Lessons during the decade since the Asian tsunami

This article first appeared in Third Sector

It’s 10 years this December since the Indian Ocean Boxing Day tsunami. We salute those who died, those who mourn, those who tended; and we celebrate those who’ve since sought to improve response to disasters and emergencies: they’ve been remarkably effective.

For doctors in unfamiliar situations, the first port of call is The Cochrane Collaboration, a huge set of high-quality reports that collate and synthesise the (reliable) evidence about what to do. Its Cochrane Reviews are produced by more than 34,000 researchers in 120 countries, most of whom do them voluntarily, coordinated by a small band of experts from a tiny office in a residential street in north Oxford.

The day after the tsunami, the former co-chair of the collaboration, Mike Clarke, realised that The Cochrane Library, where the reviews are published, was pretty unhelpful for disaster situations. Reports on fractures might assume you’re in a first-world hospital with several hours to spare per patient. You’re not, and you don’t: you’re in a makeshift field hospital with patients queueing up. Worse, relevant Cochrane Reviews are scattered, filed under umpteen categories, and you’ve got no time to search and a dodgy internet connection. And some reviews are paywalled.

Evidence Aid was born that day. Now based in Belfast, it compiles relevant reports from Cochrane and elsewhere so they’re easy to find. It creates new reviews if NGOs and medics feel existing literature is inadequate. Volunteers are creating 100-word summaries, adapting guidance to the situation: in surgery, for example, the evidence shows you’re as safe washing a wound with tap water as using expensive sterile saline; but if clean water has become precious after a disaster, or is dirty, use saline for washing. It’s obvious, really, but chaos allows no time for thinking.

It seems to be working: Evidence Aid’s advice has prevented the use of various treatments that sound plausible but are shown by the evidence to actually make things worse; NGOs contribute their ideas and requests; and advice went to the World Health Organisation within 24 hours of the Haitian earthquake in 2010.

A few months after the tsunami, a girl turned up in a clinic in Indonesia, apparently with measles – a surprise, because many agencies had worked to prevent measles after the tsunami. It transpired that she’d been vaccinated three times by several different organisations.

At the time, there was no common standard through which charities and government agencies could report publicly about their activities, so it was all but impossible to get data on what other agencies were doing. The International Aid Transparency Initiative was set up to make information easier to find and more useful, and thereby avoid these situations. The Department for International Development was the first entity to publish in IATI’s format (in 2011), since when 280 others have done so.

Much remains to be done. The response in Haiti is infamous for poor coordination and providing inappropriate aid: the International Olympic Committee funded a new stadium – at $18m! When Typhoon Haiyan hit the Philippines last year, many (myself and others) asked us not to help like we helped in Haiti.

DOI: I’m an unpaid advisor to Evidence Aid. Here’s why –>

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