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Chelsea & Westminster Postgraduate Medical Education Presents...

  • Hot Topics in Global Health by Dr Ram Vadi, UK-Med Health Director - [Virtual speaker]
  • Delivering surge support rapidly and effectively: Turkey Earthquake Response

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Doctor VDI is the UK med health director with extensive experience in outbreak response, ongoing and protracted conflicts and health system strengthening, strengthening around the globe. Before joining UK Med as health director, he was the team lead and medical coordinator for the UK emergency medical team. Beirut for blast response. He also worked for several years with the International Committee of the Red Cross in Syria, Somalia and South Sudan, as well as in Guinea throughout the West African Ebola outbreak in 2014 to 2015. Doctor Bad will hand it over to you. Great, great. Thank you very much. Thank you very much. Um Thanks for having me today, technologies for the technologies, for the technical difficulties. OK. Um Hopefully, um hopefully you hear me well, he and he, I think it was a slight echo. It was a slight echo. All right. All right. Um uh I know we're probably running. I know we're probably running a bit behind. Um So that's a really bad, it's a really bad echo coming through. Ok. I'll continue. You'll continue. Mhm. Um So I'm gonna, I'm gonna speak on the response that we had last year, which was the Turkey earthquake response. Um where UK Med, which I am the health director of which is a Manchester based NGO response team uh and set up a full field hospital. Uh Before I go through that, I'm gonna discuss a little bit about what our EMT S are emergency medical teams, which is something that we do quite a bit of how those responses kind of differ a little bit from kind of traditional forms of humanitarian response, which I'm much more into longer term programming. Um And also a little bit of some of the lessons learned that came out of that response, which have subsequently been informing our response now in Gaza, where we also have a large scale operation as well. So just very briefly on who we are as an organization. So you came out, as I said, as an NGO based in Manchester, we've existed since 1988. Uh but we have grown quite exponentially since 2020 which was really the beginnings of the COVID pandemic uh where we responded to 25 countries internationally. Uh We then in 2022 set up a large scale country program in Ukraine where we responded to the conflict and we're still active. And as I said, we have a program ongoing in Gaza, which has been since January as well. Uh These numbers are actually slightly outdated. I think it's much more than 400 now, but we maintain a humanitarian health register of about 1200 people coming about half from the NHS and half from international. So we probably deployed internationally the last uh four years upwards of 500 staff into humanitarian crisis around the world. I'm, I'll show a map later that'll show some of the countries that we responded to. We also do quite a bit in terms of training of staff, national staff and also internally on staff. And we've probably trained upwards of 10,000 national staff in various responses that we have deployed people into. And I think another thing that makes us a bit unique is that UK med, while we're an independent NGO, we are also contracted by the British government to deliver their emergency medical team. So the British government outsources their a international health humanitarian response. And UK med is the contracted partner and I will show in a bit that will explain a little bit of that. So in very brief, um because this is often a new terminology for many people, what are emergency medical teams. So emergency medical teams were kind of a newer construct that came out of wh O after the earthquake in Haiti in 2010 where it was shown that a lot of teams and organizations had come into that response and potentially a lot of learning showed potentially caused in some cases, more harm than good. So wh O convened a huge conference uh about a year or two after that response. And looked to establish a set of standards. So the book in the middle, which is called the classification of minimum standards of foreign medical teams and sudden onset disasters. A bit of a mouthful um was the initial set of standards. And UK ED was involved in setting those standards along with other partners in the World Health Organization in trying to define how teams could come into countries doing responses. And one of the key elements apart from there being a whole set of standards of clinical care, operational care. Um how logistics should work is that teams should only be invited in. So if there is an international response or huge scale disaster, what's that going on? Um that the minister of that country or the government request that assistance. So in short emergency medical teams as defined by wh o sorry, I'm getting a a very large echo on my end. So I don't know if the the it team can fix up um as stated there. So teams are groups with doctors, nurses, allied health professional and other specialized individuals such as just logisticians and wash technicians that provide vital primary and secondary care and patients affected by health crisis caused by conflict, disasters and outbreaks. But there's a whole set of standards. If people are interested, I can share this documentation but essentially UK med is follows these set of standards whenever we respond into crisis and we are invited in by host governments to provide that response, I mentioned briefly earlier that we can respond to facets, we can respond on the right