RESUMO
On January 12, 2010, a 7.0-magnitude earthquake struck Haiti. The event disrupted infrastructure and was marked by extreme morbidity and mortality. The global response to the disaster was rapid and immense, comprising multiple actors-including academic health centers (AHCs)-that provided assistance in the field and from home. The authors retrospectively examine the multidisciplinary approach that the University of Chicago Medicine (UCM) applied to postearthquake Haiti, which included the application of institutional structure and strategy, systematic deployment of teams tailored to evolving needs, and the actual response and recovery. The university mobilized significant human and material resources for deployment within 48 hours and sustained the effort for over four months. In partnership with international and local nongovernmental organizations as well as other AHCs, the UCM operated one of the largest and more efficient acute field hospitals in the country. The UCM's efforts in postearthquake Haiti provide insight into the role AHCs can play, including their strengths and limitations, in complex disasters. AHCs can provide necessary intellectual and material resources as well as technical expertise, but the cost and speed required for responding to an emergency, and ongoing domestic responsibilities, may limit the response of a large university and hospital system. The authors describe the strong institutional backing, the detailed predeployment planning and logistical support UCM provided, the engagement of faculty and staff who had previous experience in complex humanitarian emergencies, and the help of volunteers fluent in the local language which, together, made UCM's mission in postearthquake Haiti successful.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Altruísmo , Desastres , Terremotos , Serviços Médicos de Emergência/organização & administração , Incidentes com Feridos em Massa , Socorro em Desastres/organização & administração , Trabalho de Resgate/organização & administração , Chicago , Comportamento Cooperativo , Equipamentos e Provisões , Haiti , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Comunicação Interdisciplinar , Cooperação Internacional , Equipe de Assistência ao Paciente/organização & administração , Tradução , Voluntários/organização & administraçãoRESUMO
PURPOSE: The purpose of this study was to explore the experiences of nurse volunteers caring for children after the Haiti earthquake in January 2010. DESIGN AND METHODS: This descriptive qualitative study using in-depth interviews focuses on the experiences of 10 nurse volunteers. RESULTS: Four themes emerged: hope amid devastation, professional compromises, universality of children, and emotional impact on nurses. PRACTICE IMPLICATIONS: Nurses who volunteer after natural disasters have rich personal and professional experiences, including extremes of sadness and joy. Nurse volunteers will likely need to care for children. Nurses and humanitarian agencies should prepare for the unique challenges of pediatric care.
Assuntos
Terremotos , Enfermagem Pediátrica/organização & administração , Trabalho de Resgate/organização & administração , Voluntários/organização & administração , Adulto , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Feminino , Haiti , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Pesquisa Qualitativa , Estresse Psicológico , Inquéritos e Questionários , Voluntários/psicologia , Adulto JovemRESUMO
On January 12, 2010, a 7.0 magnitude Richter earthquake devastated Haiti, leading to the world's largest humanitarian effort in 60 years. The catastrophe led to massive destruction of homes and buildings, the loss of more than 200,000 lives, and overwhelmed the host nation response and its public health infrastructure. Among the many responders, the United States Government acted immediately by sending assistance to Haiti including a naval hospital ship as a tertiary care medical center, the USNS COMFORT. To adequately respond to the acute needs of patients, healthcare professionals on the USNS COMFORT relied on Haitian Creole-speaking volunteers who were recruited by the American Red Cross (ARC). These volunteers complemented full-time Creole-speaking military staff on board. The ARC provided 78 volunteers who were each able to serve up to 4 weeks on board. Volunteers' demographics, such as age and gender, as well as linguistic skills, work background, and prior humanitarian assistance experience varied. Volunteer efforts were critical in assisting with informed consent for surgery, family reunification processes, explanation of diagnosis and treatment, comfort to patients and families in various stages of grieving and death, and helping healthcare professionals to understand the cultural context and sensitivities unique to Haiti. This article explores key lessons learned in the use of volunteer interpreters in earthquake disaster relief in Haiti and highlights the approaches that optimize volunteer services in such a setting, and which may be applicable in similar future events.
