Disaster Medicine and Public Health Preparedness

Medical Requirements During a Natural Disaster:

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A Case Study on WhatsApp Chats among Medical Personnel
during the 2015 Nepal Earthquake
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Journal: Disaster Medicine and Public Health Preparedness

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Manuscript ID DMPHP-16-0773.R1

Manuscript Type: Brief Report

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Date Submitted by the Author: 28-Sep-2016

Complete List of Authors: Basu, Moumita; Indian Institute of Management, Calcutta, Social
Informatics Research GRoup
Ghosh, Saptarshi; Indian Institute of Engineering Science and Technology,
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Shibpur, India, Department of Computer Science and Technology

Jana, Arnab; Indian Institute of Technology Bombay, Centre for Urban
Science & Engineering
Bandyopadhyay, Somprakash; Indian Institute of Management Calcutta,
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India, Social Informatics Research Group

Singh, Ravikant; Doctors For You, Medicine
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Disaster, Nepal 2015 earthquake, medical resource requirements, disaster

Keywords:
preparedness, medical relief strategy

Cambridge University Press

Page 1 of 11 Disaster Medicine and Public Health Preparedness

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4 Medical Requirements During a Natural Disaster:
5 A Case Study on WhatsApp Chats among Medical Personnel during the 2015
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7 Nepal Earthquake
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10 Moumita Basu, M. Tech.,
11 Department of CST, Indian Institute of Engineering Science and Technology, Shibpur, India
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Social Informatics Research Group, Indian Institute of Management Calcutta, India
14 moumitabasu0979@gmail.com
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16 Saptarshi Ghosh, PhD,
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Department of Computer Science and Technology,
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19 Indian Institute of Engineering Science and Technology, Shibpur, India
20 sghosh@cs.iiests.ac.in
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Arnab Jana, PhD,
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24 Centre for Urban Science &Engineering, Indian Institute of Technology Bombay, India
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25 arnab.jana@iitb.ac.in
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Somprakash Bandyopadhyay, PhD,
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Social Informatics Research Group, Indian Institute of Management Calcutta, India
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30 somprakash@iimcal.ac.in
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32 Dr. Ravikant Singh, MD,
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34 Doctors For You
35 ravikant.singh@doctorsforyou.org
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Address for Correspondence:
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39 Moumita Basu
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40 Indian Institute of Management Calcutta

