Dear all:
I attended both the workshop on emergency preparedness and Miriam Labbok's talk on emergency
preparedness at the ILCA conference. I was standing up in line waiting to comment after Miriam's
talk and even though I was in line before they decided to check the time, I didn't get to put in my
2.0 ml.
I have two sources of experiences of emergency situations, one direct and the other vicarious.
The direct experience is the famine situation in clinics in Niger back in the 1980s and a bit of post
emergency during the time when the UNTAC troups were still in Cambodia. The vicarious
experience is my brother who is a firefighter EMT who calls me when he drinks a bit too much and
complains about how no one understands what he goes through and then spills his guts to me.
From these two sources I have learned that there is a particular type of personality that seems to
thrive on the adrenaline rush of the emergency settings. The emergency junkies or "masters of
disaster" tend to function less well in normal conditions because they do not get the immediate
adrenaline rush of emotion from dealing with dire circumstances. Long term planning, battling
administrative hierarchies, nudging political systems, changing behavior are way too slow and
frustrating for these people who serve a vital and important function.
While the emergency responders are crucial and should be prepared for situations that we do not
anticipate, emergency response is THE MOST EXPENSIVE type of intervention in terms of cost-
benefit. To give you a parallel, it costs much more to treat severe malnutrition in nutritional
rehabilitation clinics than it does to use primary health care to assist mild and moderately
malnourished to improve their nutritional intake and prevent severe malnutrition.
So, I ask you all to think about the most recent disasters both natural and man-made in a
nonfatalistic fashion and ask what could have been done prior to the event itself to reduce the
impact or even prevent the disaster from occurring. Preparedness should not just stop at what
one should do during an event, but also what may prevent the event from occuring in the first
place or minimizing the impact of the event should it occur. This could be getting involved in
environmental issues, understanding them better, and lobbying for changes that might mediate
climate change, or getting involved local planning boards to ensure that appropriate procedures
are in place for evacuation procedures. The emergencies one can envision are numerous and I"m
sure we all have our areas of concern.
Also, when there are disasters and I think this came out fairly clearly in the workshop, tons of
people want to help, but often get in the way. I still remember how we felt in Manhattan after the
Towers fell. All this energy to do something and not much we could do besides feed and cheer
our emergency responders on. Think of how devastating it was for so many to be prepared to
treat those that would be rescued from the Towers only to discover that there was almost no one
to treat because most did not survive? And I cannot tell you how many Nongovermental
organizations were falling all over each other in Cambodia when the UNTAC troups were leaving.
There were over 100 nongovernmental organizations and they had to set up a whole coordinating
body to keep everyone from stepping on each others toes.
So, while we all like to think of ourselves as the one jumping in and doing in the moment of
disaster, we may actually be able to do more and do more effectively by doing what we do before
the disaster strikes.
What I see we have to offer is to plan from the political level down to our first responders to make
sure that at every level people are aware of and are trained in setting up safe havens for pregnant
and lactating women, know not to separate mothers from babies, know about cup feeding even
for formula fed infants when clean sources of water are unavailable for washing bottles, and know
the basics of encouraging breastfeeding moms or those that have just delivered to put the baby to
the breast if they are willing. We can each look up who are the first responders in our areas,
figure out where the Red Cross office is and do our part to lobby that all those first responders are
given the information and training they need. Then, once they are educated, make sure they know
how to reach lactation consultants in the event that an emergency does occur and we are needed.
We do not all have to plunge in ourselves, nor will we always be needed or welcomed, but we can
ensure that those first responders can implement a few simple things to protect and encourage
breastfeeding and know how to find us if and when we are needed.
Best regards, Susan E. Burger, MHS, PhD, IBCLC
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