Press Briefing, Feb. 23
Dr. Jon Andrus
PAHO Deputy Director

The Jan 12 earthquake that crushed and paralyzed Haiti created enormous challenges for maintaining proper sanitation and hygiene, particularly among displaced populations living in some 600 temporary settlements in the Port-au-Prince area.

Even before the quake, in some parts of the country only 1 in 2 Haitians had access to safe, potable water. This situation only got worse due to earthquake damage to existing water and sanitation systems. On top of all this, the upcoming rainy season is looming and poses additional threats and challenges to maintaining safe standards of sanitation.

We know that the risk of diarrhea increases in displaced populations, and especially during the rainy season. In these kinds of settings, where sanitation and hygiene are compromised, up to 70% of diarrheal cases are viral and usually self-limiting, but they can cause significant dehydration and even death if not properly treated. Examples of diarrhea-causing viruses include norwalk and rotaviruses.

Approximately 1 in 4 cases of diarrhea are caused by bacteria and tend to be more serious, producing dysentery with nausea, vomiting, diarrhea, fever, abdominal pain. Examples include salmonella, shigella, campylobacter, and E. coli.

Cholera is one type of bacterial infection that produces a toxin causing severe diarrhea and vomiting, with very high case fatality rates. The last cholera epidemic in this hemisphere occurred in 1991. Prior to that we had not had a cholera outbreak in the Americas for the previous 100 years.

The other 6% of diarrhea cases are caused by parasites, such as amoebic dysentery.

While some of these diseases are spread by human-to-human contact, almost all are related to the breakdown of hygiene and sanitary conditions. They can rapidly spread through contaminated food and water.

In light of the upcoming rainy season, Haiti and its partners are taking actions for strengthening surveillance to detect any outbreaks earlier and be able to control them to prevent unnecessary deaths, providing safe water through chlorinated cisterns distributed at key points, constructing pit latrines to serve every 25-50 people at this phase in the crisis, and providing and collecting waste disposal bags.

The key is prevention and these actions highlight that. However, parents and families need to know that oral rehydration of their children is essential for proper management of cases should they occur, in order to prevent the more serious life-threatening consequences. Community health workers, with this in mind, are working to ensure these community strategies are in place.

Also in the area of sanitation, an interagency working group has been set up to focus on the issue of healthcare waste management, which is a particular concern due to the health risks from exposure to medical waste. The group will help develop a medium- and long-term plan to replace temporary measures that were put in place following the earthquake.

As the situation in Haiti continues to evolve, it is important to have disease monitoring systems in place, as I mentioned. To that end, PAHO is continuing to support Haiti’s Ministry of Health in the epidemiological monitoring and surveillance to detect any possible outbreaks should they occur following the earthquake.

The way the system works is basically, a suspect case of a disease in question is reported from a sentinel sites so it can be investigated and the necessary specimens can be collected. These specimens are tested to determine if the suspect case is indeed a confirmed case of the disease in question, and control measures are then implemented. This helps the public health staff to determine whether an outbreak is brewing and threatening the health of the community.

So far, the surveillance system does not show any substantial increase in infectious diseases. Of the diseases reported, respiratory infections are the most commonly reported illnesses, followed by trauma/injury, diarrhea and suspected malaria.

Two isolated cases of typhoid —not epidemiologically linked— and two cases of malaria have been confirmed through laboratory tests. 18 suspected cases of measles have been reported, but so far none have been confirmed as true measles cases. One case of diphtheria has been reported but could not be confirmed.

So the system is working; people are looking for cases and investigating them properly.

Data are also now being received from some of the settlement camps (which are not part of the sentinel sites), and we are getting preliminary reports of an elevated number of cases of hypertension.

Vaccination in the temporary settlements that began on February 16 will continue through the end of March. So far more than 62,000 people --or 10% of the nearly 600,000 target population-- have been reached and vaccinated.

These include more than 8,000 children under 7 vaccinated against diphtheria-tetanus-pertussis and more than 5,000 vaccinated against measles and rubella.

More teams are needed to finish the campaign as scheduled. To that end, Haiti’s Ministry of Health is planning to train more staff, with help from the NGOs involved in the effort.

At this point I would like to make a few comments about drug donations.

PAHO’s country office in Haiti recently issued a communiqué that summarizes new guidelines on drug donations for Haiti. They were developed in consultation with more than 100 humanitarian organizations working in or providing donations to Haiti following the earthquake.

To summarize, the basic principles include, first, that drugs that are donated should be drugs that are most needed by Haiti. This means donations should be based on expressed needs, which requires effective communication between donors and Haitian health authorities.

Second, medicines that would not be acceptable in the donor country should not be offered to any other country. Donated drugs should come from reliable sources and should meet the quality standards of both the donor and recipient countries.

Also, drugs should be valid for at least one year following their arrival in Haiti.

Donations should fully respect the wishes and authority of Haiti’s health officials and should comply with the health policies and administrative procedures that exist in the country.

These and other guidelines on how to be a good donor are available in Spanish on the www.saberdonar.infowebsite, which was developed by PAHO/WHO and partner agencies to establish standards for donation practices. In English, PAHO has published a guide called “Be a Better Donor: Practical Recommendations for Humanitarian Aid,” which is available at www.paho.org/disasters.

PAHO / WHO will be monitoring drug donations to make sure they comply with these guidelines.

Finally, I would like to close with a few observations about the road going forward.

In the short run, emphasis will be on maintaining basic services such as security, sanitation and safe water and food, while also providing basic primary care services, particularly for patients with HIV, TB, and malaria, pregnant women, and children. Security continues to remain a concern, including potential violence against women. As I mentioned earlier, providing mental health care, preparing for the upcoming rainy season, and improving disease surveillance will also be top priorities.

In the longer term, we need to help Haiti build the necessary health infrastructure so that make-shift hospitals and mobile clinics are less needed, and so that there is a permanent system in place that people can rely on, while dealing with any short-term priority that might emerge.

What will be the overall costs of reconstruction in Haiti? Experts believe it will be in the billions, some even say more than 65 billion US dollars. This is a lot of money, and it will need to be managed very effectively.  

Coordination has already been the most difficult challenge in the earthquake relief efforts, and this will become even more important as donations increase and longer-term recovery efforts get under way. It is extremely important that all partners work together for the greater good and not for their own special interests. We must recognize that is there always room for improvement and that government ownership of the recovery effort is absolutely essential.

Finally, when the media attention diminishes, will the partners’ commitment diminish? Speaking on behalf of PAHO, we are the oldest international health organization in the world. We also serve as the Regional Office for WHO. We have been with Haiti through numerous disasters over the past decades, and we will continue to be there in the future. Thank you.