Global Emergency Relief is currently amassing resources for its targeted response to the effects of Typhoon Haiyan in The Philippines. Typhoon Haiyan (known in the Philippines as Typhoon Yolanda) is the second-deadliest Philippine typhoon on record, leaving at least 4,460 dead, 921,200 people displaced and 243,600 houses destroyed. With recorded winds reaching 195 mph, Haiyan [...]Global Emergency Relief is currently amassing resources for its targeted response to the effects of Typhoon Haiyan in The Philippines. Typhoon Haiyan (known in the Philippines as Typhoon Yolanda) is the second-deadliest Philippine typhoon on record, leaving at least 4,460 dead, 921,200 people displaced and 243,600 houses destroyed. With recorded winds reaching 195 mph, Haiyan is unofficially the fourth most intense tropical cyclone ever observed. Many cities and towns experienced widespread destruction, with as much as 90% of housing destroyed in some areas. Roads are blocked, and airports and seaports impaired; heavy ships have been thrown inland. Water supply and power are cut; much of the food stocks and other goods are destroyed; many health facilities are not functioning and medical supplies are quickly being exhausted. Global ER’s objective in this response is to support the local health infrastructure by providing skilled medical personnel, planning and logistics support to facilitate the delivery of medications, equipment and supplies so that the key health facilities in Tacloban can get up and running soon.
Global Emergency Relief personnel were deployed to the Emergency Operations Center (EOC) at New York City’s Office of Emergency Management (OEM) this weekend to support response and recovery operations for Hurricane Sandy. Responsibilities included leading the Health and Medical Section of the EOC, coordinating with the Healthcare Facility Evacuation Coordination Center team and liaising with the [...]Global Emergency Relief personnel were deployed to the Emergency Operations Center (EOC) at New York City's Office of Emergency Management (OEM) this weekend to support response and recovery operations for Hurricane Sandy. Responsibilities included leading the Health and Medical Section of the EOC, coordinating with the Healthcare Facility Evacuation Coordination Center team and liaising with the many agencies working hard to help those impacted by the storm and its aftermath. The New York State Department of Health and the New York City Department of Health and Mental Hygiene (DOHMH) are leading the effort to ensure that critical infrastructure support is provided to healthcare facilities in affected areas. "In addition to moving hospital and nursing home patients from facilities located in evacuation zones, NYC has also been responding to requests for help from facilities who chose not to evacuate," Global ER Executive Director Nick Lobel-Weiss explained. "Administrators are learning that their backup power systems are not-functioning so OEM and DOHMH are working diligently to get backup generators to their facilities. This operation continues throughout the night. Another challenge has been the deployment of electricians to 'tie in' the generators to the buildings' power systems." Healthcare facilities in New York State are required to have reliable, tested backup power systems in the event of an emergency. "If you're in an Evacuation Zone and you make the decision to remain in operation, it's imperative that you have all of the resources you will need without reliance on outside support. Once the storm hits, you won't be able to rely on vendors, suppliers, or even public utilities, Lobel-Weiss said. "Facility operators are going to be looking very carefully at their emergency plans before the next storm season." Global Emergency Relief's preparedness team can work with you to ensure that your facility is prepared for a coastal storm or any number of hazards to which you may be vulnerable. Learn More
The General Hospital is here to help the people of Port-au-Prince when there is a medical emergency. As you may know, it is often difficult to get around Port-au-Prince in a vehicle. Global ER has teamed up with Whelen Engineering and JP/HRO, Sean Penn’s Relief Organization to help expedite emergency vehicle capabilities in PaP. Whelen [...]The General Hospital is here to help the people of Port-au-Prince when there is a medical emergency. As you may know, it is often difficult to get around Port-au-Prince in a vehicle. Global ER has teamed up with Whelen Engineering and JP/HRO, Sean Penn's Relief Organization to help expedite emergency vehicle capabilities in PaP. Whelen Engineering, the leader in emergency lighting systems, donated tens of thousands of dollars in emergency vehicle warning equipment to make the emergency vehicles in Port-au-Prince safer and enable them to reach their destinations quickly when every second counts. Sean Penn's organization, JP/HRO, helped transport the equipment to Haiti and is now working with local mechanics to retrofit vehicles with emergency warning capability.
