SCIENTISTS FIND NEW WRINKLE IN HOW CHOLERA GOT TO HAITI
(NPR) By Richard Knox
Most researchers currently believe that United Nations peacekeeping soldiers introduced cholera to Haiti in October of 2010.
After all, Haiti hadn't recorded cholera for as long as a century, Nepal had experienced a cholera epidemic in the months preceding the soldiers' arrival, and the Haitian and Nepalese cholera strains were found to be nearly identical.
But it's not that simple, says a research group based at the University of Maryland.
These researchers have found two very different cholera strains in some of the first Haitians to be struck by the disease.
One is a so-called 01 serotype with close resemblance to the Nepalese strain, found in about half the patients sampled. The other is a type called non-01/O139 that has never been known to cause an epidemic; it was found in 21 percent of patients. Another 7 percent of patients harbored both types.
What can this mean? It's not clear, but the leader of the team, Rita Colwell, thinks cholera germs have been lurking undetected in the Haitian environment for a long time.
"This suggests that it's very likely that local (Haitian) strains are involved," Colwell told Shots. "Because no one has tested for pathogenic cholera strains in that country before, we have no evidence that it wasn't there already."
I asked Colwell if she thinks one strain was introduced by the Nepalese soldiers and the other was native to Haiti, or at least predated the current epidemic.
"The introduction (from Nepal) can't be ruled out but it can't be proven either," she replied. "I think the evidence is at best circumstantial, and it is not sufficient to account for the entire epidemic."
Colwell, an internationally recognized expert on the interaction of cholera and environmental factors, thinks Haiti's explosive epidemic is most likely explained by the "perfect storm" of three converging factors.
"You have this massive earthquake in January 2010," she says. "The geology of Haiti is limestone. With earthquake effects disrupting the rivers, the rivers become very alkaline." Colwell's studies have shown that the bacterium Vibrio cholera thrives in alkaline waters.
"Then Haiti had one of the hottest summers on record," she continues. That warmed the estuaries where cholera likes to breed in tiny crustaceans, further abetting the bacteria's cause.
"That was followed by a hurricane that skirted Haiti, causing heavy rain and flooding," Colwell points out. "With all the river systems churned up with nutrients and warm water, and proper alkalinity, it would be ideal for the organism to become quite dominant."
No doubt some will be skeptical. With Haiti's climate, geography, proneness to hurricane-related flooding and notorious poor sanitation, some may doubt that cholera epidemics could have been absent, or overlooked, until 20 months ago.
But some scientists think Colwell is onto something.
Dr. David Sack of the Johns Hopkins Bloomberg School of Public Health doesn't buy the hypothesis that Nepalese peacekeepers started the epidemic by contaminating a leaky latrine upstream from the first cholera cases.
He thinks the epidemic exploded too soon after the Nepalese reportedly arrived in Haiti. UN officials tell him that was on October 8, and the first cholera case was recorded on October 12 in a town near the UN camp.
"Cholera's incubation period is at least 24 hours, sometimes two or three days," Sack told Shots. "Just to have a cholera vibrio floating downstream, and considering the dilution factor – well, it raises questions in my mind. Not that it wasn't imported. I think it was imported. I just question when it was imported."
Sack thinks we may never know how the South Asian strain of cholera got into Haiti.
As for the non-01/O139 strain, Sack thinks it might have been hiding in Haiti's environment, waiting for Colwell's perfect storm.
In any case, Sack says the Colwell group has focused new attention on the environmental factors behind the epidemic. And both agree that, going forward, controlling cholera in Haiti will take a massive effort to provide clean drinking water plus vaccination against the disease.
"I would be very strongly in favor of a combination of provision of safe water and vaccine," Colwell says. "That could be very, very effective."
A pilot project this spring has vaccinated close to 100,000 Haitians in Port-au-Prince and the river delta where cholera first appeared in large numbers. But it will take millions of doses, renewed every two to three years, to protect most Haitians at risk. Sack wonders where that much vaccine will come from; it's multiples of the world's current supply.
So far, Haiti has counted 557,397 cases of cholera since the epidemic's beginning, and 7,278 deaths. The current rainy season that began in March, which fosters cholera outbreaks, has added nearly 30,000 cases and 250 deaths to that total.
Showing posts with label Articles - Cholera. Show all posts
Showing posts with label Articles - Cholera. Show all posts
Tuesday, June 19, 2012
ARTICLE - AID GROUP SEES DROP IN CHOLERA
AID GROUP IN HAITI SEES DROP IN CHOLERA CASES
(Count on 2) - By AP
PORT-AU-PRINCE - The director of an international aid group says the Haitian capital is seeing a dramatic drop in the number of cholera cases as the Caribbean nation leaves the annual rainy season.
Thierry Goffeau of Doctors Without Borders says his health group has seen the number of weekly cases in Port-au-Prince jump from 708 in late April to 1,354 in late May. The number of cases in the capital dropped to 528 last week.
This drop was mirrored at a cholera treatment center in a densely populated neighborhood in Port-au-Prince. Patients filled an 80-bed facility through the month of May. The same facility now has about 10 patients.
Despite the decline, cholera continues to cause havoc. Officials say the waterborne disease has killed more than 7,200 people and sickened another 555,000.
(Count on 2) - By AP
PORT-AU-PRINCE - The director of an international aid group says the Haitian capital is seeing a dramatic drop in the number of cholera cases as the Caribbean nation leaves the annual rainy season.
Thierry Goffeau of Doctors Without Borders says his health group has seen the number of weekly cases in Port-au-Prince jump from 708 in late April to 1,354 in late May. The number of cases in the capital dropped to 528 last week.
This drop was mirrored at a cholera treatment center in a densely populated neighborhood in Port-au-Prince. Patients filled an 80-bed facility through the month of May. The same facility now has about 10 patients.
Despite the decline, cholera continues to cause havoc. Officials say the waterborne disease has killed more than 7,200 people and sickened another 555,000.
Sunday, June 17, 2012
ARTICLE - AFRICA - CHOLERA VACCINE
CHOLERA VACCINE DEPLOYED TO CONTROL AFRICAN OUTBREAK
(Nature) - By Gozde Zorlu
Patients in Guinea are first in Africa to be given oral vaccination during an epidemic.
For the first time, health officials in West Africa have begun a vaccination campaign to try to control cholera during an active epidemic.
In collaboration with the Ministry of Health in Guinea, the charity Médecins Sans Frontières (MSF; also known as Doctors Without Borders) has been administering the cholera vaccine Shanchol in the region of Boffa, 150 kilometres northwest of the country’s capital, Conakry. The programme began in late April, with patients receiving a two-dose oral vaccine. In total, almost 150,000 people received at least one dose of vaccine, and just over 110,000 people received a second dose.
Iza Ciglenecki, project manager for diarrhoeal diseases at MSF, ran the campaign in Guinea. She hopes that the results will lead to more widespread use of the vaccine in epidemics. “Until very recently, no one was using this as an extra tool to control cholera,” she says. “We hope to add to the evidence base regarding this vaccine to help develop an intervention criteria for the control of cholera in outbreaks.”
The programme follows on the heels of two modelling studies, published in the journal PLoS Neglected Tropical Diseases last year, which suggested that cholera vaccines were beneficial after outbreaks occurred in Vietnam and Zimbabwe1, 2. But more information is needed on how and when to administer the vaccine, explains Ciglenecki.
Surveillance systems in Boffa have been strengthened to enable the MSF to monitor the Guinean epidemic and to assess the effectiveness of the vaccine over the next six months.
William Perea of the Control of Epidemic Diseases Unit at the World Health Organization (WHO) in Geneva, Switzerland, is watching the intervention closely. Alongside other control measures such as cleaning up the water supply, the WHO now recommends using available cholera vaccines to control outbreaks. Opinions were divided among vaccination experts at the start of the 2010 cholera epidemic in Haiti regarding vaccine efficacy and availability. There were also concerns that time and resources would be better spent on improving water and sanitation systems than on vaccines (see ‘Would cholera vaccines have helped in Haiti?’).
Time for action
The real issue now is not the vaccine, but the mechanism by which to deliver a vaccination programme in response to an outbreak, says Perea. “We know enough about the vaccine to say it is very likely to work, but in the field where you have to respond quickly, other elements will come into consideration,” he says. “So we need to make sure we collect data and do the necessary work to make sure that the cholera vaccine will have an impact in these situations. It is time to stop talking and time to start acting.”
A WHO technical group has recommended that cholera vaccine is stockpiled ready for use in response to outbreaks, says Perea. To fund this, the organization needs to gain support from major donors, such as the GAVI Alliance in Geneva and the Bill & Melinda Gates Foundation in Seattle, Washington. Perea hopes that a stockpile will be established by January 2013, but acknowledged that it may take longer.
Meanwhile, in Haiti, the organization Partners in Health, headquartered in Boston, Massachusetts, has implemented a cholera vaccination programme to protect the thousands of people still at risk of cholera from the epidemic that broke out in the wake of the 2010 earthquake. After several delays, the programme started in April this year. Vaccine uptake has been good so far, and the results of the programme will be known by the end of September, according to Louise Ivers, chief of mission for Partners in Health in Haiti.
Ivers is excited about the MSF vaccination campaign in Guinea and hopes that the two organizations can learn from each other. “We have a vaccine that is pretty good but it is not used,” she says. “So the more information we can gather to help inform public health officials and ministries of health on the use of vaccine in the field, the better”. Ivers explains that the most important objectives are to show that a sufficient number of patients will come back for their second dose of vaccine, and that the logistical and supply systems are able to deliver the vaccines successfully.
Cholera experts are agreed on the need to tackle the root of the problem: improving water and sanitation systems in countries where these are lacking. But because this can take a significant amount of investment, in terms of time and resources, a vaccine can offer protection during an outbreak. “It’s a good tool, we have to use it,” says Perea.
(Nature) - By Gozde Zorlu
Patients in Guinea are first in Africa to be given oral vaccination during an epidemic.
For the first time, health officials in West Africa have begun a vaccination campaign to try to control cholera during an active epidemic.
In collaboration with the Ministry of Health in Guinea, the charity Médecins Sans Frontières (MSF; also known as Doctors Without Borders) has been administering the cholera vaccine Shanchol in the region of Boffa, 150 kilometres northwest of the country’s capital, Conakry. The programme began in late April, with patients receiving a two-dose oral vaccine. In total, almost 150,000 people received at least one dose of vaccine, and just over 110,000 people received a second dose.
Iza Ciglenecki, project manager for diarrhoeal diseases at MSF, ran the campaign in Guinea. She hopes that the results will lead to more widespread use of the vaccine in epidemics. “Until very recently, no one was using this as an extra tool to control cholera,” she says. “We hope to add to the evidence base regarding this vaccine to help develop an intervention criteria for the control of cholera in outbreaks.”
The programme follows on the heels of two modelling studies, published in the journal PLoS Neglected Tropical Diseases last year, which suggested that cholera vaccines were beneficial after outbreaks occurred in Vietnam and Zimbabwe1, 2. But more information is needed on how and when to administer the vaccine, explains Ciglenecki.
Surveillance systems in Boffa have been strengthened to enable the MSF to monitor the Guinean epidemic and to assess the effectiveness of the vaccine over the next six months.
William Perea of the Control of Epidemic Diseases Unit at the World Health Organization (WHO) in Geneva, Switzerland, is watching the intervention closely. Alongside other control measures such as cleaning up the water supply, the WHO now recommends using available cholera vaccines to control outbreaks. Opinions were divided among vaccination experts at the start of the 2010 cholera epidemic in Haiti regarding vaccine efficacy and availability. There were also concerns that time and resources would be better spent on improving water and sanitation systems than on vaccines (see ‘Would cholera vaccines have helped in Haiti?’).
Time for action
The real issue now is not the vaccine, but the mechanism by which to deliver a vaccination programme in response to an outbreak, says Perea. “We know enough about the vaccine to say it is very likely to work, but in the field where you have to respond quickly, other elements will come into consideration,” he says. “So we need to make sure we collect data and do the necessary work to make sure that the cholera vaccine will have an impact in these situations. It is time to stop talking and time to start acting.”
A WHO technical group has recommended that cholera vaccine is stockpiled ready for use in response to outbreaks, says Perea. To fund this, the organization needs to gain support from major donors, such as the GAVI Alliance in Geneva and the Bill & Melinda Gates Foundation in Seattle, Washington. Perea hopes that a stockpile will be established by January 2013, but acknowledged that it may take longer.
Meanwhile, in Haiti, the organization Partners in Health, headquartered in Boston, Massachusetts, has implemented a cholera vaccination programme to protect the thousands of people still at risk of cholera from the epidemic that broke out in the wake of the 2010 earthquake. After several delays, the programme started in April this year. Vaccine uptake has been good so far, and the results of the programme will be known by the end of September, according to Louise Ivers, chief of mission for Partners in Health in Haiti.
Ivers is excited about the MSF vaccination campaign in Guinea and hopes that the two organizations can learn from each other. “We have a vaccine that is pretty good but it is not used,” she says. “So the more information we can gather to help inform public health officials and ministries of health on the use of vaccine in the field, the better”. Ivers explains that the most important objectives are to show that a sufficient number of patients will come back for their second dose of vaccine, and that the logistical and supply systems are able to deliver the vaccines successfully.
Cholera experts are agreed on the need to tackle the root of the problem: improving water and sanitation systems in countries where these are lacking. But because this can take a significant amount of investment, in terms of time and resources, a vaccine can offer protection during an outbreak. “It’s a good tool, we have to use it,” says Perea.
ARTICLE - CHOLERA - URGENT ACTION NEEDED
URGENT ACTION NEEDED TO FIGHT CHOLERA IN HAITI: AID GROUP
(AFP) -
Global and local health authorities are not doing enough to fight a cholera outbreak that continues to claim lives in Haiti, Doctors Without Borders said Thursday.
"We are worried about the lack of support from the international community and the lack of action from health authorities in Haiti," Thierry Goffeau, head of the group's Haiti operations, told AFP.
Since the start of the epidemic in October 2010, 7,500 people have died from the disease that is spread through poor sanitation. This year alone, it has claimed at least 40 lives in the impoverished Caribbean nation that shares the Hispaniola island with the far wealthier Dominican Republic.
Doctors Without Borders has treated 9,800 cholera patients in special centers since early 2012, including 72 percent of cases in and around the Haitian capital Port-au-Prince.
But the group stresses that it has no intention to replace health authorities and is there to support them.
"We urge the international community and the World Health Organization to strengthen their support," Goffeau said.
(AFP) -
Global and local health authorities are not doing enough to fight a cholera outbreak that continues to claim lives in Haiti, Doctors Without Borders said Thursday.
"We are worried about the lack of support from the international community and the lack of action from health authorities in Haiti," Thierry Goffeau, head of the group's Haiti operations, told AFP.
Since the start of the epidemic in October 2010, 7,500 people have died from the disease that is spread through poor sanitation. This year alone, it has claimed at least 40 lives in the impoverished Caribbean nation that shares the Hispaniola island with the far wealthier Dominican Republic.
Doctors Without Borders has treated 9,800 cholera patients in special centers since early 2012, including 72 percent of cases in and around the Haitian capital Port-au-Prince.
But the group stresses that it has no intention to replace health authorities and is there to support them.
"We urge the international community and the World Health Organization to strengthen their support," Goffeau said.
Monday, May 7, 2012
ARTICLE - CHOLERA IN HAITI
CHOLERA IN HAITI SHOWS NO SIGNS OF BEING STAMPED OUT
(Caribbean 360) -
PORT-AU-PRINCE — Recent reports by the US Centers for Disease Control and Prevention (CDC) indicates that the cholera strain in Haiti is evolving and possibly becoming endemic to the impoverished Caribbean nation.
The researchers from the CDC reported May 3, the study the indicates that the bacterium is changing as survivors acquire at least some immunity to the original bug, which apparently was imported from Nepal less than two years ago and killed thousands of people.
Cholera experts also say such a development is expected and has happened in cholera epidemics around the world.
“This suggests that the ongoing epidemic in Haiti might be entering its next phase, since we see these shifts where cholera is endemic,” said Dr. Edward T. Ryan, an infectious disease specialist with Massachusetts General Hospital who was not involved with the study.
The change also means it could be easier for Haitians to fall ill a second time to the new cholera version because they don’t have full immunity to it if they don’t take precautions such as washing their hands or chlorinating water.
In a field study published in the CDC’s Morbidity and Mortality Weekly Report, co-authors Joan M. Brunkard and Deborah F. Talkington say researchers at the National Public Health Laboratory found that two isolates of the cholera strain collected on March 12 and 13 in Haiti’s Artibonite region differed from the Ogawa version found in Haiti when the disease was discovered in October 2010.
The CDC, the new study says, later confirmed that the isolates belonged to the Inaba serotype, the other major version of the cholera strain.
There is little or no difference in the severity or duration of the disease caused by the two versions, the report added.
Health officials have been paying especially close attention to cholera infection rates in Haiti as it heads into the rainy season, when conditions are ripe for the spread of the waterborne disease because of a paltry sewage and sanitation system.
So far, there has been evidence of a small jump in the number of reported cases, but nothing compared to the threefold spike seen at the same time a year ago.
Still, the Pan American Health Organization warns that between 200,000 and 250,000 people could contract the disease this year, many of them during the rainy and the hurricane season that peaks in late summer and early autumn.
Haiti currently has the highest number of cholera cases in the world. Health officials say the disease has sickened more than 534,000 people, or five percent of the population, and killed 7,000 others since United Nations’ peacekeepers from Nepal, according to scientific studies, were blamed for introducing the disease to the Caribbean nation in October 2010. But the infection rate is believed to be much higher because not all cases are reported.
In an effort to stem the spread of the disease, the Boston-based Partners in Health and its partner, the Gheskio Center, have launched a campaign to vaccinate 100,000 Haitians, or 1 percent of the national population, in a neighborhood in Port-au-Prince and in a rural area north of the capital.
“The good news is that the cholera vaccine that has been piloted in Haiti provides protection to both versions of the organism,” Ryan said.
The Connecticut-based health group AmeriCares announced this week that it is delivering more than 100,000 liters of intravenous solutions to cholera patients in Haiti. The group says the shipment contains enough IV fluids to treat at least 17,000 people.
(Caribbean 360) -
PORT-AU-PRINCE — Recent reports by the US Centers for Disease Control and Prevention (CDC) indicates that the cholera strain in Haiti is evolving and possibly becoming endemic to the impoverished Caribbean nation.
The researchers from the CDC reported May 3, the study the indicates that the bacterium is changing as survivors acquire at least some immunity to the original bug, which apparently was imported from Nepal less than two years ago and killed thousands of people.
Cholera experts also say such a development is expected and has happened in cholera epidemics around the world.
“This suggests that the ongoing epidemic in Haiti might be entering its next phase, since we see these shifts where cholera is endemic,” said Dr. Edward T. Ryan, an infectious disease specialist with Massachusetts General Hospital who was not involved with the study.
The change also means it could be easier for Haitians to fall ill a second time to the new cholera version because they don’t have full immunity to it if they don’t take precautions such as washing their hands or chlorinating water.
In a field study published in the CDC’s Morbidity and Mortality Weekly Report, co-authors Joan M. Brunkard and Deborah F. Talkington say researchers at the National Public Health Laboratory found that two isolates of the cholera strain collected on March 12 and 13 in Haiti’s Artibonite region differed from the Ogawa version found in Haiti when the disease was discovered in October 2010.
The CDC, the new study says, later confirmed that the isolates belonged to the Inaba serotype, the other major version of the cholera strain.
There is little or no difference in the severity or duration of the disease caused by the two versions, the report added.
Health officials have been paying especially close attention to cholera infection rates in Haiti as it heads into the rainy season, when conditions are ripe for the spread of the waterborne disease because of a paltry sewage and sanitation system.
So far, there has been evidence of a small jump in the number of reported cases, but nothing compared to the threefold spike seen at the same time a year ago.
Still, the Pan American Health Organization warns that between 200,000 and 250,000 people could contract the disease this year, many of them during the rainy and the hurricane season that peaks in late summer and early autumn.
Haiti currently has the highest number of cholera cases in the world. Health officials say the disease has sickened more than 534,000 people, or five percent of the population, and killed 7,000 others since United Nations’ peacekeepers from Nepal, according to scientific studies, were blamed for introducing the disease to the Caribbean nation in October 2010. But the infection rate is believed to be much higher because not all cases are reported.
In an effort to stem the spread of the disease, the Boston-based Partners in Health and its partner, the Gheskio Center, have launched a campaign to vaccinate 100,000 Haitians, or 1 percent of the national population, in a neighborhood in Port-au-Prince and in a rural area north of the capital.
“The good news is that the cholera vaccine that has been piloted in Haiti provides protection to both versions of the organism,” Ryan said.
The Connecticut-based health group AmeriCares announced this week that it is delivering more than 100,000 liters of intravenous solutions to cholera patients in Haiti. The group says the shipment contains enough IV fluids to treat at least 17,000 people.
Saturday, April 28, 2012
ARTICLE - CHOLERA RETURNS TO PORT-AU-PRINCE
CHOLERA RETURNS TO PORT-AU-PRINCE
(MSF-UK)
With the rainy season now underway in Haiti, Médecins Sans Frontières/Doctors Without Borders (MSF) has seen an increase in the number of cholera patients. Admissions to MSF's treatment centers in Port-au-Prince and Léogâne have more than tripled in less than one month.
New patients arrive daily at MSF's cholera treatment centers (CTC). Marie was admitted to the Martissant CTC on 16th April. "I had diarrhoea and was vomiting a lot, then I fainted. A relative brought me here because it is the centre closest to where I live. The doctors told me that I had cholera and was dehydrated," she says.
Cholera treatment centres
One-hundred-and-thirty-four other people like Marie arrived at the MSF center in Martissant between 16th and 23rd April and nearly 400 at MSF's other CTCs in Port-au-Prince and Léogâne.
MSF had to reopen a CTC in Carrefour, in the southern part of the capital city, to deal with the new influx of patients, and prevent the centres in Martissant, Delmas and Drouillard – closer to the city centre – from being overwhelmed.
