HAITI - TRANSPORT: GENERAL TRANSPORT STRIKE FOR 24 HOURS...
(HaitiLibre) -
Alexis Enock President of the Confederation of Workers in Public and Private Sectors (CSTP), which has over 6,500 members, has told the local media that the workers in the transport sector in Haiti, are "not ready" to assume an increase in fuel prices. "We are asking the state to reconsider its decision" saying that the transport unions do not support the increase, as stated by the Minister of Economy and Finance, Ronald Beaudin.
Enock Alexis reported that during a meeting at the Directorate-General of the Ministry of Social Affairs, the members of the Union have signed their refusal to increase the cost of transportation. Deploring this "arbitrary" measure that the population living in poverty, can not cope with.
Nevertheless, following these fuel increases and despite the assertions of the President of CSTP, public transport prices have increased by 25% or even 50% on some lines, causing tension between users and drivers...
Union leaders request the Government to reconsider and avoid variations in the cost of gasoline at the approach of the installation of the new Government, in April.
Several unions including the Association of Owners and Drivers of Haiti (APCH) and the Federation of Haitian Public Carriers (FTPH) have launched a demand for a general strike, in protest. They are calling on the population to take the streets to prevent the movement of all vehicles from Monday morning to Tuesday morning...
For its part, the UN Mission for Stabilization in Haiti (Minustah) said on Sunday, that they have prepared a plan to prevent violent clashes...
Reminder on the increase in petroleum products :
Gasoline 95 (octane index) increased from 196 gourds to 200 gourds (+2%),
Gasoline 91 increased from 172 gourds to 191 gourds (+11%).
Diesel increased from 119 gourds to 162 gourds (+36%) and
Kerosene increased from 112 gourds to 161 gourds (+43 %)
Monday, March 28, 2011
ARTICLE - RWANDA SENDING POLICE TO HAITI
RWANDA: 120 POLICE OFFICERS LEAVE FOR HAITI
(allAfrica)
Kigali — A contingent of 120 Police officers, Monday morning, left for a peace keeping mission to Haiti. The officers are joining an advance party of 40 who left last month.
This is the first time Rwanda has sent a Formed Police Unit (FPU) to any peace keeping mission. They will be serving under the mandate of United Nations Stabilization Mission in Haiti (MINUSTAH).
According to the Police spokesperson, Superintendent Theos Badege, the Formed Police Unit will perform various peace keeping duties.
"They will maintain order, conduct patrols, guard VIP and key installations, provide humanitarian assistance and security of Internally Displaced Persons among other duties," Badege said.
The FPU equipped with light weapons and armored vehicles will be deployed in Jérémie Town, south of Haiti. The contingent is led by Chief Superintendent, Egide Ruzigamanzi.
Emmanuel Gasana, the Inspector General of Police, reminded the contingent that they are the ambassadors and pride of their country.
"You are renowned for your professionalism. I urge you to maintain an exemplary level of discipline and commitment throughout the twelve months of your stay in Haiti," Gasana told the officers before they departed.
In addition to the FPU, there are 34 Police advisors currently serving in Haiti.
Rwanda National Police currently has 374 peacekeeping officers serving in UN missions in Liberia, Ivory Coast, Sudan, Chad and Haiti.
"Rwanda is one of the Police contributing countries selected by United Nations to bring peace to the world. This is due to its professional and disciplined security organs and willingness to contribute to stability," Gasana said.
The Rwandan National Police is committed to ensuring the safety of its citizens and contribute to peace around the World.
(allAfrica)
Kigali — A contingent of 120 Police officers, Monday morning, left for a peace keeping mission to Haiti. The officers are joining an advance party of 40 who left last month.
This is the first time Rwanda has sent a Formed Police Unit (FPU) to any peace keeping mission. They will be serving under the mandate of United Nations Stabilization Mission in Haiti (MINUSTAH).
According to the Police spokesperson, Superintendent Theos Badege, the Formed Police Unit will perform various peace keeping duties.
"They will maintain order, conduct patrols, guard VIP and key installations, provide humanitarian assistance and security of Internally Displaced Persons among other duties," Badege said.
The FPU equipped with light weapons and armored vehicles will be deployed in Jérémie Town, south of Haiti. The contingent is led by Chief Superintendent, Egide Ruzigamanzi.
Emmanuel Gasana, the Inspector General of Police, reminded the contingent that they are the ambassadors and pride of their country.
"You are renowned for your professionalism. I urge you to maintain an exemplary level of discipline and commitment throughout the twelve months of your stay in Haiti," Gasana told the officers before they departed.
In addition to the FPU, there are 34 Police advisors currently serving in Haiti.
Rwanda National Police currently has 374 peacekeeping officers serving in UN missions in Liberia, Ivory Coast, Sudan, Chad and Haiti.
"Rwanda is one of the Police contributing countries selected by United Nations to bring peace to the world. This is due to its professional and disciplined security organs and willingness to contribute to stability," Gasana said.
The Rwandan National Police is committed to ensuring the safety of its citizens and contribute to peace around the World.
ARTICLE - TRANSITIONING TO DEMOCRACY
TRANSITIONING TO DEMOCRACY IN HAITI, NORTH AFRICA AND THE MIDDLE EAST
(Media Newswire) -
Georges Fauriol, vice president of programs at the National Endowment for Democracy, discussed the importance of establishing a democratic government in Haiti and other countries during a public forum at UCF.
Georges Fauriol, vice president of programs at the National Endowment for Democracy, discussed the importance of establishing a democratic government in Haiti and other countries during a public forum at UCF.
Fauriol spoke to nearly 75 people at his presentation, which was organized by the UCF Global Perspectives Office as a feature of the Haiti Speaker Series. He also presented at events in the community.
Fauriol’s speech focused on the elections in Haiti and political unrest in the Middle East and North Africa. According to Fauriol, the United States has a great stake in the successes of transitions in Haiti, North Africa and the Middle East.
Fauriol said that, objectively, all democratic transitions have a chance of success if they follow the necessary steps, such as having open and fair elections, making sure electoral laws are crafted to encourage inclusiveness and ensuring the laws are administered with transparency.
Most importantly, he said, democratic transitions have the greatest likelihood of success when free and fair elections become routine, allowing people to develop a trust in them.
Fauriol said political reforms alone are not enough to make democracy work.
Economics play a key role, and democracy has to deliver, or else people become disillusioned, he said. In some circumstances, that means demonstrating in the streets and risking lives to generate change, similar to what is happening in the Middle East and North Africa.
For Haiti, Fauriol said, the challenge is that each political event seems to trigger another political crisis. The country demonstrates that failed transitions can create conditions of instability, and, coupled with the nation’s bad luck with natural disasters, severely hamper Haiti’s economic and governmental development.
However, the candidates in Haiti’s most recent election represent a break from the past, a change that Haiti hasn’t seen in more than 27 years, Fauriol said. With a focus on the future, the candidates pledged reconstruction, reform and development.
In addition to Global Perspectives Office, sponsors and partners included UCF Task Force H.O.P.E.; the UCF Haitian Studies Project; the UCF Global Peace and Security Studies Program; the UCF Political Science Department; the UCF Diplomacy Program; the UCF Latin American, Caribbean and Latino Studies Program; The Sibille H. Pritchard Global Peace Fellowship Program; the UCF International Services Center; UCF LIFE; the Orlando Rotary Club; and the Global Connections Foundation.
(Media Newswire) -
Georges Fauriol, vice president of programs at the National Endowment for Democracy, discussed the importance of establishing a democratic government in Haiti and other countries during a public forum at UCF.
Georges Fauriol, vice president of programs at the National Endowment for Democracy, discussed the importance of establishing a democratic government in Haiti and other countries during a public forum at UCF.
Fauriol spoke to nearly 75 people at his presentation, which was organized by the UCF Global Perspectives Office as a feature of the Haiti Speaker Series. He also presented at events in the community.
Fauriol’s speech focused on the elections in Haiti and political unrest in the Middle East and North Africa. According to Fauriol, the United States has a great stake in the successes of transitions in Haiti, North Africa and the Middle East.
Fauriol said that, objectively, all democratic transitions have a chance of success if they follow the necessary steps, such as having open and fair elections, making sure electoral laws are crafted to encourage inclusiveness and ensuring the laws are administered with transparency.
Most importantly, he said, democratic transitions have the greatest likelihood of success when free and fair elections become routine, allowing people to develop a trust in them.
