Closing a Haitian field hospital

Part of life is realizing when to throw caution aside and step forward to partake in something interesting. I did that and traveled to a field hospital in Fond Parisien, Haiti back in the middle of February. I found there a fantastic center for patient care, along with dozens of hard-working and committed local staff and volunteers. They had a data management problem — too many spreadsheets, too many lists, not enough organization. It was a burden even to produce a simple census of the tent camp patient population.

I quickly whipped together a simple Ruby on Rails EMR system based on the structure of a blog. Each patient had a medical record that was a blog entry and with each subsequent medical evaluation or event, a “comment” was added to their medical record. This improved continuity of care, helped staff remember when to give important medications, and generally improved the medical stance of the facility. (Note: the “comments” were structured medical notes, not just free text…)

There is a huge number of factors that play into the care of patients in a field hospital. Sometimes those factors do not all work well together. The hospital is closing this week, due to a lack of funding and a deteriorating security situation. Now, I get to return to the field to help disassemble the systems that I helped put together only a few months ago.

Data systems must be flexible during humanitarian response, I learned. In spite of a strong internal voice telling me to make certain that all of the data is normalized and collected in a proper format, the truth is that patient care comes first and the needs of staff change over time. When you have 300 patients and 30 doctors for a sustained period of time, you develop an understanding of what they can enter into a simple patient charting system. When you then find yourself with 300 patients and 7 staff members, you no longer can rely on the earlier learnings. The people are busy and they will not change, but we can change our data systems to accommodate their overload.

That is exactly how the Fond Parisien EMR system changed over the past few months. It left me with many questions about how to create the proper types of “data integrity tiers” that support different stages of a humanitarian response effort. GIS is vital in the beginning — proper patient discharge sheets are vital in the end, when GIS no longer is in use. How do you reconcile those changing needs into a unified system?

I look forward to helping close the hospital and to the lessons that we learn from this deployment. The staff who poured their lives into the effort surely will continue to come up with new insights based on this experience for years to come. I look forward to tagging along to capture those insights, in hopes of developing the skills and knowledge necessary to develop better data systems for humanitarian response in the future.