Ensuring Accessibility During Natural Disasters

September 12, 2011

Reports indicate that individuals with disabilities are disproportionately affected by natural disasters and emergency situations, due in large part to a lack of adequate planning. Available facilities are frequently inaccessible or are ill equipped to accommodate the needs associated with certain disabilities, therefore, by including individuals with disabilities in all stages of the disaster management process, particularly during the planning and preparation phases, the effectiveness of disaster responses can be greatly improved.

An estimated half a billion people – 10 percent of the world population – experiences some form of impairment or disability. Following recent natural disasters including Hurricane Katrina, studies have found that the regions affected by these disasters are frequently not prepared to evacuate, shelter, transport, or meet the medical needs of individuals with disabilities. In addition, the shelters, transportation services, and emergency communications and information broadcasts available in many regions are often not accessible.

By learning from problems identified following natural disasters, regarding the needs of individuals with disabilities, emergency response initiatives can be modified to ensure that the needs of people with and without disabilities are met. According to experts, all individuals, regardless of their disability status, should prepare for potential disaster situations by having a store of food and water on hand to last a minimum of three days. In addition, it is recommended that individuals with disabilities have a supply of items related to their specific needs – which may include eyeglasses, hearing aides, a laminated communication board, or medications – for at least seven days. FEMA, which recently launched a disaster preparedness app, notes that individuals with certain types of disabilities may need to take additional steps to prepare for and receive assistance following natural disasters. It is suggested that individuals with disabilities establish a network of friends, family, and neighbors who may be able to assist them in the event of an emergency.

While natural disasters affect everyone within a given region, individuals with disabilities may face barriers that can cause additional issues. A number of government agencies, including the Department of Health and Human Services (HHS) have put measures in place to help mitigate the barriers faced by individuals with disabilities in emergency situations. Ensuring the inclusion of individuals with disabilities and their representatives in strategic planning efforts and the provision of information in accessible formats before, during, and following natural disasters are among HHS’s chief concerns. In addition, the UN Convention on the Rights of Persons with Disabilities and other international policy initiatives aim to ensure that humanitarian responses to natural disasters are inclusive of the needs of individuals with disabilities.

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Click here to read the International Disability Rights Monitor (IDRM) report on Disability and Early Tsunami Relief Efforts in India, Indonesia and Thailand


Web-Accessibility for People with Disabilities

August 9, 2010

Though substantial progress has been made to ensure that all individuals with disabilities are afforded the same opportunities as those without, some barriers still remain. While millions of individuals with disabilities currently utilize the Internet to some degree, gaining access to and fully experiencing materials presented on the Internet can be problematic for individuals with certain types of disabilities. Those with motor impairments, low vision or blindness, low hearing or deafness, and/or language or cognitive disabilities often require assistive technologies or devices to access websites. A report from the Disability Statistics Center of the Institute for Health and Aging indicates that at least 2.1 million of the reported 54.4 million Americans with disabilities use the Internet from their homes or on another computer. The American Federation for the Blind states that around 1.5 million of the 7.8 million Americans who experience vision loss use computers, with just under one million reporting regular computer use. Additionally, an estimated 7.8 million people over the age of 15 experience some form of hearing loss, and a report in the American Annals of the Deaf indicates that 63 percent of those who took part in a recent study reported regular computer use. New legislative measures may help to make the web more accessible to any individual with a disability.

Web Accessibility

The World Wide Web Consortium (W3C) states “not all…disabilities affect access to the Web, but problems with vision, hearing, dexterity and short-term memory can have a significant impact on a person’s ability to use online information and services.” Individuals with disabilities frequently employ assistive technologies or make other accommodations to access information online. These may include screen readers, software utilized by individuals with visual impairments which converts information on screen into speech; alternative text (ALT text), HTML tags which provide descriptions of images for blind individuals; and closed captioning, the display of text coinciding with audio content for individuals with low hearing or deafness.

The majority of websites are still primarily inaccessible to individuals with disabilities, and the efforts by others to ensure that they are accessible to people with disabilities have been minimal. A number of “mainstream” websites have instituted accessibility features, including Facebook and YouTube, which have begun implementing changes that will improve the browsing experience of individuals with disabilities. These adaptations include the following:

  • Facebook provides an audio captcha alternative to for those using screen readers, as well as an HTML-only version of the website and instructions for increasing font size in a number of web browsers.
  • YouTube provides closed captioning options for users with low-hearing or who may not be able to hear or understand the audio portions of videos. However, captions must be added to the video by the individual who uploads it.
  • Twitter has not yet addressed the issues that prevent its use by many individuals with disabilities. However, AccessibleTwitter offers “a simple, consistent layout and navigation,” “assures that all links are keyboard accessible,” and “uses large default text size and high color contrast.” In addition, the recently introduced service TweetCall allows users to speak their tweets, which are then transcribed to text. For individuals who may have difficulty typing or using a computer, this creates an opportunity for the utilization of Twitter.