Fauriol said political reforms alone are not enough to make democracy work.
Economics play a key role, and democracy has to deliver, or else people become disillusioned, he said. In some circumstances, that means demonstrating in the streets and risking lives to generate change, similar to what is happening in the Middle East and North Africa.
For Haiti, Fauriol said, the challenge is that each political event seems to trigger another political crisis. The country demonstrates that failed transitions can create conditions of instability, and, coupled with the nation’s bad luck with natural disasters, severely hamper Haiti’s economic and governmental development.
However, the candidates in Haiti’s most recent election represent a break from the past, a change that Haiti hasn’t seen in more than 27 years, Fauriol said. With a focus on the future, the candidates pledged reconstruction, reform and development.
In addition to Global Perspectives Office, sponsors and partners included UCF Task Force H.O.P.E.; the UCF Haitian Studies Project; the UCF Global Peace and Security Studies Program; the UCF Political Science Department; the UCF Diplomacy Program; the UCF Latin American, Caribbean and Latino Studies Program; The Sibille H. Pritchard Global Peace Fellowship Program; the UCF International Services Center; UCF LIFE; the Orlando Rotary Club; and the Global Connections Foundation.
Sunday, March 27, 2011
ARTICLE - CLIMATE CHANGE AND EARTHQUAKES
CLIMATE CHANGE AND QUAKES: A LINK?
(Montreal Gazette) - By Wiliam Marsden
Earth's 'elastic' crust at issue; Melting glaciers may be lightening load, allowing tectonic plates to shift
MONTREAL - Severe earthquakes in Haiti, Chile and most recently Japan have raised the question of whether the world's tectonic plates are becoming more active and if so what is the cause.
Some scientists theorize that the sudden melting of glaciers due to man-made climate change is lightening the load on the Earth, allowing its mantle to rebound upward, causing the plates to become unstuck.
These scientists point to the historical increase in volcanic and earthquake activity that occurred about 12,000 years ago, when the glaciers that covered most of Canada in an ice sheet several kilometres thick suddenly melted.
The result was that most of Canada's crust has lifted and is still rising.
Scientists have discovered that the accelerated melting of the Greenland ice sheet over the last 10 years is already lifting the southeastern part of that island several millimetres every year.
The surface of the Earth is elastic. A heavy load like a glacier will cause it to sink, pushing aside the liquid rock underneath.
The Greenland glacier is about three kilometres at its thickest and it is believed that its weight has depressed sections of the land under the glacier about one kilometre. In fact, the weight of the glacier is so great that significant portions of Greenland have been pushed well below sea level.
"There is certainly some literature that talks about the increased occurrence of volcanic eruptions and the removing of load from the crust by deglaciation," said Martin Sharp, a glaciologist at the University of Alberta. "It changes the stress load in the crust and maybe it opens up routes for lava to come to the surface."
Sharp added that "it is conceivable that there would be some increase in earthquake activity during periods of rapid changes on the Earth's crust."
Other scientists, however, believe that the kind of tectonic movements similar to the one that last week caused the Japanese quake are too deep in the Earth to be affected by the pressure releases caused by glacier melt.
These scientists theorize, however, that glacier melts could cause shallower quakes.
Andrew Hynes, a tectonics expert at McGill University, said the issue is not so much the load shift on the Earth's crust, but rather the increased fluid pressure in the fault that lubricates the rock, allowing the plate to slide.
"All earthquakes except those produced by volcanic activity are essentially the unsticking of faults," he said.
In other words, if you pump fluid into a fault, it will reduce the friction and the rock can slide.
Could the stress transfers and the added melt from glaciers inject more fluid into the rocks creating earthquakes?
Hynes said this is a serious issue with large hydro reservoirs, where increased amounts of water into otherwise stable faults can cause them to move.
"It would only apply to earthquakes that are at shallow depths," he said. "But I wouldn't push it any further than that."
He added, however, that the decompression from melting glaciers could cause an increase in volcanism by releasing the liquid rock and its explosive potential.
Yet, at the same time, the number and severity of earthquakes appears to have increased over the last 30 years in parallel to accelerating glacial melt.
Some experts claim the increase can be explained by increased number of seismograph stations to more than 8,000, from 350 in 1931, allowing scientists to pinpoint earthquakes that would otherwise have been missed.
But this does not explain the recent increase in major earthquakes, which are defined as above 6 on the Richter magnitude scale. (Japan's earthquake was a 9.) Scientists have been tracking these powerful quakes for well over a century and it's unlikely that they have missed any during at least the last 60 years.
According to data from the United States Geological Survey, there were 1,085 major earthquakes in the 1980s. This increased in the 1990s to 1,492 and to 1,611 from 2000 to 2009. Last year - and up to and including the Japanese quake - there were 247 major earthquakes, which puts us on a path to yet another increase.
There has also been a noticeable increase in the sort of extreme quakes that hit Japan. In the 1980s, there were four mega-quakes, six in the 1990s and 13 in the last decade. So far this decade, we have had two.
This increase, however, could be temporary. Hynes said there is some evidence that one earthquake can snowball into another until the earth's crust has adjusted to the new pressure transfers.
The coast of British Columbia sits on the Pacific fault line that curves around the southern coast of Alaska, travelling southwest to Japan.
Hynes said the upper plate of Vancouver Island is flexing like a bow. It's stuck and bending upward. Ultimately it will release itself and produce a major quake, he predicted. Japan's big earthquake could change the tectonic stresses in the Pacific and possibly affect Vancouver.
"I'm afraid to say that Canada is by no means as careful about its building codes as Japan," Hynes said.
Montreal sits on a fault line that travels along the St. Lawrence River Valley. Hynes said the fault is smack in the middle of a tectonic place, making it harder to understand the stresses.
(Montreal Gazette) - By Wiliam Marsden
Earth's 'elastic' crust at issue; Melting glaciers may be lightening load, allowing tectonic plates to shift
MONTREAL - Severe earthquakes in Haiti, Chile and most recently Japan have raised the question of whether the world's tectonic plates are becoming more active and if so what is the cause.
Some scientists theorize that the sudden melting of glaciers due to man-made climate change is lightening the load on the Earth, allowing its mantle to rebound upward, causing the plates to become unstuck.
These scientists point to the historical increase in volcanic and earthquake activity that occurred about 12,000 years ago, when the glaciers that covered most of Canada in an ice sheet several kilometres thick suddenly melted.
The result was that most of Canada's crust has lifted and is still rising.
Scientists have discovered that the accelerated melting of the Greenland ice sheet over the last 10 years is already lifting the southeastern part of that island several millimetres every year.
The surface of the Earth is elastic. A heavy load like a glacier will cause it to sink, pushing aside the liquid rock underneath.
The Greenland glacier is about three kilometres at its thickest and it is believed that its weight has depressed sections of the land under the glacier about one kilometre. In fact, the weight of the glacier is so great that significant portions of Greenland have been pushed well below sea level.
"There is certainly some literature that talks about the increased occurrence of volcanic eruptions and the removing of load from the crust by deglaciation," said Martin Sharp, a glaciologist at the University of Alberta. "It changes the stress load in the crust and maybe it opens up routes for lava to come to the surface."
Sharp added that "it is conceivable that there would be some increase in earthquake activity during periods of rapid changes on the Earth's crust."
Other scientists, however, believe that the kind of tectonic movements similar to the one that last week caused the Japanese quake are too deep in the Earth to be affected by the pressure releases caused by glacier melt.
These scientists theorize, however, that glacier melts could cause shallower quakes.
Andrew Hynes, a tectonics expert at McGill University, said the issue is not so much the load shift on the Earth's crust, but rather the increased fluid pressure in the fault that lubricates the rock, allowing the plate to slide.
"All earthquakes except those produced by volcanic activity are essentially the unsticking of faults," he said.
In other words, if you pump fluid into a fault, it will reduce the friction and the rock can slide.
Could the stress transfers and the added melt from glaciers inject more fluid into the rocks creating earthquakes?
Hynes said this is a serious issue with large hydro reservoirs, where increased amounts of water into otherwise stable faults can cause them to move.
"It would only apply to earthquakes that are at shallow depths," he said. "But I wouldn't push it any further than that."
He added, however, that the decompression from melting glaciers could cause an increase in volcanism by releasing the liquid rock and its explosive potential.
Yet, at the same time, the number and severity of earthquakes appears to have increased over the last 30 years in parallel to accelerating glacial melt.
