A lot of attention has been placed on emergency preparedness since the earthquake that struck Haiti last year, and more recently, the earthquake and tsumani that struck Japan.
Considering the Dominican Republic’s vulnerability to earthquakes, flooding, and tropical storms, I communicated with Dr Luis Dominguez, the Regional Public Health Director for the Duarte Province, about the area’s disaster planning and emergency readiness. He provided me with documents from the Provincial Emergency and Disaster Plan.
To provide some background information regarding the public health status of the Duarte Province, key illnesses that result in hospital consults are respiratory infections, diarrheal disease, hypertension, and vaginal infections. Furthermore, dengue remains the primary vector-borne disease in the area. No cases of malaria were reported in 2007.
Overall, there are impressive immunization rates for Hep B, polio, diphtheria and tetanus, measles, mumps, and rubella.
Leading causes of death were heart attacks, CVAs, cancer, pulmonary edema, pneumonia, and trauma (in that order).
I think all of this information helps us understand the baseline health situation in this province at the time a natural disaster might strike.
In terms of healthcare resources, there are six hospitals, 67 rural clinics, and 91 primary care centers throughout the province.
During times of crisis, the Director of Provincial Health has the primary responsibilities of declaring an emergency, activating the Emergency Operations Center, delegating functions to members of his team, and acquiring necessary data and statistics. In addition to this, he must designate sites for temporary shelters and coordinate with other entities, whether they are national or international.
Furthermore, provincial leadership coordinates with services in epidemiology, environmental health, laboratories, social assistance, statistics, human resources, and area hospitals.
There exists in fact an Emergency and Disaster Committee that serves the hospitals in times of crisis as well. Each hospital has an emergency plan, and the committee helps evaluate the needs at each hospital, and helps identifies risks as well.
An initial assessment is made following a disaster, performed by the Emergency and Disaster Committees. Here, basic figures are made concerning the magnitude, location and time of onset, damage to infrastructure, total persons injured and killed, and need for shelter, water and food supplies.
The initial assessment also includes medication inventories, risks associated with toxins and diseases, and evacuation contingencies.
Following a disaster, the Duarte Province outlines key provisional areas for the population. First, medical services are organized and a network is established among care centers to share patient data and relay important information. To assist the medical team is a register of available beds at all medical centers in the province. Sanitation services include establishing potable water availability and elimination of human waste, hygiene practices concerning food preparation, and disposal of human remains. An epidemiologic service conducts surveillance and maintains vigilance for disease outbreaks, ensures rapid dissemination of findings among peer groups and the general public, coordinates with area laboratories, and evaluates interventions in the community and shelter sites.
Nutrition services attempt to recognize populations at risk for malnutrition following a disaster, determine the nutritional needs at shelters, and maintain vigilance within the community and shelter sites for nutritional risks.
Logistical services include communications and transportation. The communication sector attempts to build upon existing networks and coordinates with public and private sector industries, as do transportation services. The emergency plan also assigns route planning and contingency planning for evacuation routes to the transportation services branch.
The social welfare department coordinates shelter construction with governmental and international NGOs, should they be present.
Post-recent disaster response
Evidence that the Dominican Republic has taken steps to improve their disaster response capability since the Haiti earthquake in January 2010 was provided by an online document I found published by the UN. In May of 2010, the Dominican government requested an assessment of its building safety standards. Interestingly, this was the first time a country asked the UN to inspect its disaster reduction efforts. The report concluded that the country update their building codes, develop by-laws and norms for construction, and work in a bilateral manner with Haiti when either country is confronted with a disaster.
In conclusion, I think the Duarte Province in the Dominican Republic has a well-established and clearly outlined emergency readiness plan, encompassing the wide variety of sectors that must be engaged together in preparing for, responding to, and recovering from a disaster.
The fact that the Dominican Republic invited the UN to conduct a building safety assessment following the January 2010 earthquake in Haiti demonstrates the country’s commitment to public safety, emergency response, and improvement of their existing disaster plans.