White Coat Underground


The current tragedy in Haiti may turn out to be one of the worst natural disasters (if not the worst) the Western Hemisphere has seen in the post-colonial era. Immediate deaths caused directly by trauma from the quake itself will likely number in the tens of thousands but we can be pretty sure that there’s more horror to come. This is a tragedy which is going to continue for months—probably years—to come.

Science-based medicine has taught us much about how to mitigate disasters such as this one. Unfortunately, in Haiti medicine is only part of the problem; the long-standing political and economic problems have helped limit what medicine can do. But even in the most troubled of countries, attitudes toward science-based medicine can have profound effects on the health of the population. 

We in the U.S. still wield an enormous power over health policy in other countries. We have managed to insert our religious ideologies into other nations’  HIV prevention and treatment strategies via foreign aid policies.  American individuals, such as HIV-denialist Peter Duesberg, have influenced foreign leaders in making disastrous health policy decisions.  When the South African government bought into AIDS denialism, tens to hundreds of thousands died. The anti-vaccination movement has the potential to cause much more damage (and by “damage” I mean death and suffering). If the anti-vaccination crowd increases their influence, they can not only injure more Americans, but also those in other countries who are already suffering quite enough.

CBell1809One of the coming tragedies in Haiti will be widespread illness and death from vaccine-preventable diseases. A terrifying example is tetanus. Tetanus is a disease caused by the bacterium Clostridium tetani. These bacteria live in most soils, especially rich soils, and can easily infect small wounds. Once the infection takes hold, the bacteria produce a potent toxin responsible for most of the symptoms of the disease.  These symptoms include horrifying muscle spasms, including jaw spasms which give the disease its other name, “lock-jaw”.

And it is a horrifying disease, affecting adults with even minor wounds, and babies, who can become infected at the site of their umbilical cord. The disease is frightening, causing uncontrollable muscle spasms resulting in death in nearly 100% of untreated cases. Even when treated, tetanus has a very high mortality rate, and given that tetanus tends to be more common in areas with less access to treatment, the impact is doubly felt.

Neonatal tetanus is a dreadful disease, doubly so because it is so easily prevented. When mothers are vaccinated neonates are protected by passage of antibodies to the fetus in utero. Due mainly to political and economic conditions, tetanus vaccination rates in Haiti are low (about 50% in children). Previous similar disasters, such as the Kashmir earthquake and the Indian Ocean tsunami have showed us that tetanus is a special problem after natural disasters.

In developed nations such as the U.S. and the U.K., anti-vaccine movements have caused outbreaks of vaccine-preventable diseases.  If anti-vaccination activists succeed in influencing the policies of the U.S. and other governments—as other fringe health activists have done—they may become morally complicit in the deaths of thousands of Haitians.  We must remain vigilant to protect our neighbors from our less knowledgeable citizens.

Meanwhile, Haiti needs cash.  There are many organizations that are already on the ground helping.  Here is a brief list:


  1. #1 Joe
    January 18, 2010

    Many of the usual aid agencies have had their headquarters destroyed and their staffs decimated. There is a group of doctors and hospitals in rural Haiti that, reportedly, remains intact and is responding. They are Partners in Health http://www.PIH.org and they are taking donations.

  2. #2 Denice Walter
    January 18, 2010

    (FYI:I mailed my checks on Friday and have been pestering others I know to do the same).I’ve been wondering about the HIV/AIDS situation in Haiti: the country is staggeringly poor,ARV meds are expensive,there is a Catholic influence (which might interfere with prevention education), and a higher HIV rate than the US(2% vs. 0.6%, respectively)- all making it appear formidable.I know very well about the HIV/AIDS denialists, the government, and vitamin salesmen in South Africa,I am hoping that there isn’t a parallel in Haiti.

  3. #3 Kathy Orlinsky
    January 18, 2010

    Tens of thousands dead from being buried in rubble with no food or water is bad enough, but to haul them out and have them die of tetanus?!?

  4. #4 Dave
    January 18, 2010

    I don’t know how much can be mitigated in a disaster like this; this many tens of thousands dead versus that many tens of thousands dead. Focusing on bringing in potable water is probably more of a priority than tetanus.

  5. #5 PalMD
    January 18, 2010

    No, Dave, this is not a zero-sum game. Internal resources are limited, but external ones much less so. Tetanus toxoid is not expensive and not big. There is no reason to think we can only deliver water and not food, or only deliver medicine and not shelter. They must all be delivered if the people are to be saved.

    Nihilists piss me off. I mean, if you were saying, “Gee, why buy them TV’s when they don’t even have houses” that would be one thing, but fuck…

  6. #6 ginger
    January 18, 2010

    It’s especially not a zero-sum game if getting people food and water may provide a way to get them in early and vaccinated against what’s likely to be a problem for months to come. It’s unlikely that someone who’s trying to rebuild his life from a pile of rubble is going to want to take time out and go to the clinic in 6 weeks, but if he needs water anyway, and he can get a shot that will protect him against that rubble for the next 10 years, we should do our damnedest to ensure he has the option.

    My money went to MercyCorps (www.mercycorps.org), a smaller operation but an awesome one.

  7. #7 Bob
    January 19, 2010

    My gut reaction was that many more people would die due to disease caused by the loss of sanitation & basic infrastructure (cholera anyone?) Disaster recovery has to simultaneously resolve multiple problems so it’s not a matter of water or medicine, you likely need both.

