Do you need to speak the language?

Recently, several Japanese medical professionals have commented that unless you speak Japanese, you cannot possibly help in the ground response.  They cite that “even Japanese doctors are having difficulty understanding certain dialects near Sendai.”

This is an interesting proposition.  What skills does one need to respond?  Certainly, language is a huge help.  But is it enough to know disaster response and have an interpreter?  What about an experienced team with a local government liaison?

The issue of unaffiliated volunteers is complex and creates numerous ethical and operational challenges.  However, I am going to have to disagree that lack of Japanese language skills precludes value to the current response.

Phone lines are open.  Please feel free to comment here or on the OMI Facebook page at (http://www.facebook.com/#!/group.php?gid=438323775726) . .

Japan Quake Devastation

An interesting and riveting interactive piece from the

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New York Times showing the recent devastation in Japan.

http://www.nytimes.com/interactive/2011/03/13/world/asia/satellite-photos-japan-before-and-after-tsunami.html?ref=world

Japan Nuclear Reactor News and Updates

Updates for responders traveling to Japan or http://cialis4dailyusedosage.com/ following the buy generic viagra evolving situation. Additional reactors potentially failing.

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Washington Post: http://www.washingtonpost.com/business/economy/2011/03/14/ABk6rQV_story.html?wpisrc=nl_natlalert

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New York Times: http://www.nytimes.com/2011/03/15/world/asia/15nuclear.html?_r=1&hp

From Digitalglobe (Images): http://www.digitalglobe.com/index.php/27/Sample+Imagery+Gallery

Japan response resources

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from the CDC:

http://emergency.cdc.gov/disasters/tsunamis/clinicians.asp?s_cid=ccu031411_005

http://emergency.cdc.gov/radiation/?s_cid=ccu031411_004

http://emergency.cdc.gov/disasters/tsunamis/?s_cid=ccu031411_00

Crisis Mapping and Civil Unrest

For the past two years, OMI has worked with a variety of for profit

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and tracking system for disasters. One of the core requirements has always been strict user identification, stringent access control and quality assurance. This recent article from MIT’s Technology Review illustrates why security is important and how good intentions can sometime have disasterous consequences. Ms. Naone makes a strong argument for the prudent deployment of technology and a careful examination of second and third tier consequences.

Check out the link below for the entire article.

Why Crisis Maps Can Be Risky When There’s Political Unrest

Care Through Action

By David Callaway

During the past several months, I have had the opportunity to interact with an amazing group of motivated young leaders who are changing the world through their actions.  Most of these individuals have sacrificed personal comfort in order to promote a broader sense of global community, humanity and justice.

One such person is Alyssa Everett- a former Peace Corps volunteer, finance specialist and now photojournalist/ activist.  Alyssa’s group Care Through Action (http://carethroughaction.org/) offers a rare glimpse into the lives of women in the Democratic Republic of Congo who are struggling daily not just for justice, but for the ability to simply live with some degree of respect and safety.

Groups like Everett’s Care Through Action, Carolina for Kibera and the Global Emergency Care Collaborative demonstrate the power of supporting local based solutions.  They also are examples of individuals who believe that with freedom and privilege come responsibility.  The Operational Medicine Institute would like to solute these groups, there founders and their local teams.

Carolina for Kibera: A perspective from OMI

 03 August 2011

Last week, I had the unique opportunity to visit Kibera- Nairobi’s largest informal settlement and one of Africa’s largest slums.  I was accompanying my old friend Rye Barcott who helped found a community based organization named Carolina for Kibera (http://cfk.unc.edu/).  Carolina for Kibera (CFK) works through participatory development to catalyze local leadership and support community solutions to the increasingly complex problems of ethnic violence, gender- based violence and health inequality.  In Kibera, the community has turned to sports (futbol and jump rope) and well as community health (The Tabitha Clinic) to find strength and some degree of unity.

One of the most impressive accomplishments is the Tabitha Clinic.  Tabith Festo was a nurse who befriended Rye in 2001 and with a investment of $26 founded a tiny clinic in her 10×10 foot shack.  With Rye and Salim Mohamed, Tabitha helped to found Carolina for Kibera.  The clinic evolved and gained international recognition, ultimately partnering with the Center for Disease Control (CDC) to provide disease surveillance and treatment.  In 2010, the Tabitha Clinic served nearly 40,000 community members in Kibera.  Secretary Sebelius of the US Department of Health and Human Services recently visited to examine the interaction of government and non governmental organizations in addressing community health issues. 

