Note: This is a true incident. Though all characters in the story are anonymized, they are recognizable to the knowledgeable based on the events portrayed. That they have been anonymized reflects propriety rather than conformity to any hidebound traditions.

John Deer and Jane Doe are part of a small team of medical personnel doing voluntary work in an under-served Central African country that is only now recovering from a prolonged and bloody civil war. They are there treating poor villagers who often travel great distances over days to a hospital where they have a special clinic, the only one of its kind in a region that is bigger than some European countries. They are supported by the local doctors and healthcare workers in that hospital.

One day, Dr. Deer sees a young alcoholic patient who has come to the clinic from one of those remote villages with complaints of abdominal pain and weight loss of a few months duration. He finds a palpable abdominal mass, so he gets Dr. Doe to perform an ultrasound on a small portable scanner that is available there. They find a large complex cystic / solid mass.

They are stumped. Is it something untreatable in their setup, like a cancer, or is it something simpler that they could effectively treat?

John is very active in social media. He has a blog with many loyal readers, a Linkedin profile with many connections, a facebook account with many friends and a twitter account with many followers. His social media connections / friends span the globe and are a smorgasbord of non-medical people and healthcare professionals of various specialities. He tweets about the case asking if anyone can offer a solution to their dilemma. Bharat, a radiologist in India,* replies to his tweet and asks him to upload an ultrasound image so that he could opine.

John, concerned about the patient’s privacy, asks Bharat for his email address to send him the image. The email address is duly obtained via private direct message on twitter. John uses his mobile phone’s camera to take a photo of the ultrasound image from the scanner’s monitor and immediately sends it via his smart phone’s email service to Bharat with a few clinical details, none of which would identify the patient. Bharat just requires a glance at the image to recognize it as an abscess. He sees these just about every day in his practice. He promptly emails John the diagnosis and suggests a possible course of treatment.

John and his team effectively treat the patient and send them home. John emails Bharat to thank him and includes a few details of the treatment. John also thanks Bharat on twitter. A few other medical types on twitter who have followed this post a few congratulatory tweets.

Happy ending to the story.

Right.

Now begins a new, fun episode in the saga.

One of the people who followed this story as it unfolded on twitter is Jet Lee,** a young doctor in Australia who is in the finishing stages of his surgical residency. Jet is, like his namesake in filmdom, a star in the medical social media sphere.

Jet tells John that this is worth writing up and publishing as a case report, with special emphasis on the utility of social media platforms such as twitter in offering specialized medical services to under-served areas in the world.

John agrees. John and Jane are now back at their bases in the USA and Europe respectively.

Jet assiduously writes up a proper case report with suitable references and sends copies to John, Jane and Bharat who have been included as co-authors. There follows a chain of emails with suggestions and corrections between the four. All four are satisfied with the crisp case report that emerges after all the corrections. The only thing left now is to find a suitable journal to publish it in.

Jet and John think that it has a good chance of being published in one of the big medical journals which is named and famed for its sharpness.

John submits the case report in the required format to the Sharp Big Medical Journal (hereinafter shortened to SBMJ. Not to be confused with the BMJ).

The person in charge of processing new submissions in SBMJ emails John asking him if he had acquired the necessary consent from the patient for publishing their story.***

Another chain of emails ensues, with copies to all co-authors, with the back-and-forth between John and the SBMJ staffer regarding the specific nature of the consent obtained.

The SBMJ wanted to know if the patient had specifically consented to their medical data being electronically transferred and published. They were very interested in publishing the case report, because they really thought the innovative usage of twitter was a story worth publishing in their august journal. But they were worried about the possible backlash from a poor Central African villager who might sue them over publishing his medical details without obtaining proper consent.

Over the course of several emails, John tried to politely and patiently explain to the SBMJ pedant that it was practically impossible to trace the patient, who would have gone back to their remote village. John actually had trouble contacting the local doctor in the clinic where the patient was seen. That was how things worked in that part of the world.

