Haiti and beyond

Haitian earthquake survivors gather at a Red Cross distribution site in Port-au-Prince, Haiti, to receive non-perishable supplies Jan. 25, 2010. Thousands of Haitians are homeless and lack daily necessities such as soap and blankets; help for earthquake victims was slow to arrive for several reasons. (Photo: MC1 Joshua Lee Kelsey, USN.)

Haitian earthquake survivors gather at a Red Cross distribution site in Port-au-Prince, Haiti, to receive non-perishable supplies Jan. 25, 2010. Thousands of Haitians are homeless and lack daily necessities such as soap and blankets; help for earthquake victims was slow to arrive for several reasons. (Photo: MC1 Joshua Lee Kelsey, USN.)

Nearly a month after the devastating earthquake in Haiti, recovery efforts remain slow and many survivors desperate for basic needs. Members of the university community, from alumni to students to Survival Flight pilots, have been working in Haiti and at home to help. Immediate, short term aid remains the highest priority, and U-M offers advice for how to help right now.

Meanwhile, Michigan Today asked U-M experts to help us understand how communities, nations and the world can prepare for and respond to similar disasters in the future.

All disasters are local

Rosemarie Rowney is an emeritus faculty member of the University of Michigan School of Public Health and the School of Nursing. A seasoned emergency preparedness expert, she has practical experience in responding to crises—as an Oakland County Health Officer, for instance, Rowney activated disaster response teams during 2001’s 9/11 and anthrax attacks. She also knows Haiti.

Rosemarie Rowney is an expert on disaster preparedness and is active in providing health care to Haiti.

Rosemarie Rowney is an expert on disaster preparedness and is active in providing health care to Haiti.

Rowney is president of the Haiti Nursing Foundation and a board member of the Faculty of Nursing Science of the Episcopal University of Haiti (FSIL). FSIL is the only four-year, baccalaureate nursing program in the country. It was also one of the few health system buildings to survive the earthquake. The school became a haven for earthquake survivors, and its nurses and students were tending to the sick and injured, even delivering babies, in the parking lot while international aid was still days away.

Haiti is the poorest country in the western hemisphere, with no clean water source, sanitation, electricity or public school system. Health care is almost nonexistent, and hospitals in Haiti don’t provide sheets, meals or medicine. Even before the quake, says Rowney, the roads were cratered with building-sized holes. She knows well the logistical nightmare responders faced.

Unleash upon a country that’s already broken an earthquake that levels the capital city of Port-au-Prince, displaces more than a million people, kills thousands more and leaves behind literally zero infrastructure, and you have complete chaos. Haiti’s conditions were particularly grim. But any time disaster strikes, it’s simply impossible to get international teams onsite immediately. Beyond the need to gather material and transport it to a country, says Rowney, bureaucracy and logjams among and within responding agencies in the international community are unavoidable. That’s why Rowney says “disasters are local” and that preparedness must begin at home.

JoLynn Montgomery of U-M's School of Public Health, sees parallels between the earthquake in Haiti and post-Hurricane Katrina flooding in Louisiana.

JoLynn Montgomery of U-M’s School of Public Health.

“Does your family have a disaster plan?”

Indeed, in the beginning hours and days Haitians were largely on their own as the international community mobilized what is now a huge, U.S.-led relief effort. But before the military arrived, we saw images of Haitians digging frantically with spoons, boards, and bricks to free their neighbors from pancaked buildings; of NGOs already in Haiti treating victims minutes after the quake. When she was leading disaster-preparedness trainings, Rowney always asked participants, “Does your family have a disaster plan?” Her own family designated a family member not living in California as central command if an earthquake or other disaster occurred near relatives on the west coast.

Emergency preparedness should start with the family and work its way up to the workplace, town, city, county, and finally to national and international responders. But as necessary as each tier may be, it also increases complexity and confusion, says JoLynn Montgomery, director of the Michigan Center for Public Health Preparedness. Montgomery, who’s also a research investigator at U-M’s School of Public Health, saw the same need for local response when she went to Louisiana in response to Hurricane Katrina.

The small communities that sustained significant damage were deft and autonomous enough to help each other and help themselves get their towns up and running quickly, Montgomery said. She recalls one resident of Lafitte, about 45 minutes south of New Orleans, telling her, “We don’t want the government here.” Contrast that with the unforgettable images of thousands of Louisiana residents trapped and pleading for food and water, first aid, and protection from rape, theft, and beatings in the Louisiana Superdome and Convention Center. They languished for days, waiting for government help. In a major city like New Orleans or Port-au-Prince, the scale of the problem becomes exponentially worse and even if pockets of people have a sense of community, the damage is too big to fix locally.

