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This Week in The Lancet

  • Volume 377 1719 (2011)
  • May 21, 2011

Emergencies and Disasters

Poverty – A Global Humanitarian Crisis

Thursday, June 3rd, 2010


Poverty leads to conflict and conflict leads to greater poverty and an inability to effectively respond to health disasters

The world is currently trapped in a humanitarian crisis of epic proportions. This crisis is poverty. Article 25 of the Declaration of Human Rights states, ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family.’ [1] Despite this 3.2-3.8 billion people (51-60% of the world’s population) live below the ‘Ethical Poverty Line’, defined as the income level below which further income losses materially shorten life expectancy [2]. Every year 10 million children in the developing world die from preventable causes including diarrhea, pneumonia, measles, malaria and HIV/AIDS: in over half of these deaths malnutrition is an underlying cause [3].

These deaths can be directly linked to poverty because with the appropriate resources they are preventable. As illustrated on the graph below [4], poverty is a humanitarian crisis of epic proportions. The poverty related child deaths in just one year reach a death toll exceeding that of World War II.

g1 Figure 1: Graph illustrating the death toll of 20th century atrocities and the deaths of young children from poverty in one year

Many of the world’s current humanitarian crises are a result of underlying global poverty. Collier’s studies show that low income and slow growth make a country prone to civil war [5]. A country with a gross domestic product (GDP) of US$250 per capita has a 15% probability of a war in the next five years. A country with a GDP of $600 per capita has approximately half of this probability [6]. Natural disasters are likely to impact poor countries more severely because poorly developed infrastructures and lack of resources make preparation and appropriate response difficult. If Haiti were not so poverty-stricken, the country may have been able to improve its physical infrastructure to prevent the terrible devastation caused by the recent earthquake. Poverty produces poor health and makes communities more susceptible to disease but contrarily also means effective treatment is unaffordable [7]. Conflicts, which are more likely to occur in poverty-stricken countries, both cause and exacerbate disease epidemics A vicious cycle is then created: poverty leads to conflict and conflict leads to greater poverty and an inability to effectively respond to health disasters.

Poverty has many causes but there is increasing recognition that international policy can have a negative or positive impact depending on its nature [8]. The World Bank has promoted a predominantly neo-liberal approach to poverty reduction. This approach relies on the trickle down of wealth through society to alleviate poverty [9] with social safety nets to protect the poorest [8]. According to the Bank’s definition of poverty the number of people living in extreme poverty has decreased. [10] The Bank’s criteria have been criticized however, since when the ethical poverty line is used the numbers have increased by 22-30% in the last thirty years [2]. The reality of this trickle down effect is challenged by the fact that in America, one of the richest countries in the world, with a predominantly neo-liberal approach to policy, one quarter of children lived in officially defined poverty in the year 2000 [11].

In the 1980s neo-liberal policy was introduced in many developing countries in the form of Structural Adjustment Programs. These policy packages developed by the World Bank and IMF reduced the role of the state and encouraged privatization. User fees were introduced in these countries health systems resulting in less people accessing healthcare [9]. Market liberalization was encouraged but a study published by the World Bank later found that it correlated with a decrease in income growth in the poorest 40% of the population [12]. A neo-liberal market approach is efficient at making the rich richer but not so efficient at making the poor richer. In 2000 the US’s top four hundred tax payers had a combined income that exceeded the combined income of Botswana, Nigeria, Senegal and Uganda [13].

It is important to note that the recommended neo-liberal policies have not been uniformly implemented. Some international policy disregards neo-liberal recommendations in order to favor the interests of the rich. The Trade Related-aspects of Intellectual Property Rights (TRIPS) agreement jeopardizes the generic drug industry in developing countries in order to protect the profits of the pharmaceutical industry [14]. It extends patents in spite of the fact that the current patent system is economically inefficient and causes losses of a much larger scale than those caused by tariffs and trade barriers [16]. Another example of the hypocrisy in international trade related policy is subsidies. Although the World Trade Organization has encouraged poor countries to stop subsidizing their farmers the rich countries continue this practice. European citizens are currently paying $2 per cow in subsidies when half the world’s population lives off less. It is impossible for poor farmers to compete with farmers in European countries who enjoy an average of $14,000 a year in subsidies [15]. Many countries are also paying more in debt than they receive in aid. These debts became un-payable partly because of the subsidies introduced by rich countries in the 1980s [9]. Protectionism and tariffs persist and it may be that fairer trade liberalization would have more benefits for the poor [17].

