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Nearly ten years ago, in the mid-afternoon
of January 12, 2010, a magnitude 7.0 earthquake
hit just outside Port-au-Prince, Haiti, leveling
a large part of the country and killing an
unimaginable number of people in a quick thirty
seconds.
It immediately became clear that, although
the earthquake lasted only seconds, the humanitarian
disaster would last for years because of three
simple facts.
One was the earthquake’s location.
In a twist of terrible luck, the quake hit
shallow and just 16 miles or 25 kilometers
away from the country’s capital and largest
city—Port-au-Prince.
Two was Haiti’s economic situation.
It is the poorest country in the western hemisphere
with an estimated GDP per capita, at the time
of the earthquake, of just $665.
That meant that most Haitians had little money
to relocate and reestablish their lives after
their homes were destroyed.
In addition, with a poorly funded government,
emergency services were few and far between
and poorly equipped.
The third fact leading to the scale of the
humanitarian disaster was just the pure scale
of destruction.
Most buildings in the island-nation were not
nearly as stable as those in a developed nation
and therefore, whereas another developed country
might have been able to weather the quake
quite well, the buildings of Haiti crumbled
like dust.
With the scale of devastation, as soon as
word of the quake reached the rest of the
world, the focus of every major disaster response
organization in the world shifted to Haiti.
This whole world of disaster response is a
nuanced and complex one.
Simply showing up and helping where one can
just doesn’t work.
Water isn’t useful by itself.
Food isn’t useful by itself.
Doctors aren’t useful by themselves.
Every resource that might be needed following
a disaster must be carefully coordinated and
managed or else it is useless.
Behind that management, there are professionals
who spend their whole lives working on how
to best respond to moments like these—the
worst 30 seconds of Haiti’s history.
I spoke to two of those professionals on how
they do their jobs—Stephanie Kayden, “Kayden:
[00:00:26] I am a vice chair of emergency
medicine at Brigham and Women's Hospital and
the director of the Humanitarian Studies Initiative
at the Harvard Humanitarian Initiative,”
and Mike VanRooyen, “VanRooyen: [00:00:11]
I'm the director of the Harvard Humanitarian
Initiative and I'm a professor at the Harvard
Medical School and the School of Public Health.”
Both Stephanie and Mike helped establish and
then worked on the ground at the what became
one of the largest field hospitals in Haiti
following the 2010 earthquake.
“Kayden: [00:09:53] It turns out that when
you're a doctor responding to one of these
international disasters just having medical
knowledge is not good enough.
In order to do this work properly you have
to know what the international standards are
for giving humanitarian aid.
You have to know not only the medical side
but how to give food and how to give clean
water and how to give proper shelter and those
guidelines are already written down in something
called this sphere standards.”
In its 406 pages, the Sphere handbook has
specific guidelines like that everyone needs
15 liters of water per day; that a single
hand pump at a flow rate of 17 liters per
minute can act as the water source for up
to 500 people; it gives a clear step-by-step
guide to establishing a goods-delivery system;
it defines that, in an emergency shelter situation,
everyone should have at least 38 square feet
or 3.5 square meters of living space, but
that, in cold climates, that should be increased
to 48 square feet or 4.5 square meters.
It takes out as much of the guesswork in humanitarian
response as possible.
This is what much of the work by academics
like Stephanie and Mike is—developing standards
and frameworks before a disaster happens so
that, as much as possible, when disaster strikes,
people don’t need to think, they just need
to do.
This response does, of course, though, vary
depending on the nature of the disaster.
“VanRooyen: [00:45:35] An earthquake tends
to cause a lot of death immediately and also
a lot of heavy injuries like fractures or
head injuries.
They require intensive medical care and surgical
care.
They overwhelm the hospital structures as
well and so the immediate needs for a place
like Haiti for example are surgeons and people
who could manage emergency wound care and
even things like dialysis or things like that.
Let’s take another example of say a flood.
Right.
