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Mission Critical Gaps in Haiti Cholera Epidemic Management

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Michael D. McDonald's picture
Michael D. McDonald
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Joined: 2010-11-01

Now that we are deeply into the Haiti Cholera Epidemic Crisis (Trigger Point 24), it is time to reflect on the current status of the Cholera management mission.

What has been most effective to date in saving lives and reducing cholera infections?

Which systems with significant resources and infrastructure have failed to deliver in addressing the needs of Haiti's most vulnerable in this time of cholera outbreaks? Why?

Most importantly, what are the Mission Critical Gaps, we can address?

What are the priority tasks under each of the addressable Mission Critical Gaps?  

As a next step, your articulation of the Priority Tasks under each Mission Critical Gap will be reported to the Mission Critical Gaps working group to engage the tasks within the Haiti MPHISE Task Server.

These tasks will then be advanced to the X24 Haiti Cholera Epidemic Crisis Convergence meeting on November 30 to enable fifth generation FAC (Focus, Agility, Convergence) rapid response teams to self trigger to address the mission critical gaps by making a key difference on the most important, high priority tasks that fit their core competencies. 

The results of this effort will be evaluated by the National Events of Mass Consequence Advisory Council of the National Systems Science Consortium at the University of Maryland Center for Health Security and Research in the January/February 2011 time frame. The analysis of these efforts will include an analysis of programs in the United States government that are developing these fifth generation command and control approaches such as in the DHS National Biosurveillance Integration Center's "BioSwarm" initiative, the fifth generation command and control program in DOD's C2 Research, and Defense Secretary Gates's recently announced, "Latin American Crisis Cells." 

In March 2011, a Symposium on Advancements in Command and Control and Information Sharing Environment will be held at the National Defense University, co-sponsored by the University of Maryland Center for Health Security and Infrastructure and the Department of Homeland Security NBIC.  This Symposium will featuring reviews of the Haiti MPHISE initiative, DHS Bioswarm, DOD C2 Research, Exercise 24, NATO Fifth Generation Command and Control and the  National Events of Mass Consequence Advisory Council findings on the Haiti mission.

Michael D. McDonald's picture
Michael D. McDonald
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Joined: 2010-11-01
Stuart Leiderman on Haiti's Current Mission Critical Gaps

dear Mike, Jim and all:

I'm on the call and listening.  here is my first response to the MPHISE questions.  please post and use as you desire.  thanks, with appreciation!  Stuart

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What has been most effective to date in saving lives and reducing cholera infections?

- Looking at it from outside Haiti, among the most effective to date has been the HEAS/MPHISE networks leaders' evident sincerity of motive, dedication to lifesaving and social cohesion, professional competence with technology-based systems, willingness to innovate response, reporting and resolution methods, and desire to personally connect and make the most of the talent of Haitians and non-Haitians worldwide, against all odds.  

Which systems with significant resources and infrastructure have failed to deliver in addressing the needs of Haiti's in this time of cholera outbreaks?

- The UN/WHO/PAHO system has just admitted significantly underreporting cholera cases to date, and underforecasting the cholera trend for the next three-to-six months.

- In the past week, both CBS and CNN television have revealed inefficiencies, stonewalling and hording of supplies at UN/WHO/PAHO warehouse(s).

- Relief NGO's continue to report slow or no passage of their shipments through Haitian customs; some having to pay exhorbitant or surprising surcharges for release.

- Neither the U.N.'s Special Envoy to Haiti nor the Interim Haiti Reconstruction Commission nor the U.S. Department of State's Special Coordinator for Haiti have been visibly and productively responsive and engaged in the epidemic response...not for the victis, not for the workers, not for the donors.

- After a month, considerable technical resources such as Dr. Colwell's cholera investigation laboratory, have yet to get into full operation mode; in this particular case, no nationwide environmental water sampling and testing program is yet operating, despite the general desire to have one both for data-gathering, analysis and social cohesion purposes.

- No international or national leadership or institutions have challenged several dangerous norms that have prevailed since the earthquake:  a) that "saving Haiti" is more important than saving Haitians, and b) that the physical rebuilding of Port-au-Prince is of high priority, c) that it is acceptable to continue holding earthquake victims in captivity rather than resettling safely elsewhere, and d) that life and risks (and microbiology) in the countryside can be ignored.

Most importantly, what are the Mission Critical Gaps, we can address?

- after several weeks participation, a clear and detailed playbook of the full HEAS/MPHISE mission seems to be missing, both qualitatively and quantitatively, and in terms of a) goals and objectives, b) expectations, personnel, equipment, supplies, and funding requirements, and c) participation of native Haitians in receiving, running and benefiting from what the system has to offer their country.

- native Haitian reporting is significantly missing from postings to HEAS; this indicates unbalanced awareness and participation.

- despite the mission desire to embed the system into Haitian society, clear support, agreements and mutual commitments of resources among a) HEAS./MPHISE and b) candidate host Haitian organizations and networks are not yet evident and operative.

- there appears to be an implicit First World assumption that the HEAS/MPHISE system can exist and perform satisfactorily primarily on voluntary rather than paid participation at all levels; this should be examined, particularly with regard to native Haitian participation, incentives, and the building of a biosurveillance community in Haiti.


What are the priority tasks under each of the addressable Mission Critical Gaps?  


- compilation and distribution of a multi-lingual, multi-media plain-language mission playbook to earn recognition and funding for HEAS/MPHISE and expansion into Haiti.

- active recruiting of native Haitians to join HEAS/MPHISE.

- conclude at least one agreement with a Haitian organization to incorporate and carry forth the goals and objectives of the system.

- include in all funding proposals and appeals, money for Haitian participation in the system, plus their equipping, supplying and mobility. 

- - - - - - -

leiderman@minspring.com

Joanne Perodin
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Joined: 2010-11-21
Priority tasks

1. Prevent further outbreaks:

    - Great way to access mass crowd: schools and churches

    - Materials needed: hygiene education (primarily: handwashing, cooking), potable water, soap

    - Issue: not many communities have access to fuel to boil water, or tablets to purify water

2. Control current cases:

    - Cholera treatment centers: distributing information on nearby treatment centers based on individuals residential location

    - Treatment steps: education patient to activate rehydration stage from time of identification of possible cholera symptoms until seen by medical staff

    - Personal Protective measures: increase awarness on actions to diminish contamination between ill individual and caregiver (i.e. relatives, friends, etc)

Michael D. McDonald's picture
Michael D. McDonald
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Priority Tasks Under Mission Critical Gaps

What are the priority tasks under each of the addressable Mission Critical Gaps?  

 

What are the most important tasks that you see must be addressed right now (at Trigger Point 23) in the Haiti 2010 Cholera Epidemic?

Michael D. McDonald's picture
Michael D. McDonald
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Mission Critical Gaps -- We Can Address

 

 

What are the Mission Critical Gaps, we can address?

Michael D. McDonald's picture
Michael D. McDonald
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Systems that are Failing

From your observations, which systems with significant resources and infrastructure have failed to deliver in addressing the needs of Haiti's in this time of cholera outbreaks?

 

Please identify and tell us why you think that they have failed or are failing? 

Michael D. McDonald's picture
Michael D. McDonald
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Most Effective in Saving Lives and Reducing Cholera Infections

Please tell us what has been most effective to date in saving lives and reducing cholera infections?