The Logistics of Disaster Response

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    This video was made possible by Brilliant. Learn complex topics simply with Brilliantfor 20% off by being one of the first 200 to sign up at brilliant.org/Wendover. Nearly ten years ago, in the mid-afternoonof January 12, 2010, a magnitude 7.0 earthquake hit just outside Port-au-Prince, Haiti, levelinga large part of the country and killing an unimaginable number of people in a quick thirtyseconds. It immediately became clear that, althoughthe earthquake lasted only seconds, the humanitarian disaster would last for years because of threesimple facts. One was the earthquake’s location. In a twist of terrible luck, the quake hitshallow and just 16 miles or 25 kilometers away from the country’s capital and largestcity—Port-au-Prince.

    Two was Haiti’s economic situation. It is the poorest country in the western hemispherewith an estimated GDP per capita, at the time of the earthquake, of just $665. That meant that most Haitians had little moneyto 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 thehumanitarian disaster was just the pure scale of destruction. Most buildings in the island-nation were notnearly as stable as those in a developed nation and therefore, whereas another developed countrymight have been able to weather the quake quite well, the buildings of Haiti crumbledlike dust. With the scale of devastation, as soon asword of the quake reached the rest of the world, the focus of every major disaster responseorganization in the world shifted to Haiti.

    This whole world of disaster response is anuanced and complex one. Simply showing up and helping where one canjust 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 followinga disaster must be carefully coordinated and managed or else it is useless. Behind that management, there are professionalswho spend their whole lives working on how to best respond to moments like these—theworst 30 seconds of Haiti’s history. I spoke to two of those professionals on howthey do their jobs—Stephanie Kayden, “Kayden: [00:00:26] I am a vice chair of emergencymedicine at Brigham and Women’s Hospital and the director of the Humanitarian Studies Initiativeat 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 HarvardMedical School and the School of Public Health.”

    Both Stephanie and Mike helped establish andthen worked on the ground at the what became one of the largest field hospitals in Haitifollowing the 2010 earthquake. “Kayden: [00:09:53] It turns out that whenyou’re a doctor responding to one of these international disasters just having medicalknowledge is not good enough. In order to do this work properly you haveto know what the international standards are for giving humanitarian aid. You have to know not only the medical sidebut how to give food and how to give clean water and how to give proper shelter and thoseguidelines are already written down in something called this sphere standards.” In its 406 pages, the Sphere handbook hasspecific guidelines like that everyone needs 15 liters of water per day; that a singlehand pump at a flow rate of 17 liters per minute can act as the water source for upto 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 feetor 3.5 square meters of living space, but that, in cold climates, that should be increasedto 48 square feet or 4.5 square meters. It takes out as much of the guesswork in humanitarianresponse as possible.

    This is what much of the work by academicslike Stephanie and Mike is—developing standards and frameworks before a disaster happens sothat, as much as possible, when disaster strikes, people don’t need to think, they just needto do. This response does, of course, though, varydepending on the nature of the disaster. “VanRooyen: [00:45:35] An earthquake tendsto cause a lot of death immediately and also a lot of heavy injuries like fractures orhead injuries. They require intensive medical care and surgicalcare. They overwhelm the hospital structures aswell and so the immediate needs for a place like Haiti for example are surgeons and peoplewho 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, movepeople out of their house, even sweep people away, but a flood or a hurricane kills peoplebut doesn’t necessarily leave a lot of injured people. So at the end after people have died froma massive flood or a hurricane what’s left are people who have minor injuries maybe butthey don’t really overwhelm the surgical structures of a hospital where they overwhelm is thepublic health.” In an ideal world, the level of humanitarianaid given would be determined by the actual need, but in reality, this is often not thecase. 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 wasso close to the US, where many humanitarian organizations are based, it was quite easyfor them to mobilize after this earthquake so Haiti got large numbers of responders quitequickly, but this principle can also leave other countries without the help they need.

    “VanRooyen [00:14:47] So take for examplearound the same time as the Haiti earthquake there was a massive flood in Pakistan butit was very remote and very difficult to get to. So the difference in the responders is entirelydifferent. The only people that could respond in thisdistant area of Pakistan for this massive flood were the major organizations that hadlifting capacity and they could fly planes in and they could land personnel in in themiddle of someplace that’s very remote.” Haiti, on the other hand, received a massiveresponse especially, in comparison, by smaller organizations given the proximity to the USand also given the fact that individuals in the US were particularly motivated to donategiven the proximity. Through NGO’s and charities, Americans contributedabout $4 billion to the relief effort in the first three months.

    Therefore, the real issue in Haiti was notgetting 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, theseresponders needed a high degree of management from the professionals who did show up andwere practiced on the international standards. In addition, there was the issue of actuallygetting all these responders and their supplies there. “Kayden: [00:16:35] In the case of Haitiit’s an island nation, so a lot of the heavy things like fuel have to come in by ship butthe earthquake severely damaged the port in Port au Prince, and because the gas stationswith their underground tanks had also been damaged, the relief community couldn’t usethe fuel from those tanks without ruining the engines in their cars and shutting downall the trucks, and so there was a big fuel crisis early on and that meant it was hardto transport things.

