This research paper discusses the public health issues created in Haiti by the 2010 earthquake. The paper presents an analysis and description of Haiti geopolitical and major problems and infrastructure of health system prior, during and after the earthquake. There is no doubt that the earthquake had a major impact on health systems of Haiti. It is therefore essential to determine the real impact of the earthquake on health infrastructure, social issues, and human life and to determine the long term issues that need to be addressed in rebuilding the healthcare infrastructure. the research looks at the immediate world’s response the health care needs, social and public health emergencies The research discusses the various ways of setting up surveillance and monitoring systems as well as the way resources should be allocated in order to minimize the burden of the disease.

Introduction

The Republic of Haiti is a sovereign state located on the island of Hispaniola in the Caribbean Sea. The country is occupied by Taino people. Haiti is a small state of 27,750 square kilometres sharing the island with the Republic of Dominican. Haiti holds about ten million people making it the most populated island in the Caribbean sea. More than eighty percent of the residents of Haiti nation live in abject poverty and as a result of HIV and violence, it has the highest percentage of orphans in the western hemisphere. In 2010 the island was hit by a 7.3 magnitude earthquake near the town of Leogane, Haiti’s capital. More than 150,000 people died, as a result, the earthquake. However, the Haitian government puts the figure of causalities between 220,000 and 316,000. The earthquake resulted in devastating damages to the city.

Haiti Prior to the Earthquake

After independence, Haiti was a beacon of freedom but its now the poorest estate in Caribbean hemisphere. Before the earthquake, the country was marred by conflicts, political instability and environmental degradation. This is mainly because most of its residents originated from different parts of Africa with different customs, traditions, religions and social hierarchies. Haiti was considered by many as a failed state. A research group for peace had ranked Haiti and its neighbour the Dominican Republic as 12th in the world failed states list. The report had used indicators such as economic decline, deterioration of public service, the rates of crime, violations of human rights and intervention by outside countries in internal affairs. As a result of political instability, Haiti had suffered heavy brain drain as most of the educated individuals fled to the United States. In its more than two hundred years of independence, Haiti has experienced thirty-two political coups. 

Before the earthquake, the majority of Haitians in the city of Port-au-Prince lived difficult lives in slums without infrastructure and their problems were compounded by malnourishment, political instability and violence. One of the slums in Haiti, Cite Soleil, has been labelled by United Nations as the most dangerous place to live on earth. The unemployment rate is about seventy percent with about half of the population illiterate (Dept, I. M. F. 2015). Haiti climate is largely tropical with fertile valleys interspersed with the mountain ranges. More than two third of Haiti population depend on subsistence agricultural for their livelihood. The farming is however vulnerable to natural disasters like periodic storms and droughts mainly arising from widespread deforestation across the country.  Hurricanes are also huge natural disasters in this country. 

Major Health Problems and Infrastructure

The health situation in Haiti was dire even before the 2010 earthquake with the highest number of the population living under precarious conditions in abject poverty and marginalization. As a result of limited resources by the government, most of the population experiences water and sanitation problems. More than half of the population had no access to clean water with eighty percent lacking access to sanitation. Due to limited access to clean water, acute diarrhoea was highly prevalent among children aged between one and five years. All other age groups are also occasionally affected by diarrhoea.

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The precariousness of the health system was reflected at all levels: lack of or low regulation and supervisory capacity by national health authority, lack of health care access, poor development of health information channels, privatization of public health functions by health authority, weak regulation of drug systems, health funding left to international donors, lack of health workforce, and poor distribution of health facilities. The routine death notification was non-existent in Haiti with the recording of one death certificates out of twenty deaths.

 One in every three death certificates recorded did not specify the real cause of death. Therefore the real mortality information from the health desk was very inaccurate. However, the available data records on mortality rate were very alarming with infant mortality and maternal mortality rates leading the pack. Life expectancy was very low. Premature mortality is very low with more than half the deaths recorded occurring in ages lower than fifty years. Respiratory infections, acute diarrhoea, malaria, HIV/AIDS, tuberculosis, cardiovascular diseases, stroke, neoplasms, diabetes mellitus, and malnutrition were the leading causes of deaths among the Haiti population. More than half of the population lacked access to basic health services seeking the alternative of traditional healers. The infrastructure has long been compromised by lack of electric power, water problems, and impoverishment. 

