Situation Analysis of the Tsunami Diasters Public Health Impacts on National and International Scales - การวิเคราะห์สถานการณ์ผลกระทบทางสาธารณสุขของมหันตภัยสึนามิ ในระดับชาติและนานาชาติ

บทคัดย่อ

               On December 26, 2004, an undersea earthquake in the Indian Ocean 330 km off the island of Sumatra in Indonesia, occurred at 07.59 local time. It triggered a series of devastating tsunamis along the coasts of most landmasses bordering the Indian Ocean along the coastal areas in Southeast Asian and South Asian countries namely Indonesia,Thailand,Sri Lanka,India,East Africa,Malasia,Maldives, Myanmar and Bangladesh. Damages caused by the Tsunami disaster: has proved very disastrous and too costly in terms of over 300,000 lives and properties losses. This situation analysis focused on changes and impacts on public health internally and internationally resulting from the tsunami disaster in the 6 provinces. Synthesize lessons learned on public health networking and its operating processes on local, national and international interaction were synthesized leading to recommendations on strategic policy to top-level executives on relief efforts in response to massive casualties.

                  Data were gathered by a qualitative method conducted from January to May 2005, forty-four case studies with impacts on public health resulting from the tsunami disaster in the 6 provinces were selected and interviewed. They resided in Phuket ,Phang - nga ,Krabi,Ranong,Satun and Trang.

                 It was narrated that several people drowned near the coasts resulting from an irregular flash flood, irregularly high waves attacking the coasts about 20-30 minutes and there were several deaths and injuries.  Most of the patients had wounds all over the bodies or on part of the bodies. The top five types of illness were open wound and laceration of soft tissues down to the muscle on the arms, legs, chests, abdomens, and backs; drowning, mostly  dying before reaching the hospital,and pneumonia,mostly resulting from choking of water,mud and sand and almost all being infected; bone fractures of arms,legs,ribs,wrists and angles at one or more parts.

                The Health Department also set up Special Operation Center in order to manage vital support for those in need through the process situation analysis of planning to improve and monitor environtmental sanitation that would be risky to health  in order not to be affected by communicable diseases and health-threatening conditions. Risk groups in need of mental health supports included 1) victims who lost their familiesีmembers, properties and gears and equipment crucial to their livelihood.  2) survived foreigners who returned back to their home countries.  3) children, adolescents and fisherman who were able to escape relalively unharmed get suffering from Post trauma syndrome but were mentally impacted and group of orphan.  4) all professional aid workers.  5) employees who worked in these devastated area and became unemployed, lack of income and supports.

                It was concluded that,Thailand still need surveillance and warning system to effectively monitor gigantic wave movement which will provide reliable database for the early warning system. A preparedness plan for a major disaster such as tsunami should be site-specific and developed with strong local participation, particularly on preventive measures. Forensic medicine is generally the weakest link in Thailand due to a limited number of well-qualified personnel. The strength and patience of the forensic teams and volunteers were put to the extreme test. With the international assistance, half of the workload had been done within 3 months. The nation learned about the pains of inadequacy the hard way and fully realized the urgent need of capacity  building and networking in order to mobilize resources and technical assistance in time. It is worth noted the most valuable experiences of managing and co-ordinating forensic teams from 29 foreign countries.

Key words:      Tsunami, disaster, public health impact