Features
Lesson From Haitian Public Health Week
Susan J. Blumenthal, M.D., Pamela Savitz, Kate Pitts, Timothy Dempsey, Julia Liebner, and Anita Verma
A series of earthquakes have recently shaken the world, taking a traumatic toll on communities globally. More than half of the 130 cities worldwide with populations of over 1 million people are built on fault lines, making them susceptible to the calamitous impact of earthquakes, as witnessed in the recent events that occurred this Easter Sunday in southern California and Mexico as well as those that struck over the past several months . With 57 deaths following the March 8th earthquake in Turkey, 531 left dead after the February 27th quake in Chile, and an estimated 250,000 dead following the January 12th Haiti disaster, vulnerably located nations must be prepared with emergency response plans and strong public health infrastructures. Unfortunately, these natural disasters often occur in settings that are already shaken by financial instability and poor health systems. Haiti, a nation now devastated, had a weak public health system as well as a fragile economy when a 7.0 magnitude earthquake struck and shook Port-au-Prince on January 12, 2010. This traumatic event required extensive short-term emergency response efforts, but has also dramatically increased the need for health services and a strong public health infrastructure for the long term. With the United Nations Donor Conference pledging $15 billion last week, $9.9 billion of which is being allocated toward long-term reconstruction with the United States committing $1.15 billion over the next two years, it appears this urgent need will eventually be met.
The extent of Haiti’s devastation can be seen not just through the rubble, but also in the economic and public health data detailing the damage from the quake. The earthquake has been more destructive than the Indonesian tsunami of 2004 and has caused five times more deaths per million inhabitants than the 1972 earthquake in Nicaragua. It has destroyed over 75 percent of Port-au-Prince, including 250,000 houses and most government buildings, injured at least 250,000 people, and displaced 1.5 million more who are now forced to live in make-shift tent camps. The Haitian government has assessed the death toll to be between 200,000 and 250,000 people with the potential to reach or surpass 300,000.Costs related to damage from the earthquake have been estimated at $13.9 billion, twice the amount of Haiti’s annual GDP.
The earthquake has all but broken parts of this frail nation, exacerbating pre-existing conditions and creating new challenges as well. Even before the earthquake, Haiti had experienced social and health challenges in addition to facing severe economic problems. In 2006, Haiti spent just $96 per capita per year on health care (compared to the United States’ annual per capita health spending rate of $8,160), and only 1 in 50 Haitians had steady employment. In a country so impoverished, where 80% of people were indigent before the quake struck, it is easy to see how the health of Haitians has also become quite poor. Infectious diseases are the leading cause of death for infants and children in this country, and HIV/AIDS is the number one killer of adolescents and adults. As people are forced to live in crowded makeshift camps with unsanitary conditions in the earthquake’s aftermath, the threat of tetanus, typhoid, gastrointestinal infections and other water-borne communicable illnesses, such as malaria, looms dangerously close as the rainy season approaches this May. Furthermore, children, who comprise 40-50 percent of the Port-au-Prince population, are among those most at risk in disaster situations. Because their immune systems are less developed than adults, they face a range of threats, including malnutrition, acute respiratory infections, diarrhea, and susceptibility to illness resulting from a lack of availability of vaccines to protect against childhood diseases. Prior to the earthquake, only 58 percent of Haitian children under age 1 were immunized against diseases such as measles and tetanus.
The earthquake and subsequent aftershocks also had a devastating impact on Haiti’s infrastructure for safe water sources. Thus, conditions will only worsen for the 250,000 left without shelter unless a public health system is developed. Sanitation is not the only concern for Haitians now residing in tent cities with limited resources. Once nightfall arrives, women face the constant fear of rape and attack. To make things worse, the earthquake destroyed many of the rape counseling centers including Haiti’s Ministry for Women’s Affairs, which was in the midst of implementing its five-year plan to reduce violence against women. Currently steps such as the distribution of solar flashlights and rape kits, along with providing better lighting and security patrols have been implemented to protect women in the camps.
