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Running head: EPI 500 FINAL
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EPI 500 Final
Elizabeth Kalfsbeck
American Sentinel University
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EPI 500 Final
An earthquake measuring a magnitude of 7.0 on the Richter scale would forever change
the under-developed country of Haiti in 2010. With no way to prepare for what would be
considered the most severe natural disaster to plague the nation and WITH limited resources to
appropriately respond, Haiti would become almost completely dependent on international
assistance to care for its millions of affected victims. The earthquake would reshape the
landscape and complicate the delicate infrastructure while harming Haitians throughout the
country (Harrington, Gorgone, & Jocelyn, 2012).
The earthquake, lasting approximately 35 seconds, was only the start of the nightmare
that Haiti would undoubtedly suffer for the next several years (Harrington et al., 2012). All
major infrastructures would be significantly impacted, a problem worsened by the fact that Haiti
did not have a stable economy or capacity to manage a crisis of this severity. Health issues
would spiral out of control signifying a desperation for international support. Even after the
initial trauma impact of the earthquake has passed, Haitians would face a lifetime of sadness and
despair while attempting to rebuild their lives, homes, businesses, government, and country.
Geopolitical Description
Geography
Haiti is the third largest country in the Caribbean and is about the size of Maryland
(Harrington, Gorgone, & Jocelyn, 2012). Located on the western portion of the island of
Hispaniola, the official languages of Haiti are French and Creole. A mixture of mountains,
plains, valleys, and plateaus evidences an inconsistency of the territory. Because two-thirds of
the land is mountainous, this would later become a problem in 2010 when the earthquake occurs,
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as it would serve as a barrier obtaining safe shelter and heighten the threat of landslides
(Harrington et al., 2012).
The geography of Haiti, prior to the earthquake in 2010, contributed to the isolation of
the island from the rest of the Caribbean islands and the main lands of the United States. In the
event of an emergency, Haitians would be limited as to where they would be able to seek refuge
because land based facilities were lacking throughout the uneven terrain (Hussey et al., 2011).
Haiti’s tropical climate would negatively impact rebuilding efforts because the rainy season
would further damage weak building structures. Hurricanes remain a constant threat throughout
the season from June through November, and one storm, regardless of severity, would have the
potential to destroy any efforts that Haitians and rescue organizations worked diligently to
restore.
Population Demographics
Haiti’s total population prior to the earthquake was approximately 9.5 million with 2.5
million residing in the capital, Port-au-Prince (PAP) (Harrington et al., 2012). Life expectancy
ranged from 59 to 63 years of age for men and women, respectively. Sadly, child mortality rates
are alarmingly high in comparison to other neighboring countries, and are attributed to a
combination of inefficient medical care, lack of a structured health care system, poor nutrition,
and inaccess to running water. In fact, 47% of the population did not have access to basic health
care needs, 30% of children suffered from chronic malnutrition, and 40% of households did not
have access to food on a daily basis (Harrington et al., 2012).
Poverty was a major concern throughout Haiti, even before the devastating earthquake.
Approximately 80% of Haitians lived below the poverty line and 55% of all Haitians were
considered to be living in extreme poverty, defined as the inability to meet basic needs of food,
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water, shelter, sanitation, health care, and living on roughly $1.25 per day ("Rapid
Establishment," 2010; Sloand, Ho, Klimmek, Pho, & Kub, 2012). Widespread illiteracy stunted
Haitians from retaining the ability to seek higher paying jobs that would have allowed for more
secure family support. Illiteracy prior to the earthquake was estimated to affect roughly 57% of
the total population (Harrington et al., 2012).
Health problems
Running water and sanitation. Before the earthquake occurred, many Haitians were
without adequate drinking water-an absolute basic necessity for healthy living and the prevention
of numerous waterborne illnesses. In 2008, two years before the earthquake, only 70% of the
urban population and 50% of the rural population had access to improved drinking water sources
("Water and Sanitation," 2010). Improved sanitation was not available to 24% of the urban
population and 10% of the rural population ("Water and Sanitation," 2010). These essential
commodities ensure that the water used for drinking, bathing, cleaning, and cooking are free
from microorganisms that have the potential to cause life-threatening illness and affect the
quality of life. Poor sanitation results in the spread of disease by the unhealthy existence of
defecation matter within the individual communities. Diarrheal diseases were estimated to be
responsible for 16% of all deaths in children under five years of age ("Water and Sanitation,"
2010).