Immediate Impact of the Earthquake

He 2010 Haiti earthquake had a magnitude of 7.3. The earthquake-ravaged through the Haiti capital leaving hundreds of thousands dead and millions of dollars worth of property destroyed (Larson, & In Agee, 2016). The earthquake displaced a large number of city residents. About twenty percent of the population was directly affected by the earthquake.

Effect on human life

As an immediate result of the earthquake, the death toll estimate was between 100,000 and 160,000 although the Haitian government puts the figure at between 220,000 and 316,000. The number of those injured was about 300,000. The earthquake displaced about one and a half million people with half a million leaving the city for the rural areas (Larson, & In Agee, 2016). There was a makeshift camp constructed to house the remaining a million people. Many countries responded to the calls for humanitarian aid by pledging funds and dispatching rescuers, medical teams and support personnel. Delays in aid distribution, however, led to angry and desperate appeals from aid workers as survivors engaged in looting and violence.

Infrastructural damage

The damage during the earthquake was extensive and affected Port-au-Prince, Petit-Goâve, Léogâne, Jacmel and other areas in the southwest of the country. More than 30,000 buildings were severely damaged or collapsed. Léogâne which was the epicentre of the earthquake reported a total destruction of more than 90% of the total buildings. Some of the notable infrastructural landmarks that were destroyed included: presidential palace, the national assembly, Port-au-Prince Cathedral, and the main jail (Dubique, Harvard University, Ivers, Abadia, Katz, Lively, Mukherjee, 2014). The ministry of education estimated that more than half of 15,000 and 1,500 primary school and secondary schools were destroyed. Three main universities were also damaged. 

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The poor infrastructure of roads before the earthquake made the rescue and humanitarian efforts difficult. The damaged airport control towers and the collapse of seaport cranes hindered ship docking and aeroplanes landing. The earthquake also affected three hospitals with one collapsing completely. The communication system was completely run out with the public telephone system not available. The infrastructure of Haiti’s largest cellular telephone provider was extensively destroyed leading to the temporary closure of the network for two days. Most of the radio stations in the affected areas reportedly went off the air immediately after the earthquake with some completely destroyed. The ministry of finance, the ministry of public works, the ministry of education, the ministry of communication and culture, supreme court building, superior national school and national school of administration buildings were also damaged to various degrees. 

The United Nations and World Band offices were also destroyed. The clothing industry also reported structural damage. It accounts for two-third of Haiti exports. The U.S.-based Hanesbrands Inc. had reported that three of its four factories were affected by the earthquake with one facility being substantially damaged. Gildan Active wear, a Canadian clothing company reported one of its three plants was severely damaged. The art world in Haiti also suffered severely as the museum and art gallery were extensively damaged.

Social problems

The 2010 Haiti earthquake resulted in one of most significant social impacts. A key concern was the housing as the heavy damage to the house infrastructure led to residential displacement (Dubique, Harvard University, Ivers, Abadia, Katz, Lively, Mukherjee, 2014). The low-income household settlement was the worst hit. As a result, more than ten percent of the population was left homeless. This distraction led to a creation of internally displaced person camp. The camps comprised of makeshift tents of sheets, tins and tarps. The camps were in large and small sizes. These camps were mainly positioned in church grounds, school grounds, in blocked off streets, in parks and on top of damaged buildings.

The survivor’s collected bodies of dead persons and brought them to the hospitals, morgues and street curbs. O attempt was made to identify the bodies but rather United Nations and Haiti government took the bodies to a mass gravesites in outskirts of the capital. With most of the hospitals badly damaged, the injured and the dying were abandoned at the available hospitals filling even the corridors. Amputations were performed in makeshift camps by a flashlight without anesthetic.

