Wednesday, October 8, 2014

Purposeful Education

Now that the Ebola patient who was being treated in the Dallas hospital has died, it's time to get moving, without hysteria, with purposeful calm, on two fronts.

First, the media, particularly the virtual and broadcast media, need to tamp down the sensational hysteria and take that same amount of airtime to educate the American public about the value of flu shots, vaccinations for their children, and any other measures they feel might keep Americans safe.  I say this because we are about to deploy troops to Africa and it is likely that some of them -- or Americans already working in Western Africa -- might fall ill and need to be treated in our communities.

Second, it's not just hospitals who need to sit up and pay attention, and rehearse their response -- although from the comments of associations of nurses, it's clear that institutional strategies have not been shared, nor have the protective measures that will be put in place for personnel.  And the training and rehearsals must also include ambulance drivers and EMTs as well as a range of other medical support personnel. 

Meanwhile, vaccine trials proceed.   Trying out vaccines on patients already infected is not the same as a full on Stage 2 double bind trial that carries its own risks. In our rush to find a way to contain the virus, and to find a vaccine that works, we'll find a range of ethical questions presenting themselves.

Let's get started.

Wednesday, October 1, 2014

Public Health and the Secret Service both need better checklists

The Liberian public health and airport security personnel in Liberia did their jobs, and checked outgoing passengers at three distinct checkpoints.  We've patted ourselves on the back in this country for the sophistication of our medical capabilities, yet as I listened to the story today of the nurse in Dallas who followed a "checklist" and got a Big Red Flag answer back from the patient, but failed to escalate it in such a way that the team could isolate and contain the patient -- in fact, they sent him away with antibiotics and he came back a second time when he felt worse -- I thought once again of Dr. Atul Gawande's book, The Checklist Manifesto

This type of error is called one of ineptitude, as opposed to one of ignorance, presumably.  We don't know if this was an Ebola-specific checklist; one prepared by the hospital itself; or one from the Center for Disease Controls.  A quick read of Gawande's book might be very helpful, especially if the checklist has more than 5-7 items on it, without what Gawande calls "pause points."  His book is full of stories of how pilots, builders of skyscrapers and surgical teams perform extremely complicated feats, and how using checklists that involve every member of the team makes a difference.  His work in this respect for the World Health Organization has made a large impact:  deaths after surgeries have been reduced significantly by the implementation of several simple procedures that are part of the checklist.

I would also recommend the book to the new acting director of the Secret Service and to the panel that is currently being constituted to review the disturbing procedural/process failures over the last several years for the organization charged with guarding the president.  It may be that those procedures or processes have become shopworn.  Certainly it must be the case that, unless on a form of high alert (the United Nations responsibility, for example) agents' situational awareness is at an all time low.  Whether this is a factor related to the move from Treasury to the Department of Homeland Security or not is difficult to estimate, but will undoubtedly be reviewed by the panel.

The tipping point I mentioned last week seems more vivid as weeks go by.  Yet there was one piece of good news this morning:  that it appears Nigeria, the most populous and also most well-off African country in terms of infrastructure and medical personnel, has contained Ebola.  We just can't move quickly enough to get more personnel, hospitals, emergency operations centers and supplies deployed in the remaining countries. 

Thursday, September 25, 2014

A tipping point?

As I teach my second class this week, I realize how very focused I have been on two global issues, each of which has their own consequences from a risk perspective.

Many of you have been reading me on Ebola risk since last spring.  Though it does appear that the rapid mutation and growth of cases has caught the attention of the world stage, we are still a month or so away from seeing the actual deployment that result from commitments from the private sector (The Gates Foundation $50 million; Paul Allen $4 million, for example); and from both governmental organizations and world health organizations often funded with a mix of public and private sector funds.  This morning's New York Times story on home deaths in Monrovia, Liberia,  is just one more illustration of far away from our comprehension such a human situation is. All I am able to do is monitor the modeling that is now being done by research teams on how and where the virus will spread.

I understand that not more attention is being paid because terrorist threats from ISIL (The Islamist State) have risen to such a level that the United States once again finds itself leading an effort to push back against a cultural and religious landscape it doesn't understand.  This is especially the case now that ISIL is using social media to make its brutal points, as it continues to behead unbelievers on camera.

Watching the Ken Burns series called "The Roosevelts" last week caused me to reflect on how little either Teddy or FDR would have been able to accomplish today, with every moment, every gesture, every inflection studied of our leaders is analyzed into the ground.  FDR, for example, was able to prepare Americans for a war they initially did not want through the effective use of his "fireside chats."  When it was suggested after his first broadcast that he do them more often, he replied that their effectiveness would lie in them not being too frequent.  Ultimately he made 30 such talks over 11 years, covering both the Great Depression and World War II.

Today President Obama is in an entirely different place and time:  social media records every gesture,  microphones pick up even private conversations, and not much is any longer considered confidential.  He faces a passive aggressive Congress and election year votes that may change the very composition of the Congress, conveniently on a long break until after those elections.  To his credit, the president is leading as he always has wanted to lead: in the presence of other nations who also have a stake in the outcome.  To see both a Saudi prince and a Saudi woman piloting missions today is another sign of how things are evolving.

I'm keeping an eye on all of it, and have the rare privilege of being able to talk about these matters with my students as part of understanding the checks and balances that make up our system of government.  We use three lenses on such current topics:  ethics, policy, and law, especially when influenced by the evolution of technology.

For students especially, "we choose hope over fear."  (President Obama, yesterday, to the United Nations Assembly)

Sunday, September 14, 2014

Ebola Risk

I wish those public health departments would hold off from announcing that there is no risk to residents in America.  We don't know how long this will be true since globalization has truly reduced both time and space among countries.  It's also now being rather quietly suggested among epidemiologists that the virus is mutating so rapidly that it could become airborne.

