Ethnic and Regional Dimensions. It sacrificed a lot of lives, but it gave a lot of eye opening to our country.’, Physician satisfaction with post-tsunami development was balanced by critiques of missed opportunities. ADPC Challenges For example, a physician said that after the tsunami, the MOH provided the hospital with computers for electronic health records. The tsunami crashed into the North, East and Southern parts of Sri Lanka and caused slight damage to parts of the West. His research focuses on Tamil-speaking Hindus and Muslims of eastern Sri Lanka, including caste identities, matrilineal family patterns, popular religious traditions, and ethnic conflict. The government had previously prohibited some anaesthetics and opiate analgesics from reaching the east, reportedly for fear of the LTTE accessing them. Where the content of the eBook requires a specific layout, or contains maths or other special characters, the eBook will be available in PDF (PBK) format, which cannot be reflowed. World Health Organization. Funding: This work was support by the Dean’s Summer Research Program at the University of Pittsburgh School of Medicine and the Global Health Travel Scholarship at the University of Pittsburgh Graduate School of Public Health. The present study of Sri Lankan physician perspectives shows that frontline health worker experiences and physicians in leadership roles capture aspects of the processes and results of health system recovery initiatives that may not be evident in existing analyses. Sri Lanka: Tsunami two year update A new school means new hope in tsunami-stricken Hambantota, Sri Lanka. Physicians highlighted successful projects that were fashioned through multilateral collaboration. We can’t blame the system for everything. Two years after the Indian Ocean tsunami which wreaked havoc on the coastlines of Indonesia, Thailand, Sri Lanka and the Maldives, the countries worst affected by the disaster, are still a … Physicians are among many stakeholders who can be engaged in Building Back Better’s emphasis on locally driven recovery. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Retrospective analyses of Sri Lanka’s post-tsunami recovery until now have not incorporated a diverse sample of physicians or other stakeholders whose critical perspectives were informed by personal experience. Rebuilding infrastructure and improving the mental health system were targets of recovery policies. Annang Ingram L, Tinago CB, Estrada R, et al. The tsunami recovery program carried out by the government has many lessons for Sri Lanka as well as other countries facing similar situations. . It is common for Sri Lankan physicians to work full-time at public hospitals while maintaining practices at multiple private facilities. Sri Lanka: Psychosocial programmes help children heal and make friends. In 2014 we interviewed 23 Sri Lankan physicians from the Eastern and Southern regions. Those who lived through the changes highlight how success was achieved, the barriers that affected recovery and where deficiencies remain. Prices & shipping based on shipping country. Participants were recruited with snowball sampling. Second, the WHO report extensively describes decentralization efforts, with a brief commendation of the National Institute of Mental Health (NIMH), which is the country’s main psychiatric hospital. Lanka, Tanzania, and Thailand. Sri Lanka is a small island situated close to southern tip of India near the equator. Now every district has some inward facilities… But at the same time, if we think about the places we got, the wards that we got are old wards, abandoned by other professionals…, Identity politics shaped inequitable resource distribution. Factors associated with the utilisation of skilled delivery services in Papua New Guinea: evidence from the 2016–2018 Demographic and Health Survey, Global epidemiology and socio-economic development correlates of the reproductive ratio of COVID-19, International medical electives for medical students at a German university: a secondary analysis of longitudinal data, Factors influencing decision making for implementing e-health in light of the COVID-19 outbreak in Gulf Cooperation Council countries, Humoral immunological kinetics of severe acute respiratory syndrome coronavirus 2 infection and diagnostic performance of serological assays for coronavirus disease 2019: an analysis of global reports, About the Royal Society of Tropical Medicine and