The rainy season is about to hit earthquake-ravaged Haiti. The meteorological forecast for next week calls for thunderstorms beginning this Wednesday, lasting at least through the following Tuesday, and Dr. Jim Wilson is worried. Wilson is the Executive Director of Praecipio International, which is the Haiti Epidemic Advisory System (HEAS), based in Petionville-Port au Prince, Haiti. Wilson is also internationally known as the person who identified the H1N1 outbreak in Mexico and was a key player and founder of ARGUS, a global detection and tracking system for the early detection of biological events. He identified SARS outbreaks, H1NI, Marburg hemorrhagic fever, and issued the first warning of H1N1 resurgence in the United States in the summer of 2009. Wilson has been warning about the increase in diarreal disease in Haitian infants, and his warning is falling on deaf ears in the mainstream media.
For anyone who has been to Haiti and observed ground conditions there, the reasons are obvious. During the week of March 12 we were in some of the IDP camps. After a minor rainstorm floodwaters caused the overflow of pit latrines, bringing raw sewage into the camps and contaminating local water sources. This was in the camps that had pit latrines. A camp of 5,500 people near the slums of Cite Soleil had no latrines or sanitation of any sort. Feces, vomit and urine were everywhere in the surrounding bush. Obviously, contact with raw sewage greatly increases the chance of exposure to waterborne pathogens that cause diarrheal disease. Prior to the January 12th earthquake, diarrheal disease was already a leading cause of illness and death for children in Haiti. Now, children and adults are living in "shelters" that in the best conditions amount to salvaged pieces of tin providing makeshift "roofs," to tattered pieces of plastic held together with sticks. The USAID "fact sheet" about tent material would be laughable if the consequences were not so tragic.
On March 11, a USAID/OFDA flight delivered 750 rolls of plastic sheeting to Haiti. To date, USAID/OFDA has provided 15,480 rolls of plastic sheeting to meet post-earthquake shelter needs, benefiting approximately 774,000 people. The ongoing distribution of USAID/OFDA-funded plastic sheeting supports Shelter Cluster efforts to provide shelter materials to approximately 240,000 households before the likely June onset of the hurricane season.
Here is a video of what it is like to live under plastic sheeting. Imagine this scenario in the hurricane season. This video was taken on March 12, 2010.
The same "fact sheet" indicates that the United States has provided $769,948,358 in aid to Haiti. Where it has gone is anyone's guess. By the time Freedom of Information Act requests have been filed and freelance investigative journalists have done their homework, it will be too late to assist the 1.3 million estimated homeless. Infants will start dying by the thousands before the media takes note, and an outbreak of even more serious waterborne disease will likely occur.
The lies are almost frightening in the Machiavellian planning and presentation. Drive along the main roads and you will see "camps" of moderate white tents, set in orderly rows with the banners of NGOs prominently displayed. This is what you will likely see on CNN.
Take a little time to venture off the beaten path--you will not have to go far--and the reality hits you right between the eyes.
Wilson suggests that there is another area of concern that has not been examined by health officials here in the States and in Haiti.
The reason for this high level of concern is obvious to all of us who are working on the ground. An extension of that concern may be seen when considering the fragile nature of the current ad hoc medical infrastructure in the quake-affected areas. It is our assessment this infrastructure comprised mainly of volunteers is easily overwhelmed by a sudden influx of patients, particularly pediatric patients. The higher the clinical acuity, the more easily it is to overwhelm.
Wilson is being mild in his public comments. Having seen this crisis firsthand, I can assure you that it is dire. Even where a medical infrastructure exists, such as in the city of St. Marc, the hospital had no antibiotics and yet was continuing to do surgery--doctors had no options. 300 people waited in the hospital courtyard for the opportunity to see one of four rotating Haitian doctors. 500 people languished as in-patients. The administrator told our doctor that the hospital had no antibiotics. Our doctor offered his supply of medicines that will last for about a week, and pocketed a list of urgent supplies that will cost $93,000 to obtain.
Also consider Wilson's remarks that the medical "infrastructure" of Haiti consists mainly of volunteers and non-profit groups who are in a constant transitional state, and provide no continuity of care.
Amputate a leg and send someone home. To what? Fix a broken arm and send a child, homeless, to an IDP camp where there is seldom a doctor or food to be found.
We found this stash of "medical supplies" at an ad hoc camp of 2500 outside of Leogane.
This ad hoc infrastructure is both limited and easily overwhelmed. Because of these conditions, rapid identification of diarrheal disease hot spots when they emerge is critical, so that aid can be moved quickly to prevent further spread of disease and exhaustion of medical resources.
Is Haiti prepared? Probably not.
There are 800,000 doses of the oral rehydration agent, Pedialyte, stored, but it will not be enough if a large outbreak occurs. Infants can die within 24 hours if not given the proper palliative care. There are not enough oral and IV antibiotics in-country. Even if drugs and rehydration kits were freely available, there is not an adequate distribution system in place to deliver supplies and no one to coordinate at many of the camps, except those located with the guarded compounds of the NGOs. Haitian mothers have not been told how to make simple rehydration solutions of salts and sugars.
The current Haitian public health surveillance consists of forms submitted to the Haiti Ministry of Health once a week and an under-developed network of sites to support laboratory testing.
Wilson suggests that along with the forms, health workers share information about the types of health events they are witnessing.
This is referred to as "informal surveillance," and we offer the following Google group, the "Haiti Epidemic Advisory System" and the InSTEDD-supported SMS/text messaging alert system called Geochat to facilitate communication among us. In this Google group we will be sharing insights into what to look for and examples of informal surveillance in action. Please note this group is only for ground-based Haiti responders. The link to the Google group may be found here, and instructions for how to sign up for the SMS/text messaging Geochat service is found on the group website.
Our team encountered the Haitian Minister of Health, Dr. Alex Larsen, in Petionville one evening. It was a chance encounter, since all of the government offices were destroyed during the quake and officials who are still alive are hard to find.
We asked the purple-shirted chain-smoking minister if we might have a conversation with him after he finished his conversation and dinner. He said "yes," but left without even a goodbye or "we will talk later." Maybe Anderson Cooper can get him to open up. If he can find him.
A journalist friend in Rwanda sent me a message on FACEBOOK that pretty much sums up the state of media affairs with regard to Haiti.
"The problem with public affairs reporting in poor nations is that for the western media there is no news unless horror is ongoing. Real media has vanished."
Let's hope that the infants in Haiti can miraculously avoid the looming horrors. If they begin dying by the thousands, rest assured mainstream will be there, detailing every last dying breath and the valiant attempts of their celebrity doctors to save lives.
"The horror. The horror."
Crossposted with OpEd News.