Thanks to Matt Watson for tweeting the link to this NEJM report by a team of Israeli doctors who worked in Cebu after the storm: Collaboration in Response to Disaster — Typhoon Yolanda and an Integrative Model. The conclusion:
During the 10 days of our joint operation, we were able to provide medical assistance to about 300 new patients daily, for a total of 2686 cases. These results were achieved thanks to the full cooperation and coordination between the two teams. Our primary mission has always been to treat the victims, and this time we aimed to do so in partnership with the local medical team.
We could also provide assistance in rebuilding the local hospital, in restoring electricity by means of generators, and in leaving many much-needed supplies, including a mobile x-ray machine, an autoclave, and a large quantity of pharmaceuticals.
Our experience suggests that the WHO guidelines are sound and appropriate when there is a total collapse of the local medical infrastructure. When the local facility is partly functional, however, there are important short- and long-term benefits to integrating foreign teams with the local units. Foreign medical groups that blend with local ones can quickly gain the trust of the local population. A merged model allows the deployment of functioning parts of the local facility.
In the Philippines, we also observed that a cooperative model facilitates departure; after treating hundreds of patients every day, we were able to hand over care to our local partners and a small medical group that had arrived from Austria, Germany, and Slovakia, rather than abruptly discontinue medical assistance.
It is always easier to be in full control of these kinds of operations, especially when the balance of experience lies on the side of the “guest” team. Following a cooperative model may pose some challenges, particularly if the visiting team must strike compromises regarding either its own beliefs about the best management of care or important administrative issues, such as patient responsibility or setting up priorities for triage. In this instance, however, by relinquishing our well-established habit of operating as a highly independent unit, we found that, when feasible, a cooperative model can have additional and important benefits for the victims of a disaster.