Saúde Mental e Apoio Psicossocial em Emergências Humanitárias: uma análise crítica entre políticas e práticas atuais de assistência / The Political Economy of Mental Health and Psychosocial Support in Humanitarian Emergencies a critical analysis of current practices

Existe uma tensão extraordinária no sistema humanitário: crises e emergências atingem cada vez mais povos, duram mais e são gradativamente mais complexas. As consequências dos conflitos armados e desastres socioambientais para a saúde mental e bem-estar psicossocial de indivíduos e povos, bem como para a ecologia social e os recursos comunitários significativos, já são reconhecidas e continuamente pesquisadas. Esta tese, a seu turno, explora as práticas e políticas do setor de Saúde Mental em emergências humanitárias e toma como ponto de partida analítico o desenvolvimento das Diretrizes do Comitê Permanente Interagências (IASC) em Saúde Mental e Apoio Psicossocial (SMAPS) em emergências humanitárias, lançadas no ano de 2007, assim como sua subsequente disseminação e configuração de governança, além de sua influência sobre projetos e instituições. As diretrizes IASC representam um marco lógico de importante contribuição para o setor de ajuda humanitária, no entanto, ainda constituem um campo de várias disputas e paradoxos, não só na área das referências teóricas e práticas em SMAPS em emergências humanitárias, como também relativamente à sua inserção em uma economia-política do setor de ajuda humanitária paradoxal nos princípios humanitários e éticos. Essa inserção molda as características particulares do funcionamento das Diretrizes e influencia a maneira como se produzem práticas e políticas. Fundamentando-se na pesquisa-ação, nas experiências do autor, o qual atuou como psicólogo na linha de frente em crises humanitárias na Líbia, Gaza, Síria, Timor-Leste e outros contextos, e em entrevistas com atores internacionalmente renomados e responsáveis pela elaboração e gestão de políticas internacionais do setor global de SMAPS, esta tese examina esse processo em detalhe, considerando o desenvolvimento e evolução das Diretrizes IASC de SMAPS e como, atualmente, a área de SMAPS se configura no interior da economia-política do setor humanitário. Mais explicitamente, analisam-se as maneiras como o discurso e a prática do setor de SMAPS são transformados pela estrutura humanitária que ele engendra. Desse modo, e por meio da discussão de todos esses elementos, este trabalho objetiva realizar uma revisão de elementos que influenciam e permitem o desenvolvimento de assistência humanitária seja cooptada em formas particulares que se articulam a interesses não humanitários, moldando substancial e prejudicialmente os projetos de SMAPS em emergências humanitárias ao redor do mundo

There is extraordinary strain placed on the humanitarian system. Crises and emergencies are occurring more often, affecting more people, and in contexts of increasingly complexity. The impacts of conflict and disaster on mental health as well as on the social ecology and community resources needed for coping and recovery are very well documented. This research explores the politics of mental health and psychosocial programmes in humanitarian settings, and its analytical starting point is the development of the Interagency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS) in Emergencies settings launched in the year of 2007. The research explores how the field was developed, its structural governance, trying to explore the political economy configuration of humanitarian organizations providing MHPSS in its discourses, practices and impact. It is demonstrated the MHPSS IASC guidelines unprecedent contribution to the field, however it shows how it is affected by the political economy of aid that it is fundamentally part of. This structural political economy shapes the field and influences the way SMAPS is provided. Using action research, the author\'s own experiences responding to several humanitarian crises for more than 14 years, and interviews with well-known global MHPSS policy makers, this thesis examines this process in detail, considering how the development of the guidelines has developed and evolved, and how the area currently shapes in the political economy of aid. More explicitly, it analyzes the ways in which the discourse and practice of the MHPSS field are transformed by the humanitarian structure it engenders. Despite the field achievements, action research illustrates that this process allows the development of MHPSS response to be co-opted in particular ways that articulate non-humanitarian interests, substantially and harmfully influencing the MHPSS responses

Cooperación internacional ¿en qué estamos y hacia dónde vamos? / International cooperation. Where are we, and where are we heading to?

Unmet needs in global health are important issues, not yet solved by the international community. A variety of individuals, non-governmental organizations (NGO) and government institutions have tried to address this situation, developing multiple types of international cooperation (IC), such as humanitarian aid (HA), cooperation for development (CD) and medical missions (MM). In the last decades, we have witnessed an exponential growth in the creation and participation of these projects. Moreover, in the last 20 years, Chile has experimented a real paradigm switch, from a receiver to a provider of IC. Due to the recent surge in interest and relevance of the topic, we performed a narrative revision of the literature related with IC. In the present article, we characterize the different types of IC, with emphasis in MM: we address the risks, controversies and ethical problems associated with these activities. We finally propose some guidelines for the future development and promotion of MM.

