• Home

Assignment

Assignment: Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders

An important consideration when working with patients is their cultural background. Understanding an individual’s culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations.

For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.

To Prepare:

· Review this week’s Learning Resources and consider the insights they provide.

· Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.

· By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.

· Consider what history would be necessary to collect from this patient.

· Consider what interview questions you would need to ask this patient.

· Identify at least three possible differential diagnoses for the patient.

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

· Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 

· Objective: What observations did you make during the psychiatric assessment?  

· Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

· Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Training Title 82 Week 8 Substance-Related and Addictive Disorders

Name: Lisa Pittman

Gender: female Age: 29 years old T- 99.8 P- 101 R 20 178/94 Ht 5’6 Wt 140lbs

Background: Lisa is in a West Palm Beach, FL detox facility thinking about long term rehab. She has been smoking crack cocaine, approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”), and 2–3 alcohol drinks once weekly. She has past drug possession and theft convictions; currently on 2 yr probation with randomized drug screens. She tries to find the pattern for the calls in order not to test dirty urine. Her admission labs abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for cocaine, THC. Negative for alcohol or other drugs. BAL 0; other labs within normal ranges. She reports sexual abuse as child ages 5–7, perpetrator being her father who went to prison for the abuse and drug charges. She is estranged from him. Mother lives in Alabama, hx of anxiety, benzodiazepine use. Older brother has not contact with family in last 10 years, hx of opioid use. Sleeps 4-5 hrs, appetite decreased, prefers to get high instead of eating. Allergies: amoxicillin She is considering treatment for her Hep C+ but needs to get clean first. Symptom Media. (Producer). (2017). Training title 82 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-82 Training Title 114

RUBRIC

Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS

In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

assignment

NURS 314SG – Physiologic and Pharmacologic Considerations for Health Promotion

Concept Care Map – Quiz 6

Theresa Samuels, a 72-year-old-retired African American woman, arrives to the community health center for her three-month follow-up appointment. T.S., has a medical history of diabetes, type 2, osteoporosis, secondary hypertension, and dyslipidemia. Due to the death of her only daughter from COVID-19, 4 months ago, T.S., has become the sole caregiver of her three teenage grandchildren. Troubled with unexpected finances, T.S., conveys to the nurse the immense pressure and stress she has been experiencing since the death of her daughter.

The patient had her bloodwork completed at LabCorp prior to her appointment. The nurse conducts a comprehensive assessment and notes the following objective and subjective data:


Objective data:

Blood pressure = 140/90

Heart rate = 92

Respiratory rate = 22

Pulse oximetry = 94% on room air

Present weight and height= 210 lb. (95.2 kg) / 5’5

Physical Assessment

· HEENT=Pupils equal, reactive, responsive to light and accommodation.

· Cards = Regular rate and rhythm; S1S2; Grade 1/6 systolic murmur; 2+ pitting edema bilateral lower extremities; +2 pedal pulses bilaterally; +2 radial pulse bilaterally; no carotid bruit auscultated.

· Resp = Respiratory rate 22 bpm; mild wheeze noted in bases bilaterally; all other lung fields clear to auscultation

· GI = Bowels normal; present in all 4 quadrants

· Skin = Skin is dry and intact; not rashes or skin lesion noted

· GU = Voids frequently; urine output is <30mL/hr; tea-color urine

· Neuro = Intact; oriented to person/place/time/situation (X4); motor and sensory function within normal limits

Labs

· Hemoglobin A1C = 7.5%

· Cortisol level = 35 mcg/dL

· Fasting blood glucose = 132mg/dL

· Erythrocyte sedimentation rate (ESR) = 45 mm/hr


Subjective data:

· Complains of muscle aches and pains with movement, and some tingling in the lower extremities

· She states that her vision is blurry at times

· Most of the time she is compliant with her medications but will sometimes avoid taking Hydrodiuril to keep from having to go to the bathroom so often

· Sleeping 3 – 4 hours a night

· Eats a candy bar if her blood glucose is less than 120 mg/dL


Medication Reconciliation

Crestor 40 mg Daily

Diltiazem 180 mg PO Daily

Lotensin 10 mg PO Daily

Metformin ER 500 PO Daily

Cholecalciferol 25 mcg PO Daily

Calcium 1000 mg PO Daily

Hydrodiuril 12.5 mg PO Daily

NPH 10 units BID

During the health assessment, the nurse offers T.S., the yearly influenza vaccine; but T.S., declines, stating, “The flu shot will cause me to get the flu and I just don’t have the time to be sick.”

CASE MAP GRADING RUBRIC

Student Name:


Pathophysiological process:

0 points

Below Standard

1-2 points

Partially Meets Standard

3-4 points

Meets Standard

5 points

Exceeds Standard

Explains the pathophysiological process of obesity and connects (interrelates) the disorder to:

· (Alteration in glucose regulation) Diabetes Mellitus

· (Alteration in perfusion) Hypertension, Hyperlipidemia, Atherosclerosis

· Stress Adaptation and Sleep Disorder

Vague and confusing. Does not explain the pathophysiological process of obesity and does not connect to other pathophysiological processes.

Multiple (more than 5) mistakes in terminology and shows lack of understanding of many concepts.

Somewhat organized

Few (3-5) mistakes in terminology and shows some understanding of many concepts

Thoughtfully organized

Identifies important concepts and shows an understanding of many concepts. Minimal (no more than 2) mistakes in terminology demonstrating good understanding of many concepts.

Well organized.

Connects main concepts and characteristics. No mistakes in terminology and shows complete understanding of many concepts.


Assessment Findings (Recognizing Cues):

0 points

Below Standard

1-2 points

Partially Meets Standard

3-4 points

Meets Standard

5 points

Exceeds Standard

Identifies the pertinent assessment findings to include but not limited to subjective and objective data, laboratory values, and diagnostics associated with each disease processes.

Vague and confusing. None of the pertinent assessment findings are included. Multiple mistakes in terminology.

Somewhat organized. Includes some pertinent assessment findings. Few mistakes in terminology.

Thoughtfully organized. Includes most pertinent assessment findings.

Easy to follow. Minimal mistakes in terminology.

Well organized.

Includes all pertinent assessment findings. No mistakes in terminology.


Interpreting Assessment Findings (Analyze Cues)

0 points

Below Standard

1-2 points

Partially Meets Standard

3-4 points

Meets Standard

5 points

Exceeds Standard

Explain the pertinent assessment findings above and describe how they relate to the client’s health condition.

Vague and confusing. Does not explain any of the pertinent assessment findings or describe how they relate to the client’s health condition. No understanding of connections demonstrated. Multiple mistakes in terminology and shows lack of understanding of many concepts.

Connections are somewhat clear and convey some meaning.

Explain some of the pertinent assessment findings and describe how some are related to the client’s health condition. Connections demonstrate minimal understanding. Few mistakes in terminology and shows some understanding of many concepts.

Thoughtfully organized. Explains most of the pertinent assessment findings and describes how most are related to the client’s health condition. Connections demonstrate a partial understanding. Occasional mistakes in terminology demonstrating good understanding of many concepts.

Well organized. Explains all the pertinent assessment finding and describes how all are related to the client’s health condition. No mistakes in terminology and shows comprehensive understanding of all concepts.


Health Promotion (Generate Solutions):

0 points

Below Standard

1-2 points

Partially Meets Standard

3-4 points

Meets Standard

5 points

Exceeds Standard

Develops patient teaching for each disease process, incorporates the concepts of health, wellness, and illness, and the social constructs that influences healthy outcomes.

Describe the medications (prototype) for each of the associated the disease processes, relates the potential and actual risk factors, and implements principles of safety.



Multiple mistakes in terminology and shows lack of understanding of many concepts.

Few mistakes in terminology and shows some understanding of many concepts.

Identifies important concepts but makes some incorrect connections. Occasional mistakes in terminology demonstrating good understanding of many concepts.

Identifies all important concepts and shows an understanding of the relationship among the disorders.

Format, Grammar/Spelling and References

0 points

2.5 points

5 points

Uses appropriate template as instructed by faculty. Writing should be free of errors in grammar and spelling. APA Style Reference Page included as a separate word document.

Inappropriate template used OR multiple errors in grammar/spelling OR Reference Page not in APA style/not included.

Correct template used; some errors in grammar/spelling; reference page included but with errors in APA format

Uses appropriate template as instructed by faculty. Writing is free of errors in grammar and spelling. APA Style Reference Page included as a separate word document.

TOTAL

/25 POINTS

Diagram  Description automatically generated

Please note: This is a sample with some direction that students may use a guide. Please follow the directions in the rubric closely before submitting your concept map.

assignment

Prior to beginning work on this assignment, review the assigned readings and the instructor guidance for the week, read the Writing Center resource 
Writing an Article Critique (Links to an external site.)
, and view the University of Arizona Global Campus Library tutorial 
How to Read a Scholarly Article (Links to an external site.)
. Your instructor will post an announcement with the reference for the qualitative research study to be critiqued in this assignment. After reading the posted study, use the 
Qualitative Research Critique Template


 
 Download Qualitative Research Critique Template
to compose and organize your assignment.

In your paper,

· Summarize the research question, methods, and findings of the assigned qualitative study.

· Evaluate the appropriateness of the research methods and analytical approaches used in the study. Support the position with evidence cited from the textbook and at least one other scholarly source about the research design or method.

· Analyze ethical issues pertaining to how the study was carried out.

· Critique the strengths, weaknesses, and limitations of the study.

· Recommend a research question and methods for a follow-up study on the topic.

· Utilize the provided template with section headings.

The Qualitative Research Critique paper

· Must be four to five double-spaced pages in length (not including title and references pages) using the template provided and formatted according to APA style as outlined in the 
Writing Center (Links to an external site.)
’s 
APA Style (Links to an external site.)
 The template is a Word document that is pre-formatted in APA style. If unable to use the pre-formatted template, see the following instructions for formatting.

· Must include a separate title page with the following:

· Title of paper

· Student’s name

· Course name and number

· Instructor’s name

· Date submitted

For further assistance with the formatting and the title page, refer to 
APA Formatting for Microsoft Word (Links to an external site.)
.

· Must utilize academic voice. See the 
Academic Voice (Links to an external site.)
 resource for additional guidance.

· Must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear thesis statement that indicates the purpose of your paper.

· For assistance on writing 
Introductions & Conclusions (Links to an external site.)
 as well as 
Writing a Thesis Statement (Links to an external site.)
, refer to the Writing Center resources.

· Must use at least one scholarly/peer-reviewed source in addition to the study being critiqued and the course text, for a total of at least three references.

· The 
Scholarly, Peer Reviewed, and Other Credible Sources (Links to an external site.)
 table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment.

· Must document any information used from sources in APA style as outlined in the Writing Center’s 
Citing Within Your Paper (Links to an external site.)
 guide.

· Must include a separate references page that is formatted according to APA style as outlined in the Writing Center. See the 
Formatting Your References List (Links to an external site.)
 resource in the Writing Center for specifications.

assignment

1. Read the Lecture Notes in Unit 5 on persuasive writing. Below

A major emphasis of college is allowing students to express their views and trying to influence others to accept certain views or notions. This practice is known as argumentation or persuasion. Many times we think of argumentation as two or more people shouting at each other or becoming angry in expressing their views. However, in college, that is not what argumentation is about (or at least it is not supposed to be).

Instead, college is a place where everyone should be free to lay their views out on the table for others to see. If we think we have a good idea about something, we may try to influence others to accept our views. Others may evaluate our argument to see if our views are worthy of acceptance.

At this stage of college, many times the terms “Argumentation” and “Persuasion” are used interchangeably. However, there is a difference between the two. If you try to define the differences between these two terms by looking them up, you will see some variety in the definitions. However, we will go with the definition or our book in Chapter 10.9

This definition basically goes along with many other definitions in other sources that say Persuasion is more about influencing based on opinion and emotion. Argument is defined as influencing using facts and evidence.

For the essay we will be writing for this Unit 5, we will be leaning more towards the Persuasive definition.

This unit will be teaching about writing a Persuasive Essay where you try to influence the reader to accept your position on an issue. You may use opinions in your essay to support your position, but those opinions should be supported.

Here is an example. Many states have laws requiring drivers and passengers in vehicles to wear seat belts. One could take a position on this issue of seat belt laws that seat belts should not be the law; instead of wearing a seat belt should be up to each individual person.

The writer may approach this essay with an introduction defining the issue of seat belt laws. The writer could then state his or her position that wearing a seat belt should be optional, but not required by law. Since this essay is more along the lines of persuasion, the writer could begin by telling a story about his or her experiences or knowledge of how seat belts do not always help in an accident and could instead be harmful. To support the story, the writer could then cite some statistics to show a number of cases where seat belts actually did more harm than good.

To understand more of how persuasion can work in writing this type of essay, you will want to read through Chapter 10.9 in our online text. Here is a link to that page:

10.9 Persuasion

You do not need to follow all the advice in this chapter. Reading this chapter is to offer ideas for constructing this type of essay. You will have more freedom in how you organize and design the Persuasive Essay than you did with the previous two Unit essays.

Assignment

Mid-Point Proposal and The Final Project Presentation

Midpoint Proposal and The Final Project Presentation

A student should focus on the subject matter from the text that interested them the most, then develop a PowerPoint presentation that will be submitted at the end of class.

The first slide should be your Introduction slide, the next 10-15 slides should be informational slides, and the last slide should be the reference slide (the URLs of the pictures or information for citing or referencing your work).

The final project is worth a total of 80 points, 70 from the final presentation, and 10 points are associated with this week’s Final Project Proposal.

The actual final Project Presentation will be due during the final week of the course.

This is my topic: The description should be 2 to 3 paragraphs about the subject you are going to develop in your PowerPoint Presentation on.

While reading the chapters for the week my interest in interviews, hiring, firing, and promoting has struck a high interest in my mind. I would like to expand more on this chapter and research what all goes into being a manager and having to deal with employees in these hard and not easy situations. I would like to know what all it takes to do these tasks.

assignment

Workplace Environment Assessment

Clearly, diagnosis is a critical aspect of healthcare. However, the ultimate purpose of a diagnosis is the development and application of a series of treatments or protocols. Isolated recognition of a health issue does little to resolve it.

In this module’s Discussion, you applied the Clark Healthy Workplace Inventory to diagnose potential problems with the civility of your organization. In this Portfolio Assignment, you will continue to analyze the results and apply published research to the development of a proposed treatment for any issues uncovered by the assessment.

To Prepare:

· Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).

· Review the Work Environment Assessment Template*.

· Reflect on the output of your Discussion post regarding your evaluation of workplace civility and the feedback received from colleagues.

· Select and review one or more of the following articles found in the Resources:

· Clark, Olender, Cardoni, and Kenski (2011)

· Clark (2018)

· Clark (2015)

· Griffin and Clark (2014)

*Template completed in the Week 7 discussion should not be submitted with this assignment.

The Assignment (3-6 pages total):

Part 1: Work Environment Assessment (1-2 pages)

· Review the Work Environment Assessment Template you completed for this Module’s Discussion.

· Describe the results of the Work Environment Assessment you completed on your workplace.

· Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed.

· Explain what the results of the Assessment suggest about the health and civility of your workplace.

Part 2: Reviewing the Literature (1-2 pages)

· Briefly describe the theory or concept presented in the article(s) you selected.

· Explain how the theory or concept presented in the article(s) relates to the results of your Work Environment Assessment.

· Explain how your organization could apply the theory highlighted in your selected article(s) to improve organizational health and/or create stronger work teams. Be specific and provide examples.

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams (1–2 pages)

· Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment.

· Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment.

assignment

Running head: QUALITATIVE RESEARCH CRITIQUE 1

QUALITATIVE RESEARCH CRITIQUE 3

Qualitative Research Critique

[Student’s Name]

PSY 326 Research Design

[Instructor’s Name]

[Date submitted]

Qualitative Research Critique

Introduction

[Instructions for using this template: Replace the text in brackets on the title page with your information. Answer the questions and provide the required information indicated below, in the order these items are presented. Use complete sentences in your response and delete the question or instruction, including this paragraph, after you have finished typing your answers. Throughout the paper, cite the source of the information. List the references for all sources that are cited, as indicated in the note on the References page.]

What is your purpose for writing this paper?

What is the title of the study you are critiquing, and who are the authors?

Summarize the research question(s) in your own words as much as possible. If your instructor allows quotes and you find it necessary to quote from the article, use quotation marks around the quoted passage and cite the quote in APA format with author’s last name, year of publication, and page number where the quoted material appeared.

Briefly summarize background information on the topic from the study’s literature review.

Comment on whether or not there is any apparent bias in the selection of studies in the literature review.

Summary of Methods

Which qualitative research design was used?

Name the sampling method and describe how the participants were selected.

How did the researchers collect data from the participants?

Did the researchers mention bracketing, epoché, or reflexivity?

What coding and analysis procedures were used to analyze the data?

What efforts were made to ensure trustworthiness, credibility, and/or dependability?

Summary of Findings

What themes or other findings were presented in the study?

Was sufficient evidence provided to support the conclusions drawn by the researchers? If so, what is the nature of the evidence? If not, what is missing?

Ethical Aspects

Did the researchers explicitly address ethical issues in the article? If not, was there evidence in the report that the participants’ wellbeing and confidentiality were protected?

Was an approval process by an Institutional Review Board or similar ethics review committee mentioned?

Were any of the practices ethically questionable? If so, what could have been done to resolve these issues?

Evaluation of Study

Referring to a source about the research design and methods used in this study to support your evaluation, do you feel the researchers used these methods appropriately to investigate the research question?

What do you see as the strengths of how this study was done?

What limitations or weaknesses were mentioned by the authors?

What limitations do you see (if any) that they did not mention?

What suggestions did the authors make for future research on the topic?

Do you think another approach might be better for the research question than the research design and methods that were used in this study? If so, what other methods would you consider?

Conclusion

Briefly review the main points of your summary and evaluation of the study.

What would you recommend for a research question and methods for a follow-up study on this topic?

References

[Note: List references here in alphabetical order by the first author’s last name, in APA format with a hanging indent. Include all sources cited in the body of the paper. Do not list any that are not cited in the paper. At a minimum, you should use the article being critiqued, one article about the research design from the Research Methods research guide in the University of Arizona Global Campus Library, and the course textbook. An example citation featuring the textbook follows this note.]

Newman, M. (2016). Research methods in psychology. (2nd ed.). Bridgepoint Education.

Assignment

Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation 

For this Assignment, you will document information about a patient that you examined during the last 3 weeks, using the Comprehensive Psychiatric Evaluation Template provided. You will then use this note to develop and record a case presentation for this patient. Be sure to incorporate any feedback you received on your Week 3 and Week 6 case presentations into this final presentation for the course. 

To Prepare

· Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.

· Select a patient that you examined during the last 3 weeks who presented with a disorder for which you have not already conducted an evaluation in Weeks 3 or 6. (For instance, if you selected a patient with OCD in Week 6, you must choose a patient with another type of disorder for this week.) Conduct a Comprehensive Psychiatric Evaluation on this patient using the template provided in the Learning Resources. There is also a completed exemplar document in the Learning Resources so that you can see an example of the types of information a completed evaluation document should contain. All psychiatric evaluations must be signed, and each page must be initialed by your Preceptor. When you submit your document, you should include the complete Comprehensive Psychiatric Evaluation as a Word document, as well as a PDF/images of each page that is initialed and signed by your Preceptor. You must submit your document using SafeAssign. Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Late Policies.

· Then, based on your evaluation of this patient, develop a video case presentation that includes chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis including differentials that were ruled out.

· Include at least five (5) scholarly resources to support your assessment and diagnostic reasoning.

· Ensure that you have the appropriate lighting and equipment to record the presentation

Assignment

Record yourself presenting the complex case for your clinical patient. In your presentation:

· Dress professionally and present yourself in a professional manner.

· Display your photo ID at the start of the video when you introduce yourself.

· Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).

· Present the full case. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis including differentials that were ruled out.

· Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

Be succinct in your presentation, and do not exceed 8 minutes. Address the following:

· Subjective: What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning?

· Objective: What observations did you make during the interview and review of systems? 

· Assessment: What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis, and why? 

· Reflection notes: What would you do differently in a similar patient evaluation?

CASE STUDY

Name KB

Age 22years

Persons Present in SessionThe patient was present in the session. The patient is not a medical decision maker and physically attended the session.
Chief Complaint
“Need a new psychiatrist”.
Started having having anxiety and depression after parents divorced. Was having difficulty
concentrating, difficulty sleeping, sad mood, multiple suicidal attempts in middle school, Mood
swings mostly around period. Admit to multiple panic attacks. Hallucinations and delusion but
thinks is related to taking hydroxyzine. Seen a therapist in when in 7th grade, psychiatrist since high
school. Currently taking hydroxyzine, trazodone, paroxetine. Psychiatrist thought patient also had
bipolar but never was diagnosed and was also diagnosed with binge disorder. Having depression
years, worsened last month. More 10 lifetime episodes. Depressed most days of the week. Dry mouth and constipation
PHQ-9 (Total: 26)
GAD-7 (Total: 18)
MoodDQ (Q1 Total: 12, Q2 Total: 1, Q3 Total: 2)
The patient denied family history of bipolar disorder. The patient endorsed being diagnosed with
bipolar disorder, experiencing several of these symptoms at once, and having moderate problems
with work or social function. The patient endorsed experiencing a period of time where they were
not their usual self, with the following symptoms: having excess energy, unusual self-confidence,
decreased need for sleep, and racing thoughts, increased productivity, being unusually social and
irritable, being hyper-sexual and easily distracted, participating in risky behavior, going on spending
sprees, and experiencing pressured speech.
The patient denied experiencing: hyperactivity .
ASRS-V1.1 (Total: 56, Part A: 5, Part B: 10)
Stressors

No evidence of acute risk of harm to self or others
Suicide
paroxetine HCl (paroxetine
hcl)

RUBRIC

The student provides an accurate, clear, and complete description of the chief complaint and history of present illness.

Description of past psychiatric, substance use, medical, social, and family history

Discussion of most recent mental status exam and observations made during interview and review of systems

The student provides an accurate, clear, and complete discussion of diagnostics with results.

The student provides an accurate, clear, and complete diagnosis with three (3) differentials.

The response clearly, accurately, and thoroughly follows the Comprehensive Psychiatric Evaluation format to document the selected patient case.

assignment

Persuasive Essay assignment

The purpose of the Persuasive Essay assignment is to choose a topic that has some debatable issue. You will then take a position on that issue and write a 2 full-page Persuasive Essay trying to influence you to accept or agree with your position on this issue.

Here are the details:

1. Read the Lecture Notes in Unit 5 on persuasive writing. Also, especially read Chapter 10.9 in the online text for ideas on how to construct an approach persuasive writing. Here is the link to that chapter:

10.9 Persuasion

While all the information in this chapter can be helpful, what is especially helpful is the information under the heading “Writing a Persuasive Essay.”

2. Choose a topic. Your topic will be on some issue of debate where you are able to take a side on that issue. You may write on any topic so long as it is debatable and you are able to write your position without the use of any research material or outside source information.

3. Unlike the previous two-unit essays, there is no required outline or pattern that you have to use for organizing this essay. However, you will want to plan your organization so your ideas connect and make sense to the reader. You may use either of the patterns from the previous two units. Also, you may look at the different patterns presented in Chapter 10 for ideas. As a bit of advice, the structure is shown in Chapter 10.9 under the heading “Structure of a Persuasive Essay” is a helpful model to look at.

4. Since this essay is more persuasive instead of argumentative, you do not have to do any formal research, but you should have explanations and support for any positions you offer.

5. The essay will be at least two full pages long but no more than four pages (unless you have your instructor’s permission to go over 4 pages). You will use the MLA formatting guidelines that you used in the previous essays.

6. Include a title for your essay.

7. After writing the essay, be sure to take the time to read it several times for revision and editing. It would be helpful to have at least one other person proofread it as well before submitting the assignment.

Assignment

Lessons Learned from the 2011 Great East Japan Tsunami: Performance of Tsunami

Countermeasures, Coastal Buildings, and Tsunami Evacuation in Japan

ANAWAT SUPPASRI,
1

NOBUO SHUTO,
1

FUMIHIKO IMAMURA,
1

SHUNICHI KOSHIMURA,
1

ERICK MAS,
1

and AHMET CEVDET YALCINER
2

Abstract—In 2011, Japan was hit by a tsunami that was gen-

erated by the greatest earthquake in its history. The first tsunami

warning was announced 3 min after the earthquake, as is normal,

but failed to estimate the actual tsunami height. Most of the

structural countermeasures were not designed for the huge tsunami

that was generated by the magnitude M = 9.0 earthquake; as a

result, many were destroyed and did not stop the tsunami. These

structures included breakwaters, seawalls, water gates, and control

forests. In this paper we discuss the performance of these coun-

termeasures, and the mechanisms by which they were damaged; we

also discuss damage to residential houses, commercial and public

buildings, and evacuation buildings. Some topics regarding tsunami

awareness and mitigation are discussed. The failures of structural

defenses are a reminder that structural (hard) measures alone were

not sufficient to protect people and buildings from a major disaster

such as this. These defenses might be able to reduce the impact but

should be designed so that they can survive even if the tsunami

flows over them. Coastal residents should also understand the

function and limit of the hard measures. For this purpose, non-

structural (soft) measures, for example experience and awareness,

are very important for promoting rapid evacuation in the event of a

tsunami. An adequate communication system for tsunami warning

messages and more evacuation shelters with evacuation routes in

good condition might support a safe evacuation process. The

combination of both hard and soft measures is very important for

reducing the loss caused by a major tsunami. This tsunami has

taught us that natural disasters can occur repeatedly and that their

scale is sometimes larger than expected.

Key words: The 2011 East Japan earthquake and tsunami,

tsunami countermeasures, Sanriku coast, Sendai plain.

1. Introduction

On 11 March 2011, a strong earthquake of mag-

nitude M = 9.0 (JMA, 2011) occurred in East Japan,

generating a devastating tsunami. No one was

expecting an earthquake of this magnitude in Japan.

Japan is well known as a leading tsunami disaster

prevention country, because it has countermeasures

and evacuation plans set in place. Along the Sanriku

ria coast, where V-shape coastlines can cause a tsu-

nami wave to accumulate inside the bay, tsunamis can

easily be amplified to heights exceeding 10 m.

Therefore, many structural and non-structural tsunami

countermeasures were constructed along the Sanriku

coast (ABE and IMAMURA, 2010). Nevertheless, the

600 km Sanriku coast, which extends northwards

from Sendai and covers the Miyagi, Iwate, and Ao-

mori prefectures, was heavily damaged by the 2011

tsunami. Some of the damage was observed during

primary damage field surveys in Miyagi (SUPPASRI

et al., 2012a) and Iwate prefectures (YALCINER et al.,

2012). In this paper, the effectiveness of these coun-

termeasures during the 2011 tsunami, and the

mechanisms by which they were damaged, are dis-

cussed briefly; examples of breakwaters in Kamaishi

and Ofunato; tsunami gates in Fudai and Minami-

Sanriku; seawalls in Taro, Yamada, and Ishinomaki;

and control forests in Rikuzentakata and Natori are

discussed. The damage to houses in relation to the

materials that were used and number of stories is also

discussed; overturned reinforced concrete buildings in

Onagawa are presented as examples. Similar to the

lessons learned from the 2004 Indian Ocean tsunami

(SANTOS et al., 2007; SUPPASRI et al., 2012c), the les-

sons learned from this tsunami, including those

regarding the effects of the tsunami on a highland

1
International Research Institute of Disaster Science,

Tohoku University, Sendai, Japan. E-mail: suppasri@irides.tohoku.

ac.jp; shuto.nobuo@gmail.com; imamura@irides.tohoku.ac.jp;

koshimura@irides.tohoku.ac.jp; erick@tsunami2.civil.tohoku.ac.

jp;
2

Department of Civil Engineering, Ocean Engineering

Research Center, Middle East Technical University, Ankara,

Turkey. E-mail: yalciner@metu.edu.tr

Pure Appl. Geophys. 170 (2013), 993–1018

� 2012 The Author(s)
This article is published with open access at Springerlink.com

DOI 10.1007/s00024-012-0511-7 Pure and Applied Geophysics

residence in Toni-Hongo, the Namiwake shrine in

Sendai, and damage data from historical tsunamis in

the Sanriku area, are discussed. Examples of suc-

cessful evacuations, for example the ‘‘Miracles of

Kamaishi’’ and ‘‘Inamura no Hi’’, the tsunami festival

in the Wakayama province are provided.

2. Historical Tsunamis that have Affected

the Sanriku Coast and Sendai Plain Areas

The Sanriku coast is often hit by giant tsunamis. If

we limit our discussion to tsunamis generated by

earthquakes over M8.0, the first historical tsunami is

the Jogan tsunami in 869, followed by the Keicho-

Sanriku tsunami in 1611, the Meiji-Sanriku tsunami

in 1896, the Showa-Sanriku tsunami in 1933, the far-

field tsunami from Chile in 1960, and the Great East

Japan tsunami in 2011 (Fig. 1; Table 1). The 1896

tsunami caused nearly 22,000 deaths (YAMASHITA,

2008a), the highest number of deaths caused by a

tsunami in Japanese history. In fact, large earthquakes

such as that which generated the Jogan-type tsunami

occurs, on average, every 800–1,100 years (MINOURA

et al., 2001). More than 1,100 years have passed

since the Jogan tsunami, so there was a high proba-

bility that a large earthquake and tsunami would

occur. However, with only one historical record of

the Jogan tsunami and the limited Jogan tsunami

deposit areas (mainly in Sendai and Ishinomaki

plains), information about the magnitude of this

earthquake and the probability of another Jogan event

required additional support data and verification.

Before the 2011 event, there was a 99 % proba-

bility that another M = 7.5–8.0 earthquake would

occur off of the Miyagi Prefecture within the next

30 years (Table 2) (SENDAI CITY, 2010). A series of

M7.4–M8.0 earthquakes have occurred in the Miyagi

Sea since 1793, and the average time between them is

37 years (SENDAI CITY, 2010). Many countermeasures

have been constructed in preparation for these tsu-

namis, which are predicted to damage the Sanriku

coast and the Sendai plain.

The Sendai plain is a low-hazard area compared

with the Sanriku coast. Historical records show there

have been no large tsunami events in the Sendai plain

area since the 1611 Keicho-Sanriku tsunami, whereas

the Sanriku coast was affected by great tsunamis in

37

38

39

40

41

0 10 20 30 40

L
a

ti
tu

d
e

Maximum tsunami height (m)

2011 Tohoku

1960 Chile

1933 Showa

1896 Meiji

1611 Keicho

Figure 1
Historical tsunamis in the Sanriku area, the areas that were affected by the 2011 Tohoku tsunami, and the maximum tsunami height of

historical tsunamis

994 A. Suppasri et al. Pure Appl. Geophys.

1896, 1933, and 1960 (Fig. 1). The primary concern

is for the ria coast, with its remarkable tsunami-

amplification property because of its narrow,

V-shaped topography, rather than the plain coast. In

addition, because of the location of the earthquakes in

1896 and 1933, which occurred in the north, the

Sendai plain was protected from these tsunamis

because it is located inside a bay behind the Sanriku

coast (Fig. 2). For instance, in Ofunato, maximum

runup heights of 38.2 and 28.7 m were recorded for

the 1896 Meiji and 1933 Showa tsunamis, respec-

tively. However, for these two tsunamis, maximum

runup heights of less than 5 and 3.9 m, respectively

(Fig. 1), were recorded in the Sendai plain (SAWAI

et al., 2008; YAMASHITA 2008a, b). The tsunami in

1960 that was generated by the great earthquake in

Chile also concentrated in, and mainly damaged, the

Sanriku areas. However, the 2011 tsunami was gen-

erated by a large earthquake, and its 500 km rupture

covered the whole area of the Tohoku region.

3. Tsunami Countermeasures

3.1. Tsunami Breakwaters

Large-scale tsunami breakwaters are present

along the Sanriku coast. They were constructed to

protect cities from future tsunamis, because of the

region’s long history of devastating tsunamis. The

tsunami breakwaters were designed to resist tsunamis

that are similar in strength to the 1896 Meiji Sanriku

tsunami. Two well-known tsunami breakwaters are

located in Kamaishi city and Ofunato city. In

Kamaishi, the tsunami breakwaters were constructed

at the entrance to the bay; they are 63 m deep and

hold the Guinness world record for the deepest

breakwaters (Fig. 3, left). Construction of the break-

waters was completed in 2009; they have a 300 m

opening and are 670 and 990 m long (KAMAISHI PORT

OFFICE, 2011). The two tsunami breakwaters in

Ofunato city were constructed after the city was

struck by a large tsunami with long-period waves

caused by resonance with the tsunami generated by

the 1960 Chilean earthquake (Fig. 3, right). The two

breakwaters are located at the bay entrance where the

water is 38 m deep; they have a 200 m wide opening

and are 290 and 250 m long (KAMAISHI PORT OFFICE,

2011). Construction of the breakwaters was com-

pleted in 1967 and successfully protected the city

from the Tokachi-oki tsunami in 1968.

However, the 2011 Tohoku tsunami was higher

than the designers expected. The tsunami caused

major damage to the breakwaters and inundated both

cities. Nevertheless, the breakwaters helped to reduce

Table 1

Historical tsunamis in the Sanriku area and the damage which resulted

DD/MM/YY Name Earthquake

magnitude

Damage Maximum tsunami

height (m)/location

9 July 869 Jogan [8.3 More than 1,000 deaths
2 Dec 1611 Keicho Sanriku [8.1 More than 5,000 deaths
15 June 1896 Meiji Sanriku 8.5 21,959 deaths and more than

10,000 houses destroyed

38.2/Ryori area, Ofunato city

3 Mar 1933 Showa Sanriku 8.1 3,064 deaths and 1,810 houses

destroyed

28.7/Ryori area, Ofunato city

22 May 1960 Great Chilean 9.5 142 (in Japan) and 1,625 houses

destroyed

22 May 1960

11 Mar 2011 Great East Japan 9.0 19,000 deaths and more than 836,500

houses damaged and destroyed

40.5/Omoe-Aneyoshi area,

Miyako city

Table 2

Records of earthquakes in the Miyagi Sea

DD/MM/YY Lag time Magnitude

17 Feb 1793 8.2

20 July 1835 42.4 years 37.1 years on

average

7.3

21 Oct 1861 26.3 years 7.4

20 Feb 1897 35.3 years 7.4

3 Nov 1936 39.7 years 7.4

12 June 1978 41.6 years 7.4

Before 11 Mar 2011 33 years had passed,

so the possibility of

occurrence was 99 %

7.5–8.0

Vol. 170, (2013) Lessons Learned from the 2011 Great East Japan Tsunami 995

the impact of the tsunami (both tsunami height and

arrival time) on the cities, especially Kamaishi, where

many houses still remain (Fig. 4). Figures 5 and 6

show the performance of the Kamaishi breakwaters

and the mechanisms by which they were damaged

(PARI, 2011). The breakwaters were located on a

rock foundation. Thirty-meter-wide blocks were

arranged on top of the rock foundation along the

Figure 2
Comparison of the propagation patterns of the 1896 Meiji-Sanriku tsunami and the 2011 Great East Japan tsunami after 10, 30, and 60 min

996 A. Suppasri et al. Pure Appl. Geophys.

direction of the axis of the breakwaters. The blocks

rose 6 m above sea level and were designed to protect

the city from a 5.6 m high tsunami. A tsunami height

of 6.7 m was measured at a GPS station in Kamaishi

Sea. On the basis of these data, two simulations were

performed for cases with and without breakwaters

(PARI, 2011). From the results, the height (mean sea

level, MSL) of the tsunami was 10.8 m in front of the

blocks and 2.6 m behind the blocks; therefore, the

blocks helped to reduce the tsunami height by 8.2 m

(Figs. 5, 6). With regard to inundation by the

tsunami, the breakwaters reduced the tsunami height

(at the shoreline) from 13.7 to 8.0 m and reduced the

runup height from 20.2 to 10.0 m (PARI, 2011).

Because of the strong current in the 30 cm spaces

between the blocks, the rock foundation was dam-

aged. Eventually, *70 % of the blocks were
destroyed. This process occurred slowly; as a result,

the arrival time of the tsunami inundation was

delayed by 8 min (from 28 to 36 min) (PARI,

2011). However, the tsunami breakwaters at Ofunato

were more seriously damaged and are currently

submerged in the sea. Possible reasons are that the

Ofunato breakwaters were constructed using earth-

quake resistance design of nearly 40–50 years ago

and the wave period of the strong tsunami current

Figure 3
Tsunami breakwaters in Kamaishi city and in Ofunato city (before the 2011 tsunami)

Figure 4
Damage from the tsunami inundation of Kamaishi city with a maximum runup height of 11.7 m (1/6/2011) and of Ofunato city with a

maximum runup height of 10.9 m (1/6/2011)

Vol. 170, (2013) Lessons Learned from the 2011 Great East Japan Tsunami 997

might have been nearly the same as the natural period

of a wave inside Ofunato bay.

3.2. Seawalls

Seawalls are found almost everywhere along the

coasts of Japan. According to reports from Ministry

of Land, Infrastructure, Transport, and Tourism

(MLIT, 2011), the length of the seawalls damaged

and destroyed in Iwate, Miyagi, and Fukushima

prefectures is *190 km out of a total length of
*300 km. According to the reports, tsunami over-
flows of \1 m caused a relatively small amount of
damage but overflows larger than 3–4 m completely

destroyed the seawalls because most of them were

designed to protect the land from high tides or

Figure 5
Mechanisms of damage to the Kamaishi breakwaters

Figure 6
Tsunami impact reduction performance of the Kamaishi breakwaters (PARI, 2011)

998 A. Suppasri et al. Pure Appl. Geophys.

typhoons. However, some of them, for example the

seawall in Taro town, were meant to serve as tsunami

barriers. Taro town experienced tsunamis in 1611,

1896 (a tsunami height of 15 m, 83 % fatality, and

100 % of the houses destroyed) and 1933 (a tsunami

height of 10 m, 32 % fatality, and 63 % of the houses

destroyed). In 1934, construction of two, 10 m high

seawalls (measured from the mean seawater level)

was started; the purpose of the seawalls was to

protect the town by allowing the tsunami to flow

along both sides of the seawalls. They were com-

pleted in 1958, two years before the 1960 Chile

tsunami, and could fully protect the town from a

maximum tsunami height of 3.5 m. In the 1970s, the

town constructed another two lines of 10 m high

seawalls to accommodate the increasing population

(KAMAISHI PORT OFFICE, 2011). The total length of the

seawalls is *2.4 km, as shown in Fig. 7, left. The
designs of both of the seawalls took only the 1933

tsunami into consideration. However, the 2011 tsu-

nami flowed over the two-line seawalls, damaged

most houses, with 5 % fatality, and destroyed the

eastern part of the new seawall (Fig. 7, right).

There are three main reasons why the seawalls

were damaged.

• The two seawalls crossed in an X shape, which
caused the tsunami to accumulate and increase in

size at the center of the seawalls.

• The foundations of the seawalls were weakened by
the river on the eastern side of the town. Soil

properties near rivers may have disrupted the

stability of foundations.

• The seawalls were not maintained properly and had
not been adequately connected to each other. The

tsunami flowed over the seawalls and became a

high-speed water jet. The strong current at high

speed caused scouring around the foundations.

Examples of damage to typical seawalls can be

found in Ishinomaki city (Fig. 8, left) and in Higashi-

Matsushima city. The tsunami height near the control

forests of both cities was 7–8 m. On the sea side, the

surfaces of the seawalls survived, but on the land side,

severe scouring occurred at the foundations. Another

example of damaged seawalls is shown in Fig. 8, right.

In Yamada town, five blocks of seawalls of total length

Figure 7
Seawalls in Taro town. Damage occurred to the eastern parts of the new seawalls (9/11/2011)

Vol. 170, (2013) Lessons Learned from the 2011 Great East Japan Tsunami 999

of 50 m were moved by the tsunami. The block structure

survived but failed because of poor connection with the

foundations and with neighboring blocks. Figure 9

shows typical mechanisms of damage to seawalls

including sliding because of the pressure difference,

overturning because of collision of the wavefront, and

scouring by strong currents (PARI, 2011).

3.3. Tsunami Gates

Fudai village developed along the Fudai River. It

suffered from the 1896 and 1993 tsunamis that

propagated along the river. In 1984, 15.5 m high

tsunami gates were constructed to close the river

mouth in case of tsunamis. Fudai was the location of

a successful countermeasure structure that protected

the village from the 2011 tsunami. The 17 m high

tsunami flowed over the gate but inundated only a

few hundred meters past the gate (NIKKEI NEWSPAPER,

2011), as shown in Fig. 10, left. Most of Fudai

village, including the evacuation shelters (primary

and secondary schools), was protected, as shown in

Fig. 10, right, and no loss of human life was reported

(TOKEN, 2011). If there had not been a tsunami gate,

Figure 8
Seawalls damaged by scouring in Ishinomaki city (left, 26/4/2011) and by sliding in Yamada town (right, 31/5/2011)

Figure 9
Typical mechanisms of damage to seawalls (PARI, 2011)

1000 A. Suppasri et al. Pure Appl. Geophys.

the tsunami would have damaged the center of the

village (IWATE PREFECTURE, 2011).

The residents of Minami-Sanriku town have high

tsunami awareness because of previous experience

with tsunamis. The maximum height of the tsunami

in Minami-Sanriku town was [10 m in some areas,
whereas the average height of past tsunamis was

\5 m. Seawalls and tsunami gates were constructed
at ?4.6 m MSL after the 1960 Chile tsunami

(MINAMI-SANRIKU TOWN, 2011) and residents did not

expect such a large tsunami, because the first tsunami

warning had prediced 3 m in Miyagi prefecture.

Tsunami evacuation drills are conducted every year.

However, the tsunami gates and seawalls were

overwhelmed and did not stop the 2011 tsunami,

which was higher than 15 m (Fig. 11, left). As a

result, 95 % of the town, including the disaster

prevention building, was destroyed (Fig. 11, right),

and approximately half of the population was missing

immediately after the tsunami. Approximately 1,000

people died or are missing as a result of the tsunami.

Another important issue raised by the 2011

tsunami is that many firemen were lost in the call

of duty as they closed many tsunami gates and the

gates of seawalls. Two-hundred and fifty-four casu-

alties were reported in Iwate, Miyagi, and Fukushima

prefectures, and more than 70 of these were while

closing these gates (YOMIURI NEWSPAPER, 2011a).

Figure 10
The tsunami gate that protected Fudai village and led to no reported casualties (9/11/2011)

Figure 11
The damaged tsunami gate in Minami-Sanriku town and the town’s condition after the tsunami (25/3/2011)

Vol. 170, (2013) Lessons Learned from the 2011 Great East Japan Tsunami 1001

According to a questionnaire given to 471 firemen in

5 cities (Miyako, Kamaishi, Kesennuma, Ishinomaki,

and Iwaki) (KAHOKU NEWSPAPER, 2011), 61 % of

firemen met at their office and went out for duty.

Among them, 23 % went to the coast to close the

gates, and 47 % went to help the evacuation. The

percentages of fireman killed by the tsunami were

22 % during gate-closing work and 31 % during

evacuation work. Thus, the Japanese government has

a plan to install a new system to control these gates

remotely.

3.4. Control Forests

An example of a great loss of control forests is in

Rikuzentakata city. The city is known for having a

2 km stretch of shoreline lined with *70,000 pine

trees (Fig. 12, left). The 2011 tsunami, which was

nearly 20 m high, swept away the entire forest; only

one 10 m high, 200-year-old tree remains (Fig. 12,

right). This surviving tree became a very important

symbol of the reconstruction for people in the city.

