International Health.docx

SEMINAR ON INTERNATIONAL HEALTH SUBMITTED TO, MRS. SUPARNA PATIL, ASSOCIATE PROFESSOR SUBMITTED BY, MRS. SUPRIYA BATWALKAR, 2 YEAR MSC NURSING DATE : 1

General objective: At the end of the seminar group will be able to gain in depth knowledge about International Health.

Specific objectives: At the end of the seminar group will be able to 1. Discuss Global Burden of Disease under following headings  Introduction  Background  Aim  Risk factors  Global health indicators  Risk factors for global problems  Global health conditions  Global targets 2. Enlist global health rules to halt disease spread and global health priorities. 3. Explain the concepts of  International health regulation  International cooperation and assistance  International quarantine  Migration 4. Describe health tourism under health following headings  Definition  Evolution  Process  Destination  Scenario-Global and India  Features  Treatment offered in India  International trade and travel 2

5. Enumerate Health and food legislation, food adulteration laws. 6. Discuss Disaster management  Definition  Features  Types  Levels  Health effects  Phases  Management  Triage 7. Brief International nursing practice standards 8. Elaborate international health agencies 9. Illustrate International health days and their significance.

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INTERNATIONAL HEALTH LAYOUT SR. NO.

NAME

PAGE NO

1

International health

5

2

Global burden of disease

5-9

3

Global health rules and priorities

9-11

4

International health regulation

5

International cooperation assistance

13-15

6

International quarantine

1516

7

Migration

16-20

8

Health tourism

20-26

9

Health and food legislation

26-35

10

Disaster management

36-48

11

International nursing practice standards

49-51

12

International health agencies

51-71

13

International days and their significance

72-73

14

Research articles

74-76

15

Summary and conclusion

76

16

References

77

12

4

INTERNATIONAL HEALTH INTRODUCTION  Also called ‘Geographic medicine’ or ‘Global health’.  It is a field of health care, usually with emphasis towards public health dealing with health across regional and/or international boundaries  Disease in any part of the world is a threat to other countries.  Many futile attempts had been made by several rulers and States to place barriers against infection by detection and isolation of travellers.  In 14th Century - 40 days quarantine programme in Europe- Protect against the importation of plague by travellers.  Accepted in many countries -Lead to the origin of International Health Workbut later opposition came from several quarters - 40 days -long period and caused inconvenience.  Thus, International Conferences were held and organizations were set up to discussions, agreement and cooperation on matters of international health.

GLOBAL BURDEN OF DISEASE INTRODUCTION  The new Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2005 Study), which commenced in the spring of 2007, is the first major effort since the original GBD 1990 Study to carry out a complete systematic assessment of the data on all diseases and injuries, and produce comprehensive and comparable estimates of the burden of diseases, injuries and risk factors for two time periods, 1990 and 2005.  By November 2010 the project will produce a final set of estimates.  The GBD 2005 Study brings together a community of experts and leaders in epidemiology and other areas of public health research from around the world to measure current levels and recent trends in all major diseases, injuries, and

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risk factors, and to produce new and comprehensive sets of estimates and easy-to-use tools for research and teaching.  It is led by a consortium including Harvard University, the Institute for Health Metrics and Evaluation at the University of Washington, Johns Hopkins University, the University of Queensland, and the World Health Organization (WHO). This ambitious effort will be conducted systematically and transparently; both its methods and results will be made available to the public. BACKGROUND 

The original Global Burden of Disease Study (GBD 1990 Study) was commissioned by the World Bank in 1991 to provide a comprehensive assessment of the burden of 107 diseases and injuries and ten selected risk factors for the world and eight major regions in 1990.



The methods of the GBD 1990 Study created a common metric to estimate the health loss associated with morbidity and mortality. It generated widely published findings and comparable information on disease and injury incidence and prevalence for all world regions.



It also stimulated numerous national studies of burden of disease. These results have been used by governments and non-governmental agencies to inform priorities for research, development, policies and funding. The principle guiding the burden of disease approach is that the best estimates of incidence, prevalence, and mortality can be generated by carefully analyzing all available sources of information in a country or region, and correcting for bias.



The disability adjusted life year (DALY) , a time-based measure that combined years of life lost due to premature mortality and years of life lost due to time lived in health states less than ideal health, was developed to assess the burden of disease.



The GBD 1990 Study represented a major step in quantifying global and regional effects of diseases, injuries, and risk factors on population health.

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AIMS 1. To systematically incorporate information on non-fatal outcomes into the assessment of the health status. 2. To ensure that all estimates and projections were derived on the basis of objective epidemiological and demographic methods, which were not influenced by advocates. 3. To measure the burden of disease using a metric that could also be used to assess the cost-effectiveness of interventions. The metric was chosen is the DALY. Global Health Indicators: terminologies

Definition

YLDs

Years

Meaning Lived

with The sum of years of potential life lost due to

Disability

premature mortality and the years of

= Disability Adjusted productive life lost due to disability.

DALYs

Life Years QALY

A year of life adjusted A year in perfect health is for its quality or its Considered equal to 1.0 qaly. The value of a value

year in ill health would be discounted. For example, a year bedridden might have a value equal to 0.5 qaly.

IMR

AND Infant

CHILD

and

child Infant mortality is the death of young children

mortality

under the age of 1.This death toll is

MORTALITY

measured by the infant mortality rate (IMR), which is the number of deaths of children under one year of age per 1000 live births.

Morbidity

The

incidence

disease as a rate

of

a Morbidity measures include incidence rate, prevalence, and cumulative incidence, with incidence rate referring to the risk of developing a new health condition within a specified period of time.

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RISK FACTORS FOR GLOBAL PROBLEMS  Globalization  Obesity  Hypertension  Alcohol consumption  Physical inactivity  Cholesterol  Disability  Neglected tropical diseases like HIV/AIDS, TB, malaria GLOBAL HEALTH CONDITIONS  Respiratory infections 

Tuberculosis



Measles



Influenza



Pneumonias

 Diarrheal diseases 

Rotavirus diarrhoea

 Maternal health 

Complications of pregnancy and childbirth

 HIV/AIDS  Malaria  Nutrition 

Under-nutrition



Underweight



Malnutrition



Deficiencies of micronutrients



Obesity



Infections

 Chronic disease 

Cancers



Cardio-vascular conditions



Diabetes 8



Stroke



Respiratory diseases

 Others 

Violence against women and children



Trafficking



Accidents



Natural and man-made disasters

GLOBAL TARGETS 1. A 25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases. 2. At least 10% relative reduction in the harmful use of alcohol as appropriate within the national context. 3. A 10% relative reduction in the prevalence of insufficient physical activity. 4. A 30% relative reduction in the mean population intake of salt/sodium. 5. A 30% relative reduction in the prevalence of current tobacco use in persons aged 15+ years. 6. A 25% relative reduction in the prevalence of raised blood pressure or contains the prevalence of raised blood pressure according to national circumstances. 7. Halt the rise in diabetes and obesity 8. At least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes. 9. An 80% availability of the affordable basic technologies and essential medicines including generics, required to treat major non-communicable diseases in both public and private facilities.

GLOBAL HEALTH RULES TO HALT DISEASE SPREAD Global public health security depends on international cooperation and the willingness of all countries to act effectively in tackling new and emerging threats. That is the clear message of this year’s world health report entitled a safer future: 9

global public health security in the 21st century, which concludes with six key recommendations to secure the highest level of global public health security.  Full implementation of the revised International Health Regulations (IHR 2005) by all countries.  Global cooperation in surveillance and outbreak alert and response.  Open sharing of knowledge, technologies and materials, including viruses and other laboratory samples, necessary to optimize secure global public health.  Global responsibility for capacity building within the public health infrastructure of all countries.  Cross-sector collaboration within governments and  Increased global and national resources for training, surveillance, laboratory capacity, response networks, and prevention campaigns.

GLOBAL HEALTH PRIORITIES Global health priorities have in recent years been defined through several processes and by several actors and at various forums. The Top 20 have been grouped into six clusters RAISE PUBLIC AWARENESS 1. Raise the political priority of non-communicable disease 2. Promote healthy lifestyle and consumption choices through effective education and public engagement 3. Package compelling and valid information to foster widespread, sustained and accurate media coverage and thereby improve awareness of economic, social and public health impacts ENCHANCE ECONOMIC, LEGAL AND ENVIRONMENTAL POLICIES 4. Study and address the impact of government spending and taxation on health 5. Develop and implement local, national and international policies and trade agreements, including regulatory restraints, to discourage the consumption of alcohol, tobacco and unhealthy foods 10

6. Study and address the impacts of poor health on economic output and productivity MODIFY RISK FACTORS 7. Deploy universally measures proven to reduce tobacco use and boost resources to implement the WHO Framework Convention on Tobacco Control 8. Increase the availability and consumption of healthy food 9. Promote lifelong physical activity 10. Better understand environmental and cultural factors that change behaviour ENGAGE BUSINESS AND COMMUNITY 11. Make business a key partner in promoting health and preventing disease 12. Develop and monitor codes of responsible conduct with the food, beverage and restaurant industries 13. Empower community resources such as voluntary and faith-based organizations MITIGATE HEALTH IMPACTS OF POVERTY AND URBANIZATION 14. Study and address how poverty increases risk factors 15. Study and address the links between the built environment, urbanization and chronic non-communicable disease REORIENTATE HEALTH SYSTEMS 16. Allocate resources within health systems based on burden of disease 17. Move health professional training and practice towards prevention 18. Increase number and skills of professionals who prevent, treat and manage chronic non-communicable diseases, especially in developing countries 19. Build health systems that integrate screening and prevention within health delivery 20. Increase access to medications to prevent complications of chronic noncommunicable disease 11

INTERNATIONAL HEALTH REGULATIONS The International Health Regulations (2005) are a legally binding instrument of international law that aim to a) Assist countries to work together to save lives and livelihoods endangered by the international spread of diseases and other health risks, and b) Avoid unnecessary interference with international trade and travel. The purpose and scope of IHR 2005 are to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. THE PRINCIPLES EMBODYING THE IHR (2005) The implementation of IHR (2005) shall be:  With full respect for the dignity, human rights and fundamental freedom of persons;  Guided by the Charter of the United Nations and the Constitution of the World Health Organization;  Guided by the goal of their universal application for the protection of all people of the world from the international spread of disease;  States have, in accordance with the Charter of the United Nations and the principles of international law, the sovereign right to legislate and to implement legislation in pursuance of their health policies. In doing so, they should uphold the purpose of these Regulations.

