Jun 28, 2010
July 2010 Issue: The first half of 2010 saw a number of highly publicized, deadly natural disasters. On January 12, the Republic of Haiti experienced a 7.0 magnitude earthquake, with more than 50 aftershocks of 4.5 or greater in the following weeks. The event was catastrophic: the Haitian government estimated that 230,000 people had died, 300,000 had been injured, and 1,000,000 made homeless, along with major damage to buildings and infrastructure in the capital of Port-au-Prince and surrounding towns.
On February 27, an earthquake occurred off the Maule Coast of Chile, affecting six regions and 80% of the country’s population. The quake decimated buildings in several cities and triggered a tsunami that battered coastal towns. Nearly 500 were left dead. Tremors, shifts, and standing waves from the 8.8 magnitude event, one of the strongest in recorded history, were observed as far away from the epicenter as New Orleans, Louisiana—a distance of more than 4,700 miles.
Less than two weeks later, on March 8, a 6.1 magnitude earthquake hit the Elâzig province in Turkey. While the human toll was smaller—more than 40 killed, more than 70 injured—it was no less tragic for those living through it. And at the time of this writing (April 2010), a 7.1 magnitude earthquake had just struck China’s Qinghai Province, resulting in more than 600 known casualties.
A disaster can strike and leave a nation in upheaval anytime, anywhere. When this happens, medical professionals with specialized skills are in a unique position to provide aid. Four members shared with ASCO Connection their experiences following the recent earthquakes.
Early responders save lives
Mere days after the earthquake hit Haiti, physician volunteers from around the world converged on the affected region even as aftershocks brought down more buildings.
“My husband is from the Dominican Republic, so we go there often. I knew that the poverty in [nearby] Haiti was extreme. As a physician and as a human being, I wanted to see if I could do something for the people there,” said Maria-Claudia Mallarino, MD, of Florida Cancer Specialists & Research Institute. She and her husband, Guillermo Villalona, MD, were on the ground three days later.
Louis-Joseph Auguste, MD, of Albert Einstein College of Medicine, was born in Haiti, and returns there frequently to present at meetings of the Haitian Society of Oncology and to teach in area hospitals. He also serves as President of the New York chapter of the Association des Médecins Haïtiens à l'Étranger (Association of Haitian Physicians Abroad; AMHE). When he and his colleagues saw the devastating news reports of the earthquake, “we knew that the medical system was overwhelmed and had to help,” he explained. He arrived five days later with a group of 67 volunteers.
Both Dr. Auguste and Dr. Mallarino were immediately confronted by the acute need for trauma care, primarily dealing with amputations, infections, and burns. But their work was not always medical. Dr. Mallarino rented a truck to drive injured people in the Cité Soleil neighborhood to safe shelters in the neighboring Dominican Republic. One of Dr. Auguste’s first tasks was to help distribute food to hungry patients and families in the hospital facility—some had not eaten in four days.
Although he wasn’t practicing oncology, Dr. Auguste found his specialty skills to be extremely valuable. “There were patients with lacerations of the face and mouth, and broken jaws. There were no maxillofacial surgeons at the facility, but with my training in head and neck surgery, I was able to take care of these cases,” he said.
“We can help,” Dr. Mallarino said of oncology specialists. “We are physicians, we take care of patients with very complex problems, and we tend to be extremely good at internal medicine. The work that the volunteers did was amazing. People just packed their luggage and came to help, and I think they saved a lot of lives.”
“Helplessness, followed by frustration”
Even after the physical damage is repaired, those in the disaster area, and their loved ones elsewhere, experience a great emotional toll.
Uncertainty brings its own set of challenges, as Cesar Sánchez, MD, discovered. A native of Chile, Dr. Sánchez is currently pursuing a fellowship in the United States. In February 2010, he was at Washington University in St. Louis while many of his relatives and colleagues were in Concepción, very close to the epicenter of the earthquake off the Maule Coast.
