Sunday, April 26, 2015

Nepal Earthquake Notes - 2 - Response

Our experiences their experiences

(This photo was taken from the Canterbury Public Health Response Document)

In 2011 February 22nd, Christchurch was struck with a 6.4 earthquake at about 12.51 PM in the afternoon. The epicentre of the earthquake was around a place known as Lyttleton. The city centre was badly affected, many buildings collapsed and particularly in the Eastern suburbs of Christchurch, the devastation was remarkable as hundreds of houses were immediately destroyed or were rendered useless for living. People were displaced and were accommodated in several shelters across the city and a massive restoration operation was launched. Immediately following the earthquake, the death tally stood at 185. Following the initial earthquake, the city suffered about 12,000 more aftershocks over the next three years. The citizens battled the aftershocks as they rebuilt the city. Four years later, Christchurch is again coming back to her former glory and plans are afoot for the renvewal of the city. But in the rebuild and reconstruction of the city of Christchurch hangs a tale that can have important lessons for everyone around the world.

In 2015 April 25th, Nepal, in Kathmandu suffered the result of a similar earthquake of much larger intensity 7.9 Richter scale epicentre located at Lamjang in the Kathmandu Valley and not far from Everest. This also led to massive damage, about 1900 lives lost in the first 24 hours itself, and massive losses of property. Several villages disappeared, and there were avalanches from Mount Everest and other mountains that added to the woe. At the time of writing this, rescue operations are underway and several aftershocks have already taken place.

At the time of writing this, a massive recovery operation is taking place, and you can learn more about the recovery operations here

I write this on the third day of the Nepal earthquake and would like to highlight some aspects of earthquake disaster management and strategies that I saw implemented in Christchurch. Some public health and disaster management measures certainly helped people of Christchurch and led to far fewer deaths and destructions that would otherwise occur. In no particular order,

  1. Immediately after the earthquake, the public health department issued warnings about boiling drinking water and restriction of the “flushing the toilet”. Which meant, the advisories were about conservation of water and keeping in mind that it was possible that the drinking water might be contaminated. It turns out that these two activities alone led to really less load of people with stomach related diseases that would otherwise occur.
  2. The city government formed a crisis management team and the mayor oversaw the operations. The control room effectively managed hundreds of visitors and worker bees who turned up to set up search and rescue operations that led to the recovery of bodies and clearing of people who were trapped in the debris.
  3. Several volunteer organisations set up shelters that allowed people to camp out and provided food, shelter, and clothing.
  4. In addition to medical services, several additional services such as mental health services and care were pressed into action.
  5. A thorough evaluation of every building was undertaken, and each building in each residential zone was “sticker”-ed, or colour coded so that the status of the building would be known.
  6. Fresh water was provided to the affected neighbourhoods
  7. Recovery operations were televised and tally of the deceased and recovered were made available to people.

A good description of the steps are available with the Wikipedia entry

Saturday, April 25, 2015

Nepal Earthquake Notes Day One -- Donation


On 25th April, 2015, around 12 PM Nepal time and 6 PM NZ Time, a devastating earthquake of 7.9 Richter scale (?10 kilometre) deep epicentre in Lamjang, struck Nepal. The tremors were felt in several cities across North India and in China.

The news of this earthquake brought to my mind our experience of the 2011 Christchurch earthquake and its aftermath. Right now it is time for relief operations to see as few lives are lost, and salvage as much as possible, and save as many people as possible, get people out of the disaster zones.

Following the news item, I tried peeking into the blogs and twitter feeds and Facebook pages. I have to picked up or stored images here (these are available throughout the web, quite gruesome), but I have started putting together some themes that I think are important for me to learn more about the earthquake that happened and what we can do about it. I shall continue to curate and learn about this earthquake and link to our own research and experiences as much as I can over the next few months. For that, I have saved “nepal” as a search term in twitter and will continue to search google for more information.

To summarise the main information sources, it seems that immediately after the earthquake about 1400 people died in Kathmandu and Pokhara. About 18 people, who went to the Everest mountains for trekking, died on the base camp. The base camp was damaged by avalanche from Mount Everest. These are significant losses. Equally, some agencies have set up relief camps and are accepting donations. There is a website that nicely lists them and it is important that we support these sites in their relief work.

One of the first things that come to mind about disasters is to help. For many of us, helping with materials may work, but it is easier and topical to help with money, particularly with online donations. There are some interesting perspectives that people have offered about online donations for disaster relief.

Finding out People

An important area of concern is to find out people. Here,

  • Google and Facebook are doing really well online. See this article by John Fingas, over at Endgadget where he reported that

  • Facebook has rolled out its recently introduced (recently refers to April 2015) Safety Check feature to tell people if contacts in the area are okay – survivors only have to report in to ease the mind of searchers.

  • Google India office revived its longstanding Person Finder to assist you in both locating loved ones and sharing news with others. You’ll want to get in direct contact or reach out an embassy if you’re still concerned about affected locals, but these internet tools could spare you from a lot of uncertainty.

