Next Generation is a Brigham Clinical & Research News column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email us. This month’s column is written by Morgan Broccoli, MD, MPH, a Global Emergency Medicine fellow.
On Aug. 14, I learned that a magnitude 7.2 earthquake had struck Haiti, with its epicenter close to the southwestern city of Les Cayes. The next 16 hours were a whirlwind as I prepared for deployment with Team Rubicon’s advance medical reconnaissance team while also working an Emergency Department shift at Brigham and Women’s Faulkner Hospital. In what felt like no time at all, I was on a 6 a.m. flight out of Boston. I was excited, but also apprehensive: How would this disaster response be run? What would our team’s priorities be? How would we integrate into the local health care setting?
As a Global Emergency Medicine fellow, I have worked on emergency care strengthening programs in multiple countries. Strong, longitudinal relationships with local partners form the foundation of these programs, and emphasis is placed on finding local solutions for local problems. With these principles at the core, such programs are able to build emergency care capacity while also promoting bilateral knowledge sharing.
A Collaborative Approach
Historically, many well-meaning organizations have responded to disasters by acting independently, without central coordination or attempts to integrate into the local health care system. In 2010, the proximity of Haiti to multiple higher-income countries allowed numerous teams to self-deploy in an attempt to render assistance. While international aid was certainly necessary and was responsible for saving many lives, criticisms of the response centered on the lack of coordination and communication among responders, insufficient local involvement and the absence of context-appropriate treatment guidelines, particularly for surgical procedures such as amputations. The international humanitarian community has learned a lot from the 2010 earthquake, and as a result new guidelines and standards have been developed for medical care in humanitarian settings. The World Health Organization’s Emergency Medical Teams (EMTs) Initiative, which certifies, regulates and coordinates international medical humanitarian response, was established in direct response to the 2010 earthquake.
My experience responding to the 2021 earthquake showed me that the humanitarian community has taken these lessons to heart, and the field as a whole is committed to national leadership, coordination, quality and resilience. When we arrived in Les Cayes two days after the earthquake, we spent our first day traveling to different hospitals to meet with their local hospital leadership. We spoke with the medical directors about their capacity, needs and how we might be able to help them. Some hospitals said they did not need assistance, and some had specific needs (such as operating room capacity) that our team would not be able to provide.
Responding to Local Needs
At Immaculate Conception Hospital (HIC), the general hospital of Les Cayes, we met with medical director Peterson Gédé, MD, and the head of the Emergency Room, Titus Antoine, MD. As the public hospital, HIC was overrun with patients, many of whom were lying on floors waiting to be seen, with overflow spilling outside into courtyards. Dr. Gédé and Dr. Antoine agreed that our team would be a welcome addition to the Emergency Room, where we could provide assistance with patient triage and treatment. We integrated into the local hospital, and our doctors and nurses worked side-by-side with their HIC colleagues. Most patients had orthopaedic injuries, mainly open and closed fractures, dislocations, and severe soft tissue wounds, and many patients didn’t present until a week after the earthquake. We also worked in the pediatric ward — again mostly with orthopaedic injuries, although we did care for children with diabetic ketoacidosis, bronchiolitis and many premature infants.
In this way, we were able to augment the local capacity without replacing or duplicating the existing health care structure. There was also continual opportunity for bilateral learning; we were able to share some of our emergency care expertise, and our Haitian colleagues taught us how medicine is practiced in their setting. They are experts in resource allocation and disposition planning.
Eventually, the Haitian Ministry of Health sent out a formal request for international EMTs. The government was then able to direct these EMTs to the areas where they had identified the most need. Multiple EMTs have been deployed in this manner, and they are coordinated by a central command center in Port-au-Prince that works closely with the Ministry of Health.
Humanitarian actors are increasingly focused on building prepared, resilient health systems that can effectively respond to disasters. Central to such strengthening exercises is the involvement of local leadership — at the government, hospital and community level — in all aspects of the disaster response. I was able to experience this approach firsthand in Haiti; my team and others made sure to take our direction from the local leadership and to work collaboratively within the existing system. As foreigners, we were there to assist the Haitians with their earthquake response, rather than to dictate the response ourselves. I was very impressed with the collaboration I witnessed during my first disaster response, and I look forward to being part of such initiatives in the future.