The forest not only could not protect the town but

also increased the impact of the tsunami because of

floating debris.

In Natori, where Sendai airport is located, a

tsunami with a height of 10–12 m, as measured from

garbage remaining on trees (SUPPASRI et al., 2012b),

overturned most of the trees (Fig. 13, left); however,

the control forest helped to protect the airport,

because the tsunami inundation depth was only 4 m.

Unlike the first two examples, almost all of the

pine trees in the control forest in Ishinomaki survived

(Fig. 13, right). The forest reduced the destructive

Figure 12
Control forest in Rikuzen-Takata city. Approximately 70,000 pine trees were completely swept away

Figure 13
Damage to a control forest in Natori city (11/5/2011), and a control forest that survived in Ishinomaki city (26/4/2011)

1002 A. Suppasri et al. Pure Appl. Geophys.

power of the tsunami and trapped debris, for example

cars, from the water before it entered the city. The

trees may have been saved because the height of the

tsunami at Ishinomaki was lower (*6 m). The
seawall (which was later destroyed) may also have

helped protect the trees. YOMIURI NEWSPAPER (2011b)

reported results based on the estimates from a field

survey of tsunami-affected areas conducted by the

Forestry and Forest Products Research Institute.

Without control forests, it is predicted that a 16 m

high tsunami would have inundated 600 m in 18 min

with an average velocity of 10 m/s. However, with

the control forest, the tsunami arrival time was

delayed by 6 min, and its velocity was reduced to

2 m/s.

In general, control forests can withstand tsunamis

up to 3–5 m high, on the basis of historical Japanese

tsunami data in 43 locations, namely, 1896 Meiji-

Sanriku, 1933 Showa-Sanriku, 1946 Nankai, 1960

Chile, and 1983 Japan Sea, as shown in Fig. 14, left

and right (SHUTO, 1985). The circles indicate trees

that have survived whereas triangles and the rectan-

gles indicate trees that collapsed or were cut down,

respectively. For example, a tree with a diameter of

10 cm can withstand a tsunami inundation depth up

to 3 m but will collapse or be cut down if the

inundation depth is greater than 4 and 5 m, respec-

tively. Figure 14, right, shows the effectiveness of the

control forest in trapping debris and reducing the

wave current. The effectiveness of the control forest

was limited at an inundation depth of 3 m for a forest

width of \20 m. Historical data show that a forest
width [100 m is expected to be effective up to an
inundation depth of 5 m. The maximum 2011

tsunami heights in both Rikuzen-Takata (150 m

forest width) and Natori (500 m forest width) were

[10 m (out of the data range), and caused devastat-
ing damage. On the other hand, a 6 m tsunami

attacked the control forest in Ishinomaki (150 m

forest width); the damage that was caused is shown in

Fig. 14, left.

Figure 15 shows a good example of how control

forests and breakwaters could have helped to reduce

the damage to areas behind them in Ishinomaki city.

This figure was created by visual inspection of

satellite images, with gray indicating the area of

tsunami inundation by the 2011 tsunami, red indicat-

ing the areas where houses were washed away, and

blue indicating the areas with surviving houses (TEL,

2011). It is very clear that the number of houses

washed away in zone B (behind the control forest) is

much smaller than that in zone A (without a control

Figure 14
Tree damage as a function of inundation depth and tree diameter, and the effectiveness of control forests as a function of inundation depth and

forest width (SHUTO, 1985)

Vol. 170, (2013) Lessons Learned from the 2011 Great East Japan Tsunami 1003

forest). GOKON and KOSHIMURA (2012) showed that

the probability of a building being washed away in

zone C (inside the breakwaters) was *40 %, whereas
in zone D (outside the breakwaters), it was almost as

high as 90 %, confirming the 50 % reduction effect,

although both areas experienced a maximum tsunami

height lower than 7 m.

4. Residential Structures

4.1. Residential Houses

The tsunami left 115,163 houses heavily dam-

aged, 162,015 houses moderately damaged and

559,321 houses partially damaged (NATIONAL POLICE

AGENCY, 2011). Most houses in residential areas are

constructed from wood. The relationship between the

tsunami hazard level and the structural damage is

described by tsunami fragility curves. Figure 16, left

shows the tsunami fragility curves that were devel-

oped, using data from the 1993 Okushiri tsunami

(most of the houses were constructed out of wood)

(KOSHIMURA et al., 2009). These curves indicate that

the probability of damage (destroyed or washed

away) is very high when the tsunami inundation

depth exceeds 2 m. The structural materials and the

number of stories are directly related to the proba-

bility of damage. For example, the probability of

damage (destroyed or washed away) from a tsunami

with an inundation depth of 4 m is 0.3, 0.7, and 0.9

for a reinforced concrete (RC) house, a mixed-type

house in Thailand (SUPPASRI et al., 2011), and a

wooden house, respectively (Fig. 16, left). For the

same tsunami, the probability of damage is 0.9 for a

one-story house and 0.5 for a house that has more

than one story (Fig. 16, right). Figure 17, top, shows

examples of three damaged houses. Although all

three houses experienced an inundation depth of 4 m,

the level of damage is different, depending on

building typology. In Fig. 17, bottom, the first

building on the left side (green rectangle) is a two-

story RC office that sustained broken windows but no

structural damage. The two-story wooden house in

the center (yellow rectangle) sustained damage to

some of its walls and columns. The one-story wooden

house on the right (red rectangle) completely col-

lapsed. However, the impact from floating debris is

complex and difficult to ascertain at this time. In fact,

the velocity of the tsunami wave current was also

important in the structural destruction, because of the

hydrodynamic force. Nevertheless, the current veloc-

ity is quite difficult to measure using only tsunami

traces found during field surveys, especially along the

Sanriku ria coast, where the tsunami wave easily

accumulated such hydrostatic and hydrodynamic

force that the tsunami height and velocity became

Figure 15
Tsunami damage reduction effect because of the control forest and breakwaters in Ishinomaki city

1004 A. Suppasri et al. Pure Appl. Geophys.

larger than in the Sendai coastal plain. Comparison of

the housing damage ratio between the plain and ria

coast of Ishinomaki city shows that the damage ratio

for houses washed away at 3 m of inundation depth

was 0.1 along the plain coast but as high as 0.6 along

the ria coast (SUPPASRI et al., 2012b). This result

confirms the effect of current velocity on different

damage levels at the same inundation depth.

0.0

0.2

0.4

0.6

0.8

1.0

0 5 10 15 20

D
am

ag
e

p
ro

b
ab

il
it

y

Inundation depth (m)

Japan_W

Thai_Mix

Thai_RC

0.0

0.2

0.4

0.6

0.8

1.0

0 5 10 15 20

D
am

ag
e

p
ro

b
ab

il
it

y

Inundation depth (m)

Thai_One story_LV2

Thai_> one story_LV2

Figure 16
Tsunami fragility curves for different types of structural material and for different numbers of stories (KOSHIMURA et al., 2009; SUPPASRI et al.,

2011)

Figure 17
Examples of different damage levels for the same tsunami inundation depth (26/4/2011)

Vol. 170, (2013) Lessons Learned from the 2011 Great East Japan Tsunami 1005

4.2. Commercial and Public Buildings

In tsunamis it is usually recommended that people

evacuate to high-rise RC buildings or steel-reinforced

concrete (SRC) buildings if there are no mountains

nearby. The building code for earthquake-resistant

buildings was revised in 1981 and 2000 but did not

take into account tsunami load. The guid

Assignment

International Journal of Mass Emergencies and Disasters
March 2006, Vol. 24, No. 1, pp. 5-43

Traditional Societies in the Face of Natural Hazards:
The 1991 Mt. Pinatubo Eruption and

the Aetas of the Philippines

Jean-Christophe Gaillard
Laboratoire Territoires, UMR PACTE 5194 CNRS

Institut de Géographie Alpine
14 bis, avenue Marie Reynoard

38100 Grenoble
France

jean-christophe.gaillard@ujf-grenoble.fr

This article explores the response of traditional societies
in the face of natural hazards through the lens of the concept
of resilience. Resilient societies are those able to overcome
the damages brought by the occurrence of natural hazards,
either through maintaining their pre-disaster social fabric,
or through accepting marginal or larger change in order to
survive. Citing the case of the 1991 Mt. Pinatubo eruption in
the Philippines and its impact on the Aeta communities who
have been living on the slopes of the volcano for centuries, it
suggests that the capacity of resilience of traditional societies
and the concurrent degree of cultural change rely on four
factors, namely: the nature of the hazard, the pre-disaster socio-
cultural context and capacity of resilience of the community,
the geographical setting, and the rehabilitation policy set up
by the authorities. These factors significantly vary in time and
space, from one disaster to another. It is important to perceive
their local variations to better anticipate the capability of
traditional societies to overcome the damage brought by the
occurrence of natural hazards and therefore predict eventual
cultural change.

� International Journal of Mass Emergencies and Disasters

Introduction

Natural hazards are those natural phenomena that pose a threat
to people, structures and economic assets. Natural hazards include
earthquakes, volcanic eruptions, landslides, tsunamis, storms and
cyclones, droughts, floods and storm surges among others. The
response capacity of people in the face of natural hazards is defined
by the concepts of vulnerability and resilience.

Early definitions of vulnerability mostly referred to the quantitative
degree of potential loss in the event of the occurrence of a natural hazard
(e.g., United Nations Department of Humanitarian Affairs 1992). The
concept eventually evolved to encompass the wider social context in
what is commonly called ‘social vulnerability’. Social vulnerability
may be defined as the propensity of a society to suffer from damage
in the event of the occurrence of a given hazard (D’Ercole 1994:
87-88). Vulnerability thus stresses the condition of a society which
makes it possible for a hazard to become a disaster (Cannon 1994:
13). It basically depends on a large array of factors which interact
in systemic (D’Ercole 1994) and causal directions (Watts and Bohle
1993; Wisner et al. 2004). These factors are demographic, social,
cultural, economic and political in nature. It is further important to
recognize that vulnerability reflects the daily conditions of society
(Maskrey 1989; Wisner 1993). Disasters are therefore viewed as the
extension of everyday hardships wherein the victims are marginalized
in three ways: geographically because they live in marginal hazard-
prone areas, socially because they are poor, and politically because
their voice is disregarded (Wisner et al. 2004). Vulnerability further
varies according to the nature of the hazard (Wisner 2004).

People’s capability of response in the face of natural hazards also
relies on their capacity of resilience. This concept spread widely in the
disaster literature in the 1990s and is still the object of a conceptual
debate around its sense and application among social scientists (e.g.,
Klein et al. 2003). Pelling (2003: 48) views resilience as a component
of vulnerability or the ability of an actor to cope with or adapt to hazard
stress. In this regard, it basically includes the planned preparation and
the spontaneous or premeditated adjustments undertaken in the face of
natural hazards. Other scholars (Folke et al. 2002: 13) define resilience

�Gaillard: Traditional Societies in the Face of Natural Hazards

as the “flip” (positive) side of vulnerability or the capacity to resist from
damage and change in the event of the occurrence of a natural hazard. A
third approach breaks away from the previous two to define resilience
as the capacity of a system to absorb and recover from the occurrence
of a hazardous event (Timmermann 1981: 21). Dovers and Handmer
(1992: 270) further distinguish three levels of societal resilience and
differentiate 1/ resilience through resistance to change; 2/ resilience
through incremental change at the margins and 3/ resilience through
openness and adaptability. The United Nations International Strategy
for Disaster Reduction (United Nations Inter-Agency Secretariat of
the International Strategy for Disaster Reduction 2004) recently took
over this differentiation in its definition of resilience as “the capacity of
a system, community or society to resist or change in order that it may
obtain an acceptable level of functioning and structure”. Following
the same approach, Walker et al. (2004) differentiate four crucial
aspects of resilience. The first aspect is the latitude or the maximum
amount by which a system can be changed before losing its ability to
recover. The next dimension is the resistance or the ease or difficulty
of changing the system. The precariousness or how close the current
state of the system is to a limit or “threshold” is also of importance.
The final aspect is the panarchy or the cross-scale interactions and
influences from states and dynamics at scales above and below.

Resilience differs from vulnerability by addressing the capability
and the ways people deal with crises and disaster. On the other hand,
vulnerability only encompasses the susceptibility of individuals to
suffer from damage and thus to transform the occurrence of a natural
hazard into a disaster. Both concepts may rely on the same factors
(demographic, social, cultural, political, etc.) which may however
vary on different scales. Resilient societies are able to overcome the
damages brought by the occurrence of natural hazards, either through
maintaining their pre-disaster social fabric, or through accepting
marginal or larger change in order to survive. The concept of resilience
is thus intimately linked to the concept of change. Post-disaster
changes within the impacted society may be technological, economic,
behavioral, social or cultural in nature. The latitude and resistance to
change greatly depend on the type of society affected by the disaster.
The following paragraphs explore the case of traditional societies.

� International Journal of Mass Emergencies and Disasters

Traditional Societies in the Face of Natural Hazards

Traditional societies, sometimes called folk, tribal, or primitive
societies, are those groups characterized by their pre-industrial self-
sufficient ways of either hunting / gathering or extensive agriculture
type. These societies are further identified by the intimate relationship
they nurture with their immediate natural environment and the slow
level of cultural change they usually experience (Kottak 2003).

Many researchers have addressed the capacity of industrial
societies to overcome the havoc wrought by the occurrence of
natural hazards with more or less change in the social fabric (see
Drabek 1986; Bates and Peacock 1986; Nigg and Tierney 1993
and Passerini 2000 for syntheses). Fewer scholars discussed the
capability of traditional societies to cope with natural hazards. A
review of the scarce literature further denotes a lack of consensus
among social scientists. Three different theoretical frameworks may
be distinguished from the available corpus of research materials.

The first and dominant framework regards traditional
environment-dependent societies as fragile and unable to cope on
their own with large-scale fast-onset natural hazards. Destruction of
the environment due to extreme natural phenomena deprives these
societies of their main resources and pushes them to rely on external
resources in order to recover. Natural hazards are therefore viewed
as a powerful vector of socio-cultural change (Burton 1972; Burton,
Kates, and White 1993; Dynes 1976; Kates 1971; Kates et al. 1973;
Mileti, Drabek, and Haas 1975). Such an argument largely emanates
from the “top-down” technocratic and western logic characterizing
the dominant paradigm in the hazard and disaster literature. The
proponents of this approach find justification for promoting a transfer
of experience, knowledge and technology from industrialized
countries to developing nations in the poor capacity of traditional
societies to respond to natural hazards. This view takes advantage of
the results of several studies conducted following the 1943 to 1952
eruption of Paricutín volcano in Mexico (Nolan 1979; Nolan and
Nolan 1993), the 1951 eruption of Mt. Lamington in Papua New
Guinea (Belshaw 1951; Keesing 1952; Ingleby 1966; Schwimmer
1977), the 1961-1962 eruption of the volcano of Tristan de Cunha,

in the South Atlantic (Blair 1964; Munch 1964, 1970; Lewis,
Roberts, and Edwards 1972), the 1968 eruption of the volcano of
Nila in Maluku (Pannell 1999) and the 1994 eruption of Mt. Rabaul
in Papua New Guinea (To Waninara 2000).

On the other hand, the second theoretical framework sees
traditional societies as capable of recovering on their own from the
impact of natural phenomena. The environmental modifications
resulting from the occurrence of natural hazards forced these societies
to make slight adjustments without modifying the fundamentals of
their social organization (Sjoberg 1962; Torry 1978a, 1979). This
framework emerged from the growing anthropological literature
on hazards and disasters during the 1960s and 1970s (see Torry
1979 and Oliver-Smith 1996 for syntheses). The arguments of this
approach have greatly contributed to challenging the aforementioned
dominant and technocratic paradigm on disaster management by
pointing out the perverse effects of emergency measures and other
technological adjustments set up by western governments. For the
proponents of this approach, if there is temporarily an incapacity of
traditional societies to overcome the consequences of natural hazards
occurrence, it is due to the foreign relief aid that disrupts indigenous
resilience systems rather than to the intrinsic incapability of affected
societies (Waddell 1975, 1983; Torry 1978b, Cijffers 1987, Ali
1992). The radical approach is fed by the work of Spillius (1957),
eventually revisited by Torry (1978a) and Boehm (1996), on the
small island of Tikopia (Solomon islands), which was devastated by
two typhoons and a subsequent famine between 1952 and 1953; the
documentation of Schneider (1957) on the island of Yap regularly
swept by tropical storms; the monumental study of Oliver-Smith
(1977, 1979a, b, c, 1992) about the Quechua Indians of Yungay
following the total destruction of their town by a debris avalanche
triggered by the 1970 Peruvian earthquake; the researches of Lewis
(1981, 1999), Hurell (1984) and Rogers (1981) among the people
of Tonga in the face of typhoons and following the restless activity
of Niuafo’ou volcano in 1946; the comparative study of Holland
and VanArsdale (1986) in Indonesia and Peru among communities
affected by flash floods; and the investigation of Zaman (e.g.
1989, 1994, 1999; Haque and Zaman, 1994) among Bangladeshi

Gaillard: Traditional Societies in the Face of Natural Hazards

�0 International Journal of Mass Emergencies and Disasters

communities recurrently affected by floods, and Cijffers (1987) in
the Cook Islands regularly struck by hurricanes.

Finally, the third approach regarding the responses of traditional
societies in the face of natural hazards defends an intermediate
viewpoint. It argues that the occurrence of natural hazards rather
acts as a catalyst for ongoing cultural changes among traditional
societies increasingly pressured by the industrial world (Blong 1984;
Bates and Peacock, 1986; Oliver-Smith 1996). This phenomenon
has been observed among several Tarascan Indian communities
following the eruption of Paricutín volcano in Mexico between 1943
and 1952 (Rees 1970; Nolan 1979; Nolan and Nolan 1993), among
Guatemalan Mayas after the 1976 earthquake (Bates 1982; Cuny
1983; Hoover and Bates 1985), and among Yemeni highlanders
following the 1982 earthquake (Leslie 1987).

The foregoing frameworks are all driven primarily by the concept of
vulnerability or the susceptibility of traditional societies to experience
disaster following the occurrence of natural hazards. They do not
address cultural change as a way of coping with the havoc wrought
by the disaster. In this paper, we aim to tackle the capacity of response
of traditional societies in the face of natural hazard through the lens of
the concept of resilience. Our discussion will be based on the case of
the 1991 eruption of Mt. Pinatubo volcano in the Philippines and its
impact on the Aeta communities. To assess the Aetas’ resilience will
first require evaluating if the eruption brought about some changes in
the folk culture. A critical review of the factors that affected resilience
in the Mt. Pinatubo case will eventually lead to the advancing of an
alternative approach to the response of traditional societies in the face
of the occurrence of natural hazards.

The 1991 Mt. Pinatubo Eruption and the Aetas

The Aetas are one of the many ethnic minorities occupying
the mountains of the Philippine islands. They are found on the
flanks of Mt. Pinatubo which towers at the apex of the provinces
of Pampanga, Tarlac and Zambales on the main island of Luzon
(Figure 1). Considered by some as the direct descendants of the
populations that first inhabited the archipelago during the Pleistocene

��

Period (Headland and Reid 1989), the Aetas’ small height, very
dark complexion, and curly hair easily distinguish them from the
majority of Filipinos who are taller and are characterized by brown
skin and straight hair. The approximately 50,000 Aetas counted on
the slopes of Mt. Pinatubo in 1999 depend for their livelihood on
cultivating root crops and other vegetables, hunting and fishing,
and also on gathering plants and wild fruits that abound in their
surroundings (Barrato and Benaning 1978; Garvan 1964; Reed
1904; Shimizu 1989). The following paragraphs particularly focus
on the communities located within the 200km2-Pasig and Sacobia
River Basins on the eastern flank of Mt. Pinatubo, in the immediate
vicinity of the former Clark American facilities (Clark Air Base
– CAB) (Figure 2).

Figure 1: Areas Affected by the 1991 Eruption of Mt Pinatubo
and Location of the Study Area (After Data from PHIVOLCS

and Mount Pinatubo Commission).

1

25

30

40

10

5

MANILA BAY

SOUTH
CHINA
SEA

BATAAN

BULACAN

PAMPANGA

NUEVA
ECIJA

TARLAC
ZAMBALES

Botolan

Cabangan

San
Narciso

San
Marcelino

Olongapo City
Dinalupihan

Guagua

San Fernando

Angeles
City

ConceptionCapas

Tarlac

50

20
15

Mt Pinatubo

SUBIC
BAY

Clark
Air Base

Gumain River

Sac
obia

/ Ba
mba

n R
iver

O’
Do

nn
el

Ri
ve

r

Bucao River

Sto Tomas

Abacan River

Pasig Potrero River
Porac

River

Bamban

5

Dueg

Palayan City

Kalangitan

Maynang

LubaoSubic

Poonbato

Villar

Subic
Naval
Base

Sapang
Bato

Dau
Magalang

Mt Arayat

20°N

15°N

10°N

5°N

120°E 125°E

CELEBES SEA

SULU SEA

PH
ILIPPIN

E SEA

Study
area

Manila

�00 km

SOUTH
CHINA
SEA

0 20km

June 1991
pyroclastic deposits

Lahar deposits

Isopachs (in cm)
of airfall deposits

Active lahar channels

Provincial limits

Towns

Doña Josefa
PInaltakan

Mabalacat
Madapdap

Villa
Maria

Aeta resettlement sites

Gaillard: Traditional Societies in the Face of Natural Hazards

�� International Journal of Mass Emergencies and Disasters

Figure 2: Spatial Redistribution of the Aeta Villages in the
Pasig and Sacobia River Basins Subsequent to the

Eruption of Mt Pinatubo in 1991.

Mabubuteun

Pamatayan
Calang

Kaging

Mataba

StaInes
Sta Rosa

Burug

San Martin

Sacobia

Haduan

Target

Sitio Babo

Inararo
Camatsilis

Sapang Uwak

Sapang Uwak

Sa
cob

ia R
ive

r

Abacan River

Sap
ang

Ca
uay

an

Mar
imla

Riv
er

Mabulilat Angeles City

Mabalacat

Bamban

Sac
obia

Riv
er

Bamba
n Rive

r

Calumpang

Marcos
Village

Pulang Lupa

Clark Air Base Area

PoracDiaz

Calapi

Porac River

Calapi

Inararo

TimboBinga BanabaPanabunganMt
Mc Donald

Mt Dorst

To Planas

To Madapdap
Resettlement

Site

Burakin

To Palayan City

Bliss

Gate 14

Baguingan

Burug

San Martin

Pasig River

To Dueg Resettlement Site
To Kalangitan Resettlement Site
To Maynang Resettlement Site

Abandoned settlements

Old settlements
still occupied in 2001
New settlements

Main towns

Main movements
of population

Kapampangan
lowland territory

50cm ash

20cm ash

fall d
epo

sits

deposits

fall

Villa Maria
Resettlemet
Site0 2km

Isopach of ashfall deposits

Pyroclastic flow deposits

Present upper limit
of Aeta settlements

The Aetas were the first to feel the precursory signs of the volcano’s
restlessness during the first days of April 1991; they responded by
immediately warning the Philippine Institute of Volcanology and
Seismology (PHIVOLCS) (Lubos na Alyansa ng mga Katutubong
Ayta ng Sambales 1991; Tayag et al. 1996). This abnormal volcanic
activity intensified until June 1991. The eruptive paroxysm
materialized on June 12 and June 15. On these particular dates, the
volcano spewed some 5 to 7 km3 of pyroclastic materials that buried
many Aeta villages located on the slopes of Mt. Pinatubo. Since
15 June 1991, destructive lahars (volcanic debris flows), triggered
by typhoon-associated downpours, tropical monsoon rains and lake
break outs, have flowed down the flanks and foothills of the volcano
affecting anew a large number of these Aeta settlements (Pinatubo
Volcano Observatory 1991; Umbal 1997; Wolfe 1992).

��

In April 1991, with the initial signs of restlessness by the volcano,
almost all of the Aeta communities were already evacuated (Banzon-
Bautista and Tadem 1993). However, an unknown number of Aetas
who refused to leave their homes perished during the eruption.
According to oral accounts, a score of Aetas found shelter in caves that
had eventually been buried by pyroclastic flows (Shimizu 2001). At
first, the Aetas who chose to evacuate were relocated in some major
surrounding towns (Tarlac City, Capas, Bamban, Mabalacat, Angeles
City, Porac, etc.). Eventually, with the paroxysm of the eruption
on June 15 that affected even the town inhabitants, the authorities
had to once again transfer many Aeta families toward evacuation
centers that were much farther (e.g., provinces of Bulacan, Nueva
Ecija and Manila) from their villages. Inside overcrowded school
buildings, gymnasiums, churches or tent camps, nutrition problems
and diseases (pneumonia, measles…) quickly spread and left a
heavy death toll among Aeta children (Lapitan 1992; Magpantay
1992; Magpantay et al. 1992; Sawada 1992).

Faced with the impossibility of sending the Aetas back to their
former villages which had already been buried under meters of
volcanic deposits, the Philippine government had to plan a permanent
resettlement program. By June 1991, the authorities created the
Task Force Mt. Pinatubo, which was replaced in 1992 by the Mount
Pinatubo Commission (MPC), an intergovernmental structure under
the authority of the President of the Philippines. The task force then
had created eleven upland resettlement centers intended primarily
for the Aetas (Task Force Mount Pinatubo 1991). The Aetas from
the Pasig and Sacobia river basins were mainly distributed on four
sites (Villa Maria, Kalangitan, Dueg, and Maynang). Dueg, the most
remote, is about 100km away from the native villages. In each of
the centers, a lot measuring 150m² together with traditional housing
materials (bamboo, palm leaves…) was allocated for each family.
In 1995, more solid building materials (‘GI sheets’, lumber…) were
provided (Tariman 1999). Some Aetas of the Clark Air Base vicinity
were resettled in a lowland relocation site, Madapdap (municipality
of Mabalacat), with 7,000 lowland families from the neighboring
‘Kapampangan’ ethno-linguistic group who were affected by the
lahars from the Pasig-Potrero and Sacobia Rivers. Each family was

Gaillard: Traditional Societies in the Face of Natural Hazards

�� International Journal of Mass Emergencies and Disasters

awarded a 94m² lot with a concrete house equipped with sanitary
installations (Tariman 1999). There were also two resettlement
centers (Doña Josefa and Pinaltakan) implemented by NGOs
at Palayan City (province of Nueva Ecija) where the Pinatubo
Aetas rubbed shoulders with other upland ethno-linguistic groups
(Dumagats and Bagos) from the Sierra Madre mountain range.
Other resettlement attempts in more remote places such as the island
of Palawan failed because of unsuitable conditions that pushed the
Aetas back to Central Luzon (Gaillard and Leone 2000).

Methodology

The following discussion relies on extensive field work conducted
in the basin of the Pasig and Sacobia rivers between July 1999 and
June 2000 and completed by additional field explorations between
June and September 2001. The lack of reliable census data for the
study area compelled the researcher to abandon the sampling survey
and instead opt for open interviews with selected key informants.
Sixteen villages were visited. Only three occupied settlements were
avoided: one because of security concerns and the two others because
of their inaccessibility. The four neighboring resettlement sites (Villa
Maria, Kalangitan, Maynang and Madapdap) were also part of the
study. Key informants were not limited to community leaders and
included other members (both men and women) of the communities
visited. Interviews were conducted in the Kapampangan language
spoken by almost all the Aetas. Local guides sometimes served as
interpreters in the local Aeta Mag-Aantsi dialect. Questions sought
to assess the pre-eruption lifestyle, the response of the victims to
the disaster, notably their journey up to their present settlement,
and the present way of life. Community leaders further provided
approximate population figures for their village. All the respondents
were cooperative and were willing to share their experience.

In addition to the survey among the Aeta settlements, interviews
were conducted with stakeholders of the Mt. Pinatubo disaster
management. Those include the Mt. Pinatubo Commission (MPC),
other government agencies (National Commission for Indigenous
People, Department of Social Welfare and Development, Department

��

of Environment and Natural Resources, Department of Public Works
and Highways, Department of Health, Department of Agriculture,
Department of Education), local government units (LGUs) and non-
government organizations (NGOs). These interviews were aimed at
assessing the role of the authorities in the shaping of the observations
made on the field. A large amount of useful primary written documents
was also collected from these visits to institutions.

Field work was completed by the collection of secondary written
documents such as journal publications, conference proceedings,
and relevant press clippings from regional and national newspapers.
Both primary and secondary written materials provided information
mostly on the disaster management policy. Very few sources
discussed the response of the populations.

From Uplands to Foothills: The Inevitable
Redistribution of the Population

In 1990, about 1,200 to 1,300 Aeta families (approximately 7,000
individuals) were occupying the Pasig and Sacobia basins on both
the upper slopes and the lower foothills of Mt. Pinatubo (National
Statistics Office 1990; Tadem 1993). After the awakening of the
volcano in 1991, both the unsuitability of the upper flanks of the
mountain and the resettlement policy implemented by the Philippine
government led to a general redistribution of the Aeta population of
the Pasig and Sacobia river basins. Figure 2 shows that the present
upper limit of Aeta settlements matches the lower limit of the 1991
pyroclastic deposits and the 20cm-isopach of ash fall. All the Aeta
communities located on the upper flanks of Mt. Pinatubo prior to the
eruption had to abandon their small villages which had been buried
under these thick and hot pyroclastic and ashfall deposits preventing
the immediate reoccupation of the settlements. Most of these Aetas
have been relocated in the government resettlement sites, either on the
lower slopes of the volcano or on the foothills (Figures 1 and 2). Today,
these resettlement sites are the biggest Aeta settlements. Kalangitan,
the biggest relocation center is inhabited by 385 families. These
resettlement sites host Aeta communities from both the upper and
lower flanks of Mt. Pinatubo. The lack of land suitable for cultivation

Gaillard: Traditional Societies in the Face of Natural Hazards

�� International Journal of Mass Emergencies and Disasters

and the inadequate housing in resettlement sites has however led many
Aeta families native to the lower slopes of Mt. Pinatubo to return to
their old villages and till their abandoned fields (Gaillard and Leone
2000; Macatol 1998, 2000; Macatol and Reser 1999-2000; Seitz
1998, 2000; Shimizu 1992). With the exception of Villa Maria, the
population of other resettlement centers, like Maynang and Palayan
City, has greatly decreased during the last few years. Other Aetas
native to the upper slopes of Mt. Pinatubo and who chose to leave the
resettlement sites have tried to rebuild their villages on more suitable
sites (e.g., Calapi, San Martin, Burug) or near the relocation centers
(e.g., Inararo). Worth noting is that other Aetas maintain residences
in resettlement sites and at the same time tend their fields near their
former villages. This practice is very prevalent in Villa Maria. It is
now also being practiced in Maynang, prompting the service of daily
or weekly shuttles to and from their original villages. Finally, ten years
after the eruption, several families still live in evacuation centers that
were intended for temporary purposes. At Planas, for example, tents
have been replaced by bamboo huts and other sturdier structures.

All the Aeta settlements are nowadays concentrated on the lower
flanks of Mt. Pinatubo in the immediate proximity of lowland
villages and towns occupied by Kapampangan people, the dominant
ethnic group of the southwestern part of the Central Plain of Luzon
(Figure 2). Henceforth, there are no more Aeta communities left
isolated on the upper flanks of Mt. Pinatubo. All have established
regular contacts with lowlanders.

Increasing Interactions with Lowlanders

The closer geographic proximity between Aeta people and their
lowland neighbors, induced by the downhill redistribution of the
population following the 1991 Mt. Pinatubo eruption, has increased
the interactions between the two communities. These interactions
are economic and social, as well as political.

Until Mt. Pinatubo erupted in 1991, regular economic interactions
between Aetas and lowlanders were limited to the communities located
on the lower slopes of the volcano. Many Aetas of the villages situated
near the former Clark Air Base were both agriculturists and employed

��

by the US Air Force as watchmen, jungle survival instructors, and
janitors while others earned their living by scavenging the garbage of
the US servicemen in the area or by gathering scrap materials left by the
Americans during their training (Cunanan 1982-83; Gaabucayan 1978;
Simbulan 1983). The Aetas living in villages farther away from Clark
Air Base used to sell or swap their products for rice, coffee, or sugar in
the public markets of the surrounding towns at least once a week. Aeta
communities living on the highest slopes of Mt. Pinatubo lived almost
exclusively on tilling different rootcrops, hunting, fishing and gathering
tropical fruits without regular contact with lowlanders and other
ethno-linguistic groups. Noteworthy is that despite these significant
differences in their way of life, upland and lowland communities can
still be regarded as a single ethnic group on the basis of their common
physical features, language, traditional beliefs and inter-individual
relationship based on a great sense of ‘communalness’ (Barrato and
Benaning 1978; Brosius 1983; Fox 1952; Shimizu 1989). The downhill
redistribution of the population following the 1991 eruption has deeply
modified the economic landscape by making all the Aetas dependent
on the lowland market to earn their living. Interviews conducted in the
Pasig and Sacobia river basins in 1999 and 2000 show that, at present,
there are no more isolated communities and all the Aetas have thus
learnt to sell their produce directly in the public markets of surrounding
towns without being deceived by Kapampangans who used to act as
middlemen. Besides the traditional public markets, the former Clark Air
Base converted into a vast industrial, tourist and commercial complex,
Clark Special Economic Zone (CSEZ), has become another fruitful
commercial outlet for the Aetas. The Aetas are now all selling fruits
(bananas, papayas…), vegetables (banana tree hearts…), rootcrops
(taro, cassava…) and souvenir items (flutes, bows, blowpipes…) to
local and foreign tourists visiting the Duty-Free shops of Clark Special
Economic Zone. These economic interactions between Aetas and their
surrounding communities, especially with Kapampangans, now take
place on an almost daily basis and hence concern all the Aeta people.

Social interactions between Aetas and their lowland neighbors
began as soon as they rubbed shoulders together inside the overcrowded
evacuation centers that hosted the victims of the eruption of Mt.
Pinatubo in June 1991. Most of the Aetas interviewed who never

Gaillard: Traditional Societies in the Face of Natural Hazards

�� International Journal of Mass Emergencies and Disasters

previously lived beyond the domains of their respective communities
on the upper flanks of the volcano discovered for the first time the
socio-cultural way of life of the lowlands. Aetas als

Assignment

Video summary

Training Title 82 Week 8 Substance-Related and Addictive Disorders

Patient appeared drugged up during the interview. Drowsy looking, Yawning and scratches her skin. Patient verbalized been scared of so many things such as what people thought of her or will think of her if they found out she is an addict. She is also scared of getting help she needed and doesn’t want to go to Rehab even though she new she needed to go but scared of the rehab been dirty.

Patient had been in relationship with her boyfriend (Jeremy for nine months). Jeremy also happened to be her business partner. Patient never new Jeremy was an alcoholic + cocaine abuser until she found Jeremy naked and cheating with another woman in their office ( Jeremy was also using cocaine and alcohol in their office at the time he was cheating)

Patient busted into crying during the interview when explaining the situation that lead her to smoking cocaine and abusing alcohol- she mentioned that Jeremy had squander all their savings and promised to make things better after cheating so the patient took Jeremy back to her apartment and Jeremy made her try cocaine onece and the patient reported that it felt so good trying it and feel like she needs more every time.

Patient sated that she has a daughter “ Sarah” who stays with her friends and glad that the Jeremy didn’t have to be involved with her daughter.

The patient was disappointed because Jeremy betrayed her love, squandered their money and cheated on her with after taking him back. Patient appeared to still being in denial because she is partially denied hep.

Kindly help me use the above information and the other information with rubric to formulate comprehensive evaluation

Thanks

Assignment

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Eruption of Mount Pinatubo in the Philippines in June 1991

Emmanuel M. de Guzman
Consultant (Philippines)

The Pinatubo eruption of June 1991: The nature and impact of the disaster

Nature of the disaster

Reawakened after more than 500 years of slumber, Mount Pinatubo in the
island of Luzon in the Philippines showed signs of imminent eruption early April
1991. On 12 June 1991 (Philippine Independence Day), its intermittent
eruptions began. Three days after, on 15 June 1991, its most powerful eruption
happened. Mount Pinatubo ejected massive volcanic materials of more than
one cubic mile and created an enormous cloud of volcanic ash that rose as high
as 22 miles into the air and grew to more than 300 miles across, turning day
into night over Central Luzon. At lower altitude, the ash was blown in all
direction by intense winds of a coincidental typhoon. At higher altitudes, the ash
was blown southwestward. Volcanic ash and frothy pebbles blanketed the
countryside. Fine ash fell as far as the Indian Ocean and satellites tracked the
ash clouds several times around the globe. Nearly 20 million tons of sulfur
dioxide were injected into the stratosphere and dispersed around the world
causing global temperature to drop temporarily by 1*F from 1991 through 1993.
Mount Pinatubo’s eruption was considered the largest volcanic eruption of the
century to affect a densely populated area.

After the explosive eruptions, posing a more serious and lingering threat to life,
property and environment were the onslaught of lahars. Within hours after the
eruption, heavy rains began to wash deposits of volcanic ash and debris from
the slopes down into the surrounding lowlands in giant, fast-moving mudflows.
Containing 40% (by weight) volcanic ash and rock, lahars flow faster than clear-
water streams. These steaming mudflows cascade as fast as 40 miles per hour
and can travel more than 50 miles. With 90% volcanic debris, lahars move
fastest and are most destructive. When they reach the lowlands, they have
speeds of more than 20 miles per hour and are as much as 30 feet thick and
300 feet wide. They can transport more than 35,000 cubic feet of debris and
mud per second.

For years, lahars continued to flow down the major river systems around the
volcano and out into densely populated, adjoining lowlands. They destroyed
and buried everything along their path: people and animals, farm and forest
lands, bridges and natural waterways, houses and cars. They also rampage
with terrifying rumbling sounds. By 1997, lahars had deposited more than 0.7
cubic miles (about 300 million dump-truck loads) of debris onto the lowlands,
burying hundreds of square miles of land and causing greater destruction than

1

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

the eruption itself. With the volume of volcanic debris deposited on the slopes
of Mt. Pinatubo, the threat of lahars is expected to continue until year 2010.

The disaster brought about by the eruption of Mount Pinatubo had assumed a
unique nature in view of the following: the widespread devastation that impacts
on society and economy, the continuing threat of lahars and flooding, the
destruction of endemic species of flora and fauna, the alteration of landscapes
and land uses, and its impact on the global environment.

Extent of damage and socio-economic impact

The Mount Pinatubo eruptions and their aftereffects, particularly lahars during
rainy seasons, not only have taken the lives of many but also have wrought
havoc to the infrastructure and to economic activities of Central Luzon. Damage
to crops, infrastructure, and personal property totaled at least P10.1 billion ($US
374 million) in 1991, and an additional P1.9 billion ($US 69 million) in 1992. In
addition, an estimated P454 million ($US 17 million) of business was foregone
in 1991, and an additional P37 million ($US 1.4 million) in 1992. Lahars
continue to threaten lives and property in many towns in the provinces of Tarlac,
Pampanga, and Zambales.

The actual destruction, coupled with the continuing threat of lahars and ash fall,
had disrupted the otherwise flourishing economy of Central Luzon, slowing the
region’s growth momentum and altering key development activities and
priorities. Major resources had been diverted to relief, recovery, and prevention
of further damage.

The cost of caring for evacuees, including construction of evacuation camps
and relocation centers, was at least P2.5 billion ($US 93 million) in 1991-1992,
and an additional P4.2 billion ($US 154 million) was spent during the same
period on dikes and dams to control lahars.

The longevity and impact of the calamity is so great that the public and private
response must go beyond traditional relief and recovery. Return to pre-eruption
conditions is impossible. Instead, responses must create an attractive climate
for new investments, provide new livelihood and employment alternatives,
promote growth in areas that are safe from future lahars and flooding, and
provide an infrastructure that is tough enough to survive future disasters.

Areas and populations affected

During the eruption of 15 June 1991, heavy ash falls had caused widespread
damage in the provinces adjacent to Mount Pinatubo, as they covered large
tracts of land and caused the roofs of houses, buildings and public facilities to
collapse. These provinces were Zambales, Pampanga and Tarlac.

2

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

The regional office of the Department of Social Welfare and Development
(DSWD) had reported a total of 657 persons dead, 184 injured and 23 missing
as of 29 September 1991. The casualties were mostly victims of collapsing
structures, drowning due to flooding, and diseases in the evacuation center.
The provinces of Zambales and Pampanga accounted for most of the victims.

Moreover, from June 1991 to November 1992, the means of livelihood, houses,
or both were partially or wholly lost in 364 barangays or villages. Per 1990
census, about 329,000 families (2.1 million people) or one-third of the region’s
population lived in these villages.

Table 1. Total number of barangays affected as of November 17, 1992
(National Disaster Coordinating Council, 1992). [“Affected” refers to a situation
where means of livelihood, houses, or both are lost or partially or completely
destroyed]

Province Affected barangays No. of families
Zambales 96 30,115
Pampanga 173 239,131
Tarlac 88 44,367
Angeles City 5 14,197
Nueva Ecija 2 1,331

Total 364 329,141

In 1991, 4,979 houses were totally destroyed and 70,257 houses were partially
damaged. The number decreased in 1992, when 3,281 houses were wholly
destroyed and 3,137 units were partially damaged (Table 2).

Table 2. Total number of houses damaged (National Disaster Coordinating
Council, 1992; Presidential Task Force on Mount Pinatubo, 1992; Department
of Social Welfare and Development, unpublished data, 1992). [Partial damage
refers to any degree of physical destruction attributed to the disaster. Total
destruction is the condition when the house is no longer livable]

Extent of damage 1991 1992 Total
Totally destroyed houses 4,979 3,281 8,260
Partially damaged houses 70,257 3,137 73,394

Total 75,236 6,418 81,654

Of the 329,000 families (2.1 million persons) affected, 7,840 families (35,120
persons) were of the Aeta cultural minority (Office for Northern Cultural
Communities, unpub. data, August 14, 1991). Although constituting less than 2
percent of the total affected population, these cultural minorities had received
significant attention.

3

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Impact on natural resources

Moreover, the eruption had caused massive damage to natural resources. It
had buried about 18,000 hectares of forest land in ash falls of about 25
centimeters. The series of heavy rains following the eruption had induced
lahars to flow down to some 8,968 hectares of low-lying areas. At least eight
major river systems have been clogged up by lahar, namely Balin-Baquero
Bacao, Santo Tomas, Gumain, Porac, Pasig-Potrero, Abacan, Bamban and
Tarlac Rivers.

Reforestation activities had been seriously setback in the mountain range of
Zambales. About 19,799 hectares of new plantations were destroyed ash falls
and some P125 million worth of seedlings were lost. Damage to natural forest
covers and old plantations extended to around 43,801 hectares. About 10,206
hectares of agro-forestry farms under the Integrated Social Forestry Program of
the Department of Natural Resources had been destroyed.

Impact on agriculture

Agricultural land area seriously affected by the ash fall reached some 96,200
hectares. Damage to crops, livestock and fisheries was valued at P1.4 billion.
As of 17 November 1992, damage from s, flooding, and salutation was reported
to be P1.4 billion, with crops and fisheries as most affected.

Table 3. Existing damage to agricultural commodities (in million pesos;
Department of Agriculture, Region III, unpub. data, 1991; National Disaster
Coordinating Council, 1992). [Damage cost = total area damaged x expected
yield per hectare. Expected yield is computed by referring to pre-calamity yield.
Post-calamity yield is derived by referring to pre-calamity yield and subjecting
the damaged crops to recovery chances/percentages. The value of the crops
with negative chances/percentages is derived by multiplying them by the
prevailing market prices of the crops. This value then becomes the damage
cost.]

