Haiti Earthquake

>> The Human Factor – Lessons Learned from the Haiti Response

>> Responder Lessons and Questions

>> New Technologies Helped in Novel Ways with Haiti Earthquake Relief


The Human Factor – Lessons Learned from the Haiti Response

By Dee Grimm, RN, JD, National Director of Mitigation and Preparedness Services
BCFS Emergency Management Division.

Key Lessons Learned:

  • That human dynamics affect how we respond to disasters.
  • The importance of understanding the cultural environment that you are going into when responding to a disaster.
  • The need to maintain situational awareness of stressors that affect responders in catastrophic events.
  • That when developing standards for deviation of care, the human factor must be considered.

After the Haitian earthquake in January of 2010, the U.S. federal government sent out a request to the states for potential assets to assist in the response effort for that ravaged country. The State of Texas volunteered the services of BCFS. Due to complications at the federal level, our medical sheltering efforts were not utilized; however, we did respond to a request to provide a medical strike team to assist an orphanage outside of Port Au Prince that was overwhelmed and struggling. Upon arrival in Haiti, we were subsequently asked to help a hospital in Carrefour (located several miles outside of Port Au Prince) which had also become overwhelmed and was having difficulty managing their operations.

For those of us in the emergency management and medical disaster field we recognize that disasters present unusual challenges to our normal methods of operations, whether it is governmental operations, or how we run our daily businesses. It is with this understanding that systems have been developed to guide how we manage operations in disasters, such as the Incident Command System, or ICS. From a medical perspective we also recognize that medical decisions will change in large scale events relative to allocation of resources, prioritization of care, and limitations of services.  All of these issues were present and hugely magnified in Haiti. This article speaks to the experience of how these systems and issues worked in Haiti and how the human element affected the ability to use these systems and make those decisions in caring for the Haitian people.

There were many reasons that made the Haitian response unique. One reason would be the enormity of the tragedy. It is difficult to grasp the number of people who died in a matter of minutes. Media pictures could not fully show the extent of devastation and total collapse of entire sections of cities. Nor can mere pictures allow for the visceral reaction to the smells and sights responders were faced with. Can anyone truly prepare for a catastrophe of the scale experienced in Haiti? Even for seasoned disaster responders the extent of destruction, death, and injury was difficult to cope with. Add to that the complications of language barriers, multi national cooperative efforts, responding in one of the most impoverished countries in the world, and an almost total lack of the country’s political infrastructure, and you have challenges that go beyond a major disaster.

Another factor affecting the response was operating in a vastly different culture and social structure than many of us were accustomed to.  For example, when we went to the orphanage we were asked not to wear shorts or blue jeans out in public. Skirts would have been preferable for the women, but our scrubs were acceptable.  If we took pictures of anyone, we needed to ask their permission so as not to offend them, and then it was very important to show them the picture afterwards. In a country experiencing the worst disaster in their history, politeness and social etiquette were still critical. Responders also needed, at times, to work with the religious beliefs of the people and be accepting of the local Haitian medical treatments, customs, and cures. I recall one man who was sitting in the street covered with white ash and mud and asked if he needed medical care. The translator explained that the ash and mud covering him was the medical care his local “doctor” had recommended for him. Another example is one of the children that we cared for who had his leg amputated did not want to come to the hospital for the amputation; rather he asked that they take him to the local priest so God could fix his leg instead.

The economic poverty of the country also affected how we delivered medical care. The Haitian people had little before the earthquake, and many had nothing afterwards. While I was working in the labor/ delivery and pediatric unit of the hospital, a mother came to me with a newborn that she could not breast feed. She asked me for formula to feed her baby. It was a request I could happily accommodate, because the shelves in the supply room contained infant formula. But when I went to get the formula, a Haitian nurse told the woman we had no formula and that she needed to find a family member or friend who could breast feed the baby, and sent her away empty handed. I was astounded and asked the nurse why she had done that. The Haitian nurse explained that by giving the baby formula it would eventually kill the child. She continued explaining that there is no formula outside of this hospital for the mother to buy. If that child cannot be breast fed, he will starve.  So the medical care for that child was to find someone who could breast feed him for the mother, not supplement her with formula.

Unfortunately, when dealing with a disaster in a foreign country where multiple nations are also responding, the integration of multiple disaster management systems is less than seamless. Does that mean that a system like ICS has no value outside of our borders – absolutely not.  As a matter of fact, it was the institution of the ICS system that saved the hospital we were assigned to. When our Incident Management Team arrived, all was chaos. This 50 bed, general care hospital was seeing 300 to 400 people a day, weeks after the initial earthquake. The hospital administration was not familiar with HICS but recognized that their “business as usual” operations were not capable of managing this ongoing crisis. Following a short white board ICS course, the ICS process was put into place and the hospital began to flow more smoothly.  Not to imply that ICS alone fixed everything. Due to limited space, and the refusal of many Haitians to be housed inside any building (they were understandably so traumatized by the many aftershocks that any building was considered unsafe), the hospital set up post operative tents on the grounds of the hospital. Countless tents held patients with fresh amputations, fractures, head injuries, and infected wounds. And because our patient’s families had nowhere to live, the patient’s families also stayed in the tents. So what happens when the patient is ready to be discharged? There is no home for them to be discharged to, so when they left, the tent often went with them! Talk about case management challenges!