Some experts claim the increase can be explained by increased number of seismograph stations to more than 8,000, from 350 in 1931, allowing scientists to pinpoint earthquakes that would otherwise have been missed.
But this does not explain the recent increase in major earthquakes, which are defined as above 6 on the Richter magnitude scale. (Japan's earthquake was a 9.) Scientists have been tracking these powerful quakes for well over a century and it's unlikely that they have missed any during at least the last 60 years.
According to data from the United States Geological Survey, there were 1,085 major earthquakes in the 1980s. This increased in the 1990s to 1,492 and to 1,611 from 2000 to 2009. Last year - and up to and including the Japanese quake - there were 247 major earthquakes, which puts us on a path to yet another increase.
There has also been a noticeable increase in the sort of extreme quakes that hit Japan. In the 1980s, there were four mega-quakes, six in the 1990s and 13 in the last decade. So far this decade, we have had two.
This increase, however, could be temporary. Hynes said there is some evidence that one earthquake can snowball into another until the earth's crust has adjusted to the new pressure transfers.
The coast of British Columbia sits on the Pacific fault line that curves around the southern coast of Alaska, travelling southwest to Japan.
Hynes said the upper plate of Vancouver Island is flexing like a bow. It's stuck and bending upward. Ultimately it will release itself and produce a major quake, he predicted. Japan's big earthquake could change the tectonic stresses in the Pacific and possibly affect Vancouver.
"I'm afraid to say that Canada is by no means as careful about its building codes as Japan," Hynes said.
Montreal sits on a fault line that travels along the St. Lawrence River Valley. Hynes said the fault is smack in the middle of a tectonic place, making it harder to understand the stresses.
VIDEO - EDUCATING CHILDREN - CHOLERA PREVENTION
Unicef and almost every missions' focus is on cholera prevention. Unicef has produced a video showing how cholera prevention is being taught to school children. This is important for every student in Haiti to learn. To watch the video follow the link to:
www.youtube.com/watch?v=QvcvCnWxDHg
www.youtube.com/watch?v=QvcvCnWxDHg
ARTICLE - EDUCATING CHILDREN - CHOLERA PREVENTION
UNICEF AND PARTNERS EDUCATE HAITIAN CHILDREN ON HOW TO PREVENT CHOLERA
(Unicef) - By Gabrielle Menezes - http://www.unicef.org/
PORT-AU-PRINCE – In the crowded classrooms of Institute Mixte de Kervens School in Canape Vert, Port-au-Prince, children are learning critical skills in the fight against cholera.
The classroom windows look out on to hillsides dotted with white tarpaulin tents in the Haitian capital. These are the temporary homes of tens of thousands of people displaced by the January 2010 earthquake.
And it is here that the ever-present threat of cholera persists. The deadly menace has so far killed more than 4,500 people across the country.
Although for the moment the level of cholera infections and deaths has lowered, it is still a danger that could become even worse,” says Amara Kone, who heads UNICEF’s sanitation training programme in schools.
“But if cholera disease levels have decreased, it’s partially because we’ve been teaching people, such as children, that to prevent infection people need to wash their hands and drink safe water.”
Engaging children
Young students in schools such as Institute Mixte de Kervens are being taught skills not only as a means to protect themselves, but also as a way to spread the message to their families.
Hygiene Promoter Farah Sylvestre, a student nurse working for the non-profit organization GOAL, is mobilizing students at schools to better understand how cholera spreads, and showing how they and their families can prevent infection.GOAL – which is carrying out mobilization activities in 38 camps and communities – is one of around 30 UNICEF partners helping educate Haitians about preventive measures they can take to protect themselves against cholera.
At Institute Mixte de Kervens School, Sylvestre engages the children in simple lessons that demonstrate how they should wash their hands with soap to kill cholera bacteria.
She also shows the children how to create a basic fluid consisting of water, salt, and sugar that can be used as an effective treatment for diarrhoea-related dehydration caused by the infection.
“It’s important that children understand how to protect themselves,” says Ms. Sylvestre. “These children are a vehicle for carrying the cholera prevention message to adults – a means for bringing about a positive change in the behaviour of older people.”
Chain of knowledge
Rhodia, 11, a student at the school, is part of this wave of change, and is following through on making sure her father knows about cholera prevention.
After school, Rhodia arrives back to her home, which has been newly rebuilt following the earthquake. The first thing she does is sit down and tell her father about the training she has just received.
“Papa, here is what we learnt at school,” she says. “We need to throw out faeces and make sure that flies don’t come and sit on them. Flies carry disease and can sit on the food that we eat, and because of this we can get cholera.”
Rhodia’s father insists that she come to the kitchen and show him the correct way to wash her hands. She demonstrates, using soap and water from a bucket.
Even though her father is a plumber, like most households in Haiti, their house doesn’t have any running water. An inability to access proper sanitation and safe water increases people’s vulnerability to diseases such as cholera.
This year, UNICEF is increasing efforts to support sustainable, long-term ways to ensure people have access to water, including repairing and expanding piped networks.
With increased capability and more knowledge about basic hygiene, future generations and the families of students such as Rhodia will be better equipped to address cholera outbreaks and other life-threatening diseases.
(Unicef) - By Gabrielle Menezes - http://www.unicef.org/
PORT-AU-PRINCE – In the crowded classrooms of Institute Mixte de Kervens School in Canape Vert, Port-au-Prince, children are learning critical skills in the fight against cholera.
The classroom windows look out on to hillsides dotted with white tarpaulin tents in the Haitian capital. These are the temporary homes of tens of thousands of people displaced by the January 2010 earthquake.
And it is here that the ever-present threat of cholera persists. The deadly menace has so far killed more than 4,500 people across the country.
Although for the moment the level of cholera infections and deaths has lowered, it is still a danger that could become even worse,” says Amara Kone, who heads UNICEF’s sanitation training programme in schools.
“But if cholera disease levels have decreased, it’s partially because we’ve been teaching people, such as children, that to prevent infection people need to wash their hands and drink safe water.”
Engaging children
Young students in schools such as Institute Mixte de Kervens are being taught skills not only as a means to protect themselves, but also as a way to spread the message to their families.
Hygiene Promoter Farah Sylvestre, a student nurse working for the non-profit organization GOAL, is mobilizing students at schools to better understand how cholera spreads, and showing how they and their families can prevent infection.GOAL – which is carrying out mobilization activities in 38 camps and communities – is one of around 30 UNICEF partners helping educate Haitians about preventive measures they can take to protect themselves against cholera.
At Institute Mixte de Kervens School, Sylvestre engages the children in simple lessons that demonstrate how they should wash their hands with soap to kill cholera bacteria.
She also shows the children how to create a basic fluid consisting of water, salt, and sugar that can be used as an effective treatment for diarrhoea-related dehydration caused by the infection.
“It’s important that children understand how to protect themselves,” says Ms. Sylvestre. “These children are a vehicle for carrying the cholera prevention message to adults – a means for bringing about a positive change in the behaviour of older people.”
Chain of knowledge
Rhodia, 11, a student at the school, is part of this wave of change, and is following through on making sure her father knows about cholera prevention.
After school, Rhodia arrives back to her home, which has been newly rebuilt following the earthquake. The first thing she does is sit down and tell her father about the training she has just received.
“Papa, here is what we learnt at school,” she says. “We need to throw out faeces and make sure that flies don’t come and sit on them. Flies carry disease and can sit on the food that we eat, and because of this we can get cholera.”
Rhodia’s father insists that she come to the kitchen and show him the correct way to wash her hands. She demonstrates, using soap and water from a bucket.
Even though her father is a plumber, like most households in Haiti, their house doesn’t have any running water. An inability to access proper sanitation and safe water increases people’s vulnerability to diseases such as cholera.
This year, UNICEF is increasing efforts to support sustainable, long-term ways to ensure people have access to water, including repairing and expanding piped networks.
With increased capability and more knowledge about basic hygiene, future generations and the families of students such as Rhodia will be better equipped to address cholera outbreaks and other life-threatening diseases.
CHOLERA / EARTHQUAKE BULLETIN #22
HEALTH CLUSTER BULLETIN: CHOLERA AND POST-EARTHQUAKE RESPONSE IN HAITI - #22
(ReliefWeb) - Source: Pan American Health Organization (PAHO); World Health Organization (WHO) Full_Report (pdf* format - 760.9 Kbytes)
Highlights - The number of nationwide cholera cases continues to decrease.