To further improve the accessibility of the Internet, Congress recently approved legislation that would set federal standards for the telecommunications industry , including online delivery of information. These new regulations coincide with the 20th anniversary of the Americans With Disabilities Act (ADA), a landmark legislation that helped to ensure equal opportunities and accessibility. Though the ADA has led to vast improvements in many areas, as Representative Edward Markey, D-Mass, noted “The ADA mandated physical ramps into buildings, today, individuals with disabilities need online ramps to the Internet so that they can get to the Web from wherever they happen to be.”

You can evaluate the level of accessibility of a website using the online tool WAVE.

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Healthcare Following Chile’s Earthquake

March 8, 2010

While aid organizations continue to support relief efforts in Haiti, some attention has now been diverted by the 8.8-magnitute earthquake which struck Chile on February 27, 2010. As with Haiti’s tragedy, many organizations are accepting donations to benefit relief efforts in Chile via text message, and individuals have banded together on Twitter and Facebook to request help locating loved ones, provide updates, and share information.

Chilean Earthquake

Experts, including Sergio Barrientos, science chief of the Seismology Institute of the University of Chile, indicate that this quake was 50 times bigger than the one that killed thousands and destroyed much of Haiti’s infrastructure on January 12, 2010. Richard Gross, a geophysicist at NASA’s Jet Propulsion Laboratory, indicated that the force of the quake was in fact so strong that it affected the Earth’s figure axis (the axis about which the Earth’s mass is balanced) and caused the length of the day to be shortened by 1.26 microseconds. Compared to Haiti’s relatively shallow earthquake which occurred just 8.1 miles below the surface of the earth, the depth of Chile’s recent quake was 21.7 miles. This increased depth, which allowed some of the quake’s energy to disperse, and Chile’s strict building codes lessened the earthquake’s potential to cause more serious damage.

According to the National Emergency Office, 795 individuals have died as a result of the earthquake, and the 40-foot tsunami and 131 aftershocks of magnitude 5 or greater that have followed. Chilean President, Dr. Michelle Bachelet stated that it is likely that two million people were affected in some way by the recent earthquake. Many lost family and friends, and an estimated 500,000 homes sustained considerable damage, according to reports from the Chilean Red Cross.

Efforts for locate and rescue survivors are ongoing, and it is expected that, as seen in Haiti, medical and rehabilitative care will be needed by many. Information regarding the number of individuals injured or displaced by the earthquake and the aftershocks and tsunami that followed is not yet available. Though current counts of individuals killed or injured are substantially lower than following Haiti’s earthquake, these figures are expected to rise as reports indicate that as many as 500 individuals are still missing in Constitución alone. In addition to the earthquake itself, which hit most strongly in six central regions of Chile, substantial loss of life and damage to infrastructure is due to the subsequent tidal wave which submerged fishing towns on the coast of south-central Chile. More than 20 boats were swept ashore in the port of Talcahuano, and rescue workers have located over 300 bodies in Constitución. Access to drinking water, food, electricity, and other supplies to many towns in these costal areas, including Bio Bio and Concepcion, have been disturbed, leading to tension and looting in some areas.

Amid civil unrest in areas with destroyed highways and collapsed bridges, the spread of disease and the delivery of healthcare is also a concern. According to UN Humanitarian spokeswoman Elisabeth Byrs, Chile’s government has identified its emergency needs as temporary bridges, field hospitals, satellite telephones, electric generators, damage assessment teams, water purification systems, field kitchens, and dialysis centers. While reports indicate that the health network in northern Chile is operating normally, in the south access to heath services has been disrupted by the collapse of six hospitals and damage to two others. To provide some assistance, the United Nations will be sending 45 satellite phones to Chile for officials coordinating relief efforts, and is prepared to send 30 tons of food and other aid. U. S. Secretary of State Hillary Clinton has indicated that the United States will offer “not only solidarity but specific supplies” to help Chile recover. Aid from the U.S. will include 62 satellite phones, eight water purification systems, and a mobile field hospital with surgical capability. Argentina has already sent medical supplies including three tent hospitals, water processing equipment, medications, and satellite telephones to Chile. Other nations including Canada, which has pledged $2 million to support relief efforts, and Singapore, which will supply $50,000, have also offered contributions. In addition to the need for facilities and supplies, the Pan American Health Organization (PAHO)/WHO noted a shortage of healthcare personnel and has assembled an emergency response team of 80 trained specialists.

As the outpouring of support for Chile begins, governmental agencies, non-governmental organizations, aid organizations, and individuals face the daunting task of coordinating their relief efforts and some areas are still awaiting support. It remains unclear how many individuals have been affected by the earthquake, both directly and indirectly, but it is of great import that they get the care and assistance they need.

Find out about how the iCons in Medicine teleconsultation program can help following natural disasters and what iCons in Medicine and the Center for International Rehabilitation are doing to ensure the provision of rehabilitation services in Haiti.

