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Orientation for volunteers going into flood affected areas Dr. Narmeen Hamid Idara-e-Taleem-o-Agahi Lahore, September 2011 Objectives To prepare you about what to ... – PowerPoint PPT presentation

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Title: Orientation%20for%20volunteers%20going%20into%20flood%20affected%20areas

Orientation for volunteers going into flood
affected areas
  • Dr. Narmeen Hamid
  • Idara-e-Taleem-o-Agahi
  • Lahore,
  • September 2011

  • To prepare you about what to expect
  • To enable you to support the survivors in a
    sensitive and appropriate way
  • To optimize your time and the resources at your
    disposal by helping you function effectively,
    intelligently and in an organized way
  • To enable you to give a message of strength, hope
    and solidarity and to empower the survivors
    rather than make them dependent.

What to expect
  • Situation constantly changing depending on
  • Water level
  • Resources available
  • When rescue and aid teams have arrived
  • So important to think on your feet and assess
    situation on the ground

If the situation is acute Prioritize
  • Rescue
  • Shelter
  • First aid and prioritization of vulnerable groups
    like children, elderly, pregnant women and the
  • Food

If the situation is more stable
  • Health
  • Hygiene (personal, food)
  • Water
  • Sanitation
  • Womens specific needs
  • Childrens specific needs

Physical Health Problems
  • Gastro-intestinal infections (water borne,
    faeco-oral route, poor hygiene)
  • Vector borne, like malaria, dengue
  • Respiratory infections
  • Skin infections/eye infections
  • Insect and snake bites
  • Injuries

Mental Health/Psychological Problems
  • Grief, depression, despondency, hopelessness,
  • Fear, anxiety, nervousness, worrying
  • Guilt (for surviving, for not having been able to
    save others, etc.)
  • Feeling helpless and vulnerable
  • Sleep disturbances insomnia, bad dreams,
  • Irritability, moodiness, anger
  • Repeated flashbacks feelings of re-living the
    experience, often accompanied by anxiety
  • Increased marital conflict or other interpersonal
  • Difficulty concentrating, remembering slow
  • Difficulty making decisions and planning
  • Feelings of being detached from your body or from
    your experiences, as if they are not happening to
  • Feelings of ineffectiveness, shame, despair,
  • Self-destructive and impulsive behaviour
  • Suicidal ideation or attempts
  • Positive reactions such as acceptance, hoping,
    planning for the future, involvement in support
    operations and activities
  • Physical manifestation of mental
    stressHeadaches, digestive problems, diffuse
    muscular pains, sweats and chills, tremors

So How Can You Help?
Initial management of physical illnessPrior to
referral to doctors/medical camp
  • Diarrhoea/dehydration ORS/rice water/home made
  • Fever medication
  • Insect bites anti-allergic, creams like fucicort
  • Cuts, grazes cleaning and bandaging
  • Boils, skin lesions clean, apply disinfectant
    like dettol, gentian violet

Preventive Measures Hygiene Education
Clean Water perhaps the most important
intervention of all
  • Options
  • Bottled water
  • Water purifying tablets/sachets
  • Boiling
  • Chemical dis-infection
  • Sunlight (letting the water stand in sunlight for
    a few hours)

Chemical Dis-infectionExamine the physical
appearance of the water.When emergency
dis-infection is necessary, disinfectants are
less effective in cloudy, murky or colored water.
Filter murky or colored water through clean
cloths or allow it to settle. It is better to
both settle and filter. After filtering until
it is clear, or allowing all dirt and other
particles to settle, draw off the clean and clear
water for dis- infection. Water prepared for
dis-infection should be stored only in clean,
covered, containers, not subject to
corrosion.Chemical dis-infection with
chlorine/iodine (details in next slide)
Method of Chemical Dis-infection
  • Chlorine (in the form of unscented bleach) and
    iodine are the two chemicals commonly used to
    treat water.
  • Filter murky or colored water through clean
    cloths or allow it to settle. It is better to
    both settle and filter. Leave out in the sun for
    6-8 hours.
  • You can use a non-scented, household chlorine
    bleach that contains a chlorine compound to
    disinfect water. (1/8 teaspoon or 8 drops in one
    litre of water. One standard bucket contains
    approx. 8 litres therefore one teaspoon in one
  • You can use tincture of iodine to disinfect
    filtered and settled water. Common household
    iodine from the medicine chest or first aid kit
    may be used to disinfect water. Add 5 drops per
  • For both, mix thorougly and then let the solution
    stand for at least 30 minutes before using.
  • Phatkari (alum) can be used to clear turbid
    water, which can then be filtered.
  • When buckets are not available, clay gharras are
    good for this purpose.