There were obviously the challenges of medical care. As could be expected, we were operating in an incredibly impoverished country which had limited resources in the best of circumstances, much less coping in this crisis. Again, in the United States, we spend a great deal of time and thought about how we will manage medical care in extreme circumstances. The conversations and literature available about crisis standards of care are numerous.  Medical personnel frequently operated in overwhelming crisis standards – reusing needles, inadequate sterilization, and  limited waste disposal processes. Even when treatment protocols had been agreed upon, these protocols were sometimes ignored when faced with the actual patient. It is one thing to decide not to intubate any individual who presents respiratory arrest because we simply were not set up to accommodate ICU patients and we knew what the prognosis for the individual would ultimately be, and another to let a young person in respiratory extremis die in front of you without making an effort to help them. We, as medical responders, are just not made that way. So were there times when decisions regarding the best use of resources or triage categorization were made based on human emotion and not some university “best practice” model for crisis standards, absolutely.

Of course the human element was a factor for the responders as well.  Not only was there an endless stream of injured and ill, limited medical resources, long hours of exhaustive work, austere living conditions, and separation from loved ones, but we were also working in a tropical environment with heat, humidity, strange sights, and the ever lurking fear of another earthquake or aftershock. Despite this, there was little critical incident stress management for the responders.   As mentioned before, there is no way you can prepare someone for what they are going to experience in Haiti – these types of catastrophic events do not occur often enough for most responders to know how they will handle the situation. So the need for stress management becomes even more important.  Even though our organization did a great job of preparing our responders for what we were going to be getting into, it was still an emotional stress. For others who had never been in a disaster of this magnitude, some of them just could not handle it. I remember finding a seasoned ICU nurse sitting in a stairwell crying. She said she just couldn’t do this anymore. She wasn’t sleeping or eating. She couldn’t think. She felt overwhelmed and paralyzed. She had stopped functioning. The hospital sent her home that day, but as far as I know, the extent of her stress counseling was that time we spent in the stairwell. I think about her sometimes and wonder what permanent affects the Haitian experience will have on her.

And then there were the children; which were probably the most difficult part of being in Haiti for most of us. Many of the surviving children had endured experiences that were mind boggling – one young boy lay trapped for days under the bodies of his family members before he could be rescued. He described covering his face with a cloth so the fluids dripping from the bodies on top of him would not get in his mouth. He became frantic at night when he was left alone and pleaded for someone to remain with him so he would not face the long dark hours buried in the rubble with death all around him, not knowing if another aftershock would completely bury him.  And yet in the hospital, as he recovered from his leg amputation, he was a warm, resilient child who won everyone’s heart. The children in the orphanage had next to nothing. When we arrived, they were playing soccer with an empty plastic water bottle. They slept on the floor with just a blanket wrapped around them. And all they wanted was attention.

So for me, it was the human element I think of the most when I think of Haiti. The sights, the smells, the enormity of the disaster, are all imbedded in my memory, but it is the people, the children, and the human suffering that I remember most clearly. I think it is important that as we continue to develop models for crisis response that we always give a nod to how the human element affects the way we manage disasters.

About the Author
By Dee Grimm, RN, JD, National Director of Mitigation and Preparedness Services, BCFS Emergency Management Division.  BCFS is a non-profit organization which provides numerous health and human services throughout the world. The Emergency Services Division of BCFS provides disaster planning and response services primarily related to vulnerable populations; services such as medical sheltering, incident management teams for jurisdictions to support their medical and public health operation, and vulnerable populations plan writing and training. BCFS is the lead agency in the State of Texas for medical sheltering during disasters, and in that capacity have sheltered thousands of individuals with medical and functional needs in many disasters, including all major hurricanes to strike the gulf coast since Katrina, as well as other events in the United States and internationally.

For More Information Contact dgrimm@bcfs.net


Responder Lessons and Questions

In "Haiti Earthquake 2010: Lessons Learned and Essential Questions," the International Rescue Committee examines a number of the issues responders in Haiti faced, including: participation and communication, shelter and construction, coordination, local economic development, inequalities, disaster risk reduction, social capital in recovery, and food security. The organization also raises a number of esential questions emergency managers should ask to better respond to future disaters.
To read the article, Click HERE >>


New Technologies Helped in Novel Ways with Haiti Earthquake Relief

Relief workers used innovative technologies in unprecedented ways to aid in the recovery of quake-ravaged Haiti, a new report has found.

Interactive maps and SMS (Short Message Service) texts helped guide search-and-rescue teams and find people in need of critical supplies, as the Caribbean nation became a real-world laboratory for new communication tools.

Though the innovations had varying levels of impact in Haiti, they showcased the potential for use in future crises, the report, “Media, Information Systems and Communities: Lessons from Haiti,” concluded. Produced by Communicating with Disaster Affected Communities, the report was supported by Internews and funded by the John S. and James L. Knight Foundation.

“The Haitian experience strongly suggests that digital media and information technology can significantly improve relief efforts with the right on-the-ground coordination,” said Mayur Patel, Knight Foundation’s director of strategic assessment and assistant to the president. “Better integrating these tools into recovery efforts can help save lives in coming crises.”


Download the 27 page report and its specific recommendations at www.kflinks.com/haitireport.