applying lessons learned to the haiti earthquake response

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Australasian Emergency Nursing Journal (2010) 13, 4—6 available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/aenj GUEST EDITORIAL Applying lessons learned to the Haiti Earthquake response On the12th January at 4.53 p.m. (local time) the impover- ished Caribbean nation of Haiti was struck by an earthquake measuring 7.0 on the Richter scale. This was the largest earthquake to hit the island nation in over 200 years and the initial impact and subsequent aftershocks caused extreme damage and affected a population of over 3 million. The epicentre was approximately 17 km south-west of Haiti’s capital, Port-au-Prince. The nearby population centres and areas to the west and south of the epicentre were most severely affected. At the time of writing the numbers killed and injured are unknown and the dead are thought to number in the tens of thousands. Many were buried in the rubble of collapsed buildings in this desperately poor nation in which infrastructure, rescue and health capability and capacity are exceptionally poor. Damage to buildings and essential services such as power and water supplies, hospi- tals and government services was extensive, in part because of poor building standards and already overstretched ser- vices. Following the disaster many of the essential services necessary to support an effective response were too badly damaged to be used. Shipping was unable to berth and the airport control tower was destroyed severely limiting access by air. Both the main sea port and the airport were, as a result, left with very limited capacity to receive essential supplies and rescue personnel from other nations. The road network was in ruins severely limiting the distribution of aid. The extent of the damage and the already poor condi- tion of national infrastructure inevitably affected the speed and reach of the international humanitarian response. It is estimated by the Centre for Research on the Epidemi- ology of Disasters 1 that in the past 50 years more than 10,000 disasters have occurred, more than five billion people have been affected, and more than 12 million persons killed at an economic cost of more than US$4 trillion. Disasters continue to occur and the frequency of these catastrophic occur- rences is increasing. 1 In addition, the impact of disaster is becoming more severe as more people live in close proxim- ity to possible impact zones (such as ‘sea change’ locations near to the coast), in more crowded situations and with greater reliance on the community for essential services. In many countries population transitions and growth have not been accompanied by adequate development of infras- tructure and degradation of the environment has increased the impact of disaster. In addition we know that disaster does not affect populations equally and those with lower socio-economic resources are most severely affected. As a result poorer countries such as Haiti and poorer community members suffer disproportionately from disaster events. For most of us our experience of disaster, and disaster health care, is limited to the media vision and reporting that we receive from disasters such as the Haiti earthquake. The television footage is often focused on the work of surgical teams and at the site of temporary field hospitals or on rescue teams digging for buried survivors. However, the international emergency medical and rescue response to disaster, generally arrives too late and has relatively limited impact on the survival and recovery of those affected, except of course at the level of individuals fortunate enough to receive life saving treatment in a timely way or the occasional extraordinary discovery of those who have been buried for extended periods. Surgical teams generally arrive a little too late to save life and generally cease to have much influence on survival and longer-term recovery a few days or weeks after the impact of disaster. Very early during the international response to the Earthquake Haiti was described as being ‘awash’ with doctors but desperately short of public health and nursing staff. This focus on providing acute medical care to disaster affected nations is a typical feature of the international response but is often of much less value than efforts to re-establish normal healthcare services and public health standards. Nurses of course play a major role in this effort. For the health services the coordination of the health response to disaster is the most pervasive problem. An extraordinary number of non-government (NGO) and human- itarian organisations and many national governments may become involved in responding to an event such as the Haiti earthquake. Coordination of this response to ensure that it is effective, that duplication is reduced and that the maximum possible benefit can be assured is a complex task. To this 1574-6267/$ — see front matter © 2010 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.aenj.2010.02.003

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Page 1: Applying lessons learned to the Haiti Earthquake response

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ustralasian Emergency Nursing Journal (2010) 13, 4—6

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journa l homepage: www.e lsev ier .com/ locate /aenj