None of this mattered to SBMJ. Rules were rules. The red tape would only part if the requisite paperwork was provided.

Finally, even the indefatigable John was fed up and he withdrew the submission.

Jet has started his search for medical journals with less exacting standards than the less-than-keen ill-named SBMJ.

There ends the parable.

My opinion/rant about this follows the short footnotes below. Feel free to skip the rant and take home whatever lesson that you have gleaned from the story.

* Very thinly disguised!! There are only three tweeting radiologists from India as far as I know!

**Apologies to the actor with the similar name and to my handsome friend who I think resembles the actor.

***See my opinion below.

Some of my friends in the medical blogosphere and medical twitterverse know that I loathe the red tape associated with submitting articles / papers to big medical journals. The story above just reinforces my loathing.

I prefer posting case reports in my blog rather than go through this.

I seriously cannot fathom the reasoning behind this kind of bureaucratic fanaticism. From the tone of the email responses by the person in the SBMJ above, it was obvious that they wanted to publish this to show themselves to be in the loop regarding the utility of social media. But then, their hidebound nature had to intervene.

I find this highly absurd in this day and age, when social media decides the fate of long-entrenched dictatorships.

I’m sure the local newspaper, if there was one in the Central African country where this occurred, would have been happy to carry this news with “Doctors use twitter to save a patient’s life” as a hyperbolic headline.

In an age where famous and well-respected hospitals vie with each other to be in the news for having been the first to live-tweet or blog a complicated surgical procedure, I find it incredible that there are dinosaurs who insist on this kind of behaviour.

If something like this is published in a blog that has good traffic, and if it is suitably good, it has the potential to “go viral” (at least in the medical corner of the internet).

I hope an editor in at least one big shot journal has the sense to see that if a patient could be successfully treated via twitter, maybe it is not too bad to publish that story.

I don’t think that particular patient would have been too worried about consent, even if it had been required for treatment.

There is a reason these poor people travel for days often in hazardous circumstances to reach these type of voluntary / mission hospitals.

They have no place else to go.

The minute they enter the clinic/hospital, all consent is implied.

They do not have the luxury of choice that those like the officials of big-medical-journals have in their lives.

via Paul Levy’s blog post

Here’s a great fellowship opportunity in biomedical imaging being offered by the Madrid-MIT M+Visión Consortium program. Applications are welcome from people of all nations, and with a variety of backgrounds. Here is an excerpt from the description:

With a focus on accelerating innovation in biomedical imaging, promoting translational research, and encouraging entrepreneurship, the Madrid-MIT M+Visión Consortium is currently recruiting bright young talent from all over the world - engineers, physicians, scientists, and entrepreneurs interested in biomedical imaging who are in search of a career-enhancing experience and want to make their mark on the world.
Over the course of a one- or two-year fellowship in Madrid, Spain, and Boston, Massachusetts - supported by a generous stipend and travel expenses - you will be part of a team that will accelerate cutting-edge research in imaging, translate that research from bench to bedside, and establish new enterprises to enhance and enrich Madrid’s biomedical research community. Your knowledge, skills, network, and career track will all be enhanced from this remarkable experience.

Ten fellowships will be awarded. The deadline is January 25. To apply visit this site.

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Shamelessly copied verbatim from this post by Chris Nickson of the LITFL team.

The ‘Ten Commandments of Emergency Radiology’ according to Touquet et al (1995):

  1. Treat the patient, not the radiograph
  2. Take a history and examination before ordering a radiograph
  3. Request a radiograph only when necessary
  4. Never look at a radiograph without seeing the patient, and never see a patient without looking at the radiograph
  5. Look at every radiograph, the whole radiograph, and the radiograph as a whole - remember the ABCS: alignment/ adequacy, bones, cartilage (joints) and soft tissues.
  6. Re-examine the patient when there is an incongruity between the radiograph and the expected findings
  7. Remember the rule of twos - two views, two joints (above and below the injury), two sides (for comparison), two occassions (may need a follow up x-ray) and two radiographs (compare to a normal radiograph)
  8. Take radiographs before and after procedures
  9. If a radiograph does not look quite right ask and listen: there is probably something wrong.
  10. Ensure you are protected by fail safe mechanisms - establish a quality control system

References: Touquet R, Driscoll P, Nicholson D. Teaching in accident and emergency medicine: 10 commandments of accident and emergency radiology. BMJ. 1995 Mar 11;310(6980):642-5. PMID:7661941;  PMCID: PMC2549014.