Medical equipment donations in Haiti: flaws in the donation process / Donaciones de equipo médico en Haití: fallas en el proceso de donación

El terremoto de magnitud 7,0 que azotó a Haití el 12 de enero del 2010 devastó la capital, Puerto Príncipe, y sus alrededores. Los hospitales del área afectada sufrieron daños estructurales importantes y pérdidas materiales. El Proyecto Hope procuró reconstruir el equipo médico y la capacidad de ingeniería clínica del país. Un equipo deingenieros clínicos de Estados Unidos y Haití realizó un inventario y una evaluación del equipo médico en siete hospitales públicos afectados por el terremoto. El equipo encontró que solo 28% del equipo estaba funcionando adecuadamente y se usaba para la atención de los pacientes; otro 28% funcionaba pero no se empleaba por razones técnicas; 30% del equipo no funcionaba, pero podía repararse; y 14% no funcionaba y no podía repararse. La proporción de equipo en cada categoría fue similar, independientemente de que el equipo estuviera presente antes del terremoto o se hubiera donado después. Esta evaluación señala las fallas en el proceso de donación de equipo médico y recalca la importancia de los factores que implica una donación completa de equipo médico, ya delineados por la Organización Mundial de la Salud hace más de un decenio.

The magnitude 7.0 earthquake that struck Haiti on 12 January 2010 devastated the capital city of Port-au-Prince and the surrounding area. The area’s hospitals suffered major structural damage and material losses. Project HOPE sought to rebuild the medical equipment and clinical engineering capacity of the country. A team of clinical engineers from the United States of America and Haiti conducted an inventory and assessment of medical equipment at seven public hospitals affected by the earthquake. The team found that only 28% of the equipment was working properly and in use for patient care; another 28% was working, but lay idle for technical reasons; 30% was not working, but repairable; and 14% was beyond repair.The proportion of equipment in each condition category was similar regardless of whether the equipment was present prior to the earthquake or was donated afterwards. This assessment points out the flaws that existed in the medical equipment donation process and reemphasizes the importance of the factors, as delineated by the World Health Organization more than a decade ago, that constitute a complete medical equipment donation.

El terremoto de 2010 en Chile: respuesta del sistema de salud y de la cooperación internacional / The 2010 earthquake in Chile: the response of the health system and international cooperation

OBJETIVO: Conocer la respuesta que dieron el sistema de salud y la cooperación internacional a la situación de catástrofe generada por el terremoto y el tsunami ocurridos el 27 de febrero de 2010 en Chile, y elaborar propuestas para mejorar las estrategias dirigidas a reducir los efectos devastadores de los desastres naturales. MÉTODOS: Estudio descriptivo y cualitativo con una primera fase de análisis de información secundaria -como artículos de prensa, discursos oficiales e informes técnicos- y una segunda fase de aplicación de entrevistas semi-estructuradas a actores institucionales encargados de la respuesta al desastre desde el sector salud y a usuarios del sistema de salud que actuaron como líderes y/o dirigentes en dicha respuesta. La investigación se desarrolló entre mayo y octubre de 2010 y el levantamiento de información se focalizó en las regiones Maule, Bío Bío y Metropolitana. RESULTADOS: Faltaron procedimientos para el registro, la distribución y el control de las donaciones. Los servicios de salud sufrieron daños importantes, incluida la destrucción total de 10 hospitales. Los hospitales de campaña y los equipos médicos extranjeros fueron valorados por la comunidad. El modelo de salud familiar y el compromiso del personal facilitaron la calidad de la respuesta. Si bien hubo un buen manejo sanitario, se registraron dificultades para enfrentar los problemas de salud mental por la inexistencia de planes locales y de simulacros previos. La población más afectada fue la que vivía en condiciones de pobreza. Las mujeres se convirtieron en líderes sociales organizando a la comunidad. CONCLUSIONES: Aun cuando la respuesta sanitaria frente a la emergencia fue satisfactoria, tanto el sistema de salud como la movilización de la asistencia internacional acusaron falencias que reforzaron inequidades previamente instaladas, demostrando la necesidad de construir planes preventivos multisectoriales y participativos para estar mejor preparados frente a los desastres.