The approach to Tabitha Clinic in Kibera; one of the few concrete buildings in the area
CFK Execuctive Director, George Kogolla and Kathleen Sebelius, Secretary of the US Department of Health and Human Services smile after a tour of the CFK Tabitha Clinic

Kibera is like no place I have ever been.  Those of you who know me, understand the significance of this statement.   I have seen poverty.  I have seen filth.  I have seen violence.  I have seen entrepreneurship.  And, I have seen grace.  But, rarely will you find these characteristics so densely smashed together into one community.  The potential is immense.

Kibera has become very accustomed to the parades of outsiders who come to their community for a variety of reasons.   On the surface, the first thing I noticed when walking through Kibera were the flying toilets (plastic bags full of feces) that pave the dirt paths like cobble stones and the mixed glances I received from community members.  Understandable, given the bewildering effect that a short stay in Kibera has on all visitors.  For many, the shock evolves to pity which transforms into a powerful desire to “do something”.  This drive is often quickly tempered by a sense of impotence given the magnitude of the challenges.  This leaves visitors feeling schizophrenic and powerless- two things Americans in particular do not like to experience.  And, it drives home the importance of investing in something deeply- of committing with focus.

On my first foray into Kibera, I was alert; watching eyes and hands; trying to note potential threats and calculating routes for evasion.  I was polite, but non committal.  I was always moving.  It was exhausting.  And, it limited any potential to begin learning about the community.

 My initial response to Kibera illustrated, for me, some of the massive limitations with transient interventions in communities like Kibera.  Change must come from within the community.  And, you cannot be part of this until the community accepts you- this requires listening, laughing, crying and building trust.  Admiral Mullen once said, “You cannot surge trust.”  Perhaps more than any place, Kibera teaches this truism to well meaning outsiders. 

Dave Callaway joins CFK Co-Founder Salim Mohamed and Chairman of the CFK US Board Jennifer Coffman

A couple of days into the trip, I asked Rye to take me into the community.  He called Kevin (Tabitha Festo’s son) and Sam and Moses (Momma Jayne’s sons) and we headed out to see where Rye had lived when he first came to Kibera.  My perspectives on Kibera became much more nuanced as I walked the paths with Rye, listening to him speak Swahili with random people, laugh and joke with kids and ask about community challenges.  We went to his old block and met his neighbors.  “Omosh,” they yelled, “Welcome home.  Come join us!”

 The neighbors welcomed us into their homes and updated Rye on recent community developments.  The cleanliness and order of the homes was a stark contrast to the areas outside of the compounds.  People took pride in the small portion of their world that they could influence.  I was again humbled by how little I know.

CFK Co-Founder Rye Barcott talks with a Kiberan child in Swahili. In the end, CFK's success is about the personal relationships built within and throughout the community.

Rye likes to say that, “talent is universal; opportunity is not. ”  I think that he’s right.  And, it was an honor to spend some time with such a group of talented individuals working tirelessly to give the light of opportunity to the talented young leaders in Kibera.  Sports and health again offering key building blocks to stabilize and strengthen communities. . .

South Sudan: A new Nation in need of medical and disaster training

On July 9th, 2011, South Sudan officially declared their independence and the world’s newest nation was born. After a decade of civil strife, the Sudanese Peoples Liberation Army (SPLA) is transitioning to a civil governing body. The transition brings a requirement for broadened professionalization of their military and government medical system.

The Operational Medicine Institute was engaged via Frontier Medical and AECOM to assist in the development and delivery of a course of instruction focusing on combat trauma and medical ethics. The short course was a vital component of a broader educational initiative ongoing in Juba, South Sudan.

The course of instruction utilized an outcomes based methodology with tiered training strategies. During the first days, brief didactic sessions were coupled with equipment familirization and low stress practical application.

Dr. Callaway reviews the basics of ATLS and TCCC in patient assessment.

The operational medicine didactic sections focused on blast injuries, ballistics, desert survival, civil military coordination, military ethics, damage control resuscitation and trauma system development.

Dr. David Callaway presents current management strategies for blast injuries and mass casualty events to students in Juba, South Sudan.

The team complimented morning didactic sessions with afternoon practical application sessions. The practical sessions focused on escalting stress innoculation and complex decision making. Students were tested on their ability to apply these skills on field expedient wound simulators and ultimately on multiple live role models.

The training concluded with a series of train the trainer sessions. The cadre assigned students to conduct pratical application training sessions with no advance warning. Students were assessed by the OMI lead instructor as well as the fellow students. The evolutions were video taped and played back immediately on completion of the session in order to provide focused feedback.

Dr. Gawar delivers an impromptu student led training session on wound packing.

The week concluded with little fanfare, but with great lessons learned by all involved. Importantly, new friendships were established and professional relationships strengthened- the bonds that can only be built through shared, intense experience.

Two new colleagues and friends bond over lunch of goat and maize.