While media coverage and relief efforts often focus on immediate support to provide food, water and medical aid, interventions are also needed to prevent the spread of another kind of wound caused by the wreckage — the mental health effects of this traumatic event. The mental stress of the earthquake’s victims must be emphasized and integrated into the reconstruction of Haiti’s public health infrastructure. Hopefully, these needs will be addressed when allocations of the recently pledged $15 billion from the United Nations are prioritized and distributed. In disaster situations, three groups are particularly vulnerable and deserving of aid. The first are those who suffer from pre-existing mental illnesses such as schizophrenia, autism, mood and anxiety disorders. Their illnesses may be exacerbated when access to care and medication is lost. The second and largest group is comprised of those who may develop post-traumatic stress disorder from the devastating nature of the circumstances or whose illness is exacerbated following the event. Measures must be taken to provide these people with interventions and support. The third group consists of the immediate responders who face the horror of traumatic emergency situations and suffer from the emotional consequences of these experiences. Mental health interventions are under way with the assistance of the Pan American Health Organization (PAHO) and the World Health Organization (WHO) that are forming a working group to develop a long-term strategy for a more decentralized system of service delivery, as well as training new mental health professionals.
Another major concern in rebuilding Haiti lies with the estimated 100,000 amputees and the thousands of people with serious wound infections that could lead to amputation in the future. Since an estimated 2% of the population now has an amputated limb, the demand for prosthetics outweighs the incoming supply, and rehabilitation services are limited, innovative solutions must be developed to tackle this new public health problem for the nation. Already in place to aid amputee victims are physical therapy efforts established by Handicap International, Miami University, and Healing Hands in over half of the existing 91 hospital facilities to aid the victims. Experts have suggested establishing a large-scale prosthetic industry and rehabilitation center in Haiti.
Priorities for rebuilding a stronger Haiti start with building the foundation for a modern, sustainable public health infrastructure. The Centers for Disease Control and Prevention (CDC) has described areas of long-term focus that address the need for water and sanitation, health care, food, verifying the status of health care facilities, assisting in supporting health care services, and providing health education to the people of this distressed nation. Social and economic needs, such as building schools, churches, and health facilities, must also be addressed so that aid provides both immediate relief and also establishes the foundation for rebuilding a nation that had only a marginally functioning public health system to begin with.
Since the quake’s strike in January 2010, aid and relief efforts have found their way to Haiti with the help of several countries. An estimated $2 billion had already been pledged internationally in February before last week’s United Nations Donor Conference, which promised an additional $15 billion to provide relief efforts to Haiti. With the help of volunteers from NGO’s including the Red Cross, UNICEF, Save the Children, and other partners, over 400,000 adults and children have been vaccinated against diseases such as measles, diphtheria, pertussis, and tetanus. While cases of acute respiratory infections, acute diarrheal disease, and tetanus have been reported, as of February, the numbers do not reach epidemic standards. The World Health Organization has reported that there are currently no increasing trends in disease outbreaks, and that widespread vaccination campaigns were successful in preventing them. To combat the prospect of a malaria outbreak during the upcoming rainy season, thousands of anti-malarial bed nets have been distributed in addition to programs financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria that have supplied emergency anti-malaria drugs. Long-term goals are also being considered. Last week, Haiti’s Prime Minister and 300 Haitian and international experts at the United Nations Donor Conference presented a post-disaster needs assessment that requested not only food and supplies, but also called for a reconstruction of the country’s social, economic, and health systems over the next five, ten, and fifteen years.
To truly improve the health of Haitians, the social and economic drivers of disease must be addressed. This means providing educational and occupational opportunities for all, as well as establishing a sustainable, modern public health system. The public health lessons learned from this and previous disasters such as the tsunami of 2004 should be remembered and collected to inform future emergency response efforts in other nations. The creation of a web-based global resource bank that includes best practices and protocols in disaster response for all agencies of government, in collaboration with NGO’s, outlining their roles and responsibilities, is needed in order to more effectively respond to events that might occur in the months and years ahead.
