Mike Cooper, MS, MPH, NRRPT, CIH, says that his path to becoming a volunteer in Haiti was somewhat serendipitous. With a background in chemistry, public health, and failure analysis, Cooper has spent more than 20 years managing and directing corporate environmental health and safety programs for industries with both national and international sites. He is an instructor for UC Davis, and in 2015 he started his own business, M Cooper Consulting. When his son graduated from college and traveled to Haiti to volunteer with NPH International, a Catholic charity that has worked in the country for approximately 30 years, Cooper went for a visit. His trip marked the beginning of his involvement with industrial hygiene projects in Haiti, where his focus has been X-ray and CT radiation monitoring, sharps management, and hospital water purity. Cooper is a member of AIHA’s International Affairs and Biosafety and Environmental Microbiology Committees. He can be reached via email. The Synergist: What were your first impressions of Haiti? Mike Cooper: Haiti is a small country with big problems. It’s the land of NGOs; however, the NGOs are not well coordinated with the government or other NGOs in terms of all the efforts going on there. The massive earthquake in January 2010 devastated the country and leveled most of the government buildings, including medical and nursing facilities. That was followed by cholera. Even in 2016, six years later, there’s still evidence of the destruction and a very keen memory of the cholera clinics, homelessness, and deaths. A lot of work has gone in, a lot of money’s been spent, and rebuilding has taken place, but there are still signs of the difficult situation that happened some years back. I first got involved with two hospitals run by the NPH Catholic charity. They had several needs as they were looking to use some United States Agency for International Development (USAID) funds to build a hospital building, which meant that they had to do some coordination work with the U.S. Embassy in Port-au-Prince. I worked with the people who were planning that effort to assess the environmental impact in Haiti. That work revealed a number of different industrial hygiene needs at these hospitals, including radiation equipment monitoring and water purity. While I was walking on the beach near Cité Soleil, one of the poorest urban areas, I found kids playing soccer on the beach with needles in the sand. That scene led me to find out how the hospital was dealing with their sharps and what their sharps disposal procedures were. Since everything at the hospital is supported by donations, somebody had given them a medical incinerator, but it was in need of repair. Since the hospital generates a volume of sharps, my efforts included providing some industrial hygiene training on sharps management and bloodborne pathogens and figuring out ways for people to collect needles with magnets and punch-proof gloves to help prevent exposures. Another thing that was eye-opening to me was the hospital morgue. Obviously, the hospital loses patients, many of whom seek care very late in the disease cycle, often due to poverty. But because it serves the poor, sometimes an individual will pass and they’ll be brought to the hospital because their family doesn’t have money to bury them. The morgue at the hospital was a large Conex unit—a modified shipping container—that didn’t have very good refrigeration and wasn’t up to the standards of a U.S. morgue. Haitian and volunteer staff prepared the deceased, put them into the temporary Conex morgue, and then tried to find a place to bury them on available land. My son, who is in medical school for international medicine, was helping with the bodies, so I’ve provided gloves, respirators, and other equipment to help with that work. TS: What other industrial hygiene projects were you involved with at the hospital? MC: I also did survey work for the radiation equipment. The results from one-month thermoluminescent dosimeter (TLD) badges appeared a little high, but there was a question as to whether or not the badges were exposed in the multiple X-rays that were done in the airports when the units were shipped from Haiti back to the U.S. for analysis. After that, I went back and did some surveys of their radiation technicians and scatter from the X-ray units to determine exposures. I identified issues concerning recordkeeping, evidence of surveys after equipment repairs, signage, and lack of personnel dosimetry. The equipment was being operated in a proper manner by the Haitian technicians, who had received some training in U.S. hospitals. However, they had no dosimetry and no means of detecting scatter because they didn’t have survey instrumentation. Instrument scatter is typically checked on a routine basis and after any maintenance on the units. Protective lead aprons are also checked periodically to make sure they’re not cracked or separated. This type of survey is typically done on an annual basis in the U.S. to meet Nuclear Regulatory Commission and state requirements for X-ray machines. The U.S. also requires film badges so that it is possible to determine if an exposure occurs, allowing for an investigation and corrective actions. The hospital has volunteer medical and nursing teams coming in from around the world to do surgeries and sometimes there’s an X-ray tech that comes with them. Having someone come in from another country who’s operating equipment without dosimetry raises a question as to whether or not there are issues there. I spent a lot of time with the X-ray operators, talking about scatter from X-rays, why you have a maintenance log, and why you do surveys. They’d received some training on those topics, but it had been a while.
