MFK Partner and Earthquake Survivor Dr. Iannotti Returns Home, Pens Op-Ed Piece

Dr. Iannotti, Washington University Assistant Professor of Public Health, was in Port-au-Prince when the earthquake struck to promote a research study with Meds & Food for Kids. She survived “by chance alone.”

Dr. Iannotti documents her experiences—-and the ensuing public health crisis—-in an op-ed that was released today. She mentions the imperative to get Medika Mamba in the hands of Haiti’s swelling ranks of malnourished children.

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Haiti’s darkness could dawn a brighter future
By Lora IanNotti
01/21/2010
By chance alone, I survived the devastating earthquake in Haiti. I happened to be eating an early dinner with colleagues at a patio restaurant instead of in our guest house, which was leveled.

I was in Port-au-Prince and rural Leogane, also ravaged, to conduct research on malnourished young children. After the quake struck, our small team of nutritionists made our way to Doctors Without Borders to help dress wounds, fill syringes and make cardboard splints for the broken bodies of thin children with frightened, vacant eyes.

Instead of imagining their futures in strong, well-nourished bodies, we could only wish for their survival.

That’s still my dream — and one we can achieve if we also see this tragedy as an opportunity to rebuild lives and Haiti, where I’ve lived and worked over the last 20 years.

In my view, this crisis will unfold in three distinct phases. The first, of acute emergency care, is over; 70,000, perhaps thousands more, did not survive.

The second, which we’re now experiencing, is driven by basic needs for clean water, food and shelter. Many more will not survive this phase, even as humanitarian workers labor around the clock, since Haiti’s infrastructure nearly was non-existent before the quake.

The final phase will be a crisis of public health — both my area of expertise and my deepest concern.

By preparing for this crisis now, we’ll save the lives of several thousand young Haitian children and alter the life prospects of hundreds of thousands more.

Prior to the earthquake, one in four children was stunted and one in five was underweight. We know with certainty that these forms of undernutrition predispose children to infectious disease mortality, especially diarrhea. Being underweight doubles the risk of death from diarrhea and, in severely malnourished children, increases the risk by three- to nine-fold. Haitian children also suffer from inadequate zinc nutrition, which is critical for recovery from diarrhea. Sanitation conditions and access to clean water are deteriorating rapidly in Haiti and heightening the chance for outbreaks of cholera and other forms of acute diarrhea and dysentery.

Anemia is another major public health concern in Haiti: roughly two-thirds of children, and nearly half of women, are anemic.

Anemia in developing countries usually results from a lack of iron in the diet, parasitic infection, including helminthes and malaria, and chronic inflammation. Anemia leads to compromised cognitive and physical development in young children, poor birth outcomes in pregnant women and, in some severe cases, increased risk of mortality.

The night after the earthquake, we slept in an open field in Leogane along with Haitian families, many of whom were lamenting the loss of Mardi Gras celebrations and the closing of their schools.

I had seen devastated schools, trying hard not to imagine what lied beneath the rubble, but that night I realized that this, too, was a public health crisis.

Anyone working in public health knows that education strongly correlates with every positive health and livelihood outcome. Only two in five Haitian children graduate from primary school, while one in five receives no education at all. But that was before the quake, before their schools were felled.

What can be done? We must improve sanitation and, of course, ensure access to clean water for drinking and washing to prevent diarrhea. Those who succumb to diarrhea should receive oral rehydration therapy and zinc. Foods provided should meet both basic energy and micronutrient needs. Particularly promising is ready-to-use Medika Mamba, a peanut concoction manufactured in northern Haiti that is dense in both calories and micronutrients and resistant to bacterial contamination, making it ideal for preventing undernutrition and recovery from severe malnutrition.

Over the long term, we must persist in our efforts to improve nutrition, vaccinate, de-worm, prevent infectious disease, promote education and reduce poverty in Haiti.

Thanks to the superb efforts of the U.S. embassy and military, I was able to return home. My experience in Haiti last week is beyond description, an unspeakable horror. But what terrifies me more is that the world will forget this small, already desperately poor country as it now faces the exponentially worsened problems of public health.

Like the tireless, unheralded Haitian doctors and nurses I briefly worked alongside, let’s make a commitment to stay with them through many more dark nights to come — and through the dawn of their historic opportunity to thrive.

Lora Iannotti is an assistant professor at the George Warren Brown School of Social Work at Washington University. She also is a scholar at the University’s Institute for Public Health.