Dra. Carissa F. EtienneDr. Carissa F. Etienne was elected Director of the Pan American Health Organization (PAHO) on 19 September 2012 and began her five-year term on 1 February 2013. From March 2008 until 1 November 2012, Dr. Etienne served as Assistant Director-General for Health Systems and Services at the World Health Organization in Geneva, Switzerland. Prior to that, as PAHO’s Assistant Director from July 2003 to February 2008, she led five technical areas: Health Systems and Services; Technology, Health Care and Research; Health Surveillance and Disease Management; Family and Community Health; and Sustainable Development and Environmental Health.

Dr. Etienne knows well how to deal with the challenges and opportunities of emergencies and disasters because she served as the Health Disaster Coordinator, among other high level posts, in the Ministry of Health of her native Dominica.

1) Dr. Etienne, in your opinion, why is it important for the health sector of the Americas to be prepared for disasters?

I think it is a very important point because of the frequency and magnitude of disasters in the Americas. This Region is exposed to various natural and manmade hazards that can overwhelm the health care system: the threat of hurricanes in the Caribbean, for example, or the threat of earthquakes and floods in Central America. For this reason, the Americas need to ensure that the health sector is ready to respond to disasters, and disaster preparedness is critical to achieve this goal. On the other hand, we should take into account that there are existing inequities in terms of access to health services, which are totally exacerbated in a disaster. The countries must invest in disaster preparedness with equity in mind as well.

We cannot forget that the financial impact of disasters in our Region is also very serious, particularly in Central America and in the small islands of the Caribbean, where one hurricane can severely affect the financial situation of the entire country.

Finally, I think it is important to remark that the health sector is not just the public health services, but that it also encompasses the private health services, including non-profit institutions. Therefore, it is necessary to work with them all as well as with other sectors to ensure timely and adequate access to health care during emergencies and disasters.

2) What measures can be taken to ensure that the population has access to health services during emergencies and disasters?

I think the first and most important one is to ensure that health services are available, close to people, in terms of geographical distribution, and that people have access, in terms of financial availability. It is also very important that health care workers are trained and that there are enough resources on the ground. If we have a health network that is already well established, that is working in terms of addressing equity and ensuring equitable access, it will be much better able to respond to an emergency.

Countries where the local health system is well developed and where people have quick access to health services can provide a more adequate response to emergencies. Additionally, I think that in order to achieve this, it is very important to not only involve the community in the functioning of the health services, but also to train them to participate, not just as spectators or observers, but as actors of their own health. When the local health system is overwhelmed by an emergency, local response from the community becomes much more important.

It is very important that we ensure that hospitals and health facilities are safe from disasters and that they continue to function when they are most needed. For example, it is critical to ensure that the medical staff can get to the hospital and that they have supplies there. We must be able to rely on our hospitals and health centers in all circumstances to avoid an increase in the number of victims after a disaster.

A hospital must withstand the impact of a disaster to protect the life of the hospitalized patients and the health care workers. It must also protect the equipment and supplies reducing the economic impact, but most importantly, it should remain operational in disaster situations when they are more needed to save lives and provide critical services. The Safe Hospitals initiative is in essence the most effective measure to ensure that the population has access to health services during emergencies and disasters in our Region and all over the world.

3) We still face many challenges in responding to the specific needs of vulnerable populations in disaster situations. What are your recommendations on this issue?

I am very concerned about indigenous populations and people in remote geographical locations. It is imperative for us to think about how they can get the proper information during an emergency, what is available for them or where to go... this is a very important issue.

As we know, the impact of disasters is overwhelmingly higher among vulnerable population groups such as the older people, children, pregnant women and people with disabilities, among others. The appropriate and timely protection of these groups may make the difference between safeguarding their lives and wellbeing or exposing them to further physical and emotional damage. This year, the theme of the International Day for Disaster Risk Reduction is Living with Disabilities and Disasters, which I think gives us an opportunity to stress the need to keep working to better respond to the specific needs of this group in disaster situations.

We invite you to visit Dr. Etienne’s Corner at www.paho.org/director.