You’ve reported on the medical responses to the 2010 earthquake in Haiti and to armed conflict in Bosnia. You won one Pulitzer Prize for your reporting on the Ebola outbreak and another for your investigative report about Hurricane Katrina, “The Deadly Choices at Memorial.” What are the common issues that you’ve seen arise from these emergencies?
Sheri Fink: Crises like these often lead to a mismatch between the number of people needing medical care and the ability to provide that care. Questions arise about which patients should be prioritized. Should medical oxygen in post-earthquake Haiti have been saved for treating trauma wounds in the operating room or given to patients with chronic lung conditions? In New Orleans, when a hospital was surrounded by floodwaters and the power was about to fail, should the sickest have been given the first slots on helicopters or those with the best chances of survival? Questions like these matter because the way they are answered can have life-or-death consequences.
You’ve said that you think emergencies are laboratories for medical ethics. What have we learned from them and how should we use what we now know?
SF: What we've learned is that emergencies bring these types of quandaries into focus and help us grapple with ethical issues that are with us all the time. Even in the absence of an emergency, uneven access to healthcare exists. Even without an emergency, tough choices about medical interventions emerge around the dying. It's uncomfortable to look at emergencies, but doing so allows us to take what is learned and apply it. To some extent, that's already being done.
Take emergencies themselves. Knowing the problems that have arisen implies a duty to plan. Most important is planning that helps avoid the need for rationing, and also important is planning to deal with shortages in a fair way. These concepts apply not only to people in the healthcare field, but to all of us, because the general public has a crucial role in expanding resources. Are you prepared to tie a tourniquet in a mass shooting? Do you have extra supplies of medicine for your chronic illness in case the pharmacies are closed after a big snowstorm? Who is going to check on Mrs. Smith, the older adult who lives alone down the lane, if there's a heatwave?
Your book, Five Days at Memorial, chronicled the excruciating decisions health providers made in the aftermath of Hurricane Katrina. Were we any better at managing the aftermaths of Hurricane Irma and Hurricane Maria?
The healthcare industry has paid more attention to disaster preparedness and response since Katrina, but there is a long way to go. After the recent hurricanes, we saw some of the same problems and new problems also emerged. Many hospitals and nursing homes remain prone to flooding or have inadequate backup power, water, climate control, and communications systems when municipal utilities fail. Healthcare evacuations are still chaotic despite efforts to establish systems to run them, and sometimes leave those in need behind. Often the reason for the problems lies in an unwillingness (or inability) to invest money, time, and other resources in strengthening infrastructure, organizations, and individual preparedness. In short, too many vulnerable people are still suffering and dying in the aftermath of these crises.
This fall we’ve suffered hurricane-generated emergencies as well as emergencies created by a mass shooting and by wildfires. Though their causes are different, the crises they create are similar in some ways. Do different types of disasters offer any insights to help us manage our responses?
I believe they do. One of the important concepts in preparedness is planning for the most likely emergencies in your own area and context. Are you more prone to earthquakes or hurricanes? Will you need to deal with problems associated with urban density or rural distances? While every emergency throws something unique at the public and emergency responders, many emergencies share common issues related to communications, transport, shelter, medical care, and power, for example. Certain concepts apply broadly: Plan and exercise for emergencies regularly, or you won't be ready on game day. Be prepared to shift your response. Be creative in attempts to expand resources. Frequently reassess the balance of resources and needs.
You are a physician, and one of the most harrowing decisions you’ve documented is that of doctors in the midst of disasters and without resources deciding who to save and who to allow to die. What has covering these experiences taught you, especially concerning human rights?
I've learned that people whose lives are, broadly, less valued at the best of times are often the most vulnerable in emergencies.
Sheri Fink will deliver the Donia Human Rights Center Distinguished Lecture on Monday, October 23 at 5:00 p.m. at the University of Michigan Museum of Art, Apse.