Hygiene, http://www.preventionweb.net/files/2054_VL108301.pdf, https://www.adb.org/sites/default/files/publication/159342/adbi-asian-tsunami-aid-reconstruction.pdf, http://www.preventionweb.net/files/1591_9792.pdf, http://reliefweb.int/report/indonesia/stronger-together-global-red-cross-red-crescent-response-2004-indian-ocean, http://www.searo.who.int/entity/emergencies/documents/tsunami_2009/en/, http://documents.worldbank.org/curated/en/300121468760544570/Sri-Lanka-2005-Post-Tsunami-Recovery-Program-Preliminary-Damage-and-needs-assessment, https://www.gfdrr.org/sites/gfdrr/files/PDNA-Volume-A.pdf, https://www.gfdrr.org/sites/gfdrr/files/publication/DRF-Guide.pdf, http://www.who.int/mental_health/emergencies/building_back_better/en/, Receive exclusive offers and updates from Oxford Academic, Trends in obesity by socioeconomic status among non-pregnant women aged 15–49 y: a cross-sectional, multi-dimensional equity analysis of demographic and health surveys in 11 sub-Saharan Africa countries, 1994–2015, Community and health system factors associated with antiretroviral therapy initiation among men and women in Malawi: a mixed methods study exploring gender-specific barriers to care, Measuring and decomposing the effort regarding the equity of inpatient benefits based on the adjustment of the new cooperative medical scheme in western rural China, Contextual factors affecting the integration of community health workers into the health system in Limpopo Province, South Africa. Her most recent book is Breaking the Ashes: The Culture of Illicit Liquor in Sri Lanka (Cornell 2008). We have to take part of it, I think.’ For others, post-tsunami sustainability should have derived from Sri Lanka’s strategic planning process. This book is included in the following series: By using this site you agree to the use of cookies. [clarification needed] The south and east coasts were worst hit.One and a half million people were displaced from their homes. Institution-specific approaches, such as yearly requests to donors and departments committed to product maintenance, shaped how many physicians perceived sustainability. Select from premium Tsunami Recovery Continues In Sri Lanka of the highest quality. Tsunami and the end of the Sri Lankan civil war improved health workforce distribution. Routledge. Third, after highlighting mostly foreign-funded projects, the WHO report remarks that government funding of a psychiatry diploma demonstrates the country’s commitment to sustainable development of mental health services. On the other hand, physicians in the east explained how the tsunami relief reduced government checkpoints that had long prevented mobility for Tamil patients and health care workers. Published The semi-structured interview design, participant selection and recruitment approach and data analyses method adhere to qualitative research standards. Tsunami Hazard level: Medium? The book is framed within this larger political and social context, offering descriptions and comparisons between two regions (southwest vs. eastern coast) and four ethnic communities (Sinhalese, Tamils, Muslims, and Burghers) to illustrate how disaster relief unfolded in a culturally pluralistic political landscape. They broke the rules and regulations. https://www.adb.org/sites/default/files/publication/159342/adbi-asian-tsunami-aid-reconstruction.pdf [accessed 26 January 2017]. This study provides a model to assess stakeholder perspectives on how the World Bank’s disaster recovery frameworks and other methods are changing the methods and impact of stakeholder consultation. On the topic of medical product maintenance, one physician said, ‘That is a problem within ourselves, I think. Acknowledging the diversity of vulnerability concepts, vulnerability was interpreted in a simple form as referring to a person or One physician explained how he ‘grabbed the opportunity’ to improve the status of his hospital. You have to transfer the patient. Two metropolitan areas and two smaller cities were selected in order to sample the central and provincial health systems, which had different administrative and financing mechanisms, and the Southern and Eastern regions, which had different ethnic compositions and were affected differently by the Sri Lankan civil war. September 16, 2011 Improvements and barriers in equity after the tsunami, New outpatient and emergency infrastructure had been built and was still forthcoming at an Eastern teaching hospital, but administrators reportedly considered closing the projects because of a lack of health workforce and medical products. Edition 1st Edition. Observations on the Recovery and Reconstruction in Sri Lanka Following the December 26, 2004 Tsunami G. Franco, A. Sheth, and M. Meyer (2013) G. Franco, A. Sheth, and M. Meyer (2013) Page 3 Introduction and Organization of the Report During the early morning hours of December 26, 2004, a tsunami struck over half of the In contrast, participants in this study explained how political efforts concentrated psychiatric services at the NIMH at the