HelpAge Indias Mobile Medicare Units (MMUs) were used after the Gujarat earthquake in January 2001 to provide immediate emergency care in rural communities. The role of these units is normally to increase access to primary healthcare for older people who are not mobile, or who do not live near a healthcare centre. However, an assessment of the emergency response in Gujarat suggests that MMUs can play an effective role in emergency relief. These findings will feed into further disaster-preparedness work being planned by HelpAge International with its members and partners.
HelpAge International supports HelpAge Indias emergency and rehabilitation work in Gujarat. Funding for HelpAge Indias emergency response in Gujarat came from DFID and the Disasters Emergency Committee. HelpAge International manages disaster-response projects for which Help the Aged UK raises funds through its membership of the DEC.
Rapid deployment of MMUs in Gujarat
HelpAge Indias response to the Gujarat earthquake included sending MMUs to provide emergency medical care in the villages of Kutch, Rajkot and Surendranagar districts. In such crises, on-the-spot treatment is especially important for older people who have chronic ailments made worse by stress, poor food and sleeping outdoors. The MMUs policy in emergencies is to give care to all who need it in the communities they visit, but they place particular emphasis on the needs of older people.
The MMUs proved to be a very useful rapid-response mechanism, swiftly reaching inaccessible areas to establish contact and map the scale of need. The main challenge was rapid mobilisation which, in this case, was achieved. HelpAge Indias Programme Director, Ashok Rawat, recalls those hectic days. One Mobile Medicare Unit arrived in Ahmedabad the day after the earthquake and MMUs re-deployed from Bhopal, Vadadora, and Mumbai were operational in the earthquake zone by 28 January. The Head of the Mobile Medicare Units, Colonel Akilesh Sharma, moved to Ahmedabad, the capital of Gujarat, and started contacting government officials and presenting HelpAge Indias credentials to work in emergency relief. Rawat arrived in Gujarat on 29 January to begin planning emergency relief with two local project partners, Navjeevan Trust and Kutch Vikas Trust (KVT) and two other local NGOs already known to HelpAge India, the Shroff Foundation and Sadvichar Parivar. Knowing the partners well and the terrain where the earthquake happened, we were able to collect data quickly both from the government and from other agencies, he recalls. More units were moved from adjoining states to Bachau, the base camp for HelpAge India. In the first week we had six vans working in teams and co-ordinating with other international agencies CRS, Caritas, Care and the government of Gujarats health department.
This rapid response contrasted with HelpAge Indias first experience of using MMUs in an emergency, in the aftermath of the Orissa cyclone in 1999. Then, it took much longer to mobilise the MMUs, and they did not link up as effectively with local partner NGOs. There were delays in deploying them to outlying villages, and their contribution was more limited.
Adapting for emergencies
HelpAge Indias mobile medicare service has been in operation for almost 20 years, providing poor older people with basic health services in their community. There are now over 100 mobile units providing health services countrywide to about 300,000 disadvantaged older people each year. The medical vans visit each area regularly, undertaking a range of basic diagnostic tests, including blood and urine tests, eye tests and dental examinations. The staff give prescriptions for the ailments that they can treat.
Although the MMUs are not part of a specialised emergency service, staff have been able to improvise and adapt. The Head of the MMUs, Colonel Sharma, had to decide which areas could spare units and their staff. This was a major planning effort with considerable logistical implications, including providing sufficient medical supplies to keep the units stocked for emergency work at short notice and maintaining medical records. Another issue was finding sufficient staff. Because of the long hours worked, each unit needed enough staff for several shifts, in contrast to the regular programme.
Withdrawing MMUs for emergency work does pose a problem in maintaining HelpAge Indias regular health service, since some of the units were diverted to emergency work for almost three months. Careful planning is needed to avoid leaving those who depend on the regular service without access to health care.
A new role in needs assessment
In Gujarat, HelpAge India decided to focus on rural areas because, aside from the cities of Bhuj, the surrounding rural districts were worst affected. A new departure was to use the information gathered by MMU staff as part of a rapid needs assessment. As they talked to people in the villages, MMU staff gained an overview of needs and recorded information at a very early stage. Typically, the project officers who travel with the vans are trained social workers, able to win trust and talk with communities, including older people, and to map needs. Some MMU staff were also involved in the initial needs-assessment training carried out with HelpAge Indias local partners. These rapid assessments by the MMUs, combined with field visits by HelpAge India programme staff and local partners, allow them to shortlist areas where they could work. A more detailed assessment in these target areas, with help from staff at Baroda University, used focus-group interviews as well as case studies to investigate the immediate needs of older people in 15 of the worst-affected villages.
The MMUs medical and social role
After the initial assessments, HelpAge India and its partners integrated the MMUs work with their relief distributions. Their activities focused on the districts of Kutch, Rajkot and Surendranagnar, reaching 7,500 older people and their families in 52 villages. The MMUs provided preventive medicines, antibiotics, water-purification tablets and oral rehydration solutions, as well as orthopaedic treatment and psychosocial support in collaboration with partner agencies. Where necessary, they referred patients to other agencies, such as MSF.
Older people physically injured in the earthquake were found to be suffering from anxiety, depression and fear. Ashok Rawat, who had experience in a previous earthquake emergency, comments that the psycho-social aspect was important because many people, especially elders, were traumatised by the intensity of the earthquake.
The emergency aid packages provided by HelpAge India and its local partners primarily addressed food and shelter needs. In the worst-affected villages where they worked, most of the houses had been completely destroyed or seriously damaged. People were living in flimsy and hastily-constructed shelters. Most older people had not received any tents, and were living in open fields or in makeshift shelters made of plastic sheets and sacks and old clothes. These are vulnerable to wind and dust, and it was difficult to cook inside them. Many single older people had difficulty in cooking their own food, and had to depend on others. As a result, they did not eat regularly. Most older people also expressed a desire for their traditional food, especially bajri rotlo, garlic, onion, chillies and vegetables. When these were not available, they tended not to eat enough. The food distributions took account of older peoples compromised digestive systems and their desire for familiar food.
Today, the focus is on rehabilitation in rural areas, where the earthquake compounded problems created by several years of drought. HelpAge India and its partners are supporting the reconstruction of 1,575 houses for older people and their families. Income-generating activities in agriculture and traditional embroidery are planned for a similar number of older people. Household assessments were used to identify older people with the greatest needs in each village selected.
Developing disaster preparedness and capacity
Preparedness and mitigation are the keys to the rapid identification of frail or isolated older people during an emergency, reducing its impact on them, and supporting their rapid recovery afterwards. In emergencies, older people often have increased responsibility for supporting their families, mobilising resources and caring for children, orphans and other dependants. Their experience of previous emergencies, their coping strategies, their traditional skills and their knowledge of the local environment need to be recognised and valued. Older peoples vulnerability may differ in specific contexts, but it is possible to identify common factors arising from physical and psychological stress that particularly affect older people.
HelpAge International has identified the need to disseminate and share information on lessons learned in disaster preparedness among its members and partners. It is developing a project that will share the knowledge and experience of NGOs working in Africa, Asia and Latin America on disaster preparedness to respond effectively to the needs of older people and their communities in emergencies. It aims to disseminate this information in a practical toolkit. This will provide useful examples of how older peoples needs can be identified in emergencies, and will also highlight the importance of developing preparedness strategies relevant to them.
Nadia Saim is Acting Emergencies Manager, HelpAge International. For more information, contact Press@helpage.org.