Lessons from Haiti on Disaster Relief

Recent disasters have raised awareness within the nephrology community of the challenges faced by patients with ESRD and by those at risk for acute kidney injury (AKI) during these devastating situations (1–3). Given time constraints during disasters, limited resources, and the vulnerable populations who are often involved, the kidney community recognizes the value of an organized response. The term “renal disaster” was introduced by the International Society of Nephrology (ISN) Commission on Acute Renal Failure to underscore the many crush syndrome victims who required medical treatment or dialysis support after earthquakes in Armenia, China, and Turkey (4–8). ISN founded the Renal Disaster Relief Task Force (RDRTF) in 1989 to support patients with kidney injury or disease in disaster areas. Having a partnership with Medecins Sans Frontieres (also known as Doctors Without Borders), ISN RDRTF sends medical personnel, offers logistical advice on handling and distributing medical supplies, provides education on crush syndrome and AKI, and supplements local dialysis efforts (9–11). ISN provided clinical and dialysis support during the 1999 earthquake in Marmara, Turkey (11), the 2003 Bam earthquake in Iran, and the 2005 earthquake in Kashmir, Pakistan (7,12,13) and provided advice and assessment during the recent earthquakes in Southeast Asia and L'Aquila, Italy, last year (14,15). In the United States, a different type of disaster occurred after Hurricane Katrina struck the U.S. Gulf Coast in August 2005, causing widespread destruction. Katrina—the deadliest and costliest U.S. hurricane since 1928—forced more than 1 million people to evacuate the region. Although hurricanes typically provide enough advance warning for dialysis patients to leave the affected areas, many patients did not evacuate before Katrina hit the Gulf Coast. Many ESRD patients missed treatments and required hospitalization for medical and psychosocial problems (16 …