BIOSURVEILLANCE UPDATE - 19

OPERATIONAL BIOSURVEILLANCE

PAHO VALIDATES THE NEED FOR THE HEAS

PAHO’s Dr. Sylvain Aldighieri...noted that current priorities are improved surveillance and risk assessment, with timely identification of “hot spots” triggering quick responses, good case management, logistics and supplies, and information and social communication to educate people on care. Dr. Aldighieri said he was especially concerned about cholera in remote rural areas with difficult access, noting that estimates show one-third of community deaths from cholera are not being reported.

18 November 2010
Dr. Sylvain Aldighieri
Pan American Health Organization
Organization of American States
Washington, D.C.

CHOLERA IN SAINTE-SUZANNE

Multiple cases of cholera and one fatality has been reportd in Sainte-Suzanne, where there is one small clinic without supplies. HEAS is awaiting confirmation of response accept from AmeriCares.

COMMENTARY: A SNAPSHOT OF THE SURVEILLANCE AND RESPONSE LOGISTICS DISASTER IN HAITI

In this post we are deliberately and specifically using the term "disaster" to describe the backlog of medical materiel at all Haitian airports, not just Port au Prince, due to customs.

We are also deliberately using that term to describe PROMESS and the associated bureaucratic procedures that prevent timely deployment of resources, which includes the entire logistic chain from registration of an NGO with the warehouse all the way to receipt of supplies. PROMESS itself has requested emergency supply support, which is indicative of just how serious this situation is.

We are inundated with complaints from responders as the entire response grid is strained (some say collapsed) as people scramble to get access to supplies. Desparate to the point of resorting to covert means to acquire materiel. It should not be this difficult to save lives from an easily treated disease.

Aside from the eye-opening account from St Louis du Nord, we have a report this morning of one of the major NGO HEAS partners stating they use an average 8 liters of IV fluid per critically ill patient.

Here is a direct account from a donor in New York today: "No idea where these supplies can be purchased [in Haiti]-we just airlifted almost 40,000 lactated ringer solution bags in from NY and in just a weeks time, more than half have already been used". This is an example of "light" medical supply usage.

As another example of the logistics challenge, we have discovered an ominous, persistent indicator over the last couple of weeks: the slow degradation of grid level responsiveness to emergency requests for assistance. These emergency requests may be viewed here in the HEAS public portal, where there is little ambiguity that people are dying because of lack of medical care. In short, we are seeing the entire response community- both personnel and materiel- is insufficient to save all of these lives.

The entire community continues to struggle onward, but many of us feel we will move from calling this a "disaster" to a "catastrophe". The sight of random corpses in the streets of Port au Prince and Cap Haitien points to this.

Perhaps the saddest observation is the repeated failed lesson-learned that operational biosurveillance directly contributes to national security. Failure of early warning costs opportunity to mitigate with each and every hour and day lost. Failure to act upon warning information results in lost opportunity to prepare. Failure to support near-real time emergency warning and rapid response operations directly contributes to unnecessary lives lost. And with the unnecessary loss of life comes public outcry and the successful triggering of incendiary unrest that may now jeapardize the entire UN mission in Haiti.

It should not be lost on anyone reading this commentary that had the Haitian public not developed the perception that unnecessary lives were lost based on directly observed evidence, it would have been very difficult to see the level of unrest we are now observing.

In short, the same political interference and bureaucratic challenges observered post-quake are being observed here and now in the middle of the cholera disaster / catastrophe. And we are losing an untold number of lives daily because of it. The word "accountability" becomes a strong... and bitter... pill to swallow. And it is to all of our chagrin to consider the words of one senior US government official who advised us on November 10th,

...we think [the cholera epidemic] can be managed effectively, as the response has been good in Haiti, and the GOH with our help has gotten out ahead of the curve, and are working hard to stay there...This is not to say that 1,500-2,000 or so deaths from cholera a year in Haiti for the next several years is acceptable, and we hope to get the mortality rates down well below that. But this is not in the same league as the earthquake either, so I think you can turn off the alarm bells.