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The Role of the Health Care Provider in Disaster Relief

Carlos Moretta
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Presenter

Carlos Moretta

Dentist and Oral and Maxillofacial Surgeon practicing in the Loma Linda area.

Conference

Recorded

  • October 29, 2010
    4:30 PM
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well what do you guys are the remnant of the day day I was asked to the present I remember the marketing of the title of my presentation initially it was suggested that it was that I would speak that the title of my presentation the Third World are side US-based dental solutions for Third World disaster relief problems thought is that so I have back a little bit and I collected the brief experience in disaster relief that I have and I said how about we do a little more all-inclusive type presentation for purchase dentist would healthcare providers in general because of the disaster relief situation well kind of following the same under the same umbrella so this is my presentation and you'll find that as much as I tried to make this presentation non- anecdotal this can be a lot of anecdotes when you look for when you look through there the through pub med for articles on disaster relief and health care providers there are a decent amount not very many ways a decent amount when you go through the articles and in the journals a lot of them are anecdotal why well because of disasters with so many different variables this one was a hurricane this is whether this was an earthquake this was a massive fire and and so it's hard to develop studies studies that you can draw any significant information from however there are some similarities between all our disasters that you can compile and it's kind of try to do for you this afternoon so if you bow your heads with me and we'll get started with a word of prayer thank you father for this day for the opportunity again to receive your sound with which is soon coming in the company of like-minded brothers and sisters who want to take their their careers father dedicated at your service and I ask that you be with me and that as I open my mouth baby your words not mine that we might be edified and in this regard and we might be able to serve your children better is to pray in Jesus name amen so some comfort in the case I see some of my fellow travel mates are vacuuming in any in February when we actually went to Haiti I believe that some of the biggest travesty is that that have been performed in public speaking situations is when the the speaker is not familiar with his audience so would you agree so my question for you this this afternoon is other than Katrina and Haiti are many of you have been involved in disaster relief situation where where ma'am okay okay are him he will then turn many others about how many of you are involved in the Haiti disaster relief raise your hand one two zero twelve I was also involved in the Haiti disaster relief I just wanted to try to start out in and share with you some of the organizations that are involved in this perpetually are constantly obviously at the governmental level you have FEMA nongovernmental which is also nickname NGO is the acronym we have just wanted to list some of the few that are that are within our our denomination is not as great as when I actually will very search disaster relief map NGOs are nongovernmental disaster relief organizations and hit enter and then even the first of the first of the Psalms ACS you don't drive I was like yeah we are at the top instantly start with a job I thought that was great I think I misread the forefront of his reign you know this is because it was alphabetically listed so ACS Pax World release music these are its organizations or the weekend was affiliated organizations Loma Linda University throughout what I learned when I went to Haiti was you know the kind restored my faith in mankind you know people in general they want to help when this thing went down him in the airport and he you realize that you're not you don't have an original idea to go on how it's not yours all of the world was in Haiti every disaster relief humanitarian agency church or organization or group everyone was there and they are willing to help and wanting to help that was comforting for me and I believe I believe that the heart of man is generally good and in that that's good for us in denomination to because you know people eventually will will hopefully do the right thing when presented with truth ACS are addressed in a services you receive process and distribute clothing bedding food products major disasters agency brings in mobile distribution units filled with Betty and practice clothing that is free sorted according to size age gender ACS will provide emergency food and counseling and participate in cooperative disaster child program Iraq's world relief is an affiliate of our church not directly under our church plant down its leadership is primarily a business during a nationwide network of healthcare professionals it acts has teamed to provide inoculations and first response healthcare with dedicated all-terrain four wheeled vehicle medical support and response vehicles expandable semi trailers and canvas shelters acts as resources to set up a field medical facility that can provide for the Eric for area support in this organization was largely a use or we teamed up with eight as a man we teamed up with facts and the large whale a lot of our membership went to the above to see our support of the effort to actually putting forth in Haiti yesterday him and I is not that is madness from them I actually know the community I remember these services