Disaster represents an unpredictable occurrence, when to happen, where to happen, how massive it is, who the victims are. Considering the geological map, disaster occurrences in our country show that most of the Indonesian's areas are located on disastrous ones and the possibility of the disaster occurrence in the future needs to be considered. Some of the disaster impacts are the human destruction and damages both physically and mentally.

Considering the past disaster, one impact it caused till now is health problem, especially during the acute and rehabilitation periods. Providing healthcare promptly and properly requires components such as: human resource, facilities, medical- logistics (medicines, materials and disposal medical devices, etc), and communication- transportation. Problems on medical logistics are very complex. In one side, they provide services for the healthcare executors (doctors, paramedics, hospitals, health centers, disaster posts), and in the other side, they should receive and document the logistic aids/ donation in the same time where as the volume of the goods is quite large.

In the tabletop for Medical Logistic group, the participants of Disaster Management workshop are expected to examine both the individual and group responses in: the identification of medical logistic problems, to what extent the problems are able to impede the healthcare, being able to make rapid planning responses and solving the emerged problems promptly and suitable with the environment (rapid problem solving) and being able to monitor and evaluate the supply of medical logistics (recording- monitoring- evaluating- reporting).

Objective:

• examining the individual and group responses in coping with disaster
• testing the team collaboration in identifying, planning the problem action- solution in healthcare and medical help/ donation relief
• being able to compile, manage, save and distribute well- targeted medical logistics promptly and appropriate with the needs
• being able to recruit human resource with the required quality and quantity
• being able to record, monitor, assess and make medical logistic reports which are received, documented, distributed and used

(Reference: the daily journal of pharmacy storehouse head, Bantul District in Earthquake Relief, May 27, 2006 ).

After being informed that the epicenter was in the ocean 37 km south of Yogyakarta with the depth of 33 km and the magnitude 5.9 SR, there was a thought emerged, “How about Bantul Pharmacy Storehouse?” because its location is relatively closer to the southern sea. Yet, communication and coordination with the other staffs could not be done due to the broken telephone line.

Meanwhile, it was very difficult to contact the storehouse staff via phone. I did not have the key. We were helping our neighbors and could not go the office right away because the street in front of our house was heaped by the ruins of our neighboring walls and so the car could not pass it.

It would be in immense panic if the key could not be found immediately, the storehouse would be forced open by its windows or doors, or walls. The most important thing was getting the medicines and the safety of the storehouse was the responsibility of the storehouse staffs themselves not the medicines taker. This was said by someone on the phone.

The condition of the storehouse was very messy because there were some medicines fallen down from the selves, some medicines in bottles were broken, the roof fell down. Such condition made difficult for the staffs to take the medicines according to the effective rule in which the medicines should be noted down on the stock cards and others.

We prepared the storehouse for 24-hourse service right away so that the storehouse could serve the hospitals or health centers immediately when they needed some medicines. Due to the limitation of the staffs, in every period there were only two staffs assigned for services.

Key Questions for Day One

1. Where to certify/confirm the assertion of disaster?
2. How are the management and flow of command in a disaster response phase? Is it by contacting the structural staff to coordinate provincial/ district/ municipal disaster or the prepared task force? Is it done directly in person or via telecommunication device?
3. What actions to take with such infrastructure limitation and the requirement for immediate services and helps?
4. How to build logistic team by involving competent logistic parties such as the contact persons/ colleagues in MKO, Pharmacy Faculty, SMF schools, nurses, etc), profession, inviting them via the available media?
5. How is the required organization and management of logistics which fulfills the needs? It is necessary to select the logistic coordinator (leadership, coordinative, being competent in networking). The main focus may be the staff of health office (pharmacy division) or other competent staff.
6. Does a storehouse have the authority to serve disaster posts outside the hospitals (private)? To whom it may ask for assistance or provide medical logistic service? How to estimate the kinds and amount of the needs?
7. Who distribute the medicines or medical logistics directly to the disaster posts in such limitation on the supply and infrastructure?
8. Who should be given the responsibility as a liaison officer? Health officer or local government or who?
9. Limited drug supply or medical logistics at the pharmacy storehouse is only intended for health centers or district/ municipal hospitals in limited time frame. What about he requests from the disaster posts and others?
10. It was found that there was segmentation in the healthcare, especially the medical logistics and medicines, between the private sector vs government- district/municipality- provincial – national. How was the segmentation and its solution?