Personal hygiene
  • Wash hands with soap, after using the toilet,
    before and after eating
  • Cut nails
  • If available, advise use of miswaak for oral
  • Where possible advise washing, changing of dirty
  • Advise special care of spaces between fingers and
    toes, where fungal infections will grow. Need to
    keep clean and dry.

Food Hygiene
  • Inspect food that is being cooked
  • How is it being served? Are plates being used?
    Are they being washed? Is food coming in plastic
    bags? How are the bags being disposed?
  • Encourage all lactating mothers to continue
    breast feeding. Facilitate by providing private
    place. This can be a life saving measure for

Waste Disposal
  • Three categories of waste disposal in the field
  • Human waste faeces and urine
  • Liquid waste liquid kitchen and bath waste
  • Rubbish combustible and non-combustible solids

Human Waste DisposalTypes of Latrines
  • 1. Cat-hole latrine
  •  A hole approximately one foot deep and one foot
    in diameter
  •  After use, a cat-hole must be completely filled
    in and the dirt packed down      
  • 2. Straddle trench latrine
  •  If people remaining in one place for up to three
  •  Trench is dug one foot wide, two and one half
    feet deep and at least four feet long
  •  Multiple trenches should be dug at least two
    feet apart

  • Bore hole latrineThis type of latrine is
    constructed where the space available is very
    little. It consists of a circular hole of 0.30 to
    0.40 m diameter and 5.0 to 6.0 m deep, dug in the
    ground by means of auger. The bore hole is
    covered with a suitable concrete squatting slab
    with a central opening and foot rests of about
    0.85 m dia. Once the bore is filled up, the
    squatting slab and the super structure have to be
    moved to a new bore and the old bore should be
    filled up with the earth excavated from the new
    bore. Disadvantages with this type of latrines
    are foul smell and breeding of flies and
  • Burnout latrines
  • Suited to areas with high water tables, but can
    also be used when the ground is hard or rocky and
    digging is difficult or impossible
  • A burnout latrine is in use one day and burned
    out the next, so take this into consideration
    when planning the number required
  • For all latrines, ensure there is provision of
    safety and privacy for women, wherever possible a
    separate location for them.

Disposal of liquid waste from kitchen, washing,
bathing etc.
  • Soakage pits
  • Four square feet and four feet deep
  • If there are 200 or more people it is recommended
    that you have two soakage pits
  • Close soakage pit with compacted soil to keep
    away vermin and pests

Garbage and Rubbish Disposal
  • Garbage
  • Food waste that occurs during food preparation,
    cooking and serving
  • Classified as either dry or wet
  •  Rubbish
  • Non-food waste that usually comes from kitchens
  • Classified as either combustible or
  • Garbage and rubbish are disposed of in one of two
    ways burial or incineration
  • After burial, compacting the earth is very
    important. Doing so prevents flies and rodents
    from entering or exiting the pit.

Vector and pest control
  • Mosquitoes, flies, rats will become a problem in
    these areas.
  • For mosquitoes, see if local authorities can
    spray stagnant water with disinfectants or if
    mosquito nets are available.
  • Mosquito repellants (cheap versions are available
    if bought in bulk). The desi totka is tara meera
    ka tel
  • An alternative technique could be a smoke fire
    with wet sticks which may be tried near disposal
    pits. Desi technique dhooni with local
    leaves/cow dung cakes
  • Keep drinking water covered.

