Prevention and Transmission of Water-Borne Disease After the 2010

Abstract – Natural disasters are inevitable. However, they are predictable whenever there are clear signs and any previous occurrences. When they occur, they not only affect the immediate victims but also impact the country’s economic growth, political stability, health care and education system. Haiti has a history of earth movements with the highest earthquake recorded in 1842. Since then there have been other smaller earthquakes although they did not record too many damages. This paper examines the effects of the 2010 Haitian earthquake that was the most devastating in damage and fatalities in history. The paper delves into the impacts the earthquake had on the entire country, the outbreak of waterborne diseases especially cholera, its effects and what the government has done to try to contain it. Drawing from the recent international organization plans and the Haiti’s strategies to eliminate the epidemic, the paper also recommends some actions that could help bring about a long-term litigation and elimination of the disease.
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Table of Contents
TOC o “1-3” h z u 1.Introduction PAGEREF _Toc466819914 h 22.Description of Effects of the Disaster PAGEREF _Toc466819915 h 33.Response to the Disaster PAGEREF _Toc466819916 h 54.Discussion PAGEREF _Toc466819917 h 85.Conclusion PAGEREF _Toc466819918 h 126.Works Cited PAGEREF _Toc466819919 h 13
Table of Figures
Figure 1: Map of Haiti indicating extent of Earthquake…………………………………………..2
Figure 2: Image of Haitian cholera victims assisting one another…………………………………7
Figure 3: Snapshot of congested Haitian camp……………………………………………………9
Figure.

4. Water Supply and Sanitation in Haiti………………………………………………..11
Figure 4: Image of cholera patients receiving primary medication from Zanmi Lasante……….10
Figure 5: Image of a ruptured sewage at the national hospital in Port-au-Prince………………..11
Table 1: Cholera cases in countries in the Americas between 2010-2016……………………….5
IntroductionEarthquakes are a common occurrence in Haiti. Historical reports from as early as 1564 indicate that the country has been experiencing earthquakes. Previous catastrophes have resulted in the countless destruction of property such as roads, buildings, recreational facilities and natural resources. Some of the recorded earthquakes are those of November 1751, June 1770, May 1842, January 1953, and March 1994. However, the 2010 tsunami was the second highest in magnitude since the one that occurred in 1842. The 2010 Haitian earthquake took place in Hispaniola that comprises the Dominican Republic and Haiti. However, the most hit country was Haiti as it occupies the third of the western region (Campbell 2016, p.125). It was of a magnitude of 7.0 but followed by severe aftershocks of 5.9 and 5.5 in magnitude. These ensued a day after the major one with more other earthquakes of a magnitude of 5.9 taking place eight days later. The shock was extended to 25 kilometers to the southwest of the country’s capital, Port-au-Prince.

Fig. 1. Map of Haiti indicating the extent of January 12, 2010, earthquake from Pallardy, Richard. “Haiti Earthquake Of 2010”. Encyclopedia Britannica. N.p., (2016): 1. Web. 9 Nov. 2016.
It was reported that the earthquakes caused devastating property damage all over Haiti, as well as fatalities totaling to 316,000. Most of the heavily hit areas were the Gulf of Gonave, Jacmel, and Leogane. It is evident that the Haitian earthquake was a catastrophe for the entire country regarding deaths, destruction of property, injuries and diseases outbreak all that claimed the lives of thousands of Haitians.
Description of Effects of the DisasterHaitian earthquake of 2010 caused more damage than just the destruction of property and the reported thousands of fatalities. Geologists reported that the quake resulted from constructional deformations on Leogane fault that is a small thrust fault underneath the city. This fault was reported to extend far northwards although very oblique. At a depth of 13 kilometers, the quake was too shallow and hence the reason it spread to a larger scale. The impact caused most of the houses across Haiti to tremble and collapse hence injuring and killing the occupants. Some of the famous buildings affected were the UN headquarters, the national penitentiary as well as the parliament building. As a result, between 230,000 and 316,000 people lost their lives from direct impact and later from the injuries and diseases. It is also reported that more than 300,000 people were injured, over 97,000 houses destroyed thus displacing over 1.3 million inhabitants. Further, more than 188,383 houses and homesteads were severely damaged especially in southern Haiti and Port-au-Prince (Holliday and Grant 2011, p.277). In the Port-au-Prince itself, 25% of the entire civil servants died, 60% of the governmental buildings were destroyed, 80% schools damaged and more than 600,000 people displayed. Besides the buildings, the earthquake also destroyed the power lines, water sanitation, transport, communication, and health. It is reported that the power line system in the entire Port-au-Prince was cut out hence infringing services requiring a power supply. One of the damage that caused the hazards to escalate was the collapse of hospitals and health centers that claimed the lives of many health officers and medical practitioners. With such a massive loss of health staffs and the inaccessibility to the hazard scenes, it proved impossible to contain the increasing severity of injuries and fatalities (Lovett 2010, p. 1-3). At the same time, it was harder to access information from the victims as the communication systems were affected. Some of the immediate priorities were to rescue the survivors, feed them and provide first aid and health services.
Haiti was ranked among the poorest countries in America before the 2010 earthquake. About 47% lacked access to basic health care, only 60% had access to clean water, and 40% of the households had food insecurities mainly indicated by the nutrient deficiencies and low birth weight (Gelting et al. 2013, p. 666-667). This meant that the country lacked enough resources, infrastructures as well as disaster preparedness programs. After the earthquake, many of the established sanitation systems were ruined leading to risks of wound infection (gangrene), tetanus, and other communicable diseases like cholera and typhoid. The situation predisposed the survivors to the cholera epidemic that broke out months later. People succumbed to severe diarrhea from cholera. According to the report by WHO, an outbreak of cholera was first recorded in the Artibonite region of Haiti. According to another report by the Zanmi Lasante (ZL), a PIH’s sister organization working alongside the Haiti’s ministry of health after the earthquake, there have been more than 2,000 cases of grave diarrhea and 160 deaths resulting from the same within Haiti. It is indicated that there are about 25000 cases of cholera at the peak every month. And although the government is working towards containing the situation, there are still strong indications that the people are sick of Cholera to date. According to a report by Pan American Health Organization, there was a total of 117 cholera cases including 17 in Haiti deaths by the 9th October 2016 (“Epidemiological Update Cholera, 18 October 2016”).

