BIOSURVEILLANCE UPDATE - 15

OPERATIONAL BIOSURVEILLANCE

Current official stats are more than 12,300 cases and nearly 800 fatalities.

In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%.

There is no question of under-reporting. If we assume the case counts are 1/4 the true community load, then we now have nearly 48k cases shedding pathogen into the environment. We believe the true statistic to be closer to more than 60-70k based on the degree of under-reporting. It is extremedly difficult to estimate the true scale of this epidemic now. This is a grossly uncontrolled, uncontained epidemic of cholera that has exceeded public health capacity to investigate and assess every site reported and every sample received.

Evidence now suggests the epidemic has crossed the border into the Dominican Republic, which was expected.

NAN DUFOUR REGION: IDIS CAT 4 CONDITIONS

From HEAS partner working in the remote mountainous region of Nan Dufour:

...situation stabalized at our Pont Matheux Center, now experiencing outbreaks in our outpatient centers of Leger (60 cases in the last 36 hours), Fond Baptiste (13 cases in the last 24 hours).

We are anticipating similar outbreaks in the Source Mattelas and Bellanger centers soon, based on preliminary reports from our health agents in the area.

We have done OK so far and must have some additional supplies and personnel very soon. The latter are expected very shortly. If they do not arrive, I will let you know and we will need assistance. These centers are NOT equipped for this type of emergency. In anticipation we had stockpiled ORS and related treatment supplies, but we cannot keep up with the current patient flow for very long.

LA GONAVE: IDIS CATEGORY 4, POSSIBLE 5

From one of the HEAS partners:

Cholera now hits the island of La Gonave, Haiti. The only functioning hospital on the island is filled to capacity. There is insuffiicient medical staff to treat those affected. Newborn babies and their mothers are dying. The Hurricane has destroyed some of the flimsy homes built after the earthquake.

CASALE: SURGE OF PATIENTS REPORTED

From HEAS partner in Cazale:

Patients are arriving at 10pm on motorcycles with vomiting and diarrhea. We are not really set up to be a cholera treatment center. Located in Cazale (near Cabaret-NW of PAP off National Highway 1).

We are attempting to get more details now.

CAP HAITIEN REGION: GRID LEVEL MEDICAL RESPONSE STRAIN

From HEAS partners in the North (selected exerpts). The HEAS community has been alerted and attempting to assist, assets being mobilized Stateside to assist as well. MSF is heavily involved. Region remains an IDIS Cat 5.

For the 1st time in my life I see Dr. [redacted] so upset and frustrated due to lack of resources for prevention and treatment.

The first few cases in Cap-Haitien were found in Plaisance, Limbe, Cite Chauvel, Champin, CONASA, and Fougerolles the 22 and 23rd of October. 90% of cases are in the CONASA area, a very dense area. Those cases resulted from the mismanagement of 3 year old girl cholera victim corpse during the funeral.

The major challenge is stigmatization and even the medical staff fears to intervene. Doctors Without Borders is hiring staff to hep at the Cap-Haitien Gymnasium so far nobody has applied for those paidpositions. Even medical staff fears to accept these positions. Dr. Jasmin wants to mobilize resources for [education] campaigns which will reduce discrimination and stigmatization of those infected...

Meeting Notes:
22nd October – first case in north – Ba Mer Limbe

After two weeks, we started receiving patients from Concorde in Cap.

90% of patients received at the gymnasium have been from outside Cap Haitien.

Youngest death: age 3

The 2 hospitals in Limbe are both at maximum capacity. There is a lack of medication.

The gymnasium in Cap is full (852 people diagnosed; 70 deaths to date) (next to Justinien Hospital)

Main problems identified within community:

Not enough clean water – people forced to drink infected water. MSPP trying to instigate system to treat this water. Are looking at creating a chlorine-treated reservoir (300 gallons)

Canals are full after heavy rainfall therefore nowhere for dirty water to drain to

People are afraid to help each other as they are afraid of it spreading

Using tv, schools, church as means to educate and advise the communities, but feel this is not enough as not enough people are accessing these services. Would like to action a megaphone campaign on the streets.

We need to come together as one so we can make a difference in fighting the cholera. We will have to fight many battles and will lose people along the way. But we should come together to find a solution.

Comment: Water has become expensive and difficult to find. People are anxious.

If the spread continues at this rate, it is estimated that 10,000 people in the north will be affected within the next few months.

The Mayor's comment : understands the problems. Gave example of patient treated for cholera but was negative – later died.

Need more tents to be able to treat more people. Difficulty in getting hold of more tents – Haiti cannot provide them themselves. The UN have money reserved for the Director of Healthcare/MSPP but have not received it yet.

Discussion on where to accommodate patients: tents, rooms for temporary use – no decision made

There are 300 water systems ready to go – costing HT$2,500

Trying to get more trucks of treated water but cost HT$600 per truck (some HT$300)

MSF: "ALL OF THE HOSPITALS IN PORT-AU-PRINCE ARE OVERFLOWING"

FROM MSF:

The epidemic has taken grip in Port-au-Prince, and while MSF teams are scaling up capacity to 1,000-beds in locations throughout the city, the numbers of cases is already overwhelming MSF and public medical facilities.

Stefano Zannini is the Head of Mission for MSF in Haiti. Here he gives a first-person account of the situation on the ground for MSF teams responding to the spread of the outbreak in Port-au-Prince.

It’s a really worrying situation for us at the moment. All of the hospitals in Port-au-Prince are overflowing with patients and we’re seeing seven times the total amount of cases we had three days ago.

In the slum of Cite Soleil, located in the north of the city, yesterday we recorded 216 separate cases of cholera arriving at the hospital, while the total number recorded just 5 days ago was 30.

Patients are coming from everywhere, throughout the city, slums and wealthier areas. At the moment we have 400 beds set aside for the stabilization and rehabilitation of patients and we’re hoping to get that up to 1,000 by the end of the week.

But we are really worried about space. If the number of cases continues to increase at the same rate, then we’re going to have to adopt some drastic measures to be able to treat people. We’re going to have to use public spaces and even streets. I can easily see this situation deteriorating to the point where patients are lying in the street, waiting for treatment. At the moment, we just don’t have that many options.

We’re looking for alternative spaces, but you have to remember what the situation in Port-au-Prince is like. Since the earthquake, every available space that wasn’t damaged has been filled by camps where people are living in extremely precarious conditions. Just to find an empty area in this city is a major logistical challenge, so for us to find room to treat people is very complicated.

At the moment we have more than 100 international staff and more than 400 Haitian staff working in the cholera treatment centers throughout the country, but it’s just not enough. More medical staff are arriving, but there’s a chronic lack of personnel here in Haiti and we are close to being overwhelmed. Our teams are working 24 hours a day and tiredness is becoming an issue. Our teams are already stretched and are very stressed from the workload. Working inside a cholera treatment centre with the smell, the noise and the pressure of so many patients is not easy. But we will keep on providing treatment.