actually than team services and actually have a daily cancer is new series us at Adventist pastor is actually on dates and mentioned that organization successfully in the eyes of the floor in the in the face of the government and FEMA their well-recognized and they haven't a pretty good I support base Pax World relief is a news for national incident management system compliance disaster response agency able to respond within twenty four hours of federally declared incidents utilizing its volunteer army of everyone provide and they also provide mentoring services by utilizing their fleet of trucks on that copy and paste this link for this heavy equipment refrigeration trailers mobile commercial kitchen sense and support equipment limits on drug courts were very familiar with with this agency that does fall within our denomination or under the umbrella of our examination and in the wake of emergencies such as famine earthquakes there are often found the people needing basic necessities her works to get them back on their feet again by not only respond quickly but following up with long-term support and you know that that's always the biggest shortcoming about disaster relief that we have to face it we have to deal with its being there after the hype has died down and all types on this over and over and over again disaster relief comes with it feeling a high kind of an emotional high and then after the hike is gone people forget and the problem still persists there him for the loss of life by responding quickly evaluated previously the developing plans to get help areas where it is needed most popular coordinates of local governments to provide medical care food water and shelter to victims and tragedies so they were there Haney helping with the restoration of infrastructure damage Loma Linda University I was also involved in Haiti cheaply because this is our hospital love that the hospital there in Port-au-Prince is is under the direction of Loma Linda University so they take personal vested interest in that particular disaster however if you're interested in working through it again I listed these agencies for speakers on this is an organization the best thing to do it's going to come together as us in our single-minded group two to network with these the list of organizations within or affiliated with our working with our denomination that I would hope that you would choose to work with her for going to other NGOs certainly it wouldn't you know be-all whenever you can still working with other NGOs as well but these are hard are organizations that we try and work through Loma Linda University listening to do is contacts will public health or the medical center directly to see if you may have been involved with a particular disaster so you know Matthew twenty four tells us that there are more disasters to come right and we in we anticipated I remember her with when Haiti happened our missions coordinator called me up and said Carlos you not see the prophetic footprint here you know this is this is pathetic what is happening here is huge it was huge but I thought to myself wait a I will leave that you know we have to see the big picture here and just weeks after we had the chillier the chili with the Chile earthquake in the same magnitude were not a little more than said better infrastructure that's a bad less damaged so there are the disasters right I remember this particular graph going throughout the Internet and phase like with a hot buys into USGS worldwide deadly and destructive earthquakes graphs between the magnitude of six and eight a job that you do it she can see from back in the nineteen hundred and Mrs. two thousand eight so this doesn't even include Haiti right and so interesting thing is your relatively cruising along here and I see a spike to where we are and I remember thinking awesome this is free this is where the people this is no but we also have the other reality sets need a little more study little more investigation a realize and emphasize monocyte for logic equipment that they have here or here or here or here now we have media and now we have every single earthquake being reported does we do have the equipment we do have the technology to record everything you try to take that into account as well so when you look at the cycle of disaster response we as an organization at least a man as healthcare providers are not involved directly in the mitigation and prevention in the preparedness necessarily particularly warning but somewhere right here in this area we become involved or at least we like to think we this is where we step in this healthcare providers this is where we can step it disaster disaster strikes ideally him please is coordinating response there is a recovery and hopefully this be a reconstruction somewhere along the line LCD or not show you we sometimes forget and we fall off a minute I fingering here in our practice requires our efforts back at home seek here you can stay with a disaster is to bring it through its complete cycle so this is my very brief experience in Haiti Haiti earthquake January two thousand ten I had the opportunity to go two weeks after which for particularly like I say this for a reason my specialty is orally maxillofacial surgery orofacial trauma okay so I was thinking yes to find some people with some crushed faces a review surgery and when you don't make them like the way they looked before surgery so I forgot before they for that accident before surgery I so remember to make them look like they looked before they had the trauma so I was excited to go and so we we I I got the interesting thing is I was on the main media committee and I've been serving on the committee for some time