Table 1: Cholera cases in countries in the Americas between 2010-2016 from “Epidemiological Update Cholera, 18 October 2016”. Reliefweb, 2016, http:// reliefweb.int/report /Haiti/epidemiological-update-cholera-18-october-2016.
The outbreak has turned from just diarrhea to an endemic disease. Currently, it is be classified as one of the leading causes of death in Haiti. After the quake, people crowded into some rather unhygienic settings where water and sewerage mixed easily. The first outbreak was accelerated by the water from the Artibonite River that is the primary and longest waterway for Haitians (Gelting et al. 2013, p. 665). Since the outbreak, more than 350,000 cases have been reported making the country a place where the largest national cholera has ever erupted in history. By 2014, the cases reduced to about 200 cases per week. This raises concerns about what the governments have done since then to ensure that the situation is controlled given that the outbreak had reversed in 2014 from merely 200 cases per week to over 1000 cases per week.
Response to the DisasterHaiti’s government was not in any position to address the emergency immediately it occurred. According to reports in the CNN news, people were held in the rubbles for days without any form of assistance (CNN Library 2016, p.2). This was associated to the country’s unpreparedness for this type of disaster management, damage of roads and airports and low economic status of the inhabitants. People had neither water nor food and medical care. At the same time, the president could not hold a congress given that his offices were destroyed and had lost some of the officials. Before the quake, the UN had been carrying out development projects for water, macroeconomic management, security and fiscal transparency. They were the first to respond to the tragedy followed by military personnel from the US. The major response was from interest groups and international organizations such as UNDP, the International Red Cross group, Britain’s relief charities and interested nongovernmental agencies such as GCHope (giving children hope). Neighboring countries like the Dominican Republic also offered their support. According to a report published by the Handicap International, the humanitarian assistance was not in effect until 25th January, days after the aftershock of January 20. By then, most people had succumbed to injuries and trauma while there were over a thousand amputations and millions of victims in need of quick care. Within the damaged urban areas, the displaced sought refuge in common collection points built of makeshift materials and donated tents. In the absence of supplies, looting was evident. However, weeks after the earthquake, the government initiated programs to alleviate crowded conditions that proved highly unsanitary and prone to disease outbreaks (Rosen 2010, p. 448). The government also worked towards containing the massive injuries in the streets by cooperating with the humanitarian health aids in offering open-air treatments. However, the deaths were inevitable, and tolls reached to indeterminate extents with the government opting for mass graves. The US also deployed the first battalion immediately after the catastrophe who aided in rescuing those held up in the debris and airlifting them to safer places. Further, they released a hospital ship and amphibious helicopter carriers to aid in the supply of near health care. The victims were taken to the hospitals neighboring the Dominican Republic and the borders of Jimani and Neiba. Further, critical casualties were lifted to the US and Florida and treated in the hospitals across the country.
While the timing was essential to save lives and coordinate a network of rescuers to function efficiently, better coordination with the locals and precise responses were required from the government, domestic and international communities. This proved hard given that the locals were already traumatized and starving. They could not efficiently guide the humanitarian groups to locate areas worst hit and reach those requiring help. At the same time, most of the government facilities including roads, airports, and communications systems were already damaged. The rescuers could only depend on their personnel that took a long time to get into the interior of the hazard sites. The causes of bottlenecks during the operation were congestion and delays in transportation, bureaucratic problems, poor transportation infrastructures, and too much dependency even by those who were not injured. Others were increased rooting by the natives that caused those affected to starve further and hence the death tolls rose rapidly.