Commodity 1991 1992 Total
Crops (hectares) 987.2 546.8 1,534.0
Livestock (heads) 203.2 9.8 213.0
Fisheries (hectares) 284.1 164.9 449.0
Sugarcane (hectares) 56.9 56.9

Total 1,474.5 778.4 2,252.9

Impact on trade and industry

4

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

The trade and industry sector was also severely affected, especially the
manufacturing and exporting sub-sectors, affecting 599 firms with total assets of
P851 million. Foregone production losses were reported at 45% of potential
sales for the year 1991 or P454 million while capital investments of the 306
affected firms surveyed destroyed stood at a total of P425 million. The hardest
hit in the manufacturing sub-sector was the furniture industry with a total of
P156.5 million in estimated damage with 108 firms affected.

Impact on social services

Health. Morbidity and mortality rates increased mainly in evacuation centers.
The leading diseases were acute respiratory infections (ARI), diarrhea, and
measles (Department of Health, unpublished data, 1991). The death rate (Aetas
and lowlanders combined) was 7 per 10,000 per week during 1991; that for
Aetas in 1991 reached as high as 26 per 10,000 per week, and averaged 16 per
10,000 per week (Department of Health, 1992), and was especially high among
Aeta children.

Social welfare. -The continuing threat of s had required that relief – food,
clothing, shelter, and other help – be provided far beyond the period that is
normal for typhoons and other calamities. As of October 28, 1993,
approximately 1,309,000 people were being served outside evacuation centers.
As of the same date, 159 evacuation centers were being maintained by the
Department of Social Welfare and Development (DSWD) throughout Region III,
housing some 11,455 families or 54,880 persons and providing them with food-
for-work or cash-for-work assistance.

Education. About 700 school buildings with 4,700 classrooms were destroyed
displacing an estimated 236,700 pupils and 7,009 teachers. Damage to school
buildings was estimated to be P747 million as of August 1991 an amount that is
growing with continuing lahar activity. Disruption of schooling was compounded
by the use of undamaged school buildings as evacuation centers, which forced
delays in the opening of classes and caused other disruptions of the school
calendar. Initial damage to instructional materials, furniture, equipment, and
other school supplies was estimated at P93 million pesos (Department of
Education, Culture, and Sports, unpublished data, 1991).

5

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Table 4. Estimated cost of damage to school buildings by province or city as of
August 12, 1991 (National Disaster Coordinating Council, 1992; Presidential
Task Force on Mount Pinatubo, 1992; Department of Education, Culture, and
Sports, Region III, unpublished data, 1991). [Ash fall is the major cause for this
type of damage]

Province/City Cost (x1000Pesos)
Zambales 410,000
Bataan 34,000
Olongapo City 140,000
Pampanga 130,000
Tarlac 13,000
Angeles City 12,000
Bulacan 5,050
Nueva Ecija 3,200

Total 747,250

Impact on public infrastructure

In its damage assessment report as of August 23, 1991, the Department of
Public Works and Highways (DPWH) Regional Office III estimated damage to
public infrastructure amounting to P3.8 billion. The gravest destruction was on
irrigation and flood control systems, roads and bridges, and school buildings.
Additional damage of at least 1 billion pesos was done to roads and bridges by
lahars of 1992 (National Disaster Coordinating Council, 1992).

Table 5. Total cost of damage to infrastructure as of August 23, 1991 (National
Disaster Coordinating Council, 1992; Presidential Task Force on Mount
Pinatubo, 1992; Department of Public Works and Highways, Region III, unpub.
data, 1991). [The prevailing foreign exchange rate during this period was $1 =
27.07 pesos]

Infrastructure subsector/Facility Damage Cost (x1000Pesos)
Transportation 1,149,908
Communication 13,215
Power and electrification 54,918
Water resources 1,568,642
Social infrastructure 1,045,708

Total 3,832,391

6

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Overall impact on sectors

As a whole, damage and production losses resulting from the eruption and
subsequent lahars were about P10.5 billion in 1991 and P1.9 billion in 1992.
These values include only damage and losses that were readily quantifiable.
Additional losses, not included in these estimates, include human life, social
fabric of communities, children’s schooling, and other social aspects.

Table 6. Existing sectoral damage and production losses, 1991-92 (in millions
of pesos) (National Disaster Coordinating Council, 1992; Presidential Task
Force on Mount Pinatubo, 1992; National Economic Development Authority,
unpublished data, 1991, 1992).

Sector 1991 1992 Total 1991-92
Public infrastructure 3,830 454 4,284
Agriculture 1,474 1,422 2,896
Military facilities 3,842 0 3,842
Trade and industry 851 0 851
Natural resources 125 0 125
Foregone income (trade and industry). 454 37 491

Total 10,576 1,913 12,489

7

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Overview of the disaster management by the Philippine Government

Laws, policies and organization

In view of the magnitude and socio-economic impact of the eruption of Mount
Pinatubo, the Philippine Government had initiated and ensured an organized
and integrated response to the calamity and the ensuing crises. In particular,
the Philippine Congress and the Office of the President had passed and
promulgated a series of laws and regulations that governed the country’s
comprehensive response. The relief, recovery, rehabilitation and reconstruction
efforts by the government, including those supported by donor governments,
nongovernmental and international organizations, were coordinated and
implemented within the overall disaster management plan and development
strategy pursued by the government.

On 26 June 1991, President Corazon C. Aquino, through Memorandum Order
No. 369, had created the Presidential Task Force on the Rehabilitation of Areas
Affected by the Eruption of Mount Pinatubo or Task Force Mt. Pinatubo. It was
mandated to guide and coordinate all rehabilitation efforts of the government,
including those participated in by the private sector and the international
community. After a year, the Mount Pinatubo Assistance, Resettlement and
Development Commission succeeded the Task Force by virtue of a law,
Republic Act 7637, passed by the Philippine Congress and signed by President
Fidel V. Ramos on 24 September 1992. With a term of six years, the
Commission was mandated, among others, to formulate policies and plans, to
coordinate the implementation of programs and projects, and to administer the
initial 10-billion peso fund appropriated for the “aid, relief, resettlement,
rehabilitation and livelihood services as well as infrastructure support for the
victims.” Specifically, the Commission was tasked to (1) provide additional funds
for the immediate relief of victims, (2) establish resettlement centers and home
sites, (3) provide livelihood and employment opportunities, (4) repair,
reconstruct or replace infrastructure damaged or destroyed, and (5) construct
new infrastructure facilities needed by the affected communities. In pursuit of
these tasks, the Commission, through relevant government agencies,
implemented projects and activities on four major program areas: resettlement,
livelihood, social services and infrastructure. Pursuant to law, President Ramos
extended the term of the Commission to December 2000 by virtue of
Presidential Proclamation 1201 issued on 19 March 1998.

The Commission pursued a comprehensive program that aimed to alleviate the
sufferings of the victims, to protect them from further destruction, to help them
rebuild their homes, and to gain a means of livelihood. In view of the limited
term of the Commission and the necessity to sustain rehabilitation and
development efforts, all government agencies concerned with the
implementation of related works had been directed to include in their respective
annual budget the necessary funding requirements (National Budget

8

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Memorandum Circular 74). This ensured the continuity and sustainability of
critical rehabilitation programs beyond the Commission’s extended term.
Moreover, as early as 1996, government agencies and local government units
concerned had began integrating into their regular programs the delivery of
basic social services to the affected communities, including school, health and
welfare services. Similarly, the Department of Public Works and Highways had
assumed the implementation, monitoring and improvement of engineering
intervention works and lahar mitigation activities since 1997.

Before the Commission expired, President Joseph E. Estrada transferred its
chairmanship to the Department of Budget and Management (DBM) and
directed the preparation of a winding up program (Executive Order No. 269
issued on 19 July 2000). Upon her assumption to office in 2001, President
Gloria Macapagal-Arroyo issued a series of directives to ensure the continuity,
integration and sustainability of the Commission’s work. Executive Order No. 4,
issued on 5 March 2001, created an ad hoc body to complete the wind up
activities of the Commission. Executive Order No. 5, issued on 5 March 2001,
transferred the administration of upland Pinatubo resettlement communities
from the Commission to the concerned local government units. Executive
Order No. 6, issued on 20 March 2001, transferred 14 existing lowland Pinatubo
resettlement sites under the supervision of the Housing and Urban
Development Coordinating Council (HUDCC). Also, it created under the
Council the Pinatubo Project Management Office (PPMO) to manage the
resettlement areas. Eventually, under Executive Order No. 54, the PMMO
assumed the assets, records, funds, personnel, liabilities and all related
functions, tasks and responsibilities from the defunct Commission.

9

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Disaster response

Early warning and evacuation

Evacuation of the population at risk had been the concern of local authorities as
early as April 1991 when the Philippine Institute of Volcanology and Seismology
(PHIVOLCS) declared a 6-mile-radius danger zone around the volcano.
PHIVOLCS, jointly with the U.S. Geological Survey (USGS), had conducted
intensive studies and monitoring of the volcano’s activity from which it forecast
and declared an imminent eruption and issued early warnings to the
communities at risk. Among the first to have evacuated were the indigenous
Aeta highlanders who had lived on the slopes of the volcano. About 20,000 in
population, the Aetas had been safely evacuated before the eruption. People
from the lowlands heeded also the warnings and fled to safer distance from the
volcano. Also, more than 15,000 American servicemen and their dependents
had evacuated from Clark Air Base before the eruption.

Immediate response

In the immediate aftermath of the eruption, the National Disaster Coordinating
Council mobilized civilian and military resources to respond to the evacuation,
rescue and relief requirements of the affected populations. Government
agencies mobilized their respective facilities (hospitals, schools, etc.) and
personnel (medical, social workers, teachers, etc.) to provide the necessary
basic services in designated evacuation centers. The Department of Social
Welfare and Development was in the forefront of providing emergency relief
assistance to displaced families and victims in evacuation centers. The
Department of Health led in the provision of medical care and public health
services at evacuation centers, including disease surveillance. Heath advisories
were also issued and broadcast to guide the public in coping with the ashfall as
health hazard since the fine volcanic particles could cause sore eyes or trigger
asthma.

Later on, a host of countries extended humanitarian relief assistance to the
Philippine Government and its support NGOs, including the Philippine National
Red Cross. These countries included Australia, Belgium, Canada, China,
Denmark, France, Finland, Germany, India, Indonesia, Italy, Japan, Malaysia,
Malta, Myanmar, Netherlands, New Zealand, Norway, Saudi Arabia, Singapore,
South Korea, Spain, Sweden, Taiwan, Thailand, U.K., and U.S.A. International
organizations such as WHO, UNDP, UNICEF, UNDRO and WFP also extended
humanitarian relief assistance. The relief assistance was in the form of cash
donations or relief items such as food packs, medicines, and shelter materials.

10

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Recovery and reconstruction plan

Development planning concerns

The government’s recovery and rehabilitation plan was guided by a
development principle that rehabilitation and reconstruction should not be
limited to restoration of destroyed or damages areas, facilities and systems to
their original conditions but should address the vulnerabilities and deficiencies
of previously existing conditions and mitigate any future disaster impact.

With the magnitude and extent of the destruction wrought by the eruption,
development planners and policy-makers were confronted by the following
concerns, which required immediate action as well as long-term solutions.

1) Resettlement. There was need to resettle people whose places of residence

had been devastated and were beyond immediate reconstruction or had
been damaged or affected and deemed unsafe for habitation. There were
two target beneficiaries for resettlement: the indigenous Aeta highlanders
and the displaced lowlanders. The resettlement strategy for the two groups
had to differ to consider the variation in socio-cultural orientation and socio-
economic activities of the Aetas and the lowlanders.

2) Livelihood. Government had to address the pressing concern of providing

immediate and long-term, livelihood opportunities to displaced farmers and
workers. Many farmlands had been unsuitable for agriculture and caused
disruption of production of agriculture-based industries. The closure of Clark
Air Base also presented the need for short-gestating livelihood opportunities
and for alternative uses of base lands to cushion the effect of the massive
displacement of workers.

3) Social Services. The continuing nature of the calamity had put pressure on

social services sector to provide continued social services in terms of health,
social welfare and education. Health and psycho-social services had to be
extended to victims both in and outside the evacuation centers. The
immediate opening of the classes and the extension of the school calendar
had to be considered by the government at the same time that it was
providing relief services to evacuees in school facilities. Social services
would have to be extended in resettlement areas in order to prepare the
resettlers for final resettlement.

4) Infrastructure. The eruption had caused massive destruction to the region’s

roads and bridges, public buildings and facilities, communication, utilities
and river and flood control structures. There was also need to institute
disaster mitigation measures in view of the continuing threat of lahars and
flashfloods.

11

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

5) Land use and environmental management. The effects of the eruption,
especially lahar, continue to destroy farmlands, forest lands and watersheds
and had caused damages to the river systems and overall environment of
the region. This required careful physical land use re-planning of the region.

6) Science and Technology. The need to undertake scientific studies and

formulate corresponding studies and policies was an evident concern and
challenge for science and technology. The development of alternative uses
of ash fall for commercial or industrial was an important concern for both
government and the private sector.

In response to the above-mentioned concerns, the government vigorously
pursued the following specific development objectives:

・ To mitigate further the destruction brought about by the adverse effects
of the eruption, especially the lahars;

・ To normalize and accelerate economic recovery including the creation of
an alternative investment climate;

・ To provide adequate livelihood and employment alternatives, especially
for displaced farmers and workers;

・ To promote growth and development in resettlement and new settlement
areas serving as alternatives to permanently damaged/ high-risk areas;

・ To ensure the continuous flow of goods and services, especially during
relief operations when calamity strikes (lahars had made many areas
inaccessible);

・ To strengthen institutional structures, arrangements, and mechanisms
for disaster preparedness/ responsiveness and raise public awareness
on disaster mitigation and reduction;

・ To reduce susceptibility of vertical and horizontal infrastructures to
damages due to lahars and other disasters; and

・ To prevent further degradation of the environment and rehabilitate
damaged ecosystems.

Development strategy

As key feature of its development strategy, the government adopted team work
or “kabisig” in the pursuit of rehabilitation and reconstruction programs and
projects. As an overall approach, the government emphasized cooperation and
coordination among national and local government agencies, private sector,
including NGOs and the victims themselves to prevent duplication of efforts.
The government also ensured that these programs and projects were consistent
with the broader regional development framework. The overall spatial
development strategy for Central Luzon envisioned the region as the transit
lane between the resource-based areas of the Northern Luzon and the highly
populated and industrialized areas of the National capital region. As such the
region shall continue to serve as the catchment area for population and industry
spillover from Metro Manila and assume the provide the requirements of the

12

Eruption of Mount Pinatubo in the Philippines Asian Disaster Reduction Center

Northern Luzon provinces in terms of processing and manufacturing of goods
and their distribution.

Moreover, the government developed specific strategies, programs and projects
that address the concerns earlier mentioned, i.e. in areas of resettlement,
livelihood, social services, infrastructure, science and technology, and land use
and environmental management. These were made in consultation with local
government officials, community leaders and the beneficiaries themselves.

Programs and projects

In accordance with the development strateg

Assignment

Institut du développement durable
et des relations internationales
27, rue Saint-Guillaume
75337 Paris cedex 07 France

Disaster Evacuation from
Japan’s 2011 Tsunami
Disaster and the Fukushima
Nuclear Accident

N°05/13 MAY 2013 | GOVERNANCE

Reiko Hasegawa (IDDRI)

JAPAN’S 2011 DISASTER: RESPONSES TO NATURAL AND INDUSTRIAL
CATASTROPHES
The triple disaster that hit the Tohoku region of Japan on 11 March 2011

triggered a massive human displacement: more than 400,000 people

evacuated their homes as a gigantic tsunami induced by a magnitude 9.0

earthquake engulfed the coastal areas, and the following nuclear accident

in Fukushima released a large amount of radioactive materials into the

atmosphere. This study analyses the disaster response, with a particular

focus on evacuation of the population, and social consequences of this

complex crisis, based on intensive fieldwork carried out one year after the

catastrophe. It reveals that the responses of the Japanese authorities and

population were significantly different between a natural disaster and an

industrial (man-made) accident.

TWO EVACUATION PATTERNS: RISK PERCEPTION VERSUS VULNERABILITY
Being prone to both earthquakes and tsunamis, Japan had been preparing

itself against such risks for many years. A tsunami alert was immediately

issued and the population knew how and where to evacuate. In contrast,

the evacuation from the nuclear accident was organised in total chaos, as

a severe accident or large-scale evacuation had never been envisaged—let

alone exercised—before the disaster. The population was thus forced to

flee with no information as to the gravity of the accident or radiation risk.

In both cases, the risk perception prior to the catastrophe played a key role

in determining the vulnerability of the population at the time of the crisis.

SOCIAL CONSEQUENCES FROM THE DISASTER: DIVIDED COMMUNITIES
AND FAMILIES
While tsunami evacuees are struggling with a slow reconstruction

process due to financial difficulties, nuclear evacuees are suffering from

uncertainty as to their prospect of return. One year after the accident,

the Japanese authorities began to encourage nuclear evacuees to return

to the areas contaminated by radiation according to a newly established

safety standard. This triggered a vivid controversy within the affected

communities, creating a rift between those who trust the government’s

notion of safety and those who do not. The nuclear disaster has thus

become a major social disaster in Japan dividing and weakening the

affected communities.w
w

w.
id

dr
i.o

rg

Copyright © 2013 IDDRI

As a foundation of public utility, IDDRI encourages

reproduction and communication of its copy-

righted materials to the public, with proper credit

(bibliographical reference and/or corresponding

URL), for personal, corporate or public policy

research, or educational purposes. However,

IDDRI’s copyrighted materials are not for commer-

cial use or dissemination (print or electronic).

Unless expressly stated otherwise, the findings,

interpretations, and conclusions expressed in the

materials are those of the various authors and are

not necessarily those of IDDRI’s board.

Citation: Hasegawa, R. (2013), Disaster Evacua-

tion from Japan’s 2011 Tsunami Disaster and the

Fukushima Nuclear Accident, Studies No.05/13.

IDDRI, Paris, France, 54 p.

The author would like to thank both the French

and Japanese DEVAST teams for their signifi-

cant inputs and contributions in producing this

study, especially Dr Francois Gemenne (IDDRI),

Project Leader of the French DEVAST team, and

Dr Alexandre Magnan (IDDRI) for the very great

support they extended throughout the implemen-

tation of the project. The author also received

valuable and insightful advice from Dr Michel

Colombier, Scientific Director of IDDRI, and

Professor Claude Henry of Sciences Po/Columbia

University (Chair of the Scientific Council of

IDDRI). Special thanks go to Ms Rina Kojima, who

worked as an intern during the fieldwork in Japan.

Without her help, many of the interviews would

have simply been unrealisable. The field research

was successfully conducted thanks to Associate

Professor Norichika Kanie of the Tokyo Institute

of Technology (TITech), who kindly hosted IDDRI

researchers in his office during the field mission,

and also to Mr Shinji Tanada, Ms Yui Nakagawa

and Ms Miho Akatsuka, who provided valuable

assistance in conducting field visits. My sincere

thanks are also extended to all the evacuees and

municipal officers who agreed to be interviewed

despite their difficult circumstances. Lastly, the

author would like to express sincere gratitude to

the French National Research Agency (ANR) and

the Japan Science and Technology Agency (JST),

which provided the necessary funding for the

project implementation.

For more information about this document,

please contact the author:

Reiko Hasegawa – reiko.hasegawa@iddri.org

ISSN 2258-7535

IDÉES POUR LE DÉBAT 05/2011 3IDDRI

Disaster Evacuation from
Japan’s 2011 Tsunami
Disaster and the Fukushima
Nuclear Accident
Reiko Hasegawa (IDDRI)

LIST OF TABLES AND FIGURES 4

LIST OF ACRONYMS
AND ABBREVIATIONS 4

EXECUTIVE SUMMARY 5

1. INTRODUCTION 9

2. METHODOLOGY 9

3. THE GREAT EAST JAPAN EARTHQUAKE AND TSUNAMI 15
3.1. Overview of the event 15
3.2. Disaster response and evacuation 15
3.3. Perception of risk 17
3.4. Prospects of resettlement 19
3.5. Post-disaster challenges 20

4. THE FUKUSHIMA DAIICHI NUCLEAR POWER PLANT
ACCIDENT 22
4.1. Overview of the event 22
4.2. Disaster Response and Evacuation 23
4.3. Perception of risk 28
4.4. Prospects of return 30
4.5. Post-disaster challenges 35

5. COMPARATIVE ANALYSIS OF THE TSUNAMI
EVACUATION AND THE NUCLEAR EVACUATION 42

6. CONCLUSIONS 44

REFERENCES 46

APPENDICES 48
Appendix 1: Questionnaire for evacuees

(tsunami and nuclear) 48
Appendix 2: Questionnaire for

self-evacuees (only nuclear) 49
Appendix 3: Questionnaire for

municipalities 50
Appendix 4: List of meetings and seminars

attended during the field research 52
Appendix 5: Map of nuclear power plants

in Japan 53

LIST OF TABLES AND FIGURES

Table 1. Number of persons interviewed 11
Figure 1. Age of evacuees interviewed 11
Figure 2. Gender of evacuees interviewed 11
Table 2. Target municipalities for interviews 13
Map 1. The Tohoku region and three heavily
affected prefectures 14

Map 2. Map of Fukushima Prefecture 14
Map 3. Example of a hazard map
(Rikuzentakada City) 17

Figure 3. Photos of temporary shelters
(prefabricated housing) 19

Figure 4. Changes in the number
Fukushima evacuees 23

Figure 5. Changes in the total number of
evacuees 23

Table 3. Chronology of the Government’s
evacuation orders/recommendations 24

Map 4. Official evacuation zones prior
to 30 September 2011 24

Figure 6. Trends in public opinion on nuclear
energy 31

Map 5. Reorganisation of the evacuation
zone (as from August 2012) 32

Table 4. The government’s proposal on the
reorganisation of the evacuation zone 33

Figure 7. Changes in willingness to return 34
Figure 8. Willingness to return according
to age 34

Map 6. Radiation contour map
of the affected region 40

Table 5. Comparative analysis of the two
evacuations 43

LIST OF ACRONYMS
AND ABBREVIATIONS
AAR Association for Aid and Relief

ADRA Adventist Development and Relief

Agency

ANR Agence nationale de la recherche

(France)

FoE Friends of the Earth

ICANPS Investigation Committee on the

Accident at the Fukushima Nuclear

Power Stations of Tokyo Electric Power

Company (appointed by the Cabinet

Office)

IIC Independent Investigation Commission

on the Fukushima Nuclear Accident

JST Japan Science and Technology Agency

M Magnitude

METI Ministry of Economy, Trade and

Industry

MEXT Ministry of Education, Culture, Sports,

Science and Technology

MHLW Ministry of Health, Labour and Welfare

NAIIC Fukushima Nuclear Accident

Independent Investigation Commission

(appointed by The National Diet)

NISA Nuclear and Industrial Safety Agency

(under METI)

(replaced by the Nuclear Regulation

Authority in September 2012)

NGO Non-governmental organisation

NSC Nuclear Safety Commission (under the

Cabinet Office)

(integrated into the Nuclear Regulation

Authority since September 2012)

NUMO Nuclear Waste Management

Organization of Japan

OCHA United Nations Office for the

Coordination of Humanitarian Affairs

TEPCO Tokyo Electric Power Company

TITech Tokyo Institute of Technology

UNU United Nations University

Disaster Evacuation from Japan’s 2011 Tsunami Disaster and the Fukushima Nuclear Accident

STUDY 05/2013 1 5IDDRI

3. THE GREAT EAST JAPAN
EARTHQUAKE AND TSUNAMI

3.1. Overview of the event

On 11 March 2011, a magnitude 9.0 earthquake

struck off the Pacific coast of Tohoku in north-

eastern Honshu, the main island of Japan. The

tremor triggered a tsunami that had a mean inun-

dation height of 10–15 m and a run-up height of

40 m in some places (Mori and Takahashi, 2012:

pp.1 and 13). According to the National Police

Agency, 15,871 people lost their lives, with 2,778

people missing (feared dead) and 6,114 people

injured, as on 10 October 2012.13 Nearly 400,000

houses were either severely damaged or comple-

tely destroyed. The Cabinet Office estimates

the direct financial damage from the disaster at

approximately 16.7 trillion yen (€167 billion).14 It

was the most powerful earthquake ever recorded

in Japan,15 and one of the world’s biggest earth-

quakes after the 2004 Indian Ocean Earthquake

(M 9.1–9.3). The then Japanese Prime Minister,

Naoto Kan, described the disaster as the worst

crisis that Japan has had to face since the Second

World War.

According to the official figure, the disaster dis-

placed a total of 386,739 people, recorded at one

week after the disaster.16 In March 2012, one year

on from the disaster, the number was still as high

as 344,290,17 which indicates that most of the evac-

uees had not yet returned to their home or reset-

tled in permanent shelters. Half of these evacuees

originate from the Fukushima Prefecture and most

were displaced following the nuclear accident.

The number of evacuees who left on account of

the earthquake and tsunami alone can thus be es-

timated at around 170,000 people.

These evacuees are currently accommodated

in three types of temporary shelters: prefabricat-

ed houses, private apartments and public-sector

apartments. As early as April 2011, one month af-

ter the disaster, prefabricated houses were erected

13 Source: National Police Agency (http://www.npa.

go.jp/archive/keibi/biki/higaijokyo.pdf). (in Japa-

nese)

14 Source: Cabinet Office (http://www.bousai.go.jp/oshi-

rase/h23/110624-1kisya.pdf). (in Japanese)

15 Source: Japan Meteorological Agency (JMA). (http://

www.jma.go.jp/jma/en/2011_Earthquake/2011_Earth-

quake.html). (in Japanese)

16 Source: Cabinet Office (http://www.cao.go.jp/shien/1-

hisaisha/pdf/5-hikaku.pdf). (in Japanese)

17 Source: Reconstruction Agency (http://www.recon-

struction.go.jp/ topics/ 120413hinansya.pdf). (in Japa-

nese)

to house the displaced population. By May 2012,

a total of 52,858 prefabricated houses had been

constructed for the disaster evacuees, of which

48,884 units are currently occupied.18 There were

68,317 families living in private apartments, with

rent covered by the government. Public-sector

apartments, which were initially built to provide

housing for public servants, were also utilised as

evacuee accommodation. There were 19,041 of

such apartments occupied by the evacuees.

3.2. Disaster response
and evacuation

This sub-section presents the major findings from

the field interviews on the disaster response and

evacuation process induced by the earthquake and

tsunami.

Evacuation with a tsunami warning that
underestimated the gravity of the situation
Japan is a country prone to earthquakes and

tsunamis due to its geological conditions. Over

the years, it has thus developed an adaptation and

disaster prevention mechanism using advanced

technologies. The coastal communities of Tohoku

in particular had prepared themselves for the

eventuality of a disaster, as they have already

experienced many tsunamis. When the earth-

quake hit the Tohoku region on 11 March 2011, the

tsunami warning was issued by the Japan Meteo-

rological Agency (JMA) only three minutes after

the earthquake, and immediately disseminated

to the municipalities likely to be impacted (JMA

2011b: p.3). The warning was then transmitted

through loudspeakers installed in these coastal

towns for the purpose of public broadcasting. The

disaster prevention mechanism was thus acti-

vated as planned. However, the field interviews

revealed that the system had many shortcomings.

First, the estimated tsunami height announced in

the warning was considerably different from the

actual tsunami height. The JMA issued a warning

of a 6 m tsunami for Miyagi Prefecture and no

more than a 3 m tsunami for Iwate and Fukushima

Prefectures (JMA 2011a: p.3). On hearing this

alert, some residents decided to stay on the second

floor of their house instead of evacuating to higher

ground. In addition, the fact that these coastal

towns had 5–10 m breakwaters built along the

coast for protection against the inflow of tsunami

waves further delayed the residents’ decision to

flee. One evacuee from Ofunato City said:

18 Source: Reconstruction Agency (http://www.recon-

struction.go.jp/topics/120521genjototorikumi.pdf). (in

Japanese)

STUDY 05/20131 6 IDDRI

Disaster Evacuation from Japan’s 2011 Tsunami Disaster and the Fukushima Nuclear Accident

When I first heard a tsunami warning for 3

metres, I thought that it would be all right be-

cause the breakwater in our town is higher than

that.

The survey conducted by the JMA in June 2011

on the post-disaster evacuation following the

tsunami alert also collected the similar testimo-

nies from tsunami survivors (JMA, 2011a: p.5).

During our interviews, a couple of evacuees also

mentioned that those who had already evacu-

ated to higher ground even went back home after

hearing the expected height of tsunami, thinking

that they would survive in their house. Further-

more, citizen volunteers from the Community

Fire Brigade19 went to the coastal area to close the

breakwater gates, a task allocated to them by the

contingency planning, expecting the breakwater

to be high enough to stop the tsunami. Many of

them lost their lives as the tsunami engulfed the

breakwaters. In reality, the tsunami that hit the

three prefectures had a 10–15 m mean inundation

height and a 40 m run-up height in some places. It

was only after the arrival of the tsunami that the

JMA amended the height to ‘more than 10 m’ for

all three prefectures. As a result, despite the early

tsunami warning, many residents were caught by

surprise when the actual tsunami arrived.

Later, it was also discovered that the govern-

ment possessed GPS-controlled tide gauge equip-

ment, installed off the coast of Tohoku by the

Ministry of Land, Infrastructure, Transport and

Tourism (MLIT), which had accurately predicted

the height of the tsunami prior to its arrival on the

coast. According to the presentation made by the

Member of Parliament, Itsunori Onodera, at the

House of Representatives on 2 February 2012, the

information from the GPS gauge was transmitted

to the JMA before the tsunami arrived, but the

JMA did not take this into account until after the

event as it was neither part of their procedure nor

integrated into their method of calculating the tsu-

nami height.20

The second shortcoming of the tsunami warning

was the way in which the warning was disseminat-

ed. The alert is usually transmitted by the relevant

municipal offices via loudspeakers installed all

19 This is a voluntary fire corps formed by the residents of

each community/district in towns and cities. It partici-

pates in and helps the activities of fire fighters on a com-

munity level in case of fire and disasters.

20 The testimony of Itsunori Onodera (Liberal Demo-

cratic Party) at the House of Representatives during the

Budget Committee of the House of Representatives on

2 February 2012 can be viewed on the following site:

http://www.youtube.com/watch?v=efGa86LURHg (in

Japanese).

over town. The interviews with evacuees and local

authorities found that many of these loudspeak-

ers did not function either because the earthquake

had knocked down the speaker poles or because

transmission had been disrupted by the power cut

following the earthquake. According to the survey

conducted by the JMA after the disaster, 17 out of

27 affected municipalities responded that their tsu-

nami alert transmission system had broken down

and did not function properly at the time of the

disaster (Fire and Disaster Management Agency,

2011: p.7). This indicates that the installed system

was simply not well adapted to the magnitude of

the disaster and thus not reliable during the actual

crises.

Thirdly, according to the interviewed survivors,

even when the public speakers were functioning,

the warning message issued by the municipal

office was given in such a polite and calm tone

(‘Please evacuate’) that the residents did not fully

appreciate its gravity. The field research found

that only 3 out of 28 interviewed evacuees had

been prompted to flee on account of the tsunami

warning transmitted by the local authority over

the loudspeakers. The majority of residents fled

after actually witnessing the tsunami, on the ba-

sis of their own judgement or previous experience,

listening to the radio broadcasts, or being directly

warned by the community fire brigade on patrol.

In summary, the tsunami warning during the

11 March disaster, although timely, suffered from

failings with respect to an assessment of the grav-

ity of the tsunami, the transmission system used

and an inadequate communication of the level of

risk.

Relief operations and a limited capacity
to accept aid
In the field, local governments – both municipal

and prefectural authorities – were the main coor-

dination bodies for relief operations. The inter-

views with municipal officers and aid workers

from NGOs made it clear that the affected local

authorities in the remote coastal region of Tohoku

often lacked experience in working with civil orga-

nisations such as NGOs and citizen volunteers,

and were simply overwhelmed by the number

of offers. In Ishinomaki City, according to the

Director of Peace Boat Disaster Relief Volunteers

Centre (PBV), the offer of volunteers was initially

turned down by the local authority on the grounds

that the city had no coordination or reception

arrangements in place for the volunteers. In addi-

tion, one municipal officer from the same city

recalled during the interview that food aid was

sometimes wasted when the person in charge of

evacuation centres, often municipal officers, did

Disaster Evacuation from Japan’s 2011 Tsunami Disaster and the Fukushima Nuclear Accident

STUDY 05/2013 1 7IDDRI

not know how to distribute it properly. According

to him, when food aid of rice balls arrived in an

evacuee camp, the camp manager realised that

the number of rice balls was not enough to distri-

bute to everybody in the camp and thus decided to

simply throw them in the garbage in order to avoid

strife and chaos in the centre. In other instances,

the municipal officials managing the distribution

of relief items required the donating organisa-

tions and companies to provide ‘each survivor

with items that were exactly the same in brand,

type and size’ and, as a result, ‘many resources

were wasted or used inefficiently’ during the relief

operations (Yeoh, 2012: p.8).

The Secretary General of the Association for Aid

and Relief (ARR), which operates mainly in devel-

oping countries, also pointed out the cultural hesi-

tancy to accept aid, specific to Japanese society.

The relief operation in Tohoku made him aware

that, compared to beneficiaries in other countries,

the Japanese population generally lack the capac-

ity to seek help and accept assistance. When help is

offered, Japanese people tend to decline, either to

preserve their dignity or out of concern not to in-

convenience others. Another aid worker from AAR

recalled one scene:

When I arrived at a house badly damaged by

the tsunami, there was a woman still living in-

side the house without any electricity, water or

food. There was no heating stove either. When I

asked her what I could bring to help her, she said

‘No, don’t worry about me. There are people who

are in greater need than I am’.

In Japan, an industrialised country with a func-

tioning social welfare system, the local authori-

ties were simply not used to receiving help and

thus quickly became overwhelmed by all the of-

fers of assistance that came in from all over Japan

and abroad. Thus, the field interviews found that

the population’s cultural hesitancy to receive as-

sistance compounded the difficulties that volun-

teers, NGOs and other private donors encountered

in delivering aid to the needy during the relief

operations.

3.3. Perception of risk

The affected region of Tohoku had long been aware

of the tsunami risk and was thus highly prepared

for the eventuality prior to the disaster. This sub-

section attempts to analyse how this perception

influenced individual decisions to flee and disaster

mitigation during the actual crises.

High perception of tsunami risks
Prior to the 11 March disaster, the affected

coastal cities had already been expecting a major

earthquake (M 7.4) to occur with a 99% prob-

ability within the next thirty years, and the To-

hoku region had thus prepared intensively against

such risk (Mori and Takahashi, 2012: p.2). In the

Hazard map of Takada district

Municipal
Office

Stairs
Public loud speakers

Evacuation route

First Evacuation Point
Evacuation Centres
Watergate

Map 3. Example of a hazard map (Rikuzentakada City)

STUDY 05/20131 8 IDDRI

Disaster Evacuation from Japan’s 2011 Tsunami Disaster and the Fukushima Nuclear Accident

estimation, the tsunami was predicted to have a

10.2 m run-up height in Rikuzentakada City and

7.3 m in Naraha town.21 On the basis of these esti-

mates, the municipalities had created hazard maps

to mark out the zone at risk of flooding in the re-

spective cities (Map 3). Based on the hazard maps,

evacuation drills were organised regularly. All of

the evacuees interviewed mentioned that they had

been informed of such risk prior to the disaster. In

addition, most of them were familiar with tsunami

disasters and knew what to do in such an event,

having learnt from previous experiences and sto-

ries told by the elderly.

The shortcomings of hazard maps
The field survey found that the hazard maps desi-

gned to prepare the residents against tsunamis did

not always help to save lives in the actual disaster.

According to the local government employee of

Rikuzentakada City that we interviewed, the map

had indeed helped to raise the awareness of those

residents living in the predicted inundation zone

and prepare them for an eventual tsunami. On

the other hand, it also created a feeling of reas-

surance for those who lived outside the predicted

inundation zone, giving them the impression that

they were safe from the tsunami risk. Another map

shown by the same official during the interview

indicated the location of houses whose residents

lost their lives, and clearly shows the causal rela-

tionship between the hazard map and the survival

of individuals. On the map,22 it was evident that

victims resided just outside the predicted inun-

dation zone indicated on the hazard map – those

residents who were not included in the tsunami

drills. This suggests that the perception of risk and

the disaster preparedness did, in the vast majority

of cases, influence the survival of individuals at

the time of disaster.

Location of emergency evacuation points
All four evacuees interviewed in Ishinomaki City

referred to the disaster as ‘man-made’, critici-

sing the local authority for insufficient prepare-

dness against a tsunami risk. In Ishinomaki City,

which had the highest death toll (3,47123) of all the

affected towns, survivors accuse the shortcomings

of the municipality’s disaster preparation as a main

21 Information provided by Rikuzentakada City and

Naraha town councils during the interview.

22 The map was shown to us by the official of Rikuzen-

takada City during the interview but he declined to pro-

vide us with a copy of such a sensitive document out of

respect for the victims’ families.

23 Source: Miyagi Prefectural Government (http://www.

pref.miyagi.jp/kikitaisaku/higasinihondaisinsai/

pdf/09071600.pdf) (in Japanese).

cause of this high fatality rate. One of their accusa-

tions targets the location of emergency evacuation

points. These points were generally designated at

schools and public buildings but also at public car

parks or a flat field. Originally intended as gathe-

ring points in case of fires or earthquakes, some of

them were situated on lower ground close to the

shoreline or on river banks. When the earthquake

hit on 11 March 2011, many inhabitants gathered

at these emergency points instead of taking refuge

on higher ground, quite simply because these

places were regularly used during disaster drills

as the first assembly points. As a result, some of

these residents lost their lives as the locations were

completely inundated by the tsunami. One of the

most tragic examples is the case of Okawa primary

school in Ishinomaki City. Teachers decided to

take the children to the emergency evacuation

point located on the river bank instead of climbing

the hill just next to the school, because it was the

evacuation point designated in the contingency

manual. As a result of this decision, 70% of the

school children and teachers lost their lives when

the tsunami travelled up the river.24

These instances indicate that the evacuation

points were not necessarily adapted to tsunami

disasters and that the residents were not adequate-

ly informed or trained for tsunami evacuations in

Ishinomaki City. This lesson needs to be properly

addressed in future disaster planning.

Vulnerability created by previous tsunami
experiences
During the interviews, municipal officials and

evacuees mentioned that having previous tsunami

experiences had sometimes adversely affected

individuals’ decision to flee and hence their

survival during the 11 March tsunami. It is often

assumed that people with previous disaster expe-

rience respond more effectively to a subsequent

disaster and that the lessons learnt from past

experience help them to avoid similar mistakes

in the future. As Alexandre Magnan argues in the

context of adaptive capacity to climate change, in

societies regularly exposed to natural hazards, the

experience of risk may confer a certain ability to

respond to a changing climate and to integrate its

effects (Magnan, 2010: p.8). Yet in the case of the

11 March disaster, although experience did help to

24 The newspaper, Mainichi Shimbun, ‘3.11 shogen: jidou,
nakisakebi outo, gakkou saita no giseisya’ (Author’s

translation: Testimony of 3.11: screaming and vomiting

pupils, the worst death toll for schools), 19 April 2011;
the newspaper, Yomiuri Shimbun, ‘hinan yori giron data
40 fun, giseisyatasuu no ookawasyou’ (Author’s transla-

tion: 40 minutes of discussion instead of evacuation pro-

duced many victims), 13 June 2011.

Disaster Evacuation from Japan’s 2011 Tsunami Disaster and the Fukushima Nuclear Accident

STUDY 05/2013 1 9IDDRI

save lives of many, it also created a feeling of reas-

surance with respect to risk and thus made some

of the population more vulnerable. The popula-

tion in these coastal cities had their perception of

the tsunami risk shaped mainly by the experiences

of the 1960 Chile Ea

Assignment

© The Author(s) 2011. This article is published with open access at Springerlink.com www.ijdrs.org www.springer.com/13753

Int. J. Disaster Risk Sci. 2011, 2 (1): 34–42
doi:10.1007/s13753-011-0004-9

ARTICLE

* Corresponding author. E-mail: yetao@bnu.edu.cn

The 2011 Eastern Japan Great Earthquake Disaster:
Overview and Comments

Okada Norio1, Tao Ye2,*, Yoshio Kajitani1, Peijun Shi2, and Hirokazu Tatano1

1Disaster Prevention Research Institute, Kyoto University, Kyoto 611-011, Japan
2State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, Beijing 100875, China

Abstract This article briefly reviews the causes and impacts
of the massive eastern Japan earthquake and tsunami of
11 March 2011, and comments on the response measures
taken by Japan to cope with this devastating disaster. Mass
losses occurred mostly because the intensity of the quake
and the induced tsunami exceeded local coping capacity.
Particularly, the nuclear power plant crisis triggered by the
tsunami significantly increased the short- and long-term
impacts of the disaster. While the coping capacity Japanese
society built after the 1995 Hanshin-Awaji great earthquake
tremendously mitigated the damages, there is room for
improvement despite Japan’s great efforts in this disaster.
Investigating the tsunami preparedness of the coastal nuclear
power plants is an issue of paramount importance. In response
to future large-scale disasters, there is an urgent need for a
highly collaborative framework based on which all available
resources could be mobilized; a mutual assistance and rescue
system against catastrophes among regions and countries
on the basis of international humanitarian aid; and further
in-depth research on the multi-hazard and disaster-chain
phenomenon in large-scale disasters and corresponding
governance approaches.

Keywords 2011 Eastern Japan Earthquake, earthquake-
tsunami disaster chain, Fukushima nuclear crisis, impact and
response

1 Introduction

On 11 March 2011, a magnitude 9.0 earthquake occurred in
the international waters of the western Pacific and induced a
huge tsunami. These natural disasters hit the northeastern part
of Japan and caused heavy casualties, enormous property
losses, and a severe nuclear crisis with regional and global
long-term impact. On April 1, the Japanese government
officially named the disaster “The 2011 Tōhoku Earthquake
and Tsunami” (東日本大震災, Higashi Nihon Daishinsai,
literally “Eastern Japan Great Earthquake Disaster”).

2 Characteristics of the 2011 Japan
Earthquake and Tsunami

The main earthquake disaster hit Japan at 14:46 Tokyo time
on 11 March 2011. The epicenter was estimated at 38.322°N
and 142.369°E (Figure 1), merely 77 km (47.9 miles) off
the eastern coast of Japan’s Honshu island, 129 km from
Sendai, 177 km from Fukushima, and 373 km from Tokyo.
The hypocenter was at an underwater depth of 32 km
(19.9 miles).

According to the Japan Meteorological Agency (2011), the
magnitude estimate of this quake was initially 7.9, then
revised to 8.4, 8.8, 8.9, back to 8.8, and finally set at 9.0. The
data released by the United States Geological Survey was 8.8,
but revised to 8.9 the same day. On March 14, it was finally
set at 9.0. This 9.0 magnitude earthquake is the third highest
ever recorded in the world, after the 9.5 magnitude quake that
hit Chile in1960 and the 9.2 magnitude quake that hit Alaska
in 1964.

Figure 1. Epicenter of the 2011 Great Earthquake in Japan
Tokai and the hypocentral regions classified by the Earth-
quake Survey Committee, Japan
Source: Earthquake Survey Committee, Japan 2011.

Norio et al. The 2011 Eastern Japan Great Earthquake Disaster 35

A number of foreshocks and aftershocks occurred before
and after the main quake. Several thousand quakes were
recorded by April 11. Relatively severe foreshocks and
aftershocks included a magnitude 7.2 foreshock on March 9,
and magnitude 7.0, 7.4, and 7.2 aftershocks at 15:06 Japan
Standard Time (JST), 15:15 JST, and 15:26 JST on March 11.
On April 7 and 11, magnitude 7.4 (revised to 7.1) and 7.1
aftershocks occurred.

