By Frank Stadler, Professor of Humanitarian Logistics Peter Tatham and Professor of Infection Prevention and Control Ramon Shaban Griffith University
An earthquake hits or a tsunami washes over land and another town lies in ruins. Among the devastation sniffer dogs scramble nose down over rubble to find the dead and injured. But what if we could harness animals not only to rescue but also to heal the injured? Frank Stadler and colleagues from Griffith University say that the humble blowfly can assist first responders and healthcare providers in the treatment of wounds and prevent infection in austere environments.
The international spotlight during humanitarian crises is always firmly fixed on casualty scores, the need for food and shelter, and on communicable diseases such as diarrhoea and malaria. However, crises like earthquakes, civil unrest and general poverty invariably result in far greater numbers of people being injured than killed. Wound care under austere conditions is challenging and as a consequence necrosis, wound infection and debilitating chronic wounds are common. Here we outline how Maggot Debridement Therapy (MDT), the use of living fly larvae for the treatment of problem wounds, can assist first responders and medical aid agencies in the provision of highly efficacious wound care and clinical decision making in resource constrained healthcare environments.
There are mainly three areas in humanitarian and emergency medicine where Maggot Debridement Therapy could be deployed with great promise:
in the event of natural disasters such as earthquakes and tsunamis;
in response to man-made mass disasters, including industrial accidents, explosions, transport disasters, and terrorism; and
in developing nations where healthcare systems are unable to provide effective acute and chronic wound care.
To our knowledge, however, there has not been any routine use of Maggot Debridement Therapy in humanitarian medical aid despite its obvious utility. Medical maggots are highly selective and efficient micro-surgeons that, when introduced to a wound with lots of damaged tissue, will only feed on and remove the dead tissue outperforming surgical sharp removal of dead tissue with the scalpel. While medical maggots are busy cleaning the wound they also suppress and fight infection including those pathogens resistant to antibiotics. If that wasn’t enough, there is now good evidence that medical maggot digestive excretions also stimulate healing and tissue regeneration.
This triple action should make medical maggots a therapy of choice after disasters when a large number of patients need to be treated and when timely prevention of infection is of the essence. Because medical maggots perform the task of surgeon, antibiotic and growth factor, they should be also the preferred method of wound care in developing nations where healthcare providers do not have access to many skilled surgeons nor modern wound care technology and advanced dressings.
A thought on the collaborative behavior between the actors in a supply chain by Sabari Prasanna
Collaborative behavior between the actors in a supply chain has been a matter of research interest to scholars since the past two decades as soon as the concept of supply chain management found light. Organizations collaborate between each other in the chain due to several reasons. The simple reason could be route to market for a specific purpose – example RIO Olympics 2016 (down stream) or for instance at a strategic level– joint product development, or joint cost reduction. Such collaborative initiatives were found existent based on mutual benefits to the collaborators.
In one of the recent studies it was found that there are some reasons that are accountable for failure of collaboration – the desired outcome not being met over a period of time. This is due to the dependence asymmetry and power asymmetry. Such dependence and power does develop from the fabric of organizational culture that binds one organization together. On the superficial sight the seemingly compatible organizational culture with the partner organizational culture initially bound on emotional ties later start to lose strength to hold together. Some of the fundamental aspects of organizational culture as manifested through trusting relationship, dependence, commitment, information sharing and mutuality provide answer for the strength of the collaborative behavior.
Collaborative behavior does influence the performance of supply chain in a disaster or humanitarian situation. In the reconstruction phase of a disaster when actors come together to rebuild a place / provide relief to displaced people the need for new products and smart products (energy efficient) call for collaborative approach between the supplier and the humanitarian buying organization. While it can be understood that the need of the hour is the priority, organizations do have a robust R&D facility to quick build/rebuild products that best fit the needs of the buying organization (UN / Red Cross, etc.) providing enough space for trust, mutuality, commitment, information sharing and dependence to influence the collaborative relationship.
Humanitarian logistics, humanitarian operations management, humanitarian supply chain management – these are not only topics that the HUMLOG Institute are working with, but also themes that are becoming more and more popular at various conferences. I have myself attended several conferences and have had the joy to sit in at many presentations serving the most recent finding from research projects around the globe. However, many of these conferences are focused on operations management and supply chain management, which I realise can give a skewed picture about how relevant or popular humanitarian issues seem to be in academia. I am working in the HUMLOG project on Cascading innovation upstream the supply chain (CAIUS), in which we study public procurement for innovation and emergencies in Finland, and decided to go to a public management conference - the Annual Conference of the International Research Society of Public Management (IRSPM) in Hong Kong in April this year – to see what’s going on in that field. In this blog post, I elaborate on the discussions going on there, and compare them to the Annual Conference of the Production and Operations Management Society (POMS), which took place in the beginning of May.