Prepared for epidemic
With all its facilities combined, MSF currently has more than 200 beds in Port-au-Prince and more than 45 in Léogâne dedicated to cholera patients and is prepared to open more sites based on the course of the epidemic.
"Cholera is easy to treat but specialised treatment centres must be accessible and patients must be brought there as soon as possible once symptoms appear," says Dr Sophie Duterne, MSF's medical coordinator in Haiti.
"If left untreated, this disease can kill within a few hours. Treatment involves simple oral or intravenous rehydration, with antibiotics for the most severe cases. However, taking additional hygiene precautions and drinking disinfected water is still the best protection."
Since the first cases were identified in October 2010, more than 500,000 Haitians have contracted cholera.
Rainy season spreads cholera Inadequate access to disinfected water and insufficient numbers of latrines provide fertile ground for cholera. The arrival of the rainy season further promotes the spread of the disease by flooding water and sanitation systems.
"The sewers in my neighborhood are overflowing and we live in unhealthy conditions, without clean water or soap," Marie says. "I knew that I could contract cholera, but I had no choice."
That is why along with treating patients, MSF continues to encourage Haitian health authorities and its international humanitarian partners to distribute disinfected water and soap and to install and maintain latrines so that Haitians can practice good hygiene and prevent the epidemic from spreading.
--------------------------------------------------------------------------------
MSF in Haiti:
Since the epidemic began in October 2010, cholera has killed more than 7,000 people (out of approximately 500,000 cases recorded), representing approximately 5 percent of the population. As soon as the first cases were confirmed, MSF set up an unprecedented effort across the country, treating more than 30 percent of the total number of patients on its own.
(MSF-UK)
With the rainy season now underway in Haiti, Médecins Sans Frontières/Doctors Without Borders (MSF) has seen an increase in the number of cholera patients. Admissions to MSF's treatment centers in Port-au-Prince and Léogâne have more than tripled in less than one month.
New patients arrive daily at MSF's cholera treatment centers (CTC). Marie was admitted to the Martissant CTC on 16th April. "I had diarrhoea and was vomiting a lot, then I fainted. A relative brought me here because it is the centre closest to where I live. The doctors told me that I had cholera and was dehydrated," she says.
Cholera treatment centres
One-hundred-and-thirty-four other people like Marie arrived at the MSF center in Martissant between 16th and 23rd April and nearly 400 at MSF's other CTCs in Port-au-Prince and Léogâne.
MSF had to reopen a CTC in Carrefour, in the southern part of the capital city, to deal with the new influx of patients, and prevent the centres in Martissant, Delmas and Drouillard – closer to the city centre – from being overwhelmed.
Prepared for epidemic
With all its facilities combined, MSF currently has more than 200 beds in Port-au-Prince and more than 45 in Léogâne dedicated to cholera patients and is prepared to open more sites based on the course of the epidemic.
"Cholera is easy to treat but specialised treatment centres must be accessible and patients must be brought there as soon as possible once symptoms appear," says Dr Sophie Duterne, MSF's medical coordinator in Haiti.
"If left untreated, this disease can kill within a few hours. Treatment involves simple oral or intravenous rehydration, with antibiotics for the most severe cases. However, taking additional hygiene precautions and drinking disinfected water is still the best protection."
Since the first cases were identified in October 2010, more than 500,000 Haitians have contracted cholera.
Rainy season spreads cholera Inadequate access to disinfected water and insufficient numbers of latrines provide fertile ground for cholera. The arrival of the rainy season further promotes the spread of the disease by flooding water and sanitation systems.
"The sewers in my neighborhood are overflowing and we live in unhealthy conditions, without clean water or soap," Marie says. "I knew that I could contract cholera, but I had no choice."
That is why along with treating patients, MSF continues to encourage Haitian health authorities and its international humanitarian partners to distribute disinfected water and soap and to install and maintain latrines so that Haitians can practice good hygiene and prevent the epidemic from spreading.
--------------------------------------------------------------------------------
MSF in Haiti:
Since the epidemic began in October 2010, cholera has killed more than 7,000 people (out of approximately 500,000 cases recorded), representing approximately 5 percent of the population. As soon as the first cases were confirmed, MSF set up an unprecedented effort across the country, treating more than 30 percent of the total number of patients on its own.
ARTICLE - CHOLERA - 150 CASES PER DAY
HAITI REPORTING 150 CASES OF CHOLERA EVERY DAY
(Prensa Latina) -
Port au Prince - At least 150 cholera cases are reported every day in Haiti, reported authorities, who fear a new outbreak caused by rains.
According to the national coordinator to fight the disease, Francois Donald, there is "a strong upsurge" in the capital and in the Western region, mainly in the department of Croix des Bouquets.
Only in Croix des Bouquets there have been recorded in one day, 75 people infected and one death, Donald said in an interview with the local agency AlterPresse.
The new cases coincide with the rains affecting Haiti since last weekend, which have caused at least 10 deaths, 10,000 displaced people, floods and damage to crops and homes.
According to Francois, there are no cases reported in the places where the Ministry of Health launched two weeks ago a vaccination campaign against the disease, in which some 100,000 volunteers will receive two oral doses of the drug.
More than seven thousand people died of cholera here during 2011 and another 520,000, more than five percent of the population, contracted it in the same period; although the epidemic has been contained since early this year.
Calculations of the Pan American Health Organization estimates that some 200,000 Haitians may be infected with the disease this year.
(Prensa Latina) -
Port au Prince - At least 150 cholera cases are reported every day in Haiti, reported authorities, who fear a new outbreak caused by rains.
According to the national coordinator to fight the disease, Francois Donald, there is "a strong upsurge" in the capital and in the Western region, mainly in the department of Croix des Bouquets.
Only in Croix des Bouquets there have been recorded in one day, 75 people infected and one death, Donald said in an interview with the local agency AlterPresse.
The new cases coincide with the rains affecting Haiti since last weekend, which have caused at least 10 deaths, 10,000 displaced people, floods and damage to crops and homes.
According to Francois, there are no cases reported in the places where the Ministry of Health launched two weeks ago a vaccination campaign against the disease, in which some 100,000 volunteers will receive two oral doses of the drug.
More than seven thousand people died of cholera here during 2011 and another 520,000, more than five percent of the population, contracted it in the same period; although the epidemic has been contained since early this year.
Calculations of the Pan American Health Organization estimates that some 200,000 Haitians may be infected with the disease this year.
Saturday, April 21, 2012
ARTICLE - CHOLERA IN THE DOMINICAN REPUBLIC
CHOLERA COULD BE MAKING A COMEBACK IN THE DOMINICAN REPUBLIC
(Fox News Latino)
SANTO DOMINGO, Dominican Republic – The cholera epidemic may be making a comeback in the Dominican Republic.
Health officials are investigating what could be a new cholera outbreak in the northern Dominican Republic, where one woman died and more than 200 people have sought medical attention, Health Minister Bautista Rojas said Thursday.
He cautioned that only six of the more than 200 cases have been confirmed as cholera, including that of a 64-year-old woman who died on Wednesday. The remaining patients exhibit cholera symptoms but are awaiting confirmation through lab tests, he said.
The outbreak occurred in the northern town of Tamboril, where heavy rains damaged water and sewer pipes earlier this month.
Bautista said the outbreak is under control, and government officials said they are disinfecting potable water with the maximum amount of chlorine allowed.
The first cholera outbreak in the Dominican Republic occurred in late 2010 with more than 22,500 cases and 163 deaths reported. The number of cases had been dwindling since August 2011.
The neighboring country of Haiti, where the outbreak originated, is still struggling with cholera, which has killed more than 7,000 people and sickened 530,000 more, according to Haitian health officials.
(Fox News Latino)
SANTO DOMINGO, Dominican Republic – The cholera epidemic may be making a comeback in the Dominican Republic.
Health officials are investigating what could be a new cholera outbreak in the northern Dominican Republic, where one woman died and more than 200 people have sought medical attention, Health Minister Bautista Rojas said Thursday.
He cautioned that only six of the more than 200 cases have been confirmed as cholera, including that of a 64-year-old woman who died on Wednesday. The remaining patients exhibit cholera symptoms but are awaiting confirmation through lab tests, he said.
The outbreak occurred in the northern town of Tamboril, where heavy rains damaged water and sewer pipes earlier this month.
Bautista said the outbreak is under control, and government officials said they are disinfecting potable water with the maximum amount of chlorine allowed.
The first cholera outbreak in the Dominican Republic occurred in late 2010 with more than 22,500 cases and 163 deaths reported. The number of cases had been dwindling since August 2011.
The neighboring country of Haiti, where the outbreak originated, is still struggling with cholera, which has killed more than 7,000 people and sickened 530,000 more, according to Haitian health officials.
Monday, April 16, 2012
ARTICLE - DOTS IN BLUE WATER
IMMERSIVE PBL: INDIANA PROJECT REACHES FAR BEYOND THE CLASSROOM
(Edutopia) - By Suzie Boss
Suzie Boss (@suzieboss on Twitter) is a journalist and author of Reinventing Project-Based Learning: Your Field Guide to Real-World Projects in the Digital Age. She's also a regular blogger on Edutopia.
--------------------------------------------------------------------------------
Veteran science teacher Michael Baer has always tried to connect what his students are learning in the classroom to the real world. But even 35 years in education didn't fully prepare him for the powerful learning that would unfold when he agreed to help his students figure out how they could get clean drinking water to the people of Haiti.
Their project would eventually swell to engage the entire K-12 school district and community of 5,000 people in Berne, Indiana. It would test students' and teachers' capacity to be innovative problem-solvers and take them face-to-face with the worst poverty in the Western Hemisphere. And it all started, as all projects should, with a compelling question.
Anyone who wonders whether project-based learning can deliver rigorous, meaningful learning should pay attention to the lessons that emerged from a remarkable project called Dots in Blue Water.
Simple Question, Profound Consequences
On an otherwise ordinary day in late 2009, Baer was explaining to a class of sophomores at South Adams High how poor environmental decisions had contributed to humanitarian catastrophes in Haiti. By coincidence, a friend of Baer's happens to be headmaster at a small rural that sits in the flood plain outside of Port-au-Prince. Over the years, trees were stripped from this landscape and sold for quick profits. Without vegetation, topsoil eroded. When three hurricanes hit the Caribbean island in quick succession, raging floodwaters rolled right up to the schoolhouse doors. An email from the headmaster described how students scrambled onto the roof to try to survive without food or clean drinking water. Many perished.
"I'm telling my students, this is why you don't strip off the vegetation," Baer recalls. "This is why you take care of your environment. It's why we study Earth science. These are innocent children now paying the consequences for someone else's poor judgment in land management."
That's when a student raised her hand and said, "We do all these science labs to learn stuff. Why can't we do a lab and help these people figure out how to purify their water?"
For Baer, that question marks a profound before-and-after point in his lengthy teaching career. "This was one of those redefining moments," he says. "I knew that answering her question could redefine who we are as teachers, as students, as a school. I said to her, let's make that happen."
A Project Takes Shape
With approval from his administration, Baer adjusted his lesson plans so that students could spend every Friday on their new project. In classic PBL style, students organized themselves into teams according to their interests and got to work.
One team focused on research. "We knew there would be a lot of questions," Baer says. "For example, what's causing the water to be unsafe to drink? When we started, none of us knew much about Haiti's environment." The research team explored whatever questions the larger group raised.
Another team appealed to students "who were more hands-on tinkerers," Baer says. "They were our development group." Their charge: strategize and experiment with best methods to purify water. A retired Indiana engineer who had patented a water purification device gave them a prototype to work with. They began taking it apart, testing the electrolysis device with different salts and voltages, and making adjustments to improve the efficiency. Along the way, students learned that innovation can mean improving on someone else's ideas rather than inventing from scratch. "I told them, this may not be our invention, but it will certainly have our fingerprints all over it," Baer says.
Meanwhile, another team worked on marketing and promotional materials. A key moment for the marketing team unfolded when a student found an essay by nature writer Annie Dillard. In it, Dillard described her then-seven-year-old daughter's response to hearing about a deadly tsunami. The child suggested that the lives lost to drowning would look like "dots in blue water." That poignant phrase grabbed the attention of Baer's students and became the project brand.
Yet another team took on the task of community investing. "We didn't want to call it fundraising," the teacher explains. "That sounds like, if you give us money, we'll go away. We wanted people to know they were investing, not only in the work in Haiti, but truly investing in what is locally going on in our classrooms."
Each Friday, students would push together their classroom desks "so it looked like the boardroom table in Donald Trump's 'The Apprentice,'" Baer says. Teams would take turns presenting results from their week's investigations. New questions were referred to the research team who did their best to find answers by the following Friday.
As the project moved from research to real-life application, interest grew. Initially, participants were about 30 students from two sections of an integrated chemistry and physics class. Then when the 2010 earthquake struck Haiti, the need for clean drinking water became even more acute and more students got interested in the project. Baer asked his superintendent about turning Dots in Blue Water into a schoolwide effort during the 2010-11 school year. "His eyes lit up," the teacher recalled, and the project scope changed again.
Changing Lives in Haiti and Indiana
Throughout the 2010-11 school year, every student in South Adams Schools became part of this authentic learning experience. Kindergartners learned about the importance of clean hands and hygiene. Music students studied Caribbean rhythms. In art classes, students learned about the folk artists of the region. "The entire school community wrapped its arms around Dots in Blue Water. Every teacher found a way to tie in a curriculum focus on water purification or Haiti," Baer says. High school students were often in the role of teaching younger students -- or adult community groups -- about water purification or conservation issues.
Culminating activities are important to cement learning in PBL, and the project again exceeded expectations at this stage. In June, eight students selected through a competitive application process set off for Haiti, accompanied by eight teachers. Their trip was funded by $43,000 raised in the local community. The contingent brought along five purification devices. Thanks to improvements by the team of tinkerers, a single device is now capable of purifying 55 gallons of water per minute, powered by a 12-volt battery. An engineering consultant who accompanied the South Adams contingent was so impressed by one student's schematics that he asked to borrow the plans for future installations.
During a life-changing week in Haiti, students installed the devices and taught Haitians how to maintain equipment so that villagers would have a sustainable source of clean water. One system brought clean water to the same school that had suffered losses during earlier flooding. Another was installed in a nearby village, about the same size as Berne, Indiana.
While students were trying to decide where to install their last devices, news broke about a cholera outbreak in a mountain village of about 1,000. Some 300 people were already ill. "We realized cholera could wipe out the whole village," Baer says. Quickly, the team decided to send its last device there. Five teachers made the arduous trek while South Adams students stayed behind for safety reasons. Once the three-tank system was in place, the village experienced no new outbreaks of cholera.
Back in Indiana, South Adams students and teachers celebrated their accomplishments, and then dove right into launching the next round of Dots in Blue Water projects.
Baer doesn't have to look far to see the impact of this project. Four of the students who traveled to Haiti were graduating seniors. One is the same student who first asked about how they might help the people of Haiti. She's now off to college, studying to be a nurse in the developing world. Another senior, who documented the trip by making a video diary, (http://www.facebook.com/permalink.php?story_fbid=171465616255080&id=112649148798554 ) is preparing for a career as a foreign correspondent. "Our lives were changed forever by this," she says. Baer also has seven teacher colleagues who saw firsthand how students can make a real difference in their world.
"Everybody has taken a step higher," he says. "Our entire school community has a new attitude. We're not going to stand idly by and let somebody else fix the problems of the world."
See photos from the South Adams High trip to Haiti at Michael Baer's class website (http://www.southadams.k12.in.us/webpages/mbaer/index.cfm?subpage=690461) .
Learn more about the project at the Dots in Blue Water Facebook page ( http://www.facebook.com/pages/Dots-in-Blue-Water/112649148798554 ) .
(Edutopia) - By Suzie Boss
Suzie Boss (@suzieboss on Twitter) is a journalist and author of Reinventing Project-Based Learning: Your Field Guide to Real-World Projects in the Digital Age. She's also a regular blogger on Edutopia.
--------------------------------------------------------------------------------
Veteran science teacher Michael Baer has always tried to connect what his students are learning in the classroom to the real world. But even 35 years in education didn't fully prepare him for the powerful learning that would unfold when he agreed to help his students figure out how they could get clean drinking water to the people of Haiti.
Their project would eventually swell to engage the entire K-12 school district and community of 5,000 people in Berne, Indiana. It would test students' and teachers' capacity to be innovative problem-solvers and take them face-to-face with the worst poverty in the Western Hemisphere. And it all started, as all projects should, with a compelling question.
Anyone who wonders whether project-based learning can deliver rigorous, meaningful learning should pay attention to the lessons that emerged from a remarkable project called Dots in Blue Water.
Simple Question, Profound Consequences
On an otherwise ordinary day in late 2009, Baer was explaining to a class of sophomores at South Adams High how poor environmental decisions had contributed to humanitarian catastrophes in Haiti. By coincidence, a friend of Baer's happens to be headmaster at a small rural that sits in the flood plain outside of Port-au-Prince. Over the years, trees were stripped from this landscape and sold for quick profits. Without vegetation, topsoil eroded. When three hurricanes hit the Caribbean island in quick succession, raging floodwaters rolled right up to the schoolhouse doors. An email from the headmaster described how students scrambled onto the roof to try to survive without food or clean drinking water. Many perished.
"I'm telling my students, this is why you don't strip off the vegetation," Baer recalls. "This is why you take care of your environment. It's why we study Earth science. These are innocent children now paying the consequences for someone else's poor judgment in land management."
That's when a student raised her hand and said, "We do all these science labs to learn stuff. Why can't we do a lab and help these people figure out how to purify their water?"
For Baer, that question marks a profound before-and-after point in his lengthy teaching career. "This was one of those redefining moments," he says. "I knew that answering her question could redefine who we are as teachers, as students, as a school. I said to her, let's make that happen."
A Project Takes Shape
With approval from his administration, Baer adjusted his lesson plans so that students could spend every Friday on their new project. In classic PBL style, students organized themselves into teams according to their interests and got to work.
One team focused on research. "We knew there would be a lot of questions," Baer says. "For example, what's causing the water to be unsafe to drink? When we started, none of us knew much about Haiti's environment." The research team explored whatever questions the larger group raised.
Another team appealed to students "who were more hands-on tinkerers," Baer says. "They were our development group." Their charge: strategize and experiment with best methods to purify water. A retired Indiana engineer who had patented a water purification device gave them a prototype to work with. They began taking it apart, testing the electrolysis device with different salts and voltages, and making adjustments to improve the efficiency. Along the way, students learned that innovation can mean improving on someone else's ideas rather than inventing from scratch. "I told them, this may not be our invention, but it will certainly have our fingerprints all over it," Baer says.
Meanwhile, another team worked on marketing and promotional materials. A key moment for the marketing team unfolded when a student found an essay by nature writer Annie Dillard. In it, Dillard described her then-seven-year-old daughter's response to hearing about a deadly tsunami. The child suggested that the lives lost to drowning would look like "dots in blue water." That poignant phrase grabbed the attention of Baer's students and became the project brand.
Yet another team took on the task of community investing. "We didn't want to call it fundraising," the teacher explains. "That sounds like, if you give us money, we'll go away. We wanted people to know they were investing, not only in the work in Haiti, but truly investing in what is locally going on in our classrooms."
Each Friday, students would push together their classroom desks "so it looked like the boardroom table in Donald Trump's 'The Apprentice,'" Baer says. Teams would take turns presenting results from their week's investigations. New questions were referred to the research team who did their best to find answers by the following Friday.
As the project moved from research to real-life application, interest grew. Initially, participants were about 30 students from two sections of an integrated chemistry and physics class. Then when the 2010 earthquake struck Haiti, the need for clean drinking water became even more acute and more students got interested in the project. Baer asked his superintendent about turning Dots in Blue Water into a schoolwide effort during the 2010-11 school year. "His eyes lit up," the teacher recalled, and the project scope changed again.
Changing Lives in Haiti and Indiana
Throughout the 2010-11 school year, every student in South Adams Schools became part of this authentic learning experience. Kindergartners learned about the importance of clean hands and hygiene. Music students studied Caribbean rhythms. In art classes, students learned about the folk artists of the region. "The entire school community wrapped its arms around Dots in Blue Water. Every teacher found a way to tie in a curriculum focus on water purification or Haiti," Baer says. High school students were often in the role of teaching younger students -- or adult community groups -- about water purification or conservation issues.
Culminating activities are important to cement learning in PBL, and the project again exceeded expectations at this stage. In June, eight students selected through a competitive application process set off for Haiti, accompanied by eight teachers. Their trip was funded by $43,000 raised in the local community. The contingent brought along five purification devices. Thanks to improvements by the team of tinkerers, a single device is now capable of purifying 55 gallons of water per minute, powered by a 12-volt battery. An engineering consultant who accompanied the South Adams contingent was so impressed by one student's schematics that he asked to borrow the plans for future installations.
During a life-changing week in Haiti, students installed the devices and taught Haitians how to maintain equipment so that villagers would have a sustainable source of clean water. One system brought clean water to the same school that had suffered losses during earlier flooding. Another was installed in a nearby village, about the same size as Berne, Indiana.
While students were trying to decide where to install their last devices, news broke about a cholera outbreak in a mountain village of about 1,000. Some 300 people were already ill. "We realized cholera could wipe out the whole village," Baer says. Quickly, the team decided to send its last device there. Five teachers made the arduous trek while South Adams students stayed behind for safety reasons. Once the three-tank system was in place, the village experienced no new outbreaks of cholera.
Back in Indiana, South Adams students and teachers celebrated their accomplishments, and then dove right into launching the next round of Dots in Blue Water projects.
Baer doesn't have to look far to see the impact of this project. Four of the students who traveled to Haiti were graduating seniors. One is the same student who first asked about how they might help the people of Haiti. She's now off to college, studying to be a nurse in the developing world. Another senior, who documented the trip by making a video diary, (http://www.facebook.com/permalink.php?story_fbid=171465616255080&id=112649148798554 ) is preparing for a career as a foreign correspondent. "Our lives were changed forever by this," she says. Baer also has seven teacher colleagues who saw firsthand how students can make a real difference in their world.
"Everybody has taken a step higher," he says. "Our entire school community has a new attitude. We're not going to stand idly by and let somebody else fix the problems of the world."