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INTERNATIONAL COOPERATION AND ASSISTANCE MEANING International cooperation means cooperation between the nations for any reasons like: health, political affairs, tourism, etc. here main focus on cooperation for the improvement of health status of the people around the world.

IMPORTANCE  Capitalizing on migration to benefit development can best succeed through cooperative efforts.  Effective management of migration can only begin to be achieved if there is a clear understanding of the trends and flows in migration movement.  International cooperation makes a difference in managing labour migration.  In order to address trafficking in persons, states need to share law enforcements information to understand and follow patterns, and to break up organized crime networks.  The global commitment to towards a world with enhanced social equity and reduced poverty that informs the Millennium Development Goals can be achieved.  Effective migration management requires cooperation and dialogue, not only among states, but also among all stakeholders, including international organizations, and the private sectors.  Effective migration management is achieved through balanced consideration of economic, social, political, humanitarian, developmental and environmental factors, taking into account the root causes of migratory flows.  Migration management requires partnerships and responsibility sharing. Cooperation may develop where  There are similar problems to resolve  There are similar challenges to manage

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 There are different migration-related interests and goals, but is in a state’s political interest to find a cooperative solution.  There are some common interests and other conflicting interests.

TYPES OF INTERNATIONAL COOPERATION

TYPES OF INTERNATIONAL COOPERATION 1. Bilateral cooperation: cooperation is defined as bilateral when originating in an agreement between two countries and their respective official financial or technical agencies. 2. Multilateral cooperation: cooperation is defined as multilateral when the relationship is between a country and multilateral international organizations or when the relationship is exists more than two countries. 3. Regional cooperation: regional consultative processes are emerging as an effective mechanism to carry forward cooperative efforts in regional or international migration management, offering the participating states the

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opportunity to share experiences with other states of the same geographic region. IMPORTANT

POINTS

TO

BE

REMEMBERED

FOR

INTERNATIONAL

COOPERATION  Agreements should be balanced and will normally require some give and take by all parties.  The benefits of the agreement for each party should be meaningful, but realistic and financially feasible.  Cooperative approaches should include regular evaluation.  Cooperative agreements should address long term needs and not be limited to short and medium term goals.  New policies that result from cooperative agreements should be tested and assessed.  Interstate cooperation may include the provision of assistance to some states by other states.  Parties to an agreement should strive for transparent and focused dialogue and exchange of information’s, particularly where countries share an interest in specific migratory patterns in order to facilitate possible responsibility sharing agreements.  Consideration should be given to developing equitable and effective responsibility sharing arrangements that reduce the burdens on countries hosting large numbers of refugees and countries of first asylum.

INTERNATIONAL QUARANTINE DEFINITION A quarantine is used to separate and restrict the movement of people; it is 'a restraint upon the activities or communication of persons or the transport of goods designed to prevent the spread of disease or pests', for a certain period of time.

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HISTORY 

The word "quarantine" originates from the Venetian dialect form of the Italian quaranta giorni, meaning 'forty days'.



This is due to the 40-day isolation of ships and people before entering the city-state of Ragusa (modern Dubrovnik, Croatia).



This was practiced as a measure of disease prevention related to the Black Death.



Between 1348 and 1359, the Black Death wiped out an estimated 30% of Europe's population, and a significant percentage of Asia's population.



The original document from 1377, which is kept in the Archives of Dubrovnik, states that before entering the city, newcomers had to spend 30 days (a trentine) in a restricted place (originally nearby islands) waiting to see whether the symptoms of Black Death would develop.



Later, isolation was prolonged to 40 days and was called quarantine.

MIGRATION MEANING The movement by people from one place to another with the intention of settling in the new location. The movement is typically over long distances and from one country to another, but internal migration is also possible. Migration may be individuals, family units or in large groups. MIGRATION STATISTICS The World Bank's Migration and Remittances Factbook of 2011 lists the following estimates for the year 2010: total number of immigrants: 215.8 million or 3.2% of world population. In 2013, the percentage of international migrants worldwide increased by 33% with 59% of migrants targeting developed regions.

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Push factors  Not enough jobs  Few opportunities  Inadequate conditions  Desertification  Famine or drought  Political fear or persecution  Slavery or forced labor  Poor medical care  Loss of wealth  Natural disasters  Death threats  Desire for more political or religious freedom  Pollution  Poor housing  Landlord/tenant issues  Bullying  Mentallity  Discrimination  Poor chances of marrying  Condemned housing (radon gas, etc.)  War

Pull factors  Job opportunities  Better living conditions  The feeling of having more political or religious freedom  Enjoyment  Education  Better medical care  Attractive climates  Security 17

 Family links  Industry  Better chances of marrying THE TOP TEN IMMIGRATION COUNTRIES ARE: 

the United States



the Russian Federation



Germany



Saudi Arabia



Canada



the UK



France



Australia



India

THE TOP TEN COUNTRIES OF ORIGIN ARE: 

Mexico



Spain



China



Ukraine



Bangladesh



Pakistan



the UK



the Philippines



Turkey

TYPES OF MIGRATION 1. Seasonal human migration mainly related to agriculture and tourism to urban places. 2. Rural to urban, more common in developing countries as industrialization takes effect (urbanization)

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3. Urban to rural, more common in developed countries due to a higher cost of urban living (suburbanization) 4. International migration

INTERNATIONAL ORGANIZATION FOR MIGRANTS (IOM) VISION Migrants and mobile populations benefit from an improved standard of physical, mental and social wellbeing, which enables them to substantially contribute towards the social and economic development of their home communities and host societies. OBJECTIVE 

Monitoring migrant health



Enable conducive policy and legal frameworks on migrant health



Strengthen migrant friendly health systems



Facilitates partnerships, networks and multi-country frameworks on migrant health.

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PRINCIPLES:

ensures migrant health rights

avoid disparities in health status & access

public health approach to migrants health

reduce excess mortality & morbidity

minimize negative impact of the migrant process

 To avoid disparities in health status and access to health services between migrants and the host population.  To ensure migrants health rights. This entails limiting discrimination or stigmatization, and removing impediments to migrant’s access to preventive and curative interventions, which are the basic health entitlements of the host population.  To put in place lifesaving interventions so as to reduce excess mortality and morbidity among migrant populations. This is of particular relevance in situations of forced migration resulting from disasters or conflict.  To minimize the negative health outcomes of the migration process on migrant’s health outcomes.

HEALTH TOURISM Health tourism is a wider term for travel that focuses on medical treatments and the use of healthcare services. It covers a wide field of health-oriented, tourism ranging from preventive and health-conductive treatment to rehabilitation and curative forms of travel. Wellness tourism is a related field.

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Medical tourism refers to people traveling to a country other than their own to obtain medical treatment. In the past this usually referred to those who travelled from less-developed countries to major medical centres in highly developed countries for treatment unavailable at home. ORIGIN AND EVOLUTION OF HEALTH TOURISM  Health tourism is actually thousands of years old.  In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asclepius, at Epidaurus. In Roman Britain, patients took the waters at a shrine at Bath, a practice that continued for 2,000 years..  From the 18th century wealthy Europeans travelled to spas from Germany to the Nile. Since the early nineteenth century, when there were no restrictions on travel in Europe, people visited neighbouring countries in order to improve their health. MEDICAL TOURISM PROCESS The typical process is as follows:  The person seeking medical treatment abroad contacts a medical tourism provider, who is commonly referred as a ‘Facilitator’.  The facilitator usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information, such as X-rays or diagnostic testing results.  Certified physicians or consultants may advise on the medical treatment or recommend an initial consultation with a specialist.  The approximate cost of treatment, the choice of doctor and hospital, expected duration of stay, and logistic information, such as accommodation, ground transportation, and flights are discussed as well.  A patient may be asked to pay an upfront deposit for treatment. For those destinations which require a visa, the patient will be given recommendation letters for a medical visa for the relevant embassy.

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 The patient travels to the destination country, where the medical tourism provider may assign a case executive, who takes care of on the ground experience, including translation, accommodation, and arranging aftercare.  In the cases where patients self-pay for medical treatment, a final treatment bill will be presented upon completion of treatment.  If the patient underwent surgery, there may be additional postoperative checks to discharge the patient and deem him or her ‘fit and flight’ for the return home trip. DESTINATIONS FOR MEDICAL TOURISM  Africa and the middle east 

Jordan



Israel



Iran



South Africa

 Americas 

Brazil



Canada



Costa Rica



Ecuador



Mexico

 Asia and pacific islands 

India



China



Hong Kong



New Zealand



Singapore



South Korea



Thailand

 Europe 

Armenia



Finland



France 22



Germany



Turkey



United Kingdom

PRESENT SCENARIO ALL OVER THE WORLD 

In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate. Later, mostly wealthy people began traveling to tourist destinations like the Swiss lakes, the Alps and special tuberculosis sanatoriums, where professional and often specialized medical care was offered.



In this century, however, medical tourism expanded to a much larger scale.

MEDICAL TOURISM IS A GROWING SECTOR IN INDIA.  In October 2015, India's medical tourism sector was estimated to be worth US$3 billion. It is projected to grow to $7–8 billion by 2020.  According to the Confederation of Indian Industries (CII), the primary reason that attracts medical value travel to India is cost-effectiveness, and treatment from accredited facilities at par with developed countries at much lower cost.  The Medical Tourism Market Report: 2015 found that India was "one of the lowest cost and highest quality of all medical tourism destinations, it offers wide variety of procedures at about one-tenth the cost of similar procedures in the United States."  Foreign patients travelling to India to seek medical treatment in 2012, 2013 and 2014 numbered 171,021, 236,898, and 184,298 respectively.  Traditionally, the United States and the United Kingdom have been the largest source countries for medical tourism to India.  However, according to a CII-Grant Thornton report released in October 2015, Bangladeshis and Afghans accounted for 34% of foreign patients, the maximum share, primarily due to their close proximity with India and poor healthcare infrastructure.  Russia and the Commonwealth of Independent States (CIS) accounted for 30% share of foreign medical tourist arrivals.

