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The
Liaison - Center
of Excellence DMHA -
Hawaii
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Vol.
1 No. 4 Jan - Mar 2000
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CHART: Imagine a nation where large-scale civil war pits anarchistic militias battling for all-or-nothing control, using the food supply and innocent civilians along with guns and mortar fire as weapons. Compound this dreadful scenario with severe drought, catastrophic health problems and genocide. Then imagine thousands of refugees crossing borders and the rest displaced by the threat of violence in their communities. Women, children and the elderly face increased risk of death because of their vulnerability. Now, imagine being given the task of going to this country to restore order, the food and water supply, the infrastructure and health care. Imagine trying to restore faith in people whose lives have been torn apart by war or heal a nation who watched neighbors kill neighbors because of their different ethnicity. Daunting? Quite, but there is an avenue to begin to unravel the complexities inherent in both man-made and natural disasters. The Center of Excellence’s Combined Humanitarian Assistance Response Training, or CHART, is an introductory course designed to furnish military and civilian agency members with basic information about humanitarian emergencies in the international arena. The overall intent is to better prepare graduates to carry out humanitarian assistance missions. A complex emergency is academically defined by the Interagency Standing Committee of the United Nations as: “a humanitarian crisis in a country, region or society where there is a dramatic disruption in the political, economic and social situation, resulting from internal or external conflict or natural disaster, seriously disrupting the population’s capacity to survive and the national authorities’ capacity to respond, and which requires a consolidated multi-sectoral international response.” Situations in Somalia, Rwanda and the Balkans are examples. Although each was unique, they all had characteristics of a complex emergency: politically driven, high levels of violence, cultures at risk of extinction, public health tragedies and vulnerable groups at risk. Equally devastating are natural disasters. Recent earthquakes in Taipei and Turkey and the floods in China, Venezuela and Vietnam continue to leave thousands of people homeless, displaced and hungry. Many of the dead aren’t buried; they simply haven’t been found. Each complex emergency or natural disaster requires a massive logistical response, assistance in stabilizing mortality and morbidity, and reestablishment of everything from public health to the postal infrastructure. CHART gives humanitarians and responders the accouterment to accomplish this important work. The Center’s first director, Dr. Frederick “Skip” Burkle, founded the CHART course in 1993. The end of the Cold War brought about a rise in the frequency of regional conflicts around the world. The Kurdish Refugee Crisis, Somalia and Haiti, among others, prompted the need for a coordinated humanitarian response. Civilian and military relief workers often arrived on the scene of a complex emergency with little or no training. This, recalls Burkle, was the impetus for the inception of the course. He said initial requests for the course were primarily from the military. “The first group was a naval reserve unit that received orders to become a humanitarian assistance and disaster recovery asset to a unified command. The unit was not prepared for this new mission, had no expertise themselves and did not know where to go to get the training,” Burkle said. The course was designed to provide the military with the skills necessary for responding to multi-organizational needs in large-scale international events. It was also designed to serve an integrated audience, including non-government organizations, the United Nations, the International Committee of the Red Cross and multinational coalition military forces among others. The course moved to the auspices of the Center in 1994. Since then, as it continues to evolve and adapt to serve changing world events, it has gone through at least nine revisions. Burkle said, “The CHART course is highly flexible and easily transportable.” He added that the course has been given in Latvia, Great Britain, Okinawa, Singapore and many other places, nationally and internationally. It has been translated into Russian and will soon be translated into Spanish. An important step in the evolution of the course was the relationship that was formed between the U.S. Army Medical Department’s Center and School so that their Defense Military Medical Readiness Training Institute could be utilized to schedule and keep records of those trained. This process allowed the military to identify the appropriate people needing CHART and to know who has already received the training and can apply their new knowledge and skills in the field. In its present form, the course emphasizes a new paradigm in humanitarian assistance. It addresses the entire peace process, from the first onset of the emergency through to its end with the region's rehabilitation. Training advisor Peter Leentjes of the Center notes that the role of humanitarian assistance is changing. “In modern peacekeeping there are no rules-now, it requires a coherent plan.” In classic peacekeeping, governments have been in control, the infrastructure has been intact, judicial systems have been in place and international rules operable. This is no longer the case. Today, more often than not, governments are ineffective or are not in control, with factional political groupings, a broken infrastructure, and a nonexistent, or at