Responding to crises

In 2014 the world watched in horror as the biggest outbreak of Ebola in history spread with unprecedented speed across West Africa and beyond. News reports showed desperate scenes as healthcare workers clad in bulky HAZMAT suits struggled to cope with the crisis.

FACEM Rick Brennan remembers that period clearly. As Director of the Ebola Response and Coordination Team based at the World Health Organization’s (WHO) headquarters in Geneva, he was in the forefront of support efforts to address the rapidly escalating emergency.

“There were so many aspects to that outbreak that were unprecedented,” Rick says. “It was the first time Ebola had crossed borders to become a multi-country phenomenon; it was the first time the virus had entered urban environments and also the first time it had been seen on this scale.”

In two presentations at the ACEM 2017 Annual Scientific Meeting in Sydney in November, Rick will be considering some of the lessons learned during that extraordinary time and also reflecting on some of the other experiences he’s had working with the WHO in international disaster response.

Do not miss the opportunity to attend the ASM and hear keynote speakers like Rick. Register now! 

The hot zone

Although it claimed over 11,000 lives and is still the most serious outbreak of the disease on record, the Ebola crisis of 2014 is only one of many humanitarian crises that Rick has encountered during his career.

After gaining his ACEM Fellowship in 1990 and working at the Westmead Hospital in Sydney for several years, Rick completed a Masters in Public Health and spent most of the following 20 years overseeing different humanitarian programs around the world.

He joined WHO in 2012 as Director of the Department of Emergency Risk Management and Humanitarian Response. He was appointed Director of the Ebola Response and Coordination Team in October 2014.

Although it’s since been superseded by other global crises, in the middle of 2014 much of the world was terrified by the spread of Ebola in West Africa. In September the number of new cases emerging across Sierra Leone, Guinea and Liberia had reached over 950 per week and 3,000 people were already thought to have died.

“The outbreak was escalating at an exponential rate and outpacing our strategy for dealing with it,” Rick recalls. “We didn’t have the resources or the capacities to catch up with it.”

“One respected public health institution estimated that we’d have 1m cases by 2015.”

Taking control

Following a field mission and collective dialogue with senior government officials, Rick and his colleagues proposed a dramatic scale-up in the WHO response.

“We didn’t have the healthcare capacity in country to deliver the treatment required and we only had one international agency – Médecins Sans Frontières (MSF) – who had experience in managing Ebola treatment centres,” Rick recalls. “So we reached out to other NGO partners who had never done this before and worked to provide them with the training and resources they needed to work effectively and safely on the ground.”

Rick gives credit to his fellow FACEM Dr Ian Norton – who leads the WHO Emergency Medical Team Unit – for leading the efforts to create what became a network of over 50 Ebola treatment centres.

“Ian did a tremendous job in coordinating the many different NGOs involved and carrying out the design and building of the treatment centres,” Rick says.

"At the peak of the crisis there were nearly 1200 WHO staff working across 70 field sites in three countries. This is by far the largest field operation ever managed by the Organization and I am unaware of anything similar in scale from any humanitarian agency in response to an international crisis."

Local heroes

While the work of international staff and volunteers often grabs the headlines, Rick is at pains to stress that the vast majority of work to address the crisis was carried out by local healthcare workers.

“It’s the people from the countries that were affected who led the efforts to bring the outbreak under control and who deserve the most credit,” he says. “Over 300 of them died.”

One of the crucial turning points in turning the tide, Rick believes, was the role these local healthcare workers played in getting communities on the ground to understand the virus and change their behaviours.

“In these countries when someone dies, the body is typically washed and hugged,” he says, “It’s an important part of their culture to touch the body of a loved one, but the body of an Ebola-infected person is more infectious than a live carrier of the disease, so in the early stages of the response, teams of healthcare workers were going into infected areas to collect and cremate the bodies.”

This horrified local people and prompted them to hide the bodies, which amplified the outbreak.

“We had to engage sociologists and anthropologists and work closely with local healthcare workers to determine a better approach,” Rick says. “They knew how to speak to their communities and create an understanding of what the disease was and how it was spread and subsequently we found a way to make burials that were safe, dignified and – as much as possible – observed cultural practices.”

In closing

It’s a sad fact that Rick – who has moved into a new role as Director of Emergency Operations, overseeing support to WHO teams responding to outbreaks and crises from all causes  –  is busier today than he’s ever been.

WHO rates humanitarian emergencies over three grades, with the most serious type of event – a Grade 3 – typically occurring approximately once every 12 to 24 months.

Currently there are eight Grade 3 emergencies around the world.

“There’s more people in need of humanitarian assistance and forced from their homes than at any point in human history,” Rick says. “Not only do you have these crisis situations, but in most of those countries we have major outbreaks of infectious disease.”

“In Yemen for instance the on-going conflict has resulted in a humanitarian crisis of enormous sale that receives scant attention from the international press or global leaders. There are more people in need of humanitarian assistance – 18.8 million – than any other country in the world. At the same time, the country has been battling a major cholera outbreak in recent months, with over 800,000 cases. Currently, we also have teams responding to the conflicts in Syria, Iraq, South Sudan and the Democratic Republic of Congo, while managing major cholera outbreaks in six countries and rapidly scaling up efforts to prevent a cholera outbreak among the Rohingya refugees in Bangladesh."

This means the WHO is under constant pressure to improve its preparedness and readiness and work more efficiently and effectively with limited resources.

But despite the scale of the crises he has to address, Rick has no doubts about the role he’s playing.

“I feel privileged to be in this field, because I get to work with so many committed, passionate people on projects that can benefit whole communities," he says. “At the same time, my colleagues and I take great inspiration and encouragement from the dignity, courage and resilience of those whom we serve.”

“Despite its challenges, it’s an absolute honour to do this work and I never forget that.”

A compelling and interactive program

This year’s ASM will be held in Sydney from 19-23 November at the new Sydney International Conference Centre, and will focus on the themes of ‘Impossible is just a perspective’ and ‘Getting the balance right.’

The meeting will offer a compelling and interactive program, broad enough to cover the full gamut of emergency medicine, with a line-up of the most inspiring, entertaining and knowledgeable speakers in the emergency medicine world today. Each will be taking on the hard topics and exploring the nuanced discussion, plus cutting-edge research and novel ways to translate into practice.

Check out the program and registration details on the ASM website.

Bondi to Coogee Walk followed by Breakfast at 'The Bucket List'

As part of the ASM's wellness activities, you can join a relaxed Rick Brennan speaking on "A road less travelled in EM" offering insights into his remarkablec career with humanitarian emergencies and in post-conflict settings in over 35 countries across Africa, Asia, the Middle East, and Eastern Europe.

The walk with Rick takes place on Tuesday 21 November 2017 from 6am.