The condition of the pharmacy storehouse worst due to the rain falling at night before and the roof fell due to the quake. On that day, some health centers began to take medicines for the victim relief. Moreover, most of the health centers were collapsed so their medicines could not be used any longer. At that time, there was only one staff assigned at the storehouse (with non- pharmacy background); considering that most of the staffs became the disaster victims, that circumstance was quite understandable. Services were only performed by one pharmacist.

Up to the day, the medicines being used were the routine medicines of the pharmacy storehouse. Therefore, there was a concern of the medicines shortage if the medicines were distributed without considering the available distribution system. round 15.00, the substitute staff just arrived because the motor cycle run out of gas and it was quite difficult to get some gas. This was understandable because everyone was panic and everyone was the victim.

Disaster posts were built and the helps began to arrive. Pharmacy Storehouse was able to distribute medicines not only to local hospitals and health centers but also to disaster posts. The condition was very busy because there were so many posts asking for medicines and plenty of helps were arriving. The problems were due to the staff shortage and unlabelled medicines, and also most of the medicines donors refused to be checked.

Key Questions for Day Two and Three

1. How to know the med- log needs of the health services serving the disaster relief?
2. How to record the needs as well the distributed med- logistics?
3. Where to ask med- logistics?
4. How many staffs and what are their requirement in order to support the med- log management for the receiving, storing, securing, distributing and inventorying the accepted med- logistics? What are the required volunteer criteria? Who is the contact person?
5. What attempts to be done in fulfilling the needs for general staff and logistic sub- coordinator?
6. Where would the med- logistics be placed so that it is able to accommodate so many helps, facilitate the distribution and the request and maintain the quality of the med- logistics?
7. How to distribute the med- logistics so that they are received on time in the disaster posts/ locations?
8. How to assess the local resources? (provincial supply storehouse, national stock, etc; province, donators, PBF, “fresh money)
9. How to determine the quantity of the required med- logistics in such dynamic changes?
10. How to put the med- logistics in order considering that there are too many aids with such limited space?

The additional staffs began to help at the pharmacy storehouse, besides the staffs from the section/ division in the organization of Health Office and external volunteers. Actually, we needed some helps for moving stuffs but it seemed that the additional staffs were all female.

Medicinal aids for the victim relief came from many resources, both domestic and foreign ones. Often, the senders were not willing to wait so their aids could be checked, and on the other hand, the receivers were busy to serve the medicine requests; therefore, the medicines and health supply to be distributed were not checked carefully. The difficulties grew not only in the fast- in and fast- out medicines but none of the assisting staffs understood the medicine matters.

The number of the pharmacy storehouse staffs was five staffs, the night watchmen were not included. Those five staffs worked in several shifts so that they could work for 24- hours. Technical staffs were only 2 staffs (pharmacists), meanwhile, the other staffs were just general ones who only serve the medicines acquiring without knowing how much amount should be given and to whom the medicines were. As result, the pharmacists should serve from morning till night. From night to morning, the frequency of acquiring the medicines was quite low, therefore general staffs were assigned to serve at that time. The volunteers helped in the morning till noon , noon till night; and it was impossible to let them serve alone without being assisted by the storehouse staffs. The volunteers refused to help at night till morning although some storehouse staffs assisted them.

Key Questions for Day Four

1. What should be done by the time the med- logistic aids arrived in large amount and unclear identity?
2. How to recruit the required profession? Was it necessary to have a volunteer manager?
3. What med- logistics needed for the mobile medical team in the disaster location?
4. Med- logistics needed to be distributed in the disaster areas (med- logistic service)?
5. What should be done by the staffs/ med- logistic staffs so that the supply condition was monitored all the time?
6. What should be done in the monitoring / optimizing the med- logistics/ medicines/ vaccines in the other locations/ institutions? How to coordinate them?

Many efforts have been conducted to gain professional supports, whenever there is information of supports available, we shall contact through Implementation Unit in which actually is more difficult to gain supports since all of them have their own responsibility, through Professional Organization (ISFI), Universities (UAD), Volunteer Post (PKS, Red and White Volunteer) and others.

