HEALTH CLUSTER BULLETIN CHOLERA OUTBREAK IN HAITI - #6
(ReliefWeb) - Source: Pan American Health Organization (PAHO); World Health Organization (WHO)
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SITUATION OVERVIEW
The Ministry of Health, PAHO/WHO and the International Organization for Migrations (IOM) completed an assessment of 80 health facilities for scaling up cholera treatment. Of these sites, 38 were deemed suitable for the establishment of Cholera Treatment Units (CTUs) or Oral Rehydration Posts (ORPs). Maps of the completed assessments have been shared with Health Cluster and the Ministry of Health. Partners interested in supporting these facilities should contact the Health Cluster.
Last week IOM began establishing structures for 103 ORPs. The plan is create 250 ORPs to provide first-line cholera treatment in camps, which were prioritized according to environmental risks and poor coverage by sanitation and health services. Training will follow the Ministry of Health guidelines. Three people in each camp will be identified to become cholera response brigadiers. When ORPs become fully operational, they will also be being used for community sensitization and education. The establishment of the ORPs is coordinated by the Health Cluster, local authorities and other organizations working in Internally Displaced Persons Camps.
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The Ministère de la Sante Publique et de la Population (MSPP) and PAHO, the Regional of Office of the World Health Organization (WHO) for the Americas, coordinate the Health Cluster.
MSPP Cluster Contacts: Dr. Claude Surena; Dr. Jean Hugues Henrys;
PAHO/WHO Contacts: Dr. Dana van Alphen, Saran Koly:
Health Cluster partners are asked to contribute to this bulletin with information on needs and activities as well as corrections to content, by emailing:
haiclsan@paho.org (subject heading: Health Cluster Bulletin).
For useful information on meetings, guidelines, and CTC, CTU, and health facility locations, visit:
http://haiti.humanitarianresponse.info
EPIDEMIOLOGY
On 30 November, the Ministère de la Santé Publique et de la Population (the Ministry of Health) reported that the cumulative number of hospital visits and deaths due to cholera, as of 27 November, was 77,208 and 1,751 respectively. 34,248 of patients have been hospitalized due to cholera. Currently, 1,224 remain at the hospital. The in-hospital case fatality rate for the whole country is 3.6%, while the case fatality rate at health services is 1.6%.
For Port-au-Prince, the cumulative number of hospital visits and deaths due to cholera was 10,542 and 164 respectively. Of those, 3,487 have been hospitalized. The in-hospital case fatality rate for Port-au-Prince is 4.5% while the case fatality rate at health services is 1.5%.
The Ministry of Health daily reports available at http://www.mspp.gouv.ht/site/downloads/
In Dominican Republic, the Minister of Health reported that as of 28 November, there were 9 laboratory confirmed cases of cholera. One laboratory-confirmed case is imported; the other 8 are from Santo Domingo Este (4), Navarrete (3) and Santo Domingo Norte (1) municipality.
DEPARTMENT RESPONSE ACTIVITIES
North West
The International Medical Corps (IMC) team met with Dr. Beauge, the MSSP Coordinator in Port-de-Paix, CARE, ACF, MSF-France, the French Red Cross and PAHO/WHO to determine the needs in the Northwest Department. There is a need for immediate cholera interventions in St. Louis de Nord, Baie de Henne, Anse-a-Foleur and the Tortue Island. IMC plans to establish CTCs in these locations in the coming weeks.
The IOM Health Unit, together with the Logistics/Procurement Cluster, is coordinating the distribution of OFDA-donated items with health partners, and undergoing a large procurement for additional Personal Protection Equipment Kits (PPEs) to meet the needs identified by the Ministry of Health and others. This week, 1,200 PPE sets were provided to support the Ministry of Health in the North West Department, along with 2000 units of Ringers Lactate and other medical supplies. Medical supplies were also provided to Medical Teams International working in St Louis Du Nord. 1,200 PPE kits and 1,000 gallons of Clorox were also distributed to Centre de Santé Marmelade, along with 12 batteries needed to provide electricity to the hospital.
