Jason Friesen, EMT-P, is a student in the Executive MPH class at Mailman (’12), and lives in Port-au-Prince where he is the Country Representative for Project HOPE, an international health aid organization. He can be contacted at firstname.lastname@example.org
The Pandemic of Preventable Death and Disability
On Monday, January 16, at 9:30 p.m. a large truck coming down Route de Delmas in Port-au-Prince, Haiti, lost its brakes and careened off several vehicles before running over a crowd of pedestrians, including street vendors, motorcycle drivers, and passers-by. As quickly as the driver had realized that his brakes were failed, 45 people were killed – 29 instantly – and 41 more were injured.
Route de Delmas is one of the major roadways in Port-au-Prince, providing a direct connection between the infamous shantytown of Cité Soleil at the bottom of the road, to the upper class echelon of Petion-ville at the top of the road. Such a tragedy as the one on Jan. 16th could thus serve as a vivid reminder of the indiscriminate nature of injury. Unfortunately, this fact would not have been not lost on any Haitians that evening, just days after the country had marked the two-year anniversary of the 2010 earthquake that claimed hundreds of thousands of lives and injured scores more.
However, as the Delmas tragedy highlights, two years after the earthquake and the senseless loss of life in Haiti remains constant, with similar small-scale tragedies happening every day on throughout the nation. While reliable data on road traffic injuries in Haiti is difficult to obtain, Doctors Without Borders (MSF), in a press release the next day, reported that, “each week, [we] receive an average of more than 300 road accidents in [our] three hospitals…” To a medical professional working in a wealthy country these numbers are simply staggering – few ERs in the US would see as many road injuries in months, if not years, compared to those seen by these three modest facilities. Yet several factors ensure that these injuries, and many of the otherwise preventable deaths that accompany them, will continue unabated across the country.
However, Haiti’s story is not anecdotal. Instead, their struggle with preventable death and disability is comparable to most other developing countries.
Emergency Care in Developing Countries: Where Efficiency and Quality Meet
For a host of time-dependent emergency conditions – like road traffic injuries, childbirth and, in the case of Haiti, cholera – small improvements in basic emergency care training, and in access to transportation, can have a profound impact on the burden of premature death and disability that developing countries are overwhelmed by. Project HOPE is presently working in Haiti to fill these gaps through our integrated Emergency Care Development program:
- Equipping facilities with basic, essential emergency equipment and supplies
- Training doctors, nurses, and layperson first responders in basic emergency medical and trauma care
- Coordinating alternative emergency transport systems, including motorcycle-ambulances and re-fashioned Tap-Taps (local transport)
- Implementing a low-cost SMS-based emergency dispatch system to leverage widespread availability of mobile phones
Fortunately, efforts to train clinical professionals and layperson first responders, and to make transportation more readily available, are fairly straightforward to implement. More complicated in low-income countries, however, is the ability to get first responders where they need to be, when they need to be there – something that is often precluded by a lack of dependable emergency telecommunications. At the same time, a traditional 911 dispatch system is wholly unrealistic for most impoverished communities, while alternative solutions are often piecemeal and unreliable. Emergency dispatch is key to the coordination of efficient services, and the very element which is least available in such settings.
TextMedic – Crowd-Sourcing the Good Samaritans
Consequently, the innovative use of available technology is one emerging solution that we’ve been developing. A new joint partnership between Project HOPE, Trek Medics International and Medic Mobile/Frontlines SMS, is the development of “TextMedic”, a new software for low-cost mobile phones, utilizing an open source platform that does not require an internet connection to be operational. By leveraging the ubiquitous use of mobile phones in developing countries, we’re working to crowd-source emergency dispatch by relaying text messages from emergency patients to trained first responders throughout the community. This technology will provide emergency communications capabilities anywhere a mobile phone signal is available.
In September of 2011, I had the privilege of representing Project HOPE at the 6th annual Mediterranean Emergency Medicine Congress (MEMC) in Kos, Greece – “the birthplace of Western medicine” – to share updates from our ongoing Emergency Care Development Program in Haiti. While the development of our SMS software has some work yet to be done, and with financial and technical support still urgently needed, there’s no doubt that this simple software solution will have a global impact – after all, what community is safe from medical emergencies?
As a public health initiative, basic prehospital and emergency care is largely neglected. Yet until a vaccination for road traffic injuries is found, childbirth becomes risk-free, and acute exacerbations of chronic diseases no longer occur, no community will be immune to emergencies.