By JOSÉ DE CÓRDOBA PORT-AU-PRINCE, Haiti—The Hopital de l’Universite d’Etat d’Haiti, the country’s largest public hospital, is so chronically underfunded and decrepit that it has the reputation as a place where people come to die, not get better. After January’s devastating earthquake, there was hope the hospital could turn things around. Scores of foreign doctors [...]By JOSÉ DE CÓRDOBA PORT-AU-PRINCE, Haiti—The Hopital de l'Universite d'Etat d'Haiti, the country's largest public hospital, is so chronically underfunded and decrepit that it has the reputation as a place where people come to die, not get better. After January's devastating earthquake, there was hope the hospital could turn things around. Scores of foreign doctors from international medical charities flew in to treat the injured. Charities donated new equipment, and the hospital set up its first intensive care unit. There was talk of ongoing cooperation with foreign medical schools. Ten months later, the foreign doctors and charities are gone. The intensive care unit is closed. An unused defibrillator and a cardiac monitor lie askew atop a cart. Nobody at the hospital is trained on how to use either piece of equipment. "Now the hospital is the way it was before the earthquake," says Alix Lassegue, the facility's director. The tale of the general hospital casts a stark light on why Haiti has struggled to capitalize on the kindness of strangers. Donor countries like the U.S. have pledged nearly $10 billion to rebuild. Because donors have long been concerned about corruption in Haiti's government, an estimated 70% of this year's money will be channeled through charities, otherwise known as nongovernmental organizations, or NGOs. Haiti's third-largest city of Gonaives combats the cholera outbreak spreading across the country, which has already killed at least 800. Video courtesy of Reuters. But as the past few months have made clear, there is little coordination among the NGOs or between the NGOs and Haitian officials. Some NGO plans don't fit or clash outright with the plans of the government. Some are geared toward short-term relief—a classic case of giving a man a fish instead of teaching him to fish. More than a million people are still living in tent cities across Haiti, fueling a cholera epidemic that has killed 796 people even as NGOs have rushed to contain it. The United Nations has asked for $164 million to help combat the disease. There is now a growing debate over the role of NGOs in Haiti. Defenders of NGOs say there is no choice but to work through charities given the inefficiency and alleged corruption of Haiti's government. Transparency International ranks Haiti 146 out of 178 countries in its Corruption Perception Index. Critics say the NGOs have put Haiti in a Catch-22: By building a parallel state that is more powerful than Haiti's own government, aid groups are ensuring Haiti never develops and remains dependent on charities. "The system as it is guarantees its failure," says Laura Zenotti, a political scientist at Virginia Tech University who has studied NGOs in Haiti. "A word for the NGOs," warned former President Bill Clinton, the U.N.'s special envoy to Haiti, at a ceremony here marking the six-month anniversary of the earthquake, "tell us what you are doing, and where." Even NGOs with a long history in Haiti sometimes show a cavalier attitude toward the authorities, Haitian officials say. For two months, the government refused to allow a new obstetrics hospital built by Médecins Sans Frontièrs to open, saying the group ignored its request to locate the hospital elsewhere to better cover the country's health needs. "They didn't even ask permission to build, and when we asked them to stop, they didn't stop," says Dr. Claude Surena, the coordinator of Haiti's national commission to reconstruct the health system. Paul McPhun, who oversees MSF in Haiti, says the group did inform the government about its new hospital, which replaced one destroyed in the quake, and only as the hospital neared completion did the location become an issue. Mr. McPhun says MSF could have done a better job of "giving updates" to the ministry of health, but the urgency of saving lives after the quake was too acute. "To continue in Haiti, we need to be partners and have to be a part of the reconstruction plan, but I don't think anybody knows what those plans are," he says. A cholera outbreak in Haiti that has killed 796 people and hospitalized more than 12,000 is worsening despite the efforts of well-funded aid groups that manage most of the country's social services. Above, a child at a Port-au-Prince hospital is treated for symptoms of the disease. It is a bind other countries have faced as NGOs have expanded in strength and numbers since the 1980s. Haiti is one of the world's most extreme examples of a country that both needs NGOs and has also, say critics, been held back by them. Called "the Republic of NGOs," Haiti is believed to have more aid groups per capita than any nation, perhaps as many as 10,000, according to the World Bank. The NGOs range from international giants such as Save the Children, Catholic Relief Services and Médecins Sans Frontièrs (known in English as Doctors Without Borders) to a plethora of U.S. evangelical churches