A Moment of Service on a Roadside in Tanzania- Written Friday, August 31st, 2007
When the Secretary of Health and Human Services travels outside Washington D.C., there is a need for constant contact and coordination with Headquarters. By phone, email, and fax, business continues as I drive, fly or wait. Driving time is a prime opportunity for phone calls. Documents needing approval are routinely sent electronically to be printed at the next stop. Waiting for a flight often becomes a conference call briefing with a group of advisors who remain in Washington.
For the last year and a half, John Mallos, a Lt. Commander of the United States Public Health Service has been coordinating the Office of the Secretary on the road. Starting next month, John will be transitioning to a new assignment as the Health Attaché in Brazil. He will do a terrific job coordinating health activities at our Embassy in Brazil but I will miss him and the service he has provided me. He anticipates with the acuity of Corporal Radar O’Reilly and can take charge like General Patton.
John was a nurse in the Indian Health Service. He spent several years practicing in Indian Health Clinics on remote reservations. He just finished a Masters Degree in Public Health at Northern Arizona University. I know he spent lots of late nights in hotel rooms, after he finished my work, working on his thesis.
Before John became a nurse, he was a policeman in Southern California, working some tough assignments. The composite of his experiences have provided him with an endless array of colorful stories.
One of John’s many admirable characteristics is his intuitive instinct to serving. It’s a gift and situations needing somebody to step up and take charge just seem to seek him out.
John Mallos at Provincial Sanitation Facility/Millennium Challenge Corporation (MCC) Site, Quelimane, Mozambique
Last week in Africa we were transiting from the airport to a hotel in rural Tanzania. We were traveling in a motorcade being lead down a narrow road lined with typical African scenes of mud brick homes and people working with hoes in their fields. We approached a narrowed part of the road where a bus had slowed and pulled to the shoulder of the road to let us by.
Suddenly, a large truck appeared from behind the bus, foolishly trying to pass. When he saw the motorcade, the driver tried to dart back but had too much speed. He crashed the passenger side of his truck into the bus. My car was maybe 20 yards in front of the crash. Our driver swerved to avoid being part of the accident. There was the awful crashing sound that accompanies serious accidents with parts, glass and dirt flying.
John was riding in a car at the end of the motorcade. As is his manner, John took charge. He climbed into the bus, full of panicked and injured people. He didn’t speak the language but immediately began calming people and attended to their wounds. He stabilized a broken leg, cleaned and bandaged deep lacerations to the face of another. His years of dealing with trauma as a policeman and nurse were being deployed during a chaotic scene on a roadside in Africa.
On a highway in Africa, there are no law enforcement or emergency services. When accidents happen, it’s “every man for himself.” Often, I’m told people don’t help and sometimes even take advantage of the tragedy.
Oddly, the bus driver climbed back behind the wheel and began to drive away in the middle of the chaos and with John working in the back. It became clear, John had to get off the bus or face transit to some unknown part of Tanzania.
Not only was this incident a testament to John’s capability, humanity and coolness under fire but it also illustrated how appreciative we should all feel to live in a country like ours where emergency services are something we have come to take for granted.
I wish John well. I will miss our adventures together. The American Embassy gains a great asset.
Posted on September 4, 2007 in Africa
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Secretary Leavitt,
Well, traffic is bad EVERYWHERE! just don’t die!!!!! ….
I still need you to get the ball rolling on triage of patients during a pandemic situation.!! :)
This young man sounds very capable! Nursing is a profession that is probably one of the best understood in terms of compassion… and the least understood in terms of capability, and the responsibility nurses assume in providing that care.
Posted by: Kim Crady RN | September 04, 2007 at 09:05 PMDr. Leavitt,
Traffic can be bad. In rural parts of Mexico there are no lights. Intersections are marked by weird speed bump called a "topeez." I think that is how it is spelled. At night some intersections are marked by smudge pots. The look like oversized cannon balls with a wick burning on the top.
The roads can be dark, desolate and the chance for aide is remote. Traveling like that without cell phone or knowing the language seems crazy now.
I believe there are people like John Mallos. People with a heart, training, prepared and protected by good Samaritan law. I was told that in England and some other places not to touch a wounded or dying person. That there would be little legal protection for me and the real risk of prosecution. The last person to touch the injured may be blamed for making things worse.
Each country has good reasons for their laws. In my state the medical age of consent is 16. Yes a young man can bust open his ski helmet and after a short examination *decline* medical help. One would think any impact that can bust a safety helmet would do brain damage but he was alert, cognizant and capable of saying "No. Go away."
People like John Mallos can do great things - when allowed and empowered. We need more people like him.
Dr. Leavitt I know there are many more concerns than just a Pandemic. Obesity, education/training, health surveillance, etc.
