KEYNOTE ADDRESS BY THE DIRECTOR GENERAL OF HEALTH
DATE: 12-14 August 2015
VENUE: Institute for Health Management (IHM)
TITLE: Crisis and Disaster: Closing the Gaps, Executing Plans, Enhancing
Resilience
Ladies and Gentlemen,
I would like to express my gratitude to the organizing committee of
the 11th MOH-AMM (Ministry of Health-Academy of Medicine Malaysia)
Scientific Meeting 2015 (incorporating the 18th NIH Scientific and Annual
National Ethics Seminar) for inviting me to deliver the keynote address. It
is an honour for me to present the keynote address for this conference with
the theme: Major Incident and Disaster Management: Bridging the Gap.
Ladies and Gentlemen,
As we are all aware, disasters may be either natural or man-made.
Natural disasters include earthquakes, flood, tsunamis and volcanic activity
and even disease epidemics. Man-made disasters include events that are
caused by human such as industrial accidents, famine and transport
accidents.
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The UN Sec-Gen has reported in 2014 that from mid-year 2013 until
July 2014, global economic losses from disasters have exceeded $100
billion with over 16,300 death and 113 million people
affected by some
358 internationally reported disasters .
Based on the Annual Disaster Statistical Review 2010: The Numbers
and Trends published by The Centre for Research on the Epidemiology of
Disasters (CRED), major fluctuations in numbers of fatalities, victims or
damages caused by natural disasters can be seen from year to year.
Sudden high-impact events or disasters that are extensive in time and
space can bring about changes in disaster impact trends and patterns.
Disaster epidemiology brings these tendencies to light and provides
information on the temporal and spatial distributions of disasters and their
human impact around the world.
Locally, Malaysia has had its fair share of disasters over the years.
However, the types of disasters, its scale and impact have increased over a
period of time. 2014 in particular was a difficult year for Malaysia. We had
to deal with a number of high-impact, large-scaled disasters, both natural
and man-made disasters that have caused much sufferings to its people.
The aftermath from the earthquake disaster in Ranau, Sabah has led to,
emotional trauma to the climbers and the people of Ranau and this will
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take time to recover. Similarly to the people of Japan, no measurement can
describe the emotionally traumatised post –tsunami population.
Ladies and Gentlemen,
In Malaysia the National Safety Council under the Prime Minister’s
department is the main coordinator for disasters. The existing instructions
called “ARAHAN 20” provide instructions on the roles of the various
national agencies involved in managing the disasters. According to
ARAHAN 20, MOH’s main role is to clinically managed victims brought by
the search and rescue teams. However, MOH has roles in various other
types of disasters such as in haze, accidents, disease outbreaks etc where
public health activities are required to prevent and to further manage the
disasters.
At the ministry level, MOH has developed various SOP’s such as on
floods, haze etc which have been developed by teams of experts. And yet,
every incident teaches us what can be improved in the future. For example,
even though we have detailed SOPs on flood management; as flood occurs
on yearly basis in Malaysia, the recent major flood involving many states in
Malaysia faced at the end of 2014 was one of the worst disasters faced by
our Ministry. Many MOH facilities were badly damaged and many of our
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staff were severely affected. Post-flood analysis has revealed that there
were gaps in managing the floods and dealing with the aftermath.
Ladies and Gentlemen,
Post-mortem of the 2014 flood has revealed several issues during the flood
management:
Firstly, there was inadequate logistical assistance at the affected
health facilities. Several badly affected MOH facilities faced with the
difficulties in transferring the patients to safety, transporting the staff and
supplies required as the land transportation was cut-off. This issue could be
overcome with the cooperation from the intra & inter-government agencies,
NGOs and even private sectors. What’s required was the organized
coordination for efficient mobilization. A clear Chain of Command headed
by the MKN would be a start of such coordination.
Secondly, delay in transmitting the general flood warning to the highrisk MOH facilities had caused extensive damage to the equipment and
facilities. Proactive meteorological department is essential in determining
the impending risks of incoming disasters and “bomba” to issue prompt
orders for evacuation.
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Thirdly, communication devices were not functioning due to extensive
power failure and congestion in the telecommunication lines. The Crisis
Preparedness Response Centre (CPRC) in certain districts and states were
un-contactable by the MOH HQ for a prolonged period of time.
Communication channels include social media, news agencies including
TV, amateur radio channels and on-the-field information dissemination by
the volunteers and SAR team members were crucial. To cope with the
extensive power supply, contingency power source such as generators
were important equipment as the alternative power supply.
In addition, lack of profiling of the facilities with high flood risk has
dampened the organized preparedness in dealing with the flooding. Thus,
development of flood prone facility profiling is an utmost priority for all
directors of the JKNs.
Moreover, updating the floods emergency response plan based on
the latest SOPs at various levels must be emphasized. The MOH workforce
benefit from clear communication from leadership regarding deployment to
reduce uncertainty and allow opportunity for preparation.
Lastly, Safe Hospitals and Health Facilities Initiative should be
included in the disaster preparedness program by the MOH. This includes
training for MOH staff prior to other disasters, simulation and to increase
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familiarity on the protocols/SOP’s available, inter-sectorial collaboration to
enhance coordination and to ensure the BCP’s/ERP’s are in place.
Ladies and Gentlemen,
A review article published in the Journal of Public Health
Management Practice based on the Katrina hurricane had devastated New
Orleans in 2005 mentioned that the lessons learned from the tragedy
included the importance of a robust medical presence at evacuation
shelters, the value of an accurate and timely database of medical needs for
shelter occupants.
During the West Africa flood in 2008, crisis preparedness and response
system was enhanced using the Early Warning, Early Action strategy by
the International Federation of Red Cross and Red Crescent Societies
(IFRC) It was shown that the potential benefits to be realized from the use
of medium-to-long-range forecasts in disaster management.
A journal published in the South East Asian Journal of Tropical Medicine
and
Public
Health
entitled
the
Health
Emergency
And
Disaster
Preparedness in Malaysia concluded that health emergency and disaster
preparedness
includes
getting
ready
(readiness),
anticipating
consequences or impacts from hazards or emergencies (foresight),
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planning for a variety of scenarios (anticipatory planning), and taking the
necessary measures in order to avoid or reduce risk (precautionary action).
In addition, regional collaboration plays an important role as part of our
disaster preparedness. For example, the ASEAN Regional Forum Disaster
Relief Exercises (ARF DiREx) is a large scale disaster preparedness
training program involving various agencies from the ASEAN countries. It
helps in ensuring SOPs are tried and tested, loopholes identified, resource
allocation prioritized and the networking between government and NGOs
strengthened.
Ladies and Gentlemen,
The MOH would like to express our sincere appreciation and
gratitude for the hard work of our MOH staff in dealing with the 2014 flood.
Many of our staff were personally affected and suffered loss of property by
the flood continued to provide services during the crisis, showing their
loyalty and commitment to their duties. They have shown exemplary work
ethics, the highest level of dedication to their work and settling aside their
own personal needs in order to serve others.
I would like to acknowledge and thank the MOH staff who
volunteered to assist their colleague in the flood affected area. The
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assistance came in various forms. Some went on the ground to provide
service, others donated food and essential items and a large number
provided monetary assistance to help ease the burden of affected MOH
staff.
As a way forward, MOH is conducting a post mortem of the flood to
identify gaps in order to be prepared to face disasters in the future. In short,
lessons learned will strengthen our disaster preparedness in the future and
makes us ready in facing the new challenges ahead of us.
THANK YOU
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