As Louis Pasteur said, “Chance favors the prepared mind.” Today as we mark the beginning of National Public Health Week 2010, let us learn from the Haitian experience to help rebuild this country as well as put in place emergency preparedness and response plans to diminish the impact of natural disasters that may occur in the future around the world.
The authors are experts from various international institutions
From the fore going, the fight against drug trafficking should be treated as an international challenge with open collaboration, if the world leadership must win the fight!.
The circumstances or should I say the improvement on drug related activities are modifying and updating on daily basis. A close friend of mine in the United States of America who recently visited Jamaica, came with a lot of complicated information about drug trafficking and transaction. Being a qualified Nurse in US and on a visit to the Reggae Country (Jamaica), she said she was put aback when a man approached her and introduced himself as a Pharmacist. According to her, she immediately picked interest due to her professional background. To her, a business partner is birthed. But she was shocked to the narrows on learning that drug dealers or traffickers and subriquited Pharmacist in that Country. From her account, they ( The Jamaican Pharmacists), are the first set to people to meet and greet you at the Airport. No government or authority challenges them in the open due to the sophisticated nature of their transportation
Come to think of it, who would want to attack a Pharmacist on duty? Nigerians are not left out in the improvement on drug deal. A chat with a confident in the National Drug Law Enforcement Agency ( NDLEA) Rivers State Command, so revealed. The Officer draw my attention to the movement of Dispatch Riders. He said part of the reasons they ride with almost speed equivalent of the thunder lightning, is to meet up with the appointment of delivering hard drug consignment to a client of theirs. According to him, those guys popularly referred to as Yahoo Boys are the ones who now payroll dispatch riders so that they can deliver their consignment ( hard drugs) on schedule no matter the sort of traffic or weather condition. The fear of loosing rich clients and that of the unknown treatment that may come of the Boys, as the officer puts it, drives the Riders crazy thus the reason to speed even at the expense of their lives.
The account of a prominent Party Promoter, Wayne Anthony, as obtained online recently, also pointed out that ‘No Legislation Will Stop Clubbers From Doing Drugs’ Party promoter, Wayne Anthony, arrived in Ibiza, a Spanish Island in 1988, at the same time as dance music and the party drug ecstasy. Despite hallucinating badly enough to make him give up the lifestyle forever, he says laws will never stop clubbers taking drugs. “I don’t think you can control these things,” said former party promoter Wayne Anthony. He arrived in Ibiza in 1988 and began setting up club nights and raves in some of the island’s most iconic venues. In the years that followed, the sleepy Spanish island turned into a raver’s haven of clubbing and hedonism, with party drugs like ecstasy commonly found. “What Ibiza represented was this beautiful, hot island which was visually stunning and we knew you could party there quite legally,” said Wayne. “You didn’t have to look over your shoulder. You could just be as free as you possibly could be.”
That freedom came with a price. Along with the lavish clubs, all-day-benders and hot Spanish sun came drug cartels and crime. The city transformed into one the world’s most vibrant party capitals, “fuelled by a dangerous and lucrative drugs trade which drew as many criminals to its shores as it did party animals”. Wayne, one of the contributors to the documentary, spoke to Sky News ahead of its release.”I’m not going to sit here and say the cartels aren’t there. They are all there and they’ve been there from the ’90s,” said Wayne. But he said most people tried to ignore the organised crime going on around them. According to Wayne, clubbers usually took the approach of: “‘Give me 10 E’s . Behind the scenes of the filming of Ibiza Narcos with Wayne Anthony. Behind the scenes of the filming of Ibiza Narcos with Wayne Anthony. Hallucinating giant spiders Although he described the Balearic island as the “motherland”, it was eventually a bad experience with drugs that convinced Wayne it was time to leave Ibiza.
