Haiti: Who Are The First Responders?

Dr. Rick Shannon, a cardiologist and chair of the department of medicine at the University of Pennsylvania Health System, knows how Haitian medicine operates in the best of times: under duress. He first witnessed this in 2002 when he arranged for an echocardiogram machine to be delivered to Haiti's Hopital Albert Schweizer, where he was volunteering. The new $500,000 echo machine arrived in Haiti before he did; by the time Shannon got there to pick it up, "the machine had been completely dismantled, every valuable piece was taken, and there was a family of mice living in it," he says. And then there was the reality of providing care for desperate patients, who lined up at dawn to be treated. Hallways were packed with people, many of them suffering from infectious diseases, like tuberculosis and malaria. "On a good day, it's on the edge," says Shannon. Not because of a lack of will, but because of a lack of infrastructure. The earthquake? "There is no capacity whatsoever to deal with this," he says.

Which is why medical first responders and the teams that follow them are so critical to the welfare of the country. American doctors, nurses, orthopedists, surgeons and other medical experts have been arriving in Haiti since the quake struck last week. Some are employed by the government: the USNS Comfort, an enormous 1,000-bed hospital ship, docked off the coast of Haiti this week. Doctors, nurses and technicians—most of them from the National Naval Medical Center in Bethesda, Md.—began treating the wounded, who are being helicoptered onboard. Other medical personnel sign on with nongovernmental agencies like Doctors Without Borders or small relief agencies and religious groups.

Who are these medical responders? What kind of training do they have? Is it time for all hands on deck? To that last question: "No!" says Dr. Thomas Kirsch, an ER physician and deputy director of the Johns Hopkins Office of Critical Event Preparedness and Response. To all those concerned citizens and individual doctors and nurses in the United States thinking of making the trip to Haiti, "Tell them don't go. Stop," he says. Kirsch is talking about "disaster tourists" who fly in to provide medical assistance, but don't have the proper training to do so, don't speak the language, and can't commit enough time to be useful. Experienced teams bring tents and medicines with them; random individuals use up scant resources like food and water. No doubt they have good intentions, says Kirsch, "but they become a burden on the actual response."

At Doctors Without Borders, or Médecins Sans Frontières (MSF), volunteers go through a highly competitive recruitment process. They must have at least two years of professional training in the specialty they want to work in overseas and they must be skilled communicators, adaptable and calm under pressure. Only about 10 percent of applicants make the cut. "We don't take people off the street," says Nicholas Lawson, MSF's director of field human resources. "We want the most qualified and most experienced." For Haiti, in particular, staffers need to have a "high ambiguity tolerance," says Lawson. In other words, they must be able to handle limited supplies and a host of unknowns.

Volunteers, who tend to range in age from their 30s to 60-plus, must be willing to serve a minimum six months and survive on a starting salary of $1,400 a month. Some take vacation time or a leave from their jobs back home; many others work for MSF full time, jumping from one crisis to the next for months at a time.

Training is a critical part of any mission, says Tim Walton, executive officer of the federal government's National Disaster Medical System (NDMS), which oversees what are known as Disaster Medical Assistance Teams or DMATs—groups of civilian physicians, nurses, psychologists, surgeons, paramedics, fire-station EMTs, mortuary experts, and other specialists ready to respond to terrorist attacks and natural disasters. When an emergency happens, DMATs are called up to serve. Every year, DMAT members must meet for a week of field-training exercises where, among other things, they learn how to set up tents and familiarize themselves with equipment they'll be using onsite. Dr. Eric Weinstein, an emergency doc who is part of a DMAT team in South Carolina, says one of the most important steps in the process is gathering information before deployment. "You need people on the ground telling you what's wrong, where to go and how to get there." DMAT members are "intermittent" federal employees covered under USERRA, the Uniformed Services Employment and Reemployment Rights Act of 1994, which means they're put on the government payroll when they're called up (standard deployment time: two weeks), and their jobs are protected back home. There are now 256 DMAT members on the ground in Haiti and three additional teams are on alert to go, says Walton.

No matter how skilled or trained a volunteer is—and no matter how much of an adrenaline junkie—there will be moments, if not days, that are physically and mentally overwhelming. "There's emotional stress because of the devastation, there's cultural stress because you're in a different environment, there's environmental stress because you've gone from sleeping in a nice soft bed to sleeping on the floor or not sleeping," says Kirsch, who has worked with Cambodian refugees as well as victims of Katrina and 9/11. "And there's health-care stress because you're being exposed to diarrhea, malaria, dengue fever, and typhoid." Every DMAT team has a mental-health specialist on board whose job is to watch staff members for signs of distress and encourage them to take breaks when necessary. Karen Carr, head of Community Coalition for Haiti, a Virginia-based organization that has been working in Haiti for 10 years and is there now with a team of U.S. doctors, says participants spend time in the evenings debriefing each other on how they're doing and how the work is affecting them. "We do that regularly on the trip, on the way back and generally in a session once we get back," she says.

In a time like this, the Haitian people need all the help they can get, but all that help needs to be productive. "We're hanging back and seeing what the needs are," says Kirsch. "I'm not a hero. I like to make sure that before I do something I'm actually going to be useful." Shannon, for his part, is helping to coordinate treatment at Penn's hospital, which received its first three patients airlifted from Haiti—two of whom had their legs amputated—this week. When it's feasible, the best outcome for many patients is getting them out of the country.

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