Feb. 16 2010

The devastation wrought by the Haitian earthquake has resulted in one of the worst public health crises in recent years. The situation desperately requires expert public health practitioners with experience in both short-term emergency response and long-term systems development and reconstruction.

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From USAID to UNICEF to the CDC, Mailman School faculty with substantive backgrounds in disaster relief and rebuilding have taken on leadership roles directing and advising programmatic responses to this tragedy.

Collaborating with the Haitian government, their goal is a simple yet daunting one - to take this moment of international support to build better and smarter public health infrastructures in Haiti.

“The Destruction of This City is Unfathomable…”

Sharing knowledge and distilling it into actionable plans is a hallmark of the School’s faculty. The extraordinary situation in Haiti demands such expertise to meet the urgent needs not just of today, but for some time to come.

Dr. Ronald Waldman, professor of clinical Population and Family Health and of Epidemiology, has been in Port-Au-Prince since the disaster struck serving as the U.S. Government Coordinator of the Medical/Health Sector Response to the Haiti Earthquake. A physician specializing in child health in developing countries, Dr. Waldman has worked in complex emergencies in Somalia, Rwanda, Bosnia, Albania, Democratic Republic of Congo, Afghanistan and, most recently, Iraq.

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“I have seen a lot of disasters, but the destruction of this city is unfathomable,” Dr. Waldman noted in the week after the disaster. “We teach about direct and indirect consequences of disasters and about how they should be approached sequentially, but here both have to be addressed simultaneously.“ 

To better understand the scale of this tragedy, the UN and CDC worked together to carry out an assessment of the situation throughout the country. Responsible for developing this assessment tool when on leave a year ago to work at WHO and advising in its implementation is Dr. Richard Garfield, the Henrik H. Bendixen professor of clinical nursing and faculty member in the Mailman School’s Program on Forced Migration and Health.

This key tool identifies the urgent and emergent needs of the population noting those who are already receiving assistance as well as those who need assistance the most. As an advisor for the CDC, Dr. Garfield worked with 85 representatives from a number of different organizations to assess the needs in the camps. 

In addition to the work of Mailman School students and faculty, the School of Nursing has mobilized faculty and doctoral students, including Haitians, to staff the National University School of Nursing in Port au Prince.  The nursing school at that university was crushed, killing most of the students and decimating nursing staff.  Columbia faculty and students are providing patient care while serving as clinical instructors to remaining nursing staff as they assume expanded patient care responsibilities.  To date most of the nurses but few of the physicians have returned to the hospital, which is now mainly a group of tent pavilions.

Experienced Advisors

Haiti-Camp-Article.jpgIn addition to the faculty serving on-the-ground in Haiti, other Mailman School experts with extensive experience in disaster settings are collaborating with government agencies and NGOs to map out long-term recovery plans addressing a number of issues from child protection to communications to psychosocial support.

With more than 20 years experience working with children in crises, Dr. Neil Boothby, the Allan Rosenfield Professor of Clinical Forced Migration and Health and director of the Program on Forced Migration and Health, has been advising the U.S. Government and UNICEF on child protection issues in Haiti. Dr. Boothby knows firsthand the mistakes and successes that can occur in crises having written UNICEF’s post-program review of the Asian tsunami response.

“We have to ensure that lessons from the tsunami be integrated into the Haiti response,” explains Dr. Boothby. “Today, and before the earthquake, too many people died because of poor water/sanitation and lack of immunization. We need to help Haiti build public health structures that support a continuum of health – from the home to the clinic to the hospital.”

Dr. Irwin Redlener, director of the National Center for Disaster Preparedness and Clinical Professor of Population and Family Health, is another recognized leader in coordinating public health responses to large-scale catastrophic events.  Tapping into his extraordinary background, Dr. Redlener is currently advising the U.S. State Department on their response efforts and working on disaster communications in Haiti. 

The psychological impact on Haitians of this tragedy is yet another area that calls for attention.  To enable humanitarian actors on the ground to plan, establish, and coordinate a set of minimum multisectoral responses to protect and improve people’s mental health and psychosocial well-being, the World Health Organization has established guidelines, co-written by Dr. Michael Wessells, professor of Population and Family Health and senior faculty in the Program on Forced Migration and Health, that are currently being applied in Haiti.

Dr. Redlener is also heading a task force co-chaired by Dr. Sandro Galea, Gelman Professor and Chair of Epidemiology, within the Mailman School to coordinate the School’s considerable resources in disaster response planning, recovery, resiliency, development, forced migration, children and vulnerable populations in disasters as well as the mental health consequences of large scale catastrophes.

(Re)building Haiti’s Future

Hait-flag-article.jpgAfter the Asian tsunami, the President of Singapore reportedly advised his counterpart in Indonesia not to squander the moment - otherwise Indonesia risked losing the world forever.

There is hope that Haiti’s government, which has had capacity and commitment issues in the past, will be galvanized by the outpouring of international aid and support to rebuild the country with, amongst many other things, a stronger public health infrastructure.

“Lots of mistakes were made in Aceh,” concedes Dr. Boothby. “But we learned a lot and had many successes rebuilding smarter and better.  Today Aceh is a better place to live. I hope we can say the same for Haiti some years from now.”

Citing the enormity of what is being attempted, Dr. Waldman explains, “The task of rebuilding has to begin now.  It starts at square one. We can try to schedule a meeting with the Ministry of Health, for example, but where would we meet?  There is no Ministry.  The idea is not to return Haiti to the status quo ante, since that was a very bad place to be, but rather to try to ‘build it back better’; a difficult task at best.