Health problems. Infectious diseases were prevalent throughout Haiti even before the
earthquake. There was a rampant epidemic of HIV/AIDS that affected 2.2% of all Haitian adults
(Harrington et al., 2012). The disabled population was considerably high and could have
possibly been attributed to the poor medical care. After the earthquake, this population would
grow exponentially due to a lack of resources (Landry, Quigley, Nakhle, & Nixon, 2010). Other
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health problems that were considered baseline for Haiti, despite extensive occurrence, were child
abuse, various types of crime, hunger, and infectious diseases such as typhoid fever and
tuberculosis. Later, these health problems would grow to uncontrollable levels after the
earthquake.
Infrastructure
Structural design. Many Haitian building structures were established under poor
engineering designs and through utilization of substandard materials. For example, homemade
cinder blocks were used to support homes and steel reinforcement rods were absent throughout
several buildings. Building sites were poorly selected leading to the construction of homes and
other buildings on steep slopes, unstable hillsides, and at the bottom of gullies (Harrington et al.,
2012). The inadequacy of an unregulated construction industry would later contribute to an
increase in deaths and injuries during and after the earthquake because the weak structural design
would not be able to support the effects of the landscape altering disaster. After the earthquake,
government and public structures were either severely damaged or completely destroyed.
Notable landmarks including The National Palace, the Prime Minister’s office, the Ministry of
Finance, the Ministry of Justice, the Ministry of Health, and the Catholic Cathedral were reduced
to rubble (Harrington et al., 2012)
Health care infrastructure. Prior to the earthquake, the health care system throughout
Haiti was inefficient and lacked the necessary funding to provide quality health care comparable
to other nearby countries (Harrington et al., 2012). Most of the advanced, albeit still primitive,
health care organizations were located near the capital and, resources for patient care was
typically depleted. It was considered standard practice for families of hospitalized loved ones to
assume responsibility for providing the health care staff with the required medications and
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supplies (Pomerleau, 2010; "Post-Earthquake Injuries," 2011). Unfortunately, the earthquake’s
proximity to the capital would eventually lead to a total collapse of Haiti’s health care
infrastructure ("Water and Sanitation," 2010).
The weakened system was unable to keep up with the demands of increasing infectious
diseases, widespread malnutrition, and monitoring those with chronic conditions. Health care
efforts would struggle in the event of an emergency because of an already strained system
without the help of worldwide assisting organizations. An absence of an emergency response
plan would later be a problem when emergency and rescue efforts are in desperate demand after
the earthquake would occur (Hopmeier et al., 2013). Soliciting untrained help for rescue efforts
would prove ineffective during attempts to locate individuals throughout the mountainous,
underdeveloped land.
Immediate Impact of the Haitian Earthquake of 2010 and the World’s Response
During the afternoon of Tuesday, January 12, 2010, at 4:53pm, a 7.0 magnitude
earthquake lasting approximately 35 seconds struck the island of Haiti in the small town of
Léogane located sixteen miles from the capital (Hussey et al., 2011). Countless landmarks were
destroyed, building structures collapsed, and notable leaders were killed. This earthquake would
later be mentioned to be the most powerful earthquake to strike the poorest country in the
western Caribbean in 200 years (Pomerleau, 2010). The natural disaster would hinder the
struggling country’s abilities to grow and develop by erasing all economical progression and
forcing the population to rebuild with limited resources, an absence of financial capabilities, and
an uncontrollable spread of health care diseases. The air in the affected area smelled of decaying
bodies from those that were unable to be recovered and where rescue efforts were unable to keep
up (Harrington et al., 2012).
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Immediate Impact
Deaths and injuries. Research disagrees on the amount of deaths that occurred as a
result of the earthquake, but this is understandable considering that the bodies of thousands of
individuals were never recovered. According to Hussey et al., 230,000 deaths and 300,000
injuries resulted with a majority of injured Haitians seeking medical care within the initial four
weeks after impact (2011). The overwhelming demand for health care services and the structural
damage that resulted from the earthquake lead to the devastation of the Haitian health care
system that would otherwise be hopeless in caring for the vulnerable population without the help
of assisting worldwide organizations.
Of the multiple types of injuries sustained by Haitians, a majority of the injuries were
various types of fractures. Open fractures presented with possible long-term complications like
infections of the wound or bone as a result of environmental exposure (Hussey et al., 2011).
Limb amputations were prevalent as well as numerous dislocations. This would soon be
addressed by assisting orthopedic organizations that would donate equipment and supplies such
as external fixation systems and frames (Harrington et al., 2012). Orthopedic needs were
elevated, but other health issues were extensive as well.