The main quake triggered a massive, destructive tsunami
(Figure 2). It reached the eastern coast of Honshu, Japan
within a couple of minutes after the quake, and spilled into the
interior to a maximum distance of 10 km. It was estimated
that the tsunami wave was up to 38 m high (Kyodo News
2011), while field observation suggested that the record was
24 m, according to the figure released by the Port and Airport
Research Institute (2011) on March 23. Based on the analysis
of the Japan Meteorological Research Institute (JMRI 2011),
the wave source zone of the tsunami covered about 550 km
from north to south and about 200 km from east to west,
setting a record for the most extensive wave source zone
around the Japan Sea.

The tsunami caused by the quake affected almost the whole
Pacific coast, and over 20 countries on both sides of the
Pacific issued tsunami warnings, including Japan, Russia, the
Philippines, Indonesia, Australia, New Zealand, Papua New
Guinea, Fiji, Mexico, Guatemala, El Salvador, Costa Rica,
Nicaragua, Honduras, Panama, Columbia, Ecuador, Peru,
Chile, and the United States.

The quake released surface energy of 1.9 ± 0.5 × 1017J
(USGS Earthquake Hazards Program 2011a), two times that
of the Indonesia tsunami in 2004. The total energy released,
including shaking and the tsunami, amounted to 3.9 × 1022J
(USGS Earthquake Hazards Program 2011b), slightly lower
than that of the Indonesia tsunami, equivalent to 9.32 × 1012 t
of TNT or about 600 million times that of the Hiroshima atom
bomb.

Analysis of the USGS (USGS Earthquake Hazards
Program 2011b) showed that this earthquake was triggered
as the Pacific Plate slipped beneath Japan, while moving
towards the Eurasian Plate to the west. Before this disaster,
the Pacific Plate moved a few centimeters west away from the
North American Plate every year, which led to this large
earthquake as plate movement released energy.

The March 11 earthquake was induced by at least four dif-
ferent hypocenters slipping in a short period (see Figure 1).
Based on the aftershock records, these hypocenters
include not only Sanriku-Oki and Miyagiken-Oki, the two
hypocenters considered most likely to have slipped, but also
Fukushimaken-Oki and Ibaragiken-Oki. Such large-scale,
interrelated earthquakes had not been envisioned by many
earthquake experts.

3 Impacts of the 2011 Eastern Japan
Great Earthquake Disaster

3.1 Geophysical Impact

The violent shock resulting from the seismic intensity moved
the Honshu island of Japan about 3.6 m to the east, shifted the
earth’s axis by 25 cm, and accelerated the planet’s rotation
by 1.8 microseconds (Chai 2011; CBS News 2011). A total
of 400 km of Japan’s east coast has subsided about 0.6 m
because of the quake (Chang 2011). Ojika-hantou of
Miyagi-ken, located northwest of the epicenter, has moved
about 5.3 m southeast towards the epicenter, with a simulta-
neous subsidence of about 1.2 m. The World Meteorological
Organization has warned the Japanese government of poten-
tially more severe flood risk in the northeastern part of Japan
in the future (Xinhuanet 2011).

Figure 2. Tsunami caused by the 2011 Eastern Japan Great Earthquake
Source: NOAA 2011.

36 Int. J. Disaster Risk Sci. Vol. 2, No. 1, 2011

3.2 Humanitarian Impact

The influence exerted by the seismic event itself was not so
striking. Only one prefecture was impacted with a seismic
intensity of VII, and eight prefectures were impacted with a
seismic intensity greater than VI (Figure 3). But the losses
incurred by the earthquake and tsunami together were
extremely severe. According to statistical data from the Japan
National Police Agency (Table 1), by April 13, there were in
total 13,392 people dead nationwide and 15,133 missing.
More than 335,000 refugees in northeast Japan are lacking in
food, water, shelters, medical care, and even the necessary
means to conduct funerals for the deceased.i

3.3 Impact on Buildings

Up to April 3, there were 190,000 buildings damaged, among
which 45,700 were totally destroyed. The damaged buildings
in Miyagi, Iwate, and Fukushima were 29,500, 12,500,
and 2400, respectively (NHK World 2011). By April 13, the
number was further verified by the Japan Police Agency
and increased (Table 1). About 250 million tons of rubble and
debris were produced in Japan because of the earthquake and
tsunami disaster.

3.4 Impact on Key Infrastructures

Several nuclear power plants and thermal power plants were
heavily damaged in this disaster and details will be elaborated
later in this article. The power supply of the Tokyo Electric

Power Company (TEPCO) was reduced by 21 GW, causing
outages for 4.4 million families in eastern Japan (Japan
Times 2011; The Nikkei 2011). From March 14 to March 29,
TEPCO implemented rolling blackouts in most areas of
Tokyo. Meanwhile, with the support of Tokyo residents’
power-saving activities and temporary supply from steel
manufacturers’ power plants, rolling blackouts are expected
to be avoided throughout this summer (Japan Ministry of
Economy, Trade and Industry 2011).

The quake severely affected Japan’s transportation system.
After the quake, all ports in Japan were closed for a short
time, and the 15 ports impacted by the disaster were not
fully reopened until March 29 (Nihon Keizai Shimbun 2011).
Because of the quake, the northeastern part of the Tokaido
Shinkansen high-speed rail line was shut down and not
reopened to the public until March 24 (The Guardian 2011).
Sixty-two of the 70 railway lines run by the East Japan
Railway were affected to various degrees, and 23 railway
stations and seven lines were completely destroyed (Nihon
Keizai Shimbun 2011). The Sendai airport incurred massive
losses because it was attacked by the flood caused by the
tsunami one hour after the quake. Both Tokyo’s Narita and
Haneda airports were closed for about 24 hours (The Aviation
Herald 2011).

3.5 Economic Impact

It is estimated that 23,600 hectares of farmland were ruined
and 3–4 percent of the rice production in Japan was affected
in this great earthquake and tsunami disaster (Martin 2011).
Many large-scale manufacturers of automobiles (for example,
Toyota, Nissan, and Honda), steel (for example, Nippon
Steel), and chemicals (for example, Mitsubishi Kagagu) were
off production (Mainichi Daily News 2011), causing a
decline in global automobile production.

The Japan earthquake led to significant fluctuations in the
global financial markets. On the day of the earthquake, March
11, the Nikkei Stock Average dropped 5 percent (Reuters
2011), and it dropped another 1000 points (10.6 percent)
on March 15, when the seriousness of the nuclear accident
became clear (CNBC 2011). Subject to the earthquake,
Germany’s DAX index and Hong Kong’s Hang Seng index
also decreased in varying degrees. But the main American
stocks experienced a slight increase of 0.5 to 0.7 percent. The
world’s largest reinsurers, Munich Re and Swiss Re were
speculated to suffer total reinsurance losses of 10 billion U.S.
dollars (Kucera 2011) even after the losses absorbed by
primary insurers and grants from the Japanese government.

The earthquake brought about the rapid appreciation of the
Japanese yen, and the yen against the U.S. dollar at one point
reached 76.25 yen to 1 U.S. dollar, the highest point since
World War II (BBC 2011). Appreciation of the yen is harmful
to the Japanese economy, which is heavily dependent on
exports.

The Industrial Production Index dramatically decreased by
15.5 percent compared to the index in February (Table 2). Not

Figure 3. Estimated seismic intensity from observation
stations right after 14:46 on 11 March 2011
Source: Japan Meteorological Agency 2011.

Seismic Epicenter

Norio et al. The 2011 Eastern Japan Great Earthquake Disaster 37

Table 2. March 2011 Japan Industrial Production Index (100 in year 2005)

Item
Seasonally Adjusted Index Original Index

Index Changes from February (%) Index Changes from February (%)

Production† 82.7 -15.5 88.7 -13.1
Shipping‡ 85.0 -14.6 95.0 -12.1

Source: Japan Ministry of Economy, Trade and Industry 2011 (Confirmed version reported on May 19).
†: Weighted average of the amount of major items (521 items) produced by the industrial sector. Weight of each item is determined by the added value for each
item with respect to the reference year (2005).
‡: Production items shipped from factories, a measurement for actual transaction of goods.

Table 1. Damage from the 2011 Eastern Japan Great Earthquake and Tsunami (as of April 13)

People impacted Buildings damaged Damaged
places on

roads

Bridges
damaged Prefecture

Death
toll

Missing Injured
Full

damage
Half

damage
Washed

away
Totally
burnt

Half
burnt

Hokkaido 1 3

Northeast Aomori 3 1 61 272 970 6 2
Iwate 3867 4101 154 18,742 1024 30 4
Miyagi 8190 8025 3055 36,772 3452 1006 23
Akita 12 9
Yamagata 2 29 37 80 21
Fukushima 1272 3003 240 2417 959

Tokyo 7 77 3 6 3 16 1

Kanto Ibaraki 23 1 691 711 3453 307 41
Tochigi 4 135 146 1142 257
Gunma 1 35 1 7
Saitama 42 5 1 1 160
Chiba 18 2 223 706 1636 3 3 321
Kanagava 4 128
Niigata 3
Yamanashi 2
Shizuoka 4

Central Gifu 1
Mie 1

Shikoku Tokushima
Kochi 1

Total 13,392 15,133 4896 59,806 12,728 6 7 4 2137 69

Source: Japan National Police Agency 2011 (excerpt from original table).

only the damaged area, but also the non-damaged areas were
suffering from scarcity of materials, and final demand
decreases. Because many industries in the upper streams
of the supply chains were located in Tohoku, the northeast
region of Honshu, and the northeast areas of the Kanto region
around greater Tokyo, their damages caused widely spreading
economic impacts, which were unforeseen by many crisis
managers.

According to an early evaluation by analysts, the earth-
quake disaster caused direct economic losses of about 171–
183 billion USD, while the significant cost for recovery might
reach 122 billion USD (Pagano 2011). On June 24, the Prime
Minister’s office crisis management center announced a rough
estimation of over 16 trillion yen for property damages alone
(Cabinet Office, Government of Japan 2011). This estimation
is based on the damage ratio of buildings of the 1995
Hanshin-Awaji earthquake. In the best case scenario (16

trillion yen), the total property damages are 14 trillion yen in
three prefectures in the Tohoku region alone. This amounts to
about 20 percent of the total economic value of property in
these three areas.

4 The Nuclear Power Plant Crisis

The earthquake and tsunami created a serious nuclear crisis.
Affected by the quake, the 11 nuclear power plants in north-
east Japan, including the first and second nuclear power plants
in Fukushima, and the nuclear power plants in Onagawa,
Genshiryoku, and Hatsudensho, automatically stopped oper-
ating their nuclear reactors. However, the cooling system of
the first nuclear power plant in Fukushima also stopped work-
ing because of the impact of the tsunami, causing the reactor
temperature to rise. Although the Japanese government and

38 Int. J. Disaster Risk Sci. Vol. 2, No. 1, 2011

the operator Tokyo Electric Power Company adopted a series
of measures, the nuclear accident gradually became a level 7
nuclear event, which is a major accident and the highest level
on the International Nuclear and Radiological Event Scale
(INES), equivalent to the Chernobyl disaster in April 1986.
The radiation in the vicinity of the reactor rose steeply,
becoming a deadly threat to the local residents, as well as
polluting vegetables, milk, and water. TEPCO also released
tens of thousands of tons of low radiation nuclear pollution
water into the Pacific, resulting in grave concern and criticism
from neighboring countries.

The way that the nuclear incidents were triggered is plant-
specific. However, the most catastrophic consequences have
arisen from the Fukushima Daiichi nuclear plant, where three
units were exposed to level 7 accidents and one unit was
exposed to a level 3 incident. The critical issue in the crisis
became the cooling systems failures.

The Fukushima Daiichi nuclear power plant mainly uses
reactors to boil water, lets the steam drive steam engines, and
returns the cooled water to the reactors to cool them down. In
the system, water immerses the fuel rods and cycles in the
system with radioactive isotopes. Under normal conditions
this is not a problem because the process occurs in a closed
cycle. None of the water, steam, and radioactive isotopes can
escape from the closed vessel.

The earthquake and subsequent tsunami broke the closed
cycle and delivered a deadly strike against the cooling system
(Figure 4). The cooling system was designed to be supported
with four different power supplies. The offsite power supply
from the power grid and the internal power supply from the
reactor were down because of the earthquake. The on-site fuel
generator started working once the other two power sources
failed, but was damaged by the tsunami wave. Emergency
back-up batteries appeared to be affected by the tsunami as
well, but could at most have lasted for eight hours even if they

had been spared from damage. As a result, the cooling system
stopped working and this triggered the set of extremely
severe consequences.

Due to the nature of the nuclear fuel used in the plant, the
core temperature of the reactors dropped only very slowly
after the cooling system was down because there was still
slow decay even after the reactors had gone off-line. The high
temperature turned most of the internal coolant water into
steam, which in turn exposed the fuel rods to air. Without the
provision of a cooling alternative, the high temperature would
have melted down the nuclear fuel rods. Fuel would escape
away from control rods, intensify decay, melt through the
reactor floor, and consequently induce a massive release of
radioactive isotopes, a worst case scenario.

In order to avoid the most catastrophic consequences,
operators of the plant tried to inject coolant water from
external sources (first seawater, later freshwater). The injecte d
external coolant water, however, was then turned into steam
and further increased the vessel pressure, which hampered
water injection. As a result, operators had to bleed-off pres-
sure, which resulted in hydrogen explosions and the release
of radioactive isotopes from the vessel. Radioactive isotopes
released from Fukushima were later detected in North
America and other regions in the world. Coolant water that
did not escape the vessel in the form of steam accumulated in
the bottom of the reactors in highly radioactive form. These
waters either leaked or were released by the operator into
the Pacific Ocean. Widespread radioactive pollution was
created. Worse yet, though countermeasures were adopted,
the fuel rods in units 1, 2, and 3 of the plant were reported to
have experienced major damage and possibly fully melted
(TEPCO 2011a, 2011b; CNN 2011). The long-term impact of
the nuclear crisis to Japan, the Asia-Pacific region, and the
entire world is still not fully revealed.

Figure 4. Illustrative chart of the 2011 Fukushima nuclear crisis

Norio et al. The 2011 Eastern Japan Great Earthquake Disaster 39

5 National and International Response

5.1 Response of Japan

After the earthquake, a countermeasure office was immedi-
ately set up in the Prime Minister’s office crisis management
center. The Japanese government established a special head-
quarters for emergent disasters headed by Prime Minister
Naoto Kan. At the press conference on April 13, the Prime
Minister declared that it was the most serious disaster in
Japan after World War II. The other main response head-
quarters, also lead by the Prime Minister, was set up for the
nuclear crisis. These two headquarters became the main
decision-making bodies on crisis management.

The Japanese government also established a government
emergency response headquarters headed by Foreign
Minister Matsumoto. He said that Tokyo welcomes foreign
countries to provide any assistance to Japan, and Japanese
government would check foreigners in Japan and confirm
security situation of the embassies in Tokyo.

The Japanese government also established a countermea-
sure headquarters against disasters headed by the Defense
Minister, Toshimi Kitazawa. On April 13, the Japanese Prime
Minister Naoto Kan asked the Ministry of Defense to send out
100,000 self-defense officers to participate in rescue work.
The total number of troops mobilized, including those provid-
ing logistics, was 180,000, the largest number dispatched by
the Japan Self-Defense Forces since World War II.

On April 14, the Bank of Japan (the Central Bank) held
a monetary policy meeting, discussing the new monetary
easing policy to be implemented after the Eastern Japan Great
Earthquake Disaster. On March 14, 15, 17, and 22, the Bank
of Japan successively injected capital of up to 4 trillion yen in
cash into the market (Wearden 2011).

5.2 International Involvement

After the quake, Japan specifically requested quake rescue
teams from Australia, New Zealand, South Korea, the United

Kingdom, and the United States (Nebehay 2011). It also
requested satellite images of available types of the quake and
tsunami regions according to the International Charter on
Space and Major Disasters.

By March 30, 134 countries and regions and 39 interna-
tional organizations had expressed their willingness to
provide aid to Japan (Figure 5). Twenty-three countries
and regions sent out rescue teams and experts on nuclear
accidents. The statistical data released by the Narita branch
of Tokyo Customs on March 29 showed that, in total, 190
batches and 1300 tons of relief goods from 29 countries and
regions arrived at Narita Airport between March 12 and 25.
Of these 190 batches, 60 were from China, 40 from the
United States, 30 from Thailand, and 20 from Korea. The
major types of goods included food, blankets, mineral water,
radiation protection suits, and emergency lamps. By April 3
the Japanese Red Cross had received over one billion USD in
donations in response to the disaster, and dispatched more
than 200 emergency relief teams to the disaster zone.

The earthquake-tsunami induced nuclear crisis has been
of grave concern. Many countries started to evacuate their
citizens from the northern part of Japan right after the disaster.
UN agencies were widely involved in the nuclear issue,
including the World Health Organization (WHO), the
International Atomic Energy Agency (IAEA), the World
Meteorological Organization (WMO), the International
Maritime Organization (IMO), the International Civil Avia-
tion Organization (ICAO), the World Tourism Organization
(UNWTO), and the International Labor Organization (ILO).
The WHO together with the Food and Agriculture Organiza-
tion (FAO) conducts inspections and provides information
on (sea)food safety after the nuclear accident. The IAEA
Briefing on the Fukushima Nuclear Accident is updated on a
daily basis since the quake (IAEA 2011). Tourists and other
visitors to Japan are advised by the IMO, ICAO, UNWTO,
and Japanese government agencies on travel and transport
from and to Japan by air or sea.

Figure 5. Countries and regions expressed willingness to provide aid to Japan after the 2011 Earthquake disaster
Source: Wikipedia 2011.

40 Int. J. Disaster Risk Sci. Vol. 2, No. 1, 2011

6 Comments and Discussion

6.1 Prepared for the Expected

After the Great Hanshin Earthquake in 1995, the Japanese
government and society profoundly reflected on the precau-
tions that needed to be taken against earthquake disasters.
Many new measures became the solid foundation for Japan to
cope with this most recent earthquake-tsunami catastrophe to
some degree.

For example, Japan attaches great importance to scientific
research and technological development on disaster preven-
tion and mitigation. The Japan Meteorological Agency oper-
ates the world’s first earthquake early warning system, which
can warn the Japanese people ahead of a quake. It also can
detect seismic waves near the epicenter, and send out early
warnings through national television and radio networks,
even through mobile phones. On the day of the main quake,
alarm was sounded around 80 seconds before the beginning
of shaking in Tokyo area.

In Japan there are various ways for the public to get access
to disaster information—by mass media and cell phone
services, for example. The Japanese media have developed a
rapid and systematic reporting system for disaster situations,
and will promptly disclose all kinds of useful information
whenever a natural disaster occurs. Japan also invests heavily
in public disaster education, making one of the highest disas-
ter risk aware populations in the world. With the help of
disaster preparedness training carried out in communities,
the Japanese people have developed the skills and habits of
self-relief.

The Self-Defense Troops are granted much power by the
government in response to disasters. This is a significant gain
from the experience of the Hanshin-Awaji earthquake. In
response to the Eastern Japan Great Earthquake Disaster,
the Self-Defense Troops played an indispensible role in orga-
nizing emergency response actions and accomplished many
in-field missions. All of these preparations constituted a solid
foundation for the Japanese to raise evacuation rates during
the tsunami disaster and reduce the loss of lives.

Japan is also implementing one of the most stringent con-
struction standards in the world, with intensively reinforced
residential buildings, bridges, and other infrastructures. It is
worth noting that Japan is a leader in earthquake proofing
nuclear plants, although a severe nuclear crisis was induced
by the earthquake-triggered tsunami. All nuclear reactors
automatically stopped operating after the quake. The building
damages and the nuclear plant crisis were induced by the
tsunami rather than the quake per se.

6.2 Prepared Beyond the Expected: Where to Go from
Here

The 2011 earthquake-tsunami was so severe that it went
far beyond the expectation and coping capacity of Japanese
society. The quake was of high magnitude and the energy

released was huge. The tsunami triggered by the earthquake
critically overwhelmed the coping capacity of the stricken
areas. Preparedness is based on expectation and prediction,
which had not taken into account the extreme situation that
actually unfolded. From that standpoint Japan is not prepared
enough.

First, the disaster impact easily overwhelmed local coping
capacity. Although local evacuation centers and public build-
ings were available for the local people, there were cases in
which many old people died because they were not able to
evacuate quickly. In the field survey conducted by the
authors, some concrete buildings stood after the tsunami
disaster, which potentially could have become emergent
evacuation shelters if they had been reinforced/upgraded.
Although disaster evacuation drills were held regularly
in many local communities, they were not helpful to all
segments of the population because the evacuation centers
were not easily accessible for many old people and it was dif-
ficult for them to be really involved in these drills. Emergency
evacuation plans and drills require further improvement.

Second, Japan is not prepared for a truly “mega” disaster.
Experiences in other countries have shown that a large-scale
disaster cannot be coped with solely by local capacities and
aid from outside of the stricken region is indispensible. In
this earthquake disaster, the damaged/affected areas were
so extensive that clusters of local governments for cities and
prefectures were paralyzed. Not only the public sectors, but
also many private sectors were unable to provide adequate
services during this disaster due to damaged infrastructures.
These services include providing energy, food and water, and
medical treatment. A typical example of these difficulties is
the power frequency difference between East Japan and West
Japan. In Kansai area the frequency of electricity is 60 Hz,
while in Kanton area it is 50 Hz. Though there are two
stations able to covert frequency, the capacity is limited to
1 GW, far below the drop due to power plant failure.

Third, Japan’s response system is not as efficient as it
could be. A valuable lesson drawn from the Chinese experi-
ence in dealing with the Wenchuan Earthquake in 2008 (Shi
et al. 2009) is the significance of centralized power in coping
with large-scale disasters. In this earthquake-tsunami disaster,
the Japanese government appeared not as powerful as had
been expected in resolving many issues, particularly with
respect to the nuclear crisis. Coordination between the
government (emergency response headquarters), the Tokyo
Electric Power Company, and the nuclear and industrial
safety agency were not sufficiently organized. Information
was not simultaneously shared right after the disaster, which
delayed efficient decision making.

Finally, Japan, as well as probably all nuclear countries in
the world, is not truly prepared for nuclear crises. Although
there were two types of back-up power supply available in the
Fukushima nuclear power plant, they simply failed because
they were as vulnerable as the major power supply systems.
“Backup” did not make sense in this case. Obviously, a major
tsunami was not in the plan of the designer and operator of the

Norio et al. The 2011 Eastern Japan Great Earthquake Disaster 41

plant. This is a serious mistake because these plants are
located exactly in the coastal and earthquake-prone region of
the country.

6.3 Prepared for Unexpected Large-Scale Disasters

Several issues regarding the governance of large-scale
disaster risk arise from the experience of the Eastern Japan
Great Earthquake Disaster.

(1) The severity and unexpectedness of large-scale disas-
ters require a global, synergic, and efficient response system.
The response needs to mobilize all available resources, from
public and private sectors, affected and unaffected areas,
domestic and abroad. The response needs to highly coordi-
nate all disaster response entities so that the synergic effect is
achieved. The response must be founded on rational strategies
with orderly and efficient arrangements based on the
emergency plans. In this sense, centralized power in the face
of large-scale disasters is indispensible.

(2) The regionalized and globalized impacts of large-scale
disasters call for a new international platform to cope jointly.
The recent experiences of catastrophes worldwide imply that
the impact of a catastrophe is no longer confined to the
affected areas but spreads around the world in the context of
globalization. The mismanagement of the affected countries
will bring about serious consequences for the surrounding
countries or even the whole world.

The radioactive contamination caused by the nuclear
accident following the earthquake and tsunami is affecting
the rest of the world through atmospheric circulation. The
pollute

Assignment

n engl j med 364;1 nejm.org january 6, 2011

P E R S P E C T I V E

3

nancially strapped and concerned
about the cost of reform and its
ability to meet their population’s
needs.

Maine, Florida, Iowa, and other
states have already indicated that
they will seek waivers for some
insurance rules that could desta-
bilize local insurance markets.
A recent proposal by Senators Ron
Wyden (D-OR) and Scott Brown
(R-MA) would grant states addi-
tional f lexibility but falls short
of giving them full authority to
develop their own reform ap-
proaches. Since reform cannot be
implemented without them, states
could choose to take a more in-
dependent role even if Washing-
ton is slow to give it to them.

Will the President’s health care
reform look burdensome and un-
workable 2 years from now? Re-
form is no longer a 2000-page
bill sitting on the desk of a sen-
ator or representative. The exec-
utive branch has been issuing
guidance and regulations that
are beginning to fill holes in the

legislation and will change the
way the law works in practice.
Much to the chagrin of the leg-
islation’s most ardent support-
ers, Secretary of Health and Hu-
man Services Kathleen Sebelius
has been granting waivers when
the rules don’t work for every-
one, albeit on a selective basis
designed to avoid the worst po-
litical heat.3 Although such de-
cisions will soften the impact of
reform, they neither alter the
shift toward greater government
control nor slow the growth of
health care spending.

Despite the talk of repeal,
Congress will not pass any major
health legislation over the next
2 years, and the health sector and
private employers will be hard at
work preparing for 2014, when
many ACA provisions take ef-
fect. That does not make health
care reform a fait accompli. Ab-
sent a miracle, the country will
still face crushing budget defi-
cits when the next president takes
office. A Republican president,

backed by a Republican Congress,
would be wise to delay enroll-
ment in the health insurance ex-
changes, using the time and mon-
ey to develop a more targeted plan
that closes off open-ended sub-
sidies for health insurance and
gets the economic incentives right.
A Democratic president would
do the same thing out of neces-
sity — but it would take longer.

Disclosure forms provided by the author
are available with the full text of this arti-
cle at NEJM.org.

From the American Enterprise Institute,
Washington, DC.

This article (10.1056/NEJMp1012299) was
published on December 8, 2010, at NEJM.org.

1. Streeter S. Continuing resolutions: FY2008
action and brief overview of recent practices.
Washington, DC: Congressional Research
Service, 2008. (CRS report RL30343.) (http://
www.rules.house.gov/archives/RL30343.pdf.)
2. Idem. The congressional appropriations
process: an introduction. Washington, DC:
Congressional Research Service, 2007. (CRS
report 97-684.) (http://www.senate.gov/
reference/resources/pdf/97-684.pdf.)
3. Adamy J. Federal agency flexible on Mc-
Donald’s plan. Wall Street Journal. October 1,
2010.
Copyright © 2010 Massachusetts Medical Society.

Reforming Health Care Reform in the 112th Congress

Responding to Cholera in Post-Earthquake Haiti
David A. Walton, M.D., M.P.H., and Louise C. Ivers, M.D., M.P.H.

Related article, p. 33

The earthquake that struck Haiti on January 12, 2010,
decimated the already fragile
country, leaving an estimated
250,000 people dead, 300,000
injured, and more than 1.3 mil-
lion homeless. As camps for in-
ternally displaced people sprang
up throughout the ruined capital
of Port-au-Prince, medical and
humanitarian experts warned of
the likelihood of epidemic disease
outbreaks. Some organizations
responding to the disaster mea-
sured their success by the ab-
sence of such outbreaks, though

living conditions for the dis-
placed have remained dangerous
and inhumane. In August 2010,
the U.S. Centers for Disease Con-
trol and Prevention (CDC) an-
nounced that a National Surveil-
lance System that was set up after
the earthquake had confirmed
the conspicuous absence of high-
ly transmissible disease in Haiti.

However, on October 20, more
than 55 miles from the nearest
displaced-persons camp, 60 cases
of acute, watery diarrhea were
recorded at L’Hôpital de Saint
Nicolas, a public hospital in the

coastal city of Saint Marc, where
Partners in Health has worked
since 2008. Stool samples were
sent to the national laboratory in
Port-au-Prince for testing. The
hospital alerted Ministry of Health
representatives in the region and
in the capital, as well as World
Health Organization representa-
tives managing the Health Clus-
ter, a coordinating group formed
after the earthquake. In the next
48 hours, L’Hôpital de Saint Nico-
las received more than 1500 ad-
ditional patients with acute di-
arrhea.

The New England Journal of Medicine
Downloaded from nejm.org on August 27, 2017. For personal use only. No other uses without permission.

Copyright © 2011 Massachusetts Medical Society. All rights reserved.

P E R S P E C T I V E

n engl j med 364;1 nejm.org january 6, 20114

By October 21, preliminary re-
sults from the national laborato-
ry confirmed our clinical impres-
sions: though cholera had not
been seen in Haiti in at least a
century and may never have been
recorded in laboratory-confirmed
cases, it had somewhat unexpect-
edly emerged in a densely popu-
lated zone with little sanitary in-
frastructure and limited access to
potable water. As the contours of
the epidemic began to take shape,
following the winding course of
a large river in the Artibonite re-
gion, hospitals in central Haiti
started recording rapidly increas-
ing numbers of cases of acute
diarrhea. Between October 20 and
November 9, Partners in Health
recorded 7159 cases of severe
cholera. Among these patients,
161 died in seven of its hospitals
in the Central and Artibonite re-
gions.

In Port-au-Prince, sporadic
cases were reported in the early
phase of the outbreak; most were
deemed “imported cases.” On No-
vember 8, 48 hours after Hurri-
cane Tomas caused flooding and
worsening of living conditions in
Parc Jean-Marie Vincent, one of
the largest settlement camps,
Partners in Health reported seven
clinical cases of cholera within
the camp. On the same day, Doc-
tors without Borders reported see-
ing as many as 200 patients with
cholera in nearby slums. By No-
vember 9, the Ministry of Health
had reported 11,125 hospitalized
patients and 724 confirmed deaths
from cholera.

Although we responded as
quickly as we could, we were ham-
pered by the rapidity with which
the epidemic spread, overwhelm-
ing our hospitals with hundreds
of patients and stretching already
thin resources, staff, and mate-
rials. Because there was minimal

practical institutional knowledge
about cholera in Haiti, we worked
with other nongovernmental or-
ganizations to design treatment
protocols and institute infection-
control measures in affected hos-
pitals. Our network of community
health workers began distributing
oral rehydration salts, water-puri-
fication systems, and water filters
and instructing people about hy-
giene, hand washing, and decon-
tamination of cadavers. Body bags
were distributed to community
leaders, and rehydration posts
were set up throughout the coun-
tryside. A network of cholera
treatment centers and stabiliza-
tion centers was established in
coordination with the Ministry
of Health.

The cholera outbreak took most
people by surprise. Unexpectedly,
it was centered in rural Haiti and
not in the displaced-person camps
that are situated mainly in the
greater Port-au-Prince area. But
history would suggest that an
epidemic outbreak of waterborne
disease was just waiting to strike
rural Haiti. It is well known that
Haiti has the worst water secu-
rity in the hemisphere. In 2002,
it ranked 147th out of 147 coun-
tries surveyed in the Water Pov-
erty Index.1 After the earthquake,
more than 182,000 people moved
from the capital to seek refuge
with friends or family in the
Artibonite and Central regions,
increasing stress on small, over-
crowded homes and communi-
ties that lacked access to latrines
and clean water. In addition, in
many areas of Haiti, the costs
associated with procuring water
from private companies and the
lack of adequate distribution sys-
tems have rendered potable wa-
ter even less accessible for those
most at risk.

Waterborne pathogens and fe-

cal–oral transmission are favored
by the lack of sanitation in Haiti.
Typhoid, intestinal parasitosis, and
bacterial dysentery are common.
Only 27% of the country bene-
fits from basic sewerage, and
70% of Haitian households have
either rudimentary toilets or
none at all.2 But the sudden ap-
pearance of cholera, a pathogen
with no known nonhuman host,
raises the question of how it
was introduced to an island that
has long been spared this dis-
ease. Speculations on this ques-
tion have caused social and po-
litical friction within Haiti in
recent weeks. Early in the epi-
demic, the CDC identified the
cholera strain Vibrio cholerae O1,
serotype Ogawa, biotype El Tor.
Chin and colleagues (pages 33–
42) report on DNA sequencing
of two isolates from the recent
outbreak, which showed that the
cholera strain responsible for the
Haitian epidemic originated in
South Asia and was most likely
introduced to Haiti by human
activity. The implications of the
appearance of this strain are
worrisome: as compared with
many cholera strains, it is asso-
ciated with increased virulence,
enhanced ability to survive in the
environment and in a human
host, and increased antibiotic
resistance. These factors have
substantial epidemiologic ramifi-
cations for the entire region and
implications for optimal public
health approaches to arresting
the epidemic’s spread.

As the infection makes its way
to the capital city, there is de-
bate about the likely attack rate
inside displaced-person camps,
as compared with the rate in sur-
rounding communities. The latter
often have worse access to water
and sanitation than the former.
But 521 of 1356 displaced-person

Responding to Cholera in Post-Earthquake Haiti

The New England Journal of Medicine
Downloaded from nejm.org on August 27, 2017. For personal use only. No other uses without permission.

Copyright © 2011 Massachusetts Medical Society. All rights reserved.

n engl j med 364;1 nejm.org january 6, 2011

P E R S P E C T I V E

5

camps listed by the United Na-
tions camp-management cluster
reportedly have no water or sani-
tation agency, and most are far
from reaching the established
guidelines for sanitation in hu-
manitarian emergencies.3 The liv-
ing conditions of most of Haiti’s
poor, whether they’re living in
camps or communities, are equal-
ly miserable in terms of the risk
of diarrheal disease.

The reported numbers of cases
and deaths, though shocking, rep-
resent only a fraction of the epi-
demic’s true toll. We have seen
scores of patients die at the gates
of the hospital or within minutes
after admission. Through our net-
work of community health work-
ers, we have learned of hundreds
of patients who died at home or
en route to the hospital. In the
first 48 hours, the case fatality
rate at our facilities was as high
as 10%. Though it dropped to less
than 2% in the ensuing days as
the health system was rein-
forced locally and patients be-
gan to present earlier in the

course of disease, mortality will
most likely climb as the disease
spreads and Haiti’s fragile health
system falters.

This most recent crisis in Haiti
has reinforced certain lessons
regarding the provision of ser-
vices to the poor. Complemen-
tary prevention and care should
be the primary focus of the re-
lief effort. Vaccination must be
considered as an adjunct for con-
trolling the epidemic, and anti-
biotics should be used in the
treatment of all hospitalized pa-
tients. These endeavors should
proceed in concert with much-
needed improvements to sanita-
tion and accessibility of potable
water. More generally, reliable
partnerships are essential, espe-
cially if local partners are depend-
able and have practical experi-
ence and complementary assets.
Long-term reinforcement of the
public-sector health system is a
wise investment, permitting pro-
vision of a basic minimum set of
services that can be built upon in
times of crisis. And community

health workers who can be rap-
idly mobilized as educators, dis-
tributors of supplies, and first
responders are a reliable back-
bone of health care. In Haiti,
such workers can bring the time-
sensitive lifesaving therapy of
oral rehydration right to the pa-
tient’s door.

Disclosure forms provided by the au-
thors are available with the full text of this
article at NEJM.org.

From the Department of Global Health and
Social Medicine, Harvard Medical School;
the Division of Global Health Equity,
Brigham and Women’s Hospital; and Part-
ners in Health — all in Boston.

This article (10.1056/NEJMp1012997) was
published on December 9, 2010, at NEJM
.org.

1. Sullivan CA, Meigh JR, Giacomello AM.
The Water Poverty Index: development and
application at the community scale. Nat Re-
sour Forum 2003;27:189-99.
2. Ministère de la Santé Publique et de la
Population, Haiti. Enquête mortalité, mor-
bidité et utilisation des services (EMMUS-
IV): Haiti, 2005-2006. (http://new.paho.org/
hai/index.php?option=com_docman&task=
doc_download&gid=25&Itemid=.)
3. 101112 WASH Cluster situation report.
November 12, 2010. (http://haiti.humanitarian
response.info/Default.aspx?tabid=83.)
Copyright © 2010 Massachusetts Medical Society.

Responding to Cholera in Post-Earthquake Haiti

Antibiotics for Both Moderate and Severe Cholera
Eric J. Nelson, M.D., Ph.D., Danielle S. Nelson, M.D., M.P.H., Mohammed A. Salam, M.B., B.S., and David A. Sack, M.D.

Related article, p. 33

The 2010 Haitian cholera out-break has pressed local and
international experts into rapid
action against a disease that is
new to many health care provid-
ers in Haiti. The World Health
Organization (WHO) has time-
tested management protocols for
emerging cholera outbreaks. These
protocols have been used by the
Haitian government to fight an
epidemic that is merely one of
several recent tragedies in Haiti.
The use of these protocols has

allowed for a high standard of
care in this complex and evolv-
ing medical landscape. But where-
as the current WHO cholera-
treatment protocol (www.who.int/
mediacentre/factsheets/fs107/en/
index.html) recommends anti-
biotics for only severe cases, the
approach of the International
Centre for Diarrhoeal Disease Re-
search, Bangladesh (ICDDR,B),
recommends antibiotics for both
severe and moderate cases.

Several antibiotics are effec-

tive in the treatment of cholera,
including doxycycline, ciprof lox-
acin, and azithromycin, assuming
that the cholera strain is sensi-
tive. Currently, the epidemic strain
in Haiti is susceptible to tetracy-
cline (a proxy for doxycycline) and
azithromycin but is resistant to
nalidixic acid, sulfisoxazole, and
trimethoprim–sulfamethoxazole.
The WHO advocates giving anti-
biotics to patients with cholera
only when their illness is judged
to be “severe.” This recommen-

The New England Journal of Medicine
Downloaded from nejm.org on August 27, 2017. For personal use only. No other uses without permission.

Copyright © 2011 Massachusetts Medical Society. All rights reserved.

Assignment

Overview of the 2010 Haiti Earthquake

Reginald DesRoches,a) M.EERI, Mary Comerio,b) M.EERI,
Marc Eberhard,c) M.EERI, Walter Mooney,d) M.EERI,
and Glenn J. Rix,a) M.EERI

The 12 January 2010 Mw 7.0 earthquake in the Republic of Haiti caused an
estimated 300,000 deaths, displaced more than a million people, and damaged
nearly half of all structures in the epicentral area. We provide an overview of the
historical, seismological, geotechnical, structural, lifeline-related, and socioeco-
nomic factors that contributed to the catastrophe. We also describe some of
the many challenges that must be overcome to enable Haiti to recover from this
event. Detailed analyses of these issues are presented in other papers in this
volume. [DOI: 10.1193/1.3630129]

INTRODUCTION

On 12 January 2010, at 4:53 p.m. local time, a magnitude 7.0 earthquake struck the
Republic of Haiti, with an epicenter located approximately 25 km south and west of the cap-
ital city of Port-au-Prince. Near the epicenter of the earthquake, in the city of Léogâne, it is
estimated that 80%–90% of the buildings were critically damaged or destroyed. The metro-
politan Port-au-Prince region, which includes the cities of Carrefour, Pétion-Ville, Delmas,
Tabarre, Cite Soleil, and Kenscoff, was also severely affected. According to the Govern-
ment of Haiti, the earthquake left more than 316,000 dead or missing, 300,0001 injured, and
over 1.3 million homeless (GOH 2010). According to the Inter-American Development
Bank (IDB) the earthquake was the most destructive event any country has experienced in
modern times when measured in terms of the number of people killed as a percentage of the
country’s population (Cavallo et al. 2010).

The Republic of Haiti occupies the western third (27,750 km2) of the island of Hispa-
niola, located in the northeast Caribbean between Puerto Rico to the east and Jamaica and
Cuba to the west (Figure 1), and had a population of approximately 9.6 million prior to the
earthquake. The metropolitan area surrounding its largest city, Port-au-Prince, has an esti-
mated population of 3 million. Haiti has been impacted by other natural disasters in recent
years. In 2008, more than 800 people were killed by a series of four hurricanes and tropical
storms that struck Haiti during a two-month period.

a) Georgia Institute of Technology, School of Civil and Environmental Engineering, 790 Atlantic Dr., Atlanta GA
30332-0355

b) University of California Berkeley, Department of Architecture, 232 Wurster Hall, Berkeley, CA 74720-1800
c) University of Washington, Department of Civil and Environmental Engineering, 233 More Hall, Seattle, WA
98195-2700

d) Earthquake Science Center, US Geological Survey, MS977, 345 Middlefield Rd., Menlo Park, CA 94025
1The number of casualties is a highly debated issue, with estimates ranging from 70,000 to 316,000. At the time
of this publication, the official number from the Government of Haiti is 316,000.

S1

Earthquake Spectra, Volume 27, No. S1, pages S1–S21, October 2011; VC 2011, Earthquake Engineering Research Institute

The damage to the infrastructure from the earthquake in Haiti was staggering. More
than 300,000 homes collapsed or were critically damaged. It is estimated that 60% of the
nation’s administrative and economic infrastructure was lost, and 80% of the schools and
more than 50% of the hospitals were destroyed or damaged (GOH 2010). More than 180
government buildings and 13 out of 15 key government offices collapsed, including the
presidential palace and parliament. The partial destruction of the main port of Port-au-Prince
and blockage of roads from debris hampered the response and recovery for many months af-
ter the earthquake. Even nine months after the earthquake, the destruction continued to dis-
rupt the lives of many Haitians. The Interim Haitian Reconstruction Commission estimated
that as of 12 October, 1.3 million people were still displaced—either in one of the more
than 1,300 camps and other settlements registered by the International Organization for
Migration (IOM) or in temporary housing situations in both the quake-affected zone and in
non-affected regions (IHRC 2010).

Overall losses and damages from the earthquake are estimated to be between US$7 bil-
lion and US$14 billion (approximately 100%–200% of Haiti’s gross domestic product),
making this the most costly earthquake event in terms of the percentage of a country’s gross
domestic product (Cavallo et al. 2010).

PRE-EARTHQUAKE HAITI: SETTING THE CONTEXT

It is difficult to quantify the impact of pre-earthquake conditions on the devastation
resulting from the earthquake in Haiti. However, there is no doubt that the dire socioeco-
nomic conditions that existed prior to the earthquake were a major contributor to the

Figure 1. Geographic and tectonic setting of the island of Hispaniola, of which Haiti occupies
the western third. The 2010 earthquake occurred on or near the Enriquillo-Plantain Garden fault
zone and was preceded by earthquakes in southern Haiti in 1751 (two events, in October and
November), 1770, and 1860. The location of the main shock of 12 January 2010 and aftershocks
are shown in Figure 2.

DESROCHES ET AL.S2

resulting damage. Following a slave rebellion in 1804, Haiti became the first free black
nation in the world. It was subsequently forced to pay France a massive indemnity for prop-
erties lost in that rebellion, and was ostracized socially and economically by countries all
around the world. Haiti subsequently became entrapped in a cycle of poverty and misgov-
ernment from which it has never emerged (Heinl 1996).

Haiti is the poorest country in the Western Hemisphere, ranking 145 out of 169 on the
UN Human Development Index (UNDP 2010). Less than 10% of the population has access
to potable tap water and less than one-third has access to electricity, even intermittently
(UNSD 2010), which are the lowest respective percentages in the Western Hemisphere.
More than half of Haiti’s population lives on less than US$1 per day, and more than three-
quarters live on less than US$2 per day. Haiti has the highest rate of mortality among
infants, children under 5, and during maternity of any country in the Western Hemisphere
(UNSD 2010). Haiti’s exports are small: 10% of the gross domestic product. Haiti’s poor
economic performance is, in part, the result of the decline of its agricultural sector, which in
turn is due in large part to the degradation of the environment. Haiti ranks 155 out of 163
countries when it comes to general environmental degradation. For years, Haitians have cut
down trees to use as cooking fuel, resulting in less than 3% of Haiti being covered by forest,
a stark contrast to the lush forests of its neighbor, the Dominican Republic. The environ-
mental degradation only increases Haiti’s vulnerability to natural hazards.