as ourselves. But we can also respond as the British government team, which is on the left, which is the UK Emergency medical team, the underlying principles and how we operate are the same. Uh The main kind of difference is who, which t-shirt we wear and where the funding level comes uh comes from. But UK Med provides the teams for the British government. This in brief is just a map where the primarily for the last few years, we have responded both as an NGO and also as the British government team and a lot of the work that we've done in supporting training and capacity building. So the pink dots are UK Med where we've responded globally and quite a variety of countries, a big portion being in Sub Saharan Africa, but also across the Middle East Asia uh and also into the Pacific where we responded to the Solomon Islands and Papua, New Guinea and a few other contexts as well. Um The training capacity building has been primarily for other organizations and a lot of the responses have been directly to MS of health that have been affected by crisis. Um Big portion being an outbreak heavily skewed because of COVID, but a lot has also been on conflicts and also to natural disasters as well. So I mentioned about this kind of based system and this will link into how the Turkey request uh Turkey response kind for it. So the new, the kind of system that is designed for uh teams that want to respond to this large scale crisis is that am of health or a national government or any ministry will issue a request that goes to the wh O and said country wh O then transmits that request to uh essentially to Geneva and that is transmitted to all partners that are what they call verified by wh O. So they will transmit that request. So UK med would receive that or the British government and then we make a decision to decide if we can respond and I'll show them the next like how we come to that decision making process. On the right, you have a few case examples of places we have responded to in the last year. So we responded to the Libya floods last year. And people remember uh sorry, remember there was a huge scale of flooding uh and two dams burst and caused uh quite a bit of uh damage to infrastructure, quite a few deaths. So we responded to that with mobile clinics. There was also a large scale burns incident in Armenia during the fleeing from Nagorno, Karabakh, which was in um end of September. And that request went out in October. We responded with a specialized burns care team and on the bottom is the global call that came at the beginning of the Ukraine conflict when there was a request for teams to scale up capacity to respond to the conflict in Ukraine as well. Um The wh O and system has designed kind of set pieces so it's very much based around kind of set piece infrastructure. So we are required to hold all of the infrastructure supplies, et cetera to be able to deploy out as they call it self sufficiently. But the reality is it very often when we send people out, it's to embed in national structures. So in COVID, the big gap was not necessarily in terms of infrastructure, the gap was in terms of skill set. Um and the knowledge and understanding of what COVID was in Armenia, there was existing hospitals, they just simply did not have staff that could deal with the large scale amounts of burns and also to support on rehabilitation and many other countries. It's uh their infrastructure exists. Turkey has one of been one of the rare examples where so much damage was done to national infrastructure that the host government actually requested that teams come up with full scale hospitals. And Gaza has been also that case as well just very briefly, how do we de decide when there's a request for to intervene? Um There's kind of five principal mechanisms that we look at, but the overarching principle is we only respond when we're needed and we that response mechanism has to be driven by the national country itself. So even if we may want to go in, and it's quite clear that there's a humanitarian need. If the host country doesn't request our assistance, we cannot enter that country. So there's five kind of key pillars that we look at the first one, obviously being humanitarian need. And within that we look at is the national structure able to cope with that system or is it so overwhelmed that international systems make sense? Is it a strategic fit? There's lots of context where myself or maybe members of my team would be interested to go. But as an organization, does it fit with what we can deliver and do we have the capacity to be able to do that? So do we have the capacity to deliver in terms of experience, knowledge, staff, equipment, et cetera to make a vital contribution of provide some additional level of support to the country? Or are we duplicating efforts that perhaps others may be the best place to cover access and security, especially in conflict settings? Is a big element we look at but also disaster zones. So can we get our people and teams to those locations to provide um care to the populations but be able to do it by keeping everyone safe and secure? And the last one, which is the one that obviously no one wants to talk about but is a reality is funding um because we need to pay people that go out. We need to pay for the infrastructure that goes out and the drugs and supplies and obviously there's cost in the country. So we need to look at funding levels and can that sustain us to be able to do the response just in very last two years. And this was a lot of these were running at the same time as the Turkey earthquake. We have had a ongoing program in Ukraine uh respond to the conflict. So we've been running mobile clinics. We've been also