See photos from the South Adams High trip to Haiti at Michael Baer's class website (http://www.southadams.k12.in.us/webpages/mbaer/index.cfm?subpage=690461) .
Learn more about the project at the Dots in Blue Water Facebook page ( http://www.facebook.com/pages/Dots-in-Blue-Water/112649148798554 ) .
ARTICLE - CHOLERA - CHLORINE DISPENSERS
NPR REPORTS ON OXFAM'S FIGHT AGAINST CHOLERA IN HAITI
(Oxfam) - By Coco McCabe
Chlorine dispensers in rural Nippes are helping people ensure their water is clean.
When I look at pictures of Haiti’s countryside, I’m always struck by how beautiful much of the landscape is, particularly in the rice-growing region along the Artibonite River. But then I think about the grim underside of that beauty—the cholera that can so easily course through rivers like the Artibonite, spreading sickness and death.
The outbreak that started 10 months after a devastating earthquake in 2010 has now claimed more than 7,000 lives and sickened more than half a million people—as if Haiti needed any more trouble heaped on its citizens. The cholera epidemic is reportedly the largest in modern history, and it’s been in the news a lot lately. The New York Times ran a lengthy story early this month and yesterday, NPR filed its own report on the urgent health problem.
The heart of the trouble is the almost complete lack of functioning water and sanitation systems across the country. Many people are pretty much on their own when it comes to providing water for their families: They lug it home from wherever they can find it, and in the rural areas that’s often streams and rivers. Whether it’s fit for drinking—and cholera-free—can be hard for families to determine.
That’s why in the area around Petite Riviere de Nippes, as NPR reported, people are excited about a simple solution Oxfam has been working on: the installation of chlorine dispensers near where they collect their water. The devices are designed to squirt just enough chlorine to purify a five-gallon jug of water. Oxfam is installing about 90 of the dispensers. And the affordability of the chlorine could be the key that makes this solution last, as Oxfam’s Kenny Rae points out in the piece.
“The cost of chlorine is very, very low,” he said. “A $100 tub will cover all these dispensers for six months.”
That’s a sliver of good news for rural Haitians facing a new rainy season and the spike in cholera cases that could trigger.
(Oxfam) - By Coco McCabe
Chlorine dispensers in rural Nippes are helping people ensure their water is clean.
When I look at pictures of Haiti’s countryside, I’m always struck by how beautiful much of the landscape is, particularly in the rice-growing region along the Artibonite River. But then I think about the grim underside of that beauty—the cholera that can so easily course through rivers like the Artibonite, spreading sickness and death.
The outbreak that started 10 months after a devastating earthquake in 2010 has now claimed more than 7,000 lives and sickened more than half a million people—as if Haiti needed any more trouble heaped on its citizens. The cholera epidemic is reportedly the largest in modern history, and it’s been in the news a lot lately. The New York Times ran a lengthy story early this month and yesterday, NPR filed its own report on the urgent health problem.
The heart of the trouble is the almost complete lack of functioning water and sanitation systems across the country. Many people are pretty much on their own when it comes to providing water for their families: They lug it home from wherever they can find it, and in the rural areas that’s often streams and rivers. Whether it’s fit for drinking—and cholera-free—can be hard for families to determine.
That’s why in the area around Petite Riviere de Nippes, as NPR reported, people are excited about a simple solution Oxfam has been working on: the installation of chlorine dispensers near where they collect their water. The devices are designed to squirt just enough chlorine to purify a five-gallon jug of water. Oxfam is installing about 90 of the dispensers. And the affordability of the chlorine could be the key that makes this solution last, as Oxfam’s Kenny Rae points out in the piece.
“The cost of chlorine is very, very low,” he said. “A $100 tub will cover all these dispensers for six months.”
That’s a sliver of good news for rural Haitians facing a new rainy season and the spike in cholera cases that could trigger.
Friday, April 13, 2012
ARTICLE - CHOLERA - BIGGEST PROBLEM
WATER IN THE TIME OF CHOLERA: HAITI'S MOST URGENT HEALTH PROBLEM
(NPR) - By Richard Knox
In the teeming city of Port-au-Prince, Haiti, millions of people have no reliable water supply.
Many of the underground pipes that did exist were ruptured by the 2010 earthquake. Many public water kiosks are dry.
So life for most people is a constant struggle for water. And now that cholera has invaded Haiti, safe drinking water has become Haiti's most urgent public health problem. Contaminated water is the main cause of cholera, which has sickened 530,000 Haitians since late 2010 and killed more than 7,000.
In Port-au-Prince, street vendors sell water in plastic baggies for a few pennies. Much of the city's water supply is trucked in by commercial vendors or a dwindling number of nongovernmental organizations that took on the task after the quake.
On one busy street corner, just outside one of the city's biggest slums, people with plastic buckets jostle to get to a length of garden hose that snakes out of a hole in the pavement — a source of free water.
A young woman named Marlene Lucien controls the hose. A self-appointed keeper of the peace, she tries to prevent fights from breaking out.
Is it safe water? "We are used to it," someone replies. "It's the water we use every day." But another person waiting in line says she does worry about cholera. "We are scared of it because it can kill you within hours," she says. But she has no choice; she has to drink whatever water she can get.
Haiti has never had the kind of water systems that developed nations take for granted. Chalk it up to decades of dysfunctional governments and unreliable international aid. Whatever the reasons, it's never happened.
In the countryside, clean water is even harder to come by.
In the tiny rice-growing village of Ballange, 50 miles north of Port-au-Prince, people have taken their water from the Artibonite River for generations. "They spent many years drinking it and they had never been sick," says Absolue Culberte, a community leader.
Then, 18 months ago, things changed. "Suddenly, [people] started being sick," Culburte says. "They were scared because they didn't know what was going on."
Cholera had entered the Artibonite River, Haiti's longest, 60 miles upstream — most likely from a leaky latrine at a United Nations camp for peacekeeping troops, who carried it from Nepal.
Many people in Ballange got sick, and some died.
Now, cholera is entrenched in the environment. With the coming of the spring rains, cholera cases are beginning to climb again in the Artibonite Valley.
But this spring, there's reason to hope it will skip over Ballange. That's because the village has a brand-new water treatment system. A U.S.-based charity called Water Missions International installed it, along with systems in a couple of dozen other villages.
Two big tanks provide plenty of clean water for about 3,000 people. The system cost about $25,000.
Ballange is a bright spot in Haiti's quest for clean water. But a few miles upriver, in a village called Ote Dibison, there's a grimmer reality.
Another international aid group put in a similar water purifier in 2009. But it broke down just before the cholera outbreak.
Silencier Bonhomme, a member of the local water committee, says all it would take to fix the system is a couple of new batteries and a new pipe. But when villagers tried to reach the aid group, they didn't get a response.
"We don't have anyone who can fix it," Bonhomme says. "People now are using water from the river, and they get sick. We're getting close to two years since it broke down."
Other villages have the same problem. Water purifiers were put in, but they broke down, and villagers weren't able to fix them.
A hundred miles southwest there's an even bigger failure, in a seaside area called Petite Riviere des Nippes on Haiti's long, westward-pointing peninsula.
Nine years ago, the Haitian government built an elaborate water system there. It was designed to pump water from a pristine, protected stream to a hilltop reservoir and distribute it through pipes to the area. It was a big project, costing several hundred thousand dollars. A red government sign called it "a public treasure."
But it hasn't functioned in more than two years. The pump failed. A truck reportedly drove over a pipe and crushed it. Local authorities couldn't scrape up the money to get it repaired. And it's unclear when the national government plans to fix it.
"It's a tragedy," says Kenny Rae of OxfamAmerica, "particularly in the middle of a cholera outbreak, when people have to now use water they take from the river. We've tested it. It's very, very contaminated."
So Oxfam is trying a simple, low-tech solution to provide clean water. The NGO is installing what they call "chlorine boxes" — green metal poles with dispensers on top. With a quick tap, it squirts just the right amount of chlorine to disinfect a 5-gallon bucket of water.
Soon there will be 90 chlorine boxes scattered around the surrounding villages, which get their water from sometimes-contaminated streams. "The cost of chlorine is very low," Rae says. "A $100 tub will cover all dispensers for six months."
When NPR visited, the hillside hamlet of Font de Liane was buzzing with excitement as a group of men dug holes and mixed cement to install two chlorine boxes.
"We were thirsty for something like this," says Jacob Labote, a schoolteacher who is chairman of the local water committee. "I believe that everybody will be using it."
This story was produced for broadcast by NPR's Jane Greenhalgh.
Note: After myriad delays, vaccinations against cholera finally began today. The program plans to vaccinate some 100,000 Haitians against the disease.
(NPR) - By Richard Knox
In the teeming city of Port-au-Prince, Haiti, millions of people have no reliable water supply.
Many of the underground pipes that did exist were ruptured by the 2010 earthquake. Many public water kiosks are dry.
So life for most people is a constant struggle for water. And now that cholera has invaded Haiti, safe drinking water has become Haiti's most urgent public health problem. Contaminated water is the main cause of cholera, which has sickened 530,000 Haitians since late 2010 and killed more than 7,000.
In Port-au-Prince, street vendors sell water in plastic baggies for a few pennies. Much of the city's water supply is trucked in by commercial vendors or a dwindling number of nongovernmental organizations that took on the task after the quake.
On one busy street corner, just outside one of the city's biggest slums, people with plastic buckets jostle to get to a length of garden hose that snakes out of a hole in the pavement — a source of free water.
A young woman named Marlene Lucien controls the hose. A self-appointed keeper of the peace, she tries to prevent fights from breaking out.
Is it safe water? "We are used to it," someone replies. "It's the water we use every day." But another person waiting in line says she does worry about cholera. "We are scared of it because it can kill you within hours," she says. But she has no choice; she has to drink whatever water she can get.
Haiti has never had the kind of water systems that developed nations take for granted. Chalk it up to decades of dysfunctional governments and unreliable international aid. Whatever the reasons, it's never happened.
In the countryside, clean water is even harder to come by.
In the tiny rice-growing village of Ballange, 50 miles north of Port-au-Prince, people have taken their water from the Artibonite River for generations. "They spent many years drinking it and they had never been sick," says Absolue Culberte, a community leader.
Then, 18 months ago, things changed. "Suddenly, [people] started being sick," Culburte says. "They were scared because they didn't know what was going on."
Cholera had entered the Artibonite River, Haiti's longest, 60 miles upstream — most likely from a leaky latrine at a United Nations camp for peacekeeping troops, who carried it from Nepal.
Many people in Ballange got sick, and some died.
Now, cholera is entrenched in the environment. With the coming of the spring rains, cholera cases are beginning to climb again in the Artibonite Valley.
But this spring, there's reason to hope it will skip over Ballange. That's because the village has a brand-new water treatment system. A U.S.-based charity called Water Missions International installed it, along with systems in a couple of dozen other villages.
Two big tanks provide plenty of clean water for about 3,000 people. The system cost about $25,000.
Ballange is a bright spot in Haiti's quest for clean water. But a few miles upriver, in a village called Ote Dibison, there's a grimmer reality.
Another international aid group put in a similar water purifier in 2009. But it broke down just before the cholera outbreak.
Silencier Bonhomme, a member of the local water committee, says all it would take to fix the system is a couple of new batteries and a new pipe. But when villagers tried to reach the aid group, they didn't get a response.
"We don't have anyone who can fix it," Bonhomme says. "People now are using water from the river, and they get sick. We're getting close to two years since it broke down."
Other villages have the same problem. Water purifiers were put in, but they broke down, and villagers weren't able to fix them.
A hundred miles southwest there's an even bigger failure, in a seaside area called Petite Riviere des Nippes on Haiti's long, westward-pointing peninsula.
Nine years ago, the Haitian government built an elaborate water system there. It was designed to pump water from a pristine, protected stream to a hilltop reservoir and distribute it through pipes to the area. It was a big project, costing several hundred thousand dollars. A red government sign called it "a public treasure."
But it hasn't functioned in more than two years. The pump failed. A truck reportedly drove over a pipe and crushed it. Local authorities couldn't scrape up the money to get it repaired. And it's unclear when the national government plans to fix it.
"It's a tragedy," says Kenny Rae of OxfamAmerica, "particularly in the middle of a cholera outbreak, when people have to now use water they take from the river. We've tested it. It's very, very contaminated."
So Oxfam is trying a simple, low-tech solution to provide clean water. The NGO is installing what they call "chlorine boxes" — green metal poles with dispensers on top. With a quick tap, it squirts just the right amount of chlorine to disinfect a 5-gallon bucket of water.
Soon there will be 90 chlorine boxes scattered around the surrounding villages, which get their water from sometimes-contaminated streams. "The cost of chlorine is very low," Rae says. "A $100 tub will cover all dispensers for six months."
When NPR visited, the hillside hamlet of Font de Liane was buzzing with excitement as a group of men dug holes and mixed cement to install two chlorine boxes.
"We were thirsty for something like this," says Jacob Labote, a schoolteacher who is chairman of the local water committee. "I believe that everybody will be using it."
This story was produced for broadcast by NPR's Jane Greenhalgh.
Note: After myriad delays, vaccinations against cholera finally began today. The program plans to vaccinate some 100,000 Haitians against the disease.
ARTICLE - CHOLERA VACCINATION PROGRAM
VACCINATION AGAINST CHOLERA FINALLY BEGINS IN HAITI
(NPR) - By Richard Knox
After myriad delays and setback, health workers in Haiti are beginning to vaccinate against cholera.
Today, 50,000 people living in the slums of Port-au-Prince will start to get immunized against the disease. This weekend, another 50,000 villagers in the low rice-growing areas of the Artibonite River valley will get their first doses of an oral cholera vaccine.
It's a pilot project that will involve only 1 percent of Haiti's population. The aim is to show that it's possible to give the required two doses over a two-week period to desperately poor and hard-to-reach people.
If it works, the plan is to convince the Haitian government, deep-pocketed donors and international health agencies to support a much bigger campaign to vaccinate millions of Haitians at highest risk of cholera.
Dr. Paul Farmer of Partners in Health, which is organizing the rural arm of the project, says he's already working on that more ambitious goal. "What I would hope for Haiti and for the Congo and other places with cholera," Farmer told Shots, "is that it's just a matter of political will and investment to ramp up vaccine production and build a global stockpile."
The Indian producer of Shanchol, the vaccine being used in Haiti, makes it only when agencies put in orders. So the pilot project in Haiti, which is using 200,000 doses at a cost of around $400,000, is using up almost all the current world supply of the vaccine.
Dr. Jean William Pape, who heads a Haitian group called GHESKIO that's doing the Port-au-Prince part of the current campaign, thinks vaccine could blunt the impact of cholera in Haiti in the near term.
"If we give this vaccine every three years to the at-risk population, we will see that the curve of those who are infected with cholera will decrease year after year," Pape told NPR. "I think that's what we should aim for."
It's been a long and twisted path toward what vaccination proponents consider an obvious response to one of the biggest cholera epidemics on record. Over the past 18 months, 530,000 Haitians have suffered from the fast-moving disease. Tens of thousands have been hospitalized. More than 7,000 have died.
Not until this week did cholera vaccination get the green light from Haiti's Ministry of Public Health and Population, after weeks of internal wrangling over the ethics of the project.
The health minister, Dr. Florence Duperval Guillaume, approved the project last December. The previous Haitian government opposed cholera vaccination. Insiders say that's largely because influential agencies such as the Pan American Health Organization and the U.S. Centers for Disease Control and Prevention signaled their opposition.
"The general culture around cholera vaccination in public health agencies has been that it's not a good idea. It's too complicated. It's too hard. It's costly," says Dr. Louise Ivers of Partners in Health. "That the Haitians can't even get measles coverage to be high enough. There's a kind of apathy about introducing another vaccine into such a place.
"Then there's the philosophical notion – an ideological argument that you shouldn't be trying to vaccinate against cholera when really the solution is water and sanitation," Ivers said in an interview.
Vaccine advocates agree, but say cholera won't wait for improvements in water and sanitation.
Eight million Haitians lack potable water or proper sanitation, says GHESKIO's Pape. "So what are you going to do?" he asks. "In the best conditions, with the best government, it's not going to be done in five years. So you need this vaccine."
Over the past half-year, PAHO and the CDC have changed their stance to "cautious approval," as one of the involved parties puts it.
Dr. John Vertefeuille, the CDC's country director in Haiti, told NPR that the vaccination pilot project " will provide an important piece of information around the feasibility and acceptability of the vaccine."
He pointed out that "cholera vaccine's never been used in an ongoing outbreak situation with cholera."
Vertefeuille added that CDC's focus remains on improving water, sanitation, people's hygiene practices and medical services to care for cholera victims.
Another important development was the World Health Organization's approval of the Shanchol vaccine last November as safe and effective. Shanchol is cheaper than the other cholera vaccine, called Dukoral, and it's easier to administer.
But changing attitudes at the international level didn't mean smooth sailing for the project within Haiti.
In early March, a Haitian radio station raised ethical questions about the project, charging that it was an "experiment" on the Haitian people that had not won approval by a national ethics committee.
That report apparently reflected charges made by a website that Haitians were to be used "as guinea pigs in a cholera vaccine trial."
The broadcast caught Haitian health officials by surprise. It also awakened the interest of the ethics panel, which had not yet acted upon a proposal submitted by Partners in Health and GHESKIO last year, before the WHO had approved Shanchol.
At the request of the health ministry, the groups hastily submitted updated proposals. But it wasn't until this week — six weeks beyond the hoped-for vaccination start date — that the ethics committee gave its approval.
That delay has caused a lot of anxiety. For one thing, Haiti's spring rainy season has begun — a time when flooding spreads cholera germs around, often directly into people's homes, and increases the contamination of drinking water.
Second, the delay has pushed the cholera vaccination campaign up against a long-planned national campaign to vaccinate children against measles, rubella, polio, rotavirus, Hemophilus influenzae and pneumonia.
Cholera vaccine is not supposed to be given at the same time as polio vaccine in children under 10. So that has forced Partners in Health and GHESKIO to defer cholera vaccination in 9-and-under children until after they've received polio vaccine, and then to track them down and give them the cholera vaccine.
Meanwhile, the Haitian government's support for the project seems firm. "This vaccine will be able to give us good protection," Dr. Gabriel Timothe, director-general of the health ministry, said in announcing approval of the project on Wednesday. He added that the project "will enable us to evaluate the operational cost" of cholera vaccination.
But the long-term objective, Timothe said, is "to eliminate the presence of cholera on the island of Hispaniola." And that will take massive investment in clean water and good sanitation.
(NPR) - By Richard Knox
After myriad delays and setback, health workers in Haiti are beginning to vaccinate against cholera.
Today, 50,000 people living in the slums of Port-au-Prince will start to get immunized against the disease. This weekend, another 50,000 villagers in the low rice-growing areas of the Artibonite River valley will get their first doses of an oral cholera vaccine.
It's a pilot project that will involve only 1 percent of Haiti's population. The aim is to show that it's possible to give the required two doses over a two-week period to desperately poor and hard-to-reach people.
If it works, the plan is to convince the Haitian government, deep-pocketed donors and international health agencies to support a much bigger campaign to vaccinate millions of Haitians at highest risk of cholera.
Dr. Paul Farmer of Partners in Health, which is organizing the rural arm of the project, says he's already working on that more ambitious goal. "What I would hope for Haiti and for the Congo and other places with cholera," Farmer told Shots, "is that it's just a matter of political will and investment to ramp up vaccine production and build a global stockpile."
The Indian producer of Shanchol, the vaccine being used in Haiti, makes it only when agencies put in orders. So the pilot project in Haiti, which is using 200,000 doses at a cost of around $400,000, is using up almost all the current world supply of the vaccine.
Dr. Jean William Pape, who heads a Haitian group called GHESKIO that's doing the Port-au-Prince part of the current campaign, thinks vaccine could blunt the impact of cholera in Haiti in the near term.
"If we give this vaccine every three years to the at-risk population, we will see that the curve of those who are infected with cholera will decrease year after year," Pape told NPR. "I think that's what we should aim for."
It's been a long and twisted path toward what vaccination proponents consider an obvious response to one of the biggest cholera epidemics on record. Over the past 18 months, 530,000 Haitians have suffered from the fast-moving disease. Tens of thousands have been hospitalized. More than 7,000 have died.
Not until this week did cholera vaccination get the green light from Haiti's Ministry of Public Health and Population, after weeks of internal wrangling over the ethics of the project.
The health minister, Dr. Florence Duperval Guillaume, approved the project last December. The previous Haitian government opposed cholera vaccination. Insiders say that's largely because influential agencies such as the Pan American Health Organization and the U.S. Centers for Disease Control and Prevention signaled their opposition.
"The general culture around cholera vaccination in public health agencies has been that it's not a good idea. It's too complicated. It's too hard. It's costly," says Dr. Louise Ivers of Partners in Health. "That the Haitians can't even get measles coverage to be high enough. There's a kind of apathy about introducing another vaccine into such a place.
"Then there's the philosophical notion – an ideological argument that you shouldn't be trying to vaccinate against cholera when really the solution is water and sanitation," Ivers said in an interview.
Vaccine advocates agree, but say cholera won't wait for improvements in water and sanitation.
Eight million Haitians lack potable water or proper sanitation, says GHESKIO's Pape. "So what are you going to do?" he asks. "In the best conditions, with the best government, it's not going to be done in five years. So you need this vaccine."
Over the past half-year, PAHO and the CDC have changed their stance to "cautious approval," as one of the involved parties puts it.
Dr. John Vertefeuille, the CDC's country director in Haiti, told NPR that the vaccination pilot project " will provide an important piece of information around the feasibility and acceptability of the vaccine."
He pointed out that "cholera vaccine's never been used in an ongoing outbreak situation with cholera."
Vertefeuille added that CDC's focus remains on improving water, sanitation, people's hygiene practices and medical services to care for cholera victims.
Another important development was the World Health Organization's approval of the Shanchol vaccine last November as safe and effective. Shanchol is cheaper than the other cholera vaccine, called Dukoral, and it's easier to administer.
But changing attitudes at the international level didn't mean smooth sailing for the project within Haiti.
In early March, a Haitian radio station raised ethical questions about the project, charging that it was an "experiment" on the Haitian people that had not won approval by a national ethics committee.