First of all, I noticed that the healthcare area has earned a special place in public management, just as it has in operations management – both societies have established special interest groups or colleges around this area. Secondly, purchasing or procurement have panels or tracks in both conferences, and being involved in the CAIUS project these presentations were of interest to me. Turning to the Humanitarian area though the difference between the conferences are much larger: at POMS the Humanitarian Crisis and Operations Management track was, for what I recall, the second largest among the college tracks this year, while the Humanitarian sector did not have any panel area of its own at the IRSPM conference. However, the ”Sectoral challenges”-area included several panels that could be argued to invite presentations related to humanitarian logistics and supply chain management, for example ”Emergency Services Management: The Case for Bridging the Theory-Practice Divide”. There were in addition a couple of panels related to decease outbreak management, but they were cancelled.
To get a better overview of the content of these two conferences, I ran a word frequency query on the schedules in the analysis software NVivo and got the following results (although they are skewed due to the fact that the POMS program contained short abstracts in addition to the headlines of the presentations, and some words do not come from the content of the presentations but from the layout of the schedules):
It is exactly two months ago that I participated in the World Conference on Humanitarian Studies in Addis Abeba, Ethiopia. The conference was organized by the International Humanitarian Studies Association, this year’s theme being “Changing Crises and the Quest for Adequate Solutions”. What is meant by changing crises is the increasing number and diversity of crises? These new types of crises may cause confusion among local actors, governments and humanitarian organizations in their efforts to respond and to be prepared. Some of this confusion is also stimulated by a number of new actors entering the humanitarian aid industry, ranging from private military security companies and social entrepreneurs to religious groups. The part on quest for adequate solutions, on the other hand, is a complex question which can easily ignite philosophical debates. What is an adequate solution between idealism and pragmatism? Humanitarian action could potentially mean everyone and everything, within the broad sphere of alleviating human suffering. So where is the boundary between ending needs versus meeting needs, within the limits of what can be achieved? Inspired by all these questions, the main aim of the conference was to deepen understanding of how and why crises are changing, which are the actors involved, and how these changes affect the interplay between humanitarian organizations and other actors, and what type of influence this might have on the different phases of prevention, preparedness, response and long-term development. Many of these issues are of interest to practitioners and researchers working in the field of humanitarian logistics and social responsibility.
As my current research interests are much aligned with the overarching topic of humanitarian innovation, I would like to share some reflections from the presentations and discussions at the conference surrounding this specific topic. It seems that the discourse on humanitarian innovation is gaining momentum, with very ambiguous structures on how to manage, regulate, distribute and learn from innovations and the iterative processes surrounding innovation. Innovation as such is nothing new, it happens all the time and everywhere as part of human learning. But the pace of processes through which innovations are being commercialized and subjected to private profits are something relatively new in the humanitarian field.
Principles to practice with Guest writer Cécile L'Hermitte
We have once again got the pleasure of having a guest writer here on our blog. This time it is Cécile L'Hermitte with her article Developing organisational capabilities to support agility in humanitarian logistics: An exploratory study that appeared in the latest issue of the Journal of Humanitarian Logistics and Supply Chain Management. (link to the journal here)
The following discussion relates to a 3-year research project conducted with the help of the logistics staff of the World Food Programme and of Mike Whiting from the Forum for Humanitarian and Emergency Logistics Professionals (HELP) of the Chartered Institute of Logistics and Transport in the United Kingdom (CILT UK)
Since change, uncertainty and disruptions are routinely encountered in disaster relief operations and in longer-term recovery and development programmes, humanitarian organisations need to build and maintain a high level of agility, i.e. they need to be able to respond swiftly to sudden and short-term field-level turbulence and to rapidly adapt their logistics and supply chain operations in order to overcome/mitigate the emerging challenges. To date, researchers and practitioners have primarily associated agility with tactical considerations such as the ability to preposition supplies in preparation for coming emergencies, to mobilise and deploy resources within hours of a disaster occurrence, to rapidly reconfigure transport operations, or to find creative solutions to fix immediate problems in the field. Although these operational elements are crucial agility factors, being truly agile goes beyond functional skills and expertise. It also comes from the organisation’s own systems, structure and culture and should, therefore, be built into the organisation itself.
In particular, conducting agile logistics operations depends on the development of 4 higher level capabilities, i.e. being purposeful, action-focused, collaborative, and learning-oriented:
As promised, here comes a presentation of Cecilie and her thesis; Logistics activities between emergency responses: A case study of Norwegian Red Cross.Cecilie Sælør Fon has a MSc in business with specialization within logistics, operations and supply chain management from BI Norwegian Business School and is now a consultant at Inventura AS. Her thesis supervisor was Marianne Jahre, professor BI Norwegian Business School. Here Cecilie tells us about how her thesis can be used in practice and her key findings.
