Help for Haiti

As the devastation of the 7.0-magnitude earthquake that hit Haiti on January 12th continues to unfold, public and mental health experts are likely to be at the fore of those monitoring the situation. In addition to the immediate needs of survivor rescue, survivors of earthquakes and other natural disasters are at risk of malnutrition, parasite infection, and post-traumatic stress disorder and depression. While it is important to ensure that emergency medical care is delivered to those in need, it is also critical that a plan be put in place to ensure that infection and stress disorders are recognized and treated efficiently.



Time magazine reports that before the earthquake, Haiti was one of the poorest countries in the world. No Haitian city had a public sewage system, less than half of the population had access to drinking-water services, and malnutrition and disease affected a large portion of the population. According to CNN, the Red Cross has estimated three million people – one-third of the total population of Haiti – are affected by the earthquake. Many of those not among the reported 200,000 who lost their lives were seriously injured and will likely require amputations or other surgeries. As time passes, these acute health problems will be replaced by chronic heath conditions that may worsen quickly if individuals are not receiving treatment.

According to Columbia University public health expert, Josh Ruxin “The number one risk [following a natural disaster] is always bacterial infections where they have open wounds.” Without antibiotics and proper treatment, wounds can become infected and put individual’s health at risk. Though some were not physically harmed by the earthquake, reports indicate that 40,000 were left homeless and forced to “cluster together in public places without food, clean water or sanitation.” For individuals displaced by earthquakes or other catastrophic situations, the risk of contracting diseases or developing parasitic infections is increased. Water supplies can become contaminated quickly in refugee camps or settings with damaged potable water distribution systems, leading to a rapid spread of water-borne illnesses such as cholera and dysentery as well as diarrhea, malaria, and measles.

Some experts note that not all of the harm of this disaster will be physical. Dr. Daniella David, professor of clinical psychiatry at the University of Miami’s Miller School of Medicine, explains that “Once the initial resources are in…is when the psychological aftereffects are going to hit people.” Further, she explains, there is a normal and immediate stress response that accompanies a devastating effect that causes damage to homes and loss of friends and family members. According to Sandro Galea, chair of the Department of Epidemiology and Columbia University’s Mailman School of Public Health in New York City, acute stress, post-traumatic stress, and depression will likely be seen in Haiti at three to four times higher than baseline in the coming months. Symptoms of post-traumatic stress disorder (PTSD), including depression, anxiety, emotional numbing, and sleep disorders, are usually seen within three months of the incident, according to the Canadian Mental Health Association. According to experts, assistance for potential sufferers of PTSD - often called “psychological first aid” – includes making individuals aware of what signs and symptoms to watch for, and letting them know that their feelings are normal and that help is available. While reporting of PTSD and other psychological disturbances is frequently a concern due to the social stigma attached to mental illness, Haitian-born psychologist Marie Guerda Nicolas of the University of Miami indicates that Haitians tend to be expressive of their grief and psychological distress. Further, members of rescue teams from other nations at as great a risk, if not an increased risk, of developing PTSD or psychological trauma.

Though a global humanitarian response is currently underway, aid organizations face a daunting task as they attempt to coordinate vast amounts of aid relief and get it to individuals who require it urgently. It remains to be seen exactly how many were affected by the earthquake and if assistance can be delivered effectively to them, but the impact of the earthquake on Haiti and its people is likely to continue after the initial wounds have healed.

Specialty physicians who wish to offer teleconsultation support to disaster-relief workers in Haiti, health professionals who wish to provide volunteer support on the ground in Haiti, and U.S. healthcare institutions that are willing to provide services to victims of the earthquake who are airlifted to this country for urgent medical or rehabilitation care can register through iCons in Medicine

On Neglected Tropical Diseases

Clockwise from top left: An egg of the roundworm, which causes Ascariasis; a man with Lymphatic Filariasis being examined by a physician; the whipworm, which causes Trichuriasis; and a child receiving antibiotic treatment for Trachoma.

Malaria, HIV/AIDS, and tuberculosis are often considered the most pressing disease-related threats to individuals in the developing world and the quest to eradicate them receives a large portion of government and private funding. However, a group of conditions known collectively as neglected tropical diseases (NTDs) have a more widespread and devastating effect on the lives of people in many regions of sub-Saharan Africa, Southeast Asia, and Latin America. These regions account for up to 90 percent of the disease burden for this group of 13 parasitic and bacterial conditions. Reports from the Global Network for Neglected Tropical Diseases indicate that these parasitic and bacterial infections affect over 1.4 billion people, most of whom survive on less than US$1.25 per day. While NTDs may not necessarily kill those infected, they can lead to malnutrition, anemia, a range of disabilities (most often blindness), stunted growth, and greater susceptibility to other illnesses.

Individuals affected by NTDs live primarily in tropical and subtropical climates, and many experience more than one infection or parasite at a given time. According to the World Health Organization (WHO), the majority of individuals affected by NTDs live in remote and rural areas, urban slums, or areas experiencing conflict situations. Seventy percent of infections occur in low- or lower-middle income areas, and are frequently caused by unsafe water and poor housing and sanitation conditions. Further, NTDs contribute to a cycle of poverty in which children are likely to become infected due to their poor living conditions, and once infected they may experience delays in cognitive development inhibiting their ability to escape their impoverished conditions.

The seven most common NTDs are: Ascariasis, Hookworm, Lymphatic Filariasis, Onchocerciasis, Scistosomiasis, Trachoma, and Trichuriasis. These diseases, many of which are caused by parasitic intestinal worms known as helminthes, have the most devastating impact on those who contract them. For example, Ascariasis, resulting from roundworm infestation, affects 800 million people; and trichuriasis, resulting from whipworm, affects 600 million. Helminths rob children of nutrients and can lead to stunted growth, iron-deficiency anemia, and protein malnutrition. They are at an increased risk of contracting parasitic worms, as are the elderly and pregnant women. Over 40 million pregnant women are infected with hookworms, parasitic worms that attach to the small intestine and suck blood from their host, increasing vulnerability to malaria and additional blood loss during labor.

Based on Disability-Adjusted Life Years (DALYs), which refer to the years of healthy life lost to disability or premature death, NTDs are a greater health burden than tuberculosis or malaria, and approach the level of burden of HIV/AIDS. In addition, NTDs are the cause of approximately 534,000 deaths worldwide each year. Through programs to distribute medications, the WHO, pharmaceutical companies, government agencies, and international aid organizations hope to ensure fewer lives are lost. Coordinated efforts have allowed for the rapid deployment of inexpensive diagnostic tools, medications, and treatments, many of which can be administered by trained non-medical staff including teachers and community health workers. Medications are often distributed in “rapid-impact packages,” reducing costs and putting less strain on already weakened healthcare systems in the areas where NTDs are most prevalent. These packages also offer the opportunity to bundle life-saving drug treatments with other interventions such as antimalarial bed nets or nutritional supplements.

Through these and other similar efforts, it has been possible to reduce the occurrence of a number of conditions in many parts of the world. The number of cases of guinea worm disease, also known as dracunculiasis, has fallen from 3.5 million in the 1980s to just 4,619 in 2008, and the WHO has declared eradication in Nigeria and Uganda. Many other conditions are now found only in remote villages and are nearing total eradication through education programs, medication distribution, and improved sanitation.

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