The number of cases in Northeast, Port-au-Prince, North, Northwest, Artibonite, West, and Southeast departments are stable or decreasing, but cases in Centre, Nippes, South, and Grande Anse are increasing.
- During the last Health Cluster meeting, MSPP presented a strategy for the continuity of the response to cholera including criteria for closing cholera centers.
- The nutrition department of the MSPP indicates that the protocol for cholera case treatment should be reviewed to include zinc administration. It also recommends performing malnutrition surveillance through MUAC at cholera centres.
- The phasing out of health actors from cholera treatment facilities has raised concerns about local capacity to cope with a potential increase in cases. A gap analysis is underway to update needs, gaps and alternatives
Full_Report (pdf* format - 760.9 Kbytes)
The Ministère de la Santé Publique et de la Population (MSPP) and PAHO, the Regional 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. Juan Carlos Gustavo Alonso; Dr. Josep Vargas
Health Cluster partners are asked to contribute to this bulletin with information on needs and activities as well as corrections to content, by emailing hai.clustersante@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/.
HEALTH CLUSTER BULLETIN
Dear health partners, Due to the decrease in cholera cases during the last month, certain partners have started phasing out their cholera response activities.
However, heightened vigilance is of paramount importance to identify any localized outbreak which can emerge during the upcoming rainy season. It is therefore extremely important to further reinforce coordination among health actors active in the same department, to cope with the current situation and possibly new emergencies.
Situation Overview
According to data sent by the MSPP, between 20 October 2010 and 28 February 2011, the cumulative number of reported cholera cases was 249,937, including 4,670 deaths.
The cumulative number of cholera cases has stabilized. The observed cumulative incidence of cholera cases since the beginning of the outbreak is of 24 per 1,000 inhabitants, ranging from 4 per 1,000 in the Department of South-East to 42 per 1,000in the Department of North East.
To respond adequately to the cholera outbreak, NGOs have set up a significant number of cholera treatment facilities and provided them with medical supplies, sanitation facilities, water supplies, and salaries and training for local medical staff.
In view of the downward trends in cholera cases, some NGOs are now leaving these facilities. The departure has raised concerns about the capacity of local health structures and staff to cope with a possible increase in the number of cholera cases, especially in the imminent rainy season. NGOs have stated that they continue to monitor the situation and are ready to return to support an appropriate response.
However, local staff salary problems and threats of strikes are already affecting the normal service to patients looking for medical care. Certain departments hope to receive funding from the World Bank and are looking for partners to bridge the gap.
Due to the likely suspension of humanitarian activities related to cholera response by NGOs, several clusters have undertaken gap analysis to identify main trends and implications of cholera response. The results of this analysis will be available shortly.
During the MSPP presentation on the finalized strategy for continuation of cholera response, MSPP has provided the criteria for closing cholera centers that have no more than 3 cases per day for 14 consecutive days.
New and pending issues in the WASH sector include limited financing for drinking water distribution and excrement removal from latrines and septic tanks as well as the pending solution to long-term excrement management.
Additional problems pose serious concerns with regard to adequate environmental public health.
Epidemiological Surveillance
Indicator-based component
Between 20 October 2010 and 28 February 2011 the cumulative number of reported cholera cases was 249,937, including 4,670 deaths.
The observed cumulative incidence of cholera cases since the beginning of the outbreak is of 24 per 1,000 inhabitants, ranging from 4 per 1,000 in the Department of South-East to 42 per 1,000 in the Department of North East.
The overall observed case fatality ratio was 1.9%, ranging from 0.9% in Port-au-Prince to 8.9% in the North East Department.
Since the beginning of the outbreak, at least 92% of the reported cases were observed among individuals aged 5 years or more (223,239 out of 243,197 individuals for whom the age is known), with the proportion of cases observed in children under 5years ranging from 5.3% in the Department of North to 13.9% in the Department of Artibonite.
Of the total number of reported cholera cases, 54% (135,891) has been hospitalized since the beginning of the outbreak.
Despite the observed overall downward trend of the cholera outbreak since the beginning of the year, the number of hospitalized cholera cases (3,659) reported during week 22-28 February 2011 was the second highest since week ending on 31 January 2011.
Port-au-Prince accounts for 26% of the reported hospitalized cases during week 22-28 February 2011.
With respect to the previous week, increases in the number of hospitalized cholera cases were registered in the Departments of Centre, Grande Anse, Nippes, and South East.
Event-based component (alerts)
The number of alerts received daily from partners in the field is leveling off.
The alerts are increasingly reflecting hazards other than cholera and cholera hotspots (such as anthrax) in remote areas.
The rainy season, elections, as well as NGOs phasing out from cholera treatment centers and units call for heightened attention by health authorities and partners involved in surveillance activities at the health care facility level and the community level.
An accurate and timely monitoring of the evolution of the cholera outbreak that allows prompt control intervention requires integration and triangulation of all sources of information: formal and informal, quantitative and qualitative, health care facility based and community based.
In particular, the contribution of the alert-event based component introduced and systemized during the cholera outbreak has proven increasingly valuable in ensuring the early warning function with respect to other public health events.
Therefore, efforts should be made by health authorities and partners to support the process to the integrate all information sources that would allow a more effective information management process.
Wash (Environmental Health)
The financial resources of numerous NGOs that ensure drinking water distribution and removal of excrement from latrines and septic tanks in Port-au-Prince are running out or already exhausted.
Transition strategies offer only a limited solution, and serious concerns exist with regard to access to drinking water and adequate public health conditions.
The issue of long-term excrement management has not yet been resolved, contributing to the challenges in the fight against cholera. The construction work at the Titanyen disposal site that was interrupted in December have not yet resumed.
Several other sites have been identified, but there are difficulties and a final decision has not yet been made. The health and environmental risks are clear, given the limited reception capacity of the tank and the lack of adequate excrement treatment. The disposal site is not a wastewater treatment plant, but it is a reception area without any treatment procedure in place. Despite this situation, DINEPA and SMCRS resumed the Truitier user agreement. With an increased amount of trucks, the emptying of septic tanks is ensured temporarily.
PAHO/WHO continues to support health centers linked to cholera treatment by providing them with necessary equipment and disinfectant products necessary in anticipation of a possible negative evolution of the epidemic during the rainy season.
PAHO/WHO also supports the MSPP in identifying needs and health priorities of the health centers in several departments. Environmental health is an essential to prevent the spread of cholera and other diseases related to water and sanitation management.
Health Promotion
PAHO/WHO, MSPP, UNICEF and partners participated in a meeting on lessons learned from 2010 in hygiene promotion. The aim of the meeting was to develop a "Way of Working" document to guide future interventions for hygiene promotion, including minimum standards that should be respected. This workshop was essential in bringing together many experiences from the NGO community.
World Water Day 2011 on 22 March was celebrated in Port-Au-Prince at a ceremony organized by DINEPA. The theme of this year’s celebration is "Water for Cities: responding to the Urban Challenge", which ties in closely with the last World Health Day, whose theme was "Urbanism and Healthy Living". This opportunity will be used to distribute hygiene promotion materials developed following the cholera crisis.
Situation by Department
In the sections dedicated to the description of the situation in each of the departments, the following is presented: (i) trends of the cholera epidemic (number of reported hospitalized cholera cases by week), from 8 November 2010 to 28 February 2011 (source: MSPP http://mspp.gouv.ht/site/index.php)
(ii) trends and figures provided by the PAHO/WHO Teams at Departmental level;
(iii) alerts regarding public health events received since the publication of Issue 21 of the Health Cluster Bulletin, published on 4th March 2011.1
1 Source routine surveillance data: Ministère de la Sante Publique et de la Population (MSPP), http://www.mspp.gouv.ht/site/index.php# , as of 28 February 2011.
Note: Data presented should be interpreted cautiously as these are continuously corrected and updated (e.g. for some weeks, the cumulative number of cases may be lower than in the previous week; incomplete reports in some departments).
Also there might be discrepancies between data presented in this section and those provided by partners and PAHO-WHO Teams deployed at Departmental levels and presented in the dedicated section.
Data provided by the Directions Departmental de Sante and partners to the PAHO/WHO Teams in the field.
Source event based information: alert scheme currently maintained by the Pan-American Health Organization / World Health Organization in Haiti.
Northwest
The overall trend of cholera is stable.
Hotspots in the department include:
increase in the number of cases seen at a facility reported on 13 March, 2011.
