Methods: Sum of 6 focal point group treatments are carried out in 3 small towns which are badly affected by Cyclone Nargis. Manual thematic content analysis is done to find the community perceptual experience by qualitatively.
Consequences: Majority of the participants knew the warning for the cyclone but they are incognizant on what the strength and where to do landfall of cyclone. There are some spreads on readiness due to miss of experience to old cyclone and failing in cognition for how to fix for cyclone. There is some preparation and instruction on public wellness exigencies direction before the cyclone but the application and coverage of the preparation and instruction were non adequate to do equal readiness by community. Almost all of the participants get some sorts of wellness services and relieve points by wellness sector with bulk of them are positive attitudes towards wellness services given to them. However, most of the participants mentioned that they are non interested in wellness instruction given to them. Except for a few participants, they know how to fix for future cyclone and the cognition should be maintained.
Decision: Based on the consequences, there was some failing in community degree consciousness on how to fix and response to cyclone before the Cyclone Nargis. However, community consciousness is significantly improved after Cyclone Nargis but wellness sector should do certain to prolong the consciousness for optimum readiness and response to public wellness exigencies.
Major exigencies, catastrophes and crises are about 450 to 800 major exigencies per twelvemonth and are impacting societal, economic of the community and public [ 1, 2 ] . Cyclone Nargis struck the seashore of Myanmar on 2 and 3 May, 2008 and moved inland through Ayeyarwady Delta doing many deceases, destructing substructure, impacting on economic and societal activities. It was the most annihilating natural catastrophe in history of Myanmar and the most deathly cyclone in Asia since 1991 [ 3 ] . Although many exigencies are frequently unpredictable, but the impact of catastrophe can forestall and extenuate by beef uping the response capacity of states and communities at hazard [ 2 ] . Community degree readiness is besides of import because people at community degree are first respondent to exigencies and catastrophe [ 4 ] . It is besides recommended that human-centered action and wellness services in exigencies and catastrophes must esteem for the civilization and wellness perceptual experiences of the affected communities [ 5 ] . Mortality due to the 2004 Indian Ocean tsunami was concentrated in the first few yearss of the catastrophe [ 6 ] and community readiness is indispensable for prevent unneeded decease. Focus group treatment is utile to measure the perceptual experience of catastrophe readiness plan and their attitude on catastrophes and exigencies [ 7 ] . The survey done by Nozawa M besides revealed that the consciousness and behaviour of the community are indispensable for following with emptyings advice [ 8 ] . By focal point group treatment, it can besides place the socioeconomic and behaviours factors related to disaster readiness and response and it is utile for catastrophe direction in the specific country [ 9, 10 ] . It is besides advisable that obtaining feedback from community about their perceptual experience on alleviation operations is indispensable for future planning and response to disaster [ 11 ] . By happening out the community perceptual experience on readiness and response to Cyclone Nargis, the consequences will be utile for the future public wellness exigency readiness and response in Myanmar.
Materials and Methods
Cross sectional survey design with qualitative method ( concentrate group treatment ) is used for finding on perceptual experience of community consciousness on readiness and response by wellness sector to Cyclone Nargis.
The survey population is selected from Ngapudaw, Labutta, Bogale, Pyapon, Dedaye, Mawlamyinegyun, kungyangon townships which experienced high mortality due to Cyclone Nargis. The survey is carried out in 3 small towns, viz. amar small town and kyan-ka-dune small town in pyapone township and mangalake small town in kynechangone township which is badly affected by Cyclone Nargis. In each small town two focal point group treatments, one for community members and one for authorities forces and community leaders, are carried out. Each focal point group of between 6 to 9 adult females and work forces are selected harmonizing to standards such as grownup work forces and adult females with age above 18 old ages old and at least one third are adult females ; one group compose of authorities service forces such as wellness, instruction, agribusiness, constabulary and community leader and another group compose of ordinary community members.
The questionnaires such as information, warning, instruction and preparation, public wellness services and healing wellness services given to the community by wellness sector prior to and after Cyclone Nargis are prepared for appraisal of community perceptual experience on readiness and response to Cyclone Nargis by wellness sector. The focal point group treatments are recorded by tape and notes and the treatment clip scope from 65 to 95 proceedingss.
Multistage trying methods are used for choice of 3 sites for focal point group treatment to measure the community consciousness about exigency readiness and response. Two townships are selected by simple random trying methods among Ngapudaw, Labutta, Bogale, Pyapon, Dedaye, Mawlamyinegyun and Kungyankone townships which suffered the high mortality during Cyclone Nargis. Finally, one or two small towns from each township are selected by simple random trying methods. The participants for community members are choose from different businesss, instruction degrees and different subdivisions of small town by purposive sampling.