or subcommittee and then I got a call sometime in January from from Phil Mills Mister Carlos you know Doctor Catalano was still too still in the human member has to step down from from the admissions position and we're wondering if you'd be interested in considering a human missions as it are as as a position or director of admissions at will you know I've always loved missions lumbar mission trips and things like that shirt under two days later he happens and I thought to myself what is that mean that we living for me and I was like this is offset by Doctor Catalano is grounded in so I we had to very quickly as a man as as an organization and decide what is our role as as healthcare providers in the disaster relief Jesus is not in our mission statement and yet we stand in a very very pivotal spot in a strategic area with all of us can actually participate help you in the event of disaster relief situations show trial by fire the next three weeks during his senior out how to recruit how to how to inspire our Avon members to go to heed to be involved it was who was quite an experience that we learn there were some growing pains there significant right thing they destroyed it was me getting on this DC-10 failed IDC three pale dragger where you can look right in the pocket that stuff that you need to know I was scared to death on this thing is like leaving any gesture of unity Marine pouring into the time that you know and you had to the pilot had his hand on the throttle couldn't take his hand off because if he took in his hand off the throttle automatically would would would pull back and you would lose thrust so you keep the Sierra Leone chemical 's hand on you don't hope it but you know they decided to adopt it was more information that I needed get out essentially so great guy we miss Jamie is quite quite experienced in their lessons here but I wanted that I want to tell you about Port-au-Prince are a large did not look like this and this is my experience by large will this look like this there were spots that did look like this but by and large a lot of the structure was still standing but who would go back into their homes and there is a risk of inaccurate shot taking there home down to look like that's so that's why the people were in the streets are living in tents okay there's still a lot of spirit infrastructure that we didn't have okay the media is not to show you that is a want to get the impact of the disaster Doctor Kinney Jory tag was visiting the camp of the president of Iraq's gave your attack was our trip leader I went with Mary Jane I can enjoy tagged Alitalia this this this is an example that each one of you have influence each one of you have influence in a situation such as a disaster situation you have more influence and then you're aware of this young lady got on the airway from the radio of the team contacted all of her colleagues she brings a hundred thousand dollars in a matter of weeks for the effort here in Haiti and I believe that there is a prosthetics lab that she helped you to set up with her father whose orthopedic surgeon she is a family practice doc that she was our trip leader real type a personality you know go getter she was our trip leader and quite an inspiration you know when when I found out that she wrote raise a hundred grand you know and in a matter of weeks I was like but all she did was use your sphere of influence in small Northern California town you know we live in tents preparedness when you go to forget about luxury set that aside you're going your going not for yourself all those things we left when we left feeling left everything this is not a gas of the truck in Haiti not always but usually needs that are set up a primary health clinic across the street from the hospital to relieved as part of an outlet for primary care patients okay so here I am a dentist that Penrose and oral surgeon and a promise to buy at that time I was oral surgeon and there was nothing for me to do everyone that had a maxillofacial trauma at either succumb to their injuries or have been repaired already owns two weeks out at that point but from their injuries are treated by some other surgeon at another facility so what was identity is a question that the deal with side help with the rest of the group set up a primary health clinic just across the street so that all the urgencies or that the other doctors could be free to the treat seventies amputation that got infected anything that might be surgically urgent it was possible they would be encumbered by people with belly pain or headaches or things like that little boy little toy this is kind of how they entertain themselves the campus of the address University became an outlet for a lot of leaves a lot of these people who just want to go home a lot of them still at home standing on but they are they want to this university and there's essentially twenty thousand people with tents everywhere like ten city there so there are definitely issues that were going to arise and have eventually your computer to other full fruition especially with the recent outbreaks of their stuff I show this picture because I want you to know that everybody was involved you know this is just without Borders tournament knockoff from a Doctors without Borders just no words that were then took over the situation in the hospital so that all the volunteers had US level or quality food and no one would get sick this is an organization in Southern California and central California a very very deep-pocketed organizations the message ID is a leading cause of this who believes he is very humanitarian and believes in and in restoring vegetarianism and then in keeping and restoring the world saving