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Joka, Diamond Harbour Road, Kolkata -700104, India
43 Phone : (Off) +91 33 2467-8300-04/13 (Extn 411)
44 (Mob) +91 9831535538
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46 Email: moumitabasu0979@gmail.com
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Short Running Title:
50 Medical Requirements during Natural Disaster
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53 Acknowledgement:
54 This research was partially supported by a grant from the Information Technology Research
55 Academy (ITRA), DeITY, Government of India (Ref. No.: ITRA/15 (58)/ Mobile/DISARM/
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57 05). We also acknowledge our human volunteers for their sincere effort in annotating the data.
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ABSTRACT
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6 Objective: The objective of this study is to explore a log of WhatsApp messages exchanged
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8 among members of a health-care group Doctors For You (DFY), while providing medical
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relief in the aftermath of the Nepal earthquake in April 2015. The motivation is to identify the
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13 medical resource requirements during the disaster, in order to help the government agencies and
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15 other responding organizations to be better prepared to address the potential medical
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18 requirements during any upcoming disaster.
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20 Methods: A large set of WhatsApp messages exchanged among DFY members during the Nepal
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22 earthquake was collected and analyzed to identify the medical resource requirements during
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different phases of the relief operations.
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27 Result: The study reveals detailed phase-wise requirement of various types of medical resources,
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including medicines, medical equipment, and medical personnel. The data also reflects some of
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32 the problems that were faced by the medical relief workers in the earthquake-affected region.
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34 Conclusions: The insights from this study might help not only the Nepal government, but also
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authorities in other earthquake-prone regions of the world, to better prepare for similar disasters
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39 in future. Moreover, real-time analysis of such online data during a disaster would aid decision
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41 makers to formulate resource-mapping strategies dynamically.
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46 Keywords: Disaster, Nepal 2015 earthquake, medical resource requirements, disaster
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48 preparedness, medical relief strategy
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INTRODUCTION:
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6 On April 25, 2015, Nepal was hit by a 7.8 magnitude earthquake, which destroyed 0.3
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8 million houses and left more than eight million people in desperate need of assistance. The
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earthquake devastated several vulnerable portions of the countrys infrastructure and debilitated
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13 90% of the local health care system and social welfare institutions.1Subsequently, many
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15 international Non-Governmental Organizations (NGOs) like CISAR, Red Cross, WHO,
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18 UNICEF, QRCS, and others moved to Nepal for providing humanitarian assistance.
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20 One of the NGOs which was actively involved in the relief operations in the aftermath of
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22 the Nepal earthquake was Doctors For You (abbreviated as DFY), a pan-India humanitarian
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organization with international presence, that focuses on providing medical care to the
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27 vulnerable communities during crisis and non-crisis situation.2The members of DFY used the
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popular social networking platform WhatsApp, which allows formation of a discussion group
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32 and exchange of short messages via smart phones, to communicate among themselves, and plan
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34 the relief operations. The present study is an in-depth analysis of these WhatsApp messages
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exchanged among the medical personnel of DFY. The primary advantage of this data is that,
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39 since it contains conversations among medical experts, there is significant amount of micro-level
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41 information about the requirement of different medical resources. In analyzing this data, the
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44 primary objectives of this work are two-fold:
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46 1) Identifying the requirement for different types of medical resources in the aftermath of an
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48 earthquake, taking the Nepal earthquake as a case-study
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51 2) Analyzing the temporal aspect of the requirements, such as what resources are required at
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53 what stage of the relief operations.
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Overall, the motivation of this study is to provide guidelines to Government / non-Government
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6 organizations about the medical requirements in the aftermath of an earthquake, which might
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8 help in better preparedness and resource mapping during future disaster events.
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There have been few prior studies on various aspects of the relief operations after the
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13 2015 Nepal earthquake, e.g., on the medical rescue operations by Chinese medical teams3,4, and