Other obstacles occurs, since not all tasks are able to be delegated among the technical and non technical volunteer, therefore in some certain occasions when the volunteers are needed but there is no loading activity occurs, on the other hands when there are many drugs must be loaded down from the trucks, there are no volunteers available to assist. Meanwhile the staffs in drug distribution department remains busy in their service in posts needed for drugs. Such circumstance commonly causes poor performance for the staffs remains busy and exhausted, but the distributor need to load off the drugs immediately.

Other obstacles occurred were when the staffs must work overtime, not only until 7.30 PM – 2.30 AM but until late in the evening therefore lunch and dinner must be provided to them. Other obstacles occurred due to the lack of funds to manage the drugs after the earthquake. Besides, it was difficult to get some food since many parts of Bantul was damaged therefore a restaurant/markets selling food were hardly found. It was not wondering that the staffs in charge in GFK often had their late lunch at 5 P.M or more in every each day. In such case GFK was not only procuring the consumption for GFK staffs but also other staffs from Health Office, others from different sections as well as volunteered students assisting in the fields. Thus our received funds, even though it eventually came later, was along way too far from sufficient, meanwhile the students commonly prepared their own food so we just provide them some water. Drugs are a different commodity compares to other consumer's need such as rice, coffee, sugar and others. According the Law of Health No. 23 in 1992, the professional in charge for drug management is Pharmacist as well as Pharmacist Assistant.

Since June 28, 2006 , current drugs distributions has been applying the previous system. GFK only distributes the drugs to Health Office and Hospital if needed, while the drug distribution to the health posts are delivered by Health Clinic. The drugs withdrawal done by Health Clinic out of GFK is not limited in frequent, whenever the drugs are needed, Health Clinic may withdraw them form GFK at simply anytime. However, since June 11, 2006 the withdrawal schedule is limited until 5 PM because we must report the justification to the donators or the Head of Implementation Unit, and the volunteers were gradually resigned and the conditions were improved better.

The obstacles we have still ahead, when we must report our justification about the supports received, other problems occurred. It is due to the lack in the number of Human Resources and kinds of report formats. Therefore we have been compiling a recapitulation of supports and its distribution according to the formats we made. Actually the recapitulation of supports and its distribution could have be compiled as soon as possible by the assistance of volunteers and health office staffs, since they have insufficient medication background, right after being clarified the report then found incorrect. Such problem was understandable due to the large various number of drugs, not all the drugs are named generic, the large various of dosages, kinds of drug supplies, names for drugs, therefore it was difficult for those who unfamiliar with drugs. Therefore the recapitulation was revised and it finally was done in June 11, everyday after the service hour.

However after the formats were given by WHO (LSS), we must revised our recapitulation and in fact while we were busy in providing the service, we found that the new formats was less effective because they must be studied first. In June 26, we were informed that the report format were using the same formats refers to the guidelines for disaster management issued by Social Ministry. Our reports then were not acknowledged and it must be transform into the new formats. Other problem was that the number of drug items received and delivered was too large (approximately 300's). The number of supporting health post unit was also large (200's), while the deadline for reporting drugs per items was too short (must be reported on July 3).

When the problems of service and justification were solved, then other tasks must be conducted to organize the spoiled and expired drugs. Due to the limited storage space so the leftover drugs should also be organized accordingly. This task was supported by WHO, while to manage the administration and permits issued by authorities has become the responsibility of each district. Many obstacles were found in this case since there were no certain rules and mechanism for drugs termination as well as the lack of awareness about expired drugs.

Key Questions for Day 5 – Final Emergency Phase

1. What should be done on the arrival of large volume of log-med support?
2. What kinds of notation – report system as well as log-med service should be performed ?
3. How do you provide the information about log-med supplies to health post unit, health service institutions?
4. How do you select expired/spoiled/lost/leftover log-med? What should be done to organize them?
5. What is the standard notation for “auditable” donation?
6. How is the control of drugs in the public?
7. Is the appraisal price quotation should be equally determined by the government?
8. How do you prepare the report requested by many institutions included donors ?