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 Other major sources of patients include Africa and the Middle East, particularly the Persian Gulf countries.  In 2015, India became the top destination for Russians seeking medical treatment.  Chennai, Kolkata, Mumbai, Hyderabad, Bangalore and the National Capital Region received the highest number of foreign patients primarily from South Eastern countries. MAJOR FEATURES OF MEDICAL TOURISM IN INDIA:  100% Trustworthy  Top quality health care services at low cost  Expert team of professional doctors  High-end health care and medical facilities TREATMENTS OFFERED IN INDIA  Eye surgery  Spine surgery  All types of bone and joints treatments  Cosmetic surgeries  Blood vessels treatment  Stomach related treatment  Heat related treatments and surgeries  Ayurveda treatments and therapies  Dental treatments  Ear, Nose and Throat  Laser hair removal treatments  Hair implants and treatments  Spa and beauty treatments  Infertility treatments INDIA ALSO OFFERS TRADITIONAL TREATMENTS  Meditation and Yoga  Ayurveda  Music therapy 24

 Homeopathy  Aroma therapy  Naturopathy  Pranic healing  Reiki

INTERNATIONAL TRADE DEFINITION International trade is exchange of capital, goods, and services across international borders or territories. 

In most countries, it represents a significant share of gross domestic product (GDP).



While international trade has been present throughout much of history, it’s economic, social, and political importance has been on the rise in recent centuries.

IMPORTANCE OF INTERNATIONAL TRADE  Without international trade, nations would be limited to the goods and services produced within their own borders.  International trade is the backbone of our modern, commercial world, as producers in various nations try to profit from an expanded market, rather than be limited to selling within their own borders.  There are many reasons that trade across national borders occurs, including lower production costs in one region versus another, specialized industries, lack or surplus of natural resources and consumer tastes. RISKS IN INTERNATIONAL TRADE  Buyer insolvency (purchaser cannot pay);

 Non-acceptance (buyer rejects goods as different from the agreed upon specifications);  Credit risk (allowing the buyer to take possession of goods prior to payment);

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 Regulatory risk (e.g., a change in rules that prevents the transaction);  Intervention (governmental action to prevent a transaction being completed);  Political risk (change in leadership interfering with transactions or prices); and  War and other uncontrollable events.  In addition, international trade also faces the risk of unfavourable exchange rate movements

INTERNATIONAL TRAVEL DEFINITION “International tourism refers to tourism that crosses national borders.”  Globalization has made tourism a popular global leisure activity.  The World Tourism Organization defines tourists as people "traveling to and staying in places outside their usual environment for not more than one consecutive year for leisure, business and other purposes".  The World Health Organization (WHO) estimates that up to 500,000 people are in flight at any one time.  As a result of the late-2000s recession, international travel demand suffered a strong slowdown from the second half of 2008 through the end of 2009.  This negative trend intensified during 2009, exacerbated in some countries due to the outbreak of the H1N1 influenza virus, resulting in a worldwide decline of 4.2% in 2009 to 880 million international tourists’ arrivals, and a 5.7% decline in international tourism receipts.  In 2010, international tourism reached US$919B, growing 6.5% over 2009, corresponding to an increase in real terms of 4.7%. In 2010, there were over 940 million international tourist arrivals worldwide.

FOOD LAWS AND REGULATIONS The requirement of food regulation may be based on several factors such as whether a country adopts international norms developed by the Codex Alimentarius Commission of the Food and Agriculture Organization of the United Nations and the 26

World Health Organization or a country may also has its own suite of food regulations. Each country regulates food differently and has its own food regulatory framework. DESCRIPTION OF QUALITY SYSYEMS FOOD LAWS Food laws implemented for 2 reasons Regulation of specification of food  Regulation of hygienic conditions of processing/manufacturing.  Food laws are either mandatory or voluntary, they are set up to established by authorities to as a rule to measure of quantity, weight, value or quality. INTERNATIONAL ORGANIZATION GOVERNING FOOD SAFETY 1. WORLD HEALTH ORGANIZATION (WHO) 2. WORLD TRADE ORGANIZATION (WTO) 3. FOOD AND AGRICULTURE ORGANIZATION (FAO) 4. CODEX ALIMENTARUS COMMISSION (CAC) [UNDER FAO/WHO] 5. INTERNATIONAL ORGANIZATION FOR STANDARDIZATION (ISO) 6. NATIONAL ADVISORY COMMITTEE FOR MICROBIOLOGICAL CRITERIA FOR FOODS (NACMCF) 7. INTERNATIONAL COMMISSION FOR MICROBIOLOGICAL SPECIFICATION FOR FOODS (ICMSF) FOOD LAWS IN OUR COUNTRY The Indian Parliament has recently passed the Food Safety and Standards Act, 2006 that overrides all other food related laws. Such as;  Prevention of Food Adulteration Act, 1954  Fruit Products Order,1955  Meat Food Products Order ,1973  Vegetable Oil Products (Control) Order, 1947  Edible Oils Packaging (Regulation) Order 1988  Solvent Extracted Oil, De- Oiled Meal and Edible Flour (Control) Order, 1967,

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 Milk and Milk Products Order, 1992 etc are repealed after commencement of FSS Act, 2006. COMPULSORY LEGISLATIONS The Food Safety and Standards Authority of India (FSSAI) has been established under Food Safety and Standards Act, 2006 which consolidates various acts & orders that have hitherto handled food related issues in various Ministries and Departments. FSSAI has been created for laying down science based standards for articles of food and to regulate their manufacture, storage, distribution, sale and import to ensure availability of safe and wholesome food for human consumption. PREVENTION OF FOOD ADULTERATION (PFA) ACT, 1954 MODE OF OPERATION 

Ministry of Health & Family Welfare



Directorate General of health service



Central committee for food standards

SPECIAL FEATURES  Minimum quality standard  Ensure safety against harmful impurities, adulteration, mandatory law  Non-following of PFA Act leads to fine and imprisonment The Act was promulgated by Parliament in 1954 to make provision for the prevention of adulteration of food. Broadly, the PFA Act covers food standards, general procedures for sampling, analysis of food, powers of authorized officers, nature of penalties and other parameters related to food. REGULATIONS Makes provision for prevention of adulteration of food.  Adulterated, misbranded, not in accordance with the conditions of license shall be prohibited for selling.  No such food shall be imported. Standards for commodities have been specified in the rules. Proprietary foods shall specify the ingredients in the product in the descending order of their composition of the label. 28

It deals with parameters relating to food additives, preservative, colouring matters, packing & labelling of foods, prohibition & regulations of sales etc. The provisions of PFA Act and Rules are implemented by State Government and local bodies as provided in the rules. ATOMIC ENERGY RULES, 1991 (CONTROL OF IRRADIATION OF FOOD) – DAE REGULATIONS

Irradiation application of foods.



Certificate with the dose and purpose is insisted upon

SPECIAL FEATURE Certificate of irradiation indicating the dose and the purpose shall be provided by the competent authority ESSENTIAL COMMODITY ACT, 1954 (MINISTRY OF FOOD) REGULATION Regulates the manufacture of commodities, commerce and distribution.

SPECIFICATION Formations of other suborders for easy implementation

FRUIT PRODUCTS ORDER (FPO) 1955

29

MODE OF OPERATION MOFPI CENTRAL FOOD PRODUCTS ADVISORY COMMITTEE SPECIAL FEATURES  Licensing authority ‘FPO’ standard mark shall be imprinted on the products  It is mandatory for all manufacturers of fruit and vegetable products including some non-fruit products like non fruit vinegar, syrup and sweetened aerated water to obtain a license under this Order. REGULATIONS Regulates manufacture and distribution of all fruit & vegetable products.  Exempted from the provisions of the order to products prepared by Drug control act and Educational Institutions for training purposes.  Quantity shall not exceed 10kg.  License shall be issued after the satisfaction of quality of product, sanitation, personnel, hygiene, machinery, equipment and work area requirements as per the schedule specified.

FRUIT PRODUCT MEANS ANY OF THE FOLLOWING ARTICLES, 

Non fruit beverages, syrups and sherbets



Vinegar, whether brewed or non-fruit



Pickles



Dehydrated fruits and vegetables



Squashes, crushes cordials, barley water, barreled juice, and ready to serve beverages, fruit nectars or any other beverages containing fruit juices or fruit pulp



Jams, jellies and marmalades



Tomato products, ketchup and sauces



Preserves, candied and crystallized fruit and peel



Chutneys



Canned and bottled fruits, juices and pulps



Canned and bottled vegetables 30



Frozen fruits and vegetables



Sweetened aerated water and without fruit juice pr fruit pulp



Fruit cereal flakes



All

unspecified fruit

and

vegetable

products

which

are considered

microbiologically safe and contains only permitted additives within permissible limits. MEAT FOOD PRODUCTS ORDER (MFPO)  The main objective is to regulate production and sale of meat food products through licensing of manufacturers, enforce sanitary and hygienic conditions prescribed for production of wholesome meat food products, exercise strict quality control at all stages of production of meat food products, fish products including chilled poultry etc.  Meat & Meat Products are highly perishable in nature and can transmit diseases from animals to human-beings.  Processing of meat products is licensed under Meat Food Products Order,(MFPO) 1973 which was hitherto being implemented by Ministry of food Processing industries.  Under the provision of MFPO all manufacturers of meat food products engaged in the business of manufacturing, packing, repacking, relabeling meat food products meant for sale are licensed but excluding those manufacturers who manufactures such products for consumption on the spot like a restaurant, hotel, boarding house, snack bar, eating house or any other similar establishment. MILK AND MILK PRODUCT ORDER (MMPO)  The objective of the order is to maintain and increase the supply of liquid milk of desired quality in the interest of the general public and also for regulating the production, processing and distribution of milk and milk products.  As per the provisions of this order, any person/dairy plant handling more than 10,000 litters per day of milk or 500 MT of milk solids per annum needs to be registered with the Registering Authority appointed by the Central Government.

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 In every case where the milk or milk product is packed by the holder of a registration certificate in a tin, barrel, carton or any other container, the registration number shall either be exhibited prominently on the side label of such container or be embossed, punched or printed prominently thereon.

VEGETABLE OIL PRODUCTS (REGULATION) ORDER, 1998 [Ministry of Food Consumer Affairs] REGULATIONS Regulates the production and distribution of all the edible oils. Specifications of the products provided. SPECIAL FEATURES Supersedes the vegetable oil products (control) order, 1947 and Vegetable Oil Products (Standards of Quality) order, 1975. BIS Certification for the tin plates used for vanaspati packaging is deleted.