    So, while we were waiting for the port tobe fixed, a lot of the supplies had to be flown in either on airplanes that were landingat the Port au Prince airport or overland from the Dominican Republic.” In the early days of the response, both ofthose methods had their own unique difficulties. Coming from the Dominican Republic, many ofthe roads were damaged, destroyed, or covered in debris, so that was quite a slow option. The airport therefore stood alone as the onlyhigh-speed link between Haiti and the world, serving as the only route in for all the mosttime-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 airportwith essentially no control. The first semblance of control came the morningafter the quake when the US Coast Guard Cutter Forward pulled into Port-au-Prince and justhours later started working as the airport’s air traffic control from the ship.

    The airport’s own air traffic control towerwas badly damaged in the quake so it was far from operational. Soon after, that same afternoon, a team ofUS Air Force airmen landed at the airport and assumed responsibility for its air trafficcontrol. 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 guidedflights in. With this setup, they handled up to almost200 planes a day despite the fact that on a normal day the airport receives no morethan a dozen commercial flights. Eventually, Haiti officially handed controlof the airport over to the US, meaning the Americans could settle in and set up formallyfor the long-haul, and a team from the American FAA came down to take control as they setup 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 systemwhere flights would be prioritized based off what they carried with the highest demandhumanitarian goods being allowed in first.

    Of course, even once you get a plane withsupplies on the ground, getting those supplies to those in need is not a given because, inbetween the runway and the roads, there is, of course, customs. “[00:18:39] Often what happens is that thenational government of the place where a disaster’s happened has a way of sort of relaxing customsefforts for relief supplies coming in and trying to fast forward them through. But that doesn’t always happen especiallywith medical supplies which can include powerful painkillers that might be particularly regulatedby government and so a lot of times aid agencies will face a backlog in their relief suppliescoming in as they get, sort of, stuck in customs.”

    Eventually, though, once a solid supply chainis set up, responders can actually get to work. Stephanie and Mike, of course, worked to setup 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 doctorsby themselves aren’t necessarily useful. Doctors are useful when placed where they’reneeded and so, the first step was to identify what was needed. “VanRooyen: [00:19:36] So in the Haiti Responsethe HHI team identified one major gap in particular and that was the lack of rehabilitation resourcesfor patients that had big operations like orthopedic operations but had nowhere to gobecause there was no place to admit them and to rehabilitate them.” Therefore, the hospital had its focus andeverything could go from there.

    Again because of the specific nature of thedisaster, the team knew that they couldn’t set up their temporary hospital just anywhere. “Kayden: [00:29:01] After an earthquakein particular when the people who’d been injured in the earthquake have seen all the buildingsaround them fall down, they do not want to go into another building because there area lot of aftershocks afterwards and they’re afraid that these buildings might have beendamaged and that they might fall down and either kill them or cause more injury. That is a very reasonable fear and so eventhough the place where we were working had buildings that were very strong and very wellable to sustain all the aftershocks with little or no damage, the people that we were helpingwere too afraid to go inside them.”

    The hospital therefore had to be almost entirelybuilt out of tents. Despite the focus on acting as a rehabilitationcenter, the hospital did, however, still perform surgery and therefore they needed a super-sterileenvironment to prevent infection or contamination during surgery. That’s quite tough to create in a seriesof tents, so they used two solutions for this. “Kayden: [00:30:33] One, the easier waywas we had operating theater trucks. So imagine a big delivery truck that you canopen 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 veryuseful because they come already sealed. A lot of our surgeries though we had to doin what were classrooms in a school in Haiti and what we had to do there was to actuallytape up sheets over the windows—plastic sheeting to make sure that no insects or dustwould come from the outside while we were doing the surgeries so that we can make itsterile and safe place to do them.”

    Of course, the goal of responding to humanitariandisasters is to get the humanitarian disaster to end, so that means there also has to befocus on the exit strategy. “Kayden: [00:27:06] So when a disaster happensand we go in and start working even from the first day we’re always thinking about theday we’re going to leave, and so what that means is we do a number of things right fromthe start. In Haiti, for example, we wanted to make surethat as we were caring for people’s wounds we were teaching the local doctors and nursesthat we were working with how to do that kind of care if they weren’t already familiar withit so that when we left they would be able to easily carry that forward.” Getting to that finale—when the agenciespull out, when a country is back to normal, once life goes on as normal after a disaster—isa 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 theirentire careers studying and educating others on this field since certain help is certainlybetter than other help and, in a case when the worst has happened, only the best helpis enough. Working in disaster response clearly requiresthat your problem solving and critical thinking skills are quick and accurate. Those skills, in fact, are crucial fundamentalskills for life that can help with school, employment, and much more, both of which canbe developed with Brilliant’s courses.

    Really all of their courses will help withproblem solving and critical thinking skills, but a few that can especially help are theirprobability and logic courses. Luckily, both probability and logic are fascinatingfields and Brilliant takes you all the way from the basic to the advanced in these fieldwith their interactive, superbly designed courses that break complex topics into manageable,intuitive principles. To start developing your skills, you can signup for Brilliant at brilliant.org/Wendover and, if you’re one of the first 200 to doso, you’ll get 20% off.

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