However even if proven to be effective, a pure neo-liberal approach is arguably not the most efficient poverty reduction strategy. Currently each $1 of poverty reduction acquired in this way requires $166 of additional global production and consumption with the associated environmental consequences having the biggest impact on the poor [7]. There is also evidence to suggest that the wealth inequality inherent in neo-liberalism is itself health damaging. Wilkinson’s research indicated that societies with more unequal distributions of wealth generally have poorer outcomes across a range of indicators [18].

It is irresponsible to place the lives of millions in the invisible hands of the market rather than in the hands of governments who can act to solve the problem. The resources already exist to alleviate extreme poverty. The United Nations Development Program estimated the additional cost of achieving basic social services for all in developing countries at about $40 billion a year between 1995 and 2005. This is less than 0.2% of world income [2]. Ending poverty needs to be prioritized and economic growth needs to be viewed as the means rather than the end of development and as one of many tools that can be used to achieve better lives for people across the world [19].

Internationally, countries need to meet the 0.7% GDP aid commitment. International taxation needs to be considered and debt cancellation accelerated in order to redistribute wealth more equitably. Nationally the state has a role in regulating and controlling the market. Progressive taxation and universal access to health and social services can help reduce poverty [7]. As shown there is already a clearly defined alternative to the neo-liberal approach. However even if there was not human ingenuity could surely find a solution to this problem. If the human race can organize itself to enable travel and communication across the globe it can find a way to ensure everyone in the world has access to the necessities of life. Poverty is a political choice not an inevitability [2].

It is right that the world responds so efficiently and passionately to crises like the Haitian earthquake but if this response is based on horror at life needlessly wasted then our response to the lives disabled and destroyed by poverty should be amplified many times over. If governments’ commitment to a shared humanity is to be more than empty words then they need to act with the same passion and sense of urgency in the fight to end poverty as they have in the aftermath of the earthquake. This is particularly poignant considering Haiti’s long history of deprivation. Acting in the aftermath of a natural disaster is like putting a band-aid on what was already a gaping wound. A survey conducted in Haiti between 1999-2000 found that 67% of the population was living in poverty. Between 1996 and 2000 infant mortality rose from 73 to 80 per 1000 live births, an increase associated with increases in poverty, HIV and inadequate health services [20]. Increased investments should have been made long ago in infrastructure and development to alleviate the desperate poverty and silent suffering of Haiti’s people.

If we are to preserve our integrity as individuals and as nations we need to fight for the silent millions outside the gaze of the media who suffer under the weight of a global humanitarian crisis. We must be a voice for the voiceless victims of the unnatural disaster that is poverty.

Emily Wilson is a third year medical student at the University of Bristol


1. United Nations. The Declaration of Human Rights. Article 25. 1948. [Online] Accessed: 20/01/10 Available from:

2. Gordon, D. (2004) Poverty, Death & Disease, in Hillyard, P., Pantazis, C., Tombs,

S. and Gordon, D. (Eds) (2004) Beyond Criminology: Taking Harm

Seriously. London, Pluto.

3. Jones G. et al (2003) How many child deaths can we prevent this year? Lancet 362: 65-71

4. Gordon D. (2009) Poverty, Death and Disease: and introduction to inequalities and health. Presented on The International Health Course. Bristol University.

5. Collier P. (2008) The Bottom Billion: Why the poorest countries are failing and what can be done about it. Oxford. Oxford University Press.

6. People’s Health Movement, Medact, Global Equity Gauge Alliance. Global Health Watch 2; 2008 [Online] Accessed: 20/01/10 Available:

7. CSDH (2008). Closing the gap in a generation: health equity through action on the social

determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.

8. Townsend P. and Gordon D. (2002) The Human Condition is Structurally Unequal in Townsend P. and Gordon D. (eds) World Poverty: New policies to defeat and old enemy. Bristol. Policy Press.

9. Gloyd, S. (2004) ‘Sapping the poor: the impact of structural adjustment programs’ in M.Fort, MA Mercer and O. Gish (eds) Sickness and Wealth: the corporate assault on global health. Southend Press.