the world through humanitarian efforts they were there they were involved Samaritan 's purse which is an organization that let out by Billy Graham 's son Dale Rivera is hot at the Adventist University siphoning water from this large hole which had inlets from an artesian spring and they would purify water provided for all those people are in intensity campus of your receivers from showing you how many people were involved is not an original idea that we go in and provide relief this is the artesian spring so size tell you what why do I have dentist pull teeth for two days and adaptations in Argyle and pull it to and then he does I give them some time along to come back the next day and point to another to and I would look at and say yeah and that she would need to come out so I take that out and he put his hand and I to I gave you twenty of them yesterday and he'd be like and so I knew that he was taking him and going outside and Sally Newman you know the need was deeper than what I was thinking you know and so I had the kind of alter my pet my mind way of treatments I decided not to I wanted to do something a little more long-term slide inside of the late PVC I will run now is in the hospital leader all of their sisters went and did there was no municipal water supply they had nothing so I just worked with a group we can see your tagger and her father is a group of us and volunteers locally as easy all of this was feces infested swamp area behind the hospital we trekked all the way through that and see a listing we went all the way Barnett received University about two miles uphill that is artesian spring that was feeding the pool and on the other twenty thousand refugees on the campus of the University we talked that water supply and we feel the sisters praise God I felt like that was the most you know significant thing I did when I was there was an KMT you know so they knew the value that you got to be open-minded when you go it is actually a purchase on the direct specialty this is what I do I can't hinder anything else you know if you're open to fit this the Lord what is it that she wanted to highlight highlight provide for within these units little more university on your spectrum of a carrier training this is the crew eventually it was it was quite a glorious thing without water when you saw that water start trickling through and filling up the cistern norther when the tanks of the reserve in the hospital is the seeing them in their in the town this is a food market and it smelled like something else Malaga food market trip number two which was under the leadership of Doctor Catalano here and I hope that the name rapidly with Matthew it was a little bit north and this time this was a month later so the need is still there I'm in the need is still there today I remember we pulled up I had I will hold that had been the first missionary trip and they had in mind this is a missionary trip there is a different phenomena delineate this very clearly there is a difference between disaster relief and missionary trips okay and and I remember they were videotaping and say home while looking all to see the rumble with all the rubble and she was you know pretty much filming all of these these outflows water waterways that were full of trash and she was videotaping the charge saying that this was rubble from the earthquake and I said sister that's not that's not rubble from the desert from the earthquake that struck that in there for ever and you know the reality kind of set in only business this is this that was a disaster before the earthquake okay and it was a long perpetual disaster hence I decided to people in will monitor and while you will you are in and is in your will and you and you are wrong leadership unique you need an honest government you know I is in on again I'm saying is I don't know all the intricacies but I believe it starts with leadership in this United States in a few months the process whether fixing now are hard you know things that were just complicated by the earthquake you know there was believe I actually heard some of the some of the victims say yeah I lost a uncle I lost a brother by lost someone family member to this earthquake what do you think you were getting now and I thought to myself where you have to be to be okay with losing a family member so that you can get your needs your primary needs thinking you have to be pretty desperate to say something like that and so I would say that it met its leadership you know and if they take your suffix with your developed you know I remember I thought it was a great idea I'll need to speak soon as the balloons the kids and you know I I go to Bangladesh every one of some of any pollutants living in a straight line and each one gets the balloon works I was I have a picture here is my mom thought my mouth I was just positive figure polysilicon I have my arms up because if they come down to start pulling on my arm hairs because they want to balloon and it was so and I thought to myself this is probably a bad idea but I decided I said making balloons because it was so it was so intensity needed a balloon that it didn't get them balloon they were going to die it was like food and I thought okay this is a bad idea so I have to start rethinking what you mean hardware supply that need it's not a toy you know it's it's something it's something much deeper than that little boy methinks all problems are resolved soon as he got his balloon business at we eventually remember Doctor Galloway got it and we started blowing the balloons up in the truck and throwing them out through the back because if we stopped we would dispute my so we were just in the course is a survival of the fittest