Haiti & Texas & Silicon Valley

In Judiasm we pray that "our houses will not become our graves."

Throughout time, our land has been restless, unpredictably moving. Sometimes our history records that mountains skip like rams or lambs.  So last week's events which destroyed life, limb, homes, hospitals, the economy and infrastructure on the Haitian end of the island through which a known geologic fault coursed, was in a sense, not a surprise. It is the way of the world.

Now we hear whining self-promoting television reporters complaining that Haitian medical facilities are inadequate, that there are not enough operating rooms, that there are insufficient numbers of physicians and nurses, that there are not enough beds, that there are insufficient supplies of equipment and medicines.  Sorry, but these same insufficiencies in Haiti did not make CNN headlines before the dramatic earthquake, so why the feigned surprise.  Haiti is a poor country led by stealing despots who have kept their people in the prison of poverty for years. Health care was not a leading priority. No-one traveled to Haiti to get first class health care.

I have lived in Silicon Valley for more than forty years. Our geography reflects our precarious perch where two geologic plates meet.  In 1985 we had an earthquake with the most rapid ground movement ever recorded (I was on the 9th floor of a medical building on my belly holding on). The building had been properly earthquake engineered and survived that event without damage. In 1989, just as I finished seeing my last office patient for the day, a 7+ (Richter Scale) earthquake (comparable in scale to the Haiti earthquake) tore through our valley where it produced relatively little damage to our health care infrastructure because we had stringent earthquake building safety codes  Fortunately the hospital where I had been chief of staff and board member had remedied a potentially fatal weakness in its structure five years earlier.

So what does all of this have to do with Haiti  and Texas?

More than 30 years ago, a study, which in my opinion was of poor quality, was published in Texas which became the touchstone for generations of hospital closures.  The study described the savings which closure of hospitals which were not overflowing with patients, could reap.  Nationwide, citing this weak study, hospitals and medical facilities were pressured to close because they were "inefficient" and money could be garnered if their equipment was sold to speculators or third world countries and their land used for commerce.  Some for-profit hospital companies speeded-up this process of closure as they acquired competing hospitals and closed-down the competition with relatively little in the way of active opposition from government entities.

So when we have our next big earthquake, if Los Gatos' Lexington Dam collapses innundating several medical institutions in the flood plain below it, and the closed hospitals are not there to absorb the flood of sick and injured patients, and the doctors who have left the area are no longer available to provide services, will CNN be there to say "we should have learned from Haiti" or will they simply rant and rave until the publilc loses interest and turns to other entertainment.

Or if we have a terrorist dirty bomb, or a high-powered nuclear weapon attack, where will we take care of our population and who will take care of our people? If we have a horrible epidemic or biologic or chemical attack, where will we take care of our population. What if we have a natural catastrophe of greater magnitude than we have in our local recorded history? Will we resort the curbside medical care, hacksaw amputations and mass graves?

Many of the issues which existed in Haiti before the earthquake have comparable issues in the United States today. If the focus of "health car reform" is to wring every dollar out of health care, without concern for quality, ethics, availability and competence, perhaps we had better hope that the Israelis can set up emergency hospitals in our big cities because our government has demonstrated that it cannot. Some duplication in health care facilities and personnel, as protection against injury and illness resulting from an unplanned catastrophe, is an imperative. Shall we ignore the lesson of Haiti?