Naomi Campbell has reportedly postponed a planned trip to Haiti following an outbreak of malaria in the earthquake-ravaged country. The only difficulty is that there is no outbreak of malaria in Haiti now, but there are far more dire warnings of increases in infant diarrhea that are being ignored. At least Campbell gives me my much-sought-after and attention-getting lede paragraph. Doctors and epidemiologists who are on the ground in Haiti are unable get mainstream media, the Centers for Disease Control (CDC), and the World Health Organization (WHO) to heed their warnings about water-borne diseases in infants.
As Campbell backs out of her promised trip to lend a well-manicured hand to assist survivors of the earthquake, she should know that there are prophylactics available to prevent becoming infected with malaria, if it were indeed present in epidemic proportions. Most Third World travelers take precautionary medicines as a matter of course. But perhaps it is better that Campbell stay home. I would suggest that she take the money she would have burned on bodyguards, private jets, private ground transportation and the additional money spent by paparazzi and donate it to fund biosurveillance teams that are actually trying to prepare the medical community for what awaits the Haitian population once the rainy season begins.
Sorry to be so cynical, but I have witnessed celebrities around the world using disasters to hone their own images and create award winning films on the backs of victims.
While Campbell makes international headlines for her non-event, Dr. James Wilson, director of Praecipeo International, a non-profit organization that tracks global disease outbreaks, is screaming into the wind about the potential for a real health and environmental catastrophe. Wilson was involved in the detection, tracking, and warning of nearly 250,000 infectious disease events involving over 250 disease entities affecting humans, animals, or plants in nearly every country in the world including Antarctica. He says that Haiti is facing a deadly outbreak of diarrheal disease in infants, and that the country and medical infrastructure is not prepared for the event. Why is no one listening? Wilson and his team are the same analytical team that detected and warned of the 2009 H1N1 influenza pandemic in Mexico. As the Washington Post reported, Mexican health authorities tried to warn the WHO's regional office in Washington, and the Pan American Health Organization (PAHO), of a possibly brewing epidemic. People in the WHO's Geneva headquarters received several urgent warnings from Wilson's biosurveillance firm, Veratect, based in Kirkland, Washington. But the warnings went unheeded despite reams of international health regulations.
The delay in making the global health community aware happened despite the adoption in 2005 of international health regulations requiring nations to report to the WHO within 24 hours any disease outbreak that is serious, unusual, at risk of spreading internationally or potentially disruptive of trade. By the time international authorities became fully aware of the outbreak, there were about 800 cases and at least 50 deaths, and the virus was unknowingly being carried into other countries.
And now we have Haiti and history is repeating itself. The rainy season is about to unleash torrents on the pummeled cities and hillsides, and we do not mean only water. The situation is ripe for massive outbreaks of not only mosquito-borne illnesses such as dengue fever and malaria, but also waterborne diseases such as Typhoid and diarrheal illnesses in infants. Incidents of infant diarrhea are reaching 25 percent in some areas, and infants can die within 24 hours with no treatment.
The amount of typhoid being reported warrants an adjustment to our assessment, where we now include typhoid as part of "diarrheal disease". The majority of diarrheal disease in children is afebrile or with low fever, which may be associated with a variety of agents such as E. coli, rotavirus, norovirus, and giardia. Shigella and non-typhoidal salmonella species are also present. There is occasional report of febrile bloody diarrhea consistent with typhoid.
Wilson provides a kind of "National Weather Service" for infectious disease events. In total, he has and his team has detected, tracked, and provided warning of nearly a quarter of a million infectious disease events to CDC and WHO for every country on earth.
Wilson is not the only health professional sounding an immediate alarm, but still nothing is being done. In March, UNICEF told the Washington Post:
With the rains come the risk of water-borne diseases, which create intestinal bacteria and diarrhea, and diarrhea is deadly to children, said Simon Ingram, a spokesman for UNICEF. The organization estimates that 250,000 children are displaced. In addition, health-care providers noted that the rain could also escalate malaria cases as mosquitoes that reproduce near stagnant water.
The notoriously slow-to-react U.S. Centers for Disease Control and Prevention also is compiling an epidemiology report, according to the Wall Street Journal:
"As we move from one season to the other, we fully expect an increase of diarrhea and malaria," the CDC's Dr. Ronald Waldman said. "That's what always happens in the rainy season." Ronald. Waldman is a U.S. government medical emergency coordinator who has been stationed in Port-au-Prince since shortly after the earthquake, according to the WSJ.
But this is no ordinary rainy season and no one seems to be making the connection that it is about to spell disaster of epic proportions for Haiti, especially its children.
Here is a portion of a field report that described conditions in a camp in Petionville in mid-March after a very short rain event. Imagine what is about to happen to the watershed.
Overall there is degenerate health risk as you step further into the camp. The clay topsoil has through time been impregnated with urine, feces, and bacteria. The site after a 5-minute rain immediately was a disaster. The urine was immediately recharged and the fecal matter separated from the clay itself. Quickly streams of milky white recharged urine laden with soaked fecal matter laded the camp. Although, it simply rained for 5 minutes, caustic puddles formed on the low-lying areas of the camp. The walking conditions were slick and treacherous, very unsafe. The most difficult aspect was that this was a direct diarrheal disease threat and the entire watershed emptied out onto the streets of PaP (Port-au-Prince). Petionville being one of the highest neighborhoods in all of PaP would assure this caustic brew to spread throughout most of the direct lying streets and communities. This was simply unacceptable.
This also begs the question why a camp with inadequate sanitation is situated on a hill where everything drains into the watershed. Go deeper into this camp on the hill and you realize the camp itself is at the bottom of a second hill? Why? To protect the Petionville golf course from being destroyed. Such is Club Haiti, where the concerns of the wealthy still prevail over the lives of the dispossessed. Even the tennis courts are protected.
