CUBAN DOCTORS ARE ON THE RURAL FRONTLINES IN HAITI'S CHOLERA EPIDEMIC
(Miami Herald) - By Frances Robles
More than 4,000 people have died of cholera in Haiti, and while the international attention has focused on the country’s capital, Cuban doctors are providing crucial care in rural areas.
MIREBALAIS -- Wracked by diarrhea, Emmanuel Losier was surprised at what he found when, after two hours on foot, he finally reached the closest cholera treatment center to his central plateau home: plenty of empty beds and Cuban doctors he could not communicate with.
“Without them, the whole country would have been destroyed by now,” Losier said, an IV strapped to his arm and a bucket at his side. “They seem to have a real interest in helping us. I hope they stay.”
Losier was treated last month by Cuba’s medical brigade, a corps of nurses and doctors who experts here say are among the leading health care providers in Haiti’s battle against cholera. He and about a dozen critically ill patients were under a large white tent beside a Mirebalais diagnostic center, which is a joint operation between Cuba, the Haitian Health Ministry, Partners in Health and the University of Miami’s Project Medishare.
As the death toll surpasses 4,000, Haiti is still struggling against challenges of a disease the country had not experienced in 150 years. In rural villages, doctors are often difficult to find.
Some urban treatment centers have lots of beds but few patients. Many earthquake displacement camps still lack clean water and toilets, even as some aid groups begin to scale back water chlorination programs. With the epidemic entering its fourth month, the United Nations’ $164 million appeal for cholera funding remains less than half-filled.
The international community and major aid organizations came under scathing criticism when the disease swept the countryside in October. Doctors Without Borders blasted “one of the largest and best-funded international aid deployments in the world” for failing to stop the spread of the deadly illness despite vast resources.
While many critics found fault with the international community’s response to the raging disease, experts agreed that the Cuban medical brigade quickly filled a critical gap in a country where the death rate is still twice the accepted average.
“The Cuban delegation are unbelievable workhorses,” said David Walton, deputy director of Partners in Health, a Boston-based medical aid organization. “They are very savvy and not afraid to get their hands dirty.”
While the United States poured more than $45 million in supplies and expertise into Haiti’s cholera epidemic, cash-strapped Cuba provided human resources. The brigade is part of a decade-old medical diplomacy program Cuba uses to sow goodwill around the world, which critics argue is aimed at deflecting attention from human rights abuses.
“Cubans sent more doctors and nurses than any other country in the world,’’ said Gabriel Thimothe, director general of the Haitian Health Ministry. “By 7 p.m. the day after we learned of the outbreak, Cuba’s health chief was calling me on the phone saying: ‘We have doctors; where do you want to send them?’”
They sent them to the boondocks, far from established clinics and urban centers.
“The Cubans have a less sophisticated approach, but are much more mobile,’’ said Claude de Ville de Goyet, acting representative for the World Health Organization in Haiti.
At one point, the brigade numbered about 1,400, the United Nations said. By January, there were 47 mobile teams, comprised of both Cuban doctors and foreign graduates of its medical school. About 125 of the doctors deployed were Haitians who had graduated from Cuba’s medical school, former leader Fidel Castro wrote in a newspaper column.
“From time to time, a plane lands with 50 or 100 more,” Thimothe said.
Cuba’s Deputy Health Minister Lorenzo Somarriba, who leads the Haiti mission, told Telesur TV network that the teams work in a number of new community health centers the Cubans helped launch as part of an international effort to rebuild Haiti’s health system.
“What characterizes our work: being in the furthest and most inaccessible places,” he said. “To say ‘Cuban medical brigade in Haiti’ is synonymous with saying, ‘being where the population most needs it.’’’
His staff in Port-au-Prince did not respond to interview requests from The Miami Herald.
The Cuban press — including its chief booster, Castro — has boasted a death rate of .57 percent among its patients. The accepted norm is about 1 percent. Haiti’s average death rate is 2 percent.
To be sure, Cuba was not the only country that stepped in. At least 700 medical professionals flew in from the United States, including Centers for Disease Control experts and Haitian-American doctors, Thimothe said. The first to show up were doctors from the U.S. military base in Guantanamo, he said.
Doctors Without Borders set up about 35 treatment centers.
“The U.S. brought a lot of surveillance equipment and labs. The CDC helped with training,” he said. “The Cubans work in the field.”
Cuban doctors have been based out of the Mirebalais diagnostic center for 11 years and were among the first to ring the bell of alarm that cholera had come to Haiti, Somarriba said on the Telesur interview.
“There were a lot of people coming, more every day,” said Cuban nurse Virginia Quiyala, who has been assigned to Mirebalais for 19 months. “At first we didn’t know what it was, just that it was some kind of epidemic. All of them were in deplorable condition. It was obvious that we were in the middle of something big.”
Doctor Luis Denis González, who started working in Mirebalais in October, acknowledged that even with the 100 people in his team, it wasn’t enough to tackle the streams of people that arrived from the countryside.
“The hardest part of all this is seeing how many of these people don’t have access to clean water,” he said. “Here what most affects you is seeing the conditions people live in: they don’t have water. They don’t have toilets. They don’t have water treatment.”
Haiti now has 100 cholera treatment centers, including several run exclusively by the Cuban brigade. On a recent visit to the Cuban center in Carrefour, several doctors milled about waiting for patients. A Cuban flag draped the entrance.
“We’ve treated three patients so far today,’’ said a doctor who said he was not authorized to give his name. “More will come.”
Thimothe acknowledged that several cholera clinics, including the one in Carrefour, had to be relocated because there were too many unused beds. The placement of treatment centers remains one of the most difficult logistical challenges, he said.
At one point, the hospital in Cap Haitien had 600 beds and 40 patients, he said.
“I do not buy the across-the-board criticism that the international community failed in its response to cholera,’’ said Nigel Fisher, the United Nations’ chief humanitarian officer. “The CDC is doing a lot of work, so are Canada and Latin American nations including Brazil, Argentina, Chile and Venezuela.
“The Cubans are in the most inaccessible areas doing preventive work. They don’t make a lot of noise, they just do it.”