Setbacks To Health Progress In Central America

November 12, 1998

Washington, DC, 12 November 1998- The effects of Hurricane Mitch could result in setbacks to health progress in Central America, according to officials at the Pan American Health Organization.

"It is really unfortunate that all our advances of this decade, like increased coverage of drinking water, and sanitation, access of the population to health services, elevated vaccination rates, and notable gains in life expectancy run the risk of a great setback," said Dr. Mirta Roses, PAHO's Assistant Director.

The Pan American Health Organization (PAHO) has been working intensively with Central America since long before health became a bridge for peace in the conflict-ridden 1980s. Central America, one of the most vulnerable areas of the continent with high levels of poverty, had made significant progress in health, although its needs will be much greater after the devastating effects of the Hurricane Mitch, she said.

The result of Hurricane Mitch, she said, is that "All the diseases that afflicted people in Central America are going to continue. The interruption of health services, difficulties of transportation and communication hampering access to displaced populations, and desperation from the loss of lives and of family members, having abandoned their houses and their lands, make the situation more urgent."

Today, Central America faces three distinct and separate problems, Dr. Roses said. The first is dealing with populations in areas that are still inaccessible, because "we don't know what situation they're in and how we can reach them with assistance." Nongovernmental organizations, neighboring towns and international agencies have been doing great work mobilizing transport to those populations, she said.

The second problem involves people in shelters, Dr. Roses said. "These people have very specific needs and we are working with the Health Ministries to provide water, sanitation, and food to those still in shelters. In Honduras and Nicaragua some people are beginning to abandon these shelters, and as the waters recede they are attempting to return to what remains of their homes," she said.

"The third group involves the population of the cities, where our basic task is to reestablish basic services: transport, which facilitates the distribution of aid; electricity, and the water systems, Dr. Roses said. "United Nations agencies and the people themselves have responded admirably, and natural leaderships have arisen in a very positive way in small communities constituted in those groups."

Dr. Roses said "the call by the Director of PAHO, Dr. George Alleyne, for cash donations is very important. It's what we need to move the aid, for transportation, fuel. To mobilize the shipments of drugs and food, money is an imperative need."

She added that "Basic health services are our priority and we must concentrate all our energies on reestablishing them. If health services are available it is much simpler to help people and detect diseases in elderly, diabetics and those suffering cardiac problems."

PAHO's country offices are "in the line of fire in Central America," Dr. Roses said. "In the first 48 hours, they performed a rapid assessment and organized an Emergency Committee with specialists in different areas to support the Central American countries", Dr. Roses explained. "As PAHO we are organizing collaboration with the ministries of health in order to arm these teams with the minimum primary care equipment to take care of the three types of population mentioned."

"We are engaged in the repair of the most critical hospital services of certain complexity, such as radiology, laboratory, and surgery. In Honduras and El Salvador we also have a very good experience in mobile surgery," she said.

"There are chronic patients, people with AIDS, elderly people, and pregnant women who fear being abandoned in emergencies. The epidemics take the entire stage, and it is difficult to perceive the psychological crises and acute mental health problems that can arise as a result of the disaster. However, violence has been very sporadic and solidarity prevails", Dr. Roses said.

"In terms of health service infrastructure the capacity is important in Central America and much progress has been made in the last decade," Dr. Roses said. "It is very painful hat this disaster implies a damage of 70% of the infrastructure in Honduras and Nicaragua, the two most affected countries. We speak of roads and bridges, but also of water systems that correspond to the health sector and hospitals. It will probably take us three months, with a good organizational capacity and international support, to reestablish the minimum services," she said.

"Repair and rehabilitation of the health network will take at least one year to 18 months, with the corresponding planning," Dr. Roses said.

The first countries to respond in emergencies are neighbors, she said. Belize and Costa Rica, which had the least damage were the first ones to assist the four countries with more damage. El Salvador, which was well prepared and has an efficient disaster committee, also helped its neighbors. The United States, Mexico, Panama, and Canada, also responded quickly, as did Southern Cone countries like Chile, Argentina, and Brazil, which sent specialized rescue teams with engineers, helicopters, and dogs. Specialized physicians and support teams came from Mexico, Cuba, and Costa Rica, Dr. Roses noted.

"The entire continent has been mobilized in an exemplary manner, proving the importance of what we call Pan Americanism", she said.

"As an Organization we feel pride in having developed for almost 20 years a disaster preparedness capacity", she said. In addition the SUMA project, a tool for the management of humanitarian supplies, is helping manage the flow of supplies efficiently and transparently, with accountability and tracking, she said.

Hurricane Mitch has been a hard blow, according to Dr. Roses. Intangible investments such as sectoral analyses carried out over a year or more to identify opportunities for reform, investment projects, and interventions will have to be prepared again. "It's as if we lost all that work. It is now a new situation: from that standpoint they are new countries, and will have to analyze their situations from scratch," Dr. Roses said. Fortunately, she noted, the Economic Commission for Latin America and the Caribbean ECLAC, with the support of specialized U.N. agencies the World Bank, and the International Monetary Fund have begun an economic assessment of impact of this disaster.

"Sometimes in a crisis we have to find the opportunity," Dr. Roses said. "Everything we build as a result of this disaster-- all the water and sanitation systems, health centers, hospitals, transport and communications infrastructure-- must use the lessons of Mitch and be built more solidly, in less vulnerable areas, and better able to resist any new attacks."

"As Dr. Alleyne noted, this is the first disaster of any magnitude that has the support of the Internet system. Previously, one of our problems was the lack of communication that has always been a vital input for the management of disasters. Before communications by satellite it was practically an impossible challenge to reestablish communications with the countries. We have advanced," she said.

PAHO, based in 1902, provides technical collaboration in a broad range of fields including emergency preparedness and disaster relief. It works to improve health and living conditions in the countries of the Americas. It also serves as the Regional Office for the Americas of the World Health Organization.

Pan American Health Organization

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