Figuring out the Fixing: Understanding the Underlying Processes for Designing and Implementing Crisis Medical Relief Efforts

摘要

Extreme events have the ability to cause substantial harm to the people subjected to them. In particular, disasters and public health emergencies can lead to an increase, sometimes substantial ones, of people in need of medical care. Delivery of that care becomes an important part of the response and relief effort. This research seeks to answer the question "How do the actors that become involved providing international medical relief to an international crisis event plan and implement that effort?" To answer this question, I use a combination of interview, observation, and document data. Using interviews, observation, and document analysis, I study the development of relief efforts of multiple groups involved in response to at least one of two crisis events: the 2014-2016 Ebola outbreak in West Africa and the April 25, 2015 earthquake in Nepal.;This decision-making took place in an operational context in which characteristics of the event, the political, legal, social, and cultural environment, physical environment, and resources all influenced those decisions. Relief workers captured information about this setting through the process of developing situational awareness, in which they gathered, communicated, and processed that information. They worked with definitions and boundaries as they developed that situational awareness. They ultimately made decisions through the use of a matching process. These three processes were linked together through a sort of feedback loop. Collectively, they created a condition of decisional inertia in decision-making, where as groups committed more resources towards a particular course of action and made more and more decisions over time, fewer and fewer opportunities were available to participate in the broader response, and it became increasingly difficult for organizations to change course in their relief effort. However, when substantial forces acted upon the relief efforts, such a s a change in the event itself or large-scale changes within an organization, new opportunities for participation opened up, allowing for change in organizational activity previously not available.