Cyclone Nargis, which happened in 2008, caused the worst natural disaster in the recorded history of Myanmar. It wreaked havoc, created catastrophic destruction and caused at least 138,000 fatalities and involved approximately 2.4 million individuals. This number of deaths may be inaccurate due to those occurring after the natural disaster due to health issues such as disease and lack of resources for health care. The WHO reported that the Government of Myanmar formed an Emergency Committee that had priorities of providing adequate food, safe drinking-water and shelter to the affected people. The WHO Regional Office for South-East Asia and the WHO Country Office in Myanmar were also involved in response to the crisis. The WHO published that the major health problems in Myanmar are communicable diseases (malaria, dengue, measles) and malnutrition. The State Peace and Development Council in Myanmar spend less than US$1 (i.e. 60 cents) per person per year, on healthcare. Approximately, 1 in 4 households live below the poverty line therefore lack of healthcare resources are commonly found in Myanmar. The structural damage caused by the cyclone and the flooding of water supplies, there was also an increase of waterborne diseases affecting the populations. Subsequently, damage to infrastructure and distribution systems will increase the risk of foodborne diseases.

One report written by an international rescue team called Team Singapore found that the most common diagnoses seen amongst adults were: upper respiratory tract infection, gastritis/gastroenteritis, and lower respiratory tract infection. Many adults and children also suffered from post-traumatic stress disorder from the experiencing the crisis. Emergency rescue teams like Team Singapore broke into teams that focused on different cities to offer aid to due to the lack of government set up emergency plans. Injuries from the cyclone were the highest reported cause of death (lacerations, blunt trauma and puncture wounds). Doctors without Borders in the first two months, aided 460,000 individuals with primary treatments geared towards diarrhea, malaria, dengue fever, and malnutrition. The British Red Cross reports that in 2010, Myanmar is on its way to recovery and has rebuild 24 schools and has been working to make sure the most vulnerable (elderly, disabled, women) are given the right assistance and support. They are focused on providing clean water and improving sanitation which has been successful due to the improvement in water quality and prevention of water-borne diseases. The British Red Cross is now offering basic first aid courses to encourage community-based disaster risk management training. In times of crises, local government often have to take the initiative to make certain policy changes or implement programs and training, in alignment with being prepared as a community in case of another catastrophic emergency.

I can’t imagine being a healthcare provider in Myanmar at this time. It would have been in such a hectic state especially due to the lack of resources and government set up emergency agents. It would have been very important to maintain hand hygiene in the efforts to prevent the spreading of disease during the crises and to offer the best educational support to affected individuals especially when medical resources were scarce. I think that the United States is better set up for a natural disaster if one were to occur because of increased resources and different government set up agencies such as FEMA. I reflect on natural disasters such as Hurricane Katrina and hope that our government and the citizens of the United States are better equipped and educated about what to do during a natural disaster.

References:

Doctors without Borders. (2008). Myanmar: Two Months After Cyclone Nargis, Needs Remain

Critical. Retrieved from http://www.doctorswithoutborders.org/news-stories/field-

news/myanmar-two-months-after-cyclone-nargis-needs-remain-critical

Lateef, F. (2009). Cyclone Nargis and Myanmar: A wake up call. Journal of Emergency Trauma

Shock, 2(2), 106-113.

The British Red Cross. (2010). Myanmar recvering two years after Cyclone Nargis. Retrieved

from http://www.redcross.org.uk/en/About-us/News/2010/April/Myanmar-recovering-

two-years-after-Cyclone-Nargis

The Who. (2008). Communicable disease risk assessment and interventions: Cyclone Nargis:

Myanmar. Retrieved from

http://www.who.int/diseasecontrol_emergencies/MyanmarCycloneNargis090508.pdf

Watson, J. T., Gayer, M., & Connolly, M. A. (2007). Epidemics after Natural Disasters.

Emergency Infection Disasters, 13 (1), 1-5.

After spending some time thinking about end of life care, I think that there are multiple options for what I would personally like done, depending on the situation.At this age, if I coded, I would like to be a full code status. If I was a diagnosed with a terminal disease, I would like to die in the most humane way and be a DNR/DNI status. If I was involved in an event that left me in a vegetative state with no brain activity then I would like to be taken off life support. If I was in a long-term coma with brain activity, I am not sure what I would want for myself. I think it would depend on what my family would want and how it would affect them. If there was a possibility of  me returning then I am really not sure what I would want and am continuing to think about this. I think that making my parents the executor of my will/health directive would be the most appropriate decision, however I would have to my wishes well defined because I think they would have a hard time making these decisions without my prior explanation.

I think my family would want a similar situation to what I would personally want for myself. I have spoken to my parents and grandma (on my mom’s side) and they have all expressed that they would not like to be kept on mechanical life sustaining support if it came down to that. I think it would be important to have a more in-depth conversation about this topic to see what specifically they would want if faced with this terrible possibility. My family lives about 100 miles south in Orange County and think that this is more of an in-person conversation so I have not facilitated a detailed conversation about this yet.