Data aggregation and analysis
The ethical blessings from Ministry of Health, Myanmar and Faculty of Tropical Medicine, Mahidol University are already acquiring prior to transport out the focal point group treatment. The focal point group treatment is carried out in April 2010. Two facilitators and two note takers are used to transport out the focal point group treatment. The information from focal point group treatment is coded by two individuals to sum up the replies from participants on information, readiness and response to Cyclone Nargis by wellness sectors. Agreement between the two programmers is determined and if understanding is good, manual thematic content analysis is used to analyse by qualitatively to happen out their experiences on information, warning, instruction and preparation, public wellness services and healing wellness services given to the community by wellness sector prior to and after Cyclone Nargis.
Features of participants
The sum of 22 community members is involved in 3 community members groups. The youngest is 18 old ages old and the oldest is 58 old ages old with average age is 34.4 old ages in this group. Most of the community members are husbandmans and others are pupils, merchandisers, fishermen, manual labours, and dependants. There are 20 participants in authorities forces, community leaders and NGOs member with 7 wellness forces, 5 community leaders, 5 NGOs members and 3 from other authorities sections. The youngest in this group is 24 old ages old and the oldest participant is 67 old ages old with average age is 41.1 old ages.
Information related to Cyclone Nargis
Most of the participants in community members groups knew the intelligence of warning and there were some of the participants who still did n’t hear the information. Many of the participants who knew the warning said proclamation was made in frequent interval from wireless and telecasting. However, they noticed the warning merely in short clip before the storm made land autumn on their country. Majority of the participants were non cognizant of the strength and where to hit the Cyclone Nargis.
“ I knew from the telecasting and warning was announced after every vocal. However, I did n’t even recognize the cyclone was coming to my small town and merely knew the warning 2-3 hours in front. ” ( 19 old ages old pupil )
About all of the participants in the authorities forces and community members noticed the information of the storm. But some of them still did n’t detect countries which were hit by Cyclone and they did n’t relay information to the villagers.
“ As a small town leader, I did n’t relay the warning to villagers. Most of them ( villagers ) knew and they did n’t anticipate this strength. ” ( 42 old ages old village leader )
For the beginning of warning, most of the villagers received Nargis warning from mass media such as wireless and telecasting.
“ Most of the villagers knew from wireless and they did n’t make anything. Because of deficiency of electricity in my small town, we relied on wireless for information. “ ( 37 old ages old adult female )
By and large, the villagers knew the Cyclone Nargis information from mass media but they lack the cognition on reading of the warning. The villagers noticed the warning in short clip which is non adequate to do equal readiness for the Cyclone.
Percept and readiness on Cyclone Nargis
Majority of participants reference they did n’t hold about none of readiness due to miss of old experience on how to response to cyclone. There were besides due to spreads in cognition on Cyclone Nargis heading to their country. A few mentioned on spiritual believe ( KARMA ) for making nil.
“ Every homo being has the birth and decease as spiritual believe and I did n’t fix anything. ” ( 53 old ages old adult female )
“ I did n’t hold any readiness because I have ne’er experienced like this before. The warning did n’t include how to fix and it did n’t upset my repast. ” ( 39 old ages old adult females )
They left their place after cyclone damaged their place and went to spiritual and public edifices for shelter.
“ My house destroyed by Cyclone at 10pm, my household went to village monastery. Every villager went to monastery because it was situated in high land and rather strong. Our small town was rather fortunate with a few deceases to take shelter in monastery but in Laut-me small town some causalities occurred. ” ( 23 old ages old adult female )
One participant from authorities forces and community leaders mentioned stimulation exercisings in his country after the Indian Ocean tsunami in 2005 but villagers were non interested.
“ Tsunami drill was carried out in my small town at national degree through division and townships after tsunami in 2005. Unfortunately, the villagers were non interested. ” ( 53 old ages old wellness staff )
Overall, the villagers did n’t cognize how to fix for Cyclone due to miss of involvement and failing in instruction or preparation on Cyclone readiness before Nargis.
Training on catastrophe readiness and response before Cyclone Nargis
Majority of the participants pointed that there was some spreads or failing of developing on catastrophe readiness and response in their country one twelvemonth before Cyclone Nargis. One wellness forces mentioned the having preparation for catastrophe direction in undergraduate plan before Nargis but she was n’t familiar with how to use in public wellness exigency state of affairss.
“ In wellness aid preparation plan, the subject ( disaster direction ) was included. I did n’t relay the instruction on the villagers because they were non interested. ” ( 30 old ages old wellness staff )
Some participants said the catastrophe readiness subject was involved in basic instruction course of study for school kids but parents were non interested.
