Guide for Mental Health in Disaster SituationsIn disaster situations and complex emergencies there is a deterioration of social fabric, a loss of structure in normal life and an increase of signs of psychological distress, such as grief and fear, which may increase psychiatric morbidity and other social problems. After an emergency or disaster, mental health problems in survivors require care for an extended amount of time in which they have to face the task of rebuilding their lives.

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In 1990, PAHO/WHO began a program to strengthen national efforts to increase the disaster resistance of new and existing health facilities. In February 1996, at the invitation of the Government of Mexico, and with the support of numerous agencies, PAHO convened the International Conference on Disaster Mitigation in Heath Facilities in Mexico City.

While there has been progress, much more needs to be done to convince decision-makers that reducing the health sector's vulnerability to natural disasters is an essential part of national planning. The Conference Recommendations presented in these Proceedings reflect the commitment of Governments, institutions, and individuals to work toward the goal of reducing the loss of life, material damage, and the social and economic disruption caused by natural disasters.

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The Guide for Evaluators is the principal training tool. It provides guidance and standardized criteria for evaluating the components of a health facility individually and as part of the health services network. The Guide is used by a multidisciplinary team of Evaluators, which can include engineers, architects, health staff, hospital directors and others who have undergone previous training. The Guide explains the methodology and rationale for the Hospital Safety Index as well as how to calculate and interpret the health facility's safety score.

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Form 1: General information about the health facility. This form should be completed prior to the evaluation by the hospital's disaster committee. It includes information on a health facility's level of complexity, the population it serves, specialty care and other available services, and health staff.

Form 2:  Safe Hospitals Checklist. A trained team of Evaluators then uses the Safe Hospitals Checklist to assess the level of safety of 145 areas of the health facility, grouped by location, structural, nonstructural and functional components. 

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In a period of only 15 years, between 1981 and 1996, 93 hospitals and 538 health care centers in Latin America and the Caribbean were damaged as a consequence of natural disasters. This resulted in the loss of service of some 24,000 beds. The direct cost of these disasters has been enormous; just as devastating has been the social impact of the loss of these critical facilities at a time when they were most needed.

Hospitals and health centers are complex; they have high occupancy levels and play a critical role in disaster situations. For these reasons, special consideration must be given to disaster planning for these facilities. Assessing and reducing their vulnerability to natural hazards is indispensable.

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Technical knowledge and experience have taught us that it is possible to reduce to a minimum the risks and damage caused by disasters if preventive measures are incorporated early in the design, construction and maintenance of new health facilities. What this complex issue needs now is greater visibility in political and development agendas in Latin America and the Caribbean.

This is the premise of the Guidelines for Vulnerability Reduction in the Design of New Health Facilities for those responsible for management, design, construction and inspection of new health facilities projects.

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It is almost always the case that, when struck by large-scale natural disasters, hospital services are interrupted temporarily or permanently, mainly due to damage to their infrastructure. The operational loss of these facilities signifies more than the loss of the capital investments. Far more importantly, it has a major negative impact on the wellbeing and the socioeconomic development of the population and the country.

In recent years, various PAHO/WHO member states have managed to reduce the vulnerability of their hospitals; several of them withstood the effects of subsequent disasters. Even countries with limited financial resources can serve their populations well by providing them with hospitals and other health facilities that are resistant to earthquakes, hurricanes, and other natural hazards.

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