One Year On

Today marks one year since the devastating earthquake rocked Haiti to its core.  In the early days and months following the destruction I wrote on caregiving and the changing culture of old and new health concerns. This past fall, Haiti was rocked again by a cholera outbreak and a contentious and volatile presidential election. While I watch in awe as all of these events unfold from the comfort and distance of my laptop…a couple of colleagues have been in Haiti (as participant observers) telling part of the story.

•Working for the International Medical Corps, a close friend has been in Port-au-Prince since the summer working in the country’s struggling and overflowing residential care centers. During the cholera outbreak she relayed first-hand accounts of the disease spread and prevention efforts. You can hear her discussing the current situation for many children here!

•In her first trip to Haiti over the last week, a college friend and colleague who works for Management Sciences for Health had the opportunity to meet public health aid workers and see their efforts and practice on the ground. Lucky for us, she has recounted her experience in a recent blog post (and here too!).

We will have to wait and see where this year takes Haiti, but like with so many pressing public health issues, locally and globally, continued interest, research and outreach is the best aid we can give.

*Image: Alexandra Kramer, International Medical Corps, Haiti.

Haiti in the Time of Cholera

UPDATE: As of November 11, the death toll from Cholera in Haiti has risen to over 720 – this following Hurricane Tomas last week and the disease reaching the camps in Port-au-Prince.

Cholera is a disease of literary backdrops and far off lands. Yet, as I’m sure and hope you already know, it is currently thriving nearly next door. Haiti is currently experiencing a cholera outbreak and as of last night, over 250 people have already died with over 3,000 cases reported…new cases are now being reported in the capital of Port-au-Prince. On a hopeful note this morning, officials are saying the worst may be over.

Unfortunately, this event – the outbreak of a disease spread by contaminated water and food – is not surprising considering the environment Haiti exists in today. The physical setting and infrastructure, both struggling to recover from the devastating earthquake in January, have made Haiti the perfect setting for an event such as this. Thousands of people are living communally with poor sanitation and water supplies and the health system is not equipped to handle the day-to-day challenges Haitians were already facing. This lack of surprise, however, does not make the outbreak any less concerning. For now, organizations such as Partners in Health, with deep roots in the country, are on the front line of triage and the PAHO is monitoring the disease spread.

A good friend and colleague is currently working in Haiti with International Medical Corps to strength some of the country’s orphanages. Her experience the last few days highlights how important non-medical personnel are in circumstances such as these. For example, her role is to make sure orphanages are taking appropriate precautions: “…what I’ve done is make sure all the orphanage care takers with whom we work were called to be reminded about proper hand washing techniques as well as the importance of boiling water, and if there are any cases of diarrhea, to take the children to the hospital IMMEDIATELY.” Outbreaks such as these affect all sectors of society, including aid workers, and the spread and root causes must be approached from all angles – not just medically.

Cholera is becoming part of Haiti’s historical context and will shape their cultural and health environment going forward. For now, those of us next door can do what we can to remind each other about washing hands and support the people of Haiti and those on the ground doing what they can to squelch this historic outbreak.

Another Perspective: How Easily We Forget

A colleague pointed out over the weekend, in her blog haba na haba, hujaza kibaba, that less than 40 days after the earthquake that rocked Haiti to the core, the public and media have already moved on. While its not surprising that the media and much of our attention is now focused on the Olympics and our own political messiness (remember the health care negotiations this coming Thursday!), this does not mean that the people of Haiti aren’t still suffering and facing daunting challenges. Not being an expert in disaster relief, transition, and development, I am overwhelmed by the thought of the sheer amount of coordination and continued dedication that will be needed. If you are interested in learning more, or being part of the solution, you should look at her blog and a post I had in January about health challenges Haitians are facing post-earthquake.

In the News: Cabin Fever

*There have been various academic debates about the benefits and downsides to prehistoric lifestyles and diets. Apparently, however, some people aren’t waiting to see the next journal article and are trying it out themselves. The “philosophy is based on the idea that the human body is best suited to the lifestyle of the people who roamed the Earth tens of thousands of years ago” – this includes running across the Brooklyn Bridge barefoot!

*Following-up on a post I had a couple of weeks ago on Haiti’s health concerns going forward – an article from last week’s NYTimes on Haiti’s fight against TB and a report from Dr. Tom Kirsch on advanced TB and HIV/AIDS in Haiti from Haiti: Operational Biosurveillance.

*Interesting report on ABC WorldNews on changes to the Diagnostic and Statistical Manual of Mental Disorders. What is normal and what is a ‘disorder’? Do we, as a culture, over diagnosis? I tend to lean towards ‘yes’, but can a label sometimes serve a positive purpose and allow individuals to self-advocate? What makes this all more complicated is how the changes in diagnosis procedures will affect prescriptions, insurance, drug companies, education, etc. Complicated and messy.

*Don’t forget, the Vancouver Olympics start tomorrow (Feb. 12)! They may not be that related to health, but I definitely think the Olympics, at the very least, will do a little good for everyone’s well-being!

What Comes Next in Haiti

In a post last week, I mentioned briefly the long-term health and cultural changes Haiti will have to face in the coming months and years. With the growing number of amputees and changes in living conditions, new health concerns are mixing with old ones (see recent NPR report). Two of the many issues the Haitian people will have to tackle are prosthetic care and the continued treatment and control of HIV/AIDS and TB.

Credit: jansochor.com

With poor local health infrastructures before the earthquake, the increased need for permanent prosthetics has the potential to be overwhelming. Specific care is needed to ensure that stumps heal appropriately and muscles remain strong enough to support prosthetics. If amputees are able to do this, then they must hope to be fitted with an appropriate, permanent prosthetic. Children will face the added strain that prosthetics will need to change as they grow. A logistical nightmare for sure, how amputees are accepted, cared for, and function in newly formed communities and living conditions, however, may turn-out to be just as challenging.

These newly formed camps and communities create practical struggles for amputees, but they may also amplify the already severe state of HIV/AIDS and TB in Haiti. A number of organizations have worked long and hard in Haiti to help combat these epidemics (Partners in Health, Catholic Medical Mission Board), but some of their clinics and devoted staff were lost in the earthquake. Those with HIV/AIDS will need access to antiretroviral drugs, but in the near term there are a few AIDS clinics that survived and the risk of increased infection is not as immediate. For TB however, those in an acute state need to continue their drug regiments or risk spreading the disease to those around them. Cramped living conditions with poor sanitation are prime locations for TB to spread – Haiti already has the highest per capita rate of TB in Latin America and the Caribbean. Cholera and other diarrheal diseases also spread easily in conditions such as these, but with EMDRTB and HIV/TB co-infection possibilities, TB should be a priority as health decisions are being made for the Haitian people moving forward.

This mixing of new and old health concerns may well change the challenges, perspectives, and priorities of both the Haitian people and those determined to help them.

Update 20/2/2010: Article in NYTimes, discussing the poor sanitary conditions and spread of disease in the newly formed Haitian tent camps.

*Image originally came from this photo essay.