Amputation and Prostheses in Haiti

February 8, 2010

As government agencies and non-governmental organizations flood Haiti to provide relief support, many are finding a lack of even the most basic medical equipment and supplies. Even before January 12th, Haiti’s healthcare system was unable to fully support the needs of the Haitian population which included 800,000 individuals with disabilities, and life-saving medications were in short supply but high demand. While outbreaks of tuberculosis, HIV, and cholera are the current major public health concerns, insuring the provision of rehabilitation services to the estimated 200,000 (some reports indicate 250,000) individuals who have undergone amputations as a result of the earthquake are especially pressing. This figure includes not only the 2-3,000 individuals who have had amputations of major bones as well as the thousands more who have fingers or toes amputated (per personal correspondence with Al Ingersoll, CP; Healing Hands for Haiti).

Without proper medical equipment and often in unsterile conditions, physicians providing care in Haiti since the earthquake struck have had to amputate the limbs of individuals who otherwise would die. The social stigma attached to individuals with disabilities in Haiti and other developing nations has led some Haitians to leave gangrene infections untreated, as they would rather die that face the prospect of living without an arm or leg. In addition to possible infection at wound sites, individuals who have suffered “crush injuries” or rhabdomyolysis are at risk developing kidney failure when the crushed muscle ruptures. Studies indicate that between four and 33 percent of patients with rhabdomyolysis develop kidney failure, but amputation of the affected limb has the potential to save the patient’s life. In order to perform these amputations, CNN reports that some surgeons have had to use “civil war medicine” – amputating limbs with saws and other instruments, often without anesthesia. Some estimates indicate that as many as 95 percent of Haitians who suffered crushing injuries in the earthquake will undergo amputation.

Haiti’s hospitals sustained considerable damage and what remains of the Haitian healthcare system has been overwhelmed by the demand of those in need of medical services. To fill this gap, clinics run both by local hospital staff and international aid organizations have been setup in tents outside the devastated buildings. Reports indicate that surgeons at University Hospital, Port-au-Prince’s largest hospital, performed approximately 225 amputations within the first few days following the earthquake. Though statistics are not available yet for the number of new amputees, Mirta Roses, director of the Pan American Health Organization, has indicated that some hospitals have reported performing as many as 30 amputation surgeries per day. Limitations of space, medical personnel, and other resources have forced many makeshift Haitian surgical wards to discharge individuals after amputations are completed, overloading what remains intact of Haiti’s fragile hospital system with patients in need of post-operative care. To assist further assist these individuals, organizations like Healing Hands for Haiti, Handicapped International, and Doctors Without Borders are making efforts to provide surgical and post-operative care following amputation. Additionally, Global Relief Technologies has introduced a system that allows for critical information about patients to be collected and uploaded to a PDA so that this information can be shared with other aid organizations to ensure high-quality care for all amputees.

In addition to the importance of post-operative care, individuals who have undergone amputation are in need of prostheses, but the devices commonly used in the developed world may not be best suited for use in Haiti. An average prosthesis can cost between $4,000 to $6,000 and in the United States a new amputee could expect to undergo a minimum of four fittings a year for the life of the prosthesis to ensure that the device is comfortable – in Haiti this is simply outside the realm of possibilities. Low-cost, high-quality devices developed by non-profit organizations, including the Center for International Rehabilitation (CIR) and Legs for All may be applicable for use in Haiti. Developed specifically for use in areas with limited resources, the Center for International Rehabilitation’s CIR Casting System could allow for the rapid fitting of Haitian amputees. Unlike traditional plaster-based prosthetic fabrication methods, the CIR Casting System uses a fabric bag filled with polystyrene beads and allows for the fabrication of prostheses in a fast, simple, and low-cost manner. A final prosthesis can be fabricated in less than two hours during a single clinical visit, compared with at least two clinical visits using traditional plaster-based methods. In addition to the development of this innovative fabrication method, the CIR conducts blended distance learning initiatives that combine online training with hands-on workshops to familiarize local technicians with the fabrication method. Since 2008, following trainings in Thailand and India, over 2,500 individuals have been fitted using the system and it has been widely accepted in these regions. However, as Jeffrey Bigelow, resident neurologist at Yale University who completed a survey of the needs of Haitian amputees for Healing Hands for Haiti in 2004, notes,  it is important to recognize that even when using this type of appropriate technology, “devices need to be skillfully made or they’re just too painful to wear.”

Dr. Steven R. Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center, noted that even in the best of circumstances, when an amputation site can be properly cared for, it can take four to six months for a traumatic amputation to heal completely. Even before they can be fitted, many of Haiti’s new amputees will require counseling to come to terms with their new lives as a part of Haiti’s generation of amputees.

Specialty physicians who wish to offer teleconsultation support to disaster-relief workers in Haiti, Health professionals who wish to provide volunteer support on the ground in Haiti, and U.S. healthcare institutions that are willing to provide services to victims of the earthquake who are airlifted to this country for urgent medical or rehabilitation care can register through iCons in Medicine.

Find out more about The Center for International Rehabilitation and the CIR’s innovative prosthetic technologies