 
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Editor's note: This article is part of a Synergist series called “Pole to Pole.” Exclusive to the digital magazine, this series focuses on the challenges of practicing industrial and occupational hygiene around the world. Each month, the digital Synergist features an edited Q&A based on an interview with an industrial hygienist about how the IH/OH profession differs from country to country. The previous installment of “Pole to Pole” features AIHA member Garrett D. Brown, who discussed IH and safety in Bangladesh. This month, the series focuses on Haiti.
|Pole to Pole: Haiti |
An Interview with Mike Cooper
Access this article from a desktop computer or tablet to view a slideshow of images of Haiti provided by Mike Cooper.
"Haiti is a small country with big problems. It’s the land of NGOs; however, the NGOs are not well coordinated with the government or other NGOs in terms of all the efforts going on there." -Mike Cooper
TS: What was your experience working in Haiti? MC: I was very fortunate because the NGO I worked with, NPH, has a good infrastructure, including transportation, meals, and safe lodging. Haiti at times can be a violent country, and it experiences a lot of political and social unrest. When you’re working in an area like that, you go in, keep your head down, and do as much as you can while trying to figure out how to make the efforts sustainable so that the work you’re doing will be effective after you’re gone. That sustainability piece is so important. For example, if a U.S. hospital donates a piece of equipment, whether it’s a survey meter or something else, sustainability concerns include whether people are going to be trained in its proper use: is there going to be maintenance done on the unit, is the unit going to be calibrated appropriately, is there money for any needed repairs, et cetera? These types of things that we take for granted in the U.S. are not necessarily going to happen within a country like Haiti because the infrastructure or funding may simply not be available. TS: How would you describe the practice of industrial hygiene there? MC: Industrial hygiene appears to be in its infancy in Haiti. I didn’t meet any industrial hygienists, but I did meet some folks at the U.S. Embassy who were aware of environmental health and safety concerns. There’s a large need for industrial hygiene education, training, and awareness for the various industries in Haiti—particularly the medical industry. Since about 2004, permanent UN peacekeeping troops have been present in the country—the hospital I was working at was right across from the UN compound—and in such an unstable political situation, industrial hygiene is not a high priority. Almost any skill set that you have in industrial hygiene is something that would be useful in an area like Haiti. I only just scratched the surface in terms of what kind of IH efforts would help the within the country. There are many opportunities for anyone interested in this work.

TS: What other industries in Haiti would benefit from the help of industrial hygienists? MC: Certainly any industry that’s related to the disposal of contaminated wastewater and the disposal of sharps. From my limited view, many industries within Haiti are small family businesses that would be of concern from a worker safety viewpoint because they don’t have anyone trained or regulating what’s going on. But with so many larger concerns within the country such as unrest, violence, and poverty, workplace safety is less of a priority and not well coordinated on the government side.
TS: What have you taken away from your work in Haiti? MC: Any time you do pro bono work in a third-world country, it’s life changing. It opens your eyes to what’s out there, and you start to realize that the resources and tools you have can be effectively used there. Very simple things can make a large difference. For example, I brought magnets and puncture-proof gloves in order to help with some of the sharps issues at the hospital. Same with the dosimetry: it’s very simple to get dosimetry in the U.S., but it was just something that wasn’t available there. There are a lot of organizations doing tremendous work in Haiti—notably Paul Farmer’s Partners in Healthcare—but the coordination of the numerous NGOs remains a challenge. One issue that can arise from all of this aid—and I’ve seen this in other countries like Cambodia—is a situation where there’s a tacit dependency on the NGOs because there’s not a way for the public sector within the country to really accomplish what needs to be done. When you add political unrest and corruption, the situation becomes even more difficult. But I see something hopeful in Haiti, especially with NGOs like NPH. They have dedicated personnel and Haitian staff who accomplish so much with so little. It is encouraging when volunteers step in to fill the gaps.
Typical scene in Port-au-Prince leaving the airport en route to the hospital.Typical scene in Port-au-Prince leaving the airport en route to the hospital.Entrance and guard house for St. Damien's Hospital compound.Haiti-figure3Medical waste collection and incinerator at St Damien’s.Radiology area and scatter experiment setup for X-ray unit.
Photos provided by Mike Cooper.
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