WASHINGTON, DC—As part of the overall US relief effort for Haiti, the US military began a massive effort last month to provide assistance in the wake of a deadly earthquake that killed thousands of people and left a staggering number of others injured and in need of help.
Images from the earthquake-torn country showed an overwhelming scene of human suffering, piles of rubble and wreckage, and rescue workers trying to find any victims who may have survived. Haitian authorities were estimating that in all, at least 1 million were homeless as a result of the earthquake.
With the country trying to cope with the thousands who were dead, a second strong magnitude 5.9 aftershock (USGS) rocked Haiti days after the initial quake.
According to US Southern Command, as of January 24, more than 17,000 US military personnel, 24 ships and more than 120 aircraft were supporting operations to provide relief and care. In the immediate days following the disaster, the US military’s focus was search, rescue and disaster relief. “We are employing all of our resources as fast as we can. And we continue to make progress here every day. We do not underestimate the scope of the challenge in front of us,” Army Maj Gen Daniel B Allyn, told reporters at the Pentagon from Haiti last month.
In addition to delivering bottles of water and food rations to the people in Haiti, the military was also providing medical care. The hospital ship USNS Comfort was among the military’s medical assets deployed to treat patients. The USNS Comfort’s hospital capabilities include fully-equipped operating rooms, a 1,000-bed facility, digital radiological services, a medical laboratory, a pharmacy, an optometry lab, a CAT-scan, and two oxygen producing plants. According to the military, the Comfort has one of the largest trauma facilities in the United States. The ship is equipped with a helicopter deck capable of landing large military helicopters.
The majority of the medical personnel that sailed onboard the USNS Comfort were from the National Naval Medical Center, with medical personnel from the Naval Medical Center Portsmouth also included in the effort. Chris Walz, public affairs officer for NNMC, told U.S. Medicine that the team from NNMC aboard the ship includes corpsmen, pediatricians, orthopedic specialists, neurosurgeons, and ophthalmologists, among others. Many of the medical personnel going to Haiti deployed for Hurricane Katrina, and many were just in Haiti in April as part of Continuing Promise 2009, he said.
Additionally, USS Bataan and USS Carl Vinson were receiving and treating dozens of injured survivors.
Public Health Concerns
It was a race against time for health care organizations in Haiti dealing with acute medical care and looming public health threats. The Pan American Health Organization was reporting at least eight hospitals and healthcare facilities were destroyed or damaged in and around Port-au-Prince, Léogâne, and Jacmel. Still operating hospitals were being overwhelmed by large numbers of survivors.
A growing number of field hospitals from a number of countries were providing medical care including an Israeli field hospital, a Russian military hospital, a Nicaraguan military hospital, and additional field hospitals arriving from Mexico, Indonesia, Turkey, France, Doctors Without Borders, Indonesia, and the US. Some patients were being evacuated to Jamaica, Martinique, Florida, and the Dominican Republic.
While rescuing and treating survivors was a priority in the immediate aftermath of the earthquake, Dr Jon Andrus, deputy director of the Pan American Health Organization, told reporters that emerging public health risks must also be dealt with.
While malaria transmission is low in Port au Prince, malaria could be a concern in resettlement areas, he said. In addition, other bacterial and viral causes of diarrhea could become problematic. “Haiti is a country that has low immunization coverage rates. So vaccine preventable diseases, these are risks that we can manage and manage well in the upcoming months if we put them in our response plan for our reconstruction,” he said.
Rabies is endemic in Haiti, so attention will need to be given to that as well, according to Andrus. “Other vector borne disease could emerge, so vector borne programs will be important,” he said.
Measles could also become a problem. “In displaced populations, experience shows that measles can emerge. As we phase out of the acute response into a more long-term response, these issues will have to be addressed. Certainly, in the case of measles, making sure everyone is vaccinated is important,” he said.
Public health experts noted that the potential for waterborne diseases underscored why getting clean water on the ground, as organizations are trying to do, is so important. “When there is an interruption of water, sewage, and electricity that predisposes to certain public health problems like diarrheal disease, everything associated with unclean water in a population that does not have access to the best medical care becomes a threat,” Col Kent Kester, commander of the Walter Reed Army Institute of Research, told U.S. Medicine last month.
CDC Assists in Response
CDC was also providing assistance in Haiti by supporting efforts of HHS, the US military, World Health Organization, PAHO, and USAID, among others. As of January 24, 225 CDC staff members were involved in the response; 19 staff members were deployed to respond to the emergency.
Represented among deployed CDC staff were specialists in epidemiology, veterinary medicine, environmental health, and infectious diseases that included physicians, public health advisors, sanitarians, and nurses. “Primarily, right now, the chief aim is to help alleviate and mitigate public health issues before they become medical issues,” CDC spokesperson Matthew Reynolds told U.S. Medicine.
Reynolds said that CDC was in a support role and not the lead in the public health efforts in Haiti. Among its efforts, CDC staff in Haiti was working with its partners to finalize public health surveillance instruments that will be used to identify public health problems and prioritize interventions.
Reynolds said that two major public health issues of concern moving forward are water and sanitation issues. CDC staff, he said, are developing a map showing zones where post-earthquake populations are congregating in order to identify whether they are near water, open fields, soccer stadiums or other sources of potential natural threats like mosquitoes and other disease-carrying insects. “You’ve got water that could be contaminated that people might be drinking or may pose sanitation issues, and that is one of the things that we are doing is trying to figure out where those people are and where the water is,”” he said.
Because vaccination rates are not high in Haiti, Reynolds said that there is always the possibility of certain diseases spreading. “We want to make sure that we are there to help monitor for that with surveillance and public health information.”