Puerto Rico and the Response to Hurricanes Irma and Maria - A Truly Inspiring Lecture by a MEMA Official

Today the students in my Humanitarian Logistics and Healthcare class at the Isenberg School had the great honor and privilege of hearing from a consummate professional and practitioner - Mr. Patrick Carnevale of MEMA (Massachusetts Emergency Management Agency). Mr. Carnevale presented a guest lecture in my class entitled, Puerto Rico 2017: Hurricanes Irma and Maria. He spoke about the weeks that he spent there in October assisting in the extremely challenging response.

His presentation was, honestly, lifechanging to all those in the audience. In fact, I just received a long email from a student in the class who wrote what is a beautiful tribute to him, and I quote just a part of it below:

The talk by Mr. Carnevale this morning was really touching and inspirational. It is not often that one encounters people like him who take pride in the work they do and are so emotionally attached because they care so much about the well-being of  the less fortunate. 

As an international student at UMass, since my first day, I have seen the country go through a major transformation (for the worse), but hearing Patrick today restores some faith in the good people that we are surrounded by and shows that there is some hope for the country as long as we have people like him working for us!

Mr. Carnevale has worked for MEMA for 17 years and he said that the hurricanes hitting Puerto Rico was the "most difficult" disaster to be part of. He worked 7 days a week there, 14 hours a day, and slept on an Italian cruise ship (don't ask him about the food or accommodations, a photo of the latter he shared with us), which was housing 2,500 of the responders. Puerto Rico in September had 3.4 million people and the temperature there was about 84 degrees with high humidity. The rainy season is April to November so the responders also had to deal with that. There are now 35,000 Puerto Ricans leaving the island monthly with the highest number of families now living in Massachusetts with additional challenges because of the housing stock and schools.

46% of the people in Puerto Rico lived in poverty even before the multiple hurricane strike. Moreover, the infrastructure already was subpar from the electric power networks to the roads and bridges.

Mr. Carnevale told us how the San Juan Convention Center was taken over by the federal government and served as a joint field office.. Although he stated that the coordination was OK, he found the bureaucratic forms and paperwork very much slowed down the delivery of the supplies, assuming that you could even find the contacts. He said that it took 3 days to schedule a mission because of this. In the field there were 1,500 representatives from the military, Homeland Security, VOADS, and urban search and rescue folks, and he was also in the field.

His mission was to lead  the central island coordination task force. MEMA was the second group on-site and he mentioned that the military had 180 helicopters, with the big ones able to carry 6 pallets of goods. There were many isolated communities to which trucks could not deliver baby supplies, food, water, and medicines. He spoke of a very useful federal app, known as MAGE,  that was helpful in mapping route disruptions, destroyed bridges, etc. His mission coordinated 587 flights and 32 ground trips.

The challenges the responders faced were immense and included challenges in communications: dealing with language barriers, limited cell phone services, and sporadic functioning of satellite phones because of congestion. Additional challenges were the constantly changing environmental conditions with new landslides and bridge outages.

He shared with us experiences and insights that you do not read about in the media and that were incredibly eye-opening!

He also spoke of the successes from relationship building to the delivery of supplies. ATM machines were not functioning so many responders carried cash and Mr. Carnevale also took part in "extraordinary examples of altruism" as my student so brilliantly wrote after hearing him speak today.

We thank Mr. Patrick Carnevale from the bottom of our hearts for his extraordinary work and that of his team and for his great humanity and for sharing his experiences and wisdom with us today. He is a true Humanitarian Hero!

And this afternoon, he was in Boston meeting with the Governor and Lt. Governor.

Brilliant Lecture on Healthcare and Operations Research by Dr. Hari Balasubramanian

Yesterday, Professor Hari Balasubramanian of the Mechanical and Industrial Engineering Department at UMass Amherst kicked off our Spring 2018 UMass Amherst INFORMS Speaker Series.  His lecture: Care Coordination for Complex, High-Utilizing Patients: The Camden Coalition Experience was brilliant.

The announcement for his talk even made the UMass Amherst homepage!

The UMass Amherst INFORMS Student Chapter President, Deniz Besik, introduced him, although to many he did not need an introduction given his renown as an educator and also as a researcher, having received an NSF CAREER Award. Before joining the faculty at UMass Amherst in 2008, Dr. Balasubramanian spent two years as a postdoc at the Mayo Clinic in Minnesota.

Dr. Balasubramanian began his talk with excellent motivation including that he first became familiar with the Camden Coalition project through a video report by Dr. Atul Gawande (I am a huge fan of his books) on doctor hotspots, which is a must see. Dr. Balasubramanian contacted the Coalition and then began working with them and using what is being called the most detailed dataset in healthcare. The data is granular, time data. He shared with us that 1% of the top "spending" patients account for 25-30% of the total costs. There is a very skewed structure - a minority of the patients experience multiple hospitalizations - higher hospitalizations account for higher costs. He spoke about patients being on 17 different medicines and how the outcome for many of these patients does not improve. Some of this is due to poor coordination of care and after care. Their care is fragmented and there had not been enough studies done on the associated time effort.

Dr. Balasubramanian's lecture was in three parts: patient trajectories, learning and prediction, and workload and staffing (perfect for operations research to address via queuing and capacity planning). The Camden Coalition consists of nurses as well as social workers and community health workers. The dataset has data on 531 patients and 331 have "graduated" from this program. The patient's trajectory begins when the patient agrees to an "intervention" and the trajectories are also mapped and time stamped (with icons that were very effective). A patient "graduates" when he/she is "self-reliant".

Dr. Balasubramanian detailed numerous research questions, such as what are the links between workload of the providers and the high-utilizing care patient outcomes. He also described some of the approaches to investigation, including the use of machine learning, and decision trees and random forests (which generated a lot of questions from the audience), and, of course, beautiful classical and advanced queuing theory! The work is with partners at the Camden Coalition and his doctoral student, Ekin Koker, a very active UMass Amherst INFORMS Student Chapter member and former Webmaster!

His talk was an exemplar of Doing Good with Great Operations Research. He is also working now in Holyoke, Massachusetts, which has some of the healthcare shortcomings as Camden had and still has.

We had a lovely lunch at the UMass Amherst University Club after his lecture.

To celebrate his great talk the group of six shared four desserts, including the one below.

Afterwards, Dr. Balasubramanian was interviewed in the Supernetworks Lab at the Isenberg School for a video that the chapter will be positing on its youtube channel soon, a fabulous initiative begun this year. See the interview with Dr. Renata Konrad by Deniz Besik here. Also, see the interview with Dr. Dmytro Matsypura by Pritha Dutta.

A HUGE thanks to Professor Balsubramanian for all his time and efforts for speaking to us and from the great work that he and his team are doing in Operations Research and Healthcare!