Poverty intensifies peril in Haiti

LOS ANGELES – In Haiti, average life expectancy is 53, three-quarters of women give birth without a health attendant, diarrheal illnesses are the second-leading cause of death, and 30 percent of children under 5 have stunted growth.

And that was before Tuesday’s 7.0 earthquake.

This time, emergency medical responders will have to provide much more than the usual food, water, latrines and bandages to stop the spread of disease, said Dr. Christina Catlett, associate director for health preparedness at the Johns Hopkins Office of Critical Event Preparedness and Response in Baltimore. They’ll also have to create a public health system on the fly.

Haitians are in such desperate need of clean water that there was a stampede Thursday when a rumor spread that water was available, Catlett said. One person needs about 15 liters of clean water for drinking and hygiene per day to limit disease. It’s not yet clear if emergency workers will have enough resources to meet all needs.

“My heart absolutely broke when I heard about (the quake),” Catlett said. “Haiti had significant health problems prior to the earthquake: HIV, tuberculosis, severe malnutrition, intestinal parasites, anemia and a host of other problems.”

The Western Hemisphere’s poorest nation spends only $96 per person on health annually, compared to the United States’ $6,090 and France’s $3,040. Half of all Haitian families live in a single-room dwelling. About 8 percent of newborns and children under 5 die of malnourishment each year. There are roughly three doctors in Haiti for every 10,000 people, according to the World Health Organization.

“This would be a disaster anywhere,” said Dr. Alina Dorian, assistant director of the UCLA Center for Public Health and Disasters. “However, when you’re starting with pretty much zero infrastructure, this really overwhelms everything.”

Haiti will challenge the track record of the global public health response to natural disasters, said Dr. Georges Benjamin, executive director of the American Public Health Association. Such responses have been generally effective, with successful efforts to curtail disease outbreaks and subsequent deaths after the Indian Ocean tsunami of 2004 and Hurricane Katrina.

“We know how to do this. That’s not an issue,” he said.

But in Haiti, existing humanitarian support systems, such as the World Health Organization and non-governmental organizations, have been crippled by the disaster. According to news reports, only one hospital in the city of Port-au-Prince is functioning.

Clean water is the most critical need. Diseases such as cholera, dengue fever and dysentery may emerge if people begin to drink contaminated water.

But food too is more crucial than after most disasters. Many Haitians are already underweight and won’t be able to survive as long without food as a healthy American, Dorian said. Because of existing malnutrition, emergency health responders may need to set up therapeutic feeding stations to care for people who are in danger of starving.

If Haitians flock to shelters, overcrowding will raise the threat of disease. Haiti already has high rates of diseases such as tuberculosis and measles.

“You have worry about hand-washing and hygiene and roaches and vermin that carry disease,” Benjamin said. “Waste disposal is so important. Anyone who has ever been on a cruise ship knows how easily a gastrointestinal illness like norovirus can spread.”