FOR IMMEDIATE RELEASE

November 17, 2010

CHOLERA OUTBREAK IN HAITI:  UPDATE

Maine-Based Konbit Sante Is Working to Prevent Spread of the Deadly Disease

On October 20, 2010 the first case of cholera was reported in the central part of Haiti, in a region known as the Central Plateau in the Artibonite Valley, and particularly in the coastal town of St. Mark.  The last reported case of cholera in Haiti prior to this time was in 1960, meaning that most of the current population has no built-up resistance to the disease.  

Cholera is transmitted through exposure to infected fecal material, usually through water or food that has been contaminated.  Haiti is particularly vulnerable to this kind of disease since few people in Haiti have access to clean drinking water and there are no public sanitation systems in the country.  Concerns about spread of the disease immediately focused on densely-populated Port-au-Prince where people left homeless by the January 12 earthquake live in very close quarters with poor sanitation and drainage. 

Although numbers are changing rapidly and some are difficult to verify because some people are dying at home, our best information is that on October 22, the disease was first reported in the northern part of the country where we work.  Six cases and two deaths were reported that day.  By November 13, according to government figures, there were 1392 cases and 99 deaths in the north.  In Cap-Haitien itself, there have been 492 cases and 34 deaths and these numbers are increasing every day.  Some officials expect this epidemic to last six months to one year and to infect as many as 200,000 people nationwide before the epidemic runs its course.  

People living in affected areas have been urged not to migrate to other parts of the country and to maintain good hygiene - hand washing, purifying water, properly disposing of sewage.  A challenging aspect of managing a cholera outbreak is that as many as three-quarters of people who are infected do not experience serious symptoms.  As fear is understandably running very strong in the hardest hit areas of Haiti right now, people are fleeing to other parts of the country, including many of these people who do not know that they are carriers of the disease.  The infection has thus been introduced to most of the poorest areas of the country.  Those who do become symptomatic generally do so within 2-5 hours of exposure.  The symptoms are severe diarrhea and vomiting, and the most severe cases can die within hours from extreme dehydration if they are not properly rehydrated quickly. 

Treatment of the disease is fairly straightforward and nursing intensive - oral rehydration with liquids like Gatorade in the early stages, if people can keep liquids down.  If people are vomiting, then liquids are delivered by IV.  Antibiotic treatment and immunizations have not proven to be effective in the setting of an outbreak.

Most cases in the north are coming to Cap-Haitien or nearby Limbe for treatment, and efforts are being made to isolate these patients to avoid spread of the disease.   Hundreds of people have been treated in a gymnasium in Cap-Haitien where earthquake victims were triaged in January and February.  Officials have done their best to provide water, sanitation, and electricity in this space, but it is suboptimal.  Neighbors are very disturbed that infected patients from the countryside are being brought into the heart of Cap-Haitien.  

There are problems getting people who are ill to facilities for treatment because of lack of transportation and lack of security at night.  Taxi drivers are afraid to have infected people in their vehicles. According to Dr. Youseline Telemaque, Konbit Sante’s OB/GYN in Haiti, there are increasing numbers of deaths at home in the impoverished communities we serve.

There is a problem properly managing the bodies of the victims who have died, which are highly contagious, and also with proper disposal of infected waste.  Normally private funeral homes and organizations remove bodies, but they are reluctant to touch the bodies for fear of infection.

During the last few weeks the regional government including the Ministry of Health and the Ministry of Planning, and NGOs including Oxfam, World Health Organization (WHO), UNICEF, Doctors Without Borders, Action Sanitaire, private clinics, and Konbit Sante have been working together to formulate a coordinated plan for treatment and education to stop the spread of the disease. 

Two weeks ago Konbit Sante began to mobilize resources to help provide needed supplies for the region.  Working with partners, Direct Relief International and Hope International, we have several 40 foot containers of critical supplies en route, the first one of which arrived last week.  Konbit Sante is purchasing a large order of chlorine water disinfection tablets (1.4 million tablets, each of which can treat 20 liters of water) and other supplies. 