SUGAR (CONTROL) ORDER, 1966 [Ministry of Agriculture and Irrigation Department of Sugar] REGULATIONSRegulates the manufacture, quality and sale of sugar

EXPORT (QUALITY CONTROL & INSPECTION) ACT, 1963 MODE OF OPERATION  Ministry of Commerce  Export inspection council, 5 regional export inspection agencies network of 50 offices REGULATION Regulates compulsory pre-shipment inspection  Exportable commodities list has been notified for pre-shipment inspection  Quality control of various export product is monitored SPECIAL FEATURES-

32



AGMARK has been recognized as an agent for inspection and quality control of certain items



Voluntary inspection at the request of foreign buyers and advice of export inspection council is also carried out

STANDARDS ON WEIGHTS AND MEASURES ACT, 1976 MODE OF OPERATION  Ministry of Food & Civil Supplies  Directorate of weights and measures

REGULATION Prescribed conditions for packed products with respect to quantity declaration, manufacturing date and sale price

SPECIAL FEATURES Provides relief to the weaker sections of the society and protecting the consumer in general by guaranteeing the quantity for the amount paid

THE CONSUMER PROTECTION ACT, 1986 [Ministry of Food & Civil Supplies] REGULATION

Provision made for the establishment of consumer councils and other authorities for the settlement of consumer disputes.

SPECIAL FEATURES Protection of the interest of consumer

ENVIRONMENT PROTECTION ACT, 1986 [Ministry of Environment & Forestry] 33

REGULATIONS Regulates

the

manufacture,

use

and

storage

of

hazardous

microorganisms/ substances cells used as foodstuff SPECIAL FEATURES

Compulsory for every food plant discharging waste into mainstream to obtain a No objection certificate (NOC) from respective State Pollution Board.

THE INSECTICIDE ACT, 1968 [Directorate of Plant Protection, Quarantine and Storage, Ministry of Agriculture] REGULATIONS Describes the safe use of insecticides to ensure that residual level doesn’t pose any health hazard

VOLUNTARY STANDARDS 1. AGRICULTURAL PRODUCE (GRADING & MARKETING) ACT, 1937 [Directorate of Marketing and Inspection] REGULATION Grade and Standards are prescribed for Agricultural & Allied Commodities Grading, sorting as per quality attributes and inspection are included SPECIAL FEATURES Activity based on marketing and grading at producer’s level. AGMAR certification. Standards are being harmonized with international standards keeping in view the WTO requirements. Certification of agricultural commodities is carried out for the benefit of producer/manufacturer and consumer 34

2. BUREAU OF INDIAN STANDARDS (BIS) [Indian Standards Institution] REGULATION Prescribing of grade standards, formulation of standards, specification of foods, standards for limit of toxic compounds as applicable.  Implementation of regulation by promotion through its voluntary and third party certification system, specifying of packaging and labelling requirements. SPECIAL FEATURES

General cover on hygienic conditions of manufacture, raw material quality & safety are given. Quality and safety oriented standards

2.1 CERTIFICATION MARKS SCHEME, BIS ACT, 1986 (rules and regulations) [BIS] REGULATIONS

Regulates the certifications scheme for various processed food products, ingredients and packaging containers.

SPECIAL FEATURES Ensure the quality to the consumer by certification.

35

DISASTER MANAGEMENT INTRODUCTION Disasters have been integral parts of the human experience since the beginning of time, causing premature death, impaired quality of life, and altered health status. The risk of a disaster is ubiquitous. On average, one disaster per week that requires international assistance occurs somewhere in the world. The recent dramatic increase in natural disasters, their intensity, the number of people affected by them, and the human and economic losses associated with these events have placed an imperative on disaster planning for emergency preparedness. Global warming, shifts in climates, sea-level rise, and societal factors may coalesce to create future calamities. Finally, war, acts of aggression, and the incidence of terrorist attacks are reminder of the potentially deadly consequences of man’s inhumanity toward man. DEFINITIONS WHO defines Disaster as “any occurrence that causes damage, ecological disruption, loss of human life, deterioration of health and health services, on a scale sufficient to warrant an extraordinary response from outside the affected community or area.” Red Cross (1975) defines Disaster as “An occurrence such as hurricane, tornado, storm, flood, high water, wind-driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, building collapse, transportation wreck, or other situation that causes human suffering or creates human that the victims cannot alleviate without assistance.” UNDP (2004) defines “Disaster is a serious disruption triggered by a hazard, causing human, material, economic or (and) environmental losses, which exceed the ability of those affected to cope.” Disaster can be defined as “Any catastrophic situation in which the normal patterns of life (or ecosystems) have been disrupted and extraordinary, emergency interventions are required to save and preserve human lives and/or the environment.”

36

Disaster may also be termed as “a serious disruption of the functioning of society, causing widespread human, material or environmental losses which exceed the ability of the affected society to cope using its own resources.” THUS, A DISASTER MAY HAVE THE FOLLOWING MAIN FEATURES:

Unpredictability



Unfamiliarity



Speed



Urgency



Uncertainty



Threat

TYPES OF DISASTER Disasters are classified in various ways, on the basis of its origin/cause. 1.

Natural disasters

2.

Man-made disasters

AND ON THE BASIS OF SPEED OF ONSET1.

Sudden onset disasters

2.

Slow onset disasters

NATURAL DISASTERS A serious disruption triggered by a natural hazard (hydro-metrological, geological or biological in origin) causing human, material, economic or environmental losses, which exceed the ability of those affected to cope. Natural hazards can be classified according to their (1) Hydro meteorological, (2) Geological or (3) Biological origins.

37

HYDROMETER LOGICAL DISASTER – Natural processes or phenomena of atmospheric hydrological or oceanographic nature. Phenomena / Examples – Cyclones, typhoons, hurricanes, tornados, Storms, hailstorms, snowstorms, cold spells, heat waves and droughts. GEOGRAPHICAL DISASTER – Natural earth processes or phenomena that include processes of endogenous origin or tectonic or exogenous origin such as mass movements, Permafrost, snow avalanches. Phenomena / Examples – Earthquake, tsunami, volcanic activity, Mass movements landslides, Surface collapse, geographical fault activities etc. BIOLOGICAL DISASTER – Processes of organic organs or those conveyed by biological vectors, including exposure to pathogenic, microorganism, toxins and bioactive substances. Phenomena / Examples – Outbreaks of epidemics Diseases, plant or animal contagion and extensive infestation etc. HUMAN-INDUCED DISASTERS A serious disruption triggered by a human-induced hazard causing human, material, economic or environmental losses, which exceed the ability of those affected to cope. These can be classified into – (1) Technological Disaster and (2) Environmental Degradation. TECHNOLOGICAL DISASTER – Danger associated with technological or industrial accidents, infrastructure failures or certain human activities which may cause the loss of life or injury, property damage, social or economic disruption or environmental degradation, sometimes referred to as anthropological hazards. Examples include industrial pollution, nuclear release and radioactivity, toxic waste, dam failure, transport industrial or technological accidents (explosions fires spills).

38

ENVIRONMENTAL DEGRADATION – Processes induced by human behaviours and activities that damage the natural resources base on adversely alter nature processes or ecosystems. Potentials effects are varied and may contribute to the increase in vulnerability, frequency and the intensity of natural hazards. Examples include land degradation, deforestation, desertification, wild land fire, loss of biodiversity, land, water and air pollution climate change, sea level rise and ozone depletion. LEVELS OF DISASTER Goolsby and Kulkarni (2006) further classify disasters according to the magnitude of the disaster in relation to the ability of the agency or community to respond. Disasters are classified by the following levels: 1)

Level I: If the organization, agency, or community is able to contain the event

and respond effectively utilizing its own resources. 2)

Level II: If the disaster requires assistance from external sources, but these

can be obtained from nearby agencies. 3)

Level III: If the disaster is of a magnitude that exceeds the capacity of the local

community or region and requires assistance from state-level or even federal assets. KEY ELEMENTS OF DISASTERS Disasters result from the combination of hazards, conditions of vulnerability and insufficient capacity or measures to reduce the potential negative consequences of risk. HAZARDS Hazards are defined as “Phenomena that pose a threat to people, structures, or economic assets and which may cause a disaster. They could be either manmade or naturally occurring in our environment.” Hazard is a potentially damaging physical event, phenomenon or human activity that may cause the loss of life or injury, property damage, social and economic disruption or environmental degradation. (UN ISDR 2002) 39

VULNERABILITY Vulnerability is the condition determined by physical, social, economic and environmental factors or processes, which increase the susceptibility of a community to the impact of hazards. (UN ISDR 2002) CAPACITY Capacity is the combination of all the strengths and resources available within a community, society or organization that can reduce the level of risk, or the effects of a disaster. Capacity may include physical, institutional, social or economic means as well as skilled personal or collective attributes such as ‘leadership’ and ‘management.’ Capacity may also be described as capability. (UN ISDR 2002) RISK Risk is the probability of harmful consequences, or expected losses (deaths, injuries, property, livelihoods, economic activity disrupted or environment damaged) resulting from interactions between natural or human-induced hazards and vulnerable conditions. (UNDP 2004) HEALTH EFFECTS OF DISASTERS The health effects of disasters may be extensive and broad in their distribution across populations. In addition to causing illness and injury, disasters disrupt access to primary care and preventive services. Depending on the nature and location of the disaster, its effects on the short- and long-term health of a population may be difficult to measure. Disasters affect the health status of a community in the following ways: –  Disasters may cause premature deaths, illnesses, and injuries in the affected community, generally exceeding the capacity of the local health care system.  Disasters may destroy the local health care infrastructure, which will therefore be unable to respond to the emergency. Disruption of routine health care services and prevention initiatives may lead to long-term consequences in health outcomes in terms of increased morbidity and mortality.

40

 Disasters may create environmental imbalances, increasing the risk of communicable diseases and environmental hazards.  Disasters may affect the psychological, emotional, and social well-being of the population in the affected community. Depending on the specific nature of the disaster, responses may range from fear, anxiety, and depression to widespread panic and terror  Disasters may cause shortages of food and cause severe nutritional deficiencies.  Disasters may cause large population movements (refugees) creating a burden on other health care systems and communities. Displaced populations and their host communities are at increased risk for communicable diseases and the health consequences of crowded living conditions. PHASES OF A DISASTER There are three phases of disaster. 1.

