Boxing Day, 2004. You’re in Sri Lanka, and a tsunami has turned a beautiful day into utter devastation. You’re a doctor and everywhere are ill people, injured people, distraught people: you’re also worried about epidemics of cholera, measles and so on. You know that some medical interventions will be better than others, and that some plausible-sounding ones may actually be harmful. You need a way to tell them apart. What do you do?
The medical profession is pretty organised about producing evidence on how effective an intervention is – even, often, on the relative effectiveness of different interventions. However, because the results of studies often conflict – some might show a small negative effect, some no effect, and others a strong positive effect – The Cochrane Collaboration was set up to produce rigorous objective summaries of all the evidence. So, as a doctor, The Cochrane Library (the go-to place for all Cochrane reviews) would be your first port of call.
Bad luck. The Cochrane Library wasn’t well set-up for disaster and emergency situations The material in it was too disbursed to be found quickly, and it wasn’t clear how relevant it might be: for instance, the literature about fixing broken limbs is fine if you’re in an American hospital and have three hours per patient, but not so good if you’re in a shack and have a queue of people with fractures, as you would after an earthquake.
On the day of the Indian Ocean tsunami, Professors Mike Clarke (who’d recently ended his term as chair of The Cochrane Collaboration’s Steering Group) and Sally Green (the Co-Director of the Australasian Cochrane Centre) realised that the material needed to be easier to find.
Under Mike’s guidance, The Cochrane Collaboration set up Evidence Aid to focus on producing and disseminating systematic reviews of evidence about medical care relevant to disaster and emergency situations, and to make sure that the people who need this evidence can find it quickly. Evidence Aid is still pretty microscopic, employing only two people (with a few volunteers), but with a large global network of aid agencies, NGOs, academics, and governments involved.
It seems to work. Cochrane’s rigorous systematic reviews showed that “brief debriefing” – a single-session counseling service designed to prevent psychological trauma which is sometimes used after bank raids – is at best pointless after a natural disaster and possibly harmful, so people in affected by the tsunami in South India were spared it. In 2010, medics working in Haiti after the earthquake found Evidence Aid’s summaries accessible and useful.
Much charitable giving goes to disasters and emergencies, and it’s important that the interventions and care are based on the very best we know about what works, and that we are able to avoid what doesn’t work. We all want to do more good than harm. Hence Evidence Aid’s work – nerdy, analytical and miles behind the front line – is crucial. I’m delighted to join the Advisory Board to help.
Evidence Aid is on Twitter (@EvidenceAid), Facebook (Evidence Aid), and here. Article in the British Medical Journal about it.
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