Assuntos
Terremotos , Hospitais Militares/organização & administração , Medicina Naval/organização & administração , Socorro em Desastres/organização & administração , Navios , Tradução , Voluntários/organização & administração , Adulto , Cuidados Críticos/organização & administração , Desastres , Feminino , Haiti , Humanos , Controle de Infecções/organização & administração , Medicina Interna/organização & administração , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
On January 12, 2010, Haiti was struck by a 7.0 earthquake which left the country in a state of devastation. In the aftermath, there was an enormous relief effort in which academic medical centers (AMC) played an important role. We offer a retrospective on the AMC response through the Mount Sinai School of Medicine (MSSM) experience. Over the course of the year that followed the Earthquake, MSSM conducted five service trips in conjunction with two well-established groups which have provided service to the Haitian people for over 15 years. MSSM volunteer personnel included nurses, resident and attending physicians, and specialty fellows who provided expertise in critical care, emergency medicine, wound care, infectious diseases and chronic disease management of adults and children. Challenges faced included stressful and potentially hazardous working conditions, provision of care with limited resources and cultural and language barriers. The success of the MSSM response was due largely to the strength of its human resources and the relationship forged with effective relief organizations. These service missions fulfilled the institution's commitment to social responsibility and provided a valuable training opportunity in advocacy. For other AMCs seeking to respond in future emergencies, we suggest early identification of a partner with field experience, recruitment of administrative and faculty support across the institution, significant pre-departure orientation and utilization of volunteers to fundraise and advocate. Through this process, AMCs can play an important role in disaster response.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Atenção à Saúde , Desastres , Terremotos , Serviços Médicos de Emergência/métodos , Altruísmo , Comportamento Cooperativo , Planejamento em Desastres , Haiti , Pessoal de Saúde/estatística & dados numéricos , Humanos , Cidade de Nova Iorque , Voluntários/organização & administraçãoAssuntos
Acessibilidade aos Serviços de Saúde , Cooperação Internacional , Área Carente de Assistência Médica , Unidades Móveis de Saúde/organização & administração , Pobreza , Voluntários/psicologia , Relações Comunidade-Instituição , Haiti , Humanos , Relações Profissional-Paciente , Estados Unidos , Voluntários/educação , Voluntários/organização & administração , Recursos HumanosRESUMO
The weak health system in Honduras contributes to poor health indicators. To improve population health, a number of volunteer medical brigades from developed countries provide health services in Honduras. To date, there is little information on the brigades' activities and impact. The primary objective of this article is to increase understanding of the type of health care provided by voluntary medical brigades by evaluating and presenting data on patients' presenting symptoms, diagnoses, and care outcomes. The article focuses on an ongoing medical brigade organized by Canadian health professionals in conjunction with Honduras' largest national non-governmental organization. This is a descriptive study of data that are routinely collected by volunteer Canadian health care professionals. Data on all patients presenting to temporary primary health care facilities across Honduras between 2006 and 2009 were analyzed. The data were used to analyze patient demographics, presenting symptoms, diagnoses, and treatments. We found that the brigades provide additional human resources to the relatively weak Honduran health care system. However, while brigades may increase solidarity between Hondurans and Canadians, concerns persist regarding cost-effectiveness and continuity of care for conditions treated by short-term brigade volunteers. Greater scrutiny is needed to increase brigades' effectiveness and ensure they are supportive of domestic health systems.
Assuntos
Registros de Saúde Pessoal , Missões Médicas/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Voluntários/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/etnologia , Criança , Pré-Escolar , Continuidade da Assistência ao Paciente , Feminino , Pessoal de Saúde/organização & administração , Pessoal de Saúde/estatística & dados numéricos , Honduras/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Missões Médicas/organização & administração , Pessoa de Meia-Idade , Voluntários/organização & administração , Adulto JovemRESUMO
PURPOSE: This study outlines the evolution of a pediatric field hospital after the January 2010 Haiti earthquake. METHODS: Project Medishare set up a field hospital in Port-au-Prince 48 hours after the event. Our institution staffed the pediatric component for 45 days, with sequential deployment of 9 volunteer medical teams. Evolving facility and manpower requirements and changing patient demographics over time were evaluated. RESULTS: Delegations consisted of surgeons, pediatricians, nurses, operating room (OR) personnel, physical therapists, pharmacists, and support staff. Primary goals involved creation of a child-specific ward, pediatric OR, and a wound care center. Major inpatient demographic changes occurred as time from the disaster elapsed. Initial census showed that 93% of the patients were surgical admissions with 40% undergoing operations, mostly fracture and wound care, over the first week. Eight weeks later, medical illnesses accounted for 70% of inpatients, whereas OR volume dropped by more than 50%. A second trend involved increasing acuity of care. Initially, children were admitted for serious or limb-threatening, but usually not life-threatening, injuries. Within 2 months, one third of the patients were housed in the developing NICU/PICU; and only 12% were admitted for injuries related to the earthquake. This change in patient needs led to alterations in facility requirements and in staffing and leadership needs. CONCLUSION: A disaster involving significant casualties in a populated area demands the rapid development of a field facility with pediatric personnel. Requirements for equipment, manpower, medical records, and systems addressing volunteer stress and ethical dilemmas can be anticipated.