I second Kim Crady, RN, remarks on pandemic prep. September is emergency preparedness month. Some places like the Defense department have not only made plans but have started testing them and training employees. This is good. It is called "Operation Crush Bug"
Operation Crush Bug - part 1 - Military personnel and their families. Contractors are optional.
http://dodvclips.mil/index.jsp?fr_story=736b7bfb859af73440f442d9715f5ff14fb9a249
Operation Crush Bug- part 2 - Training the employees.
http://dodvclips.mil/index.jsp?fr_story=b2d7b35d2c8b05f46f5efadf8c7d90ee5f6ca390
Another story about washing hands, social distancing, etc.
http://64.233.169.104/search?q=cache:VpddS_ZgdjEJ:www.blackanthem.com/+operation+crush+bug&hl=en&ct=clnk&cd=4&gl=us
Also September is emergency preparedness month.
http://www.ready.gov/ <- news and instructional videos
Main page
http://www.ready.gov/america/npm07/index.html
Events for September 1-8th
http://www.ready.gov/america/npm07/week1events.html
Sadly "anything we do now will seem like too much. Anything we try to do afterwards will be too little" - I forgot who said that but the words stuck with me.
Regards and looking forward to your next post,
Posted by: Allen | September 05, 2007 at 03:07 PMAllen
"Am I my brothers keeper?"
Secretary Leavitt,
Posted by: J John Swanko | September 05, 2007 at 05:08 PMGreat story. Sounds like you are losing a friend.
Dr. Leavitt, and others
Quick road side assistance, Clinic in a box and now Missouri has a 12 page pandemic book written for laymen.
Source:
http://www.missourinet.com/gestalt/go.cfm?objectid=D2E15C31-F646-E651-22DB030D2D49F7D1
Reminds me of Ben Franklin. Build buildings around the country and stock them with expensive books for people to read at no cost. The idea of libraries caught on. They even have meeting rooms you can use for free. The rooms are great for presentations to a group or the community.
Education is but the first step. The lab to test blood that you helped open is a much larger one. It requires trained technicians, admin staff, machines, supplies, water, power, sewage facilities and a stable government that will preserve the lab, water and power sources.
Communication in Mozambique must be interesting. It is about the same size and shape of California with 16 million or more people (July 2007 est) and only 1 phone per 100 people. Less than 1/3 speak a common language of Portugese as a second language. Yet they want to fight the untamed killer of AIDS against which we have no cure and few defenses. After years of civil war the fear of death unites them.
I hope they are ready for a pandemic.
I assume the villages and cities are kind to travelers and refugees?
Regards,
Posted by: Allen | September 06, 2007 at 08:41 AMAllen
"Always remember that you are unique - just like everyone else."
What a rare character, I envie those who live and work him. God guide and bless him
Posted by: Peter Karasira | September 06, 2007 at 09:18 AMDr. Leavitt,
Best wishes for a good weekend.
On Tuesday, Sept 11th, I have EOC (Emergency Operations Center) Call taker training. We have a room full of call takers, about four people in all, who respond to citizens requests. In the six years following 9-11 so much has changed and so little is different.
10 Years ago we put in an IVR (interactive voice response) unit for the Navy DITY (Do it yourself ) move program. This empowers people to move their own house hold goods. They can also keep most of the money if they can do it cheaper than the Navy could contract it out for. Some people do it for the money, others because it is less of a problem. The IVR allowed people to call in, leave messages, get an update of their status or find out what forms are needed when.
New incoming calls where given to call takers during business hours. Once a day processed information was uploaded to the IVR. Good way to get and give information from any phone with out needing a computer. PDA's where not popular in the pre-blackberry world.
Punch cards may have a bad reputation after the 2004 election but they are a proven technology for collecting information dating back to 1890. An IBM 5081 is durable, Y2K compliant, needs no power and is good for long term storage.
Regards,
Posted by: Allen | September 07, 2007 at 11:46 AMAllen
Secretary Leavitt,
This is somewhat off topic, but I would like to tell you about the new blog http://www.democracyspace.org, which is intended for community leaders and public officials who are working to address pressing issues.
Today, I wrote a post about your blog and several others that are written by public officials.
Click my name to see the post.
Safe travels!
Posted by: Julie Fanselow | September 07, 2007 at 05:51 PMDear Secretary Leavitt and others,
Yesterday I took my sons to a historical festival. Volunteers not only planed the event but other volunteers spent the night setting up and the all day in the hot sun demonstrating their interest in history. Some people where Sailors, some where doctors, somewhere Civil War, some where signal corps. Everyone had a good time.