OBJECTIVE: Understand the health system and international cooperation response to the catastrophic situation left by the earthquake and tsunami of 27 February 2010 in Chile, and draft proposals for improving strategies to mitigate the devastating effects of natural disasters. METHODS: Descriptive and qualitative study with a first phase involving the analysis of secondary information-such as news articles, official statements, and technical reports-and a second phase involving semistructured interviews of institutional actors in the public health sector responsible for disaster response and users of the health system who acted as leaders and/or managers of the response. The study was conducted between May and October 2010, and information-gathering focused on the Maule, Bío Bío, and Metropolitan regions. RESULTS: Procedures for recording, distributing, and controlling donations were lacking. The health services suffered significant damage, including the complete destruction of 10 hospitals. The presence of field hospitals and foreign medical teams were appreciated by the community. The family health model and the commitment of personnel helped to ensure the quality of the response. While public health management was generally good, problems dealing with mental health issues were encountered due to a lack of local plans and predisaster simulations. The poor were the most affected. Women became social leaders, organizing the community. CONCLUSIONS: Although the health response to the emergency was satisfactory, both the health system and the mobilization of international assistance suffered from weaknesses that exacerbated existing inequities, revealing the need for multisectoral participatory mitigation plans for better disaster preparedness.

Abordajes frente al terremoto y tsunami del 27 de febrero del 2010: experiencia de la Sociedad Chilena de Psicología Clínica (SCPC) / Interventions after the hearthquake and tsunami of February 27/2010: the experience of the Sociedad Chilena de Psicología Clínica (SCPC)

En el presente artículo se describe de forma sintética las actividades realizadas por la Sociedad Chilena de Psicología Clínica posteriormente al terremoto y tsunami del 27 de Febrero del 2010, en la zona sur y centro de Chile. Dentro de éstas se presenta la coordinación de capacitaciones a psicólogos y equipos de salud que trabajaron en terreno, preparación de material escrito que fue entregado a la población en la ciudad de Santiago y el trabajo conjunto con la Policía de Investigaciones en la difusión de información al público en la zona cero de Talcahuano. Finalmente se reflexiona acerca de la necesidad de encontrarnos preparados para actuar frente a situaciones de desastre natural, especialmente dada la constitución geográfica de nuestro país. Se hace evidente desde allí incorporar en las mallas curriculares de las diversas escuelas de psicologías, cursos o al menos unidades centradas en estrés post traumático, sus abordajes y tratamientos, así como situaciones de emergencias, catástrofes y acciones orientadas a su afrontamiento.

The next article describes in systematic form the activities done by Chilean society of clinical psychology after the earthquake and the tsunami which were on February 27th of 2010, in the south and center zone of Chile. Inside this, it's presents coordination of trainings to psychologists and health's equipments who worked in area, preparation of written material that was delivered to the people in Santiago city and the work with Investigation Police in the diffusion of information to public in the Talcahuano zero zone. Finally, it is thought over about the need to be prepared to react in front of natural disaster situations, especially for geographic constitution that have our country It's evident incorporate in the curricular meshes of the different psychologist's schools, courses or at least unities centered in post traumatic stress, their boarding and treatments, like emergency's situations, catastrophes and actions orientated to his confronting.

Chile se pone de pie otra vez: [editorial] / Chile: standing up again: [editorial]

One of the biggest earthquakes recorded in human history has recently devastated a large part of the Chilean territory and, followed by a Tsunami, destroyed cities, seaports, fishermen’s coves, bridges, and countryside houses. This cataclysm affected a large proportion of our population, leaving homeless families, no working tools for work places, hospitals, schools, public buildings, museums. However, the loss of human Uves was small compared to similar disasters. It destroyed part of the national heritage as well as damaged people's living conditions. A national movement started immediately to help and recover, and international resources, both human and technological were also set in motion. As after previous earthquakes in Chile, young M.D.'s and medical students were organized in voluntary groups backed by institutions or by their own organizations and went from large cities as Santiago and others to provide medical and psychological care to those in most need. Young members and students of other health professions (nurses, physical therapists, etc.) were included in these groups or worked in their own ones. National and international experience indicates that the forthcoming months require special care of psychological reactions and sequel (posttraumatic stress symptoms) and health consequences after water pollution, restrictions in housing and deteriorated sanitary conditions. Nevertheless, our country will stand up once more.

Reflexiones y sentimientos desde un equipo de voluntarios del Ministerio de Salud y el Colegio Médico de Chile, después del terremoto reciente / Reflections and feelings from a team of volunteers from the Ministry of Health and the Chilean Medical Association, after the recent earthquake