Fig. 2. Haitians suffering from cholera helping each other as they wait for medication from Pallardy, Richard. “Haiti Earthquake Of 2010”. Encyclopedia Britannica. N.p., (2016): 5. Web. 9 Nov. 2016.
Cholera outbreak was a prick to an already bleeding wound for the Haitians. The country had barely recovered from the earthquake’s trauma when the disease started claiming lives from October 2010. However, reports indicate that the cholera was not as a result of the poor sanitation after the earthquake. Rather, it was introduced by the UN peacekeeping unit who had been rotating in the country in their peacekeeping mission. Cholera had originated from Nepal and was only accelerated by the poor sanitation after the earthquake. According to Piarroux, the disease broke out after the UN-Haitian contractor emptied the septic tanks at the peacekeepers camp into a stream that drained into the Artibonite River (2016, p.3). The tank was contaminated with the bacteria, and hence it spread to all people who depended on the river. However, the UN refused to take responsibility even after scientific teams confirmed the report. Instead, the response, in this case, was conducted by MSPP (Ministry of Public Health and Population) and DINEPA (Directorate for Potable Water and Sanitation). The later had just taken over the WASH project before the disaster stroke thus forcing them to change from long-term water projects to tackle the emergency water shortages in the IDP (internally displaced people) camps. Together with UNICEF and other local and international agencies, they supplied tanked water and ensured safe removal and disposal of latrine waste from the IDP camps. Further, they partnered with the Red Cross and U.N. agencies to bridge the gap in response and enhance timely and quality humanitarian assistance. Since the outbreak, DINEPA has been leading in projects to decontaminate the water sources and manage the water systems within the urban centers (Hopmeier et al. 2010, p.105-113). However, Cholera has continued to be a challenge given that many organizations used their funds to respond to the hazards and left the initiated projects incomplete afterward. The primary concern now is how the situation can be contained. The UN must have exploited Haiti’s ability to detect and control outbreaks. They managed to convince the government that the outbreak was as a result of obstinate problems like poverty and climate change.
DiscussionThe impact and scale of the Haitian 2010 earthquake were not only unprecedented but also caused a devastating damage in the country. It hit an already impoverished country making it drop from a 145th position of the 169 countries in the UN’s Development Index to almost the last. With the level of damage, the only remaining challenge was for the government to re-strategize and plan the city, contain the cholera outbreak and respond to the water and food challenges in the country. The combined effort to provide care has so far responded to the crisis but will not hold forever. As a result, there remain major crisis in the supply of water, sanitation, better shelters and hygienic supplies. So far, the local and government response indicate a large fragility for the country’s recovery given that most of the families depend on the support from international organizations. This could be further affected by the rising food shortages across the world due to changing climates. Essentially, local resilience will be the determining factor for the country’s ability to fight the cholera outbreak.
The current major problem facing the country is poor sanitation especially due to congested settlements by the IDPs and overdependence on a single water source that is also contaminated with human waste. Cholera is a waterborne disease instigated by unhygienic and contaminated water, foods and foodstuffs. It is only contracted upon ingestion of contaminated things. In Haiti, it was promoted by the makeshift settlement by millions of the internally displaced persons whose access to disinfected water and treated sewerage system was impossible.

Fig. 3. A congested camp settlement in Haiti after the earthquake from CNN Library, “Haiti Earthquake Fast Facts.” CNN. N.p., (2016): 1. Web. 9 Nov. 2016.
The unhygienic circumstances lead to cholera’s fast spread with people succumbing to severe diarrhea and dehydration.
Containment of cholera starts with the decontamination of water sources and supply of clean water sourced throughout Haiti. Up to date less than half of the citizens have access to clean water.

