As the medical director for this team I know full well that our effectiveness is dependant on several things.

1) I need to be sure that our team is safe.
2) I need to sure that we have the resources that we need to do our job or I need to work with the team to help them come up with creative ways to use the resources we have.
3) I need to be sure that we have adequate communications both internally and externally.
4) I need to be sure that I understand how we fit into the bigger picture.
5) I need to constantly assess how we are doing and look to the future with a willingness to adjust the plan based on feedback from the team and others.

The last point actually impacts the other three significantly. Networking is key during disasters. The strength of a disaster response in general has to do with how well the various resources cooperate. During this trip I introduced mind-mapping software called Mindmiester. This software allows us to track relationships in a visual format that will help our team get things done more effectively and more efficiently. We have found that the iPhone has been a very powerful and dependable communications tool her in Haiti. The folks at Mindmeister have an app that allows us to edit our map on the fly. All of us on the team can share the same map. The team back in the US can also see how the network is expanding. I anticipate that this type of technology will become more and more important as we respond to disasters in the future.

It occurred to me that many of you might not know how to flush a toilet when there is no running water. There are 2 important rules:

1) If it's clear, it stays here.
2) If it's brown, it goes down.

A corollary: if your urine isn't clear, you are dehydrated and need to start pouring down the liquids so as to not become part of the problem.

It turns out that there are two strategies for flushing. One of our team members is convinced that the best thing to do is get a bucket of water and fill the tank and then flush it as usual. The strategy that I prefer, however, is to just pour the water directly into the bowl. Need more pressure? Pour from higher up. Bottom line (so to speak): you have options next time your water stops running. Oh, the things that we take for granted.

Today was a very productive day. We were able to track down a pressure cooker type autoclave for sterilizing our surgical instruments. We were also able to track down an "oxygen concentrator". It is a piece of equipment that allows us to give patients increased oxygen. This can be a matter of life and death in the operating room. What a tremendous blessing! I'm still amazed that we found one.