that help one school or one Haitian church at a time. Aid groups provide four-fifths of social services here, according to a 2006 analysis by Washington's National Academy of Public Administration, a congressionally chartered, nonpartisan group of management experts. Jean Palerme Mathurin, economic adviser to Prime Minister Jean-Max Bellerive, says NGOs may account for as much as a quarter of Haiti's gross domestic product. He says the NGO presence has permanently "infantilized" the country, creating a vicious cycle: The government lacks the money—and historically, the inclination—to provide social services. Those services, therefore, are provided by NGOs, which means the government, in turn, has no incentive to improve. Paul Farmer, founder of Partners in Health, an NGO which, in conjunction with the ministry of health, is the country's largest health provider, believes that NGOs and foreign governments should channel some of their funds directly to the Haitian state. "NGOs have flourished in number and size as the public sector has withered in Haiti," says Dr. Farmer. Many of the NGOs are a world apart from the rest of Haiti, based in rented mansions in the affluent mountaintop Port-au-Prince suburb of Pétionville. Here, fleets of SUVs with stenciled initials of the organizations are constantly on the move. "There must be hundreds," said Hans van Dillen, the former representative for the Holland division of MSF, earlier this year. "Cars, cars, cars, clogging up the streets of Port-au-Prince." Sitting at a table in the leafy home where MSF Holland is based, Mr. van Dillen recalled a mad scramble after the earthquake as different NGOs fought each other to control sites to put up field hospitals and medical tents, as he said, "putting their logo over your logo." At night, most aid workers disappear. Fearing kidnappings and other crimes, NGOs typically have strict curfews for their staff beginning as early as 6:30 p.m. There is no doubt the aid money has saved thousands of lives here and provided relief to millions, especially in the aftermath of the earthquake. But whether the efforts of well-funded aid groups—some of which have been in Haiti for 50 years—can improve Haiti's long-term outlook is another matter. Life for millions of Haitians has barely improved over the decades. In terms of economic development, Haiti ranks 149th—just ahead of Sudan—out of 182 countries tracked by the U.N. The challenges to remaking Haiti's public health-care system are on display at the Hopital de l'Universite. Its annual budget is just $5 million, 95% of which goes to pay salaries. As a comparison, MSF raised $100 million for its Haiti program after the quake. The Red Cross raised $816 million. Hours after the quake hit, the hospital became a bloody triage center. Hundreds of injured Haitians lay on the ground in front of the complex, screaming in pain or lying in shocked, stunned silence. The nursing school collapsed, killing some 30 student nurses. The badly cracked pediatric wing was evacuated, forcing patients into makeshift army tents. Within days, scores of foreign doctors arrived, working around the clock in horrific conditions, sometimes performing amputations without anesthetic. Claire-Marie Cyprien, a Haitian-American anesthesiologist from Florida, says the other foreign doctors she worked with "were very dedicated" and quickly turned things around. She helped amputate the hands of her sister, who lived in Haiti. The Haitian doctors, just emerging from an almost indescribable disaster, appeared lost, she says. "In retrospect, I think they were a bit dazed, and we shunted them aside." The hospital director, Dr. Lassegue, stayed at his post, as did Marlaine Thompson, the chief nurse. Many of their colleagues, dealing with family tragedies, didn't return for months. "Many were traumatized," said Dr. Lassegue. To manage relations with the foreign doctors, Dr. Lassegue asked two prominent NGOs, California-based International Medical Corps, known as IMC, and Partners in Health to act as the liaison with all other medical groups working in the hospital. At the height of the emergency, there were 19 NGOs at the hospital. Dr. Lassegue says these included Médecins Sans Frontièrs, the Norwegian and Canadian Red Cross, Scientology Volunteers Ministry, Operation Blessing, Mission of Love, the Duke University Team, the Mount Sinai University Team, and the Bomberos Unidos Sin Fronteras, a Spanish firefighters' group. Haitian doctors acknowledge the contributions of the foreign doctors. Nevertheless, there was friction. "They came, they helped, it was good, but they didn't work with Haitian doctors," says Max Harry Kernisant, a surgeon at the hospital. He says that while there is no doubt that the foreign doctors did excellent work, he sometimes felt their attitude betrayed condescension and arrogance, and that they were partly driven to build up their numbers on medical operations to drum up contributions. Things would be worse if it weren't for NGOs, says Samuel Worthington, president of InterAction, an umbrella group that represents major U.S. aid groups, including IMC. "What NGOs can say is that there are a lot more kids in school, a lot less mothers dying, thanks to their efforts," says Mr. Worthington, who