Saturday, January 16, 2010

Five Diseases Prevented by Basic Sanitation

I'm getting out of the apartment this morning to build sets at Gaslight, and grateful for the excuse to tear myself away from the television. I can't stop watching the coverage of the Haiti disaster.

My sophomore roommate and dear friend from college, Laurie Richardson, has been a community development worker in Haiti since the mid-1990s. We lost touch — communications between here and Haiti were a challenge even before last year's hurricane or this year's earthquake — and now I'm hoping against hope to see her face on my television screen, or hear her name, or see it listed among American survivors. If any visitors to this blog know Laurie, or have heard from her, can you please let me know? And this is a cautionary tale: if you've lost touch with people who are important to you, take ten minutes today to send them a postcard or an email, or pick up the phone. You don't always have the time you think you have.

Anyway, the news coverage has emphasized the importance of getting help in fast — not only to prevent additional deaths with water and food, but also to try to forestall the outbreak of diseases caused by the breakdown of what little infrastructure was in place. These are five diseases people in developed nations usually don't have to worry about, which are just waiting for opportunities like this.

Contrary to popular belief, the unburied dead aren't the major source of disease in the aftermath of a disaster; the unwashed survivors are.

1. Cholera. Cholera is a bacterial infection of the intestines, and can be mild or severe. In severe cases, people die of dehydration and shock after a day or two of violent diarrhea and vomiting. It is spread by contaminated food and water, but that's a euphemism; the bacteria lives in the fecal matter of its victims, and the contamination spreads in areas that don't have sewers or water treatment programs. In clean, well-lighted places, it is easy to prevent and easy to treat; when infrastructures break down, it is one of the first diseases to attack.

2. Typhoid Fever. Another bacterial infection of the intestines, spread in the same way. It's a life-threatening illness that continues to affect more than 21 million people around the world every year; it can kill you, or it can give you no symptoms at all (as in the notorious case of Typhoid Mary). It is relatively easy to treat with antibiotics, and vaccines exist; these vaccines are effective for a period of years, but need boosters every 2-5 years, depending on the type. A major danger of typhoid is the fact that people can be infected without realizing it, and remain contagious for a period of time after their symptoms are gone. Travelers abroad can protect themselves from typhoid by following the rule "Boil it, cook it, peel it, or forget it," but that is not possible for the people of Haiti. In fact, Haiti had outbreaks of typhoid in 2004 and 2003.

3. Hepatitis A.
An acute viral infection of the liver, spread through fecal contamination. Victims are contagious well before they show symptoms. The Hep-A virus is resilient and not always easily killed by basic hygiene practices, which is why most American infants are now vaccinated against it, and hepatitis A vaccines were recommended for all visitors to Haiti even before the earthquake. The good news is that Hep-A is, in most cases, "self-limiting" — that is, most victims recover within a certain period of time, with no permanent damage, and the mortality rate is very low.

4. Leptospirosis. Rising numbers of leptospirosis cases in humans had been reported before the earthquake, and since this is another water-borne disease (transmitted through the urine of infected animals), it's likely that we'll see more of this as well. It is endemic among animals in certain parts of the United States, and Dizzy gets vaccinated against it. In humans, it causes high fevers, chills, body aches, vomiting and diarrhea; left untreated, it becomes Weil's disease, and can cause death by kidney failure, liver failure, or meningitis. It too is relatively easy to treat with basic antibiotics, if it's caught early enough.

5. HIV. In developed countries, we protect ourselves from HIV with basic hygiene practices, avoiding exposure to contaminated blood, and using condoms. These things will not be possible for many in Haiti in the weeks ahead. We think of Haiti as being rife with HIV, and the infection rate was among the highest in the world in the 1980s; but Haiti has been a success story in the management of HIV infection and AIDS treatment, and the infection rates have declined dramatically. Partners in Health, a Boston-based nonprofit organization, and GHESKIO, the Haitian nongovernmental organization dedicated to HIV/AIDS and related infections, have created programs that have lowered Haiti's HIV infection rate to 2.2% — still high, but much, much lower than many other parts of the world. But the earthquake has disrupted and will disrupt the treatment and prevention programs, and the extent of this disaster may well mean that people are exposed to infected blood. Partners in Health has sent out a call for medical volunteers and supplies; if you can help, click here.

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