10. World Bank (2010) World Development Report 2010: Development and climate change. Washington. World Bank.

11. Hofrichter R. (2003) ‘The Politics of Health Inequality’ in Hofrichter R. (eds) Health and Social Justice: politics, ideology and inequality in the distribution of disease. San Francisco, John Wiley & Sons.

12. Oxfam (2000) Agricultural trade and the livelihoods of small farmers: discussion paper for DFID. Oxfam GB Policy department. [Online] Accessed: 15/01/09 Available:

13. Sachs J. (2005) The End of Poverty: Economic Possibilities for Our Times. London, Penguin Books.

14. People’s Health Movement, Medact, Global Equity Gauge Alliance. Medicines in Global Health Watch ; 2005-06. [Online] Accessed: 20/01/10 Available from:

15. Oxfam (2002) Milking the CAP: How Europe’s dairy regime is devastating livelihoods in the developing world. Briefing Paper 34. [Online] Accessed: 15/01/09 Available:

16. Baker D. Financing drug research: what are the issues? Washington DC, Center For Economic and Policy Research; 2004b.

17. Stiglitz J and Charlton A. (2005) Fair Trade for All: how trade can promote development. Oxford. Oxford University Press.

18. Wilkinson RG and Pickett KE (2009). The Spirit Level: Why more equal societies almost always do better. Penguin.

19. Sen (1999) Development as Freedom. Oxford. Oxford University Press.

20. Pan American Health Organization. Basic Health Indicator Database. [Online] Accessed: 20/01/10 Available from:

Children Survivors of Displacment and War in Northern Uganda: A Cohort Study of the Itinerant “Night Commuters” and the Importance of Shelter and Security

Friday, June 6th, 2008

Rohan Radhakrishna’s study on Uganda’s “night commuters” was one of the winners of the first annual The Lancet-GHEC 2008 prize. An abstract of Rohan’s study – which will be presented at the 2008 GHEC conference – is provided below.

Context: An ongoing 22 year civil war has devastated Northern Uganda’s health infrastructure and caused the displacement of 1.8 million civilians. The displaced itinerant children in war-affected Northern Uganda known as the “night commuters” are a group who flee their villages and IDP (internally displaced person) camps at night for fear of rebel abduction and come into the town center for shelter and security. However, they have never been studied using randomized sampling, control groups, or mixed methods yet numerous policies have been implementing to improve their wellbeing. I arrived in Northern Uganda as a medical and public health student in 2006 working as a consultant for UNICEF and Caritas to conduct a needs assessment of the “night commuters” however the governor of Kitgum Province decided to abruptly close the 13 shelters were 4,500 children were finding sanctuary.

Objectives: To reveal the demographics of the “night commuters,” to understand their motivations for secondary displacement, and to promote evidence-based decision making by government, non-government organizations (NGOs), and humanitarian organizations through including the views of the populations they serve. My goal was also to use our research findings to convince the governor to not abruptly close the shelters and instead to slowly phase out the shelters using a case management approach for the extremely vulnerable children who weren’t able to return home immediately (AIDS orphans, disabled, child-headed households, formerly abducted children, children in congested homes etc.).

Design, Setting, and Participants: A retrospective cohort study of 720 “night commuter” children (aged 7-17) in 13 shelters in 1 district using stratified random sampling and a control group of 410 non-night commuting children (aged 7-17) in villages and camps for IDPS in the same district selected through random cluster sampling during July and August of 2006. Follow-up through an evaluation and prospective cohort study of 120 former “night commuters” in villages and camps in August of 2007. Quantitative surveys were administered in addition to qualitative methodologies using grounded theory: direct observation, key informant interviews (n=45), focus groups in 2006 (n=20) and focus groups in 2007 (n=8).

Main Outcome Measures: Sociodemographic information, housing situation, self-reported health indicators, sense of security, and motivations for displacement.

Results*: Night commuters were more likely to be partial or total orphans than non-night commuters. Lack of accommodation (44% p <.01) was found to be a greater reason for secondary displacement than lack of security (41% p<.01). Respondents cited other causes of insecurity after the rebels had left (thugs and local defense units). Over a dozen push and pull factors influencing their displacement were elucidated.

