Global Health conference addresses building robust, agile health care systems

By Deborah Wormser

Strategies to create and sustain robust health care systems in the developing and the developed world were the focus of UT Southwestern Medical Center’s fifth annual Office of Global Health Symposium.

“If you don’t like the results, look at the process. Health systems are all about the process, whether in Dallas or Dakar,” Dr. Fiemu Nwariaku, Associate Dean of the Office of Global Health, said in his remarks. The Jan. 22-23 event on North Campus included faculty members, students, and international visitors.

A panel discussion on dealing with complex emergencies showed how quickly modern transportation systems can transform a health care emergency in one part of the world into a potential crisis in another, whether via busloads of hurricane survivors or one ill international traveler arriving by airplane. The three panelists underscored the need to have plans, processes, and relationships in place before a complex emergency unfolds.

The complex emergencies panelists have teamed up on several such situations, including the city’s response to the first Ebola case diagnosed in the U.S., which happened in September 2014. 

Zachary Thompson, Director of Dallas County Health and Human Services, makes a point as fellow panelists Drs. Frederick P. Cerise and Alexander Eastman (center, right) listen during the complex emergencies presentation.
Zachary Thompson, Director of Dallas County Health and Human Services, makes a point as fellow panelists Drs. Frederick P. Cerise and Alexander Eastman (center, right) listen during the complex emergencies presentation.

When asked to describe his experiences with prior complex emergencies, Dr. Alexander Eastman, Assistant Professor of Surgery, likened it to teamwork delivered to address the pressing needs of survivors who arrived from the New Orleans area after Hurricane Katrina.

“Absorbing 30,000 people with special needs and ill patients from Louisiana during Hurricane Katrina brought together some people and groups that had never worked together before. We had to build a freestanding hospital inside the Dallas Convention Center,” he said.

Dallas and North Texas are safer today because of those relationships, added Dr. Eastman, who also serves as Trauma Medical Director and Chief of The Rees-Jones Trauma Center at Parkland Memorial Hospital, and as a lieutenant on the Dallas Police Department.

Dr. Frederick P. Cerise, President and CEO of Parkland Health System, was on the other end of that emergency. As Secretary of the Louisiana Department of Health and Hospitals in 2005, he worked to expedite getting patients to other cities following Hurricane Katrina.

A report by U.S. Bureau of Labor Statistics economists describes that storm as “one of the largest and most abrupt relocations of people in U.S. history.”

“The (health care) infrastructure can never anticipate the magnitude of something like Katrina,” Dr. Cerise said. One lesson from that experience is the need to prepare for well-meaning volunteers who overwhelm office phone lines with offers of help that poorly mismatch the needs of the moment, he added.

As vehicles and buses loaded with thousands of Katrina victims threaded along the highways toward Dallas and other large cities, Dr. Cerise stayed in touch by phone with Dr. Eastman and the third panelist, Zachary Thompson, Director of Dallas County Health and Human Services.

Mr. Thompson said in the first days following the storm, those working in the medical unit at the convention center realized that medical needs were only the beginning. Mental health services, social support services for uprooted families, and housing were all challenges after the storm, he said. The BLS estimates that more than 30 percent of Katrina survivors who came to Texas remain.

With Ebola, the challenges included culture and communication, often simultaneously.

The nation’s first diagnosed Ebola case manifested in a man who had flown from Liberia in Africa via Brussels and was staying with his fiancée in a neighborhood where about 50 different languages are spoken.

Beyond translation of health messages, the health care team had to find community members who were trusted by residents at Vickery Meadow apartments. Those community health promoters helped distribute messages in order to secure the residents’ cooperation, the speakers said.

The speakers also discussed how repeated changes in U.S. Centers for Disease Control guidelines for use of protective gear caused confusion during the city’s response to Ebola, and have since sparked discussion and change.

“Public health may be global, but in terms of response it’s local,” Mr. Thompson said. “We need experts on the ground, indigenous to the community, to guide that process.”