The challenges facing aid workers

Routine medical issues can quickly become emergencies in disaster zones, say experts

RELIEF AGENCIES are reacting quickly to the unfolding horrors in Haiti, not least because many of them were well established in a country already on its knees due to hurricanes, poverty and political instability.

Dublin-based Will Devas had been in Haiti last August and September in his role as a disaster risk reduction adviser with Concern. He may have anticipated further disaster for the country but was not expecting an earthquake on this scale.

Concern has about 100 local staff in Haiti and while just one died in the earthquake, Devas explained that many more have lost family members. “It is all very well and good to talk about being prepared , but our staff themselves have been going through the trauma of losing loved ones and having to go and search for relatives who are missing.

“We have had to try to support them while, of course, also meeting the needs of other people,” he pointed out.

Like Devas, Bev Collins, a health policy and practice adviser with Médecins Sans Frontières (MSF), has worked in other disaster zones. The image which has stayed with her from Indonesia after the tsunami is the “glazed” look on so many faces following the trauma they had experienced.

“I think it was terror we saw on their faces. I remember we managed to reach people in an isolated area on the coast who had not seen anyone for weeks. They had been surviving on coconut juice,” she said.

“They had run for safety to a higher point and they saw their village swallowed up. It just disappeared. They thought the world was coming to an end. That part of the coastline had disappeared, some of them had lost their wives and children.”

Like in Indonesia, Pakistan, Darfur and so many other disaster areas, the aid workers in Haiti fear for the mental health of the survivors even as they struggle to meet their immediate physical needs.

As hospitals crumble and local people refuse to stay inside because of their fear of further tremors, Collins said that medics can often end up working in the most difficult circumstances.

“I have in the past seen surgery done in mud huts. As long as you have ventilation, lights and sterile conditions, it can be done.”

As bodies pile up in Port-au-Prince, Collins, like her colleague UK-based Dr Tejshri Shah, head of MSF’s medical department, believes that for survivors, this is one of the most traumatic aspects of the nightmare.

“It is very stressful for families who cannot find and want to bury their loved ones, especially as there will be specific rituals they want to follow to rest those that have died,” according to Shah.

She also pointed out that in addition to the immediate physical and mental stresses on people, the collapse of basic medical care means that “routine” problems can become medical emergencies.

“People may now no longer have access to medication they need to survive, for example those with diabetes, hypertension, tuberculosis or HIV.”

A logistics expert, Devas says the immediate priorities for the aid agencies have been the sourcing of clean water, sanitation, shelter and basic healthcare.

“People cannot go without water for a week while you are getting organised,” he pointed out. While water is relatively easy to source, the relief agencies must ensure that it is purified before it is distributed, hence the key role played by water and sanitation engineers in these emergencies.

“We use what are called bladder tanks containing hundreds of thousands of litres but, of course, it is also important to have a supply of jerrycans. There is no point in having a tap if the people queuing have nothing to carry the water in,” said Devas.

While horrifying images of piled-up corpses and mass graves have shocked the world, Shah pointed out that corpses do not spread infectious diseases unless these were the cause of death.

There has never been a reported cholera outbreak in Haiti, but doctors believe there is a danger of a measles outbreak in crowded camps. Just 58 per cent of Haitian children have been vaccinated against measles.

“The thing that struck me about Haiti was that there were so many shanty slums on very steep slopes – houses perched on what looked like thin air,” said Devas.

“But these houses all seemed to have some brick or concrete in the structure. If it was just wood people might have escaped with sore heads when they collapsed.”

After Thursday’s aftershock in Haiti, specialist engineers checked the stability of a number of hospitals in Port-au-Prince. The operating theatres at Choscal hospital were deemed safe but, as MSF staff noted, “the patients prefer to stay outside in tents”.

As four surgical teams worked around the clock at the hospital, patient consultations had by the weekend moved outside onto plastic sheeting with local staff too afraid to stay inside.

Doctors predicted that surgery might also have to be performed under tents.

There are two functioning operating theatres in the Trinité area of Port-au-Prince – one is based in a shipping container.

Following the most recent tremor, a hospital in Pacot was described by the engineers as at risk of collapsing. As doctors prepared for the mammoth task of transferring patients, an inflatable 120-bed hospital complete with operating theatres was being erected by MSF staff.