Delivering First-World Medicine in Third-World Disaster Relief
and Volunteerism
Samir Mehta, MDUniversity of Pennsylvania
Everything I Wish I Knew Before I Left the Country …
Everything I Wish I Knew Before I Left the Country …
No International Incidents to date …
Choose Your Own Adventure
Choose Your Own Adventure
Volunteerism
• Who are you?– Overseas work– Disaster areas – be ready, credentialing– Organization – OTA, SIGN, FOT, AO, HVO, DMAT
• What can you offer?– Part of the solution
• Infrastructure– At home and abroad
Tip #1
• Bring a Cell Phone
• Bring a charger (solar)
• Make sure it has international functioning
Tip #1
• Bring a Cell Phone
• Bring a charger (solar)
• Make sure it has international functioning
• Turn off your roaming!
What are the local conditions?
Haiti•50% no access to clean water BEFORE QUAKE•50% adults middle school education•GNP 1/5 to 1/7 that of DR•60% unemployment •Subsistence farming
Haiti …
• The disaster was as much social as geologic
Why so destructive?
• Poor construction– No codes– Little rebar– Poor concrete
How Can You Help?
• Decision
• Loved ones– Not alone
• Not Vacation
Acronyms decoded
• HHS- US Dept. of Health and Human Services• NDMS- National Disaster Medical System• DMAT- Disaster Medical Assistance Team• IMSuRT- International Medical Surgical
Response Team• USAID- US Agency for International
Development• DoD- US Department of Defense
How does IMSuRT work?
• Multidisciplinary team• Self contained surgical hospital, personnel
support• Equipment loaded on pallets• Driven onto DoD aircraft (C-17)• Deployable within 48 hours
Disaster Response
• “If you want to go quickly, go alone. If you want to go far, go together”– African proverb
• “…We need to go very far very quickly”– Al Gore
Private groups
HSS Team
HHS Team
What do you need?
• Permission– Passport– Visa– License– Malpractice
Transportation
– Air– Ground– Return– Supply chain
Healthcare (your own)
– Vaccinations (Hep A/B, Typhoid, Tetanus, MMR, DPT)– Malaria prophylaxis– Yellow card– Dengue Fever?– HIV– Tuberculosis (N95 mask)– Leptospirosis– Anthrax– Ebola
Water
Tip #2
• Bring self-filtration water kits
• Bring energy bars
Food
Shelter
Protection
•Crowd control•Aid distribution
Power
• You need a lot of stuff• You need to bring it all…
Spain
Russia
Germany
Puerto Rico
US Embassy
EMR
Real Medical Record
Evac to USNS Comfort
Tip #3
• Baby Wipes– Unscented
Strategic Deployment
• Nine Full Days• 1200 lbs of supplies• 84 surgical procedures
– 76 Earthquake
• ~1000 patient contacts• Implemented systems
– Daily wound rounds– “Sign your site”
• No follow-up
0%
10%
20%
30%
40%
Fracture Infection Soft-tissue
Hospital Antonio Lenin FonsecaManagua, Nicaragua
Tip #4
• Know the local politics
• Don’t take things personally
The Contrast – The “Private Hospital”
The People
Wards
Intensive care
Emergency
Equipment
Medications
Bringing HUP to Managua
Teaching
Tip #5
• Check the State Department Website
• Know where the Embassy is
Case #1: Injury 3 years ago
Case #2: Hardware Removal
Case #3: 19M s/p fall from truck 4wks ago
Case #4
Case #5: Machete injury, contralateral BEA
Case #6: 15F, 4wks old, head injury
Tip #6
• Leave your Ego at the Door
2nd Inpatient Tower Under Construction
Volunteerism
Volunteerism
• Not about going somewhere necessarily• Locally or Nationally• Organized Medicine
– OTA– AAOS– AOA– AMA
• Unique Skill Set
Volunteerism
• Life Changing
– For Them
– For You