About 30-40% of affected homes were safe for occupation. However, residents had vacated for the fear that the houses might crash them in the aftershock of the earthquake. Access to disaster relief services at the IDP camps also contributed to people moving from their houses for if they stayed in their homes they would not access the relief (In Donlon, 2012). Following the earthquake, many residents left the capital using private means and means provided by the government. This migration resulted to strain in rural communities as the host families spent their savings and food stocks feeding the survivors.

World’s response

The world response to Haiti earthquake included national governments, charitable and non-government organizations from all around the world which begun coordinating humanitarian aid aimed at helping Haitian people. Some nations volunteered and arranged to sent relief and rescue workers and humanitarian supplies to the damaged areas. Other countries organized for the monetary aid for the non-profit organizations working directly in Haiti for the rescue operations. Information was being disseminated through the United Nations relief web portal. The governments of United States, United Kingdom, Cuba, Canada, Brazil and Italy sent disaster relief, medical personnel, security personnel and technicians for reconstruction with Cuba sending the largest number of health professional. Cuba had sent more than 1,000 military and disaster personnel with United State being the single large contributor to the relief fund. The international community committed major assets like field hospitals, hospital ships, naval vessels and transport aircraft. 

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Major medical issues in the first six weeks

After the earthquake, Haiti faced the worst health care issues than before. With the basic health care and sanitation completely destroyed, and millions left homeless, the small island faced the threat of infections and contamination among the survivors especially the ones in the congested internally displaced person camp (Dubique, Harvard University, Ivers, Abadia, Katz, Lively, Mukherjee, 2014). The Earthquake destroyed more than sixty percent of health facilities in Haiti. Ten percent of medical staff were either killed or left the country. With this destruction, the health care was moved to medical containers, temporary shelters and inflatable hospitals. Major operations such as amputations were done in makeshift hospitals camp. With many people who were injured and some in the congested IDP camps, there was the risk of reinfection of wounds more especially because there were no hospitals to take care of the wounded.

 The earthquake damaged the major infrastructure creating a contamination risk of drinking water. The contamination posed a risk of diarrhoea infections especially for more than a million survivors in the camps. The breakdown of the infrastructure resulted in some areas gathering pools of stagnant water which provided a good breeding environment for mosquitoes. The acute spike in the mosquitos’ related illnesses was apparent. Due to the magnitude of the earthquake, the focus shifted from community-based strategies for preventable and chronic illnesses to the direct victims of the earthquake (In Donlon, 2012). This disruption could lead to years of a setback in the fight against these diseases.

After the Initial Impact of Trauma on the Health System

The earthquake brought with it huge trauma oh health systems. With the destruction of the health care system, the country was left with an uphill task of reconstructing the system again. This was in the midst of the health challenges that continue to present themselves in the aftermath of the earthquake like increased mortality rate. In an attempt to rebuild the system, the government in collaboration with WHO, must take actions of controlling the prevalent diseases by monitoring and controlling the infection rates.

Public health issues monitors

The Haiti Government was left with a huge burden of restoring the health systems which might take years to implement (Polonsky et al., 2013). The input of World Health Organization is highly required especially in public health surveillance. The WHO should set up a surveillance department in Haiti to help in the continuous systematic collection, analysis and interpretation of data related to health which is useful in planning, implementation and evaluation health policies and practices. Some of the health issues that could be used as monitors are:

Tuberculosis (TB)

This is an infectious airborne bacterial disease which is characterized by nodule growth in tissues, especially in lungs. Haiti had the highest incidence of tuberculosis in the whole American region. More than half of tuberculosis cases had been reported in the area hit by the earthquake. Even though tuberculosis clinics resumed after a month, most of the patients were scattered in the camps without medication. The conditions in the camp provided a fertile grounds for the spread of the disease. WHO should identify the sick cases in the camps and put them under medication. The ones who are severely affected should be separated from the rest of the camps.