best corrupt, judicial system. It’s a world where “Civilian casualties become a political strategy,” Leentjes said. Modern peacekeeping requires multidimensional, multinational operations with a focus on integrated political, economic and social solutions. The CHART course, over a five-day period, begins to put all these pieces together. It begins with an overview of what constitutes a complex humanitarian emergency, whether man-made or natural. The pace of the course is rapid, quickly moving to considerations of the operational environment where such things as players, logistics and issues of sovereignty are discussed. An important part of the discussion is International Humanitarian Law. Considering that in the last 10 years there have been over 40 conflicts with 5.2 million civilian deaths and 1.1 military deaths, learning about the body of rules and principles that seeks to save lives and alleviate suffering during conflict is significant. The fourth day of instruction is termed the “Special Emphasis” day. This day can be customized to fit the audience whether medical, legal or veterinarian. At a recent CHART course, which took place at Hickam Air Force Base in Hawaii, the special emphasis day focused on the medical field. Doctors, nurses and technicians learned about water and sanitation, mental health issues, malnutrition, dehydration, triage, immunization and communicable disease. The course can be easily adapted and taught in-depth-everything from international law for attorneys, to religious customs for chaplains. The final day of the course focuses on measures of effectiveness and transition to sustainable development of the affected country or region. The entire course is brought together and solidified in the form of a case study. This exercise encourages participants to use all of the knowledge learned during the week of instruction. It’s actually a continuation of a case study given earlier in the week. Students are asked to do their best in deciding a plan of action for a mythical humanitarian emergency. By the end of the week they feel a great deal more confident in their ability to devise a solution to the complex issues presented in the case. The educational format of the 40-hour course is based on adult learning principles. It uses didactic lectures, group discussions, small-group problem solving and group presentations to introduce students to the operational concepts and practices in disaster management. Students earn 24 CME (Continuing Medical Education) credits for attending the course. CHART continues to evolve. The vision for the course is to train national and international civilian and military personnel for a coordinated response to humanitarian assistance missions within complex emergencies and natural disasters. The goal is to achieve a 50/50 mix of civilian and military, both national and international, attendees. The need for experts in disaster management continues to grow so plans are being formulated to accommodate the accompanying demand for training. Leentjes said the goal is to conduct 50 CHART courses each year throughout the world with about 60 students attending each class. According to Leentjes, increasing the number of “Train-the-Trainer” courses is the only way to achieve this goal. Participants interested in becoming instructors are invited to apply after completion of the CHART basic course. It’s
anticipated that CHART will be expanded to accommodate an advanced level
of the course. CHART I, the present version, would continue for operational
personnel as an introductory course to combined humanitarian assistance.
CHART II, the expanded version, will constitute a graduate-level course
that expands on the strategic sections of the CHART I topics. Teachers
as Students Each member of the CHART course faculty brings a unique set of experiences that contributes to the students’ understanding of disaster management. All have operational experience, which adds realism to the academics of the course. Because of their experience, the instructors are passionate about the material, but for every bit of experience each instructor brings to the table, they all also say they take something away from teaching the course. Jeff Lewis, a training advisor with the Center of Excellence, served eight years with the United Nations’ World Food Programme. Lewis related, “I teach a lot of the humanitarian aspects because my background is humanitarian operations.” With a graduate degree in management from Thunderbird: The American Graduate School of International Management, he is at home teaching logistics and interrelationships of the humanitarian functions. However, it’s his real-world experience that adds the most value to the classes he teaches. “I basically want to provide the audience with the humanitarian aspect from an operational point of view,” Lewis said. What Lewis takes away is a current view of humanitarian operations. He said, “Anytime you teach something you also have to reconfirm or reevaluate the information yourself in order to pass that on…you always pull out recent articles or whatever and look at what has changed.” He added, “It keeps you up to date on everything that you are teaching.” Lewis said he always tries to add discussion to the lecture to get feedback from the students. He said students see a situation from different points of view, much like the players in a real disaster. He added, “Even in the same disaster every single player will see it differently, so hearing another point of view [in a class situation] helps you understand the total picture.” Some of the CHART instructors are heavily tasked. Peter Leentjes, another of the Center’s training advisors, teaches a broad base of subjects: humanitarian law, the security environment, peace operations, “…and a bit of