DO NOT COPY. Disasters and Pregnancy. Early Challenges. Contraception. Minimum Initial Service Package (MISP)

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1 Disasters and Pregnancy Pierre Buekens Tulane University School of Public Health and Tropical Medicine Early Challenges Minimum Initial Service Package (MISP) Prevent sexual violence Reduce the transmission of STIs/HIV Prevent excess maternal and neonatal mortality and morbidity Plan for the provision of comprehensive reproductive health services % Contraception Preevacuation Postevacuation 55 adolescents and young women in New Orleans 2 unintended pregnancies postevacuation as a result of a lack of access to care Kissinger et al.,

2 Infectious Diseases? Environmental Toxins? Folic Acid 2

3 Pacific EMPRINTS Transcript Disasters and Pregnancy Part 1 Expert: Dr. Pierre Buekens, M.D., Ph.D., M.P.H. Dean, School of Public Health and Tropical Medicine, Tulane University New Orleans, Louisiana Date: January 16, 2008 Part 1, Slide 1: Disasters and Pregnancy Opening: The following presentation was recorded at Pacific EMPRINTS 2008 Pacific Preparedness Conference: Capacity Building to Address Vulnerable Populations, which took place on January 16, 2008, at the Hilton Waikiki Prince Kuhio Hotel. Pacific EMPRINTS is honored to present Dr. Pierre Buekens, Dean of the School of Public Health and Tropical Medicine at Tulane University, giving his presentation entitled Disasters and Pregnancy. Moderator Dr. Seiji Yamada: This time I have the pleasure of introducing Pierre Buekens M.D., Ph.D., M.P.H. Professor Bueken is the Dean of the Tulane University School of Public Health and Tropical Medicine in New Orleans, Louisiana. He was recently appointed as the William Hamilton Watkins Professor of Epidemiology there. He is trained both an obstetrician, gynecologist, and an epidemiologist. He is an internationally renowned advocate for perinatal health. He is also chair for the Global Health Committee for the Association of Schools of Public Health. He has served as president of the Society for Pediatric and Perinatal Epidemiologic Research and of the Associations of Teachers of Maternal and Child Health. He is the vice president of the Association of French Speaking Epidemiologists. And he has served as a consultant to many governments and leading health organizations around the globe, including the WHO, UNICEF, the Belgian Ministry of Education, and the United Nations. Please join me in welcoming Dr. Buekens. Thank you very much indeed, thanks for the nice introduction, thank you for the invitation; it s really a pleasure for me to be here today. I m not a specialist in disaster; I m a victim I guess. That s why I became interested in the topic. I, myself, am part of vulnerable population; not only my age, but my LEP, you know, my Limited English Proficiencies. So, please bear with me today and don t hesitate to interrupt if you cannot understand my English.

4 Part 1, Slide 2: Tulane University Health Sciences Center That s our campus, it's Tulane. Not a pretty site during Katrina, it was completely flooded and it was the case as you know for the vast majority of the city. Part 1, Slide 3: Early Challenges During the aftermath of the hurricane there were a lot of early challenges we had to address. The picture on the right is the entrance to the School of Public Health with the big pipes trying to dry the first floor which was completely destroyed. But we knew it could flood, so we don t have computers there or anything; just the very expensive and fancy meeting rooms which we had to redo. And you see the National Guard in the back, taking care for the safety of the students. Because we came back very quickly and we all were able to work with all the friends came to help, and many are here today and I d like to thank them for everything they did. Part 1, Slide 4: Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations We re faced with a situation which was often described as being a developing country situation, and unfortunately we are not a developing country so things are not as organized as they would be in a developing country where, believe it or not, generally there is a very organized public health system. There is also support from agencies trained by the U.N. If we would be a developing country, probably all of us or most of us would have been trained to follow the recommendations of the inter-agency U.N. commission. We would probably have taken this course on Minimum Initial Service Package Provision for Reproductive Health in Crisis Situations. We do, in the U.S., have the equivalent, to some extent; you know some colleagues from the CDC here today have done a fantastic job in helping us and they have themselves participating in diffusing different kits and they have created different kits. But I m sure they will agree that it s a bit touchy too, when you compare that to the kind of organized preparation people going to refugee camps in developing countries often have. Because when you go to a refugee camp in a developing country, you know that you have to put emphasis on reproductive health. And you have generally taken a course or followed some sort of information. Or you have deadlines inspired by things like this package. Which is one, you know, among many. Part 1, Slide 5: Minimum Initial Service Package (MISP) When you look at what you find in these packages, and you find it in some CDC documents too. What you have to do when you have a disaster, you have to remember that reproductive health has to be an important and a key part of the package you re providing to the population. You have to remember that you have pregnant women there, you have to remember that you have women who can be