Health services after cyclone Nargis
All the small towns from which the participants resided received some sorts of wellness services after Cyclone Nargis and on the other manus, the arriving of medical squads to their small towns ranged from 2 yearss to 2 hebdomads. They took interventions from medical squads if they had the wellness jobs and there were few ailments of inexperient medical squads.
“ Medical squad included both experienced and inexperient squads. It is better to come by experient medical squads. ” ( 35 old ages old husbandman )
About all of the participants received some relieve stuffs such as H2O and sanitation points, bed cyberspaces and medical specialties from wellness sector but difference in having relieve points among small towns were mentioned by some villagers.
“ First medical squad arrived in 10 yearss after Cyclone and villagers seek intervention from the squad. They distributed H2O purification tablets but the villagers did n’t cognize how to utilize and the odor was rather strong. ” ( 43 old ages old adult male )
Most of the villagers mentioned the success in healthful latrine building but the others said it was non successful in their small towns due to the facts that the hapless villagers could non build healthful latrine by providing of merely latrine pans.
“ — — – constructed the healthful latrines for free and there was about no healthful latrine at the small towns before Nargis. The villagers constructed them because the organisation provide non merely latrine pan, but besides give building cost. ” ( 45 old ages old husbandman )
Few villagers mentioned the deficiency of psychosocial wellness attention and dead organic structures ‘ clearance in their small towns. Majority said they merely went to wellness instruction if they were given some inducements such as alleviating points.
“ Health instruction on catching diseases were present, most of the villagers did non fall in because they were busy and non settled. ” ( 24 old ages old adult female )
The wellness forces besides pointed out that the villagers were seeking interventions from medical squads that resulted in success of immunisation plan and others. However, they mentioned the deficiency of involvement on wellness instruction by villagers. By and large, the villagers took wellness services given by wellness sectors if required but non interested in wellness instruction.
Attitudes towards wellness attention after Cyclone Nargis
About all villagers said they were satisfied with wellness attention provided but they preferred those who paid them all disbursals including referral disbursals. They besides preferred the station medical squads to mobile squads due to handiness of wellness services all the times.
“ We were satisfied with all medical squads, they gave adequate drugs. The diseases were besides cured and villagers sought intervention. But, we preferred onsite squad for seeking intervention in clip of demand. ” ( 19 old ages old adult female )
Most of the participants are positive attitudes towards relive points provided by wellness sector and community leaders besides pointed out the villagers were satisfied with having relieve points because they are hapless.
“ We preferred organisations ( — — — — ) for giving both interventions and relieve points. Most of the villagers were satisfied if the squad gave relieve points. ” ( 42 old ages old village leader )
Health forces mentioned coordination between NGOs and township wellness section was good and some ailment of inappropriate or more than adequate supply of points was provided to them.
“ Township arranged the coordination meetings and there was no imbrication of medical squads in one country. But, some of points arrived in more than adequate measure such as malaria drugs, B1 tablets and surgical instruments. Our township was non malaria prevalent. ” ( 53 old ages old wellness staff )
Majority of villagers mentioned deficiency of involvement in wellness instruction because they were busy with their work. The wellness forces besides mentioned the success of some wellness plans such as immunisation after Cyclone Nargis but stressed on deficiency of involvement on wellness instructions by villagers.
“ Villagers came to wellness instruction if merely given relieve points because they were hapless and rather negative attitudes towards wellness instruction. ” ( 34 old ages old wellness staff )
By and large, villagers had positive attitudes towards the medical squads and relived points given by medical squads. On the other custodies, they did n’t desire to take part in wellness instruction due to several grounds.
Common diseases and unwellness after cyclone Nargis
The villagers pointed out that pneumonia, ARI, diarrhoea diseases, hurts and mental wellness jobs were common wellness jobs in their country instantly and within 6 months after Cyclone Nargis. Health forces besides agreed with the common wellness jobs mentioned by villagers. The wellness forces besides reported that there was no eruption of catching diseases within 6 months after Cyclone.
“ The villagers suffered diarrhoea, common cold, pneumonia particularly in kids, abdominal hurting. Some suffered the hurts due to Nargis. We got plenty drugs with no costs. ” ( 25 old ages old fisherman )
By and large, the wellness jobs reference by villagers was compatible with common diseases reported by wellness direction information systems/INGOs after Cyclone ( 11 ) .