A flood can be amazingly devastating, move
people out of their house, even sweep people
away, but a flood or a hurricane kills people
but doesn't necessarily leave a lot of injured
people.
So at the end after people have died from
a massive flood or a hurricane what's left
are people who have minor injuries maybe but
they don't really overwhelm the surgical structures
of a hospital where they overwhelm is the
public health.”
In an ideal world, the level of humanitarian
aid given would be determined by the actual
need, but in reality, this is often not the
case.
The reality is that often, but not always,
the more accessible a disaster site is, the
more response it gets.
What that means is that, because Haiti was
so close to the US, where many humanitarian
organizations are based, it was quite easy
for them to mobilize after this earthquake
so Haiti got large numbers of responders quite
quickly, but this principle can also leave
other countries without the help they need.
“VanRooyen [00:14:47] So take for example
around the same time as the Haiti earthquake
there was a massive flood in Pakistan but
it was very remote and very difficult to get
to.
So the difference in the responders is entirely
different.
The only people that could respond in this
distant area of Pakistan for this massive
flood were the major organizations that had
lifting capacity and they could fly planes
in and they could land personnel in in the
middle of someplace that's very remote.”
Haiti, on the other hand, received a massive
response especially, in comparison, by smaller
organizations given the proximity to the US
and also given the fact that individuals in
the US were particularly motivated to donate
given the proximity.
Through NGO’s and charities, Americans contributed
about $4 billion to the relief effort in the
first three months.
Therefore, the real issue in Haiti was not
getting a response, it was managing the response.
Because of that accessibility from the US,
a huge number of less professional responders
showed up, and in order to be effective, these
responders needed a high degree of management
from the professionals who did show up and
were practiced on the international standards.
In addition, there was the issue of actually
getting all these responders and their supplies
there.
“Kayden: [00:16:35] In the case of Haiti
it's an island nation, so a lot of the heavy
things like fuel have to come in by ship but
the earthquake severely damaged the port in
Port au Prince, and because the gas stations
with their underground tanks had also been
damaged, the relief community couldn't use
the fuel from those tanks without ruining
the engines in their cars and shutting down
all the trucks, and so there was a big fuel
crisis early on and that meant it was hard
to transport things.
So, while we were waiting for the port to
be fixed, a lot of the supplies had to be
flown in either on airplanes that were landing
at the Port au Prince airport or overland
from the Dominican Republic.”
In the early days of the response, both of
those methods had their own unique difficulties.
Coming from the Dominican Republic, many of
the roads were damaged, destroyed, or covered
in debris, so that was quite a slow option.
The airport therefore stood alone as the only
high-speed link between Haiti and the world,
serving as the only route in for all the most
time-sensitive supplies.
In the initial 24 hours after the earthquake,
Port-au-Prince’s airpot saw chaos as flights
poured in with no direction into an airport
with essentially no control.
The first semblance of control came the morning
after the quake when the US Coast Guard Cutter
Forward pulled into Port-au-Prince and just
hours later started working as the airport’s
air traffic control from the ship.
The airport’s own air traffic control tower
was badly damaged in the quake so it was far
from operational.
Soon after, that same afternoon, a team of
US Air Force airmen landed at the airport
and assumed responsibility for its air traffic
control.
Their operation was made up of, quite literally,
a bunch of folding tables and handheld radios
set up at the end of the runway as they guided
flights in.
With this setup, they handled up to almost
200 planes a day despite the fact that on
a normal day the airport receives no more
than a dozen commercial flights.
Eventually, Haiti officially handed control
of the airport over to the US, meaning the
Americans could settle in and set up formally
for the long-haul, and a team from the American
FAA came down to take control as they set
up a portable, temporary air traffic control
tower.
Of course, even working at full capacity,
there was still an enormous backlog at this
small airport, leading them to set up a system
where flights would be prioritized based off
what they carried with the highest demand
humanitarian goods being allowed in first.
Of course, even once you get a plane with
supplies on the ground, getting those supplies
to those in need is not a given because, in
between the runway and the roads, there is,
of course, customs.
