The health workers in official-looking lanyards walk up to the immigration desk and hand over their passports. “Where are you from? Why are you in my country?” barks a fierce, khaki clad official.
“We’re coming to help the ministry of health in response to the cyclone,” replies one woman.
“Where’s your visa paperwork? Take your hat off.”
The health workers, representing the World Health Organisation (WHO), had just arrived in Namuna, a fictional island nation devastated by a category five cyclone.
Actors posing as government officials were not making things easy for the candidates who had come from across the Asia Pacific and Europe to Darwin for a disaster response training course with the National Critical Care and Trauma Response Centre (NCCTRC).
“There will be a doctor with no registration, a nurse who just likes to help, a tourist who’s hurt,” explains Matt Harper, the NCCTRC’s director of disaster management preparedness and response, and – for the simulation – a Namuna customs official. “I’m going to give them an exceedingly hard time.”
Monica Murphy and Inda Acharya play the part of Namuna immigration officials, questioning, intimidating and at one point appearing to rip off the health workers trying to get past them into the country.
“Depending on how they react, some of them … can be very nervous and timid so we go easy on those sort of people, but you get the smartarses as well and we give them a real hard time,” Murphy says.
Once through immigration and customs, the candidates are sent upstairs to coordinate an emergency medical team and begin helping those suffering after the cyclone.
“There will be trauma, displaced people and a lack of access to healthcare for the first two weeks due to the impact of the cyclone. Then we’re going to throw them a curveball,” says Ian Norton, chief of foreign medical teams for the WHO and project leader for the exercise.
Many of the candidates are already in these kinds of roles for their own governments but Thursday’s simulation seeks to teach extra skills as well as train them in managing the UN system and work with international teams under intense pressure while supporting a devastated local health system.
“Each country is different … Usually you’ve travelled a long way and are quite tired, it’s quite a high emotion situation and in the immediate aftermath of a crisis you need to be able to enter a country and understand there are cultural and system differences,” says Professor Tarun Weeramanthri, chief health officer of Western Australia.
“So you’ve got have patience and go with the local procedures, but you’ve also got to stick together as a team. You’ve got to form a culture very very quickly and find effective ways to work together.”
The training and protocols were designed after the 2010 Haitian earthquake, which saw numerous doctors and nurses – and some people posing as such – turn up with good intentions but no capacity to be self-sufficient or operate appropriately under the conditions.
“We saw what we always see in disasters – lots of doctors and nurses and paramedics wanting to do the best thing, watching CNN or the news and jumping on a plane and going with a little backpack,” Norton tells Guardian Australia.
“But when they got to Haiti they didn’t realise it was among the poorest countries in the world with a poor security situation before the earthquake, never mind after.”
Norton cowrote a new medical standard for disaster response, fine-tuning and improving it over a succession of disasters in the Philippines, Vanuatu, West Africa and finally Nepal where he said 150 teams and 4,500 responders were sent into the field within a day of arriving.
The Ebola outbreak in West Africa saw a shortage of health workers – largely out of fear of catching the disease.
“Part of our work now is to create more outbreak disease-ready teams, ready to come forward and treat Ebola, cholera, maybe Sars or some other respiratory infection,” says Norton. “Because we shouldn’t plan for the last outbreak of disease, we should plan for the next.”
With the new protocols a basic set of standards is added to and adapted for specific disasters. Teams are registered, inspected and verified by the WHO. Earthquakes demand expertise in trauma and surgical emergencies, but typhoons and floods have more maternal and child health problems, as well as infectious diseases.
“But underneath the standards are the same – you can’t expect the local government to come and give you food and medicines to hand out,” says Norton.
The candidates have been on this particular course for a week, and the Namuna simulation will last two days.
“The styles of various people are what’s made it so rich, and the candidates are learning more from each other than I think they ever learned from the faculty,” says Norton.
“It’s really taught me that when we run these courses now we need to have a mix of nationalities because that’s exactly what you have in a real response. Understanding how each team works and thinks allows you to deploy them to their maximum, but underneath it all we’re hoping the human side wins through and they’re all there for the same core reason, which is to care for people.”