In addition to its poor socioeconomic standing, Haiti’s limited recent history of large
earthquakes (Figure 1) left it unprepared for the 12 January 2010, earthquake. Haiti had few
seismologists and no seismic network in the country. It only had one seismic hazard map,
which was outdated and lacked sufficient detail to be useful. The best geological map dated
to 1987 (Lambert et al. 1987). The building code was outdated, rarely used, and not
enforced (CUBiC 1985). There was no earthquake preparedness program and no contin-
gency plan for earthquakes. The typical university curriculum did not include seismic
design, seismology, or the geosciences.

SEISMOLOGICAL ASPECTS

GEOLOGY AND TECTONICS

The geologic evolution of Hispaniola can be traced to the Mesozoic breakup of Pangea
and the creation of the Atlantic Ocean. This process resulted in the formation of the Carib-
bean microplate, with subduction zones forming around the margins (Garcia-Casco et al.
2008). The geology of Hispaniola, including Haiti, consists of igneous rocks formed within
a volcanic island arc, as well as abundant marine sedimentary rocks that have accreted at
the oceanic subduction margin (Woodring et al. 1924, Maurrasse 1982).

The 12 January 2010 earthquake occurred on or near the Enriquillo-Plantain Garden
Fault, a prominent strike-slip fault that is clearly evident in high-resolution relief maps of
the Southern Peninsula of Haiti. Field studies confirmed that the mapped Enriquillo-Plantain
Garden Fault in the epicentral region separates basaltic rocks south of the fault from marine
sedimentary rocks (chalk, sandstone, and limestone) to the north. Thus, the fault can be eas-
ily discerned by its morphology and geology. However, detailed field and geophysical stud-
ies indicate that the fault rupture was a complex event that involved slip on more than just

OVERVIEW OF THE 2010 HAITI EARTHQUAKE S3

the Enriquillo-Plantain Garden Fault (Nettles and Hjörleifsdóttir 2010, Prentice et al. 2010,
Calais et al. 2010, Hayes et al. 2010).

SEISMICITY

For several decades prior to the 12 January 2010 earthquake, seismic activity within the
island of Hispaniola had been heavily concentrated in the eastern two-thirds of the island in
the Dominican Republic, and Haiti had been relatively seismically quiescent. Indeed, since
the establishment of a modern global seismic network in 1964, the Port-au-Prince region of
southern Haiti has experienced only one earthquake of magnitude greater than 4.0, with sev-
eral additional events occurring 100 km to the west. However, studies of historical seismic-
ity have established that large (magnitude 7.0 or greater) earthquakes have struck the Port-
au-Prince region in the historic past. These earthquakes are all attributed to movement on
the east–west oriented Enriquillo Fault (Figure 2). The largest earthquakes occurred in 1751
(two events), 1770, and 1860 (O’Loughlin and Lander 2003). One of the two earthquakes
of 1751 occurred near the longitude of Port-au-Prince and destroyed buildings throughout
the city (modified Mercalli intensity [MMI] of X). The 1770 earthquake occurred an

Figure 2. Topographic map of the Southern Peninsula of Haiti: (a) Port-au-Prince, (b) Léogâne,
and (c) Port Royal. The east–west oriented Enriquillo Fault (red line) passes the main shock epi-
center (single larger focal mechanism SE of Léogâne). The Enriquillo Fault is a left-lateral fault
that accommodates 7þ=�2 mm=yr of strain (Manaker et al. 2008). Aftershocks (yellow circles)
are concentrated to the west of the main shock, and their focal mechanisms (orange) indicate
reverse faulting. Panels centered on Léogâne indicate the extent and magnitude of fault slip on
three rupture planes (Figure 3).

DESROCHES ET AL.S4

estimated 30–50 km further to the west on the Enriquillo Fault, and once again resulted in
the widespread destruction of buildings in Port-au-Prince and Léogâne (O’Loughlin and
Lander 2003). The 1860 earthquake was located still further to the west of Port-au-Prince
and was observed to cause uplift of the sea floor. This uplift is significant because it indi-
cates that crustal strain accommodation and release is partitioned between pure strike-slip
and reverse-faulting structures (Nettles and Hjörleifsdóttir 2010, Hayes et al. 2010, Calais
et al. 2010).

THE MAIN SHOCK AND AFTERSHOCKS

The 12 January 2010 event occurred at 04:53:10 p.m. local time. The U.S. Geological
Survey (USGS) located the epicenter at 18.44� N, 72.57� W, which placed the event 25 km
WSW of Port-au-Prince, on or near the Enriquillo Fault. The estimated depth was 13 km,
but the lack of local seismic data made the precise depth uncertain. The USGS assigned a
horizontal uncertainty of þ=� 3.4 km. The first-motion focal mechanism (ref) for the main
shock indicated left-lateral oblique-slip on an east–west oriented fault. However, there was
clear evidence of coastal uplift north of the Enriquillo Fault (Hayes et al. 2010) as well as
vertical ground deformation imaged by interferometric synthetic aperture radar (InSAR)
data. These observations require significant slip on a nearby reverse fault (Figure 2). The fi-
nite fault model by Hayes et al. (2010) showed slip on three fault planes and satisfies seis-
mologic, geodetic, and geological observations. This model showed a maximum slip of 3.5
m on the reverse fault (Figure 3). The earthquake source zone (i.e., the surface area of the
fault that slipped) was quite compact, with a down-dip dimension of approximately 15 km
and an along-strike dimension of close to 40 km. This source dimension is about two-thirds
the size of a typical Mw 7.0 earthquake. The earthquake rupture was very abrupt and sharp;
maximum moment release occurred in the first 4–8 seconds of the fault slip, and 80% of the
moment release occurred in 12–14 seconds (Hayes et al. 2010).

The main shock was followed within 20 minutes by two large aftershocks with moment
magnitudes of 6.0 and 5.7, respectively. Eight days after the main shock, on 20 January
2010, a Mw 5.9 aftershock occurred. Overall, the early aftershock sequence from this earth-
quake was three times more productive than a typical aftershock sequence in California.

SEISMOLOGICAL AND GEODETIC FIELD ACTIVITIES DURING 2010

The first accelerometer to measure aftershocks was installed on the grounds of the U.S.
Embassy in Port-au-Prince on the evening of 27 January 2010 (Eberhard et al. 2010). In
March 2010, additional temporary seismographs were deployed by the USGS and French
and Canadian research groups and these data were being interpreted at the time of this writ-
ing. GPS and InSar data have been collected (Calais et al. 2010, and references therein),
and Coulomb stress changes imparted by the 12 January 2010 event have been calculated
(Lin et al. 2010). These data and additional analytical models will be used to guide the next
generation of seismic hazard maps (Frankel et al. 2010).

GEOTECHNICAL

The earthquake-affected region is a physiographically diverse area with a complex geo-
logic history. The topography within the study area is relatively rugged, with steep mountain

OVERVIEW OF THE 2010 HAITI EARTHQUAKE S5

ranges and hillfronts, deeply incised streams and narrow intermountain stream valleys, and
broad coastal delta fans and valleys. Quaternary deposits in the epicentral zone include Holo-
cene to late Pleistocene fluvial alluvium (channel, terrace, floodplain overbank deposits) de-
posited in the Port-au-Prince valley and interior incised river valleys, alluvial fan and collu-
vial wedge deposits along the margins of larger valleys, coastal delta fan complexes where
larger streams discharge into the sea along the coast, localized organic sediments within
marshes and swamps, and beach sands along protected portions of the coast. Port-au-Prince
spans a broad region from the relatively level floor of a large alluvial valley underlain by
Holocene to Pleistocene deposits, southward to low hills underlain by Mio-Pliocene deposits.
Léogâne and Carrefour are located on large delta fans and are underlain by Holocene to
Pleistocene alluvium. Coastal areas adjacent to Port-au-Prince are mostly composed of artifi-
cial fill placed during westward expansions of the city during the past 200 years. Post-earth-
quake reconnaissance visits to Haiti have provided opportunities to acquire detailed informa-
tion on geologic and geotechnical conditions throughout the affected area (Cox et al. 2011,
Green et al. 2011, Rathje et al. 2011, Hough et al. 2011, Lekkas and Carydis 2011).

Figure 3. Geometry of fault ruptures for the January 2010 Haiti earthquake. Fault plane A (red
outline) contains the earthquake hypocenter (locus of slip initiation; red star) and is a steeply-
dipping (70�) left-lateral strike-slip fault. Fault plane B (blue outline, top) is a blind thrust fault
(55� dip), shows the largest slip displacement (up to ca. 350 cm) and is responsible for approx.
80% of the seismic moment released during the earthquake. Fault plane C (black outline, bot-
tom) is a reverse fault with a modest amount (ca. 100–200 cm) of slip (from Hayes et al. 2010).

DESROCHES ET AL.S6

The observed structural damage from the earthquake correlates well with these geologic
conditions. Ground-motion amplification was a primary factor in alluvial soils in the north-
central and coastal region of Port-au-Prince, Carrefour, and Léogâne. Hough et al. (2010)
used weak-motion data from aftershock recordings at seismograph stations deployed fol-
lowing the earthquake to determine that the mean amplification ratio of peak ground accel-
eration (PGA) for stations on alluvium was 1.78 þ=� 0.58 compared to a reference station
on hard rock. Rathje et al. (2011) documented that the largest concentrations of damage
occurred in areas underlain by Holocene alluvium with average shear wave velocities in the
upper 30 m (VS30) of approximately 350 m=s, which corresponds to National Earthquake
Hazards Reduction Program (NEHRP) Site Class D.

Large concentrated zones of damage also occurred in the southern portion of Port-au-
Prince that extends into the hills underlain by Mio-Pliocene, weakly cemented deposits. In
these areas, both topographic amplification and site effects contributed to higher levels of
shaking. Hough et al. (2010) compared weak-motion recordings at sites located in the foot-
hills of Port-au-Prince with a hard-rock reference station and found that the PGA was ampli-
fied by a factor of 2.94 þ=� 1.06; amplification ratios as high as 5 were calculated for fre-
quencies of several Hertz. Rathje et al. (2011) and Hough et al. (2011) have used digital
elevation models to correlate observed damage patters with topographic features in the area.

Artificial fill in the port areas of Port-au-Prince and Carrefour experienced extensive
liquefaction, lateral spreading, and settlement damage. At the Port de Port-au-Prince, lique-
faction-induced lateral spreading (Figure 4) resulted in the collapse of the pile-supported
North Wharf, damage to two steel-frame warehouses, and other port facilities (Green et al.
2011, Werner et al. 2011). Geotechnical site investigations performed after the earthquake
includes soil borings with standard penetration tests (SPT), dynamic cone penetration tests
(DCPT), and surface wave (MASW and SASW) tests (Green et al. 2011). Grain size analy-
ses indicated that the coarse-grained soils were well-graded mixtures of sands and gravels

Figure 4. Liquefaction-induced lateral spreading leading to the collapse of the North Wharf at
the Port de Port-au-Prince.

OVERVIEW OF THE 2010 HAITI EARTHQUAKE S7

with median grain sizes ranging from 0.2 mm to 10 mm. The calcium carbonate (CaCO3)
content of the materials was 80%–90% and is attributed to the marine origin of the fill mate-
rials. Level-ground liquefaction analyses performed using the SPT and DCPT data indicated
that the liquefaction potential of the soils is very high, which is consistent with the extent
and severity of liquefaction-induced ground failures at the port. Green et al. (2011) also
compare observed values of permanent deformation with estimates obtained from various
empirical methods and found that the observed values generally exceed the estimated val-
ues. Ground-motion amplification in the soft fill soils was likely a contributing factor to the
partial collapse of and extensive damage to the remaining portion of the South Pier at the
Port de Port-au-Prince (Werner et al. 2011).

Many of the road failures observed along the coast west of Carrefour occurred where
the road crosses marshy ground and the distal ends of small alluvial valleys. Settlement and
localized creep=slumping of sediments underlying the roadbed appear to be responsible for
many of the road failures, rather than lateral spread failure, because cracking typically was
confined to the roadbeds and fill and did not extend through natural soils shoreward of the
roadways. Localized liquefaction of loose, saturated sediments in these areas may have con-
tributed to the road failures, but was not the major factor.

Numerous landslides and rockfalls occurred within the Mio-Pliocene and older lime-
stone bedrock in steep slopes and roadcuts within the epicentral zone. In some cases these
failures appear to have been restricted to colluvial soil and fractured=dilated rock within a
weathered zone that extends about 1–3 m deep into the slopes. However, some deeper-
seated slumps and debris avalanche/slide failures occurred in less-weathered, deeper bed-
rock in steep mountainous slopes. These failures appear in part to be influenced or con-
trolled by bedrock joints or weak zones. In places, developments on steep slopes appear to
have been impacted by slope raveling or foundation sliding=slumping. Additional analyses
of landslides in the epicentral zone are described in Liu et al. (2011).

PERFORMANCE OF BUILDINGS

The earthquake caused extensive damage to buildings throughout the Port-au-Prince
metropolitan area, and in the rural areas and towns to the west and south of the city. Nearly
all of the severe damage and collapses appeared to occur in buildings that were constructed
without considering the effects of earthquakes. The majority of buildings that were designed
for earthquakes and that were well constructed did not collapse in the earthquake.

BUILDING INVENTORY

A nationwide census conducted in 2003 documented many characteristics of Haitian so-
ciety, including the frequency of common building types, as well as the materials used to
construct the walls, roofs, and floors. The percentage of each type of building is reported for
urban and rural areas in Table 1, which was compiled with data from the Haitian Ministry
of Statistics and Informatics (IHSI). Within urban areas, 78% of the buildings were classi-
fied as one-story houses and another 14% were classified as multistory houses or apartments
(IHSI 2010). The remaining 8% of the buildings consisted of slum housing or traditional
forms of construction (two common types are kay atè, buildings with a combined roof and
walls, and ajoupas, rural homes with thatch, straw, or palm leaf roofs). Within rural areas,

DESROCHES ET AL.S8

ordinary one-story houses were again most common (69%), multistory structures were rare
(<1 percent), and ajoupas made up 25% of the building inventory.

The wall materials for each building type in urban areas are summarized in Table 2,
which was also developed from the IHSI data. In urban areas, concrete block walls predo-
minated (79%), particularly in multistory houses and apartments (97%). In rural areas, the
most common wall material was earth (33%), followed by concrete block (22%), and clis-
sage (19%), consisting of intertwined sticks, twigs, and branches. Considering all building
types and regions, approximately two-thirds (69%) of the structures had metal roofs, but for
multistory houses and apartments, 89% had roofs made of concrete (IHSI 2010).

Typical reinforced concrete frame buildings with concrete block infill had numerous
vulnerabilities known to cause seismic damage. Figure 5 shows a typical low-rise reinforced
concrete frame building with infill concrete block walls that was under construction at the
time of the earthquake. Columns were slender with depths in the range of 200 mm to 250
mm. Such columns were often reinforced with 4 #4 bars, sometimes deformed and some-
times smooth. Column and joint transverse reinforcement was minimal (e.g., #2 smooth
ties) and spaced at a distance roughly equal to the column depth. Concrete and mortar

Table 1. Distribution of building types in urban and rural areas (IHSI 2010)

Location

Type of Building Urban Areas (%) Rural Areas (%) Combined (%)

Kay atè (combined roof and walls) 0.5 1.9 1.4

Taudis (slum housing) 3.2 2.5 2.8

Ajoupas (rural home with roof made
of thatch, straw, or palm leaves)

3.7 25.3 17.6

One-Story House 78.3 69.2 72.5

Multistory House=Apartment 13.7 0.8 5.4

Others 0.6 0.3 0.4

Table 2. Distribution of wall materials for each building type in urban areas (IHSI 2010)

Wall Material

Type of Building
Concrete

Block (%)
Earth
(%)

Wood/
Planks (%)

Clissage
(%)

Other
(%)

Kay atè (combined roof and walls) 0.0 91.3 0.0 7.6 1.1

Taudis (slum housing) 11.3 8.3 15.3 8.5 56.6

Ajoupas (rural home with roof made
of thatch, straw, or palm leaves)

0.0 54.6 9.6 28.2 7.6

One-Story House 82.4 3.8 2.9 3.0 8.0

Multistory House=Apartment 97.4 0.0 0.6 0.0 1.9

Others 67.0 0.4 6.2 0.7 25.7

All 78.7 5.7 3.2 3.7 8.8

OVERVIEW OF THE 2010 HAITI EARTHQUAKE S9

quality appeared to vary significantly. In the building shown Figure 5, concrete blocks were
placed outside the frame lines. More typically, the concrete block walls were used as infill.
In some structures, column steel splices were placed directly above the elevation of the
floors.

BUILDING PERFORMANCE

Damage to residences and commercial buildings was widespread. According to Figure
11 (USAID 2010), approximately 40%–50% of buildings were “destroyed” in Carrefour
and Gressier, communes near Port-au-Prince. In downtown Port-au-Prince, Eberhard et al.
(2010) found that 28% of the 107 buildings surveyed had collapsed partially or totally, and
an additional 33% were damaged enough to require repairs. The damage was even higher in
Léogâne, the city nearest the epicenter. According to Figure 11, 80%–90% of buildings
there were destroyed.

Two adjacent structures in downtown Port-au-Prince illustrate the consequences of poor
seismic proportioning and detailing. Figure 6 shows the collapse of the multistory Turgeau
Hospital, constructed in 2008. The building’s lateral-force resistance was provided by a re-
inforced concrete frame with masonry infill. As with the residence shown in Figure 5, the
columns were slender, and the columns and joints had little transverse reinforcement. In
contrast, the Digicel building (Figure 7) across the street had only minor structural damage,
consisting mainly of concrete spalling at the base of the columns. The building had been
designed to resist earthquakes; it had much larger columns with closely spaced ties and
included shear walls.

It appears that some buildings performed better than their neighbors because of their
low mass. For example, the wood-frame building shown in Figure 8a was adjacent to a col-
lapsed reinforced concrete structure. Similarly, the one-story church shown in Figure 8b
had a light-metal roof supported by masonry walls. Although it appeared to be constructed
with materials of poorer quality than those used in a neighboring concrete bearing-wall
house, the masonry church structure suffered less damage.

Figure 5. Residential concrete block slab construction.

DESROCHES ET AL.S10

PERFORMANCE OF LIFELINES

BRIDGES

There are very few bridges in Haiti, and most are short, single-span bridges or culverts.
We did not learn of any bridge collapses attributable to the earthquake. Within Port-au-
Prince, most of the crossings over streams were accommodated by box culverts, which did
not appear to be damaged. Along the Route Nationale No. 2, small streams were also
spanned by culverts. The culverts themselves were not damaged, but in at least one case,
the approaches to the culvert settled relative to the culvert itself.

The main river crossings on Nationale No. 2 were spanned by bridges with precast gird-
ers resting on cast-in-place reinforced concrete bents and supporting a cast-in-place deck.
We observed damage to two such bridges. The bridge over the Momance River had minor
pounding damage at one of the intermediate supports. In the Carrefour section of Port-au-
Prince the external shear keys (Figure 9) of a similar bridge were damaged at both interme-
diate supports. This failure was apparently caused by the lack of hook anchorage at the end
of the top beam reinforcement.

WATER AND WASTEWATER

The main public water system in Port-au-Prince is supplied by a series of springs
located in the nearby mountains. The water is chlorinated in the spring boxes and sent to the
distribution system, which serves 1,000,000 people (Edwards 2010). Prior to the earth-
quake, this supply was unreliable, and the water was not drinkable without further treat-
ment. There were relatively few water main breaks, which is unusual for a system this large.
Most of the breaks were repaired within one to two weeks of the earthquake.

There were no working wastewater treatment plants in Haiti. In the metropolitan areas,
wastewater was discharged in open drainage channels and directed to Port-au-Prince Bay.
Many of the drainage channels were blocked by debris and trash.

Figure 6. Turgeau hospital in downtown Port-au-Prince: (a) Before the earthquake (Simon
Young CaribRM), and (b) collapsed structure after the earthquake.

OVERVIEW OF THE 2010 HAITI EARTHQUAKE S11

Figure 7. Damage to two structures across the street from one another in Port-au-Prince: (a)
Reinforced concrete frame with masonry infill, and (b) new Digicel building under construction
appears to be nearly undamaged.

DESROCHES ET AL.S12

Figure 8. Light buildings that were damaged but did not collapse: (a) Wood-frame building,
and (b) church with masonry walls and light-metal roof.

Figure 9. Damage to shear key at intermediate support.

OVERVIEW OF THE 2010 HAITI EARTHQUAKE S13

TELECOMMUNICATION SYSTEMS

The telecommunication system in Haiti is comprised of a single wireline carrier (Tel-
eco), and three wireless mobile vendors (Edwards 2010). Teleco is a wireless-based utility
providing service through a network similar to those operators throughout the United States.
The earthquake caused the collapse of the Teleco building in Port-au-Prince. At several
locations throughout the Port-au-Prince metropolitan region, the placement of COWS (Cells
on Wheels or Mobile Cellular System and Telescoping Antenna Array) outside of several
telephone central offices was a temporary solution to enable inter-exchange traffic.

Digicel, one of Haiti’s largest wireless cellular providers, had significant damage due to
the collapse of buildings onto antennas. According to Digicel officials, it was estimated that
20% of the company’s network was damaged beyond repair and unable to return to service.
By 27 January 2010, the company had restored 92% of radio frequency capability with the
regulator’s grant of additional spectrum for a period of 12 months.

SOCIOECONOMIC IMPACT

Researchers distinguish between emergencies, disasters, and catastrophes (Comerio 1998,
Teirney 2008), and by all measures, the earthquake in Haiti can certainly be classified as a
major catastrophe—perhaps the worst in modern history. Not only were the physical and
social impacts extremely large relative to the population of the affected areas, but also relative
to the country as a whole. Given the extent of the damage, the government was paralyzed and
an international response faced massive challenges—with limited access to the damaged port
and airport, and uncertainty over who could or should take charge. The United Nations (UN),
which had a peacekeeping mission in Haiti prior to the earthquake, lost a significant number
of their own staff, as did the numerous International Non-Government Organizations
(INGOs) that provided a wide variety of health care, housing assistance, training, and other
social services. With every segment of civil society impacted—the government, schools, uni-
versities, businesses, health clinics, orphanages, INGOs, and churches—it was often difficult
to understand who could provide relief and assistance to the earthquake victims.

The U.S. Armed Forces initially took over airport operations. UN and World Bank rep-
re

assignment

Philosophy of Nursing Paper Guidelines and Grading Rubric

The philosophy of nursing paper is a two to three-page, double-spaced, 1” margin reflective “mission” statement. When thinking about nursing, in the first person, summarize your guiding principles using present tense. Submit all philosophy of nursing papers on Bb using your last name and then the name of the assignment on day assigned in Course Outline. Emailed papers are unacceptable. You may use SafeAssign before submission to check for citation problems and plagiarism.

Content

Possible

Points

Points Earned

1. Personal beliefs. Describe your values and beliefs about nursing. You may use “I believe…” statements that include your:

a. Your definition of nursing.

b. What are your beliefs on how nursing is related to the general population (Who are they?), general health (What is it?), and the environment (Where is nursing practiced?).

c. Beliefs about the profession of nursing.

d. Significance of collaboration with other health professionals.

10

10

10

10

2. Nursing as a career. Demonstrate that you have given thought to your career and explain the rationale for your decision.

a. Inspiration from the past. (Who or what?)

b. Define professional goals.

c. Identify roles and responsibilities to advance the profession of nursing.

d. How you will provide safe, effective care?

e. How your academic preparation will facilitate your positive contributions to the health care system?

10

10

10

10

10

3. Organization, grammar, and APA format.
Proofread your paper before submission to make sure that your paper:

a. Complies with length requirements 2-3 pages;

b. Consistently uses APA (7th edition-student paper) format (title page, page numbers, and if needed, in-text citations and reference list);

c. Is free of grammatical, sentence structure, spelling, punctuation and organizational (introduction, body and summary with logical flow) errors.

3

4

3

4. Deductions

See guidelines outlined in the syllabus adherence to submission deadline.

Grade

Assignment

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

 (The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. This section contains the symptoms that is bringing the patient into your office. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP.

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings)

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).


A

ssessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good. 

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

© 2020 Walden University

Page 1 of 3

Assignment

Should Parole be abolished?  What type of supervision has the federal government implemented upon offender release and why?  

APA format 2 pages

Assignment

Assignment 4: Disseminate the Evidence (E-Poster and Kaltura Presentation (16 Points)
This assignment will assist students to develop scholarly skills to disseminate research findings for a practice change project
utilizing an E-Poster and Kaltura Capture. This presentation is to sell the audience on the implementation of the evidence-based
intervention develop in the Week 1 PICOT question using an E-Poster, Kaltura Capture, and student’s presentation skills. Be
creative, innovative, and persuasive!
Assignment Criteria:
Students will develop an E-Poster presentation that includes the following criteria:
1. Go to Make Signs website (https://www.makesigns.com/SciPosters_Templates.aspx) and choose a free 48” x 36” or 56” x
42” size scientific e-Poster PowerPoint template or use the ACON Poster Template. Both can be found in the Week 7
Canvas Module.

a. Edit the categories on the E-Poster template to meet the needs of this assignment.
2. Describe the problem related to the approved PICOT question from Week 1.
3. State the PICOT question and describe the components.
4. Describe the intervention.
5. Summarize the evidence that supports the intervention (internal and external evidence).
6. Provide a summary of the pilot project for the intervention
7. Explain the implications of the intervention on practice and the science of nursing.
8. After the E-Poster is created, utilize Kaltura Capture to present the E-Poster with voice over (use computer and
microphone).
9. The E-Poster presentation should be no more than 10-12 minutes in length.
10. Be complete and concise. Use bulleted statements not complete sentences or paragraphs. Resources found in ACON
Student Resources located in the Modules.
11. A minimum of 3-4 references will be required for this E-Poster presentation part of the assignment. References should be
from scholarly peer-reviewed journals (check Ulrich’s Periodical Directory) and be less than five (5) years old.

Consider the following structure for Assignment # 4 – outline each section of your e-poster based on the assignment criteria
1. Clinical problem 
2. PICOT describing components 
3. Intervention 
4. Summary of Evidence 
5. Summary of Pilot project
6. Implications for practice                                                                                                                                          7. References

The PICOT question in this case is that: In adult patients with the Crohn’s disease, how effective is plant-based diet compared to pharmaceutical treatment in relieving symptoms within six months?

Assignment

Cannabis 101 for Nurses

Write a 1000-1500 word essay addressing each of the following points. Be sure to completely answer all the questions for each bullet point.

There should be two main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper.

Support your ideas with at least four (4) sources using citations in your essay. Sources within the last 5 years. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount.

· Explain how cannabis works in the body by including information regarding the endocannabinoid system (ECS) and endocannabinoid deficiency syndrome.

· Describe four different delivery routes patients may use cannabis, the onset of action for each, and one pro and one con of each route.

Assignment

Group Presentation:

SITUATION: newly appointed CEO of Cremona Hospital in Northern Italy during the peak of the pandemic. Tasked with outlining a way forward through the turmoil that is currently engulfing your facility. Consider what steps need to be taken within assigned realms of logistics and strategic support

BACKGROUND: Cremona Hospital overwhelmed by a rapid increase in the number of patients with COVID-19 induced pneumonia.​

· 500-bed facility ​

In the first 8 weeks into the pandemic:​

· 1706 patients evaluated in the emergency room​

· 1542 admissions​

· 242 intubations​

· 419 underwent non-invasive ventilation​

· 342 died​

Medical care required for many severely ill patients with limited resources and overworked healthcare employees.

ASSESSMENT: Within the midst of the pandemic the logistics during this was chaos. The purpose of the environment of care is to provide safety for all persons in the HCO, provide the physical environment required for the mission, including all buildings equipment, and supplies, plan for contingencies and implement guest services at satisfactory levels of the economy, attractiveness, and convenience (reference book). A plan for emergency and disaster response is a planned and systematic response to community disasters where large numbers of patients must be treated for trauma and stress (reference book). The management of disaster events addresses four phases mitigation, preparedness, response, and recovery (reference book).

Problems within the midst of the pandemic with logistics and strategic support (not in order of relevance):

1. Communication with other community agencies, is essential ad normal channels are often overwhelmed

2. Triage

3. High stressed staff medical staff with lack of support

4. Low number of ventilators, beds, and space for adequate triage and isolation

RECOMMENDATION:

Review opportunities for improvement and make corrections to plans for emergency and disaster response. Implement provisions for relief and rehabilitation for associates that are negatively affected during emergency and disaster events.

Emergency management requirements: (reference book)

1. Emergency preparedness: plan, training, utilities and communications management, drills with formal evaluation, annual review and approval by senior leadership. Evaluations of all disasters occurrences, collaboration with community response partners.

2. Life-safety and fire protection: evacuation plans and routes, routine inspection, life safety training and drills.

The design of the plan is a major project that requires the coordinated efforts of virtually all HCO leadership, elements include: (reference book)

1. Rapid assembly of clinical and other personnel

2. Inclusion of HCO leaders

3. Reassignment of tasks, space, equipment

4. Establishment of supplementary telephone ad radio communication

5. Triage of arrived patients

6. Temporary shelter for the homeless

7. Continued care of patients already in the hospital

8. Housing and food for hospital associates

9. Provision of information to the media, volunteers, and families

Assignment

ASSIGNMENT DESCRIPTION:

Write an original academic assignment on ONE topic (with all its subtopics) from the list shown below (minimum 1000 words not counting reference list). Your assignment should be well written and well-organized. Ideas should flow clearly from one paragraph to the next. 

THIS IS AN ACADEMIC assignment NOT AN OPINION PIECE. Support your points with class readings and examples from case studies. Do not simply list everything there is on the readings, explain your reasoning and support it with course readings/video lectures. Use a Minimum 6 readings from class, there is no maximum amount. For your core 6 sources you can only include 1 multimedia source (videos or videolectures), the remaining 5 must be class provided articles or a combination with external sources ONLY if required in the prompt. You can use external sources to supplement the mandatory 6 class readings depending on the prompt you chose below. See instructions. 

ASSIGNMENT SPECIFICATIONS (GRADED):

All of the following are part of the assignment grade:

  • Create a doc or docx file. Times New RomanFont, Size 12, SINGLE SPACE. 1 Inch margins.
  • Identify the Topic you chose to answer, name, date and class in a separate title page. No abstract, index, pictures or graphs allowed. The ideas should flow from paragraph to paragraph in ONE assignment. Connect the subtopics with transitions, do not divide the assignment by subtopics. 
  • No lengthy introductions, you can start your assignment with a simple statement of about 50 words maximum and then go straight for the answers to the questions. 
  • THIS IS NOT AN OPINION assignment so use paraphrasing of class readings and support this paraphrasing with APA in text citations, check the APA guides provided on the folder in the course modules.
    • Example: Citing in text means to paraphrase and credit your sources (Brown, 2012). 
  • NO “direct quotes”, paraphrase and reference your source in APA in text citations. All your text must be ORIGINAL. 
  • If the prompt requires external sources, do not cite Wikipedia, Encyclopedia Britannica (all definitions of terms for class are provided in the readings), Atlas Obscura, Culture trip or any blogs, non-academic or non-official publications. See our academic sources policy in your syllabus.
  • Include a Reference list at the end, in APA style and alphabetical order.
  • Spell-check and re-read your responses, grammar and composition will be graded.  
  • TOPICS: SELECT ONE TOPIC AND ANSWER ALL SUBTOPICS

Topic #1: Disasters affect all countries in the world but the effects of these events are disproportionate. Answer both 1.1 and 1.2: MINIMUM 6 CLASS READINGS from any 3 Case studies studied so far (2 readings per case study week 2 to week 7).

Subtopic 1.1: Describe with examples TWO of each: political/social (2), economic (2) and physical (2) vulnerabilities that CAUSE extreme losses during disasters. Vulnerabilities present before the disaster and that later contributed to higher effects in people, property and environment. Make sure you discuss VULNERABILITIES NOT CONSEQUENCES. Use specific examples from the readings to discuss how these vulnerabilities lead to the disaster consequences we studied in class? USE SPECIFIC EXAMPLES FROM ANY DISASTERS STUDIED SO FAR (AT LEAST 3 DIFFERENT). (700 words minimum)

Subtopic 1.2 Propose 1 solution for each type of VULNERABILITY discussed above (total 3 solutions). Base your proposed solutions on the readings from Week 2: Core Concepts of Emergency Management and other readings in class. (300 word minimum)

Topic #2: In class we have seen the situations before, during and shortly after the disaster events. But what happens many years after a major disaster event? After a disaster, emergency managers and public officials often see a “window of opportunity” for better practices. Building back better and long term policies. For this topic you will use 3 class readings + 3 external articles (independent research) to answer all of the following (2.1 and 2.2):

Subtopic 2.1: Select any 3 case studies studied in class (Week 3-7) and describe their disaster case very briefly: Maximum 400 words total for all 3 cases. 

Subtopic 2.2: Disaster events often repeat over time. Identify one recent disaster event in each country from 2.1 (same type of disaster) and compare response and recovery from that recent event compared to your discussion in 2.1 (only recent disasters in the years between 2000-2021). Have there been any improvements in Emergency Management practice for those events? (Minimum 600 words)

(Example: Comparing the Indian Ocean Tsunami of 2004 with the tsunami in Indonesia in 2018) 

Your independent research should be based on news articles, academic articles and books. NO BLOGS, WIKIPEDIA, QUORA, ENCYCLOPEDIA BRITANNICA, ATLAS OSCURA ETC (See syllabus P.12 for academic sources policy). MINIMUM 3 CLASS READINGS + 1 EXTERNAL SOURCE PER EACH DISASTER CASE (3), TOTAL 6 SOURCES. 

Identify 1 NEW articles/sources for EACH case study. I recommend:

  1. Relief Web
  2. Prevention Web
  3. Google Scholar (very good to find scholarly articles)
  4. FSU Libraries Online (online articles like google scholar)
  5. Open access Journals
  6. Open Knowledge Repository
  7. Open Access BASE Research Site
  8. United Nations Digital Library   

GOOD LUCK!!

    • 2 months ago
    • 25

    Assignment

    Select a company or organization that you currently work for, a company/organization where you previously worked, or a company/organization you aspire to work for in the future. 

    Scenario: The management at your organization has approved funding for a brand new full-time position. This position is eligible for full benefits. As an HR professional, you have been tasked with creating a detailed job description for this new position. You can use your current job, a former job, or a position you would like to move into. Instructions Based on what you know and have learned about job analysis, employment laws, and safe working environments, create a job description for this new position, and write a 4–6 page that includes the following: 1. Write a company overview that summarizes the company’s vision, mission, and organizational strategy. 2. List three or more qualifications for the position including required knowledge, skills, and abilities. Include specific academic and technical skills and any required professional affiliations, licenses, or previous experience. 3. Describe three or more ways the duties and responsibilities associated with this role reflect the organization’s vision, mission, and strategic goals. 4. Explain the purpose the job/position serves within the company. 5. Explain how you determined the duties and qualifications for the job. 6. Identify which employment laws were considered when creating the job description. Note: The numbered assignment requirements outlined above correspond to the grading criteria in the assignment scoring guide, so be sure to address each point. The bulleted content below the numbered criteria is there to clarify, support, and contextualize the assignment instructions. Format This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. The specific course learning outcome associated with this assignment is: Create a detailed job description with a rationale for each element. The company I current work for is Allied Universal Security company and please review the scoring rubric before writing paper. If you need any more information please ask. Scoring Guide Write a company overview that summarizes the company’s vision, mission, and organizational strategy. 15 % Unacceptable Did not write a company overview that summarizes the company’s vision, mission, and organizational strategy. Needs Improvement Partially writes a company overview that summarizes the company’s vision, mission, and organizational strategy. Competent Satisfactorily writes a company overview that summarizes the company’s vision, mission, and organizational strategy. Exemplary Thoroughly writes a company overview that summarizes the company’s vision, mission, and organizational strategy. List three or more qualifications for the position including required knowledge, skills, and abilities. 15 % Unacceptable Did not submit qualifications for the position including required knowledge, skills, and abilities. Needs Improvement Partially lists two qualifications for the position including required knowledge, skills, and abilities. Competent Satisfactorily lists three qualifications for the position including required knowledge, skills, and abilities. Exemplary Thoroughly lists three or more qualifications for the position including required knowledge, skills, and abilities. Describe three or more ways the duties and responsibilities associated with this role reflect the organization’s vision, mission, and strategic goals. 15 % Unacceptable Did not submit or incompletely described the ways the duties and responsibilities associated with this role reflect the organization’s vision, mission, and strategic goals. Needs Improvement Partially describes two ways the duties and responsibilities associated with this role reflect the organization’s vision, mission, and strategic goals. Competent Satisfactorily describes three ways the duties and responsibilities associated with this role reflect the organization’s vision, mission, and strategic goals. Exemplary Thoroughly describes three or more ways the duties and responsibilities associated with this role reflect the organization’s vision, mission, and strategic goals. Explain the purpose the job/position serves within the company. 15 % Unacceptable Does not explain the purpose the job/position serves within the company. Needs Improvement Partially explains the purpose the job/position serves within the company. Competent Satisfactorily explains the purpose the job/position serves within the company. Exemplary Thoroughly explains the purpose the job/position serves within the company. Explain how you determined the duties and qualifications for the job. 15 % Unacceptable Did not explain how you determined the duties and qualifications for the job. Needs Improvement Partially explains how you determined the duties and qualifications for the job. Competent Satisfactorily explains how you determined the duties and qualifications for the job. Exemplary Thoroughly explains how you determined the duties and qualifications for the job. Identify which employment laws were considered when creating the job description. 15 % Unacceptable Does not identify which employment laws were considered when creating the job description. Needs Improvement Partially identifies which employment laws were considered when creating the job description. Competent Satisfactorily identifies which employment laws were considered when creating the job description. Exemplary Thoroughly identifies which employment laws were considered when creating the job description. Clarity, writing mechanics, and formatting requirements. 10 % Unacceptable More than 6 errors present. Needs Improvement 5–6 errors present. Competent 3–4 errors present. Exemplary 0–2 errors present ding,

      • 2 months ago
      • 30

      Assignment

      In this assignment you will examine competitive market models and competitive forces in health care economics. Prices, supply and demand, quality of care, consumerism, and provider compensation are affected by the competitive forces found in health insurance and in the labor market. There is a direct relationship between insurance models, the labor market, and the financial performance of health care systems. You will write a paper about the economics of health care market models, health care delivery structures, provider compensation, and financial risk for health care systems.

      Instructions

      Write 6–8-pages in which you:

      1. Analyze your state’s current competitive market model in health care. 
      2. Compare and contrast the market power of monopolistic and monopsony markets in health care.
      3. Analyze the main competitive forces and the major factors that influence the fundamental manner in which the competitive forces determine prices, supply and demand, quality of care, consumerism, and providers’ compensation.
      4. Evaluate the positive benefits and negative aspects, respectively, of HMO-managed care from the provider’s point of view—i.e., a physician and a health care facility—and from a patient’s point of view. Provide a rationale for your response.
      5. Assess the efficiency of the types of economic incentives available to providers in the delivery of health care services in your own state.
        • 30

        Assignment

        7:25 PM (CT)

        Assignment Details

        Assignment Description
        Review the following LinkedIn Learning videos to help you with your assignments in this Unit.

        You have been requested to design a software application for a large toy company that provides an online product catalog for ordering all types of toys and games. There are four
        types of users:

        Guests
        Members (credentials and history saved)
        Titanium Members (achieved after spending $10,000 in one calendar year)
        Administrators

        Products will have typical information stored on them to include name, category, description, age group, price, weight, and much more. There will also be a rating system for
        products that members and titanium members can contribute to. Guests can review the rating information, but not contribute to it.

        The software application should have a reporting function, so sales information needs to be retained.

        Review the requirements above and, using Visio or any other diagramming software, create Class diagrams for User, Product, Rating System, and Sales. Explain each diagram
        and how the classes interrelate.

        Note: Templates can be found in Visio by accessing the UML System template.

        Click here to refer to a Visio tutorial to learn Visio basics.

        Once you have completed your diagrams, copy them into a Word document.

        Save your document with the course, assignment, and your name (e.g., ITCO­620_Unit3_IP_Neo_Anderson.docx). Submit your document for grading. 

        Refer to the Grading Rubric for this assignment.

        This assignment will also be assessed using additional criteria provided here.

        Please submit your assignment.

        For assistance with your assignment, please use your text, Web resources, and all course materials.

        Reading Assignment

        Read the following from the AIU Library:

        Computational Thinking: A Beginner’s Guide to Problem­Solving and Programming
        Chapter 11: Effective Modeling

        Object­Oriented Analysis and Design Through Unified Modeling Language
        Chapter 3: Modeling
        Chapter 4: An Overview of UML
        Chapter 5: Classes and Relationships
        Chapter 6: Common Mechanisms and Diagrams
        Chapter 9: Class Diagram and Object Diagram
        Appendix A: UML Notation

        Please Note: You have been given Visio as part of your course materials. Please use this instead of a trial version of Visio.

        Assignment Objectives
        Design programs using classes, control structures, and common data types
        Discuss the advantages to programming as a form of problem solving
        Explain classes, data abstraction, inheritance, and composition
        Formulate the plan necessary to develop an application

        Other Information
        There is no additional information to display at this time.

        Legend
        Extra Credit View Assignment Rubric

        Unit 3 ­ Individual Project 

        Assignment Overview

        Unit:  Classes and UML
        Due Date:  Tue,3/8/22
        Grading Type:  Numeric
        Points Possible:  140
        Points Earned: 
        Deliverable Length:  5 pages

        Type:  Individual Project

        Go To:

        This assignment is the Common Assignment
        Looking for tutoring? Go to Smarthinking

        Assignment Details
        Learning Materials
        Reading Assignment

        My Work:

        Online Deliverables: Submissions

        7:25 PM (CT)

        Assignment Details

        Assignment Description
        Review the following LinkedIn Learning videos to help you with your assignments in this Unit.

        You have been requested to design a software application for a large toy company that provides an online product catalog for ordering all types of toys and games. There are four
        types of users:

        Guests
        Members (credentials and history saved)
        Titanium Members (achieved after spending $10,000 in one calendar year)
        Administrators

        Products will have typical information stored on them to include name, category, description, age group, price, weight, and much more. There will also be a rating system for
        products that members and titanium members can contribute to. Guests can review the rating information, but not contribute to it.

        The software application should have a reporting function, so sales information needs to be retained.

        Review the requirements above and, using Visio or any other diagramming software, create Class diagrams for User, Product, Rating System, and Sales. Explain each diagram
        and how the classes interrelate.

        Note: Templates can be found in Visio by accessing the UML System template.

        Click here to refer to a Visio tutorial to learn Visio basics.

        Once you have completed your diagrams, copy them into a Word document.

        Save your document with the course, assignment, and your name (e.g., ITCO­620_Unit3_IP_Neo_Anderson.docx). Submit your document for grading. 

        Refer to the Grading Rubric for this assignment.

        This assignment will also be assessed using additional criteria provided here.

        Please submit your assignment.

        For assistance with your assignment, please use your text, Web resources, and all course materials.

        Reading Assignment

        Read the following from the AIU Library:

        Computational Thinking: A Beginner’s Guide to Problem­Solving and Programming
        Chapter 11: Effective Modeling

        Object­Oriented Analysis and Design Through Unified Modeling Language
        Chapter 3: Modeling
        Chapter 4: An Overview of UML
        Chapter 5: Classes and Relationships
        Chapter 6: Common Mechanisms and Diagrams
        Chapter 9: Class Diagram and Object Diagram
        Appendix A: UML Notation

        Please Note: You have been given Visio as part of your course materials. Please use this instead of a trial version of Visio.

