ARTICLE - CLINIC CHOLERA CHALLENGES

HAITIAN CLINICS BATTLE CHOLERA WHILE FACING OVERWHELMING CHALLENGES
(Catholic News Service - CNS) - By Chris Herlinger

PORT-AU-PRINCE -- Despite its numerous corrugated steel and cinder-block shacks, the impoverished, crowded and crime-ridden Cite Soleil area of Port-au-Prince was spared some of the worst effects of the 2010 earthquake.

Not so during Haiti's cholera epidemic, said Sister Marcella Catozza, an Italian Franciscan who has worked in the Wharf Jeremie area of Cite Soleil for five years.

"I spent my holiday time with cholera," she said of the epidemic that began in October and has affected more than 200,000 people nationwide.

Sister Marcella, 48, does not like to dwell on the particular horrors of the victims. But she does recall what was probably the worst moment.

Early in the epidemic, she arrived at the health clinic she oversees and found two people barely alive at the front door. Within 10 minutes, they were dead.

The Franciscan's pragmatic manner betrays no hint of exhaustion or frustration with having to deal with one more chronic problem in what had already been a difficult year. Not only has she dealt with the human suffering after the January 2010 earthquake, Sister Marcella also has had to rebuild her damaged clinic and has struggled to provide health care in a part of Port-au-Prince where many nongovernmental groups refuse to work because of the Cite Soleil's notorious reputation.

In the densely populated area surrounding the clinic, cholera has taken a serious toll. In November, Sister Marcella's clinic became a cholera treatment center. Staff treated 80 patients a day in a facility with half as many beds.

Overall, about 2,000 cholera patients have been treated at the clinic. Seventeen died. Haiti's Ministry of Health and Population reported that as of Jan. 24, 209,034 Haitians had contracted the water-borne disease, with 4,030 dying.

Although the number of patients has declined in recent weeks, Sister Marcella said cholera is unsparing and unpredictable, and she expects cases to spike again.

Sister Marcella noted that cholera -- which causes severe vomiting and diarrhea and, left untreated, can kill a person within hours -- is linked to Haiti's other ailments and social problems, including malnutrition and hunger.

"Malnutrition is a basic problem for people here," she said, noting that those who suffer from a poor diet are more susceptible to the disease.

Dr. Jean-Gardy Marius is another clinician who knows the tremendous challenges Haitians face all too well. He oversees the OSAPO Clinic in Rousseau 65 miles north of Port-au-Prince that receives assistance from U.S. and European churches.

While the number of new cholera cases at the rural clinic declined by mid-January, Marius noted that treating the disease is "problematic because it's tied to so many other things, like poor nutrition."

Small clinics such as Sister Marcella's and Marius' are limited in what they can do in the absence of a functioning health system. Some 52,000 persons are dependent on health care from OSAPO. Its overworked staff must deal not only with cholera, but also with other problems, including malaria.

Yet, Marius and his staff seem to be doing some good.

Germilia Omisca, a mother of nine who lives in the nearby village of Coline, was among the cholera patients at the clinic's outdoor tent facility. Laying in a bed with an intravenous drip replenishing lost fluids in mid-January, Omisca told Catholic News Service that she felt much better since arriving a day earlier. She confirmed some of Marius' concerns: She had not been eating regularly before becoming ill.

Such problems must be addressed holistically, said Marius and Sister Marcella.

"We need to figure out a way to break this cycle," said Sister Marcella, arguing that temporary "emergency" solutions won't solve long-standing underlying problems.

She knows firsthand about the challenges and shortfalls of temporary measures. One humanitarian group working in Haiti, the Brazil-based Viva Rio, established temporary portable latrines, with paid latrine monitors, on her clinic grounds.

While welcome, such assistance is unsustainable because the latrine monitors eventually will leave, Sister Marcella said. She suggested the group's high-tech "bio-digester" latrines aren't as practical as simpler, composting toilets.

Nearby, another set of latrines, donated by Doctors Without Borders, had been sitting full for weeks, waiting to be cleaned or removed.

Charles Wilner, one of several young Haitian volunteers who work with Sister Marcella at the clinic, said problems like drug and alcohol abuse and violence are constant in Wharf Jeremie.

"There are no police here," he said. "It's a ghetto zone."

As for the presence of cholera, Wilner said residents have accepted it as one more fact of life in an unsettled, volatile environment. Still, they believe that with care about usage and handling of water and with ongoing educational efforts, cholera can be controlled.

Sister Marcella said speculation as to how cholera reached Haiti -- with many arguing it was brought to Haiti by U.N. peacekeeping forces -- is understandable. But, she said, cholera is now a fact of life in Haiti, just as it is in her native Italy.

"When cholera is in a country, it doesn't leave," she said. "It's a condition of life. Cholera is now endemic to Haiti. It's part of the country now."