In Port de Paix, A two-day inter-agency mission was conducted with humanitarian partners in order to carry out a quick assessment of the situation, and to identify gaps, in order to improve the response. The Direction Sanitaire du Nord-Ouest (DSNO) requested funding to train community mobilization and hygiene promotion staff. There were also requests for soap, filters, aquatabs, PUR, and hygiene kits. The 124 Hygiene kits and 3,000 ORS distributed in Bassin Bleu on November 26 will add to the 100 hygiene kit packages, 1,600 jerrycans, and 4 packs of PPE distributed in various areas since November 1st.
North East
The situation in Fort Liberté and the North East Department is manageable compared to other areas. The case management continues to improve, although slowly, as reflected by the total numbers of cases matching the numbers of hospitalized cases. Given the fact that the number of cases has not increased to alarming levels and that health personnel at the hospitals are beginning to use ORS more, this trend is likely to decrease on the coming weeks. PAHO/WHO logistics team helped to create the layout and set up four tents to organize patient flow, in coordination with MERLIN UK. Each of these tents will be used for a specific purpose: a clean area for nurses/supplies, triage, observation and an extra ward for hospitalized patients. Construction of latrines and other semi-permanent structures should start soon. Two other tents have been taken to Ouanaminthe hospital to support activities there.
Compared to its neighboring departments, North and North West, the North East Department is not in a critical situation and still has some room for prevention of cases rather than concentrating all efforts in case management and supplies stocks. So far the Direction Sanitaire has identified and trained health teams in communities.
Grande Anse
MDM France is asking for intervention of other health and WASH partners to provide a complete coverage of the department.
Artibonite
On 23 November 2010, a team of PAHO/WHO staff (epidemiologist and logistician) was deployed to a dispensary in Perodin, to verify an alert reported on 21 November. Perodin and Medor Communal Sections cover around 15,000 and 16,000 habitants respectively. Both villages are three hours away from the nearest hospital in Petite Riviere. Most of the houses in the communal section are isolated in the mountains. Perodin and Medor are only accessible through a difficult mountain path.
INTERAIDE set up one dispensary with 10 beds in Perodin and another with 20 beds in Medor. Two trained local medical assistants are working in both communities and available 24 hours a day. Most of the severe cases and death are referred to the Perodin and Medor dispensaries to be treated.
There is neither communication nor medical and WASH material provided by the UCS PRVL, in Verretes.
International Medical Corps (IMC) operates four CTCs with a combined bed capacity of 155 in Verrettes, Saint-Michel-de-l'Atalaye, in Gonaives and Ennery.
A nurse and a statistician from the UCS SDG (Saint Marc, Desdunes and Grande Saline) have been designed to assist the PAHO/WHO team (Epidemiologist and WASH Specialist) in order to collect and gather data of number of deaths at community level. In addition, she will provide training in best practices on body management.
IOM has adopted a 3 x 3 response approach to the cholera outbreak. The 3 cholera hotbeds to be addressed are the camps, the border between the DR and Haiti, and the epicenters of the outbreak, namely St. Marc and Gonaives.
Gonaives
The IOM WASH teams carried out community mobilization and hygiene promotion campaigns, reaching 18,446 people (31% male) in Pont Tamarin, Petite Riviere, Poteaux, Chemin Neuf, and Bassin.
St. Marc
Some 500 people are working throughout the Lower Artibonite to deliver messages related to hygiene, sanitation, and the treatment of cholera. Approximately 120,000 individuals have received the information directly. Some 50 people are actively engaged in sanitation to ensure a clean environment in places where patient care is being provided. Cleaning supplies and protective gear are also being provided to support the workers. In a partnership with Partners in Health, workers were sent to decontaminate the St. Marc Prison cells, where 23 cases of cholera were reported.
West
In Léogâne, there is only 1 CTC with 168 beds and 1 oral rehydration post in Gressier. Even though two ambulances are available, the distance between the oral rehydration post and the CTC is too great. The delay in implementing the community strategy, involving health agents put back health promotion activities. And partners struggle to obtain ORS for oral rehydration posts and the WASH kit that health agents would bring for sensitization.
