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Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

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Page 1: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Delivering First-World Medicine in Third-World Disaster Relief

and Volunteerism

Samir Mehta, MDUniversity of Pennsylvania

Page 2: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Everything I Wish I Knew Before I Left the Country …

Page 3: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Everything I Wish I Knew Before I Left the Country …

No International Incidents to date …

Page 4: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Choose Your Own Adventure

Page 5: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Choose Your Own Adventure

Page 6: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

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

Page 7: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Tip #1

• Bring a Cell Phone

• Bring a charger (solar)

• Make sure it has international functioning

Page 8: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Tip #1

• Bring a Cell Phone

• Bring a charger (solar)

• Make sure it has international functioning

• Turn off your roaming!

Page 9: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

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

Page 10: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Haiti …

• The disaster was as much social as geologic

Page 11: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Why so destructive?

• Poor construction– No codes– Little rebar– Poor concrete

Page 12: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

How Can You Help?

• Decision

• Loved ones– Not alone

• Not Vacation

Page 13: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

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

Page 14: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

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

Page 15: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

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

Page 16: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Private groups

Page 17: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

HSS Team

Page 18: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

HHS Team

Page 19: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

What do you need?

• Permission– Passport– Visa– License– Malpractice

Page 20: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Transportation

– Air– Ground– Return– Supply chain

Page 21: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Healthcare (your own)

– Vaccinations (Hep A/B, Typhoid, Tetanus, MMR, DPT)– Malaria prophylaxis– Yellow card– Dengue Fever?– HIV– Tuberculosis (N95 mask)– Leptospirosis– Anthrax– Ebola

Page 22: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Water

Page 23: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Tip #2

• Bring self-filtration water kits

• Bring energy bars

Page 24: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Food

Page 25: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Shelter

Page 26: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Protection

Page 27: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

•Crowd control•Aid distribution

Page 28: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Power

Page 29: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

• You need a lot of stuff• You need to bring it all…

Page 30: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Spain

Page 31: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Russia

Page 32: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Germany

Page 33: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Puerto Rico

Page 34: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

US Embassy

Page 35: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
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Page 42: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

EMR

Page 43: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Real Medical Record

Page 44: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 45: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Evac to USNS Comfort

Page 46: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Tip #3

• Baby Wipes– Unscented

Page 47: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 48: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 49: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

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

Page 50: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Hospital Antonio Lenin FonsecaManagua, Nicaragua

Page 51: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Tip #4

• Know the local politics

• Don’t take things personally

Page 52: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

The Contrast – The “Private Hospital”

Page 53: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

The People

Page 54: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 55: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 56: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Wards

Page 57: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 58: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Intensive care

Page 59: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Emergency

Page 60: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 61: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Equipment

Page 62: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
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Medications

Page 68: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Bringing HUP to Managua

Page 69: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Teaching

Page 70: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Tip #5

• Check the State Department Website

• Know where the Embassy is

Page 71: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Case #1: Injury 3 years ago

Page 72: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 73: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Case #2: Hardware Removal

Page 74: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Case #3: 19M s/p fall from truck 4wks ago

Page 75: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
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Case #4

Page 78: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Case #5: Machete injury, contralateral BEA

Page 79: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Case #6: 15F, 4wks old, head injury

Page 80: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
Page 81: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Tip #6

• Leave your Ego at the Door

Page 82: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

2nd Inpatient Tower Under Construction

Page 83: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania
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Volunteerism

Page 90: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Volunteerism

• Not about going somewhere necessarily• Locally or Nationally• Organized Medicine

– OTA– AAOS– AOA– AMA

• Unique Skill Set

Page 91: Delivering First-World Medicine in Third-World Disaster Relief and Volunteerism Samir Mehta, MD University of Pennsylvania

Volunteerism

• Life Changing

– For Them

– For You


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