Major medical issues. The unsanitary environment of Haiti worsened after the disaster.
As already mentioned with regards to orthopedic injuries, wound infections on other parts of the
body were observed among those that eventually were able to seek medical care. Unfortunately
because of the delay from time of microorganism exposure to obtaining medical care, some of
the infections had progressed to a systemic disease that would either result in limb amputation, or
in severe cases, death. Fortunate individuals that were able to seek care early were able to avoid
limb amputation by undergoing wound debridement. However, the procedure was not without
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risks. The lack of resources and the fact that many individuals were now homeless, complicated
the post-procedural care to prevent reinfection of the wound.
Cardiac and respiratory conditions agonized the population as well. The most commonly
reported conditions were Acute Respiratory Infections and various types of arrhythmias ("Rapid
Establishment," 2010). Malaria became a constant threat, as prophylactic measures, like
insecticide nets, were lost during the disaster. Other health issues that increased in occurrence
were injuries sustained to the head, face, and brain thought to have mostly happened as a result
of structural collapse.
Social problems. Of the building structures that collapsed as a result of the earthquake,
Haitian prisons were not spared. This led to the escape of criminals that further impacted the
status of the country ("Post-Earthquake Injuries," 2011). Crime increased because escaped
criminals and desperate displaced Haitians could not satisfy even the basic human needs such as
water, food, and shelter. Thieves stealing supplies struck throughout the night sometimes
targeting relief organization camps (Hopmeier et al., 2013). Security was non-existent because
numerous law enforcement officers and fire personnel were killed during the earthquake.
Crowds rioted further increasing destruction, children were sexually abused, and the incidence of
rape related injuries grew (Sloand et al., 2012). According to Hopmeier et al., two “Doctors
Without Borders” were kidnapped and later safely released a few days after the abduction
(2013).
Temporary shelters were established throughout Haiti, but most near the capital where
the majority of damaged occurred. Temporary shelters helped house the estimated 1.3 million
homeless Haitians, which accounted for about 15% of the country’s total population (Landry et
al., 2010; "Rapid Establishment," 2010). Refugees needed to be relocated to higher grounds to
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avoid the immense flooding concerns. The geographical location of Haiti in the tropics became
problematic during the rainy months because only about 40% of the refugees had tents
(Hopmeier et al., 2013). Haitians congregated in the few buildings that remained intact, but
living in close proximity and the often-damp environment, further heightened the risk for
infectious disease development. Nine hundred camps were established in the capital within days
after the earthquake and an additional four hundred were established slightly west of PAP
("Rapid Establishment," 2010). However, because of the amount of newly homeless Haitians,
the camps quickly became overcrowded.
Though most of the problems that plagued Haiti after the devastating earthquake struck
were disastrous, few positive experiences were noted. A mother that gave birth to twins in the
days before the earthquake was able to receive education from relief volunteers that facilitated
effective breast-feeding. This aid would have possibly been nonexistent if relief workers were
not present. A young pre-earthquake homeless boy was found wandering the destructed streets.
Upon examination, the boy was diagnosed with a rare skin disease, which required treatment in
the United States. He was later adopted to an American family (Sloand et al., 2012).
Infrastructure Damage
Health care. The collapse of the health care infrastructure was part of a desperate cry for
assistance. Even if the health care infrastructure had not been demolished, the system would not
have been able to support the demand for care for all of the earthquake victims. Eight hospitals
were completely destroyed and another 22 were severely damaged (Harrington et al., 2012).
Without a health care infrastructure, reporting conditions that required mandatory reporting, like
child abuse, were made impossible (Sloand et al., 2012).
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An unaffected rural hospital north of PAP in Milot, Haiti, became a receiving hospital for
victims that needed to be air lifted for acute medical care. Hospital Sacre Coeur (HSC), a 70-bed
facility, soon became overwhelmed while attempting to care for as many victims as possible.
During the initial six weeks after the earthquake, the hospital reported a census of over 400 and
became a site where assistive volunteers were stationed (Pomerleau, 2010). This hospital was
selected for emergency care not only because it was intact, but also due to a pre-earthquake
reputation of being the nations best hospital.
Medical care was being delivered rapidly once relief efforts were instituted, and to assist
as many victims as possible at a rate needed for life-saving conditions, documentation suffered.