So where is the CDC in all of this? The United States has pledged millions and one would expect at least some of it would go to health care and monitoring of potential disease outbreaks. The answer can be found on the CDC webpage, and it is a travesty.
The organization is vague about how many field investigators it has in country--perhaps fifteen. Its main concerns are malaria and other vector transmitted diseases as well as making sure that relief workers and Haitians do not bring TB back to the States with them. There appears to be no comprehensive plan in place to prepare and mitigate the waterborne disease epidemic that is almost certain to unfold. The CDC is focused on vaccination programs and vector control for malaria and dengue. This issue of infant mortality due to diarrhea is off the CDC's broken radar. Naomi Campbell is spreading the rumors of a non-event and helping the CDC in its misguided focus on malaria.
As Dr. Wilson told us, public health has a built in resistance to having and effectively using a "National Weather Service"-like warning system for infectious disease crises and disasters. The big threat of a warning system is that its very existence becomes a mechanism for accountability. Having warning information and not acting precipitates Congressional investigations. Hear no evil see no evil. Bureaucrats are risk-adverse by nature.
There are also major infrastructure issues that are compounding the problem of delivery of medical care, even if it becomes available. The Miami Herald reported that a private hospital was forced to close its doors to make way for mobile clinics staffed by NGO contractors.
What kind of aid is this? Health care in Haiti before the earthquake was inadequate. Now many health care workers have been killed, others have left the country and those that remain are overwhelmed not only with delivering care, but also with putting their own lives back together and dealing with friends and family who lost everything in the quake. So what happens? Predictably, the international NGOs roll in and force the closure of part of the established infrastructure. Why? One would suspect so that they can garner a part of the billions in funding promised by the UN donor conference.
The fact is that nearly a billion dollars is being hoarded by the big NGOs while emergencies are evolving right under their feet. This money was donated by the American public and was also given to them by the US government---therefore it is taxpayer money. For example the CDC is grossly under-funded and under-resourced compared to the American Red Cross. The American Red Cross has all but pulled out of Haiti in terms of ground presence. When we were in Leogane several weeks ago, the Canadian, Austrian, Finnish, Croatianh and Spanish Red cross were all that remained.
The NGOs offer a flawed, self-serving, and self-perpetuating system that can vanish as quickly as it materializes. It makes no sense at all to demolish what little of the current infrastructure that remains standing. Medical responders on two-week rotations staff this ad hoc NGO medical structure. They will be there as long as funding remains and will vanish when the funding runs out. Consider the example of the much-heralded USNS Comfort hospital ship. The "Comfort" had 1,000-beds and a 550-person medical staff. They stayed for seven weeks and performed 843 surgical operations. The amputees were sent back to the slums from which they came. No follow up, no after care. The Comfort did its public relations job and left the wounded and the forsaken behind. They offered a band-aid. Nothing more.
As Wilson suggests, these ad hoc clinics and hospitals continue to operate without infectious disease early warning and tactical situational awareness that is facilitated through constant face to face interactions. Because his team is grounded in the states without the meager $125,000 it needs to become operational, getting a head start on a disease outbreak is compromised at best.
Is it any surprise that mainstream media promotes the Comfort, the CDC and WHO while ignoring Wilson?
Consider the lack of coverage of Cuba's contributions to Haiti, and it is no surprise that corporate media continues to neglect its journalistic responsibilities.
No mention is made in the mainstream media of Cuban doctors who have been for years the main medical support for Haiti.
Within the first 24 hours, they (Cuban doctors) had completed 1,000 emergency surgeries, turned their living quarters into clinics, and were running the only medical centers in the country, including 5 comprehensive diagnostic centers (small hospitals) that they had previously built. In addition another 5 in various stages of construction were also used, and they turned their ophthalmology center into a field hospital-which treated 605 patients within the first 12 hours following the earthquake.
Cuba has called for full delivery of international aid to Haiti agreed at the UN Haiti donor conference in New York on Wednesday.
"Cuban foreign minister Bruno Rodriguez Parrilla said there should not be projects of doubtful charity or splitting of Haiti into market segments as the US $9.9 billion starts to trickle into the earthquake devastated island."
Meanwhile, Wilson is very concerned. Already there have been incidents of long lines at IDP camps, with people fainting and having seizures while waiting in the stifling heat for care.
Logistics remains a key issue. There remains a lack of efficient resource tracking at the hospitals and clinics due to the fact many are ad hoc constructs. When considering this and the fact the infrastructure is contracting, the medical infrastructure in Port-au-Prince is becoming more sensitive to abrupt changes in patient flow, and it portends a high probability of losing control in the context of an outbreak response during the coming rainy season. Some of the responder organizations have forward-deployed oral rehydration salts in response to HEAS advisories issued regarding the potential for pediatric diarrheal disease.
What needs to be done?
Wilson simply wants to get back to Haiti. He has depleted his family's 401K and the bottom line is that he needs minimal funding to fully deploy his early warning system.
Here are Wilson's immediate action plans.
Direct ground support and coordination for situational awareness in Port-au-Prince and other quake-affected areas as a priority.
Provide immediate evaluation and support for expanding the auxiliary medical countermeasure stockpiles.
Provide direct rapid response support for sites experiencing increases in diarrheal disease, assess the site situation, and report back to the Ministry of Health. Offer stockpile reserves as appropriate to support the responders on-site, assuming supplies are available.
Assuming supplies are available is a big IF.
The cost to do this? $125,000. Chump change for celebrities.
Naomi Campbell, if you want to be a heroine, here is your opportunity.
(All Haiti photographs by Georgianne Nienaber)
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