The Ministry of Health approved the installation of a Red Cross 80-beds CTC at Camp La Mertan in Carrefour (PaP). The Centre will be operated with the support of the Canadian, the Japanese and the Spanish Red Cross. The Japanese Red Cross ERU is already in the country and started to work with the German Red Cross for the transfer of national staff of the German Red Cross Hospital to the CTC. An advance team from Canadian Red Cross arrived on November 26 to work out the technical and operational aspects with the sister Societies of Japan and Spain and the International Federation.
IFRC is supporting Red Cross National Societies and Bureau of Delmas, Médecins du Monde Canada, Médecins du Monde France, Save the Children, MERLIN and other health partners in their efforts in the field. Some 45,000 ORS sachets, 1,000 liters of ringer lactate, soap and tents, chlorine and aquatabs were given for distribution to CTU and mobile clinics. The IFRC, supported by the British, Canadian and Spanish Red Cross, has provided 6 pick-up trucks for the Haitian Red Cross ambulance service for the cholera patients. This activity will be further strengthened. The German Red Cross CTC in Arcahaie is still operational.
IMC has been requested by the Departement de Sanitaire de l’Ouest (DSO) to open a CTC in Arcahaie. IMC team visited Fonds Baptiste, a locality in the mountainous area of Arcahaie that is almost two hours away from the nearest highway by car, with an estimated population of 40,000. There was no health agency working in that area and the local priest said that more than 40 patients have died since the first case was detected a month ago. IMC will set up a 30-bed CTC in this area.
The DSO has asked IMC to establish the two CTCs on opposite points of the island – Anse A Galet on the northern coast and Pointe-a-Raquette in the south. Concern Worldwide is currently working on the island and has offered to provide WASH activities for the CTCs. IMC and and Concern have met and a formal assessment will be conducted next week pending security after the elections.
South
MSF and the Ministry of Health have requested IMC to manage the CTC at the Immaculée Hospital. The Head of the Health Department in Les Cayes, Dr. Serge Louissaint, has also requested assistance from IMC to operate a CTC in the area of St. Louis and Aquin. the Ministry of Health has already installed a tent at the hospital in Aquin and they are serving patients. IMC teams were dispatched to the hospitals on the third week of November and are already assisting both Immaculée Hospital and Aquin Diagnostic Hospital teams; Aquin hospital team consist of combined the Ministry of Health and Cuban Brigade medical personnel. The Medical Director of Aquin Hospital agreed for IMC to set up a full CTC with a minimum 30 bed capacity.
IMC is already in discussion with the Ministry of Health about land for a CTC in Les Cayes. The patient load at the hospital is increasing and CTC site at Immaculée Hospital is insufficient for the growth in demand that will likely happen.
Challenges
The safe management of excreta is essential to limit the spread of diarrheal diseases. Several critical points are subject to interventions by "Water, Sanitation and Hygiene" cluster partners in order to reduce the risk of transmission. These interventions have been strengthened and expanded with the appearance of cholera, including support for the establishment of CTCs.
Access to sanitation in the camps and health centers has been improved with the response since the earthquake of January 12, 2010. Currently there are 113 people per toilet, one tenth of the initial ratio.
Special case of CTC / CTU
The excreta should be disinfected by chlorination on site which greatly reduces the risk of infection before transport to the final discharge.
The excreta of the camps present a higher risk of transmission than those of CTCs / CTUs (provided disinfection measures are applied properly), due to the high percentage of asymptomatic infected persons.
The application of disinfection measures in the CTCs / CTUs and the regularity of the discharge facilities should be assessed and monitor. For human waste transport, specific trucks must be dedicated solely to the emptying of CTCs / CTUs.
