Infectious Diseases In Haiti After The Earth Quake

HISTORY OF HAITI

Haiti was founded by a righteous revolution in 1804 and became the first black republic. It was the first country to break the chains of slavery, the first to force Emperor Napoleon to retreat, and the only to aid Simon Bolivar in his struggle to liberate the indigenous people and slaves of Latin America from their colonial oppressors. Tragically this history of liberty and self determination has drawn two centuries of political and economic ire from powerful countries resulting in policies which have served to impoverish the people of Haiti.

Feared by Thomas Jefferson for their successful uprising; exorted by France in 1825 for 150 million francs to compensate the loss of the Empires property both slaves and land { a debt the Haitian people completed paying, with interest, more than a century later}; occupied by US military between 1915 and 1934 to stifle European influence in Western Hemisphere; and disrespected in their quest for democracy by an unrelenting series of dictators; the free people of Haiti have been continually reshakled politically and economically.

In the wake of January 12, 2010, earthquake, Haiti history of unrelenting struggle for justice is its greatest resource. This  history as Haitian remind us Haiti had for centuries been caught up in tran national economic and political web, a condition very much similar before and after earth quake.

Introduction

After a magnitude 7.0 earthquake had struck Haiti in January many experts were worried about the invasion of infectious diseases in this region. In Hiati large part of population prior to the earth quake already lived without access to reliable sanitation and clean water, the infrastructure was further was further disrupted by the disaster with wide spread of infectious diseases such as cholera whose mode of transmission is by faecal contaminated water.

Cholera might sound like a disease that is seen in 19 th century, but it is still  infecting about 3 million to 5 million people worldwide killing about 120,000 people each year mainly in countries like India and sub Saharan Africa.

An anthropologist Dr. Paul Farmer health care system of Hiati and health of the people is mainly affected by the structure violence ie  construction of social arrangements that place members or group of people in harmful way, these group mainly include females and the people belonging to lower socioeconomic classes. Hiati is one of the world poorest country which shows perpetuation of the people affecting by the societal frame work.

HAITI GEOGRAPHY

Haiti includes about 27,750 square of the western part of the island of Hispaniola in the Carribean sea.

EARTH QUAKE IN HAITI JANUARY 12, 2010

Prior to the tragic earth quake, the margin of life in Haiti was already narrowed; after the earth quake it was earth razor thin. Before the earth quake, Haiti had vast reservoir of air borne diseases. As after the earth quake 300,000 people were sleeping in open, poor sanitation system,  living in overcrowded places with disrupted access to clean drinking water  raising the threat of cholera and other infectious diseases to even more dangerous level than before. Rapid spread of infectious diseases  leads to increased in morbidity and mortality rate, may be even greater than that caused by the direct impact of disaster itself.

The most recent outbreak of diarrheal diseases due to detoriation in public health infrastructure was dramatically illustrated by introduction of cholera in Haiti starting in October 2010. This outbreak appeared 10 months after a severe earthquake on January 2010 that killed an estimate of 250,000 people, left 1.3 millions homeless, and badly damaged the distant from Latin America isolate.

Approximately 30,000 of postquake deaths were due to infectious diseases from infected wounds, pneumonia, malaria, acute respiratory infection such as viral upper respiratory infection, influenza , tuberculosis and diarrheal illnesses such as cholera.

CHOLERA

Cholera is a diarrheal disease transmitted through contaminated food and water. Severe cases can cause some victims to die of dehydration the same day they fall ill. However, far more people carry cholera bacteria without suffering severe symptoms, making it hard to know who is infected and capable of spreading the disease.

After the earth quake in 2010 cholera epidemic developed in Haiti with about 100,00 cases reported and more than 1100 deaths, the causative agent was quickly identified by the Haitian National Public Health Laboratory and the United States Centers for disease control and prevention as Vibrio cholerae . Cholera is one of the swiftest lethal infectious diseases caused by rod shaped bacteria called vibrio cholera that thrive in unsanitary water, it is  characterized by an explosive outpouring of fluids and electrolytes of the body by vomiting, diarrhea within hours of infection that, if not treated can lead to death with in hours, and it can spread with stunning speed through entire population by faecal oral route. The cholera organism is capable of producing a toxin called as cholera toxin which causes the disease. Thus it is a bacterial infection of the intestine.

Haiti's cholera epidemic killed close to 9,000 people and hospitalized hundreds of thousands more. The epidemic also spread to several neighboring countries.

