ARTICLE - CHOLERA CONTINUES TO SPREAD

CHOLERA CONTINUES TO SPREAD WITH CASES OVERWHELMING MEDICAL FACILITIES
(http://www.msf.org.uk/)

To date, MSF teams have treated more than 15,000 people for cholera and cholera-like symptoms, and the organisation is anticipating that the spread of the bacteria will not stop soon.

MSF has deployed more than 150 international staff who are working alongside 1,000 Haitian staff to run cholera treatment programmes, maintaining a capacity of more than 1,000 beds across the country.

While continuing to scale up our ability to treat growing numbers of patients, MSF is also urging other organisations and actors who have the capacity to get more involved in the medical, hygiene, water and sanitation, and communications efforts needed to counteract the outbreak.

"Simply put, other actors need to get more involved because the needs are far too great to be covered solely by the organisations currently working to prevent and treat cholera,” said Stefano Zannini, MSF Haiti head of mission. “Both the short-term and long-term forecasts indicate that this situation will get worse, possibly far worse, before it gets better.”

According to the Haitian authorities, the official death toll is already nearing 1,000. In some places in the north, and elsewhere in the country, hospitals continue to admit suspected cholera cases above their bed capacity. Ensuring clean drinking water, waste management, and safe burials is yet to be developed or implemented, undermining effective prevention and treatment efforts.

“When people have finished their treatment and they leave the centres, they go back to what is potentially a cholera infected area,” said Zannini. “Here in Port-au-Prince, 1.4 million people are still living in camps, where hygiene, sanitation, and clean water are often scarce. These 1.4 million people depend mostly on humanitarian aid groups for clean water. Infrastructure is weak and it’s very difficult to get medical aid and water to all of these people.”

The situation in the north of Haiti remains extremely serious. MSF teams working in the region are overwhelmed by the needs of the many new patients arriving at facilities in Cap Haitien, Port de Paix, Gonaives, and Gros Morne every day. Fears persist in the communities, including in Port-au-Prince, over the presence of cholera treatment centers (CTCs), in spite of their importance to immediate lifesaving measures against the epidemic.

“Minutes can make a huge difference in cholera treatment,” said Danielle Ferris, MSF project coordinator in Martissant, one of the biggest slums in Port-au-Prince. “We had one little girl who was about two years old. Her family had traveled in the Artibonite region and she was very ill when she came in. We treated her by intravenous drip, and about four hours later she was alert and moving around, which just shows how treatable cholera is if you’re treated quickly enough.”

In the lower Artibonite region, where the outbreak started, MSF teams in Petite Rivière and St. Marc are still very busy. While there are some indications of the epidemic possibly stabilising, the CTCs in both places are at capacity. The caseload in Dessaline, however, is still increasing; 177 people were admitted on Friday and a 280-bed capacity facility is being built. In general, as in the north, it is still difficult to reach remote areas to offer treatment where it is needed. MSF has resorted, in some cases, to dropping materials from helicopters to support some local health centres.

In Port-au-Prince, the picture remains chaotic and troubling. The Cite Soleil neighbourhood, a sprawling slum, is essentially the frontline of the outbreak in the capital. Efforts are underway to increase admissions to 250 per day at the MSF-supported, Ministry of Health, Choscal Hospital. People presenting with severe symptoms are transferred to CTCs in MSF facilities in the nearby Sarthe and Tabarre neighborhoods. Teams are also looking for another place to construct a cholera treatment unit (CTU) in the neighbourhood.

“We have very little space,” said Javid Abdelmoneim, an MSF doctor working in Cite Soleil.

“With the permission of the hospital director we have taken over the car park of Choscal Hospital and set up the cholera treatment tent there. That was the last available space that we could use that is isolated from the rest of the hospital, which is crucial to maintaining an infection barrier.”

Tremendous risk factors remain, such as the fact that most water in Cite Soleil is not chlorinated.

In Cite Soleil, MSF provides approximately 280,000 litres of water per day, enough drinking water for an estimated 14,000 people but far below the requirements of the neighbourhood’s inhabitants. Few organisations are filling the gap.

Already, MSF’s CTCs in Sarthe (70 beds), Tabarre (200 beds), and Carrefour (112 beds) are occupied. New facilities are planned for Sarthe (another 320 beds), St. Louis (18 beds), and Delmas 33 (100 beds). Teams have also developed a plan to increase capacity at the facility in Bicentenaire, from 75 beds to upwards of 370 beds, if necessary.

Fortunately, for the moment, the situation in the south of the country has not yet become as serious. MSF teams in Leogane are seeing an average of one patient per day, and staff in Jacmel have not received any patients as of yet.

MSF cargo planes arrived in Haiti on Sunday and Monday to bolster supplies.

A video update from MSF teams in Haiti is available here.