        Assignment Objectives
        Design programs using classes, control structures, and common data types
        Discuss the advantages to programming as a form of problem solving
        Explain classes, data abstraction, inheritance, and composition
        Formulate the plan necessary to develop an application

        Other Information
        There is no additional information to display at this time.

        Legend
        Extra Credit View Assignment Rubric

        Unit 3 ­ Individual Project 

        Assignment Overview

        Unit:  Classes and UML
        Due Date:  Tue,3/8/22
        Grading Type:  Numeric
        Points Possible:  140
        Points Earned: 
        Deliverable Length:  5 pages

        Type:  Individual Project

        Go To:

        This assignment is the Common Assignment
        Looking for tutoring? Go to Smarthinking

        Assignment Details
        Learning Materials
        Reading Assignment

        My Work:

        Online Deliverables: Submissions

        Assignment

         Reflecting upon the past seven weeks, provide the three most prominent items learned in the course and how you plan on using this knowledge in the future. In your final paragraph address what you felt to be the most helpful in learning the material of this course and also how the course can be improved in the future. 

        the class is called organizational change  ORGD 6355 

        Assignment

        ACC 601 Managerial Accounting
        Group Case 3 (160 points)

        Instructions:

        1. As a group, complete the following activities in good form. Use excel or
        word only. Provide all supporting calculations to show how you arrived at
        your numbers

        2. Add only the names of group members who participated in the completion
        of this assignment.

        3. Submit only one copy of your completed work via Moodle. Do not send it to
        me by email.

        4. Due: No later than the last day of Module 7. Please note that your professor
        has the right to change the due date of this assignment.

        Part A: Capital Budgeting Decisions

        Chee Company has gathered the following data on a proposed investment project:

        Investment required in equipment …………. $240,000

        Annual cash inflows ……………………………. $50,000

        Salvage value …………………………………….. $0

        Life of the investment …………………………. 8 years

        Required rate of return ………………………… 10%

        Assets will be depreciated using straight

        line depreciation method

        Required:

        Using the net present value and the internal rate of return methods, is this a good investment?

        Part B: Master Budget

        You have just been hired as a new management trainee by Earrings Unlimited, a distributor of
        earrings to various retail outlets located in shopping malls across the country. In the past, the
        company has done very little in the way of budgeting and at certain times of the year has
        experienced a shortage of cash. Since you are well trained in budgeting, you have decided to
        prepare a master budget for the upcoming second quarter. To this end, you have worked with
        accounting and other areas to gather the information assembled below.

        The company sells many styles of earrings, but all are sold for the same price—$10 per pair. Actual
        sales of earrings for the last three months and budgeted sales for the next six months follow (in pairs
        of earrings):

        January (actual) 20,000 June (budget) 50,000
        February (actual) 26,000 July (budget) 30,000
        March (actual) 40,000 August (budget) 28,000
        April (budget) 65,000 September (budget) 25,000
        May (budget) 100,000

        The concentration of sales before and during May is due to Mother’s Day. Sufficient inventory should
        be on hand at the end of each month to supply 40% of the earrings sold in the following month.

        Suppliers are paid $4 for a pair of earrings. One-half of a month’s purchases is paid for in the month
        of purchase; the other half is paid for in the following month. All sales are on credit. Only 20% of a
        month’s sales are collected in the month of sale. An additional 70% is collected in the following
        month, and the remaining 10% is collected in the second month following sale. Bad debts have been
        negligible.

        Monthly operating expenses for the company are given below:

        Variable:
        Sales commissions 4 % of sales

        Fixed:
        Advertising $ 200,000
        Rent $ 18,000
        Salaries $ 106,000
        Utilities $ 7,000
        Insurance $ 3,000
        Depreciation $ 14,000

        Insurance is paid on an annual basis, in November of each year.

        The company plans to purchase $16,000 in new equipment during May and $40,000 in new
        equipment during June; both purchases will be for cash. The company declares dividends of
        $15,000 each quarter, payable in the first month of the following quarter.

        The company’s balance sheet as of March 31 is given below:

        Assets
        Cash $ 74,000
        Accounts receivable ($26,000 February sales; $320,000 March sales) 346,000
        Inventory 104,000
        Prepaid insurance 21,000
        Property and equipment (net) 950,000

        Total assets $ 1,495,000

        Liabilities and Stockholders’ Equity
        Accounts payable $ 100,000
        Dividends payable 15,000
        Common stock 800,000
        Retained earnings 580,000

        Total liabilities and stockholders’ equity $ 1,495,000

        The company maintains a minimum cash balance of $50,000. All borrowing is done at the beginning
        of a month; any repayments are made at the end of a month.

        The company has an agreement with a bank that allows the company to borrow in increments of
        $1,000 at the beginning of each month. The interest rate on these loans is 1% per month and for
        simplicity we will assume that interest is not compounded. At the end of the quarter, the company
        would pay the bank all of the accumulated interest on the loan and as much of the loan as possible
        (in increments of $1,000), while still retaining at least $50,000 in cash.

        Required:

        Prepare a master budget for the three-month period ending June 30. Include the following detailed
        schedules:

        1. a. A sales budget, by month and in total.

        b. A schedule of expected cash collections, by month and in total.

        c. A merchandise purchases budget in units and in dollars. Show the budget by month and
        in total.

        d. A schedule of expected cash disbursements for merchandise purchases, by month and in
        total.

        2. A cash budget. Show the budget by month and in total. Determine any borrowing that would
        be needed to maintain the minimum cash balance of $50,000.

        3. A budgeted income statement for the three-month period ending June 30. Use the

        contribution approach.
        4. A budgeted balance sheet as of June 30.

        Part C: Variance Analysis for Decision Making

        Bronfenbrenner Co. uses a standard cost system for its single product in which variable overhead is

        applied on the basis of direct labor hours. The following information is given:

        Standard costs per unit:

        Raw materials (1.5 grams at $16 per gram) ………………………. $24.00

        Direct labor (0.75 hours at $8 per hour) ……………………………. $6.00

        Variable overhead (0.75 hours at $3 per hour) …………………… $2.25

        Actual experience for current year:

        Units produced ……………………………………………………………… 22,400 units

        Purchases of raw materials (21,000 grams at $17 per gram) .. $357,000

        Raw materials used ………………………………………………………… 33,400 grams

        Direct labor (16,750 hours at $8 per hour) ………………………… $134,000

        Variable overhead cost incurred ………………………………………. $48,575

        Required:

        Compute the following variances for raw materials, direct labor, and variable overhead,

        assuming that the price variance for materials is recognized at point of purchase:

        a. Direct materials price variance.
        b. Direct materials quantity variance.
        c. Direct labor rate variance.
        d. Direct labor efficiency variance.
        e. Variable overhead spending variance.
        f. Variable overhead efficiency variance.
        g. As a manager, why is variance analysis important?

        Part D: Evaluation of Decentralized Organizations

        The Clipper Corporation had net operating income of $380,000 and average operating assets of

        $2,000,000. The corporation requires a return on investment of 18%.

        Required:

        a. Calculate the company’s return on investment (ROI) and residual income (RI).
        b. Clipper Corporation is considering an investment of $70,000 in a project that will generate

        annual net operating income of $12,950. Would it be in the best interests of the company to
        make this investment?

        c. Clipper Corporation is considering an investment of $70,000 in a project that will generate
        annual net operating income of $12,950. If the division planning to make the investment
        currently has a return on investment of 20% and its manager is evaluated based on the
        division’s ROI, will the division manager be inclined to request funds to make this
        investment?

        d. Clipper Corporation is considering an investment of $70,000 in a project that will generate
        annual net operating income of $12,950. If the division planning to make the investment
        currently has a residual income of $50,000 and its manager is evaluated based on the
        division’s residual income, will the division manager be inclined to request funds to make
        this investment?

        Part E: Preparing Statement of Cash Flows

        Boscia Corporation’s balance sheet appears below:

        Comparative Balance Sheet

        Ending

        Balance

        Beginning

        Balance

        Assets:

        Cash and cash equivalents ……………………. $ 44 $ 38

        Accounts receivable ……………………………. 82 69

        Inventory …………………………………………… 71 69

        Plant and equipment ……………………………. 537 500

        Accumulated depreciation ……………………. ( 240) ( 201)

        Total assets ………………………………………… $494 $475

        Liabilities and stockholders’ equity:

        Accounts payable ……………………………….. $ 70 $ 60

        Wages payable ……………………………………. 24 21

        Taxes payable …………………………………….. 19 22

        Bonds payable ……………………………………. 226 300

        Deferred taxes …………………………………….. 19 18

        Common stock ……………………………………. 22 20

        Retained earnings ……………………………….. 114 34

        Total liabilities and stockholders’ equity .. $494 $475

        The net income for the year was $108. Cash dividends were $28.

        Required:

        Prepare a statement of cash flows in good form using the indirect method.

        Assignment

         

        1. What clues does your college (university) give about its culture?
        2. What are four things you could do today to learn more about an organization you are interested in?
        3. Imagine that your good friend is starting a new job next week. What recommendations would you give your friend to help him or her do a great job onboarding into the organization?

        Assignment

        1.Use Kotter’s Model of Change Management and apply it to Sears. How would you have implemented each stage in this company’s strategic direction? Include enough detail for each step. How would you have applied Kurt Lewin’s Model to Sears? Include enough detail for each stage (ch. 10). (minimum answer requirements: 7 paragraphs of 6+ sentences each). 

         2.Explain the “psychological contract”. What occurs when employees perceive that this contract has been breached? What are the possible negative organizational outcomes? How can leadership prevent negative responses? Provide a possible plan of action to prevent employees from holding on to this perceived contract (ch. 8). Include detail (minimum answer requirements: 6 paragraphs of 6+ sentences each)View keyboard shortcutsEditViewInsertFormatToolsTable12ptParagraph
         

         

        3.Apply the PESTLE Framework to Tesla. Include enough detail for each of the external environmental factors. How does each factor impact Tesla’s competitiveness? Should the company make changes based on these findings?  Include detail (minimum answer requirements: 7 paragraphs of 6+ sentences each)

        4. Explain the internal organizational change drivers. List the pressure (driver), provide an example (company), describe how the driver and company interact and what the implications are. There are 5 drivers, use all 5 and include detail for each (ch. 3). (minimum answer requirements 5 paragraphs of 6+ sentences each). 
         

        Assignment

        Discus why we as officers and as a society should care that people who are mentally ill are significantly overrepresented in Jails.  How are the needs of those with serious mental illnesses being met and how are you communicating with them?  

        2 PAGES, APA FORMAT

        Assignment

        In a minimum of 300 words, using scholarly material and proper citations, discuss the right to a speedy and fair trial as requested by the Sixth Amendment. Your assignment must reflect at least five sources, such as your textbook and other scholarly materials (i.e., journal articles, information for other textbooks are not acceptable), APA formatted paragraphs with in-text citations, and an APA formatted reference list to receive full credit.  Your scholarly references are to be material within five years of the date of this class.  Do not submit any academic material without the author’s name or original published date of the material. No author or dated (n.d.) material is acceptable.
        You will need to submit your assignment in an APA paragraph format with in-text citations and an APA formatted reference list for grading.  Any discussion information presented as an attachment is not acceptable for grading.  If you are not familiar with the APA format, you will need to review the APA and Sample Assignment under Course Information.  Additionally, your assignment will need to be a WORD or PDF document for grading.  Any coursework written in the add comment area on BlackBoard is not acceptable for grading.

        Assignment

        Watch video link: https://www.pbs.org/wgbh/pages/frontline/handofgod/view/ another link if needed https://www.pbs.org/wgbh/pages/frontline/handofgod/

        One theory Athen’s Theory of Violentization and Hirschi’s Social Control Theory  introduce how two theories can explain crimes or criminals shown in the film.  Provide some debates between the two chosen theories and offer your critical comments on those debated areas. 

          APA formatted 2-3 pages

        Assignment

        Locate an article that covered the 2016 presidential election. Look for evidence in the article for priming, framing, and slant. Make sure to include in your assignment:

         
        Name of the article and its author
        Is the article made by a public or private entity?
        Who is the author trying to reach (audience)?
        Are they playing more to one specific ideology and if so, what ideology is it?
        Looking at the article as a whole, and based on what you have found in your analysis, do you believe that this article is a credible source? Why?

        Assignment

         

        1. Students, ..Read the Vignette below carefully and answer the five questions one by one… The Five (5) answers MUST be typed below by clicking on the item to write your answers… It MUST be written in your own words as if you were talking to the parents of Elizabeth.

        1. When Elizabeth was 4 years old, she had a near-drowning incident that resulted in a significant brain injury. Now Elizabeth is a 15 year old high school student. Elizabeth enjoys school but often struggles to understand instructions given to her by teachers and has difficulty concentrating for long periods. Elizabeth dreams of becoming an actress and would like to go to acting school, but her parents are apprehensive about her plans since she would have to move on her own to attend school…

          1). What type of disability does Elizabeth demonstrates?
          2). Explain the characteristics of this form of disability
          3). What type of interventions should Elizabeth be receiving in her school?
          4). As a teacher or psychologist, how would you deal with Elizabeth and her parents?
          5). What would be your recommendations?

          • 6

          assignment

          Assignment- Eating Disorders

          Top of Form

          Bottom of Form

          Module 04 Content

          1.

          Top of Form

          In a 3-page paper, written in APA format using proper spelling/grammar, research the topic of eating disorders and address the following:

          1. Compare and contrast anorexia nervosa and bulimia nervosa.

          2. Who is more likely to suffer from anorexia nervosa and bulimia nervosa? Why?

          3. What are the causes contributing to anorexia nervosa?

          4. What are the consequences of eating disorders?

          5. How can one diagnose eating disorders?

          6. What are the treatment and support options for a person who has eating disorders?

          Be sure to include APA citations for any resources you used as references.

          Rasmussen’s Library and Learning Services team has developed a variety of Guides to help support students’ academic endeavors. For this assignment, the Writing Guide and APA Guide may both be helpful. Also consider submitting each assignment to the online Writing Lab for feedback on your draft prior to submitting it for grading. You will find links to these Guides as well as other writing resources and services on the Resources tab.

          Submit your completed assignment to the drop box below. Please check the Course Calendar for specific due dates.

          Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

          Jstudent_exampleproblem_101504

          Bottom of Form

          Top of Form

          Bottom of Form

          assignment

          Nutrition and Disease

          Top of Form

          Bottom of Form

          1.

          Top of Form

          Nutrition plays a vital role in a person’s overall health and well-being. Not getting enough of the recommended nutrients over the long-term can lead to malnutrition which often results in disease and illness.

          In a 3-page paper, written in APA format using proper spelling/grammar, address the following:

          1. Define malnutrition and identify a specific disease that can result from it.

          2. Perform library research about the selected disease, and explain its physiological effects on a person’s body. 

          3. Describe the relationship between specific foods/nutrients and the disease. Use the questions below to guide your response.

          4. Does research indicate that a lack of specific foods/nutrients increase a person’s chance of contracting the disease?

          5. Are there specific foods/nutrients that should be avoided by an individual afflicted with the disease?

          6. How do specific foods/nutrients work physiologically within the body to help combat the disease?

          7. Evaluate nutritional recommendations to help combat the disease.

          8. Cite at least 3 credible references and present the resources in APA format on the References page.

          For information about the impact of diseases on body systems and assessing the credibility of resources, consult the resources below.

          .
          How do I know if a source is credible?

          .
           I need to find information about a disease and the body system it impacts.

          Submit your completed assignment to the drop box below. Please check the Course Calendar for specific due dates.

          Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below

          Bottom of Form

          Top of Form

          Bottom of Form

          Assignment

           

          Consider your own level of resilience as a leader. Honestly answer the following questions:

          1. Resilience is an important personal resource for the change manager (and for managers in general). How have you displayed resilience as a leader?
          2. Resilience is a capability that can be developed and improved through training and practice. In what ways have you developed your level of resiliency as a leader?
          3. Ways to improve resilience include mindfulness, meditation, self-awareness, self-confidence, relaxation, humor, keeping fit and healthy, developing supportive relationships, and avoiding harmful actions such as alcohol and drug abuse. How do you plan on continuously improving your level of resiliency in the future?

          Assignment

          PCN-672 Safety Plan

          Scoring Guide

          Grading Category

          Points

          Comments

          The safety plan includes the actions that will be taken to establish and maintain safety, both physically and mentally.

          0/___



          The safety plan indicates if an order of protection will need to be filed.

          0/___

          Safety plan lists any alternative routes the child can take to avoid the other child.

          0/___

          The safety plan includes that law enforcement and school officials are involved in the child’s protection.

          0/___

          Safety plan includes safe person(s) the child can go to if bullying continues on or off school grounds.

          0/___

          The safety plan includes the child support group (family, teachers, friends)

          0/___

          Safety plan follows industry best practices and adheres to latest version of DSM/ICD.

          0/___

          Safety plan follows a logical order, little to no grammatical errors present.

          0/___

          Total

          0/

          ©2015 Grand Canyon University. All Rights Reserved.

          assignment

          1.

          Top of Form

          Imagine you have been asked to speak to a group of parents about promoting self-esteem in school-age children. You need to research the topic and prepare a visually appealing PowerPoint slideshow to accompany your presentation. Your PowerPoint slideshow will need to:

          1. Have a title slide.

          2. Contain 5-10 content slides that include Speaker Notes which provide supporting details to use when elaborating on the slide contents.

          3. Address the following questions:

          4. How does level of self-esteem typically change during middle childhood? What factors contribute to this change?

          5. What are some influences on school-age children’s self-esteem?

          6. Does very high self-esteem always have positive effects on children’s adjustment? Why or why not?

          7. What are the typical consequences of low self-esteem?

          8. What are some other strategies that parents and teachers can use to promote children’s self-esteem? What behaviors should adults avoid, and why?

          9. Be written using proper spelling/grammar.

          10. Cite at least 3 academic references and present the sources in APA format on a References slide.

          For information about creating PowerPoint presentations or how to add Speaker Notes, consult the resources below.

          .
          Writing Guide: PowerPoints

          .
          How do I add speaker notes to my PowerPoint presentation slides?

          Submit your completed assignment to the drop box below. Please check the Course Calendar for specific due dates.

          Save your assignment as a Microsoft PowerPoint presentation. (Mac users, please remember to append the “.pptx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

          Jstudent_exampleproblem_101504

          Bottom of Form

          Top of Form

          Bottom of Form

          Top of Form

          Bottom of Form

          assignment

          Module 03 Content

          1.

          Top of Form

          People lead busy lives. Many individuals find it easy to lose track of just how much food and drink they have consumed throughout the day. This assignment will provide you with an opportunity to track and reflect on your nutritional intake. The results may surprise you!

          For this assignment, use the Nutritional Intake Worksheet (below) to:

          1. Familiarize yourself with the 2020 – 2025 USDA Dietary Guidelines for an adult.

          2. Track all of the food and beverages you consume for a 3-day period.

          3. Analyze your nutritional intake compared to the USDA Dietary Guidelines.

          4. Answer a series of self-evaluation questions.

          . File: 

          Nutritional Intake Worksheet

          Submit your completed assignment to the drop box below. Please check the Course Calendar for specific due dates.

          Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

          Bottom of Form

          Assignment


          Thesis Statement for the Integrative Literature Review

          In this assignment, you will create the thesis statement for your Final Assignment. The thesis is the statement of your perspectives on the literature. It should also include the rationale and relevant empirical and theoretical background supporting your perspectives. The primary objective of this assignment is to outline specific areas of inquiry you intend to answer in the course of the Integrative Literature Review. Although they may change during the course of the review, articulating these areas of inquiry early will help provide focus and direction for your research.

          Begin by introducing the areas of inquiry to be included in your Integrative Literature Review. Explain your perspective on the literature and include how you arrived at this viewpoint, how the literature you have chosen to include supports this viewpoint, and why this perspective is relevant to the field of psychology.

          Based on your introduction, briefly discuss the literature you have chosen by integrating concepts developed from your four different content domains. Be sure to utilize at least one peer-reviewed source per domain. Construct clear and concise arguments using evidence-based psychological concepts and theories to support your perspectives regarding the literature.

          To conclude your assignment, identify any overarching implications shown in the studies and describe how these influenced your perspectives on the literature.

          The Integrative Literature Review: Thesis Statement

          · Must be two to three double-spaced pages in length (not including title and reference pages) and formatted according to APA style as outlined in the UAGC Writing Center.

          · Must include a separate title page with the following:

          · Title of paper

          · Student’s name

          · Course name and number

          · Instructor’s name

          · Date submitted

          · Must begin with an introductory paragraph that has a succinct thesis statement.

          · Must address the topic of the paper with critical thought.

          · Must end with a conclusion that reaffirms your thesis.

          · Must use at least four peer-reviewed sources (one source per domain).

          · Must document all sources in APA style as outlined in the UAGC Writing Center.

          · Must include a separate reference list that is formatted according to APA style as outlined in the UAGC Writing Center

          Final Assignmnent


          Week 6 – Final Assignment

          · Due Mar 14 by 11:59pm

          · Points 30

          · Submitting an external tool


          Integrative Literature Review

          Pathbuilder is being used for this assignment. Please be certain to complete the “Survey Acknowledgement Quiz” this week in order to submit the Integrative Literature Review. You will not be allowed to submit your Final Paper until you have completed the quiz this week.

          The primary goal of this literature review is to integrate concepts from four different content domains within the larger field of psychology. The four content domains should be chosen from previous coursework in this program. In this paper, students will review the findings in the individual empirical articles, organize the research in a meaningful way, evaluate the reliability, validity, and generalizability of the research findings, and present an integrated synthesis of the research that sheds new light on the topics within and across the four domains.

          The result of a successful integrative literature review may be a significant contribution to a particular body of knowledge and, consequently, to research and practice. Therefore, before writing this literature review, substantive new research must be conducted via the Internet and within the UAGC Library for each of the four chosen domains. A minimum of six sources must be included for each of the four domains. Although content from literature reviews completed in prior courses within this program may be included, it may not constitute the total research for the individual domains addressed within this assignment. No more than four sources from previous literature reviews completed in this program may be utilized for this integrative review.

          The headings listed below must be used within the paper to delineate the sections of content. These sections include the following: a clear introduction that provides a general review and organizes the research in a meaningful way; a discussion in which the evidence is presented through analysis, critique, and synthesis; and a conclusion in which the discussion is drawn together in a meaningful way, the claims of the introduction are brought to a logical closure, and new research is proposed.

          Introduction

          · Provide a conceptual framework for the review.

          · Describe how the review will be organized. The questions below may be used to guide this section.

          · What are the guiding theories within the domains?

          · How are the domains connected?

          · Are there competing points of view across the domains?

          · Why is the integration of these domains important?

          · What is the history of these domains?

          · What are the related theories or findings?

          · Describe how the literature was identified, analyzed, and synthesized.

          · How and why was the literature chosen?

          · What is your claim or thesis statement?

          Discussion

          · Provide the analysis, critique, and synthesis for the review.

          Analysis

          · Examine the main ideas and relationships presented in the literature across the four domains.

          · Integrate concepts from the four different content domains within the larger field of psychology.

          · What claim(s) can be made in the introduction?

          · What evidence supports the claim(s) made in the introduction?

          Critique

          · Evaluate the reliability, validity, and generalizability of the chosen research findings.

          · How well does the literature represent the issues across the four domains?

          · Identify the strengths and the key contributions of the literature.

          · What, if any, deficiencies exist within the literature?

          · Have the authors omitted any key points and/or arguments?

          · What, if any, inaccuracies have been identified in the literature?

          · What evidence runs contrary to the claims proposed in the introduction, and how might these be reconciled with the claims presented?

          · Explain how the APA’s Ethical Principles of Psychologists and Code of Conduct might influence the reliability and/or generalizability of the chosen findings.

          · Did the ethical issues influence the outcomes of the research?

          · Were ethical considerations different across the domains?

          Synthesis

          · Integrate existing ideas with new ideas to create new knowledge and new perspectives.

          · Describe the research that has previously been done across these domains, as well as any controversies or alternate opinions that currently exist.

          · Relate the evidence presented to the major conclusions being made.

          · Construct clear and concise arguments using evidence-based psychological concepts and theories to posit new relationships and perspectives on the topics within the domains.

          Conclusion

          · Provide a conclusion and present potential future considerations.

          · State your final conclusion(s).

          · Synthesize the findings described in the discussion into a succinct summary.

          · What questions remain?

          · What are the possible implications of your argument for existing theories and for everyday life?

          · Are there novel theories and/or testable hypothesizes for future research?

          · What do the overarching implications of the studies show?

          · Where should the research go from this point to further the understanding of these domains and the greater study of psychology?

          Attention Students: The Masters of Arts in Psychology program is utilizing the Folio portfolio tool as a repository for student scholarly work in the form of signature assignments completed within the program. After receiving feedback for this Integrative Literature Review, please implement any changes recommended by the instructor, go to your Folio account and upload the revised Integrative Literature Review as a project in your portfolio. (Use the Setting Up and Using Folio

          (Links to an external site.)

          guide to create an account if you do not already have one.) The upload of signature assignments will take place after completing each course. Be certain to upload revised signature assignments throughout the program as the portfolio and its contents will be used in other courses and may be used by individual students as a professional resource tool.

          The Integrative Literature Review

          · Must be 20 to 30 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the UAGC Writing Center.

          · (Links to an external site.)

          ·

          · Must include a separate title page with the following:

          · Title of paper

          · Student’s name

          · Course name and number

          · Instructor’s name

          · Date submitted

          · Must begin with an introductory paragraph that has a succinct thesis statement.

          · Must address the topic of the paper with critical thought.

          · Must end with a conclusion that reaffirms your thesis.

          · Must use at least 24 peer-reviewed sources, including a minimum of 20 from the UAGC University Library.

          · Must document all sources in APA style as outlined in the UAGC Writing Center.

          · Must include a separate reference list that is formatted according to APA style as outlined in the UAGC Writing Center.

          Assignment

           

          If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

          These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

          In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

          To Prepare:

          • Review the Resources and select one current national healthcare issue/stressor to focus on.
          • Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
            • 10

            Assignment

            1. Compare and contrast the use of licensure and accreditation in terms of accountability and quality improvement.

            2. What role can or should accreditation play in the future, as the public availability of performance data increases?

            3. What roles do the market, regulation, and professionalism play in defining and promoting the use of accreditation as a means of accountability across the continuum of care? How would the implementation of a single-payer, government-financed system affect

              • 10

              ASSIGNMENT

               As healthcare has evolved so has the concept of a patient or consumer of healthcare. Technology and culture are among the many variables that have affected our concept of a healthcare patient. Consider these items among the others noted in your text:

              • What has most influenced the way you view yourself as a consumer of healthcare?
              • What factors led to the redefinition of the patient as a consumer in the late twentieth century?

              assignment

              Prior to beginning work on this assignment, review Chapter 1 and Chapter 2 in your course textbook, Chapter 3 in the Jarman (2013) e-book, the Week 1 Instructor Guidance, and review the 

              Describing Data (Links to an external site.)

               video and the Khan Academy video on 
              Interquartile Range (IQR)
               (Links to an external site.)
              . Also, complete the Week 1 learning activity and Week 1 weekly review.

              This exercise requires the use of a descriptive statistics calculator. You can find this tool in some versions of Excel (as part of the Analysis ToolPak) or you can use one of the many free online descriptive calculators such as the 
              Descriptive Statistics Calculator (Links to an external site.)
               by Furey (n.d.).

              Your instructor will post an announcement with the data set for your Week 1 assignment.

              First, use either Excel or the Furey (n.d.) descriptive statistics calculator to calculate the descriptive statistics for the given data set. This is explained in Chapter 1 of your course text.

              You should get an output similar to the image in Figure 1.3 from your textbook. This output must contain the following values: mean, standard error, median, mode, standard deviation, sample variance, kurtosis, skewness, range, minimum, maximum, sum, and count.

              Next, begin writing your paper by reporting your results for each of the values listed above.

              Include the data set, the output from the analysis, and the answers to the following questions:

              · Evaluate the measures of central tendency. Address the following when completing this component:

              · Which measure of central tendency is most appropriate based on the data type?

              · Are the mean, median, and mode close to the same value? If not, what does this tell you about the numbers in the set?

              · Identify any mode(s) in the data set. Is there a mode at all? Is there more than one mode?

              · Calculate manually the interquartile range and the values of Q1 and Q3. (It is important to calculate this manually because the interquartile range and quartiles output from Calculator Soup might not be accurate.) Address the following when completing this component:

              · Test to see if there are any outliers in the set. If so, which number(s)?

              · Which method from Section 2.4 of the text did you first use to check for outliers?

              · Now try the other method from Section 2.4 of the text. Do you come to the same conclusion about outliers in the data set?

              · Explain which descriptive statistic you think best summarizes this set of numbers and why.

              · Choose three of the descriptive statistics that you feel best represent this data set. Why were they chosen?

              The Descriptive Statistics Data Analysis assignment

              · Must be two to three double-spaced pages in length (not including title and references pages) and formatted according to APA Style as outlined in the Writing Center’s 

              APA Style (Links to an external site.)


               resource.

              · Must include a separate title page with the following:

              · Title of paper

              · Student’s name

              · University name

              · Course name and number

              · Instructor’s name

              · Date due

              For further assistance with the formatting and the title page, refer to 

              APA Formatting for Microsoft Word (Links to an external site.)


              .

              · Must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear statement that indicates the purpose of your paper, to report and explain your analysis of the data set.

              · For assistance on writing 

              Introductions & Conclusions (Links to an external site.)


              , refer to the Writing Center resources.

              · Must use the course text and Excel or the 

              Descriptive Statistics Calculator (Links to an external site.)


              .

              · Must document any information used from sources in APA Style as outlined in the Writing Center’s 

              APA: Citing Within Your Paper (Links to an external site.)


               guide.

              Must include a separate references page that is formatted according to APA Style as outlined in the Writing Center. See the 

              APA: Formatting Your References List (Links to an external site.)


               resource in the Writing Center for specifications.

              Assignment

              You will need to answer the questions attached to the pictures in the uploaded file.

              Make sure you label the question by writing the question then the answer and stating for which section it is since the questions are the same but the sections are different. 

              There are 4 sections you will need to observe and then answer the question.

              The answer for the questions do not have to be long responses they can be short simple responses.

              There are a total of 6 pictures, 4 of them include the sections and the other two the questions.

              Assignment

              Assignment Description:

              WriteanWritea essayon ONE topic (and all itssubtopics) from the list shown below (min 1000 wordsnot counting your Reference List). Your essayshould be well-organized. DO NOT DIVIDE THEESSAY BY SECTIONS, THE ESSAYDISCUSSION SHOULD FLOW BETWEENPARAGRAPHS.

              THIS IS AN ACADEMICESSAY NOT AN OPINION PIECE. Support your points with class readings and examples from case studies. Do not simply list everything there is on the readings, explain your reasoning and support it with course readings/slides/lectures.

              Use a Minimum 6 sources from class, there is no maximum amount. For your core 6 sources you can only use 1 multimedia source (class videos), the remaining 5 must be class provided articles. You can use more multimedia sources and even external articles to supplement (not replace) the core 6 class sources. 

              Assignment Specifications (Graded)
              • Create a doc or docx file. Times New Roman, Font Size 12, SINGLE SPACE. 1 Inch margins.
              • Identify the Topic you chose to answer, name, date and class in a separate titlepage. No abstract, index, pictures or graphs allowed. This is aessay  it does not have sections. The ideas should flow from paragraphtoparagraph.
              • No lengthy introductions, you can start youressay with a simple statement of about 50 words maximum and then go straight for the answers to the questions. No separate conclusionsorclosing statements allowed, these tend to be redundant. 
              • THIS IS NOT AN OPINIONESSAY so use paraphrasingof class readings and support this paraphrasing with APA in text citations, check the APA guides provided on the folder in the course modules.
                • Example:Citing in text means to paraphrase and credit your sources (Brown, 2012). 
              • NO “direct quotes”, paraphrase and reference your source in APA in text citations. All your text must be ORIGINAL. 
              • Include reference list at the end, in APA style and alphabetical order.
              • Spell-check and re-read your responses, grammar and composition will be graded. 

              TOPICS: SELECT ONE AND ANSWER ALL ITS SUBTOPICS

              TOPIC #1: In the course of the semester we have studied multiple disasters from all over the world, we have learned that each country faces specific challenges when practicing emergency management. We can thus conclude that Emergency Management is done better when applied to local unique characteristics/ vulnerabilities. Choose 1 case study from Weeks 3-7 and 2 case studies from Week 9-14 (can include your disasterpaper), to discuss:

              1.a The importance of emergency management practice tailored to local characteristics. Identify local characteristics (one specific characteristic/ vulnerability per case) that made these 3 cases unique in the world. How did these local characteristics influence the disaster consequences in the 3 cases. (700 words minimum)

              1.b For EACH case study (total 3) discussed above describe Emergency Management practices to reduce that unique vulnerability. Which activities in mitigation, preparedness, response and recovery (discuss all 4) can help reduce disaster consequences in each case? (300 words minimum)

              Assignment

              2

              Transcript

              Inside Italy’s COVID War

              View film https://www.pbs.org/wgbh/frontline/film/inside-italys-covid-war/

              FRANCESCA MANGIATORDI:

              It’s 8 o’clock on March 17. I just finished my 12-hour shift, and what affected me most tonight? A lady asked me, crying, what was going to happen to her? Why was she there on a stretcher in the hallway with 15 others and only one toilet? There is no dignity anymore; we’ve lost the sense of humanity.

              I don’t know what the aim is of working in this way. And in the end, the role of the doctor loses its meaning.

              FRANCESCA MANGIATORDI:

              I can barely cry. I don’t know how the patients can have such capacity to stay there, waiting for hours and hours, in some cases days, without knowing what their fate will be. And you really can’t give them an answer.

              FRANCESCA MANGIATORDI:

              Hi, Francesca Mangiatordi, Emergency Room. What’s your situation for beds? Nothing, OK, bye.

              Hello, ER. Can you tell me if you have any beds, please? Nothing? Thanks. F—— hell!

              Hello, ER. Can you tell me the situation for beds, please? Nothing? Thanks. There are no beds.

              MARCH 2020, NORTHERN ITALY

              THE HEIGHT OF THE CORONAVIRUS PANDEMIC

              MALE NURSE:

              No, no, no, no, no no no. You have to keep it on, really.

              FRANCESCA MANGIATORDI:

              Check if there’s space in Waiting Room 3.

              EVERY WARD AT CREMONA HOSPITAL IS FULL OF COVID PATIENTS

              FRANCESCA MANGIATORDI:

              They’ll be a bed available in gynecology. But not for an hour. There’s been a death and they’re waiting for the cleaning. Yes, yes. COVID.

              All the CT scans are practically the same now. They are all ugly. He’s 35 years old. He’s young! We’ll definitely have to admit him, since it’s possible.

              Unfortunately, I’m going to have to choose whether to admit him or an 85-year-old.

              FEMALE VOICE:

              What will you choose?

              FRANCESCA MANGIATORDI:

              The 35-year-old. We’ve had to make choices like this for a month now.

              CRISTEL,30 years old:

              I told my husband I’m going to the hospital. He was scared to let me come. We have three small girls and there’s a higher risk of infection. I ended up coming. The doctor said—I’m not sure if I have the virus, but she said it sounds like the initial stages of pneumonia. Let’s hope it all goes well.

              I hear that those unlucky not to make it are the elderly. I’m 30. I’m young. I hope—I’m hopeful. But I’m very scared.

              Tell me, I’ve got three girls, tell me the truth?

              FEMALE NURSE:

              Three girls? I don’t know, do they live with you?

              CRISTEL:

              No, I mean, is it serious?

              FEMALE NURSE:

              I can’t say, but I mean—

              OK, I’ll get you a bottle of water so you can drink.

              GIRL’S VOICE ON PHONE:

              Mama!

              CRISTEL:

              Chiara, can you pass me to Daddy?

              FEMALE NURSE:

              Take this.

              CRISTEL:

              Thank you. Listen, where are you? Go downstairs a second. They said it’s not pretty, so—I don’t know yet, Sebastian. The radiologist needs to check the X-rays, but at first glance, it’s not pretty. I don’t know, Sebastian. [Coughs] Don’t say anything in front of the girls. OK, bye, bye.

              FRANCESCA MANGIATORDI:

              Yes, it’s fairly widespread. It starts here and practically her whole lung has pneumonia. No longer functioning. There’s no doubt that the test will come back positive.

              She’s 30 years old. Healthy. It’s no longer true that it’s affecting just the elderly.

              Hi, excuse me from the ER. Do you have a female bed? There’s a young woman to transfer.

              CRISTEL:

              It feels like a nightmare.

              FEMALE VOICE:

              How old are your girls?

              CRISTEL:

              The eldest is 11, the middle one 7 and the little one is 3. The little one can’t live without me.

              Sebastian? I can’t handle this. I’m scared. [Cries]

              FRANCESCA MANGIATORDI:

              Take some deep breaths. Gently.

              I know my colleagues, they’re struggling, fighting every moment, having to choose the life of a younger person over an older one. Their faces are almost expressionless now. They’re like walking ghosts, because they don’t want to have to make the decision whether to intubate someone or not.

              I believe it’s an unfair battle. We have few weapons; the virus has them all. But with the few we have, we are trying to resist and fight back. It may be an unfair battle, but we are fighting it anyway. We won’t give up.

              MALE NEWSREADER:

              [Speaking English] Let’s bring you some breaking news from Italy. Coronavirus deaths have risen by 683 in 24 hours, lifting the total death toll to 7,503.

              FEMALE NEWSREADER:

              [Speaking English] We’re now into Day 9 of the lockdown. The authorities believe that the next week or so is very crucial. The peak infection rate still has not yet been reached here.

              MALE NEWSREADER:

              [Speaking English] Today Italy has passed a deadly milestone: more people dead from the virus than in China.

              FRANCESCA MANGIATORDI:

              [Speaking Italian] I’m just going to wash my hands. OK, I’m ready. Have you studied everything, kids?

              FRANCESCA’S KIDS:

              Yes.

              FRANCESCA MANGIATORDI:

              All of it?

              FRANCESCA’S KIDS:

              Yeah.

              MARIA TERESA MANGIATORDI:

              Guess what the homework was about? Viruses.

              FRANCESCA MANGIATORDI:

              Viruses. You’re talking about coronavirus. Let’s say the only positive thing is that there’s no more pollution. Only that, the rest is tragedy. Right, let’s get organized to eat, I’m hungry.

              When I get home from work, my family is there. My husband, Michele, and my kids, Damiano, who’s 13, and Maria Teresa who’s 11.

              So now we are six people down in the ER.

              MICHELE MANGIATORDI:

              It’s war.

              FRANCESCA MANGIATORDI:

              Yes, it’s a war. We’re dropping like flies.

              I read today that we’ve reached—actually we’ve overtaken—

              MICHELE MANGIATORDI:

              China?

              FRANCESCA MANGIATORDI:

              Yes, China.

              MICHELE MANGIATORDI:

              Yeah, I read that.

              FRANCESCA MANGIATORDI:

              With Michele, my husband, I talk about everything that happens at the hospital. He’s always been very supportive, even though he’s more scared than me.

              He suffers from a respiratory problem, so if I bring COVID home, he’d be the first to catch it. This scares us both. The thought of living alone at this time would have been really hard, even harder. I don’t think I would’ve been able to confront everything I did in the hospital.

              We haven’t hugged each other in a month, and I feel the burden because the desire to hug and kiss them is very strong. But I need to protect them. There’ll be other times when I’ll be able to cuddle them.

              Stay home!

              MATTIA, 18 years old

              FRANCESCA MANGIATORDI:

              This morning we admitted an 18-year-old patient named Mattia, one of the youngest patients we’ve seen so far. He’s been intubated and he’s now in the ICU.

              The lower parts are totally inflamed.

              MALE MEDICAL COLLEAGUE:

              Poor kid. While they were putting him to sleep, he said, “I’m scared I’m going to die.” I said, “No, we’re doing this to help you.”

              FRANCESCA MANGIATORDI:

              There was no one with him, right? The parents?

              MALE MEDICAL COLLEAGUE:

              I asked him if he wanted to speak to his mom and he said he didn’t feel up to it.

              FRANCESCA MANGIATORDI:

              And then did you get in touch with her?

              MALE MEDICAL COLLEAGUE:

              I think Intensive Care did.

              FRANCESCA MANGIATORDI:

              Damn it!

              It’s terrible. For a mother, a situation like this is devastating. She couldn’t see him, be close to him, hold his hand in the moment when he was intubated. I would’ve thrown myself on him like a blanket to protect him, really. Because young people are the basis for everything. The elderly have played their part. It’s almost normal that there’s death after a certain age. But waiting for death at 18—it’s horrible.

              I hope with all my heart that he will get better. But from what I’ve seen in the scan—I don’t know.

              I’m not expecting big improvements. Damn it. All right. There you go, the mask broke.

              FRANCESCA’S MOTHER [on phone]:

              Hello?

              FRANCESCA MANGIATORDI:

              Mom?

              FRANCESCA’S MOTHER [on phone]:

              Beautiful, what are you doing?

              FRANCESCA MANGIATORDI:

              I’m just leaving the hospital. How are things? Is everything OK?

              FRANCESCA’S MOTHER [on phone]:

              Not bad. Your dad is not getting up.

              FRANCESCA MANGIATORDI:

              Ah, it’s OK. Let him rest, leave him. Are you eating?

              FRANCESCA’S MOTHER [on phone]:

              Yes, your dad had milk and cookies.

              FRANCESCA MANGIATORDI:

              OK, good.

              My father has dementia. My mother cares for him. They’re both 80 years old. They never used to go out except to church. They haven’t really understood how serious the situation is.

              FRANCESCA’S MOTHER [on phone]:

              [Laughs] Oh, well! Yes, come for the Easter holidays.

              FRANCESCA MANGIATORDI:

              What are you saying, Mom. We won’t be allowed to travel by Easter.

              FRANCESCA’S MOTHER [on phone]:

              I wish! But I don’t think so. This morning the pope said, “Pray, pray for me.”

              FRANCESCA MANGIATORDI:

              Ah, not for everyone? Yes, you pray and I’ll keep busy.

              FRANCESCA’S MOTHER [on phone]:

              [Laughs] All right.

              FRANCESCA MANGIATORDI:

              Kisses, Mom, speak to you tomorrow.

              The pope will resolve everything, we’ll be fine. [Laughs]

              FEMALE NEWSREADER:

              [Speaking English] There are now more than 525,000 cases globally. The pandemic has killed more than 23,000.

              FEMALE NEWSREADER:

              [Speaking English] I can’t quite believe we’re seeing these numbers. Nine hundred nineteen people have lost their life in the last 24 hours in Italy. That is by far the biggest loss of life in a 24-hour period, not just in Italy, but globally.

              FEMALE NEWSREADER:

              [Speaking English] It’s impossible to imagine what that feels like for the people working on the front line, the doctors and nurses. We know now that 14% of the positive cases are front-line health care workers as they are well into their third week in lockdown with no end date in sight.

              FRANCESCA MANGIATORDI:

              [Speaking Italian] Can you hear me? Stick your tongue out. It’s totally dry. Let’s send him to have a head CT scan.

              A patient has arrived from another ward with a little bleeding on the brain. Tell them he can be

              transferred from orthopedics.

              FEMALE MEDICAL COLLEAGUE:

              So he’s not a COVID patient?

              FRANCESCA MANGIATORDI:

              No.