  • Nepal Earthquake Search

    Donating and doing Something

The other area where you can help is by donating online. Christopher Dawson at CNN sums up,

  • The Nepal Red Cross Society is the epicenter of the relief efforts and is a direct way to help the people of Nepal. Here is its online donation link, NRCS, please note that their website connectivity is on and off, so you might not be able to get through.

  • AmeriCares has sent its response team to the impact zone and relief workers are preparing shipments of medical aid and relief supplies for survivors. You can help by donating online to their disaster relief fund.

  • CARE is on the ground and preparing to provide temporary shelter, ready-to-eat meals and water purification and latrine construction. You can learn more about their relief plans here or go directly to their donation page to help.

  • Global Giving has created a Nepal Earthquake Relief Fund to immediately help both local Nepalese nonprofits and international aid organizations. Supporters can donate online or text GIVE NEPAL to 80088 to donate $10.

  • Handicap International has been in Nepal since 2000 and the 47-person team is safe. They are providing wheelchairs and assistance to the local hospitals which they report are overwhelmed. You can go online to directly support their Nepal Earthquake Response .

  • The International Federation of Red Cross and Red Crescent Societies (IFRC) is preparing an emergency response operation and is prepping resources from its hubs in New Delhi, Kuala Lumpur and Bangkok. The federation is releasing funds from its Disaster Response Emergency Fund to support the initial emergency response, and you can further support their efforts by donating here.

  • International Medical Corps is on the ground coordinating their response and sending additional staff and resources to support relief efforts. You can support the Nepal Earthquake Response online, or by texting MED to 80888 to give $10.

  • MercyCorps has launched the Nepal Earthquake Response fund to help provide food, water and temporary shelter in the aftermath of this disaster.

  • Oxfam International is working to help provide clean water, sanitation and emergency food for those affected by this disaster. Donate via Oxfam America here

  • Save the Children is working to protect vulnerable children and provide relief to families. You can donate online to directly support the Nepal Children’s Emergency Relief Fund

UNICEF is working with the government and other partners to meet children’s immediate needs in water and sanitation, protection, health and nutrition. You can help by donating online.

Caveat Emptor while donating?

Donation itself is great, however, it is also important that one should be careful while donating funds.
Amrita Khalid has written this set of words to the wise,
Amrita Khalid writes,

Only hours after a 7.8 magnitude earthquake claimed an estimated nearly 1,000 lives in Nepal on Saturday morning, requests for donations are making the rounds on Twitter. Aid groups such as American Red Cross, CARE, and Save the Children are deploying on the ground assistance to help the Nepal earthquake victims. But it’s been five years since chaotic relief efforts in the wake of the Haiti earthquake drew worldwide controversy. If texting your $10 to help the victims of Nepal did nothing to eliminate that pit of worry in your stomach, it’s hard to blame you.

According to The New York Times, the earthquake in Nepal was about 16 times more powerful than the 2010 Haiti earthquake. Lack of communication from the country further amplifies concerns over the exact scale of the earthquake’s destruction. While nothing should discourage you from contributing to such badly needed relief efforts, it’s normal to question whether aid groups have improved their disaster response since the last incident of such a massive scale.

Many organizations such as the United Nations, aid groups and experts in the field have weighed in on what went wrong in Haiti and what needs to change in the light of another natural disaster of such a massive scale. Now is a timely opportunity to review the problems that first cropped up and what nations, aid workers and the general public can do to make sure the mistakes that happened with Haiti don’t repeat in Nepal.

Research before donating

If you were one of Wyclef Jean’s many Twitter followers who donated to Yéle in Haiti’s aftermath, you probably learned this lesson the hard way. Financial mismanagement riddled most of Yéle’s efforts in Haiti, with had raked in more than $16 million from the musician’s fans concerned about the earthquake. Following the Yéle’ fiasco, the Better Business Bureau came out with a list of mistakes to avoid when donating to disaster relef campaigns. First off, it’s best to stick with well-known organizations such as American Red Cross and Oxfam. If a charity’s name includes the name of the disaster, make sure it’s affiliated with an older, reputable organization and didn’t crop up overnight. Be sure the charity details the exact efforts your money is going towards. Will your dollars go to purchasing food and water for the victims, or to paying staff? BBB always warns against shipping off unsolicited donations such as food and clothing. Relief organizations prefer to buy such items near the site of the disaster in order to eliminate the time and costs associated with delivery.

If you’re unsure of whether the charity you’re considering donating to is legit, BBB’s Wisegiving Alliance can give you a comprehensive report on how the organization measures up.

Engage with the local community

A big criticism of the international community’s response with Haiti was its lack of involvement with the people of Haiti in vital decisions.

Francois Grünewald of Groupe URD noted that many aid workers arrived in Haiti with no knowledge of the local language. Many NGOs bypassed working with local municipal governments entirely.

Writes Grünewald:

“In the future, the aid system won’t be able to function as an ‘occupying alien’ as it largely did in Port-au- Prince, and instead will have to engage with local people, local authorities and local realities.”

