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LOGISTICS IN EPIDEMIOLOGICAL INVESTIGATIONS (ABSTRACT)

C.C. DRAPER
London School of Hygiene and Tropical Medicine, Keppel Street (Gower Street), London, WC1E 7HT, England.

The first investigative team that went under emergency conditions to the Sudan in October 1976, from London and from Nairobi, encountered many difficulties in transport and communications. When a second team went from London in January 1977 many of these difficulties had been resolved but nevertheless some problems arose, particularly in communications.


DISCUSSION
S.R. Pattyn : From our experience in Zaire we composed two lists of equipment. The first one enumerates the items necessary to investigate an epidemic for a short time and to bring to the laboratory, in the best conditions, the specimens necessary for diagnosis. The second one contains more and larger equipment and is intended for a longer stay, with more people in an epidemic area to help in its containment, surveillance and study. These lists certainly should be studied extremely carefully because indeed the smallest details are of the utmost importance once you are on the spot.
C.E. Gordon Smith : I would just like to restress the communication problem. It is the only part of this exercise I took part in, sitting in London having phone calls from various places and trying to keep track of the operation. We had the situation of our people in the Sudan, at risk of their own health and communications were really extremely bad. The very few occasions on which we were able to make contact at all was through Nairobi and in &bout a 45 minutes telephone call about two questions were answered, somewhat. This was prolonged by the fact that every time we stopped to wait for an answer, the telephone operator in Nairobi pulled out the plug and we had to start again all the way from London to get the answer to the next question. We know that not very far away from these people there was radio communication but it was not possible to obtain diplomatic clearance to communicate across the border with the other team. This would have facilitated a great many things but, for reasons which I don't clearly understand, this was not possible. I think that everything possible must be done on any future occasion to provide adequate communication systems particularly by radio.
D.P. Francis : A suggestion was made at one time at CDC that any emergency medical team should be preceded by an administrative, logistic officer to find out the problems about customs, addresses, transportation, etc. To avoid situations where one finds himself on a 'plane without one's supplies, and has to fly all the way back. To have such a person would be worthwhile.
K.M. Johnson : Particularly if he speaks a lot of different languages ! I think you are right and there might be a number of short-cuts that might be envisioned in this.
Arevshatsian : Was there any communication between the two teams in Zaire and the Sudan during their investigations ?
K.M. Johnson : I am not sure who was really trying hardest to send a message to the other group, but the answer is no. When the group in Zaire had pretty clear evidence, and this will probably have been about two weeks after they had arrived in the country, that syringe and needle in that situation were of some significance there was an attempt to pass this information to the team in Sudan. It was done in what might be called bilateral channels. We never knew whether that team heard the word and in fact it turned out that it did not. The two teams knew before they went into the respective countries that there was need to have this kind of communication. In Zaire it took us quite a long time to have any radio-communication between Kinshasa and the Yambuku area, but when it was established we did in fact end up with one extra set and the theoretical capacity to be able to use that set in Sudan. For reasons that are not quite clear, it never quite came off.
P. Brès : I agree that there were very important questions for which exchange of data would have been extremely useful. One was the case fatality ratio, we spent evenings trying to know what the other team could have found and whether we were right in the interpretation. When we discovered ten possible generations we would have liked to know whether the other team had also observed this. What happened in the region between the two foci ? What was the situation for relief if a member of the expedition came down with the disease ? Exchange of information would have been very much appreciated. But we have to take into account the contingency and if two countries are not willing to allow free exchange of communications through private radio systems, nothing can be done about it.
K.M. Johnson : I would think that if you want to talk about advanced logistics it is fair to raise the question as to, whether or not, particularly from the standpoint of an organization like WHO., you are going to include in your base package the radio equipment, and how many. There is no doubt that for the group in Zaire that turned out to be a very negative factor in terms of what happened in a timeframe and in the investments that were done.
C.E. Gordon Smith : If the technical ability in the sense of a transmitter and someone who can operate it is provided at the beginning, then the possibility exists of using it and this is important for internal purposes within the country, quite apart from whether it is then also possible to communicate internationally. But the time scale is such that if you don't get the radio into the equipment at the beginning, it will never get there in time to be useful. I also believe that the problem about communication between Sudan and Zaire would have been solved had there been a long enough time for the rather slow diplomatic processes to work. If this had been asked for, right at the beginning, the problem would have been solved. And the impetus to solve it would exist if the radio existed but, in the absence of the radio, one puts off actually making the necessary arrangements.
A. Fabiyi : It might be advisable right now to request WHO. at this moment that it should make all the arrangements with the different governments to obtain advanced clearance for communication in cases of emergencies which we are discussing.
K.M. Johnson : Including the kind of equipment and the frequencies to be used.

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