Exploring the Supports Available for Health and Social Service Providers from Canada Responding to the Disaster in Haiti

The world has experienced multiple disasters in recent years that have highlighted the importance of effective disaster preparedness and response initiatives. One prominent example is the January 12, 2010, 7.0 magnitude earthquake that shook Port-au-Prince, Haiti. The massive disaster made it difficult for local Haitian community officials to respond immediately, leaving the country reliant on foreign aid and international and non-governmental relief organizations. Within days, hundreds of organizations and volunteers mobilized to send physicians and medical specialists, nurses, physiotherapists, psychologists and social workers to the affected area. However, the political and financial instability of Haiti, in conjunction with limited resources and severe destruction from the earthquake, made it difficult to coordinate response efforts between hundreds of responding organizations. The literature indicates that when health professionals are disorganized and unprepared, they are at risk physically, emotionally and mentally which could hinder their effectiveness as first responders. While these risks have been made known, there is little literature that explores the effectiveness of the supports, as perceived by Canadian health and social service providers in Haiti. In order to address this gap, this qualitative study explores various supports that were available to health and social service providers in Haiti by focusing on their lived experiences pre-deployment, on-site and postdeployment. These findings provide evidence to inform policy development regarding future disaster relief and the supports available to health and social service workers assisting with international disaster response. SUPPORT FOR HEALTH and SOCIAL SERVICE PROVIDERS IN HAITI 6 CHAPTER 1: Introduction 1.1 Background The world has experienced devastating disasters such as the terrorist attacks of “9/11” (September 11 th , 2001), the Haitian earthquake (January 13, 2010) Hurricane Katrina (August 29, 2005), the floods in Pakistan (late July 2010), and the 9.0 earthquake, tsunami, and nuclear disaster from 2011 which is still unfolding in Japan. The states of emergency and chaos faced by these countries have brought attention to the need for comprehensive disaster preparedness, response, and recovery initiatives for natural disasters causing chemical, biological, radiological, nuclear, and explosive (CBRNE) impacts. Disaster response and recovery are often coordinated by national and international organizations. An example of this type of response was seen in the recent 2010 earthquake in Port-au-Prince, Haiti that left 240,000 dead, 200,000 injured, 1.5 million homeless, and 600,000 displaced (de Ville de Goyet et al.; 2011, McKersie, 2010). When the 7.0 magnitude earthquake struck, the already politically and financially unstable country of Haiti faced yet another challenge, that of recovering from this disaster. Since the majority of Haiti’s social services were already engaged in disaster response, providing essential services, such as food, shelter and housing to their citizens, the earthquake left few resources available for psychosocial and health services (Bigelow, 2010). The 5.9 magnitude aftershocks destroyed the already weakened infrastructure in the country, and instilled great fear in both the responders and the Haitian people. Before the earthquake, there were less than 2000 physicians in all of Haiti, many of whom had not been paid in over a year, due to the financial constraints of the government (DeGennaro Jr, 2011). The earthquake destroyed hospitals, clinics, and other infrastructure, leaving many health and social service workers buried in the rubble (Fraleigh, 2010; Julien and Heilicser, 2011). An estimated SUPPORT FOR HEALTH and SOCIAL SERVICE PROVIDERS IN HAITI 7 1,300 educational facilities and over 50 hospitals or health centers collapsed or were left unusable (de Ville de Goyet et al., 2010). However, the earthquake was not the only challenge that Haiti faced. Nine months after the earthquake, there was a cholera epidemic in the country that claimed the lives of 4,600 people (PAHO, 2011). While large NGOs and other organizations rushed to assemble sanitary healthcare facilities and provide access to clean drinking water in the country, delegates were left with the challenge of aiding cholera victims, a disease that is not common to Canada (World Health Organization, 2010). These conditions added stress to a situation that was already considered a ‘worst case scenario’. According to Archer, Moschovis, Le and Farmer (2011), “January 12, 2010 was the worst-case scenario – a large scale disaster amplified by poverty, densely populated communities and the lack of basic infrastructure. Nine months later, the cholera epidemic further highlighted the importance of healthy communities with sanitation, pest control, clean water and access to essential vaccines, medicines