The thesis aimed to create a basis for developing a logistics strategy in Norwegian Red Cross, accounting for their overall international strategy and organization, as well as the International Federation of Red Cross and Red Crescent (IFRC) logistics strategy and structure. I did not look at the Emergency Response Unit (ERU) and their activities. Focusing on the logistics staff in Oslo Headquarters (HQ) and ongoing program activities abroad, I mapped their capacity and competencies, and compared with the support and services programs and other ongoing projects expect them to provide. By analysing gaps between the resources and the needs, the thesis sought to identify the logistics competencies and capacity Norwegian Red Cross will need in the future. I based my study on semi-structured interviews with logistics and other staff in Oslo and abroad conducted January – May 2015, as well as secondary data including reports, prior case studies, and strategy documents. I also participated in courses provided by the organization.
Even though research within humanitarian logistics has increased immensely during the past decade, very little has been published on logistics strategy development within humanitarian organizations. Accordingly, I developed a new framework for data collection and analysis, combining elements from commercial and humanitarian logistics research. The framework captures activities, actors, and resources in humanitarian supply chains including material, information, and money flows. Humanitarian organizations in general can use the framework to reveal gaps between currently performed activities and existing strategies in addition to logistics resource and competence gaps.
Guest writer A.L.R. Santos shares her principles to practice
Every once in a while, we have guest writers here on our blog. This time we have the joy of having Ana Laura Santos writing about her article and findings and how this can be implemented in practice. Here are her key findings from her article Systemic barriers and enablers in humanitarian technology transfer in the Journal of Humanitarian Logistics and Supply Chain Management.
The concept of systems thinking is rather novel in the field of transfer of medical technology in humanitarian settings. Some of the lessons derived from this theoretical framework are described in the referred publication.
Humanitarian organizations that go about transferring medical technology, i.e. anything from an x-ray machine to a complex process like the cold chain, are usually result-oriented. There is a lot of focus on delivering (and achieving) fast results, because that is thought to be the most important and efficient approach. However, considering the examples mentioned by experts in the field, this approach reveals to be rather inefficient because of the diversity of contexts, unpredictable nature of work and the lack of understanding of key relationships in the processes being carried out. In practice, the appropriation of systems thinking principles can motivate and guide the shift of this result-focused approach to one that is focused on a life-cycle, holistic perspective of technology transfer, and logistic operations. One that requires flexibility, coordination and collaboration.
A flexible planning and orientation means that instead of solving problems, the humanitarian organization manages solutions. This allows projects to take a direction lead by planners and users at the same time. It means including buffers in the planning to deal with diversity and uncertainty and allowing ad-hoc decisions to be made. Although more maintenance intensive, this way of planning may result in a better match between the organization’s goal and the effective possibilities on the ground. Coordination needs special attention to the interrelations between the many steps, individuals and hierarchy levels in a process (e.g. procurement, transport, customs clearance etc). If there are inconsistencies between these interrelationships, a plan B is devised and no work falls under “it’s not my job”. Finally, participatory approaches may lead to potentially more innovative and sustainable project solutions. A clear definition of roles and responsibilities and a decision maker at all levels and steps are essential to allow the inclusion of different internal and external perspectives and the construction of shared goals (e.g. collaborations with companies or national governments).
Best Masters Thesis award 2015 by the HUMLOG Institute
This year the HUMLOG Institute received many great nominations for the Best Master's Thesis in Humanitarian Logistics 2015 award. Unfortunately we could not award all, but awarded two outstanding Master's thesis by Lauren A. Seelbach and another by Cecilie Sælør Fon. Here you can see a short profile of Lauren and her thesis. Stay tuned to read about Cecilie.
One of the most immediate and important functions of emergency response and disaster relief organizations is providing essential supplies to disaster survivors. Supplies like water, food, and shelter – those which survivors cannot afford to go without in the hours and days after a disaster. The logistics networks of the responding organizations must be prepared to meet these needs in advance of a disaster occurring in order to ensure they are successful.
Lauren Seelbach’s master’s thesis focuses on the question of how agencies can prepare their logistics networks in advance of a disaster. Her thesis answers the questions of (1) where should inventory be placed, considering both normal, steady-state allocation of inventory as well as allocation of inventory in advance of a notice event such as a hurricane, (2) how does private sector involvement change the response capacity of a logistics network, and (3) what is the impact of reduced demand for critical commodities on the logistics network’s ability to respond?