He’d been partying for days when he realised he’d taken too many drugs. A friend told him to drink cough medicine, dangerous advice that he now says could have killed him. “I saw the worst hallucination I’ve ever seen in all of my life. I ended up locking myself in the villa with all the shutters down. When he sobered up, he realised he had “come to the end” of his party life on the island. “I never looked back. I never took another drug. I got away from the club world.” ‘I don’t think you’re going to be able to stop it’ Despite his life-changing experience, he doesn’t think criminalising drugs is a good idea – or particularly effective. “If you’re old enough to vote for who’s going to be a world leader, if you’re old enough to put your name down on debt for 25 years, I feel like you should be old enough to govern what you put inside your own body, you know?” said Wayne.
Back to Nigeria, some illicit drugs worth over N30billion seized at Onne Port in Rivers State.
This blood chilling development forced the Federal Government to declare a state of emergency at the Onne Port, following what authorities described as repeated incidents of importation of dangerous cargo, including arms and ammunition through the said port. To this effect, the government said it was immediately implementing emergency protocols at Onne Port for the next three months by conducting thorough examinations of all suspected containers in the premises.
The Comptroller-General of Customs, Bashir Adeniyi, in charge of the port via a press conference, said it henceforth, unveiled the seizures of illicit goods by the Nigeria Customs Service, Area 2 Command, Onne in Eleme Local Government Area of Rivers State. In defence for his action, Adeniyi said the recurring incidents posed a threat to national security, adding that the health of citizens at the Onne Port is increasingly being used as a destination for dangerous and illicit cargo, describing it as a disturbing trend.
The customs boss stated, “Earlier today, I joined numerous stakeholders to take a significant step towards the cause of trade facilitation through the inauguration of upgraded facilities provided by the West Africa Container Terminal, Onne. “As I express delight that trade facilitation is getting traction in Onne Port, I cannot help but call your attention to a grave concern. This has to do with the repeated incidents of national security breaches unfolding in Onne Port. I appreciate your presence, as we all have a shared responsibility in safeguarding our national security. As we are all aware, the policy thrust of Mr President supports the re-energising of our business environment to drive faster import clearance and grow our capacity for exports, Our emphasis has been to promote initiatives that speak to Trade facilitation and economic development. “It is a matter of regret that criminal elements in the international supply chain are exploiting our pro-trade stance to commit atrocities bordering on national security breaches”.
“The attempts to test our will through the importation of dangerous cargo through this port has necessitated the declaration of a state of emergency in Onne Port, coming on the heels of a seizure of a huge cache of arms a couple of months ago. It is disheartening that perpetrators have not backed down on their illegal acts. Recent intelligence and seizures have revealed a disturbing trend; Onne Port is increasingly being used as a destination for dangerous and illicit cargo. The scale and nature of these illegal importations pose a significant threat to our national security and the health of our citizens. Today, we are here to showcase yet another series of significant seizures made by the diligent officers of the Area 2 Command. On display are twelve containers of illicit goods intercepted through a combination of intelligence gathering, inter-agency collaboration, and meticulous physical examination. Seizures on Display include: Three (3) x 40-feet containers: Containing 562,600 bottles of 100ml cough syrup with codeine and 3,150 pieces of chilly cutters, with a Paid Duty Value (DPV) of N4,716,573,846.
“Others are, three x 40-feet containers containing 380,000 bottles of 100ml cough syrup with codeine, 24,480,000 tablets of Royal Tramadol Hydrochloride, 5,350,000 tablets of Tapentadol and Carisoprodol, and other items, with a DPV of N17,432,506,000 were seized”.
According to the report, more seized items were, “Five (5) x 40-feet containers; Containing 892,400 bottles of 100ml cough syrup with codeine, 1,300,000 tablets of 50mg Really Extra Diclofenac, 7,250,000 tablets of 5mg Trodol Benzhexol, and other items, with a DPV of N8, 128,568,295,90. This very action of the Nigeria Customs Service, further complicated the hope of how soon the fight against drug trafficking could be brought to a halt owing to its high profile nature.