The experience of a group of 9 doctors and 6 nurses, most of them younger than 30years of age, whom were part of the several volunteer groups directed towards the most damaged earthquake regions, is described. The team had to overcome a number of intense personal emotions related with the magnitude of the destruction, especially in the "adobe"-constructed houses and villages, in order to provide useful medical support. Moving out of the hospital setting, reaching out to the community in schools and emergency posts proved to be important in rural communities. An appropriate coordination of the volunteer groups, with the simultaneous action of municipal and state health authorities, together with well-guided leadership, was critical for an effective response in the larger city of Talcahuano /Hualpén. Within the second week of the aftermath, acute respiratory and intestinal infections were the most common medical complaints together with intense -in many cases severe- emotional distress associated mostly with fear to after shakes ("replicas"), tsunami, and social unrest. The severe earthquake that struck Chile has left many lessons for the future that will need to be analyzed seriously and with the conviction that effective and timely prevention of catastrophic aftermath consequences, although costly, must be a key element of the country's development plan. More importantly, the hundreds if not thousands of volunteers from a variety of health related professions that were moved by the scenes of suffering, and whom responded to individual or group initiatives, allow to foresee that the nation has the moral stamina required to overcome the tragedy and become a better society.

Capacidad de Respuesta del Hospital de Especialidades "Eugenio Espejo" para enfrentar los efectos que sobre la Salud causan los Desastres Naturales y Antrópicos / Response Capacity from the Hospital of Specialities \"Eugenio Espejo\" in Order to Face Health efects caused by Natural and Antropic Disasters

Partimos de una ineludible realidad, que es la de estar conviviendo desde el principio de la historia con la gran naturaleza de hermosas montañas inmensos océanos, transparentes cielos pero que continuamente nos recuerdan en sus manifestaciones abruptas y muchas veces impredecibles lo vulnerables que somos los seres vivos incluido el medio ambiente en el que nos desarrollamos. Pero no solo la naturaleza es una amenaza sino también el hombre y su incontenible deseo de transformación del entorno con la tecnología y con su afán de conquista han generado violencia, muerte y destrucción en lo que llamamos eventos de orígen antrópico.Los efectos de los eventos adversos al rebasar la capacidad de respuesta institucional o comunitaria nos llevan a una situación de desastre, término que está definido como desgracia grande , o catástrofe, del griego Kathartikos, cuya traaducción significa vuelta, acontecimiento imprevisto y funesto

Her Royal Highness Princess Maha Chakri Sirindhorn: her activities in humanity and medicine.

Her Royal Highness Princess Maha Chakri Sirindhorn, the Executive Vice-President of the Thai Red Cross Society has followed the footsteps of her fore-bears, carrying the noble humanitarian work they began, particularly the work of the Thai Red Cross society and the Faculty of Medicine, Chulalongkorn University. Her contributions have been a benefit to all, and she has earned great love and is held in high esteem by her people. Her ideas, thoughts, words, and activities have been of immense value to the faculty in both tangible and intangible ways. A selfless, dedicated women who is willing to make sacrifices for the common good, Her Royal Highness serves as a model humanitarian for the staff of the Faculty of Medicine, Chulalongkorn University, whose morale she has boosted and whose operations she has planned with the foresight ofa first-class administrator. Her devotion to the Thai Red Cross, and thus her devotion to her people, have indeed made her the royal gem within Thai hearts, with sparkling brilliance of her humanitarian deeds instilling the warmth of her love in our spirits.

Disaster management: lessons from immediate responses to the tsunami.

There are many lessons learnt from the immediate reactions of people in the aftermath of the vast destruction from the giant waves that hit Sri Lanka. Reactions of victims fell between extremes of resilience and helplessness. Responses of those not directly harmed illustrated the two extremes--selflessness and depravity. These responses offer insight into how we live and how we react to situations, and also to an extent how we should be reacting. Among these is that helpers should respect and involve, from the inception, the resources within the group or community affected by the disaster. Control of the relief effort to the maximum feasible extent, should be in the hands of those at whom it is directed.

The aftermath of a disaster. Recovery following the volcanic eruptions in Montserrat, West Indies

The people of Montserrat have experienced serious volcanic eruptions since the middle of 1995. These resulted in the evacuation of the capital town Plymouth in 1997. An exclusion zone was declared and two-thirds of the original population of 10,324 migrated abroad. The remainder was left to initiate the recovery process. This paper reviews the action taken to maintain and then restore the health services and the health of the people. The recovery process is now well advanced and is following a characteristic pattern described as the Post Disaster Recovery Scenario. A new hospital was set up in the North of the island and the four remaining clinics refurbished. The health service was restored to a reasonable standard by the end of 2000. A Disaster Preparedness Team is kept on full alert to deal with any emergencies. The disaster caused serious disruption to the health services and to the way of life of the people. It had a number of adverse health effects which included immediate harm to respiratory health followed by other more serious problems such as mental illness, poor nutrition and violence. These were due to the disruption caused by resettlement, overcrowding, breakdown of family life and economic hardship. The lessons learned may be of benefit to countries experiencing similar events in the future