Don’t just do something. Stand there!

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Should I stay or should I go?

An article in yesterday’s USA Today caught my attention.  In it, an emergency room doc, Scott Plantz, recounts his voluneteer experience in Haiti.  He describes it as working in a “chaotic hell” with  the presentation of patients with broken bones that were  “the worst injuries I have ever seen.”

He expresses his frustration at the lack of coordination between hospitals as a real problem.  Some faciltities have far too few of desperately needed neuro and vascular surgeons.  The facilities he worked at, Project Medishare and the University of Miami Global Institute Hospital, had four orthopedic surgeons.  Down the road, at another facility, patients with broken limbs were being turned away and told to return in two weeks due to a shortage of the orthopedic surgeons which his facility had too many.

This reminded me of “Woodall’s Axiom: There is no such thing as an adequate response to a catastrophe.”  One can not expect things to run smoothly after a horror like what Haiti experienced.  But, we only hope to get closer and closer to acceptable responses to the overwhelming challenges.

Of note, Dr. Plantz describes what I have seen many times,

“I flew down with a group of 200 college students with no association with Project Medishare- probably the most frustrating aspect. They came down to “help out,” each at a cost of $500.  They had no construction or medical skills.  When you realize that $500 will keep two Haitian children alive for a year, watching anyone arrive that is not trained is aggravating.  Funding the sending of carpenters or one bulldozer would have been 1,000 times more effective.”

There was a saying I remember from my medical training that seems absurd and counter-intuitive.  “Don’t just do something.  Stand there!”   This saying was meant to tell us to think carefully about what the most strategic and helpful intervention would be to help a patient.  We were asked to resist immediate actions based on our own emotional responses that might make us feel good because we are doing something,  but that would not really be in the patient’s best interest.

It boils down to a question a doctor is trained to ask themself: “Is my acting based on me trying to prove to myself I’m useful, or is it really in the best interest of the patient?”  The patient comes first, not my desire to feel helpful, or to calm my anxieties about how bad things are,  or prove to myself I have a life’s mission, or to launch a new phase of my life, or gain recognition for being a humanitarian.   These all get checked at the door.  The patient’s real needs come first.

Then, the sober analysis must begin as to how one can be of the most help.  Dr. Plantz felt that these 200 college students were treating their own desire to be seen as helpful, while likely being of very little actual help.  It is very likely that they consumed food that was not readily available, contributed to an already overloaded sewage capacity, took time and resources away from generous hosts who had to accomodate them.

It may be that such “missions” can have some positive effect.  But, there may have been 100 other interventions that would truly be more effective in helping many more people without burdening already broken systems.  Such modest interventions  might not allow for  a “life changing experience” for the person who wants to go to help.  But, it is not about the care giver having a life changing experience.  It is about actually helping those in need.

So, for now, it seems to me, that if you can help medically treat or nurse this child, find a way to go to Haiti, preferably by connecting to an agency that is established there to maximize your efficiency.

If you can provide a way to clean up sewage and treat water, by all means, get yourself to Haiti.  If not,  it is probably best you stay home and raise funds for those who can or provide material that is specfically requested by agencies on the ground in Haiti that have the means to distribute it.

If you can help to clear and rebuild this, consider going to Haiti.

There will come a time when the emergency phase of this calamity is over.  That will be a time for other types of services to be brought to Haiti in earnest.  That will be a time for non-specialists.  But, until the sewage and water systems are intact, until food is readily available, until basic accomodations are there for Haitians at the pre-earthquake levels, consider the strain you are putting on the system by trying to be of help.  Honestly ask if your personal input is more valuable then the strain your presence puts on these systems.

Be honest.

Wanting to help and being willing to sacrifice yourself to help are different than actually being helpful.  Your best intentions to help may best be fulfilled by not going and doing something here that benefits many there.  No one may know of your effort, but that is really the measure of who you are really going for.

If you would regret if no one knew you went to help, don’t go.

If you have no specific skills to render at this time, seriously consider not going.

If you have no systematic plan to be of help, seriously consider not going.

Be honest.

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  1. Bridgette says:

    There is a bit of me that hopes some or even most of these volunteers flew down out of the truest unbounded desire to sacrifice with no thought of self for the healing of those in need-a quality to which I humbly and respectfully tip my hat. A pity indeed that they were so caught up in this desire as to not ask your questions and thus ended up being inadequate to serve or worse yet, detrimental to the plight of the nation.

  2. catherine chapman says:

    Great observation about helpfulness. This could be applied to any aspect of life’s many relationships whether between individuals or groups – but there is no doubt that the difference between the instinct to help and real help becomes obvious in emergency situations, big and small. The instinct to want to help is a vital instinct for collective life. But being able to reflect on how to be most helpful in a given situation takes restraint, humility and a special kind of intelligence in my opinion – and in an emergency or chaotic situation, that moment of reflection has to be instantaneous as things happen so fast!

  3. John says:

    Thanks Catherine. You’re right. This applies to many aspects of life. This is an elaborate way of saying what we’ve all heard, “The Road to hell is paved with good intentions” Our methods have to be as wise as our intentions are pure in order to be effective. It was after having worked in man disaster efforts (the war in the Balkans, NYC after 9/11, New Orleans and the Gulf Coast after Hurricane Katrina) that led me to design a system that could act both as a system to build capacity after a crisis, but also to act as a kind of innoculation in a community to minimize the effects of any kind of disaster once it occurs. This, again, by building local capacity to work together toward service.

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