expense of planned system decentralization. Conclusion Michele R. Gamburd and Dennis B. McGilvray, Dennis B. McGilvray is Professor and Chair of the Department of Anthropology, University of Colorado at Boulder. Many of the dead were adults and the elderly. He explained. One psychiatrist described how inequity was reinforced by leadership and governance issues within the field of psychiatry. The 2004 Indian Ocean tsunami caused significant damage to the health system in Sri Lanka. A hospital director described how local identity politics rather than corruption resulted in delayed construction at a beachside location, which he lamented for its limited accessibility and significant environmental hazards. Are street tree inequalities growing or diminishing over time? For example, recovery analyses from the government and CSOs rarely document how the Sri Lankan civil war, fought between the Sri Lankan government and Liberation Tigers of Tamil Eelam (LTTE) from 1983 to 2009, impacted the recovery.4,6,7 Reports such as the WHO 10 y retrospective analysis lack ground-level perspective on the causes and consequences of inequities, delays and limited sustainability.8 For example, the WHO and others commended a national mental health policy that reportedly was the product of a stakeholder-driven process.8,9 However, follow-up evaluation on mental health policy implementation and impact is lacking, including assessment of the participation of and impact perceived by the stakeholders who were consulted in the planning. Lessons learned from tsunami recovery: key propositions for Building Back Better. So again human resources is a limitation, but although the building is there.’ Physicians claimed that the Medical Officer of Mental Health (MOMH) positions, which were designed to provide decentralized mental health care, remained mostly unfilled without explanation. Post-tsunami health system recovery planning and implementation in Sri Lanka did not involve local physician stakeholders in ways that have been prioritized more recently in other recovery frameworks. Since the introduction of Building Back Better concepts after the 2004 tsunami, there has also been an evolving approach to incorporating local stakeholders in the assessment, planning and operationalization stages, not just in retrospective analyses. WCS and TB created the codebook. Second, the war is also over… Over thirty-three consultants are here working, with all the subspecialties. The southern facility was built promptly, but the eastern facility was delayed for almost 10 y by, according to physicians directly involved, the politics of the civil war. The Sri Lankan civil war limited post-tsunami equity in some instances, but the disaster lifted other barriers created by the civil war. Many participated in disaster relief efforts, and some took significant personal risks in doing so. The planning systems used in 2004 did not prioritize local stakeholder perspectives and, until now, retrospective analyses have lacked diverse physician stakeholder perspectives that add context to and challenge recovery narratives. Demonstrating the key importance of comprehending the local cultural contexts of disaster recovery processes, the book is a timely and useful contribution to the existing literature. The use of oxygen hoods in patients failing on conventional high-flow oxygen delivery systems, the effects on oxygenation, mechanical ventilation and mortality rates in hypoxic patients with COVID-19. And where there is lack of space, resources are more.’ Physicians generally believed that provincial system hospitals benefited more than central system hospitals. World Bank. The WHO’s 10 y retrospective analysis of tsunami recovery did incorporate local physician perspectives through a review of academic publications, but this study contributes a significantly more diverse physician sample.8 The usefulness of these diverse perspectives is exemplified by the context that they add to the WHO report titled ‘Building Back Better: Sustainable Mental Health Care after Emergencies’.15 First, the WHO report, authored mostly by Sri Lankan government officials, highlights improvements in the number of mental health facilities. The interviewer was permitted to ask follow-up questions of the participants if it would assist in clarifying or eliciting more information relevant to what the participants had already stated. The project completion report has a full assessment of lessons learned. Nagai M, Abraham S, Okamoto M, et al. Sri Lanka 1144 310 1454 Maldives 450 153 603 Total 5597 4333 9930. Post-disaster needs assessments guidelines: volume B. https://www.gfdrr.org/pdna-volume-b [accessed 26 January 2017]. On the 26 th of December 2004 a Tsunami wave triggered by an