With a lack of infrastructure or an intact health care facility, comes a shortage of resources on
which to adequately document the plan of care. However, in life-threatening and emergency
situations that occur with a national state of disaster, priorities were modified to include
providing medical care to the millions in need without regards to maintaining a medical record
("Post-Earthquake Injuries," 2011).
Transportation. Because Haiti is part of an island, international aid would only be made
possible through air and sea travel. The harbor near PAP was rendered inoperable for immediate
rescue as the seaport sustained structural damage (Harrington et al., 2012). The Toussaint
Louverture International Airport was considered the most advanced airport in Haiti because its
wide runways allowed for accommodation of large transport aircraft. The earthquake caused a
total destruction of the control tower, passenger waiting terminal, and the runway. Air transport
to Haiti was now limited at a time when it was most needed. Relief workers and volunteers
carrying essentials often had to circle in the air for up to an hour while awaiting the ability to
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safely land because of the structural damage and the constant influx of relief organizations
attempting to enter a severely deprived country.
The use of the country’s other airports was not a feasible alternative because roads and
bridges were so damaged that transport from the alternative airport to the area of need was
difficult. Vehicle travel from the Dominican Republic’s airport in Santa Domingo to PAP, a
drive that usually takes about 4.5 hours, was taking over 15 hours because of the road conditions
and the threat of landslides (Harrington et al., 2012). Traffic jams, downed power lines, and road
debris made travel throughout the island difficult and dangerous. According to Harrington et al.,
there was “enough debris to fill the New Orleans Superdome five times” (2012, p. 422).
Communications. The public communication infrastructure crumpled after the
earthquake. Millions of Haitians were left without access to television and radio, a main avenue
for delivering messages regarding public safety and rescue to the country’s inhabitants
(Hopmeier et al., 2013). Few radio stations fared through the earthquake and numerous
television cable towers were destroyed. This attributed to a delay in medical care for many
victims because there was no direction as to where to seek help.
Mobile phones were of little use because mobile providers suffered damage to their
systems. By January 14, most of the systems had been at least partially repaired, but the amount
of calls attempted overwhelmed the strained system (Harrington et al., 2012). Two main
newspaper organizations experienced minimal damage, but the majority of the damage was
concentrated on the printing presses. Even if the ability to print newspaper was available, it
would not have been possible to reach the vulnerable population because of damaged roadways
and poor ground transportation.
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Education. The education infrastructure completely collapsed from the earthquake and
the Ministry of Education, responsible for the governmental education sector, was reduced to
rubble. Many facilities were severely damaged including 15,000 primary schools and 1,500
secondary schools (Harrington et al., 2012). Universities in PAP sustained damaged and one of
the three nursing schools was completely demolished.
World’s Response
International aid, that arrived to Haiti as early as a few hours after the earthquake struck,
is believed to have positively reduced the casualties and deaths that would have occurred as a
result of the disaster (Landry et al., 2010). Many lives were saved through relief provided by
numerous non-governmental organizations (NGOs). International response time was rapid.
Approximately 600 relief and rescue organizations worldwide flocked to Haiti to provide care
and assistance to help the country cope with the difficult situation (Harrington et al., 2012).
Countless volunteers offered services in any way in which they were able, which was not only
health care related needs. Volunteers that were fluent in the national languages assisted relief
workers in translating for the victims. Volunteers to further facilitate the relief services
explained cultural differences.
The World Health Organization (WHO). The WHO was appointed as the lead agency
for prioritizing the most prominent health care concerns. The agency monitored the health
response system and identified interventions that were necessary to improve public health issues
("Water and Sanitation," 2010). Through support of the local health authorities, the WHO
teamed up with Haitian officials and recognized a problem that demanded immediate attentionthe loss or nonexistence of an adequate water supply. Beginning with health care facilities and
health care relief camps, running water and improved sanitation were quickly accessed to
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improve environmental concerns. Haitian authorities assisted in these measures by organizing
the transportation of water and water-related supplies to the facilities in need. The absence of
water supply was directly associated with poor hygiene and an increased risk for infections.
Once the water supply was addressed, the WHO redirected efforts to another important
issue-ensuring that the established water supply was favorable for optimal health outcomes. The
WHO organized water chlorination to reduce the bacterial contaminants found in the water.
Health care facilities were without a safe way to dispose of medical waste, so the WHO
organized a system that would prevent cross-contamination of the vulnerable population. A
location for underground waste disposal was soon identified, and through collaboration with
Haiti’s Metropolitan Solid Waste Collection Service (SMCRS), an efficient plan was enacted to
dispose of waste. The WHO ensured safety from exposure to SMCRS workers by providing
personal protective equipment and necessary immunizations ("Water and Sanitation," 2010).
