Collaboration in Response to Disaster — Typhoon Yolanda and an Integrative Model (New Eng Jour Med)

[pinto]

Collaboration in Response to Disaster — Typhoon Yolanda and an Integrative Model

Ofer Merin, M.D., M.H.A., Yitshak Kreiss, M.D., M.H.A., M.P.A., Guy Lin, M.D., Elon Pras, M.D., and and David Dagan, M.D.
February 19, 2014

The powerful typhoon that struck the Philippines on November 8, 2013, was the strongest in local history, causing massive destruction and affecting 25 million people.1 More than 5000 people were confirmed dead, 22,000 were still reported missing when our team arrived in the country, and many others had lost their homes. The damage to the infrastructure left many areas without running water and electricity and caused total devastation in others. Some hospitals were shut down altogether, and some continued to work at partial capacity, leaving many of the injured without access to medical assistance. Various countries and relief organizations responded by sending medical supplies and personnel.2 Our delegation, from Israel, was assigned by the Philippine government to provide medical assistance to the city of Bogo (population, 75,000), which had been severely affected by the storm.

Five days after the catastrophic event, the delegation's 147 members landed on the island of Cebu with 80 tons of supplies and set out for the Severo Verallo Memorial District Hospital, which serves more than 250,000 people living in the region. This 80-bed hospital had a staff of five physicians and included an emergency room, a single operating room, a delivery room, four wards (pediatrics, maternity, male, and female), and basic laboratory and x-ray facilities. When we arrived, the hospital had no electricity, no running water, and about 120 hospitalized patients. The operating room, laboratory, and x-ray apparatus were not functional, and the two physicians assigned to each shift were struggling to cope with the overwhelming number of patients.

Foreign medical teams customarily arrive at a disaster zone and follow the World Health Organization (WHO) guidelines for field hospitals, which recommend being “entirely self-sufficient.”3 Our team has had experience in relief missions throughout the world and had previously deployed as a freestanding, self-sufficient field hospital. In such instances, we followed a model of “nonintegrative collaboration,” which is especially suitable for a chaotic area with a nonfunctioning infrastructure. This time, however, we realized that we'd entered an unusual situation in which there was a local system in place. We decided to rethink our standard operating procedure and combine our physical setup with the local structure and our medical and auxiliary staff with the local staff in order to provide the most benefit. Thus, we created a model of “fully integrative collaboration.”

http://www.nejm.org/doi/full/10.1056/NEJMp1315960?query=TOC

Copyright © 2014 Massachusetts Medical Society. All rights reserved.

[Jefferson23]

1. Excellent. n/t