During the first week of March 2011, the Beraca hospital, which was receiving an average of 2 to 3 cases per day, admitted 16 cases to the hospital on 11 March, 2011.
14 patients came from a locality called Guichard and the rest came from a locality within few miles from there.
Last week, the meager funds available to the department have dried up. As a consequence, the community component of the response has almost come to a halt since the Brigadiers are not paid.
Therefore, there are no more awareness campaigns, distribution of ORS and Aquatabs, and other efforts at the community level.
The response to cholera in the department in recent weeks is provided only by MSPP staff with the exception of the towns of Jean Rabel and Bombardopolis, where BMI is still active declining due to insufficient funds.
North
The overall trend of cholera incidence is stable.
The weekly average of cholera cases reported daily is presented in Table 1.
The transmission of surveillance data remains problematic and cholera cases seen at ORC are underreported.
Table 1 - Week 6 - 61
Week 7 - 58
Week 8 - 73
Week 9 - 74
Week 10 - 46
Several CTCs and CTUs are closing down or are being progressively transformed.
Nonetheless, health partners in the area stay alert in the event of new outbreaks.
Water analysis performed by MSF-CH revealed that 80% of the analyzed samples contain fecal matter, an indication of contamination source.
Hotspots in the department:
Hotspots in the department include: Quartier Morin, Pignon (six community deaths among members of the same household reported a week later), Cap-Haïtien, and Grande Rivière.
The increase in cases observed in the commune of Pignon seems to be originated from Crébapié and Bas Pont regions, where a strong network of health agents is present.
In order to direct the activities of the community agents better, information is gathered in order to assess the origin of cases and patients, and the nature of their drinking water source.
With the support of MSF-CH, a new CTU is established at the Saint-Raphael health center to replace the one established by MSF-FR at the Evangelist hospital. In view of aforementioned increase of cases, reception capacity of the Pignon CTU has been increased.
The CTCs in Vertiere and Plaine du Nord have been closed, and the CTC in Fort St. Michel is transformed to an ORC and stabilization center since Bravo CTC currently has enough capacity for adequate case treatment.
Sans Souci CTC will close shortly if no new cases are reported.
CESVI is planning to establish 10 new ORCs at Saint Raphael in collaboration with the MSPP.
CESVI and FIP are coordinating their activities with MSF-CH for awareness raising activities in schools and for the donation of health center items.
Northeast
The overall trend of cholera cases is decreasing. The weekly average of cholera cases reported daily is presented in Table 2.
Agreements have been made to hold weekly surveillance meetings between the Cuban Medical Brigades and the Direction Departmental de Santé. Community brigades are being organized and are contributing more to surveillance activities.
Vallière remains a silent spot for reporting and cholera cases seen at ORCs are underreported. A sampling scheme on cases presenting diarrheal illness is being established in order to monitor the distribution of etiologies as well as the antimicrobial sensitivity pattern of Vibrio cholera.
The CTC in Sense is closing and several health centers supported by Merlin (Fort Liberté, Ouananminthe, Trou du Nord hospitals) are considerably reducing the number of personnel.
Merlin will remain active in smaller CTCs and CTUs in the area.
Preparations are made to install latrines, showers and washing areas in the hospitals of Ouanaminte and Fort Liberté.
Table 2 - Week 6 - 77
Week 7 - 60
Week 8 - 39
Week 9 - 24
Week10 - 22
Hotspots in the department include:
Ouanaminthe (102 cases during week 9 and 10), Fort-Liberté (28 cases during week 9), et Trou du Nord (37 cases during week 9 and 10).
Merlin, Haiti Plan, CDS and several small NGOs continue their suport to ORPs and Community brigades.
ARTIBONITE
The overall trend of cholera incidence is stable.
No hotspots in the department reported.
A new CTC is being finalized by MSF-France in Dessalines and will open mid March.
MSF-E is downsizing its support and other health actors will soon follow.
IMC and MSF-F would like to integrate some of the CTC as smaller units in the existing health care structures.
Out of the seven CTUs existing in the department, the commune of Dessalines, St. Michel de la Atalaye and Gross Morne are those which will require most help in case of a major emergency.
Coordination and prepositioning of supplies and materials are the two aspects which need particular support due to the department’s size and population.
Center
The overall trend of cholera cases is increasing in the department.
Hotspots in the department
On 3 March 2011, there was a significant increase in the number of cholera cases admitted at Belladere CTC: from 5 cases per day to 30 cases per day. This increase of cases is attributed to increased cholera in Totoy locality associated with unsafe burials.
A total of over 70 cases, including 4 deaths were associated with the outbreak in Totoy.
Community and water and sanitation interventions were carried out.
There is a low level of human resources (one doctor and one nurse) at CTU/Health center in Tilory.
The CTU receives 5 to 6 cases per day and has an average of 10 admitted patients.
Partners are working to identify a medium term solution.
9 March 2011: Lack of water supply over the previous four weeks reported in Mirebalais.
10 March 2011: Increase in the number of cholera cases admitted at Belladere CTC due to Croix de Fer locality (12 cases).
11 March 2011: Increase in number of cases, mainly in Maissade town for the past 2 weeks. The number of patients has increased from 2-3 per day to an average of 8-10 per day, with a peak of 14 in a single day.
The public water reservoir in Maissade area has been having problems for about a month. Most of the agencies (WorldVision, Save the Children, Zamni LaSante, Caritas, etc.) have long term projects in the department and therefore do not plan to leave soon.
Preparedness and capacity to respond to cholera outbreak will most likely not be affected.
However, some areas are insufficiently covered, such as the commune of Cerca la Source, which lacks healthcare personnel.
The presence of PAHO/WHO providing help in coordination and logistics for preparedness and response will be essential in case of a major outbreak or any other disaster.
West
Leogane-Gressier
The overall trend of cholera cases is stable.
From week 4-3-2010 to 8-2011, 3,481 hospitalized cholera cases have been reported by MSF-CH and Save the Children. The total number of institutional deaths is 40, corresponding to a CFR of 1.1% among hospitalized cases.
In week 8, the proportion of hospitalized patients younger than 5 years was 13%.
Hotspots in the department include:
Grande Rivière and Cormiers where the weekly incidence of cholera cases has increased in week 8, compared to the previous two weeks. It is doubtful whether there are local capacities to cope with a cholera outbreak, as 90% of facilities in this area are private.
Port-au-Prince The overall trend of cholera incidence is decreasing.
While the trend of cholera activity in the metropolitan area is decreasing, trend in rural areas of the West department, where there are few health centers and limited access by road, is increasing.
The DSO has started to set up cholera teams in those areas. As a preparation to cater cholera cases in an endemic situation, French Red Cross is taking over responsibility to train staff in the management of cholera in all health centers.
The DSO has sent teams (two nurses and 12 health agents for every communal section) to the mountains to undertake health education and cholera prevention, treat patients, and disinfect contaminated houses.
Southeast
A slight overall increase in weekly incidence of new cholera cases has been observed over the past few weeks (0.2 cases per 1,000 inhabitants).
While in most communes the amount is decreasing, the total number of new cases increased between 5-11 March. (89 new cases, against 76 new cases the week before).
There was an increase in the number of cases at the CTCs of Belle Anse and Jacmel, probably due to carnival. The CTCs and CTUs in Jacmel, La Vallee, Marigot Perredo Marigot Seguin and Anse à Pitre have been handed over from MSF-E to the MSPP.
The one in Bainet was handed over to Save the Children.
PAHO/WHO along with other partners have been working to ensure the provision of supplies, but it seems that MSPP is not able to pay salaries to the staff.
The situation is extremely worrisome, especially with regard to the CTU in St. Michel in Jacmel, where the majority of cases have been seen. Local staff is very competent and efficient; however, due to lack of salary payment, they are threatening to go to strike.
Main health actors in the department are: Save the Children, Red Cross (Canadian, Dutch, and Haitian), CCH, MHDR, Plan Haiti, Caritas, CISP and the Cuban Brigade.
As in most of the departments, there is a need for better access to preventative measures such as more latrines within the communities, especially in remote areas, and better access to sensitization tools that explain the mechanism of transmission, and better method of transporting patients to health services.
This last issue continues to be one of the main difficulties in adequate response to the epidemic.
The SMS reporting system from the CTC/CTU is being piloted. The flow of data through community-based schemes is suboptimal.
Hotspots in the department include:
There is a significant and continuous increase in the number of cholera cases admitted at CTC St. Michel in Jacmel.