That report apparently reflected charges made by a website that Haitians were to be used "as guinea pigs in a cholera vaccine trial."
The broadcast caught Haitian health officials by surprise. It also awakened the interest of the ethics panel, which had not yet acted upon a proposal submitted by Partners in Health and GHESKIO last year, before the WHO had approved Shanchol.
At the request of the health ministry, the groups hastily submitted updated proposals. But it wasn't until this week — six weeks beyond the hoped-for vaccination start date — that the ethics committee gave its approval.
That delay has caused a lot of anxiety. For one thing, Haiti's spring rainy season has begun — a time when flooding spreads cholera germs around, often directly into people's homes, and increases the contamination of drinking water.
Second, the delay has pushed the cholera vaccination campaign up against a long-planned national campaign to vaccinate children against measles, rubella, polio, rotavirus, Hemophilus influenzae and pneumonia.
Cholera vaccine is not supposed to be given at the same time as polio vaccine in children under 10. So that has forced Partners in Health and GHESKIO to defer cholera vaccination in 9-and-under children until after they've received polio vaccine, and then to track them down and give them the cholera vaccine.
Meanwhile, the Haitian government's support for the project seems firm. "This vaccine will be able to give us good protection," Dr. Gabriel Timothe, director-general of the health ministry, said in announcing approval of the project on Wednesday. He added that the project "will enable us to evaluate the operational cost" of cholera vaccination.
But the long-term objective, Timothe said, is "to eliminate the presence of cholera on the island of Hispaniola." And that will take massive investment in clean water and good sanitation.
ARTICLE - CHOLERA VACCINATIONS BEGIN
VACCINATIONS BEGIN IN A CHOLERA-RAVAGED HAITI
(New York Times) - By Deborah Sontag
A year and a half after cholera first struck Haiti, a tiny portion of the population on Thursday began getting vaccinated against the waterborne disease that has infected more than 530,000 Haitians and killed more than 7,040.
Organizers of the vaccination campaign, who have been pushing to do this since the epidemic began, cleared their final political hurdle this week when a national bioethics committee approved their plan to use all available doses of the cheapest cholera vaccine to immunize about 1 percent of the population.
On Thursday, tens of thousands of slum dwellers in Port-au-Prince took their first of two doses of the oral vaccine, Shanchol; tens of thousands of rural residents of a rice-growing community near St. Marc will begin this weekend. The second dose will be administered in two weeks.
The organizers — Partners in Health and Gheskio, which also collaborate on H.I.V. and AIDS care — had hoped to beat the spring rains that spread the cholera germ. But they ran into an unanticipated roadblock and the rains have already started to drench the country, causing flooding and a spike in cases.
The roadblock surfaced in March when a Haitian radio station raised questions about the vaccination campaign, which had been approved by the Haitian health minister last year.
The radio station asked if the campaign could be seen as a medical experiment using poor Haitians as guinea pigs, which prompted the bioethics committee to take up the issue.
Announcing this week that the “pilot project” would move forward, Dr. Gabriel Timothée, director general of the Haitian Health Ministry, said, “This is not a study, it is not a vaccine trial, it is not an experiment.”
The use of cholera vaccine in Haiti has been mired in controversy since the epidemic began in mid-October of 2010.
World health authorities initially opposed vaccination, citing cost, logistical challenges and limited vaccine supplies.
Shanchol was still under review by the World Health Organization then, “with significant concerns in that review about safety and manufacturing practices,” said Jon Kim Andrus, deputy director of the Pan American Health Organization.
But proponents argued that the vaccine could save lives, reduce the caseload and buy time until long-range solutions like water and sanitation systems could be put in place.
They called for expediting approval for Shanchol, for increasing vaccine production by offering manufacturers purchase commitments and for using available doses to immunize especially vulnerable people.
World health authorities eventually endorsed a trial campaign, but the Haitian government did not want to stir political trouble by choosing who would get the vaccine.
Time passed; a new government took power; Shanchol, which is manufactured in India, was approved. And the small vaccination campaign has begun, with organizers hoping that it will succeed and lead to a broader use of the vaccine in Haiti.
“It’s the ethical and equitable thing to do,” said Dr. Paul Farmer, a co-founder of Partners in Health. “If cholera had exploded in the United States like it did in Haiti, everybody would have gotten the vaccine by now.”
(New York Times) - By Deborah Sontag
A year and a half after cholera first struck Haiti, a tiny portion of the population on Thursday began getting vaccinated against the waterborne disease that has infected more than 530,000 Haitians and killed more than 7,040.
Organizers of the vaccination campaign, who have been pushing to do this since the epidemic began, cleared their final political hurdle this week when a national bioethics committee approved their plan to use all available doses of the cheapest cholera vaccine to immunize about 1 percent of the population.
On Thursday, tens of thousands of slum dwellers in Port-au-Prince took their first of two doses of the oral vaccine, Shanchol; tens of thousands of rural residents of a rice-growing community near St. Marc will begin this weekend. The second dose will be administered in two weeks.
The organizers — Partners in Health and Gheskio, which also collaborate on H.I.V. and AIDS care — had hoped to beat the spring rains that spread the cholera germ. But they ran into an unanticipated roadblock and the rains have already started to drench the country, causing flooding and a spike in cases.
The roadblock surfaced in March when a Haitian radio station raised questions about the vaccination campaign, which had been approved by the Haitian health minister last year.
The radio station asked if the campaign could be seen as a medical experiment using poor Haitians as guinea pigs, which prompted the bioethics committee to take up the issue.
Announcing this week that the “pilot project” would move forward, Dr. Gabriel Timothée, director general of the Haitian Health Ministry, said, “This is not a study, it is not a vaccine trial, it is not an experiment.”
The use of cholera vaccine in Haiti has been mired in controversy since the epidemic began in mid-October of 2010.
World health authorities initially opposed vaccination, citing cost, logistical challenges and limited vaccine supplies.
Shanchol was still under review by the World Health Organization then, “with significant concerns in that review about safety and manufacturing practices,” said Jon Kim Andrus, deputy director of the Pan American Health Organization.
But proponents argued that the vaccine could save lives, reduce the caseload and buy time until long-range solutions like water and sanitation systems could be put in place.
They called for expediting approval for Shanchol, for increasing vaccine production by offering manufacturers purchase commitments and for using available doses to immunize especially vulnerable people.
World health authorities eventually endorsed a trial campaign, but the Haitian government did not want to stir political trouble by choosing who would get the vaccine.
Time passed; a new government took power; Shanchol, which is manufactured in India, was approved. And the small vaccination campaign has begun, with organizers hoping that it will succeed and lead to a broader use of the vaccine in Haiti.
“It’s the ethical and equitable thing to do,” said Dr. Paul Farmer, a co-founder of Partners in Health. “If cholera had exploded in the United States like it did in Haiti, everybody would have gotten the vaccine by now.”
Friday, April 6, 2012
ARTICLE - AMERICARES - CHOLERA RESPONSE
AMERICARES HAITI FRONTLINE CHOLERA RESPONSE CONTINUES
(Reuters) -
AmeriCares frontline cholera response continues in Haiti amid an alarming rise in cases reported in the northern and western regions of the country. Our Haiti team is working to save as many lives as possible, delivering aid to treat people in immediate need, and supporting programs to prevent the spread of this deadly diarrheal disease.
The most recent AmeriCares shipment included medical aid to help more than 100,000 people:
•Cholera treatment: Doxycycline, catheters, rehydration salts, and gloves to replenish current stocks of supplies.
•Cholera prevention: Soap, sanitizer, buckets, detergent, and other items for community outreach programs that help safeguard against infection and raise awareness about the importance of sanitation.
Cholera is treatable, but without prompt intervention the disease kills quickly; rapid response is especially crucial to saving lives. The disease, caused by bacteria in contaminated water or food, has claimed more than 7,050 lives among the 530,000+ cases reported in Haiti thus far.
Proactive response, lifesaving prevention programs
Advance preparation helped AmeriCares quickly respond to urgent requests for aid. "We've pre-positioned cholera supplies in every corner of the country, stepping up our work for months before the rainy season, when we usually see an uptick in cases," said Brian Hoyer, AmeriCares Haiti Country Director. "At the same time, we've kept our warehouse well-stocked with IV fluids, IV sets, rehydration salts, antibiotics, gloves, disinfectant and other crucial supplies in anticipation of emergency requests."
Controlling a Killer
Since 2010 we have:
•Delivered more than 936,000 cholera treatments
•Supported the training of more than 200,000 people in cholera prevention
Mike Martin, field administrator for the International Faith Missions treatment center, explained how AmeriCares aid has made a lifesaving difference for the people in the impoverished rural village of Fond Parisien. “At least 85 percent of the supplies we’ve used since we opened in 2010 have been from AmeriCares,” he said. “To date, 99 percent of the 6,500 patients treated here have survived. Without treatment, at least half would have died.”
In addition to emergency shipments of supplies, AmeriCares works with the Haitian Ministry of Public Health and other partners to build defenses against the disease, by establishing rehydration posts and supporting the training of more than 200,000 people in cholera prevention.
Our in-country presence, quick response and proven ability to deliver large volumes of supplies has positioned AmeriCares Haiti as one of a handful of organizations effectively meeting national needs during the ongoing cholera crisis. Since October, 2010, we’ve sent more than $5 million in cholera aid to Haiti, working with dozens of partners to help drive mortality rates from nearly 7 percent at the onset to 1.3 percent at present.
Saving lives, one at a time:
Izmaelda: Our field team visited cholera treatment centers throughout Haiti, meeting patients like baby Izmaelda who was rushed to a center as soon as she showed the first signs of infection. Since little Izmaelda received treatment early, she is expected to survive and recover completely.
Medgine: When Medgine became ill, she went to Hopital Espoir – a small facility near the temporary settlement where she lives with her family of 10. This free clinic would have closed long ago without funding and supplies from AmeriCares. Medgine was treated with IV fluids and recovered. Since we began supporting the clinic, more than 275 cholera patients have been treated and all have survived.
(Reuters) -
AmeriCares frontline cholera response continues in Haiti amid an alarming rise in cases reported in the northern and western regions of the country. Our Haiti team is working to save as many lives as possible, delivering aid to treat people in immediate need, and supporting programs to prevent the spread of this deadly diarrheal disease.
The most recent AmeriCares shipment included medical aid to help more than 100,000 people:
•Cholera treatment: Doxycycline, catheters, rehydration salts, and gloves to replenish current stocks of supplies.
•Cholera prevention: Soap, sanitizer, buckets, detergent, and other items for community outreach programs that help safeguard against infection and raise awareness about the importance of sanitation.
Cholera is treatable, but without prompt intervention the disease kills quickly; rapid response is especially crucial to saving lives. The disease, caused by bacteria in contaminated water or food, has claimed more than 7,050 lives among the 530,000+ cases reported in Haiti thus far.
Proactive response, lifesaving prevention programs
Advance preparation helped AmeriCares quickly respond to urgent requests for aid. "We've pre-positioned cholera supplies in every corner of the country, stepping up our work for months before the rainy season, when we usually see an uptick in cases," said Brian Hoyer, AmeriCares Haiti Country Director. "At the same time, we've kept our warehouse well-stocked with IV fluids, IV sets, rehydration salts, antibiotics, gloves, disinfectant and other crucial supplies in anticipation of emergency requests."
Controlling a Killer
Since 2010 we have:
•Delivered more than 936,000 cholera treatments
•Supported the training of more than 200,000 people in cholera prevention
Mike Martin, field administrator for the International Faith Missions treatment center, explained how AmeriCares aid has made a lifesaving difference for the people in the impoverished rural village of Fond Parisien. “At least 85 percent of the supplies we’ve used since we opened in 2010 have been from AmeriCares,” he said. “To date, 99 percent of the 6,500 patients treated here have survived. Without treatment, at least half would have died.”
In addition to emergency shipments of supplies, AmeriCares works with the Haitian Ministry of Public Health and other partners to build defenses against the disease, by establishing rehydration posts and supporting the training of more than 200,000 people in cholera prevention.
Our in-country presence, quick response and proven ability to deliver large volumes of supplies has positioned AmeriCares Haiti as one of a handful of organizations effectively meeting national needs during the ongoing cholera crisis. Since October, 2010, we’ve sent more than $5 million in cholera aid to Haiti, working with dozens of partners to help drive mortality rates from nearly 7 percent at the onset to 1.3 percent at present.
Saving lives, one at a time:
Izmaelda: Our field team visited cholera treatment centers throughout Haiti, meeting patients like baby Izmaelda who was rushed to a center as soon as she showed the first signs of infection. Since little Izmaelda received treatment early, she is expected to survive and recover completely.
Medgine: When Medgine became ill, she went to Hopital Espoir – a small facility near the temporary settlement where she lives with her family of 10. This free clinic would have closed long ago without funding and supplies from AmeriCares. Medgine was treated with IV fluids and recovered. Since we began supporting the clinic, more than 275 cholera patients have been treated and all have survived.
Thursday, April 5, 2012
ARTICLE - CHOLERA - 200,000 FOR 2012?
HAITI SEES RISE IN CHOLERA CASES; 200,000 COULD CONTRACT DISEASE IN 2012
(Caribbean Journal) -
Haiti has seen an increase in cholera cases in three departments, confirming predictions of higher incidence of the disease with the arrival of the rainy season, according to the monthly Haiti Humanitarian Bulletin published by the UN’s Office for the Coordination of Humanitarian Affairs.
There was an increase in cholera cases reported by the Health Cluster in the Artibonite, Nord-Ouest and Ouest departments, according to the report. In the beginning of March, the Ministry of Public Health reported 77 daily new cases in Haiti. According to PAHO estimates, some 200,000 additional people could contract cholera in Haiti in 2012.
Several reports have found that United Nations peacekeepers from Nepal brought cholera into the country. A lawsuit against the UN has also been filed on the same grounds.
The alerts, which were received at the end of March, coincided with the early arrival of abundant and regular rains, which should continue until June.
The Pan American Health Organization and IOM have deployed medical teams and additional medical supplies in support of Haiti’s Ministry of Public Health and Population.
Since last June, when the country saw peaks of more than 1,000 cholera cases on some days, cholera had been on the decline in all of Haiti’s 10 departments.
Haiti’s national strategy to fight the disease include access to safe water and sanitation in health care facilities, improving capacity building in the detection and reporting of outbreaks, and strengthening response to alerts.
The UNOCHA has recommended the creation of a national coordination structure in response to cholera in Haiti. Members of the new structure, which was recommended following a meeting March 28, would include the Department of Public Health and Population, the National Directorate for Drinking Water and Sanitation, the Ministry of Finance and humanitarian actors.
(Caribbean Journal) -
Haiti has seen an increase in cholera cases in three departments, confirming predictions of higher incidence of the disease with the arrival of the rainy season, according to the monthly Haiti Humanitarian Bulletin published by the UN’s Office for the Coordination of Humanitarian Affairs.
There was an increase in cholera cases reported by the Health Cluster in the Artibonite, Nord-Ouest and Ouest departments, according to the report. In the beginning of March, the Ministry of Public Health reported 77 daily new cases in Haiti. According to PAHO estimates, some 200,000 additional people could contract cholera in Haiti in 2012.
Several reports have found that United Nations peacekeepers from Nepal brought cholera into the country. A lawsuit against the UN has also been filed on the same grounds.
The alerts, which were received at the end of March, coincided with the early arrival of abundant and regular rains, which should continue until June.
The Pan American Health Organization and IOM have deployed medical teams and additional medical supplies in support of Haiti’s Ministry of Public Health and Population.
Since last June, when the country saw peaks of more than 1,000 cholera cases on some days, cholera had been on the decline in all of Haiti’s 10 departments.
Haiti’s national strategy to fight the disease include access to safe water and sanitation in health care facilities, improving capacity building in the detection and reporting of outbreaks, and strengthening response to alerts.
The UNOCHA has recommended the creation of a national coordination structure in response to cholera in Haiti. Members of the new structure, which was recommended following a meeting March 28, would include the Department of Public Health and Population, the National Directorate for Drinking Water and Sanitation, the Ministry of Finance and humanitarian actors.
Tuesday, April 3, 2012
ARTICLE - UN - CHOLERA INCREASING
UN IN HAITI SEES JUMP IN CHOLERA CASES
(Seattle Times) - By Trenton Daniel (AP)
Haiti is seeing a jump in the number of cholera cases as the Caribbean nation heads into the annual rainy season, a United Nations humanitarian agency said Tuesday.
PORT-AU-PRINCE — Haiti is seeing a jump in the number of cholera cases as the Caribbean nation heads into the annual rainy season, a United Nations humanitarian agency said Tuesday.
The U.N.'s Office for the Coordination of Humanitarian Affairs said in a monthly bulletin that the new cholera cases were found in the western and northern parts of the country and that Haitian health officials recorded 77 new cases a day for the whole country in early March, when the rains began.
Medical teams have been deployed to stem the spread of cholera but their effectiveness has been hampered in part by little coordination and an absence of salaries paid to people working in cholera treatment centers run by Haitian authorities, the U.N. bulletin said.
The day-to-day operations of the Haitian government have been largely been put on hold after Prime Minister Garry Conille suddenly resigned in February because of clashes with President Michel Martelly. Martelly named his foreign affairs minister, Laurent Lamothe, as his next pick but it's unclear when Parliament will vote on Lamothe's candidacy.
The new cholera cases come after a steady decline since June of last year when aid workers saw peaks of more than 1,000 cases on certain days.
The Boston-based group Partners in Health said it saw the number of cholera cases nearly triple from almost 19,000 in April 2011 to more than 50,000 two months later.
The same group wants to introduce a cholera vaccine to Haiti but its distribution is on hold as an ethics committee studies the program.
The disease, now the largest cholera outbreak in the world, has killed more than 7,000 people and sickened another 530,000, health officials say. The disease was likely introduced by a U.N. peacekeeping unit from Nepal, where the disease is endemic, several months after the January 2010 earthquake.
Cholera is caused by a bacteria found in contaminated water or food, and can kill people within hours through dehydration. It is easily treatable if caught in time.
(Seattle Times) - By Trenton Daniel (AP)
Haiti is seeing a jump in the number of cholera cases as the Caribbean nation heads into the annual rainy season, a United Nations humanitarian agency said Tuesday.
PORT-AU-PRINCE — Haiti is seeing a jump in the number of cholera cases as the Caribbean nation heads into the annual rainy season, a United Nations humanitarian agency said Tuesday.
The U.N.'s Office for the Coordination of Humanitarian Affairs said in a monthly bulletin that the new cholera cases were found in the western and northern parts of the country and that Haitian health officials recorded 77 new cases a day for the whole country in early March, when the rains began.
Medical teams have been deployed to stem the spread of cholera but their effectiveness has been hampered in part by little coordination and an absence of salaries paid to people working in cholera treatment centers run by Haitian authorities, the U.N. bulletin said.
The day-to-day operations of the Haitian government have been largely been put on hold after Prime Minister Garry Conille suddenly resigned in February because of clashes with President Michel Martelly. Martelly named his foreign affairs minister, Laurent Lamothe, as his next pick but it's unclear when Parliament will vote on Lamothe's candidacy.
The new cholera cases come after a steady decline since June of last year when aid workers saw peaks of more than 1,000 cases on certain days.
The Boston-based group Partners in Health said it saw the number of cholera cases nearly triple from almost 19,000 in April 2011 to more than 50,000 two months later.
The same group wants to introduce a cholera vaccine to Haiti but its distribution is on hold as an ethics committee studies the program.
The disease, now the largest cholera outbreak in the world, has killed more than 7,000 people and sickened another 530,000, health officials say. The disease was likely introduced by a U.N. peacekeeping unit from Nepal, where the disease is endemic, several months after the January 2010 earthquake.
Cholera is caused by a bacteria found in contaminated water or food, and can kill people within hours through dehydration. It is easily treatable if caught in time.
Sunday, April 1, 2012
ARTICLE - CHOLERA EPIDEMIC - GLOBAL FAILURES
IN HAITI, GLOBAL FAILURES ON A CHOLERA EPIDEMIC
(New York Times) - By Deborah Sontag
MIREBALAIS — Jean Salgadeau Pelette, handsome when medicated and groomed, often roamed this central Haitian town in a disheveled state, wild-eyed and naked. He was a familiar figure here, the lanky scion of a prominent family who suffered from a mental illness.
On Oct. 16, 2010, Mr. Pelette, 38, woke at dawn in his solitary room behind a bric-a-brac shop off the town square. As was his habit, he loped down the hill to the Latem River for his bath, passing the beauty shop, the pharmacy and the funeral home where his body would soon be prepared for burial.
The river would have been busy that morning, with bathers, laundresses and schoolchildren brushing their teeth. Nobody thought of its flowing waters, downstream from a United Nations peacekeeping base, as toxic.
When Mr. Pelette was found lying by the bank a few hours later, he was so weak from a sudden, violent stomach illness that he had to be carried back to his room. It did not immediately occur to his relatives to rush him to the hospital.
“At that time, the word ‘cholera’ didn’t yet exist,” said one of his brothers, Malherbe Pelette. “We didn’t know he was in mortal danger. But by 4 that afternoon, my brother was dead. He was the first victim, or so they say.”
In the 17 months since Mr. Pelette was buried in the trash-strewn graveyard here, cholera has killed more than 7,050 Haitians and sickened more than 531,000, or 5 percent of the population. Lightning fast and virulent, it spread from here through every Haitian state, erupting into the world’s largest cholera epidemic despite a huge international mobilization still dealing with the effects of the Jan. 12, 2010, earthquake.
The world rallied to confront cholera, too, but the mission was muddled by the United Nations’ apparent role in igniting the epidemic and its unwillingness to acknowledge it. Epidemiologic and microbiologic evidence strongly suggests that United Nations peacekeeping troops from Nepal imported cholera to Haiti, contaminated the river tributary next to their base through a faulty sanitation system and caused a second disaster.
“It was like throwing a lighted match into a gasoline-filled room,” said Dr. Paul S. Keim, a microbial geneticist whose laboratory determined that the Haitian and Nepalese cholera strains were virtually identical.
