Haiti is still reeling from the massive earthquake with over 1 million people living in tent cities. The unfolding cholera outbreak is causing much more misery. Now, Hurricane Tomas is heading that direction. What is the synergy of destruction that is likely to come if Tomas hits Haiti as well?
As of October 27, there were 4,722 cases of cholera and 303 deaths according to the WHO. Realistically though, both the number of cases and deaths is likely much higher due to the difficulties of collecting this data in a country that has had its entire infrastructure so incredibly ravaged.
The health care system there now (at least what there is of it) is overwhelmed by the number of patients with cholera. There are no beds remaining. Patients have to lie on the floor or outside on the ground. This actually should be a major warning shot across the bow of the US health care infrastructure.
Surge capacity is “The ability to obtain adequate staff, supplies and equipment, structures and systems to provide sufficient care to meet immediate needs of an influx of patients following a large-scale incident or disaster.” Essentially it is describing the ability to care for a large number of people.
Therein lies the problem in the US. There are a decreasing number of bed days available in hospitals. That is essentially a count of the number of available beds each day around the country. That is occurring at the same time that the baby boomer generation will be using MORE of those bed days as they age. (Healthc Financ Manage. 2007 Jun;61(6):114-5.)
Some people might wonder why that is a problem. Won’t the invisible hand of economics resolve the issue? Take a look at where the US stands in comparison to other countries on the number of hospital beds per 1,000 population. It should be noted that this represents the number of licensed, staffed beds. It isn’t looking at usage rates, which paints a far more ominous picture for the future of US health care. The US is far behind other industrialized countries on this measure.
During the winter (pneumonia and influenza season), hospitals can easily reach capacity, without the impact of a disaster. That is the most worrisome part of this problem. The US health care system keeps losing its capacity to care for patients with routine problems. If a major event were to unfold, the system would not likely be able to absorb the impact of mass casualties.
Most people don’t know what hospital care is like until they are older and need it for themselves. Labor and delivery isn’t a good comparison because hospitals fund and market these areas differently than the rest of the facility. Today, staff feel overworked and this can lead to mistakes or at least a less than desirable experience for the patient.
A good analogy of what is happening in health care is the airline industry. Think about what happens when airlines consolidate. Routes are reduced, smaller aircraft are used, and each plane is filled beyond capacity. Travelers now have to deal with minimal leg room, eight peanut meals, baggage fees, and increased chances of getting bumped from a flight. There will be a number of problems in the health care industry as well, although it will be hard to predict exactly what the parallels could be drawn between “riding the friendly skies” and “riding the friendly gurneys.” The equivalent of getting bumped in a hospital though could be tragic.
Is that realistic though? Could hospitals really become that overwhelmed in the US? One only has to look back at the 1918 Spanish Influenza pandemic for a model. Johns Hopkins University Hospital CLOSED to anyone but staff and students. Hospitals routinely turned away patients in Philadelphia. Two military base hospitals at the time paint a grim picture. Camp Devens (near Baltimore) had a hospital that was built to hold 1,200 patients but had OVER 6,000 during the worst of the outbreak. Camp Grant (near Rockford, Ill.) went from 610 to 4,102 patient in only six days. An event on that scale would cripple the health care system today. US hospital capacity is in critical condition.
Back to Haiti
The refugees in Haiti are facing something terrible. Fortunately, it doesn’t look at this time like Tomas will make landfall in the area. However, they have a 50% chance of having to deal with sustained tropical storm (>=39 mph) surface winds and rain. Imagine trying to live that way in a tent or shack. The minimal housing that they have could easily be destroyed. The government has already suggested evacuating these sites, but that will obviously not be possible for a number of people in these areas.
This whole scenario could easily increase the rates of cholera in the area. More of the environment could become tainted and sanitation and clean water facilities could be compromised. This could give an entirely new meaning to the concept of “a perfect storm.”