Association of Medical Doctors of ASIA, founded in 1984, Consultative Status with UN ECOSOC since 1995

At the 34th *CMAAO General Assembly India held in September 2019, I had the honor of addressing the concept of the World Platform for Disaster Medicine, a scheme specially designed for enhancing disaster medical response. The platform is aimed at promoting collaboration between seven sectors, namely, UN agencies, governments, World Medical Association, NGOs, academia and public interest organizations.
(*Confederation of Medical Associations in Asia and Oceania)

With numerous quakes, landslides and flooding, the 21st century has become an era in which climate change has taken a toll on people’s lives. In tackling frequent natural disasters and extreme temperatures, we need to urgently establish a framework with a focus on disaster medicine in light of mass-scale catastrophes. The seven-sector collaboration will contribute to building a reliable scheme that dramatically improves the overall competence of medicine in disaster situations.

In November 2017, the concept received an approval from Dr. Yoshitake Yokokura who was heading World Medical Association (WMA) at the time. At a WMA board meeting held in Latvia in April the following year, WMA requested Japan Medical Association (JMA) to build a network for this purpose across Asia and Oceania regions.

World Platform for Disaster Medicine is a culmination of AMDA’s over 200 humanitarian medical activities which span across 50 countries and regions. I am very much confident that actual programs will be ready to be delivered in 2020.

What defines disaster medicine?
One crucial difference between disaster medicine and emergency medicine is the availability of logistics that bolsters medical activities. As for disaster medicine, a small group of medical professionals work for a large number of people in a place without medical facilities. Whereas, in the case of emergency medicine, an adequate number of medical staff are allocated for a small number of patients in a well-equipped medical environment.

Disaster medicine also needs to take into account the aspect of disaster reconstruction, while emergency medicine does not. This means the former needs to foresee the living environment of disaster victims in the midst of disaster recovery period. The truth behind disaster medicine is not about “preparing for the worst”, but rather, “one will never prepare unless worst situations occur”.

Seven-sector collaboration
Let us now take a look at how each sector can contribute to this framework. I basically have three expectations on each of them.

1) UN agencies:
Things to expect: 1) provision of information, 2) policy making, 3) general coordination

In 2006, AMDA became the 137th organization to obtain UNECOSOC General Consultative Status, and was the first Japanese NGO ever to receive the accreditation. With its capacity to propose policy recommendations, AMDA can collaborate with WMA to actively call on policies to the following UN agencies:

1) UN Office of Coordination for Humanitarian Affairs (OCHA)
2) World Health Organization (WHO)
3) United Nations International Strategy for Disaster Risk Reduction (UNISDR)
4) United Nations High Commissioner for Refugees (UNHCR)
5) United Nations Education, Scientific and Cultural Organization (UNESCO)

2) Governments:
Things to expect: 1) issuance of visa and other permissions, 2) security, 3) logistics and manpower

AMDA dispatched a relief team in response to an earthquake which devastated Taiwan in September 1999. After AMDA’s medical team arrived in Taipei, the group of medical professionals flew in a military helicopter to reach an affected mountainous area. In fact, the personnel transportation is one of the most important elements in disaster relief. It is fair to say that the swift relief work could not have made possible without the governmental support.

When Typhoon Yolanda landed Visayas in the Philippines in November 2013, lack of food, water and medical supplies worsened the security in the city of Tacloban, the capital of Leyte. Due to the political instability in the region, foreign aid teams could not enter the city’s outskirt districts. However, since AMDA already had a partnership agreement with the Development Academy of the Philippines, the navy sent an escort team to back up AMDA’s relief activities, enabling AMDA doctors to work in the suburb.

An increasing number of Asian countries have been declining offers from oversea medical teams that are willing to provide emergency medical relief. This makes it hard for aid organizations to act independently unless they have oversea branches or counterparts.

3) World Medical Association (WMA):
Things to expect: 1) provision of medical licenses, 2) local initiatives and networking, 3) personnel deployment

In disaster medicine, it is essential to have every medical professional to be under the guidance of the doctors of the disaster-hit nation. Unlike the 20th century, we live in the era where a mere humanitarian cause is not persuasive enough for a government to accept foreign relief teams with open arms. In February 2006, more than 1,000 people were killed in the landslide caused by torrential rains in a village in Southern Leyte, Philippines. At the time when AMDA personnel were working under Southern Leyte Medical Association’s direction, I was deeply moved by the fact that branch organizations of Philippine Medical Association had been sending their doctors to volunteer in the relief operation.

In the case of Nepal which was struck by a huge earthquake in April 2015, we launched a program to train mental health counselors that could support the victims traumatized by the catastrophe. Had it not been for Nepal Medical Association, the effort could not have been realized.

 
4) NGOs/NPOs:
Things to expect: 1) local initiatives, 2) personnel dispatch, 3) financial assistance

We were given three preconditions by the local government in Sichuan, China, when we tried to send a relief team in response to calamitous tremors in May 2008. The authority requested doctors 1) to be fluent in Mandarin, 2) to have a Chinese medical license, and 3) need to be either surgeons or orthopedists. AMDA Taiwan immediately responded by forming a team comprising thirty-some medical professionals after consulting with a local association of private hospitals and clinics. The doctors worked around the clock to treat patients with severe cases such as bone fractures at a local Sichuan hospital, which received much praise.