And, as the deaths and continuing caseload indicate, the world’s response to this preventable, treatable scourge has proved inadequate. Cholera, never before recorded in Haiti, stayed one step ahead of the authorities as they shifted gears from the earthquake recovery. While eventually effective in reducing the fatality rate, the response was slow to get fully under way, conservative and insufficiently sustained.
“In the future, historians will look back and say, ‘Wow, that’s unfortunate,’ ” said Dr. Paul Farmer, co-founder of Partners in Health, a nongovernmental organization that provides health care for the poor. “This unfolded right under the noses of all those NGOs. And they will ask, ‘Why didn’t they try harder? Why didn’t they throw the kitchen sink at cholera in Haiti?’ ”
While the world has dedicated $230 million so far to combating the unexpected epidemic, the United Nations is now pleading for an additional $53.9 million just to get the vulnerable displaced population through the rainy months ahead.
At the same time, Haitian cholera victims are seeking compensation from the United Nations, pressing it to accept responsibility. Early on, protests against the United Nations hindered the construction of treatment centers and the delivery of lifesaving supplies. Now distrust of some cholera programs lingers, and the issue has strained the peacekeepers’ relationship with the Haitians they are protecting in an eight-year-old mission to stabilize the politically volatile nation. So, too, have unrelated allegations that they engaged in criminally abusive behavior.
“In telling the truth, the U.N. could have gained the trust of the population and facilitated the fight against cholera,” said Dr. Renaud Piarroux, who led an early investigation into the outbreak. “But that was bungled.”
The United Nations maintains that an independent panel of experts determined the evidence implicating its troops to be inconclusive.
Questioned for this article, though, those same experts said that Dr. Keim’s work, conducted after their own, provides “irrefutable molecular evidence” that Haiti’s cholera came from Nepal, in the words of G. Balakrish Nair, an Indian microbiologist.
“When you take the circumstantial evidence in our report and all that has come out since, the story now I think is stronger: the most likely scenario is that the cholera began with someone at the Minustah base,” said another expert, Daniele Lantagne, an American engineer, using the French acronym for the United Nations mission.
Even so, Anthony Banbury, a United Nations assistant secretary general, said last week, “We don’t think the cholera outbreak is attributable to any single factor.”
Many health officials consider the cholera response “pretty remarkable,” as John Vertefeuille, the Centers for Disease Control and Prevention’s director in Haiti, said.
A sky-high initial fatality rate of over 9 percent has declined to 1.3 percent (less than 1 percent is considered a well-managed epidemic). And the most recent statistics show new cases dropping to 120 daily.
Others, though, believe the bar for success was set too low and more lives could have been saved. Some critics bemoan weak disease surveillance and case-tracking, others inadequate water distribution and latrine building, and still others what they see as a penny-pinching reluctance to use antibiotics and cholera vaccine.
Also, some think cholera could have been stymied, even eradicated, last winter during the dry season after the first wave. Instead, it flared with the rains even as aid groups shuttered or reduced operations. And now, after another winter without an aggressive prevention and eradication effort, the health authorities fear a reprise.
“I think it’s going to be another bad year for cholera,” said Dr. John Carroll, an Illinois doctor who works in Haiti.
A Rapid Death
Here in the epicenter of the epidemic, all signage relates to life in the time of cholera. Surrounding the town square are heart-adorned posters that say, “Living with cholera: Always wash your hands with clean water and soap.” Banners slung across the streets, in contrast, bear skulls and crossbones: “Justice and reparations for all victims of the Minustah cholera.”
Inside City Hall, the deputy mayor, crisply dressed in a chambray shirt and slacks, described how he personally buried 27 bodies for fear that workers would not take precautions, how he nearly lost two of his own children to cholera and how he seethed every time Nepalese troops entered his offices.
“They were in my face every day, and the feeling inside me got stronger and stronger,” said Ocxama Moise, the deputy mayor. “A few months ago, I even considered killing a soldier or two to see what would happen. I shared the idea with some friends, and they said, ‘Don’t. You’re an official.’ But it’s only a matter of time before the population finds a way to get justice.”
After the earthquake, when Haitians were living amid cadaver-filled ruins in the sprawling Port-au-Prince area, international health officials were concerned that infectious diseases would rip through the tent camps.
Well before the earthquake, Haiti was fertile ground for a disease that spreads primarily through fecal contamination of water: in 2008, only 12 percent of the population had access to piped, treated water, and only 17 percent to “improved sanitation,” which includes the simplest pit latrines. Haitians’ latrine access actually declined, from 24 percent in 1990.
“For decades we as partners have failed to ensure safe water and sanitation is provided to every resident of Haiti,” said Dr. Jon Kim Andrus, deputy director of the Pan American Health Organization.
But Haiti had escaped the cholera that raged through Latin America in the 1990s, and even the cholera that struck the Caribbean in the 19th century. It appeared “extremely unlikely” that cholera would present itself, a C.D.C. post-earthquake brief said.
“The risk of cholera introduction to Haiti is low,” it said, noting relief workers were “likely to have access to adequate hygiene and sanitation facilities within Haiti, such that any cholera organisms they import would be safely contained.”
Seven months later, that assumption would be challenged.
On Oct. 8, 2010, hundreds of Nepalese troops began arriving in Haiti after a cholera outbreak in their homeland, where cholera is endemic; the country weathers outbreaks well, with that one causing nine deaths.
Cholera also affects individuals differently; many infected develop no symptoms or only mild or moderate diarrhea.
Falling violently ill in October 2010, Mr. Pelette was not one of the lucky ones. Severe cholera causes profuse watery diarrhea, often accompanied by vomiting. Treatment is straightforward: replacing lost fluids and electrolytes, orally or intravenously. But those like Mr. Pelette who get no treatment can become so dehydrated that they go into shock and swiftly die.
Nobody knows for sure, but people here believe that Mr. Pelette was the first Haitian to die of cholera, and, though he was not named, he was presented as the “first case” in The American Journal of Tropical Medicine and Hygiene in January.
Some details in that widely cited article, like Mr. Pelette’s age and date of death, did not match those on his death certificate, obtained by The New York Times. Also, Mr. Pelette does not offer an example of untreated mental illness, as the article contended; he had received care at a hospital for chronic mental diseases, his brother said.
“When he took his pills, he was calm,” Malherbe Pelette said, speaking on the porch of his sundry store. “He would come here every day, stand at the door waiting for a soda or cookies, and give a fist bump to everybody who came in. Sometimes, he showed up completely naked. He had a terrible speech impediment, and when he was agitated, it was really hard to understand him.
“Still, my friend, I cried when he died — a lot, a lot.”
Enter the Epidemic
A couple of hours after Mr. Pelette died from what the family priest proclaimed to be a poison of some sort, Rosemond Laurimé, 21, a “small businessman” in his family’s description, got sick in nearby Meille.
In Haiti, small businesses are minuscule, selling mangos or charcoal today to survive tomorrow. Mr. Laurimé peddled soap at a stand outside the Nepalese base, which sits on the banks of a fly-specked stream that flows into the Latem and then into Haiti’s longest river, the Artibonite.
Around 6 p.m. on Oct. 16, when he returned to his shack near the base, he was clutching his stomach. Soon, doubled over from violent diarrhea and vomiting, he begged for help.
His grandmother, 70-year-old Marie-Jean Ulysse, did her best, finally summoning a moto-taxi at daybreak to take Mr. Laurimé to the hospital in Mirebalais, run by a Cuban medical brigade.
By the time he got there, it was too late: “His body had lost all its water,” Ms. Ulysse said.
On Oct. 17, Mr. Laurimé became the first to die of cholera at a hospital in Haiti. The next day the Cuban doctors, who had seen five dozen cases of acute diarrhea in preceding days, notified the Haitian Health Ministry that something was terribly wrong.
Mr. Laurimé’s grandmother also fell ill and, hovering near death, witnessed the frightening explosion of the epidemic as she lay absorbing fluids intravenously on a hospital cot. She saw a chain of sick prisoners stripped of clothing and handcuffed one to the next. She watched an endless parade of patients carried in, bodies carried out.
“I said to my children, ‘Please do your best to take me home because I don’t want to end up in the big hole where they’re dumping all those bodies,’ ” she said.
While she is fine now, Mr. Laurimé’s mother is not. Yverose Fleury wears a cloth binding her midsection in an effort to contain her sorrow. She said neighbors had ripped up her son’s photograph because she keened over it incessantly.
“Nothing is the same with us after the cholera,” she said. “My husband is weak and cannot work, my remaining son has a mass on his neck, my little daughter can’t hold down food, and I am sick in the head.”
From Meille, the epidemic coursed through the Artibonite River valley, landing with a thump 46 miles northwest, and downstream, in the coastal St. Marc area. On Oct. 19, three children died in rapid succession in a classroom in the rice fields. On Oct. 20, the St. Nicholas Hospital was overrun.
Patients sprawled on every surface, doubled and tripled up on beds, in the halls, in the courtyard and even on the sidewalk outside. By nightfall, there were 404. Forty-four died.
“At that moment, I felt like I didn’t want to live any longer myself,” said Dr. Yfto Mayette, the hospital director. “It was so sudden and so brutal.”
On Oct. 21, as a brass band accompanied Mr. Pelette’s white coffin to the cemetery, the national laboratory completed its analysis of the bacteria.
At 11 that night, Dr. Jordan W. Tappero of the C.D.C. got a call in Atlanta from the laboratory’s director: “Jordan,” he said, “It’s positive.”
Louise C. Ivers, Haiti mission chief for Partners in Health, had just arrived in Boston for a meeting. “My first thought was, ‘You can’t be serious.’ Everyone was exhausted.”
In Port-au-Prince, Jocelyne Pierre-Louis, a senior Haitian health official, had steeled herself. “We were in a way waiting for the other shoe to drop,” she said. “We had barely picked ourselves up after the earthquake when the cholera fell on us.”
Dr. Pierre-Louis reported to the large tent that replaced her collapsed office after the earthquake. Dr. Ivers took the next plane back, and Dr. Tappero flew in, too, with the first of 119 C.D.C. employees who would deploy to Haiti.
“It was a herculean effort at the time, people working 18, 20 hours a day, trying their best to make a difference,” Dr. Tappero said.
There was much to do, from treating patients to treating water, from importing personnel to training Haitians, from distributing supplies to distributing basic disease and hygiene information.
But there were also fundamental decisions to be made, and nobody was firmly in charge. International health officials deferred to the Haitians — “our partners” — but in reality held the purse strings and know-how. This led to an often awkward collaboration, colored by Haitians’ resentment that cholera had been imported in the first place.
It did not help that the initial projection used by international officials for planning purposes — 200,000 cases in six months — was an underestimate. There would be that many cases in three months’ time, with a daily death toll of more than 100 by mid-December.
As the epidemic took off, the players who operated outside the “health cluster,” a consortium of humanitarian groups, were able to react most nimbly.
At first, Doctors Without Borders and the Cuban medical brigades, both self-financed, handled the overwhelming majority of cases. “We felt quite lonely at the beginning,” said Yann Libessart, spokesman for Doctors Without Borders. “It made no sense. Everybody was in Haiti. It was the biggest density of humanitarian actors in the world, and we two organizations were dealing with 80 percent of the cholera.”
Gaëtan Drossart, mission chief for Doctors Without Borders-Belgium, said the health cluster had good intentions, “but there’s a lot of meetings and a lot of blah blah blah.” He said other groups were limited by agreements with donors to working in the earthquake zone and could not redeploy quickly.
Also, everybody initially worried most about the epidemic’s arrival in Port-au-Prince. But Haiti’s meager health care resources have always been concentrated in the capital, and after the earthquake humanitarian personnel and supplies were, too. That would eventually increase the cholera survival odds in Port-au-Prince, which would have a 0.7 percent fatality rate compared with 4.5 percent in the southeast.
But it took several deadly weeks for the disease to forcefully strike the capital, where rehydration solutions were warehoused; water, latrines and medical professionals were more plentiful; and organizations had had time to set up proper treatment centers.
Proper treatment centers maintain rigorous infection control to keep from becoming cholera contamination centers: chlorine sprayers to disinfect shoes, hand-washing stations, cots with holes and buckets underneath, disposal systems for waste and bodies.
None of this was in place at the start. Doctors Without Borders sent a team to the St. Marc hospital. “It was really, really awful,” Mr. Drossart said. “There were an enormous number of cases, it was totally disorganized, the cholera patients were not isolated, and they were not being treated correctly.”
Even four months later, that hospital did not have cholera cots; patients defecated in bed or risked a potentially fatal drop in blood pressure by getting up, United Nations investigators found.
“Hospital staff reported walking on feces in cholera units,” they added.
Understaffed hospitals sometimes discharged patients too soon, sending them home to their deaths. They deputized relatives as caretakers although many patients arrived so dehydrated that they needed intravenous lines and nurses to watch over them. Pregnant women were a particular challenge.
“Our greatest heartbreak is that while the women survived, we only saved one pregnancy,” said Ian Rawson, managing director of Albert Schweitzer Hospital in central Haiti.
Truth vs. ‘The Blame Game’
Within a week of the outbreak, officials in Mirebalais were pointing fingers at the United Nations base, and United Nations officials were trying to stifle what they portrayed as rumors. The struggle began between those who thought that determining the epidemic’s origin was important and those who lamented “the blame game.”
At first, the United Nations said the base’s handling of its waste met international standards — that it used sealed septic tanks, which were regularly emptied by a Haitian contractor, with the waste buried in a proper landfill.
But on Oct. 27, Al Jazeera filmed peacekeepers with shovels “working furiously to contain what looks like a sewage spill.” Latrines appeared to be emptying black liquid directly into the river, a reporter said, and the air smelled foul with excrement.
That same day, The Associated Press observed an overflowing septic tank at the base and discovered the landfill to be open pits in a residential area uphill from the community’s bathing stream.
Even four months later, the United Nations’ own experts, examining the base’s supposedly improved sanitation, discovered haphazard piping with “significant potential for cross-contamination” between toilets and showers.
They also noted the “potential for feces to enter and flow from the drainage canal running through the camp directly” into the tributary. Contaminants would have been distributed throughout the river delta in two or three days — a timeline consistent with epidemiological evidence tracing the cholera trail, the experts said.
Before long, hundreds of Haitians were marching on the base, with demonstrations spreading to Port-au-Prince and riots developing in Cap Haitien.
Edmond Mulet, then head of the United Nations stabilization mission, complained that it was “really unfair to accuse the U.N. for bringing cholera into Haiti.” United Nations officials believed that agitators were taking advantage of the issue to sow unrest before November elections. But many Haitians were genuinely incensed — and fearful. Some wanted an explanation, others a scapegoat. Voodoo priests were being lynched for their supposed role in bringing the curse of cholera on Haiti, the government said.
In early November, the C.D.C. said that Haitian cholera samples matched strains commonly found in South Asia.
Dr. Piarroux, an infectious diseases specialist and parasitologist from Marseilles, arrived to lead a three-week French-Haitian investigation. He and his colleagues built a database of cases, identified geographic clusters and mapped the epidemic’s movement.
His conclusion: the only explanation for an outbreak of South Asian-style cholera in a rural area of Haiti home to a Nepalese Army base with a faulty sanitation system had to be infected soldiers on the base itself.
In early December, Dr. Piarroux’s mission report was posted on the Web site of the newspaper Le Monde. Eventually his findings would be peer-reviewed and published in the C.D.C.’s Emerging Infectious Diseases journal.
But at that point, he said, he was considered “a renegade and a mythomaniac.” A leading medical journal, The Lancet, rejected his study after publishing an editorial that said, “Although interest in how the outbreak originated may be a matter of scientific curiosity for the future, apportioning blame for the outbreak now is neither fair to people working to improve a dire situation, nor helpful in combating the disease.”
Nonetheless, Ban Ki-moon, the United Nations secretary general, announced an independent panel “to get to the bottom of this and find answers the people of Haiti deserve.”
Money and Lives
From the start, financial concerns colored the response to the epidemic, which had killed more than 3,600 Haitians by the first anniversary of the earthquake. It was partly a question of getting money flowing. Some donors hesitated, given the plodding pace of the earthquake reconstruction; others had to wait for a new budgetary year. Some institutions had time-consuming grant or contracting processes.
It was also a question of philosophy.
Some health officials wanted to use the least expensive prevention and treatment strategies and to marshal resources for the long battle ahead.
Others wanted to employ every available weapon at once, from free drinking water and antibiotics to aggressive case-tracking, mass vaccination, and water and sewer system building.
If that meant spending more upfront, so be it, they said. A year after the earthquake, many organizations were sitting on donations that remained unspent. The American Red Cross, for one, still had nearly half of the $479 million it had raised; it would ultimately dedicate $18 million directly to cholera prevention and treatment. Doctors Without Borders would spend $45 million.
Dr. Farmer of Partners in Health, who calls himself “a maximalist,” said he wanted “health equity” — for the developed world to respond to cholera in Haiti as it would at home.
His organization initially requested potable water be trucked into the Haitian heartland so that a traumatized population would not have to filter and treat its water. Purification tablets were delivered instead because it was considered cheaper and simpler, he said.
“There was a fetishization of the simple,” Dr. Farmer said. “But there’s nothing simple about the introduction of a new pathogen or stopping its spread in a water-insecure place. There’s nothing cheap about it, either.”
Dr. Farmer said he kept thinking about the many water stations at the New York City Marathon: “That’s for a sport, for heaven’s sake. You’re telling me the giant humanitarian aid machine can’t do that in an epidemic?”
Mark Henderson, a Unicef official, said water trucking was done inside the town of St. Marc. “I don’t know if it would have been logistically possible to send a water truck to every village in the Artibonite,” he said. “And I’m not sure it would have yielded better results than getting water, which is available locally, and applying chlorine.”
There was also a reluctance to use antibiotics, which can reduce diarrhea, spare suffering and potentially limit the disease’s spread.
The Cubans alone, who claimed in a report that without their help “another 1,000 Haitians would have died at Haitian Health Ministry institutions,” dispensed antibiotics to all cholera patients and preventively to their relatives.
World health authorities, concerned with cost and drug resistance, initially said antibiotics should be reserved for severe cases. Nearly three months later, the C.D.C. recommended antibiotics for moderate cases, too.
The fiercest disagreement was over vaccination. Again, citing cost as well as limited supplies and logistical challenges, world health officials initially did not endorse it. Some worried aloud that Haitians could get a false sense of security and become lax about hygiene.
Also, one of the two oral vaccines available — Shanchol, the cheaper one — was still under review by the World Health Organization.
But proponents argued that vaccines could save lives and buy time until long-range solutions like water and waste systems were put in place. They called for fast-tracking approval for Shanchol and increasing vaccine production by offering manufacturers purchase commitments. In mid-December, after a C.D.C. analysis indicated that using the available vaccine doses could reduce the caseload by 22,000, the Pan American Health Organization agreed a pilot vaccination project would be useful.
Influenced by arguments against vaccination, though, the Haitian government said no. Choosing a small group to be immunized would inflame tensions, it said; at least 500,000 needed to be vaccinated, said Jean Ronald Cadet, Haiti’s vaccination chief. “They brought us cholera, they have to take responsibility for taking care of it,” he said.
Delay and Disbelief
In February 2011, nearly four months after the outbreak, the United Nations’ independent experts arrived in Haiti.
The secretary general’s office wanted them to move quickly but not too quickly; it did not want the findings released until the Nepalese contingent had concluded its six-month rotation, Ms. Lantagne said.
When the experts revealed their findings in May, the secretary general’s staff members were surprised, Ms. Lantagne said. Early theories had proposed environmental and climatological explanations for the outbreak. “I believe they fully expected our results to be that there was no possibility cholera was imported into Haiti,” she said.
Instead, the panel said not only that the cholera had come from South Asia but that it originated in the tributary behind the Nepalese base.
Yet the United Nations experts noted that “the introduction of this cholera strain as a result of environmental contamination with feces could not have been the source of such an outbreak without simultaneous water and sanitation and health care system deficiencies.”
And they diplomatically concluded that the epidemic was “not the fault of, or deliberate action of, a group or individual.”
The panel had examined the Nepalese base’s infirmary logs and found no reports of severe diarrhea in September or October of 2010. Many took that to mean that the soldiers were probably unwitting, asymptomatic carriers of cholera. But Dr. Piarroux did not think that asymptomatic carriers would have shed enough bacteria to have caused such a sudden, marked contamination of the river. He believed that many soldiers must have had diarrhea — even if it was only mild or moderate diarrhea that, being military men, they did not report to the infirmary.
Testing the soldiers would have been the only way to learn the truth, Dr. Piarroux said. But Haitian health officials were not permitted onto the base to examine the soldiers.
After the United Nations panel dispersed, Danish and American scientists collaborated to scrutinize the Haiti-Nepal connection using the most comprehensive type of bacterial genetic analysis — whole-genome sequence typing.
Dr. Rene S. Hendriksen of Denmark persuaded the Nepalese to provide samples from their outbreak. Dr. Keim’s Translational Genomics Research Institute in Arizona sequenced the DNA, comparing it with Haitian samples already sequenced by the C.D.C.
The Haitian and Nepalese strains were virtually identical — a conclusion the Nepalese were reluctant to accept. “They were trying to fish around for whether our analysis was properly conducted,” Dr. Hendriksen said. “But finally they gave up simply because our data was valid. We agreed we would balance the paper and not get into the blame game.”
Citing this study and other evidence, a legal claim was submitted to the United Nations in November on behalf of Haiti’s cholera victims.
Anticipating compensation, thousands flooded treatment centers seeking medical certificates attesting to their cholera. Doctors Without Borders set up a special unit to process the requests, and has asked the United Nations to clarify whether a legal proceeding is even moving forward.
The victims’ lawyers have asked the United Nations to establish a commission to hear the claim. Mr. Banbury of the United Nations said the claim is “under serious review by the legal affairs department.”
“The U.N.’s choice is simple,” the lawyers wrote in a legal article. “It can rise to the occasion and demonstrate that the rule of law protects the rights of poor Haitians against one of the world’s most powerful institutions, or it can shrink from the challenge and demonstrate that once again in Haiti, ‘might makes right.’ ”
A Breather, and Then Disaster
It is tempting now, when reported cholera cases are at a low, for Haitians to relax their guard and for health officials to take a breather.
