# Presentation: 547345

## Health Information for Disaster Preparedness in Latin America

**Central American Disaster Health **
**Information Network**

***Presentation to:***
***EnHIOP, 12-04***
***Tallahassee, FL***
***By: John C. Scott***
***Center for Public Service Communications***
***On behalf of:***
***National Library of Medicine***

**Notes:**
Imagine living in an area susceptible to volcanoes, earthquakes, hurricanes, landslides, floods, and if there isn’t a hurricane or flood, then a drought.  Central America is extremely vulnerable to numerous natural and human-made disasters and is continually challenged to improve local, national and regional capacities to prepare for and respond to them.

## Project Origins 

**   **

**Hurricane Mitch - 1998**

**El Salvador Earthquakes -****2001**

**Notes:**
Este proyecto es parte de la respuesta del gobierno de los Estados Unidos al huracán Mitch hace cuatro años y también los terremotos en El Salvador el año pasado 

## Project Goal

-    Support, rebuild, and improve the health information infrastructure of Honduras, Nicaragua, and El Salvador and Guatemala:
-  Technology infrastructure
-  Training of health science librarians
-  Information product development

**Notes:**
NLM and the Pan American Health Organization or PAHO are now working together to support several countries in Central America, Honduras, Nicaragua, and El Salvador, to rebuild and improve their health information infrastructure.  We are focusing on three main areas:  improving the technology infrastructure (meaning access to computer equipment and the Internet), training of health science librarians to access and use this information and and the development of information products specifically needed to assist with disaster planning and preparedness activities.  I would like to emphasize that this project focuses on disaster preparedness activities, rather than on response.

## Managing Disasters  is Managing Information

**Reliable information is the **
**most valued commodity **
**before and after a disaster.**

**Notes:**
According to Dr. Mirta Roses, director of PAHO, managing disasters is Managing Information.  Reliable information is the most valued commodity before and after a disaster. Disaster management relies on a multitude of scientific groups that don’t communicate with each other.  For example, hospital building codes need input from meteorologists and volcano or earthquake experts, as well as engineers, architects, builders and physicians.

## Background

**Hurricane Mitch ****October 1998**

**El Salvador****Earthquakes****Jan./Feb. 2001**

**Notes:**
So, how did NLM get involved in this project?  Back in October 1998, Hurricane Mitch, a category 5 hurricane, struck Central America, hitting Honduras and Nicaragua the hardest.  Thousands of people were killed or injured and over 3 million people left homeless.  All economic and social lifelines were crippled, as well as the access to health care facilities and communication systems.  The damage done in a few days by Mitch totaled over $5 billion.  Mitch once again brought the critical need for disaster preparedness and prevention activities to the forefront.   
Shortly after Hurricane Mitch, several international organizations held a meeting in Costa Rica on networking among disaster information centers.  The purpose was to identify strategies to share knowledge and information, stimulate collaboration, and improve cost-effective dissemination of information.  A wealth of scientific information is available, but slow to arrive to those who need it most.  Dr. Melvin Spann, who at the time was associate director for Specialized Information Services here at NLM, gave a keynote address.  Based on what Dr. Spann heard at the conference, he felt that NLM, together with PAHO, could provide much needed information support to the region.
Then in 2001, two earthquakes, exactly one month apart struck El Salvador.  Again many were killed or injured and the health services were incapacitated.  After these tragedies, NLM was asked by PAHO and CRID to add El Salvador to the project.

## NLM/PAHO Special Project

- Unique opportunity for collaboration between NLM, as the world’s largest medical library and PAHO whose mission is improving the health of the people of the Americas
- Use the Regional Disaster Information Center for Latin America and the Caribbean (CRID) as contractor

**Notes:**
NLM and PAHO viewed these disasters as an opportunity to collaborate on a unique project to strengthen the health information infrastructure, first of Honduras and Nicaragua, and more recently, of El Salvador. In September of 2000, NLM signed a contract with the Regional Disaster Information Center for Latin America and the Caribbean, or CRID. CRID, whose offices are shown here, is based in San Jose, Costa Rica. Their mission is to create a disaster prevention culture through the collection and dissemination of information.  CRID, formed in 1990, is supported by several organizations, most notably PAHO and the United Nations International Strategy for Disaster Reduction (UN ISDR).  As the contractor, CRID serves as the coordinator for the project and as liaison with the three participating countries.