Pre-Impact Phase

2.

Impact Phase

3.

Post – Impact Phase

PRE-IMPACT PHASE It is the initial phase of disaster, prior to the actual occurrence. A warning is given at the sign of the first possible danger to a community with the aid of weather networks and satellite many meteorological disasters can be predicted. The earliest possible warning is crucial in preventing toss of life and minimizing damage. This is the period when the emergency preparedness plan is put into effect emergency centres are opened by the local civil, detention authority. Communication is a very important factor during this phase; disaster personnel will call on amateur radio operators, radio and television stations.

41

The role of the nurse during this warning phase is to assist in preparing shelters and emergency aid stations and establishing contact with other emergency service group. IMPACT PHASE The impact phase occurs when the disaster actually happens. It is a time of enduring hardship or injury end of trying to survive. The impact phase may last for several minutes (e.g. after an earthquake, plane crash or explosion.) or for days or weeks (eg in a flood, famine or epidemic). The impact phase continues until the threat of further destruction has passed and emergency plan is in effect. This is the time when the emergency operation centre is established and put in operation. It serves as the centre for communication and other government agencies of health tears care healthcare providers to staff shelters. Every shelter has a nurse as a member of disaster action team. The nurse is responsible for psychological support to victims in the shelter. POST – IMPACT PHASE Recovery begins during the emergency phase and ends with the return of normal community order and functioning. For persons in the impact area this phase may last a lifetime (e.g. – victims of the atomic bomb of Hiroshima). The victims of disaster in go through four stages of emotional response. 1.

Denial – during the stage the victims may deny the magnitude of the problem

or have not fully registered. The victims may appear usually unconcerned. 2.

Strong Emotional Response – in the second stage, the person is aware of

the problem but regards it as overwhelming and unbearable. Common reaction during this stage is trembling, tightening of muscles, speaking with the difficulty, weeping heightened, sensitivity, restlessness sadness, anger and passivity. The victim may want to retell or relieve the disaster experience over and over. 3.

Acceptance – During the third stage, the victim begins to accept the problems

caused by the disaster and makes a concentrated effect to solve them. It is important for victims to take specific action to help themselves and their families. 42

4.

Recovery – The fourth stage represent a recovery from the crisis reaction.

Victims feel that they are back to normal. A sense of well-being is restored. Victims develop the realistic memory of the experience. DISASTER MANAGEMENT CYCLE THE DISASTER EVENT This refers to the real-time event of a hazard occurring and affecting the ‘elements at risk’. The duration of the event will depend on the type of threat, for example, ground shaking may only occur for a few seconds during an earthquake while flooding may take place over a longer period of time. There are five basic phases to a disaster management cycle (Kim & Proctor, 2002), and each phase has specific activities associated with it. RESPONSE The response phase is the actual implementation of the disaster plan. The best response plans use an incident command system, are relatively simple, are routinely practiced, and are modified when improvements are needed. Response activities need to be continually monitored and adjusted to the changing situation. Activities a hospital, healthcare system, or public health agency take immediately during, and after a disaster or emergency occurs. RECOVERY Once the incident is over, the organization and staff needs to recover. Invariably, services have been disrupted and it takes time to return to routines. Recovery is usually easier if, during the response, some of the staff have been assigned to maintain essential services while others were assigned to the disaster response. Activities undertaken by a community and its components after an emergency or disaster to restore minimum services and move towards long-term restoration. 

Debris Removal



Care and Shelter



Damage Assessments 43



Funding Assistance

DISASTER MANAGEMENT CYCLE EVALUATION/DEVELOPMENT Often this phase of disaster planning and response receives the least attention. After a disaster, employees and the community are anxious to return to usual operations. It is essential that a formal evaluation be done to determine what went well (what really worked) and what problems were identified. A specific individual should be charged with the evaluation and follow-through activities. MITIGATION These are steps that are taken to lessen the impact of a disaster should one occur and can be considered as prevention and risk reduction measures. Examples of mitigation activities include installing and maintaining backup generator power to mitigate the effects of a power failure or cross training staff to perform other tasks to maintain services during a staffing crisis that is due to a weather emergency.

44

PREPAREDNESS/RISK ASSESSMENT Evaluate the facility’s vulnerabilities or propensity for disasters. Issues to consider include: weather patterns; geographic location; expectations related to public events and gatherings; age, condition, and location of the facility; and industries in close proximity to the hospital (e.g., nuclear power plant or chemical factory). DISASTER TRIAGE The word triage is derived from the French word trier, which means, “to sort out or choose.” The Baron Dominique Jean Larrey, who was the Chief Surgeon for Napoleon, is credited with organizing the first triage system. “Triage is a process which places the right patient in the right place at the right time to receive the right level of care” (Rice & Abel, 1992). Triage is the process of prioritizing which patients are to be treated first and is the cornerstone of good disaster management in terms of judicious use of resources (Auf der Heide, 2000). NEED OF THE DISASTER TRIAGE 1.

Inadequate resource to meet immediate needs

2.

Infrastructure limitations

3.

Inadequate hazard preparation

4.

Limited transport capabilities

5.

Multiple agencies responding

6.

Hospital Resources Overwhelmed

45

AIMS OF TRIAGE 1.

To sort patients based on needs for immediate care

2.

To recognize futility

3.

Medical needs will outstrip the immediately available resources

4.

Additional resources will become available given enough time.

PRINCIPLES OF TRIAGE The main principles of triage are as follows: –  Every patient should receive and triaged by appropriate skilled health-care professionals.  Triage is a clinic-managerial decision and must involve collaborative planning.  The triage process should not cause a delay in the delivery of effective clinical care. ADVANTAGES OF TRIAGE  Helps to bring order and organization to a chaotic scene.  It identifies and provides care to those who are in greatest need  Helps make the difficult decisions easier  Assure that resources are used in the most effective manner  May take some of the emotional burden away from those doing triage TYPES OF TRIAGE There are two types of triage: 1.

Simple triage

2.

Advanced triage

46

SIMPLE TRIAGE Simple triage is used in a scene of mass casualty, in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or colored flagging. S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly trained lay and emergency personnel in emergencies. Triage separates the injured into four groups: ·

0 – The deceased who are beyond help

·

1 – The injured who can be helped by immediate transportation

·

2 – The injured whose transport can be delayed

·

3 – Those with minor injuries, who need help less urgently

ADVANCED TRIAGE In advanced triage, doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. Advanced care will be used on patients with less severe injuries. Because treatment is intentionally withheld from patients with certain injuries, advanced triage has an ethical implication. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive. Principles of advanced triage is  “Do the greatest good for the greatest number”  Preservation of life takes precedence over preservation of limbs.  Immediate threats to life: HEMORRHAGE. 47

 ADVANCED TRIAGE CATEGORIES

CLASS I (EMERGENT) RED IMMEDIATE – Victims with serious injuries that are life threatening but has a high probability of survival if they received immediate care. – They require immediate surgery or other life-saving intervention, and have first priority for surgical teams or transport to advanced facilities; they “cannot wait” but are likely to survive with immediate treatment. “Critical; life threatening—compromised airway, shock, hemorrhage” CLASS II (URGENT) YELLOW DELAYED – Victims who are seriously injured and whose life is not immediately threatened; and can delay transport and treatment for 2 hours. – Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under “normal” circumstances). “Major illness or injury;—open fracture, chest wound” CLASS III (NON-URGENT) GREEN MINIMAL – “Walking wounded,” the casualty requires medical attention when all higher priority patients have been evacuated, and may not require monitoring. – Patients/victims whose care and transport may be delayed 2 hours or more. “minor injuries; walking wounded—closed fracture, sprain, strain” CLASS IV (EXPECTANT) BLACK EXPECTANT They are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock, severe head or chest wounds); They should be taken to a holding area and given painkillers as required to reduce suffering. “Dead or expected to die—massive head injury, extensive full-thickness burns”  USING RPM TO CLASSIFY PATIENTS

CATEGORY (COLOR) Critical (RED) Urgent (YELLOW) Expectant: dead or dying (BLACK)

RPM INDICATORS R = Respiratory rate > 30; P = Capillary refill > 2 seconds; M = Doesn’t obey commands R < 30 P < 2 seconds M = Obeys commands R = not breathing

48

INTERNATIONAL NURSES STANDARDS NURSES AND PEOPLE  The nurse’s primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected.  The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment.  The nurse holds in confidence personal information and uses judgement in sharing this information.  The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations.  The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction. NURSES AND PRACTICE  The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning.  The nurse maintains a standard of personal health such that the ability to provide care is not compromised.  The nurse uses judgement regarding individual competence when accepting and delegating responsibility.  The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence.  The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people. NURSES AND THE PROFESSION  The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education.

49

 The nurse is active in developing a core of research-based professional knowledge.  The nurse, acting through the professional organisation, participates in creating and maintaining safe, equitable social and economic working conditions in nursing. NURSES AND CO-WORKERS  The nurse sustains a co-operative relationship with co-workers in nursing and other fields.  The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person. THE ICN CODE OF ETHICS FOR NURSES  The ICN Code of Ethics for Nurses is a guide for action based on social values and needs.  It will have meaning only as a living document if applied to the realities of nursing and health care in a changing society.  To achieve its purpose the Code must be understood, internalised and used by nurses in all aspects of their work.  It must be available to students and nurses throughout their study and work lives APPLYING THE ELEMENTS OF THE ICN CODE OF ETHICS FOR NURSES  The four elements of the ICN Code of Ethics for Nurses : nurses and people, nurses and practice, nurses and the profession, and nurses and co-workers, give a framework for the standards of conduct.  The following chart will assist nurses to translate the standards into action. Nurses and nursing students can therefore:  Study the standards under each element of the Code.  Reflect on what each standard means to you. Think about how you can apply ethics in your nursing domain: practice, education, research or management.  Discuss the Code with co-workers and others. 50

 Use a specific example from experience to identify ethical dilemmas and standards of conduct as outlined in the Code. Identify how you would resolve the dilemmas.  Work in groups to clarify ethical decision making and reach a consensus on standards of ethical conduct.  Collaborate with your national nurses’ association, co-workers, and others in the continuous application of ethical standards in nursing practice, education, management and research.