“We are no longer 24/7 cholera,” Dr. Pierre-Louis said. The same thing happened last year. Then the rains hit, and Port-au-Prince, like other places, experienced more cases — 24,000 — during a 42-day period than at the epidemic’s start. It was a scramble to deal with the surge; many grants had expired, emergency workers had gone home, and treatment centers were closed.
“We had supplies and structures prepositioned, but it wasn’t simple,” said Mr. Drossart of Doctors Without Borders. “We couldn’t keep mobilizing staff for Haiti. There are other things going on in the world.”
Dr. Vertefeuille of the C.D.C. said a key focus now was making the response sustainable without a large international presence. But the government health system, weak and underfinanced, will be hard-pressed to assume greater responsibility.
Dr. Vertefeuille also said cholera was likely to persist in Haiti absent the development of water and sanitation systems, the cost of which has been estimated at $800 million to $1.1 billion.
A singular achievement was the opening of Haiti’s first wastewater treatment site last fall. But humanitarian groups fret that short-term water and sanitation solutions are not being pursued aggressively, and that tent camps have lost the free water and, in some cases, the latrine services that gave them a buffer against cholera.
Many also express keen frustration that the dry season is not being used for aggressive case tracking — chasing the disease into pockets where it flares, investigating and chlorinating the water source, and mobilizing the community.
“You can’t wait with your arms crossed until the rain falls again,” Dr. Piarroux said. “You have to go after these areas like firemen trying to extinguish every last burning ember of a forest fire.”
Those who now find the official response sluggish — “daily” epidemic surveillance is posted after a delay of weeks — point to what happened recently in Pestel in southwest Haiti.
On Dec. 10, a severely dehydrated man showed up at the cholera treatment unit. The man was too far gone to be resuscitated, said Dr. Seneque Philippe, the physician in charge.
Dr. Philippe’s cholera unit had been inactive because the government had not paid the staff’s salaries. He was not ready for another outbreak.
Within two weeks, however, Dr. Philippe believed that he was in the midst of one. People were dying during the long journey down from the rugged mountains to his coastal hospital.
He said that he alerted Health Ministry officials on Dec. 24, and that they were unresponsive. So he contacted an American missionary who had been working in Pestel for decades. She, in turn, tapped into an Internet network of health professionals involved in Haiti and gathered volunteers, supplies and money to pay Dr. Philippe’s nurses.
They arrived Jan. 10 to find the cholera treatment unit overflowing. Most patients were coming from the mountains, so the volunteers, bolstered by other recruits, set up remote treatment tents. They also conducted a door-to-door census in the villages. Including treatment records, too, they calculated 278 suspected cholera cases and 62 deaths in December and January, with most deaths occurring before the ad-hoc group of foreigners arrived.
In Port-au-Prince, Dr. Pierre-Louis of the Health Ministry maintained that the reported outbreak in Pestel had been a “false alarm,” with only 65 cases and three deaths. She said that “the local doctor” had rebutted the larger numbers.
But Dr. Philippe, the local doctor, while saying he is “personally aware of only about 15 deaths,” said he knew of 300 cases — a significant outbreak.
“I felt abandoned to handle the problem myself,” he said.
Farther north, one effort to use the dry season to establish a bulwark against the disease was running into other problems.
Late last fall, the new government of President Michel Martelly had authorized a vaccination campaign. It was to start small, immunizing 50,000 residents of a Port-au-Prince slum and 50,000 rural residents in the St. Marc area.
The organizers, wishing they could have begun a year earlier and more broadly, were nonetheless relieved to have secured the new administration’s cooperation; it helped that Shanchol, the cheaper vaccine at $1.85 a dose, had been approved.
The organizers — Partners in Health and the Haitian group Gheskio — were also pleased to be starting well before the rains; the vaccine, considered nearly 70 percent effective, is administered in two doses two weeks apart and takes another week to take effect.
In February, Djencia Augustin, 25, a petite, vivacious law student, was racing from mud hut to mud hut in the rice fields of Bocozel to register residents. She wore a T-shirt with a wordy slogan — “We are fighting cholera with Shanchol vaccine without forgetting the other principals of hygiene” — and, in the shade of breadfruit trees, gathered barefoot villagers in threadbare clothing around her as she recorded their information on a computer tablet.
“Some people think cholera is not in our country anymore,” Ms. Augustin told them. “That’s not true. Cholera will come to visit when the rains arrive, so you need to be prepared.”
Bocozel seemed eager. Chavan Dorcelus, 58, said: “It’s a real bonus for us. Plus it’s free, and it can’t hurt.”
Told that pregnant women were ineligible, Fada Joseph, 24, patted her belly. “That’s not really fair. I’m very scared of cholera,” she said. “And if I got an abortion, would that help?”
But in mid-March, radio reports characterized the project as an experiment on Haitian guinea pigs. With $370,000 of vaccine sitting in coolers, a government bioethics committee took up the issue. The campaign appeared in peril. Dr. Farmer said last Thursday, however, that the Haitian health minister had just promised him that she would resolve the issue in the coming week.
‘Would Have Burned It Down’
In Meille, the walled gate at the United Nations base is freshly painted now with the insignia of Uruguayan peacekeepers. The Nepalese are gone.
The mission itself is reducing its forces nationwide. Nepal’s troop strength is being cut by two-thirds, more than any other country’s. United Nations officials said that this was unrelated to tensions over cholera.
But people here think otherwise: “If they hadn’t left, we would have burned it down,” Deputy Mayor Moise said of the base.
In February, an Uruguayan advance guard was there, removing latrines and generally “sanitizing the operation so previous problems do not repeat themselves,” as one soldier said.
Across the street, the open pits where the base’s waste used to be deposited were fenced. “They stopped dumping the foreigners’ poo there after the cholera,” said Ludner Jean-Louis, a farmer, his two cows tied to trees.
Mr. Jean-Louis, who had survived the disease himself, added, “I don’t guess you can be mad at Minustah for the cholera. Only for the poo.”
Behind the base, the stream where the epidemic began bustles with life now as it did before the outbreak; many who live and work beside it have no other access to free water.
Recently, just behind the base’s barbed-wire periphery, Dieula Sénéchal squatted with her skirt hiked up, scrubbing exuberantly colored clothes while a naked 6-year-old girl, Magalie Louis, defecated by the bank, gnawed on a stalk of sugarcane and then splashed into the water to brush her teeth.
Approaching with a machete on his way to hack some cane, her gap-toothed father, Légénord Louis, said Magalie had contracted cholera late last year but after four days of “special IVs” was restored to health. He knew the river water was probably not safe, he said, but, while they brushed their teeth in it, they did not swallow.
For drinking water, Mr. Louis said, his family relies on a local well. But he lives from hand to mouth and cannot afford water purification tablets; the free supply he got in 2010 ran out long ago. So he gambles.
“If you make it to the hospital,” he said, “you survive the cholera.”
André Paultre contributed reporting from Port-au-Prince, Haiti.
(New York Times) - By Deborah Sontag
MIREBALAIS — Jean Salgadeau Pelette, handsome when medicated and groomed, often roamed this central Haitian town in a disheveled state, wild-eyed and naked. He was a familiar figure here, the lanky scion of a prominent family who suffered from a mental illness.
On Oct. 16, 2010, Mr. Pelette, 38, woke at dawn in his solitary room behind a bric-a-brac shop off the town square. As was his habit, he loped down the hill to the Latem River for his bath, passing the beauty shop, the pharmacy and the funeral home where his body would soon be prepared for burial.
The river would have been busy that morning, with bathers, laundresses and schoolchildren brushing their teeth. Nobody thought of its flowing waters, downstream from a United Nations peacekeeping base, as toxic.
When Mr. Pelette was found lying by the bank a few hours later, he was so weak from a sudden, violent stomach illness that he had to be carried back to his room. It did not immediately occur to his relatives to rush him to the hospital.
“At that time, the word ‘cholera’ didn’t yet exist,” said one of his brothers, Malherbe Pelette. “We didn’t know he was in mortal danger. But by 4 that afternoon, my brother was dead. He was the first victim, or so they say.”
In the 17 months since Mr. Pelette was buried in the trash-strewn graveyard here, cholera has killed more than 7,050 Haitians and sickened more than 531,000, or 5 percent of the population. Lightning fast and virulent, it spread from here through every Haitian state, erupting into the world’s largest cholera epidemic despite a huge international mobilization still dealing with the effects of the Jan. 12, 2010, earthquake.
The world rallied to confront cholera, too, but the mission was muddled by the United Nations’ apparent role in igniting the epidemic and its unwillingness to acknowledge it. Epidemiologic and microbiologic evidence strongly suggests that United Nations peacekeeping troops from Nepal imported cholera to Haiti, contaminated the river tributary next to their base through a faulty sanitation system and caused a second disaster.
“It was like throwing a lighted match into a gasoline-filled room,” said Dr. Paul S. Keim, a microbial geneticist whose laboratory determined that the Haitian and Nepalese cholera strains were virtually identical.
And, as the deaths and continuing caseload indicate, the world’s response to this preventable, treatable scourge has proved inadequate. Cholera, never before recorded in Haiti, stayed one step ahead of the authorities as they shifted gears from the earthquake recovery. While eventually effective in reducing the fatality rate, the response was slow to get fully under way, conservative and insufficiently sustained.
“In the future, historians will look back and say, ‘Wow, that’s unfortunate,’ ” said Dr. Paul Farmer, co-founder of Partners in Health, a nongovernmental organization that provides health care for the poor. “This unfolded right under the noses of all those NGOs. And they will ask, ‘Why didn’t they try harder? Why didn’t they throw the kitchen sink at cholera in Haiti?’ ”
While the world has dedicated $230 million so far to combating the unexpected epidemic, the United Nations is now pleading for an additional $53.9 million just to get the vulnerable displaced population through the rainy months ahead.
At the same time, Haitian cholera victims are seeking compensation from the United Nations, pressing it to accept responsibility. Early on, protests against the United Nations hindered the construction of treatment centers and the delivery of lifesaving supplies. Now distrust of some cholera programs lingers, and the issue has strained the peacekeepers’ relationship with the Haitians they are protecting in an eight-year-old mission to stabilize the politically volatile nation. So, too, have unrelated allegations that they engaged in criminally abusive behavior.
“In telling the truth, the U.N. could have gained the trust of the population and facilitated the fight against cholera,” said Dr. Renaud Piarroux, who led an early investigation into the outbreak. “But that was bungled.”
The United Nations maintains that an independent panel of experts determined the evidence implicating its troops to be inconclusive.
Questioned for this article, though, those same experts said that Dr. Keim’s work, conducted after their own, provides “irrefutable molecular evidence” that Haiti’s cholera came from Nepal, in the words of G. Balakrish Nair, an Indian microbiologist.
“When you take the circumstantial evidence in our report and all that has come out since, the story now I think is stronger: the most likely scenario is that the cholera began with someone at the Minustah base,” said another expert, Daniele Lantagne, an American engineer, using the French acronym for the United Nations mission.
Even so, Anthony Banbury, a United Nations assistant secretary general, said last week, “We don’t think the cholera outbreak is attributable to any single factor.”
Many health officials consider the cholera response “pretty remarkable,” as John Vertefeuille, the Centers for Disease Control and Prevention’s director in Haiti, said.
A sky-high initial fatality rate of over 9 percent has declined to 1.3 percent (less than 1 percent is considered a well-managed epidemic). And the most recent statistics show new cases dropping to 120 daily.
Others, though, believe the bar for success was set too low and more lives could have been saved. Some critics bemoan weak disease surveillance and case-tracking, others inadequate water distribution and latrine building, and still others what they see as a penny-pinching reluctance to use antibiotics and cholera vaccine.
Also, some think cholera could have been stymied, even eradicated, last winter during the dry season after the first wave. Instead, it flared with the rains even as aid groups shuttered or reduced operations. And now, after another winter without an aggressive prevention and eradication effort, the health authorities fear a reprise.
“I think it’s going to be another bad year for cholera,” said Dr. John Carroll, an Illinois doctor who works in Haiti.
A Rapid Death
Here in the epicenter of the epidemic, all signage relates to life in the time of cholera. Surrounding the town square are heart-adorned posters that say, “Living with cholera: Always wash your hands with clean water and soap.” Banners slung across the streets, in contrast, bear skulls and crossbones: “Justice and reparations for all victims of the Minustah cholera.”
Inside City Hall, the deputy mayor, crisply dressed in a chambray shirt and slacks, described how he personally buried 27 bodies for fear that workers would not take precautions, how he nearly lost two of his own children to cholera and how he seethed every time Nepalese troops entered his offices.
“They were in my face every day, and the feeling inside me got stronger and stronger,” said Ocxama Moise, the deputy mayor. “A few months ago, I even considered killing a soldier or two to see what would happen. I shared the idea with some friends, and they said, ‘Don’t. You’re an official.’ But it’s only a matter of time before the population finds a way to get justice.”
After the earthquake, when Haitians were living amid cadaver-filled ruins in the sprawling Port-au-Prince area, international health officials were concerned that infectious diseases would rip through the tent camps.
Well before the earthquake, Haiti was fertile ground for a disease that spreads primarily through fecal contamination of water: in 2008, only 12 percent of the population had access to piped, treated water, and only 17 percent to “improved sanitation,” which includes the simplest pit latrines. Haitians’ latrine access actually declined, from 24 percent in 1990.
“For decades we as partners have failed to ensure safe water and sanitation is provided to every resident of Haiti,” said Dr. Jon Kim Andrus, deputy director of the Pan American Health Organization.
But Haiti had escaped the cholera that raged through Latin America in the 1990s, and even the cholera that struck the Caribbean in the 19th century. It appeared “extremely unlikely” that cholera would present itself, a C.D.C. post-earthquake brief said.
“The risk of cholera introduction to Haiti is low,” it said, noting relief workers were “likely to have access to adequate hygiene and sanitation facilities within Haiti, such that any cholera organisms they import would be safely contained.”
Seven months later, that assumption would be challenged.
On Oct. 8, 2010, hundreds of Nepalese troops began arriving in Haiti after a cholera outbreak in their homeland, where cholera is endemic; the country weathers outbreaks well, with that one causing nine deaths.
Cholera also affects individuals differently; many infected develop no symptoms or only mild or moderate diarrhea.
Falling violently ill in October 2010, Mr. Pelette was not one of the lucky ones. Severe cholera causes profuse watery diarrhea, often accompanied by vomiting. Treatment is straightforward: replacing lost fluids and electrolytes, orally or intravenously. But those like Mr. Pelette who get no treatment can become so dehydrated that they go into shock and swiftly die.
Nobody knows for sure, but people here believe that Mr. Pelette was the first Haitian to die of cholera, and, though he was not named, he was presented as the “first case” in The American Journal of Tropical Medicine and Hygiene in January.
Some details in that widely cited article, like Mr. Pelette’s age and date of death, did not match those on his death certificate, obtained by The New York Times. Also, Mr. Pelette does not offer an example of untreated mental illness, as the article contended; he had received care at a hospital for chronic mental diseases, his brother said.
“When he took his pills, he was calm,” Malherbe Pelette said, speaking on the porch of his sundry store. “He would come here every day, stand at the door waiting for a soda or cookies, and give a fist bump to everybody who came in. Sometimes, he showed up completely naked. He had a terrible speech impediment, and when he was agitated, it was really hard to understand him.
“Still, my friend, I cried when he died — a lot, a lot.”
Enter the Epidemic
A couple of hours after Mr. Pelette died from what the family priest proclaimed to be a poison of some sort, Rosemond Laurimé, 21, a “small businessman” in his family’s description, got sick in nearby Meille.
In Haiti, small businesses are minuscule, selling mangos or charcoal today to survive tomorrow. Mr. Laurimé peddled soap at a stand outside the Nepalese base, which sits on the banks of a fly-specked stream that flows into the Latem and then into Haiti’s longest river, the Artibonite.
Around 6 p.m. on Oct. 16, when he returned to his shack near the base, he was clutching his stomach. Soon, doubled over from violent diarrhea and vomiting, he begged for help.
His grandmother, 70-year-old Marie-Jean Ulysse, did her best, finally summoning a moto-taxi at daybreak to take Mr. Laurimé to the hospital in Mirebalais, run by a Cuban medical brigade.
By the time he got there, it was too late: “His body had lost all its water,” Ms. Ulysse said.
On Oct. 17, Mr. Laurimé became the first to die of cholera at a hospital in Haiti. The next day the Cuban doctors, who had seen five dozen cases of acute diarrhea in preceding days, notified the Haitian Health Ministry that something was terribly wrong.
Mr. Laurimé’s grandmother also fell ill and, hovering near death, witnessed the frightening explosion of the epidemic as she lay absorbing fluids intravenously on a hospital cot. She saw a chain of sick prisoners stripped of clothing and handcuffed one to the next. She watched an endless parade of patients carried in, bodies carried out.
“I said to my children, ‘Please do your best to take me home because I don’t want to end up in the big hole where they’re dumping all those bodies,’ ” she said.
While she is fine now, Mr. Laurimé’s mother is not. Yverose Fleury wears a cloth binding her midsection in an effort to contain her sorrow. She said neighbors had ripped up her son’s photograph because she keened over it incessantly.
“Nothing is the same with us after the cholera,” she said. “My husband is weak and cannot work, my remaining son has a mass on his neck, my little daughter can’t hold down food, and I am sick in the head.”
From Meille, the epidemic coursed through the Artibonite River valley, landing with a thump 46 miles northwest, and downstream, in the coastal St. Marc area. On Oct. 19, three children died in rapid succession in a classroom in the rice fields. On Oct. 20, the St. Nicholas Hospital was overrun.
Patients sprawled on every surface, doubled and tripled up on beds, in the halls, in the courtyard and even on the sidewalk outside. By nightfall, there were 404. Forty-four died.
“At that moment, I felt like I didn’t want to live any longer myself,” said Dr. Yfto Mayette, the hospital director. “It was so sudden and so brutal.”
On Oct. 21, as a brass band accompanied Mr. Pelette’s white coffin to the cemetery, the national laboratory completed its analysis of the bacteria.
At 11 that night, Dr. Jordan W. Tappero of the C.D.C. got a call in Atlanta from the laboratory’s director: “Jordan,” he said, “It’s positive.”
Louise C. Ivers, Haiti mission chief for Partners in Health, had just arrived in Boston for a meeting. “My first thought was, ‘You can’t be serious.’ Everyone was exhausted.”
In Port-au-Prince, Jocelyne Pierre-Louis, a senior Haitian health official, had steeled herself. “We were in a way waiting for the other shoe to drop,” she said. “We had barely picked ourselves up after the earthquake when the cholera fell on us.”
Dr. Pierre-Louis reported to the large tent that replaced her collapsed office after the earthquake. Dr. Ivers took the next plane back, and Dr. Tappero flew in, too, with the first of 119 C.D.C. employees who would deploy to Haiti.
“It was a herculean effort at the time, people working 18, 20 hours a day, trying their best to make a difference,” Dr. Tappero said.
There was much to do, from treating patients to treating water, from importing personnel to training Haitians, from distributing supplies to distributing basic disease and hygiene information.
But there were also fundamental decisions to be made, and nobody was firmly in charge. International health officials deferred to the Haitians — “our partners” — but in reality held the purse strings and know-how. This led to an often awkward collaboration, colored by Haitians’ resentment that cholera had been imported in the first place.
It did not help that the initial projection used by international officials for planning purposes — 200,000 cases in six months — was an underestimate. There would be that many cases in three months’ time, with a daily death toll of more than 100 by mid-December.
As the epidemic took off, the players who operated outside the “health cluster,” a consortium of humanitarian groups, were able to react most nimbly.
At first, Doctors Without Borders and the Cuban medical brigades, both self-financed, handled the overwhelming majority of cases. “We felt quite lonely at the beginning,” said Yann Libessart, spokesman for Doctors Without Borders. “It made no sense. Everybody was in Haiti. It was the biggest density of humanitarian actors in the world, and we two organizations were dealing with 80 percent of the cholera.”
Gaëtan Drossart, mission chief for Doctors Without Borders-Belgium, said the health cluster had good intentions, “but there’s a lot of meetings and a lot of blah blah blah.” He said other groups were limited by agreements with donors to working in the earthquake zone and could not redeploy quickly.
Also, everybody initially worried most about the epidemic’s arrival in Port-au-Prince. But Haiti’s meager health care resources have always been concentrated in the capital, and after the earthquake humanitarian personnel and supplies were, too. That would eventually increase the cholera survival odds in Port-au-Prince, which would have a 0.7 percent fatality rate compared with 4.5 percent in the southeast.
But it took several deadly weeks for the disease to forcefully strike the capital, where rehydration solutions were warehoused; water, latrines and medical professionals were more plentiful; and organizations had had time to set up proper treatment centers.
Proper treatment centers maintain rigorous infection control to keep from becoming cholera contamination centers: chlorine sprayers to disinfect shoes, hand-washing stations, cots with holes and buckets underneath, disposal systems for waste and bodies.
None of this was in place at the start. Doctors Without Borders sent a team to the St. Marc hospital. “It was really, really awful,” Mr. Drossart said. “There were an enormous number of cases, it was totally disorganized, the cholera patients were not isolated, and they were not being treated correctly.”
Even four months later, that hospital did not have cholera cots; patients defecated in bed or risked a potentially fatal drop in blood pressure by getting up, United Nations investigators found.
“Hospital staff reported walking on feces in cholera units,” they added.
Understaffed hospitals sometimes discharged patients too soon, sending them home to their deaths. They deputized relatives as caretakers although many patients arrived so dehydrated that they needed intravenous lines and nurses to watch over them. Pregnant women were a particular challenge.
“Our greatest heartbreak is that while the women survived, we only saved one pregnancy,” said Ian Rawson, managing director of Albert Schweitzer Hospital in central Haiti.
Truth vs. ‘The Blame Game’
Within a week of the outbreak, officials in Mirebalais were pointing fingers at the United Nations base, and United Nations officials were trying to stifle what they portrayed as rumors. The struggle began between those who thought that determining the epidemic’s origin was important and those who lamented “the blame game.”
At first, the United Nations said the base’s handling of its waste met international standards — that it used sealed septic tanks, which were regularly emptied by a Haitian contractor, with the waste buried in a proper landfill.
