The October 8 earthquake spanned two mountainous countries and claimed the lives of 60 times more people than did Katrina. Rosborough, a part-time MPH student (Class of 2006) and senior fellow in international emergency medicine at Brigham and Women's Hospital, spent a month in Pakistan as part of an International Rescue Committee (IRC) disaster relief team.

Upon arrival, Rosborough's team worked for several days doing assessments with officials from the Pakistani Ministry of Health and military, which provided equipment, maps, helicopters, and GPS technology that could be used for rescue efforts.

Her team included Pakistanis and Afghan refugees, as well as international relief workers like herself. All volunteered for the IRC to help provide health care, water, shelter and sanitation, plus distribute food and non-food necessities. As part of a mobile health unit, she conducted health assessments and vaccinated for measles and tetanus, which had begun to crop up in some relief camps.

"On any given day, we went out in a mixed team and learned how to do each other's assessments, including water, sanitation, and shelter," Rosborough explained.

Over and above injuries and widespread destruction of property, the team encountered some other difficulties. Survivors from among the most vulnerable populations had to be protected from the type of abuse and neglect that often develops after a catastrophic event.

She found women, for example, who were left without access to government benefits because the men in their families had perished. Relief workers also found scores of children and elderly people with no one to care for them.

Right after the earthquake hit, survivors worked quickly to bury the dead. Then, many people who lived high in the mountains attempted to carry the injured, who often had to be strapped to boards and handed down steep precipices to reach cities below.

All earthquakes have the potential to cause terrible injuries, said Rosborough. Falling buildings can crush, impale, and suffocate those who happen to be in or near them. Survivors might bleed to death or develop life-threatening infections, well after the first shocks. To make matters worse, a region's health infrastructure might be destroyed along with residences and roads.

But, this particular earthquake was unusual because so much damage occurred in extremely hard-to-reach areas. Horrific injuries went untreated because responders could not get to some of the world's highest mountains to reach victims. Rosborough was surprised, she said, to find so many survivors with serious-but untreated- bone breaks and lacerations a full three weeks after the initial quake.

Food was not in short supply, but clean water was a problem. In that region, mountain springs provide drinking water, but metal pipes carrying water to towns were broken. Rosborough saw women and children walking as far as 2 1/2 miles, twice a day, to get water for their families.

The biggest threat to survivors was the need for shelter strong enough to withstand the region's bitter winter, which was beginning as Rosborough returned to Boston. Without proper shelter, people will surely die, she said.

Rosborough heard much concern among NGO workers that there were not enough winterized tents available in the whole world to help those affected by this earthquake. Prefab shelters are expensive, and it takes time and tools to erect them. So, the IRC put together rebuilding kits, which included shovels, wheelbarrows, pickaxes, small tools, nails, and eight sheets of tin roofing.

"They can take rubble and use the kit to quickly reconstruct a small hut for winter," she explained. "In spring, they can build something more permanent."

Rosborough said she made good friends among members of the mobile team with whom she worked. They traveled into remote areas without obvious security problems. People were just glad for their help, she said. Rosborough in turn was amazed by the survivors' resilience and strength.

"A lot of people wanted to know if Americans thought all Muslims-in particular Pakistanis and Afghanis-were terrorists," she said. "If so, they wanted to set the record straight: Islam is a peaceful religion."

The Pakistan earthquake was Rosborough's fifth international deployment in 2005. She responds to international emergencies as needed under the auspices of various NGOs. Earlier this year, she helped improve the health care delivery system at a refugee camp in Kibondo, Tanzania; taught ER skills to junior physicians and mid-level health providers in Tigray, Ethiopia; and worked with an NGO doing broad-based assessments of the needs of people in many different sectors of the population of northwest Uganda.

She also participated in a Peace Through Health project that taught emergency medicine skills to Palestinian and Israeli doctors in East Jerusalem; took a course in humanitarian crises in Geneva, Switzerland; and taught humanitarian topics to groups with Jennifer Leaning and Michael VanRooyen, co-directors of the Harvard Humanitarian Initiative.

When Rosborough is in Boston, she works as a part-time attending physician in the Brigham and Women's Hospital emergency room and is a part-time HSPH student.

Growing up in rural southern Alabama, Rosborough knew she wanted to work in emergency medicine the night she followed a local country doctor on his rounds. A scholarship took her to Phillips Academy in Andover, MA. She graduated from Harvard, Class of 1996, with a BA in philosophy. From there, she went to Albert Einstein College of Medicine of Yeshiva University in New York, and Yale-New Haven Hospital for her residency.

"International work is part of who and what I am," she said. "I love to travel, am fascinated by other cultures. I think you learn more about yourself every time you go somewhere new."

—PHC