ARTICLE - STRUGGLES IN PREVENTION

GLOBAL VOICES: HAITI STRUGGLES TO PREVENT CHOLERA'S SPREAD
(Toronto Star) - By Craig and Marc Kielburger, Global Voices

Angeleno wears rubber boots, thick gloves and a blue medical gown as he piles rubbish under the hot, Haitian sun.

Beads of sweat appear around his facemask, but he’s thinking of Jamanese.

Jamanese is unlike the other 60 cholera victims Angeleno cleans up after at the Zanmi Lasante hospital in Hinche.

She is his wife.

“I rushed home immediately and the woman I saw was so close to death,” he says, recalling the day he learned Jamanese was ill. “It almost seemed pointless to take her to the hospital.”

Angeleno saw how quickly cholera works. In the morning, Jamanese was fine. Smiling and bright, Jamanese was about to go into town to sell fruit just like she has for the 20 years they’ve been together. During that time, they raised two children ages 18 and 14.

Hours later, Jamanese was severely dehydrated and lifeless.

After four days, she is still alive, but motionless with an IV attached to her wrist. Her cot is under a tent that’s cordoned off from the rest of the hospital grounds. Yellow caution tape and a crude fence separate the cholera victims. Among them are children who lie motionless and an elderly man whose ribs are visible through his back as he sits up to be changed.

The makeshift “ward” looks like a field hospital. It’s not stigma keeping doctors from moving victims inside. They just can’t afford an outbreak in the HIV/AIDS ward or among the malnourished infants.

Treatment is just half what the doctors do. They’re also in the business of prevention.
Unfortunately, a lack of progress on reconstruction across Haiti has made the hospitals the only place where prevention is possible.

“We need more blues!” yells Dr. Prince, the hospital director. He’s running short on the medical gowns his staff wear to prevent contamination.

They change frequently and the “blues” are discarded. Angeleno adds them to his pile before setting it on fire just metres from his wife’s bed. Meanwhile, a mother admits her limp toddler.

“The evolution isn’t good. We’re seeing many more cases,” says Dr. Prince. Since Oct. 23, when the hospital saw its first case of cholera, they’ve treated more than 1,850 patients. “They just keep coming and coming and coming.”

This hospital has contained the infection to its rudimentary ward. But, the community simply doesn’t have that luxury.

Before the earthquake, only half of Haiti’s population had access to sanitation and one-third had clean drinking water.

In the 11-month-old refugee camps like the one just down the road from Zanmi Lasante, no one does.

About 90 people live in this small grouping of tents, set up like a suburban block. From the tent’s awning at Iman’s which constitutes her front porch, you can see bright plastic flowers she decorates with. She shares a clothesline with her neighbour, Ophelia, who lives with her husband and four children.

The family sleeps side-by-side on the ground each evening amid cooking pots and a bag of USAID rice. Although crowded, Ophelia says they took in neighbours during Hurricane Tomas when the strong wind uprooted tent pegs and the heavy rain crushed the shelter.

It’s a community. It just doesn’t have the infrastructure.

“There is no water, no bathrooms,” says Ophelia, as she sits outside her tent. “We are here, but we don’t have anything.”

Miraculously, Zanmi Lasante has only seen 21 deaths of the nearly 2,000 cholera cases. But treatment isn’t as effective as prevention. With patients constantly entering the hospital gates, it will soon be oral rehydration salts, IV needles and antibiotics in short supply along with the “blues.”

Angeleno knows these limits. That’s why he takes care putting on his gloves, boots and medical dress before beginning work. Jamanese is attached to an IV, but after four days is still vomiting, experiencing diarrhea and barely opening her eyes.

“Only God knows if she will be okay,” says Angeleno. “But even when we have someone who dies, we have no way of bringing them to the cemetery.

“I’ll just keep working and taking care of her at the same time.”

Marc and Craig Kielburger are children’s rights activists and co-founded Free The Children, which is active in the developing world. Their column appears Mondays online at thestar.com/globalvoices.