But on Oct. 27, Al Jazeera filmed peacekeepers with shovels “working furiously to contain what looks like a sewage spill.” Latrines appeared to be emptying black liquid directly into the river, a reporter said, and the air smelled foul with excrement.
That same day, The Associated Press observed an overflowing septic tank at the base and discovered the landfill to be open pits in a residential area uphill from the community’s bathing stream.
Even four months later, the United Nations’ own experts, examining the base’s supposedly improved sanitation, discovered haphazard piping with “significant potential for cross-contamination” between toilets and showers.
They also noted the “potential for feces to enter and flow from the drainage canal running through the camp directly” into the tributary. Contaminants would have been distributed throughout the river delta in two or three days — a timeline consistent with epidemiological evidence tracing the cholera trail, the experts said.
Before long, hundreds of Haitians were marching on the base, with demonstrations spreading to Port-au-Prince and riots developing in Cap Haitien.
Edmond Mulet, then head of the United Nations stabilization mission, complained that it was “really unfair to accuse the U.N. for bringing cholera into Haiti.” United Nations officials believed that agitators were taking advantage of the issue to sow unrest before November elections. But many Haitians were genuinely incensed — and fearful. Some wanted an explanation, others a scapegoat. Voodoo priests were being lynched for their supposed role in bringing the curse of cholera on Haiti, the government said.
In early November, the C.D.C. said that Haitian cholera samples matched strains commonly found in South Asia.
Dr. Piarroux, an infectious diseases specialist and parasitologist from Marseilles, arrived to lead a three-week French-Haitian investigation. He and his colleagues built a database of cases, identified geographic clusters and mapped the epidemic’s movement.
His conclusion: the only explanation for an outbreak of South Asian-style cholera in a rural area of Haiti home to a Nepalese Army base with a faulty sanitation system had to be infected soldiers on the base itself.
In early December, Dr. Piarroux’s mission report was posted on the Web site of the newspaper Le Monde. Eventually his findings would be peer-reviewed and published in the C.D.C.’s Emerging Infectious Diseases journal.
But at that point, he said, he was considered “a renegade and a mythomaniac.” A leading medical journal, The Lancet, rejected his study after publishing an editorial that said, “Although interest in how the outbreak originated may be a matter of scientific curiosity for the future, apportioning blame for the outbreak now is neither fair to people working to improve a dire situation, nor helpful in combating the disease.”
Nonetheless, Ban Ki-moon, the United Nations secretary general, announced an independent panel “to get to the bottom of this and find answers the people of Haiti deserve.”
Money and Lives
From the start, financial concerns colored the response to the epidemic, which had killed more than 3,600 Haitians by the first anniversary of the earthquake. It was partly a question of getting money flowing. Some donors hesitated, given the plodding pace of the earthquake reconstruction; others had to wait for a new budgetary year. Some institutions had time-consuming grant or contracting processes.
It was also a question of philosophy.
Some health officials wanted to use the least expensive prevention and treatment strategies and to marshal resources for the long battle ahead.
Others wanted to employ every available weapon at once, from free drinking water and antibiotics to aggressive case-tracking, mass vaccination, and water and sewer system building.
If that meant spending more upfront, so be it, they said. A year after the earthquake, many organizations were sitting on donations that remained unspent. The American Red Cross, for one, still had nearly half of the $479 million it had raised; it would ultimately dedicate $18 million directly to cholera prevention and treatment. Doctors Without Borders would spend $45 million.
Dr. Farmer of Partners in Health, who calls himself “a maximalist,” said he wanted “health equity” — for the developed world to respond to cholera in Haiti as it would at home.
His organization initially requested potable water be trucked into the Haitian heartland so that a traumatized population would not have to filter and treat its water. Purification tablets were delivered instead because it was considered cheaper and simpler, he said.
“There was a fetishization of the simple,” Dr. Farmer said. “But there’s nothing simple about the introduction of a new pathogen or stopping its spread in a water-insecure place. There’s nothing cheap about it, either.”
Dr. Farmer said he kept thinking about the many water stations at the New York City Marathon: “That’s for a sport, for heaven’s sake. You’re telling me the giant humanitarian aid machine can’t do that in an epidemic?”
Mark Henderson, a Unicef official, said water trucking was done inside the town of St. Marc. “I don’t know if it would have been logistically possible to send a water truck to every village in the Artibonite,” he said. “And I’m not sure it would have yielded better results than getting water, which is available locally, and applying chlorine.”
There was also a reluctance to use antibiotics, which can reduce diarrhea, spare suffering and potentially limit the disease’s spread.
The Cubans alone, who claimed in a report that without their help “another 1,000 Haitians would have died at Haitian Health Ministry institutions,” dispensed antibiotics to all cholera patients and preventively to their relatives.
World health authorities, concerned with cost and drug resistance, initially said antibiotics should be reserved for severe cases. Nearly three months later, the C.D.C. recommended antibiotics for moderate cases, too.
The fiercest disagreement was over vaccination. Again, citing cost as well as limited supplies and logistical challenges, world health officials initially did not endorse it. Some worried aloud that Haitians could get a false sense of security and become lax about hygiene.
Also, one of the two oral vaccines available — Shanchol, the cheaper one — was still under review by the World Health Organization.
But proponents argued that vaccines could save lives and buy time until long-range solutions like water and waste systems were put in place. They called for fast-tracking approval for Shanchol and increasing vaccine production by offering manufacturers purchase commitments. In mid-December, after a C.D.C. analysis indicated that using the available vaccine doses could reduce the caseload by 22,000, the Pan American Health Organization agreed a pilot vaccination project would be useful.
Influenced by arguments against vaccination, though, the Haitian government said no. Choosing a small group to be immunized would inflame tensions, it said; at least 500,000 needed to be vaccinated, said Jean Ronald Cadet, Haiti’s vaccination chief. “They brought us cholera, they have to take responsibility for taking care of it,” he said.
Delay and Disbelief
In February 2011, nearly four months after the outbreak, the United Nations’ independent experts arrived in Haiti.
The secretary general’s office wanted them to move quickly but not too quickly; it did not want the findings released until the Nepalese contingent had concluded its six-month rotation, Ms. Lantagne said.
When the experts revealed their findings in May, the secretary general’s staff members were surprised, Ms. Lantagne said. Early theories had proposed environmental and climatological explanations for the outbreak. “I believe they fully expected our results to be that there was no possibility cholera was imported into Haiti,” she said.
Instead, the panel said not only that the cholera had come from South Asia but that it originated in the tributary behind the Nepalese base.
Yet the United Nations experts noted that “the introduction of this cholera strain as a result of environmental contamination with feces could not have been the source of such an outbreak without simultaneous water and sanitation and health care system deficiencies.”
And they diplomatically concluded that the epidemic was “not the fault of, or deliberate action of, a group or individual.”
The panel had examined the Nepalese base’s infirmary logs and found no reports of severe diarrhea in September or October of 2010. Many took that to mean that the soldiers were probably unwitting, asymptomatic carriers of cholera. But Dr. Piarroux did not think that asymptomatic carriers would have shed enough bacteria to have caused such a sudden, marked contamination of the river. He believed that many soldiers must have had diarrhea — even if it was only mild or moderate diarrhea that, being military men, they did not report to the infirmary.
Testing the soldiers would have been the only way to learn the truth, Dr. Piarroux said. But Haitian health officials were not permitted onto the base to examine the soldiers.
After the United Nations panel dispersed, Danish and American scientists collaborated to scrutinize the Haiti-Nepal connection using the most comprehensive type of bacterial genetic analysis — whole-genome sequence typing.
Dr. Rene S. Hendriksen of Denmark persuaded the Nepalese to provide samples from their outbreak. Dr. Keim’s Translational Genomics Research Institute in Arizona sequenced the DNA, comparing it with Haitian samples already sequenced by the C.D.C.
The Haitian and Nepalese strains were virtually identical — a conclusion the Nepalese were reluctant to accept. “They were trying to fish around for whether our analysis was properly conducted,” Dr. Hendriksen said. “But finally they gave up simply because our data was valid. We agreed we would balance the paper and not get into the blame game.”
Citing this study and other evidence, a legal claim was submitted to the United Nations in November on behalf of Haiti’s cholera victims.
Anticipating compensation, thousands flooded treatment centers seeking medical certificates attesting to their cholera. Doctors Without Borders set up a special unit to process the requests, and has asked the United Nations to clarify whether a legal proceeding is even moving forward.
The victims’ lawyers have asked the United Nations to establish a commission to hear the claim. Mr. Banbury of the United Nations said the claim is “under serious review by the legal affairs department.”
“The U.N.’s choice is simple,” the lawyers wrote in a legal article. “It can rise to the occasion and demonstrate that the rule of law protects the rights of poor Haitians against one of the world’s most powerful institutions, or it can shrink from the challenge and demonstrate that once again in Haiti, ‘might makes right.’ ”
A Breather, and Then Disaster
It is tempting now, when reported cholera cases are at a low, for Haitians to relax their guard and for health officials to take a breather.
“We are no longer 24/7 cholera,” Dr. Pierre-Louis said. The same thing happened last year. Then the rains hit, and Port-au-Prince, like other places, experienced more cases — 24,000 — during a 42-day period than at the epidemic’s start. It was a scramble to deal with the surge; many grants had expired, emergency workers had gone home, and treatment centers were closed.
“We had supplies and structures prepositioned, but it wasn’t simple,” said Mr. Drossart of Doctors Without Borders. “We couldn’t keep mobilizing staff for Haiti. There are other things going on in the world.”
Dr. Vertefeuille of the C.D.C. said a key focus now was making the response sustainable without a large international presence. But the government health system, weak and underfinanced, will be hard-pressed to assume greater responsibility.
Dr. Vertefeuille also said cholera was likely to persist in Haiti absent the development of water and sanitation systems, the cost of which has been estimated at $800 million to $1.1 billion.
A singular achievement was the opening of Haiti’s first wastewater treatment site last fall. But humanitarian groups fret that short-term water and sanitation solutions are not being pursued aggressively, and that tent camps have lost the free water and, in some cases, the latrine services that gave them a buffer against cholera.
Many also express keen frustration that the dry season is not being used for aggressive case tracking — chasing the disease into pockets where it flares, investigating and chlorinating the water source, and mobilizing the community.
“You can’t wait with your arms crossed until the rain falls again,” Dr. Piarroux said. “You have to go after these areas like firemen trying to extinguish every last burning ember of a forest fire.”
Those who now find the official response sluggish — “daily” epidemic surveillance is posted after a delay of weeks — point to what happened recently in Pestel in southwest Haiti.
On Dec. 10, a severely dehydrated man showed up at the cholera treatment unit. The man was too far gone to be resuscitated, said Dr. Seneque Philippe, the physician in charge.
Dr. Philippe’s cholera unit had been inactive because the government had not paid the staff’s salaries. He was not ready for another outbreak.
Within two weeks, however, Dr. Philippe believed that he was in the midst of one. People were dying during the long journey down from the rugged mountains to his coastal hospital.
He said that he alerted Health Ministry officials on Dec. 24, and that they were unresponsive. So he contacted an American missionary who had been working in Pestel for decades. She, in turn, tapped into an Internet network of health professionals involved in Haiti and gathered volunteers, supplies and money to pay Dr. Philippe’s nurses.
They arrived Jan. 10 to find the cholera treatment unit overflowing. Most patients were coming from the mountains, so the volunteers, bolstered by other recruits, set up remote treatment tents. They also conducted a door-to-door census in the villages. Including treatment records, too, they calculated 278 suspected cholera cases and 62 deaths in December and January, with most deaths occurring before the ad-hoc group of foreigners arrived.
In Port-au-Prince, Dr. Pierre-Louis of the Health Ministry maintained that the reported outbreak in Pestel had been a “false alarm,” with only 65 cases and three deaths. She said that “the local doctor” had rebutted the larger numbers.
But Dr. Philippe, the local doctor, while saying he is “personally aware of only about 15 deaths,” said he knew of 300 cases — a significant outbreak.
“I felt abandoned to handle the problem myself,” he said.
Farther north, one effort to use the dry season to establish a bulwark against the disease was running into other problems.
Late last fall, the new government of President Michel Martelly had authorized a vaccination campaign. It was to start small, immunizing 50,000 residents of a Port-au-Prince slum and 50,000 rural residents in the St. Marc area.
The organizers, wishing they could have begun a year earlier and more broadly, were nonetheless relieved to have secured the new administration’s cooperation; it helped that Shanchol, the cheaper vaccine at $1.85 a dose, had been approved.
The organizers — Partners in Health and the Haitian group Gheskio — were also pleased to be starting well before the rains; the vaccine, considered nearly 70 percent effective, is administered in two doses two weeks apart and takes another week to take effect.
In February, Djencia Augustin, 25, a petite, vivacious law student, was racing from mud hut to mud hut in the rice fields of Bocozel to register residents. She wore a T-shirt with a wordy slogan — “We are fighting cholera with Shanchol vaccine without forgetting the other principals of hygiene” — and, in the shade of breadfruit trees, gathered barefoot villagers in threadbare clothing around her as she recorded their information on a computer tablet.
“Some people think cholera is not in our country anymore,” Ms. Augustin told them. “That’s not true. Cholera will come to visit when the rains arrive, so you need to be prepared.”
Bocozel seemed eager. Chavan Dorcelus, 58, said: “It’s a real bonus for us. Plus it’s free, and it can’t hurt.”
Told that pregnant women were ineligible, Fada Joseph, 24, patted her belly. “That’s not really fair. I’m very scared of cholera,” she said. “And if I got an abortion, would that help?”
But in mid-March, radio reports characterized the project as an experiment on Haitian guinea pigs. With $370,000 of vaccine sitting in coolers, a government bioethics committee took up the issue. The campaign appeared in peril. Dr. Farmer said last Thursday, however, that the Haitian health minister had just promised him that she would resolve the issue in the coming week.
‘Would Have Burned It Down’
In Meille, the walled gate at the United Nations base is freshly painted now with the insignia of Uruguayan peacekeepers. The Nepalese are gone.
The mission itself is reducing its forces nationwide. Nepal’s troop strength is being cut by two-thirds, more than any other country’s. United Nations officials said that this was unrelated to tensions over cholera.
But people here think otherwise: “If they hadn’t left, we would have burned it down,” Deputy Mayor Moise said of the base.
In February, an Uruguayan advance guard was there, removing latrines and generally “sanitizing the operation so previous problems do not repeat themselves,” as one soldier said.
Across the street, the open pits where the base’s waste used to be deposited were fenced. “They stopped dumping the foreigners’ poo there after the cholera,” said Ludner Jean-Louis, a farmer, his two cows tied to trees.
Mr. Jean-Louis, who had survived the disease himself, added, “I don’t guess you can be mad at Minustah for the cholera. Only for the poo.”
Behind the base, the stream where the epidemic began bustles with life now as it did before the outbreak; many who live and work beside it have no other access to free water.
Recently, just behind the base’s barbed-wire periphery, Dieula Sénéchal squatted with her skirt hiked up, scrubbing exuberantly colored clothes while a naked 6-year-old girl, Magalie Louis, defecated by the bank, gnawed on a stalk of sugarcane and then splashed into the water to brush her teeth.
Approaching with a machete on his way to hack some cane, her gap-toothed father, Légénord Louis, said Magalie had contracted cholera late last year but after four days of “special IVs” was restored to health. He knew the river water was probably not safe, he said, but, while they brushed their teeth in it, they did not swallow.
For drinking water, Mr. Louis said, his family relies on a local well. But he lives from hand to mouth and cannot afford water purification tablets; the free supply he got in 2010 ran out long ago. So he gambles.
“If you make it to the hospital,” he said, “you survive the cholera.”
André Paultre contributed reporting from Port-au-Prince, Haiti.
Sunday, January 15, 2012
CHOLERA IN PESTEL - JANUARY 14, 2012
CHOLERA IN PESTEL - JANUARY 14, 2012
(PJ Star) - By John Carroll MD
This is my narrative of the last four days in rural Haiti.
I am going to try and not beat dead horses.
I am going to try and not be too cynical or too sarcastic or too snarky. And I will not point fingers at the UN, at the Haitian government, at international governments, at the gran mange in PAP, at the billions of NGO’s in Haiti, at the “where did all the pledged money go questions”, at church leaders or the voodoo priests, at the adacemicians, the “do gooder” blan doctors, or at Catholic nuns or the little church lady Protestant missionaries who spend 30 years of their lives here doing as much good as they possibly can do.
There is no time to criticize anyone right now.
Cholera is infecting and killing many Haitians as I post this from Pestel, Haiti this afternoon– January 14, 2012.
I feel very rushed to post this. My access to internet is almost absent. Electricity is never a guarantee.
My conclusions are probably not that complete, but I hope they are practical and they come from being on the ground here. And the good part of this post is that the conclusions and comments are located at the beginning. So if you don’t want to read further you don’t have too.
After the conclusion and comments is a blow-by-blow account of the last four days in very rural rural Haiti describing the chaotic situation and trying to describe the nuts and bolts of the cholera epidemic here. (I will post first names only of the team members here with me.)
And I don’t have any statistics that I am willing to give right now. I have lots of numbers and a good idea, but the numbers will be published by Miriam, our team leader, so we can give the most accurate information possible. It is not good to over estimate or under estimate cholera statistics.
My big thanks to Maria and Luke, Tommie and Diane, Ed and Mary, Jeffrey, Miriam, Judy, Shane, Mike and Kathy and Jim and Stephanie and Leslie and many others, and Madame Jacques for all of their support and help in every way. And thank you DIRT for showing up with all your supplies, hands, and hearts.
Conclusions and Comments:
There is still much cholera in rural Haiti. And people are dying in rural Haiti of cholera. And they shouldn’t have to.
The roads in Haiti and the communication in Haiti is bad. A poor person may have a phone but that does not mean he has money in the phone or the phone has a charge because electricity is hard to find much of the time. And Digicel works some places and Natcom works some places… but not all the time. Good communication is a must to beat cholera.
Cholera needs to be managed locally in rural Haiti. Local leaders need to take this responsibility themselves. The trickle down effect is not working except the stuff that trickles down will make you very ill. Community education needs to be done by local leaders. Aquatabs, Chlorox, etc needs to be passed out to every house by community people.
Nurses, community health workers, and CERT need to be done locally. These people all need to be paid fairly. And the nurses staffing Cholera Treatment Centers need good housing and somone to help prepare their food and do their laundary so they can take care of sick patients in the tents. The Haitian nurses need to have the patient’s survival at the top of their list rather than their own survival in this very difficult environment.
Cases of cholera or suspected cholera need to followed to the house in the village and then to the water source. Each water source needs to be tested. If cholera is found, water engineers need to intervene.
CTU and CTC need to be placed in strategic easy to find locations in the mountains so people don’t have to travel such long distances to receive care when their small intestines are attacked by cholera toxin and they are losing their body fluids and their lives.
The supply chain of cholera material has to be never ending and appropriate for the size of the tent and the patient census. No rationing of life saving IV Ringer’s Lactate or ORS should have to happen. If a patient needs 5 liters of LR in three hours, he/she should get it.
Our experts are telling us that there will be a fourth, fifth, and sixth wave of cholera in Haiti, starting in March/April of this year. And we better believe them.
From what I have seen during the last few days, rural Haiti will not do well with the new up coming outbreaks unless local changes are made immediately.
And each time there is a cholera death in Haiti, we should all take it personally. It is our responsibility to stop this epidemic because we are all part of the human race. It is not the poor Haitian’s fault when he gets cholera. I have heard the poor Haitians being blamed for getting cholera. We need to understand they have no clean water to wash their hands properly. I can tell you they don’t enjoy having cholera. And how many well to do Haitians or well to do NGO people do you know who have died from cholera in Haiti?
———–
Tuesday, January 10, 2012
I arrived in PAP on Tues. January 10 at 4 PM. Stayed overnight in a guest house in Port.
Wednesday, January 11, 2012
I left PAP at 7:30 AM in a van I caught near Portail de Leogannes across from the soccer stadium in downtown PAP.
I arrived in Cayes four hours later and went directly to the new Natcom store and swapped out my Sprint BlackBerry SIM card for an Natcom SIM card. After trying with the new Natcom SIM card for hours, I could not get on the internet, but my BlackBerry does work like a dumb phone now so I can call and receive a call and a text when I am in Natcom country. But Natcom is not working here in Pestel. So I cannot use my BlackBerry with the natcom SIM card. Digicel is working. Natcom did work in the mountains just south of Pestel…but spottily.
I would advise anyone coming to this part of Haiti to buy an unlocked latest generation iPhone from Apple and put a Haitian provider SIM card in it. It will work much of the time with a local provider. Wish I had had the time to do that prior to this trip.
Communication is very important in rural Haiti during this cholera epidemic. In the 80′s and 90′s all we had was Teleco here to make a call. But cell phones, ideally smart phones, if they work are so important right now during this epidemic. By the way the Haitian dumb phones (Nokia) works well here in Pestel with Digicel.
On Wednesday night, I stayed in Cayes at Cite Lumiere and made plans to leave for Pestel the next day.
——-
Thursday, January 12, 2012—
I left Cayes for Pestel after seeing a 30 year old tetrology of Fallot patient of mine who I have been following in Haiti for 12 years. Mona needs heart surgery…pulse ox is 87 and I have her echo video if anyone is interested operating her.
The trip towards Pestel was beautiful but dangerous. We went on the new road to Camp-Perin and then on up the mountains to Duchity. I saw quite a few Caterpillar graders and tractors, but did not see any one using them.
Their was hardly any traffic. The road is one lane much of the time, and the side of the mountain goes straight down. We had to put the Land Rover in reverse at times as a big truck or bus came towards us. The big guy is always going to win in these situations. We literally had inches on the right side where the mountain went down.
We passed over Riviere Glace (Ice River) and the water looked pretty good to me.
After Duchity we seemed to be coursing down some through the mountains and slowly inched our way north to Pestel.
I got a call from Judy at this point and she asked me to call a team called DIRT. I called the number and spoke with John, leader of the DIRT team. John had spoken with my wife Maria in Illinois and Maria explained to John how to get hold of me. John said they had supplies for cholera treatment units and that they were in PAP and that they would come right away with the supplies. They had eight on their team. I told him that I would call him back when I knew more.