These ought to be put up prominently (engraved in stone tablets if so desired) in every Emergency and Radiology Department.

Three news articles in the first two days of the new decade indicate that the Medical Council of India is contemplating a major overhaul of medical education in India

Beginning with undergraduate medical education (MBBS).

The Hindu: MCI suggests major reforms in undergraduate course [my comments in bold italics in parentheses]

The MCI has recommended major reforms in the undergraduate course in medicine by converting conventional education into a competency-based module to develop skilled doctors through early clinical exposure. It has also suggested doubling the intake of medical students to meet the healthcare needs of the country in the coming years. Pointing out that the current undergraduate curriculum in medicine did not make an MBBS degree holder feel equipped with adequate skills and competence to take care of the common problems at the secondary and tertiary level, the Undergraduate Education Working Group has said this factor also prevents young doctors from going to practice in the rural and primary health centres. The goal of training is not focused on providing health care to the needy and the disadvantaged, the eight-member working group has said in its report. [A very honest appraisal of the current status of MBBS education.]

It recommends options for distance education towards a fellowship or diploma in areas such as diabetic care, HIV medicine, geriatric medicine, hospital infection control, hospital management, and inclusion of medical ethics, forensic medicine and hospital infection control in the regular curriculum. [These are welcome additions, but I find that they are again giving more importance to hospital/institution based medicine, rather than community-based preventive medicine.]

According to the report, the current intake of medical colleges and the critical mass of doctors would have to be doubled if India had to achieve the world average doctor-population ratio of 1.5:1000 by 2031 as against the present 1:1700. At present, there are 330 medical colleges with an intake of approximately 35,000 and with the present intake the shortfall of doctors by 2031 is estimated at 9.54 lakh. [We are going to face a shortfall of nearly a million doctors by the time doctors of my age are near the official retirement age.]

…the group stressed the need for restructuring the MBBS course with a four-year course and six months elective with a one-year internship. Clinical training should be included from the first year itself. [I couldn't agree more. Instead of mugging up the Kreb's Cycle, first-year-MBBS students ought to be exposed to how and why blood sugar levels are tested in real patients. That will give them a better perspective about biochemistry.]

The past curricular revisions have mostly added to the existing content without undertaking the exercise to remove what is obsolete and outdated. This exercise needs to be taken up in a detailed and extensive manner and make the curriculum as efficient as possible, the report has said. It has to be discipline-based curriculum and lack of integration between basic and laboratory science and clinical medicine should be addressed. [Same point that I made above.]

It goes on to add that each medical college should be linked to the local health system, including Community Health Centres, taluka hospitals and primary health care centres that can be used as training base for medical students. [They conveniently forget to mention what happens to the large number of un-attached & un-attachable-to-government-hospital private medical colleges.]

…and going on to post-MBBS specialities…

The HinduMake specialised PG courses uniform: MCI [my comments in bold italics in parentheses]

The MCI has recommended that all specialised post-graduate courses be made uniform, with the curriculum revised periodically depending on new developments in the fields. [Good]

It also proposes a national common entrance examination for PG and super speciality courses from July this year. [Good in theory, but a political nightmare. I don't believe this can be implemented this year.]