              FEMALE MEDICAL COLLEAGUE:

              Is he at risk of getting infected?

              FRANCESCA MANGIATORDI:

              Very high.

              Five weeks have passed, and, bit by bit, our colleagues are getting sick.

              Put your mask on! Otherwise the virus will fly around.

              That’s another fallen soldier.

              FEMALE MEDICAL COLLEAGUE:

              Oh, yes?

              FRANCESCA MANGIATORDI:

              Yes. A colleague who worked until yesterday. He was fine.

              This is the list of the new doctors who are helping us out. So initially we had 9, 10, 11—11, and we’re left with 2, 3, 4, 5—and 5. So we’re left with less than half.

              When we started to admit COVID patients in the first week, I understood that, as medical personnel, we were very fragile.

              MALE NURSE:

              I’m going out for a breath of fresh air. I’ve got abdominal pain.

              FRANCESCA MANGIATORDI:

              It’s all the tension.

              We were always questioning each other. Any or all of us could be next.

              Your temperature? You’ve taken it? All good?

              LAURA BOCCHI:

              Yeah, but yesterday my nose started running.

              LAURA BOCCHI:

              I also started getting chills. Then the paranoia started.

              There’s a fear of becoming infected and in turn infecting the ones who are closest to me. It feels like the virus is circulating and the circle is getting smaller. Now I’m worn out, I’m tired and I’m more scared. So, yeah.

              FRANCESCA MANGIATORDI:

              We’ll make it, Bocchi.

              Let’s give each other strength. I’m almost a stranger to myself. My head and body go in different directions.

              LAURA BOCCHI:

              You know what my heart rate was last night? 110.

              FRANCESCA MANGIATORDI:

              Very good. I haven’t measured mine, might have to now. I’m smoking like hell.

              LAURA BOCCHI:

              Maybe I should start smoking, too.

              FRANCESCA MANGIATORDI:

              OK, speak later.

              THE NEXT DAY, LAURA IS TESTED FOR COVID-19

              LAURA BOCCHI:

              Today we got back the results from the swab. The swab is positive.

              It’s weird being here, at home alone. It’s strange to be here, isolated from my husband and son. So, now I have crossed to the other side. And that’s that.

              It’s complicated for me to accept.

              LAURA BOCCHI:

              But this is how it is.

              And so, little by little, not without fear, we’ll attempt to come out of it. And we’ll try to do the things I always say to my patients, but that now I have to do myself instead.

              I’m a patient and unfortunately I possess medical knowledge, which doesn’t calm me down and instead sometimes makes my fear worse.

              FEMALE NEWSREADER:

              [Speaking English] Sixty-one doctors have now died from COVID-19 along with 11,500 citizens in just 5 1/2 weeks. The head of Italy’s emergency response says the virus may now be at its peak, but there’s no respite yet for the country’s health care.

              FEMALE NEWSREADER:

              [Speaking English] —and the head of the U.N. says the pandemic is the worst global crisis since World War II.

              ANTÓNIO GUTERRES, Secretary-General of the United Nations:

              We are slowly moving in the right direction, but we need to speed up and we need to do much more if we want to defeat the virus and if we want to support the people in it. This is not a financial crisis. This is a human crisis.

              ALDO [on phone]:

              [Speaking Italian] Francesca?

              FRANCESCA MANGIATORDI:

              I can’t believe it, Aldo! Damn it! I saw you were a bit odd when we did the afternoon shift, remember?

              ALDO [on phone]:

              I was tired.

              FRANCESCA MANGIATORDI:

              I was saying, “Strange, Aldo’s like that.” It seemed to me way too odd. And when on Friday they said, “He’s got a fever,” I went, “F—, another fallen at war, damn it.”

              ALDO [on phone]:

              No, I was tired. For a few days, I had a bit of nausea. Not much appetite.

              FRANCESCA MANGIATORDI:

              Yes, Aldo, we’ve seen the picture, you’re not in the clear. You know it well, let’s see what it looks like. In the meantime, let’s find out if you’ve got pneumonia or not.

              ALDO [on phone]:

              Yeah, but I’ll s— my pants, you know? Picturing my lungs full of—

              FRANCESCA MANGIATORDI:

              No! Full of what? You breathe well, your saturation is good. We shall see tomorrow, OK?

              Another fallen.

              MICHELE MANGIATORDI:

              It’s like Laura said, “The circle gets smaller.”

              In the morning when she leaves I text her, “Keep me updated!” And she just—Got it?

              FRANCESCA MANGIATORDI:

              It’s true.

              MICHELE MANGIATORDI:

              It’s not easy. Absolutely not. Then, a bit, but just a tiny bit, I’m a little more fearful than her. Just a tiny bit. Could you not be a house painter?

              FRANCESCA MANGIATORDI:

              [Laughs] Then we wouldn’t have met! Sacrifice and blood. [Laughs] So—

              Bye.

              DAMIANO MANGIATORDI:

              I don’t worry about Mom because I know she’ll make it.

              DAMIANO, 13 years old

              DAMIANO MANGIATORDI:

              Well, you know when in movies, or in games—ah, “Endgame,” OK? There’s the final part where all the Marvel heroes are—I imagine Mom like Captain America. She gives the order to attack. I imagine her in the role of Captain America.

              MARIA TERESA MANGIATORDI:

              When I was younger, I didn’t really understand what her job was. I just knew she was a doctor.

              MARIA TERESA, 11 years old

              MARIA TERESA MANGIATORDI:

              But now she’s in contact with a lot of people who have coronavirus, I’m scared that she might bring it home. Not much for myself and my brother, but for my dad, who could get it.

              DAMIANO MANGIATORDI:

              I’m proud of her because I know how difficult it is to be a doctor. I know how tough it’s been for her now. She doesn’t do it for herself, but she does it for us. And for others, too.

              MARIA TERESA MANGIATORDI:

              I’m scared. I’m also scared for my parents because I’m scared that if they get a severe case of coronavirus and that me and Damiano, my brother and I have to be at home alone and—I don’t know how to cook and him neither, I mean, not very well. And we don’t know how to divide the chores between us. [Cries] Without them, we don’t know how to do anything.

              INTENSIVE CARE UNIT

              MATTIA

              CRISTINA PILATI:

              Here we don’t really see them get better, unfortunately. Either they die, or the ones who improve are transferred.

              SASHA JOELLE ACHILLI, Correspondent:

              How many deaths have there been?

              CRISTINA PILATI, ICU Nurse:

              Here? I’ve lost count.

              This is a really, really horrible thing. All this in the body of a child. Because at 18 years old you’re still a child.

              FRANCESCA MANGIATORDI:

              So, I’ve been upstairs to visit Mattia, the 18-year-old boy who was intubated. I read an article in the newspaper, written by his mom, who, in the evening while she’s waiting for the phone calls, hopes not to receive any that might give her even worse news. And above all she asks the nurses to caress him—as if she were doing it herself.

              LAURA BOCCHI:

              Today I’m starting to get used to the idea that I need to stay locked in here and that I have become a patient.

              I’m starting to adapt to the space that my son so generously gave me—namely, his room.

              RULES

              1. Knock & don’t open

              2. Enter only with gloves and mask

              3. Wash Laura’s things separately

              4. Wash hands every time you cough and you touch the mask

              5. No kisses for now

              I love you all.

              LAURA’S SON:

              Mom? Mom?

              LAURA BOCCHI:

              Tell me?

              LAURA’S SON:

              Am I disturbing you?

              LAURA BOCCHI:

              No, love, tell me.

              LAURA’S SON:

              I wanted to ask if you wanted tonight to have passatelli in broth.

              LAURA BOCCHI:

              You’ve made passatelli?

              LAURA’S SON:

              We’d like to make them, they only take 10 minutes.

              LAURA BOCCHI:

              Yes, yes, that’s fine. But can you tell Dad that I’d like a tea please?

              LAURA’S SON:

              I can make it for you if you want.

              LAURA BOCCHI:

              Will you make it? Thank you.

              LAURA’S SON:

              OK.

              LAURA BOCCHI:

              What prevails today most of all is a huge fatigue, physical, that has me wondering how was I able to keep on working?

              LAURA’S HUSBAND:

              If you bring me my cup, we can sit for a bit with Mom.

              Are you done?

              LAURA BOCCHI:

              Yes.

              LAURA’S SON:

              Can I take this off?

              LAURA’S HUSBAND:

              No, if we’re inside no, if we’re outside, yes.

              LAURA’S SON:

              How am I supposed to eat then, like this?

              LAURA BOCCHI:

              Hi!

              LAURA’S SON:

              Hi.

              LAURA BOCCHI:

              How are you?

              LAURA’S SON:

              Good.

              LAURA’S HUSBAND:

              Did you put lipstick on?

              LAURA BOCCHI:

              Oh, yes, I put some on as it’s been a while that I’ve looked very dark and cadaverlike. It’s been two days since I started again.

              Maybe this is also a time to rest, to let the images of this past month go a bit—that has been strenuous, from every perspective, both physical and psychological.

              LAURA’S HUSBAND:

              You know, it’s 10 past five.

              LAURA’S SON:

              Can we go play for a bit?

              LAURA’S HUSBAND:

              We’ll stay on the terrace for a bit since it’s a nice day.

              LAURA’S SON:

              True.

              LAURA BOCCHI:

              That’s right. Even I’m keeping the window open. It’s really nice today.

              LAURA’S HUSBAND:

              Listen, thanks for the company.

              LAURA’S SON:

              Bye, Mom!

              FRANCESCA MANGIATORDI:

              Hey, Laura!

              LAURA BOCCHI [on phone]:

              Hey! Do you think if I come out of the room with mask and gloves—? What the f— can happen? Nothing.

              FRANCESCA MANGIATORDI:

              That you infect your family? I mean—

              LAURA BOCCHI [on phone]:

              With the mask?

              FRANCESCA MANGIATORDI:

              Yeah, Laura. Don’t risk it, c’mon.

              LAURA BOCCHI [on phone]:

              You know what? I really miss the presence of physical contact. It’s driving me mad, this thing.

              I know you say, “What the f— do I cry for, you’re home not doing a f—— thing.”

              FRANCESCA MANGIATORDI:

              No, of course not. I can only imagine it’s a damn situation. Because being home and being basically a prisoner—

              LAURA BOCCHI [on phone]:

              In the end, I try to keep busy, you know. But I also feel a bit useless here.

              FRANCESCA MANGIATORDI:

              I know, I know. But staying at home isn’t useless right now. Listen, I’ll call you tonight, when I’m done.

              LAURA BOCCHI [on phone]:

              Don’t you worry, I’m not going to jump out the window.

              FRANCESCA MANGIATORDI:

              No, it’s too low, it would also be a shame for the pavement, so leave it. [Laughter] C’mon, I’ll call you tonight, OK. Bye love, bye.

              MATTIA

              10th day in ICU

              FRANCESCA MANGIATORDI:

              We now have Mattia’s CT scan. Let’s look at the images. These look a little better. It’s less, let’s see, ventilation of the two inferior lobes has definitely improved. With regression of the pulmonary consolidation and infiltrates, it’s improved.

              FEMALE NURSE:

              Mattia, do you feel pain? No. Squeeze my hand, Mattia. Well done, really good. OK, good job.

              SASHA JOELLE ACHILLI:

              It’s tough having Mattia in here, isn’t it?

              FEMALE NURSE:

              Yes. It’s tough, very tough. I’m not a mom but most of my colleagues are parents and for this reason they identify with Mattia’s mom. It’s as if he were our son in the end. So knowing that it’s going a little bit better—obviously we don’t want to jinx it, but for us it’s a very positive thing. Well, it really helps us.

              FEMALE NURSE:

              Do a video call?

              MALE NURSE:

              Yes, yes, I’ll do a video call. Video call his mom.

              Do you remember the number? Are you ready? Shall I start it? Don’t get too emotional, though.

              MATTIA’S MOTHER [on phone]:

              Hey!

              MATTIA:

              Hi, Mom.

              MATTIA’S MOTHER [on phone]:

              Hi, Mattia!

              MATTIA:

              I miss you. I miss you all.

              MATTIA’S MOTHER [on phone]:

              You miss me? That’s good. Do you miss my scolding? Or do you miss me?

              MATTIA:

              Everything.

              MATTIA’S MOTHER [on phone]:

              The doctors are good, aren’t they? Even the nurses are good?

              MALE NURSE:

              Watch it or I’ll have to hang up, I’ll stop the call!

              MATTIA’S MOTHER [on phone]:

              What?

              MALE NURSE:

              No, I’m joking.

              MATTIA’S MOTHER [on phone]:

              No, I always say it.

              MALE NURSE:

              Thank you.

              MATTIA’S MOTHER [on phone]:

              Look, we’ve both fought, you’ve been a real hero, and I’m proud of you because you’ve fought so much alongside the doctors and the nurses and now the two of us have to continue fighting.

              MATTIA:

              Yes, I know.

              MATTIA’S MOTHER [on phone]:

              Do you agree?

              MATTIA:

              Yes, Mom.

              MATTIA’S MOTHER [on phone]:

              Are you a bit tired now?

              MATTIA:

              Yes, a bit.

              MALE NURSE:

              Shall we let you rest?

              MATTIA’S MOTHER [on phone]:

              Shall I let you rest?

              MATTIA:

              Shall we speak tomorrow?

              MATTIA’S MOTHER [on phone]:

              Yes, we’ll speak tomorrow, OK.

              MATTIA:

              Thank you.

              MATTIA’S MOTHER [on phone]:

              You rest, OK?

              MATTIA:

              You, too, Mom.

              FEMALE NURSE:

              Send her a kiss.

              MATTIA’S MOTHER [on phone]:

              Mwah!

              MATTIA:

              Bye.

              MATTIA’S MOTHER [on phone]:

              A kiss! Well, I want to see if you kiss the girls like that!

              MATTIA:

              Well, no.

              MATTIA’S MOTHER [on phone]:

              No, well, go figure. [Laughter]

              SASHA JOELLE ACHILLI:

              How was it?

              FEMALE NURSE:

              Emotional. But luckily it was a positive emotion after all the horrible things we’ve felt in the last few weeks.

              MALE NURSE:

              It was beautiful.

              FEMALE NURSE:

              Really powerful.

              MALE NURSE:

              Beautiful, eh?

              FEMALE NURSE:

              He was dying.

              CRISTINA PILATI:

              For us, you really are our victory, you know that?

              MATTIA:

              Thank you.

              APRIL 2020

              MALE NEWSREADER:

              [Speaking English] The city of Cremona at the heart of the country’s coronavirus crisis. Another 651 deaths nationwide over the past 24 hours. Terrible figures, yet better than the previous 24-hour period and, according to the authorities, offering a glimmer of hope for the future.

              FEMALE NEWSREADER:

              [Speaking English] It’s the lowest death toll in a week. It does confirm the general declining trend. Two weeks ago the rates of new infection were some three or four times the figure that it is right now.

              FRANCESCA MANGIATORDI:

              [Speaking French] Good day, everybody! Good day, everybody!

              [Speaking Italian] Hi, from the ER. Can you tell me about the beds situation? Thank you. Bye.

              So we have two, three, four, five, six, seven, eight, nine, 10, 11 available beds.

              MALE MEDICAL COLLEAGUE:

              More beds than patients!

              FRANCESCA MANGIATORDI:

              F—, that’s beautiful. Almost historic!

              MALE MEDICAL COLLEAGUE:

              Can I post it on Facebook? [Laughter]

              FRANCESCA MANGIATORDI:

              Yes. Take a picture!

              There have been cases, but there has been a decrease in admissions, which comes as a relief to us. So, we’re finally able to say something is working. It would be dangerous to lay down arms just yet. I’m worried it’s just a fleeting moment of respite and that there could be a relapse.

              TWO DAYS LATER

              SASHA JOELLE ACHILLI:

              There’s a bit of chaos today.

              FRANCESCA MANGIATORDI:

              Yeah, quite a bit. It’s really busy. There are loads of patients in ER 3—there’s about 10 of them. So things are getting bad again. This one needs to go on a ventilator.

              Angela!

              MALE MEDICAL COLLEAGUE:

              It was calm here, now it’s chaos.

              FRANCESCA MANGIATORDI:

              They’re coming back.

              We’ve been calling you asking for a bed for a woman, damn it, can I speak to someone? Yes, hello from the ER. I’m Dr. Mangiatordi. Put up a divider because I have no way of hospitalizing them in other places. We’re back to how we were before, yes, there’s no other way.

              No, guys, I hope it doesn’t go back to the bad times we’ve already been through.

              FEMALE NEWSREADER:

              [Speaking English] After more than a month of strict lockdown measures, the country is slowly reopening.

              FEMALE NEWSREADER:

              [Speaking English] Italy will allow a limited number of shops to open Tuesday. The World Health Organization says there is still a risk.

              MALE SPEAKER:

              [Speaking English] Now is the time for vigilance. Now is the time to double down. Now is the time to be very, very careful.

              FEMALE NEWSREADER:

              [Speaking English] The WHO will release guidelines Tuesday for countries considering easing lockdowns, saying the virus spreads too quickly and has proven to be deadly not to have some protections in place.

              FRANCESCA MANGIATORDI:

              [Speaking Italian] The absurd thing is that these people think everything is resolved. Nothing’s resolved at all.

              MARIA TERESA MANGIATORDI:

              Anyway, the last places they should open are the crowded ones, like schools or places of congregation. How can you not get close to people? How can you stay at a meter’s distance?

              FRANCESCA MANGIATORDI:

              In fact, they may not even open the schools in September.

              Here. There are 26 people who have already been seen in the ER and 13 still to be seen. And I think the numbers will rise even more tomorrow.

              MICHELE MANGIATORDI:

              So, this thing is growing again?

              FRANCESCA MANGIATORDI:

              Unfortunately, yes.

              DAMIANO MANGIATORDI:

              No-o-o-o! We’ll never go back! We’ll never go back to school.

              MARIA TERESA MANGIATORDI:

              I’d like to live in the Perugina chocolate factory.

              FRANCESCA MANGIATORDI:

              Just this morning I was hearing, do we want to go back to opening everything in a month? OK, but are you doing anything so that we can reopen everything in a month? I mean, at businesses, are swabs being done? Are they doing a selection of positive and negative patients? No. How can you reopen a business when you let your staff come back without knowing if they are positive or negative? How can everything just be left to chance? It’s all just left to chance. I’ll go rest for the night shift.

              MICHELE MANGIATORDI:

              Go rest.

              FRANCESCA MANGIATORDI:

              Tonight’s going to be another night of fire.

              DAMIANO MANGIATORDI:

              Bye.

              FRANCESCA MANGIATORDI:

              They’ll say I’m out of my [expletive].

              MICHELE MANGIATORDI:

              Amen, Sister.

              FRANCESCA MANGIATORDI:

              Amen, Brother.

              RECOVERY WARD

              MATTIA

              SASHA JOELLE ACHILLI:

              What was the last thing you remember before you went to sleep?

              MATTIA:

              I remember that I sent my last texts. I gave my phone to the doctors. Then I saw the tube with the smoke in front of me. I mean, I fell asl

              assignment

              · to monitor allergic reaction, in which case feeding that particular food should be ceased.

              · Supervision while eating is paramount, for example upright posture to avoid chocking. Honey should be avoided as it can cause foodborne illnesses.

              · Adolescence.

              · Adolescents should eat 3 balanced diet meals per day with healthy snacks, reduce amount of salt and increase amount of fiber in their diet, drink plenty of water and restrict sugary drinks including fruit juices, instead opting for whole fruits, reduce the amount of butter and heavy gravies they use, eat more chicken and fish and limit red meat, opting for lean meats instead. They should eat grains, vegetables, fruits, dairy and protein.

              · In girls, physical changes occur that changes the nutritional needs, habits and food choices. Nutritional deficiency affects their future health , eg, delayed sexual maturation or retarded growth. They require a balanced diet rich in

              1. Energy – Due to the amount of activity, basal metabolic rate and increasing need to support pubertal growth and development.. They need approximately 2200 calories per day hence need to consume a variety of lean proteins, low fat dairy products, whole grains and fruits and vegetables.

              2. Fats and oils- 255 calories in girls, 90-425 calories in boys according to their ages.

              3. Proteins-They need 40-60g a day hence need to consume beef, chicken, eggs and dairy products, soy beans and nuts.

              4. Calcium- They need 1200 mg of calcium from milk, cheese, ice cream and frozen yoghurt.

              5. Iron- They need 12-15g from beef, chicken, legumes, whole grains and green leafy vegetables.

              6. Zinc- They need 9mg/day from red meat ,breakfast cereals and whole grains.

              7. Folate- for DNA,RNA and protein synthesis. They need to eat ready to eat cereal, orange juice, bread, milk and dried beans/lentils.

              · Teens should avoid snacking unhealthily due to risk of obesity and diseases like diabetes, skipping breakfast and incorporate vigorous physical activity often for good health and fitness.

               

              3.Beneficial foods;

              · Infancy – At 6 months; Meat, poultry, or beans that have been cooked and pureed, single-grain cereal, ground and cooked, or newborn cereal with breast milk or formula, single-grain cereal, ground and cooked, or newborn cereal with breast milk or formula and avocado and mashed bananas.

              Assignment

              N317 Interview Paper Grading Rubric

              Content

              Points

              Possible

              Points Earned

              Clearly introduce paper, its purpose, and the planned organization of content.

              5

              Condense interview information to present an overall profile of the community dwelling older adult.

              · See the interview guide for suggested questions to address during the interview.

               15

              Reflect on your interview and address the following questions:

              · What were your concerns prior to the interview?

              · With what areas of the interview were you the most and the least comfortable?

              · What would you differently in a second interview?

              20

              Apply the nursing process:

              · Based on the interview data that you collected, identify 2 nursing diagnosis for your interviewee.

              · Identify at least 4 (2 for each nursing diagnosis) evidenced-based interventions (include appropriate citation) that you could teach your interviewee based on the identified nursing diagnosis. Cite diagnoses and interventions. Place in table format versus narrative format.

              Nursing Diagnoses

              Nursing Interventions

              1. 1.

              1.

              2.

              2. 2.

              1.

              2.

              20

              Discuss the extent to which the interview will influence your nursing practice with older adults. Describe specific practices you will utilize in caring for older adults. Provide rationales and citations based on textbook readings.

              20

              Provide an overview paragraph of what you achieved and learned by completing this assignment.

              5

              Organization, grammar, and APA style.

              15

              Deductions

              a. Five points will be deducted for each page exceeding the page limit (excludes title and reference page).

              b. Papers submitted after the due date and time will be subject to point deductions as outlined in the late policy guideline per the course syllabus.

               

              Grade

               100

              N317: Fundamentals of Nursing in the Context of the Older Adult

              Assignment: Interview Paper Guidelines

              Purpose of Assignment: The Interview Paper provides the learner with opportunities to:

              · Interview an older adult to examine their life and daily activities.

              · Apply theories of communication and interpersonal relationships.

              · Reflect on the interview and its effect on your future nursing practice.

              · Use the nursing process to identify nursing diagnosis and interventions.

              Outcomes: The learner will:

              · Write a formal paper addressing the elements/topics listed above.

              · Evidence skills in communication and writing in a critical, reflective manner.

              · Submit a paper that conforms to the specified guidelines and requirements.

              Guidelines: To prepare for the Interview paper assignment, the learner will:

              · Identify an older adult (70 years of age or older) and conduct a face – to – face interview (Video conference/virtual platform during the COVID-19 pandemic). State age range in paper.

              · Grant permission from the older adult to record (audio recommended) interview information.

              · Maintain HIPPA requirements and do not use interviewee initials (Do not record identifiers manually or via audio).

              · Destroy all notes and audio recordings upon completion of the assignment.

              · Understand that the “N317 Interview Paper Rubric” will be used to evaluate/grade the paper.

              · Utilize correct APA format/style and correct grammar/syntax/spelling in writing paper.

              · Ensure the paper is at least 4 pages and no more than 6 pages in length (double-spaced); this count excludes cover and reference pages.

              Assignment

               

              PART A:

              Please write a paragraph about the background and overall information of the organization/workplace you are using to answer these questions.

              Part B:

              1. Think of a case in which your manager tried to motivate the employees in the organization. Please briefly explain the background information. Which motivational theory did the manager use? Was this the best motivational theory to be applied in such a case? If not, please suggest another theory and provide the rationale.
              2. Think of a previous manager/supervisor you worked with. Please explain his/her leadership style based on the theories you learned in this class. Was this leadership style the most effective for the organization? If not, please suggest another theory and provide the rationale.
              3. Please describe the culture of the organization. What can the organization do to create a more positive culture?
              4. Please describe the structure of the organization. Based on what you learned in the class, how can the structure be modified to help improve the overall productivity and culture of the organization.

              Assignment

               

              Throughout the pandemic until current times the Federal Reserve has been extremely active in trying to stimulate growth and then to control inflation. Specifically, the Fed followed one policy in 2020, and a different one now. You are to compare and contrast Fed activities during 2020 and the recent and current period in 2022. Here are the elements:

              1. What were/are the Fed’s goals in the two periods?

              2. What tools did the Fed employ in both periods in an attempt to achieve the goals described in (1).

              3. Using the concepts developed in class, analyze Fed activities in the two periods. Examples are the bond, loanable funds, and money markets. Also AS/AD. These examples are for illustrative purposes only. Use the concepts that you deem relevant.  outside sources are required with proper citation.    Use subheadings

              Assignment

              51% of the US budget is Mandatory spending 

              The debt of defense has a 1 trillion dollar budget.

              You will need to find out what was the total US budget for 2020.

              You will also need to find out what was the amount they went over in that year. 

              Then you will need to create two paragraphs. 

              1 paragraph will need to answer the question listed below 

              Can you balance the budget without touching mandatory spending of raising taxes? And explain why or why not. 

              The second paragraph will need to answer the question listed below 

              How would you balance the budget if you had no restrictions. As well as What would be the consequences of your actions.

              List the sources you used for each paragraph  under that particular paragraph.

              Assignment

                Please look at the attachment for Directions :

              This is my topic: The description should be 2 to 3 paragraphs about the subject you are going to develop in your PowerPoint Presentation on.

              While reading the chapters for the week my interest in interviews, hiring, firing, and promoting has struck a high interest in my mind. I would like to expand more on this chapter and research what all goes into being a manager and having to deal with employees in these hard and not easy situations. I would like to know what all it takes to do these tasks. 

              PowerPoint Presentation 10 slides only 

              assignment

              Module 04 Assignment – Portrayal of Families and Relationships

              Top of Form

              Bottom of Form

              1.

              Top of Form

              As societal-norms evolve, a variety of popular entertainment media (books, movies, TV shows, etc.) feature stories of characters who are a part of traditional and non-traditional family or relationship structures. Examples include but are not limited to: traditional families, cohabitation, single-parent households, blended families, same-sex couples, and grandparents as the primary care-givers for their grandchildren.

              In a 3-page paper, written in APA format using proper spelling/grammar, address the following:

              1. Describe a book, movie, or TV show that you are familiar with which features characters in families or personal relationships.

              2. Select at least two families/relationships from your chosen story and explain the relationship characteristics and dynamics between individuals.

              3. Apply terminology presented within the module when analyzing the relationships. Be sure to include APA citations for any resources you used as references.

              Rasmussen’s Library and Learning Services team has developed a variety of Guides to help support students’ academic endeavors. For this assignment, the Writing Guide and APA Guide may both be helpful. Also consider submitting each assignment to the online Writing Lab for feedback on your draft prior to submitting it for grading. You will find links to these Guides as well as other writing resources and services on the Resources tab.

              Submit your completed assignment to the drop box below. Please check the Course Calendar for specific due dates.

              Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

              Jstudent_exampleproblem_101504

              Bottom of Form

              Top of Form

              Bottom of Form

              Top of Form

              Bottom of Form

              assignment

              Welcome to Task 5!

              For Task 5 you will set up a paper for APA and practice properly using and citing source materials.

              APA Overview

              APA Style is a method for formatting papers for submission to school and/or publication. It is a set of conventions, created and published by the American Psychological Association, to guide what your paper should look like on the page (margins, font type and size, title, page numbers); how your paper should be structured (headings, paragraphs); and how you document sources (citations, References page). APA style is frequently used in the social science fields (psychology, sociology, etc.), and is one of several different established styles.

              Stratford University expects students to learn how to use APA style in all classes—that way assignments are submitted in a consistent format. Using APA style will earn you better grades and help you practice the skills of presentation and polishing, which will help you do better in the professional world in any field. This Task is designed to introduce you to APA style and how to use it.

              First, visit Stratford University’s Library Guide (libguide) on APA Style 

              here

              .  Watch the Prezi presentation in the center of the page under “How APA 7e is Used at Stratford University” to get an overview of APA style at Stratford.

              Second, click 

              here

               to find a pre-formatted APA 7e style template in Microsoft Word.  In the “Sample APA Formatted Paper” box:

              1.      Click the “Sample APA Formatted Paper”

              2.      Open the download – it should open in Microsoft Word.  You may have to then click on “Enable editing”

              3.      Remove the “Abstract” page if it is not needed

              4.      Click on “File” and then click on “Save As”

              5.      Choose where you want to save the file.

              6.      Name the file:  APA 7e Template  and save the file

              Whenever you need to write a paper in APA 7e, open the APA 7e Template file and click on “File” and “Save As” and give the new file a name.  By doing this you have saved a fresh copy of the template as well as preserved the original template.

              Third, watch the following videos (find them here: 

              https://guides.stratford.edu/APA_7e/how_to_videos

              ) to learn how to manually format certain elements of your paper as necessary:

              APA 7e Formatting and Title Page – this video discusses the four main formatting rules as well as the elements needed on the title page.

              APA 7e Abstract and Body of the Paper – this video discusses how to format the Abstract page as well as how to format the paragraph and level header indentations.

              APA 7e Reference Page – this video discusses how to format the reference page using hanging indents.

              Fourth, prepare an APA formatted document for the assignment you will submit as Task 5. Go back to the APA Template in Word and follow these instructions:

              ·         This time, save it as “Task 5 [your name].”

              ·         Enter the following information on the cover page and headers:

                                      Properly Using and Citing Sources (title – make sure you bold it)

                                      Your Name (author)

                                      Stratford University (institutional affiliation)

                                      ENG111 – College Composition (course)

                                       Your Instructor’s name and title

                                      The specified due date for Task 5

                                      Insert the page number in the header on the cover page

              Fifth, complete the below assignment to practice using sources properly in APA in the document you created above in Step 4. On-ground students – your instructor will explain what text(s) you should be using. Online students – you may select the articles. Read the article(s), and then follow the below instructions, using the skills you learned in Lesson 5:

              1.      
              Summarize
              : Underneath the title “Properly Using and Citing Sources” on page 2, summarize the article in a single paragraph. Add the proper in-text citation and an entry for the source on your References page.

              2.      
              Paraphrase
              : Underneath your summary paragraph(s), write a paragraph in which you paraphrase two key passages of the article. Add the proper in-text citations.

              3.      
              Quote
              : Underneath your paraphrase paragraph, write a paragraph in which you quote two key quotations from the article you selected. In the paragraph use introductory tags such as “In his article, Smith states”, use correct punctuation, and add the proper in-text citations. Please note that your direct quotes do not have to be dialogue.

              Assignment

              Interview Guide for N317 Interview Paper

              Use the following suggested questions as you conduct your N317 interview. Please see
              the paper guidelines and rubric for more specific information related to this assignment.

              Demographic Information:

              • What year were you born?
              • Tell me about your education. Schools attended? Ethnic origin?
              • What gender is the interviewee?
              • Tell me about the jobs you’ve had since you first began working until your

              retirement.
              • Are you presently managing your own financial affairs?
              • Are you having any difficulty in this area?
              • Do you go to any particular church?
              • Participate in religious activities?

              Health:

              • Have you had any serious illnesses in the past?
              • Are you presently seeing a doctor on a regular basis? If so, for what

              condition(s)?
              • What types of medications are you currently taking? (include over the counter).
              • How do you compare yourself physically and mentally to other adults your age?
              • What is your definition of health?
              • Does the client have any obstacles to performing the Instrumental Activities of

              Daily Living?
              • Does the client use any assistive devices?

              Self-Concept:

              • How would you describe yourself?
              • What things in life are now especially important to you?
              • What do you consider the most significant events in your life? (Example:

              Marriage, first job, birth of children, winning an award).
              • What have been the pleasant “surprises” in your life?
              • What have been the unexpected events that had a major impact on who you

              are?

              Social Support:

              • About your family, do you have any living children?
              • Do you have any living brothers or sisters?
              • Is there anyone whom you can talk to when you have worries or

              difficulties? (Determine who and the relationship)
              • Whom do you rely on for help? (What is the client’s mode of transportation)?
              • Is there anyone who helps you with grocery shopping, getting to appointments,

              getting prescriptions filled?

              Home Environment:

              • Do you live alone or with others? (Describe)
              • Describe the living facilities, space, satisfaction with living arrangement, actual or

              potential safety hazards, exposure to stressors and hazards.

              Interpersonal:

              • Describe for me a typical day for you.
              • What kinds of things do you do to pass the time? (Example: employed (full or

              part time), attend senior activities, gardening, painting, handwork, visit with
              friends).

              • Do you have a favorite activity that you like to do most?
              • How often do you get together with friends? family?

              Life Satisfaction:

              • What do you enjoy most about this stage of life?
              • Compared with your younger years, how would you rate your present level of

              happiness and satisfaction?
              • What are your future plans or goals?

              Assignment

              Domestic Violence Resources for Families with Children and Adolescents

              Complete the matrix below by listing the resources in your area or nearby area that will assist families with minor children who need safe housing due to domestic violence situations. You will need to contact the agency and obtain as much information as possible to complete the required components to this assignment. The minimum number of resources required for this assignment is three. If you cannot locate three resources in your immediate area, please move outside of your area. Be advised due to the nature of the work done at the shelters and for the safety of the clients, some may not be able or willing to release all information. If you encounter this, please indicate which information could not be released in the matrix as well.


              Name of Resource (Include the names and addresses of the resources, and the ages they are willing to serve)

              Services Offered (safe housing, treatment, child care, tutoring, counseling)

              Circumstances Necessitating Referral (can anyone contact this agency or will they need a referral from their counselor or case worker?)

              References:

              © 2016. Grand Canyon University. All Rights Reserved.

              ASSIGNMENT

              Background design is of Cal
              Poly Pomona logo

              INDIVIDUAL
              BEHAVIOR,
              PERSONALITY, AND
              VALUES

              MHR 3020: ORGANIZATIONAL BEHAVIOR

              Ruben Delgado, Ph.D., SPHR, SHRM-SCP, CCP, CPLP, CLRP

              1

              LEARNING OBJECTIVES

              Upon completion of this lecture/discussion, you will
              be able to:
              • Define behavior, personality, and values.
              • List and describe the four elements of the MARS
              Model.

              • Identify and describe 5 types of individual behavior.
              • Describe the Schwartz Values Model.
              • Describe how personality and values affect
              individual behavior.

              MARS MODEL OF INDIVIDUAL
              BEHAVIOR

              Individual
              behavior and
              results (BAR)

              Individual
              behavior and
              results (BAR)

              Situational
              factors

              Situational
              factors

              Personality

              Values

              Self-concept

              Perceptions

              Emotions &
              attitudes

              Stress

              Personality

              Values

              Self-concept

              Perceptions

              Emotions &
              attitudes

              Stress
              Role
              perceptions

              Role
              perceptions

              MotivationMotivation

              AbilityAbility

              TYPES OF INDIVIDUAL BEHAVIOR

              Task Performance

              Organizational Citizenship Behaviors (OCBs)

              Counterproductive Work Behaviors

              Joining and Staying in Organizations

              Maintaining Work Attendance

              PERSONALITY IN ORGANIZATIONS

              Personality – relatively enduring patterns of
              thoughts, emotions, and behaviors that
              characterize a person, along with the
              psychological processes behind those
              characteristics.

              • external traits
              • internal states

              NATURE vs NURTURE OF
              PERSONALITY

              Influenced by nature
              • Heredity explains about 50 percent of behavioral
              tendencies

              Influenced by nurture
              • Socialization, learning

              Personality stabilizes in young adulthood
              • Self-concept gets clearer, more stable with age
              • Executive function regulates behavior
              • But some traits change throughout life

              FIVE-FACTOR PERSONALITY MODEL
              (CANOE)

              conscientiousness
              agreeableness

              neuroticism
              open to experience

              extraversion

              FIVE-FACTOR PERSONALITY AND
              INDIVIDUAL BEHAVIOR

              JUNGIAN PERSONALITY THEORY

              Swiss psychiatrist Carl Jung
              Model includes preferences for perceiving the
              environment and obtaining and processing information
              Myers-Briggs Type Indicator (MBTI)

              • Measures Jungian types
              • Most widely used personality test in business
              • Good for self-awareness and other awareness
              • Poor predictor of performance, leadership, team
              development

              JUNGIAN & MYERS-BRIGGS TYPES

              VALUES IN THE WORKPLACE

              Stable, evaluative beliefs that guide our preferences
              • Define right and wrong, good and bad: what we
              “ought” to do

              • Direct our motivation, potentially decisions and
              behavior

              Value system: hierarchy of values
              Compared with personality, values are:

              • Evaluative (not descriptive)
              • May conflict strongly with each other
              • Affected more by nurture than nature

              SCHWARTZ’S VALUES MODEL

              PERSONAL VALUES AND BEHAVIOR

              How personal values influence decisions and behavior:
              1. Affect the relative attractiveness of choices

              2. Frame perceptions

              3. Act consistently with self-concept and public image

              Why personal values fail to influence decisions and behavior:
              • Situation—interferes with values-consistent behavior

              • Awareness (salience)—relevance of values isn’t obvious
              • Values are abstract

              • Routine behavior makes us less mindful of values consistency

              VALUES CONGRUENCE

              Similarity of a person’s values hierarchy to
              another source
              Importance of values congruence

              • Team values congruence—higher team
              cohesion and performance

              • Person–organization values congruence—
              higher job satisfaction, loyalty, and
              organizational citizenship, lower stress and
              turnover

              VALUES ACROSS CULTURES

              collectivism/individualism
              power distance

              uncertainty avoidance
              achievement-nurturing

              THE END…

              • Comments.

              • Questions.

              • Concerns.

              • Slide 1
              • LEARNING OBJECTIVES
              • MARS MODEL OF INDIVIDUAL BEHAVIOR
              • TYPES OF INDIVIDUAL BEHAVIOR
              • PERSONALITY IN ORGANIZATIONS
              • NATURE vs NURTURE OF PERSONALITY
              • FIVE-FACTOR PERSONALITY MODEL (CANOE)
              • FIVE-FACTOR PERSONALITY AND INDIVIDUAL BEHAVIOR
              • JUNGIAN PERSONALITY THEORY
              • JUNGIAN & MYERS-BRIGGS TYPES
              • VALUES IN THE WORKPLACE
              • SCHWARTZ’S VALUES MODEL
              • PERSONAL VALUES AND BEHAVIOR
              • VALUES CONGRUENCE
              • VALUES ACROSS CULTURES
              • THE END…

              assignment

              ENGLISH 1301 PROF NOTES TO HELP YOU SUCCEED IN UNIT 3: RHETORICAL ANALYSIS

              Dr. Stacia Dunn Campbell ©2021  NOTE: If you would like to print, A COPY OF THIS MATERIAL IS ATTACHED HERE as a file: 


              1301 PROJECT 3 notes RHETORICAL ANALYSIS.pdf


                

              your complete assignment sheet is in the GREEN link below in Week 10 — don’t forget to study it closely. (It is a printable 2-page PDF file and includes STEPS and GRADING CRITERIA, length req, etc.) 

              During Unit 3, we will be discussing how music can relay social justice messages. Our thematic content will come from music videos that express song lyrics that speak to social issues in America.  We will consider HOW artists relay PERSUASIVE messages through songs delivered with the added rhetorical content of a MUSIC VIDEO.  Students should work hard to study the lyrics (by printing and annotating them) as well the visual elements of the video (viewing several times and turning off the sound and taking notes on what is placed, what is seen, what appears how, and pacing of images).  Remember, you do not have to AGREE with the message being sent; your job is to ANALYZE it, which could include pointing out the biases in the artist’s perspective or choices in how the message was delivered.  YOU ARE ANALYZING, NOT EVALUATING.  To analyze means to “break apart” and to consider how the parts of something contribute to the whole.  Keep that goal in the forefront.

              We will also be learning and applying key concepts from RHETORICAL & SOCIAL THEORY, including


              Kairos, Ethos, Pathos, Logos, Standpoint Theory (positionality), agency/structure, and Stasis.

              Be ready to learn!  Your learning objectives for this unit are to

              1)    Learn key terminology from the field of rhetoric that will be useful in analyzing a text and its artist’s choices

              2)    EXPERIENCE multimodal texts to stimulate critical thinking

              3)    STUDY both visual and TEXTUAL (LYRICS) messages as an intellectual playground through the packaging of a music video and its song

              4)    ANALYZE using the vocabulary and voice of an analyst

              5)    APPLY REASONING to point out EVIDENCE of artists’ CHOICES and RHETORICAL STRATEGIES within a message

              6)    WRITE college-level academic analysis using THIRD-PERSON POINT OF VIEW to engage a text

              7)    BUILD WRITING SKILLS of expository analysis, grammar, revision, editing, and proofreading.

              TEXT CHOICES (You must choose ONE of these for your rhetorical analysis paper)

              1.
              https://www.youtube.com/watch?v=5r6A2NexF88
                  “The Joke” by Brandi Carlile viewed in class 2/28

              2.
              https://www.youtube.com/watch?v=gAg3uMlNyHA
                “Wings” by Macklemore x Ryan Lewis viewed in class 3/2

              3.
              https://www.youtube.com/watch?v=VYOjWnS4cMY
               “This is America” by Childish Gambino  viewed in class 3/7

              4.
              https://www.youtube.com/watch?v=amwVyRH2B8A
                “Ain’t No Reason” by Brett Dennen

              5.
              https://www.youtube.com/watch?v=0MKm9TB9b6s
               “We Americans” by The Avett Brothers

              6.
              https://www.youtube.com/watch?v=bs4dR4YjGPg
                “Making Do” by Lake Street Drive

              7.
              https://www.youtube.com/watch?v=ClU3fctbGls
                 “What About Us” by P!nk

              8.
              https://www.youtube.com/watch?v=-LI8X-GhFA8
                “Get Along” by Kenny Chesney

              9.
              https://www.youtube.com/watch?v=y8Gf4-eT3w0
                “How to Love” by Lil Wayne  viewed in class 3/7

              10.
              https://www.youtube.com/watch?v=DeTu8xSGpEM
               “Penthouse Floor” by John Legend featuring Chance the Rapper

              11.
              https://www.youtube.com/watch?v=Zl_GlPquElI&list=PLxuwp_b8zZ4WGo104UieCZ9bgFTXlijui
                “War” by Residente (with subtitles in English)  

              12.
              https://www.youtube.com/watch?v=AqAJLh9wuZ0
               “The Man” by Taylor Swift (nominated by Shaiza)

              Assignment

              Christianity: An Introduction, Third Edition. Alister E. McGrath.
              © 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd.

              Anyone beginning to study Christianity soon realizes that the Bible plays a very important role
              in Christian life and thought. If you attend a Christian service of worship, you will hear the
              Bible read publicly as an integral part of that worship. You will probably hear a sermon preached,
              based on one of the biblical passages read during the service. If you join a small group of
              Christians who meet for study and prayer, you may well find that their meetings include “Bible
              study” – that is, reflection on the meaning and relevance of a short passage from the Bible.

              So what is this Bible? And why is it so important? In this chapter we shall explore the
              structure and contents of the Christian Bible and the role it plays for Christians.