I called our team leader Miriam and she said they were in JoliGilbert high in the mountains above Pestel. Believe it or not, I was right in front of the local pastors house when I called her and she and her team of seven were standing off to the side of the road near the house. What good luck! It was the first time we had met. Introductions took about two minutes. It was great to be wherever I was.
Squatted down in front of me was man of about sixty with one day history of vomiting and diarrhea..he had his wife with him. He was very weak. And there was a father cradling his two year old little boy with the same history as the old man. also appearing weak with vomiting and diarrhea.
So we loaded both of them up in our vehicles and headed for Desvereaux about 15 minutes down the road.
There was a tent set up and all we had was 12 liters of normal saline in quarter liter bags. This was not ideal but it we had to go with it. We had 22 gauge needles and IV tubing so we put two 22s in the old man and one in the baby and started IV rehydration on both. The old man could go through the entire 12 liters himself in the next 24 hours…we were doing the best we could and both patients could still drink and we did have ORS packets.
While we were starting the IV’s we hired a Haitian nurse on site and dickered with her about her salary. We offered her three and one half times the salary of MSPP nurses I had worked with in the past and she asked for more anyway. This Haitian nurse had recently worked in Beaumont, about 1.5 hours south of Desveraux, and treated hundreds of cholera patients. She needed a job and we needed her.
After these two patients were stabilized we unpacked our supplies in the adjacent depot.
A large hole had been dug in the back of the cholera tent area to dump all garbage and human waste from the cholera tent. The hole looked to be about 10 feet long and 5 feet wide and about 10 feet deep. The soil appeared to be largely red clay.
An older lady got my attention and said that she lives just down the hill from where the hole is dug and she asked me when it rains is it going to be safe for her husband and her to live in her house which is made of the red clay and rocks. (No cement because it is too expensive.) She was bringing up good point so the hole will be covered and another hole dug further away…we need help here from experts.
We headed to Perla, another “locality” in the Pestel area at this point. We slowly coursed through downtown Desvereaux with the market women on the sides of the street scurrying to move their tables.
The road to Perla was the worst road I have ever been on in Haiti. It was more like a wide path with leaves of trees and bushes poking in the windows as we went by. Many rocks and holes were in the path and we could only go a couple of miles per hour.
We passed a little house with many kids and an older lady waving at us from the front yard. Rumor had it that there were four cholera deaths recently from that house alone. So I jumped out of our vehicle and talked to the lady who appeared to be in charge. She told me that in the last couple of months she had lost two of her children, a two and one half year old and a five year old, as well as her brother and her mother to vomiting and diarrhea. I assume this was cholera.
About 30 minutes later we arrived in a community of Perla. Clean water and fortified rice was passed out and we met with some local leaders who had numbers of cholera cases and deaths, and the names of springs that fed the area of Perla and the mountain village in the distance called Pavion. And Pavion has six smaller villages with about seven springs. (This could get confusing if we are not careful.)
After Perla, we headed back down the horrible path and back to JoliGilbert…about an hour trip. We rested for a few minutes, ate supper outside under a tarp while holding our flashlights on our plates of food. We then loaded back in the car and headed for another mountain village called Tozia.
Tozia was about 45 minutes away on another horrid road. We arrived in the little village of Tozia that had one working street light and all else was dark. We went to the building that was the local health center and found three patients inside being treated for cholera. The inside of the building was terribly depressing in the dark. A middle aged man was quite weak on one cot and so we put in an IV using flashlights and his wife held a small kerosene lamp. I kept pushing her hand away so the flame didn’t burn me as I inserted the IV. The man’s daughter lay in the corner on another cot and she seemed kind of sluggish but had a good radial pulse and was drinking without vomiting and so I did not put an IV in her. (An IV had been removed earlier in the day after her vomiting had slowed.)
The nurse at this CTC in Tozia explained to me she had been there for 13 months and had seen the place overflowing with cholera patients. The other nurse who worked there recently fell and has a large intrarticular hematoma of her knee and is unable to work now. So Tozia has one very overworked nurse. She also explained to me that they receive patients from all over the Pestel area. And that people carry their family members for hours on their shoulders on a wooden door or stretcher of some sort to get to Tozia.
We left Tozia and crept slowly down the road again back to JoliGilbert and crashed for the night. The air was cool and damp but lying supine felt pretty good.
Miriam had contacted the DIRT team and told them that we needed any supplies they could bring us. needed. They left PAP at 5 PM and were headed our direction…about an 8-10 trip in the dark.
George, one of Miriam’s team, volunteered to lie on his cot all night long on the side of the dirt road outside of our sleeping quarters at the Pastor’s house. At 4 AM when he heard vehicles approaching, George got up and flagged down the three DIRT vehicles with their very tired paramedics, nurses, and an anthropologist piled out. He got them some of our left over food from supper and they went to sleep for a few hours.
———–
Friday–January 13, 2012:
I got up about 6 AM and took some photos of our camp as the sun was coming up. The red clay mud was slippery but I promised myself to be careful. However, I wasn’t careful enough and slipped going down a slippery embankment. As I was going down on my back, all I could think about was protecting my camera in my left hand. I lifted my left hand high but fell hard and my camera came jamming down beside me in the wet clay. I was really,really mad. The bottom of the SLR camera was caked with red clay which started to harden almost immediately. So for the next 45 minutes I was gently scraping off the clay from my camera bottom, hinges, and screen. The lens was not damaged.
I had red mud all over me and my scrubs. So I washed off with a bucket shower and got red clay in my bucket of water which I was slopping all over me. Not so good..but the camera was ok.
We had breakfast and the DIRT team got up, introduced themselves, and Miriam called for a meeting of both of our teams so everyone would be on the same page.
DIRT had brought over 2000 liters of Lactated Ringers, IV tubing and set ups, antibiotics, plus many more supplies. We had no LR before they arrived. Fabulous.
So we all headed back down the road to Desvereaux to visit our patients in the cholera tent. Two new patients had been added to this tent to make a total of four now. All their IV’s were either out or infiltrated.
The tent was a disaster. One new middle aged man’s IV was disconnected, and he told me he was “pa bon net” (not good at all). He had got sick the night before with vomiting and diarrhea and could barely move he had lost so much fluid. So I put two 18 gauge angio caths in him and we hung the new RL and blasted him with fluid. A new four year old also got a 22 gauge and I put the rate at slower than usual because he was drinking and alert and he looked like he had some kwashiorkor and I didn’t want to be to cavalier with his fluids because I thought he could third space alot.
The Haitian nurse we hired for this tent the day before was gone and before she left she had turned over responsibility of the tent to an auxillary nurse. She may have been there, but during the havoc to resuitate the patients I did not notice if this nurse was on site.
After another cruel trip to Perla we all headed down the mountain to Pestel.
Pestel is the largest village in the area with about 4,000 people. It is located on the ocean. It took about 75 minutes to slowly course down the mountain roads so we didn’t go over the edge.
The general hospital in Pestel has a CTC. The hospital is in total disrepair and filthy. There were only a couple of inpatients. I saw no employees at all in the hospital. This is the only hospital in the Pestel area (including the mountain villages where whe had just come from) for 80,000 people.
The Pestel hospital has four nurses assigned to the CTC but none were present because none have been paid by the Haitian government in four months. The CTC in Pestel at the hosptial had four patients…a young father and his two sons ages six years and three years…both were naked and covered with flies on the cholera tents. Another 5 year old child and an old man were the remaining patients. And all of these patients had come from Desvereaux during the last three days. The old man had come by motorcycle.
Dr. Phillipe is the head doctor in the this part of the peninsula. His responsibilty includes everything east of Jeremie to Pestel. This is a huge swathe of land with tens of thousands of people. We met with Dr. Phillipe and he outlined the population section by section as well as the number of cases of cholera and deaths from cholera during the last few months. (Miriam has the info and will publish it when she can.)
When Dr. Phillipe was asked what he needed the most, he replied “money to pay my Cholera Treatment Center nurses”.
John A. Carroll, MD
www.haitianhearts.org
(PJ Star) - By John Carroll MD
This is my narrative of the last four days in rural Haiti.
I am going to try and not beat dead horses.
I am going to try and not be too cynical or too sarcastic or too snarky. And I will not point fingers at the UN, at the Haitian government, at international governments, at the gran mange in PAP, at the billions of NGO’s in Haiti, at the “where did all the pledged money go questions”, at church leaders or the voodoo priests, at the adacemicians, the “do gooder” blan doctors, or at Catholic nuns or the little church lady Protestant missionaries who spend 30 years of their lives here doing as much good as they possibly can do.
There is no time to criticize anyone right now.
Cholera is infecting and killing many Haitians as I post this from Pestel, Haiti this afternoon– January 14, 2012.
I feel very rushed to post this. My access to internet is almost absent. Electricity is never a guarantee.
My conclusions are probably not that complete, but I hope they are practical and they come from being on the ground here. And the good part of this post is that the conclusions and comments are located at the beginning. So if you don’t want to read further you don’t have too.
After the conclusion and comments is a blow-by-blow account of the last four days in very rural rural Haiti describing the chaotic situation and trying to describe the nuts and bolts of the cholera epidemic here. (I will post first names only of the team members here with me.)
And I don’t have any statistics that I am willing to give right now. I have lots of numbers and a good idea, but the numbers will be published by Miriam, our team leader, so we can give the most accurate information possible. It is not good to over estimate or under estimate cholera statistics.
My big thanks to Maria and Luke, Tommie and Diane, Ed and Mary, Jeffrey, Miriam, Judy, Shane, Mike and Kathy and Jim and Stephanie and Leslie and many others, and Madame Jacques for all of their support and help in every way. And thank you DIRT for showing up with all your supplies, hands, and hearts.
Conclusions and Comments:
There is still much cholera in rural Haiti. And people are dying in rural Haiti of cholera. And they shouldn’t have to.
The roads in Haiti and the communication in Haiti is bad. A poor person may have a phone but that does not mean he has money in the phone or the phone has a charge because electricity is hard to find much of the time. And Digicel works some places and Natcom works some places… but not all the time. Good communication is a must to beat cholera.
Cholera needs to be managed locally in rural Haiti. Local leaders need to take this responsibility themselves. The trickle down effect is not working except the stuff that trickles down will make you very ill. Community education needs to be done by local leaders. Aquatabs, Chlorox, etc needs to be passed out to every house by community people.
Nurses, community health workers, and CERT need to be done locally. These people all need to be paid fairly. And the nurses staffing Cholera Treatment Centers need good housing and somone to help prepare their food and do their laundary so they can take care of sick patients in the tents. The Haitian nurses need to have the patient’s survival at the top of their list rather than their own survival in this very difficult environment.
Cases of cholera or suspected cholera need to followed to the house in the village and then to the water source. Each water source needs to be tested. If cholera is found, water engineers need to intervene.
CTU and CTC need to be placed in strategic easy to find locations in the mountains so people don’t have to travel such long distances to receive care when their small intestines are attacked by cholera toxin and they are losing their body fluids and their lives.
The supply chain of cholera material has to be never ending and appropriate for the size of the tent and the patient census. No rationing of life saving IV Ringer’s Lactate or ORS should have to happen. If a patient needs 5 liters of LR in three hours, he/she should get it.
Our experts are telling us that there will be a fourth, fifth, and sixth wave of cholera in Haiti, starting in March/April of this year. And we better believe them.
From what I have seen during the last few days, rural Haiti will not do well with the new up coming outbreaks unless local changes are made immediately.
And each time there is a cholera death in Haiti, we should all take it personally. It is our responsibility to stop this epidemic because we are all part of the human race. It is not the poor Haitian’s fault when he gets cholera. I have heard the poor Haitians being blamed for getting cholera. We need to understand they have no clean water to wash their hands properly. I can tell you they don’t enjoy having cholera. And how many well to do Haitians or well to do NGO people do you know who have died from cholera in Haiti?
———–
Tuesday, January 10, 2012
I arrived in PAP on Tues. January 10 at 4 PM. Stayed overnight in a guest house in Port.
Wednesday, January 11, 2012
I left PAP at 7:30 AM in a van I caught near Portail de Leogannes across from the soccer stadium in downtown PAP.
I arrived in Cayes four hours later and went directly to the new Natcom store and swapped out my Sprint BlackBerry SIM card for an Natcom SIM card. After trying with the new Natcom SIM card for hours, I could not get on the internet, but my BlackBerry does work like a dumb phone now so I can call and receive a call and a text when I am in Natcom country. But Natcom is not working here in Pestel. So I cannot use my BlackBerry with the natcom SIM card. Digicel is working. Natcom did work in the mountains just south of Pestel…but spottily.
I would advise anyone coming to this part of Haiti to buy an unlocked latest generation iPhone from Apple and put a Haitian provider SIM card in it. It will work much of the time with a local provider. Wish I had had the time to do that prior to this trip.
Communication is very important in rural Haiti during this cholera epidemic. In the 80′s and 90′s all we had was Teleco here to make a call. But cell phones, ideally smart phones, if they work are so important right now during this epidemic. By the way the Haitian dumb phones (Nokia) works well here in Pestel with Digicel.
On Wednesday night, I stayed in Cayes at Cite Lumiere and made plans to leave for Pestel the next day.
——-
Thursday, January 12, 2012—
I left Cayes for Pestel after seeing a 30 year old tetrology of Fallot patient of mine who I have been following in Haiti for 12 years. Mona needs heart surgery…pulse ox is 87 and I have her echo video if anyone is interested operating her.
The trip towards Pestel was beautiful but dangerous. We went on the new road to Camp-Perin and then on up the mountains to Duchity. I saw quite a few Caterpillar graders and tractors, but did not see any one using them.
Their was hardly any traffic. The road is one lane much of the time, and the side of the mountain goes straight down. We had to put the Land Rover in reverse at times as a big truck or bus came towards us. The big guy is always going to win in these situations. We literally had inches on the right side where the mountain went down.
We passed over Riviere Glace (Ice River) and the water looked pretty good to me.
After Duchity we seemed to be coursing down some through the mountains and slowly inched our way north to Pestel.
I got a call from Judy at this point and she asked me to call a team called DIRT. I called the number and spoke with John, leader of the DIRT team. John had spoken with my wife Maria in Illinois and Maria explained to John how to get hold of me. John said they had supplies for cholera treatment units and that they were in PAP and that they would come right away with the supplies. They had eight on their team. I told him that I would call him back when I knew more.
I called our team leader Miriam and she said they were in JoliGilbert high in the mountains above Pestel. Believe it or not, I was right in front of the local pastors house when I called her and she and her team of seven were standing off to the side of the road near the house. What good luck! It was the first time we had met. Introductions took about two minutes. It was great to be wherever I was.
Squatted down in front of me was man of about sixty with one day history of vomiting and diarrhea..he had his wife with him. He was very weak. And there was a father cradling his two year old little boy with the same history as the old man. also appearing weak with vomiting and diarrhea.
So we loaded both of them up in our vehicles and headed for Desvereaux about 15 minutes down the road.
There was a tent set up and all we had was 12 liters of normal saline in quarter liter bags. This was not ideal but it we had to go with it. We had 22 gauge needles and IV tubing so we put two 22s in the old man and one in the baby and started IV rehydration on both. The old man could go through the entire 12 liters himself in the next 24 hours…we were doing the best we could and both patients could still drink and we did have ORS packets.
While we were starting the IV’s we hired a Haitian nurse on site and dickered with her about her salary. We offered her three and one half times the salary of MSPP nurses I had worked with in the past and she asked for more anyway. This Haitian nurse had recently worked in Beaumont, about 1.5 hours south of Desveraux, and treated hundreds of cholera patients. She needed a job and we needed her.
After these two patients were stabilized we unpacked our supplies in the adjacent depot.
A large hole had been dug in the back of the cholera tent area to dump all garbage and human waste from the cholera tent. The hole looked to be about 10 feet long and 5 feet wide and about 10 feet deep. The soil appeared to be largely red clay.
An older lady got my attention and said that she lives just down the hill from where the hole is dug and she asked me when it rains is it going to be safe for her husband and her to live in her house which is made of the red clay and rocks. (No cement because it is too expensive.) She was bringing up good point so the hole will be covered and another hole dug further away…we need help here from experts.
We headed to Perla, another “locality” in the Pestel area at this point. We slowly coursed through downtown Desvereaux with the market women on the sides of the street scurrying to move their tables.
The road to Perla was the worst road I have ever been on in Haiti. It was more like a wide path with leaves of trees and bushes poking in the windows as we went by. Many rocks and holes were in the path and we could only go a couple of miles per hour.
We passed a little house with many kids and an older lady waving at us from the front yard. Rumor had it that there were four cholera deaths recently from that house alone. So I jumped out of our vehicle and talked to the lady who appeared to be in charge. She told me that in the last couple of months she had lost two of her children, a two and one half year old and a five year old, as well as her brother and her mother to vomiting and diarrhea. I assume this was cholera.
About 30 minutes later we arrived in a community of Perla. Clean water and fortified rice was passed out and we met with some local leaders who had numbers of cholera cases and deaths, and the names of springs that fed the area of Perla and the mountain village in the distance called Pavion. And Pavion has six smaller villages with about seven springs. (This could get confusing if we are not careful.)
After Perla, we headed back down the horrible path and back to JoliGilbert…about an hour trip. We rested for a few minutes, ate supper outside under a tarp while holding our flashlights on our plates of food. We then loaded back in the car and headed for another mountain village called Tozia.
Tozia was about 45 minutes away on another horrid road. We arrived in the little village of Tozia that had one working street light and all else was dark. We went to the building that was the local health center and found three patients inside being treated for cholera. The inside of the building was terribly depressing in the dark. A middle aged man was quite weak on one cot and so we put in an IV using flashlights and his wife held a small kerosene lamp. I kept pushing her hand away so the flame didn’t burn me as I inserted the IV. The man’s daughter lay in the corner on another cot and she seemed kind of sluggish but had a good radial pulse and was drinking without vomiting and so I did not put an IV in her. (An IV had been removed earlier in the day after her vomiting had slowed.)
The nurse at this CTC in Tozia explained to me she had been there for 13 months and had seen the place overflowing with cholera patients. The other nurse who worked there recently fell and has a large intrarticular hematoma of her knee and is unable to work now. So Tozia has one very overworked nurse. She also explained to me that they receive patients from all over the Pestel area. And that people carry their family members for hours on their shoulders on a wooden door or stretcher of some sort to get to Tozia.
We left Tozia and crept slowly down the road again back to JoliGilbert and crashed for the night. The air was cool and damp but lying supine felt pretty good.
Miriam had contacted the DIRT team and told them that we needed any supplies they could bring us. needed. They left PAP at 5 PM and were headed our direction…about an 8-10 trip in the dark.
George, one of Miriam’s team, volunteered to lie on his cot all night long on the side of the dirt road outside of our sleeping quarters at the Pastor’s house. At 4 AM when he heard vehicles approaching, George got up and flagged down the three DIRT vehicles with their very tired paramedics, nurses, and an anthropologist piled out. He got them some of our left over food from supper and they went to sleep for a few hours.
———–
Friday–January 13, 2012:
I got up about 6 AM and took some photos of our camp as the sun was coming up. The red clay mud was slippery but I promised myself to be careful. However, I wasn’t careful enough and slipped going down a slippery embankment. As I was going down on my back, all I could think about was protecting my camera in my left hand. I lifted my left hand high but fell hard and my camera came jamming down beside me in the wet clay. I was really,really mad. The bottom of the SLR camera was caked with red clay which started to harden almost immediately. So for the next 45 minutes I was gently scraping off the clay from my camera bottom, hinges, and screen. The lens was not damaged.
I had red mud all over me and my scrubs. So I washed off with a bucket shower and got red clay in my bucket of water which I was slopping all over me. Not so good..but the camera was ok.
We had breakfast and the DIRT team got up, introduced themselves, and Miriam called for a meeting of both of our teams so everyone would be on the same page.
DIRT had brought over 2000 liters of Lactated Ringers, IV tubing and set ups, antibiotics, plus many more supplies. We had no LR before they arrived. Fabulous.
So we all headed back down the road to Desvereaux to visit our patients in the cholera tent. Two new patients had been added to this tent to make a total of four now. All their IV’s were either out or infiltrated.
The tent was a disaster. One new middle aged man’s IV was disconnected, and he told me he was “pa bon net” (not good at all). He had got sick the night before with vomiting and diarrhea and could barely move he had lost so much fluid. So I put two 18 gauge angio caths in him and we hung the new RL and blasted him with fluid. A new four year old also got a 22 gauge and I put the rate at slower than usual because he was drinking and alert and he looked like he had some kwashiorkor and I didn’t want to be to cavalier with his fluids because I thought he could third space alot.
The Haitian nurse we hired for this tent the day before was gone and before she left she had turned over responsibility of the tent to an auxillary nurse. She may have been there, but during the havoc to resuitate the patients I did not notice if this nurse was on site.
After another cruel trip to Perla we all headed down the mountain to Pestel.
Pestel is the largest village in the area with about 4,000 people. It is located on the ocean. It took about 75 minutes to slowly course down the mountain roads so we didn’t go over the edge.
The general hospital in Pestel has a CTC. The hospital is in total disrepair and filthy. There were only a couple of inpatients. I saw no employees at all in the hospital. This is the only hospital in the Pestel area (including the mountain villages where whe had just come from) for 80,000 people.
The Pestel hospital has four nurses assigned to the CTC but none were present because none have been paid by the Haitian government in four months. The CTC in Pestel at the hosptial had four patients…a young father and his two sons ages six years and three years…both were naked and covered with flies on the cholera tents. Another 5 year old child and an old man were the remaining patients. And all of these patients had come from Desvereaux during the last three days. The old man had come by motorcycle.
Dr. Phillipe is the head doctor in the this part of the peninsula. His responsibilty includes everything east of Jeremie to Pestel. This is a huge swathe of land with tens of thousands of people. We met with Dr. Phillipe and he outlined the population section by section as well as the number of cases of cholera and deaths from cholera during the last few months. (Miriam has the info and will publish it when she can.)
When Dr. Phillipe was asked what he needed the most, he replied “money to pay my Cholera Treatment Center nurses”.
John A. Carroll, MD
www.haitianhearts.org
Subscribe to:
Posts (Atom)