United Nations International Children’s Emergency Fund (UNICEF). In partnership
with the WHO, UNICEF was actively involved in efforts to improve water, sanitation, and
hygiene. The agency also set it’s main goals on bettering the lives of Haiti’s children by locating
children that have become separated from their families and protecting them from harm and
exploitation ("UNICEF Gears Up," 2010).
With the future of Haiti’s young population a main priority of UNICEF, feeding
programs were established to provide adequate nutrition to malnourished children. It is
estimated that this program has saved over 15,000 lives ("Haiti Earthquake," 2012). Children
were provided with learning materials so education could be maintained and reached while
schools were under reconstruction. Immunization rates improved through UNICEF and
increased routine coverage from 58% to 80% between 2010 and 2011 ("Haiti Earthquake,"
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2012). Because rates of HIV/AIDS were epidemic prior to the earthquake, it was suspected that
rates would only increase during the relief phase so; UNICEF tested thousands of pregnant
women to help lower rates of HIV transmission to their unborn child. Anti-retroviral treatment
was provided to 1,875 HIV-positive women ("Haiti Earthquake," 2012).
The United Nations (UN). Volunteer teams with the UN stepped in to help with
coordination of emergency services. Total collapse of Haitian infrastructures led to an
inappropriate use and distribution of essential supplies (Hopmeier et al., 2013). The team was
part of the United Nations Disaster and Coordination System (UNDAC).
The United States of America (USA). American nurses visited HSC to work with
surgeons who were surgically repairing injuries sustained to earthquake victims. Specialized
knowledge possessed by various types of American nurses was used to create and design training
clinics (Pomerleau, 2010). With each volunteered trip to Haiti, nurses and other health care
professionals brought along supplies that would be desperately needed in the depleted nation.
Field hospitals were established throughout the hard-hit area near PAP by American
organizations. Because Haiti’s health care infrastructure was not able to support the demands for
medical needs of the population, field hospitals served as primary centers for complete medical
care. A major strain was experienced by field hospitals because they were not designed to house
patients that needed more monitoring. Since there were no intact hospitals, the health care
providers running the field hospitals were faced with concerns: send the patient home to an
environment that is not conducive for healing or keep the patient in the field hospital even
though a lack of resources and space dictates that it is not possible ("Post-Earthquake Injuries,"
2011)?
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Nurses within specialized areas of nursing, such as obstetrics, were unsure how
significant their skills would be in assisting Haitians that have sustained fractures, brain injuries,
and non-healing infected wounds. To alleviate these concerns and encourage those that
possessed the desire to help, the United States developed programs within the USA for nurses.
These programs refreshed nurses on emergency protocols, various skills that are often required
from a first responder, and methods on dealing with families in crisis (Pomerleau, 2010).
Obstetric nurses, though newly prepared to handle situations outside of their specialty, reported
an experience in which they were not prepared to handle- emotionally supporting the healthy
health care working in Haiti, specifically, the nursing staff. The Haitian nursing staff of HSC
was more than grateful for the American nurses that volunteered to help staff the intensive care
units to assist with a dramatic increase in patient census. Some of the American nurses
responded quickly to the need and were volunteering in Haiti within one week of the earthquake
(Pomerleau, 2010).
In addition to the multiple volunteer health care providers that offered their time and
skills to assist the vulnerable population, the United States government provided a seven billion
dollar grant to help with relief efforts under President Barack Obama’s administration (Hopmeier
et al., 2013).
The United States Navy Ship (USNS) “Comfort”. The USNS disembarked from
Baltimore four days after the earthquake and was stocked with supplies and health care staff
prepared and trained to manage any medical condition that would be encountered. Docked off
the coast of PAP, the USNS was intended to operate as a floating hospital that could safely care
for 1,000 inpatients and provide trauma care in the 50-bed casualty receiving area. The 80-bed
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intensive care units, 12 operating suites, and 20-bed post-anesthesia care unit was equipped to
treat a variety of illnesses significant of disaster victims (Hussey et al., 2011).
An on-ship laboratory proved to be convenient for processing various specimens,
performing multiple laboratory blood tests, and analyzing histology. A morgue was part of the
ship as well as a blood bank to hold blood products that would be needed to transfuse victims
that suffered severe injuries. Efficient operations allowed the USNS to support 1,056
admissions, perform 843 surgeries, and complete 3,600 radiologic studies within the first forty
days of operation (Hussey et al., 2011).
