During the summer of 2016, Jade McLaughlin '17 and Madellena Thornton '17 worked as Global Health Initiative interns at Hospital Cayetano Heredia (HCH) in Lima, Peru. Their work on emergency preparedness focused on the willingness of healthcare workers to respond in a disaster.
by Madellena Thornton '17
The eight districts in Northern Lima stricken by poverty are incredibly vulnerable to devastation from a natural or biological disaster due to the lack of first-response services, potentially collapsible and densely clustered housing, and enormous education and income disparities. Hospital Cayetano Heredia (HCH), a general level III-1 hospital, constitutes one of three hospitals in the Ministry of Health in Northern Lima. Among the three hospitals, there are fewer than 900 beds. With a population of 2.75 million people, these hospitals together have insufficient capacity for healthcare, overwhelmed emergency services, and large gaps in disaster risk management for the population that they serve.
In the case of a disaster, like an earthquake or epidemic, the hospital response involves, among many things, enabling of expansion areas, massive mobilization of resources, attention to patients in acute and chronic conditions, and, above all, the use of emergency health personnel. In the case of a disaster, it is important to understand the availability of human resources and who the hospital can count on as well as an appreciation of facilitating factors and obstacles affecting the staff's willingness to work.
In the last 10 years there have been several studies in Australia, the United States, and India that focus on availability of various departments of hospital staff in response to disasters. Despite the existence of a large number of studies in developed countries, there is a lack of evidence from Latin American countries that addresses this issue. This study is the first of its kind to investigate the availability of staff in the emergency department of a hospital in Peru.
Under the guidance and leadership of Dr. Raul Acosta Salazar, M.D., Jade and I created and implemented a survey to investigate the availability and willingness of emergency department staff at Hospital Cayetano Heredia to report to work during a seismic and biological disaster. The specific objectives of our investigation were to identify important barriers and facilitators that influence staff willingness and availability during a disaster, understand the basic level of knowledge of both disaster risk management and appropriate hospital response, and assess the attitude and preparedness of emergency department staff to work during a disaster.
To carry out this investigation, Jade and I designed and implemented a survey, which we administered to all types of staff in the emergency department at HCH: doctors, nurses, administrators, and technicians. Data collection involved compiling the responses of the 220 emergency department staff members who participated in the study. With Dr. Acosta's guidance, we analyzed the results and created a 40-page report, in both Spanish and English, detailing the findings of our investigation.
The results of the study identified barriers to and facilitators for the availability of health personnel in the emergency department of the hospital. In the case of doctors, only 16.6% report that they live inside Northern Lima, as compared to 46.6% of residents, 66.0% of nurses, 61.8% of technicians, and 70% of administrators who participated in the investigation. This poses a large problem because bridges connecting the area of the hospital with surrounding areas would completely collapse in the case of an earthquake, thereby preventing doctors, nurses, and other health personnel who live outside of Northern Lima from reaching the hospital.
In addition to the issue of living far from the hospital, there are many social factors that serve as barriers to doctors' willingness and availability to report to work during either a seismic disaster or a sudden viral epidemic. The majority of doctors (61.1%) are married, compared to 34.0% of nurses and 38.2% of technicians. Furthermore 63.9% of doctors have at least one child, compared to 41.6% of nurses, 15.4% of residents, and 58.2% of technicians. A large percentage of doctors (86.1%) have at least one job in additional to theirs at HCH, compared to 0% of residents, 24.5% of nurses, and 30.9% of technicians, with some having more than two additional jobs. These personal obligations and responsibilities—the need to work an additional job and the impossibility of leaving children, spouses, pets, and elderly adults—serve as impediments to doctors' willingness and availability to work long work shifts during either a seismic disaster or a biological disaster, such as a viral epidemic.
The residents' results are significantly different compared to the results of doctors, nurses, technicians, and administrators. We recorded 84.5% of residents are 25-34 years-old, an age bracket younger than most staff in the emergency department at HCH, and one in which more endurance working during a disaster could be expected. In general, the residents in this study are not married, with 89.7% reporting that they are single. Additionally, the majority of residents lack children (84.5%), pets (81.0%), or elderly people (84.5%) under their responsibility. In contrast to doctors, residents report fewer barriers to their availability to report to work during a disaster. Nevertheless, significantly fewer residents than doctors are willing to report to work during either a natural or biological disaster. We recorded 84.5% of residents compared to 100% of doctors report a willingness to work in the case of an earthquake and 60.3% of residents compared to 77.8% of doctors report a willingness to work in the case of a viral epidemic.
Additionally, the overwhelming majority of residents (89.7%) do not know the current HCH's Hospital Response Plan in the case of an emergency or disaster, which indicates a lack of understanding of evacuation and emergency procedures. The low levels of residents' willingness and availability to report to work during a disaster is worrying because of the region's incredible vulnerability to earthquakes and fast-spreading viral epidemics, such as cholera, in 1991, and dengue in the Amazon, in 2012. In all health personnel groups (doctors, nurses, residents, technicians, administrators), if the participants reported that they are not willing to report to work in the case of an earthquake or epidemic, it is likely that the participant also reported that they do not know the HCH Hospital Response Plan. The increased mistrust and uncertainty due to not knowing the Hospital Response Plan results in a decreased willingness to report to work during a natural or biological disaster.
The results of this investigation suggest the tremendous opportunity for growth and improvement of disaster risk management in Hospital Cayetano Heredia and the larger Northern Lima area. Our recommendations include the implementation of an emergency shelter near the hospital as a safe place for family members of health personnel to stay while emergency department staff report to work at HCH; a plan for helicopter transportation of health personnel to the hospital in the case of an earthquake; the centralization of information, in the form of a general database of all employees at HCH, to aid rapid and immediate communication with health personnel during a viral epidemic; educational initiatives and disaster risk management training in medical schools to promote the understanding of the Hospital Response Plan, what it means to work in a disaster setting, and how to reduce and manage risks.
These findings were presented to disaster risk management experts and mayors of each district in Lima to further the discussion on how to improve disaster planning, emergency preparedness, and response systems in Lima and the surrounding areas. In terms of next steps, this study will be implemented throughout Hospital Cayetano Heredia (beyond the emergency department). Furthermore, the findings of this investigation have inspired other hospitals in Lima to make future plans to perform the same type of investigation—assessing the availability and willingness of emergency department staff to report to work during a disaster. The pathway for future investigation requires the compliance, investment, and cooperation between municipal governments and hospitals.