How to fix for future Cyclone
The villagers, community leaders and authorities forces stressed the importance of building of cyclone shelter and catastrophe opposition edifice, presence of life jacket, imbibing H2O and nutrient as readiness for Cyclone. They besides desired to hive away drugs, collapsible shelters and H2O and sanitation points in wellness centres because of roads obstruction after Cyclone. They would wish to acquire advanced warning on Cyclone and carry out of drill and preparation on catastrophes. There are besides a few villagers, who do n’t desire to do any readiness due to belief on KARMA ( spiritual belief ) .
“ Life jackets should be distributed to villagers and villagers should fix for H2O containers and H2O because the pools could non be used after Cyclone because of entryway of saltwater. ” ( 47 old ages old adult female )
“ As a infirmary, we should predisposition of indispensable drugs, H2O and sanitation points, and impermanent collapsible shelters for patients because the infirmary can be destroy by Cyclone. Drill should be carried out as readying for catastrophe. ” ( 53 old ages old wellness staff )
Overall, the participants had consciousness on how to fix and response to future Cyclone and this cognition should be sustained.
Datas from the survey revealed that some villagers and community members will non be familiar with the conditions warnings and there should be beef uping of instruction plans for community on familiar with upwind warnings. Weather warnings should include how to fix and response for Cyclone. Warnings should besides be through small town leaders because of unknowingness the warning from mass media by some villagers. Education on common catastrophes term such as strength of hurricane can increase the community knowledge about jeopardies hazards [ 13 ] . It is besides recommended that the warning should be advanced for adequate clip on emptying and readiness by community and should include how to fix and response. The communities are first respondent to exigencies and there is besides advisable that beef uping of community based preparation on how to fix and response to disaster [ 4 ] . The villagers will take shelter in public topographic points and spiritual edifice in exigency state of affairs and public and spiritual edifices should be catastrophe resistant. World Health Organization besides recommended that building of catastrophe immune wellness installations as safe infirmary enterprises [ 14, 15 ] . Sometimes, it may take 48 to 72 hours to take outside medical squads to make the catastrophe affected country [ 16 ] and community hunt and deliverance squad with sensitivities of medical specialties and equipments should be strengthened at township degrees based on demand appraisal for immediate response before the outside medical squad arrived [ 14 ] . Topics on wellness sector catastrophe direction should be beef uping in preparation of basic wellness staffs because basic wellness staffs are giving the indispensable wellness attention at community degree. Without proper coordination among different stakeholders, response to public wellness emergencies/disasters may hold negative impact [ 17 ] . Good coordination for medical services between stakeholders in response to Cyclone Nargis should be maintained for future public wellness exigency response. The alleviation operation should see the local context affected by catastrophe and sometime the alleviation operation fails to see the local beliefs and contexts [ 5 ] . The most of the focal point group participants are positive attitudes towards wellness services given to them but besides consider the voices of concern from a few participants particularly the vulnerable population in future public wellness exigency response [ 13, 18 ] . It is besides recommended that distribution of drugs and medical equipments should be based on demands at community degree. Sustainability of community consciousness is besides of import for public wellness exigencies direction and wellness sector should besides see how to do attractive for wellness instruction given to disaster affected population [ 19 ] . In add-on, Ricon et Al revealed that old exposure to hurricane may non hold affect on better readiness to future hurricane in United States [ 20 ] . Cyclone shelters should be constructed in large small towns situated in storm rush country because catastrophe opposition edifices cut down the hazard of catastrophes [ 17 ] . Drill is the best pattern for proving of public wellness exigencies readiness and bore affecting community should be done at least annually for preparedness for readiness [ 4 ] .
There are besides restrictions about the survey. First, study population will non reflect the perceptual experience of the whole population due to little sample size. Second, information prejudice may probably to come out because the survey is carried out two old ages after the events.
There is some failing in community consciousness, readying and response to Cyclone Nargis. Community degree planning, consciousness, readiness and response are indispensable for bar and response to public wellness exigency. It is found that community consciousness is significantly improved after Cyclone Nargis and wellness sector must prolong the community degree consciousness because of the low frequence and high impact nature of major catastrophes.
The writers declare that there have no viing involvements.
Writers ‘ parts
NWM, JK, PS were involved in the conceptualisation and design of the survey. NWM prepared research instruments and other survey logistics, collected informations in Myanmar. KWT assisted in survey direction and informations support in Myanmar. KC, PS, AKM, PP provided conceptual model and proficient support for the survey. NWM and JK performed analyses and drafted the manuscript. All writers read and approved the concluding manuscript.
We would wish to thank Myanmar Ministry of Health for permission to transport out the survey. We give particular thanks to Pyapone District Health Department and Kungyankone Township Health Department and the participants for focal point group treatments to take portion in survey. Thank you DAAD and SEAMEO-TROMED for their partially support in research grant.