## CRID

- Collect and disseminate literature on disasters
- DESASTRES bibliographic database
-  Over 15,000  disaster-related documents
- _[www.crid.or.cr](http://www.crid.or.cr/)__  or__[www.crid.desastres.net](http://www.crid.desastres.net/)__ _

**Notes:**
Thank you Dr. Roses.  Dr. Roses has given us an excellent overview of the Regional Disaster Information Center, CRID, and their mission to create a disaster prevention culture through the collection and dissemination of information.  We are taking advantage of their expertise both with information services and with working with all of the Central American countries, in having them serve as the focal point of this project. [As the contractor, CRID serves as the coordinator for all activities and as liaison with the participating sites in the three countries.]
Dr. Roses has already described many of the activities of CRID, including their premier product, the bibliographic database DESASTRES.
[CRID has a well-populated web site that includes information on recent disasters, links to many disaster-related resources, and their premier product, a bibliographic database, aptly named DESASTRES (disasters, in Spanish), which contains over 13,000 references to disaster documents.  Most of these are not available electronically. ]

[This database, in addition to being available on the CRID web site, is also made available through the BIREME Virtual Health Library web site, a PAHO organization in Brazil.]  

## Disaster Information Management 

**Wealth of information but little is accessible**
-  Information about lessons learned is valuable throughout the region, but little in writing and often not circulated.
**Grey Literature**
- Disaster health information in developing countriesis perishable: it’s not peer-reviewed; frequently unpublished
**Internet Access**
-  Internet access has been limited, but this is changing.  Info access has gone from weeks/months to minutes and from hard copy to searchable electronic files

**Notes:**
Before I describe the sites chosen to participate in the project let tell you a little about the issues and challenges in managing info. related to disasters.  Lots of info. is available, but not necessarily in written form.  Also, if it is written, it is not widely circulated among those who need it.  In addition, most of this info. constitutes reports, assessment, or personal experiences, and is not part of the peer-reviewed scientific literature.  Finally, Internet access is reaching the region, but slowly.

## Participating Sites - Honduras

***University of Honduras ***
***Medical School***

***Centro Universitario Region Norte***

**Notes:**
Six sites, 2 each of the countries were chosen to participate in this project.  In Honduras and Nicaragua we are working with the national universities, since they have the capability as well as the responsibility for health information and play an important role in disaster prevention activities in their countries.
In Honduras, we are working with the medical school at the National Autonomous University of Honduras in the capital of Tegucigalpa, and with a branch of the University, the Central University of the North Region, in San Pedro Sula.  Here several NLM and PAHO staff are shown with the staff from the library in San Pedro Sula.  When we visited over a year ago, the medical school library in Tegucigalpa had one, very slow, computer that could connect to the Internet.  In San Pedro Sula they had no computers.

## Participating Sites - Nicaragua

***School of Public Health****** of UNAN ***

***University of Nicaragua ***
***Medical School***

**Notes:**
The situation in Nicaragua was slightly better and both sites had several computers with slow Internet access.  In Nicaragua, we are working with the medical school of the National Autonomous University of Nicaragua in Leon and the School of Public Health, located in Managua.  Here is a librarian at work at one of the new workstations.

## Participating Sites – El Salvador

***Center for the Protection ***
***against Disasters ***

***Health Documentation & Information***
***Center, Ministry of Health****** & University ***
***of El Salvador***

**Notes:**
In El Salvador we are working with the Health Documentation and Information Center, part of the Ministry of Health and a community organization, the Center for the Protection against Disasters or CEPRODE. The Health and Documentation Information Center has the primary responsibility for collecting and disseminating health information in El Salvador and CEPRODE has extensive experience working with many organizations providing disasters services in the country.

