the scoop on cholera in the grand’anse
On October 21st, the Ministry of Public Health confirmed the first case of cholera in St. Marc, 100 miles northeast of Jérémie. Only one week later, all of our Health Agents (44 of them), facilitators, nurses, regional supervisors, and staff met to discuss the possibility (or inevitability) of transmission to the Grand’Anse, and the implications of such a public health emergency. A representative from the Ministry of Public Health in Jérémie gave a presentation, reviewing the definition of the disease, mode of transmission, symptoms, and implications of infection. The discussion then turned to the various ways of preventing and minimizing the spread of the disease. Hygiene is king!
I asked the health agent sitting next to me how he planned on passing health messages and educating the two zones for which he is responsible. It’s a large and mountainous area with around 4,500 residents, many of whom are not able to read. He explained that the day after the meeting he had two meetings with the Mother’s group and Father’s group in his villages’ church. The day after there would be a general community meeting, as well as a meeting with the youth group of the villages. He was planning community festivals at which they would sing public health songs, instructing community members on proper hygiene practices through popular songs. (Unlike education in schools, all of the public health education is in Creole). Aside from that, he said, “we look out for each other.”
During the meeting, community health agents were quick to stress the importance of a multi-sectorial approach to surveillance and cooperative approach to evacuations. They pointed out that whether a neighboring village was censused by the foundation or not made no difference. From a public health standpoint, we are all in the same epidemiological boat—an outbreak in a neighboring village will inevitably affect everyone around it for the worse. Health Agents were instructed to keep open lines of communication between all villages around their own, and to assist those villages if necessary. Each village had already created an evacuation committee and protocol, should a member of their community need emergency medical assistance.
I was really impressed with the rapidity of this organized effort at preventing the spread of cholera, especially when a lot of people didn’t know what it was at first. What is even more impressive is the long-term educational infrastructure that has been built continuously for more than 20 years. During that time Duvalier left, Aristide came and went, and Preval is now on his way out (not to mention Namphy, Manigat, Avril, Abraham, etc), but this institution has been a stable source of vital services and collaboration with Haitians when the government wasn’t. In that time, through thousands of trainings and educational initiatives, the infrastructure necessary to combat cholera has been built. Over 40,000 people have already been trained to mix Oral Rehydration Solution or to make it from ingredients in their own home. If epidemiological emergencies necessitate rapid communication, education, and prevention, then the people we work with are in real good shape. Within a week of the first rumors of cholera in the Artibonite, hundreds of thousands Haitians on the end of the peninsula were receiving life-saving information.
This isn’t to say that everyone has access to clean water, and that is another (much more political) topic for another day. Unfortunately it is the poorest folks living in the cramped urban areas with no latrines and open sewage that are going to be hit the hardest. This is one such neighborhood that I’ve been spending a lot of time in lately:
At this time, there have been 917 reported fatalities and over 14,600 cases. As pointed out by Praecipio International, however:
In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%. In many areas of Haiti, we are documenting outbreaks that are not being accounted for in the official statistics…If we assume the case counts are 1/4 the true community load, then we now have nearly 60k cases shedding pathogen into the environment. We believe the true statistic to be closer to more than 100k based on the degree of under-reporting. It is extremely difficult to estimate the true scale of this epidemic now. This is a grossly uncontrolled, uncontained epidemic of cholera that has exceeded public health capacity to investigate and assess every site reported and every sample received.
Looks like Haiti is, unfortunately, in it for the long haul.
