Disease poses threat despite aid efforts

The first urgent need is water. Immediately following that is
food and shelter.

Organizations carrying out relief efforts in South Asia are
gravely aware of the supplies they must deliver to the hundreds of
thousands of victims affected in the area.

Meanwhile, the massive numbers of dead bodies and debris present
major public health concerns.

Non-governmental agencies like the Red Cross are experienced at
disaster response, but the devastation from the Dec. 26
earthquake-triggered tsunami is unparalleled in magnitude.

Public health experts are wary to project a timeline for
regaining some state of normalcy.

“The scope of this disaster is unprecedented,” said
Judith Siegel, a professor of community health sciences in the UCLA
School of Public Health. “So what we do here is we
extrapolate from other research to this setting, but the extremity
of it makes it hard to do that.”

The environment of the area itself provides many obstacles to
the delivery of relief.

“A lot of these countries do not have much infrastructure
to begin with, and what little there was has been destroyed ““
bridges, roads, communications, stores where you can go and buy
food,” said Ron Halbert, an associate professor in community
health sciences. “You know, the things we take for granted
all around us to sustain life.”

The groundwater supply in areas of Sri Lanka, Indonesia and
other countries has been contaminated by saltwater, sewage,
gasoline and diesel fuel leaked by overturned cars and trucks, and
sewage. Despite potential dehydration, the unavailability of clean
water presents other health dangers to tsunami victims in the form
of waterborne diseases: typhoid, cholera and diarrhea.

“This is an area of the world where we do see things like
cholera and because we’ve got unclean water supplies,
transmission of cholera can increase,” said Kim Shoaf, a
professor in the UCLA Center for Public Health and Disasters.

“We are looking potentially at long-term public health
impacts if the sanitation and water situation is not taken care of
quickly,” Shoaf said.

Cases of cholera have yet to be reported, but the World Health
Organization has received reports of diarrhea in several
countries.

In the days after the waves, floodwater collected in the debris
may turn brackish, presenting another public health threat by
providing ideal mosquito breeding grounds.

Diseases transmitted by mosquitoes, such as malaria and dengue,
are already endemic to the area and rates of transmission could
increase in the coming weeks, said Linda Bourque, a professor of
community health sciences.

“It’s thought that the dead bodies are a source of
disease, when in fact these other things are a bigger
concern,” Bourque said, adding that the rapid disposal of
dead bodies in mass graves could potentially present long-term
psychological effects for surviving loved ones.

The impact of the disaster will also indirectly affect chronic
diseases like cancer and epidemics like AIDS, with the widespread
destruction of buildings and health care facilities.

“(HIV) is an epidemic that’s determined by social
behavior, and at the moment, survival is the major issue ““
the kinds of activities that cause AIDS transmission would likely
be on hold,” said Roger Detels, chair of epidemiology at
UCLA.

“For individuals who already have a diagnosis of AIDS,
their access to medical care is going to be severely
compromised,” Detels said.

The World Health Organization has established a surveillance
verification and response disease system in Indonesia, Sri Lanka,
the Maldives, Thailand, and India.

After the cleanup and initial shock of the disaster, long-term
impacts may manifest psychologically in tsunami survivors.

“The kinds of resources that are generally available after
a disaster to help people to cope are not available in this
situation,” Siegel said. “The fact that entire families
and communities are no longer there means that people don’t
have anything familiar to turn to that is going to be reassuring to
them.”

Support for the South Asian countries has poured in from outside
nations, perhaps due to the timing of the disaster during the
holiday season.

“The holidays are over now, people are going back to
work,” Halbert said. “Six months from now, when the
need for long-term development comes, people may have turned to
more pressing interests ““ the next disaster, if you
will.”

But the United States and other countries can learn from this
incident and the ongoing relief efforts, public health experts
feel.

“Southern California and the Western Coast of the United
States isn’t ready for tsunamis,” Shoaf said.

“There are things that we need to learn about warnings,
about responding to warnings, about preparedness.”