              The term “the Bible” is used by Christians to refer to the collection of writings that they
              regard as authoritative. Other ways of referring to this collection of texts are also used in
              Christian writings, such as the descriptions “Sacred Scripture” or “Holy Scripture.” However,
              the term “Bible” is the most widely used.

              The unusual word “Bible” needs explanation. Like many words in modern English, it is
              the almost direct transliteration of a Greek original. The Greek word that has been taken
              into English is biblia – literally meaning “books.” The whole Greek phrase is in the plural
              (ta biblia, “the books”; singular biblion) and refers to the collection of books, or writings,
              brought together in the Bible.

              So what sorts of books are gathered together in this way? And how are they arranged?
              In the next two sections of this chapter we shall explore the two groups of writings known
              as the “Old Testament” and “New Testament.”

              The Christian Bible

              2

              The Christian Bible 29

              Box 2.1 The books of the Old Testament

              Title Abbreviation
              Genesis Gen
              Exodus Ex
              Leviticus Lev
              Numbers Num
              Deuteronomy Dt
              Joshua Jos
              Judges Jdg
              Ruth Ru
              1 Samuel 1Sa
              2 Samuel 2Sa
              1 Kings 1Ki
              2 Kings 2Ki
              1 Chronicles 1Ch
              2 Chronicles 2Ch
              Ezra Ezr
              Nehemiah Neh
              Esther Est
              Job Job
              Psalms Ps
              Proverbs Pr
              Ecclesiastes Ecc
              Song of Songs SoS
              Isaiah Is
              Jeremiah Jer
              Lamentations Lam
              Ezekiel Ez
              Daniel Dan
              Hosea Hos
              Joel Joel
              Amos Am
              Obadiah Ob
              Jonah Jon
              Micah Mic
              Nahum Nah
              Habakkuk Hab
              Zephaniah Zep
              Haggai Hag
              Zechariah Zec
              Malachi Mal

              30 The Christian Bible

              The Old Testament

              The Christian Bible is divided into two major sections, traditionally referred to as the Old
              Testament and the New Testament. The Old Testament consists of 39 books, beginning
              with Genesis and ending with Malachi. It is almost entirely written in Hebrew, the lan-
              guage of Israel; however, some short sections are written in Aramaic, an international
              language widely used in the diplomacy of the ancient Near East. The Old Testament itself
              includes a number of different kinds of writings, of which the most important are the
              following:

              1 The Five Books of the Law These are sometimes also referred to as the Five
              Books of Moses, reflecting a traditional belief that they were largely written by
              Moses. In more scholarly works, they are sometimes referred to as the Pentateuch
              (from the Greek words for “five” and “bookcase”; teuchos). They are: Genesis,
              Exodus, Leviticus, Numbers, and Deuteronomy. These books deal with the creation
              of the world, the calling of Israel as a people, and its early history, including the
              exodus from Egypt. The story they tell ends with the people of Israel being about to
              cross over the Jordan and enter the promised land. One of the most important
              themes of these books is the giving of the Law to Moses and the implications of this
              act for the life of Israel.

              2 The Historical Books Joshua, Judges, Ruth, 1 and 2 Samuel, 1 and 2 Kings, 1 and 2
              Chronicles, Ezra, Nehemiah, and Esther are “historical” books in that they deal with
              various aspects of the history of the people of God, from their entry into the promised
              land of Canaan to the return of the people of Jerusalem from exile in the city of Babylon.
              They include detailed accounts of the conquest of Canaan, the establishment of a
              monarchy in Israel, the great reigns of Kings David and Solomon, the breakup of the
              single nation of Israel into two parts (the northern kingdom of Israel and the southern
              kingdom of Judah), the destruction of Israel by the Assyrians, the defeat of Judah and
              the exile of its people, both caused by the Babylonians, and the final return from exile
              and rebuilding of the temple. The books are arranged in historical order.

              3 The Prophets This major section of the Old Testament contains the writings of a
              group of individuals understood to be inspired by the Holy Spirit who sought to make
              the will of God known to their people over a period of time. There are 16 prophetic
              writings in the Old Testament, which are usually divided into two categories. First, there
              are the four major prophets: Isaiah, Jeremiah, Ezekiel, and Daniel. These are followed by
              the twelve minor prophets: Hosea, Joel, Amos, Obadiah, Jonah, Micah, Nahum,
              Habakkuk, Zephaniah, Haggai, Zechariah, and Malachi. The use of the words “major”
              and “minor” does not imply any judgment about the relative importance of the prophets.
              It refers simply to the length of the books in question. The prophetic writings are
              arranged roughly in historical order.

              Other types of book can be noted, for instance the “wisdom” writings: Job, Proverbs,
              Ecclesiastes. These works deal with the question of how true wisdom may be found, and
              they often provide some practical examples of wisdom.

              The Christian Bible 31

              From what has been said, it will be clear that the phrase “Old Testament” is used by
              Christian writers to refer to those books of the Christian Bible that were (and still are)
              regarded as sacred by Judaism. For Christians, the Old Testament is seen as setting the
              scene for the coming of Jesus, who brings its leading themes and institutions to fulfillment.
              The same texts, of course, continue to be held as sacred by Jews to this day. This means that
              the same collection of texts is referred to in different ways by different groups. This has
              stimulated a few proposals for alternative ways of referring to this collection of texts, none
              of which has gained general acceptance. Three main alternative names for the Old Testament
              may be noted.

              1 The Hebrew Bible This way of referring to the Old Testament stresses the fact that it
              was written in Hebrew and is sacred to the Hebrew people. However, it fails to do justice
              to the way in which Christianity sees an essential continuity between the Old and the
              New Testament. A minor difficulty is also caused by the fact that parts of the Old
              Testament are written in Aramaic rather than Hebrew.

              2 The First Testament This way of referring to the collection of texts avoids using the
              word “old,” which is held by some to be pejorative. “Old,” it is argued, means “outdated”
              or “invalid.” Referring to the Old Testament as the “First Testament” and the New as the
              “Second Testament” is held by some to emphasize the continuity between the two
              collections of texts.

              3 Tanakh This is an acronym of the Hebrew words for “law, prophets, and writings”
              (torah, nevi’im, ketuvim), which is the standard Jewish description of the works that
              Christians call the “Old Testament.” Tanakh is perfectly acceptable for Jewish use but
              does not reflect the specifically Christian understanding of the nature of the continuity
              between Israel and the church.

              There is presently no generally accepted substitute within Christianity for the traditional
              phrase “Old Testament,” which will therefore be used throughout this study. Nevertheless,
              readers should be aware of the alternatives and of the issues that led to their being
              proposed.

              There are some disagreements within Christianity over exactly what is included in the
              Bible, which primarily focus on the Old Testament. The most important of these disagree-
              ments concerns a group of works usually referred to as “the Apocrypha” (from the Greek
              word for “covered, hidden”) or as “the Deuterocanonical works.” This category includes
              books such as the Wisdom of Solomon and the book of Judith. These books, although
              dating from the period of the Old Testament, were not originally written in the Hebrew
              language and are thus not included in the Hebrew Bible.

              Protestants tend to regard these “apocryphal” books as interesting and informative, but
              not as being of doctrinal importance. Catholics and Orthodox Christians, on the other
              hand, regard them as an integral part of the text of the Bible. This difference is probably best
              reflected in the way in which Protestant and Catholic Bibles are laid out. Many Protestant
              Bibles do not include the Apocrypha at all. Those that do – such as the famous King James’s
              Bible of 1611 – include these texts as a third section of the Bible. Catholic Bibles – such as
              the Jerusalem Bible – include them within the Old Testament section of the Bible.

              32 The Christian Bible

              Major Themes of the Old Testament

              The Old Testament is a remarkably complex work, which merits much fuller study than is
              possible in this overview. If you have the time to take the study of the Old Testament further,
              you are strongly recommended to make use of one of the excellent introductions currently
              available (which are noted in the Further Reading section for this chapter). What follows is
              a very basic and brief introduction to some of the themes of the Old Testament.

              The creation

              The Old Testament opens with an affirmation that God created the world. The fundamental
              theme asserted in the opening chapters of the book of Genesis is that God is the originator
              of all there is in the world. No created thing can compare with God. This point is of
              particular importance, given the importance of worship of, for example, the sun or the stars
              among other religions of the ancient Near East. In the Old Testament, God is superior to
              everything in creation. The height of God’s creation is declared to be humanity, which alone
              is created in the image and likeness of God. Humanity is understood to be the steward (not
              the possessor!) of God’s creation and is entrusted with its care.

              The account of the creation is followed by an account of the nature and origins of sin. One
              of the fundamental points made in Genesis 3 is that sin enters the world against God’s inten-
              tions. Sin disrupts the close relationship between God and the creation; it leads to humanity
              rebelling against God and asserting its autonomy. This theme recurs throughout the Bible. For
              example, the story of the Tower of Babel (Genesis 11: 1–9) is basically about human attempts
              at self-assertion in the face of God. God’s hostility to sin is depicted in a number of ways; the
              expulsion of Adam and Eve from the Garden of Eden and Noah’s flood are two of them.

              So how important is the theme of creation to the Old Testament? In the twentieth century,
              the great Old Testament scholar Gerhard von Rad (1901–1971) argued that the most
              characteristic insight of the Old Testament was that its God was sovereign over history,
              especially the history of Israel. In the Old Testament, faith in God is primarily faith in a God
              who acts within, and is sovereign over, cosmic and human history. While von Rad is careful
              to stress that the faith of Israel included reference to creation, he believed that the primary
              emphasis lay on God bringing Israel out of Egypt and into Canaan. The doctrine of creation
              takes its place as a secondary doctrine, providing a certain context for the affirmation of
              divine lordship over history.

              Abraham: Calling and covenant

              The calling of Abraham is seen as being of foundational importance to the emergence of
              Israel, both as a nation and as the people of God. The central theme of God’s calling of
              Abraham (Genesis 12: 1–4) carries the idea that God has chosen an individual whose
              descendants will possess the land of Canaan and will become a great nation. The theme of
              the fulfillment of this promise is of major importance throughout the Pentateuch. It is also
              of importance in the New Testament – to Paul, who sees Abraham’s willingness to trust in
              the promises of God as a prototype of Christian faith.

              The Christian Bible 33

              The idea of a “covenant” between God and Abraham and his descendants is introduced
              at this point. The ritual of circumcision is seen as the external sign of belonging to the cov-
              enant of the people of God. For Paul, it is of particular importance that God’s promise to
              Abraham precedes the external sign of this covenant; this, according to Paul, implies that
              the promise takes precedence over the sign. As a result, Gentiles (that is, those who are not
              ethnic Jews) do not require to be circumcised when they convert to Christianity.

              The book of Genesis traces the fortunes of Abraham and his descendants, showing the
              manner in which the covenant between God and Abraham is realized. The book ends with
              an account of the way in which Abraham’s descendants settle in the land of Egypt, thus
              setting the scene for the next major theme of the Old Testament.

              The exodus and the giving of the Law

              The story of the exodus (a word of Greek origin that literally means “exit” or “way out”) is
              well known. A new ruler arises in Egypt (he is referred to as “Pharaoh”), who regards the
              descendants of Abraham as a potential threat. The identity of this Pharaoh is unknown,
              although there are good reasons for suggesting that he may have been Ramesses II (who
              ruled during the period 1279–1213 bc). He subjected the Hebrews to a series of oppressive
              measures designed to limit their numbers and influence. The book of Exodus describes
              God’s call to Moses to be the liberator of Israel from its bondage in Egypt.

              One of the most important Old Testament festivals is closely linked with the exodus from
              Egypt. The Passover festival began in the period before the exodus. The origins and purpose
              of the festival are described at Exodus 11: 1–12: 30. It marks an act of divine judgment
              against Egypt. The regulations for the marking of the festival are laid down with some pre-
              cision. Each household or group of households in Israel is to sacrifice a perfect lamb or goat
              and to daub its blood across the sides and tops of the doorframes. This will mark off its
              inhabitants as God’s own people and will distinguish them from their Egyptian oppressors.
              These people are then to eat a meal, in order to recall their time in Egypt. Part of the meal
              consists of “bitter herbs,” which symbolize the bitterness of their bondage. Another major
              part of the meal is unleavened bread. This “bread made without yeast” points to the haste in
              which the people were asked to prepare to leave Egypt. There was not even enough time for
              dough to rise through the action of the yeast. The festival is named “the Lord’s Passover,”
              which refers to the fact that God will “pass over” the houses of his own people as he brings
              vengeance on the firstborn sons of the Egyptians. In commemoration of this act of deliver-
              ance, the Passover is to be celebrated every year as a “lasting ordinance.” Further regulations
              concerning its celebration are mentioned later (Exodus 12: 43–49).

              The theme of the covenant between God and Israel is developed further in the book of
              Exodus. Two particular points should be noted. First, a specific name is now used to refer
              to God. This is the term “Lord,” which is the English word designed to translate a cypher of
              four letters that is used to name God specifically. This group of four letters, often referred
              to as the “Tetragrammaton” (from the Greek words for “four” and “letters”), is sometimes
              represented as “Yahweh” or “Jehovah” in English versions of the Bible. Other Hebrew words
              may be used to refer to gods in general; but the specific name “Lord” is used only to refer to
              the “God of Abraham, Isaac, and Jacob.” Unlike other Hebrew words for “god,” it is never

              34 The Christian Bible

              used for any other divine or angelic being. These other Hebrew words act as common
              nouns, designating “god” or “gods” in general, and can be used with reference to Israel’s own
              God or to other gods (such as the pagan gods of other nations). But the Tetragrammaton is
              used only in naming the specific God whom Israel knew and worshipped.

              Second, the obligations that being the covenant people of God impose on Israel are made
              clear. This is a series of specific and unconditional demands, which are now usually referred
              to as the “Ten Commandments,” and which Moses received at Mount Sinai. These com-
              mandments continue to be of major importance within Judaism and Christianity alike,
              especially as Israel enters the promised land of Canaan and attempts to establish a society
              that is based on this covenant between God and the people.

              After leaving Egypt, the people of Israel spend a period of 40 years wandering in the
              wilderness of Sinai, before finally crossing the Jordan River to enter the promised land of
              Canaan. The occupation of Canaan was seen as consolidating the distinctive identity of

              Box 2.2 The Ten Commandments

              1 I am the lord your God, who brought you out of the land of Egypt, out of the
              house of slavery. You shall have no other gods before me.

              2 You shall not make for yourself an idol, whether in the form of anything that is in
              heaven above, or that is on the earth beneath, or that is in the water under the
              earth. You shall not bow down to them or worship them; for I the lord your God
              am a jealous God, punishing children for the iniquity of parents, to the third and
              the fourth generation of those who reject me, but showing steadfast love to the
              thousandth generation of those who love me and keep my commandments.

              3 You shall not make wrongful use of the name of the lord your God, for the
              lord will not acquit anyone who misuses his name.

              4 Remember the sabbath day, and keep it holy. Six days you shall labour and do all
              your work. But the seventh day is a sabbath to the lord your God; you shall not
              do any work – you, your son or your daughter, your male or female slave, your
              livestock, or the alien resident in your towns. For in six days the lord made
              heaven and earth, the sea, and all that is in them, but rested the seventh day;
              therefore the lord blessed the sabbath day and consecrated it.

              5 Honor your father and your mother, so that your days may be long in the land
              that the lord your God is giving you.

              6 You shall not murder.
              7 You shall not commit adultery.
              8 You shall not steal.
              9 You shall not bear false witness against your neighbor.

              10 You shall not covet your neighbor’s house; you shall not covet your neighbor’s
              wife, or male or female slave, or ox, or donkey, or anything that belongs to your
              neighbor. (Exodus 20: 2–17)

              The Christian Bible 35

              Israel. In particular, it established that the worship of the Lord and obedience to the cove-
              nant between the Lord and Israel were of central importance to the identity and wellbeing
              of people. The book of Joshua describes elaborate measures being taken to ensure that the

              Area controlled by ancient Israel

              Probable route of wandering in the Sinai
              and entry into and conquest of Canaan

              Battle

              Rameses

              EGYPT

              Noph
              (Memphis)

              On
              (Heliopolis)

              Pithom?

              Succoth

              DESERT OF
              SHUR

              Kadesh
              Barnea

              DESERT OF
              ZIN
              Oboth?

              Beersheba
              Makkedah?

              Eglon?Besor Br.

              W
              adi of

              Egypt

              Lachish
              Azekah

              PH
              IL

              IS
              TI

              A
              Jarmuth

              Beth Horon
              Gideon

              Bethel
              Shechem

              Mt Gilboa

              Mt Tabol

              Merom

              Kedesh

              Hazor BASHAN
              Sea of
              Kinnereth

              Edrei

              Jo
              rd

              a
              n

              Shiloh
              Giloel?Abel Shittim

              Heshbon
              Jeridho

              Jerusalem
              Hebron Jahaz?

              Dibon

              Iye
              Abraham?

              Punon?

              E
              D

              O
              M

              M
              O

              A
              B

              Zered Br.

              Marah?

              Elim?
              S I N A I

              DESERT OF
              PARAN

              Ezion Geber

              Dophkah?
              Hazeroth?

              Rephidim?

              RED SEA N

              0

              0

              25

              25

              50

              50

              75 miles

              100 km75

              L.Sinai
              (traditional
              Iocation)

              M
              ID

              IA
              N

              G
              O

              S
              H

              E
              N

              THE GREAT SEA

              L. Menzaleh

              Debi

              Figure 2.1 The route of Israel’s exodus from Egypt and conquest of Canaan.

              36 The Christian Bible

              worship of the Lord was not in any way compromised by indigenous Canaanite religions.
              Canaanite religion was strongly oriented toward fertility issues – such as the fertility of the
              land, animals, and humans. Its major deities – including Baal and Ashtaroth – feature reg-
              ularly in biblical accounts of the history of Israel over the next centuries. Canaanite religion
              continued to exercise a fascination on Israel for some time to come and is a regular subject
              of condemnation in the prophetic literature.

              The establishment of the monarchy

              In its early period Israel had no king. During the period following the conquest of Canaan,
              the region was ruled by a series of charismatic religious and political leaders known as
              “judges.” The book of Judges documents the serious threats (partly from internal disunity,
              partly from external forces) that arose at this time to the unity of Israel and notes the role of
              judges such as Gideon, Samson, and Samuel in this regard. Under Samuel, the last of the
              “judges,” a series of moves were made that resulted in the establishment of the monarchy.
              The first king was Saul, who probably reigned during the period 1020–1000 bc. Saul’s reign
              is portrayed as divisive and tragic. One of his most significant internal opponents was
              David. Following Saul’s death in a battle against the Philistines, David launched a military
              campaign that eventually led to the restoration of the unity of Israel and the expansion of its
              territory. Although opposition to David continued throughout his reign, particularly from
              the supporters of Saul, David was able to maintain his hold on the nation until the final
              years of his reign.

              The reign of David (c. 1000–961 bc) saw significant developments taking place in Israel’s
              religion. David’s conquest of the city of Jerusalem led to its becoming the center of Israel’s
              religious life, a development that would be consolidated during the reign of Solomon. The
              role of the king became important religiously, as he was seen to be a son of God. The theme
              of a future successor to David, who would rule over a renewed people of God, became a
              significant element of messianic hopes within Israel and explains the importance of the
              “David” theme within parts of the New Testament. For New Testament writers (especially
              Matthew and Paul), Jesus of Nazareth is to be seen as the successor to David as king of
              Israel. Many Old Testament writings, particularly within the Psalter, extol the greatness of
              the king, the temple, and the city of Jerusalem (often referred to as “Zion”). All three are
              seen as tokens of God’s favor toward Israel.

              David was succeeded as king by Solomon, who reigned during the period 961–922 bc.
              During his reign the temple was constructed as a permanent place of worship for the Lord.
              A strongly centralized administrative system was set in place and extensive trading
              agreements were negotiated with neighboring countries. Solomon’s extensive harem caused
              disquiet to some, on account of the pagan religious beliefs of some of his wives. Solomon
              was famed for his wisdom, and some collections of proverbs in the Old Testament are
              attributed to him.

              After the death of Solomon, the nation of Israel proved unstable. Eventually the nation
              split into two sections, each with its own king. The northern kingdom, which would now be
              known as “Israel,” would eventually cease to exist under the Assyrian invasions of the eighth
              century. The southern kingdom of Judah, which retained Jerusalem as its capital city,

              The Christian Bible 37

              continued to exist until the Babylonian invasions of the sixth century. At this point the
              monarchy ended. Jewish hopes increasingly came to focus on the restoration of the monarchy
              and the rise of a new figure like David. From a Christian perspective, these expectations
              could be directly related to the coming of Jesus of Nazareth.

              The priesthood

              The centrality of religion to the identity of Israel gave the guardians of its religious traditions
              a particularly significant role. The emergence of the priesthood is a major theme in its own
              right. One of the most significant functions of the priesthood related to the cultic purity of
              Israel. This purity could be defiled (or “made unclean,” as this type of occurrence is often
              described) by various forms of pollution. The priesthood was responsible for ensuring the
              cleanliness of the people, which was seen as being vital for the proper worship of the Lord.

              More importantly, the priesthood was responsible for the maintenance of the sacrificial
              system, and particularly for the Day of Atonement ritual, in which sacrifices were offered
              for the sins of the people. A distinction is to be drawn between “uncleanliness” (which
              arises from natural bodily functions) and “sin” (which has strongly ethical overtones). Sin
              was seen as something that created a barrier between Israel and God. It is significant that
              most of the Old Testament images or analogies for sin take the form of images of separation.
              In order to safeguard the continuing relationship between the Lord and Israel, the priest-
              hood was responsible for ensuring that the proper sacrifices were offered for sin.

              A related theme is that of the temple. During the first period of its history, Israel used a
              movable tent or tabernacle for its religious rites. However, when David captured the
              Jebusite city of Jerusalem and made it his capital, he declared his intention to build a
              permanent place of worship for the Lord. This was actually carried out under the direction
              of his successor, Solomon. The splendor of the building is a frequent theme in Old
              Testament writings dating from around this period. The temple was destroyed by the
              Babylonians in 586 bc and rebuilt after the return from exile, half a century later. The
              Second Temple (as the building erected by the returned exiles is known) appears to have
              been rather less magnificent. However, with the end of the monarchy, the temple came to
              have increased civil significance, in that temple authorities were responsible for both
              religious and civil matters.

              A more splendid temple was constructed under Herod. Although work on this project
              appears to have begun in the decades immediately prior to the birth of Christ, the work was
              only completed in ad 64. The temple was destroyed, never to be rebuilt, during the suppres-
              sion of a Jewish revolt against the Romans in the city in ad 70. The western wall of the
              temple largely survived; it is now widely referred to as “the wailing wall” and constitutes an
              important place of prayer for Jews to this day.

              Prophecy

              The English word “prophet” is generally used to translate the Hebrew word nabi, which is
              probably best understood as meaning “someone who speaks for another,” or perhaps “a rep-
              resentative.” The phenomenon of prophecy was widespread in the ancient Near East, not

              38 The Christian Bible

              restricted to the “prophets of the Lord.” The Old Testament refers to a number of “prophets
              of Baal” – charismatic individuals who claimed to act or speak on behalf of the Canaanite
              deity Baal. Early prophets of importance include Elijah and Elisha, both of whom were
              active during the ninth century bc. However, the most important period of prophetic
              activity focuses on the eighth to the sixth centuries bc and deals with the will of the Lord
              for Israel during a period of enormous political turbulence, which arose from the increasing
              power of Assyria and Babylonia. Prophets such as Jeremiah proclaimed a coming period of
              exile, which would be both a punishment for the past sins of the people and an opportunity
              for them to renew their religious practices and beliefs. After the period of exile in Babylon,
              post-exilic prophets such as Haggai and Malachi address some of the issues that came to be
              of importance as the returning exiles attempted to restore Jerusalem and its temple.

              The prophets of Israel were seen as affirming the Lord’s continued commitment to and
              presence within Israel. Yet, with the ending of the classic period of prophecy, the Holy Spirit
              seemed to have ceased to operate. God came to be viewed in distant and remote terms. No
              longer was the “voice of God” heard within Israel. Even the most senior rabbis (or “teachers”)
              could expect to catch nothing more than an echo of the voice of God – an idea that was
              expressed in the technical phrase bath qol (literally, “the daughter of the voice”). The enormous
              interest in both John the Baptist and Jesus of Nazareth partly reflects this concern. Might
              the coming of these two figures signal the renewal of prophecy and the restoration of Israel?
              The account of the baptism of Jesus (see Mark 1: 10–11) clearly indicates that the coming of
              Jesus marks the inauguration of a period of renewed divine activity and presence.

              Exile and restoration

              One of the most important events recounted in the Old Testament is the exile of Jerusalem
              to Babylon in 586 bc. In 605 bc the Babylonian Emperor Nebuchadnezzar defeated the
              massed Egyptian armies at Carchemish, establishing Babylon as the leading military and
              political power in the region. Along with many other territories in this region, the land of
              Judah became subject to Babylonian rule, possibly in 604 bc.

              Jehoiakim rebelled against Babylon. He may have been encouraged in this move by a suc-
              cessful Egyptian counterattack against Babylon in 601, which may have seemed to suggest
              that Babylon’s power was on the wane. It was a serious misjudgment. Judah was invaded by
              Babylonian forces, and Jerusalem was besieged. The king, the royal family, and the circle of
              royal advisors gave themselves up to the besieging forces early in 597 bc. They were
              deported to Babylon, along with several thousands of captives. A failed rebellion a few years
              later led to the deportation of most of the population of Jerusalem to Babylon. Jerusalem
              was left unpopulated and vulnerable, its temple desecrated.

              The prophets of Israel interpreted this period of exile in the first place as a judgment against
              Judah, on account of its lapse into pagan religious beliefs and practices; and, in the second, as
              a period of national repentance and renewal that would lead to the restoration of a resurgent
              people of God. Following the conquest of Babylon in 539 bc by Cyrus, king of Persia (559–530
              bc), the exiled inhabitants of Judaea were allowed to return to their homeland.

              The return of the deported inhabitants of Jerusalem to their home city after decades of exile
              was seen by Old Testament writers as a demonstration of the faithfulness of the Lord and as an

              The Christian Bible 39

              Figure 2.2 The Hanging Gardens of Babylon, one of the greatest wonders of the Ancient World;
              after Johann Bernhard Fischer von Erlach, c. 1700. Source: AKG Images.

              Box 2.3 How to refer to passages in the Bible

              How do you identify the biblical passage you want to study or talk about? To make this
              as easy as possible, a kind of shorthand way of referring to biblical passages has evolved
              over the centuries. To locate a verse in the Bible, you need to identify three things: the
              book of the Bible; the chapter of that book

              Assignment


              Assignment-Please pay close attention. All requirements should be met.

              Expanding Cultural Knowledge

              Create a PowerPoint presentation that addresses each of the following points/questions. Be sure to completely answer all the questions for each bullet point.

              Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation.

              Support your content with at least three (3) sources using APA citations throughout your presentation. Make sure to cite the sources using the APA writing style for the presentation.

              Include a slide for your references at the end. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements.

              Pick a cultural group (different from yours) that you commonly care for at work- I work in ER-Level 1 Trauma Center. Research the answers to the following…

              · Health Beliefs and Practices

              · Family patterns

              · Communication style

              · Space orientation and Time orientation

              · Nutritional Patterns

              · Pain Responses

              · Childbirth and perinatal care

              · Death and Dying

              · Spirituality, religion, and faith (include holy days)

              · Prayer and meditation

              · What knowledge did you gain about this group that you were not aware of?

              · How will this knowledge change the way you care for this cultural group?

              1.

              1. Title Slide (1 slide)

              2. Objective Slide (1 slide)

              3. Health Beliefs and Practices (1-2 slide)

              4. Family patterns (1-2 slide)

              5. Communication style (1-2 slide)

              6. Space orientation and Time orientation (1-2 slide)

              7. Nutritional Patterns (1-2 slide)

              8. Pain Responses (1-2 slide)

              9. Childbirth and perinatal care (1-2 slide)

              10. Death and Dying (1-2 slide)

              11. Spirituality, religion, and faith (include holy days) (1-2 slide)

              12. Prayer and meditation (1-2 slide)

              13. What knowledge did you gain about this group that you were not aware of? (1-2 slide)

              14. How will this knowledge change the way you care for this cultural group? (1-2 slide)

              15. References (1 slide)

              Assignment

              ACC 601 Managerial Accounting
              Group Case 2 (100 points)

              Instructions:

              1. As a group, complete the following activities in good form. Use excel or
              word only. Provide all supporting calculations to show how you arrived at
              your numbers

              2. Add only the names of group members who participated in the completion
              of this assignment.

              3. Submit only one copy of your completed work via Moodle. Do not send it to
              me by email.

              4. Due: No later than the last day of Module 4. Please note that your professor
              has the right to change the due date of this assignment.

              Part A: Fixed and Variable Cost

              Stuart Manufacturing produces metal picture frames. The company’s income statements for the last two

              years are given below:

              Last year This year

              Units sold …………………………………………… 50,000 70,000

              Sales ………………………………………………….. $800,000 $1,120,000

              Cost of goods sold ………………………………. 550,000 710,000

              Gross margin ……………………………………… 250,000 410,000

              Selling and administrative expense ……….. 150,000 190,000

              Net operating income ………………………….. $100,000 $ 220,000

              The company has no beginning or ending inventories.

              Required:

              a. Estimate the company’s total variable cost per unit and its total fixed costs per year.
              (Remember that this is a manufacturing firm.)

              b. Compute the company’s contribution margin for this year.

              Part B: Cost-Volume-Profit Analysis

              Belli-Pitt, Inc, produces a single product. The results of the company’s operations for a typical month are

              summarized in contribution format as follows:

              Sales …………………………….. $540,000

              Variable expenses ………….. 360,000

              Contribution margin ………. 180,000

              Fixed expenses ……………… 120,000

              Net operating income …….. $ 60,000

              The company produced and sold 120,000 kilograms of product during the month. There were no

              beginning or ending inventories.

              Required:

              a. Given the present situation, compute
              1. The break-even sales in kilograms.
              2. The break-even sales in dollars.
              3. The sales in kilograms that would be required to produce net operating income of

              $90,000.
              4. The margin of safety in dollars.

              b. An important part of processing is performed by a machine that is currently being leased for
              $20,000 per month. Belli-Pitt has been offered an arrangement whereby it would pay $0.10
              royalty per kilogram processed by the machine rather than the monthly lease.
              1. Should the company choose the lease or the royalty plan?
              2. Under the royalty plan compute break-even point in kilograms.
              3. Under the royalty plan compute break-even point in dollars.
              4. Under the royalty plan determine the sales in kilograms that would be required to

              produce net operating income of $90,000.

              Part C: Relevant Cost/Special Order

              Gottshall Inc. makes a range of products. The company’s predetermined overhead rate is $19 per direct

              labor-hour, which was calculated using the following budgeted data:

              Variable manufacturing overhead ……. $225,000

              Fixed manufacturing overhead ………… $630,000

              Direct labor-hours ………………………….. 45,000

              Component P0 is used in one of the company’s products. The unit cost of the component

              according to the company’s cost accounting system is determined as follows:

              Direct materials ………………………………….. $21.00

              Direct labor ………………………………………… 40.80

              Manufacturing overhead applied …………… 32.30

              Unit product cost ………………………………… $94.10

              An outside supplier has offered to supply component P0 for $78 each. The outside supplier is

              known for quality and reliability. Assume that direct labor is a variable cost, variable

              manufacturing overhead is really driven by direct labor-hours, and total fixed manufacturing

              overhead would not be affected by this decision. Gottshall chronically has idle capacity.

              Required:

              Is the offer from the outside supplier financially attractive? Why?

              Part D: Relevant Cost/Make or Buy Decision

              Part U67 is used in one of Broce Corporation’s products. The company’s Accounting Department reports

              the following costs of producing the 7,000 units of the part that are needed every year.

              Per Unit

              Direct materials …………………………………… $8.70

              Direct labor ………………………………………… $2.70

              Variable overhead ……………………………….. $3.30

              Supervisor’s salary ………………………………. $1.90

              Depreciation of special equipment ………… $1.80

              Allocated general overhead…………………… $5.50

              An outside supplier has offered to make the part and sell it to the company for $21.40 each. If

              this offer is accepted, the supervisor’s salary and all of the variable costs, including direct labor,

              can be avoided. The special equipment used to make the part was purchased many years ago

              and has no salvage value or other use. The allocated general overhead represents fixed costs of

              the entire company. If the outside supplier’s offer were accepted, only $6,000 of these allocated

              general overhead costs would be avoided.

              Required:

              a. Prepare a report that shows the effect on the company’s total net operating income of
              buying part U67 from the supplier rather than continuing to make it inside the company.

              b. Which alternative should the company choose?

              Part E: Relevant Cost/Sell or Process Further

              Farrugia Corporation produces two intermediate products, A and B, from a common input. Intermediate

              product A can be further processed into end product X. Intermediate product B can be further

              processed into end product Y. The common input is purchased in batches that cost $36 each and

              the cost of processing a batch to produce intermediate products A and B is $15. Intermediate

              product A can be sold as is for $21 or processed further for $14 to make end product X that is

              sold for $32. Intermediate product B can be sold as is for $44 or processed further for $28 to

              make end product Y that is sold for $64.

              Required:

              a. Assuming that no other costs are involved in processing potatoes or in selling products, how
              much money does the company make from processing one batch of the common input into
              the end products X and Y? Show your work!

              b. Should each of the intermediate products, A and B, be sold as is or processed further into an
              end product? Explain.

              Part F: Relevant Cost/Dropping a Product

              The management of Woznick Corporation has been concerned for some time with the financial

              performance of its product V86O and has considered discontinuing it on several occasions. Data from

              the company’s accounting system appear below:

              Sales ………………………………………………………. $150,000

              Variable expenses …………………………………….. $72,000

              Fixed manufacturing expenses …………………… $50,000

              Fixed selling and administrative expenses …… $33,000

              In the company’s accounting system all fixed expenses of the company are fully allocated to products.

              Further investigation has revealed that $30,000 of the fixed manufacturing expenses and $13,000 of the

              fixed selling and administrative expenses are avoidable if product V86O is discontinued.

              A. According to the company’s accounting system, what is the net operating income earned by product

              V86O?

              B. What would be the effect on the company’s overall net operating income if product V86O were

              dropped?

              Assignment

              THE ASSIGNMENT

              Assignment: Analysis of a Pertinent Healthcare Issue

              The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

              Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

              In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

              To Prepare:

              · Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.

              · Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.

              · Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.

              The Assignment (3-4 Pages):

              Analysis of a Pertinent Healthcare Issue

              Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

              · Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).

              · Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.

              · Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

              Looking Ahead

              The paper you develop in Module 1 will be revisited and revised in Module 2. Review the Assignment instructions for Module 2 to prepare for your revised paper.

              RESOURCES INSTRUCTOR PROVIDED

              1 Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

              · Chapter 2, “Transformational Leadership: Complexity, Change, and Strategic Planning” (pp. 34–62)

              · Chapter 3, “Current Challenges in Complex Health Care Organizations and the Quadruple Aim” (pp. 66–97)


              2


              Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce – ProQuest

              3


              Moving Closer to the 2020 BSN-Prepared Workforce Goal (ovid.com)

              4


              Engaging Employees in Well-Being: Moving From the Triple Aim to the Quadruple Aim (ovid.com)

              5


              Nurse Practitioner-Physician Comanagement: A Theoretical Model to Alleviate…: EBSCOhost

              6


              Is health care payment reform impacting nurses’ work settings, roles, and education preparation? – ScienceDirect

              7


              How Evolving United States Payment Models Influence Primary Care and Its Impact on the Quadruple Aim | American Board of Family Medicine (jabfm.org)

              8


              Workforce planning and development in times of delivery system transformation (biomedcentral.com)

              9


              Removing restrictions on nurse practitioners’ scope of practice in New York State: Physicians’ and nurse practitioners’ perspectives (ovid.com)

              10


              Reconfiguring Health Workforce Policy So That Education, Training, And Actual Delivery Of Care Are Closely Connected – ProQuest

              WHAT I WROTE ON

              Healthcare Issue

              The increased cost of the expenses in the hospitals is the most recognizable national health care issue. In most medical institutions, the services offered and the tools and equipment used are costly (McCray et al., 2018). In addition, the staff required to provide the health care service needs to be paid for their work done. Therefore, the cost of enhancing the healthcare services in all the institutions is the major issue. The impact of the increased cost to maintain a suitable health care setting is prolonged losses and lack of enough resources to sustain appropriate health care services. The high price led to high employees turnover due to the inability to pay them on time. In addition, the work setting has been experiencing a lack of suitable patient healthcare services due to a lack of enough drugs and equipment.

              The health system work setting has been able to respond to the issue of increased cost in health care. The health care setting has reduced the number of staff to cater to the needs of the few employees available (Childers & Maggard-Gibbons 2018). In addition, networking with the external experts who have been doing well in the health care sector has helped share the costs of some items. For example, networking has allowed the purchase of medical equipment at a reduced price, enabling the purchase of any equipment for the patients to have appropriate services. In addition, the pre-planning strategy has helped the organization utilize the funds effectively and save the rest for emergencies and urgent needs. The system has helped in ensuring that that accumulated fund is maintained. In addition, the organization has confirmed that the balance in expenditure is enhanced for the top priority services to ensure that there are some sections of care that the patient can effectively cater. The organization has also confirmed that the institution does not have to offer free medal health care to patients; hence, it is the duty of the patients to pay for the medical expenses to share the cost of maintaining good healthcare services. The regular inspection of the record is done to ensure that there is no waste of resources or embezzlement of funds to create transparency in the organization.

              The laying off employees is one of the strategies that had been implemented. The departments available in the institution have to be occupied by only two employees to pay them. In addition, the employee’s pay has been reduced by 4% to ensure that other expenses arere-met. The work setting has changed the supplier agents to deal with the new suppliers that offer affordable medical drugs and equipment. In addition, the health care setting has been able to change its financial management strategy. For example, the finance officer must ensure that 45% of the accumulated fund is taken to the risk management account to cater to urgent needs and emergencies.

              References

              Childers, C. P., & Maggard-Gibbons, M. (2018). Understanding costs of care in the operating room. JAMA Surgery, 153(4), e176233-e176233.

              McCray, S., Maunder, K., Barsha, L., & Mackenzie‐Shalders, K. (2018). Room service in a public hospital improves nutritional intake and increases patient satisfaction while decreasing food waste and cost. Journal of Human Nutrition and Dietetics, 31(6), 734-741.

              ASSIGNMENT

              EQUAL EMPLOYMENT OPPORTUNITY

              CHAPTER 3

              LEARNING OBJECTIVES

              Identify the major government agencies that enforce employment discrimination laws.

              Outline key provisions in the Civil Rights Acts of 1964 and 1991 and compare the two theories of unlawful employment discrimination.

              Show how women are affected by pay, job assignments, and career issues.

              Distinguish between the two types of sexual harassment and explain how employers can prevent such misconduct.

              List key elements of disability discrimination laws.

              ‹#›

              THE NATURE OF EQUAL EMPLOYMENT OPPORTUNITY

              Employment decisions must be made on the basis of job requirements and worker qualifications.

              Unlawful discrimination occurs when employment decisions are made based on protected characteristics.

              Protected characteristics: Individual attributes such as race, age, sex, disability, or religion that are protected under E E O laws and regulations.

              Equal employment opportunity (E E O): Employment that is not affected by illegal discrimination.

              ‹#›

              THEORIES OF UNLAWFUL DISCRIMINATION

              Disparate treatment: Individuals with particular characteristics that are not job related are treated differently from others.

              Overt and intentional

              Follows a pattern or practice

              Disparate impact: When an employment practice that does not appear discriminatory adversely affects individuals with a particular characteristic.

              Individuals are substantially underrepresented as a result of employment decisions that work to their disadvantage

              Unintentional because identical criteria are used, but the results can differ for certain groups

              ‹#›

              BROAD-BASED DISCRIMINATION LAWS

              Civil Rights Act of 1964, Title VII

              States that it is illegal for organizations to discriminate in any way based on a person’s sex, race, national origin, color, and/or religion.

              Civil Rights Act of 1991

              Requires employers to show that an employment practice is job related for the position and is consistent with business necessity.

              Executive Orders 11246, 11375, and 11478

              ‹#›

              SEX AND GENDER DISCRIMINATION LAWS

              The Pregnancy Discrimination Act (P D A)

              Treating maternity leave the same as other personal or medical leaves.

              Family and Medical Leave Act (F M L A)

              Giving up to 12 weeks of unpaid family leave and allowing the individual to return to job.

              The Equal Pay Act

              Paying similar wage rates for similar work without regard to gender.

              ‹#›

              SEXUAL HARASSMENT (1 OF 2)

              Quid Pro Quo

              Sexual harassment that links employment outcomes to the granting of sexual favors.

              Hostile Environment

              Sexual harassment occurs when an individual’s work performance or psychological well-being is unreasonably affected by intimidating or offensive working conditions.

              ‹#›

              SEXUAL HARASSMENT (1 OF 2)

              Sexual Harassment Causes and Issues

              Preventing Sexual Harassment

              ‹#›

              DISABILITY DISCRIMINATION

              Rehabilitation Act of 1973

              Provided for equal employment opportunity for disabled workers and applicants by federal contractors.

              Americans with Disabilities Act (A D A)

              Applies to private employers, employment agencies, and labor unions with 15 or more employees

              ‹#›

              AGE DISCRIMINATION LAWS

              Age Discrimination in Employment (A D E A)

              Prohibits discrimination against all individuals age 40 or older employed by an organization having 20 or more workers.

              Older Workers Benefit Protection Act (O W B P A)

              Amendment to the A D E A.

              Protects employees who sign liability waivers for age discrimination in exchange for severance packages.

              ‹#›

              IMMIGRATION AND DISCRIMINATION

              Immigration Reform and Control Act (I R C A)

              Requires that employers verify the employment eligibility status of all employees without any discrimination.

              Requires that each employee must complete an Employment Eligibility. Verification (I-9) form within the first three days of employment

              E-Verify federal database verifies the employment eligibility of employees.

              Has broadened visa requirements to accommodate highly skilled employees.

              ‹#›

              THE END

              Questions.

              Comments.

              Concerns.

              Proceed to and complete assignments related Chapter 3.

              ‹#›

              assignment

              Nutrition and Disease

              Top of Form

              Bottom of Form

              1.

              Top of Form

              Nutrition plays a vital role in a person’s overall health and well-being. Not getting enough of the recommended nutrients over the long-term can lead to malnutrition which often results in disease and illness.

              In a 3-page paper, written in APA format using proper spelling/grammar, address the following:

              1. Define malnutrition and identify a specific disease that can result from it.

              2. Perform library research about the selected disease, and explain its physiological effects on a person’s body. 

              3. Describe the relationship between specific foods/nutrients and the disease. Use the questions below to guide your response.

              4. Does research indicate that a lack of specific foods/nutrients increase a person’s chance of contracting the disease?

              5. Are there specific foods/nutrients that should be avoided by an individual afflicted with the disease?

              6. How do specific foods/nutrients work physiologically within the body to help combat the disease?

              7. Evaluate nutritional recommendations to help combat the disease.

              8. Cite at least 3 credible references and present the resources in APA format on the References page.

              For information about the impact of diseases on body systems and assessing the credibility of resources, consult the resources below.

              .
              How do I know if a source is credible?

              .
               I need to find information about a disease and the body system it impacts.

              Submit your completed assignment to the drop box below. Please check the Course Calendar for specific due dates.

              Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below

              Bottom of Form

              Top of Form

              Bottom of Form

              Assignment

              1. 400 words. This should include introduction, Analysis and Conclusion and References.

              One theme in this course is effective use of IDS tools to defend against specific types of attacks and misuse. How effective are companies and