Haiti: Epidemiologist outlines health needs after earthquake

Brigg Reilley is an epidemiologist with Médecins Sans Frontières/Doctors Without Borders (MSF) in Haiti. He’s gathering information on what medical needs and issues MSF teams are seeing. The data helps to create a bigger picture of what people’s healthcare needs are after the earthquake, and how those needs may evolve. This knowledge allows MSF staff to continue to effectively treat survivors now as well as plan for the critical medical work ahead. Reilley shares some of MSF’s ongoing priorities as well as what those priorities will be in the weeks and months to come.

Haiti | 29 January 2010

In the days after the earthquake in Haiti, the media inundated audiences with images of massive destruction and the horrible toll the disaster took on human lives. They showed an alarming number of dead bodies, leading some to worry that those bodies would spread disease. This concern is largely unfounded. Dead bodies are generally not the source of an outbreak or a cause of propagating an epidemic. People are much more likely while they're alive to spread disease, when they actually have the symptoms of disease. So the bodies are of course a concern, but from an epidemiological point of view they are not a priority.

Every natural disaster unfolds a bit differently and the priorities in Haiti are evolving. In the beginning we saw large numbers of trauma, wounds and crushing injuries. We have for the most part passed the acute surgical phase that addressed those needs. Infected wounds and fractured bones are now a serious concern.

Wounds that are infected may become gangrenous and in turn become fatal, so we've really got to get out there and treat people who are not able to come to us. MSF is trying to get out into the community with mobile clinics and make sure no one is sitting in their home unable to get care for these wounds which can go from minor to major to fatal.

There are many patients with bone fractures that need to be set. There were so many life-saving priorities to address in the early days after the earthquake that people with fractures were turned away because their injury wasn't considered serious enough. The result has been that doctors are still setting broken legs and broken arms.

We are also worried about tetanus, which is naturally occurring. It's in the soil, it's in the environment, so big open dirty wounds are likely to become infected with tetanus. The vaccination rate in Haiti is only about 60 per cent. There is no cure and it is fatal in more than 50 per cent of cases. There have already been a few cases. The incubation period is usually about 14 days and we are about to hit that, but tetanus is also something that can affect you months after infection. Vaccinating people with wounds for tetanus is going to be a priority as well.

The risk of disease outbreaks is now elevated. In Haiti two things have happened as a result of the earthquake. One is that a lot of the infrastructure that keep infections at bay have been disrupted or destroyed - shelter, water, food. Secondly, the population’s health has been greatly weakened. So not only are you more likely to become ill, but the illness is more likely to be severe.

We are now concerned with potential epidemics of water-borne diseases – a particular threat to children – diarrheal diseases that can lead to death by dehydration. As well, almost everybody who has been affected by the earthquake is sleeping outside. This can contribute to a lot of respiratory infections, which is again a big issue for children.

Vaccination rates in Haiti are poor. In a weakened population, a disease like measles can cause many deaths and much sickness, with children under five years old being most vulnerable.

MSF is trying to meet the immediate medical needs of our patients while taking into account these evolving concerns. It's a fluid situation right now because the acute surgical phase, while still important, is now ending. There are a lot of other organizations offering assistance – with more arriving every day. We are trying to work with them to avoid duplication of efforts.

Haiti’s recovery will be a long-term one, especially for those people who have suffered major injuries. The most serious injuries will need continual dressing and cleaning, all part of a very nursing-intensive process. We're eventually going to need skin grafts and prosthetics. These will be needed not only in the next days, but in the coming weeks, months and beyond. Even after the current media spotlight on Haiti fades, there will be patients with extensive orthopedic needs as a result of the earthquake.