UEST EDITORIAL

pplying lessons learned to the Haiti Earthquake

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n the12th January at 4.53 p.m. (local time) the impover-shed Caribbean nation of Haiti was struck by an earthquakeeasuring 7.0 on the Richter scale. This was the largest

arthquake to hit the island nation in over 200 years and thenitial impact and subsequent aftershocks caused extremeamage and affected a population of over 3 million. Thepicentre was approximately 17 km south-west of Haiti’sapital, Port-au-Prince. The nearby population centres andreas to the west and south of the epicentre were mosteverely affected. At the time of writing the numbers killednd injured are unknown and the dead are thought toumber in the tens of thousands. Many were buried in theubble of collapsed buildings in this desperately poor nationn which infrastructure, rescue and health capability andapacity are exceptionally poor. Damage to buildings andssential services such as power and water supplies, hospi-als and government services was extensive, in part becausef poor building standards and already overstretched ser-ices. Following the disaster many of the essential servicesecessary to support an effective response were too badlyamaged to be used. Shipping was unable to berth and theirport control tower was destroyed severely limiting accessy air. Both the main sea port and the airport were, as aesult, left with very limited capacity to receive essentialupplies and rescue personnel from other nations. The roadetwork was in ruins severely limiting the distribution ofid. The extent of the damage and the already poor condi-ion of national infrastructure inevitably affected the speednd reach of the international humanitarian response.

It is estimated by the Centre for Research on the Epidemi-logy of Disasters1 that in the past 50 years more than 10,000isasters have occurred, more than five billion people haveeen affected, and more than 12 million persons killed at anconomic cost of more than US$4 trillion. Disasters continueo occur and the frequency of these catastrophic occur-

ences is increasing.1 In addition, the impact of disaster isecoming more severe as more people live in close proxim-ty to possible impact zones (such as ‘sea change’ locationsear to the coast), in more crowded situations and withreater reliance on the community for essential services.

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574-6267/$ — see front matter © 2010 College of Emergency Nursing Aoi:10.1016/j.aenj.2010.02.003

n many countries population transitions and growth haveot been accompanied by adequate development of infras-ructure and degradation of the environment has increasedhe impact of disaster. In addition we know that disasteroes not affect populations equally and those with lowerocio-economic resources are most severely affected. As aesult poorer countries such as Haiti and poorer communityembers suffer disproportionately from disaster events.For most of us our experience of disaster, and disaster

ealth care, is limited to the media vision and reporting thate receive from disasters such as the Haiti earthquake. The

elevision footage is often focused on the work of surgicaleams and at the site of temporary field hospitals or onescue teams digging for buried survivors. However, thenternational emergency medical and rescue response toisaster, generally arrives too late and has relatively limitedmpact on the survival and recovery of those affected,xcept of course at the level of individuals fortunatenough to receive life saving treatment in a timely way orhe occasional extraordinary discovery of those who haveeen buried for extended periods. Surgical teams generallyrrive a little too late to save life and generally cease toave much influence on survival and longer-term recoveryfew days or weeks after the impact of disaster. Very

arly during the international response to the Earthquakeaiti was described as being ‘awash’ with doctors butesperately short of public health and nursing staff. Thisocus on providing acute medical care to disaster affectedations is a typical feature of the international responseut is often of much less value than efforts to re-establishormal healthcare services and public health standards.urses of course play a major role in this effort.

For the health services the coordination of the healthesponse to disaster is the most pervasive problem. Anxtraordinary number of non-government (NGO) and human-

tarian organisations and many national governments mayecome involved in responding to an event such as the Haitiarthquake. Coordination of this response to ensure that it isffective, that duplication is reduced and that the maximumossible benefit can be assured is a complex task. To this

ustralasia Ltd. Published by Elsevier Ltd. All rights reserved.

Page 2: Applying lessons learned to the Haiti Earthquake response

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Applying lessons learned to the Haiti Earthquake response

end, following the Asian Tsunami disaster the United Nationsestablished the Global Health Cluster (GHC) comprised ofkey international organisations and led by the World HealthOrganisation. The GHC provides coordination of the inter-national effort and hopefully improves the outcome of therescue and recovery effort.

It is common for health professionals to self-respondto disasters creating a major problem for affected nationsrequiring identification and credentialing of these respon-ders and the provision of resources to protect and to housethem. Health and humanitarian organizations experienced indisaster response arrive in the disaster zone with a level ofself-sufficiency, providing their own communications, logis-tics, supplies and the like. Well meaning self-respondersgenerally do not have these resources and should be dis-couraged from travelling into disaster zones. Anyone wishingto volunteer as a responder should do so as a member of amulti-disciplinary contingent organised by a national gov-ernment or by a reputable non-government organisationexperienced in disaster relief such as a member of the GHC.

The health response is frequently tainted by commonmisconceptions about disaster. We frequently have too lit-tle experience ourselves and can be easily fooled by publicinformation sources when forming our understanding ofwhat happens in disaster situations and what the health pri-orities should be. Often a relatively poor understanding ofthe heath impacts of disasters and the best evidence-basedapproaches leads to mis-guided and inappropriate healthactions. These are complex events and difficult to manageeven when responders are well rained, knowledgeable andexperienced.