Two case studies are conducted on the logistics networks of the Federal Emergency Management Agency (FEMA) and the Florida Division of Emergency Management (FDEM). Results from these case studies indicate that applying stochastic modeling and the associated metrics to inform the allocation of critical commodities in a logistics network demonstrate measurable benefits in terms of fraction of overall demand met, time to serve a disaster affected population, and related metrics. For prepositioning decisions in FDEM’s logistics network the benefits were particularly convincing. By locating stock closer to the areas predicted to suffer the greatest losses, FDEM is able to decrease the time per unit served of two critical commodities by 10-15%. For FEMA’s logistics network, results indicate that restructuring the terms of contract stock has the potential to increase fraction of overall demand served by 14% within 24 hours after a disaster and 16% within 36 hours after a disaster.
There are many challenges facing humanitarian organisations after an emergency is declared. How to bridge the relief resource and capability gap is the first challenge. To stage a response and overcome this gap, humanitarian organisations depend on their supply network composed of a number of loose partnerships with a range of actors. After an initial assessment the next step typically consists of the installation of reception areas for displaced people in a safe zone, screening and registering of survivors, provision of first aid and medical support, shelter, food rations, potable water and sanitary installations. Time is the most critical factor under these circumstances and, in order to establish a supply chain for humanitarian aid as quickly as possible, good communications are a must.
Examining previously declared emergencies, Sierra Leone, Nepal, the Philippine’s, Haiti, Pakistan and the Asian Tsunami the government mobilised their armed forces to assist in the humanitarian relief effort. The military have assets such as transport aeroplanes, helicopters, communications equipment, trucks and heavy construction equipment (such as bulldozers and cranes), as well as the personnel trained to operate and repair them. The military also have medical expertise and personnel that they can deploy to assist in the relief effort as in West Africa in 2014.
As part of the disaster relief effort the international community normally dispatches their military to assist in the aid effort. To the layperson, the term civil-military coordination evokes notions of a seamless division of labour between aid workers and international military forces. Media coverage from crises such as Sierra Leone, Nepal, the Philippines, Haiti, New Orleans, Pakistan, and the Asian Tsunami has reinforced this expectation, showing relief agencies distributing food and medicines under the guard of heavily armed soldiers, or aid workers and military working together to construct refugee camps, set up field hospitals, provide emergency water and sanitation. Donor countries, providing relief and development aid and troops to such missions expect efficient teamwork as pure common sense. This has raised important discussions around the implications of military collaboration within the humanitarian space.
Civil military coordination essentially deals with two aspects of military support to civilians, firstly the provision of security, e.g. a military escort for a humanitarian convoy, and secondly, the provision of military assets, e.g. equipment such as trucks or helicopters, and skills, knowledge and manpower such as medical and engineering expertise. We saw both these elements emerge in Sierra Leone, Nepal, the Philippines, Haiti, Pakistan and during the Asian Tsunami relief effort.
This blog entry is a brief introduction to the city and the fire that spread across its hills and Eija's field research in Chile.
My feet are stuck in two fields of research: that of community resilience and humanitarian logistics and supply chain management (HLSCM). Disaster relief within HLSCM studies how the aid can and should be provided and often the focus on actors external to the affected communities. Meanwhile, community resilience studies how the affected communities prepare for, face and recover from disasters. The year 2015 I spent in Chile studying the reconstruction after the urban-forestal fire that spread across the hills of Valparaíso in April 2014. This blog entry is a brief introduction to the city and the fire that spread across its hills and my field research in Chile.
Valparaíso is a Chilean port city, famous for its three dozen steep hills and colorfully painted houses built into the steep slopes. Its architecture, exquisite graffiti and vibrant atmosphere have earned it a UNESCO status. Valparaíso has a neighborhood spirit lingering over it that the locals say other cities, such as Santiago, have lost. There are only a few bigger supermarkets and people continue to buy their groceries from the corner shops and the market places. One of Pablo Neruda’s houses is in Valparaíso and the city is famous for its cultural scene.
A roof-top view over the Valparaíso and its port, 2015.
In April 2014 a fire spread over the hills of Valparaíso, advancing both in the forest, as well as on the inhabited hills of the city. The fire in Valparaíso could be attributed to both natural and man-made causes: for example, the soil and trees were dry after the summer and trash had been gathering into the ravines between the hills. The official trigger of the fire was pointed at birds that had caught fire while sitting on the electricity lines. While the red glowing inferno of the fire was a haunting sight and phenomenon, the hazard was just the spark that started the disaster for the over 12 000 affected people.
Disaster relief is categorized into different phases that the affected community goes through. The hazard sparks the immediate response in the community, after which recovery and future disaster preparedness follow. These phases are intertwined. For example, the urgent fulfilment of basic needs that characterizes the immediate response overlaps with reconstruction, and future earthquake preparedness is built into the infrastructures during reconstruction from the previous earthquake. The external actors supporting each phase change or shift their focuses, but – at least in theory - the community persists.