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Walden Magazine // Jul 01, 2015

Crisis Control

Public health experts offer tips to prepare for and respond to emergencies that affect your home or workplace

Mercy Chikhosi Nyirongos

Public health emergencies and natural disasters often strike with little warning, and if a population isn’t properly prepared, the consequences can be deadly. Mercy Chikhosi Nyirongo ’14, an MPH graduate, and Dr. Tony Cappello ’12, a PhD in Public Health graduate, know this firsthand. They’ve faced down cholera, flooding, rabies, anthrax, and other emergencies as experts in public health—and they credit their Walden educations with helping to prepare them for difficulties in the field.

Nyirongo, the Malawi Country Director for the Zimbabwe Orphans Endeavor (ZOE), began her career in public health in 2010 when she studied the H1N1 influenza virus in Malawi as a nurse researcher. ZOE aims to break the cycle of poverty for orphans and other vulnerable children in Africa by teaching them to farm, offering vocational training and micro-grants, and helping children stay healthy and disease-free. She also works with the Mkukula community in Malawi on community-led health initiatives designed to empower girls and women.

When cholera broke out in Malawi in March—with 55 confirmed cases and two deaths—Nyirongo helped distribute cholera kits and sanitize water, and provided treatment to the afflicted.

“We investigated the cause of the outbreak by checking drinking water and food that may have been contaminated at the source or during transport or storage,” she says. “My Walden classes and lessons about public health ethics, epidemiology, biostatistics, policy, and leadership helped me to respond, support and lead a team, as well as control the spread of the outbreak.”

Cappello, the Public Health Director for the Northeast Colorado Health Department, spearheaded efforts to contain and manage the largest case of rabies in the state’s history, and helped communities affected by flooding in Colorado. His research on radon-contaminated private drinking wells—the basis for his doctoral dissertation—has been heralded as groundbreaking by the American Public Health Association.

“We often forget just how important public health is until it is challenged and we no longer have the luxuries it has provided,” Cappello says. “Every day we take for granted fresh drinking water, flushing toilets, protection from vaccine-preventable diseases, healthy and safe food sources, and a public health system that is trained and ready for response.

“But public health emergencies have the potential to wreak havoc on communities both domestically and abroad,” he says. “Not being adequately prepared, trained, and supported can mean disaster for the general public.”

Here, Nyirongo and Cappello offer their tips on how individuals, families, businesses, and nonprofits can prepare for, respond to, and recover from public health crises.


Dr. Tony Cappello

Undoubtedly, the first step is to identify potential risks for you, your family, your company, or your whole community. Do you live in a flood plain, a tornado alley, or near an unvaccinated population? Consider what’s likely to happen where you live, and prepare as best as you can for what can go wrong, then:

Make a plan. As a public official, Cappello has a unique perspective on planning for public health emergencies. He has to educate and prepare the public before disaster strikes, and work with his colleagues to determine a plan for how to handle an emergency while developing consensus recommendations from experts and first responders.

He suggests that you create a disaster plan, and make sure to keep it updated and fresh in your mind. “If only a few core people developed the plan and the rest of the staff—or family—doesn’t know about it, that spells trouble,” Cappello says.

It’s important to designate responsibilities, charting out who in your home will handle what task. The same goes for the workplace and at agencies, where you may need to obtain signed endorsement from leadership and delegate responsibilities for handling the media, the public, and partner teams so there is a clear chain of command when crisis strikes. You have to come to agreement on who releases what information, when, and how. Spokespeople should always be at the ready, and clearance and approval procedures should be clear to everyone involved.

When an anthrax outbreak among cattle in Colorado exposed more than 20 people to the disease in 2012, Cappello and his team updated an existing disaster plan to stop the spread of the disease in the animals. He also had to limit human exposure while disposing of infected carcasses in a fast, efficient, and environmentally sound manner.

Test systems and enforce drills. You’ve heard it time and again: Practice makes perfect. While there’s likely not a perfect scenario when it comes to emergencies, you can get much closer by practicing your plan.

“It’s important to participate in mass drills so that when something does occur the response is second nature for everyone involved,” Cappello says. “Often, these plans get put on a shelf and people never test it or practice portions of it.