Dealing with corpses
  • You may come across human and animal dead bodies.
  • Contrary to common belief, there is no evidence
    that corpses pose a risk of disease "epidemics"
    after natural disasters. Most agents do not
    survive long in the human body after death (with
    the exception of HIV -which can be up to 6 days)
    and the source of acute infections is more likely
    to be the survivors. Human remains only pose
    health risks in a few special cases requiring
    specific precautions, such as deaths from cholera
    or haemorrhagic fevers.
  • However, workers who routinely handle corpses may
    have a risk of contracting tuberculosis,
    bloodborne viruses (such as Hepatitis B/C and
    HIV), and gastrointestinal infections (such as
    rotavirus diarrhoea, salmonellosis, E. coli,
    typhoid/paratyphoid fevers, hepatitis A,
    shigellosis and cholera).
  • The public and emergency workers alike should be
    duly informed to avoid panic and inappropriate
    disposal of bodies, and to take adequate
    precautions in handling the dead . Wash hands
    thourougly after handling.
  • These bodies need to be given respectful and
    proper burials

Womens needs
  • Privacy
  • Menstruation what to use, how to dispose
  • Pregnancy
  • Child birth sterile razor and string essentials
  • Lactation

Childrens needs
  • Trauma
  • Fear
  • Hunger
  • Illness
  • They need special handling.

Working with children
  • Childrens reactions
  • After a stressful experience involving loss,
    childrens grief is often abrupt and they may
    switch quickly from intense grief reactions to
    play and having fun. Almost all children play,
    even if they have gone through an intense crisis
  • Younger children may behave aggressively towards
    caregivers or other children, while at the same
    time cling to their caregivers and show signs of
    separation anxiety. There may be changes in
    behaviour, e.g. regression to the behaviour of
    younger children such as bedwetting, thumb
    sucking, or not being able to sleep alone. This
    shows loss of trust. In such situations, stable
    and secure relationships are very important

  • Supporting children
  • In a crisis situation, keeping up daily routines
    best supports children. Restore a certain kind of
    routine as soon as possible, such as maintaining
    eating and sleeping routines. Celebrate birthdays
    and special occasions if possible.
  • Children need as much normality, play and fun as
    possible and to be given a chance to regain their
    feelings of trust and safety. It is important
    that caregivers fulfill their roles as before,
    and dont let the children take on adult roles.

  • Children need to know
  • Children and adolescents need information about
    what has happened in an age appropriate manner.
    They should be encouraged to ask questions.
  • Talking is important, however children should not
    be overwhelmed with information that they did not
    ask for. It is important to be honest and to use
    words that children understand. Avoid letting
    children hear adult-talk about frightful things
    and do not let them watch upsetting news stories
    on TV.

  • Techniques that will help children
  • Drawings/Art Take paper and coloured pencils
    with you
  • Games with a bat and a ball
  • Board games like luddo
  • Story telling

Providing Emotional Support
What about your feelings and attitude?
  • Our feelings, beliefs and attitudes towards the
    people we work with have important implications
    for the quality of support we provide. Our
    attitudes are expressed through our behaviour,
    tone and words when communicating with people. We
    need to be aware of this and make an effort to
    challenge unhelpful attitudes and to learn skills
    that empower (give power to) rather than
    disempower (take power away from) the community.
  • For example, do we think of these people as flood
    victims or survivors?
  • Do we consider them helpless, dependent on our
    help, or do we think they have the power to help
  • Do we consider ourselves helpless in the face of
    this great tragedy and therefore not giving out a
    message of strength?
  • Are we mentally strong enough to handle such a
    situation and to be able to bear possible anger,
    non-cooperation, depression, extreme emotions?