“[00:18:39] Often what happens is that the
national government of the place where a disaster’s
happened has a way of sort of relaxing customs
efforts for relief supplies coming in and
trying to fast forward them through.
But that doesn't always happen especially
with medical supplies which can include powerful
painkillers that might be particularly regulated
by government and so a lot of times aid agencies
will face a backlog in their relief supplies
coming in as they get, sort of, stuck in customs.”
Eventually, though, once a solid supply chain
is set up, responders can actually get to
work.
Stephanie and Mike, of course, worked to set
up that field hospital to start treating all
the most severe injuries from the earthquake.
While the Harvard Humanitarian Initiative,
who they both work for, doesn’t typically
itself actually respond on the ground to disasters,
they did exceptionally in this case and, as
the literal experts in this sort of activity,
they were able to set up a stellar operation.
As experts, they knew, once again, that doctors
by themselves aren’t necessarily useful.
Doctors are useful when placed where they’re
needed and so, the first step was to identify
what was needed.
“VanRooyen: [00:19:36] So in the Haiti Response
the HHI team identified one major gap in particular
and that was the lack of rehabilitation resources
for patients that had big operations like
orthopedic operations but had nowhere to go
because there was no place to admit them and
to rehabilitate them.”
Therefore, the hospital had its focus and
everything could go from there.
Again because of the specific nature of the
disaster, the team knew that they couldn’t
set up their temporary hospital just anywhere.
“Kayden: [00:29:01] After an earthquake
in particular when the people who'd been injured
in the earthquake have seen all the buildings
around them fall down, they do not want to
go into another building because there are
a lot of aftershocks afterwards and they're
afraid that these buildings might have been
damaged and that they might fall down and
either kill them or cause more injury.
That is a very reasonable fear and so even
though the place where we were working had
buildings that were very strong and very well
able to sustain all the aftershocks with little
or no damage, the people that we were helping
were too afraid to go inside them.”
The hospital therefore had to be almost entirely
built out of tents.
Despite the focus on acting as a rehabilitation
center, the hospital did, however, still perform
surgery and therefore they needed a super-sterile
environment to prevent infection or contamination
during surgery.
That’s quite tough to create in a series
of tents, so they used two solutions for this.
“Kayden: [00:30:33] One, the easier way
was we had operating theater trucks.
So imagine a big delivery truck that you can
open the doors and instead of finding boxes
inside you find an OR or an operating theater.
We had a couple of those and that was very
useful because they come already sealed.
A lot of our surgeries though we had to do
in what were classrooms in a school in Haiti
and what we had to do there was to actually
tape up sheets over the windows—plastic
sheeting to make sure that no insects or dust
would come from the outside while we were
doing the surgeries so that we can make it
sterile and safe place to do them.”
Of course, the goal of responding to humanitarian
disasters is to get the humanitarian disaster
to end, so that means there also has to be
focus on the exit strategy.
“Kayden: [00:27:06] So when a disaster happens
and we go in and start working even from the
first day we're always thinking about the
day we're going to leave, and so what that
means is we do a number of things right from
the start.
In Haiti, for example, we wanted to make sure
that as we were caring for people's wounds
we were teaching the local doctors and nurses
that we were working with how to do that kind
of care if they weren't already familiar with
it so that when we left they would be able
to easily carry that forward.”
Getting to that finale—when the agencies
pull out, when a country is back to normal,
once life goes on as normal after a disaster—is
a delicate science that doesn’t always go
to plan.
No matter how many frameworks, handbooks,
and guidelines one has, a disaster is a disaster
and does not follow plans.
The role of all the planning and preparation,
though, is to provide structure where there
is none.
People like Stephanie and Mike spend their
entire careers studying and educating others
on this field since certain help is certainly
better than other help and, in a case when
the worst has happened, only the best help
is enough.
Working in disaster response clearly requires
that your problem solving and critical thinking
skills are quick and accurate.
Those skills, in fact, are crucial fundamental
skills for life that can help with school,
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