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15 on damages to buildings due to the earthquake5. Extensive research has also been carried out by
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18 medical experts on preparedness and hazard mitigation strategies in the area of disaster
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20 management.6-8However, none of the prior studies have used social media data for the purpose.
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22 In contrast, the present work relies on social media (WhatsApp) data from medical experts who
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were actually present at the site of the disaster. Hence the data is reliable, and contains detailed
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27 description of resource requirements. To the best of our knowledge, no prior study has reported
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the requirements of medical resources after a disaster in such diminutive details as in this study.
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34 METHOD:
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A WhatsApp group was formed within the members of DFY on April 27, 2015 (two days
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39 after the earthquake struck Nepal) for intra-organizational interactions. The messages posted in
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41 this group during the first 3 months after the disaster, i.e., from April 27 to July 30, 2015, were
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44 collected and analyzed. Each message contains the timestamp when the message was posted, the
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46 mobile number from which the message was posted, and the message text. The messages were
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48 first cleaned and pre-processed using computer programs. Also, Personal Identifiable
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51 Information (PII) in the messages (e.g., names, cell numbers) was substituted to preserve the
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53 privacy of the members posting the messages. The sanctified set of messages was then given to
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three human volunteers, who were asked to identify the various types of medical resources that
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6 were reported as required in the dataset.
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8 It can be noted that, apart from medical resources, the dataset also contained information
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about requirement / availability of other types of resources, such as tents, electric power sources,
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13 and so on. But in the present study, we are focusing specifically on the medical resources.
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18 Stages of the relief operation: As stated earlier, one of the objectives of this work is to analyze
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20 the temporal aspects of the resource requirements, such as what resources are required at what
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22 stage of the relief operations. To this end, the guidelines set down by the American Red
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Cross9are followed, which states that during the first three months after a disaster, the relief
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27 operations transit through the following (overlapping) stages: Heroic Phase (that occurs
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immediately after a disaster strikes), Honeymoon Phase (from about a week to six months after
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32 the disaster), Disillusionment Phase (that begins couple of months after the disaster).
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Limitations of the study: The observations made in this study are limited to the information
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39 contained in the messages exchanged among the DFY members, and do not reflect an exhaustive
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41 picture of the relief efforts in the aftermath of the Nepal earthquake. Hence, the observations in
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44 this study should be considered as indicative, and not exhaustive.
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48 RESULTS:
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51 Table 1 describes the detailed phase-wise requirements of different types of medical
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53 resources, e.g., medicines, medical equipment, and medical personnel, during different phases of
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the relief operation. The medicines have been categorized considering the essential medicine
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6 classification of the World Health Organization.10
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9 TABLE 1: Timeline-wise Aggregated Requirements for Different Resource Types
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13 Heroic phase: During the heroic phase (immediately after the earthquake), the primary focus
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15 was to deal with the earthquake-allied injuries, which essentially needed surgical dressing
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18 debridement. Thus, the requirements include appliances typically related to surgical support and
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20 orthopaedics like x-ray, implant, implant fixator, plasters, spinal needles, and anaesthetics.
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Urgent necessity of ventilators was evident, since a large number of trauma patients from several
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27 earthquakes affected districts of Nepal were in need of ventilator support. Requirement of
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supplementary food for infants was also manifest.
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32 There was also a huge requirement of doctors and medical personnel, because a large
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34 fraction of the resident medical personnel were themselves affected by the earthquake. Primarily,
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Orthopaedic Surgeons, Anaesthetists, Gyneochologists, and Emergency Medicine Specialists
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39 were required to deal with earthquake-related injuries and maternal death. Occupational
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41 Therapists were also needed for helping people come out of trauma resulting from the disaster.