we are destroyed and give the kids something to laugh with to play with force which is the kind of take your mind off of awful lot of all the negative integer this is a voodoo house was empty of the guys are cracking was nothing really going on again some of say you know there's a lot of animals around us probably more wrote down on the floor when we went to our village ED eighty seven there was more going on on the lives and what there was no place you can staff that there was an go down into thinking there is to the steering around this I mean it remains a public health your project narrative spans several years from sure this is one of the clinics we establish the validity seven a.m. you know you do it she can but I was feeling like a camp here this is my trade only do something but all in all all the while going his people need more than this you know the need more than a truth hold so dear on disaster relief situation in a way when I would look at these patients I would think to myself these people are hard you know they're there they lost the need is so profoundly that they lost and show one night when I look at this quote by John Bradford English reformer and martyr best remembered for his utterance there but for the grace of God was John Bradford and these are words where that he uttered when Bradford by Bradford while imprisoned in the Tower of London when he saw criminal on his way to execution do we really understand the condition as of this is why to meet emissions and now disaster relief is is so profound that is where I go over there that the needs the physical means the basic the basics of life and means while they might be physical for the people point out what I think about myself I come back here to lunch I got water I have all my needs met water water what is my condition my spiritual conditions were my concern is when I have everything provided is so we have learned counsel about about reaching reaching those that are neither knew some of the more more the better no United is a notice to be greater than what I hereby whereby the disease only be reached in new fields no work is so successful is medical missionary work medical missionary work is to bear the same relation to work and the third angel of the third Angels message that that the arm and hand bear to the Bonnie the monotony of our service for God needs to be broken up every church member I love that the monotony of our service there is nothing that breaks the monotony of your service like getting out of your comfort zone instead getting really uncomfortable and in him for the sake of someone else the majority of our service regard needs to be broken up every church member should be engaged in some line of medical missionary service for the master and God reaches hearts your relief of physical suffering sometimes it's your very own heart and then that deserves agreement in on anything I think are distributed through their missionary work I was rebaptized a year ago and so sometimes when you're out there and you realize that you are teaching we got to helping these individuals were in such need that you are in such team but your need is a little bit different you know and that's when God says I got so will the medical missionary work is to relieve human suffering and by doing so you create inroads to the soul and by doing so you introduce the victim to Jesus from the above mathematical equation takes a little longer developments in a disaster scenario this is where I want to try to draw the line of distinction this is not a mission trip we were number one the need is somewhat controlled number one disaster relief work pre-existing knee becomes profound in a wife by way of example our member can I ask you telling me I just met this kid and he says where are my shoes where are my shoes I thought originally I don't know issues and bring them he was like eight years old with so much assertion so much additionally I remember going to evangelistic meeting where her brother here was was country and I sat down places full I sat down next to a young man and I was I was very quiet I was actually guy said our mix and get his Bible and and he was he was listening test leads them to Doctor Thompson is he as he preached just he was maybe fifteen years old to specific and taking notes and writing was like Prince God Norton who missed all of the staff members people are still searching but the need is still there the physical need is still there and still I sat and looked at him and I don't try not to be true to deliver it but I reached in my pocket and I pulled out two dollars dollar had in my pocket and was he when he took a break and looked away I grabbed his Bible a little to me very slowly they look back to the notice Bible was going to the dollar two dollars on the right hand slipped them into the Bible slogan I keep listening and he saw me actually fight back to it shall be opened to where he was a season two dollars and he looks at me and says our so what exactly is as I was thinking that he is not two dollars the need is so profound is so profound and yet I have the mindset of I was on a mission trip I wasn't on disaster relief the understand kind of the difference in the facility to sometimes spiritual anxiety and mission works Virgil seems to be introduced right at the outset and and and spiritual themes you can try but sometimes I think instead I feel like sometimes there because they're there feeling that there is the handout after the speaker CEQ and you can't see can be negative towards that because the need is still there and so you know it shouldn't keep you from presenting spiritual things as long as you understand sometimes not before of the victim 's mind VisualWorks