Assuntos
Planejamento em Desastres/organização & administração , Desastres , Terremotos , Hospitais Pediátricos/organização & administração , Criança , Medicina de Desastres/organização & administração , Feminino , Haiti , Humanos , Lactente , Recém-Nascido , Cooperação Internacional , Masculino , Unidades Móveis de Saúde , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/cirurgia , Salas Cirúrgicas/organização & administração , Avaliação de Programas e Projetos de Saúde , Socorro em Desastres/organização & administração , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo , Voluntários/organização & administraçãoRESUMO
This is a human interest story and update on the current state of healthcare and earthquake recovery in Haiti. This is drawn from experiences the author has gained through disaster response after the 7.0 earthquake and in returning to Haiti as a medical volunteer in October 2010. What has been accomplished in the last year since the earthquake and the challenges that lay ahead for the Haitian people are addressed through personal experiences with patients, American volunteers, and local healthcare staff. The experience of being a medical volunteer in Port au Prince, Haiti, is portrayed through the surrounding environment, interactions with patients and fellow volunteers, and the resulting emotional and psychological impact. This piece culminates with the impression such volunteer work has left on the author and how it has been life-changing.
Assuntos
Desastres , Terremotos , Voluntários/organização & administração , Haiti , Humanos , Estados Unidos , Voluntários/psicologiaAssuntos
Atenção à Saúde/organização & administração , Medicina de Desastres/organização & administração , Planejamento em Desastres/organização & administração , Terremotos , Acessibilidade aos Serviços de Saúde/organização & administração , Nefrologia/organização & administração , Voluntários/organização & administração , Comunicação , Comportamento Cooperativo , Haiti , Humanos , Cooperação Internacional , Objetivos Organizacionais , Sociedades Médicas , Fatores de Tempo , Meios de Transporte , Populações VulneráveisRESUMO
On January 12, 2010, a 7.0 M(L) earthquake devastated Haiti, the most impoverished nation in the Western hemisphere with extremely limited health care resources. We traveled to Milot, Haiti situated north of Port-au-Prince, to care for injured patients at Hôpital Sacré Coeur, an undamaged hospital with 74 beds and 2 operating rooms. The massive influx of patients brought by helicopter from the earthquake zone transformed the hospital to >400 beds and 6 operating rooms. As with the 2005 Kashmir and 2008 China earthquake, most victims suffered from extremity injuries, encompassing crush injuries, lacerations, fractures, and amputations with associated dehydration and anemia. Preoperative evaluation was limited by language issues requiring a translator and included basic questions of fasting status, allergies, and coexisting conditions. Goals included adequate depth of anesthesia, while avoiding apnea/airway manipulation. These goals led to frequent use of midazolam and ketamine or regional anesthesia. Although many medications were present under various names and concentrations, the absence of a central gas supply proved troublesome. Postoperative care was limited to an 8-bed postanesthesia care unit/intensive care unit caring for patients with tetanus, diabetic ketoacidosis, pulmonary aspiration, acute renal failure due to crush, extreme anemia, sepsis, and other illnesses. Other important aspects of this journey included the professionalism of the health care personnel who prioritized patient care, adaptation to limited laboratory and radiological services, and provision of living arrangements. Although challenging from many perspectives, the experience was emotionally enriching and recalls the fundamental reasons why we selected medicine and anesthesiology as a profession.