INTERNATIONAL HEALTH AGENCIES WORLD HEALTH ORGANISATION The World health organization is a specialised, non-political health agency of the United Nations, with headquarters at Geneva. In 1946, the constitution drafted by the ’Technical preparatory committee under the chairmanship of Rene Sand was approved in the same year by international conference of 51 nations in New York. The constitution came into force on 7th April 1948 which is celebrated every year as world health day. OBJECTIVES OF WHO: The main objective of WHO is ―”the attainment by all peoples of the highest level of health‖which is set out in the preamble of the constitution.” THE PREAMBLE OF THE CONSTITUTION STATES:  Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

51

 The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without didtinction of race, religion, and political belief, economic and social condition.  The health of all people is fundamental to attainment of peace and security and is dependent upon the fullest cooperation of the individuals and the states.  The achievement of any state in the promotion and protection of health is value to all.  Unequal development in different countries in the promotion of health and control of disease, especially communicable disease is a common danger. Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.  The extension to all people of the benefits of medical, psychological and related knowledge is essential to fullest attainment of health.  Informed opinion and active co-operation on the part of the public are utmost importance in the improvement of the health of the people. The WHO is a unique UN specialized agencies in that it has its own constitution, own governing bodies, own membership and own budgetit is a part of UN and not a subordinate of the UN. MEMBERSHIP:  Membership of the WHO is open to all countries. most of the members of both the UN and the WHO.  Territories which are not responsible for the conduct of their relations may be admitted as Associate members.  Associate members participate without vote in deliberations of the WHO.  Each member contributes yearly to the budget and each is entitled to the services and aid the organization can provide. WORK OF WHO; 1. PREVENTION AND CONTROL OF SPECIFIC DISEASES WHO has played a vital role in preventing the spread of communicable diseases. Eg:the global 52

eradication of smallpox is an outstanding example of international health cooperation. 

Epidemiological surveillance is an important activity of WHO carried out in case of communicable diseases.



The WHO collects and disseminates epidemiological information on diseases subject to International Health Regulations and occasionally other communicable diseases of international importance through an Automatic Telex Reply (ATRS) and the ―Weekly Epidemiological Record‖ (WER).



Immunization against various common childhood diseases is now a priority programme of WHO.

2. DEVELOPMENT OF COMPREHENSIVE SERVICES 

WHO’s most important function is to promote and support national health policy development and the development of comprehensive national health programmes.



This endeavour encompasses a wide range of activities i.e. organising health systems based on primary health care, building of long term national capability, particularly in areas of health infrastructure development, and managerial capabilities.



Appropriate technology for health (ATH) is another new programme launched by WHO to encourage self-sufficiency in solving health problems.

3. FAMILY HEALTH 

Family health is one of the major programme activities of WHO since 1970, and is broadly subdivided into maternal and child health care, human reproduction, nutrition and health education.



Chief concern is to improve health of family as a unit.

4. ENVIRONMENTAL HEALTH 

Promotion of environmental health is an important activity of WHO.



WHO advises governments on national health programmes for the provision of basic sanitary services 53



A number of practices have been developed such as ―WHO environmental Health criteria programme‖ and ―WHO Environmental Health Monitoring Programme’ towards improving environmental health.

5. HEALTH STATISTICS 

Earliest days in 1947, WHO has been concerned with the dissemination of a wide variety of mortality and morbidity statistics relating to health problems. The data is published in the I. Weekly Epidemiological Record II. World health statistics quarterly III. World health statistics



Statistics of different diseases are compared and formulated by WHO and it publishes it in the issue of ―International Classification of Diseases‖ which is updated every 10th year.

5. BIO-MEDICAL RESEARCH 

WHO is greatly involved in Research Work.



It has established a world-wide network of WHO collaborating centres, besides awarding grants to research workers and institutions for promoting research.



A regional advisory committee formulates regional health research priorities for health research in conjunction with a Global advisory committee which in close collaboration with regional committee deals with policy of global import.

7. HEALTH LITERATURE AND INFORMATION 

WHO library is one of the satellite centres of the Medical Literature Analysis and Retrieval System (MEDLARS) of the U.S national Library of Medicine.



WHO has also a public information service both at headquarters and each

54

8. COOPERATION WITH OTHER ORGANISATION 

WHO collaborates with the UN and with the other specialized agencies, and maintains various degrees of working relationships.



WHO has also established with a number of international governmental organizations. Of the six regional 6 offices.

STRUCTURE: WHO consists of three principal organs: 1) The World Health Assembly 2) The Executive Board 3) The Secretariat 1) THE WORLD HEALTH ASSEMBLY  It is the ―Health Parliament‖ of nations and the supreme governing body of the organizations.  It meets annually in the month of May and generally at the Headquarters in Geneva.  The Assembly is composed of delegates representing Member states, each of which has one vote FUNCTIONS: I. To determine international health policy and programmes II. To review the work of the past year. III. To approve the budget of the following year. IV. To approve the budget needed for the following year. V. To elect Member states to designate a person to serve for three years on the executive board and to replace the retiring members. The Director General is appointed on the nominations provided by the Executive Board.

55

2) THE EXECUTIVE BOARD  The board had originally 18 members which had been incremented to 31 members by the health assembly.  The members of the board are to be technically qualified in the field of health they are designated by their respective governments, but do not represent their respective governments.  One third of the membership is renewed every year is renewed every year.  The executive board meets every year in the month of January and May after the meeting of the World Health Assembly.  The main work of the board is to give effect to the decisions and policies of the assembly  The board also has power to take in an emergency such as epidemics, earthquakes and floods where immediate action is needed. 3) THE SECRETARIAT  The secretariat is headed by Director General who is the chief technical and administrative officer of the organization.  The primary function of the secretariat is to provide member states with technical and managerial support for their national development programmes.  At WHO there are 5 Assistant Director-Generals each of whom is responsible for the work of such divisions as may from time to time that is assigned by the Director General. THE DIRECTOR SECRETARIAT IS COMPRISED OF THE FOLLOWING DIVISIONS: 1) Division of epidemiological surveillance and health situation and trend adjustment. 2) Division of communicable diseases. 3) Division of vector biology and control 4) Division of environmental health 5) Division of public information and education for health division of public information for health 6) Division of mental health 56

7) Division of diagnostic, therapeutic and rehabilitative technology. 8) Division of strengthening of health services. 9) Division of family health 10) Division of non-communicable diseases 11) Division of health-manpower development 12) Division of information systems support 13) Division of personnel and general services 14) Division of budget and finance REGIONS: WHO regional organizations are as follows:

Sr. no.

Region

Headquarter

1

South-East Asia

New Delhi(India)

2

Africa

Harare(Zimbabwe)

3

The Americas

Washington D.C(U.S.A)

4

Europe

Copenhagen(Denmark)

5

Eastern Mediterranean

Alexandria(Egypt)

6

Western Pacific

Manila(Philippines)

 The regional offices each are headed by a regional Director, WHO is assisted by technical and administrative officers, and members of the secretariat.  There is a regional composed of representative of member states in the region Regional committees meet once in a year to review the health work in the region and plan it’s continuation and development.  Regional plans are amalgamated into overall plans by the Director General of the WHO. THE SOUTH-EAST ASIA REGION(SEARO)-WHO 1) Bangladesh 2) Bhutan

57

3) India 4) Indonesia 5) Korea(Democratic people’s Republiv) 6) Maldives Islands 7) Myanmar 8) Nepal 9) Sri Lanka 10) Thailand ACTIVITIES CARRIED OUT BY WHO IN SEARO REGION: 1) Malaria eradication 2) Tuberculosis control 3) Control of other communicable diseases 4) Health laboratory services and other communicable diseases 5) Health statistics 6) Maternal and child health 7) Nursing 8) Health education 9) Nutrition 10) Mental health 11) Dental health 12) Medical rehabilitation 13) Quality control of drugs and medical education

UNICEF  UNICEF is one of the specialized agencies of United Nations established in the year 1946 to rehabilitate children in war ravaged countries. UNICEF’s regional office is present at New Delhi, also known as South Central Asian Region.  It consists of the following regions: 58

1) Sri Lanka 2) India 3) Maldives 4) Mongolia 5) Nepal 

UNICEF is governed by a thirty nation executive board. Headquarters is at United Nations, New York.



UNICEF works in close collaboration with WHO, UNDP,FAO and UNESCO in combating problems like malaria, tuberculosis and venereal diseases.



It’s assistance to countries covered varied fields such as maternal and child health and environmental sanitation.

THE EXECUTIVE BOARD  The Executive Board is the governing body of UNICEF.  It is responsible for providing inter-governmental support to and supervision of the activities of UNICEF, in accordance with the overall policy guidance of the General Assembly and the Economic and Social Council of the United Nations.  The Board meets three times each year, in a first regular (January), annual (June) and second regular session (September). The Board, like the governing bodies of other United Nations funds and programmes (UNDP, UNFPA and WFP), is subject to the authority of the Council. Its role is to  Implement the policies formulated by the Assembly and the coordination and guidance received from the Council  Receive information from and give guidance to the Executive Director on the work of UNICEF  Ensure that the activities and operational strategies of UNICEF are consistent with the overall policy guidance set forth by the Assembly and the Council  Monitor the performance of UNICEF Approve programmes, including country programmes

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 Decide on administrative and financial plans and budgets Recommend new initiatives to the Council and, through the Council, to the assembly as necessary  Encourage and examine new programme initiatives and  Submit annual reports to the Council in its substantive session, which could include recommendations, where appropriate, for improvement of field-level coordination. The Board has 36 members, elected for a three-year term with the following regional allocation of seats: 

8 African States



7 Asian States



4 Eastern European States



5 Latin American and Caribbean States



12 Western European



Other States (including Japan)

 The officers of the Board, constituting the Bureau, are elected by the Board at its first regular session of each calendar year from among Board members.  There are five officers—the President and four Vice-Presidents— representing the five regional groups at the United Nations. Officers of the Board are elected for a one-year term. The Board year runs from 1 January to 31 December.  The Economic and Social Council elects States to sit on the UNICEF Executive Board from States Members of the United Nations or of the specialized agencies or of the International Atomic Energy Agency.  Board sessions are held at United Nations Headquarters in New York. All formal meetings of the Board are interpreted in the six official languages of the United Nations (Arabic, Chinese, English, French, Spanish and Russian). A set of established Rules of Procedure facilitates the conduct of meetings.  The Office of the Secretary of the Executive Board (OSEB) is responsible 60

for maintaining effective relationship between the Board and the UNICEF secretariat.