On 10 March 2011, there were 15 cases >5, and on 11 March 2011 there was 1 case <5 and 19 cases >5.
The increase happened following an unsafe burial among household and community members in Mont Carmel reported on 12 March 2011.
A slight increase in the number of cholera cases admitted at CTU Belle Anse was reported on 12 March 2011.
This CTU has been receiving 0-2 cases consistently for the last couple weeks. On 10 March 2011, they received 5 cases >5 years of age. The increased number is attributed to carnival activities.
Three community deaths were reported in Belle Anse on 16 March 2011.
Nippes
The overall trend of cholera incidence is increasing. No hotspots in the department are reported.
South
The overall trend of cholera incidence is increasing.
Weekly incidence of reported cholera cases increased from 0.6 cases per 1,000 inhabitants in week 9 to 0.8 cases per 1,000 inhabitants in week 10.
The incidence increased across all communes, highest in Port au Piment and Aquin (1.8 cases per 1,000) and Les Cayes (1.7 cases per 1,000).
One death was reported during week 10.
Proportions for cases from Aquin (17%), Les Cayes (15%), Camp Perrin (11%), Torbeck (12%), Chantal (8%) were the highest.
Data emphasizes the areas that are underserviced by ORC plan and treatment centers (Torbeck and Chantal) or believed to have a low burden (Camp Perrin).
Data management at the Direction Departmental de Sante remains suboptimal.
ORC reporting scheme will be refined and integrated with the work carried out by the community brigades.
PAHO/WHO, together with UNICEF is prepositioning medical inputs to prepare for the rainy season.
Hotspots in the department include:
2 March 2011: During the month of February consistently high proportion of cholera cases (~30%) from Roche à Bateau locality admitted at CTU Port à Piment.
12 March 2011: Approximately 60 cholera cases from Kanmi, near Cavaillon, seen at the CTC run by IMC and MSF in Les Cayes
13 March 2011: Rapid increase in cases seen and hospitalised in «Zanglais», neighbourhood of Aquin, 88 cases visited CTU Aquin since the night of 12 march 2011.
On March 15, this number had increased to 350.
14 March 2011: starting from 12 March 2011, continuous increase of number of cholera cases coming from Conde, remote area of Coteaux, seen at CTU Port a Piment. This happened following the week long rains.
15 March 2011: Increased number of cholera cases reported in Bourdet and Maniches (near Les Cayes)
15 March 2011: Increased number of cholera cases reported in Port Salut
17 March 2011: Approximately 20 cholera cases reported in Randelles. No access to treatment and mobile CTU being deployed.
Grande Anse
The overall trend of cholera cases is increasing. An epidemiological alert unit has been created and procedures for verification, investigation, response, and information management has being established at the departmental level.
There was persistence of under reporting due to different reasons including silent CTC/CTU and lack of registries in the health care facilities. Weekly reporting of quantitative data is regarded as a key measure to improve the overall performance of the surveillance system.
Hotspots in the department include:
4 March 2011: Increased number of cholera cases reported at CTU Iles Blanche
8 March 2011: Increased number of cholera cases reported at CTU Mouline, commune of Corail, and attributed to several localities: Debarrière, Amiel, Tardieu, Fond d’Ycaque, Troubois, Miya, Carrier, Andre, Etandier.
12 March 2011: Increased number of cholera cases from Dériveaux locality admitted at CTU Pestel. Water supply at CTU Pestel continues to pose challenges. Arrangements made for 1,500 L water to be delivered at the beginning of the week starting 21 March 2011.
14 March 2011: Report of one case of cutaneous anthrax, in 8 month old baby, admitted at Jérémie hospital and resident in Didon, Ravine à Charles. The clinical evolution is favorable. Verification in progress regarding the occurrence of similar cases in the family as well as animal deaths in the community.
15 March 2011: Veterinary Departmental authorities reports anthrax activity in the animal population in Commune de Corail. Further investigations have revealed that two cutaneous anthrax cases, in two children residents of Duquillon, had been seen at Corail Health Centre around 7 March 2011.
15 march 2011: Increased number of cholera cases reported in the Commune de Doco.
(ReliefWeb) - Source: Pan American Health Organization (PAHO); World Health Organization (WHO) Full_Report (pdf* format - 760.9 Kbytes)
Highlights - The number of nationwide cholera cases continues to decrease.
The number of cases in Northeast, Port-au-Prince, North, Northwest, Artibonite, West, and Southeast departments are stable or decreasing, but cases in Centre, Nippes, South, and Grande Anse are increasing.
- During the last Health Cluster meeting, MSPP presented a strategy for the continuity of the response to cholera including criteria for closing cholera centers.
- The nutrition department of the MSPP indicates that the protocol for cholera case treatment should be reviewed to include zinc administration. It also recommends performing malnutrition surveillance through MUAC at cholera centres.
- The phasing out of health actors from cholera treatment facilities has raised concerns about local capacity to cope with a potential increase in cases. A gap analysis is underway to update needs, gaps and alternatives
Full_Report (pdf* format - 760.9 Kbytes)
The Ministère de la Santé Publique et de la Population (MSPP) and PAHO, the Regional 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. Juan Carlos Gustavo Alonso; Dr. Josep Vargas
Health Cluster partners are asked to contribute to this bulletin with information on needs and activities as well as corrections to content, by emailing hai.clustersante@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/.
HEALTH CLUSTER BULLETIN
Dear health partners, Due to the decrease in cholera cases during the last month, certain partners have started phasing out their cholera response activities.
However, heightened vigilance is of paramount importance to identify any localized outbreak which can emerge during the upcoming rainy season. It is therefore extremely important to further reinforce coordination among health actors active in the same department, to cope with the current situation and possibly new emergencies.
Situation Overview
According to data sent by the MSPP, between 20 October 2010 and 28 February 2011, the cumulative number of reported cholera cases was 249,937, including 4,670 deaths.
The cumulative number of cholera cases has stabilized. The observed cumulative incidence of cholera cases since the beginning of the outbreak is of 24 per 1,000 inhabitants, ranging from 4 per 1,000 in the Department of South-East to 42 per 1,000in the Department of North East.
To respond adequately to the cholera outbreak, NGOs have set up a significant number of cholera treatment facilities and provided them with medical supplies, sanitation facilities, water supplies, and salaries and training for local medical staff.
In view of the downward trends in cholera cases, some NGOs are now leaving these facilities. The departure has raised concerns about the capacity of local health structures and staff to cope with a possible increase in the number of cholera cases, especially in the imminent rainy season. NGOs have stated that they continue to monitor the situation and are ready to return to support an appropriate response.
However, local staff salary problems and threats of strikes are already affecting the normal service to patients looking for medical care. Certain departments hope to receive funding from the World Bank and are looking for partners to bridge the gap.
Due to the likely suspension of humanitarian activities related to cholera response by NGOs, several clusters have undertaken gap analysis to identify main trends and implications of cholera response. The results of this analysis will be available shortly.
During the MSPP presentation on the finalized strategy for continuation of cholera response, MSPP has provided the criteria for closing cholera centers that have no more than 3 cases per day for 14 consecutive days.
New and pending issues in the WASH sector include limited financing for drinking water distribution and excrement removal from latrines and septic tanks as well as the pending solution to long-term excrement management.
Additional problems pose serious concerns with regard to adequate environmental public health.
Epidemiological Surveillance
Indicator-based component
Between 20 October 2010 and 28 February 2011 the cumulative number of reported cholera cases was 249,937, including 4,670 deaths.
The observed cumulative incidence of cholera cases since the beginning of the outbreak is of 24 per 1,000 inhabitants, ranging from 4 per 1,000 in the Department of South-East to 42 per 1,000 in the Department of North East.
The overall observed case fatality ratio was 1.9%, ranging from 0.9% in Port-au-Prince to 8.9% in the North East Department.
Since the beginning of the outbreak, at least 92% of the reported cases were observed among individuals aged 5 years or more (223,239 out of 243,197 individuals for whom the age is known), with the proportion of cases observed in children under 5years ranging from 5.3% in the Department of North to 13.9% in the Department of Artibonite.
Of the total number of reported cholera cases, 54% (135,891) has been hospitalized since the beginning of the outbreak.
Despite the observed overall downward trend of the cholera outbreak since the beginning of the year, the number of hospitalized cholera cases (3,659) reported during week 22-28 February 2011 was the second highest since week ending on 31 January 2011.