Another hair-raising report of the illicit drug deal has it that when NDLEA bursted a Snake-Guarded Shrine Used For Storing Illicit Drugs sometime ago in Edo State. This very news report was published in The Tide Newspaper on June 24, 2024. According to the report, NDLEA said its operatives uncovered a shrine, guarded by a snake, being used for storing illicit drugs, during an operation in Edo State. The Agency in a statement by its spokesperson, Femi Babafemi, added that its operatives discovered a specially constructed large hole in a wall, hidden behind wallpapers and fetish objects used for drug storage. It further noted that methamphetamine, Loud, Colorado and Arizona, all strong strains of cannabis with a total weight of 8.743kg among others, were recovered from the shrine.
To be cont’d
King Onunwor
The persistent clash between farmers and herders in Nigeria has been a longstanding issue. These conflicts, often, over resources like land and water, have led to loss of lives, destruction of property, displacement of large numbers of people, deep-seated mistrust between communities and insecurity. Herders, traditionally nomadic, move their livestock in search of grazing land and water. Farmers, on the other hand, require the same resources for their crops. This competition often leads to clashes, especially in areas where land is becoming increasingly scarce due to population growth, climate change, and environmental degradation. As these clashes intensify, there has been a growing call for sustainable solutions. Two weeks ago, President Bola Tinubu took a bold step towards tackling the issue by inaugurating the Presidential Committee on Implementation of Livestock Reforms and creating the Ministry of Livestock Development.
The committee which has the president as the chairman and the former Chairman of the Independent National Electoral Commission (INEC), Professor Attahiru Jega as the deputy chairman has the mandate to address obstacles to agricultural productivity and open up new opportunities which benefit farmers, herders, processors, and distributors in the livestock-farming value chain as well as propose recommendations aimed at fostering a peaceful co-existence between herders and farmers, ensuring the security and economic well-being of Nigerians.The establishment of the Ministry of Livestock Development was part of the recommendations of the National Livestock Reforms Committee. Part of the 21 recommendations submitted to the president include: “This agenda should include the establishment and resuscitation of grazing reserves as suggested by many experts and well-meaning Nigerians and other methods of land utilisation.
“Create the Ministry of Livestock Resources in line with practice in many other West African countries. In the alternative, Federal and State Governments should expand the scope of existing Departments of Livestock Production to address the broader needs of the industry,” among others. Experts in the agricultural sector have posited that the livestock industry can create millions of jobs directly in farming, processing, and distribution, and indirectly in related sectors like feed production, veterinary services, and marketing. It provides livelihoods for rural populations, helping to reduce poverty and improve the quality of life in rural areas. It also increases the Gross Domestic Product (GDP) and foreign exchange earnings through the exports of livestock and livestock products such as meat, dairy, wool and leather.
According to them, a well-funded livestock industry supports the growth of agro-processing sectors, such as meat packing, dairy processing, and leather manufacturing, adds value to raw products and creates additional economic activity as well as stimulates the development of supply chains, including logistics, packaging, and retail, contributing to broader economic growth. It enhances economic resilience by diversifying the agricultural sector and providing a buffer against crop failures or other agricultural shocks and many more. Some other agriculturists have also opined that the livestock industry in Nigeria is currently underdeveloped and that by the creation of the ministry of livestock development will open up the industry which will be a huge money spinner for Nigeria.
Reports have shown that a Livestock Ministry can play a pivotal role in mitigating conflicts between farmers and herders by implementing policies and programmes aimed at fostering coexistence and sustainable resource management. The Ministry can work towards clearly demarcating grazing routes and farming areas. This would reduce instances of trespassing and accidental crop destruction, a common flashpoint for conflict. While introducing rotational grazing systems can ensure that land is used sustainably, preventing overgrazing and land degradation, establishing water points and boreholes specifically for livestock can reduce competition for water resources. Similarly, promoting the development of pasturelands through reseeding and controlled burns can improve grazing conditions.