expects his members to be in Haiti for 50 years. "As long are there are social problems, there will be NGOs working here." Between them, IMC and Partners in Health managed the emergency room and staffed the hospital's first intensive-care unit. There was talk about making the ICU a permanent fixture, through ongoing cooperation with foreign medical schools. But by March, the only NGOs with doctors on hand were IMC and Partners in Health. Most doctors worked in two-week rotations, and the staff was stretched thin as it tried to man the emergency room and the ICU at the same time. By the end of July, both groups had pulled their doctors out. Partners in Health says it decided to return to its focus on health in rural areas. In conjunction with Haiti's ministry of health, it has broken ground on a new teaching hospital. Jason Erb, IMC's Haiti director, says the group left after six months as part of an agreement with the hospital's administration. He says it was a strain for IMC to keep a volunteer program at the hospital, but IMC would have found a way had the organization been asked to. IMC is still in Haiti, where it maintains a network of 15 primary care clinics, and runs nutrition and mental-health programs. Since the charities left, the hospital is back to business as usual. The occasional rat scrambles across the grounds, and sewage seeps from broken pipes by the emergency room, where dozens of half-naked patients lie in narrow cots. "And what happens now? We are in the same situation as before," says Dr. Kernisant. Some help may be on the way. U.S. Secretary of State Hillary Clinton and French Foreign Minister Bernard Kouchner recently signed a joint memorandum to provide $50 million to rebuild the hospital. The agreement doesn't specify when the money will start flowing in. In July, the American Red Cross agreed to make a $3.8 million grant to the hospital to pay staff bonuses. In the meantime, 20 miles from Port-au-Prince in the devastated town of Leogane, Médecins Sans Frontièrs has opened a new hospital in place of the impromptu field hospital it set up in the days immediately following the quake of Jan. 12. Shipped in containers from Europe, the "hospital-in-a-box" comes complete with an operating room. While doctors in Haiti's public hospitals often go unpaid, sometimes juggling two or three jobs and using outdated equipment, MSF doctors are earning top dollar, in local terms, plus bonuses. The aim, says MSF, is to hand over the facility to Haiti's ministry of health once the earthquake emergency is over. MSF's Mr. van Dillen was unapologetic about scooping up Haitian staff, many of whom worked at hospitals destroyed by the quake. But worried about the long-term impact that hiring away doctors could have on the country, he lowered the bonus to 50% of salary, rather than the original 100%. He also said MSF is exploring ways to work with the ministry of health, including combining some of its facilities in Carrefour, a heavily damaged area on the edges of Port-au-Prince, with facilities at a next-door Haitian hospital that suffered earthquake damage. "It would help get us away from the parallel system we have built," he said, "which is good for Haiti's poor now, but not good for Haiti in the future." http://online.wsj.com/article/SB10001424052702304023804575566743115456322.html
I’m working on an emergency evacuation plan for The General. I hope this will enable us to purchase the right equipment to get patients out of buildings in a hurry or just to have protocols for how to move patients away from a hazard that doesn’t necessitate leaving the building. We needed to consider some [...]I'm working on an emergency evacuation plan for The General. I hope this will enable us to purchase the right equipment to get patients out of buildings in a hurry or just to have protocols for how to move patients away from a hazard that doesn't necessitate leaving the building. We needed to consider some of these strategies in advance of Hurricane Tomas. Here are some of the plan's elements:
- Hospital Emergency Operations Center
- Patient evacuation devices
- Patient transportation equipment
- Alternate care sites
- Patient evacuation teams
- Rapid Patient Discharge
- Patient transport teams
- Family Service Center
- Public information strategy
As Tomas spun toward Haiti, we needed to be ready at The General. Not only were all patients from the tuberculosis ward in danger of high winds and flooding, but the vital resources used to care for patients also risked destruction. In cooperation with with dedicated volunteers including patients’ family members, we relocated all medical [...]As Tomas spun toward Haiti, we needed to be ready at The General. Not only were all patients from the tuberculosis ward in danger of high winds and flooding, but the vital resources used to care for patients also risked destruction. In cooperation with with dedicated volunteers including patients' family members, we relocated all medical supplies from the tuberculosis unit's satellite pharmacy to safe locations in the new ward and other places safe from the storm. As time was limited, the move took place at night. By late evening, much of the equipment was moved, even though there was not sufficient space to relocate everything.
