Category: Haiti

Don't just do something.  Stand there!

Don’t just do something. Stand there!

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.

In Haiti: first, find the women who can find diapers

In Haiti: first, find the women who can find diapers

The women who can find diapers are the most important people in a disaster response.  That’s the way it always works.   Finding these women and empowering them in creative ways is critical right now in Haiti.  The biggest challenge is the same that accompanies every major disaster: connecting the resources that are pouring into the country with the people most in need.  As we are seeing increasingly there and as has always been true in disaster responses, this is enormously difficult to do. The reason is the lack of local capacity to channel the resources through.  Here’s where we pick up on the ladies and the diapers.

To the savvy manager of an aid agency, you look for the women who have figured out what the needs of the most people are and have used their wits to meet them.  That’s the person you want to work with to set your priorities and develop the best method of delivery of resources.   This is what happened in Bosnia and Croatia when I was running a trauma response program during and after the war there.   In town after town where the disaster spread, I’d see women looking everywhere for water, food, diapers.  The woman who was the most resourceful in finding these the quickest became the “go to” person.

Reports of mass confusion and increasing levels of threat are mounting as frustration turns to desperation from the inevitable inefficiencies of a disaster response.   The chief bottleneck happens at the final point of distribution.  The current model of crisis response is like a factory conveyor belt.  Deliver material and dump it at the end.  We are good at sending material down the conveyor belt.  We are not good at distributing the material at the end of the belt.  There is another way.

The women who use their wits to find the diapers, food and water need to be empowered to organize clusters of families into Action Teams. These Action Teams consult together about what the needs of the cluster are and what resources are needed to meet them.  They prioritize actions that they can take themselves without waiting for understaffed aid agencies.  These Action Teams can be organized into a Unity Council in a village to coordinate the delivery of services and to interact as a united and coordinated voice with aid deliverers.  By itself, this would greatly increase the sense of empowerment of the people most in need.  It would decrease social tension born from chaos and desperation.  It would undercut lawlessness and violence.  It affords the people the chance to become partners in their own recovery, builders of their own hope and role models of active and creative resilience instead of merely passive victims who receive aid.

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