| Cholera in Haiti: From control to elimination | |||||
Two years after a massive earthquake and subsequent cholera outbreak, Haitians are trying to improve public health.
Meera Dalal
Last Modified: 13 Jan 2012 11:12
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In an effort to eliminate the water borne disease, officials from the Pan American Health Organisation (PAHO), UNICEF and the US Centers for Disease Control and Prevention (CDC) announced a partnership with the governments of Haiti and the Dominican Republic on Wednesday, to try and improve sanitation and access to drinking water in the Western Hemisphere’s poorest country. The goal is to extend proper sanitation facilities to at least two-thirds of the Haitian population by 2015, a daunting task which could cost $1.1bn. “Of course we need to control [the epidemic], of course we need to reduce the mortality,” said Dr Mirta Roses, Director of PAHO, in her opening address at the international press conference in Washington, DC. “The call of action is for a cholera-free Hispaniola [the island containing Haiti and the Dominican Republic], which means not just prevention and control, but elimination.” The cholera epidemic began in October 2010, ten months after the earthquake, causing at least 7,001 deaths and making more than half a million seriously ill. The disease spread like wildfire; the CDC calls it one of the largest cholera epidemics to affect a single region in modern history. Cholera is a water-borne gastrointestinal illness caused by the bacteria Vibrio cholerae. Patients experience uncontrollable diarrhea, rapidly leading to severe dehydration, electrolyte imbalances and sometimes death. Cholera can be easily treated with proper hydration and antibiotics. Even still, the latest figures from the World Health Organisation (WHO) show three to five million cases worldwide with 100,000-120,000 cholera-related deaths each year. Poverty and infrastructure “Cholera is a disease that defines poverty; it has done so historically and continues to do so today,” said Dr Sanjay Wijesekera, Chief of Water and Sanitation at UNICEF. “In [some] rural areas, 99 per cent of people practice open defecation. This has huge public health implications.”
“There is no effective public water system in Haiti,” said Dr Louise Ivers, Chief of Mission for Partners in Health, a Boston based non-profit organisation, living in Haiti. “The river is the place where bathing, drinking and defecation all occur.” By contrast, 93 per cent of people living in the Dominican Republic have access to proper sanitation, which is comparable to the rest of Latin America and the Caribbean. Dr Kevin De Cock, Director of the Centre for Global Health at the CDC, agrees. "It comes as no surprise that when cholera was introduced, it turned into one of the largest cholera epidemics in history.” Origins of an epidemic Haiti had not seen cholera in almost a century; the strain that started the epidemic was originally isolated from Bangladesh, according to a recent report in the New England Journal of Medicine. The question of how this strain arrived in Haiti was the subject of a UN special report which concluded that the source of the epidemic was most likely a camp for UN peacekeepers from Nepal, whose human waste was dumped by independent contractors into an unsecured pit that was susceptible to flooding in heavy rainfall. Haitians, who had suspected as much, were understandably upset. The US-based Institute for Justice and Democracy has filed claims against the UN on behalf of some 5,000 cholera victims, demanding hundreds of millions of dollars in compensation. They argue that the UN mission in Haiti failed to screen peacekeepers for cholera and allowed untreated waste from the base to be dumped into the main river. When epidemiologists trace the spread of a disease, finding the first carrier, or the 'index case' is important. After numerous reports and speculation, a recent study published this week in the American Journal of Tropical Medicine and Hygiene uncovers what is believed to be the first case of Haiti’s cholera epidemic. Researchers believe the first man to contract the disease was a 28-year-old from the rural town of Mirebalais, with a history of untreated psychiatric disease. Blaming this particular individual, however, misses the structural problem of contaminated water. “If it wasn’t him, it would have been someone else,” Ivers told Al Jazeera. “The problem of exposure through the river still would have been there.”
