Recovery and Health Care in Haiti

By Bryan Schaaf on Sunday, August 15, 2010.

The credibility of any government is determined in large part by its capacity and willingness to provide basic services.  Health care can bring people together when there is equal access, or divide people when there is not.  Before and after the earthquake, quality health care in Haiti was/is primarily provided by non-governmental and international organizations (NGOs/IOs). The NGOs and IOs have been instrumental in keeping disease outbreaks at bay and access to health care for many residents in Port au Prince, at least for now, is better than it was before the earthquake.  While significant accomplishments, much more remains to be done before we can say that the health care system is truly being reconstructed. 

 

Even prior to the earthquake, the health care situation was poor (health statistics are available at the WHO and UNICEF websites.)  Health care services were provided by the private sector (for those who could afford it) or NGOs (for those who could not).  The Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population), or MSPP, has generally been regarded as one of the more accountable Ministries, but is short on resources and capacity.  Then and now, one would be hard pressed to find a government health care facility in Haiti that is consistently well-stocked, well-staffed, and well managed.  Many of the best hospitals in Haiti are run by non-governmental organizations.  These include the Partners in Health (PIH) facilities on the Central Plateau, the Albert Schweitzer Hospital in Deschapelles and the Comité de Bienfaisance (CBP) Hospital in Pignon.  Haitians along the border frequently access health care in the Dominican Republic.  In the days and weeks after the earthquake, Dominicans supported Haitian health care facilities and set up referral systems to treat the severely injured in Dominican hospitals.  Their solidarity saved many lives.

 

Many of the NGOs already present in Haiti, such as PIH and Project Medishare, expanded operations into Port au Prince in the days after the earthquake.  The International Federation of Red Cross and Red Crescent Societies (IFRC), of which the Haitian Red Cross is a part, ramped up operations with support from societies around the world including Canada, Chile, Colombia, Cuba, Finland, France, Germany, Iran, Israel, Japan, Mexico, Norway, Qatar, Republic of Korea, Spain, Sweden, Turkey, the United States and many others.  Emergency response is not without irony as the Iranian and Israeli tents were established across from each other.  Together, the Societies treated more than 135,000 people in the six months after the earthquake.  The American Red Cross has also been very active in the health sector.  It took the unusual step of providing direct budget support to pay the salaries of over 1,800 doctors, nurses, and other staff in the largest general hospital in Port au Prince, all of whom had been without pay since the earthquake.

 

When the Cluster Approach was called, the WHO/Pan American Health Organization (PAHO) and MSPP became responsible for coordinating health actors.  Many organizations that responded were new to both Haiti and the Cluster Approach which made coordination difficult.  The more experienced NGOs participated in the Health Cluster, shared information with its members, and tried to support the MSPP's mandate.  For example, The United Nations Childrens Fund (UNICEF), WHO/PAHO, and the U.S. Centers for Disease Control and Prevention (CDC) worked with the MSPP to develop a minimum package of health services for the camps and re-established disease surveillance systems.  The MSPP, WHO/PAHO, UNICEF, and the Haitian Red Cross jointly launched an emergency vaccination campaign that reached more than 150,000 people and was instrumental in preventing outbreaks of infectious diseases such as measles.  Many earthquake survivors have lost limbs.  The MSSP and partners are supporting seven orthopedic workshops for the fabrication of prosthesis.  Handicap International also established 12 satellite sites providing rehabilitation services and the Cuban Medical Brigade (La Brigada) is working with 20 hospitals to provide rehabilitation services as well.

 

Haiti does have a health related success it can build upon, being one of only a small number of countries to reverse its HIV/AIDS epidemic.  Political will, an engaged civil society, and generous support made possible through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) helped to make this possible.  Models for HIV/AIDS treatment in low resource settings developed in Haiti, have been replicated throughout the developing world.  Sadly, the earthquake disrupted the infrastructure for both HIV/AIDS and broader health services.  According to the Joint United Nations Program on HIV/AIDS (UNAIDS), the region around Port au Prince used to house 55 percent of national treatment sites, 49 percent of prevention of mother-to-child transmission sites, and 66 percent of newly diagnosed tuberculosis patients.  UNAIDS states the priorities for restoring HIV/AIDS prevention, treatment, and care services in Haiti are to: (1) Rebuild health systems; (2) protect displaced people from HIV, (3) rebuild the national network of people living with HIV, (4) support social protection measures; (5) revitalize HIV prevention programs; and (6) re-establish coordination mechanisms for the AIDS response, and (7) develop a comprehensive monitoring and evaluation mechanism.

 

What does it take to build a health care system? According to the WHO, all health systems have six basic building blocks:

 

1) Service Delivery: Effective provision of health interventions to people needing them, with a minimum waste of resources.

 

2) Health Workforce: Adequately trained and equipped health workers that provide fair and equitable access to needed services.       

 

3) Financing: Adequately funded health systems that ensure service delivery and protect systems from financial disaster.       

 

4) Medical Products and Technologies: Equitable access to safe, effective and affordable drugs, supplies, tools and other products.       

