PUBLIC HEALTH ENGINEERING IN HUMANITARIAN CONTEXT Flashcards
PUBLIC HEALTH ENGINEERING?
- DEFINED AS THE ART AND SCIENE OF PREVENTING DISEASE, PROLONGING LIFE AND PROMOTING HEALTH THROUGH THE ORGANISED EFFORT OF SOCIETY
- HUMANITARIAN CONTEXTS ARE CREATED WHEN AN EVENT OR SERIES OF EVENTS REPRESENTS A CRITICAL THREAT TO THE HEALTH, SAFETY, SECURITY OR WELLBEING OF A COMMUNITY OR OTHER LARGE GROUP OF PEOPLE, USUALLY OVER A WIDE AREA (EVENTS SUCH AS ARMED CONFLICTS, EPIDEMICS, FAMINE, NATURAL DISASTERS
- PUBLIC HEALTH ENGINEERING IN THE HUMANITARIAN CONTEXT WORKS TO REDUCE EXPOSURE TO HEALTH RISKS IN A BID TO REDUCE MORBIDITY AND MORTALITY
MANAGEMENT OF PUBLIC HEALTH ENGINEERING ACTIVITIES, STEPS
- ASSESSMENT AND ANALYSIS
- STRATEGY PLANNING
- IMPLEMENTATION
- MONITORING
- EVALUATION
DESCRIBE STEPS IN MANAGEMENT OF PUBLIC HEALTH ENGINEERING ACTIVITIES - ASSESSMENT AND ANALYSIS (ACUTE VS CHRONIC EMERGENCY)
ACUTE EMERGENCY: RAPID ASSESSMENT (1 OR 2 DAYS)
CHRONIC EMERGENCY: IN-DEPTH ASSESSMENT (FROM A FEW DAYS TO A FEW WEEKS)
DESCRIBE STEPS IN MANAGEMENT OF PUBLIC HEALTH ENGINEERING ACTIVITIES - STRATEGY PLANNING
- DEFINE GLOBAL OBJECTIVE
- ENUMERATE ACTIVITIES
- HUMAN AND LOGISTIC NEEDS
- DETAILED BUDGET
- STAKEHOLDER CONSIDERATIONS
DESCRIBE STEPS IN MANAGEMENT OF PUBLIC HEALTH ENGINEERING ACTIVITIES - IMPLEMENTATION
- EXPLORATORY PHASE (INITIAL ASSESSMENT) AND FIRST ACTIONS
- STAFF TRAINING WITH THE START-UP OF ACTIVITIES TO GUARANTEE QUALITY AND SUCCESS
- CLEAR DELEGATION OF RESPONSIBILITIES
- AVAILABILITY AND ACCESSIBILITY TO INFORMATION AND TOOLS
DESCRIBE STEPS IN MANAGEMENT OF PUBLIC HEALTH ENGINEERING ACTIVITIES - MONITORING
- REGULAR OBSERVATION AND RECORDING OF ACTIVITIES
- COMPARISON BETWEEN INFORMATION FROM THE INITIAL ASSESSMENT TO INFORMATION DURING IMPLEMENTATION
- USE: ACTIVITY REPORTS, FINANCIAL UPDATES, MEDICAL AND LOGISTICAL COMMUNICATIONS
DESCRIBE STEPS IN MANAGEMENT OF PUBLIC HEALTH ENGINEERING ACTIVITIES - EVALUATION
- CAN BE DONE DURING OR AFTER THE LIFE OF THE PROJECT
- CONSIDER IMPACT AND RESULTS
- EVALUATE COVERAGE OF SET OBJECTIVES
- EXAMINE STRENGTHS AND WEAKNESSES TOWARDS CORRECTIONS IF NEEDED
PROVIDING SHELTER FOR REFUGEES - IMPORTANCE
SHELTER PROVIDES:
- PROTECTION FROM WEATHER
- LOWER RISK OF POOR HEALTH
- SUPPORT FOR FAMILY AND COMMUNITY LIFE
- DIGNITY
- SECURITY
- LIVELIHOOD
INTERVENTION TYPES IN SHELTER PROVISION, EXAMPLES
- Household items
- Construction materials
- Tools
- Emergency shelter
- Transitional shelter/ T-shelter
- Support for host families
- Rental support
- Core housing/ progressive housing
- Housing Repairs and retrofitting
- Cash/ vouchers
- Loans
- Advocacy/ legal
- Site planning
- Infrastructure
- Training
- Structural assessment
- Guidelines/ materials/mass
communications
WATER SUPPLY IN A HUMANITARIAN CONTEXT - COLLECTION AND HOUSEHOLD STORAGE
Collection and household storage •Distribute containers •Minimum storage capacity of 40 l/ household. •Containers should have a small opening for pouring out water rather than large openings that allow for dipping to avoid contamination. - Locally made materials (e.g. clay containers) can be used. •Regular cleaning and disinfection of containers should be encouraged.