That being said, engaging with the local community is easier said than done, especially during times of turmoil and confusion in politically turbulent nations, as was the case with Haiti. United Nations Emergency Relief Coordinator John Holmes writes candidly of the first few months of his time in Haiti and details how frustratingly impossible a balancing act this can be, such as when the Haitian president refused food aid after the first few weeks of the earthquake. Especially during times of turmoil and confusion, the needs of a host country and the missions of a aid organization can conflict more often than one would think.

Writes Holmes:

“One of the most common criticisms of the response is that we failed to engage enough with local actors, even when they had begun to recover from the devastation of the earthquake, and failed to understand well enough the local political, economic and social dynamics. The early problems of access to the Minustah base, and of too many meetings in English, have been well-documented. These are certainly valid points. Many mistakes were made.”

Don’t Fail to Keep NGO’s Accountable and Figure Out Who’s In Charge

Because 99 percent of the aid provided to Haiti came from the way of outside nations and organizations, Haiti is often referred to as “The Republic of NGOs”. A weak, national government and a bevy of NGOs with no one entity to reign them all in was a recipe for disaster. The Nation reported that NGO’s in Haiti used a meager one percent of the money that poured in after the disaster on actually recovery assistance As Vijaya Ramachandra of the the Center for Global Development notes, “A system for registration of NGOs would be a good start, especially as the government still has limited capacity. Eventually, the government might be able to monitor NGO activities and ensure coordination.”

Keep Expectations Realistic

It’s likely the international community’s response to Nepal will be an indication of whether the status quo has changed for international aid. But aid workers and other experts often point out that what went wrong with Haiti has gone wrong during natural disasters in the past, and will continue to do so in the future. Lessons learned or not, the unplanned nature of natural disasters, the sheer scale of their destruction and the differing geographical, political and societal factor of the regions affected can make each recovery effort an entirely different challenge.

Dr. Mirta Roses Periago of the United Nations sums up the problem with Haiti, and other natural disasters in a nutshell:

“If the impact was unprecedented, the organization of the response was not. It followed the same chaotic pattern as past disasters. Information was scarce, decisions were not evidence-based, and overall sectoral coordination presented serious shortcomings. Management gaps noted in past crises were repeated and amplified in Haiti. The humanitarian community failed to put into practice the lessons learned

Notable Sites where you can send help

So, there are mixed messages, and a lot of opportunities out there to go and help out there.

Wednesday, April 22, 2015

Cold Brewed Coffee

About cold brewed coffee

Can’t remember where I read about the cold brew process, but it sounded quite interesting when I read this. I decided to give it a try today. Essentially cold brewed coffee is where you just coarse grind coffee beans, then steep in water overnight (the recommended period is at least 8 hours and about 18-24 hours), and then pour the resultant supernatant fluid over muslin or cheese cloth or kitchen towel or strainer and a combination of paper towel into the container and store it in refrigerator. Then use it cold or hot. That's about it.

Does it make a difference?

A chef from Jamie Oliver’s group blogged that cold brewed coffee offered “… a very different, far more refined creature" that made him "realise the unique magic of cold coffee, just in time for the pleasant English summer". This blog has a nice summary of the difference between cold brew and iced coffee.

But cold brewed coffee is not iced coffee

  • For one, cold-brewed coffee is coarse ground coffee steeped in cold water, and iced coffee is generally brewed hot and poured over ice.
  • Iced coffee tends to be bitter, whereas the cold brewed coffee should be sweeter (based on the reviews I read).
  • Cold brew, takes 18-24 hours according to some, but it can be I understand also be done within 8-10 hours, but the gentler infusion process produces a drink of lower acidity, which is why cold brew coffee is naturally sweeter.

How to cold-brew coffee at home (these instructions are from this site

  • You need beans for this: coarse grind the beans, roughly the same consistency as breadcrumbs. Any finer and you risk cloudy, grimy-tasting coffee.
  • Sterilise a jar (or any large receptacle with a lid). Working to roughly a 1:8 coffee-to-water ratio, place your grounds in the bottom of the jar, and cover with cold water. I did a 1:6 coffee to water ratio and decided to steep it overnight. Will know the results later.
  • Stir gently until well combined, cover, and leave to steep for 18-24 hours, either in or out of the fridge.
  • When brewed, strain into a large bowl through a sieve to remove the larger grounds. Discard these (ideally into compost), and then, tucking either your muslin or a few sheets of paper towel into the cleaned sieve, strain back into the jar.
  • Repeat two or three times, until you are seeing no murky residue at the bottom as you finish your pour.
The general advice is to drink it cold, but I was wondering if it is possible to drink it hot as well, and it turns out that it is OK to drink it hot. I searched Reddit and I found that people have first heated water or milk in microwave or water heater, or kettle, and then added or filed in the prepared coffee and most people were raving about the preparation. So there. Depending on the taste of course, but for hot coffee, most people recommend mixing 1:1 ratio (water: coffee concentrate), or for cold coffee 1:3 ratio (one part coffee and three parts water).

Tuesday, April 21, 2015

Shape of things to come in medicine

Jon Brassey posted a picture on his blog, future

Interesting future. Not far away.

Pick one thing and do it until done

Time management ninja writes, "At the end of the day, you may have worked on fewer tasks… but the ones you did will be done."
I agree.