1. Cultural & Ethical Issues Disaster Medicine in a Foreign Land

2. Cultural & Ethical Issues  Objectives  Preparation  Cultural limitations  Gender effects  Language barriers N Engl J Med. 2010 Mar 11; 362(10): e34.

3. Cultural & Ethical Issues  Language barriers  Professional interpreters optimal

4. Cultural & Ethical Issues  Language barrier  Clinical situation  Availability  Patient preference  Language gap

5. Cultural & Ethical Issues  Gender bias  Women highest mortality  Not taught to swim  Clothing restricts motion  Cannot leave home without male Asia Pacific Forum on Women, Law and Development (APWLD)

6. Cultural & Ethical Issues  Gender bias  Women poorest medical care  Males restrict mobility and contacts  Women maintain household Asia Pacific Forum on Women, Law and Development (APWLD

7. Cultural & Ethical Issues  Preparation  Stay tuned to World News  Hurricanes  Wars  Famine

8. Cultural & Ethical Issues  Preparation  Earthquakes & Tsunamis  demand an immediate response making you dependent on your group

9. Cultural & Ethical Issues  Preparation  Hurricanes  Wars  Famine  Time to study Central Intelligence Agency

10. Cultural & Ethical Issues  Preparation  Hurricanes  Wars  Famine  Time to study U.S. Department of State

11. Cultural & Ethical Issues  Preparation  Hurricanes  Wars  Famine  Time to study

12. Cultural & Ethical Issues  Preparation  Hurricanes  Wars  Famine  Time to study  Most important  Call

13. Cultural & Ethical Issues Haiti, Disaster Medicine: the Tale of Two Earthquakes National Geograhic

14. Cultural & Ethical Issues Haiti, Disaster Medicine: the Tale of Two Earthquakes Google Earth

15. Cultural & Ethical Issues  Haiti before the quake  Geography and culture http://svs.gsfc.nasa.gov/vis/a000000/a002600/a00 2640/ Wunderground.com

16. Cultural & Ethical Issues  Haiti before the quake  Geography and culture  Population & location

17. Cultural & Ethical Issues  Haiti before the quake  Geography and culture  Population & location  Law & order wikipedia

18. Cultural & Ethical Issues  1994 before LA quake  Geography & culture Wunderground.com

19. Cultural & Ethical Issues  After the quakes  neighbors Wunderground.com

20. Cultural & Ethical Issues  After the quakes  Neighbors © 2011 Los Angeles County Fire Department

21. Cultural & Ethical Issues  After the quakes  Neighbors  Search & Rescue USAID_IMAGES' photostream © 2011 Los Angeles County Fire Department

22. Cultural & Ethical Issues  After the quakes  Neighbors  Search & Rescue  Trauma Care U.S. Coast Guard www.gettingprepared.info

23. Cultural & Ethical Issues  Medicine after a Disaster  Principles  Cannot do the best for each individual victim  Do the best for the largest number of victims http://www.agenciabrasil.gov.br/media/imagens/2010/01/1 4/14.01.10RP5967.jpg/view

24. Cultural & Ethical Issues  Medicine after a Disaster  Principles  Cannot do the best for each individual victim  Do the best for the largest number of victims Fink S. (2010). Doctors Face Ethical Decisions in Haiti. Retrieved from: http://www.thweorld.org/2010/02/doctors-face- ethical-decisions-in-haiti/

25. Cultural & Ethical Issues  Medicine after a Disaster  Principles  Cannot do the best for each individual victim  Do the best for the largest number of victims  Do what can be sustained locally Ann Intern Med. 2010 Jun 1; 152(11); 733-7.

26. Cultural & Ethical Issues  Historic Twist  Antisepsis Orthopaedics in an Austere Environment

27. Cultural & Ethical Issues  Open Wound care

28. Cultural & Ethical Issues  Lack of Fluoro

29. Cultural & Ethical Issues  Lack of records  Lack of follow up

30. Cultural & Ethical Issues  Women are at a disadvantage before and during a disaster  Professional interpreters facilitate medical care everywhere  Limit your surgical goals to match environment, culture, materiel and personnel to prevent further dysfunction  World history and geography are great hobby