I attained a small bit of fame this week when I was contacted by both the Star Tribune newspaper and WCCO TV (links to both articles) to explain what happened to 72 bottles of DEET that I had tried to transport to Haiti for use by pregnant women at a birthing center in CapHaitian, Mama Baby Haiti. Unfortunately, both articles chose to focus on the interaction with the airline and not so much with what I was trying to accomplish in getting bugspray to a population that was sorely in need of the product.
The birthing center sees 100 women each week for prenatal care, the majority of whom are too poor to pay for their services beyond a few dollars to enroll in the program. These women spend their waking hours outside the confines of their small, lightless homes preparing food over open fires, carrying potable water and washing clothes in the closest river. Unlike the mosquito that transmits malaria, the Zika mosquito is most active during the day, thus putting pregnant women at high risk of being exposed. According to the CDC, the best method to prevent infection is use of a product with 40% DEET. Unfortunately, our shipment was turned away at the check in desk due to a perceived risk of combustion.
The reaction in the US, especially in my northern state of Minnesota, has been that pregnant women have cancelled vacations to Caribbean locations and Mexico. If they may have been exposed, the CDC is offering free testing and their insurance companies will pay for fetal ultrasounds. If a fetal malformation such as microcephaly is found early enough in the pregnancy, the woman has the option to terminate the pregnancy. If a child is born with this malformation, many social services are available to the parents.
Contrast this with the plight of a pregnant Haitian woman. She spends her daily life in a country that is part of the endemic zone. No testing is available to determine if her unborn child is at risk, abortion is illegal and social services for the care of a child with microcephaly, the neural defect thought to be a consequence of infection with Zika virus, are non-existent. Increasing awareness , while not providing resources, is ethically a poor decision.
Countries such as El Salvador have gone so far as to recommend that women delay pregnancy for 2 years or until the Zika virus risk can be better understood. As a predominately Catholic country, birth control options are very limited and abortion is illegal. Women in this Central American country have been jailed in the past for miscarriages and stillborns, due to concern that they may have had a part in the unfavorable end to their pregnancy. What may be the outcome if their child is born deformed?
Caribbean nations such as Haiti depend on tourism as the main source of income, especially during the winter months. The perceived risk of Zika infection, even to those tourists who are not pregnant, are causing many to cancel their holiday plans. This further destabilizes an already fragile economy.
Each time I am asked to write a letter for a pregnant patient that has decided to cancel her warm vacation, I think about pregnant women in Haiti and other countries, hoping that new preventive efforts will be soon found and they will have one less worry in their lives.