within those mobile clinics doing primary health care and also providing mental health and psychosocial support to populations that have either been displaced or affected by the conflict. And that's either been in newly accessible areas or on front lines close to the um where the fighting is taking place in the far east. We've also had surgical teams, uh nursing teams and microbiology teams embedded into host structures so into national Ministry of Health hospitals in Ukraine, providing care and support and also training. And we've also done a lot of training for prehospital care mass casualty incident and also supporting on CBRN so chemical biological, radiological and nuclear training as well. Last year, we had a team uh deployed at the request of WH O and funded by WH O into Somalia. So we had a surgical team in Mogadishu which was after a twin bombing attack and we provided direct patient care services of actual surgical operations and working in patient wards, also supporting infection prevention control at the emergency departments. We did a lot in terms of trauma training and also on surgical case management. So, right, trying to raise standards of care within the facility, I'll speak about the Turkey deployment. Uh After this, we also responded at the same time last year in Malawi. Um this was as the UK EMT. So the British government team, um it was kind of a Multiphase response. So we started out by sending a team to work in a cholera treatment center. So there was a huge cholera outbreak in Malawi. So we had a team of clinicians embedded into a national uh a nationally set up uh Cholera treatment center. What happened during that response that there was a cyclone, so cyclone Freddy which made landfall. Um I think it's still on record. It's the longest lasting cyclone on record. So it was sat in the ocean for about six months, making landfall and going back out um and made landfall in the south. So we deployed a new team and some members of the team working in the car treatment center to deploy to the South. We then subsequently deployed a surgical team and also set up a uh mobile clinic team. So we were running 3 to 4 clinics for the displaced population there as well as alongside continuing to function in the Cholera Treatment Center. We also responded to the earthquake in Morocco last year. Uh There's some photos there on the right um and provide an assessment team after the assessment, the Moroccan government chose not to have a full response. So they were fine with having an assessment team, but much of the response was covered by national actors. So they did not accept our offer for further assistance, which is the case in uh in a few of the responses that we have had, we also deployed the Libya floods as I said earlier and into Armenia where we had a surgical and burn specialized care team after the fuel incident, uh fuel explosion incident rather. So Turkey earthquake um this happened on February 6 last year. Um Just to give it an idea of the impact of that, I'm sure most people have seen on the news last year, the earthquake affected a geographical area both in Turkey and in Northwest Syria about the size of Germany. Um And the impact of that earthquake, I mean, you see varying numbers was somewhere upwards of 30 Hiroshimas. So you can imagine people in the middle of the night and getting hit with something of that large of a scale on the right. You can see just some of the the damage of infrastructure but having visited that area, large, large parts of the areas were completely damaged. So unlike many other countries that we've seen that have been impacted by earthquakes that have had or are very much prone to earthquakes. Like Japan, Korea and some countries in South America that have much more earthquake proof buildings. Turkey which sits on a large fault line. Unfortunately, in many areas and unfortunately much more of the poor areas does not have that ability. So many buildings collapsed immediately uh in the middle of the night. So we deployed a team out um quite soon after that um after that earthquake. So the earthquake struck on February 6th morning, as I said, but within 24 hours and actually less than 24 hours, I think it was within 12 to 14 hours, we had the first members of our team in country in Turkey. So it was a bit of a mixture. We had some team members that went out on commercial flights which were still functioning to various airports, not to the directly to the impact area, but close enough that they could get there by flight and then transfer to cars. And we also deployed some team members by Royal Air Force. So you can see in the photo so that some of our team there that took off from an airbase with supplies uh on a military flight. Um We made an immediate offer of assistance to the UK uh from the UK government to the Turkish government which took a period of negotiation. Obviously, in this large scale impact of a crisis, it took a bit of time for the Turkish government to come back with an answer. Which is understandable, but we were immediately preparing on the back end. So some of the supplies you see on the top, right, we hold a lot of that, but we immediately began to prepare because it was quite clear that a request would be coming through. And we understood that through context that we had in British government and also in the World Health Organization. So we did end up sending out an entire field hospital from our side. And we actually ended up having a kind of a partnership deployment, which is the first time we've ever really done that. So Ministry of Defense of UK uh also deployed on a team, a large scale surgical hospital. We deployed out a primary healthcare focused facility, but it