## Participataing Site: Guatemala

***Universidad de San Carlos, Biblioteca ***
***de la Facultad de Medicina***

- Note:  Guatemala was funded by U.K. via PAHO

## Project Objectives

**Training of health science librarians **
**Improving technology infrastructure**
**Development of Information Products**

**Notes:**
Let’s go back to the specific objectives of the project and review our progress.  As mentioned earlier, in September 2000, NLM signed a two-year contract with CRID, the Regional Disaster Information Center for $300,000 per year.
The purpose of the contract is to assist several of the poorest countries in Latin America rebuild and improve their health information infrastructure in three areas:  the first is the training of health science librarians. 

## Librarian Training

**Four train-the-trainers courses**
-   Costa Rica ( 2001);  Bethesda, MD (2001)  Nicaragua (2002); Guatemala (2004)
-   Librarians and computer specialists
**Additional training**
-  Librarians now training  professionals, researchers,    government officials, community organizations, etc in their own countries

**Notes:**
Three training courses, coordinated both by NLM and CRID, will be taught during the project period.  A train-the-trainers approach is being used, so that the information professionals trained during the courses will in turn, conduct training courses for other information and health professionals in their countries and encourage the use of these resources by health professionals responsible for or involved with disaster planning and prevention.
The first training course for 15 librarians and computer specialists was held in Costa Rica last April.  This was a week long course and covered a wide variety of topics [from an introduction to disaster preparedness and risk analysis to searching and evaluating health and disaster resources on the web.
The second training course was held two years ago at NLM.  12 librarians with representatives from all of the participating sites, plus CRID staff, came to NLM for a week long training course covering NLM resources such as PubMed, Toxicology and Environmental Health databases, and MeSH, UMLS, etc.  A third training course was held last Sept. in Managua, Nicaragua.  The focus was web site development and maintenance, development of local info. products, and resources from the BIREME library.

## Technology Infrastructure

**Computer Equipment Installation**
** ****Honduras, Nicaragua, and Costa Rica (Summer 2001)**
** ****El Salvador (Summer 2002)**
**Guatemala (January 2004) **
** ****Each site received **** a server, router, UPS,  switch, **** laser  printer, scanner, and two PCs**
**Internet Connectivity**
**128K in Honduras, Nicaragua, and El Salvador**
**256K at CRID**

**Notes:**
Developing an appropriate technology infrastructure is an extremely complex task, made even more difficult by distance and language barriers. However, we are fortunate to have the assistance of Mr. Victor Cid, Office of Computer and Communication Systems, here at NLM.  Mr. Cid is a computer specialist who has worked on developing the technology infrastructure for several organizations, including the Native American Cultural Center in Maryland.  Mr. Cid worked with the computer specialists at CRID and in Honduras and Nicaragua to identify appropriate equipment and Internet connectivity needed for the project.  Last August, he spend two weeks in Central America working at each of the sites to ensure that the equipment was installed properly and training the computer specialists in managing the systems. The computer equipment was installed in Honduras and Nicaragua last summer.  [Each site now has a complete system including a a server, router, UPS, switch, laser printer, scanner, and two computer workstations.]  Since El Salvador was just added to the project it is expected that equipment will be installed this spring.
In addition, Mr. Cid worked with the CRID and the participating sites in obtaining Internet connectivity.  A contract was signed with an ISP vendor to serve all 4 sites in Nicaragua and Honduras and they now have 128Kbps. CRID is in the process of upgrading their internet connection, as well.  CRID must use the national ISP, which is having difficulty upgrading the service.  Victor and the CRID staff are continuing to work with the ISP on this issue.  Again, since El Salvador just joined the project, it is expected that Internet service will be established this spring.

