Saturday, May 1, 2010

Supply Chain Lessons from Haiti

When Paul Auerbach arrived in Haiti, after the January 2010 earthquake, he faced a sea of death and misery the likes of which he'd never seen. A member of Stanford Emergency Medicine's rapid response team under the auspices of International Medical Corps, Auerbach, Sloan '89, eventually assumed the role of lead physician coordinating the medical and logistical efforts of teams from around the globe.

STANFORD GRADUATE SCHOOL OF BUSINESS —When Paul Auerbach arrived at the University Hospital in Port-au-Prince, Haiti, after the January 2010 earthquake, he faced a sea of death and misery the likes of which he'd never seen. A thousand people were critically injured or ill, buildings were in ruin or condemned, and medical supplies were scarce. "It was like Armageddon," said the Stanford professor of surgery to an audience at the Stanford Graduate School of Business in April.

A member of Stanford Emergency Medicine's rapid response team under the auspices of International Medical Corps, Auerbach, Sloan '89, forced himself to override his initial shock to help ratchet down the chaos. With no sleep after an all-night trek from Santo Domingo, he literally hit the ground running, eventually assuming the role of lead physician and coordinating medical and logistical efforts of his team of Stanford doctors and nurses with those of other NGOs, the military, medical volunteers, and organizations from around the globe. By the end of the exhausting 12-day ordeal, the team had created a functioning, though makeshift, hospital operation that was treating patients and saving lives.

Speaking at the fourth annual conference on "Social and Environmental Responsibility in the Global Supply Chain," Auerbach said that his trial by fire was a huge lesson in supply chain implementation in the face of disaster. "The first lesson: Now we know what kinds of items and systems we need to have in place to prepare for similar medical operations in the future," he told the corporate and nonprofit leaders, policymakers, and academics attending the event sponsored by the Stanford Global Supply Chain Forum.

Without x-rays, CT scans, proper traction equipment, and, at times, pain medication, the Stanford health care professionals, along with those from other universities and countries such as Switzerland and Norway, diagnosed and treated men, women, and children with severe spinal injuries, head trauma, fractures, and wounds, many of whom required limb amputations. "God bless the U.S. military," Auerbach said. Starting with the first officer to ask him, "Sir, what do you need," the military personnel, he said, "were the only effective supply chain. Three hours after I gave them a very substantial list, the choppers started delivering."

Amidst a steady influx of 500 new patients a day, Auerbach helped organize the setup of tents, generators, dialysis and transfusion systems, food, and other supplies that began to pour in, sometimes in disarray. Sleeping only a few hours a night, he and his team worked incessantly to treat patients. "It was like Schindler's List," said the Stanford professor.

"At the end of every day we wished we could have done more." Amidst the horrifying death and pain all around them, the Stanford Emergency Medicine team also witnessed the birth and care of newborns. "The Haitian people were remarkably helpful, strong, and grateful," Auerbach said. "It wasn't the first time they'd faced adversity. They do so every day. This was a straw, but it didn't break the camel's back."

"When you're in a situation like this as a relief worker;" he told attendees, "you have to keep in motion. The main thing you have to remember at all times is that you're there for the victims. You simply can't feel sorry for yourself."

At the same time, he said, workers need to be careful not to exceed their physical and emotional limits, noting, "Disaster is a distance sport, not a sprint." As team leader, he was constantly on the lookout for signs of burnout among his colleagues, "rotating them out" to recuperate if they appeared to be approaching exhaustion. Such disaster scenarios also require one person to be in charge. "It's not the time for committee work, and you need to get rid of egomaniacs quickly," he said. At the same time, he emphasized, "teamwork is everything. You need to have a buddy system and at least one person being positive at all times."

As to lessons for supply chain management in disaster scenarios, Auerbach said that establishing more sources of food, supplies, and medicine for transport to affected areas will be important work for the future. As he learned the hard way, having someone on the ground to receive and shepherd supplies is essential. Bringing communication equipment and setting up lines of communication is also fundamental, as is establishing and adhering to chains of command and knowing how to work with the various agencies involved.

Although the work in Haiti is by no means done, the most acute part of the crisis is over, so Stanford Emergency Medicine's rapid response team is now back in Palo Alto. The group is working to formalize supplies and systems so that they may be better prepared should disaster strike anywhere in the world again. "You need to be ready to leave at a moment's notice, but you hope you never have to," said Auerbach.

The one-day conference explored how innovative collaborations among businesses, nonprofits, and governments can solve social and environmental problems while maintaining or even enhancing profits. Other speakers described collaborative supply chain creation in India and efforts to support sustainable agriculture in connection with cotton for the apparel industry.

The conference was sponsored by the Stanford Global Supply Chain Management Forum and the Center for Social Innovation at the Stanford Graduate School of Business, in partnership with AMR Research.