It was extremely hot and dusty as the caravan of humanitarian aid workers from Team Rubicon pulled up to a farmhouse in Matarara, Mozambique – 40 miles west as the crow flies from Beira, but a nearly 8-hour journey overland due to road washouts and poor conditions. Team Rubicon had arrived to as part of the Cyclone Idai response after the storm ripped through Mozambique and caused monumental flooding throughout the country.
Using Fulcrum in Mozambique
Team Rubicon was three days into a medical deployment and the arrival at the farmhouse was the first opportunity to showcase our skill set: remote-area medical. The farmhouse was truly remote; not even local cellular phone carriers received signal. The only way to contact the outside world was via satellite phone, which explained the delayed reporting that nearly 9,000 survivors were in need of food, clean drinking water, and medical treatment, with some of the survivors cut off from traditional aid services as a bridge over the neighboring river was destroyed in the floods. The only way to reach these survivors would be by helicopter. Team Rubicon is uniquely suited for these missions.
Challenges and achievements in Matarara
In July 2018, Team Rubicon became the first North American NGO verified as a WHO Type 1 Mobile EMT. This status proved they could deploy in remote, resource-constrained locations. They could remain self-sustained for 14 days without resupply and treat 100 patients per day. Despite deploying internationally as a medical team since 2010, this was their first deployment as a WHO EMT Type 1 Mobile. Team Rubicon began this deployment by servicing an IDP camp about two hours outside of Beira. However, more remote areas affected by Cyclone Idai required attention. Other medical teams were unable or unwilling to travel to these areas. The area around Matarara, with its trapped survivors, presented an opportunity. Team Rubicon recognized this opportunity and excelled at solving it.
Medical operations and data management
As Team Rubicon’s medical team began unloading their gear from the convoy vehicles to break camp for the night, team leader Dan checked in with Team Rubicon’s National Operations Center in Dallas, TX by satellite phone. Dan was told there were new reporting requirements from the Health Cluster’s Emergency Medical Team Coordination Cell (EMT/CC) that were imperative to transmit due to the growing concern of a Cholera outbreak. Cholera is an infectious and often fatal bacterial disease of the small intestine, typically contracted from infected water supplies, that causes severe vomiting and diarrhea. When the floods from Cyclone Idai swept through, it destroyed or contaminated the village wells. With no way to source clean drinking water, village survivors were forced to drink the contaminated water and reports of Cholera were on the rise. Given the monumental amount of flooding, Malaria was also rising.
Using technology against epidemics
Team Rubicon needed to demonstrate its ability to collect and analyze patient data for the WHO EMT verification. The team worked in mobile, remote, and austere locations, so they created a paper patient record and distribution process. This system generally worked if they could transfer paper records to the appropriate authority each day. However, the EMT/CC required all patient data in a large Microsoft Excel spreadsheet. This file couldn’t be transmitted via email using satellite hotspots. As a result, Team Rubicon couldn’t send daily reports to its National Operations Center or the EMT/CC. This situation left the medical team operating in a complete vacuum. They needed to find another way to collect, analyze, and transmit information to the WHO. This step was crucial to prevent an epidemic that could take even more lives.
Expanding its impact with Fulcrum
Earlier in 2019, Team Rubicon deployed with NetHope to install wireless access points on the Colombia/Venezuela border to provide Venezuelan refugees with access to news information and offers of assistance. NetHope utilized Fulcrum to track access-point install requests as well as record successful installs. Team Rubicon received training on Fulcrum during the deployment and grew to like the offline form entry capability, ability to change forms on the fly, and manipulate and analyze the collected information via the console. When faced with the need to collect medical information in an internet-disconnected environment and transmit reports later when within range of internet, Team Rubicon reached out to Fulcrum for support. Fulcrum provided a community disaster grant to facilitate Team Rubicon’s Cyclone Idai response, including developer assistance to rapidly publish medical forms.
Daily operations and information flow
Each day, Team Rubicon’s operations began with loading into a helicopter at the farmhouse in Matarara. After a 15-minute helicopter ride across the river, they hiked 5-10 miles with all their gear to reach the village. While providing medical assistance, Team Rubicon also conducted multi-sector rapid needs assessments. They identified available food stores, access to clean drinking water, and other unmet needs in the village. This information must be transmitted back to the EMT/CC and the United Nations Cluster Coordination System. It was crucial for providing early warning of the Cholera outbreak and identifying locations needing humanitarian aid distributions.
Critical contributions
Fulcrum allowed Team Rubicon to quickly enter patient and multi-sector needs assessment data in a disconnected environment. The Fulcrum app works on a cellular phone, eliminating the need for bulky paper forms. Once back at base camp with internet access, Team Rubicon could transmit daily collected information. This data went to its National Operations Center, which generated the EMT/CC daily reports in the preferred format.
Team Rubicon was one of the only WHO EMTs that provided timely reports to the EMT/CC. Team Rubicon collected information via Fulcrum, leading to numerous life-saving medical evacuations after Cyclone Idai. This data also facilitated and expedited deliveries of food, water, and non-food items (NFI) by other international NGOs. These efforts helped save lives and stop the spread of diseases within the affected villages. Team Rubicon utilized Fulcrum for the entire duration of its Cyclone Idai response. The EMT/CC lauded Team Rubicon for the amount and timeliness of data transmitted, which would not have been possible without Fulcrum.
Continued commitment post Cyclone Idai response
As Team Rubicon was demobilizing from Cyclone Idai response, Cyclone Kenneth struck Northern Mozambique, so the team immediately pivoted and redeployed to Northern Mozambique. Team Rubicon was the only WHO EMT that responded to the area and continued the use of Fulcrum during the team’s response to Cyclone Kenneth.
Team Rubicon serves communities by mobilizing veterans to continue their service, leveraging their skills and experience to help people prepare, respond, and recover from disasters and humanitarian crises. Its mission is providing disaster relief to those affected by natural disasters, be they domestic or international. By pairing the skills and experiences of military veterans with first responders, medical professionals, and technology solutions, Team Rubicon aims to provide the greatest service and impact possible. Learn more at teamrubiconusa.org.
All images courtesy of Team Rubicon.