International responses

U-M's Armando Matiz Reyes says that some level of bureaucratic and logistical difficulty is inevitable in disaster zones. But Haiti's was made worse by the paucity of pre-quake infrastructure.

U-M’s Armando Matiz Reyes.

Following the Jan. 12 quake, massive amounts of international help mobilized almost immediately, but according to a Jan. 14 article in the Christian Science Monitor, it took almost a week or longer for some of the crucial supplies, such as the mobile hospital The USNS Comfort, to arrive. Food, medicine, and water sat in the airport while desperate Haitians begged for help.

Many experts with on-the-ground experience seem resigned to the fact that disaster relief will probably never go as smoothly as the world would like. Unfortunately, lumbering bureaucracy and slowdowns are unavoidable in such situations, said Armando Matiz Reyes, a lecturer and research associate in the U-M School of Public Health. In Haiti, the lack of infrastructure made the slowdown even worse.

Ironically, even the glut of first responders hindered more than helped early on, because the country simply had no infrastructure or supplies to support the newcomers. Responders with the best of intentions initially complicated the situation. Dean Lorich, M.D., was part of a team of surgeons who made their way to Haiti and found themselves rendered helpless by the incredible scale of destruction and what one Lorich called “The complete lack of a medical infrastructure in the country.” After days of trying in vain to help traumatized patients and surviving attacks by armed bandits on their thin supplies, Lorich and the team had to abandon the country under the protection of armed Jamaican soldiers. (Read Lorich’s full account here.)

U-M Professor Mark Wilson says that responding to disasters requires local knowledge and infrastructure as well as international resources.

U-M Professor Mark Wilson

“As much a man-made disaster as it was a natural disaster”

Mark Wilson, professor of epidemiology in the SPH, noted that the quake left the United Nations mission headquarters in ruins and killed dozens of U.N. aid workers—workers who could have helped lead disaster relief efforts

.”You could argue that (Haiti) was as much a man-made disaster as it was a natural disaster,” says Wilson. “I feel like there has been an attempt to try to find blame for a problem that is fundamentally no single organization’s fault. Things were simply destroyed in a setting where there wasn’t much there to begin with. Poverty and inadequate infrastructure are as much responsible as is seismic activity.”

Still, preparing for and mitigating disasters is possible, and many argue that impoverished countries like Haiti, which lack the resources to prepare an adequate local response, need more international help. Some argue that the fact that Haiti is only 90 minutes from Miami make the abhorrent conditions there even more unbelievable and more inexcusable.

“The international community has a responsibility to help developing countries build strong infrastructure: roads, water, power, etc,” said Rowney, whose group just applied for a grant that would fund a joint emergency relief and recovery for 200,000 people in Leogane, a city 20 miles west of Port-au-Prince.

“You also need a local knowledge base to respond effectively when a disaster happens,” Wilson says, and this responsibility also falls to the international community.

The need for coordination

Training local people in disaster planning is key. Solid local infrastructure and training won’t prevent chaos and loss of life in a disaster, but it certainly mitigates a disaster’s impact. On the global level, however, experts say an international governing body for disasters is unrealistic—too many egos and politics involved.

“The one thing that makes this a difficult situation is there is no norm for how you coordinate things, there is no oversight body that’s responsible,” says Wilson.

“Think about the recent summit on climate and how we couldn’t even get the cooperation of people inhabiting this globe,” Rowney says.

However, says Montgomery: “To have a UN-run preparedness and disaster committee that would instantly meet and assess any disaster to decide, ‘OK, it’s an earthquake in Haiti, who can be in charge,’ that would be a way, the only way, to make a situation like that work.”

Wilson agrees. “Absolutely. Some kind of a coordinating body would be extremely useful; it could function through the UN.”Finally, and perhaps most importantly, experts stress it’s critical not to forget Haitians after Anderson Cooper and Sanjay Gupta leave the country to cover breaking stories elsewhere.

“One of my biggest concerns is what will happen after the first stage of the crisis,” says Reyes. “This catastrophe involves issues beyond what we see on television now, we need to think about short term and long term needs.”

Some of that help is forthcoming. According to a New York Times story on Jan. 25, international donors had agreed on a 10-year rebuilding effort that the government said would cost $3 billion. The article also said the U.S. government declined to comment on how much it would contribute. According USAID, the U.S. government’s principal disaster relief organization, the U.S. has so far contributed $394 million in earthquake response funding.

Finally, says Rowney, it’s important to stay optimistic. “This is an opportunity to rebuild Haiti, and it’s only 90 minutes from Miami. It’s in our backyard. We can do this.”

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