WATER SUPPLY IN A HUMANITARIAN CONTEXT - PUBLIC WATER DELIVERY POINT
Public water delivery point •Should not exceed 100m distance. •Planned to allow at least 200-250 persons per tap. •Good flow at minimum 10 litres/minute/tap •Hand pump wells should serve 500-750 persons per pump •the design and construction must be sturdier than used in similar domestic connections.
DISTANCE BETWEEN DISPOSAL OF WASTEWATER AND WATER RESOURCE SHOULD BE:
> 30m
SANITATION PECULIARITIES IN A HUMANITARIAN SETTING (what is permitted in a humanitarian setting but wouldn’t be permitted in a non humanitarian setting)
- Plastic bags are sometimes provided in acute situations. Advocacy
on appropriate use should be provided.
• Defaecation field or controlled open defecation is designed as 0.5
m2/user/day.
• 1 improved trench latrine/100 users. (trench latrine: communal toilet option widely-used in emergencies)
• The recommendation is to provide family latrine closed to each dwelling (place of residence) or on a row not too far from general dwelling area. Each
family can padlock theirs.
• If this is not possible, the alternative is to construct one latrine per
lot of three or four dwellings (or about 20 people). It is called a
cluster latrine.
• The same number of bathing facilities as toilets per 50 persons (short-term) or 20 persons (long-term) should be provided for communities
DAILY GENERATED VOLUME OF SOLID WASTE FOR A PERSON
RANGES FROM 0.5 AND 10L
SOLID WASTE MANAGEMENT IN A HUMANITARIAN SETTING - HOUSEHOLD LEVEL VS COLLECTIVE
• Household-level management strategy should focus on education
and enlightenment.
• Collective management focuses on the right location for facilities
CATEGORIES OF MEDICAL WASTE
- INFECTIOUS WASTE
- RADIOACTIVE MATERIALS
- PHARMACEUTICAL WASTE
- CHEMICAL WASTE
- GAS CONTAINERS
- TOXIC SUBSTANCES
- SHARP MATERIALS
- HUMAN ORGANS
THE MINIMUM THREE BIN METHOD TO COLLECT AND SEGREGATE MEDICAL WASTE
CATEGORIES:
1) GENERAL WASTE/NOT HAZARDOUS (E.G. PAPER); CONTAINER COLOUR/LABEL: BLACK
2) USED SHARPS/HAZARDOUS, INFECTIOUS (E.G. NEEDLES, INFUSION SETS, BROKEN GLASS..); CONTAINER COLOUR/LABEL: YELLOW, LABELLED ‘SHARPS’, LEAK-PROOF AND PUNCTURE PROOF
3) NOT SHARPS/ HAZARDOUS, INFECTIOUS (E.G. MATERIALS CONTAMINATED WITH BODILY FLUIDS, SUCH AS SWABS, DRESSINGS, LABORATORY CULTURES..); CONTAINER COLOR/LABEL: YELLOW, LABELLED AND LEAK-PROOF
DESCRIBE VECTOR CONTROL THROUGH ENVIRONMENTAL CONTROL
Environmental Control:
Site selection and planning: Good location to reduce risk of exposure.