Good News: Patients in The General Hospital’s tuberculosis ward were moved out of the tents where patients with the disease have been treated since January. The patients are now in a building, sheltered from the rain. Bad News: There is not sufficient space in the new space and many patients were discharged from the hospital. [...]Good News: Patients in The General Hospital's tuberculosis ward were moved out of the tents where patients with the disease have been treated since January. The patients are now in a building, sheltered from the rain. Bad News: There is not sufficient space in the new space and many patients were discharged from the hospital. Most still do not have homes, or even tents, to live in. Now that Tomas has passed, the "TB Tents" for many months a fixture here at The General, are now gone. New challenges remain for a significantly downsized ward where only a limited number of patients can receive vital in-hospital care. The decisions in a healthcare system with no resources are difficult and, too often, deadly.
We now have a 20 Bed Cholera Treatment Center (CTC) at The General. Utilizing the space that was once used to house PIH volunteer doctors and nurses, we have set up a facility to care for adult and pediatric patients suffering from symptoms consistent with Cholera. We expect this Center to surge to capacity immediately. [...]We now have a 20 Bed Cholera Treatment Center (CTC) at The General. Utilizing the space that was once used to house PIH volunteer doctors and nurses, we have set up a facility to care for adult and pediatric patients suffering from symptoms consistent with Cholera. We expect this Center to surge to capacity immediately. We have identified an additional space adjacent to our emergency department to treat some of the patient surge but acknowledge that this will not be sufficient. We continue to experience severe limitations in medications, equipment and supplies.
As reports of a deadly Cholera outbreak emerged from Artibonite and the Central Plateau, Global ER was already on the phone. We contacted our partners at AmeriCares who were ready to send thousands of pounds of critical medical supplies to save lives from the disease, which can leave untreated patients dead of dehydration within hours. [...]
As reports of a deadly Cholera outbreak emerged from Artibonite and the Central Plateau, Global ER was already on the phone. We contacted our partners at AmeriCares who were ready to send thousands of pounds of critical medical supplies to save lives from the disease, which can leave untreated patients dead of dehydration within hours.
Cholera is a bacterial infection transmitted between people through the ingestion of contaminated water and/or food. While the treatment for cholera (often fluid replacement through oral rehydration therapy or IV administration) is not particularly complicated, the lack of basic supplies such as oral rehydration solution, IV fluids, tubing, needles, gloves, disinfectant and other items can leave an ill-equipped hospital powerless to care for the throngs of patients.
In an emergency good supply chain (i.e. the process to get the stuff from where it is to where it needs to be) is critical to saving lives. While supplies may be in Haiti, it is often difficult to locate where they may be, or to alert organizations to where emergency shortages exist.
Conversations with colleagues at my Hospital (The General), at Medishare/Bernard Mevs, and at JP/HRO confirmed that critical supply stocks were already short.
Within hours, I was on a plane back to Port-au-Prince, carrying several cases of cholera treatment supplies provided by a generous donor and New York physician. When the airline ticket agent advised that that the cargo exceeded size and weight requirements, CNN's Dr. Sanjay Gupta saved the day by persuading the airline to transport the materials!
Ever since October 22nd, I have been developing a Cholera Response Plan specific to The General Hospital. The objective of the plan is to limit mortality from Cholera at HUEH. Effective implementation of the plan requires significant resources commitments from outside stakeholders. MSPP is developing a nationwide strategy to mitigate a Cholera outbreak, but this [...]Ever since October 22nd, I have been developing a Cholera Response Plan specific to The General Hospital. The objective of the plan is to limit mortality from Cholera at HUEH. Effective implementation of the plan requires significant resources commitments from outside stakeholders. MSPP is developing a nationwide strategy to mitigate a Cholera outbreak, but this plan focuses on operational components and strategies aimed at protecting HUEH Staff, patients, family members, and the community. Here are some of the operational components (i.e. physical structures or resources needed to implement the plan):
- Cholera Treatment Center (CTC)
- Laboratory facilities for sample collection and diagnosis
- Surveillance and Epidemiology Operations Center
- Cholera Education Centers (CEC)
- Emergency Morgue Surge Facility
- In-Hospital Infection Control
- Alternate patient intake and treatment protocols
- Alternate Environmental Service Proceedures
- In-hospital Patient Transportation
- Public information
- Alternate Discharge protocols
- Case Reporting
- Mass Fatality Management