The garbage trucks are allowed to dump in designated areas arranged by the authorities. A specific landfill site, Truitier was developed (UNICEF project in partnership with World Vision) to Port-au-Prince Region. The general tightness of Truitier site is secured by 3 layers of clays (IDB study)
WATER AND SANITATION
The International Federation of the Red Cross continues to provide services to vulnerable population also affected by the January earthquake. The current average of liter/person/day in IFRC supported camps and other distribution sites is 6.7, with a concentration of residual chlorine of 0.7 milligrams per liter (incremented of 0.2 milligrams, from the usual dose of 0.5 milligrams, as a preventive measure against cholera). The International Federation continues to provide support to the German Red Cross CTC in Arcahaie, where there are now two water tanks of 2,000 liters each.
The WASH Cluster coordination in cooperation with the Haitian Red Cross carried out hygiene promotion activities in 39 camps and seven public areas (market squares), reaching 30,000 families. These included 10,429 tent visits on 28 camps. Additionally, in other public areas 4,551 people received mass WASH training, while other 198 received individual training. Around 11,876 persons participated in mass camp promotions and 10,370 individual households received similar training. After a promotion activity was carried out, the Haitian Red Cross and the IFRC did 600 random phone calls to verify whether individuals who participated in this promotion received the key messages. In addition to this, selected people in 69 camps received Red Cross training on how to handle water and 149 Red Cross workers received training in cholera prevention.
The IFRC continues to support Haitian Red Cross and PNS in their response to cholera. The IFRC supports the plan of the Haitian Red Cross, and promotes cascade training. A SMS promotion campaign continues. Around 3.74 million messages reached Voila subscribers living in Haiti with practical advice on how to prevent cholera, the symptoms of the disease and what to do if someone in the family is infected. According to the organizers, 89,120 people called the information line following the reception of an SMS message. In addition, 30,000 posters for prevention and 30,000 for treatment have been printed, and 200,000 flyers are ready to be distributed.
HEALTH PROMOTION & TRAINING
The Ministry of Health in North East Department has decided to train groups to intensify the prevention activities, especially in the communities. An assessment took place in Dumas, Acul Samedi, Opech, Danda, Sodo, Miniere and Bayaha, locations where they identified 3 members of the community to form the teams. It is planned to have one of the members (preferably a nurse of health worker) deal with initial case management, one with disinfection procedures, including dead bodies and the last one to disseminate health promotion messages. Some 15 people were identified and received training on at Fort Liberte, receiving also materials such as ORS sachets, health promotion posters, and chlorine.
Plan International continues a door –to-door awareness campaign against cholera in the districts of Chambouin, Tremblay, Roche Blanche Bellaton 1 and 2.
During the week, IOM carried out 22 hygiene promotion sessions in Carrefour (1), Cite Soleil (10), Croix-des-Bouquet (1), Delmas (1), Jacmel (2) Pétion-Ville (1), Petit Goâve (2), Port-au-Prince (2), and Tabarre (2). Of these 22 sessions, 6 were "Training of Trainers" sessions involving the local camp populations. The participants are now expected to be able to replicate the trainings in their respective communities, thus further developing cholera response capacity. The Red Cross is currently scaling up its cholera activities to cover a wider geographic area using as platform the current disaster preparedness surge project. Hundreds of volunteers from Haitian Red Cross Society branches are receiving training on hygiene promotion and are taking part in cholera prevention awareness-raising activities in schools, communal areas and markets throughout the country. Some 661 Haitian Red Cross volunteers were trained in Hygiene Promotion, Cholera Prevention, Transmission and Treatment. They have worked in their communities sensitizing over 5,000. Other 102 volunteers from the psychosocial support program received similar training. Evaluations are presently being carried out to determine whether beneficiaries have understood the information correctly.
REFERENCES
- Health Cluster website: http://haiti.humanitarianresponse.info/Default.aspx?tabid=77
- Ministère de la santé publique et de la population (the Ministry of Health): www.mspp.gouv.ht
- Pan American Health Organization(PAHO/WHO): www.paho.org
- Interactive Atlas (PAHO/WHO): http://new.paho.org/hq/images/Atlas_IHR/CholeraHispaniola/atlas.html
This Health Cluster Bulletin only includes contributions from the Global Health Cluster Members.
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