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46 Honeymoon phase: A week after the earthquake, in the Honeymoon Phase, infection of
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48 respiratory tract, gastrointestinal tract, and skin were the most common ailments, leading to the
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51 requirement of Anti-Infective Medicines, Gastrointestinal Medicines and Inhalers. Further, some
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medicines and surgical equipment. The multiple earthquakes had a large impact on water
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quality. Consequently, Disinfectants like chlorine tablet or chlorine solution were needed to
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6 disinfect the water to avert the probable spread of diarrhoeal diseases. Furthermore, requirements
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8 of orthopaedic equipment and consumables were observed in this phase due to large number of
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11 secondary infection or wound infection cases coming to hospitals from various districts of Nepal.
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13 Among medical personnel, primarily Psychologists and Physiotherapists were sought,
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15 along with Gyneochologists. However, need for orthopaedic doctors were not as acute as in the
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18 heroic phase, since most injuries had been operated within the first week after the earthquake.
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20 Additionally, preventing maternal deaths, ante-natal care, safe delivery services, and
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post-partum care for pregnant woman were of prime concern during the heroic and honeymoon
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phases. Hence, resources like cord clamps, labor room equipment, Oxytocics and Antioxytocics
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27 were in demand. According to UNICEF, three-fourths of the pregnant women in Nepal were
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30 anemic, thus requirement of Medicines affecting the blood, i.e., drugs like Iron folic acid tablets
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Disillusionment Phase: In the Disillusionment Phase also, several aftershock earthquakes hit
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39 Nepal, leading to the need for First Aid kits and Medicines for Pain and Palliative Care.
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41 Additionally due to the trauma of aftershocks several team members of DFY as well as
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44 earthquake victims could not sleep peacefully at night. Therefore, Post-traumatic Stress Disorder
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46 Medicine was entailed to improve mental health of the victims as well as volunteers.
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Furthermore, due to heavy rainfall and flooding from the monsoon, there was spread of food-
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53 Medicines and Anti-Infective Medicines were sought. A wide range of medicines and kits were
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Dermatological Medicines, Medicines Affecting The Blood, Antiallergics, Delivery and Preterm
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6 Infants Care Unit, and so on. There was still a large requirement of medical personnel, especially
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other Support Staff.
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15 DISCUSSION:
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18 In this research, we attempted to analyze the requirement of medical resources that
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20 emerge post an event like the Nepal earthquake. Apart from the requirement of resources, the dataset
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sources, problems in transportation of medical personnel and supplies, difficulty in operating hospitals
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27 due to unavailability of electric power, stress-related issues of the relief workers themselves, and so on.
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35 medical personnel, but also alternative power sources need to be arranged for, so that hospitals can
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operate even without electricity.
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42 Disaster Risk Management in Nepal. Furthermore, the study can provide invaluable inputs for
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preparatory provisioning of various medical resources at earthquake-prone regions, so that they
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47 can be readily available in the event of a disaster. Thus, it is hoped that, the observations in this
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49 study would help authorities in not only Nepal but also other earthquake-prone regions to better
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prepare for resource mapping during similar disasters in future.
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CONCLUSION:
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6 This post-hoc study analyzes a dataset of WhatsApp messages exchanged among
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8 members of Doctors For You in the aftermath of the Nepal earthquake in April 2015. In
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contrast to prior works, the data in this study is more reliable since it is obtained from medical
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13 experts who are known to have been present at the disaster site. The main contribution of the
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15 study is the identification of the requirements of various medical resources, during different
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18 phases after the disaster.
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20 The study also demonstrates that real-time (i.e., actually during the disaster) analysis of
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22 such online data would aid decision makers in forming resource mapping strategies dynamically.
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These results could then assist disaster management authorities in assessing the requirement,
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27 allocating resources, providing logistic support in real time, which in turn will reduce loss of
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human life during disasters.
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34 REFERENCES