Fig . 4. Water Supply and Sanitation in Haiti from “Improved Water Source (% Of Population With Access) | Data”. Data.worldbank.org. N.p., 2016. Web. 22 Nov. 2016.
The current water supply is a piped water system with collection points with hand pumps. However, most of these pumps are faulty due to poor maintenance. The Member States should thus strengthen surveillance systems for early cholera detection and conduct quick diagnostic laboratory approval of cases, to provide timely treatment and mitigate the further spread of the epidemic. Currently, the government ought to cooperate with the World Bank and other international organs such as WHO, MSPP, and UNDP who are spearheading programs to provide clean water and surveillance for successive outbreaks of cholera. At the same time, they should embark on quarantine mechanisms and effective treatment method. This will help treat all those infected and prevent transferring the disease to others and especially in the congested areas. According to the study conducted by the University of Florida, regardless of the decrease in cases of cholera in 2014, the isolation frequency remained minimal. This was the reason for the resurgence of an outbreak where victims tripled almost immediately (Oshitani et al. 2016, p.3). The research indicates that the disease could have established a permanent habitat in the water catchment areas. Given that cholera proliferates in response to environmental factors, the only suppression method is to have an alternative water supply as efforts to decontaminate the aquifers take place. The government in coordination with the health organizations needs to start off cholera vaccinations to stop further transmissions (Splete 2012, p. 51). This, however, requires a lot of financial and logistic support from the federal government and international relations.
The second method to help curb the waterborne diseases is through offering basic education. Health-related education including the need to use disinfected objects and maintaining hygiene before consuming anything would be highly beneficial. It should be tied to the donations of soaps, disinfectants, and oral rehydration salts so that people can start taking health and hygiene as a personal responsibility. The Zanmi Lasante, a governmental health institution, is leading in the campaign where some quick response teams are posted on the ground to reach patients on the ground and assist them to access the hospital within the early stages of infection (Mukherjee 2016, p. 4).

Fig. 5. Cholera patients receiving primary medication from Zanmi Lasante care, providers, before they access the hospital from Mukherjee, Joia. “Cholera In Haiti: Another Disease Of Poverty In A Traumatized Land”. Pih.org. N.p., (2016): 4. Web. 9 Nov. 2016.
This number could be increased to cover the entire region and perform both the task of rescuing and educating. At the moment they can only help save few lives. The epicenter of the epidemic control rests on the provision of a long-term source of clean water for the residents of Artibonite.
In a similar manner, medical supply, health workers training and disaster management personnel ought to be improved or re-established owing to the previous massive deaths. All participants in the health care sector should set up strategies to assess and mitigate epidemics and disasters immediately they happen so that there can be no increased fatalities. In the case of cholera, prompt but adequate control and prevention measures, case management, and surveillance system must be adopted so that the infectious disease burdens could be mitigated. Surveillance in itself establishes a continued but profoundly correct informational access. This helps strengthen and quicken the response process and hence the ability to halt infection at the initial stages.
To regenerate their economic growth, Haiti needs to embark on reestablishing infrastructures. Many equipment, buildings, and skilled personnel were lost during the earthquake. This reduced the government’s ability to respond to the catastrophe and epidemic. However, the loss of pertinent infrastructures like communication, transport and power systems will make it difficult to deliver supplies, workforce, and other services. Although there has been progressing in macroeconomic managements, creating transparency and budget planning, more effort should be put towards rebuilding a hygiene settlement system, creating stable infrastructures and making disaster preparedness plans for future occurrences (Van Berlaer et al. 2016, p.2-5).

Fig. 5. A ruptured sewage at the national hospital in Port-au-Prince days after the 2010 earthquake from Darg, David. “The Day The Earth Shook: Haiti Earthquake – Operation Blessing International”. Operation Blessing International. N.p., 2016: 1. Web. 9 Nov. 2016.
ConclusionSupporting residents with sheltering solutions is a part of the initial response to an emergency like the Haitian earthquake. However, it should be noted that there are other severe consequences of hosting too many people in a congested place. Communicable and waterborne diseases are the major challenges that can wipe out an entire population within days. Where the damage in Haiti has already been done, the only remaining course is to rebuild a safer and hygiene country. Reestablishing infrastructures and socio-economic conditions are paramount but not as prioritized as having healthy citizens. The government must work towards decentralizing the populated IDP areas, stabilize the health care and education sector, create efficient waste and refuse management programs and control the population that is bound to rise due to poor birth controls and poverty within the camps (Lu, Bengtsson and Holme 2012, p. 11576). A workable new strategy for Haiti would be an integrated approach towards a sustainable long-term stability and economic growth, investments for sustainability, closer partnership with international organizations and prospective future disaster management strategies. But more so Haiti must try to decontaminate the water catchment areas and vaccinate people halt further spread of the epidemic.
Works Cited
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