Conclusions: Respondents cited lack of accommodation and insecurity from non-rebel sources (e.g. thugs and local defense units) as major contributors to their secondary displacement which was not adequately considered by the government or humanitarian groups. Results helped construct a 10 Point Plan for responsible shelter closure adopted in consensus by stakeholders which led the governor to change his policy. I wrote 3 reports from my research leading to increased funding for health centers, schools, and shelter. This study revealed the need for developing minimum standards in population based research for displaced populations during complex humanitarian emergencies to promote more robust research, more representative sampling, and more locally informed decision-making.

*Full results available upon request. Some statistical tests are pending and a manuscript is being submitted.

Disaster medicine: the birth of a specialty?

Monday, February 11th, 2008

James Matheson interviews some experts on the potential of this exciting new specialty

In May 2006 the American Board of Physician Specialties announced board-certification in Disaster Medicine and, in the United States, a new specialty was born. The Florida hurricanes and a heightened awareness of the terrorist threat in the wake of 9/11 had demonstrated America’s vulnerability to disaster and concerns were high about the ability to respond.

Dr Maurice A. Ramirez, founder-chairman of the American Board of Disaster Medicine (ABODM) explains why: “The most ominous words ever uttered by a disaster preparedness expert were that given the current state of hospital preparedness and the rate at which facilities are becoming disaster ready, there will be no meaningful level of preparedness in this decade unless someone blows up a hospital.


The struggle for health after cyclone Sidr in Bangladesh

Wednesday, December 12th, 2007

Kayvan Bozorgmehr gives an account of his experiences following Cyclone Sidr in Southern Bangladesh where he was working with the Bangladeshi NGO, Gonoshasthaya Kendra

villagekakchira5_subdistrictpatharghata_251107_bozorgmehr.JPGThe devestation in Kakchira village, Patharghata District

On 10th November the International People’s Health University of the People’s Health Movement took place in Savar, Dhaka in the North of Banagladesh. On the campus of the local NGO Gonoshasthaya Kendra (GK- Gonoshasthaya Kendra- People’s Health Centre is a Bangladeshi NGO founded in 1971, which provides people-oriented health management, primary education and women’s empowerment programmes), more than 40 health professionals, activists and scientists from 15 different nations came together to discuss and exchange their experience on the social, political and economical determinants of health.

Five days later Cyclone Sidr threw a shadow over the country. In Dhaka, telecommunication, internet services and electricity supply broke down. Government officials were unable to provide the number of casualties in the worst affected areas, but with every passing day, news about the vast impact of the cyclone emerged. While international donors made the first financial comittments to the Government of Bangladesh, the stunts of US helicopters at the Bay of Bengal dominated the media – we were observers of a CNN-effect just being launched.

villagekakchira2_subdistrictpatharghata_251107_bozorgmehr.JPGAnother scene from Kakchira Village

I joined Dr. Rezaul Haque, the Rural Health Coordinator of GK on his assessment mission to the South in order to get an impression of the impact of the disaster on public health, the needs of the people and the coordination of the humanitarian relief. While the public health consequences associated with tropical cyclones include many factors like storm-related mortality, injury, infectious diseases, psychosocial effects, displacement and homelessness, damage to the health-care infrastructure, disruption of public health services, transformation of ecosystems, social dislocation, loss of jobs and livelihood, and economic crisis (1), it is known that these outcomes disproportionately befall developing nations, with human factors strongly influencing the observed disparities. (2)

It was too early to assess the economical losses, but I had the feeling that this disaster combined with its counterpart of extreme poverty, international debts and corruption was going to increase the sufferings of millions of affected people for a long time – especially as Sidr affected areas are surplus areas for production of rice to feed Bangladesh. (3) Despite some success in cushioning exreme poverty to a limited extent in rural Bangladesh, the process of poverty reduction in such Bangladesh is always fragile and the livelihoods of rural areas are fraught with vulnerability that stems from a variety of factors, ranging from natural to social arenas and macro to micro levels – like floods, economic shocks, death and illness in the household, insecurity of life and property – all these and other factors can offset the gains in the poverty frontier. (4)

On day 8 after the cyclone, we headed for the south with a public bus from the Saidabad bus terminal in Dhaka – with generic antibiotics and other essential drugs on the roof of our bus. At that moment GK had 10 doctors and approximately 40 paramedics in the Southern regions, who were already providing health care services.