We are in talks with Haiti Hospital Appeal (which supports a hospital on the outskirts of Cap-Haitien, close to some of the affected areas), MINUSTAH (United Nations Stabilization Mission in Haiti), UNICEF, Doctors Without Borders, as well as our own staff and Action Sanitaire about expanding both the treatment capacity in the area as well as prevention of new infections.  Dr. Israel Telemaque from Action Sanitaire (an organization of volunteer Haitian physicians and health workers that Konbit Sante helped establish in Cap-Haitien after the earthquake), has developed excellent connections all over the city with neighborhood leaders and is working with representatives from more than 45 areas.  He has an impressive cadre of volunteer Haitian clinicians who are highly motivated.  These people, along with our network of health workers, traditional birth attendants, and Oxfam community volunteers will provide a significant platform for community prevention work.

  

In terms of increasing treatment capacity, Konbit Sante will focus on the Haiti Hospital Appeal, a private hospital, and the gymnasium.  The Haiti Hospital Appeal is located on a large piece of property, and it may be possible to set up hospital tents on their grounds with the help of Doctors Without Borders.  We feel fortunate to be in a position to have a positive impact in this dire situation because of our long history working with the Ministry of Health and other partners in the region.

Now the news that you have probably seen this week which increases the degree of difficulty greatly.  Tuesday it was reported that protests broke out in Cap-Haitien and several other communities, fueled by fear and reports that the cholera strain is traced to the current outbreak in Nepal.  Many Nepalese U.N. peacekeepers are working in Haiti, including in Cap-Haitien.  Demonstrators have targeted the U.N. bases in Cap-Haitien, and there are substantiated reports of gunfire and deaths.  Burning tires in the streets have blocked travel in and out of the city, and the airport has been closed.  The police station was reported burned as well as a World Food Program storage depot.  Schools and banks were closed, and our staff reported gunfire near the office Monday afternoon.  A national general election is scheduled for November 28, and some say that this violence against the U.N. could be politically motivated.  This is unsubstantiated so far.  We are hoping this violence, whatever the motivation, will be short-lived as it is endangering lives and delaying the arrival of important resources to deal with the cholera epidemic.

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Since 2001, Konbit Sante staff and volunteers have worked in collaboration with the Haitian Ministry of Health and other partners to build local capacity in all aspects of the health system - from door-to-door community outreach programs, to strengthening community health centers, to improving care at the regional referral hospital.  In Haitian Creole, a konbit is a traditional Haitian method of working together to till your friends’ fields as well as your own - working together toward a common goal.  The word sante means health.   For more information about Konbit Sante-supported programs in community outreach and disease prevention, pediatrics, women’s health, procurement and management of medical equipment and supplies, improvement of water quality at the regional referral hospital and more, please visit www.healthyhaiti.org.

Working to Prevent Cholera at the Community Level

Update from Haiti

 

December 8, 2010

Dear Friends,

The outbreak of cholera has now raged for almost seven weeks in northern Haiti where Konbit Sante has been working for nine years.  Unlike the cataclysmic earthquake in January that grabbed international headlines, the cholera epidemic is taking one life at a time and continues to spread.  The situation is very grim. The first case of cholera was reported in northern Haiti on October 20, and within just five weeks, the government reported more than 6300 cases and 260 deaths in the North alone.  Actual numbers are believed to be higher because deaths at home are going unreported due to fear over the stigma associated with the disease.  The UN has recently estimated that there will be 650,000 cases country-wide before the epidemic is brought under control, and has called for international assistance.

 

Konbit Sante has been active since the beginning of the epidemic, working with the Ministry of Health and with other NGOs to treat the ill and to slow the spread of the disease among the vulnerable population in the hardest-hit communities.  Our Haitian and Maine-based staff helped to establish a treatment center in the center of the city that Doctors Without Borders has now expanded to more than 400 beds, and we have worked collaboratively with Doctors Without Borders and Haiti Hospital Appeal to set up an additional 200-bed treatment center on the outskirts of Cap-Haitien.  After the treatment centers were well-established, Konbit Sante's primary focus turned to prevention, education, and early intervention.