“This past year we conducted a mass vaccination exercise, using flu vaccine, as well as an Ebola tabletop exercise where we simulated and practiced what we would do in an actual event,” Cappello says. “Yearly practice is necessary in identifying our current strengths, weaknesses, and needed resources. Doing so during an event is often much too late, and places you at a disadvantage in responding in a timely, accurate, and effective manner.”

In January of this year, Nyirongo facilitated a fire outbreak drill, and learned that there were some problems to address: Staffers didn’t know the location of fire exits or where extinguishers were located, and there was no clear way of contacting firefighters. “This helped us identify the gaps and improve on our preparedness and response,” she says.

It’s just as important in the home as it is at a government agency or a business. Know escape routes as well as safe places in the house for different types of disasters. Teach family members how to extinguish fires and review safety drills on a regular basis.

Partner up for success. When it comes to public health crises or natural disasters, success depends heavily on partnerships. Establish procedures to collaborate and coordinate with other response teams and agencies.

“It is important to network and coordinate among government and non-governmental agencies when managing public health emergencies,” Nyirongo says. “They are not competitors; they’re partners with a common goal to save lives and support victims. Sharing of information and resources is vital during these events.”

When planning ahead for possible disasters, Cappello makes sure to communicate and collaborate with organizations such as law enforcement, hospitals, businesses, and elected officials. “It may not always be feasible to get all parties at the table,” he says. “But knowing who to contact, having met them before, and previously discussing how support can be provided is always a good idea.”

“You need to build partnerships in the community—with employers, employees, and public officials—before an event occurs,” Cappello says. “Public health agencies in general aren’t very big and are underfunded. Having a broad-based partnership puts more troops on the ground to combat the crisis.”


Walden University

In a hyper-connected world, there are a lot of bases to cover when communicating. “You need to be able to communicate internally and externally,” Cappello says. “Prioritize what needs to happen and get that message out. Most people have access to technology, but some people don’t. It’s important to communicate in every possible fashion, from Twitter and Facebook to the radio and the newspaper.”

There is a balancing act at play here though; act too quickly and you could provide inaccurate information, but act too slowly and people will feel lost. “Allow people the right to feel fear,” Nyirongo says. “Acknowledge their fears and give them the information they need.”

“During an emergency it can be hard to check sources, and there’s always hype,” Cappello says. “People get very excited. One of our jobs is to disseminate correct information and weed out what’s inaccurate.”

Another strategy for communication is to crowdsource—but carefully. When a wastewater system wasn’t working correctly, Cappello’s agency put out a call on Facebook to learn about what people were doing to handle their waste safely. “It reminded people that this is a community, and that we can all work together to get through a disaster,” he says.

Keep calm and carry on. It almost goes without saying—although it’s easier said than done—but do not panic in the face of an emergency or public health crisis. Check on vulnerable people who might need help, notify family members of where you are and what is happening, and monitor updates. Staying away from the affected areas is essential—unless it’s your job, don’t try to be the hero.

As an official at one of the agencies or response groups, make sure to provide encouragement to your people as they cope with the disaster. Watch stress levels and provide breaks and food when needed.

Once the crisis has ended, it’s time to pick up the pieces. Take advantage of available counselors to help cope with the emergency—for both responders and victims—and find support from other people in your community. Update your emergency plan so that you’ll be even more prepared for the next crisis—what went right and what could improve? Focus on individuals’ strengths to help carry on once the storm clears.

After the disaster hits, begin to prioritize and shift tasks. “Priorities will help to save lives as well as reduce stress caused by the emergency,” Nyirongo says. “It will help in identifying urgent and important things to do first, getting organized, setting goals, and having specific action items to achieve the goals.”

Once that is set in motion, Nyirongo says, “It’s good to shift tasks from trained health personnel to less-specialized health workers as a way to deal with staff shortages and burnout.”

Emergency Essentials

 When creating a plan for yourself or your family, have a well-supplied emergency kit and make sure everyone knows where it is kept.

The kit should include:

  • Enough water to last 3 days
  • Nonperishable food items
  • A manual can opener
  • First aid kit and medications
  • Blankets
  • Flashlight with extra batteries
  • Whistle to signal for help
  • Hand sanitizer
  • Tools to turn off utilities
  • Local maps
  • Hardcopy lists of emergency numbers
  • Cell phone and solar chargers
  • Battery-powered radio

Photo credit: Daniel Berehulak / Getty Images