## Information Products

**   ****Digital Library **
-   3,800 documents digitized and available   through the CRID web site
-   Links from DESASTRES   database to documents
-   Documents also available from  local disaster information  centers
-   CDs: Top 100 documents
- 		special topics

**Notes:**
The first area in which we are working is to provide electronic access to key documents.  Most of the documents at CRID are not available electronically  and these documents are a challenge to scan and store. They constitute the “gray literature” – often reports and technical documents that are not published in mainstream journals.   Many contain charts, maps (some hand drawn) and can be quite lengthy.  In order to get a core set of documents digitized quickly, the first 100 documents were scanned by a professional company.  These were scanned in January and HTML and PDF formats are available. CRID staff are currently creating links from their bibliographic database to the full-text of the documents.  In addition they are providing the documents to each of the participating sites on CD-ROM.
However, we want to develop the capacity of CRID staff to continue this effort and develop a full-text library of disaster information related to the health sector, so CRID is purchasing a high-quality scanner and will begin training staff shortly.  Each site will also have the capability of scanning and storing documents relevant to their local area.  It is expected that a minimum of 500 additional documents will be available electronically by the end of this year.

## Information Products (continued)

**Document accessibility**
-  Develop full-text searching capability of  documents
-  **Web site development by participating sites**
-  Health resources
-  Disaster resources
-  Local resources

**Notes:**
This year CRID will also work on the development or identification of a system for the full-text searching of the documents.  In addition, the participating sites are developing their own, local resources to make available on the web, along with links standard health and disaster resources.

## Future Activities

**Disaster  Health Information Center Toolkit**
**Expansion of Network **
** **Funding from UK to add Guatemala
-  Possible Caribbean, South America expansion
- Increased attention to related issues: environmental health/toxicology
**Promotion and Evaluation **
**Information Product Development**
**Information Technology Support**

**Notes:**
NLM anticipates continuing this project for at least another year.  The main focus on NLM’s support will be to fund CRID to create a disaster info. center toolkit to be used by other countries or orgs in Latin America to develop info. centers.  

## Evaluation and Sustainability

- Use of  NLM and CRID resources by participating sites for disaster planning
- Incorporate information resources into curriculum
- Migrate program to local management withcontinued support from the internationaldonor community

**Notes:**
We anticipate that this pilot project will be successful for CRID, the participating sites in all three countries, and NLM.  Several Latin American countries will have improved their health information infrastructure which in turn may contribute to disaster reduction in their areas by participating in this project and using the resources offered by NLM and CRID. We hope that this pilot project will continue past the two years of NLM funding - PAHO meets regularly with the international donor communities in the United States, Canada, and the United Kingdom.  They will use the success of this project to encourage other donors to continue the efforts.  
In addition, we hope that this project will assist NLM and other libraries in developing models for working with underserved populations with limited access to technology and other resources.
[As Internet costs decrease and connections become easier and the use of information becomes part of the routine, the ability of the participating sites to become self-sustaining or obtain resources from others will become easier.]

## Lessons Learned

- Success requires leadership and vision at many levels
- Multiple sites require time, energy, patience,flexibility
- Collaboration requires sensitivity to linguistic and cultural issues
- Partnerships require teamwork and compromise
- Possible applicability in US states/local communities
- Value in NLM-PAHO collaboration

## Conclusion

**Dissemination of quality information is:**
***the most cost ***
***effective disaster ***
***reduction activity***
***and a way to ***
***empower national ***
***and local ***
***communities***

## Project Team

***NLM***: Ms. Stacey Arnesen; Mr. Victor Cid Dr. Melvin Spann
***PAHO***: Mr. Ricardo Perez
***CRID***: Mr. Dave Zervaas  and staff
***CPSC***: Mr. John Scott

**Notes:**
Finally, I want to thank and acknowledge the team that has been working on this project, particularly Dr. Melvin Spann who led the effort to initiate and implement the project.  

## Project Team

***Dave Zervaas & CRID staff***

***Mel Spann , NLM***

***Stacey Arnesen, Victor Cid. NLM***

***Ricardo Perez, PAHO;******John Scott, CPSC***

***Central American librarians******& computer specialists***

***Cecilia Garcia, UNAH***

**Notes:**
Finally, I want to thank and acknowledge the team that has been working on this project, particularly the many librarians and computer specialists in Central America, the staff at CRID,  and Dr. Melvin Spann who led the effort to initiate and implement the project.