1. 2010 NMA Response to the Haiti Earthquake

 
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The National Medical Association is seeking information on members' and non-members' interest serving in various relief efforts in Haiti. Please help us respond to the earthquake in Haiti by completing the survey below.

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* 1. What is your specialty?

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* 2. Are you aware of the extent of the need for health care in Haiti?

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* 3. Would you be willing to work in any of the following areas?

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* 4. As a Physician, are you interested in donating your services in a hospital-based setting in Haiti? If yes, then please continue to question #5. If no, then please skip to question # 12.

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* 5. What would be your preferred length of service in a hospital-based setting in Haiti?

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* 6. How much notification time would you need to be ready to deploy?

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* 7. When is your preferred start date?

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* 8. Would you volunteer realizing that the trip will require that you cover your travel and meal expenses during the time away?

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* 9. Have you ever been deployed to clinically support a public health emergency or disaster?

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* 10. Which of the following disaster life support courses have you taken?

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* 11. Are you affiliated with any organizations that provide emergency relief in Haiti?

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* 12. What languages do you speak?

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* 13. Do you have any experience in providing care in Haiti?

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* 14. Are you of Haitian decent?

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* 15. Are you able to donate or raise any of the following items, domestically, in order to aid the NMA relief efforts in Haiti?

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* 16. Are you a Medical Administrator?

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* 17. Do you know any other Physicians that would be interested in volunteering?

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* 18. Would you like a someone from the NMA to contact you for more information about volunteer opportunities?

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