The laboratory was especially busy processing, on average, just over 100 various tests per
day. Thirty-seven patients had limb amputations performed on the USNS and twenty-one
patients were treated for infected wounds on their pre-existing amputated extremity attributed to
a lack of a public sanitation system (Hussey et al., 2011). Being prepared to safely deliver babies
proved to be beneficial as nine babies were born on the USNS (Hussey et al., 2011).
University of Miami Global Institute/Project Medishare (UMGI/PM). The first field
hospital established in PAP was through UMGI/PM and assisted with medical/surgical and
rehabilitative needs. During the time of service (January 13, 2010-May 28, 2010), 42% (581) of
the total patients seen suffered injuries, of which, 60% (346) required surgical intervention
("Post-Earthquake Injuries," 2011). The UMGI/PM expanded nine days after arrival from two
tents able to serve 250 patients, to four tents with seventeen ICU beds, three operating suites, and
220 volunteers from the United States and Canada serving five to seven day missions ("PostEarthquake Injuries," 2011)
Various Assistive Efforts. Volunteer health professionals helped with proper
maintenance of health records because during the initial weeks after the earthquake, the priority
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lied with treating as many victims as rapidly as possible. Hepatitis A, Hepatitis B, typhoid fever,
and tetanus vaccines were provided to individuals choosing to donate time while assisting the
struggling Haitian population. They were also provided with malaria prophylaxis, antidiarrheal,
and insect repellants (Harrington et al., 2012). Other countries sent personnel to repair damaged
pipes and with them, they brought water purification systems (Harrington et al., 2012)
Monitoring Haiti’s Health After the Initial Impact
Monitoring Public Health Issues
Haiti struggled with the containment and management of numerous diseases prior to the
earthquake of 2010. Efforts to continue suboptimal disease management and prevention suffered
extensively due to the unknown whereabouts of existing patients and the rapid spreading of
disease among Haitians living in overcrowded shelters. Among the health issues that demand
attention after the initial impact of the earthquake include infectious diseases, vector-borne
diseases, and diseases associated with the condition of a poor water and sanitation system.
Sadly, these conditions continue to affect the vulnerable population throughout the country.
Infectious diseases. Measles, diphtheria, pertussis, acute respiratory infections,
meningococcal diseases, HIV/AIDS, and tuberculosis are diseases that are known to increase in
prevalence when health conditions of a population are poor. With regards to the earthquake
aftermath in Haiti, these mentioned conditions were noted to be on the rise, and is associated
with the overcrowding in shelters. An inadequacy of a ventilation system prohibits the
introduction of clean air into the living space creating a favorable environment for disease
transmission (The World Health Organization [WHO], 2010).
There was a severe problem with access to proper toilets affecting 80% of Haitians
(Wise, 2012). Without a sewage system in place, human defecation near clean water sources
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used for hygiene and injection was not unusual. Haiti’s pre-earthquake sewage and water
infrastructure did not adequately suffice the requirement to keep waterborne infections at bay.
“Decades of neglect and the failure to invest in these areas have led to many illnesses associated
with the consumption of contaminated water, lack of education in the practice of good hygiene,
and poor excreta management” (Wise, 2012, para. 3). A cholera outbreak that would
significantly impact the lives of Haitians already trying to recover from the disaster was reported
to begin in October of 2010 (Harrington et al., 2012). The number of Haitians becoming
infected with cholera was rising dramatically resulting in the deaths of thousands. Three years
after the earthquake, the threat of cholera still lingers affecting millions of the still vulnerable
population.
Tuberculosis was noted to be a significant health concern in Haiti and “has the highest
per capita tuberculosis (TB) burden in the Latin America and Caribbean region” (Karabanow,
2013, para. 2). Tuberculosis is spread through droplets caused by coughing or sneezing between
individuals in close proximity. Displaced Haitians that have the disease, and are living in close
quarters, can readily pass the disease on to other individuals. A major concern with the
tuberculosis endemic is that it is often coupled with HIV infection. Though HIV is not spread
through droplets, co-infection with the HIV virus reduces one’s immune response making
combatting the disease difficult.