HIV/AIDS 

After the earthquake, tourism fell by 80%. The United States stopped importing Haitian goods. This culminated to increase in poverty which fueled the spread of HIV/AIDS among the Haitians living in camps (Dubique, Harvard University, Ivers, Abadia, Katz, Lively, Mukherjee, 2014). To reduce this spread, WHO should provide condoms in the especially in the camps and carry out awareness campaigns about the disease. It should also train the locals on ways of administering the antiretroviral drug therapy (ARV) to the affected individuals.

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Malaria 

This was an epidemic in Haiti even before the 2010 earthquake. Due to the destroyed water infrastructure, a lot of it was left stagnating in areas near the camps. These waters are good breeding places for Plasmodium mosquito which aided the spread of malaria within the camps. The infected persona included the American aid workers (Schuller, & Morales, 2012). The WHO should provide the mosquito nets to the affected residents in camps. They should also engage in environment clearance by draining all stagnant water and clearing the bushes around the camps.

Rabies

Haiti has the highest rates of the canine-mediated human disease. After the earthquake, the effort to control rabies was hindered as the resources were reassigned to emergencies control. With less control of the canines and the affected persons, the disease spread inside the camps. WHO should develop a strategy of controlling the canines most of which are on the loose. Infected person ought to be medicated appropriately in order to control the spread of the disease.

Disease burden

Before the earthquake, Haiti government allocated little resources to health care. In the aftermath of the earthquake, more resources needed to be injected in the ailing health sector. However, proper control and allocation must be made in order to ensure full benefits. The players in the health sector including the WHO should establish and allocate appropriate resources to a disease research and monitoring centre. It would assist in eliminating diseases by monitoring and controlling the infection rates. Resources should also be allocated to hiring training health officers who would work in hardy to reduce the effects of the diseases (In Donlon, 2012). Sensitization campaigns should be carried out in the whole country in an attempt to sensitize the Haitians on how to prevent themselves from the communicable diseases. More than half of hospitals were destroyed during the earthquake; proper resources should be allocated to rebuild the hospitals which will ensure better handling of patients.

Long-Term Health Issues

One of the areas that needed immediate reconstruction is the healthcare infrastructure. The earthquake left many persons behind that would require long-term medical care thus while rebuilding these hospitals, it’s apparent to consider some of the ailments that might require consideration. 

Physically challenged persons 

The earthquake resulted into a high number of people who had their limbs amputated. These individuals would require specialized care for quite a long time. Therefore while rebuilding health care, the infrastructure should be able to accommodate and cater these physically challenged individuals. This is by the provision of mobility of maimed individuals as well provision of artificial limbs.

Mental health 

The tremor had left many individuals traumatized and in dire need of psychological help. While building the health care system, the provision of a psychological unit in every hospital should be established to ensure that the survivors will be able to access mental health care in future (Raviola, Giuseppe, Eustache, Eddy, Oswald, Catherine, & Belkin, Gary 2012). This would work well in reducing the psychological effects of the earthquake.

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Poverty 

The public health system before the earthquake did not accommodate the poor as most of them were left to seek medical assistance from traditional healers and this affected the mortality levels in the island (Bell, 013). While rebuilding the infrastructure, the Haitian government and stakeholders must ensure that the public health is well supplied and is available for the common Haitian. Public health insurance should be encouraged among the population to ensure the sustainability of the system which caters to all.

Food and Housing Shortages 

During the aftermath of the earthquake, food shortage and housing problem became eminent as citizens could not engage in economic activities as well as they had no place to call home. This presented a problem for the strained medical facilities as on top of medical supplies they had to supply food as well. Therefore while rebuilding the healthcare infrastructure, the persons who are settled in the IDP camps should be considered and offered alternative income activities that would enable them to reconstruct their lives and reduce their dependency on relief.

Conclusion

The Haiti earthquake elevated the health problems that were eminent in Haiti public health care system by the destruction of the few existing facilities that were already strained. The problems were indicated by the high mortality rates and high rates of diseases. The earthquake presented health problems that required an overhaul of the entire health system. As well as upgrading of the system that would ensure that it is able to support the new problems resulting from the earthquake. The country and the stakeholders are also tasked to rebuild a public health infrastructure that can withstand the challenges of epidemics in future.