Dr. Callaway participates in Joint Disaster Preparedness Training

Disaster Diplomacy

Full spectrum Disaster Diplomacy includes collaboration throughout the entire disaster cycle (preparedness, planning response and recovery).  As part of their ongoing efforts to support and advance Disaster Diplomacy, OMI participated in the July CENTCOM Infectious Disease and Disaster Preparedness Conference in Abu Dhabi, United Arab Emirates.  The highly successful conference was sponsored by Center for Disaster and Humanitarian Assistance Medicine (CDHAM) at the Uniformed Services University of the Health Sciences (USUHS), US Central Command, the Armed Forces Surveillance Center and the Government of the United Arab Emirates.

OMI Director, Dr. David Callaway lectured on Force Health Protection and Strategic Communications in disaster response to a group of military and civilian medical personnel from UAE, Jordan, Yemen, Kuwait and Iraq.  The presentations focused on the importance of mission clarity, trust building activities, and aggressive information acquisition and dissemination.  The participants collaborated in a series of table top exercises that provided a unique opportunity for multi-national team building and networking.

This opportunity resulted in a series of new contacts throughout civilian and military disaster preparedness professionals in the Middle East.  The wide variety of issues faced is daunting.  For example, how does a single professional create an All Hazards Plan that accounts for civil unrest like the Arab Spring, insurgent violence as seen in Iraq, the emergence of new pandemics such as H1N1, accidental mass casualty incidents and natural disasters across a region with variable standards for governement accountability and social engagement?  The chanllenges are immense, but surmountable.

Fellow Harvard Disaster Medicine colleague, Dr. Saleh Fares discussed the UAE response to the 2009 H1N1 pandemic and suggested future options for rapid medical threat assessment and resource mobilization.  Dr. Fares, now in the UAE, is working to develop a comprehensive emergency management system for his nation.

For more information about the presentations or to request OMI participate in a conference, training or consultancy project, please contact us via our webpage.

Seeking Support (thank you!), Maintaining Momentum

from Toff Peabody and Ari Hoffman, San Francisco, CA

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HIT Rescue continues to provide essential services on the ground in Fond Parisian, Haiti. Our Patient Tracking Software now provides robust, real-time census data on all patients in this field hospital. Vulnerable patient populations, including unaccompanied minors, amputee victims and pregnant women continue to be tracked and followed by specialized teams. 17% of this field hospital continues to be amputee victims.

Highlights of Patient Tracker Program
Besides tracking vulnerable populations, providers still have real-time access to patient x-rays directly on their mobile device. Assessments and Plans are recorded for each patient daily, and critical SPHERE data during the rainy season is tracked for each of the 278 patients currently at Fond Parisian.

Next Steps
OMI team members are currently interacting with tech partners to improve on the current patient tracker system that is deployed in the field. The end goal is to create a workable post-disaster program that can work in any environment.

Fundraising
OMI continues to fundraise for providing support in Haiti. Fundraising teams are holding diverse and creative events to help ensure that OMI can provide its essential services.

1. Maureen Richardson organized an event that raised over $1,000 at the gastro-pub The Republic in San Francisco. The event featured the OMI slideshow http://www.youtube.com/watch?v=DYs8Qlbz_vk

2. Following up with the event he attended at The Republic, Jerry Richardson (Maureen’s father), has set up multiple meetings and has leveraged his personal contacts to continue the Richardson Family’s fundraising and organizational efforts for OMI. Jerry’s efforts have matched and exceeded the amount raised at the Republic event.

3. Nisha Thapa and the team from Sahayeta.org (check out their amazing work: http://www.sahayeta.org/), invited OMI to an amazing event at the Temple Bar in San Francisco to celebrate Nepali New Year. The Bay Area Nepali, Tibetan and Bhutanese communities came together to raise an impressive $3,000 at this event. These funds will enable OMI, to continue its efforts on-the-ground in Haiti.
- If you or your organization would like to hold an event to continue these amazing efforts please contact us, and as always you can donate online: http://opmedinstitute.org/haiti/

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Academic Update
The OMI team, grounded in actionable, on the ground projects has begun its academic analysis of HIT Rescue and is preparing manuscripts for publication in the relevant medical journals to continue to share the lessons in using technology in a unique manner post-disaster. Our organization is committed to disseminating all of the information we have learned, and continues to strive to make the technology that we develop as Open Source as possible.
In this vein, the team continues to share its experience and get feedback at academic conferences. Most recently, Ari Hoffman attended the UCSF Association of the Clinical Faculty Meeting: “Aid and Relief for Global Disasters,” where the HIT Rescue project continued to receive supportive feedback.

Those who society abandons, we defend.