Port-au-Prince accounts for 26% of the reported hospitalized cases during week 22-28 February 2011.
With respect to the previous week, increases in the number of hospitalized cholera cases were registered in the Departments of Centre, Grande Anse, Nippes, and South East.
Event-based component (alerts)
The number of alerts received daily from partners in the field is leveling off.
The alerts are increasingly reflecting hazards other than cholera and cholera hotspots (such as anthrax) in remote areas.
The rainy season, elections, as well as NGOs phasing out from cholera treatment centers and units call for heightened attention by health authorities and partners involved in surveillance activities at the health care facility level and the community level.
An accurate and timely monitoring of the evolution of the cholera outbreak that allows prompt control intervention requires integration and triangulation of all sources of information: formal and informal, quantitative and qualitative, health care facility based and community based.
In particular, the contribution of the alert-event based component introduced and systemized during the cholera outbreak has proven increasingly valuable in ensuring the early warning function with respect to other public health events.
Therefore, efforts should be made by health authorities and partners to support the process to the integrate all information sources that would allow a more effective information management process.
Wash (Environmental Health)
The financial resources of numerous NGOs that ensure drinking water distribution and removal of excrement from latrines and septic tanks in Port-au-Prince are running out or already exhausted.
Transition strategies offer only a limited solution, and serious concerns exist with regard to access to drinking water and adequate public health conditions.
The issue of long-term excrement management has not yet been resolved, contributing to the challenges in the fight against cholera. The construction work at the Titanyen disposal site that was interrupted in December have not yet resumed.
Several other sites have been identified, but there are difficulties and a final decision has not yet been made. The health and environmental risks are clear, given the limited reception capacity of the tank and the lack of adequate excrement treatment. The disposal site is not a wastewater treatment plant, but it is a reception area without any treatment procedure in place. Despite this situation, DINEPA and SMCRS resumed the Truitier user agreement. With an increased amount of trucks, the emptying of septic tanks is ensured temporarily.
PAHO/WHO continues to support health centers linked to cholera treatment by providing them with necessary equipment and disinfectant products necessary in anticipation of a possible negative evolution of the epidemic during the rainy season.
PAHO/WHO also supports the MSPP in identifying needs and health priorities of the health centers in several departments. Environmental health is an essential to prevent the spread of cholera and other diseases related to water and sanitation management.
Health Promotion
PAHO/WHO, MSPP, UNICEF and partners participated in a meeting on lessons learned from 2010 in hygiene promotion. The aim of the meeting was to develop a "Way of Working" document to guide future interventions for hygiene promotion, including minimum standards that should be respected. This workshop was essential in bringing together many experiences from the NGO community.
World Water Day 2011 on 22 March was celebrated in Port-Au-Prince at a ceremony organized by DINEPA. The theme of this year’s celebration is "Water for Cities: responding to the Urban Challenge", which ties in closely with the last World Health Day, whose theme was "Urbanism and Healthy Living". This opportunity will be used to distribute hygiene promotion materials developed following the cholera crisis.
Situation by Department
In the sections dedicated to the description of the situation in each of the departments, the following is presented: (i) trends of the cholera epidemic (number of reported hospitalized cholera cases by week), from 8 November 2010 to 28 February 2011 (source: MSPP http://mspp.gouv.ht/site/index.php)
(ii) trends and figures provided by the PAHO/WHO Teams at Departmental level;
(iii) alerts regarding public health events received since the publication of Issue 21 of the Health Cluster Bulletin, published on 4th March 2011.1
1 Source routine surveillance data: Ministère de la Sante Publique et de la Population (MSPP), http://www.mspp.gouv.ht/site/index.php# , as of 28 February 2011.
Note: Data presented should be interpreted cautiously as these are continuously corrected and updated (e.g. for some weeks, the cumulative number of cases may be lower than in the previous week; incomplete reports in some departments).
Also there might be discrepancies between data presented in this section and those provided by partners and PAHO-WHO Teams deployed at Departmental levels and presented in the dedicated section.
Data provided by the Directions Departmental de Sante and partners to the PAHO/WHO Teams in the field.
Source event based information: alert scheme currently maintained by the Pan-American Health Organization / World Health Organization in Haiti.
Northwest
The overall trend of cholera is stable.
Hotspots in the department include:
increase in the number of cases seen at a facility reported on 13 March, 2011.
During the first week of March 2011, the Beraca hospital, which was receiving an average of 2 to 3 cases per day, admitted 16 cases to the hospital on 11 March, 2011.
14 patients came from a locality called Guichard and the rest came from a locality within few miles from there.
Last week, the meager funds available to the department have dried up. As a consequence, the community component of the response has almost come to a halt since the Brigadiers are not paid.
Therefore, there are no more awareness campaigns, distribution of ORS and Aquatabs, and other efforts at the community level.
The response to cholera in the department in recent weeks is provided only by MSPP staff with the exception of the towns of Jean Rabel and Bombardopolis, where BMI is still active declining due to insufficient funds.
North
The overall trend of cholera incidence is stable.
The weekly average of cholera cases reported daily is presented in Table 1.
The transmission of surveillance data remains problematic and cholera cases seen at ORC are underreported.
Table 1 - Week 6 - 61
Week 7 - 58
Week 8 - 73
Week 9 - 74
Week 10 - 46
Several CTCs and CTUs are closing down or are being progressively transformed.
Nonetheless, health partners in the area stay alert in the event of new outbreaks.
Water analysis performed by MSF-CH revealed that 80% of the analyzed samples contain fecal matter, an indication of contamination source.
Hotspots in the department:
Hotspots in the department include: Quartier Morin, Pignon (six community deaths among members of the same household reported a week later), Cap-Haïtien, and Grande Rivière.
The increase in cases observed in the commune of Pignon seems to be originated from Crébapié and Bas Pont regions, where a strong network of health agents is present.
In order to direct the activities of the community agents better, information is gathered in order to assess the origin of cases and patients, and the nature of their drinking water source.
With the support of MSF-CH, a new CTU is established at the Saint-Raphael health center to replace the one established by MSF-FR at the Evangelist hospital. In view of aforementioned increase of cases, reception capacity of the Pignon CTU has been increased.
The CTCs in Vertiere and Plaine du Nord have been closed, and the CTC in Fort St. Michel is transformed to an ORC and stabilization center since Bravo CTC currently has enough capacity for adequate case treatment.
Sans Souci CTC will close shortly if no new cases are reported.
CESVI is planning to establish 10 new ORCs at Saint Raphael in collaboration with the MSPP.
CESVI and FIP are coordinating their activities with MSF-CH for awareness raising activities in schools and for the donation of health center items.
Northeast
The overall trend of cholera cases is decreasing. The weekly average of cholera cases reported daily is presented in Table 2.
Agreements have been made to hold weekly surveillance meetings between the Cuban Medical Brigades and the Direction Departmental de Santé. Community brigades are being organized and are contributing more to surveillance activities.
Vallière remains a silent spot for reporting and cholera cases seen at ORCs are underreported. A sampling scheme on cases presenting diarrheal illness is being established in order to monitor the distribution of etiologies as well as the antimicrobial sensitivity pattern of Vibrio cholera.
The CTC in Sense is closing and several health centers supported by Merlin (Fort Liberté, Ouananminthe, Trou du Nord hospitals) are considerably reducing the number of personnel.
Merlin will remain active in smaller CTCs and CTUs in the area.
Preparations are made to install latrines, showers and washing areas in the hospitals of Ouanaminte and Fort Liberté.
Table 2 - Week 6 - 77
Week 7 - 60
Week 8 - 39
Week 9 - 24
Week10 - 22
Hotspots in the department include:
Ouanaminthe (102 cases during week 9 and 10), Fort-Liberté (28 cases during week 9), et Trou du Nord (37 cases during week 9 and 10).
Merlin, Haiti Plan, CDS and several small NGOs continue their suport to ORPs and Community brigades.
ARTIBONITE
The overall trend of cholera incidence is stable.
No hotspots in the department reported.
A new CTC is being finalized by MSF-France in Dessalines and will open mid March.
MSF-E is downsizing its support and other health actors will soon follow.
IMC and MSF-F would like to integrate some of the CTC as smaller units in the existing health care structures.
Out of the seven CTUs existing in the department, the commune of Dessalines, St. Michel de la Atalaye and Gross Morne are those which will require most help in case of a major emergency.