RISK FACTORS OF CHOLERA DISEASE

1.      Poor social and economic environment and ustable living conditions ie insufficient water supply,poor sanitation and high population density.

2.      Underlying disease and conditions for example malnutrition and chronic diseases such as tuberculosis and AIDS can increase susceptibility to cholera.

3.      Gender ;- Women are more prone to cholera than man due to lack of knowledge.

4.      Environmental and Seasonal factors

SOURCE FOR THE ONSET OF CHOLERA DISEASE IN HIATI

After the beginning of the outbreak of cholera, the source of 2010 outbreak was a topic of debate.

The suspected source for the epidemic of cholera was the Artibonite river which was used as drinking water by many of the people who was infected with the disease.

Three hypothesis were proposed to know the source of cholera, the first hypothesis assume that virulent strain of V. cholera came from Gulf of Mexico via ocean currents. The second hypothesis state that a local non toxigenic cholera strain converted into the toxic, virulent strain from Haiti environment .The third hypothesis proposed the source of the outbreak of the disease was an infected human who carried the virulent strain of cholera from the endemic region outside the country.

PREVENTION FROM THE ONSET OF THE DISEASE

Oral cholera vaccines have been recommended in cholera epidemic outbreaks. Surprisingly, vaccine against cholera has existed since 1800s but still the people of Haiti have to suffer from the after-effects of the disease. This has been attributed to the fact that it is extremely challenging to vaccinate people especially in rural regions of Haiti. The vaccine needs to be kept at low temperatures for maintaining its stability, and it goes without saying that maintaining low temperatures in rural Haiti can be really hard due to less than optimum infrastructure (University of Colorado at Boulder, 2012). To top it, there have been social concerns associated with the use of the vaccines. The Haitians have a concern that they are being used as lab guinea pigs to test if the vaccine really works. These concerns have delayed the use of the vaccine due to which the people still have cholera spring up here and there. 

Vaccination, was estimated to reduce the probability of an outbreak by around 60 percent at best. While cholera vaccines prevent severe symptoms when people are exposed to the pathogen, they do not necessarily prevent people from becoming infected and unknowingly transmitting to others. Given the limited supply of cholera vaccines, the researchers argue that vaccination might be better used in response to emergencies.

"One of the goals of modeling is to get a sense of the potential large-scale outcomes of different policies," said Joseph Lewnard, the study's lead author and a Ph.D. student at the School of Public Health. "Evidence that the available interventions are effective substantively changes the conversation about preventing cholera introduction during deployments."

National Institutes of Health-supported scientists are working to help avoid outbreaks like Haiti's in the future by studying how cholera spreads and designing tactics to test for it. New tools like water contaminant sensors and computer models are better equipping scientists, policymakers and public health workers so they can contain infectious diseases after disasters strike.

To control cholera outbreaks, it helps to know which water sources are contaminated. J. Manuel Perez, a chemist at the University of Central Florida, devised a technique to test water for cholera bacteria. He and his colleagues created a sensor with microscopic particles of iron oxide and a sugary coating.

The sugar they used, called dextran, has a structure very similar to the molecule that cholera normally locks onto in the body - so the bacteria easily mistake the sugar for their usual landing spots. By measuring the amount of bacteria bound to their sugar, Perez's team can gauge the risk of people catching cholera from a given water supply.

Perez's technique is quick and inexpensive. It doesn't need refrigeration or bulky equipment, so it can be used in the field soon after a natural disaster

PRECAUTIONARY MEASURES TO PREVENT THE SPREAD OF CHOLERA

1.      Ensuring access to chlorinated drinking water in sufficient quantity,

2.      Promoting and facilitating hygienic practices.

3.      Rehydration and early health seeking behaviour at health facilities.

4.      Mobilising different community group and households to take action, based on resources available.

CONCLUSION

 Based on the epidemiological, water and sanitation and molecular analysis investigation conducted, the Independent Panel of Expert proposed following conclusion.

The evidences provided doesnot support that outbreak of cholera was from a natural source, they state the disease outbreak was due to the strain from Gulf of Mexico and not due to the contamination of Artibonite River with the pathogenic strain.

Cholera has been deeply linked with poverty and it is also documented that Cholera thrives in areas full of chaos. Haiti provided a fertile home to the disease as it had both poverty and chaos in full abundance especially after the earthquake. But it is still not clear who should be blamed for this epidemic in Haiti which still continues to disturb the normal life of Haitians (MMWR, 2010).

In spite of a cholera vaccine, consuming clean water and food is considered to be the best solution against cholera (Sack DA, 2004)