Dr. Paul S. Auerbach is no stranger to human suffering. As professor of surgery at Stanford University's Division of Emergency Medicine, he's seen more than his share of crises. But he wasn't entirely prepared for the devastation from the 7.0 earthquake that struck Haiti on January 12 of this year.

Auerbach was part of an eight-person medical team from Stanford, working under the auspices of the International Medical Corps, that responded within hours of the disaster. The group's mission was reach to Haiti as quickly as possible, then do whatever it could to treat the wounded and the dying.

They had no idea of the obstacles that stood in their way.

Chief among them was a broken supply chain - not the kind of problem that typically occupies the mind of a skilled emergency physician. In Haiti, Auerbach and his team could ignore it no longer. "Everything I know about supply-chain management, I learned in the two weeks after the earthquake in Haiti," he said at a recent Stanford conference on social issues in global supply chains.

Now he's back with a number of valuable lessons on maintaining supply chains in times of crisis. Even if you're not facing a life-or-death situation, Auerbach's advice is well worth heeding.

Start with the difficulty of reaching the scene. The Stanford team was at the Santo Domingo airport in the Dominican Republic within 36 hours. Assuming that there wouldn't be much in the way of critical supplies on site, they had brought along as much as they could pull together on short notice. Now it was a question of getting into Haiti.

Easier said than done. A hoped-for helicopter never materialized. What they got, after a frustrating delay, was a small chartered bus and an invitation to follow a Polish national search and rescue team into Haiti. The vehicle had to hold all of the Stanford doctors and nurses, along with their gear. During an all-night ride, the bus broke down and had to be replaced.

The team finally made it to Port-au-Prince, Haiti's capital. They found utter devastation, and suffering beyond imagination. "Hardly a building was left standing," Auerbach recalled. "It was a sea of death and misery." There was rioting, looting and sporadic gunfire. Port-au-Prince's University Hospital, where the doctors set up operations, was a hospital in name only, in that it lacked even the basics of medical care. And there were hundreds of the critically injured to be treated.

Over the next two weeks, the Stanford team would work 22-hour days, much of that time without the benefit of pain medications and other vital supplies. A makeshift operating room conducted non-stop amputations. Doctors improvised traction for broken bones by hanging cinder blocks from casts. There was no system of medical records, so they wrote on the patients.

Compounding their frustration was the fact that necessary medical supplies were sitting at the airport but couldn't be accessed due to bureaucracy and a lack of security. Finally, the U.S. military stepped in and got the shipment to the scene. "They were our supply-chain battalion," said Auerbach.

The Stanford specialists worked alongside teams from many other locations, including Boston, New York, Canada, Switzerland, Norway and Spain, aided by relief organizations such as the IMC, Doctors Without Borders, Partners in Health and various national branches of the Red Cross. But all of those groups together couldn't entirely smooth out the supply problems that accompany disasters of this magnitude. So Auerbach offers a number of lessons for supply-chain managers who are responding to a crisis:

Plan ahead. "Avoid the mad scramble that will occur in any crisis situation," he says. Be prepared for likely occurrences, and stock supplies accordingly. Have your passports available and your vaccinations current. Be ready to depart for the scene within 12 hours or less.

Have someone on the ground to receive and shepherd critical supplies. Emergency items are of no use if they can't be properly received and shielded from looters.

Have multiple methods of moving supplies. That helicopter you were counting on might not be waiting for you after all.

Know how to work with organizations on the ground. Numerous groups are sure to be on the scene, including government agencies and non-governmental organizations.

Put one individual in charge of your efforts, if possible. In Haiti, Auerbach said, "there wasn't time for a whole lot of committee work."

Stay connected in your chain of command and various relationships. Disasters are always accompanied by a high level of chaos. It's easy to get disconnected from key people, especially when basic methods of communication aren't functioning.

Apply fundamentals of good leadership. Conduct regular meetings with your team to review all activities. Use praise as "currency." Remove egomaniacs and hangers-on quickly. Handle personnel problems in private. And stay focused on your mission. "Remember you're there for the victims, and not vice-versa," said Auerbach.

Be wary of the press. "With the media," he said, "nothing is off the record." Ouch.

Auerbach expects the team's experience in Haiti to provide the basis of a more formalized system for disaster response. Private companies can learn from it, too. No response effort is ever executed perfectly, but there are some basic steps you can take to reduce the number of obstacles you'll encounter.

Want to help Haiti? The Emergency Department of the Stanford School of Medicine welcomes donations to its program. You can donate to the International Response Fund of the American Red Cross here. UNICEF has been instrumental in helping the children of Haiti. And don't forget the links already given to Doctors Without Borders and Partners in Health.

To read more about the Stanford team's experience in those harrowing first two weeks following the quake, check out Auerbach's from-the-scene blog.

- Robert J. Bowman, SupplyChainBrain

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