Cholera

Even in more peaceful times, Haiti's patchwork system of governmental, charity, and private sector health care facilities were insufficient to meet the needs of the population.  Conflict with and between gangs has caused the situation to deteriorate further with over 30 private and public health care facilities having been vandalised or forced to close.  Those still open often lack staff, stocks, and security.  Haiti has only enough vaccines to last until the end of the month, health care facilities throughout the country struggle to have pharmaceuticals delivered through largely gang-controlled Port-au-Prince, and cholera is spreading on top of increasing food insecurity and malnutrition.  At this point, the situation is so difficult that re-establishing security would in and of itself be a health intervention.  The full article by Jacqueline Charles of the Miami Herald is linked and follows. 

With gangs operating in almost total impunity throughout Port-au-Prince, catastrophic levels of hunger in some areas, and a growing cholera epidemic, the United States has decided to back a multinational rapid reaction force to Haiti.  This will not be a UN peacekeeping force and the USA is expected to play a major role in its operations.  At the same time, the USA has deployed a USAID Disaster Assessment Response Team (DART) and is expected to ramp up its humanitarian support.  The current situation is untenable and hopefully the multi-national force can help stabilise Haiti somewhat. The full article by MIchael Wilner and Jacqueline Charles in the Miami Herald follows. 

The World Bank recently pledged $50 million for water and sanitation programs in Haiti.  The funding will cover all clinics and schools in rural areas that are considered hot-spots for cholera.  Haiti is one of a small number of countries in which sanitation deteriorated over the last twenty-five years. Investing in water and sanitation is essential for promoting public health.  More information follows:

According to Trenton Daniel and Martha Mendoza, a ten year $2.2 billion dollar plan to eliminate cholera in Haiti and the Dominican Republic will be released shortly.  The plan will be government-led with support from the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF) and the WHO/Pan American Health Organization (PAHO).  It is yet to be determined who will fund the plan and to what extent although the World Bank has indicated it will contribute.  Although it will take years, eliminating cholera is neccesary both for protecting public health and promoting investment. 

Water, Sanitation, and Hygiene (WASH) conditions in Port-au-Prince were not good even before the devastating January 2010 earthquake.  Perversely, the poor often paid the most for drinking water.  Against this backdrop, a number of international organizations and non-governmental organizations are working with the Haitian government to help establish a more effective and equitable water system.  One of these non governmental organizations, International Action, has been involved with water related issues in Haiti since 2006.  Below is an update as to their latest activities.

On Wednesday, January 12th, the American Medical Association, the National Institutes of Health, the National Disaster Life Support Foundation Inc. and Disaster Medicine and Public Health Preparedness will host a free webinar on the current status of public health and health care in Haiti, including the ongoing cholera response.  More information follows.  You can register for the event by clicking here. 

Haiti is in the midst of a cholera outbreak, the origin of which is and may remain unclear.  We live in a mobile world and the source could be Africa, Asia, South America, or it may have already been in the environment.  Where it came from is less important than the fact that Haiti, and especially the poorest of the poor, will always be vulnerable without clean water, adequate sanitation, and good hygiene.  This is an update on the current cholera emergency and a reflection on actions that can prevent this from happening again.