Haiti Relief Efforts

July 26, 2010

Dear Colleague:

It gives me great pleasure to announce that, after considerable negotiations, I have secured a time and location for an ICS US Section sponsored Surgical Mission to Haiti. This mission will take place between October 3-17, 2010,  and the site will be at the Adventist Hospital in Port au Prince. There is a special need for orthopedic surgeons, OR nurses, anesthesia and possibly general surgery. Surgeons of other specialties are also welcome to apply. I will discuss with my contact at Adventist how surgeons from other specialty areas may contribute to this effort.
 
Living arrangements will be spartan, cots in one of the hospital wings, but possibly in tents and, of course, we are expected to self fund our travels. As I learn more I will provide more information to those who are interested in serving during this time. At present, this is simply a call for volunteers so that we may know who is interested in serving the people of Haiti through this mission.
 
Please forward your replies to me and to Nick Rebel as soon as possible.
 
Warm regards,
 
Jay Bachicha MD FICS FACOG FACS
President, United States Section
International College of Surgeons
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Other information about the Haiti situation

Scroll down to find out how you can become involved in relief efforts and what other
members of ICS and the groups that they are involved with are also doing.

This an AUSTERE environment with harsh living conditions for rescue workers.
Up to date information about this disaster and the  humanitarian response is available at:

Relief Web
http://www.reliefweb.int/rw/dbc.nsf/doc104?OpenForm&rc=2&cc=hti

Relief International
http://ri.org/

Operation Giving Back  

World Health Organization
http://www.who.int/hac/crises/hti/en/index.html

International Federation of Red Cross and Red Crescent Societies
http://www.ifrc.org/

For further information regarding working in a disaster response, austere medical environment:

CDC Health Recommendations for Relief Workers Responding to Disasters
http://wwwnc.cdc.gov/travel/content/relief-workers.aspx 

CDC Updated Recommendations

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Security Update

InterAction Security Coordination Unit
Situation Report

Sent to: Security, Haiti

DATE: 27 January 2010

LOCATION: Haiti

Several incidents have been reported in which foreigners (aid workers and journalists) angered local populations by taking photographs deemed inappropriate by locals. In one instance, an INGO photographer was chased through the streets after he attempted to photograph a group of young men with machetes involved in a dispute in the BelAir area (A2). It has also been reported that foreigners have angered locals by taking photographs of women and children who have been forced by circumstance to bathe in public. This information comes on the heels of reports that there is widespread anger on the part of Haitians toward journalists (see IA Haiti SitRep 25-Jan).

In a recent food distribution in Leogane, Haitian National Police (HNP) who were providing protection abandoned their posts (reportedly because they did not receive an expected bribe). The distribution, which had been properly planned to include an escort (HNP) and other crowd control measures, became disorganized after the escort had left, resulting in the crowd jumping the fence and overwhelming the effort. Assistance from troops was late in coming. No injuries were reported (A2).

NOTE: Many organizations are reporting that food distributions have gone smoothly when well planned. Meeting with beneficiary community leaders a day or two in advance; providing tokens or tickets to beneficiaries that they can exchange for rations; and explaining exactly what can be expected at the distribution are reportedly successful strategies. Many organizations are reporting that the presence of MINUSTAH escorts also serves to keep the distributions orderly. NGOs can request a MINUSTAH escort, one day in advance and in person, at the Logbase.

Some banking services have resumed as of the weekend. Long lines were reported over the weekend, and MINUSTAH and HNP have been providing security. There is a $2500 cap on withdrawals (A1). 

The following comments and forwarded email is from a colleague of ICSUS President, Jay Bachicha that may be helpful and interesting to those who wish to help with the Haiti situation.

My update today is inspired by the email attached below, written by the leader of a highly skilled surgical team with the best intentions to help in Haiti, but who lacked critical elements for a successful mission.

In 18 yrs of disaster relief work, both national and international, I have seen everything from medical students walking on the World Trade Center rubble pile at 9/11 wearing sneakers and scrubs (lacking proper protective clothing) and a backpack filled with first aid supplies, to well organized, financed, and politically connected teams like the one described below, who while well intentioned, are operating "rouge" and outside the established disaster response process. While well intentioned, they can either fail to accomplish their mission, or worse, can become a liability to the response process, putting themselves and others at risk.

This team's experience reminds me that this work is not for the faint of heart, or for the inexperienced. Their failure to have team leadership from an experienced international emergency responder led to a cascade of critical failures including but not limited to: proper planning for security, resupply, or provision of basic necessities to deliver care; a failure to integrate with the existing disaster management process (which they apparently never found even though it exists); and a miscalculation that sophisticated western medical care can simply be brought to such a chaotic and austere environment and be immediately supported.

