A video of a presentation by David Meates, Chief Executive of the Christchurch District Health Board and the West Coast District Health Board, during the first plenary of the 2016 People in Disasters Conference. The presentation is titled, "Local System Perspective".The abstract for this presentation reads as follows: The devastating Canterbury earthquakes of 2010 and 2011 have resulted in challenges for the people of Canterbury and have altered the population's health needs. In the wake of New Zealand's largest natural disaster, the health system needed to respond rapidly to changing needs and damaged infrastructure in the short-term in the context of developing sustainable long-term solutions. Canterbury was undergoing system transformation prior to the quakes, however the horizon of transformation was brought forward post-quake: 'Vision 2020' became the vision for now. Innovation was enabled as people working across the system addressed new constraints such as the loss of 106 acute hospital beds, 635 aged residential care beds, the loss of general practices and pharmacies as well as damaged non-government organisation sector. A number of new integration initiatives (e.g. a shared electronic health record system, community rehabilitation for older people, community falls prevention) and expansion of existing programs (e.g. acute demand management) were focused on supporting people to stay well in their homes and communities. The system working together in an integrated way has resulted in significant reductions in acute health service utilisation in Canterbury. Acute admission rates have not increased and remain significantly below national rates and the number of acute and rehabilitation bed days have fallen since the quakes, with these trends most evident among older people. However, health needs frequently reported in post-disaster literature have created greater pressures on the system. In particular, an escalating number of people facing mental health problems and coping with acute needs of the migrant rebuild population provide new challenges for a workforce also affected by the quakes. The recovery journey for Canterbury is not over.
The greater Wellington region, New Zealand, is highly vulnerable to large earthquakes. While attention has been paid to the consequences of earthquake damage to road, electricity and water supply networks, the consequences of wastewater network damage for public health, environmental health and habitability of homes remain largely unknown for Wellington City. The Canterbury and Kaikōura earthquakes have highlighted the vulnerability of sewerage systems to disruption during a disaster. Management of human waste is one of the critical components of disaster planning to reduce faecal-oral transmission of disease and exposure to disease-bearing vectors. In Canterbury and Kaikōura, emergency sanitation involved a combination of Port-a-loos, chemical toilets and backyard long-drops. While many lessons may be learned from experiences in Canterbury earthquakes, it is important to note that isolation is likely to be a much greater factor for Wellington households, compared to Christchurch, due to the potential for widespread landslides in hill suburbs affecting road access. This in turn implies that human waste may have to be managed onsite, as options such as chemical toilets and Port-a-loos rely completely on road access for delivering chemicals and collecting waste. While some progress has been made on options such as emergency composting toilets, significant knowledge gaps remain on how to safely manage waste onsite. In order to bridge these gaps, laboratory tests will be conducted through the second half of 2019 to assess the pathogen die-off rates in the composting toilet system with variables being the type of carbon bulking material and the addition of a Bokashi composting activator.
Background: Up to 6 years after the 2011 Christchurch earthquakes, approximately one-third of parents in the Christchurch region reported difficulties managing the continuously high levels of distress their children were experiencing. In response, an app named Kākano was co-designed with parents to help them better support their children’s mental health. Objective: The objective of this study was to evaluate the acceptability, feasibility, and effectiveness of Kākano, a mobile parenting app to increase parental confidence in supporting children struggling with their mental health. Methods: A cluster-randomized delayed access controlled trial was carried out in the Christchurch region between July 2019 and January 2020. Parents were recruited through schools and block randomized to receive immediate or delayed access to Kākano. Participants were given access to the Kākano app for 4 weeks and encouraged to use it weekly. Web-based pre- and postintervention measurements were undertaken. Results: A total of 231 participants enrolled in the Kākano trial, with 205 (88.7%) participants completing baseline measures and being randomized (101 in the intervention group and 104 in the delayed access control group). Of these, 41 (20%) provided full outcome data, of which 19 (18.2%) were for delayed access and 21 (20.8%) were for the immediate Kākano intervention. Among those retained in the trial, there was a significant difference in the mean change between groups favoring Kākano in the brief parenting assessment (F1,39=7, P=.012) but not in the Short Warwick-Edinburgh Mental Well-being Scale (F1,39=2.9, P=.099), parenting self-efficacy (F1,39=0.1, P=.805), family cohesion (F1,39=0.4, P=.538), or parenting sense of confidence (F1,40=0.6, P=.457). Waitlisted participants who completed the app after the waitlist period showed similar trends for the outcome measures with significant changes in the brief assessment of parenting and the Short Warwick-Edinburgh Mental Well-being Scale. No relationship between the level of app usage and outcome was found. Although the app was designed with parents, the low rate of completion of the trial was disappointing. Conclusions: Kākano is an app co-designed with parents to help manage their children’s mental health. There was a high rate of attrition, as is often seen in digital health interventions. However, for those who did complete the intervention, there was some indication of improved parental well-being and self-assessed parenting. Preliminary indications from this trial show that Kākano has promising acceptability, feasibility, and effectiveness, but further investigation is warranted. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619001040156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377824&isReview=true
A video of a presentation by Dr Erin Smith during the Community Resilience Stream of the 2016 People in Disasters Conference. The presentation is titled, "A Qualitative Study of Paramedic Duty to Treat During Disaster Response".The abstract for this presentation reads as follows: Disasters place unprecedented demands on emergency medical services and test paramedic personal commitment to the health care profession. Despite this challenge, legal guidelines, professional codes of ethics and ambulance service management guidelines are largely silent on the issue of professional obligations during disasters. They provide little to no guidance on what is expected of paramedics or how they ought to approach their duty to treat in the face of risk. This research explores how paramedics view their duty to treat during disasters. Reasons that may limit or override such a duty are examined. Understanding these issues is important in enabling paramedics to make informed and defensible decisions during disasters. The authors employed qualitative methods to gather Australian paramedic perspectives. Participants' views were analysed and organised according to three emerging themes: the scope of individual paramedic obligations, the role and obligations of ambulance services, and the broader ethical context. Our findings suggest that paramedic decisions around duty to treat will largely depend on their individual perception of risk and competing obligations. A reciprocal obligation is expected of paramedic employers. Ambulance services need to provide their employees with the best current information about risks in order to assist paramedics in making defensible decisions in difficult circumstances. Education plays a key role in providing paramedics with an understanding and appreciation of fundamental professional obligations by focusing attention on both the medical and ethical challenges involved with disaster response. Finally, codes of ethics might be useful, but ultimately paramedic decisions around professional obligations will largely depend on their individual risk assessment, perception of risk, and personal value systems.
A natural disaster will inevitably strike New Zealand in the coming years, damaging educational facilities. Delays in building quality replacement facilities will lead to short-term disruption of education, risking long-term inequalities for the affected students. The Christchurch earthquake demonstrated the issues arising from a lack of school planning and support. This research proposes a system that can effectively provide rapid, prefabricated, primary schools in post-disaster environments. The aim is to continue education for children in the short term, while using construction that is suitable until the total replacement of the given school is completed. The expandable prefabricated architecture meets the strength, time, and transport requirements to deliver a robust, rapid relief temporary construction. It is also adaptable to any area within New Zealand. This design solution supports personal well-being and mitigates the risk of educational gaps, PTSD linked with anxiety and depression, and many other mental health disorders that can impact students and teachers after a natural disaster.