Coordination and prepositioning of supplies and materials are the two aspects which need particular support due to the department’s size and population.
Center
The overall trend of cholera cases is increasing in the department.
Hotspots in the department
On 3 March 2011, there was a significant increase in the number of cholera cases admitted at Belladere CTC: from 5 cases per day to 30 cases per day. This increase of cases is attributed to increased cholera in Totoy locality associated with unsafe burials.
A total of over 70 cases, including 4 deaths were associated with the outbreak in Totoy.
Community and water and sanitation interventions were carried out.
There is a low level of human resources (one doctor and one nurse) at CTU/Health center in Tilory.
The CTU receives 5 to 6 cases per day and has an average of 10 admitted patients.
Partners are working to identify a medium term solution.
9 March 2011: Lack of water supply over the previous four weeks reported in Mirebalais.
10 March 2011: Increase in the number of cholera cases admitted at Belladere CTC due to Croix de Fer locality (12 cases).
11 March 2011: Increase in number of cases, mainly in Maissade town for the past 2 weeks. The number of patients has increased from 2-3 per day to an average of 8-10 per day, with a peak of 14 in a single day.
The public water reservoir in Maissade area has been having problems for about a month. Most of the agencies (WorldVision, Save the Children, Zamni LaSante, Caritas, etc.) have long term projects in the department and therefore do not plan to leave soon.
Preparedness and capacity to respond to cholera outbreak will most likely not be affected.
However, some areas are insufficiently covered, such as the commune of Cerca la Source, which lacks healthcare personnel.
The presence of PAHO/WHO providing help in coordination and logistics for preparedness and response will be essential in case of a major outbreak or any other disaster.
West
Leogane-Gressier
The overall trend of cholera cases is stable.
From week 4-3-2010 to 8-2011, 3,481 hospitalized cholera cases have been reported by MSF-CH and Save the Children. The total number of institutional deaths is 40, corresponding to a CFR of 1.1% among hospitalized cases.
In week 8, the proportion of hospitalized patients younger than 5 years was 13%.
Hotspots in the department include:
Grande Rivière and Cormiers where the weekly incidence of cholera cases has increased in week 8, compared to the previous two weeks. It is doubtful whether there are local capacities to cope with a cholera outbreak, as 90% of facilities in this area are private.
Port-au-Prince The overall trend of cholera incidence is decreasing.
While the trend of cholera activity in the metropolitan area is decreasing, trend in rural areas of the West department, where there are few health centers and limited access by road, is increasing.
The DSO has started to set up cholera teams in those areas. As a preparation to cater cholera cases in an endemic situation, French Red Cross is taking over responsibility to train staff in the management of cholera in all health centers.
The DSO has sent teams (two nurses and 12 health agents for every communal section) to the mountains to undertake health education and cholera prevention, treat patients, and disinfect contaminated houses.
Southeast
A slight overall increase in weekly incidence of new cholera cases has been observed over the past few weeks (0.2 cases per 1,000 inhabitants).
While in most communes the amount is decreasing, the total number of new cases increased between 5-11 March. (89 new cases, against 76 new cases the week before).
There was an increase in the number of cases at the CTCs of Belle Anse and Jacmel, probably due to carnival. The CTCs and CTUs in Jacmel, La Vallee, Marigot Perredo Marigot Seguin and Anse à Pitre have been handed over from MSF-E to the MSPP.
The one in Bainet was handed over to Save the Children.
PAHO/WHO along with other partners have been working to ensure the provision of supplies, but it seems that MSPP is not able to pay salaries to the staff.
The situation is extremely worrisome, especially with regard to the CTU in St. Michel in Jacmel, where the majority of cases have been seen. Local staff is very competent and efficient; however, due to lack of salary payment, they are threatening to go to strike.
Main health actors in the department are: Save the Children, Red Cross (Canadian, Dutch, and Haitian), CCH, MHDR, Plan Haiti, Caritas, CISP and the Cuban Brigade.
As in most of the departments, there is a need for better access to preventative measures such as more latrines within the communities, especially in remote areas, and better access to sensitization tools that explain the mechanism of transmission, and better method of transporting patients to health services.
This last issue continues to be one of the main difficulties in adequate response to the epidemic.
The SMS reporting system from the CTC/CTU is being piloted. The flow of data through community-based schemes is suboptimal.
Hotspots in the department include:
There is a significant and continuous increase in the number of cholera cases admitted at CTC St. Michel in Jacmel.
On 10 March 2011, there were 15 cases >5, and on 11 March 2011 there was 1 case <5 and 19 cases >5.
The increase happened following an unsafe burial among household and community members in Mont Carmel reported on 12 March 2011.
A slight increase in the number of cholera cases admitted at CTU Belle Anse was reported on 12 March 2011.
This CTU has been receiving 0-2 cases consistently for the last couple weeks. On 10 March 2011, they received 5 cases >5 years of age. The increased number is attributed to carnival activities.
Three community deaths were reported in Belle Anse on 16 March 2011.
Nippes
The overall trend of cholera incidence is increasing. No hotspots in the department are reported.
South
The overall trend of cholera incidence is increasing.
Weekly incidence of reported cholera cases increased from 0.6 cases per 1,000 inhabitants in week 9 to 0.8 cases per 1,000 inhabitants in week 10.
The incidence increased across all communes, highest in Port au Piment and Aquin (1.8 cases per 1,000) and Les Cayes (1.7 cases per 1,000).
One death was reported during week 10.
Proportions for cases from Aquin (17%), Les Cayes (15%), Camp Perrin (11%), Torbeck (12%), Chantal (8%) were the highest.
Data emphasizes the areas that are underserviced by ORC plan and treatment centers (Torbeck and Chantal) or believed to have a low burden (Camp Perrin).
Data management at the Direction Departmental de Sante remains suboptimal.
ORC reporting scheme will be refined and integrated with the work carried out by the community brigades.
PAHO/WHO, together with UNICEF is prepositioning medical inputs to prepare for the rainy season.
Hotspots in the department include:
2 March 2011: During the month of February consistently high proportion of cholera cases (~30%) from Roche à Bateau locality admitted at CTU Port à Piment.
12 March 2011: Approximately 60 cholera cases from Kanmi, near Cavaillon, seen at the CTC run by IMC and MSF in Les Cayes
13 March 2011: Rapid increase in cases seen and hospitalised in «Zanglais», neighbourhood of Aquin, 88 cases visited CTU Aquin since the night of 12 march 2011.
On March 15, this number had increased to 350.
14 March 2011: starting from 12 March 2011, continuous increase of number of cholera cases coming from Conde, remote area of Coteaux, seen at CTU Port a Piment. This happened following the week long rains.
15 March 2011: Increased number of cholera cases reported in Bourdet and Maniches (near Les Cayes)
15 March 2011: Increased number of cholera cases reported in Port Salut
17 March 2011: Approximately 20 cholera cases reported in Randelles. No access to treatment and mobile CTU being deployed.
Grande Anse
The overall trend of cholera cases is increasing. An epidemiological alert unit has been created and procedures for verification, investigation, response, and information management has being established at the departmental level.
There was persistence of under reporting due to different reasons including silent CTC/CTU and lack of registries in the health care facilities. Weekly reporting of quantitative data is regarded as a key measure to improve the overall performance of the surveillance system.
Hotspots in the department include:
4 March 2011: Increased number of cholera cases reported at CTU Iles Blanche
8 March 2011: Increased number of cholera cases reported at CTU Mouline, commune of Corail, and attributed to several localities: Debarrière, Amiel, Tardieu, Fond d’Ycaque, Troubois, Miya, Carrier, Andre, Etandier.
12 March 2011: Increased number of cholera cases from Dériveaux locality admitted at CTU Pestel. Water supply at CTU Pestel continues to pose challenges. Arrangements made for 1,500 L water to be delivered at the beginning of the week starting 21 March 2011.
14 March 2011: Report of one case of cutaneous anthrax, in 8 month old baby, admitted at Jérémie hospital and resident in Didon, Ravine à Charles. The clinical evolution is favorable. Verification in progress regarding the occurrence of similar cases in the family as well as animal deaths in the community.
15 March 2011: Veterinary Departmental authorities reports anthrax activity in the animal population in Commune de Corail. Further investigations have revealed that two cutaneous anthrax cases, in two children residents of Duquillon, had been seen at Corail Health Centre around 7 March 2011.
15 march 2011: Increased number of cholera cases reported in the Commune de Doco.
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