Assuntos
Serviço Hospitalar de Anestesia/organização & administração , Defesa Civil/organização & administração , Planejamento em Desastres/organização & administração , Terremotos , Serviços Médicos de Emergência/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Incidentes com Feridos em Massa , Salas Cirúrgicas/organização & administração , Altruísmo , Anestésicos/provisão & distribuição , Atitude do Pessoal de Saúde , Competência Clínica , Comportamento Cooperativo , Equipamentos e Provisões/provisão & distribuição , Haiti , Recursos em Saúde/organização & administração , Humanos , Objetivos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Cuidados Pós-Operatórios , Papel Profissional , Voluntários/organização & administraçãoRESUMO
This study explores the effects of social integration on behavioral change in the course of an intensive, community-based public health intervention. The intervention trained volunteers and mobilized local organizations to promote 16 key family health practices in rural San Luis, Honduras, during 2004 to 2006. A mixed methods approach is used. Standard household sample surveys were performed in 22 villages before and after the intervention. Eight villages were then resurveyed. A household survey, focus groups, and key informant interviews measured health behaviors and several social structural and psychosocial variables. The villages were then ranked on their mean behavioral and social integration scores. The quantitative and qualitative rankings were in close agreement (Kendall's coefficient of concordance = .707, p < .001). Behaviors changed most markedly in the villages where respondents participated in local organizations, observed that others performed those behaviors, and depended on their neighbors for support. The results show that social integration conditions health behavioral change. Health interventions can be made more effective by analyzing these features a priori.
Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Apoio Social , Socialização , Agentes Comunitários de Saúde/organização & administração , Honduras , Humanos , Meio Social , Voluntários/organização & administraçãoAssuntos
Atenção à Saúde , Terremotos , Serviços Médicos de Emergência/organização & administração , Honorários e Preços , Missões Médicas , Prática Privada/economia , Voluntários , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Haiti , Humanos , Missões Médicas/economia , Missões Médicas/organização & administração , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/tendências , Setor Privado/economia , Setor Público/economia , Voluntários/organização & administração , Recursos HumanosRESUMO
BACKGROUND: On Tuesday, January 12, 2010 at 16:53 local time, a magnitude 7.0 M(w) earthquake struck Haiti. The global humanitarian attempt to respond was swift, but poor infrastructure and emergency preparedness limited many efforts. Rapid, successful deployment of emergency medical care teams was accomplished by organizations with experience in mass disaster casualty response. Well-intentioned, but unprepared, medical teams also responded. In this report, we describe the preparation and planning process used at an academic university department of anesthesiology with no preexisting international disaster response program, after a call from an American-based nongovernmental organization operating in Haiti requested medical support. The focus of this article is the pre-deployment readiness process, and is not a post-deployment report describing the medical care provided in Haiti. METHODS: A real-time qualitative assessment and systematic review of the Hospital of the University of Pennsylvania's communications and actions relevant to the Haiti earthquake were performed. Team meetings, conference calls, and electronic mail communication pertaining to planning, decision support, equipment procurement, and actions and steps up to the day of deployment were reviewed and abstracted. Timing of key events was compiled and a response timeline for this process was developed. Interviews with returning anesthesiology members were conducted. RESULTS: Four days after the Haiti earthquake, Partners in Health, a nonprofit, nongovernmental organization based in Boston, Massachusetts, with >20 years of experience providing medical care in Haiti contacted the University of Pennsylvania Health System to request medical team support. The departments of anesthesiology, surgery, orthopedics, and nursing responded to this request with a volunteer selection process, vaccination program, and systematic development of equipment lists. World Health Organization and Centers for Disease Control guidelines, the American Society of Anesthesiology Committee on Trauma and Emergency Preparedness, published articles, and in-country contacts were used to guide the preparatory process. CONCLUSION: An organized strategic response to medical needs after an international natural disaster emergency can be accomplished safely and effectively within 6 to 12 days by an academic anesthesiology department, with medical system support, in a center with no previously established response system. The value and timeliness of this response will be determined with further study. Institutions with limited experience in putting an emergency medical team into the field may be able to quickly do so when such efforts are executed in a systematic manner in coordination with a health care organization that already has support infrastructure at the site of the disaster.