earthquake of magnitude 9.5 in the Richter scale off the coast of Sumatra in the Indian Ocean hit Northern, Eastern and Southern coastal regions of Sri Lanka causing 40,000 human deaths, 500,000 internally displaced people and US $ 900 million worth of infrastructure and environmental damage. As Sri Lankan physicians traditionally hold positions as administrators and team leaders, their experiences can contribute to filling an explanatory gap of how and why the health system changed after the tsunami. WCS and TB critically revised the manuscript for intellectual content. A physician involved in government planning explained, ‘The thing is, these funding agencies, they will not give just money, but they will impose a lot of conditions, recommendations, and so on. Approaching the issue from four disciplinary perspectives - anthropology, demography, political science, and disaster studies - chapters by experts in the field analyse regional and ethnic patterns of post-tsunami reconstruction according to different sectors of Sri Lankan society. New Dehli, India: World Health Organization, Regional Office for South-East Asia. Physicians identified as victims, social servants and opportunists during the tsunami and its aftermath. Better, faster, smoother roads have been a central part of the government's efforts to rebuild Sri Lanka after a long and brutal civil war and the 2004 tsunami. For both formats the functionality available will depend on how you access the ebook (via Bookshelf Online in your browser or via the Bookshelf app on your PC or mobile device). Sri Lankan physicians demonstrated leadership and critical analysis during the post-tsunami health system recovery. 16 TAFREN (2005), "Rebuilding Sri Lanka: Post-tsunami Reconstruction and Rehabilitation" June 2005. Actually, there was surplus… There was a free flow of drugs at that time. The reconstruction process was soon hampered by political patronage, by the competing … The tsunami waves which crashed into homes, hotels and other property, also destroyed a passenger train in Peraliya killing over 1,700 people. A summary below: Local Solutions – A well-defined role for local governments in disaster response is necessary. Inclusion criteria were being in medical school or a practising physician at the time of the tsunami, speaking conversational English and currently working in one of the selected tsunami-affected areas. Two physicians at one hospital independently described the tsunami as a ‘blessing in disguise.’ Others explained how the tsunami brought attention to pre-existing health sector deficiencies and general awareness of the country, often through vivid images of the destruction. It is a developing country with the total population just over 20 million. The Golden Wave: Discourses on the Equitable Distribution of Tsunami Aid on Sri Lanka’s Southwest Coast  Michele R. Gamburd  5. With the two you can’t treat the patient completely. The case of post tsunami Sri Lanka exemplifies the issues related to the post disaster long term recovery in developing countries. The Asian Development Bank estimated US$84 million was needed for recovery of the health care system alone,4 which included the repair of 97 hospitals and clinics that were damaged in the tsunami.5 The government reached memoranda of understanding with 45 organizations to repair the affected facilities and improve on more than 100 facilities that had not been damaged.5 Within 2 y, 55 of the damaged facilities had been reconstructed.4. There are a lot of wards, and people all over the country are coming. New buildings came to peripheral… Lot of people got new instruments, and some experts came and worked temporarily, so that was a positive side. WCS applied the codebook and drafted the manuscript. Peripheral hospitals benefited more than central hospitals. Sri Lanka: Focus of tsunami recovery is shifting to ‘bricks-and-mortar’ reconstruction. “All of it was really driven by the members of the household, the families themselves,” said Sharad Aggarwal, director of international programs. Offline Computer – Download Bookshelf software to your desktop so you can view your eBooks with or without Internet access. Post tsunami recovery and reconstruction. http://www.who.int/mental_health/emergencies/building_back_better/en/ [accessed 26 January 2017]. Despite his personal success with this approach, the doctor identified the need for better coordination among donors: Rather than giving the short little bit of money, what they can do is: there are several organizations in one country, they can get together and form one organization or whatever… Because that is the sort of big project that is very useful for this region, rather than just giving one equipment and no service, no