 

Cap-Haitien is a city of more than 300,000 people without municipal water and wastewater treatment.  Engineer Hugh Tozer, SVP at Woodard &

Proper hand washing technique to slow the spread of cholera is demonstrated at a community health meeting in Cap-Haitien

Curran, board president and head of Konbit Sante's infrastructure improvement team, joined me in Haiti on Friday last week to begin addressing the critical need for clean water in the poorest neighborhoods of Cap-Haitien.  While in Haiti, Hugh is evaluating water contamination levels and determining appropriate disinfectant doses of chlorine utilizing 1,200 Colilert water contamination testing kits, donated by Westbrook's IDEXX Laboratories.  In addition, he is training Konbit Sante-supported community health workers to test and treat water and will be collecting epidemiological data about water sources, waste disposal methods, and incidence of cholera in neighborhoods. 

 

Though cholera spreads easily and quickly, it is relatively uncomplicated to treat and prevent.  Widespread access to simple water disinfection options, clean water receptacles, soap, and education about how to use them can dramatically slow or stop the progression of this deadly disease.  Early diagnosis and immediate and sustained rehydration usually lead to full recovery.  International experience with cholera suggests an expected death rate of 1-2%.  However, with Haiti's poor public health situation, lack of accurate information, inadequate facilities, and lagging relief efforts, the death rate is currently three times the norm in such an epidemic. 

 

While primary efforts to date have been directed at treatment, we need the same level of effort to help people protect themselves from the disease in the first place.  To help people protect themselves, Konbit Sante is coordinating a massive grass roots, community-wide campaign that involves mobilizing many people and using all available media (radio, television, community meetings, illustrated literature, and megaphone trucks) to help get the word out.  Working with Oxfam GB, Haiti Hospital Appeal, UNICEF, and others, we are setting up 45 community cholera prevention and early intervention stations where water disinfection tablets, chlorine, water buckets, hand soap, and oral rehydration solution will be distributed.  This is critical to fighting cholera in the short term, but more sustainable neighborhood options -- which might take 6 -12 months and higher levels of funding to implement -- need to be considered.  So far, 55 new health workers have been trained to work in the most affected neighborhoods, and an additional 40 workers will be added in adjacent areas this week.  In the coming weeks the coverage area will expand even further, with the goal of covering the entire urban area with up to 100 posts.

 

Our efforts are only limited by the available resources, not our will.  Many of you have received our annual report in the mail and are aware that we are in the middle of our annual fundraising campaign - the one major effort each year to raise the funds needed to support our core programs in Haiti.  However, given the gravity of the cholera outreak and our unique capabilities in Cap Haitien's poorest and most vulnerable neighborhood and suburbs, this year we are asking donors to consider making an additional contribution which will go quickly and directly to support our cholera prevention work.  You have our great appreciation for your ongoing support as well as your support of this immediate lifesaving effort!

 

Sincerely,

 

Nathan M. Nickerson, RN, DrPH

Executive Director

About Konbit Sante

Since 2001, Konbit Sante staff and volunteers have worked in collaboration with the Haitian Ministry of Health and other partners to build local capacity in all aspects of the health system - from door-to-door community outreach programs, to strengthening community health centers, to improving care at the regional referral hospital.  In Haitian Creole, a konbit is a traditional Haitian method of working together to till your friends' fields as well as your own - working together toward a common goal.  The word sante means health.  For more information about Konbit Sante-supported programs in community outreach and disease prevention, pediatrics, women's health, procurement and management of medical equipment and supplies, improvement of water quality at the regional referral hospital and more, please visit www.healthyhaiti.org.

Konbit Sante is a 501(c)3 not-for-profit corporation organized in the State of Maine.