Sherri
L. Porcelain*
A disaster will not spontaneously
trigger an outbreak of disease, unless, of course, a highly infectious disease
such as Ebola is the reason for the emergency event. Countries are vulnerable
to both newly emerging and remerging communicable diseases when collapsing
infrastructure and continuing neglect threatens the health of residents and
tourists visiting the country.
Cuba’s current challenges with
cholera, dengue, and its viral relative, chikungunya, are good examples.
Cholera and dengue continue to spread throughout the island, while the Cuban
government claims that all the reported cases of chikungunya have been imported
to the island from Haiti and the Dominican Republic. According to the Pan
American Health Organization’s (PAHO) Update on Chikungunya Fever in the
Americas (August 8, 2014), Cuba has officially reported 11 imported cases with
no suspect or confirmed locally acquired cases since the start of the outbreak
in the Americas. (1)
Chikungunya, a viral disease
transmitted by an infected mosquito, has reached this hemisphere for the first
time in history in December 2013 when it arrived on the Caribbean island of
Saint Martin and spread throughout the region. Recent data shows local transmission
of chikungunya has been identified in 29 countries and territories in the
Caribbean, Central, South and North America, including the United States with a
cumulative total of 508,122 suspected and 5,271 laboratory-confirmed cases, as
of August 1, 2014. (2) Cuba rebuffs what independent journalists, rumors, and
local health professionals describe on the island.
Here we go again.
Most likely Cuba’s failure to report
chikungunya is intentional and not due to poor data gathering capabilities.
Cuba has an advanced epidemiologic surveillance system with highly skilled
scientists and dedicated health professionals. However, the government’s
failure to release timely outbreak data threatens health security today.
A brief discussion on the relationship
of climate change, failing infrastructure, and the frequency and intensity of
natural disasters is considered below to identify both the challenges and
realities with such diseases as cholera, dengue, and chikungunya in Cuba.
Climate
Change
Scientists project that climate change
will impact both the frequency and intensity of extreme weather patterns. The
Caribbean region, and islands like Cuba, could expect rise in sea levels, and
this combined with more intense weather events will make flooding more common.
Cuba’s coastal regions will be
impacted the most, however, Cuba could experience protracted seasons of both
droughts and flooding, and reliable potable water could become scarce.
According to José Rubiera, top Cuban
Meteorologist, the “seawater temperature is rising and the conditions in the
upper atmosphere are favorable to rapid intensification. These cases are now
somewhat more frequent; it means something is changing.”(3)
The vibrio cholera bacteria has been
known to survive in brackish waters and estuarine environments, attaches to
zooplankton and moves along the ocean currents as it is carried into new
areas,(4) continuing the threat to Cuba and Hispaniola.
This danger is especially problematic
in countries where fragile water, sanitation, sewage, and housing systems are
further threaten by climate change and rising water temperatures where the
multiplication of the cholera bacteria has been documented.(5)
Infrastructure
Even though Cuba’s official reporting
on their health status indicators match developed world measures, I suggest
that the earlier investment in the Cuban public health infrastructure is
eroding quickly and without greater attention, the likelihood of infectious
diseases spreading spatially and temporarily will continue.
As reported in New England Journal of
Medicine article earlier this year, the reality is that, “Any visitor can see
that Cuba remains far from a developed country in basic infrastructure such as
roads, housing, plumbing, and sanitation.” (6)
According to Relief Web, PAHO warned
Cuba a week before Hurricane Sandy (October 2012) struck that further damage to
the sanitation system could be problematic in the areas previously affected by
cholera and other illnesses related to water use and handling of food.
It is no surprise that “Drinking water
is contaminated in most Cuban cities,” and neighborhoods have ongoing problems
with sewage in the streets. (7)
Let’s not overlook the poor hygienic
conditions in hospitals and clinics. Cuban independent journalists along with
dissident physicians have described water and vector borne disease outbreaks
associated with the government’s failure to meet basic sanitation standards.
(8)
Current water treatment facilities
seem to lack the chemicals, equipment, and appropriate filter units, along with
the inconsistent availability of chlorine for safe water. (9)
Furthermore, a failure to maintain
continuous water pressure will hinder the amount of water and contributes to
the contamination of the water supply. (10)
Lastly, a valuable engineering report
on Cuba’s infrastructure reminds us “more than 50% of the water pumped through
the distribution system is lost due to leaks in deteriorated piping.” (11)
Natural
disasters
Based upon what we know about climate
change and infrastructure demands in Cuba, the vulnerability and hazard
reduction strategies associated with natural disasters are especially important
with high winds, surging seas, and flooding. Hurricane season begins June 1
through November with October and November recognized as the most active times
for cyclones to strike in Cuba.
Fifteen hurricanes and two major
storms have struck Cuba since the new millennium. The greatest risk for
landslides is located in the eastern provinces where earthquakes also have a
higher likelihood of threats.
While Cuba has a well-developed
emergency evacuation and response plan, they show a poor performance in
disaster reconstruction, recovery, and mitigation. (12) This is evident as the
battering of their public health infrastructure continues to decline.
According to researchers the most
“troublesome is the lack of meaningful official programs to attempt to minimize
or mitigate the damage that is caused by the severe vulnerability of the built
environment to the hazard agents of hurricanes and earthquakes,” (13)
Hurricanes Michelle (November 2001),
Isadore (September 2002) followed by Lily (late September 2002) presented
national challenges.
