Special Report – Health Concerns in Haiti: Infectious Disease and Mental Health Perspective
Balintfy: The US Department of Health and Human Services, the parent agency to NIH, has been collaborating with the government of Haiti and an international coalition of relief groups to deliver urgent assistance to the Haitian people in the wake of the recent earthquake there. To look a little past the headlines, and gain some in-depth insight on how these kinds of tragedies impact people, I talked to two, prominent NIH experts: Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, and Dr. Thomas Insel, Director of the National Institute of Mental Health. I asked them each, what are some of the most common, compelling health problems in situations like this. Here's Dr. Fauci:
Dr. Fauci: The first thing people need to understand is that there usually is misinterpretation, that the most compelling problem, when you have an earthquake with a lot of deaths like this, that there's going to be major outbreaks of communicable diseases. Actually, that isn't the case. In the immediate aftermath, people have crush injuries, people have injuries to virtually every part of their body, immediately, the concern is, what about wound infections? So that's the first thing; you usually think about communicable diseases, the first thing is wound infections, is to get people properly taken care of from a surgical and from a medical infectious disease standpoint.
Balintfy: Dr. Fauci adds, that later, after the first few days, then the critical issue becomes the infectious diseases associated with the lack of clean water.
Dr. Fauci: There are waterborne infectious diseases that can easily outbreak when you have crowded conditions, unsanitary conditions, and a lack of supply of good, fresh, clean drinking water. If you think of the diarrheal diseases, or the diseases out of the GI tract, you think of salmonellosis, shigellosis, hepatitis A, cryptosporidiosis are all issues that you need to pay attention to. We often hear people say, mistakenly, but understandably, they're concerned about an outbreak of cholera. There is no cholera in Haiti, so it would be extremely unlikely that there would be an outbreak of cholera in Haiti, even though you don't want to completely rule it out, it's not the first thing that you think of when you think of an outbreak of waterborne disease.
Balintfy: Respiratory diseases are also a concern, Dr. Fauci says. It is conceivable that there could be an outbreak of the flu — even an upsurge of the H1N1 influenza — as well as measles.
Dr. Fauci: Also, when you have crowded conditions in unsanitary conditions, you can have the spread of diseases, different types of pneumonia, different types of meningitis, things like that. Those are some of the things that you think of right off the bat. So there are a whole array of infectious diseases, some of which people wouldn't think about right away, but others of which they think about and are probably not of great concern.
Balintfy: For the mental health perspective, Dr. Tom Insel at NIMH discusses three groups of people.
Dr. Insel: The first, which is probably the most often overlooked, is you have people in Haiti with all these disorders, like schizophrenia and autism and serious mood and anxiety disorders and they will be people who will be particularly vulnerable when they lose access to care, when they lose access to medication, and when, as in this case, they may be separated from family members who have been providing care. So, that's an acute issue that probably requires more attention than it has received.
Second big area, obviously, are the –– is the general population, which –– for which, now, all the attention is focused on, as it should be, acute trauma, food, shelter, trying to find a safe environment for these people so that they don't become prey to infectious diseases, to starvation. As time goes on, we worry more and more about the mental health consequences of any sort of trauma like that, and that includes, here, the people who have experienced massive loss, sometimes are at this point experiencing tremendous fear because of the unknown, the inability to plan, and for many people the sense of helplessness, which we know is a real set-up for problems that come later. The most classic one is post-traumatic stress disorder, PTSD, but depression and many other mental health consequences –– this particular population, because of poverty, because of other losses in the past, one might think would be immunized against that, but there's no reason to presume that.
Balintfy: Dr. Insel says the third population is the first responders.
Dr. Insel: These are people who –– many of who have not seen this level of destruction or horrific suffering before. And it tends to be overlooked that those people who you expect to be on the front lines, to be able to do the most good, are also often people who are subject to feeling the psychological impact of the trauma.
Balintfy: Dr. Insel adds that waves of mental health needs will come in coming weeks, months and even years. To minimize the impact, he says, things can be done right now.
Dr. Insel: The first group, those that are in acute need of medication and of care, that is going to have to be dealt with just the way we would with physical injuries. Somebody has to get to those –– often children, but sometimes adults –– and make sure that they get access to the very thing that was keeping them going before.
The second piece of this that, you know, with a large population, which is at risk, requires what we would call resilience building. And you know, we tend to focus on the risk here of developing psychiatric disorders as a result of the trauma. Important to remember that even though everybody is traumatized, most people are tremendously resilient, and will be able to recover. They will have sleepless nights, they will have tremendous waves of fear, they will have intrusive thoughts and nightmares, and yet they will get better. They'll recover. But there is some fraction that will not.
Balintfy: Dr. Insel says for most of the population, social support, making sure that people don't become isolated from familiar things, whether that's religion, a job, or just being part of a family group is needed. But Dr. Fauci points out, a very real challenge facing Haiti is the massive destruction of homes and buildings preventing people from going back to where they live.
Dr. Fauci: So you have to start very, very quickly, getting up housing quarters for individuals, be they trailers, be they tents, or what have you. The diminution of the risk of the conditions that lead to the types of infections that we're discussing is going to be directly related to how quickly you get these facilities up for those individuals.
Dr. Insel: One of the things that you see in an environment like this is the loss of the sense of the future, and that is one of the most traumatic aspects. We don't often think about this, but for all of us, being able to plan and to be able to have a future that has a structure to it and a predictability to it is one of the anchors that we use to be able to cope. That anchor has been removed for many, many victims of this earthquake, and so finding a way to put that back in place as soon as possible is one of the things that will help people to overcome this psychologically.
Dr. Fauci: One of the things that this tragedy, this terrible tragedy that has befallen the people of Haiti, particularly the people in the Port-au-Prince area, would be to have the world realize the difficult conditions that were there, even before the earthquake, and not only repair the damage of the earthquake, but make it a place that's much, much better than it was before the earthquake. I think that could be something that would, in some respects, have a silver lining to all of this.
Balintfy: Thank you Dr. Fauci and Dr. Insel. For more information on infectious diseases, visit www.niaid.nih.gov. For details on mental illnesses, visit www.nimh.nih.gov. And to learn more about HHS relief and support activities in Haiti, visit www.hhs.gov/haiti. This is Joe Balintfy, National Institutes of Health, Bethesda, Maryland.