A working group, set up by the MCI Board of Governors in July to review PG courses, in its report, … has said the duration of training should be uniform: diplomas (two years), degrees (three years), fellowships (three years), DM/MCH (three years) and Post-DM fellowship (two years). [I expected them to do away with the anachronistic idea of post-graduate medical Diplomas!! Where is the uniformity if you hand out diplomas and masters degrees in the same specialty? Why have that kind of step ladder approach to specialization? Increase the number of masters residencies & scrap diplomas altogether.]

There should be extra-departmental rotations for at least six months in allied disciplines, and continuous, formal structured assessment with regular feedback for post-graduation. [I couldn't agree more. Especially the second part.]

Pointing out that there are many vacant seats in basic specialities like anatomy, resulting in a shortage of expertise, the report suggests that more incentives be given for candidates taking up these courses such as differential pay scales or accelerated promotions for teachers in these subjects. [I believe the shortages are only in government-run institutions. Private medical colleges pay qualified teachers in basic medical sciences more than they pay physicians and surgeons who work in their hospitals. The government has to give meaningful incentives for people to be interested in serving in its basic medical sciences departments.]

Recommending special incentives to private institutions for starting courses in basic specialities, the working group says shortage is due not only to a lack of seats, but also to popularity of courses. That is why private institutions are hesitant to start these courses, says the report. [Good luck with this. It's a vicious cycle, that isn't likely to become better. Rather than incentives to the institutions, the students who graduate from these specialities ought to be given guarantees of jobs with meaningful growth potential and incentives. The government should create a demand for these jobs, ie, make them more attractive, for the supply to increase.]

On continuing professional development, the working group says the MCI guidelines on accreditation of organisations for conduct of a continuing medical education programme and of individuals are already there but there is need to ensure regular participation. [The MCI has sidestepped the issue with some fancy wordplay. What is required is a definitive protocol/schedule of periodic re-accreditation like that followed in the US. I became a radiologist for life eleven years ago. How does the patient who comes to me today know that I've kept up with all the advancements in my specialty over the past decade? I don't expect this issue to be raised by a group of wise-old-men such as the current governing body of the MCI who will be terrified of such a prospect.]

…and finally this article…

The Hindu: National board of exams to be abolished

…which has left me speechless. A committee just decided to kill the agency that has given me my radiology diploma and thousands of other doctors their National Board Diplomas in various other specialties. I feel like Arthur Dent.

From the transcript of a video by Dr. Mark G. Kris, MD, Chief, Thoracic Oncology, Memorial Sloan-Kettering Cancer Center, published in MedscapeRadiology [Registration required. Free] speaking on the recent announcement by the National Cancer Institute about the release of data from the National Lung Screening Trial [Abstract & link below].

…we have never had a screening test for lung cancer that met the gold standard for a successful screening test (ie, a test that is able to prove that the deaths due to lung cancer in a population of patients were decreased by screening). The data released … in the National Lung Screening Trial, which included over 53,000 patients randomized to receive 3 yearly chest x-rays or 3 yearly low-dose CT scans, there was a 20% decrease in mortality from lung cancer. It’s simply an amazing result with an immediate impact on this disease. One thing we have been fighting to do, as control of other cancers has improved, is to improve the control of lung cancer and cut down the death rate like the death rate has been cut down in prostate, breast, and colorectal cancer.

Finally we have a screening test that meets that gold standard and has a substantial opportunity to decrease the death rate for lung cancer. In the group that was screened, all patients had smoked 30 pack years, which is the equivalent of 1 pack per day for 30 years, 2 packs per day for 15 years, and so on. The technique used was a standard helical CT using a low-dose radiation technique. This type of scan is available anywhere.

Based on these data, it makes sense to recommend screening with a low-dose helical CT for any person who has smoked 30 pack years. This is a very substantial change; again, we’ve had no recommended screening for lung cancer. Another interesting piece of data is that all-cause mortality for the screened group was actually 7% less in the group that had the CT compared with those that had a chest x-ray. I think people are concerned that the x-rays themselves could lead to some sort of cancer risk, but that clearly was not borne out of this trial.