After two hours we reached the river Padma. The stream, which springs from the Himalaya and the Ganges, carried us on a ferry towards the Bay of Bengal passing a beautiful landscape. Two more hours passed until we left the ferry and continued our ride on the bus. We crossed the river Payra with a second ferry and reached a stoney, torn road, on which we continued our trip. We followed the track of devastation, passed thousands of broken trees and power poles bent like blades of grass. Finally we reached our destination after 10 shaking hours – the subdistrict Patharghata in the district Barguna.

Mr. Selam Khan, the UP Officer of Patharghata and the authority in charge for the subdistrict, was responsible for the coordination of the support in the seven unions of the subdistrict and for the communication with the 20 NGOs, which worked in these areas. He explained the comprehensive Cyclone Preparedness Programme (CPP) provided by the Ministry of Disaster Management and Relief and the Bangladesh Red Crescent Society, while Dr. Haque informed him about the intentions of GK in the nearer future.

According to Mr Khan, “As one of the worst affected areas, Pathargatha has been hit by the eye of the cyclone with a speed of 220 miles per hour for a duration of 3 to 5 hours, accompagnied by a tidal wave with the height of 15-17 feet (approx. 5meters). 95 % of the houses, a total number of 35.700, are lost. 283 people died, 205 are still missing. 36.000 livestock have been killed. 190 educational buildings, 626 kilometers of road and 39 bridges are destroyed. There has been a warning 48 hours before the disaster, so we succeeded to evacuate 24.000 people – but many refused to be evacuated.”

The death toll of Sidr was relatively low compared to the 1991 Bangladesh Cyclone, one of the deadliest tropical storms on record that killed nearly 140.000 people. (5) Sidr was not less severe than the 1991 Bangladesh Cyclone, but due to preventive actions of the government and local NGOs, the building of cyclone shelters and embankments, and the appropriate action of evaquating 1.5 million people of an estimated 5 million people in the costal areas, the death toll could be reduced this time.

Apparently lessons learned from previous cyclones, namely that the risk of dying was related to the type of shelter (6) and that easy access to shelters was a significant factor in reducing the risk of dying (7) had led to an emphasise on preventive actions. But we noted, that there is still a lack of shelters, especially of multifunctional ones. In the whole subdistrict of Patharghata, an area of 387 km², there were only two official cyclone shelters – for many people too far to reach. Mr. Khan agreed with us that additional shelters for animals could increase the willingness of people to be evacuated as that would decrease the loss of livestock – a loss which can impoverish a whole family.

Among the 20 NGOs, only one was dealing with mental health problems. The lack of awareness of mental health problems after disasters may lead to delays in the psychosocial rehabilitation (8) or even to Post Traumatic Stress Disorder among the survivors. The impact of Sidr on the psychological status of the people revealed itself, when we strolled through destroyed villages in Kakchira, Bodma, Horinghata and Djintola and talked to desperate people, each with individual stories of beloved, but lost family members.

We also saw the effects of well-intentioned but poorly implemented aid: for example youngsters from Dhaka throwing clothings randomely from the roof of a building towards a crowd, creating scenes of fighting women and screaming children. There was also a camp organised by a leading NGO, with the capacity to supply 200 children with food for one day over a period of one month. But how can you pick 200 children out of the many in need for help? The information about the camp had been announced in the few schools which had outlasted the cyclone. Lots of children had walked many kilometers to reach the place. I remembered a scene from Bodma, a fishing village in 11 kilometers distance: a 4 year aged child with a spoon in his small hands scratching out a green coconut and feeding the last bits of the precious coconut-flesh to his crying brother with ascites, who was younger than himself. I wondered if those children, who could walk such a distance were those in most urgent need of help. And what about newborns and infants? Among 200 hundred children there were only 8 newborns, all carried by their brothers or sisters – parents or mothers were not allowed to stay in the camp. There were no sanitation facilities for the 200 children.

The medical support and food distribution in the areas we visited was disproportionate. While the international NGOs mainly concentrated on central areas, they were underrepresented in remote areas and duplication of aid occured more than once – despite the CPP and the general effort of the NGOs to coordinate and to cooperate with the governement. In general, the governmental primary health care stations were very poor equiped – a few antibiotics, some paracetamol, some waterpurification tablets. The GK teams and other NGOs were fairly better equiped. But still there was a lack of many things, e.g. gloves for the staff, simple surgical instruments, local anaesthetics and tetanus vaccines in some NGO camps.