There are many lessons in the experiences of the team described below that go beyond what the author shares. I personally disagree with the conclusion drawn by the author in his statement towards the end: "Our role now being back in NY is to expose the inadequacies of the system to the media in the hopes of effecting a change in this system immediately [sic]." I think the more important lesson in his team's experience is that anyone or any team interested in volunteering to participate in such complex humanitarian disasters should do so with organizations who make it their business to respond to these events. Well intentioned efforts, even when well funded and with 'political connections,' risk mission failure or worse when they lack experienced disaster response leadership and logistical support.

Hernando

-----Original Message-----
Date: Thu, 21 Jan 2010 00:11:38
Subject: Re: Haiti

I believe we went in with a reasonably comprehensive service we wanted to provide acute trauma care in an orthopedic disaster. Our plan was to be at a hospital where we could utilize our abilities as trauma surgeons treat the acute injuries involved in an orthopaedic disaster. We expected many amputations however came with a philosophy that would reasonably start limb salvage in what we thought was a salvageable limb.

David Hxxxxt put a team together which included:
2 orthopaedic trauma surgeons
3 orthopaedic trauma fellows
2 highly skilled anesthesiologists
1 general surgery trauma surgeon
2 synthes reps who were also scrub techs
1 trauma nurse practioner to do triage
2 OR nurses

Our equipment including a huge amount of anesth medications and equipment, ability to construct 150 ex fix both small and large, OR equipment including scalpels etc, OR soft goods, splint material, OR prep material.

We also had a plan of physician and equipment replacemnt that was dynamic where w/i 24hrs we could bring in what was necessary on the Sxxxxxs private jet.

We thought the plan was a good one.

We were incredibly naïve.

Disaster management on the ground was nonexistent. The difficulties in getting in despite the intelligence we had from people on the ground and david hxxxxt's high political connections with Partner's in Health as well as the Clintons only portended the difficulties we would have once we arrived.

We started out friday morning, got a slot to get in friday that was eventually cancelled when we were on the runway to be rescheduled the next day. We diverted to the DR and planned on arriving in P OP saturday.

Once on the ground the hospital we had intelligence that was up and running with 2 OR's General Hospital was included severely in the earthquake and not capable of running functioning OR's as there was no running water and only a limited electrical supply on generator.

We quickly took our second option
Community Hospital of Haiti. We found approx 750 pt in the hospital upon our initial eval, the hospital had running water, electricity and 2 functional OR's
Our naivette did not expect that the 2 anesth machines would not work, there would be 1 cautery for the hospital, autoclave that fit instruments the size of a cigar box, no sterile saline, no functioning fluoro and no local staff only a ragtag group of voluntary health providers who like us had made it there on there own.

To summarize we had no clue the medical infrastructure of the country was so poor.

As we got up and running in the OR and organized the patients for surgery we communicated our new needs back to Synthes and more supplies were loaded for a second trip - these included battery operated pulse lavage, a huge supply of saline, soft goods in the OR. This plane landed as planned sunday pm, equipment was loaded on a truck and subsequent hijacked between the airport and the hospital.

At the hospital we had zero security despite promises form NYPD and NYFD to provide that to us.

Our philosophy was to work like this was a marathon run the OR's around the clock with the idea that we would have a defined extraction time of 11pm tues. The plane that extracted us would come in with a new medical staff compliment to replace us. Equipment included urgent things to maximize issues that were nonexistent in the hospital that would enable us to provide better and more efficient care:
2 portable anesth machines
2electrocautery
2 portable monitors for the pacu
2autoclaves
Replacement exfix
Things that didn't arive with the previous flight

That planes slot was cancelled by the military at 6am tues.
We also previously had seen daylight in the remaining patients monday night haviving completed approx 100 surgeries. However on tues morning we found a huge # of new patients. The hospital was forced to undergo lockdown closing its gates to the outside and outside crowd becoming angry.

We also noted tues morning that many of the patients we were operating on were becoming septic.
We finished operating at noon tues, the last surgery our group assisting an obstetrician on a caesarian and resuscitating a baby that was not breathing.

We decided as a group the situation for us at the hospital was untenable supplies were running out, team was exhauted, safety a huge concern, and no extraction plan with resupply. We decided to make our way to airport thru the help of a hospital benefactor. Jamaican soldiers with M-16 were necessary to escort us out with our luggage as the crowd outside saw us abandoning the hospital.

We made it to airport on back of a pickup track, got onto the tarmac, hailed a commercial plane that carried cargo to montreal and had private jet pick us up there.

The issues we were unprepared for and witnessed were
1. The amount of human devastation
2. The complete lack of a medical infrastructure in the country
3. The lack of support of the haitian medical community
4. The complete lack of any organization on the ground. Noone was in charge, we had the first functional up and running hospital in the P OP area yet noone and I me NOONE came to the hospital to assess what we were doing, what we were capable of doing and what we would need, to be more efficient. The fact that the military could not or would not protect the resupply equipment on sunday or let the tues flight come in says it all.
5. Lack of any security at all at the hospital

I would take away that disasters like this need organization on a much higher level than we had with the clear involvement and approval of the military from the beginning.