I published an ASA News & Notes column last Monday on high level Ebola risk and the cultural dimensions that make containing Ebola just that more difficult.  Tomorrow a London-based magazine called The Risk Universe will be publishing a piece directed primarily to the financial sector, on how firms can prepare for bio-threats.  I'll post it up to our website, in case you're not already signed up to receive updates.  You can adapt many of the practices I recommend for businesses for your own family.

Monday, August 25, 2014

The bell has tolled. Did you hear it?

We all shivered when we read that the Napa region in California was recovering from a 6.0 magnitude earthquake early yesterday morning.  Today, some of the excitement has receded, as the area assesses damage and cleans up.
Always in the trunk of my car: boots, water bottle and "evac pack" with flares, blanket, etc.

From first floor hallway, our "away" backpack that contains supplies, water, food. I also have included information on medications, insurance policies, credit cards, etc.

We're nearing the end of a glorious Seattle summer, and starting to think about back to school matters.  Even as we're out there picking up school supplies, why not see what you can do about building or enhancing your emergency supplies kit?  Take a look at what you've got that needs to be replaced, or what you need in fact to get started.

My own challenge is larger than life.  Though we have one of those backpacks filled with dried rations, I don't eat processed foods any longer.  So I've started to think about what I could maintain off the grid that might work:  cans of low salt beans or tomatoes work fine, as do containers of unsalted nuts, but that's about it.  I eat several cups a day of raw salad or steamed vegetables, and four fruits, and a handful of nuts.  So that means I've got to start thinking about year-round gardening in a relatively small space.  I'll keep you posted on what I come up with.

In our neighborhood, we've organized even further.  Not only do we have the 300+ house region divided up with first aid and daycare sites identified, but we've raised the money to invest in medical supplies housed in each region.  We're now producing a laminated flyer with area-specific information for residents.   We're hosting a community event in September, and also signing up folks at an upcoming neighborhood event.  We have identified neighbors with special skills or access to tools we might need in the event of a major earthquake.

So we're moving forward, on the assumption that there won't be help from police or fire or emergency teams from the city for at least three days.  We are getting ready, that is, to help ourselves.

This model can be replicated in any city, anywhere.  If you'd like more information, let me know.

Thursday, August 14, 2014

My hands are raised.

There are so many critical points of decision for any thinking person nearly every day.  For each decision made, one would hope that there is a risk managed.  But it's not always so.  In the last week or so, the Ebola virus and the  Ferguson, Missouri chain of events take a great deal of thought, but without any clear path forward, no matter how much our hearts and minds might ache for those involved.  Is containment possible in either case?

I am saddened by the Africans' fear of American doctors, by the belief that the doctors brought and are spreading the virus.  At such a level of fear, education is very much hit and miss -- why should they believe medical personnel who tell them not to touch the bodies of their dead ones, or let them be burned by those wearing protective suits, who look like space aliens?  Why especially believe in the seriousness of the problem when your government leaders downplayed the risk for so long, when travel continues even now?  And then there's us:  we are told not to worry here, that there's very little risk.  Please expect that information to change once several more non-Africans are infected and cross borders.

Then we have Ferguson, Missouri.  Investigators have not yet even agreed on what happened last weekend.  Was an unarmed black youth's hands in the air, and was he yelling "Don't shoot?"  Or was he trying to take a police officer's gun away?  Who was the officer who shot him multiple times?  It won't be until outside investigators are on the case, this many days later, that we will begin to have answers or eyewitnesses are interviewed.  The fact of the matter is that the suburb of Ferguson has become a place not unlike Jackson Mississippi in the 60s, except that so far dogs and fire hoses have not been used. Riot gear and weapons are the modern replacements, but the police mindset is exactly what it was 50 years ago.  They are facing off against members of the media and a few troublemakers in what has each night been a peaceful crowd of citizens, exercising their right to peaceably assemble, as guaranteed in the First Amendment to the U.S. Constitution:

"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble and to petition the government for a redress of grievances."

Unfortunately,  shooting young black men is an altogether too familiar news story for us here in America.  Congressman John Lewis asked today who knows what those young men could have become:  "How many more young men of color will be killed before we realize that we have a problem in America? We are permitting the incarceration and shooting of thousands of black and brown boys in their formative years who might have become great artists, leaders, scientists, or lawyers if we had offered them our support instead of our suspicion.

Yesterday, this photo appeared from students at Howard University.

I stand with the Howard University students, and with the Ferguson citizens who have come out each night to ask for an accounting of what happened last weekend, whose hands are also raised.  I hope you will consider standing with them too.   Not just this week, but into the future as we demand better accountability and less stereotyping and profiling from our police officers, no matter what city we are in.

Tuesday, July 29, 2014

Travel risk is high

It's not just that airplanes have been disappearing, or shot down, or that the infectious disease Ebola is out of control in parts of Africa, or that Tel Aviv travel was suspended by major airlines when shelling came too close to the airport . Travel risk has always been an issue for corporations whose employees are spread round the globe.  In this morning's New York Times article, Joe Sharkey goes inside a gathering of corporate travel managers to better understand their concerns, including legal and ethical risks, given the last week or so of travel events.

If you're traveling on your own and don't have a corporate travel office to rely upon to filter out threats and make best recommendations, then your best bet is to go to the Department of State's website and read through the threat analysis they perform on countries you might visit. 

If you're just learning to travel, then the "On The Road" chapter of Advice From A Risk Detective will be of use.

No one wants you to stop traveling.  But we do want you to make safe choices at a time when many parts of the world are less stable than usual.