BMJ  2008;336 (17 May), doi:10.1136/bmj.39581.553924.47

Editor's Choice

Responding to disasters

It can be hard to know how to respond to events as enormous as the cyclone in Burma (doi: 10.1136/bmj.39580.510683.DB) and the earthquake in China, beyond getting out one’s credit card. The BMJ’s immediate response, on the day after Cyclone Nargis swamped Burma’s coastal plain, was to re-emphasise on bmj.com that the last thing doctors should do is try to go out there themselves and help. The consensus on this, from experts in and outside affected countries, is impressive, as documented over the past few years in articles in the BMJ (2005;330:263, doi: 10.1136/bmj.330.7485.263; 2006;332:244, doi: 10.1136/bmj.332.7535.244; 2005;330:261, doi: 10.1136/bmj.330.7485.261-a). Of course this advice is now redundant in the face of the Burmese junta’s blanket refusal to allow any foreign aid workers into the country. And China, although now more open to outside influence, may decide it has enough internal resources to manage without help despite the unfolding enormity of the earthquake’s effects.

But there are disaster zones in which doctors are being encouraged to volunteer. Last month in a speech at the Imperial War Museum in London, the UK’s health secretary, Alan Johnson, encouraged NHS managers to support doctors who wanted to volunteer for short assignments in Iraq and Afghanistan, especially doctors working in emergency medicine, intensive care, and neurosurgery. Ann Gulland describes the training benefits of this exchange: during a three month tour a doctor will typically deal with more trauma than during 15 years working for the NHS (doi: 10.1136/bmj.39568.496424.94).

Meanwhile the harshness of life for people in southern Sudan shows no sign of improving despite a precarious peace, say Médecins Sans Frontières (doi: 10.1136/bmj.39577.475637.DB). People continue to die because of a shortage of clinics, trained medical staff, and medicines. The list of preventable diseases is long and depressingly familiar: tuberculosis, malaria, meningitis, measles, cholera. Maternal mortality is among the highest in the world as a result of years of war and no development. The UK’s Foreign Office has warned against all travel to Sudan, so our best response must be to provide financial and moral support to those already out there and to bear witness, as Mary Black movingly does in her column this week on what it means to be free (doi: 10.1136/bmj.39580.470509.59). "Yes I may worry these days. But I am pretty free, while so many women and girls in this world are not. Just when can they have worries like mine?"

This week’s journal is our research theme issue on hypertension, the result of a call for papers last November to which we received more than 90 submissions. The three research papers we are publishing address important clinical aspects of the monitoring and treatment of high blood pressure. Does a patient’s age affect the benefits of treatment and the choice of drug (doi: 10.1136/bmj.39548.738368.BE)? Does blood pressure in early pregnancy predict pre-eclampsia (doi: 10.1136/bmj.39540.522049.BE)? And what influences long term adherence to treatment? A simple take-home message is that patients should be encouraged to take their drugs in the morning (doi: 10.1136/bmj.39553.670231.25).

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Relevant Articles

Delay in delivery of aid adds to risk of epidemic in Burma

Peter Moszynski
BMJ 2008 336: 1092. [Extract] [Full Text] [PDF]

Precarious peace has brought little improvement to health in southern Sudan, charity says

Peter Moszynski
BMJ 2008 336: 1093. [Extract] [Full Text] [PDF]

Lessons from the battlefield

Anne Gulland
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Freedom

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Rapid Responses:

Read all Rapid Responses

Doctors in Disasters

Colin F Thompson
bmj.com, 16 May 2008 [Full text]