When a large-scale disaster strikes even a wealthy country, it can stretch medical resources very thin making life saving efforts a challenge. However, when the country is Haiti, the poorest country in the Western Hemisphere, a natural disaster such as the 7.0 magnitude earthquake of January 12th can mean little medical assistance is available without significant involvement from other countries. Arriving emergency teams must work to handle the rapidly changing medical needs that occur within a disaster zone.
So what are the medical needs following an earthquake?
In the immediate aftermath of an earthquake, many of the survivors will have injuries related to falls and falling objects such as fractures, sprains, strains, scrapes and cuts. Observations published by Changzheng Hospital indicate that the more seriously injured will be those who have suffered crushing injuries that can cause shock and failure of the kidney, heart or multiple organs at the same time. Complications from crushing injuries are understandably the major cause of death immediately following an earthquake.
In the days following an earthquake, new threats arise for survivors. Both treated and untreated open wounds can become infected. This can be due to debris in the wound or simply due to poor or inadequate wound care. Stress, lack of clean water and lack of food can easily make an individual more vulnerable to infection.
At the same time, survivors also face the threat from a lack of clean drinking water. People who are mobile may face dehydration risks due to scarce availability of water. For those trapped in collapsed buildings, no water may be available at all. In general, we can only survive for 3 to 5 days without water especially in a tropical environment like Haiti. Without water, our bodies can go into shock and suffer from multiple organ failure. Freeing people from collapsed buildings is critical.
If water is available in an earthquake zone, there is no guarantee that is safe to drink unless emergency response teams are treating it. Contaminated water can cause diarrhea from numerous viruses and bacteria including cholera and E. coli. With diarrhea, the key risk is again dehydration because the body cannot retain sufficient liquids. The risk is particularly high for children and the elderly.
While much media attention is directed toward the risks of epidemics following a disaster, epidemics are actually rare in these cases. Though tragically, there may be many deaths from the trauma caused by collapsing structures, the risks to survivors from the bodies are not high. According to the London School of Hygiene and Tropical Medicine, the reason for this is that most victims were not ill when they died and as a result, have no infection to pass along to the living.
Generally rescue workers and military personnel having close contact with the dead are the only people who need worry about standard infection risks such as HIV, hepatitis, and tuberculosis. That said, if poor water quality results in deaths from cholera, the bodies of cholera victims represent a much higher risk of infecting the population. The key to prevention is to ensure early access to clean water and sanitation.
In the weeks following an earthquake, the risks to survivors continue to change. According to a study from the University Hospital of Besançon, the risks will include respiratory infection in roughly 30% of households with pneumonia being present in as many as 1 in 5 such infections. Similarly, skin infections will also be present in approximately 30% of households.
In this time period, those who are most at risk of death, according to a study by National Yang-Ming University, are those who are already ill, those who are moderately disabled, and those who are the poorest. Extra care must be taken to preserve the lives of individuals in these categories.
If survivors are forced to relocate, a rare occurrence for earthquakes, overcrowded, cramped quarters and unsanitary conditions will help spread diseases such as hepatitis A and E, malaria, meningitis, dengue fever, measles, giardia as well as other diarrhea-causing viruses and bacteria. Once again, however, epidemics are rare in these cases.
Lastly, many months following the disaster, as survivors try to rebuild their lives, mental disorders such as post-traumatic stress disorder (PTSD) can afflict survivors. In a study conducted by the New York Academy of Medicine, researchers found that 95% of children following the Armenian earthquake of 1988 suffered from PTSD. In less affected locations, the rate of PTSD dropped to 20%. The study also found that women are more prone to PTSD than men. However, many people will suffer long after the disaster has occurred.
As the extent of the catastrophe in Haiti becomes understood, it is important to understand the considerable ongoing health challenges that survivors will face in the days, weeks and months to come. Aid is needed immediately, but aid will also be needed for some time to allow the people of this battered nation to restore some sense of normality to their lives. Unfortunately, once the spectacle of such disasters passes from the media's focus and they move on to the next emerging story, many of the suffering will no longer be in our thoughts. Their suffering should not be so easily forgotten.
Here are some good links to allow donation to the relief efforts:
http://www.google.com/relief/haitiearthquake/#utm_campaign=en&utm_source=en-ha-na-us-sk&utm_medium=ha&utm_term=haiti%20donations
http://www.msf.ca/
Related Links
https://www.cia.gov/library/publications/the-world-factbook/geos/ha.html
http://pnpcsw.pnpco.com/cadmus/testvol.asp?year=2005&journal=jem
http://ccforum.com/content/13/6/R178
http://www.cdc.gov/ncidod/EID/13/1/1.htm#dea
http://publications.paho.org/english/dead_bodies.pdf
http://www.ncbi.nlm.nih.gov/pubmed/16704799
http://www.wpro.who.int/internet/files/eha/tookit_health_cluster/Epidemics%20After%20Natural%20Disasters,%20CDC,%202007.pdf
http://aje.oxfordjournals.org/cgi/content/full/160/7/688
http://epirev.oxfordjournals.org/cgi/content/extract/27/1/78
http://www.cmaj.ca/cgi/reprint/176/9/1293.pdf |