Objectives of emotional support
  • Specific objectives of emotional support
    provision are to create and sustain an atmosphere
  •  Safety
  • Calm
  • Connectedness
  • Recovery and resilience
  • Self-efficacy and self-confidence
  • Empowerment
  • Hope and motivation

Techniques for emotional support
  • Making the survivor comfortable
  • Building trust
  • Listening and validation
  • Showing genuine support and concern (but not
    getting emotional yourself)
  • Giving them space to express emotions
  • Stroking Stroking refers to praising the survivor
    for taking constructive action. Distressed people
    are often unsure of their own abilities. Stroking
    them is a form of encouragement, reassurance and
    reinforcement, thus enhancing their
    self-confidence and sense of self-control. Every
    little step that the survivor takes in a positive
    direction is worth acknowledging through
    statements such as, Well done! I can see that
    you're working very hard on this."
  • Giving information
  • Empowering them by encouraging them to make their
    own choices and empathising.

  • Empathy , or an understanding of the
    situation from the survivors point of view, is a
    very important skill for the support worker.
    Empathy is different from sympathy, which
    involves an element of pity. Sympathy can be
    disempowering as it places an immediate distance
    between the listener and the speaker and gives
    the message that the survivor has been through
    something unique, something that the listener
    cannot comprehend. Empathy, on the other hand,
    has an empowering message within it that the
    worker is with the survivor, that s/he is trying
    to look at things from the survivors point of
    view and that s/he understands. This does not
    mean that the listeners feeling is trivialised
    as something that everyone goes through, but that
    the emotion is understandable and natural and not
    something extraordinary and strange.

This table will help you understand the
  • Empathy
  • I can understand what you are going through
  • I can understand that you are feeling angry at
    what has happened to you
  • I can see you are scared its natural to feel
    scared at a time like this
  • Simply sitting in silence while the survivor
    talks or cries
  • Sympathy
  • Poor you, it is bad that this has happened to you
  • It is horrible that this has happened to you
  • Dont be scared Im here to help you
  • I am so sorry for you, dont worry, everything
    will be fine, please dont cry

How will you organize yourselves?
  • Dont go if you are not accompanied by some sort
    of material help. The need is too acute for
    people to accept only verbal support right now
  • Go as a team
  • Divide tasks between members
  • Make a check list based on what you have learnt
    today and assess situation according to that
  • Assess the needs and the resources. Address the
    gaps and take over the job that no one else is
  • In all tasks, prioritize vulnerable groups who
    cannot fight for food or other support.children,
    elderly, pregnant women, disabled

Check List
  • Food availability, distribution, hygiene
  • Health first aid, personal hygiene
  • Water
  • Waste disposal
  • Vector and pest control
  • Women pregnant, other issues
  • Children games, establishing routines
  • Emotional support
  • Documentation

  • It is very important to document the following
  • No. of families/total number of people
  • No. of pregnant women
  • No. of children under 5
  • No. of disabled
  • No. of people needing medical assistance (if
    possible also note what kind, eg. X no. of people
    suffering from diarrhoea, y from skin infections
  • No. of school going children
  • From our check list, see which needs are being
    met and which are notput ticks or crosses
    against each
  • This will help in planning and allocating
    resources and in letting authorities know where
    and what kind of help is needed.

Document the relief items you are taking
  • Please make a list of the things you are taking
    and the services you have provided during your
    trip so that these can be duly acknowledged and
    put up on our website and regular updates.
  • This helps keep everything transparent as
    well as informing the organizers regarding which
    needs are being met and where gaps still exist

Ways to empower survivors
  • Educate and Delegate
  • For every responsibility that one of you assumes,
    find a member from the community that you will
    hand over the task to before you leave
  • If possible make a committee of elders (including
    women) that can take charge
  • If aid items are not enough for everybody let the
    committee decide how to prioritize and let them
    distribute in your presence.
  • Respect and make an effort to explore local
    wisdom and totkas eg they may already be
    practicing water purification of some sort,
    harmals etc.
  • Remember you are there to help them help

Leave with a message of solidarity, support and
  • We shall overcome this
  • together!
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