Very early in the response phase we hear about the risk ofdisease and the problem off decomposing bodies. Reports oflooting and violence begin to emerge along with complaintsabout the delay in getting vital supplies to affected people,the delivery of health care to the injured and the exclusionof non-government and charitable organisations. For most ofus these issues appear to be the expected sequellae of dis-aster but in fact they demonstrate how the lessons learnedfrom disasters have failed to influence the understanding ofthe media, the average citizen and our own colleagues inhealth care.

We know, for example, that decomposing bodies areunlikely to be a risk to health. Mass burials are usually unnec-essary. The rush to bury the dead makes identification of thedeceased very difficult and can deeply affect bereaved rel-atives who may find it more difficult to come to terms withtheir loss. Mass burial has severe psychosocial consequencesand should be avoided whenever possible. Generally, therisk of infection arising from dead bodies is very low. Evenif infectious diseases such as cholera, plague or typhus arepresent in the community it is far more likely that they willbe spread by those who are still alive rather than by corpses.The myth that bodies spread disease appears to arise fromthe infectious risk associated with handling the deceasedwherein normal blood and fluid protective measures shouldbe taken. People handling corpses have to be suitably pro-

tected with masks and gloves to avoid infection by HIV andother blood-borne microbes. However there is no evidencethat dead bodies spread disease even when in an advancedstate of decomposition.2 Indeed, a rush to pick up the deadmay well be life-threatening. It can divert resources away

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rom rescue efforts for those who are alive and buried underubble or in urgent need of medical care. In Haiti mass burialas once again an early feature of the response.

Another common myth associated with disasters is thathey bring out the worst in human behaviour, when in fact,hile people are shocked and wonder why they survived andthers died, their resilience is generally extraordinary andhe stories of goodwill and support that arise from disastersemonstrate the very best of the human spirit. We know, forxample, that looting is rare3 although isolated cases areuickly reported in the media. Often, in situations whereeighbourhoods are isolated and families are starving fooday be liberated from markets and other locations, but of

ourse this represents a rescue response rather than crimi-ality. Once again in Haiti reports of widespread looting risklacing too much resource into security and too little intoesponding to the very real needs of the population for food,afe water and shelter.

Another myth is that donations will arrive quickly andhat donations of food, clothing and household goods con-titute an effective response to relief in disaster-affectedommunities. It is common for well meaning groups through-ut the world, including in Australia and New Zealand, toollect donations of clothing, food and other goods and toend these to disaster sites. However, not all donations areelpful, and at times large amounts of donated goods mayorsen, or at least complicate, the disaster response effort.onations of items such as blankets, shoes or clothing mayause a secondary disaster, clogging up ports and consumingesources to sort and re-distribute these donations. Essen-ial resources such as food, shelter and clothing can usuallye purchased effectively within the affected region or coun-ry and this greatly assists local and regional economies inheir recovery. Donations of cash to reputable humanitariangencies or to governments constitute the best response.lexander3 argues that these common mis-conceptions workgainst effective response and effective education of healthersonnel as responders.

Disasters will continue to occur and it seems likely thatheir impact will become greater as a result of chang-ng population demographics. Effective responses by healthrofessionals and their organisations will require more edu-ation opportunities, good discipline and preparedness andn improved understanding of the health aspects of disaster.o support this effort the International Council of Nurses,member organisation of the Global Health Cluster, has

ccredited the Flinders University Research Program for Dis-ster Nursing. This program’s mission is to enhance research,evelopment and the recognition of the nursing contributiono disaster preparedness and response.

Paul Arbon, AM ∗

School of Nursing and MidwiferyFaculty of Health Sciences, Flinders University

World Association for Disaster and Emergency MedicineSt John Ambulance, Australia

Correspondence address: School of Nursing and Midwifery,Australia. Tel.: +61 8 8201 3972.

E-mail address: [email protected]

17 February 2010

Page 3: Applying lessons learned to the Haiti Earthquake response

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eferences

1. Em-Dats emergency data base. Centre for Research on theEpidemiology of Disasters [CRED]; 2007. Available from URL:http://www.cred.be/emdat.

Guest editorial

2. De Ville de Goyet C. Myths, the ultimate survivors in disasters.Prehospital and Disaster Medicine 2004;22(2):104—5.

3. Alexander DE. Misconceptions as a barrier to teaching aboutdisasters. Prehospital and Disaster Medicine 2007;22(2):95—103.