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1. Peleg K. Notes from Nepal: Is There a Better Way to Provide Search and Rescue?
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39 Disaster Med Public Health Prep.2015;9(6):650-652. doi:10.1017/dmp.2015.107.
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41 2. Welcome to DFY. Doctors For You. http://doctorsforyou.org/content.php? subpageid=11.
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44 Published 2013. Accessed July 3, 2016.
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46 3. Yang J, Yang Z, Lv Q, et al. Medical Rescue of China International Search & Rescue Team
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48 (CISAR) in Nepal Earthquake. Disaster Med Public Health Prep. 2016;10:1-4.
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51 doi:10.1017/dmp.2016.16.
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4. Wang J, Ding H, Lv Q, et al. 2015 Nepal Earthquake: Analysis of Child Rescue and
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6 Treatment by a Field Hospital. Disaster Med Public Health Prep. 2016;10:1-3.
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8 doi:10.1017/dmp.2016.22.
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5. Goda K, Kiyota T, Pokhrel RM, et al. The 2015 Gorkha Nepal earthquake: insights from
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13 earthquake damage survey. Frontiers in Built Environment. 2015;1:1-15.
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15 doi:10.3389/fbuil.2015.00008.
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18 6. Fukasawa M, Suzuki Y, Nakajima S,et al. Systematic Consensus Building on Disaster
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20 Mental Health Services After the Great East Japan Earthquake by Phase. Disaster Med
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22 Public Health Prep.2015;9(4):359-366. doi:10.1017/dmp.2015.13.
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7. Jamshidi E, Majdzadeh R, Namin MS, et al..Effectiveness of Community Participation in
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27 Earthquake Preparedness: A Community-Based Participatory Intervention Study of Tehran.
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Disaster Med Public Health Prep. 2016;10(2):211-218. doi:10.1017/dmp.2015.156.
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32 8. A Schultz CH, Koenig KL, Noji EK. A Medical Disaster Response to Reduce Immediate
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34 Mortality After An Earthquake. N Engl J Med.1996;334:438-
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444.doi:10.1056/NEJM199602153340706.
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39 9. Understanding the Four Phases of Disaster Recovery. Duanes Dartboard.
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41 https://duanehallock.com/2010/01/27/phases-of-disaster-recovery/. Accessed July 04, 2016.
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44 10. World Health Organization. 19th WHO Model List of Essential
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46 Medicines.http://www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-
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48 15.pdf. Published April 2015. Accessed July 04, 2016.
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TABLE 1: Timeline-wise Aggregated Requirements for Different Medical Resources
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5 Timeline Medical resources required
6 Medicines: Anesthetics (e.g., Ketamine), Oxytocics and Antioxytocics (e.g., Misoprostol),
7 Medicines affecting the blood (e.g., Iron Folic Acid), Anti-Infective medicines
8 April 28-
9 May 03
Medical equipment: Ventilators, Spinal Needles, Cord Clamps, Labor Room equipment,
10 Supplementary Foods, Digital X-Rays, Implants, Surgical Appliances,
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12 PHASE
Medical personnel: Gyneochologists, Anesthesiologists, Emergency Medicine Specialists,
13 Orthpaedic surgeons, Physiotherapists, Occupational Therapists
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15 Medicines: Anti-Infective medicines (e.g., Ciprofloxacin, Albendazole, Antifungal Ointments, IV
16 Fluids), Medicines affecting the blood (e.g., Folic Acid, Iron supplement), Vitamins and Minerals
17 (e.g., Calcium, Vitamin A, Multivitamin), Oxytocics and Antioxytocics (e.g., Misoprostol),
18 May 04- Disinfectants (e.g., Chlorine Tablets, Medichlor Chlorine Solution), Inhalers (e.g.,
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19 May 31 Bronchodilators), Medicines for diseases of joints (e.g., Allopurinol), Gastrointestinal medicines
20 (e.g., ORS)
21 HONEYM
22 OON Medical equipment: Ventilators, Muac Strip, Ortho Equipment, ambulance, telemedicine, C-
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23 PHASE Arm Machine
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27 Medicines: Gastrointestinal medicines (e.g., Zinc Sulphate, Lactobacilles , ORS powder),
28 Medicines for pain and palliative care (e.g., Aceclofenac, Paracetamol),
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29 Anti-Infective medicines (e.g., Neomycin + Bacitracin Ointment, Cotrimoxazole Powder for oral
30 suspension, Sulfamethazole, Trimethropium, Cefixime Syrup, Moxifloxacin Vaginal Pessaries,
31 Skin Ointments, Antifungals Ketoconazole Cream, Cotrimazole Cream, Albendazole, Monostat
32 Antifungal Cream for Vaginal Itching, Abacavir, Metro Tab),
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33 First aid kit (e.g., Tongue Depression Wood, Alcohol Swabs, Cotton Ball, Antacid Syrup,
34 June 01- Gentamycin Cream, Volini Gel, Soaps, Tongue Depressor, Talcum Powder),
35 July 31 Inhalers, Dermatological medicines (topical) (e.g., Silver Sulfadiazine Cream 1%, Permethrine
36 Cream, Calamine Lotion, Hydro Corticosteroid Ointment),
HONEYM Medicines affecting the blood (e.g., Tonopheren Syrup, Iron Tablets),
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38 OON + Antiallergics (e.g., Cetrizine), Post-traumatic stress disorder medicine (e.g., Paroxetine Tab),
39 DISILLUSI Vitamins And Minerals (e.g., Calcium Tablets, Multivitamin, VitaminA, B complex, C, D3
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40 ON-MENT Sachet, E), Zytee Gel, Cough Syrup

41 PHASE
42 Medical equipment: Delivery and Preterm Infants Care Unit (e.g., Labor Room, Newborn
43 Corner, Focus Lights (Episiotomy Lights), Number 0 Mask (Preterm), Incubator Repair Adult
Ambu with Mask Mixter, Forceps for OT (Internal Iliac Ligation)), BP Apparatus, Glucometers,
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Hygiene Kits, Delivery Kits, Dressing Kits
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Medical personnel: Emergency Medicine Specialist, Paediatrician, Gyneochologist,
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Anaesthetist, Doctors, Nurses, Support staff
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