Haiti—A Nation in Peril

Seth Kandel, writing for the Infectious Disease Special Edition, warns of the threat posed by disease to the continued safety of those affected byt the January 12 earthquake.

In earthquake-ravaged Haiti, another potential crisis threatens those lucky enough to have survived the natural disaster—infectious disease. Approximately 300,000 have people died as a result of the earthquake, and that number may continue to rise if medical efforts fail to address the looming diseases. “The country lacks the appropriate support at the administrative level,” said Ziad Sifri, MD, assistant professor of surgery at University of Medicine and Dentistry of New Jersey, who recently spent time in Haiti on a humanitarian mission. “Distribution of care is very poor; supplies are abundant in some places that don’t have a high need, whereas supplies are lacking in areas with high need/use.”

The infrastructure around Haiti’s capital is devastated, potable water is virtually nonexistent, and human excrement runs through the streets, creating ideal conditions for the formation and spread of disease. People are living in close quarters in makeshift tent cities, so one undiagnosed infection can quickly multiply into many.

“The biggest obstacle was the lack of coordination of care between different organizations and local staff,” said Dr. Sifri. “Overnight nursing care was limited or nonexistent, intensive care units’s without proper monitoring devices prevented us from taking care of sick patients, and transferring those with complicated injuries to higher levels of care was extremely difficult.”

The World Health Organization (WHO) recently reported that respiratory infections have now replaced trauma or injury as the leading reason for those appearing in the country’s health clinics since the earthquake. Haiti currently is in its rainy season, adding the threat of mosquitoes carrying malaria, dengue, and typhoid to the country’s growing list of dangers.

“In my opinion, the likelihood [of infectious disease outbreak] is moderate to very high depending on location,” said Dr. Sifri. “We met with WHO representatives who promised to administer vaccinations to all patients injured in the quake and those living in crowded areas without proper hygiene.”

Even before the earthquake, Haiti averaged the shortest life expectancy of any nation in the Americas at 61.5 years. General mortality (21.1 per 1,000 individuals) and maternal mortality also were the highest in this region, and 1 in 12 newborns never live to see their fifth birthday.

The WHO reported that before the earthquake, about 30% of deaths in Haiti were the result of preventable infectious disease. Vector-born disease—such as malaria and dengue—were common, and infectious diseases like AIDS and tuberculosis were among the leading causes of death.

Sanitation issues also have plagued the island nation in the past; in 2009 an estimated 45% of the country had no access to safe drinking water and 83% had no access to adequate sanitation. Relief efforts after the disaster have begun to rectify this situation, but much work is still needed. “My heart goes out to the Haitian people. They are experiencing incredible pain and suffering that they did not bring on themselves,” said Dr. Sifri. “The world needs to remember Haiti as Haiti is in big need of the world.

For more go to http://www.idse.net/index.asp?section_id=248&show=dept&issue_id=636&article_id=15194

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