The American Defense Institute for Medical Operations (DIMO) states that deaths associated with disasters have increased by 50 percent each decade and as Alexander (2002) notes, although disasters require special organization, coordination and resources, they are not exceptional events. Disasters tend to be repetitive; often re-occurring in the same places and as such, are sufficiently frequent and predictable enough to plan for. Disasters are occurring more frequently due to industrialization and rapid development, and as the world’s population has grown, large numbers of people are “vulnerable”; living in less desirable, less ‘safe’ areas. “Natural” disasters hit developing countries perhaps harder, where more people are vulnerable, infrastructure is lacking to begin with and resources are already stretched. Many countries including South Africa are challenged by the increasing number of natural disasters and how to protect the most vulnerable who are without basic infrastructure and largely without access to media. Thus effective public health communication and promotion has become of critical importance particularly in high risk communities and is possible since disasters often occur in the same places. Purpose Literature exists on the efficacy of using media channels to reach people with critical public health messages during disasters, but no studies have focused specifically on other means of communicating public health messages during disasters in places where media doesn’t reach or people can’t justify the cost of batteries for their radios. No research has been done to determine if the people affected recall life saving lessons imparted during disasters; why or why not. Similarly, there is little in the way of documentation detailing the following during past disasters that have occurred both on the African continent and worldwide: who communicated public health messages; what messages were communicated and how messages were imparted. Media – specifically radio and television are used in developed countries to communicate warnings and evacuation messages for example. At best there are reports from the different NGO’s that operate in communities affected by a disaster or NGO’s that arrived to provide humanitarian assistance. It can be surmised that communication is done by those that take the JENNIFER HESLOP/ Student ID No. 0516028Y 6 initiative using whatever channels exist; this may likely include the affected country’s own resources, NGO’s and responders. Coordination to prevent duplicating messages or groups operating in the same areas has in the past been lacking. As such, there is a need to look critically at vulnerable places and people, the value of the information imparted during disasters, why messages may or may not be heeded and if communities would apply the information in future without outside assistance. The study looks at a community that was affected by a specific disaster in South Africa; what proportion of the sample learned life-saving information for the first time during the disaster and whether they would recall these life-saving mechanisms, unaided, in similar future scenarios. Another objective was to determine if gender, age, education or employment status was of any significance against the portion of the study population that learned the information for the first time during the floods. The research leads one to question whether messages are in context with people’s realities and what would prevent them from applying the principles imparted. Broader questions arose, like, do disasters provide an opportunity for learning where there was no learning yet established; and is there an opportunity for engagement between “outsiders” (those with expertise) and “insiders” (affected community) that is truly beneficial to those in need of the information – beneficial in the sense that the information could be applied in future without outside assistance? Design/ methodology The research included two key groups of people: those responsible for the decision making around the communication and public health response to the disaster, and the affected communities. The research design included qualitative key informant interviews accessed through snowballing technique and quantitative face-to-face interviews with 100 community members. The qualitative study was a descriptive, semi-structure interview outline designed to provide a framework to describe the situation, the health risks, priorities, health promotion messages that were communicated and how they were communicated. Key informants were made up of members of the disaster response team as well as others that played a role during the floods. The interviews were transcribed; reoccurring themes were identified and distilled to get the three most critical public health messages that were communicated during the floods. The recurring themes formed the basis of the quantitative questionnaire. JENNIFER HESLOP/ Student ID No. 0516028Y 7 The quantitative study, a cross sectional descriptive study, relied on one hundred community members living in the broader Qho area during the floods and provided they met the criteria (they lived in the area during the floods and could recall what happened), they were asked for their consent before the interview commenced. The data were captured and analysed using Epi Info 6, frequencies were run to describe the sample, and then cross tabulations were performed, looking for associations between the outcome variables and demographic and media variables; chi square tests were performed to test for significance. The three most critical public health messages were: water purification, oral re-hydration therapy for diarrhea and warnings not to eat an animal that had died of unknown causes during the floods. Findings The findings of the research indicate that across two public health messages more than half of all respondents learned the information that may have saved their lives for the first time during the floods. Forty-eight percent learned how to purify water for the first time during the floods; 54.2 percent learned about oral re-hydration therapy during the floods; and 55.6 percent learned not to eat an animal that has died of unknown causes during the floods. Determining whether the sample population would apply the same lessons learned, unaided, in future similar circumstances, is harder to prove since it is self-reported. Nearly 100 percent across the three questions said categorically that they would and most could name ways to purify water, stop diarrhea and said that they knew not to eat an animal that has died of unknown causes. One hundred percent of responders said they would know what to do to make dirty water clean and some cited ways they would do this by boiling and/ or the use of ‘Jik’ (brand of bleach; in South Africa, the word ‘Jik’ has become synonymous with ‘bleach’). Ninety percent of the sample said they would use “the salt and sugar mixture in water” to treat diarrhea and 90 percent knew they should not eat an animal that has died of unknown causes. It is perhaps of interest to note that significantly more men learned during the flood to use OTR for diarrhea than women. Thus disasters may likely provide an opportunity for men to learn health practices that normally women would be more likely to have learned. There was also a significant difference between those that learned about ORT during the floods and those that learned before the floods by level of education, with 63 percent of those that learned about ORT before the floods, having completed primary school. Also of interest was the fact that while only 15 percent of the total sample population has access to television, of the 55.6 percent that learned not to eat an animal that has died of an unknown cause during the floods, 24.5 percent had access to television, and 86 percent of those with access to TV learned about this during the flood. Practical implications Disasters provide opportunities to fast-track development and public health goals. However, based on the research, for communication to have the desired response, communities and public health experts should be involved in dialogue with broader stakeholders before, during and after disasters. It is important to include “locals” (experts from the broader community) and community healthcare workers on an on-going basis, in public health promotion and preparedness strategies and to involve men in the community; a group that has largely been absent in communities and not historically involved in family health care. When a disaster is declared, an injection of resources – human, physical and financial assists significantly in making things happen, from providing and / or upgrading infrastructure to getting critical information and resources to affected populations. Just as critical is education – teaching people how to respond and why, as opposed to just telling people. Knowledge is more sustainable than physical resources, although both are often required. People need to truly understand the information in their own contexts, as well as the “why’ and “how” if they are going to be able to replicate the lessons unaided in future. Concurrently, affected people are more open to information and changing behaviours that may now seem foolish or outdated. Electronic media channels cannot be relied upon as the sole means of communication but need to be incorporated despite low penetration, due to the powerful effect the mediums have in stimulating word-of-mouth transmission of messages, particularly messages that may lead to social discomfort. Alternative means of communication like face-to-face dialogue and use of cell phone messaging, and understanding how communication must be done to ensure effectiveness is imperative - and these guidelines are applicable across cultural, political and socio-economic JENNIFER HESLOP/ Student ID No. 0516028Y 9 boundaries. It is imperative that those providing assistance understand the affected population and their realities as if they were his or her own. This includes local resources like media; literacy levels; beliefs and values; as well as who is trusted by the community.

published_or_final_version / Geography and Geology / Master / Master of Philosophy