number three the most humble thoughts are often working with very humble spirited people who put in work before you got there euro and brought people to the clinic brought people to evangelistic crusade and end in disaster relief or even a lot of opportunistic birds a sense of entitlement aggressive behavior that any and again you have to be sensitive to you just can go relaxing these people think they are builders and is neither that's why the number four course officers organized communication and disaster relief there is often chaos in a disaster everyone wants to go we talked about this many individuals many governmental and NGOs involved in member when I was leaving when I was leaving Haiti I received helicopters and in every country the airport was followed just of the so many other church organizations and NGOs that were there I highlighted this logistics and communications chaos because this is one of probably the most the most biggest challenge that you have that situation around because my only thing that sentiment is on mine this is an article written in the American Journal disaster medicine international response the two thousand four Southeast Asian tsunami was noted to have multiple areas of poor coordination in two thousand five the health cluster approach the court to coordination was formulated while that's wonderful what the cluster log parser is a group of agencies organizations and/or institutions working together towards a common objective rises to address the needs in a particular sex sectors such as health questions especially if the call group and there should be no differentiation between the two terms of their objectives and activities that the aim of filling gaps in ensuring adequate preparedness and response should be the same with the cluster approach a cluster approach is a way of organizing coordinating cooperating among humanitarian actors to facilitate joint strategic planning at country level it number one establishes a clear system of leadership and accountability for international response in the sector and are under the overall leadership of the American coordinator and to provide a framework for effective partnerships among international and national humanitarian actors in each sector the aim is to ensure the international responses are appropriately aligned with national strike on structures and to facilitate strongly condemns among international organizations national authorities national supplies civil society and other stakeholders that was buying world health organ as last year wonderful everything is in place well in this statement is however the state in the two thousand ten he was just that many of the same problems continue another significant limitations such as inconsistent attendance poor dissemination of information and a perceived lack of benefits to providers and victims so return is still in the same place why why is this well chiefly because there aren't that many disasters happening sequentially one right after the other right and so I poured all this these funds in these efforts into these organizations to be prepared for disaster no disaster happened and sometimes that money has to be redirected into other things that are more you know that that are more urgent at the moment all of a sudden a disaster happens are back to square one if you yeah and you know if this is this is an article this is an article in the secular art journal she have to think that people go to disaster relief scenarios are seeing and relief efforts to get something out of it you shed any light like when you get because people like to go on mission trips especially when you gone a humanitarian effort to see what experience I can get on the go on a trip to do cleft lip speakers I don't be classless back in the United States jeered one there with the effort not to give you going to get some ornaments of experience so there's some of that sentiment that I didn't really get anything out of any training and experience are so all over the site and share with you what your role as a healthcare provider is a disaster relief aid with me my secret my last few slides so a disaster happens and what you do what you got to find the time the time from school the time practice you just can't pick up and go usually there's patients that depend on you so and so forth so you need to decide to what extent can I get involved can I get involved can I get involved in directly after funds through support for another organization even if I can go number to get in full you know who is who's involved in the primary secondary assessment and only refuge you have no idea how many times you hear an anecdote from this group are don't go all the needs are already met you don't have to go everything is taken care save your money you are so glad I didn't listen to those you know because the need is still there today if you decided to go today and often register about Haiti China try to give you that but the overall perspective this is the same situation that happens in all disaster situations you know this is the same thing happens there still needs month after all the hype and all that you know the the media attention has gone so make sure that you're getting your information about the needs over and that in that particular place and are they reputable do they have to split up on site logistic people that are giving you correct information to get a team together there is safety in numbers corporate efforts materials and funding can need your tag as well as and David and David Vaynerchuk has been going on you know David's was a was a mission trip that turned into disaster relief mission trip as well because even going to Haiti every year