What WHO's unified global health emergency workforce will look like

Emergency and crisis are followed by international mobilization of the aid community to address the medical needs of those affected, as witnessed in Haiti, in recent disasters such as Typhoon Haiyan in the Philippines, the Nepal earthquakes and now Myanmar, which is currently experiencing its worst floods in decades. But such disastrous scenarios don’t lend themselves to having the most qualified health experts already on the ground. What happens when it takes too long to get emergency responders in? Worse, when those on the ground aren’t properly prepared, get injured or fall ill to diseases endemic in the country? In the first few months of the Ebola outbreak in West Africa, many national doctors and nurses, not yet fully aware of the dangers of epidemic they were treating, lost their lives to the disease. Infections continued to spread even after international medical help arrived. The outbreak has given way to a heightened sense of awareness of the global need for more front-line responders who are prepared, agile and immediately available in the country or nearby. In March, various stakeholders, led by Save the Children, announced their plans for a Humanitarian Leadership Academy. More than 100,000 individuals — seasoned aid worker or otherwise — are expected to undergo training and emerge ready to respond to a crisis situation at home or in neighboring countries over the next five years. But what about medical responders in particular? In 2014, the World Health Organization launched its Foreign Medical Team unit, tasking it with building a global registry system for foreign medical teams — at the country-level or as part of nongovernmental organizations — and developing national and regional capacity for medical response. The reality The team, under WHO’s Department of Emergency Risk Management and Humanitarian Response, is expected to kick into high gear improvements in the way the global health community responds to emergencies, and in the long run break the chains that allow for inefficiencies and delays in global medical response. The man tasked with steering the initiative, Dr. Ian Norton, is a seasoned emergency physician and disaster preparedness expert who joined WHO in February 2014 after for more than a decade training and leading Australian disaster teams overseas. His experiences mean he’s no stranger to the inadequacies on the ground. In his previous role as director of disaster preparedness and response at the National Center for Trauma and Disaster Response in Australia, Norton was responsible for designing training and simulations for the disaster response team. “It's a basic human right to have the right amount of pain relief when you have surgery.” --— Dr. Ian Norton, head of WHO's Foreign Medical Teams unit. “It came about because before that, teams were being sent out, doctors and nurses, from the wards of the hospitals in Australia, without necessarily being trained and ready for the difficult conditions, the devastation they will see, the human suffering they would see. And some were coming back quite traumatized,” he told Devex. The five-day course he helped develop is meant to expose medical workers to the realities of an emergency situation outside the comforts of the four walls of a medical facility in a high-income setting like Australia. Doctors and nurses meet different actors on the ground, including security forces, and face access issues like road checkpoints and blockades to learn the art of negotiating with various actors to perform their duties and deal with security incidents. The medical practitioners are also given the chance to experience spending nights in the bush — which has a high probability of happening, especially if they will be serving in a conflict zone — set up a field hospital, and practice and perform surgery in a setting vastly different from the one they’re used to. “It's not that one country is poorer than another, but you can't perform the same kind of surgery to somebody who's been lying in water for 12 hours,” the disaster response expert noted. “We learned that in war zones that type of difficult or complex surgery needs a special approach. We teach surgeons, doctors, nurses how to manage the specific injuries.” The simulations are done days after the training sessions, and allow actors to “confront their worries.” But Norton also admitted they are “very, very graphic and difficult to deal with,” especially for those with no prior experience working in disaster zones. The whole program works to the advantage of responders, but also benefits disaster-affected communities. The general lack of preparedness is not exclusive to the doctors and nurses Norton met and trained in Australia. It’s a global and persistent issue faced by many medical responders, who arrive in a disaster zone with the best intentions, but find they lack the right equipment, the right skills and the right drugs, he said. The WHO official witnessed this five years ago in Haiti, and while a lot has improved since, he said he saw it again In the aftermath of Typhoon Haiyan in the Philippines, for example, where some teams performed surgery on patients without adequate painkillers because they hadn’t brought enough, he said. “That's just unethical,” Norton said. “It's a basic human right to have the right amount of pain relief when you have surgery.” These instances call for heightened professionalism and standards, so when medical responders come in with the best intentions, they also can deliver the best possible care in very difficult circumstances, Norton added. The task Now with WHO’s Foreign Medical Team unit, Norton’s team’s task is to set the standards for training, logistics, the types of equipment teams should bring, the type of coordination they should expect on the ground, and the setup they need to know in terms of working with a country’s relevant ministry. WHO has already published the core principles and standards on how foreign medical teams registered with the U.N. health agency should function and conduct their operations in mid-2013, which Norton said he helped write. These guidelines were made immediately available in the Philippines during Typhoon Haiyan, Vanuatu after Cyclone Pam, and in quake-ravaged Nepal. Though not perfect, Norton claims the guidelines helped improved the response and coordination in these disasters, although it was still a struggle at the height of the Ebola crisis in West Africa. They realized most teams are prepared for earthquakes and tsunamis, but not for disease outbreaks “and anything quite as threatening” as Ebola. They are also preparing to develop countries’ national medical response capacities — particularly those in Asia, Africa