everything else.” His expertise is relied upon heavily. Before joining the Center last October, Leentjes had spent almost five years as the senior training advisor of the Department of Peacekeeping Operations at the United Nations. He said, “Teaching is a great experience because students not only take what they learn and use it but also pass it on. “If you have interested students you can see at the end of any day, or the end of any hour, that these people have taken something in that they didn’t know before and that they are now going to use…it’s a rewarding experience,” Leentjes said. One of his goals is that “students improve how they deal with other people, how they deal with their subordinates and how they train and prepare them.” Besides the fundamentals of logistics and humanitarian law and the like, there are some very practical matters that must be taught. For example, how do you set up bathrooms for 800,000 refugees who are camped on a lava bed? The job of teaching water and sanitation falls to Lt. Col. Steven Astriab, chief of operations and the executive officer for the Pacific Regional Medical Center. He said he takes an objective approach to the subject, which inevitably elicits a few giggles from the class. “If you simply taught it exactly the way it was listed in text books, or exactly the way you would have to go through a check list, it would be very boring,” Astriab said. “You have to make it as interesting as possible—especially right before lunch or right after lunch.” His main objective is to ensure that students know how to create an environment that is as sanitary for the situation as they can and that sufficient water is available both in quantity and quality. Astriab was assigned to PRMC in 1998. Shortly after his arrival, he attended a CHART course and was asked to give a short talk on his disaster management experience. He spoke about his role as chief of the operations disaster team in Kuwait City shortly after the Marines went through in February 1991. Following his talk, he was asked if he would be interested in teaching a portion of the CHART course. He agreed and has since taught two. “I enjoy working with the students, I enjoy their comments—they often relate experiences that they have had that I have not. I can incorporate some of the knowledge I gain from them into subsequent lectures,” Astriab said, adding, “It’s fun.” Another instructor who enjoys working with students is Lt. Col. Patricia Hastings, acting director of the Center of Excellence. She has taught about 15 CHART courses over the last three years and has been a teacher of every subject at one time or another. “I’m one of those multitasked people, partly because I have been here so long and partly because of the roles I’ve served,” Hastings said. Hastings, who is a physician, said what she enjoys teaching most are the medical topics of the course. “I think I can impart the important aspects of medical lectures to people who are nonmedical,” she said. “I’m not going to turn a line officer into a tropical disease expert but I can help him understand why communicable diseases are important, not only to him personally and professionally for his men, but also for the refugees.” Hastings said that probably every instructor learns from the students, too. “The students have very diverse backgrounds and have a fresh look at not only the subject matter but also the world in general,” she said. “People are a lot more aware of the global implications of our efforts.” Because of this, “I think the biggest things that I take away are perspective and a better understanding of what we do.” Hastings is no stranger to disaster management and humanitarian activities. Her domestic experience includes the Oklahoma City bombing, the Northridge earthquake and the fires in Eastern Washington. Internationally she has spent time in Tanzania working in the N’duta refugee camp. Lewis, Leentjes,
Astriab and Hastings represent a cross-section of the CHART course faculty.
There are about 20 instructors nationwide which the Center calls upon.
Who gets called to serve as an instructor depends on the focus of the
particular CHART course. For those who think they may be interested in
bringing their talents to the table, the Center offers a Train-the-Trainer
CHART at least twice a year. If you have field experience in the area
of disaster management or humanitarian assistance, contact the Center’s
Education & Training Program staff. As evidenced by the faculty highlighted
here, the takeaways are well worth the effort. More
or Less In addition to the CHART course, the Center of Excellence has two other opportunities for disaster management and humanitarian assistance training: Health Emergencies in Large Populations or H.E.L.P., which offers more, and the Training Assistance Program or TAP, which offers less. First, Something More H.E.L.P. is an intensive three-week course focusing on public health interventions, international humanitarian law, human rights, responsibilities of health professionals, and ethics. It’s broken into two modules: H.E.L.P. I, a two-week section that focuses on health emergencies; and H.E.L.P. II, a one-week section that focuses on health, ethics, law and policies. The course is organized jointly by the International Committee of the Red Cross; the Center of Excellence; the Department of International Health; the University of Hawaii-John A. Burns School of Medicine; the Johns Hopkins University; Pan American Health Organization-Emergency Preparedness and Disaster Coordination Program; and the American Red Cross. H.E.L.P. is intended for health professionals including doctors, nurses, nutritionists and public health officers. Those professional field workers not directly related to health, but having a sufficient understanding of