Culture, family and diversity play a huge role in end-of-life decisions. Different religions do not allow life-support to be taken away while some might favor this action. Family values could also affect whether or not resuscitation efforts are continued or ended. I think regardless of culture, family or diversity, all decisions should be counted as valid for that individual/family and as nurses we have to respect these choices even if we do not agree with them.

I asked some of my family, friends and coworkers about their knowledge of the medications that they take, regarding to pharmaceuticals, over the counters, and homeopathic remedies. I found it interesting and surprising at the respond that I was given by many of them.

Mom/Dad: My parents both do not work in the medical field but are respected professionals in their own field of work. My mom said that she takes Lipitor for high cholesterol because she had lab work that showed her levels were elevated. She did not know exactly the mechanism of how the drug worked so I educated her that it inhibiting HMG-CoA which is an enzyme that is responsible for catalyzing an early step in the synthesis of cholesterol. She knew some of the side effects to look for based off the information on the box. Her and my dad both took a daily multivitamin. My dad did not take any daily perscribed medications, but had recently taken azithryomycin when he had a cold. He had a left-over unused unexpired one that he took when he felt he was sick. I asked him if it had helped him and he said no, he was still sick. I explained to him the importance of NOT taking prescribed medications unless you are actually prescribed one because that is how individuals become drug resistant! When I asked about other the counter medications, both stated that they read the information on the box to determine side effects and correct daily dosages especially for medications such as acetaminophen which could potentially harm the liver.

Friends: The majority of my friends stated that they did not take daily medications with the exception of albuterol for asthma or a multivitamin. When discussing how over the counter medications worked such as acetaminophen or ibuprofen, they did not know the mechanism or that there was possible harmful side effects from taking these medications because they were so commonly used. I talked to them about using different electronic resources such as skyscape or epocrates (which is free) to look up drugs and become more educated about what they are putting into their bodies.

Coworkers: I work with nurses so when I asked them about medications, they all seemed to kind of giggle about it. The majority of them stated that they do in fact look medications up in electronic sources or their drug books if they are not familiar with them

I thought that it was interesting the different individuals knowledge of medications. My family was somewhat knowledgeable, but still participated in bad habits that needed re-education. My friends were not really educated about the drugs that they take and hopefully they will become more educated! Co-workers, not surprisingly, were the most educated.

Novartis, a company that develops drugs and vaccines has just been granted an FDA priority review of a new heart failure drug called LCZ696. The company is well known worldwide for the manufacture of drugs such as clozapine, valsatan and methylphenidate. This new drug, LCZ696, has its final FDA action date in August of 2015 and has received accelerated assessment in the European Union. The drug will be dosed twice daily and will work by strengthening protective neurohormonal systems of the heart while also reduces harmful effects of the renin-angiotensin-aldosterone system. This new drug is predicted to reduce the risk of cardiovascular-related deaths by approximately 20%.

A study was conducted by Novartis and overseen by an executive committee, an independent data and safety committee. The trial consisted of three phases where informed patients who were 18 years of age, had New York Heart Association class II, III or IV symptoms, ejection fraction of less than 35% and required to have a plasma B-type natriuretic peptide level of at least 150 pg per milliliter. The first phase consisted of patients receiving enalapril (an ACE inhibitor), a single-blind run in which all patients then received LCZ696 and then a double-blind treatment in the two study groups. A total of 10,521 patients in 1043 centers in 47 countries were recorded with 4187 patients going into the actual trials. Death from cardiovascular causes or hospitalization for heart failure occurred in 914 (21.8% of patients in the LCZ696) & 1117 (26.% of patients in the enalapril) patients. LCZ696 reduced the risk of hospitalization from heart failure by 21% (P<0.001) and had higher proportions of patients with hypotension, nonserious angioedema but lower proportions with renal impairment, hyperkalemia and cough than the enalapril group.

I thought that this article was really interesting to know what kind of new drug could be appearing in hospitals in the future. It is great that this shows some improvement than the ACE inhibitor it was compared against in this very large, multi-continental study. I wonder what will happen with the FDA later this year and if this drug will be on the market in the United States in the near future. I also wonder what those implications will be for those with heart failure and the different side effects that nursing will manage if this drug does come onto the market.

Sources:

http://www.nejm.org/doi/full/10.1056/NEJMoa1409077#t=articleBackground

http://www.bidnessetc.com/34902-novartis-ag-adr-heart-failure-drug-granted-fda-priority-review/

I am quite excited for this course! I have never encountered an interactive website for a class and am interested to see how it will work for us. It is hard to say what my likes and dislikes for the class are at this early stage of the course. I would say that so far my likes are CIKeys, the fairness of the class (randomizing the choice of topics, even though my group was put in last choice -_-), and the ability to take the final before the nursing pinning. My dislikes are possibly CIKeys due to technological issues that could occur in the future. Overall, the positive likes far outweigh the one possible negative of the course. I am very intrigued by critical care and hope to learn as much as possible with everyone else!