Preparing For A Possible Crisis: Pediatric Diarrheal Disease
Jim Wilson, MD
The meteorological forecast for next week calls for thunderstorms
beginning this Wednesday and lasting at least through the following
Tuesday. We will follow the forecasts closely as this time draws
near.
We are all seriously concerned about an increase in diarrheal disease,
specifically in children. It has already been documented that
diarrheal disease is a major cause of morbidity and mortality both
before the earthquake and after. We have observed apparent ‘bumps’ in
diarrheal disease incidence following periods of sustained rainfall,
however the epidemiological baseline remains unclear in terms of what
is normal and expected for the Haitian population during the minor
rainy season. That said, we have maintained a WATCH status of alert
for diarrheal disease in Haiti, and we expect to move this alert up to
a WARNING with sustained rainfall.
The reason for this high level of concern is obvious to all of us who
are working on the ground. An extension of that concern may be seen
when considering the fragile nature of the current ad hoc medical
infrastructure in the quake-affected areas. It is our assessment this
infrastructure comprised mainly of volunteers is easily overwhelmed by
a sudden influx of patients, particularly pediatric patients. The
higher the clinical acuity, the more easily it is to overwhelm.
To that end, we would like to encourage the following discussion from
the responder community in Haiti:
Preparedness.
Let us ask ourselves the difficult question of whether we are truly
prepared if a substantial increase in diarrheal disease is observed
across multiple locations? Specifically, although Promess has a large
supply of Pedialyte, is it enough? What about oral and IV
antibiotics? IV fluids and kits? How fast is this materiel able to
be deployed throughout the IDP camps in response to reported outbreaks
of diarrheal disease? Is the application mechanism agile enough to
handle a high volume of requests, even though coming from unregistered
groups? Have Haitian mothers been taught how to make oral rehydration
salts (ORS) and how to use ORS solution proactively with their
children?
Early Warning and Situational Awareness.
Formal public health surveillance currently consists of filling out
forms and submitting them to the Haiti Ministry of Health once per
week, with a developing network of sites to support laboratory
testing. To augment this process, we would like to strongly encourage
cluster members to not only fill out these forms but also engage in
routine information sharing about events. This is referred to as
“informal surveillance”, and we offer the following Google group, the
“Haiti Epidemic Advisory System” and the InSTEDD-supported SMS/text
messaging alert system called Geochat to facilitate communication
among us. In this Google group we will be sharing insights into what
to look for and examples of informal surveillance in action. Please
note this group is only for ground-based Haiti responders. The link
to the Google group may be found here, and instructions for how to
sign up for the SMS/text messaging Geochat service is found on the
group website:
http://groups.google.com/group/haiti-epidemic-advisory-system?hl=en
Response.
If we are prepared and we are sharing warning information and
situational awareness, are we then prepared as a community to
respond? Response in this context may become quite challenging,
particularly if the roads become more difficult to travel on due to
rain and slides. Further, if we do not have adequate supplies coupled
to agile logistical distribution, we will not be empowered as a
responder community to respond. Imagine multiple sites say in Port-
au-
Prince that may or may not have on-site medical personnel who may or
may not have enough supplies to respond to a crisis of diarrheal
disease. We need to confront these questions as a community and make
sure we are able to answer them before a crisis occurs.
We are here to facilitate this process and assist in a positive
outcome for Haiti’s children. It is acknowledged this is a
substantial and complex challenge, and we may see the deaths of
children despite everything we attempt to prevent it. Here we
encourage an exploration of all possible options proactively before
the crisis is thrust upon us unprepared.
Cheers,
Jim
James M. Wilson V, M.D.
Executive Director, Praecipio International
Haiti Epidemic Advisory System (HEAS)
Petionville-Port au Prince, Haiti
+1.571.225.3671
jim.w...@praecipiointernational.org
http://www.praecipiointernational.org <http://
www.praecipiointernational.org/>