The Core Competencies in a Disaster Zone

Chapter 108 The Core Competencies in a Disaster Zone


The Haitian Experience



Glenn R. Stryjewski, MD, MPH


As a physician educator in the United States, I believe in the values set forth by the Accreditation Council for Graduate Medical Education (ACGME) in their outcomes project. The six core competencies capture the many facets of what defines excellent physicians and the quality of care they deliver. The question in Haiti, however, was whether these competencies maintain their relevance amidst a disaster. If so, then are the competencies different in Haiti than in the well developed health care environment of the United States?



Medical Knowledge



“You Know What You Know”


The truth of this aphorism became apparent upon first patient contact and served as a source of discomfort for me throughout my time in Haiti. It exposed my dependence on others as a safety net for my own knowledge gaps. I am a pediatric critical care physician by trade. In some ways my training provided me with much of the requisite knowledge to care for the injured children of Haiti. However, the bits of knowledge I did not possess, I rarely had the opportunity to ask about or search for in the medical literature. I was surrounded by wonderful and intelligent practitioners, but certainly I did not have the usual array of subspecialists from whom I so frequently draw knowledge. Their absence was magnified by the presentation of unique diseases such as tetanus, something we are rarely called upon to treat in the highly immunized community in which I practice. However, my discomfort with my knowledge base made me fail back upon my years of study and practice and doctoring processes I had learned. I was forced to make diagnoses and treatment decisions about which I was unsure. But the solid foundations of medical knowledge from medical school and residency carried the day. I was compelled to reinvigorate my history-taking skills; my physical examination skills were revitalized; and, once again, clinical judgment reigned over sophisticated testing. My eyes, ears, nose, and hands, combined with the knowledge of anatomy and physiology I had acquired over time, helped me do what I was trained to do. My discomfort waned as my inner physician once again resurfaced.



Patient Care



What Is Quality Care?


We apply a certain standard of care that we feel is adequate and appropriate to deliver within our local health care environment. Most of us feel that we deliver a high standard of care every day. So what is quality care when there is no standard to compare it with? We lacked needed supplies, so we improvised where possible. Substitutions that we would never have made at home suddenly seemed justifiable. Was this delivering poor-quality patient care? Honestly, this took some time to get used to. Initially, this felt awful, as if we were doing a disservice to the very people we were trying to help. Perhaps we should just go home. How could we even consider using amoxicillin alone to treat a massive cellulitis on an injured leg? How could we provide deep sedation without a pulse-ox monitor? How could we care for a premature newborn without any ability to keep the baby warm? It was impossible to provide care at the level we would have provided in Philadelphia. What we did in Haiti, however, was raise the standard of available patient care the best we could. Ultimately, we met the community standard and exceeded it by far. We created a pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU). As far as we could tell, these were the only functioning PICU and NICU in the country! Despite unfortunate imbalance in health care standards worldwide, patient care is as much what we do as how we do it. Care was delivered with compassion, concern, and empathy. We tried our best to offset the shortcomings in our provision of care with compassion in our demeanor and with vigilance in our follow-up and daily concern.

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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on The Core Competencies in a Disaster Zone

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