health problems who are interested in attending, will also be considered for admission to the course. H.E.L.P. is being offered two times this year in the United States: July 10-July 28, at the Johns Hopkins University, Baltimore; and from July 17-Aug. 4, through the University of Hawaii in Honolulu. It is also being offered in six additional locations around the world in the year 2000. For a registration application for the Honolulu H.E.L.P. course, email Winnie Yamaguchi at the Center. (winnie.yamaguchi@coe-dmha.org) The course can accommodate up to 30 students and fills up quickly. The ICRC created the H.E.L.P. course with the participation of the University of Geneva and the World Health Organization (WHO). Since it was first offered in 1986 in Geneva, 50 H.E.L.P. courses have been given in various parts of Latin America, North America, Africa, Asia, Western and Eastern Europe, training more than 1,000 professionals. And Something Less The Center also offers a shorter, customizable version of the CHART course called the Training Assistance Program (TAP). The host organization selects the curriculum and, with the assistance of the Center, runs the training. The course length, driven by the client's requirements, typically runs from two to four days. Any of the curriculums available from the standard CHART course can be utilized for a TAP. Additional subject matter may be selected ad hoc. However, unlike the full CHART, TAP does not offer continuing medical education credits. Up to three instructors per TAP can be supplied by the Center. The Center will organize the presentation material—lectures and case studies—and furnish a copy to the organizer to reproduce for the course attendees. Registration, administration, class size and facility arrangements are the responsibility of the host. TAP is a
great way to get a head start on disaster management and humanitarian
assistance training. Another advantage to the shorter format at a home
base is that it eliminates travel expenses, thereby allowing more individuals
to be trained at a lower cost to the client. For more information on arranging
a TAP course for your organization, military component or command, contact
the Center’s assistant course director Winnie Yamaguchi at: winnie.yamaguchi@coe-dmha.org.
Sounds
great! Now what?: The ‘How-To’ for Hosting a CHART Course Although the Combined Humanitarian Assistance Response Training course is taught by the Center of Excellence faculty, the logistics of scheduling, registering, enrollment and ensuring the facilities are adequate falls to the Defense Medical Readiness Training Institute (DMRTI), in Fort Sam Houston, Texas. Lt. Jessie Gee is the officer in charge and course director for CHART at DMRTI. “We do everything except provide the faculty members, from applying for the continuing education medical credits, to all the paper work,” she said. When a command or agency initiates a request to host a CHART course, the first thing that Gee needs to know is the objective. “What is your command? What are your training needs? What is your mission? Why do you need the course?” Gee explained. Balancing between DMTRI’s other courses and the Center’s commitments, resources get spread thin. It’s Gee’s job to ensure that if a CHART is scheduled it’s appropriate to the agency or command making the request and that the greatest number of students, both civilian and military, participate. Once a request is made and passes the initial screening, DMRTI emails a ‘host organization requirements’ letter. “This may change their minds once they see everything that’s entailed,” Gee said. The host must furnish adequate classroom facilities, make arrangements for audio/visual needs and draft a welcome letter with information regarding accommodations and food availability, among other things. After establishing need and working out the host’s facilities and logistics, a date for the course is confirmed. “I look at our schedule, because we do a lot of training, and based on our resources and the Center’s resources, which of course is the faculty, I assign dates,” Gee said. Once everything is confirmed, Gee begins marketing the course. It is open to personnel, both military and civilian, outside the host command or agency, although first priority is given to the host. She said, for example, at a recent course in San Antonio, there were 120 seats available but 20 were held back for outside requests. If your organization is interested in hosting a CHART course or if you are interested in attending a scheduled course, contact:
Currently, the memorandum of understanding assigns DMRTI with the responsibility of conducting four CHART courses each year; however because of demand, that number may double. Under certain circumstances, a CHART can also be coordinated through the Center. Col. Mike Ward, the course director at the Center, said that there are three COE CHART courses scheduled between now and October. But, unlike those scheduled through DMRTI, “They are not open to outside attendees…they are strictly for the requesting command,” Ward said, adding “They are very command focused…more like a Training Assistance Program course.” Ward said the exception is the “Train-the-Trainer” CHART scheduled for 18-24 October in Honolulu, Hawaii. This course is designed to increase the number of qualified instructors for CHART. The goal is to eventually teach 50 CHART courses a year but in order to do this, “We must develop a cadre of instructors,” who are qualified to teach the subject matter. This course is open to all qualified potential instructors. For more
information on attending the Train-the-Trainer course contact the Center’s
assistant course director, Winnie Yamaguchi at: winnie.yamaguchi@coe-dmha.org.
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