Water management: Avoid creation of breeding sites and removal of existing breeding sites.
Safe excreta disposal: Reduce the opportunities of insect vectors breeding on excreta dumps.
Waste Management: To avoid creating a breeding site/transmission site for vectors.
General Construction: Inclusion of insect screens, sealing of openings under doors, and use rodent baffles in drainpipes in buildings.
Removal of Vegetation: Cleaner environment. Mowing or even controlled burning of vegetation in the vicinity of buildings help control mites and ticks.
DESCRIBE VECTOR CONTROL THROUGH PERSONAL PROTECTION
Personal hygiene and behaviour: Reduces risk of disease transmission by flies or lice.
Protection by clothing Increasing the thickness of clothing and the area of skin covered can reduce risk to insect bites. Clothing can also be
impregnated by appropriate insecticide/repellent.
Repellents: Can be natural or chemical to protect against insects. Chemical lasts longer but must be used appropriately.
Coils: Vapours from coils are quick and easy way to neutralise insects in rooms or enclosed areas. Does not require electricity.
Electric vaporiser systems: Requires electrical heating device to evaporate an insecticide from a base which is often refillable.
Aerosols: Often used in enclosed areas to kill flying or crawling insect. Those for flying insect killers have approximately 20 minutes
effective period while. Crawling Insect killers can last between 4 to 12 weeks before re-appearance of insects.
Long Lasting Insecticidal Nets (LN): Insecticide treated nets are one of the most effective ways of controlling malaria. They are also easy to distribute to the
populace/use in humanitarian settings. They can also be used to isolate an already infected person from further transmission.
Other insecticide-treated materials: Examples are blankets, curtains and other shelter materials.
DESCRIBE VECTOR CONTROL THROUGH CHEMICAL CONTROL
Insecticide Residual Spraying (IRS): Widely used for control of mosquitoes, triatomine bugs and sandflies. It is applied to the surfaces inside a tent or house. The susceptibility of local vectors, duration of the residual effect in relation with the length
of the transmission season should be verified and considered.
Insecticide zooprophylaxis: Could be used here vectors bite domestic animals as well as humans. It is applied to the air and skin of domestic livestock using a sponge or
animal dip.
Insecticidal dusting: It consists of talcum powder, or another inert carrier powder mixed
with insecticides. Can be applied on rodent footpaths and habitats or
dusting people against lice.
Rodenticides: It should be a slow acting poison to reduce rats and mice related
health risks. Should be accompanied with health promotional
activities.
Larvicide: It is complex, requires expertise but highly effective. It is applied in
low concentrations to vector breeding sites (larva sites) that have
been mapped
ROLES OF AID ORGANISATIONS IN DISPOSAL OF DEAD BODIES
Provision of morgues in health facilities
Cemetery or cremation sites
Provision of shrouds and /or transport
Provision of leak proof body bags, blanket, mats, clothes and coffins (in acute emergencies or where families cannot afford to provide them)
Provision of protective clothing for those coming in contact with the dead bodies
DESCRIBE PROVISION OF MORGUES IN HEALTH FACILITIES IN HUMANITARIAN CONTEXT
- 20 BED HEALTH FACILITY SHOULD PROVIDE SPACE FOR 2 DEAD BODIES
Windows should be avoided.
Vents should be protected from rodent’s entry.
Floor should be smooth concrete with a 1% slope towards drain.
Masonry tables should be avoid placing bodies on the floor.
Privacy screens or curtains should be provided for relatives.
Water point should be close to the morgue for body disinfection and washing.
HOW FAR AWAY FROM ANY WATER SOURCES CAN CEMETERIES BE BUILT IN A HUMANITARIAN SETTING?
