Improving Access to Health and Disaster Information
A Progress Report
by John C. Scott, CPSC, Ricardo Perez, PAHO, Stacey J. Arnesen, NLM

As reported in an article in the ISDR Informs Issue 2, 2000, the National Library of Medicine in the United States is working with the Pan American Health Organization (PAHO) Emergency Preparedness and Disaster Relief Coordination Program to support the rebuilding and improvement of local and national health information infrastructure in Honduras and Nicaragua after Hurricane Mitch. The broad objective of this partnership is to contribute to disaster reduction in the Region.

This NLM/PAHO initiative is based chiefly on the use of Internet as a means of access to disaster-related health information and as a communications channel to link individuals and organizations interested in sharing information about disaster health issues. Because of its unique capabilities and mission the Centro Regional de Información Sobre Desastres (CRID), located in Costa Rica, was cosen as the principal technical partner for the initiative. With a view to sustaining these activities in the future, the project then selected university libraries in Honduras and Nicaragua as priority centers to gather and disseminate technical and scientific disaster and health information. In addition to the CRID center in San Jose, Costa Rica, the four initial partner sites in Honduras and Nicaragua are:

• The Medical School of the at the Autonomous National University of Honduras (UNAH), in Tegucigalpa, Honduras;
• The Centro Universitario Region Norte (CURN), the UNAH campus at San Pedro Sula, Honduras;
• Centro de Investigacion y Estudios de la Salud (CIES), the school of public health of the Autonomous National University of Nicaragua (UNAN), in Managua, Nicaragua; and
• The Medical School of UNAN in Leon, Nicaragua

Not long after the project began El Salvador suffered a series of major earthquakes that severely affected the country’s infrastructure. Within the last month two sites have been added to the CRID/NLM/PAHO project. They are: the El Salvador Ministry of Health/PAHO Documentation Center and CEPRODE (Centro de Protección para Desastres), both in San Salvador. The project will provide funding and technical support (similar to Honduras and Nicaragua) in order to strengthen these centers in the areas of Internet connectivity and basic computer resources, training, and the creation of special disaster and health information services (full-text documents, databases, training material, etc.)

In April of this year the project’s first training program took place, in San Jose. Participants from all project sties met to be trained in the use of basic computer software, web searching, evaluation of electronic information resources, use of disaster resources on the web, and other Internet resources. Training was also given in use of CRID’s disaster information resources (database, thesaurus use, etc.), on LILACS (Latin American and Caribbean Literature on Health Sciences, produced by BIREME), and MicroISIS (BIREME’s database management system used in most countries in Latin America).

The “Training the Trainers” approach that is being promoted in this project has proven to be effective in may past projects of both NLM and PAHO. It seems to be successful in this case too. Since the first training session in San Jose, sites in Honduras, Nicaragua and El Salvador have already conducted subsequent training sessions in their respective countries, thereby multiplying the cadre of interested and knowledgeable professionals associated with and benefiting from the project.

The second formal project training session was recently completed in early October at the National Library of Medicine in Bethesda, Maryland, USA. Participants from each site spent a week at NLM undergoing extensive training in the use of NLM databases and resources including MEDLINE, PubMed and MEDLINEplus; Toxicology and Environmental Health Information Resources and TOXNET databases; Medical Subject Headings (MeSH), and the Unified Medical Language System (UMLS).

By the time this article is in print each project site should have completed installing and testing the technical equipment provided through NLM funding. This equipment package includes new Personal Computers, routers, and servers connected in a Local Area Network, and reliable 128 kbps Internet connectivity at each site.

Thoughts about sustainability:

The principal strategy for ensuring sustainability of the effort is selecting the partners that have the intellectual capacity and national responsibility to develop and maintain the services that the project is designed to enhance. CRID is the primary focal point of this initiative and is supported by some of the most important international organizations operating in the region (PAHO, ISDR, IFRC, MSF, CEPREDECAC, etc.). Costa Rica is also the headquarters PAHO’s regional disaster office for Central America.

Partner sites in Honduras, Nicaragua and El Salvador are high-level agencies and institutions that are the most qualified within their respective countries to deal with these issues. This project fits into the core mission of each partner so that the operations are thus likely to be incorporated into ongoing plans. Also in each case the PAHO country offices will continue to provide support to the partners and will provide information content and technical assistance to the project. It is hoped that in the long run, resources to sustain the project will be provided by and sustainable within regular and ongoing budgets of the partners.

There are at least two broad areas to consider regarding sustainability:

• Sustainability as it relates to current project sites

- After the project Internet connectivity costs will have to be borne by sites themselves (note that costs are coming down; now already 40% lower than when project began)
- Computers provided through the project will have to be amortized and the hardware will have to be maintained
- “Training the Trainers” will have been accomplished as part of the project so that future requirement will largely consist of these trainers maintaining competency and working with new staff
- Future training and other types of support might be found though fostering relationships with US regional medical libraries, BIREME, and other potential partners.

• Sustainability as it relates to growth and expansion of the initiative

- The hope is that the value of the project will receive attention and that other sites will “join” the initiative, either self-funding their involvement or looking for funding from the international donor community.
- The principal advantage of being a “partner” is the training, hardware and connectivity. Additional sites do not have to be a part of the project to gain access to the information and the databases.

About the authors

John Scott is President of the Center for Public Service Communications in Arlington, Virginia, USA. Acting as consultant to NLM, he is responsible for coordinating the implementation of the project.

Ricardo Perez is Information Expert at the Pan American Health Organization’s Emergency Preparedness and Disaster Relief Coordination Program in Washington, D.C. He will be PAHO’s liaison to the project. Stacey Arnesen is the Project Manager at the National Library of Medicine Division of Specialized Information Services.

For additional information contact:
Regional Disaster Information Center for Latin America and the Caribbean (CRID), Apdo. 3745-1000 San Jose, Costa Rica. Tel: (506) 296-3952, Fax: (506) 231-5973, crid@crid.or.cr, www.crid.or.cr
or
Stacey Arnesen, Project Manager, National Library of Medicine Division of Specialized Information Services, Lister Hill Building, Bethesda, Maryland 20894, ARNESES@mail.nlm.nih.gov