FUNDING

UNICEF is funded primarily by voluntary contributions from governmental and non-governmental organizations. Donations from the private sector also fund this organization. CURRENT EVENTS The 2000 Millennium Summit established 8 goals, referred to as the Millennium Development Goals (MDG). At this summit, over 150 heads of state came together at the UN to talk about ways of eliminating poverty, ensuring equal human rights to all people and new goals for the new millennium.

THE GOALS INCLUDE: 1) The eradication of extreme poverty and hunger 2) Achieving universal primary education 3) Promoting gender equality and empowering women, 4) Reducing child mortality 5) Improving maternal health 6) Combating HIV/AIDS, malaria, and other diseases, 7) Ensuring environmental sustainability 8) Developing a global partnership for development for the new millennium.

SERVICES PROVIDED BY UNICEF: 1) CHILD HEALTH  UNICEF has provided substantial aid for the production of vaccines and sera in many countries  UNICEF has supported the BCG programme in India since its inception  UNICEF has helped in the erection of a penicillin plant near Pune  UNICEF assists in environmental sanitation programmes  UNICEF has been providing primary health care to mother and children through services like immunization, infant and young child care.

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2) CHILD NUTRITION 

UNICEF gives high priority to child nutrition



In the aid to provide nutrition to the children UNICEF started up with provision of supplementary feeding, development of low cost protein mixtures.



In collaboration with FAO, the UNICEF also started applied nutrition programmes through channels like community development, agricultural extension, schools and health services



UNICEF has also provided equipment’s to dairy plants in various parts of India

(Maharashtra,Gujrat,Karnataka,Uttarpradesh,West-

Bengal,Andhrapradesh) 

It provides specific nutrition for intervention against nutritional diseases, viz. provision of large doses of vitamin A in areas where xeropthalmia is prevalent; enrichment of areas with salt rich iodine



Provision of iron and folate supplements



UNICEF collaborates with FAO and WHO for the development of national food and nutritional policies.

3) FAMILY AND CHILD WELFARE  Their main purpose is to care for children both within their and outside their homes  These include a varied number of services i.e. parent education, day care centres, child welfare and youth agencies and women’s clubs  These projects are carried as a part of health, nutrition and education.

4) EDUCATION-FORMAL AND NON-FORMAL  In collaboration with UNESCO, UNICEF is assisting India in the expansion and improving of teaching science in India.  It provides science laboratory equipment, workshop tools, library books, audio-visual aids to educational institutions.  UNICEF is providing a campaign known as GOBI which encourages 4 strategies for ―child health revolution‖: 62

G - Growth charts to better monitor child development O - Oral rehydration to treat all mild and moderate dehydrate B - Breast Feeding I - Immunization against measles, diphtheria, polio, pertussis, tetanus and tuberculosis.  UNICEF has been participating in Urban Basic Services(UBS) to upgrade basic services 

Health



Nutrition



Water supply



Sanitation and education

UNDP  United Nations Development Programme was established in the year 1966.It is the main source of funds for technical assistance.  The member countries, both the rich and the poor meet annually and pledge contributions to the UNDP.  The main objective is to help poorer nations develop their human and natural resources more fully.  The UNDP projects cover virtually every economic and social sectoragriculture, industry, education and science, health, social welfare.

World leaders have pledged to achieve the Millennium Development Goals, including the overarching goal of cutting poverty in half by 2015. UNDP's network links and coordinates global and national efforts to reach these Goals. Their focus is helping countries build and share solutions to the challenges of: 

Democratic Governance



Poverty Reduction



Crisis Prevention and Recovery



Environment and Energy



HIV/AIDS

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FAO The food and agriculture organization(FAO) was formed in the year 1945 with headquarters in Rome. It was United Nations organization specialized agency created to look after several areas of world co-operation. The chief aims of FAO are as follows; 1) To help nations raise living standards. 2) To improve the nutritional status of people of all countries. 3) To increase the efficiency of farming, forestry and fisheries. 4) to better the condition of rural people and better the opportunity of productive work

ACTIVITIES OF FAO: FAO's activities comprise four main areas: 1) PUTTING INFORMATION WITHIN REACH FAO serves as a knowledge network. We use the expertise of our staff agronomists, foresters, fisheries and livestock specialists, nutritionists, social scientists, economists, statisticians and other professionals - to collect, analyse and disseminate data that aid development. A million times a month, someone visits the FAO Internet site to consult a technical document or read about our work with farmers. We also publish hundreds of newsletters, reports and books, distribute several magazines, create numerous CD-ROMS and host dozens of electronic fora.

2) SHARING POLICY EXPERTISE FAO lends its years of experience to member countries in devising agricultural policy, supporting planning, drafting effective legislation and creating national strategies to achieve rural development and hunger alleviation goals.

3) PROVIDING A MEETING PLACE FOR NATIONS On any given day, dozens of policy-makers and experts from around the globe convene at headquarters or in our field offices to forge agreements on major food and agriculture issues. As a neutral forum, FAO provides the setting where 64

rich and poor nations can come together to build common understanding.

4) BRINGING KNOWLEDGE TO THE FIELD Our breadth of knowledge is put to the test in thousands of field projects throughout the world. FAO mobilizes and manages millions of dollars provided by industrialized countries, development banks and other sources to make sure the projects achieve their goals. FAO provides the technical know-how and in a few cases is a limited source of funds. In crisis situations, we work side-by-side with the World Food Programme and other humanitarian agencies to protect rural livelihoods and help people rebuild their lives.

ILO In 1919,the International league of nations was established as an affiliate of league of nations to improve working and living conditions of the working population all over the world:

The purposes of ILO are as follows: 1) To contribute to the establishment of lasting peace by promoting social justice. 2) To improve through international action, labour conditions, and living standards. 3) To improve economic and social stability 

The international labour code is a collection of international minimum standards related to health, welfare, living and working conditions of workers all over the world.



The ILO provides also assistance to organizations interested in the betterment of living and employment standards.



There is a close collaboration between ILO and WHO in the field of health and labour.



The headquarters of ILO is in Geneva, Switzerland

65

BILATERAL HEALTH AGENCIES USAID The US government extends aid to India through three agencies: 1) United agency for International development 2) the public law 480 programme 3) The US import bank. The USAID was created in the year 1961.it is being administered by the technical cooperative mission The US government is assisting in a number of projects designed to improve the health of Indian people. 1) Malaria eradication 2) Medical education 3) Nursing education 4) Health education 5) Water supply and sanitation 6) Control of communicable diseases 7) Nutrition 8) Family planning

COLOMBO PLAN  At a meeting of the common wealth foreign ministers at Colombo in January Colombo in January 1950, a programme was drawn up for cooperative economic development in South Asia and South-East Asia.  Membership comprises 20 developing countries within the region and 6 non-regional members-Australia, Canada, Japan, New-Zealand, UK and USA.  The bulk of Colombo plan assistance goes into industrial and agricultural development.  Colombo plan has been useful in providing Cobalt therapy units to medical institutions in India.

66

SIDA The Swedish international development agency is assisting the national Tuberculosis programme since 1979. 

The SIDA assistance is usually spent on procurement of supplies like Xray unit, microscope and anti-tubercular drugs.



SIDA authorities are also supporting the short course Chemotherapy drug Regimens under pilot study, which were introduced in 18 districts of the country during 1983-1984.

DANIDA The government of Denmark is providing assistance for the development of services under National Blindness control Programme since 1978.

NON-GOVERNMENTAL

AND

OTHER

AGENCIES ROCKFELLER FOUNDATION  Rockfeller foundation is a philanthropic organization chartered in 1913 and endowed by Mr.John .D rockfeller.  Its purpose is to promote the wellbeing of mankind throughout the world.  In its yearly years the foundation was actively chiefly in public health.the work of the Rockfeller foundation in India began in 1920 with a skill for control of hookworm infection with the Madras presidency.  The foundation’s programmes included the training of competent teachers and research workers, training abroad of candidates from India through fellowships and travel grants.  The sponsoring of visits of a large number of medical specialists from the USA, providing grants in aid to selected institutions. Development of medical libraries, population studies, assistance to research projects and institutions, (eg. National institute of virology at Pune). 67

 At present the foundation is directing it’s support to the improvement of agriculture, family planning and rural training centres as well as to medical education.

FORD FOUNDATION The Ford foundation has been active in the development of rural health services and family planning. The ford foundation has helped in the following projects:  Orientation training centres at Singoor, Poonamallaietc  Research cum action projects. These projects were aimed at improving environmental sanitation problems (eg: Designing and construction of anitary latrines in rural area.  Pilot project in rural health services, Gandhigram (tamilnadu).Among a rural population of 100,000 which provide a useful model for health administrator in the country.  Establishment of NIHAE: In the last few years the ford foundation has supported the national support institute of health administration and education at Delhi.  Calcutta water supply and drainage Scheme  Ford foundation Supports Family planning for research in reproductive biology.

INTERNATIONAL RED CROSS The Red Cross is a non-political and non-official international humanitarian organization devoted to the service of mankind in peace and war. It was founded by Henrary Dunant, A young swiss businessman in the year 1859. The first Geneva convention took place in 1864 and atreaty was signed for the relief of the wounded and sick of the armies in the field. Thus came into being the International committee of red cross(ICRC).An independent, neutral institution,the founder organization of the red cross.

68

ROLE OF RED CROSS:  It was largely confined to the victims of the war.  mainly it tries to involve itself into activities like first aid in case of war like situations, mch services  lately it has tried to extend its research in Disaster management and has designed emergency protocols.

CARE FOUNDATION The abbreviation when extended is ―Co-operative for assistance and relief everywhere‖ last founded in North America in the wake of the second world war in the year 1945. 

It is one of the world’s largest independent, non-profit, non-sectarian international relief and development organisations.



CARE provides emergency aid and long term development assistance.



CARE began its operation in India in 1950, till the end of 1980’s in India.



The primary objectives of CARE in India was to provide food for children in the age group of 6-11 years from mid-1980’s ,CARE-India focused its food support in the ICDS programme and in developments of programmes in areas of health and income supplementation.