I met Zaman, a young doctor of GK. He had reached the affected areas as one of the first teams and had been working in remote areas for the last 8 days. He described the situations he had faced shortly after arriving, the dead bodies, the seperated hands and limbs lying around in the villages, unpassable roads and severe fractures. He said that the main problems now were diarrhoea, pneumonias, colds and fever, and major water and sanitation problems.”  In fact all the 451 ponds in the subdistrict used for drinking water were damaged.

Dr. Amal Chandra Roy, the Union Health and Family Planning Officer, was in charge for the coordination of health and medical supply for all the seven unions in the subdistrict Patharghata. By the light of a lantern, we sat in his office, a small room of the only hospital in an area of 387 km² with a total sum of 31 beds. 18 doctors of the government were working in this area since the disaster happened – 18 doctors for an estimated population of 162.000 people. “That is almost one for 10.000 people”, he told us. “Before the disaster there were only two doctors in the whole area, this is a 9-fold increase”. He would appreciate a better cooperation with NGOs, especially with international ones, to avoid duplication.

Experiences from 1991 show, that in the post-cyclone period, the affected areas actually received a much higher level of health-services than they had ever before. Nevertheless, 6 months after the cyclone 1991, there was a significant rise in the prevalence of severe malnutrition in the affected areas for children aged 1-5. This suggests that there were deficiencies in the post-cyclone medium to long term health response. (9) This is the time when the international and national media coverage of the rehabilitation process usually fades – and with them the CNN-effect of pulsative aid, leaving behind the need of sustainable aid to turn relief into self-relience. There is a urgent need to solve not only disaster related problems, but also longterm, global problems – the manmade parts of natural disasters.

I left Dr. Roy’s office and stepped into the room next door, the emergency room of that hospital, where a paramedic sewed an injury close to a man’s eye by the pale light of a candle while a doctor, one of the eighteen, examined a crying child. “We are used to this darkness”, he said.

Kayvan Bozorgmehr
Globalisation and Health Initiative (GandHI)
German Medical Students’Association

(1) Shultz JM, Russell J, Espinel Z. Epidemiology of Tropical Cyclones: The Dynamics of Disaster, Disease, and Development. Epidemiol Rev. 2005;27:21-35

(2) United Nations Development Programme. Reducing disaster risk: a challenge for development. New York, NY: John S. Swift Company, 2004

(3) Emergency Response Programme of Gonoshasthaya Kendra : SIDR – 2007. Available from:

(4) Islam Aminul S. Overcoming Poverty in Bangladesh: Search for a New Paradigm. Bangladesh e-Journal of Sociology. Volume 1. Number 2. July 2004.


(6) Bern C et al. Risk factors for mortality in the Bangladesh cyclone of 1991. Bull World Health Organ. 1993;71(1):73-8 Avaiable at:

(7) Siddique AK, Eusof A. Cyclone deaths in Bangladesh, May 1985: who was at risk. Trop Geogr Med. 1987 Jan;39(1):3-8.

(8) Choudhury WA, Quraishi FA, Haque Z. Mental health and psychosocial aspects of disaster preparedness in Bangladesh. Int Rev Psychiatry. 2006 Dec;18(6):529-35.

(9) Rahman  MO, Bennish M. Health related response to natural disasters: The case of the Bangladesh Cyclone of 1991. Soc Sci Med. 1993 Apr;36(7):903-14

The emergency response to the Interstate 35W collapse in Minneapolis: medical students in action

Wednesday, August 22nd, 2007

  Human behaviour is difficult to predict. A public infrastructure disaster puts stress on the health care and emergency response systems, and individuals are forced to react. The collapse of the Interstate 35W bridge over the Mississippi in Minnesota during evening rush hour traffic on Aug 1, 2007, showed one community’s emergency preparedness. Catherine Pastorius interviews some first responders to the scene

Following the collapse, amidst a cloud of dust and debris, bystanders rushed to the shores to help rescue victims whose cars had been dumped into its murky waters. Room mates and fourth year medical students at the University of Minnesota, Nicole Kopari and Missie Wayne, were integrally involved in the emergency response, aiding victims, families, and health professionals. They were home eating dinner when Missie’s worried mother called to ask, “Are you safe?” (more…)