included an emergency department. And if you can see on the foot on the bottom left, there's Turkish flags that is from the Turkish National Emergency Medical Team, which also deployed with us. And so we work jointly together sharing patients doing internal referrals between ourselves and being able to offer a full spectrum of patient care from primary and outpatient care to trauma and surgical care. As well as some inpatient. We saw our first patients on February 13th. Um and the UK me, we were slightly set up a bit before the UK military operation which started on February 15th. We then subsequently expanded those activities because as I said, the geographical area is quite wide so you can see on the front of the tents, there's quite a bit of mountains there and there's a lot of villages in those mountains and many of those people had either diminished access after the earthquake or even prior to the earthquake because they're quite remote. So we set up mobile clinics to be able to respond to those areas and actually provide some care to those populations that were equally affected by the scale of the earthquake. Um As I said, in terms of the immediate health needs, we had an assessment team on country. Um and we were already doing negotiations in terms with the government and also the Ministry of Health in terms of what we would deploy out. Um and they were in country fairly rapidly and be able to make those on in country decisions within one thing. We and we have to give full credit is the Turkish system. Whilst much of the infrastructure was not prepared in terms of medical and response capacity was definitely well prepared. The numbers that I've been quoted from the World Health Organization is something like 40. So 40 to 50,000 people were immediately evacuated uh from affected areas and national hospitals and from areas as far as Istanbul, which was about a 1 to 2 day drive. So massive amounts of trauma that was picked up and nationally referred from Turkish ambulance services and primary health care responders into uh national systems. So a lot of the immediate trauma. And by the time we were set up was dealt with, what was uh very much lacking was the services that were rendered um uh no longer functional or because health actors had either unfortunately perished or had moved away with their families to cities that were not affected. So a lot of the gaps that we saw in those initial assessment periods was in primary health care, obstetrics and gynecology, pediatrics, rehabilitation for those patients affected by trauma. And obviously, mental health impacts on those people uh affected by the areas and still very critical services. So we started to establish a lot of those services cause there was a big gap that we saw until the national services could uh eventually come back online. The area there. Uh sorry, the area that we set up in was a town called Turku. This was identified by the Turkish government. Um You can see some photos there of the impact but also the town on the left. So quite a picturesque town right underneath the mountains, 80,000 people, a fairly functional city before the the crisis but highly impacted. Um the population, the city is not so far from the Syrian border. So the high population of people that came across during the Syrian uh the ongoing Syrian conflict, but a relatively stable town in terms of um security and peace, many of the people in affected by that earthquake actually remained in town. So unfortunately, the economy of that area was not strong enough for many people to move away even though they lost their housing, et cetera. So many people remaining in tents or um temporary shelters when we arrived. Um There was also an 80 bed hospital which was highly impacted. So the building was not quite sound. So we weren't able to embed within that national hospital. So secondary services and also primary health care services were severely uh put offline and many medical staff unfortunately were the ones who did have the means to leave. And as I said earlier were the ones who left and went to uh to bigger cities or areas they might have had family uh that weren't impacted by the earthquake. That's a photo of the hospital there, you can't see it so clearly. But in both sides of the buildings, there was a huge crack down the middle of the building. Um And the until the s the national engineers were able to come in and state that it was structurally sound, we weren't able to go into the building. And one night, actually, the CT machine actually caught on fire independently. Someone had forgotten to take out the plug and there was a huge fire in the building. So quite a bit of risk in the area apart from only the immediate impacts of the earthquake. Um in terms of the structure that we set up, there's a var I'm sorry, a variety of photos So as I said, we needed to, when we deployed into these types of situations, we need to bring everything with us. That's not only the elements to be able to respond to patient needs, it's also the elements of being able to uh maintain our own team. And as you can see on the bottom left, it was tenting. So it's Turkey, Southern Turkey in the middle of February, it gets down to a minus 10, minus 15 in the night. You you had frost on the tents in the night. We had to provide all of our in the initial days, all of our own food and water. So we had to ship that out. So it was meal ration packs. We eventually did find local catering services, but we need to bring everything with us. So everything that is shown in these photos we brought with us including the laptops and boards. Um It is a heavy kind of operation. We had assistance from the Ministry of Defense to ship it