Rogue Consultants

Johnnie and I are listed on the Official Miami University Field hospital as "Rogue Consultants" at the top of the page.

 

It is dogma in the field of diaster relief that one doesn't go "rogue."  To have a bunch of Medics and ER docs, well wishers, clown college dropouts and voyeurs running around the streets with trauma shears and best of intentions is a bad idea.  ACEP (american college of emergency physicians) has a specific policy statement opposing such endeavors.

 

I agree wholeheartedly that this is not the way to go, but I can now attest to the fact that there is a place for some discretion in this matter.  If everyone did it  the net effect would surely be detrimental.  However the dogma may have gone too far.

 

I went with the sole intention of working at Housing Works clinics serving as a family practice doc.  I imagined being inundated with patients with valid medical complaints who had nowhere else to go.  "A busy urgent care center" as Marie Normil put it before I came to replace her in this role. 

 

However when I got there seveal things were true:  1) it was a 3 day holiday for Carnival (they went to church not partying in the streets) so the clinics were all closed   2) I had 2 awesome medics worknig with me  and 3) I am an ER doc not a family practice doc. So as a team we would blaze thru patients finishing all our work by about noon on days clinic was open   4) The entire time I was there the Haitian head of Housing works was in Washington DC, loaning us his driver and van so we had perfect transportation at our beck and call the entire time.  5) The miami field hospital- probably the biggest level 1 trauma center, had no ER doc for the first 6 days I was there and signed me on within my 1st 24 hours in the country

 

We had a safe place to stay, food in our bellies, a very  mobile team that gelled early, ample energy, know how, gumption who had no formal oversight or boss for the ~ 21 hours a day that we weren't dealing with patients in the family practice clinics

Stars don't usually align like this. 

 

This morning I wrote Charles King a formal letter of thanks and in it I specifically pointed to several things he did that accentuated our ability to get involved.  1-- as I already mentioned, he set our minimum agenda and structure (food, water, shelter, safery, transport and translators were all provided, and our mission was clear-- care for patients at FP clinic)  but he gave us tremendous latitude to do what we felt we needed to do and trusted that we kept the big pictue in mind of helping to establish a stronger clinic for the longterm in the end.   But there was something else he did:  He strongly beleives in the need for the volunteers to live IN the community it is trying to serve.  We 3 volunteers slept in the backyard along with a total of about 10 Hatian locals.  And when I say Hatian locals it conjurs the image of a faceless anonymous possible untrustworthy stanger.  But it wasn't.  It was Simone with her Hugs ang kisses every night and off color humor and laughter.  Her sister of 44 who has severe Hypertension and 3 strokes and smiles and waves but barley speaks and has such trouble getting out of the tent at night.  and 2 year old Schneider, who is cute as hell, loves to be chased but has to be one of the noisiest kids starting at about 6:01 am every every every morning.  the list go on.  regular people. some I liked more than others, but just regular people.  It demystifies the city.  we weren't scared to go out.  we probably wouldn't have been anyway because we all like "getting out there" anyway, but it felt much more seemless and normal.

 

Before coming down, I was looking at maps to try to figure out what to do if there was massive civil unrest.  I pictured robber at the edge of a machete as a pretty plausible scenerio.  I received the same harrowing email from about 6 different ER docs of one doc's supposed firsthand account that may or may not be true of needing armed escorts. If the email is in fact true, and I have my doubts, I really really suspect that the need for the escorts and perceived danger all around may have been more imaginary than real.  I know more healthcare workers in philly who have been robbed at gun point or otherwise (1) than in Haiti (none)

 

When University of Miami suddenly had a new shipment of docs-- way overstaffing the ER (went from 1 ER doc-- me) to TEN er docs in 1 shipment,  I did 2 things-- 1) stopped working there  2) tried my best to recruit docs to come out with me-- to disseminate them to the countless locations they were needed.   Though one very cool doc did leave briefly for a tour of Gen Hospital, that was teh exception.  The rest were on a spectrum of terrified for there lives to leave (there are several choice slang words for these supposed ER docs that are too crude to put here) and at the gutsiest end of the spectrum, scared to leave the compound because the rules of the comppound forbids them from leaving and says if they do, they are "on there own"    I pretty much apply the same slang words to these folks too.

 

SO, why was it important to get out there? 

Miami FH is huge: generators, internet, literally hundreds of volunteers, Cheif medical officer, US command and control, flights to the ship, full time Logistics tent with a logistics coordinator with 2 phones and internet.  Within 3 days of "going rogue" driving around the city meeting the various players  we were more knowledgeable about the location of physical and human resources throughout the city than they were.  Im sure they knew things we didn't know, of course they did.  But there were so so many instances where we had answers when then had none

   they had run low on oxygen regulators.  After several days I think they got a new shipment, but we found a huge carton filled with oxygen regulators in one of the 20 shipping containers located less than a mile from Miami FH which contained supplies that WHO was literally giving away.  (we did load up our van full and strapped more to the roof before we left of course)  Not only did WHO have these 20 containers of goods that were donated to them but never ijnventoried because they did not fall within the scope of what they did (meds) but they had an entire airconditioned wharehouse of meds that has been in place for 18 years and no one at Miami knew about this either.

  when it came to turning away patients and transferring them elsewhere we had literally met face to face with accepting administrators and physicians at 5 of the major destinations, exchanged phone numbers and established transfer protocols before the CMO and another doc from Miami ultimately did the same several days later (we had already compiled this list and typed it up and added it to miami's offical list, literally doubling the length of thier document and correcting several errors in the process) the list we created of course was completely unkown to the CMO when he went on his field trip 2 days later.  Mind you they had been on the ground (hundreds of them) for over 6 weeks at this point, we'd been there 6 days at this point).

Numerous times (maybe 20-25 times)  we saw patients-- either while at local hospitals or in our clinic or tent city (and during the car accident on the side of the road) when we were able to identify a problem that could not be addressed at the current location (including in hospitals) and we simply picked up the phone and called our new friends at the appropriate institution, spoke on a 1st name basis, traded some niceties and arranged definitive transport to the right institution.

We also connected with Quisqueya, CDC, and a non profit that donated 15 local cell phones w minutes so we could communicate more easily.

 

Again, I know this may sound braggardly or it may sound naive. I am sure people at other institutions felt they had good systems.  For example University hospital's Gabrielle "the dude" logistics man was phenominal and knew way way more resources than we did.  But none of the people we met knew him so we made telephone introductions to connect these people.

 

I am absolutely not trying to imply that we did better than others.  What miami FH did was so far beyond anything I could imagine, helping thousands of people, it was an amazingly efficient and productive machine. as were all the machines providing relief work.  what I am saying is that what we did going rogue was DIFFERENT than anything we saw and I think at times added benefit to the process.  maybe 99% of the work should be done "on the reservation" but I do think there is a role for a small portion of the workers to go "off the reservation" a little.  No to be reckless or provide cowboy medicine, amputating kids feet in the street, just to cross polinate institutions.  make connections, identify resources by actually travelling around the city as a doctor talking to workers and patients alike

 

  Those hard to reach placed were definately reached, by others before us.  The tent cities had been mined several times over by teams of docs in the early days after the quake. 

 

Anyway, I will have to edit this some time in the future, its just that I am on a computer finally, in a hotel in Santo Domingo, clean, hot shower and wanted to put some thoughts down.

again, listing our accomplishments in such an unappologetic definatley could come across the wrong way, I dont' mean it that way.  I am just responding to the voices I had rattling around in my head before I came down-- and responding to them now with the perspective of hindsight