Currently there is Noone obviously running the show and care is in chaotic at best. MD's are coming in country with no plan of what the are going to do. Surgeons that expect to just show up and operate are delusional as to what there role would be as without a complement of support staff and supplies they would be of limited or no value.

I hope this helps. We all felt as though we abandoned these patients and that country and feel terrible. Our role now being back in NY is to expose the inadequacies of the system to the media in the hopes of effecting a change in this system immediatly. We feel that the only way to really help now is an urgent programtic change and organization in the support of the medical staff on the ground and what is critically needed to expeditiosly bring in.

Cherrios on the tarmac are not getting it done on these patients which clearly would be savable if good care could urgently be provided.

Please share this email with everyone and anyone you find might help.
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MediSend Logo
 
Grey LIne

A Coalition of North Texas Organizations Enables MediSend International to Answer the Urgent Plea for Medical Equipment and Supplies for Haiti
January 29, 2010
The overwhelming number of injuries suffered in the devastating earthquake on January 12th in Haiti has exhausted medical supplies and equipment in the impoverished country. Organizations working in Haiti have issued an urgent plea for immediate emergency medical relief.

Thanks to the generosity of three North Texas-based companies, Estech Systems,Inc. (ESI), Strasburger & Price Law Firm and American Airlines, MediSend International is sending four forty foot containers filled with 24 tons of medical supplies and biomedical equipment to the earthquake-ravaged island. Doctors, nurses and community health-workers with Partners in Health and Salvation Army Emergency Relief will receive the life-saving shipments from MediSend thanks to American Airlines' commitment to airlift the goods.

Dan Butcher, Managing Partner of Strasburger and Chairmen of the MediSend Board of Directors said, "Strasburger is a loyal supporter of MediSend's work in developing countries. We can think of no organization better able to steward our donations to Haiti, and we are proud to be a part of this life-saving mission."

Estech Systems Inc. (ESI) has supported MediSend in emergency situations in the past, funding shipments of emergency aid to the victims of the tsunami in Indonesia, the Pakistan earthquake and to flood-ravaged Bangladesh.

"Seeing the images of men-women and children in such misery and suffering makes it impossible not to come forward with whatever help we can offer," says Eric Suder, Founder and CEO of Estech Systems, "We are proud to once again join with MediSend."

On Tuesday, volunteers from ESI and Strasburger worked with MediSend staff to label, shrink-wrap and stage the boxes of medical supplies at MediSend's warehouse, located in the Elisabeth Dahan Humanitarian Center, MediSend's global headquarters in Dallas. The shipments will be immediately airlifted to Port au Prince through American Airlines' Emergency Relief Program.

The shipments will reach several organizations partnering with MediSend in Haiti. Partners in Health, headquartered in Boston and with longstanding ties to Harvard Medical School, has been working in Haiti for over twenty years and has been a major participant in the relief efforts since the earthquake. Salvation Army Haiti Relief is currently caring for over 20,000 people made homeless by the disaster. Doctors, nurses and community health-workers working with the organizations will receive the desperately needed shipments from MediSend.

"We are very grateful to all of our generous and compassionate friends, partners and financial supporters in this mission," says Nick Hallack, President and CEO of MediSend International. "However, fulfilling the emergency medical needs resulting from the earthquake will very quickly deplete our inventory of medical supplies, equipment and resources. Haiti will need aid for many months to come, so we are asking medical supply and equipment manufacturers, distributors, and hospital systems to please join us in our ongoing commitment to providing desperately needed medical relief to Haiti."

About MediSend
MediSend is a 501(c) (3) nonprofit, humanitarian organization founded by ICS Fellow, Dr. Martin Lazar, that supports under resourced hospitals in developing countries with a multi-dimensional approach to improving community health. Medisend's mission includes education, training, technical support and management technologies in Biomedical Equipment Repair, as well as the distribution of life-saving medical supplies and biomedical equipment. MediSend is a proud member of The Clinton Global Initiative.
Quick Links...
 
 
Contact Information
MediSend International
Elisabeth Dahan Humanitarian Center
9244 Markville Drive
Dallas, Texas 75243
p: (214) 575-5006
f: (214) 570-9284
 

January 30, 2010
 
Dear Clinician Outreach and Communication Activity (COCA) Partner,
 
CDC is committed to providing information to its partners, so that you can stay informed and communicate accurate information to your constituents.
We would like to provide you with the talking points document (click here for pdf) from the U.S. Department of Health and Human Services, with an update on activities being implemented, in response to the earthquake in Haiti.
We want to ensure that these updates are timely and helpful. Please remember to send any questions or comments to coca@cdc.gov
  
On behalf of the Clinician Outreach and Communication Activity (COCA)
Joint Information Center (JIC) Clinician Communication Team
Centers for Disease Control and Prevention