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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