delivering first-world medicine in third-world disaster relief and volunteerism samir mehta, md...

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