It is helping in the following projects: Integrated nutrition and health projects, better health and nutrition projects, anaemia control project, improving women’s health projects, improved health care for adolescent’s girls projects, child survival projects, Improving women’s reproductive health and family spacing project, Konkan integrated development project.



CARE-India works in partnership with the government of India, state Government, NGO’s etc. Currently it has projects in Andhra Pradesh, Bihar, MP, Maharashtra, and Orissa and UP and West-Bengal. INDIAN RED CROSS SOCIETY

Indian Red cross society was Constituted under an Act of Indian Legislative council in 69

1920 it is auxiliary to the state authorities and armed forces medical services as per statutes of the Red Cross Red Crescent Movement. ORGANISATION/MEMBERSHIP/ACTIVITIES The National Headquarters of the Society is located at 1 Red Cross Road, New Delhi. Recognised by the International Committee of the Red Cross (ICRC) on 28th February 1929, it was affiliated with the International Federation of the Red Cross & Red Crescent Societies (then League) on 7th August 1929. The President of India is the President of the Society. STRUCTURE  At the national level, the management of affairs of the Society rests with the Managing Body comprising of members elected by the Branch Committee, and members, including a Chairman, nominated by the President of the Society.  The Managing Body elects a Vice Chairman from among them and appoints with the approval of the President of the Society a Treasurer and a Secretary General.  The Secretary General is the Chief Executive.

BRANCHES  There are State/Union Territory/Regional/District and sub district branches numbering over 700 spread all over the country.  The branches of the society are autonomous bodies with control over their own finance though they work under the guidance of the National Headquarters on questions relating to general policies and basic principles of the Red Cross.  The National Headquarters is the federal focal point among other things for the purposes of (a) the unity of the organization, (b) guidance and assistance towards promotion and expansion of services, (c) co-ordination of inter-state, national and international efforts; 70

(d) Dissemination and application of humanitarian laws and fundamental principles of the Red Cross.

ACTIVITIES The activities of the Indian Red Cross may be broadly grouped under the following categories:  Relief work during floods, famine, earthquake, epidemic etc.  Training health visitors, nurses, dais and public health education  Cooperation with the St. John Ambulance Association in the training of men and women in First Aid, Home Nursing etc.  Running a Home at Bangalore for disabled Ex-servicemen  Welfare services in military hospitals  Medical after-care of ex-service personnel - Maternity & Child Welfare  Junior Red Cross  Voluntary Blood Donation MEMBERSHIP Members of the Red Cross make the backbone of the Organisation. The Indian Red Cross Society has the following grades of members Patron; Vice Patron; Life Member; Life Associate; Institutional Member; Annual Member; Annual Associate. The membership subscriptions range from Rs.10/- to Rs.20,000/-

71

INTERNATIONAL HEALTH DAYS AND THEIR SIGNIFICANCE DATE

DAY

SIGNIFICANCE

7 April

World health day

To mark WHO’s founding/ to draw world attention to global health each year.

24 March

World tuberculosis

To build public awareness about the global

day

epidemic of TB & efforts to eliminate disease.

25 April

World malaria day

Recognizes global effort to control malaria.

April last

World immunization

To raise awareness & increase rates of

week

week

immunization.

30 January

World leprosy day

To increase public awareness about leprosy.

4 February

World cancer day

To raise awareness of cancer and to encourage its prevention, detection and treatment.

1 December World AIDS day

Raising awareness of AIDS and mourning those who have died of the disease.

8 May

5 June

14 June

World thalassemia

To spread awareness and to focus on its

day

prevention to avoid transmission.

World environment

Encourage worldwide awareness and action for

day

the environment.

World blood donor

To raise awareness of the need for the safe

day

blood and blood products and to thank the blood donors for saving live.

1-7

The national

To intensify awareness generation on the

September

nutritional week

importance of nutrition for health.

21 October

World iodine

To generate awareness of adequate use of

deficiency day

iodine & to highlight consequences of deficiency.

12 October

World arthritis day

To raise awareness of the condition and make sure that sufferers and caregivers know all the supports and help that is available to them.

72

26

Anti-obesity day

To highlight obesity is a public health hazard.

World haemophilia

It is an awareness day for haemophilia and

day

other bleeding disorders, to raise funds. attract

November

17 April

volunteers for the program. 3 December International day of persons with

To focus issues that affect people with disabilities worldwide.

disabilities 28

World rabies day

September

14

Raise awareness about the impact of rabies on human and animals, provide information.

World diabetes day

Global awareness campaign.

International day of

Raising awareness about issues affecting the

older persons

elderly persons.

World heart day

Awareness and interventions for healthy heart.

International day for

To make the voice of the poor heard, to honour

the eradication of

victims of poverty, hunger, violence and fear.

November 1 October

29 September 17 October

poverty

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RESEARCH: OXFORD ACADEMIC MIGRATION STUDIES Troubling freedom: Migration, debt, and modern slavery Julia O’Connell Davidson Migration Studies, Volume 1, Issue 2, 1 July 2013, Pages 176–195, https://doi.org/10.1093/migration/mns002 Published: 13 February 2013 Abstract Aim: This article is concerned with the role of debt in contemporary practices of mobility. It explores how the phenomenon of debt-financed migration disturbs the trafficking/smuggling, illegal/legal, and forced/voluntary dyads that are widely used to make sense of migration and troubles the liberal construction of ‘freedom’ and ‘slavery’ as oppositional categories. The research literature reveals that while debt can lock migrants into highly asymmetrical, personality, and often violent relations of power and dependency sometimes for several years, it is also a means by which many seek to extend and secure their future freedoms. Financing migration through debt can be an active choice without also being a ‘voluntary’ or ‘autonomous’ choice, and migrants’ decisions to take on debts that will imply heavy restrictions on their freedom are taken in the context of migration and other policies that severely constrain their alternatives. Vulnerability to abuse and exploitation is also politically constructed, and even migrant-debtors whose movement is state sanctioned often lack protections both as workers and as debtors. Indeed, large numbers of migrants are excluded from the rights and freedoms that in theory constitute the opposite of slavery. Conclusion: this illustrates the contemporary relevance of Losurdo’s historical account of the fundamentally illiberal realities of self-conceived liberal societies. 74

There remain ‘exclusion clauses’ in the social contract that supposedly affords universal equality and freedom, clauses that are of enormous consequence for many groups of migrants, and that also deleteriously affect those citizens who are poor and/or otherwise marginalized.

The Health Tourists’ Satisfaction Level of Services Provided: A CrossSectional Study in Iran Ali Mohammad Varzi,Koroush Saki,Khalil Momeni,Ghasem Rajabi Vasokolaei,Zahra Khodakaramifard, Morteza Arab Zouzani and Habib Jalilian Glob J Health Sci. 2016 Sep; 8(9): 294–301. Published online 2015 Jan 31. doi: 10.5539/gjhs.v8n9p294 Abstract Introduction: Patient satisfaction with provided services is used as an indicator of health care quality. Patient satisfaction is defined as patient perception of provided care compared to expected care. This study was administered to evaluate the health tourists’ satisfaction of provided services in Lorestan University of Medical Sciences affiliated hospitals in 2015. Method: In this descriptive case study, 1800 (696 (54.4%) men and 812 (45.6%) women, 74.5 province native) patients were selected by random sampling from among the patients of Lorestan University of Medical Sciences affiliated hospitals in 2015 spring. The data collection instrument is a semi-structured questionnaire in this study. The questionnaire has 62 general and specific items. Each of the specific items is scaled on four points; satisfied, fairly satisfied, dissatisfied and O.K. In order to analyse the data both descriptive and inferential statistics were used. 75

Results: Poldokhtar Imam Khomeini Hospital had the highest Level of satisfaction of 68 percent in all aspects (hoteling, discharge, paramedical, nurses, medical and admission) among the studied hospitals. Kuhdasht Imam Khomeini hospital had the lowest level of satisfaction of 53 percent. The overall satisfaction level in all hospitals was 61%. Discussion and Conclusion: Despite the shortcomings observed in different areas, the results of the present study are in an intermediate status compared to other studies. While treating patients, patient-centred issue and patients ‘need and preferences should be focused on to enhance health care quality. Considering Patients preferences not only are morally good but also lead to improved care and access to sustainable care practices. Therefore it is needed to drive organizational management approach toward the customer preferences management and needs.

SUMMARY Today we have completed international health-global burden of diseases, international

health

regulations,

international

cooperation

and

assistance,

quarantine, migration, health tourism, international trade and travel, health and food legislation, disaster management international agencies, international days and their significance.

CONCLUSION “Nothing is more international than a disease.” - Paul Russel Health and diseases has no political boundaries. Disease in any part of the world is a threat to other countries. Therefore it is mandatory to maintain well equipped system to restrict the disease spread and promote the health wellness of the society and universe.

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REFERENCES:  Bijayalakshmi dash, community health nursing, first edition, 2017, jaypee publication, pp-720-756.  AH Suryakantha, community medicine.fourth edition,2017,jaypee publication, pp318-319.  Shridhar

Rao,

community

health

nursing,

first

edition

2017,AITBS

publishers,pp538-546, 555-560  J Kishore, national health programs of India, 12th edition, 2017, century publication, pp960-984  BT Basvanthappa, community health nursing, 3 rd edition, vol 2, 2016, jaypee publication, pp 1399-1420  Dr.

zakirhusain

sheikh,

concise

text

in

community

medicine,

first

edition,2016,AIBTS publishers, pp 449-453  K. Park, textbook of preventive and social medicine, 23 rd edition, 2015, Bhanot publication, pp 119-120, 918-925  I clement, basic concepts of community health nursing, 2 nd edition, 2011, jaypee publication, pp 325-335, 240-247  https://www.ejmanager.com/mnstemps/157/1571455953098.pdf?t=1461605095  https://en.wikipedia.org/wiki/Medical_tourism_in_India  https://en.wikipedia.org/wiki/Quarantine  https://en.wikipedia.org/wiki/International_Health_Regulations  https://pariharraj.wordpress.com/2011/01/20/disaster-nursing/  https://academic.oup.com/migration/pages/article_collection_2017  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064070/  https://www.researchgate.net/publication/7889317_Global_health_priorities__Priorities_of_the_wealthy  http://content.time.com/time/health/article/0,8599,1687159,00.html  https://en.wikipedia.org/wiki/International_tourism

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