Lack of medical care, safe drinking water top list of threats, experts say
As devastating as the immediate aftermath of Tuesday's 7.0-magnitude earthquake in Haiti has been, potentially worse public health calamities could lie ahead in the days, weeks and months to come, health experts say.
The decimation of Haiti's infrastructure will be the tragic backdrop to coming public health crises, both short- and long-term. And the country -- one of the most impoverished in the world -- did not have a robust public infrastructure to begin with.
"Now you've got the problem, which is fairly common in disasters like this, that a lot of the infrastructure related to health is severely damaged, for example, hospitals," explained Tom Birkland, a professor of public policy at North Carolina State University in Raleigh. "It's probably worse now, 10 to 100 times worse. The physical systems that support the health systems are broken badly."
"It's a system that's already on the treadmill on a daily basis, so you put this catastrophe on top of it and you have a collapsing system," added Dr. Pascal Goldschmidt, dean of the University of Miami Miller School of Medicine, which has sent medical teams to the devastated country.
Haiti is still lacking power and most telecommunications. The port and airport were severely damaged by the quake, as were roads, making rescue and relief efforts that much more difficult.
For now, doctors and nurses -- in fact, everyone -- are concerned with finding victims who are still alive and tending to those who have injuries.
The situation is totally unlike that of the 2004 tsunami in Southeast Asia, Goldschmidt said, where most people died immediately from the incoming wall of water. Haiti has many more injured casualties, meaning meager health resources will continue to be severely challenged.
Rough estimates state that 3 million Haitians have been affected by the earthquake, and the Red Cross said Thursday that as many as 50,000 people may have died.
Many hospitals and clinics are simply gone, and survivors of the quake can't get to the ones that are open, Birkland said.
Dr. Barth Green, chairman of the Miller School's department of neurological surgery, has set up a medical camp in Haiti and has been subsisting on no sleep, along with crackers and bottled water.
"The view of the situation that they have right now is still pretty limited to Port-au-Prince and the major epicenter of the earthquake near the airport," Goldschmidt related. "There is a major problem with food supply and the availability of clean water, which will have a huge impact immediately on the population with the spread of infectious diseases."
In fact, lack of clean water may be the major health challenge facing survivors in the coming days and weeks.
"In general, people can survive without food for several days. It's the lack of water that is the major challenge," Goldschmidt said. "After an entire day without water, people are starting to become severely dehydrated and, after a couple of days, they are dying."
"Dehydration would be a tragic outcome," Goldschmidt added. "The other tragic outcome is if those who are dehydrated get water that is not of sufficient quality and get infections [such as typhus and cholera]. Then you have the next crisis."
The lingering presence of corpses in public areas is less of a hazard in terms of the spread of disease than people believe. "The biggest problem is it's really unpleasant and traumatizing," Birkland said.
The International Committee of the Red Cross (ICRC) said it's not true that dead bodies cause epidemics after natural disasters.
ICRC forensic expert Ute Hofmeister said: "There is a widespread myth that dead bodies may be the cause of epidemics in natural disasters. This is not the case. The bodies of people that have died in a natural disaster do not spread disease, since they have died of trauma and not disease. Hasty and uncoordinated disposal of the bodies, for example in mass graves or by cremation, should be avoided at all cost, as that would make it impossible to identify the bodies later and to inform the families."
As time passes, acute health problems such as injuries will be replaced by chronic health problems, both those related to the quake and those that were present beforehand.
"In the long-term, chronic conditions that were either created by the disaster or during the disaster or existing chronic conditions may worsen because people aren't getting treatment," Birkland said. "Lung disease, for example, may be exacerbated by dust in the air."
That will increase the burden on Haiti's traditionally fragile health-care system, which will be further strained for a long time.
Also in the longer term, said Goldschmidt, "the problem is that Haiti is going to have a substantial need for additional health-care providers. We're going to need to make sure that an anesthesiologist is available for the woman who needs to deliver a baby by C-section," he added, by way of example.
"The country is substantially challenged and only an international effort will bring the resources to make sure they don't have a long-term catastrophe with a lot of people dying and suffering from lack of medical resources," he said.