On January 12, 2010, a 7.0 magnitude earthquake struck near Haiti’s capital of Port-au-Prince, causing massive casualties and destroying the country’s already fragile medical infrastructure. Members of America’s Essential Hospitals took their expertise with mass trauma and disaster coordination overseas en masse, with 32 members (representing 83 individual hospitals) participating in the effort. By providing on-site clinical services, helping to rebuild the public health system, treating airlifted patients in the United States, and sending money and supplies, members demonstrated that their commitment to caring for the most vulnerable patients knows no borders.
More than 250 medical personnel from our member hospitals went to Haiti, many without pay and on their own personal time. “When I was asked to join the team in Haiti, it never occurred to me to say no,” says David Chesire, PhD, then an assistant professor of surgery in the University of Florida (UF) College of Medicine-Jacksonville, who traveled with one of the multiple UF Health teams that went to Haiti. These initial responders attended to immediate needs, such as rehabilitation for spinal cord injuries, treatment for amputees and burn patients, and assistance with food preparation.
Working on the ground in this type of disaster situation required adaptability and ingenuity. For example, a nurse volunteer from The Ohio State University Wexner Medical Center helped establish the only neonatal intensive care unit in Port-au-Prince, using suitcases lined with thin plastic and heating lamps to hold injured and premature newborns. A team from Jackson Health System in Miami used shoelaces, ropes, and plastic foam from swimming noodles to create leg and arm braces, and retrofitted adult crutches for use by children with amputated or broken limbs. Volunteers also had to construct makeshift clinics outdoors to avoid further injury from aftershocks and damaged buildings and perform many tests manually, as lab equipment often malfunctioned in the extreme heat.
Building a Health Care Infrastructure
Providing lifesaving trauma care is part of what makes safety net hospitals essential, but they also strive to improve the overall health status of their communities – often through public health services. Most members of America’s Essential Hospitals maintain a relationship with their local health department, including sharing resources and information. Some are even integrated into the department itself. This characteristic became a defining force for much of the work that occurred weeks and months after the earthquake, as members began to focus on the longer-term health needs of a population without a safety net.
In March 2010, a team from the Los Angeles County Department of Health Services traveled to Haiti to conduct a one-day assessment of the country’s medical and surgical needs. After that initial visit, LA County periodically sent medical teams to provide care. Volunteers found that because of the lack of a post-disaster health care system, many patients sought treatment for non-earthquake-related ailments.
In April 2010, UF Health sent a team of public health experts – nicknamed Santè pou Lavi (Health for Life in Creole) – to address ongoing public health needs, such as malaria detection and screening; clean water; health education for teachers, parents, and children; health data tracking; and basic medical care for children in orphanages.
“Working on the ground near the epicenter of the quake in the Leogane and Gressier communities, the UF team has had an ongoing presence since January 2010,” says Michael G. Perri, PhD, dean of the UF College of Public Health and Health Professions. “We have assisted in the rebuilding of two schools and have established health clinics staffed by Haitian doctors and nurses in four schools. With funding from the National Institutes of Health and the Department of Defense, we constructed a modern public health laboratory where research studies on cholera and malaria are under way.” By establishing strong partnerships with Haitian stakeholders and nongovernment organizations, UF Health has developed educational programs ranging from training laboratory technicians to teaching health professionals how to conduct public health research. “Indeed, in the past 3.5 years, we’ve witnessed some remarkable progress in Haiti,” Perri notes.
As an academic medical center, UF Health has also involved students in its ongoing support. In 2012, the organization established a student-oriented global health outreach program to Haiti, organizing trips of medical students during the university’s spring break. That year, a group of 15 traveled to the Lac Azuei region to evaluate heath needs and provide acute care and nutritional support. In 2013, they returned to four villages in the region and established electronic health records for the 600 people they treated. “Establishing electronic records was a first in this area and often challenging,” says Harvey Rohlwing, MD, a UF Health emergency medicine physician. “Many people knew how old they were but didn’t know their exact birth date. So we entered dates of January first, plus the appropriate year, and have many ‘New Year’s’ birthdays in the area.”
Finding Room at Home
The U.S. military began evacuating patients to Florida January 13, 2010, with the help of Jeanne Eckes-Roper, RN, MBA, then director of emergency preparedness for Broward Health in Ft. Lauderdale and the region vii health/medical chair for the Southeast Domestic Security Task Force. Eckes-Roper helped coordinate the evacuation of more than 650 (mostly uninsured) patients to Florida hospitals—more than 500 of whom were treated by members of America’s Essential Hospitals. Jackson Health System managed 205 victims using its Hospital Incident Command System, which commits all hospitals, centers, and services to supporting disaster operations. As patients arrived, Jackson’s trauma center, burn center, children’s hospital, medical/surgical units, and emergency services performed initial assessments, stabilization, and treatment. Among those who received these vital services, a 2-month-old baby buried beneath rubble for four days was ultimately reunited with her parents, and an Arizona State graduate student injured while volunteering in Haiti now ice climbs with her prosthetic leg.
But the influx of so many critically injured patients overwhelmed Florida hospitals, causing them to quickly reach surge capacity, thus temporarily halting evacuations. The federal government soon activated the National Disaster Medical System (NDMS), which allowed certain hospitals (those with more than 100 beds in large metropolitan areas) to voluntarily admit evacuees and receive federal reimbursement for qualified patients at 110 percent of the Medicare rate. The NDMS eased the burden on Florida safety net hospitals, enabling them to continue to provide care to evacuees and local patients alike. Subsequent research concluded that quicker activation of NDMS (at the outset of a crisis) and reimbursement mechanisms for hospitals aiding patients of foreign disasters could help essential hospitals provide uninterrupted care during times of crisis.
And while hospital care was of critical importance to earthquake victims, it wasn’t the only avenue through which members of America’s Essential Hospitals offered aid. Many members provided mental health care, such as grief and post-traumatic stress disorder counseling, and legal services for Haitian Americans who were affected by the earthquake. They also sponsored community forums for Haitians seeking temporary residency status. In addition, 14 members collected and donated supplies including medical and surgical equipment, drugs and vaccines, food and water, and toiletries and clothing; and 13 members donated money.
Ultimately, members of America’s Essential Hospitals reacted to this disaster in the way they are trained to do, day in and day out. But beyond their technical experience responding to those in crisis, the people who work at essential hospitals are driven to serve—not as doctors or nurses, but simply as human beings who won’t ignore the suffering of others. As Chesire says, “Witnessing such humanity in a time of grim despair was perhaps the most remarkable thing I had ever seen. I consider myself a better person because of that experience.”