02.01.10

All These Useless Doctors

Medical care is vital after a disaster. But it's not at the top of the list of urgent basics. Infectious disease expert Kent Sepkowitz asks: What are all these physicians doing in Haiti?

Few doctors can resist a medical catastrophe. Epidemics, tsunamis, earthquakes—anywhere there is human calamity, the doctor, like Mary's little lamb, is sure to go. I know, because I myself am so afflicted, looking for relief of an unbearable urge. It remains unclear whether the interest is altruistic or self-aggrandizing, humane or prurient, psychopathic or admirable. But whatever it's about, it's predictable as can be.

Adequate plumbing in Haiti surely will save more lives than antibiotics or surgery or cardiac medicines.

The most recent example of this fatal attraction can be found in the doctor response to Haiti. The tragedy wrought by this month's earthquake has reached biblical proportions, moving countless people to offer money, time, and prayers. Help has poured in from just about everywhere: priests and nuns, guys with trucks, the military. And of course doctors, brigades of doctors have entered the fray, flexing and preening for the ubiquitous television cameras. We see them everywhere—serious, distracted, hurrying away, as tearful as you and me.

But just what on earth are these Sgt. Fury's of Medicine doing exactly? Besides grimacing, that is. I decided to stay put almost immediately after realizing I am not what Haiti needs. Medical care of course is important after a natural disaster. But it's not at the top of anyone's list of urgent basics. Rather, the central immediate goal is preservation of health, not delivery of health care. This is achieved by provision of fresh water, a warm-enough place to sleep, food, and of course adequate plumbing.

However, we aren't getting reports for, by, or about the engineers sent down there trying to make certain that the displaced thousands, as well as the phalanx of newly arrived volunteers, don't drink each other's excrement. Diarrheal illnesses always follow natural calamities as the water supply becomes contaminated and intestinal pathogens are cycled and recycled. Adequate plumbing in Haiti surely will save more lives than antibiotics or surgery or cardiac medicines. Give me a new six-foot piece of copper pipe and a fresh-water well over a chairman of medicine any day of the week.

The public, though, is more fascinated by doctors and crushed spleens and the race to re-attach a finger. It's understandable from a certain perspective; such stories make for mighty good TV. We get a self-contained docudrama complete with tears, danger, a laugh or two, and some feel-good moments of hope not relentlessly dashed by misery. And the incongruously bright, cheerful Haitian sky surely is a winning backdrop. Plus no one, except perhaps a 5-year-old boy, wants to watch hours of trucks and bulldozers going up small hills all day long. Or people pouring cement. Or someone yelling to someone else for another O-ring or a box-end wrench.

Good TV aside, the focus on doctors in this particular tragedy (and indeed, most of them) is odd because, well, because doctors in these settings are just about useless. OK, orthopedic surgeons, sure—setting bones and wrapping sprains; obstetricians to help deliver those babies conceived months ago; and someone to treat the few persons with medical illnesses who have not yet passed beyond the ken. And those doctors who already are in the country and know the territory provide care that is nothing short of miraculous, as a report from Haiti in this week's New England Journal of Medicine attests. But the swarm of well-intentioned, free agent physicians looking to help out: they add no value. Rather, send in a few busloads of nurses, people who can actually do something useful and immediate—distribute medications, wrap wounds, calm the worried—skills many doctors have long ago forgotten (or never learned).

This harsh reality is a surprise to many making their first expedition to a disaster. For many doctors, one of the core attractions of the medical crisis is its promise of a return to medicine the way it once was, when doctors ruled the world. You know, before junk happened like civil rights and women's rights and all those meddlesome regulations got in the way. Yes, we envision a field of the needy with us doctors cutting and pasting, doing as much as we can before moving onto the next case. Frontier medicine, ma'am: we're just doin' our darndest. Plus perhaps we can bark orders just like old times too and maybe even flirt with the cute nurses. No meetings or paper work. Nothing. Free at last: the medical catastrophe promises to be the last place for a doctor to strut among the desperately appreciative. And after a career in New York, a guy could get used to hearing, "whatever you say, doc."

However, Haiti and previous crises demonstrate that the medical clock has not been turned back to the glory days of the 1950s but rather to the 1650's. And instead of an adoring audience, we stand face to face with the dead and dying without much to offer. We mostly are useless without our equipment—no, not the fancy stuff like MRI scans or laser this or robotic that, but the basics: electricity and clean water and refrigeration for drugs. So in such situations, we become simply an extra set of hands, someone to help dig graves and latrines, carry stones from here to there, or sit with a kid whose lifeless parents were just found—useful as humans, not professionals. Rather than Hawkeye and Trapper John, we resemble a priest, holding a hand, helping someone die as easily as possible. On second thought, for those who stay long enough for their disappointment to fade, doctors in Haiti can help out a great deal.

Kent Sepkowitz is an infectious disease specialist in New York City. He has contributed to The New York Times, Slate, and, oh-so-briefly, O Magazine. He also writes academic medical articles that are at times pretty tough sledding.