Boots on the Ground

By Sylviane Duval

Dateline: Haiti, January 2010. Robin Cardamore, a fourth-year resident in emergency medicine at McGill, does her rounds in a field hospital. She learns that the elderly woman in Tent 2, Row 8, has not heard from her family since the recent catastrophic earthquake. Cardamore circulates from tent to tent, piecing together fractured information about who might know whom. Hunches are played, calls are placed and — after a tense wait — good news is finally relayed back to Tent 2. A happy ending, yes, but Cardamore is struck by the disconnect between medical care and the inability to organize follow-up. She decides to develop a patient-tracking system that health care workers can use in hand-held devices. This is McGill’s brand new Humanitarian Studies Initiative in action.

Formal humanitarian relief is a relatively new phenomenon. Launched in the mid-1900s by the Red Cross, it gained incredible momentum with the formation of Doctors Without Borders in the 1970s. Since then, a number of organizations have sprung up, each one marching to the beat of its own drum.

In 2005, Dr. Kirsten Johnson, now a professor in McGill’s Faculty of Medicine, was studying for her Master’s in Public Health at Harvard. She found herself shoulder-to-shoulder with heavy hitters in the humanitarian field. Together, they founded the

Dr. Kirsten Johnson, of McGill's Humanitarian Studies Initiative. (Photo by Rachel Granofsky)

Harvard Humanitarian Initiative, a complement of courses and materials designed for graduate students and medical residents interested in relief work. (The program now attracts a full complement of 150 students twice a year.) In 2007, Johnson moved to McGill and brought elements of the Harvard program with her to create the Humanitarian Studies Initiative (HSI). Harvard and McGill are now the only two academic institutions in the world to offer this kind of comprehensive training.

The long-term goal of the HSI is to standardize the way humanitarian work is done and to professionalize the practitioners. That means doing the research to see what is needed and training people to do it safely and effectively.

“We just can’t have young people, barely out of their teens, being sent to manage refugee camps anymore,” says Johnson. “Ultimately, it wastes money and, worse, it costs lives!”

The McGill program involves a core Harvard course on humanitarianism; a brutally realistic three-day field simulation; a series of modules on climate change, urban planning, international law, anthropology, epidemiology and medicine: a one- to three-month field placement; and a final project. Students graduate with field skills and field experience, a solid base of theory, ethics, history and research techniques as well as a certificate in Humanitarian Studies — on top of the requirements of their main program — on which to build a career.

The Humanitarian Studies Inititative's goal is to standardize the way humanitarian work is done around the world, such as in this field hospital to help victims of the Haitian earthquake. (Photo by Normand Blouin)

“People want to help out after natural disasters,” says Robin Cardamore, the fourth-year resident who worked in Haiti, “but they don’t know how to get involved or how to be useful. This program gives us a framework around which to apply our skillset to humanitarian situations.”

As happened during Cardamore’s time in Haiti, HSI field placements often result in innovative new practices. Other times, they lead to the creation of standardized data, or a needs analysis or a policy position paper — all invaluable resources in the desperate push to provide evidence-based patient care and to improve delivery of services. Marie-Renee Lajoie, a resident in family medicine, has developed a survey to examine how NGOs use community health workers, how these people are paid and evaluated, factors contributing to retention levels. The resulting data could help in delegating certain duties to competent personnel in order to free up physicians for tasks that need their expertise.

“It’s an enormously exciting area for research not only because it’s so new, but also because of the new methodology we’re creating,” says Johnson. “It requires creativity in our research methods because these aren’t randomized, double-blind studies done in clinical settings. We’re in war zones, dealing with populations on the move, with linguistic and cultural barriers. We have to hit the ground running.”

Johnson herself is used to dodging bullets — literally. She and her colleagues are studying sexual violence in war zones, notably the eastern Democratic Republic of Congo. They will also be among the first to document politically motivated gender-based violence, such as the voter intimidation tactics leading up to the 2007 election in Kenya. This work is expected to inform justice and peace-building activities in the run-up to the 2012 Kenyan election, as well as address gaps in current services and meet the needs of survivors.

“We can be advocates for populations that don’t have a voice,” says Johnson. “We can make a difference for the people we’re trying to serve and enhance the standards of practice in the field.”

This is only the second year of McGill’s program, but it’s attracted such strong interest — not just from medical students, but from engineers, political scientists and others — that Johnson has opened it up to all graduate students. She receives requests every week from students around the country.

“I want to create a community here for organizations that don’t have their own research to draw upon. I want to build the program, mentor kids,” says Johnson. “Humanitarianism is a booming industry and it’s only going to get bigger. The JFK Hospital in Monrovia, Liberia, needs a trauma database — information on injury patterns to determine the key services it will provide. And I have access to people at McGill with this expertise. Nobody else is doing this kind of work in Canada.”

Kirsten Johnson is an assistant professor in the Faculty of Medicine, interim director of the International Division in the Department of Family Medicine and co-director of the HSI. The HSI is not funded but keenly searching for benefactors.