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
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.
- 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 Hispanola.
- 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)
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.
- 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)
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
- 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,”
- Hurricanes Michelle (November 2001), Isadore (September 2002) followed
by Lili (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
- 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.
(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,
(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
(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.
(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
(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.
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