Because no alcohol, profanity and very few vendors where allowed many teachers gave credit for attending. Home schoolers came out learn, the adults showed up to touch and hold in person what they could only see on The History Channel, a video or a museum.
It was the 15th time this educational event has happened. “If you build it – they will come” and it does not need plasma screens, fancy theaters, large well paid committee: just the chance to empower people to do all such good works as they are lead to.
The cost was time, feeding the people who volunteered. Some got a hay allowance for their animals or gunpowder for their cannons/muskets and of course permits.
I say this because fairs and events like this seem like a good way to teach health, pandemic awareness, AIDS, etc. There are things that cannot be brought up in school. There are things that cannot be shown or taken to school even by professionals or historians.
Like what happened in Texas and Massachusetts with HPV (human papaloma virus) people will often respond to a kind word than an order. (Note: Texas tried order to protect girls and it was shot down. Massachusetts used education pamphlets and now they cannot keep HPV in stock. There is a waiting list.)
People who would not take to a forced lecture on AIDS. H5N1 or obesity may stop by a booth out of curiosity. Humans are driven by curiosity and a good time. This may work in Africa as well as America.
Regards, sincerely.
Allen
“May you have an intuitive grasp of the obvious – for many do not recognize what they see before them” – Kobie Maru. (see FluWiki)
Posted by: Allen | September 09, 2007 at 01:05 PMDr. Leavitt, and others
Tomorrow is the 5th anniversary of September 11th. A day that will be used by many for many ends.
Before tomorrow ask - are we better off. In the years since 9/11, Katrina, Enron, etc.
How do *you* define better off?
More privacy?
More freedom?
More security?
More united?
What is more money without the ability to enjoy it daily?
How can governments carry out the will of the people without knowing the will of the people?
This is not a political message but chance for each to evaluate what they want and believe that we can awaken and do something. Something for ourselves, something for our community, something for our country, something for others in the world. Each person gets to pick that something and either act on it or ignore it.
Be healthy, be kind, be informed, be helpful, be prepared.
Regards,
Posted by: Allen | September 10, 2007 at 10:29 AMAllen
Mr. Secretary,
I sure hope that the "thumbs up" sign does not mean the same thing in Mozambique as it does in the neighboring country of Swaziland!
John sounds like a very capable man who will be successful no matter what capacity he serves in.
About that pandemic planning...at what point do you think that it will be most appropriate to fully inform the public that there is a pandemic breathing down our necks. I know the danger of telling people too soon. I have experienced that myself. Having told people in my town to soon, they have dismissed the pandemic. I am glad that I backed away when I did because I can still revisit the issue having not lost total credibility. I planted a seed which is being watered by others...
I have not given up. Unfortunately neither have the virii.
I have to make sure that the next time that I revisit this issue in my town, that I have perfect timing. There is no room for error. To push to soon would do a lot of harm. The COOPS are completed and the all hazards approach covered but the necessary pandemic plans are not well laid.
Any assistance that you can offer to this lowly non-professional would be greatly appreciated.
Prayers and supplications,
Jackie-"standingfirm"
P.S. Please keep up the blogging. I look forward to your posts. Cultural anthropology has always been an interest. Thank you.
Posted by: standingfirm | September 11, 2007 at 08:15 AMDr. Leavitt, and others
The Emergency operations training went well today. Since September 11th so much is different and so little has changed to accommodate what has happened.
Each department will do their job. Not one will drill the public or prepare them. Stories of what happened with the last disasters filled the room but no changes where made to the SOP - Standard operating procedures.
This is not how things happened on "Star Trek" An odd reference? Possibly. In the movies the public either knows how to run to bomb shelters / escape pods or there is panic, riots and confusion.
After today's lesson on the computer it looks like the confusion will be far more documented than ever before. Yet the hardest part for me was privacy. How to know who needs Oxygen or Air conditioning during a heat wave while protecting their right to privacy. These may not be issues in where you and John are but with our computers they are. I am kinda surprised no one has started a business to be the clearing house of information during an emergency.
Who has gas, who has food, who has propane for grill, which pharmacies are open, which are closed, who needs help - the questions boggle my mind.
Jackie="StandingFirm" - best wishes. Never give up. I like your idea of being ready for when the time is right. Some people believe that being ready for one emergency helps you cope with another emergency. BTW, to day in class one person lamented over losing hundreds of dollars worth of food when the power failed. Instead of getting a generator or something they now empty their freezer in June before hurricane season starts. Kinda scares me.
Dr. Leavitt I do hope you blog. There seems like there is so much to be done.
Regards,
Posted by: Allen | September 11, 2007 at 04:38 PMAllen
"I can not lead people who are unprepared to follow" - Admiral Agwunobi, U.S. Dept of HHS.