Reproductive, Maternal and Child Health Reproductive, Maternal and Child Health IssuesIssues

Post Tsunami Experiences in Sri LankaPost Tsunami Experiences in Sri Lanka

Manouri P. SenanayakeManouri P. SenanayakeProfessor in PaediatricsUniversity of Colombo

President Sri Lanka College of Paediatricians

• Birth planBirth plan

•• Care of the newbornCare of the newborn

•• Health of mothers Health of mothers (Mental health(Mental health))

•• Nutritional aspectsNutritional aspects

•• Child protection issuesChild protection issues

•• Care of unaccompanied minorsCare of unaccompanied minors

•• Psychological impactPsychological impact

Centered around the childCentered around the child

• All health workers• Volunteers – relief workers• Planners & policy makers

In the rescue phase ....................In the rescue phase ....................

Lack of preparedness - a major drawback

Lack of public understanding – receding sea

Lack of communication- between zones, waves

To reduce impact (deaths)To reduce impact (deaths)in Sri Lankain Sri Lanka

• Public awareness on tsunami behaviour• National Disaster Preparedness Plan• Public education on disaster management• Capacity building at community level …• Paramedics• Paediatric intensive care facilities

31/ 35 were saved …....

In the aftermathIn the aftermath

Functional health Functional health services were services were restored & restored & maintainedmaintained

Limitation of foreign mobile hospitals

Capacity building on immediate responseCapacity building on immediate responseto disastersto disasters

•• Training of policy makers Training of policy makers •• Training of professional Training of professional –– paramedicsparamedics•• Training of volunteersTraining of volunteers•• Community based trainingCommunity based training•• Development of school curricular Development of school curricular •• Formal training in universitiesFormal training in universities

In camps & temporary sheltersIn camps & temporary shelters•• Women & children were Women & children were

given prioritygiven priority

•• Women volunteers Women volunteers ––child protection & care child protection & care of womenof women

•• Availability of pre Availability of pre existing mechanisms existing mechanisms for child welfare (NCPA, for child welfare (NCPA, UNICEFUNICEF……))

• Abuse and violation of rights were reported

• Rape• Child sexual abuse • Child trafficking• Child conscription

Outbreaks of illnessesOutbreaks of illnessesAverted successfullyAverted successfully

EFFECTIVE DISEASE EFFECTIVE DISEASE SURVEILLANCESURVEILLANCE

Special Notification formsDaily camp composition

& characteristicsGood coordination –local &

central health authoritiesPre existing high immunization

coverageLiterate population

In first 12 weeks

2/32/3rd rd of < 5 yrs of < 5 yrs -- ARIARI

1/51/5thth DiarrhoealDiarrhoealdiseases diseases

Better access to rebel held areas

Primary health care strategiesPrimary health care strategies

• CHDR – the majority were replaceable Tracing section kept in clinic

• Immunization programs recommenced• Growth monitoring ….

Nutritional aspectsNutritional aspects

•• Written guidelinesWritten guidelines were issued to MOHs on feeding infants & under fives

• Active support of breast feedingbreast feeding•• Discouraged accepting donations of formulaDiscouraged accepting donations of formula• Priority to pregnant & lactating motherspregnant & lactating mothers•• Food preparation Food preparation -- centrally & hygienically centrally & hygienically • Regular &adequate supply of foodsupply of food (DS & MOH)

Optimal feeding practices discussed Optimal feeding practices discussed individuallyindividually

•• Public Health Midwives visited all familiesPublic Health Midwives visited all familiesfamilies with children under 5 yrschildren who had lost both parentschildren who had lost the motherall infants irrespective of whether they were living in irrespective of whether they were living in camps or with relativescamps or with relatives……....

By the end of the first 12 weeks after Tsunami:By the end of the first 12 weeks after Tsunami:

? Increase of Malnutrition? Increase of Malnutrition

Acute PEM Acute PEM –– 14% to 16%14% to 16%

? Vitamin A status (A one day ? Vitamin A status (A one day VitVit A campaign)A campaign)

Arrangements for pregnant mothersArrangements for pregnant mothers* Antenatal Care- nearest institution or camp* Antenatal cards replaced and updated* High risk mothers identified* Birth plan for each mothers* Iron and Nutritional supplements* Tetanus Toxoid and anthelminthics* Field laboratories – blood grouping* Hand-outs……

(MOH, SLCOG)

Postnatal period............................Postnatal period............................

Extended hospital stay

Moved to a neighbour’s home

Daily visits by midwife –

MENTAL HEALTH OF MOTHER

Promotion of Breast feeding

Health & care of baby

Care of unaccompanied minorsCare of unaccompanied minors• The number…. Who? Where ? • Available Options • Current Laws - inadequate

(1000 children have lost BOTH parents)(1000 children have lost BOTH parents)

• TIME TAKEN to identify children

• Duplication

• Movement of children

• Register of custodians with Govt. Agents

•• Institutional care Institutional care –– every effort taken to reduce stay(harmful to development, devoid of love)

•• Adoption Adoption –– not for 2 yearsnot for 2 yearsParents being found / Emotionally affected Parents being found / Emotionally affected inin--country rather than intercountry rather than inter--countrycountry

•• Foster care Foster care ––within a homewithin a homemay be a forerunner to adoptionmay be a forerunner to adoption

majority are with relativesmajority are with relatives• Culturally accepted arrangement• Kinship groups are a good form of care• All custodians have to register with the GA• Not a legal arrangement ….

current law (CYPO) - inadequate inadequate ““Fit PersonFit Person””

•• Movement from one arrangement to another..A new Bill A new Bill ––

Minimum standards for foster careMinimum standards for foster careA panel of evaluatorsA panel of evaluatorsMonitoring by peripheral units of NCPAMonitoring by peripheral units of NCPA

•• Provide financial support to foster familyProvide financial support to foster familygovernment approved amountgovernment approved amountNo direct contact with childNo direct contact with child

•• Monitor progress of child Monitor progress of child ––through schools….

Dept of Probation & Child Care & NCPA -

Psychological impactPsychological impact

• Acute stress reactions • 90% - 50%50% (3/12)- <10% (1 yr)

• Role played by schools – Routines….• Majority of schools opened within 2-3wks• Instructions- Identifying & meeting needs•• Lack of trained personnel Lack of trained personnel

Adolescent age groupAdolescent age group•• Community centers / DropCommunity centers / Drop--in centersin centers

( younger age groups also accepted) ( younger age groups also accepted) Out-reach clinicActivities – games, play groundSocial security schemes / sponsorships Learning opprtunities – English classes Vocational trainingLibrary