What diseases can arise from the lack of clean water in Haiti?

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The lack of clean water in the stricken Haitian capital fosters conditions that may spawn an epidemic of enteric disease.

“Having large numbers of people in close proximity and not using appropriate sanitation can potentially spark those epidemics, particularly if people are forced to drink surface water,” said Rebecca Dillingham, MD, of the University of Virginia in Charlottesville, who works closely with an infectious disease clinic near the heart of Port-au-Prince.

Waiting in the wings are diseases caused by bacteria, such as Salmonella typhi and less invasive salmonella microbes, as well as protozoans, such as cryptosporidium.

Those pathogens constantly circulate in the crowded conditions of Port-au-Prince, where, even in good times, access to clean water is difficult and sanitation is rudimentary. But water and sewage lines were smashed by Tuesday’s magnitude 7.0 earthquake.

“I wouldn’t want to minimize the water problems that exist on any given day in Port-au-Prince,” Dillingham said, “but now it’s much worse.”

Thousands of people are camping out in the Champ de Mars, the large park near the presidential palace, either because their homes are shattered or because they’re afraid to go indoors.

The park has no sanitation facilities and people were reported to be defecating on old Styrofoam plates and takeout dishes. Similar conditions exist throughout the city.

If there’s a bright spot, it’s that cholera is not an issue, according to Marilyn Lee, MSc, an expert on water quality at Toronto’s Ryerson University.

While cholera is endemic in many countries, it’s not reported from Haiti, Lee said, “and that’s a good thing.”

On the down side, Lee said, even enteric illness that is usually relatively mild can be life-threatening when usual care — mainly hydration and rest — is not available.

Before the earthquake struck, the city had 21 public health facilities, including four hospitals, to serve a population of 3.5 million people, half of whom live in slums.

Most of those facilities are severely damaged and out of action, while others are overwhelmed with patients needing acute care.

“Even if people get ordinary salmonella,” Lee said, “where are they going to go to get help?”

Staff members at the GHESKIO clinic, where Dillingham’s colleagues work, are trying to deliver medical care to people in the shattered downtown, but they are hampered by shortages of almost everything.

The clinic is the heart of a long-running and robust system of chronic care for people with HIV/AIDS, Dillingham said, but staff are now trying to deal with the acute needs of the neighborhood, including food and water.

Basic medication, antibiotics, and painkillers are also needed but no outside aid has reached the clinic, she said, and supplies are running short.

Many of the aid agencies have begun trying to get water and food into the city but movement remains difficult. And, Dillingham said, the GHESKIO clinic is in a neighborhood that is not regarded as safe.

Some of the city’s water needs may be met soon.

The aircraft carrier USS Carl Vinson has arrived in the area, with 19 helicopters, 51 hospital beds, and three operating rooms.

The Vinson can provide hundreds of thousands of gallons of water a day, using helicopters to shuttle them and other supplies to the city, according to U.S. Southern Command.

The ship is also bringing 30 pallets of supplies.

Oxfam, the British-based aid group, said it had managed to get some water tankers into the city.

Private and government agencies from around the world have been sending planeloads of food, water, tents, blankets, water purifiers, and earth-moving equipment, as well as search-and-rescue experts and medical personnel.

The UN’s World Food Program has begun to set up distribution centers for food and water, including 6,000 tons of food recovered from a damaged warehouse.

But officials and aid workers fear that the continuing crisis may soon encourage violence. Some looting has been reported and Kim Bolduc, acting chief of the UN mission, acknowledged “the risk of having social unrest very soon.”

The UN said at least 37 of its personnel in the country have died and another 330 are missing. The UN had 12,000 people in Haiti before the earthquake.

The earthquake struck about 5 p.m. Tuesday, with an epicenter about 10 miles southwest of Port-au-Prince. The tremor apparently destroyed about 10% of the buildings in the city, including the presidential palace, which had been designed to withstand an artillery attack.

The coastal city of Jacmel, about 25 miles south of Port-au-Prince on the other side of the epicenter, was also badly damaged, according to footage aired on CNN.

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