Defending the Response in Haiti
I have just read the editorial by Marie-Eileen Onieal in the February issue [When Helping Hands Are Tied. 2010;20(2):cover, 18-20]. My first question is, “Has she ever been to Haiti?” If she has spent time in that country, then her remarks will be taken with value; if she has not, then I only consider them a typical “armchair quarterback” response.
I am a nurse practitioner and my husband is a surgeon. We have been working in Haiti for 10 years and have a deep love for the country and its people. We have traveled the roads, worked within the existing medical system, and negotiated with its many branches of government. There is no country in the world that has Haiti’s density of people, lack of systems, and unjust distribution of wealth and power, as well as lack of natural resources and depth of poverty.
The response by aid and military supports was overwhelming, and the work that they performed was of extremely high quality. We applaud what continues to be offered even today. This was an impossible situation due to the complexity of Haiti’s problems with transportation and fragmented government and to the magnitude of the natural disaster.
Mary Helen Rappole, MSN, FNP, CWHNP, Jamestown, NY
I read with intense interest Ms. Onieal’s editorial and her description of the medical challenges encountered following the earthquake in Haiti on January 12. Her comparison between the lessons learned in Hurricane Katrina and the Haitian earthquake is challenged.
Hurricane Katrina was an unfortunate national catastrophe, and our country has learned many lessons in disaster response as a result. Control of the National Medical Disaster System, and its elite Disaster Medical and International Surgical Assistance Teams, was transferred from FEMA to the Department of Health and Human Services. Varying scenarios have been prepared to prevent another “Katrina,” and these teams are designed to augment our nation’s health care systems in the event of a disaster.
The Haitian earthquake likewise is an unfortunate catastrophe for the Haitian people. The vast differences are that Haiti has had a poor to almost nonexistent health care system, which has relied heavily on nonprofit organizations. This nation has the world’s poorest population, with the average Haitian making $1 to $2 a day in income.
The Haiti International Airport’s control tower was heavily damaged, and airplanes landed without direction or control. At one point, the airport was so congested that airplanes could not land to offload equipment, personnel, or supplies; not until US military air traffic controllers intervened and a mobile air traffic control tower was erected would airport traffic be routed effectively. Unfortunately, military aircraft supersede civilian air traffic (due to the need for military forces, security, equipment, and supplies).
The Haitian government ceased to function because of the devastation to its facilities and death of staff. Within 24 hours, the US government dispatched the Disaster Medical Assistance Team (DMAT) from Massachusetts (MA-1), as well as the International Surgical Response Team from Massachusetts (IMSuRT-East). These teams are composed of physicians, nurse practitioners, physician assistants, nurses, and support staff. They arrived in Haiti within 48 to 72 hours of notification and worked in the most arduous conditions known to mankind.
The Incident Command System was initiated and performed flawlessly. Whenever multiple agencies (military, civilian, foreign) work together in a combined effort, there will be command and control issues. They were protected by elements of the US Army’s 82nd Airborne. All these teams met numerous challenges during this event, including the tremendous number of limb amputations.
These teams were relieved every two weeks by other federal components, including IMSuRT-West and IMSuRT-South, with medical support from numerous other DMATs. The Israeli government dispatched an impressive Boeing 747 airborne surgical hospital, and they too were overwhelmed with the number and scale of devastating injuries.
The experiences and lessons learned from these teams are used to better prepare our nation for future disasters. Are we better prepared than we were during Hurricane Katrina? You bet; however, there is never a flawless machine or system, and every disaster is a learning experience for all. In the background of every potential disaster or federal event of national significance, DMATs and IMSuRTs stand at the ready.
Louis M. Velazquez, PA-C, North Carolina 1, DMAT, Ahoskie, NC
Editor’s Note: In Dr. Onieal’s editorial, it was erroneously stated that Haiti lies 3,000 miles from the Florida coast. Several astute readers pointed out that the actual distance is about 700 miles.
Money Wasted on Translation
Your article on medical translation [Lost in translation. Clinician Reviews. 2010;20(2):cover, 10, 12, 14.] is enough to make my blood boil. Do you have any idea how much, in precious health care dollars, this costs us every year? Money that should be spent on actual health care is being wasted on frivolous crap such as translation services.