Vector-borne diseases. Vector-borne diseases became more prominent throughout Haiti
after the earthquake due to a lack of shelter and exposure to the respective vectors responsible for
disease transmission (WHO, 2010). Malaria, a parasite transmitted to humans through a
mosquito bite, occurred in all areas of Haiti even before the disaster. Infections in PAP were not
substantial compared to other areas of the country, but rates increased in locations near the
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epicenter of the earthquake zone. After the earthquake, factors such as a loss of insecticidetreated nets, the lack of insecticide-treated net ownership, the inability to obtain insect repellant,
and the essence of Haiti’s damp climate, led to optimal conditions for disease transmission.
Dengue, a viral disease also transmitted through mosquitoes, increased in occurrence after the
earthquake for the same reasons that lead to the spread of malaria. The virus known to cause
dengue that harbors within the mosquito vector, Ae. aegypti, can be found in locations where
standing water is present (WHO, 2010).
Pets that fared through the earthquake remained close to their owners and other
earthquake victims displaced in shelters. Leptospirosis is a disease that is transmitted to humans
through contact with an animal’s urine infected with a spirochaete bacteria (WHO, 2010).
Overcrowded shelters made it highly likely that humans would come into contact with the
animal’s excrements more often than prior to the earthquake. Since leptospirosis was endemic to
Haiti before the disaster, it was not unexpected to see an increase in cases.
Surveillance Plan
The rise in communicable diseases during the earthquake’s aftermath was indicative of an
immediate surveillance plan to monitor diseases and detect outbreaks. The affected population
had to be precisely characterized in efforts to target specific relief labors. However, again, the
pre-earthquake state of Haiti’s health care infrastructure was detrimental to the urgent need for
establishment of a surveillance plan. Collaboration between Haiti’s Ministry of Public Health
and Population, Pan-American Health Organization, the Centers for Disease Control and
Prevention, and other national agencies merged within two weeks of the disaster to attempt to
control the situation by initiating the National Sentinel Site Surveillance (NSSS). Changes in
living conditions meant that it would be crucial to monitor additional diseases than the ones that
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were monitored in the past. Including other causes of watery diarrhea, additional vector-borne
diseases, and new outbreaks of communicable diseases was necessary ("Launching a
Surveillance System," 2010). Surveillance sites were established throughout Haiti without
regards to the degree of damage caused by the earthquake. Monitoring these areas was necessary
to control the spread.
Setting up the surveillance plan. Focusing on which health issues need monitoring
should occur early in the process of developing a surveillance plan. A comprehensive plan that
appropriately notifies the indicated health department is necessary for the proper trending of
diseases, detection of unusual occurrences, and to determine if health interventions have been
effective ("Case Definitions," 1997). An effective plan is simple to use and include standard
case definitions and reporting forms. When specified diseases are encountered, an alert system
should be in place so immediate investigation can occur.
Preparing for an outbreak is an essential component and should not be overlooked when
the surveillance plan is being developed. Individuals responsible for responding to outbreak
situations should be geared with the appropriate personal protective equipment and medications
specific to treating the disease in question ("Launching a Surveillance System," 2010).
Identifying laboratories of which collected specimens will be transported and analyzed, is key to
the surveillance plan, as individuals will need to know what organization has been appointed to
assist in the event questions arise about specimen processing, transportation, or other queries
related to laboratory samples ("Launching a Surveillance System," 2010). The laboratories
should allow for prompt diagnosis and disease confirmation. It is important that the laboratory
possess the means necessary means to identify the samples and the equipment needed to process
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it correctly. Data must then be forwarded to the responsible health official, and if indicated, the
WHO.
Haiti’s post-earthquake surveillance plan should include several diseases in addition to
the other diseases the country was currently monitoring. The plan should include the specific
infectious diseases, waterborne diseases, and vector-borne diseases mentioned earlier. Other
diseases that were not mentioned but should be included because of their significance in the postearthquake recovery process are, tetanus, hepatitis A, polio, human rabies, and lymphatic
filariasis, to name a few ("Launching a Surveillance System," 2010).
Health Indicators
Health indicators are a breakdown of the larger dimension of public health into individual
factors that depict the overall well being of a geographic area. This data is utilized by public
health officials to guide public health programs, assess public health interventions, and to
determine if measures that assist in the improvement of a community’s health, have been
effective (Cavanaugh, 2013). Given the pre-earthquake and post-earthquake state of Haiti was
rich with infectious diseases and poverty, monitoring indicators such as poverty rates,
tuberculosis, infant mortality, and HIV/AIDS mortality would be considered a public health
priority. Following data pertaining to the mentioned indicators would track the progress of the
conditions over the course of several decades displaying the challenges that the nation faced and
is currently facing. Data is then publicized to, not only the community level but also to, the
national level signaling a need for international aid for health improvement. International aid
response then assists the nation with methods for improvement and the means to improve, if the
country is lacking in resource utilization.
