Among the chief concerns is exposure to asbestos, which was commonly used for insulation in the era when many of the 7,000 buildings damaged or destroyed in the April 27 tornado were built. Inhaling asbestos fibers can cause serious lung damage, but no air quality testing is being done in the area.

‘We’ve had folks that have come in with a lot of foot injuries from stepping on nails, folks with cuts and scrapes from branches and sprained backs,’ said Brad Fisher, spokesman for DCH Regional Medical Center. ‘But as far as exposure to asbestos, while it might be occurring, we don’t have any record of it.’

More than 13,000 volunteers have flocked to Tuscaloosa to work with the tornado-related cleanup. their tasks vary from clearing debris to sorting donations, but each person goes through brief safety training, according to LaDonnah Roberts, Tuscaloosa area coordinator of volunteer resources.

‘Obviously, people working the cleanup need to take appropriate precautions and wear safety gear,’ Roberts said. ‘What type of safety gear depends on the specific task.’

Holt resident Thad Garner said that with all the debris in his neighborhood, he’s concerned about what might be in the air and how that might affect people working the cleanup. ‘After just breathing the air near the debris, I start coughing and coughing for an hour,’ he said.

Sonya Chapin, the clinic manager at American Family Care, said they have seen more patients with allergy symptoms and respiratory problems, as well as an increase in children with asthma complications. she also said more people have been diagnosed with bronchitis and pneumonia, both of which are rare this time of year.

Chapin said most people they have treated live in or near the affected areas, or have been working there.

The increase in patients began about a week after the storm and continues, Chapin said. she said she expects the increase to continue as more debris is moved, releasing dirt and dust particles into the air.

Workers at other local clinics and doctors’ offices reported seeing an increase in people from affected areas complaining of coughing and chest congestion, but they said no definite link can be made to debris or other environmental contaminates.

If working with debris outdoors, people should wear long pants, long sleeves and hard-soled shoes like boots, Roberts said. Thick gloves, eye protection and masks are also recommended, as well as sunscreen and in some cases, hard hats. People should also consider getting tetanus shots, which are being given at the Tuscaloosa County Health Department.

All volunteers going out to clear debris are given masks and gloves as part of the training, Roberts added.

Volunteers are also trained to look for asbestos. ‘But, it’s not something we are aware of or have seen,’ Roberts said.

According to the Centers for Disease Control, exposure to asbestos can occur when buildings containing asbestos are being torn down. Asbestos is a fibrous, heat-resistant material that was previously used in construction materials like roofing shingles, ceilings and floor tiles. The use of asbestos was banned by the Environmental Protection Agency in 1989, but it’s still often found in older buildings.

According to the CDC, asbestos exposure can cause serious lung problems and cancer. but prolonged exposure to asbestos is usually required for long-term health effects, which usually won’t show for years.

The Alabama Department of Environmental Management does regular air quality tests at its testing site in Duncanville. but no specific tests for asbestos have been done because of the tornado and none are planned, said Ron Gore, director of the air division of ADEM.

When buildings are being demolished or renovated, only standing commercial buildings are regulated for asbestos removal, not residential structures, Gore said.

‘Single-family homes aren’t regulated,’ Gore said. ‘During normal situations, the amount of asbestos in a home is considered very trivial.’

To reduce the chances of asbestos in the air, ADEM recommends that all debris should be soaked with water before removal. Workers should be properly clothed and should wear masks.

Reach Lydia Seabol Avant at 205-722-0222 or lydia.seabol avant@tuscaloosanews.com. Staff intern Laura Metcalf contributed to this report.

AS IF a cholera epidemic were not enough, Haitian health authorities are investigating the sudden deaths of more than a dozen people after a voodoo ceremony and a deadly spate of paralysis in recovering cholera patients.

Ariel Henry, chief of staff of the Haitian health ministry, said epidemiologists were sent to the town of Fonds Baptiste, about 30km from Port-au-Prince, to investigate the large number of sudden deaths there.

"the victims were said to have died suddenly after being seized with strong migraines, vomiting and struck blind," Dr Henry said, recounting reports from witnesses.

A nurse contacted by telephone said 16 people had died since the start of the week in the town.

Dr Henry put the number of deaths at about a dozen, while Daniel Epstein, a spokesman with the Pan American Health Organisation, said the exact number had not been determined yet.

"we are investigating two groups of deaths … that occurred after a voodoo ceremony," Dr Epstein said, adding that they appeared to be from poisoning.

They may have consumed a homemade alcohol, or eaten fruit from the ackee tree, which contains a toxic compound that can be fatal if the fruit is not harvested and prepared correctly, he said.

Another doctor, who asked not to be identified, suggested the cause of death was probably ethanol poisoning."the first data gathered show that they had drunk homemade brew," he said.

In a separate medical mystery, the Pan American Health Organisation said Haitian and international health authorities were looking into four cases of paralysis in recovering cholera patients in the town of Port-de-Paix.

Three of the four patients died, and one is slowly recovering in a hospital in Port-au-Prince, it said.

"These patients, hospitalised for severe cholera, presented an ascending bilateral flaccid paralysis of acute onset 24 to 72 hours after the end of the cholera treatment," the agency said.

The cases were first reported on January 10 in Haiti’s Nord-Ouest Department.

"all of the cases were seen at the same cholera treatment centre and returned 2-4 days later with neurological symptoms, at which point they were hospitalised," the agency said.

"Experts including toxicologists are investigating possible contamination at a hospital or at home from medication, food, or another source as the cause of death in these cases," it said.

"Although considered highly unlikely, polio has not been completely ruled out, pending laboratory results of samples," it said.

The experts do not believe it is polio because the disease rarely causes death.