Mon, Jan 03, 2005 page8

• Taiwan needs a tailored relief effort

  • By Frank Shih 石富元
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  The earthquake that occurred on Dec. 26 caused an ocean surge that resulted in the loss of tens of thousands of lives in Southeast Asia. Taiwan has played an active role in a number of relief efforts over the past few years, from the earthquakes in El Salvador, India, Indonesia, and Iran, to the wars in Afghanistan and Iraq. However, a search through international media reveals little indication of Taiwan's contribution, with the exception of the occasional mention of institutions responsible for making large donations of money or resources.

  In fact, Taiwan cannot officially join many international organizations. I suspect we are being excluded from participating in coordinated international humanitarian relief efforts is that we lack expertise and knowledge regarding international hygiene and humanitarian aid. As our past experience of such efforts is limited, we are not very familiar with how these international operations are conducted.

  Nobody doubts the altruism and sense of mission that spurs on various Taiwanese groups, but the way they actually carry things out may only be of little practical help to the disaster victims, actually add to the chaos there, and waste already stretched local resources.

  We are used to the way we deal with disasters in Taiwan, but if these same methods are used abroad, it can raise a few eyebrows. For example, news reports say again and again that if nothing is done about the bodies of the victims, there is the risk of an epidemic flaring up.

  Every time there is a major natural disaster, the World Health Organization (WHO) says that there is no danger posed by the decomposing bodies above and beyond the nasty odor. Epidemics arise when there is inadequate clean water, water treatment and checks to prevent the spread of disease.

  The media should stop broadcasting erroneous information, and instead instruct relief groups to concentrate on improving water and food supplies as well as the living conditions of the local people. With the continuous misinformation provided by Taiwan's media, few Taiwanese groups may be able to fit in with international relief efforts.

  The actual disaster happens over a limited period of time. The media concentrates on the subsequent emergency response period, and this spurs many disaster relief groups to set out for the disaster area. There are groups from all countries, many ill-prepared and speaking different languages, using up resources to little effect. This causes a "secondary disaster," making it more difficult for disaster victims.

  In terms of medical relief, there is already an established way of doing things within the international community. Anything that gets in the way of this could hamper the integrated implementation of relief. In general, local services deal with the emergency response immediately following the actual disaster, and they only need technological support from abroad.

  It is in the subsequent restoration period that people require large amounts of material resources and manpower. This period could go on for several years, whereas the fervor for providing aid has a shelflife of weeks, leaving disaster victims on their own. International relief organizations stress that aid should not be excessive in the emergency response period, but not slacken during the restoration period. Taiwanese relief groups should adapt their approach accordingly.

  There are internationally accepted rules on what is appropriate to donate, and the method and nature of donation. These can be checked on the WHO Web site. They list four types of items that are not needed, under food, clothes, blood donations, and unsolicited volunteers -- these can contribute to a "secondary disaster."

  Medicine is acceptable, but it is recommended that donations are made in batches according to WHO standards. If they are not, they may be turned down, as sorting and checking takes too much time. Medical personnel are only required in affected areas, and will only be accepted if they do not present any cultural clash and if they can communicate in the local language. Otherwise their ability to treat patients is compromised.

  It is becoming standard practice for people to donate money to international organizations, who then find medical personnel familiar with the local language to provide necessary medical services.

  The focus of health provision is in terms of hygiene and disease prevention. Drinking water, hygiene, and disease prevention don't require huge sums of money, yet they can make a real impact on the health of the disaster victims.

  For the Taiwanese, we much prefer our own way of dealing with disasters, irrespective of what other international organizations try to tell us. A Belgian formerly in charge of disaster medicine in the Pan-American Health Organization was also my neighbor when I was studying disaster medicine in Washington. I mentioned to him that Taiwan was not allowed to join the WHO, and was not allowed to participate in disaster relief operations.

  He couldn't come up with an explanation for this. He said he never took the country of the aid's origin into consideration, and he was unaware of any countries being excluded from offering aid due to politics. The objective is to ensure that disaster victims receive the attention they need, and that their suffering is relieved.

  These relief missions have additional motivations -- to demonstrate the government's efficiency, to raise Taiwan's international profile, to further diplomacy, to promote cooperation with other countries, and to train domestic disaster relief teams. However, these goals can only be achieved if we provide concrete assistance to the victims of disasters, and this needs to be done in a scientific way.

  It is best to see this aid as the start of an operation, as a commitment to restoring the health of disaster victims in neighboring countries over the long term, and a way to master international health standards.

  In this way we can build a reputation in addition to expertise. This is something that, in addition to going to Geneva and making our case heard, we not only can, but actually should, do.

  Frank Shih is an attending physician in the emergency department at National Taiwan University Hospital.

  TRANSLATED BY PAUL COOPER
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