The Panama Canal is renowned worldwide for the tremendous commercial impact it has made for the countries that use it. It is also the main source of income for the Republic of Panama.
Since the grand opening of this unique interoceanic waterway one hundred years ago on August 15, 1914, the Panama Canal has had a huge impact on world trade by shortening the distance of travel between trading nations. The opening of the Panama Canal sparked a worldwide explosion of commercial and economic exchange by offering a shorter route and cost effective trade between nations.
The result has been a decisive influence on the patterns of world commerce that has stimulated the economic growth of both developed and lesser developed nations. The Panama Canal has also provided the sought after stimulus for economic growth in even the most remote regions of the world.
In 2007, the Republic of Panama began construction of a new set of locks that would accommodate the interoceanic transit of Post Panamax ships. At a cost of more than 5 billion US dollars, once completed the new locks will keep pace with the future of interoceanic trade and allow commerce to continue its growth worldwide.
On August 15, 2014, the world celebrated the 100 year anniversary of the opening of the Panama Canal and all the benefits to world trade that have resulted. That date also marked the 100 year anniversary of the influence of the Panama Canal on the public health of the Americas.
Early historical documents paint a picture of the isthmian region that is in stark contrast to what we find today. For centuries prior to the Panama Canal, the isthmus of the Americas was a place of widespread transmittable diseases that made the countries in the region inhospitable to humans. Often leading to death, such diseases included not only malaria and yellow fever, but also pneumonia, tuberculosis, nephritis, dysentery, typhoid, diarrhea in children, and leprosy.
Discovering how to control and eventually eradicate the spread of many of these diseases became a primary concern for canal engineers who knew that the construction and successful completion of the Panama Canal depended on it. The result was a major initiative to create a public health and sanitation program that included providing the isthmian population with sewage treatment, water drainage, clean potable water, more water wells, and even sidewalks with gutters. All of these measures were new to the region, but they generated a huge impact on the country’s health as a nation. It is important to remember that many of the early sanitation efforts were aimed at successfully completing the Panama Canal, and these early efforts were the beginnings of good health and sanitation that exist throughout the Americas today.
On May 29th of this year, Dr. Jorge A. Motta, research associate at the Gorgas Health Institute, was a forum speaker at the 100 Years of the Panama Canal: A Centennial of Contributions to Global Health conference. Noting the nation’s socio-economic status, Dr. Motta stated that between 1904 and 1916, the main causes of death in hospitals in the region were due to yellow fever, tuberculosis, malaria, trauma, nephritis, dysenteries, heart diseases, typhoid, diarrhea in children, and cancer.
The Rise, Decline, and Legacy of Yellow Fever
In a forum organized by the University of South Florida, Dr. John McNeil from Georgetown University stated that yellow fever was first introduced to the region through the European plantation agriculture system of growing sugarcane for export and also the building of harbored cities in Panama City and Colon. The disease, however, proliferated out of control because of the region’s warm and wet climate. That climate was a favorable to the disease vector soon discovered to be a particular breed of mosquito.
Dr. McNeil further stated that the human costs of yellow fever were always high. Between 1647 and 1905, thousands of young teenagers lost their lives to the disease. Death rates were particularly high in clustered populations, such as cities, army installations, and among ships crew. However, people born and raised in less populated endemic zones were less affected by the disease.
During the French attempt at building the Panama Canal between 1882 and 1889, yellow fever accounted for 25% of the annual mortality rate among European labor, while labor from Jamaica and Barbados were far less affected.
In 1881, Cuban researcher Dr. Carlos Juan Finlay hypothesized that the disease was transmitted by means of an intermediary agent identified as the Aedes Aegypti mosquito. Finlay announced his hypothesis at the International Health Conference in Washington DC.
Later that same year, Dr. Finlay proved his hypothesis through experiments with Cuban volunteers, and notably observed that individuals who were bitten only once by an infected Aedes Aegypti developed an immunity to some of the symptoms of yellow fever. This observation led to the development of a serum to combat yellow fever.
For almost 20 years, Dr. Finlay’s research went virtually ignored by the scientific community, until the end of the Spanish American War, when Cuba’s Governor Leonard Wood called for a more detailed review of Finlay’s research and continued experimentation.
In December 1898, Dr. William Crawford Gorgas was named Cuba’s Superior Health Chief, and the Commission on Yellow Fever was directed to continue Finlay’s groundbreaking discoveries. The commission set about to isolate infected individuals and to eradicate the Aedes Aegypti mosquito through public works projects. In less than 8 months, the prevalence of yellow fever virtually disappeared from Cuba.
Dr. Gorgas was then sent to the Panamanian Isthmus to apply the same procedures that had proven to be so effective in Cuba. The procedure worked a second time, allowing the Panama Canal to be completed. A plaque stands today on the grounds of the Panama Canal Administration Building commemorating Dr. Finlay’s early discoveries and his contribution in the construction of this world class mega project.
The strategies and methods to fight malaria and yellow fever that were so successful in Panama were replicated in other parts of the region with equal results.
The Legacy of Other Public Health Interventions
Dr. Motta also stated that the arrival of Dr. Gorgas signaled the beginning of not only eliminating the threat of malaria and yellow fever on the isthmus but also to provide first class hospital care for infected individuals. Hospital Santo Tomas soon went into full operation caring for canal workers as well as people of from all walks of life, and this had a great impact on the health and well being of the nation as a whole.
Other public health projects that quickly got underway were Panama’s first clean water plant, sewage treatment facilities, and a system for garbage collection.
Public Health Policy
Many of the policies, projects, and strategies improving public health in Panama at the time of the construction of the Panama Canal were replicated in other counties in the region. Dr. Mirta Rose Periago, Director Emeritus of the Pan American Health Organization , says that Panama’s role as a model for other nations should never change.
In a forum moderated by Dr. Periago, entitled Innovative Interventions to Create Adequate Public Policies that Guarantee Improvements to the Regional Health Index, Dr. Periago stated that Panama’s health policy objectives at the beginning of 20th Century were to control transmittable diseases so that Panama could empower a global market and aid the development of other nations. However, Dr. Periago went further to say that in the 21st Century the focus of politics and policy should be on maintaining the free and healthy circulation of people now that Panama has become an important transit zone.
The Republic of Panama’s public health policies are now a legacy, and the legacy continues more than a century later. Since 2005, health and safety along the Panama Canal has been guided by International Health Regulations, which has made Panama the sentinel for public health in international events and assures the good health of Panama’s citizenry, labor force, and tourists by promoting research and sharing information. In so doing, health and safety in Panama continue to be a top priority for the nation, the region, and the world that transits the Panama Canal.
In his commemorative speech at the 100 Years of the Panama Canal: A Centennial of Contributions to Global Health conference, Dr. Jorge A. Motta stated, “Public health improvements have become one of Panama’s greatest legacies over the past century. Without health, the Panama Canal would not have been completed successfully. Without health, we could not have built the country we wanted.” One hundred years of Panama Canal influence on the public health of the Americas continues.