5 victims of sexual violence, you have to remember that you have to prevent sexually transmitted diseases, HIV, AIDS. You have also, of course, to prevent maternal and neonatal mortality and morbidity; you have to plan for the future, you have to do all that. I m not sure we did that, I m not sure we did that. For example, I don t think that we put a lot of emphasis on pregnant women, I don t think we put a lot of emphasis on prevention of STIs, or HIV/AIDS. When you go to a refugee camp, providing condoms, for example, is very important; I m not sure we did that. Part 1, Slide 6: Contraception We did not do a very good job at ensuring access to contraception which is also something which is now seen very important in refugee camps. And you can look at the results, we only have very touchy data to present, but Patty Kissinger in our Department of Epidemiology published an interesting paper late last year. Patty was doing a study with a group of about 60 adolescents and young women in New Orleans and the study was interrupted by Katrina. She was able to count on them after the storm; actually she was following more than 55 but she was only able to find 55. And what she found was that before the storm, almost all of them were using contraception, contraceptive methods. After the storm, only 60%, so 40% of them have lost their access to contraception. And in this small group, 2 reported an unintended pregnancy post-evacuation and they say it was the result of a lack of access to care. So what we can learn from what we do in refugee camps in developing countries is that, access to contraception, prevention of STIs, prevention of HIV/AIDS, are important components. And it s not the first thing you have in mind when you have to jump into a disaster situation; not at all, maybe it s the last thing you have in mind, you know, contraception. But that s a real problem if you don t have access to your contraception. Part 1, Slide 7: Infectious Diseases? Now, what we have in mind, it s not contraception. What we have in mind is infectious diseases. And if you are, and many of you are, specialized in disasters you know that that s the number one stereotype, the number one myth; is that infectious disease is the main risk after a disaster, after a natural disaster. I m not saying there is no risk when you put people in a shelter, you know, especially thousands of them as we did, you know you have to think about immunization. And when you think about immunization, you have to ask yourself if some of these women are not pregnant, you have to be careful there. So there is something there, but it s a minor problem, it s a minor problem. It s a problem coming from all fields. We have all these bodies transmitting infectious diseases and creating huge epidemics. Of course safe water is important, but if you look at the literature it s always the same thing; this is not the main issue, you have to take care of it, but it s not the main issue. And I was in New Orleans, and there was a complete disconnect for me between what I was living and what I was

6 reading in the media. The media were telling me, you know, it s cholera, it s malaria. Somebody called me from Africa saying Are you sure you have malaria in New Orleans? I said, I don t know. I assume so, I don t know which online magazine. And actually, we didn t have malaria. We had fewer mosquitoes after Katrina than before. They came back after that, you know, and they were different. They were different, and then we had a problem with Aedes. Just after Katrina we had very few. So all of the emphasis was on that, on vector-borne disease, on water-borne disease; it s important, but it was not our main problem. Part 1, Slide 8: Environmental Toxins? All of the emphasis was also on the toxic gumbo. You know, I hope you like gumbo and I hope you don t like it toxic. Sure we have to be careful, we continue to do studies to look at the impact of Katrina on environmental health, so there is a potential risk, but it s a potential risk. It s not something which has been demonstrated, I think, in any major disaster. You have to keep an eye on it, and people are very anxious. That s why we were very pleased that CDC supported OTIS to have a help line which pregnant women, or women having children could call to ask questions that they could have about the risk of having been potentially exposed to environmental toxins. So it s very nice that this website is there. It s still there, it s very nice that you can call OTIS. Very important, but if you look at the reality of the facts we have, infectious diseases are not the number one problem. And the exposure to environmental toxins or toxics was not the main problem either. There were problems and we do have to study them; they were not the main problems. Part 1, Slide 9: Folic Acid Actually if you look at this very issue, it s interesting. If you look at the literature on this very issue of the link between disasters and congenital malformations, because this is what this is about, right? Actually, there are a few papers suggesting a link. Do you know where they re from and what kind of link? The references I found were about the hurricane children in Jamaica and a real increase in neural tube defects. Why? Because of lack of folic acids supplementations; not supplementation, lack of intake of folic acid preconceptionally. It s okay to think about toxins and whatever, but we have to remember that, you know, the number one problem might be that after a hurricane in Jamaica is because for a long time there was no access to fresh fruit and vegetables. But in neural situation, it s more the disruption of the folic acid supplementation which can be a problem. So I m not saying we don t have to pay attention to environmental toxics, but that we can fix. And we have to think about infectious diseases, but it s not a reason to forget contraception I think. Resources:

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