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March 10, 2010
After leaving Haiti and returning to my life in the Bay Area, I felt as if I returned to another world. The orderly rows of lights as I descended into Miami airport were a stark contrast to the haphazard state of Port-au-Prince. There are few similarities between the scene I left and that to which I returned. But, what if the same tragedy happened in our own country? I learned many lessons during my five-week mission to Haiti, and will share a few of them here so that we can be better prepared to respond to future events on our own soil.
We have all heard the statement, “Communication is always the biggest problem during a disaster.” In retrospect, I realize I never truly understood the implications of this statement until now. When I arrived in Haiti, local phone coverage was intermittent, at best. Even when calls went through, the reception was often so bad that it was more frustrating than helpful. Satellite phones were unreliable and generally unusable. Surprisingly, my iPhone seemed to send and receive text messages and e-mail without much problem. Although this was good for simple communications, texting proved too time-consuming, and time was a luxury I did not have. Coordinating relief operations via any electronic means proved to be difficult, and face-to-face communication became invaluable. As a lesson learned, I would urge everyone to become adept at text messaging so that you are better prepared for times when communication is limited. I heard many stories of trapped victims texting their friends and family. Through this communication alone victims were rescued.
Although helpful, the time delay and content limits of text messages made me realize how important it is to be self-sufficient and decisive during the aftermath of a disaster. “Be prepared,” is another commonly heard statement in disaster readiness. Before I left for Haiti, I read The Unthinkable, Who Survives When Disaster Strikes—and Why by Amanda Ripley.1 She describes human response to disasters and discusses ways in which we can react better to such situations. Ms Ripley writes that the people around you during a disaster are the critical component to whether you survive it. In Haiti, several days passed before international aid arrived. Before then, the Haitians could rely only on those around them. Preparation makes a difference not only in how effective the response is, but ultimately in how many lives are saved. As a lesson learned, each and every one of us should think of how we will help our neighbors during a disaster. The more times you run through scenarios in your mind or in a drill, the better you will react in a real event. Now when you hear “Be prepared,” don't just consider the supplies you might need, but also think of what role you will play in the hours or days after a disaster without communication.
The next lesson is one that became a hot topic after Hurricane Katrina: “Crisis care guidelines,” previously: “crisis standards of care” or “alternate standards of care.” During the management of disasters, resources are limited, and patients will not be able to get the same quality of care that they would get during an average, non-disaster-stricken time. Crisis care guidelines were developed to help medical professionals navigate through these difficult times. For instance, if there are too few ventilators for patients who require one, which patients get the ventilators? Similarly, mass casualty triage is another form of crisis care management. In Haiti, the baseline country standard of care was generally not to intubate critically ill patients. As disaster responders it is imperative that we have a grasp of the current standards of care.
What also became apparent is that these standards change rapidly depending on the resources available. For instance, when the German Red Cross set up a tent hospital 15 minutes away from our clinic with ventilator and intensive care unit capability, our clinic's standards of care changed. Similarly, when the hospitals around us filled up and stopped taking critically ill patients, our standards changed. This occurred day by day, and sometimes hour by hour. This accentuated the fluid nature of disaster work, and is something that should be considered when we consider crisis care guidelines in our own hospitals and within our own communities.
Finally, the last lesson is organization. In a blog, I mentioned the chaos in Haiti during the emergency response. This is not unique to Haiti, and is expected after any catastrophic event. Whereas I seem to thrive in chaotic environments, I also recognize the importance of trying to minimize chaos to improve efficiency and productivity. During visits to several different hospitals in Port-au-Prince, I witnessed American physicians, nurses, and medical support volunteers arriving unannounced and offering their expertise. Similarly, many donors sent large quantities of supplies to various hospitals in Haiti. Although these gestures are very much appreciated, the proper coordination of these activities would allow for better productivity of volunteer medical staff and better management and use of supplies. Similarly, better coordination would allow for better safety, security, and planning. The lesson learned from this is that if anyone is interested in participating in future disaster efforts, signing up now to be a health care volunteer is the best approach. You may do this through your hospital, www.kpcares.org (available to any Kaiser Permanente employee nationally), your county or state professional associations, or various nongovernmental organizations. If you wish to donate money or supplies to future relief efforts, donate to organizations that you trust now so that they can appropriately coordinate their efforts and be prepared and ready for the next disaster. If everyone followed these simple steps, I am convinced that the level of chaos would be more manageable and the efficiency of response efforts would improve.
The people of Haiti may seem like they live in a different world, but as Amanda Ripley describes in her book, “Fear is a primitive response.” Humans, no matter where they are, will have the same fear response. If we stand ready for disaster, we will fear it less, and we will come together and manage it. Let us learn from this tragedy and prepare ourselves, so that this historic tragedy will not repeat itself.
Thank you for your tremendous support.