IAmA Miriam Aschkenasy, disaster response doctor just back from the Philippines, AMA!

How did you get started in disaster response medicine? It seems like an exciting and rewarding field.

I started by going to medical school and after that I got a Masters in Public Health with an area of focus in Humanitarain and Field Response. You don't have to be a doctor or in the medical field to do this but you do need advanced training - such as a masters in public health, nutrition, or humanitarain studies. You can find programs like these in the US and Europe (for instance the London School of Hygeine, the Harvard School of Public Health, or Tufts gradutes studies Masters in Humanitarian studies to name a few.)

Do you ever worry about your own health and personal safety in these situations?

Always. We have a saying "you can't take care of other people if you don't take care of yourself". This was our mantra in Haiti where the condititions were very stressful. One of the things we do at the MGH Center for Global Health is conduct a training on International Health, Safety,and Security. This is a very important part of being preapred and staying safe.

i just got back from anteguera and tacloban too!! crazy time and place. lots of sadness but i was really impressed with the work people are doing out there!

I was also very impresed with the quaility of response, the good coordiantion, and the overall resiliance of the Fillipino people!

I am currently a student particularly interested in your field. First of all, I just want to say thank you for your inspiration to us med school hopefuls, and what advice would you give to a neuroscience major interested in pursuing this type of career?

Try to get some early global health exposure. Most disaster response is not the place to be getting your feet wet in global health, get out there first in the development and non emergency phase before moving on to the more stressful and complicated emergency response work. Also, find a good mentor - always key.

What was it like over there? How did the impact of the aftermath affect you?

These responses always provide me the opportunity to be grateful. Grateful for my family and work at home the provides me the opportunity to do this work and for the everyday luxuries that most of us take for granted like running water, easy transportation, access to medical care (for most not all), the money I need to buy food, have a strong house over my head etc.

How would you compare the typhoon with the other disasters you mentioned? Was it more or less devastating? Just different?

Every disaster response has some qualities that are the same and some things that make it unique. This Typhoon reminded me a lot of responding to Hurricaine Katrina and Rita. The Philippines is a middle developed country so you see power lines and developement all around ...you would be driving along and then you would start to see every single power line down - either in the road or the rice field or on a house/buidling. Some areas were not touched and some totally devistated - we went to one island that did not have a single building that still had a roof.

What's the best way for Redditors to help out? Can you suggest a charity that gets the job done?

It is not very romantic or exciting but really the best way to help out is to donate money. You really want professionals on the ground to be able to response and purchase goods locally. This way you don't undermine the local economy, you are buying culturally appropriate and relevant goods, and the people are really getting what they need - cash. Just think if you lost everything would you want someone to send you shoes or give you money so you could make the decision what is more important to you - shoes or food? shoes or soap or medicne? worse yet - used shoes.

You SHOULD always cross check any charities you give to on Charity Watch - they rate the charity based on how much money actually gets used for services and how much goes to administrative costs. Yes, some has to go for administrative costs but not 50%! So like with anything else be an informed consumer. An example of a good place to donate would be the Phillipine Red Cross - that way your money will go right to the people that need it the most for the things they need the most.

What's your favorite color?

Maroon, red is a close second.

Not a question, but I worked at MGH for a while, and just wanted to stop by and say what an amazing experience, privilege and place it was to work. Keep up with the great work!

I miss Boston. :( Probably one of the best places in the world to get sick. So many world-class hospitals in one area.

I agree! I have personally never worked at an instituion that was supportive of its staff doing global work and disaster response. The administration of the hospital really supports its mission statement and that was a really nice new experience for me.

My thank you for your humanitarian work. You truly are someone to be looked up to.

What was the most rewarding, fulfilling event while you were out there? Also, what was the most heartbreaking thing you witnessed?

Its funny but this is something I am very often asked and honestly can't give you a good response. Pretty much every moment carries both the best and heartbreaking in it. Even when you do something wonderful you can not escape the context and vise versa. Sorry I can't give you a more precise response but that is how I feel - very rarely can I bring to mind that one moment. Also I have been doing this for over 10 years so you stop seeing your role that way - its hard to explain but since it is a large picture sort of gratification it is hard sometimes to parse out the everyday actions.

Hi Dr. Miriam, great to find your AMA. My question to you is after arriving back here in North America from the Philippines, what can you still remember in your mind during your mission in the Philippines?

(By the way, I am a Filipino.)

First, you have a beautiful country - with wonderful people and food! I have never eating so well duirng a disaster response. We would do mobile medical clinics everyday and the community would insist that we eat lunch which was made for us and it was truely an amazing experience. I remember quite clearly how hard working everyone was and what wonderful spirit they had in general. The desire to get back on their feet and the appreication that the global community was reaching out to help was evident. I got 3 kisses on the cheek one 81 year old, a 4 year old and a 9 year old.

of the countries you have experience, can you rank them in which respond best to foreign aid, and if there are obvious fixes to help bring up lagging countries that aren't being done for whatever reason.

I have to tell you I just can't answer this question. There are way to many nuances to how each country works and what the individual needs are. Generally good governance makes a big difference but then even the USA had trouble with our own disaster resposne post Katrina. We are constantly looking at the individual needs for each country and part of the long term work is disaster risk reduction and preparedness planning - if a country does this well they are off to a good start (by the way this is something the US learned after Katrina and did better at with Sandy).

Thanks both for this AMA and all that you do, Doctor.

My question: What are some of the hardest things to do medically in disaster areas?

Also, generally, how well are you and your organization supported with provisions while in these disaster areas? Adequately or inadequately?

For me, personally, the hardest thing to do is to sepearte what my treatment expections are abilities are when at home and when responding. You have a public health imperative to do what is right for the whole population - this means introducting culturaly appropriare and sustainable actions, not imposing western/northern standards when not appropriate etc. There is a fine line when making these decisions.

We do this professional so we travel in a manner that means we can take care of ourselfs and our team members for two weeks without any outside provisions. This is why it is so important to know what to do. We had all we needed and we also brought with us what we needed just in case.

Thanks for responding.

Just out of curiosity, what would an example be of when you used "culturally appropriate" medical practices rather than relying on conventional Western medicine?

There are so many. We in the west/north are so used to getting all the things we want when we want them - for instance keeping someone one life support when they are near death. This would not be approrpirate to do in this setting as not only are the needed tools maybe not there but it is also at great financial expense to the family - so you have to understand this give and take.

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Meditation and Yoga

While you have been in the Philippines have you seen much improvement in the situation on the ground?

And which national governments respond the best to humanitarian disasters?

The Government of the Philippines did a very good job with the response, to be quite honest. They were clearly in charge and knew what they were doing - which was very refreshing as this is not usually the case (even in the USA after Katrina). I have personally never participated in a humanitarian response that has moved from relief to recovery so quickly. The Fillipino people were very resiliant and were clearly already rebuilding and replanting when we left which was only 4 weeks after the intial impact.

Does having such a good PR team at the hospital make your mission easier?

It does actually help - it is important that we raise awareness and try to keep the plight of the affected indviduals in the minds of the public and good PR and Media help make this happen. This is important to purshcase the supplies we need to respond directly (such as plane tickets) AND to do things like purschae the drugs and wound care materials we use to treat patients.

How are the people doing now? Any problems with the spread of disease?

The Govt of the Phillipines has a surveillance system that they use just for disaster response called SPEED. They look for diarrhea, measles, menigitis, and other diseases that have the potential to become epidemic. As far as I know none of these have been reported in any numbers that would be a cause for concern. We did find an outbreak of chicken pox !