> 50m
5 Fs
Feaces, Fluids, Fingers, Flies, Food
ALL PUBLIC HEALTH ENGINEERING ACTIONS AND PROVISION OF FACILITIES IN A HUMANITARIAN CONTEXT MUST FOCUS ON:
- Maintaining the dignity and the rights of populations
- Safeguarding the populace against the 5 Fs:
faeces, fluids, fingers, flies, food
Factors to Consider when Planning Camps
Context Cultural Habits Land Availability Access Legislation/Land rights Existing Facilities Security and Safety Climate Water Terrain Environmental Health risks Local Communities Human Resources
T-SHELTER?
THE TERM CAN MEAN EITHER:
- TEMPORARY SHELTER
- TRANSITIONAL SHELTER
(THE DEFINITIONS OF THE 2 OVERLAP WHICH CAN PROVIDE FLEXIBILITY WHEN THE TERMS TEMPORARY OR TRANSITIONAL ARE POLITICALLY UNACCEPTABLE)
TYPES OF SHELTERS?
EMERGENCY - SHORT TERM
TEMPORARY - IN SOME LOCATIONS SUCH AS CAMPS WHERE THERE IS NO PLANNED END STATE, SHELTERS CANNOT BE ‘TRANSITIONAL’, AND TEMPORARY SHELTER MUST HAVE A LONG DURATION (CAN BE REMOVED AT A CERTAIN POINT)
TRANSITIONAL - an incremental process which supports the shelter of families affected by conflicts and disasters, as they seek to maintain alternative options for their recovery (SHELTERS WHICH ARE PHYSICALLY PERMANENT BUT PEOPLE USE THEM FOR A LIMITED AMOUNT OF TIME BEFORE SETTLING SOMEWHERE ELSE)
PROGRESSIVE - IN SOME COUNTRIES, THE TERMINOLOGY ‘TRANSITIONAL SHELTER’ MAY BECOME UNACCEPTABLE, ESPECIALLY WHERE RECONSTRUCTION ON A PERMANENT SITE IS POSSIBLE; THESE SHELTERS CAN BE CALLED PROGRESSIVE SHELTERS
CORE/PERMANENT HOUSING - IN SOME LOCATIONS IT IS POSSIBLE TO BUILD PERMANENT STRUCTURES (PERMANENT HOUSING), BUT FOR REASONS INCLUDING BUDGETS, EQUITY AND SPEED IT IS DECIDED TO BUILD ONLY A PART OF A FINAL HOUSE (CORE)
HOUSEHOLD LEVEL SOLID WASTE MANAGEMENT IN A HUMANITARIAN SETTING
TEMPORARY STORAGE: Waste bin (at dwelling/single residency level)
COLLECTION: Household member
TRANSPORT: Manual
‘TREATMENT’ (INCINERATION, COMPOSTING..): Generally not recommended
FINAL DISPOSAL: Domestic refuse pit
COLLECTIVE SOLID WASTE MANAGEMENT IN A HUMANITARIAN SETTING
TEMPORARY STORAGE: 100L drum (max 15m away)
COLLECTION: Team (2.5 persons/ 1000 inhabitants)
TRANSPORT: Cart/motorised vehicle
‘TREATMENT’ (INCINERATION, COMPOSTING..): Only if specialised equipment and personnel are available
FINAL DISPOSAL: Burial trenches or controlled tip
REQUIRED DISTANCE FROM LATRINE (TOILET) AND A WATER SOURCE?
AT LEAST 30m
REQUIRED DISTANCE FROM A WATER SOURCE AND A REFUSE PIT (PIT FOR DISPOSAL OF SOLID WASTE)?
AT LEAST 15 AND UP TO 30m
REQUIRED DISTANCE FROM DWELLING/RESIDENCE AND A REFUSE PIT (PIT FOR DISPOSAL OF SOLID WASTE)?
AT LEAST 10 AND UP TO 30m
REQUIRED DISTANCE FROM A CEMETERY AND DWELLINGS/RESIDENCIES
AT LEAST 500m