Long-Term Health Issues During Rebuilding
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Rebuilding Haiti after the earthquake will take decades and require international support.
Millions of homes were destroyed, few businesses were left intact, and a complete collapse of
the health care infrastructure will prove to complicate the process. Access to running water and
appropriate sanitation is a basic need and a necessity in keeping a country lacking a health care
system healthy.
Long-Term Health Issues
Prevention of infectious disease transmission begins with educating health professionals
who then educate the community. Promoting adequate hygiene habits using the available
resources will decrease diseases such as rare skin conditions, common colds, and influenza
("Water and Sanitation," 2010). With international aid making the establishment of a clean
water source a priority, this long-term health issue will, hopefully, improve.
Rehabilitation services. The already strained and overwhelmed health care in Haiti will
face yet another challenge in the long-term after international aid has declined. Prior to the
earthquake, the prognoses associated with complex chronic injuries were poor because the health
care infrastructure lacked appropriately trained and qualified personnel and resources to care for
the affected individuals (Landry et al., 2010). The involvement of volunteer health agencies
from around the world flooded the PAP area with highly specialized and experienced health care
providers. This resulted in the improvement in health care that allowed many victims to avoid
amputation, survive complications associated with paralysis, and benefit from surgical fixation
of a fracture.
Victims that have developed a chronic condition as a result of the earthquake and have
received health care from assisting agencies, will likely need rehabilitation services and
monitoring. The health care system is not prepared to meet these long-term necessities (Landry
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et al., 2010). Rehabilitation services were in short supply throughout Haiti prior to the
earthquake. According to Landry et al., per ten million Haitians, there were only an estimated
twelve physical therapists, no occupational therapists, and very few psychiatrists (2010). When
the reality of the fact that native health care professionals were not spared from injuries sustained
from the earthquake, the perspective of a strained system is enhanced. The need for
rehabilitation services increased dramatically after the earthquake overwhelming the demand for
skilled assistance. Over one thousand amputation patients, hundreds of thousands of fracture
patients, and approximately 200 spinal cord injury patients now requiring long-term
rehabilitation needs (Landry et al., 2010). To further complicate the situation, many of the
rehabilitation health professionals were not skilled in treating the conditions that surviving
victims were now attempting to manage because the demand for these services was low prior to
the earthquake. Because prognosis was poor and the health care system was not able to handle
the demands, patients did not often survive long enough to need rehabilitation.
Mental health issues. An international health care organization called Partners in Health
(PIH), is a group of American psychiatrists focused on assisting the Haitian health care providers
in providing adequate long-term mental health care. Mental health disorders, such as depression,
gender-based violence, pediatric protection issues, and grief stemming from a result of countless
situations brought on by the disaster plagued the nation (Raviola, Eustache, Oswald, & Belkin,
2012). Partners in Health provided mental health services by finding those victims in need of
psychiatric care and treating not only disorders resulting from the trauma of the earthquake, but
also those with pre-existing disorders (Raviola et al., 2012). A development of programs aimed
to service the vulnerable population at the community level was created by PIH while supporting
victims and their families with coping measures. To ensure that interventions were continued
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after PIH withdrew from Haiti, PIH physicians trained Haitians physicians to provide psychiatric
care and how to appropriately prescribe psychopharmacological medications (Raviola et al.,
2012).
Conclusion
What many would consider an unfortunate disaster has left a small, deprived country
without an adequately functioning economy or government. There are still multiple issues that
are in need of being addressed such as rebuilding the country’s infrastructure, ensuring the
public’s health is monitored and assistance is available when needed, and the water and
sanitation system is maintained. Because the earthquake affected a heavily, densely populated
area of Haiti, millions of lives were affected and their health statuses would be influenced for
years to come ("Water and Sanitation," 2010).
Infectious disease prevalence is a major concern for the Haitian population and
international aid may not be available indefinitely. Eventually, Haiti may have to assume a
majority of the responsibility of preventing, monitoring, and treating the diseases but, with a
struggling health care system and a slow progression towards an independently operating entity,
the health care in Haiti may be slow to advance. Support from international agencies, volunteers,
and non-governmental organizations may be essential in the rebuilding efforts that Haiti so
desperately needs while recovering from a traumatic, unfortunate, natural disaster.
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