Wednesday, January 20, 2010

Haiti, Update 3--The Public Health Matters

The UN continues to be Fact Central for charities and governments all over the world, including our own. They are the leading proponent and most coordinated system for ensuring world public health.

Epidemic Worries
According to the paper I read, epidemic disease has always been a concern of aid organizations during quake disasters. Historically, though, post-quake epidemic has not occured on the feared scale. That can be because rescue always kept it in mind and so averted a second wave of disaster. But Haiti has significant health deficits, and of course their infrstructure for public health is gone.

Good Figures to Work With
Haiti has participated in the UNICEF and World Health Organization data collection, so we do have some information on the risks that will complicate health care delivery there. It's important to note ALL countries self-report  health stats to the UN. That means each number relies on the skill and the honesty of the reporting country. Looking at these figures, I would say that Preval's tenure as president/ the MINUSTAH presence has shown a marked increase in capability and honesty in reporting figures. The figures will still probably be somewhat low, since the population was still underserved.

The reported immunization rate in Haiti against diptheria, tetanus, measles, and other childhood diseases is all over the map, generally between 40-60%. The WHO goal was to deliver immunizations at a rate close to 80%.  You can say what you like about immunization in this developed country, but diptheria, tetanus, and measles are potentially fatal diseases. The immunization level indicates that about 50% of population is threatened.

Population: 9,035,536. (all ages, entire country). Figures are 2009 unless otherwise specified.

Bad Sanitation/Waterborne and Foodborne Disease
Port-au-Prince, before the earthquake, had 70% of its population able to access clean water; for the country in full, about 58% had access to clean water. Therefore, the system never reached everybody. Previous to the eathquake, the country was already considered a high-risk area for bacterial and protozoal diarrhea, hepatitis A and E, and typhoid fever. Another water-borne disease noted by the CIA Factbook as a high risk includes leptospirosis.

Water facilities were one of the first apparatus brought by many rescue teams, and bottled water continues to be delivered by the Joint Task Force and others. Yet this capacity will need to be increased--and worse--maintained. Some of the purifiers came as portable factories and were initial or stop-gap measures. Some of these facilities (e.g., Oxfam's) have run out of fuel and are therefore shut down temporarily. Water will continue to be part of the logistic nightmare. New systems of distribution (not using damaged or vandalized water mains) will undoubtedly be a priority.

Injuries and Injury-based Infections.
Tetanus: There's a 72-hour window from exposure to tetanus-exposed soil and the ability to immunize against tetanus. The disease itself is extremely lethal, causing muscle rigidity and excruciating pain. According to some reports, there are long lines where Haitians have been able to seek tetanus shots. So the word is getting out.

Estimates of the number of injured are still incomplete. Latest reports estimate 250,000 injured. That would be a quarter of a million tetanus injections--

Malaria, HIV, Tuberculosis
Haiti is a tropical state with endemic malaria (164,590 cases). The ruins create more possible avenues for mosquito-borne disease. January is traditionally a dry month. The rainy season begins about May, right along with hurricane season, so this is a deadline of a sort for bulldozing, demolition. amd mosquito control, as well as housing.

Haiti also has a high percentage of HIV in the adult population: 2.2%, or about 120,000 adults. (100,000 to 140,00; 120,000 is considered best estimate.)

Tuberculosis: a reported 35, 099 cases. 29,333 of those cases were first reported in 2007. Now you see what I mean about recent improvements in Haiti's public health reporting.

Note: The Red Cross notes on its site that dead people, while distressing, are not significant carriers of disease. The danger of epidemic comes from living people. Those who work with the dead need to be able to clean up in order to remove any bacteria from fecal matter, but are not likely to otherwise become ill. So we are back to water again.

References/Further Reading: UNICEF, Haiti Country Statistics; World Health Organization research portal; Index Mundi with a huge list of possible diseases to catch.
Picture from Big Picture blog at a vandalized water pipe in Cite Soleil slum of Port-au-Prince.


the observer said...

Ann T.

A quarter of a million tetanus shots?!

Sheesh, I get tired just thinking about it.

The Observer (RN)

Ann T. said...

Dear The Observer,
I can just imagine--no, on reflection, I can't imagine it at all. . .

I have a question. Would you give an anti-tetanus shot if someone presented to you after the 72 hour window but had not yet shown tetanus symptoms?

I'm guessing yes, but you're the RN!

Thanks for writing in!
Ann T.

the observer said...

Ann T

At the risk of being wrong I am going to say that it is probably not going to hurt anything to vaccinate outside of the 72 hour period. Our motto in the ER is "when in doubt, vaccinate." What I am trying to remember is if there is a tetanus "immune globulin" like the one for hepatitis that can be given--I am not sure and would have to look it up. Once tetanic spasms start up, it is a very bad outlook, as the patient can literally suffocate from being unable to breathe. The only hope is rendering them unconscious with dopey drugs until the body beats the bug.

The Observer

Ann T. said...

Dear The Observer,
I've heard that someone with tetanus goes into spasms if even their sheets move slightly as the air changes from opening a hospital room door.

A terrible disease. It's a miracle that we can prevent it. And a triumph of medicine.

Thanks for checking back and getting an answer,

Ann T.