However, it was Hurricanes such as
Charley (August 2004) which became the most destructive to strike Cuba’s
western Havana region since 1914 followed by Ivan (September 2004), the first
Category 5 hurricane to hit Cuba in 80 years. This battered Pinar del Rio,
Cuba’s most western region, which has been more regularly impacted by
hurricanes.
The 2005 hurricane season was very
active with Dennis (July), Rita (September), and then Wilma (October) reporting
the worst death toll in Cuba in more than 40 years.
After some quiet hurricane seasons,
Gustav (August 2008) a Category 4, and weeks after tropic storm Fay hit, became
the strongest storm in 60 years with an estimated $5 billion to damage to
medical facilities, schools, infrastructure, crops and livelihood. (14)
Hurricane Ike (September 2008)
reported hundreds of water wells in rural areas damaged, dams overflowing, and
more than 1 million without potable water.
U.S. engineers report that the “water
supply system is unstable because pumps are in need of repair and because of
frequent interruptions in the electrical supply needed to run the pumps,” (15)
which is especially challenging during hurricane seasons.
Hurricane Sandy (October 2012) hit the
eastern region leaving devastation in Santiago de Cuba and Holguin while
threatening highly populated communities and destroying critical public health
infrastructure.
In 2013, Ricardo Mena, a United
Nations official responsible for disaster risk reduction in the Americas
announced that “Cuba has enormous amount of deteriorated buildings that can't
withstand natural disasters." (16)
While Cuba has a well-developed
disaster response system, the foundation to protect its people continues to
crumble and expose the fragility of the water, sanitation, sewerage, housing
and road systems. Rising sea levels, flooding, warming temperature, and the
number and frequency of emergency events are expected to create both
water-borne and vector-borne diseases threats in the 21st century. So if we
want to blame Cuba’s recent problems on climate change, natural disasters, or
other reasons it doesn’t matter. What matters is protecting the health of the
country’s residents and visitors. This must begin by reminding the
international community that Cuba's silence on disease outbreaks (17) -along
with their deteriorating infrastructure- could wreak havoc when nature calls.
Notes
(1) PAHO Epidemiology
Week Report on Chikungunya to Date (Week 32), August 8, 2014.
(2) Center for Disease
Control and Prevention (CDC), Chikungunya in the Americas
http://www.cdc.gov/chikungunya/geo/americas.html, accessed August 8, 2014.
(3) Patricia Grogg.
Hurricanes Getting Stronger in the Caribbean, InterPress Service, Interview
with José Rubiera July 10, 2013,
http://www.ipsnews.net/2013/07/qa-hurricanes-are-getting-stronger-in-the-caribbean/
(4) RR Colwell Global
Climate Change and Infectious Disease The Cholera Paradigm (1996) Science, 274
2025-2031.
(5) Joan L Aron &
Johnathan Patz Ecosystem Change and Public Health: A Global Perspective (2001).
(6) Edward D Campion,
and Stephen Morrissey, A Different Model-Medical Care in Cuba New England
Journal of Medicine Perspective, January 24, 2014.
(7) Katherine
Hirschfeld, Book Review, Linda Whiteford and Laurence Branch’s Primary Health
Care in Cuba: The Other Revolution (Rowman and Littlefield, 2008), in Soc
(2009) 46:293–296 Published online: 27 March 2009 p. 294.
(8) Katherine
Hirshfeld (2009).
(9) Eds. Manuel
Cereijo and Helena Solo-Gabriele, Infrastructure Assessment for a Transition in
Cuba (March11, 2011), Endowment for Cuban American Studies p. 11.
(10) Ibid.
(11) Cerijo and
SoloGabriel (2011), p.12.
(12) B. E. Aguirre and
Joseph E Trainor, Emergency Management in Cuba: Disasters Experienced, Lessons
Learned, and Recommendations for the Future, in ed. David A. McEntire
Comparative Emergency Management: Understanding Disaster Policies, Organizations,
and Initiatives from Around the World,
http://training.fema.gov/EMIWeb/edu/CompEmMgmtBookProject.
(13) Aguirre and
Trainor, p.5.
(14) Canadian Red
Cross, Cuba Hurricanes 2008, accessed August 7, 2014
(15) Helena M.
Solo-Gabriele and Armando I. Perez Water and Waste Sector: Environmental
Literature, Institutional and Economic Issues and Future Work, 378-389, in
Infrastructure Assessment for a Transition in Cuba (2008)
http://ctp.iccas.miami.edu/InfrastructureAssessment.asp p. 387.
(16) Jean
Friedman-Rudovsky. Hurricane Tips From Cuba, New York Times, 30 July 2013: D.6
(17) Luis Rosas Suarez, El silencio epidemiológico y
la ética de la salud pública cubana, Revista Cuban de Salud Pública 39(3)
(2013), 524-539 and Sherri L. Porcelain Cuba’s Silence is Dangerous to Your
Health, ICCAS Focus in Cuba Issue 197, August 5, 2013 http://ctp.iccas.miami.edu/FOCUS_Web/Issue197.htm.
_________________________________________________
*Sherri L. Porcelain
teaches global public health in world affairs at the University of Miami
Departments of International Studies and Public Health Sciences and Senior
Research Associate, Institute for Cuban and Cuban-American Studies.
_________________________________________________
Nota del Editor: Articulo recibido por correo electrónico
desde la fuente.