According to a veterinary doctor, Dr Andrew Obadiah, by providing training for herders on sustainable livestock practices and for farmers on conflict resolution, both parties can understand the importance of coexistence. He said that extension services of the ministry can offer advice on improving livestock health and productivity, reducing the need for large herds and extensive grazing. “Setting up local committees involving both farmers and herders to mediate disputes can provide a platform for dialogue and peaceful resolution. Encouraging community-based conflict early warning systems can help prevent clashes before they escalate”, he emphasised.For Mrs. Stella Ugwu, a farmer, having a ministry dedicated to the development of the livestock industry can help in diversifying income sources for both farmers and herders and in turn reduce dependence on land.
”For instance, promoting agro-pastoralism can provide farmers with livestock and herders with agricultural produce”, she explained, adding that providing incentives for adopting sustainable practices, such as subsidies for fodder production or crop insurance, can ease economic pressures. Ugwu was however of the opinion that the creation of a new ministry to handle livestock affairs was uncalled for, since the job can effectively be done by the Technical and Service Department of the Federal Ministry of Agriculture and food security and its equivalent on the states level.In some countries, the establishment of a Livestock Ministry or similar bodies has shown promising results. For example, Ethiopia’s Ministry of Agriculture includes a dedicated department for livestock which has successfully implemented programmes to improve pastoral livelihoods and reduce conflicts.
In Kenya, the establishment of the National Drought Management Authority has helped manage resources better, thus reducing clashes between herders and farmers during dry seasons.The president of Miyetti Allah Cattle Breeders Association of Nigeria (MACBAN), Othman Ngelzarma, sees the Ministry of Livestock Development achieving the same feat for Nigeria in the near future. He told newsmen that, “MACBAN expresses its deepest appreciation to the Federal Government for creating a ministry of livestock to unlock the trillion-naira livestock economy and create qualitative and productive jobs across the value chain to improve the Nigerian economy. With this development, MACBAN believes the hope of the Nigerian pastoralists is now achieved under the Renewed Hope Agenda.
However, the Middle Belt Forum took a different view of the proposed Ministry of Livestock Development, saying it was not enough to sustainably resolve the decades-long farmers-herders crisis in the country. According to the National President of the association, Mr. Bitrus Pogu, what is needed to end the perennial farmers/herders clashes is a deliberate action by regulatory bodies and the government to stop criminal elements from carrying out deadly attacks on innocent Nigerians, mainly farmers. Hear him: “If the reason for creating the Ministry is to stop clashes, I think it is wrong because all of these attacks and killings that are happening have nothing to do with conflicts between farmers and herders. “Farmers have never connived at any given time to go and attack herders, but rather, criminals who happen to be Fulani gang up and attack farmers, kill, maim and chase them out of their ancestral homes.
“Then, the Fulani will come and occupy them. So, it is more about invasion, criminality, and terrorism. And the majority of those they hire to do these evils are not even those who have cattle. So, a deliberate action has to be taken by the government against the perpetrators, which will address the criminality.” Mr. Pogu suggested that the government should adopt ranching for productivity and enduring peace between the pastoralists and farmers in particular and the entire country in general.While the establishment of a Livestock Ministry presents a viable solution, it is not without challenges. Funding constraints, bureaucratic inefficiencies, and corruption can hamper its effectiveness. Additionally, deeply ingrained cultural practices and mistrust between farmers and herders can be difficult to overcome.
Critics argue that without a holistic approach that includes land reform, climate change adaptation, and broader economic development, a Livestock Ministry alone may not be sufficient. Therefore, it must work in tandem with other governmental and non-governmental bodies to ensure comprehensive solutions. “A dedicated Livestock Ministry, with its focus on sustainable resource management, conflict resolution, and economic incentives, offers a promising avenue to address the root causes of these clashes. However, its success depends on effective implementation, adequate funding, and the cooperation of all stakeholders involved. With the right strategies and commitment, devoid of any political or selfish interest, it can play a crucial role in fostering peace and prosperity in affected regions”, they advised.
Calista Ezeaku
