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Drawn to disaster: Doctors giving aid

When a natural disaster strikes, physicians give their time and skills to help victims heal their wounds.

By Damon Adams, amednews staff. July 9/16, 2001.

By day, Lauren Shaiova, MD, and her fellow physicians treated dozens of villagers left battered by the fierce storm.

At night, after the wounds had been mended, the doctors often slept on cement floors or in village homes that had survived intact despite the harsh winds and rains that struck weeks earlier.

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Hurricane Mitch cut a swath of destruction through Nicaragua, and Dr. Shaiova and two other doctors from New York were among the medical personnel who came to aid those in dire need of care.

In times of natural disasters such as 1998's Mitch, doctors put aside their practices, load up medical supplies and journey to areas stateside and around the world to help victims of nature's fury. Earthquakes, floods, hurricanes and tornadoes compel them to travel in hopes of alleviating pain and suffering.

What struck Dr. Shaiova when she volunteered was the ruin left by Mitch. More than 2,800 were killed. Thousands were left homeless, including communities buried in a mudslide at the base of a volcano. Bridges and roads were washed away. Food and supplies were hard to come by.

"The devastation [was] ... amazing because I'd never seen a natural disaster," said Dr. Shaiova, who works for Beth Israel Medical Center's Dept. of Pain Medicine and Palliative Care in New York City. "One day you're fine, and the next day your life is wiped out."

To reach the destitute, Dr. Shaiova waded through waist-high water, what was left from more than 30 inches of rain dumped on Nicaragua. She and other doctors were welcomed by villages wherever they went.

"When we would put a stethoscope around our neck, they would come out from behind trees and everywhere," Dr. Shaiova said.

What she encountered were open wounds with maggots and infections. "We found lots of cholera and endemic disease. We set up clinics in people's homes."

With Beth Israel coworkers and internists Paula Rackoff, MD, and Michelle Torres, MD, Dr. Shaiova treated the afflicted with drugs and supplies brought from her hospital and a hospice.

Amid the death, they found life. "We birthed a baby," Dr. Shaiova said.

Responding to Mitch's aftermath in Honduras was Bob Agnew, MD, a surgeon from Fargo, N.D. Since 1984, he has gone on short-term mission trips to provide humanitarian aid to various countries. Those experiences prepared him for natural disasters.

"You're working with basically the equipment you can carry in and setting up a clinic in a building that is not designed for that use," he said. "You have to be very resourceful when you're doing it." Dr. Agnew mostly treated eye, skin and respiratory infections and depression.

Even simple gestures such as giving out quilts made by North Dakota townspeople to Honduras residents made a large impact. Quilts were handed out in a chilly mountainous section to a grandmother caring for her grandchildren, whose parents died in the storm. A mother used one to comfort her toddler.

"That was very moving to see," said Dr. Agnew, now retired and president of the Christian Medical and Dental Assns. "I believe God works through people's willingness to help other people."

Doctors often take part in medical relief efforts through agencies such as Doctors Without Borders, Samaritan's Purse, the government's National Disaster Medical System and the American Red Cross. Many are volunteers; some are paid.

When Tropical Storm Allison flooded Houston in June, government-sponsored medical teams were sent to Texas, providing care for patients relocated to the Astrodome and a community center.

"They are having to make up for normal demands and whatever additional demand there is from the disaster itself," said Robert Knouss, MD, emergency preparedness director for the Dept. of Health and Human Services and director of the National Disaster Medical System, which sent the teams to Houston.

More than medical care

Medical aid during natural disasters is much more than tending to broken limbs and lacerations. It's putting in place a care system that will help get the local medical community back on solid ground. Typically, that's done through health assessments by specially trained doctors.

Following the deadly August 1999 earthquake in Turkey, Kevin Kelly, MD, led an assessment team for the American Red Cross, arriving in Turkey within 24 hours of the quake.

"It looked like the end of the world. There were still many people alive under the rubble," said Dr. Kelly, an emergency pediatrician in Baltimore who is paid by the Red Cross for his overseas efforts.

Despite the tragic scene, Dr. Kelly knew he couldn't let his emotions take over.

"You realize people don't need your tears or sympathy, they need your help. If you're going to get sentimental about it, you do that when you get home."

In Turkey, he evaluated what would be the minimum acceptable standards for care, such as determining how much land, toilets, water and shelter were needed for homeless quake victims.

"The chance of an epidemic is so much heightened if you have many people in a small space," he said.

Relief and assessment happen simultaneously in disasters, Dr. Kelly said, and the object is to put a long-term health plan in place for when doctors and other relief workers head home.

"When we leave, we're leaving a lot in the country," said Dr. Kelly, who spent three weeks in Turkey and recently developed a long-term medical program after India's earthquake.

Tyler Cymet, DO, an internist in Baltimore, didn't expect to be treating earthquake victims when he went to Guatemala earlier this year. He was a volunteer on a mission trip for the relief organization DOCARE International when a quake rocked nearby El Salvador. The health care practitioners felt the ground shake at their site in Guatemala.

Dr. Cymet and other volunteers headed to a crippled El Salvador, where Dr. Cymet treated broken bones, helped diabetics and soothed psychological wounds of victims.

It wasn't his first natural disaster. Three years ago, he was giving a lecture at a university in Arkadelphia, Ark., when a tornado struck. He could hear the wind rushing and see trees snapping and a dorm roof peeling off.

After the howling wind stopped, he pitched in for 12 hours at a hospital, caring for the walking wounded, then residents who were pulled from the rubble.

In Arkansas and El Salvador, he said he felt a great sense of satisfaction.

In El Salvador, "We had people run up to us and give us food for thanks," said Dr. Cymet, who also is an assistant professor of internal medicine at Johns Hopkins University School of Medicine, Baltimore. "The best part was just feeling as wanted as you were."

Not just anyone, however, can step into a natural disaster and make a difference. Doctors must be trained for such work.

Richard V. Aghababian, MD, who trains doctors to handle disasters, said physicians must know how to work in an orderly fashion while also taking care of their own health and safety. Many are allowed to respond by their universities, and those in private practices often have their patients covered by other doctors. Another way to free up doctors is to stagger times of deployment so they leave in waves.

Disaster doctors should be able to handle triage and treat patients quickly, Dr. Aghababian said.

He knows from experience.

He helped provide medical care after a 1987 earthquake in Armenia and following Hurricane Andrew in South Florida.

"It was pretty much what you see on a regular basis -- you just have to do it out of a makeshift situation," said Dr. Aghababian, professor and chair, Dept. of Emergency Medicine, University of Massachusetts Medical School, Worcester.

He tells doctors to be ready. "You're going to be involved in a disaster someday. You can count on it."

Michael VanRooyen, MD, MPH, studies disasters and serves as a resource to many organizations and agencies as director of the Center for International Emergency, Disaster and Refugee Studies in Johns Hopkins' Dept. of Emergency Medicine in Baltimore.

In a disaster, "The main need is to support the local [medical] system," he said.

Dr. VanRooyen was involved in various efforts after Hurricane Mitch, the earthquake in Turkey and flooding in Mozambique.

During such times of tragedy, he said it's natural for him to want to use his medical skills to heal the hurting.

"You feel like it's a privilege [that] you're changing the world," he said.