“I couldn’t reach my family for several days,” he said. “I had no idea of their situation or their needs. When you hear about an enormous earthquake affecting your home and you are unable to get in touch with your family and loved ones, the feeling is of loneliness and helplessness, followed by frustration.”
Mehmet Artaç, MD, of Selçuk University, Konya, Turkey, was not in an area directly affected by the earthquake in Elâzig, but seeing areas of his home country in upheaval brought back memories from more than a decade before. In 1999, an earthquake hit Izmit, Turkey, where many of Dr. Artaç’s colleagues were located. More than 18,000 people were killed. “Professionals also need help in these kinds of disasters,” he said. “If you are watching the disaster on television, you can’t understand the extent of the devastation. When you come face-to-face with the earthquake, you understand the need to help people.”
Volunteers, who know their homes are safe, are still emotionally susceptible to the destruction a disaster leaves behind. “As a physician, as a professional, my priority was to help. When I got home, that’s when it was difficult for me, emotionally,” Dr. Mallarino said. “I had never seen so much suffering in my life.”
Some of the volunteers in Dr. Auguste’s group sought counseling as they grappled with the overwhelming experience. “There’s nothing that can prepare you for the sight. As physicians, we’ve seen death, but never of that magnitude. We functioned and we took care of the patients that came our way, but when we left Haiti the stress and the pain manifested,” he said.
There were, however, moments of brightness and small triumphs. “You have to see the courage of the victims. I seldom saw anyone crying, even though they had lost their homes, their wives or husbands, their children, their friends. For them to be so calm shows great strength of character,” Dr. Auguste said. He observed moments of generosity and hope—people sharing their food, helping amputees to eat, babies being delivered. In the face of tragedy, people came together and life continued.
Dr. Mallarino did not expect to practice her specialty when she went to Haiti, but she could not turn her back on the patients with cancer who were suffering. “I expected to go as a physician, but ended up doing some oncology, too,” she said.
On her second volunteer trip, she cared for a woman with breast cancer and brain metastases. “The family had to drop her off at the emergency room in Port-au-Prince because they couldn’t care for her. Nobody wanted to deal with her—some people will avoid all patients with cancer, and oncologists are the ones who can make a difference,” she said.
Dr. Mallarino has invested herself in the continuing recovery effort. On her third volunteer trip, she saw five patients with cancer or possible cancer, including lymphoma, breast, gastric, and head and neck cancer. It was clear that there was a need in Haiti for oncology diagnoses and care. She set up a clinic for oncology and internal medicine with the help of her U.S. practice staff and Haitian physicians, including one generous doctor who volunteered his home as an initial site for the clinic.
“There is nothing set up for oncology in Haiti right now—patients are on their own, and there are many undiagnosed patients,” she said. “We are trying to at least meet the basic needs of people with cancer there.”
Is there any way to prepare?
Just as no country is immune from cancer, no country is immune from disaster, and often it strikes when least expected. Oncologists in affected regions may not be able to provide immediate care to patients with cancer, particularly if operating rooms are commandeered for trauma surgery, or if pharmaceutical supply deliveries are interrupted by shipments of emergency supplies and support personnel.
While many disaster preparedness strategies rely on government decisions (such as constructing structurally sound hospitals and having clear evacuation procedures), oncologists can take steps to prepare themselves and their patients before a large-scale emergency occurs.
Dr. Sánchez recommends having a good communication strategy. Knowing how to reach patients and relatives through multiple channels—by phone, e-mail, or even social networking sites—is a simple and effective way to prepare. “In Chile, communication networks such as Twitter and Facebook were very useful,” he noted. It can also be beneficial to have relationships with multiple pharmaceutical suppliers, in case one source becomes unavailable.
“Local health care professionals remain the backbone of the recovery process. We do not need to wait for a disaster to strike to make a volunteer program for doctors and nurses” who are trained and able to mobilize during an emergency, Dr. Artaç said. “We can make an emergency program for triaging patients with cancer and sending them to other oncology centers near the disaster area.”
By Virginia Anderson, Senior Writer/Editor, ASCO Connection