    Anecdote time: My sister’s boyfriend is a captain in the Army. Right now he’s a real hot commodity, being a diver and the leader of an engineering unit. For the past few days he’s been busting ass to deploy to Haiti to put their harbor back together so ships bringing supplies can tie up and unload. You could argue that his effort isn’t directly helping victims, but you’d be hard pressed to claim that recovering the harbor or clearing roads or controlling air traffic aren’t each a high priority. Vaccination should also be a high priority; there’s no point in handing out all that water to someone who’ll eventually die of tetanus.

  8. #8 Dave
    January 19, 2010

    I’m not being a nihilist. As of the News last night, surgeons are performing 75 amputations a day and are currently limited by the lack of surgeons and nursing staff to increase the rate of amputations. Gangrene and resultant septic shock will probably kill more than lack of a tetanus vaccine. It’s been a while since I have done trauma resuscitation but I’m pretty sure that vaccination is somewhere after secondary survey…. Besides, what makes you think that experienced rescue-disaster / combat medical teams like Doctors without borders, the Israeli Army, and the US Military wouldn’t bring tetanus vaccine with them? This isn’t the first time these groups have been to this dance.

    You know what pisses me off? Pedantic stuffed shirts that feel a need to bring everything in the world down to the narrow focus they are most comfortable with.

  9. #9 MonkeyPox
    January 19, 2010

    W. T. F.

  10. #10 Micawber
    January 19, 2010

    The whole thing is heart wrenching – one’s feeling of helplessness is magnified by the proximity one feels via television.

    What has occurred to me, Dr. PayPal, is that even here in the US we seem ill-prepared for disasters like this.

    Yep, it will be like being up sh*ts creek without a paddle.

    You prolly know all about that though.

  11. #11 DrugMonkey
    January 19, 2010

    Pedantic stuffed shirts that feel a need to bring everything in the world down to the narrow focus they are most comfortable with.

    The notion that you are the only person in the entire world who thinks about complexity!! and TheWholePicture1!!1 and therefore you are Teh briLLiant DeepThinker and everyone else is stoopidz is an adolescent conceit.

  12. #12 Mu
    January 19, 2010

    Compare that to the idiots from my hometown who waste precious cargo space to send electronic bible readers to Haiti right now. Because the word of the Lord is more important that vaccinations 🙁

  13. #13 Calli Arcale
    January 19, 2010

    Mu: now that’s depressing. Every report I’ve seen has had relief workers begging for people to NOT come down and NOT send anything but money unless they’re relief workers already on the job in Haiti, because the system is just utterly clogged just trying to get *water* to these people.

    And the fundies don’t even think of that. WTF? I mean, electronic bible readers? That wouldn’t have even made sense a week ago; why give e-books to people who can’t afford to *feed* themselves, and who are largely illiterate? Hell, even sending print Bibles wouldn’t make sense (though I suppose they could be used as fuel).

    That. Pisses. Me. Off.

  14. #14 Shay
    January 19, 2010

    Mu@12: Who on earth has the clout to pre-empt necessary cargo by sending electronic bible readers on aid flights right now?

    I’m not doubting you, I’m just wondering how they get away with it.

  15. #15 Mu
    January 20, 2010

    Luckily, as it turns out, they don’t have the cloud, they’re wining loudly that they need to fly the stuff in on private planes and private planes are not allowed yet. They also added some 2 tons of rice and beans to the load to not look too stupid.

  16. #16 Prometheus
    January 20, 2010

    A lot of planes got in before the airport clogged. Unfortunately they were loaded with journalists and evangelical chaplains from the Billy Graham crusade instead of food and medical personnel.

    This is as repulsive to me as the fact that Haiti had no margin because the NGOs and the Catholic church manipulated billions of dollars in aid to gratify their poverty fetish instead of building infrastructure.

    The Bride and I sent a pig through Heifer International. We are going to take up an office collection to see how many goats we can get.

  17. #17 Calli Arcale
    January 21, 2010

    Samaritan’s Purse is another organization that will allow you to purchase animals for people in other parts of the world.

    Regardless of which agency you use, it’s a much better gift to some poor farmer than a freakin’ e-book. Heck, it’s a better gift than a stack of 20 MREs. Animals make good support because they’re Von Neumann machines — they have the capacity to make more animals. And they can be used for more than just today’s meal. Hens provide feathers and eggs. Cows produce milk. Ewes and nanny goats provide milk and wool. (Note: not all goats are suitable for wool; depends on the breed.) Large quadrupeds can be harnessed and trained to pull, which can increase a farm’s production and can even be hired out for additional income.

    Bottom line: though right now livestock isn’t a good thing to ship to Haiti (since they need medical supplies and water far more desperately), once they’re stabilized, livestock could be really helpful.

  18. #18 Cat Faber
    January 21, 2010

    Sending livestock *might* be helpful, but check it out a bit more. I had the impression Haiti was severely deforested and might not be able to stand up to the environmental stresses of more livestock. A goat that starves to death isn’t much help.

  19. #19 SurgPA
    January 23, 2010

    @18: A goat won’t starve to death anywhere; they’ll eat scrub brush, garbage, an old shoe, the odd tin can… Your point is taken, however.

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