and healthy foods” (p.891). Large-scale natural disasters often make it difficult for local community officials and first responders to respond immediately (McCunn et al, 2010). In order to cope with the medical demands of its people, Haiti relied heavily on international relief (Bigelow, 2010). As hundreds of relief organizations flooded into the Republic of Haiti, the Pan-American Health Organization took charge and led the health cluster aspect of the response. According to PAHO, these teams included the following: Medical components of urban search and rescue (USAR) teams, bilateral government medical teams, UN or UN related agencies, the Red Cross system, International NGOs, Bilateral non-state institutions, teams from social or religious associations, and ad hoc SUPPORT FOR HEALTH and SOCIAL SERVICE PROVIDERS IN HAITI 8 initiatives that were set up in response to the Haitian earthquake (de Ville de Goyet, Sarmiento, Grünewald, 2010). Because of Haiti’s geographic location in relation to North America, and its accessibility by both land and water, many Canadian, US, and other international delegates were quick to respond (de Ville de Goyet, Sarmiento, Grünewald, 2010). According to Hopmeieret al. (2010), there were three groups of responders in Haiti. The first of these included the national search and rescue teams that arrived from countries such as the United States, France, and Israel. The second group consisted of NGOs including Médecins Sans Frontièrs (Doctors Without Borders) and the Red Cross and Red Crescent societies. The final group was made up of volunteers that assembled for what Hopmeier et al call an “ad-hoc” response. Responding health professionals included physicians and medical specialists, nurses, rehabilitation therapists (such as physiotherapists), and social workers. Because of the complexity of this disaster, new responders were faced with a steep learning curve upon arrival (Hillel, 2010). Furthermore, because new volunteers were arriving on site every two weeks, there was an increased demand placed on the experienced workers on-site, who were expected to train these new recruits, in addition to fulfilling their original roles (Hillel, 2010). This factor, combined with a high volunteer turnover, left little consistency in the medical response (Hillel, 2010). NGOs were faced with the challenge of ensuring that their efforts were consistent with the goals of Haitian health and social workers (DeGennaro Jr, 2011). While the literature indicates that most responding organizations agree that cooperation and coordination are key to an effective response, conflicting ideas regarding who should lead this cooperative effort still exist (Ansell et al, 2010). Some recommendations suggest that when it comes to crisis SUPPORT FOR HEALTH and SOCIAL SERVICE PROVIDERS IN HAITI 9 management, self organization is often the better choice over official coordinated responses (Ansell et al., 2010). As seen in the many narratives regarding experiences in Haiti, however, this does not necessarily hold true (Lorich et al, 2010; Rosborough, 2010). According to McCunn et al. (2010), it typically takes international organizations two to three days to organize their response teams before deploying individuals to the affected area. However, this estimated time applies only to military and other large response organizations that have pre-established preparedness plans and trained personnel. Many responders, particularly in the health and social services sector, are not affiliated with such organizations. As a result, these individuals arrive on-site without having received the same standard of preparedness or training as military and other personnel (McCunn et al., 2010). If not properly coordinated, the arrival of additional volunteers could potentially result in a haphazard response. Since 9/11, developing an organized response between relief agencies during a disaster response effort has been a primary goal for many governments and NGOs (Jagim, 2008; Rodes et al., 2008). In Haiti, the Pan American Health Organizations (PAHO) of the World Health Organization (WHO) held the position of “Health Cluster lead” (PAHO, 2011). The purpose of this organization was to ensure that all of the parties involved in the response were working towards the same goals as Haiti’s Ministry of Health and Population. According to PAHO, this cluster organization was the only coordinating body between Haiti’s Ministry of Health and the international relief organizations. To date, there have been over 400 health organizations involved in the Haitian relief effort. To organize these efforts, the WHO created seven subclusters in the Haitian health response. These included the following: 1) mobile clinics; 2) SUPPORT FOR HEALTH and SOCIAL SERVICE PROVIDERS IN HAITI 10 hospitals; 3) disability and rehabilitation centres; 4) health information; 5) disease surveillance; 6) reproductive health; and 7) mental health and psychological supports (PAHO). While this organizational strategy was av