Transcript Delivering First-World Medicine in Third

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 …
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?
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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
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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)
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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”
40%
30%
20%
10%
0%
• No follow-up
Fracture
Infection
Soft-tissue
Hospital Antonio Lenin Fonseca
Managua, 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