Assuntos
Serviço Hospitalar de Anestesia/organização & administração , Defesa Civil/organização & administração , Planejamento em Desastres/organização & administração , Terremotos , Serviços Médicos de Emergência/organização & administração , Hospitais Universitários/organização & administração , Incidentes com Feridos em Massa , Equipe de Assistência ao Paciente/organização & administração , Altruísmo , Comportamento Cooperativo , Eficiência Organizacional , Equipamentos e Provisões/provisão & distribuição , Guias como Assunto , Haiti , Humanos , Cooperação Internacional , Objetivos Organizacionais , Pennsylvania , Seleção de Pessoal/organização & administração , Avaliação de Programas e Projetos de Saúde , Telecomunicações/organização & administração , Fatores de Tempo , Estudos de Tempo e Movimento , Voluntários/organização & administraçãoRESUMO
The Miller School of Medicine of the University of Miami and Project Medishare, an affiliated not-for-profit organization, provided a large-scale relief effort in Haiti after the earthquake of 12 January 2010. Their experience demonstrates that academic medical centers in proximity to natural disasters can help deliver effective medical care through a coordinated process involving mobilization of their own resources, establishment of focused management teams at home and on the ground with formal organizational oversight, and partnership with governmental and nongovernmental relief agencies. Proximity to the disaster area allows for prompt arrival of medical personnel and equipment. The recruitment and organized deployment of large numbers of local and national volunteers are indispensable parts of this effort. Multidisciplinary teams on short rotations can form the core of the medical response.
Assuntos
Atenção à Saúde/organização & administração , Desastres , Terremotos , Hospitais de Emergência/organização & administração , Hospitais Universitários/organização & administração , Socorro em Desastres/organização & administração , Florida , Previsões , Haiti , Humanos , Triagem/organização & administração , Voluntários/organização & administraçãoAssuntos
Serviços de Saúde Comunitária , Educação em Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Seguridade Social/estatística & dados numéricos , Voluntários/educação , Adolescente , Serviços de Saúde do Adolescente , Fatores Etários , Idoso , Diarreia Infantil/epidemiologia , Diarreia Infantil/prevenção & controle , Feminino , Serviços de Saúde para Idosos , Humanos , Lactente , Bem-Estar do Lactente , Masculino , Peru , Desenvolvimento de Programas , Saúde Pública , Voluntários/organização & administraçãoRESUMO
On January 12, 2010, a major earthquake in Haiti resulted in approximately 212 000 deaths, 300 000 injuries, and more than 1.2 million internally displaced people, making it the most devastating disaster in Haiti's recorded history. Six academic medical centers from the city of Chicago established an interinstitutional collaborative initiative, the Chicago Medical Response, in partnership with nongovernmental organizations (NGOs) in Haiti that provided a sustainable response, sending medical teams to Haiti on a weekly basis for several months. More than 475 medical volunteers were identified, of whom 158 were deployed to Haiti by April 1, 2010. This article presents the shared experiences, observations, and lessons learned by all of the participating institutions. Specifically, it describes the factors that provided the framework for the collaborative initiative, the communication networks that contributed to the ongoing response, the operational aspects of deploying successive medical teams, and the benefits to the institutions as well as to the NGOs and Haitian medical system, along with the challenges facing those institutions individually and collectively. Academic medical institutions can provide a major reservoir of highly qualified volunteer medical personnel that complement the needs of NGOs in disasters for a sustainable medical response. Support of such collaborative initiatives is required to ensure generalizability and sustainability.
Assuntos
Centros Médicos Acadêmicos/métodos , Altruísmo , Terremotos , Incidentes com Feridos em Massa , Centros Médicos Acadêmicos/organização & administração , Chicago , Comportamento Cooperativo , Haiti , Humanos , Cooperação Internacional , Estudos de Casos Organizacionais , Organizações , Telecomunicações/organização & administração , Voluntários/organização & administraçãoRESUMO
The experience of a group of 9 doctors and 6 nurses, most of them younger than 30 years of age, whom were part of the several volunteer groups directed towards the most damaged earthquake regions, is described. The team had to overcome a number of intense personal emotions related with the magnitude of the destruction, especially in the "adobe"-constructed houses and villages, in order to provide useful medical support. Moving out of the hospital setting, reaching out to the community in schools and emergency posts proved to be important in rural communities. An appropriate coordination of the volunteer groups, with the simultaneous action of municipal and state health authorities, together with well-guided leadership, was critical for an effective response in the larger city of Talcahuano /Hualpén. Within the second week of the aftermath, acute respiratory and intestinal infections were the most common medical complaints together with intense -in many cases severe- emotional distress associated mostly with fear to after shakes ("replicas"), tsunami, and social unrest. The severe earthquake that struck Chile has left many lessons for the future that will need to be analyzed seriously and with the conviction that effective and timely prevention of catastrophic aftermath consequences, although costly, must be a key element of the country's development plan. More importantly, the hundreds if not thousands of volunteers from a variety of health related professions that were moved by the scenes of suffering, and whom responded to individual or group initiatives, allow to foresee that the nation has the moral stamina required to overcome the tragedy and become a better society.