I think you’re going to see a lot of discussion about this trial. It’s appearing on the front page of at least my hometown newspaper. I urge you to read the information carefully, look at the specifics of the trial as they come out in the next few weeks, and also think about which patients in your practice and which patients who you see would meet these screening criteria. It’s going to change how we do business and it’s going to put a tremendous burden on our systems, but I think it is worth assuming as it means fewer deaths from lung cancer — something we have only hoped to achieve.

Many people have been supporting this. Many people, myself included, have been waiting for this result. Now that it’s out, there is, in my estimation, no reason to wait another day to begin screening.

The National Lung Screening Trial: Overview and Study Design, published online in Radiology before print.

Abstract:
The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.

Full text available here [Free]

H/T this retweet by my friend Ramona.

[Image Credit]

From the The Local:

Berlin’s Charité Hospital has achieved a world-first by creating MRI images of a baby being born in order to provide extraordinary insights into the birthing process. A team comprised of obstetricians, radiologists and engineers have built an “open” MRI scanner that allows a mother-to-be to fit fully into the machine and give birth there, the hospital announced on Tuesday. The MRI scanner has already taken unique images of the body of a mother and the movement of her baby through the birth canal to the point where its head emerges into the world. The birth that took place in the scanner went smoothly and both mother and baby were in good health, a hospital spokeswoman said.

The birth was the culmination of a two-year project by the research team. MRI uses powerful magnets to magnetise some atoms in the body which makes them detectable to radio waves. Importantly, it can make cross-section images of a subject, showing intricate detail of soft tissue and bones in the body. The team built a special “open MRI” scanner, a new type of machine whose open structure had the necessary space for the mother to give birth.

The new machine will enable the researchers to study in greater detail how the baby moves through the mother’s pelvis and down the birth canal - issues that have long been studied and debated. The hospital’s Institute for Radiology and Obstetrics Clinic will work closely together on the project. Among other benefits, it should help researchers to understand why about 15 percent of pregnant women need a Caesarian section because the baby does not progress properly into the birth canal.

medGadget says that the scanner used was a modified version of a Philips Panorama high field Open MRI.

More from the Philips News Center: [emphases are mine]

This operation was the culmination of two years of research and development work by the “open high-field MRI” task force specialising in radiology. “We had to develop a new type of foetal surveillance monitor whose measuring technology is not adversely affected by the extremely strong magnetic field of the MRI scanner,” says project manager Felix Güttler in explaining one of the challenges the team faced. The Philips Avalon CTS cordless monitoring system, which was used with the appropriate modifications, provided doctors and midwives with vital information throughout the birth about the child’s heart tones and movements, the strength of contractions, as well as the mother’s blood pressure.

“The ability to monitor the progress of a birth by magnetic resonance imaging was made possible by the open high-field MRI scanner from Philips,” emphasises PD Dr. Ulf Teichgräber, senior physician at the Institute of Radiology at the Charité Hospital. “Unlike other conventional MRI scanners, it does not have a typical tube shape, but rather has an open design in which patients enjoy an unrestricted 360 degree view.” This open design also allows good access to the mother and child from all sides throughout the birth - a key criterion for the doctors treating the patient.

Specialists from Philips were also present during this unusual event because the medical imaging of the MRI scanner had to be specially adapted for this unique birth. “This was also a very special moment for Philips Healthcare because it is not every day that we experience such milestones in medical research where there is such a focus on our solutions,” says Ivar Nackunstz, Business Development Manager of Philips. “The open high-field MRI task force at the Charité Hospital has developed many technical and clinical solutions for interventions in our panorama and helped to make the outstanding quality of the images produced by magnetic resonance imaging useable for completely new areas of application.”

The task of this interdisciplinary group of researchers is now to conduct further investigations to examine the preconceived ideas which have been formed since the 19th century regarding the birth process and movements of the unborn child in the mother’s pelvis. One of the aims of the scientists is to gain a better understanding in future of why in 15 percent of all births there is a stalled labour which makes it necessary to deliver the baby by Caesarean section.