and South America — so they can immediately respond to a disaster at home or to a situation happening in a neighboring country, which is relatively faster compared with waiting for outside help from the other end of the globe. It’s not often highlighted in the media, but Norton said more than 800 responders to the Ebola crisis in West Africa came from the affected countries’ neighbors that are part of the African Union. Further training for disaster coordinators, who play a critical role in emergencies, will start in October, but Norton has already started with U.N. disaster teams that could be called upon to set up a foreign medical team coordination cell. At the same time, he’s working to improve the registration of foreign medical teams in the global registry, which can be a game changer in sudden onset disasters but also in health emergencies. The registry’s list of teams that meet WHO’s minimum standards for deployment allows countries to tap into specific teams that can meet their current needs, whether it be a tsunami, earthquake, floods or disease outbreaks like Ebola. The registry also allows the country, with the help of the Foreign Medical Team unit, to identify specific skills set that is required in the field. It can become a resource for donors looking for teams to support on the ground. And it can be the platform in which foreign teams and organizations can be informed of a country’s procedures and requirements. “Can you imagine 4,000 people arriving in 140 teams, or requiring help with getting set up, sometimes in logistics? Certainly [teams] need to understand what the context is, what the protocols are for treatment in the country … and we need to make sure these teams don’t come with their own things that may not be appropriate in that particular country,” Norton said. The registry could also prevent what the doctor refers to as “humanitarian tourists.” In the Philippines, he came across groups of people arriving wearing “uniforms that looked like medical [gear]” but who clearly lacked necessary equipment for medical work. When he approached them and inquired, he was told they were not doctors at all, and were only wearing medical uniforms so the military would offer them a lift to the affected area. “I ask people to pack on two things when they come on in these responses: flexibility and a sense of humor. You need to be able to adapt; there’s no cookie cutter approach, there’s no standard approach.” --— Dr. Ian Norton, head of WHO's Foreign Medical Teams unit. “This is the bad side of what can occur sometimes,” Norton said. “And we need to have a coordinated and professional approach to it. And that’s what guides me on. We need to make sure that teams that arrive are who they say they are. And this is why the registry is so important.” The unavoidable danger But it’s not all about providing care. Part of Norton’s team’s work is to ensure the protection of health care workers, before departure and during the job, and in the event of injury or sickness while attending to a patient. In West Africa, the doctor explained they helped set up a focal point, or a place where both national and international workers could be treated if they were infected with Ebola or another disease endemic in the affected countries. A plan was also put in place to assist health workers in traveling home and finding care in their home countries, although Norton said this was a “key limit” in the early part of the response. These “focal points” should not be limited to the Ebola response, Norton said. “What we’re looking at is a coordinated approach, in that the teams who come in can help care for each other, and we have one or two very high-level teams — type three we call them — [who can provide areas where there are] lots of operating theaters, diligent sense of care, lots of bed capacity [and] they become the place that the humanitarian workforce can come and get treated themselves,” he said. The idea makes sense, Norton argues, as these are people who are “putting themselves in harm’s way” but would be much more likely to step forward and volunteer if they had surety of care. Still, the danger of the work remains. In Nepal, international medical group Médecins Sans Frontières lost three of its staff members in June in a helicopter crash after delivering medical and humanitarian supplies in affected areas in Sindhupalchowk district. “It’s difficult. … And then there are those who get infected. We do a lot of work with them to make sure that they are properly vaccinated and what malaria prophylaxis to take, but sometimes they still get [infected] from the endemic diseases, even if it’s not an outbreak,” Norton said. No matter how heavy the training and preparation, teams need to be prepared for the unexpected, he said. “I ask people to pack on two things when they come on in these responses: flexibility and a sense of humor. You need to be able to adapt; there’s no cookie-cutter approach, there’s no standard approach,” he said. “We always tell you the principles, and we teach you the command, control and coordination aspects, but from then on you need to be able to adapt to the particular context — and that context changes every day.” The future Foreign medical teams — perhaps to be renamed “emergency medical teams,” according to Norton — composed of national government teams and national NGOs could “be offered to each other in times of crisis,” Norton said, but they are only a piece of the bigger WHO idea. The plan is to have what WHO Director-General Margaret Chan mentioned in her opening speech at the World Health Assembly in May: A Global Health Emergency Workforce, which will have several subunits under it, such as a team that will specifically look at outbreaks, a team that will be composed of technical experts — through Global Outbreak Alert and Response Network and other partners — that can come and work with country ministries for a set period of time, and a team that Norton refers to as the Global Health Cluster, which will be composed of NGOs that will be sent in places “that perhaps government teams don’t want to go — the conflict regions, the famines, the protracted crises.” For now, however, Norton hopes to grow his team of eight at headquarters to between 15 and 20, some of whom will be based in different regions across the world. And in the long run, he’s hoping the teams the unit trains will eventually be the ones training other national teams in their own regions, like a pay-it-forward gesture. Whether you’re a seasoned expert or budding development professional — check out more news, analysis and advice online to guide your career and professional development, and subscribe to Doing Good to receive top international development career and recruitment news every week.