This month once again brings a tragedy of mammoth proportions in Sumatra with the news of the devastating quake in Nias. It has also brought misfortune on a much smaller but non-the - less tragic scale. At least one volunteer in Aceh has lost his life to preventable diseases (malaria & hepatitis) while providing aid on the disaster ravaged island. This must be a warning to all would-be volunteers or aid workers that strict precautions should be taken when going to post-disaster stricken areas. It is the first and foremost golden rule in any first-aid situation (and let’s face it, disaster aid is just a great big first-aid task whether you’re shoveling mud or working in an operating theatre), to look after yourself before you give aid to anyone else. Communicable disease following a natural disaster is the biggest threat to survivors and workers alike. All normal water and sanitation systems shut down, waste including corpses and affluent begin to rot and disease carrying insects such as mosquitoes and flies are rife. Most well organized NGO’s will have strict guidelines as to who may or may not go to ground zero in these circumstances, and will provide adequate prophylactic medication and information to those on their teams. Here are some guidelines for anyone who may be considering Aceh as their next port of call.
Make sure that you are in good general health. Any one suffering from the following conditions should not go to post-disaster areas.
- Those who suffer from chronic disease such as diabetes, epilepsy, moderate to severe asthma.
- Immuno-compromised people suffering from diseases such as HIV, chronic blood disorders etc.
- Anyone who is considered emotionally or mentally unstable.
- Pregnant women (pregnant women are more likely to contract malaria and will get a more severe form of the disease).
Vaccinations recommended for post-disaster areas would be:
- Tetanus - full course or booster depending on your status.
- Hepatitis A & B - full course or booster depending on your status. The usual recommended course spans a 6 - 12 month period, however fast-track courses can be completed in one month.
- Typhoid Fever - Single shot
- Japanese Encephalitis - full course or booster depending on your status.
- Rabies - full course or booster depending on your status.
- Tuberculosis - one single shot after TB free status is confirmed on mantoux.
Don’t forget that most vaccines do not give you full protection until at least one month after the start of the course. No vaccine gives 100% protection (most 70% - 90% efficacy).
Malaria prophylactics are essential. I usually recommend Doxycycline as it has the least side effects and reaches a therapeutic level only 2 days after the start of the course. Other drugs can take up to 2 weeks to be effective. The suggested dose is 100 mg daily. You should commence taking the drug 2 days before entering a malaria risk zone, and continue for 2 weeks after leaving the area. (This drug should not be taken by children under 8 years of age, as it may affect tooth development). If you are taking Doxycycline, you should wear a good sunscreen while in direct sunlight, as this drug can cause sun sensitivity.
Insects, particularly mosquitoes, can spread a myriad of diseases such as Malaria, Japanese Encephalitis, and Dengue fever. The best prevention is to avoid being bitten.
- Wear long sleeved loose cotton clothes, and apply a personal insect repellant containing DEET 30-40%, every 4 hours. If you are using a sunscreen, apply your insect repellant last. Remember to re-apply your repellant after bathing.
- Avoid the use of dark clothing and perfumes/colognes as these all attract mosquitoes.
- Spray your room or tent with a good “Knock down” spray, each evening at dusk, and before sleeping.
If all this sounds too much for you or you have a condition that will not allow you to travel to the intensive post disaster scene, and you still feel that you would like to help, contact organizations that are involved and volunteer as a “long distance aide’. There is plenty to do in fields such as administration, accounting, planning and logistics that you can probably do from your own home.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