Over the past decade or so, with the advent of better MRI scanners and faster scanning protocols, dynamic MRI has been tried, and perfected, for a range of moving structures in the human body. The commonest uses for dynamic MRI have been in musculoskeletal imaging. But dynamic MRI has also been used to study the beating heart and to study the pelvic floor muscles. MR Defecography is one such example [ Experience of 4 Years with Open MR Defecography: Pictorial Review of Anorectal Anatomy and Disease. July 2002 RadioGraphics, 22,817-832 - full text]. Personally, I tend to agree with a comment in the Wikipedia article on Defecography:

More recent techniques involve the use of advanced, cross-sectional imaging modalities such as magnetic resonance imaging [This video is an example of MRI defecating proctography]. Using MRI for this is considered by many to be an outrageous waste of medical resources.

But then, research-oriented minds forging ahead to further broaden the limits of scientific knowledge had already studied the male and female genitals during coitus and female sexual arousal using MRI back in 1999 [BMJ 1999;319:1596-1600- fulltext - Graphic images. NOT SAFE FOR WORK].

It was only a matter of time before someone with the resources, time and willing subject did something like this.

I cannot contemplate any conceivable clinical scenario wherein a pregnant woman in the throes of labour would have to be subjected to an MRI, but as the news reports say, such studies will be invaluable in helping us better understand the heretofore mysterious (some would say magical) phenomenon of birth.

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via DNACentre cracks the whip on Indian Medical Association for endorsing products.

Sending a strong signal to doctors endorsing products for private companies, Medical Council of India (MCI) has banned top office-bearers of Indian Medical Association (IMA) from practising medicine for six months. IMA’s national president Goparaju Samaram and secretary Dharam Prakash have been removed from the Indian medical register for six months, which means they cannot practise as doctors in this period. The action was taken following a complaint that IMA was endorsing products for private companies. Earlier, MCI had issued warnings to IMA and affiliated associations to refrain from endorsing such products.

This is probably the first time IMA office-bearers have been punished, though MCI has been taking action against doctors on a case-to-case basis. The association reportedly endorses about six products, including Dettol and Aquaguard.

MCI has also issued a censure letter to all executive committee members of IMA warning them not to repeat such practices.

“The ministry received a complaint relating to endorsement of some food products by Indian Medical Association in 2009. The complaint was forwarded to MCI for appropriate action. The ethics committee of MCI, at its meeting held on November 9, 2010, considered the matter and decided to remove the name of the president and secretary of IMA from the Indian medical register for a period of six months and issue a censure letter to all executive committee members of IMA to not repeat such practices in future,” minister for health and family welfare Ghulam Nabi Azad said in a written reply to a question in Lok Sabha on Friday. “There is a code of medical ethics in place, according to which no doctor or association can endorse products. There is a watchdog in the government and a group of people is monitoring all such endorsements,” SK Sareen, chairman of MCI’s board of governors had told DNA earlier. He said MCI had jurisdiction over not only doctors but also their associations. “If doctors can’t, even IMA cannot,” Sareen said. [emphases are mine. read the full story here]

More on the same via ToIIMA officials penalized for endorsements.

After more than two years of arguments at different forums over Indian Medical Association (IMA) endorsing two food products in violation of its own ethics and Medical Council of India (MCI) regulations, MCI decided to remove secretary and president of the IMA from the Indian medical register for six months. As a result, these doctors cannot practise for six months. MCI has also decided to serve censure letters to all the 187 IMA executive committee members ”to not to repeat such practices in future”. IMA represents two lakh [200,000] doctors in the country. This is the first time in IMA’s history that names of its office bearers would be removed from the register. The decision was taken at an MCI ethics committee meeting on November 9. This was later ratified by the board of directors. Union health minister Ghulam Nabi Azad announced the MCI decision in a written reply to a question in the Lok Sabha on Friday.

