Space Eagle Productions

Updates on Infectious Disease in Haiti
by Cinabear


What do you need to know about infectious diseases in Haiti? The next seminar discussed infectious diseases that have been prevalent, most urgent health disease issues, and public health concerns. A quick poll of nurses attending the meeting identified that approximately only 40% of the attendees would travel to volunteer in Haiti over the next twelve months. In addition over 80% of Haitian college graduates choose to live and practice in the United States. Education is being deferred due to the immediate need for survival of the fittest along with safety issues. Prior to the earthquake, approximately 50% of the population was illiterate which included an 80% poverty level.



The pre earthquake status identified that already less than half the children were vaccinated and 40% of the population had access to basic healthcare. UNICEF is actively providing and focusing on administering three vaccines: measles, tetanus, and diphtheria. The goal is to vaccinate approximately 200,000 children in camps and an additional 500,000 children nationwide.



The heat and humidity along with a rainy season is the perfect environment to spread disease. The ideas of antiseptics and asepsis are quite common in the U.S., yet very rarely adhered to in Haiti. The crowding, poor sanitation and sewage systems, low immunization rates, and inadequate safe drinking water only led to the development of widespread disease for the population already at risk.



The waterborne diseases of greatest concern are Typhoid Fever and Hepatitis A and E. What are the reasons why typhoid is more likely to pose a threat in the post-earthquake Haiti? First of all, it’s most famous for being an asymptomatic carrier. The incubation period is one to four weeks. The result can be death if not diagnosed in time because the intestines will perforate from the hemorrhage caused by the bacteria in the bowel. The two huge problems are sanitation and lack of access to antibiotics. The problem with antibiotic resistance also exits worldwide with these new “super bugs.” The ability to provide first line defense antibiotics is critical, yet if they are not effective and the patient develops resistance strains another more potent antibiotic would need to be added to the treatment regime. (Most commonly zithro and cipro) Many Haitians are afraid to take antibiotics due to religious beliefs and lack of education. In addition, the Haitians and nursing staff are educated on the importance of taking antibiotics and completing the treatment regimen. Although antibiotics were flown in from all over the world, the huge nursing task was to sort out the medications and supplies for the physicians and patients. The most common problem visible is sanitation.



Many Haitians are seen bathing and drinking in the same water as pigs and goats. The nurses testified to the beaches being contaminated with sewage and bad smells and lack of designated latrines. It wasn’t uncommon to see puddles of urine and feces outside of the makeshift hospitals and buildings. There are miles and miles of tents and everyone is crowded together in one area. Consequently, there is no differentiation between clean and dirty. Hepatitis A and E are also feared due to poor sanitation. However, Hepatitis E is of greatest concern due to no vaccine and the possibility of it being ingested due to contaminated feces. The good news is that if one gets the disease and recovers, they will not be re-infected as with their “sister viruses”. Outbreaks are feared not only due to lack of latrines and portable toilets, but also due to no place to remove or dump the waste. Haiti does not have one single sewage treatment center. The major focus is to build up a human waste center to decrease the spread of disease on a more devastating level.



The mosquitos borne disease of greatest concern are malaria, dengue, and lymphatic filariasis. The rainy season brings mosquitoes. The need to maintain insect management is essential in preventing the spread of disease. There are flies, bugs, and insects ravaging everywhere in Haiti. The nurses testify to using fly swatters to kill bugs on daily rounds as they are cleaning and disinfecting wounds on the floor. They have expressed the need to educate families to kill the bugs and keep them away from the wounds. It is humbling when one thinks that in the U.S., “one bug” in the OR would cause an outrage and panic attack! The Haitians do not have access to insect repellant and many only have the shirts on their backs, let alone long sleeves when the weather is so hot. The Haitian only has the articles that the family brings in for them. Many only have the clothes that they have on and when the family brings sheets in they are often dirty and/or are used for days at a time. The operating room would provide blue sheets or “chucks” so that family could wash the linen.



The nursing staff has had to educate the family and patients regarding the use of external fixators or “ex-fixers” to stabilize the bones and promote healing of limbs. The people were afraid that the surgeons were going to amputate the limbs, but over time they have gained trust of nurses and physicians. They have only just begun to trust the staff regarding cleaning of wounds and taking antibiotics. The stigma surrounding amputations or “limb knobs” is very bad in Haiti. The people would rather have a leg that is useless and infected than an amputation. One nurse spoke about a little girl who needed a below the knee amputation. The wound could not be closed due to the need to heal and after amputation she became very distant and sad. Another boy needed his finger amputated and came back to the clinic for three days. His mother wouldn’t allow him to get his finger amputated due to the stigma. The mother finally conceded, but due to the time frame surrounding the amputation there, will be decreased functional ability and the wound will take longer to heal completely.



There are also different perspectives regarding pain in the Haitian culture. They hesitate to take pain medication and are afraid of addiction. There is a myth that morphine is associated with death and therefore the patients needed education regarding taking the medication for health healing and recovery. Many times once the nurses explained that the medication would help them feel better to get up and ambulate, the patients were more apt to comply and take the medication thereby facilitating wound healing. Another myth that was rapidly spread, even by the media, was that dead bodies are major disease spreaders. The truth is that dead bodies are rarely responsible for spreading disease. There were mass graves especially during the first few weeks after the aftermath of the earthquake. One nurse reported knowing of at least 3,000 people being buried. There were also many bodies that were burned. The real issue being that dead bodies are undignified and difficult to observe.



The 2010 earthquake had only complicated an already challenged public health system in Haiti. The infectious diseases are not a new problem only exacerbated now due to the current conditions. It is critical for emphasis to remain on “picking up the pieces” in regards to immunizations, sanitation, and wound management for public health in Haiti. ~ cinna



Sources:



DeBaun, B. & Petruzzella, E. (February 24, 2010). Infectious Disease in Haiti. webinar at Http://www.nurse.com



Personal Interviews nurses and physicians February 24, 2010.