with the group so in an end by the way that trip is still available for those of you are interested this March February March so keep that in mind that the knee process are you together you know can he had everything life she thought of everything in there some people are born for this I am not she had every detail covered funeral from where you get water wondering what is your exit strategy and I cannot have that their download list here what's your exit strategy what happens if you buy Haiti in something happens violence happens how you get on the country can you get into Dominican Republic you have a contact in Dominican Republic you know you have to think about those things are get support from an organization and this is you know as amen members call us okay call us because we team up with Pax World weekly chemo with address Loma Linda ACS Weber is on-site we came up were not a disaster relief agency that we like to provide our members with opportunities to get involved with with whatever's going on in the way of relief so call ice feel free Ricky hears RAR are missions coordinator okay and I am the director of missions so call us and if we know something will let you know will tell you who's involved to contact so that you can get writing again we talk about getting an exit strategy a contingency plan is it safe to go right now and if I go can I get out how Armenia don't forget you have to think about those things because they are still people here in these United States of America need you to patients and families on and so forth you have to think about that be prepared personal items make sure you have things you know that you mean to subsist because sometimes you can't find them there and educate yourself and I remember when we got to the move the plan was to stick together okay get to our site and build don't get diverted were distracted so we're getting thinking this is a mission trip and saw that the thing was to get through the airport with your luggage in hand get on the bus and let's go but there were people managing all I want to talk real with that with that with the locals while you start on the grill with the locals which is not part of the plan is your mission you have a directive and show it off they start amassing a group of people on these people are the must have money that they want to communicate with us and sure enough for me when when it was time to get on them by sending this this particular couple had an issue turns it trying to grab their their their luggage get on the bias because all the locals wanted to help them and then get paid for it so when they were given in a couple box unit that was offensive because it was a group of gentlemen party breakdown so they seems to think about okay be flexible this is not about you like we said this is about the people right this is about the people even though you know you may have gone on a mission trip we got a warm fuzzy feeling so that was great I loved it people love me I love them be creative there are many ways to do the same thing and often many of those different ways of doing it are by the locals that teach you your way is not the only way be open-minded don't column this is not the way you know be sensitive be culturally sensitive and that comes part and partners with educating yourself and again peace be fixed in you may not if the warm fuzzy feeling is seeking but they shouldn't be why you are there be ready to do whatever is necessary okay again I have friends writing back I told him that I had a late high through through extra minute infested fields who were foolish I would never do not you know whatever is necessary to alleviate human suffering that's why you went ready to work with locals we talk about that be like Jesus think about that when you're there at yourself in the situation where where you know these think about what Jesus would do I hate that sounds really really cliché but you sometimes have to step back and think what Christ to institute in such a situation be ready to return when the hype is over but the need persists so this is why were so inviting you to Haiti in February with Doctor Catalano lessons learned in Yosemite there really think we prepare to do it ever is necessary to teach the victims to cinch okay better in the fish are teaching the fish feature with this teacher would take care of themselves teaching them to fend for themselves teaching the gross stop teaching to the phase sensitive to take care of their food and choose choose dates and to whatever extent they can to take care of themselves nutritionally the best way they can to keep your food clean to get it out keep your animals away from your food sources I get your information for equitable source again sometime Journal reputable sources and the only way of knowing is by going you might have to make that decision pray about it and and move upon whatever inspiration got partner that warm fuzzy feeling you may never get a few numbers significant spiritual impact often necessitates a sustained presence after the disaster is long forgotten and ultimately that's why were there were there so that Christ could rain and so is in a disaster situation is much more intense it's much more surgical compared him here so you got to be little more aggressive that they get in there and make an impact and make a difference and repeat the effort so that eventually someone going there and preach evangelistic campaign eventually reached the will this year was produced by audio verse four amen medical management to learn more about Nina please visit www. nine hundred and I will like the more free online service please visit www. on universe

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