[here's the root cause] In April 2008, IMA had signed a Rs 2.25-crore [Rs. 22,500,000, nearly half a million US $] contract with Pepsico to allow Tropicana fruit juice and Quaker oats to use the IMA logo on their packs for three years ending 2011. Dr K V Babu, an IMA central committee member, complained to MCI on June 6, 2008 and followed it up with RTI applications that brought out details of this and other endorsements. [read the full story here]

I wonder when the Indian Dental Association is going to get penalized for endorsing certain brands of toothpaste?

I got an email from Mari (M4ID_Mari in twitter) on behalf of the WHO’s Emergencies and Humanitarian Action team in South East Asia, based in New Delhi about the WHO’s first social media driven effort, aiming to engage 1 million people in the issue of hospitals safe in disasters.

Floods, tsunamis, earthquakes, cyclones - the WHO South-East Asia Region is particularly vulnerable to natural disasters. In 1996-2005, such events led to the deaths of more than half a million people in this region. This makes up 58% of the total number of people killed worldwide due to natural disasters.

Hospitals are lifelines in the aftermath of a disaster, when large numbers of people are critically injured or vulnerable. It is particularly vital that they remain intact and functional to save lives. In addition to treating disaster victims, hospitals must also quickly resume treatment of everyday emergencies and routine care. When hospitals are damaged or destroyed during disasters, it has a social, economic as well as health impact. Hospitals and health facilities are at the core of the structure of every community. They also protect health workers and the most vulnerable people - the sick - all the time. When these are damaged, it can have a psychological impact on the entire community.

The health impact of damaged hospitals can be long-term as well as immediate. For example, in Aceh, Indonesia, the tsunami of 2004 destroyed 61% of its health facilities, and killed 7% of its health workers and 30% of its midwives. It led to a crisis in Aceh’s primary care, maternal health and neonatal care.

Damaged health facilities are also an economic issue, as hospitals, and their human resources, are an enormous investment for any country. The indirect costs to a nation -such as decline in health and wellbeing of the population, the impact on overall recovery and a disincentive for future external investments-are incalculable.

When disasters damage health systems, they do more than destroy the community’s lifeline. They affect the country’s development potential. Its ability to achieve the Millennium Development Goals such as reducing child mortality and maternal mortality, and combating HIV/AIDS, tuberculosis, and other diseases, is seriously compromised.

The direct and indirect cost of a damaged health facility far exceeds the cost of building a disaster-resilient one.

The technology already exists.

Incorporating disaster-protection elements into the design will add only 4% to the cost of the building. Retrofitting costs vary but can sometimes be as low as 1% for certain parts called nonstructural elements.
Ensuring hospitals are disaster-resilient goes beyond the physical structure of the buildings. Training the health workforce to function in emergencies plays a fundamental role in making a hospital safe from natural disasters.

Keeping hospitals safe from disasters is everyone’s business. It can make all the difference between life and death. [source]

WHO’s social media outreach approach is part of their ongoing work to make South-East Asia more disaster-prepared. The initiative is spearheaded by a Facebook reaction test application and a simple message:

Disasters Destroy in Seconds - WHO Needs You To React Fast

[click on the image above or here to go to the app page]

If you are on facebook, click on the image below or here to go to the facebook app. You can then challenge your friends for their reaction times (and make them aware)

The apps invite people to test how quickly they can respond and to challenge friends to beat their time. Each reaction counts towards building the wave of public support WHO now needs to push decision-makers (who committed to this issue last year) in to making hospitals safe.

This is a novel approach for the WHO and it is the first step towards social web driven disaster preparedness and response communication.

With partners, WHO is working to ensure health facilities are build to withstand emergencies, have contingency plans in place and that staff are trained to help people under post-disaster conditions. This will save thousands of lives. As a result of coordinated efforts, last year, governments (including India) officially committed to ensuring health facilities, old or new, are made safe from disasters. With the help of public support, the WHO seeks to push the same decision-makers and the hospital industry in to taking concrete action to prevent needless loss of life in future.

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