out, but it was somewhere between 10 to 15 tons of medical infrastructure that were shipped out plus the people. And over the lifetime of the deployment, we deployed upwards of 100 and 20 international staff staff and also hired a fair amount of national staff. So it's also a large scale footprint in terms of being able to sustain the operations alongside all of the elements of the patient care as well. Um I said earlier, this was kind of an integrated facility as ourselves. Well, in this, in this instance, as the UK emergency medical team. So wearing the British government teams shirts, we were joined along my colleagues from the UK uh Ministry of Defense and also the Turkish Search and Rescue team uh called um which is one of the national entities in Turkey. And you can see there on the tent, we put all three flags up to kind of signify that it was a joint facility and also that we were working in, in clear collaboration with each other. We did a mobile clinics in the surrounding areas. At the peak of our services, we were seeing somewhere upwards of 400 patients per day, so very busy uh and ranging from all elements, trauma care, outpatient pediatrics, uh also surgical care as well. Uh And the last that we saw in our combined efforts between us, about 20,000 patients until we handed back over to the National Services, just some kind of overall for those who I think that are kind of interested in this line of work. Um And I think lessons learned that we've seen from a lot of the last responses we've done over the past few years is that many international responses. The view that we see them at the beginning often changes. Turkey was a very good example, many people that come into these that were coming into rather these types of large scale responses expecting to come and do lots of trauma, critical care, surgical care. And the reality is we did a the biggest bulk of patients we saw was MC H some maternal child health and outpatient care because those were the critical things that were needed because those services just simply didn't exist and much of the trauma was absorbed by the national kind of response mechanisms which were functional. Um So it's key that we remain open and informed on how things will change uh on both in terms of needs and also the responses required um that other actors are very often in the country uh and able to respond. And this was a good example. The trauma services did exist in country and were trained and impaired and there's no need to um to duplicate those efforts that we used to engage with local and international key stakeholders, which was kind of how we did that through this unified response to deliver, really what was needed uh in terms of engaging with the communities, you know, we need to look at and assess what is really required. So many of the communities that we went out to assess actually did request that we not bring trauma care that we bring them, they had high populations of Children. So I asked that we bring a pediatrician to see those areas and we kind of adapted to the feedback we got from the communities and the sharing of, of the findings. So we work within, with other partners, we work with national structures. So we share those findings with other actors to ensure that they don't make the same mistakes. That's fine. Thanks. Um lastly is being accountable uh both at UK med. But I think in the wider humanitarian sphere is that accountability is key. So we need to look at those affected by a crisis or disaster as beneficiaries of our services, not simply as victims involving the communities. Like I said, liaising and working with stakeholders to understand gaps in knowledge and communities, we may not be seeing. So the so called hidden populations, we need to be kind of mindful and respectful to ask for feedback or guidance whenever we respond and working with people who very often know better than we do because they work and live within that context uh involving local stakeholders. They do understand those places and they're the key people and they're the people who will remain behind when we leave these, these areas. So it's key to involve them and where we can train and upskill them, try to integrate that in our services. And lastly is avoiding, about avoiding unreal estate expectations. When we respond out, we need to be truthful with communities and stakeholders. But what it is we, our assessment or response may lead to and where we can't provide that response. But also trying to ensure that we work with partners to find those response mechanisms, be it through un agencies or other international agencies. So care and support can be delivered to populations affected by crises around the world. And I think that is the end of my presentation. So I will leave it there. I'm very happy to take any questions or clarify on anything. Thank you, short term. Thank you so much, doctor. Can you hear me? Mhm. Brilliant. OK. We've got some questions online for you. Um Our first and what do you recommend? Ok, so the question was about what types of response are we doing presently in conflicts? Um So we are presently responding to two conflicts. We have a large scale program in Ukraine, as I mentioned earlier and we have a large scale program as well in Gaza. So we've been operational in Gaza since January of this year. Um There was a request, an international request for assistance as well. So we did not deploy outside of any mechanism. The request came via the Ministry of Health of Gaza and the World Health Organization uh representatives in country. And so we have quite a large scale program. Actually, we've been, we started our program with doing mobile clinics uh so similar to a little bit in