After the outbreak began in Haiti, cases of cholera were reported as far as Miami and Boston. “One of the key learning points is that the interconnectedness of both rich and poor countries can lead to a global spread,” Ivers told Al Jazeera. In another recent paper, researchers were able to track the spread of the disease through social media. News of the cholera outbreak hit Twitter and Facebook two weeks before traditional data was available to Haiti’s Ministry of Health, according to this week's piece in the American Journal of Tropical Medicine and Hygiene. “We used global data from people with relatives in Haiti, friends, aid workers, even celebrities who visited,” Dr Rumi Chunara, the study’s lead researcher, told Al Jaeera. “This method has a lot of potential for places where the infrastructure has been disrupted, like post-disaster areas.” Relief efforts In the wake of the epidemic, countless governmental organisations, charities, medical relief groups and individual practitioners rallied to the country. Souad Lakhdim has been the PAHO Regional Manager in Haiti since the earthquake. “Our strategy [for cholera] had two objectives. One was to save lives, the other, to prevent the spread of disease,” she said. For the first, numerous Cholera Treatment Centers or CTCs were set up around the country, and local medical staff were trained in cholera treatment guidelines. Additionally, oral rehydration centers were set up in smaller communities for patients who did not necessarily require intensive medical care. To prevent the spread, health promotion initiatives were launched in the form of door-to-door programmes teaching proper personal hygiene, hand washing and defecation practices. Aid groups taught water chlorination and supplied chlorine tabs as well as attempted to secure clean water. After the interventions, mortality decreased from 10 per cent of cholera victims at the start of the epidemic to a stable rate of less than one per cent from January 2011 onwards. Steps forward
As foreign aid groups pull out of Haiti from December 2011 onwards, the Ministry of Health has plans to incorporate the cholera relief effort into the country’s existing health care system. In the long term, however, elimination will require major structural changes. Building an infrastructure to fulfill the goals of the Call to Action will require $1.1bn, and a lot of patience. Based on similar cholera outbreaks in Africa and more recently in Central America after Hurricane Mitch, experts expect it will take around 10 years to fully control the disease. In the meantime, Wijasekera said that many short term solutions are available. “Simple behavioral changes, such as washing hands at critical times, can have a huge impact. Low cost, huge impact. Of course, meant to be in conjunction with long term infrastructure changes, but these are immediate, inexpensive things we can do.” In what could be a sign of brighter days to come, Haitian kids recently set a Guinness World Record for hand washing after 7000 school children soaped-up for National Hand-Washing Day. Michel Martelly, Haiti's President, encouraged the international community to get involved during Wednesday’s international call to action. “Decades of neglect and the failure to invest have led to many illnesses associated with the consumption of contaminated water, lack... of good hygiene, and poor excreta management,” he said. “More than ever before, now is the time to address these deficiencies.” Follow Meera Dalal on twitter @MeeraDalal Source URL: http://www.aljazeera.com/indepth/features/2012/01/2012111193155842439.html It seems like everyone has forgotten what happened only 2 years ago to Haiti. A 7.0 magnitude earthquake rocked Haiti and killed thousands in an instant and more as the days followed and bodies were discovered through the rubble. Africa was hit with another crisis...but wait, Haiti isn't in Africa, but we thought it was, right? Because a bunch of impoverished black people facing a catastrophe can only happen in Africa, that's where it always happens, so far far away from us. This one is different though, this one is on our side of the world, much closer than we may have thought. With the stuggles of living in a modern rat-race chasing the material world we often forget those who are actually in a stuggle. This is just one of many examples... This article illustrates that even while engaging in rescue missions and humanitarian efforts we must be very careful in how we deal with issues such as refugee camps and waste management. Although our efforts are in the right place, we must be very careful in the actions we take. This article highlights how humanitarian efforts can go wrong when proper protocol is not made or followed when dealing with human waste, and how the improper procedure can create a snow-ball effect with massive repercussions. This crisis seems to be at the beginning stages since Haiti has not had a case of cholera for almost 100 years. They are not prepared to deal with disease control, let alone a disease that has been missing from the landscape for almost a century. With the disease claiming over 7000 lives and making more 500,000 seriously ill, Cholera is just starting its initiation period. "Haiti continues to see 200 new cases of Cholera a day. This is expected to increase to 1000 cases per day in April 2012, when the rainy season begins." -Dalal. Although the disease is spreading like wildfire throughout the country a great partnership has emerged to tackle the issue - Pan American Health Organization, UNICEF, and US Center for Disease Control and Prevention. Together, they have announced an effort to try and improve sanitation and access to drinking water in the Western Hemisphere's poorest country. The goal of this partnership is to extend proper sanitation facilities to 66% of the population by 2015. This will cost around 1.1 billion dollars. This system has been implemented in African nations with similar cholera outbreaks and is believed to take upto 10 years to properly control this outbreak in Haiti. The country itself is not prepared for something like this, after all its been around a century since cholera was last seen, who would be prepared... The cholera crisis in Haiti triggers me to react to two different crisis at different levels. The first crisis is detailed in the article - a cholera outbreak 10 months after the earthquake claiming thousands of lives and infecting many more, with incidence rates rising. The other crisis is more subtle, the fact that only two years of a massive earthquake hit Haiti we barely remember where Haiti is. The only way we can inform people is by telling them "the country besides Dominican Republic" because they may have gone there on a vacation. The fact is, just like we always do, we have normalized something that is not so normal. Iraq, Afghanistan, Libya, Egypt, Syria, Somalia, Nigeria, Sierra Leone, Sudan, Pakistan, and Mexico are just some of the countries where people die "natually" in unnatural (to us) ways. We have normalized crisis in these countries because "it happens so often anyways" or "we just don't care" - and that in itself is a crisis. My advice to those involved would be to work towards improvement in sanitation standards of the country. Another advice would be for the foreign NGO's to get local people part of the process design and implementation. Nationals of Haiti needs to be involved in the structure and design of their own country. They need to feel a belonging to their community and country. By building relations we create a source of love and personal pride and belonging that makes living in a chaotic world easier. Susan Lieberman |
Saturday, 14 January 2012
Haiti: one country, two crisis
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