company here, and we don’t use after some time…. WCS and TB designed the study protocol. Actors in a Masala Movie: Fieldnotes on the NGO Tsunami Response in Eastern Sri Lanka Timmo Gaasbeek  8. https://www.gfdrr.org/sites/gfdrr/files/publication/DRF-Guide.pdf [accessed 26 January 2017]. Rebuilding infrastructure and improving the mental health system were targets of recovery policies. An eyewitness account of Sri Lanka's remarkable recovery from the Boxing Day tsunami of 2004 that saw 90-foot walls of water crash into the coastline The tsunami was triggered by … As the months and years passed, physicians began to recognize the tsunami as an opportunity for the health sector. The 2004 Indian Ocean tsunami caused significant damage to the health system in Sri Lanka. Some drugs were not allowed to come to the north and east, certain category of drugs, during the conflict… [After the tsunami] we got quite a lot of donations. Tsunami Recovery in Sri Lanka . However, as our study demonstrates, physician leadership and perspectives on Sri Lanka’s health system recovery extended beyond the MOH, to include academic physicians and private practitioners. Psychiatrists expanded their scope of practice to manage psychosocial issues, which had a significant long-term impact on the field. We are united by a love of Sri Lanka and its people and a desire to help Sri Lankans to re-establish their lives and have access to improved educational resources. One physician described how international partners helped reduce corruption in a post-tsunami project: ‘There were a lot of politics, you know, tug of wars between whom this contract should be.’ Without oversight by the foreign government, ‘it could have been a flop, because in this part of the world you know a lot of things are going under the carpet.’. Global Facility for Disaster Reduction and Recovery. http://documents.worldbank.org/curated/en/300121468760544570/Sri-Lanka-2005-Post-Tsunami-Recovery-Program-Preliminary-Damage-and-needs-assessment [accessed 26 January 2017]. It is reported that when tsunami happened in 2004 in Sri Lanka, the preliminary meeting held with the broadcasters decided to open an emergency operation center within the premises of Sri Lanka broadcasting centre and send broadcaster team to collect food, clothes and basic needs from other parts of Sri Lanka and send the assistance to the tsunami victims. All transcripts were coded in an iterative process by the interviewer/author (WCS) until thematic saturation was achieved. Rebuilding Sri Lanka was founded by a group of individuals and families who were staying in Sri Lanka at the time of the tsunami in 2004. As one explained, ‘[After the tsunami] psychiatrists and psychiatric field are not only dealing with severely disabled psychiatric patients, but there are some other issues handled by psychiatrists, which makes stigma reduced, which is one reason that made psychiatry come to another level.’. This report was produced as … Rather than viewing stakeholders as valued generators of locally specific data, the needs assessment restricted their participation to a role with limited agency. In one physician’s experience, the funding surge after the tsunami decentralized planning through a process that increased her participation and formal training, ultimately leading to a career in health sector strategic planning. Government of Sri Lanka and Development Partners Steering Committee. As one summarized, ‘It’s a mismatch. Conflict, Coastal Vulnerability, and Resiliency in Tsunami-Affected Communities Randall Kuhn  Part 2: Ethnographic Materials  4. from the tsunami recovery literature on the key factors contributing to vulnerability to the 2004 Indian Ocean Tsunami and to emerging vulnerabilities related to post-disaster recovery in Sri Lanka and Indonesia. The duration of the participants’ availability and their backgrounds determined which of the 29 questions were used to provide a semi-structure to the interview. Within 1.5 km distance they made another base hospital. All rights reserved. The inequity remediation potential of the MillionTreesNYC initiative. One psychiatrist in training at a peripheral hospital after the tsunami commented on how psychiatrists initiated post-tsunami programmes at the new facilities but then left for other institutions with no plan for sustainability. WCS carried out the interviews and transcribed the interviews. Physicians emphasized that Sri Lankans needed to take responsibility for sustainability. Products provided by the government were also difficult to sustain due to the cost and inconvenience of repair. The interviewer developed an initial codebook based on open coding of two transcripts using Atlas.ti. 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