Turkey in terms of to displaced, so internally displaced populations and also areas affected by the crises which have been primarily run by national staff. We also had embedded surgical teams. So we had teams working in national hospitals that had been mobile in some sense. So when hospitals were either not allowed to be operational anymore, or there was too much security risk. We would move those surgical teams to another facility and that was surgical in the sense that there were surgeons, anesthetists, nursing staff, and also rehabilitation. And we also did some intensive care work as well. Um We have now started to expand those services. So we have set up a full surgical field hospital as well, which is in the south of the country, uh which is a mixture of international staff and a few 100 national staff as well. So we've been working with the Ministry of Health to be able to offer one employment but also a way for clinical staff across the country. I moved to the south to be able to work and support the populations as well. So that includes surgical care inpatient facility for up to 100 patients, emergency care, uh primary health care service as well. Uh pediatrics, maternal child health will soon be having um Cesarean section capability as well and that's also a fully independent facility. So that facility is fully run by UK med, but it includes all of the uh clean water provision includes the ability to sterilize equipment. We have all the food for the patients, uh fuel et cetera to be able to run it. So it's fully run by us independently. Uh Obviously, with support from the Ministry of Health in terms of the staff, but the functional functionality and the running and the technical oversight of the facility done by us. Uh We will soon also start working in the one of the hospitals that was affected by the crisis and we'll be working in the emergency department both with the rehabilitating the facility itself, but also ensuring the functionality. So we would be deploying international national staff to work within that facility as well to have services upwards up and running. We've been doing a lot of work in terms of rehabilitation as well. So early integration of rehabilitation to improve patient outcomes. And we've also been doing a lot in terms of community engagement. So we've reached about 20,000 people through community engagement and health promotion services as well. So quite a large scale program, um Just one question I think is the stream was how the train and what level of competency would you require as eligibility for you? I caught the last part if you wouldn't mind to just repeat it, please, how the trainees get involved with your payment and monitor your um eligibility criteria for competencies? Sure. Um Let me work backwards, competencies for us is I guess it's a trickier one. I mean, we do, we have a register, as I said, of about 1200 people that's growing. I've been in this role for 33 years, just over three years when I came in, we had about 500 people. So we've added about 700 people and it's not just simply for the sake of adding people, it's actually that we've needed to use those people. So of those 700 probably about 400 or so have deployed out. And that ranges across all clinical specialties, surgical specialties, nursing specialties and also includes operational staff, finance, et cetera. In terms of competencies. We do look for a certain level of humanitarian. I don't wanna say um only experience, we do look for the kind of awareness. So when we do technical interviews, we also provide a lot of training in house. And we also put people through who have less, less amounts of skill through simulation exercise to test people's competent to work within these environments because they can be quite challenging. I mean, the work itself is one element of being extremely challenging. The trickier part is working it within the context, being away from home, working within new multi and also the challenge that comes with field life. I mean, this photo is a, I think a good example, this is taken in the morning and I think it's still minus two. but the team has been there for about two weeks, you know, without showers, without proper food, meal packs, et cetera. So it's they're extremely challenging environments to work in aside from what you see on a day to day basis, in terms of patient care, we don't normally recruit trainees. We do look also for a certain number of years of experience, post graduate. Part of the reason for that is that very often when we are deploying people into the countries, it's not only to provide direct patient care. A lot of it is on training and capacity building. So we want people to be both confident and capable in the skill sets that they have post graduate to be able to provide that to national actors. Um in terms of how you can get in the sector, which is often a kind of a question. I think one is a simple answer is, is be informed, try to attend as many events as you can try to learn as much as you can because humanitarian uh work is very difficult um but very different as well as many events as you can, as much networking as you can and try to gain the skills, both hard and soft skills to be able to work in these environments. And as I said, it's not only about trauma, I mean, a lot of it is understanding the complexities of these environments and often what are the needs. So how to engage with people, et cetera. Some of the skills that we often look for apart from only the kind of technical skills of being able to work in these environments. Thank you so much and thank you so much, joining us. Thank you very much. Thanks for having me, we have a 15 minute right now. So if you.