Aid worker administers medicine to Haitian child in Léogâne.With the current wave of natural disasters and international conflicts extant in the world today, the number of people engaged in global humanitarian relief, including medicine, is growing. As a result, there have arisen special concerns for providing medical care and other types of assistance during humanitarian efforts. At the Wilderness Society summer annual meeting in 2010, Cindy Bitter, MD, led a round table discussion entitled “Challenges and Controversies in Humanitarian Medicine.” I will use materials she prepared for the syllabus to offer some observations about the general topic of humanitarian medicine, which is very often practiced in outdoor settings that are austere.
Current estimates state that, worldwide, there are more than 5,000 organizations providing humanitarian aid at a total expense of $15 billion. Medical assistance is given in many situations, including natural disasters, conflict and refugee care, provision of basic medical needs in low-resource areas, surgical missions, local resource development, and sanitation and nutrition projects. In 2009 alone, there were 103 global natural disasters, including 85 floods, 30 storms, 21 earthquakes, 16 landslides, eight droughts and six cold spells. It is a safe estimate that disasters affect 200 million people each year. 2010 and 2011 have borne out that estimate. Contributing to vulnerability are refugee and indigenous displaced populations.
Augmenting basic health needs involves supporting local health care providers and infrastructure, so that those who are otherwise unable to receive care may do so, and so that the level of care available (when available) can be increased. Specialty medical missions typically involve plastic surgery, orthopedic surgery, ophthalmology, dental services, obstetrics and gynecology, and burn care. The “elephants in the room” are nutrition and sanitation, including providing safe drinking water, and immunization for and treatment of infectious diseases.
Considerations for providing medical global humanitarian assistance include appropriate attitudes in effective volunteers, training, matching services to needs, setting expectations, selection of partners for assistance, selecting recipients of services, identifying low-technology and high-technology solutions, recognition and respect for cultural and social norms, appropriateness of various approaches to health care delivery, sustainability of interventions, adequate financing, and procurement of medication and supplies.
Examples of successful projects include placing cement floors in homes to improve sanitation, distributing eyeglasses and surgically correcting cataracts, repairing cleft palates, performing lower limb tendon release operations on “crawlers,” immunization programs, distribution of bed nets, mental health counseling, and others.
The medical model, in which the benefit is to a person or a few persons, is contrasted with the public health model, in which the benefit is to larger populations. While the intent in both cases is to alleviate suffering and provide services, in the public health model the creation of systems and community interventions take precedence over providing state of the art care to a limited number of individuals.
A successful mission often is predicated upon performing a needs assessment for services, applying cultural awareness and appreciation for non-medical factors that might influence outcomes, maintaining high standards of care (similar to those practiced at home), having adequate equipment and supplies, partnering with local healers, and paying attention to data reporting and analysis of outcomes.