a1 Departments of Emergency Medicine, State University of New York Downstate Medical Center and Kings County Hospital Center, Brooklyn, New York USA
a2 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center. Pittsburgh, Pennsylvania USA
a3 Department of Critical Care Medicine, US National Institutes of Health, Bethesda, Maryland USA
Introduction Increasing attention is being focused on the needs of vulnerable populations during humanitarian emergency response. Vulnerable populations are those groups with increased susceptibility to poor health outcomes rendering them disproportionately affected by the event. This discussion focuses on women's health needs during the disaster relief effort after the 2010 earthquake in Haiti.
Report The Emergency Department (ED) of the temporary mobile encampment in L'Hôpital de l'Université d'Etat d'Haïti (HUEH) was the site of the team's disaster relief mission. In February 2010, most of the hospital was staffed by foreign physicians and nurses, with a high turnover rate. Although integration with local Haitian staff was encouraged, implementation of this practice was variable. Common presentations in the ED included infectious diseases, traumatic injuries, chronic disease exacerbations, and follow-up care of post-earthquake injuries and infections. Women-specific complaints included vaginal infections, breast pain or masses, and pregnancy-related concerns or complications. Women were also targets of gender-based violence.
Discussion Recent disasters in Haiti, Pakistan, and elsewhere have challenged the international health community to provide gender-balanced health care in suboptimal environments. Much room for improvement remains. Although the assessment team was gender-balanced, improved incorporation of Haitian personnel may have enhanced patient trust, and improved cultural sensitivity and communication. Camp geography should foster both patient privacy and security during sensitive examinations. This could have been improved upon by geographically separating men's and women's treatment areas and using a barrier screen to generate a more private examination environment. Women's health supplies must include an appropriate exam table, emergency obstetrical and midwifery supplies, urine dipsticks, and sanitary and reproductive health supplies. A referral system must be established for patients requiring a higher level of care. Lastly, improved inter-organization communication and promotion of resource pooling may improve treatment access and quality for select gender-based interventions.
Conclusion Simple, inexpensive modifications to disaster relief health care settings can dramatically reduce barriers to care for vulnerable populations.
CM Bloem, AC Miller. Disasters and women's health: reflections from the 2010 earthquake in Haiti. Prehosp Disaster Med. 2013;28(2):1-5 .
(Received March 22 2011)
(Revised July 15 2012)
(Accepted August 31 2012)
(Online publication January 04 2013)