And last but not least, our experience in Afghanistan will never be lost in oblivion.
In 1998, AMDA invited and mediated Deputy Public Welfare Minister of Taliban and Vice Foreign Minister of National Front of Afghanistan at a respective time to have each sign an armistice agreement. As a result, AMDA succeeded at having both parties come to a momentary ceasefire until every child in Afghanistan gets immunized. On a side note, this helped the Japanese government to organize the International Conference on Reconstruction Assistance to Afghanistan in Tokyo in 2002, because an officer from the Japanese foreign ministry came into contact with both ministers at the signings.
 
5) Academia:
Things to expect: 1) personnel dispatch, 2) investigations and research, 3) staff training

To confront horrendous earthquakes and tsunami that destroyed coastal areas of Sumatra, Indonesia in December 2004, more than 100 relief personnel from over 10 AMDA chapters joined forces with AMDA Indonesia in carrying out emergency relief. At the same time, AMDA counterpart Hasanuddin University in Sulawesi dispatched more than 300 medical staff to partake in the mission. This proved enormous strengths of universities in delivering manpower to large-scale relief operations.

In Nepal, AMDA worked hand-in-hand with Tribhuvan Medical School to offer mobile clinic services at the time of 2015 earthquake, as the school had excellent human resources. 

6) Public interest organizations:
Things to expect: 1) personnel dispatch, 2) logistics, and 3) financial assistance

At the time when AMDA deployed a relief mission with Myanmar’s health ministry for 2008 Cyclone Nargis flood disaster, local people were evacuated to Buddhist monasteries. It was an insightful moment to understand that Buddhist monasteries do play a role of social safety net in certain countries.

For 2018 flood relief in Kerala India, AMDA partnered with two organizations, namely, Seva Bharati and Chengannur Rotary Club, to conduct disaster response. Seva Bharati is a prominent Indian NGO that has excellent logistics capabilities. Whereas, Rotarians around the world comprise people of various occupations including dentists and doctors, boasting a superb human network wherever they are present.
 
As a fellow UNECOSOC General Consultative Status holder, my hope is to conclude the Memorandum of Understanding with the Rotary International and Lions Club International in the near future.

7) Private Enterprises:
Things to expect: 1) information on disaster sites and local situations, 2) logistics, 3) financial support

The 20th century marked the beginning for private enterprises to commit themselves to corporate social responsibility (CSR). It has become increasingly important in the century that followed, especially in the era in which conscience carries a significant weight in corporate activities.

For companies, CSR initiatives are not only appealing to local people who are hired as their employees, but also effective in promoting their social contribution activities toward disaster victims. What counts in the present-day public relations is to have people understand through media how hard the companies are working for such a cause. And in fact, this is what defines a conscientious corporation.   

AMDA puts an emphasis on the following three points when it collaborates with private companies:

1) Providing medical support and relief supplies to firms directly affected by disaster
2) By means of reciprocation, giving the companies some media coverage whenever they provided support to AMDA activities
3) Introducing companies to the seven-party networking

Based on the above, our first step is to consolidate the foundation of the platform in Asia Pacific, because wealth of the world has been concentrated in the East. At the same time, it makes it easier to share the three-pillar concept (mutual assistance, partnership and local initiative) in the region where countries have similar value systems.

As far as the platform is concerned, what comes after the success in Asia Pacific will be Central and South America. The third region will include Central Asia to the Islamic world in the Middle East, followed by Africa as its fourth region. As for North America and Europe, it is well understood that their armies are capable of responding to medical needs in disaster situations, for appropriate systems already in place.

The validity and certainty of the seven-party collaboration owe to a constant effort which is to be made by each country to uplift their competence in disaster medicine. In other words, trustworthy relationships need to be built and extended on a daily basis. It is these strong connections that will be maximized when a large-scale calamity hits each nation.

The following three things will be achieved when the platform launches medical response for the victims of natural disasters in a coherent and valid manner:

1)  The concept of disaster medicine becomes a norm amongst doctors and medical students around the globe
2) Medical associations will go beyond public interest organization to virtually become public entities
3) WMA will start leading the seven-party collaboration

In closing
Although Japan is dubbed “the hotbed of natural disasters”, it has succeeded at presenting a model case for disaster response. And in fact, the best possible way to respond to crisis is simply running away from it. Its methodology can be made up of various aspects such as giving early alert, designating evacuation sites, giving guidance on actual evacuation methods, storing daily supplies, and planning for a life in the shelter.

Cell phones have made it convenient for citizens to receive early disaster warnings. JMA has been gaining experience in disaster medicine through setting up its own relief team called JMAT. It is now playing a vital role in Japan’s disaster response system along with the Self Defence Forces and health-ministry-led Japan Disaster Medical Assistance Team (DMAT).

My strong hope is to have the platform’s Asia Pacific secretariat set at AMDA Headquarters and continue to chalk up the experience in disaster medicine. This of course involves close cooperation with JMA and relevant bodies in this region.