 

5) Health Information System: Production, analysis, dissemination, and use of reliable and timely information on health determinants, health systems and health status.       

 

6) Leadership and Governance: Institutes strategic, integrated policy frameworks; sets monitoring, regulative and accountability measures; and designs and coordinates coalitions and systems.

 

A strengthened MSPP is needed to produce coordinated, tangible, sustainable results in each of these six areas.  To be fair, the MSPP is trying, for example by asking NGOs to provide health care services through existing public or private health care facilities.  Shifting services from the camps to neighboring communities is a key step in moving from emergency response to development of systems.  Due to long-standing issues with efficiency and accountable, most NGOs have shied away from working with government health care facilities.  There are exceptions.  Konbit Sante, a small NGO in Cap Haitian, works closely with the Justinian Hospital, the largest public facility in the north, to build its physical infrastructure and the capacity of its staff.  In this way, Konbit Sante supports the MSPP instead of the other way around.  This sort of partnership, if replicated with in Port au Prince and elsewhere with NGOs and universities, could promote a transition from emergency response to sustainable development.  This will not happen overnight and transition is not just a question of resources.  It is also an issue of reform.  The MSPP can show leadership by devolving authority to governmental health care facilities in the provinces so they can better manage their own operations.  As is, public hospitals receive financial support from the central government infrequently which makes budgeting extremely difficult.  Hospitals in the provinces also require high-level clearance from Port au Prince to high and fire staff, which makes management a major challenge.  A high absenteeism is not uncommon given that staff know they are unlikely or unable to be fired unless authorities in Port au Prince signs off on it.

 

In the short to medium term, health services will continue to be delivered by NGOs, many of which are attempting to balance the challenge of meeting the needs of earthquake victims in Port au Prince and the greater south with victims of abject poverty in rural areas.  There are ways to accomplish both.  On July 3rd, PIH broke ground on a new teaching hospital in Mirebalais which is less than an hour outside of Port au Prince on a paved road. PIH anticipates that by January 12, 2011 the seven buildings of the main hospital campus will be constructed, and the work on the interiors can begin.  The hospital should begin accepting patients by the end of 2011.  The new hospital will have 320 beds and will integrate research, training, and service.  The Haitian Minister of Health has said, “What Haiti needs now are true partners to help us build back better by strengthening our country's public infrastructure.  The new teaching hospital at Mirebalais will be a model for our national health system, offering high-quality medical services, a place for our clinicians to study and train, and hope and dignity to all who will seek—and offer—care there."

 

Other governments are engaging the Haitian government on health issues.  The U.S. Centers for Disease Control and Prevention (CDC) is developing a long-term strategy for building the capacity of the MSPP.  Cuba has long provided staff and training to the MSPP and significantly ramped up their operations after the earthquake.  Brazil and the United Nations Development Program (UNDP) signed an agreement to strengthen tracking of infectious diseases.  These governments will accomplish more by developing joint plans and working together over the long term.  My concern is that as time goes on, and major disasters occur elsewhere, attention from other governments will fade.  Time to finalize those work-plans.

 

Public health also depends upon progress in other areas as well.  The health of women and children depends in part on developing a culture that values human rights and a government that enforces them.  Gender based violence was a serious human rights challenge prior to the earthquake, and it is remains one today.  Concerning reproductive health, the MSPP has a national policy for free obstetric care in public health facilities although emergency obstetric and newborn care are limited in terms of quality and availability.  The United Nations Population Fund (UNFPA) has been working with the MSPP and NGO/IO partners to support reproductive health services.  For example, UNFPA ordered and distributed 7 million male condoms in the earthquake-affected areas.  For more information on reproductive health in Haiti, take a look at a repor that the Women’s Refugee Commission released on that subject in May. Another issue central to public health is nutrition.  Malnutrition weakens the immune systems and cognitive development of children.  Water, Sanitation, and Hygiene (WASH) is also fundamental to protecting the health of children.  Issues to be addressed in future blogs.

 

What would it take to move Haiti's health system further from emergency response and closer to development?  Any sustainable strategy will require building the capacity of the MSPP.  It should be supported with secondments from partner governments and international organizations so that it can plan, prioritize, and organize the hundreds of organizations, public and private, providing health care services in Haiti.  A great many short term medical missions take place to Haiti each year, but they are more useful for training the foreign health care providers than for the delivery of services to Haitians.  Instead, The MSPP could develop formal programs to attract Haitian health care providers in the Diaspora, of which there are many, back to Haiti for months, years, or a career.  Health care providers from other countries in Latin America and the Caribbean may also be willing to participate. The MSPP should continue encouraging the NGOs to partner with fixed health care facilities, not just in Port au Prince but also throughout the country.  If the MSPP can commit to equipping and predictably financing government health care facilities, NGOs will be more likely to enter into long term partnerships where they help Haitians manage their own health care facilities.

 

Interested in learning more about health in Haiti?  Take a look at the Haiti Resource Finder to view over 1,300 health care facilities throughout Haiti.  There is also a google group for discussing the listings on the Haiti Resource Finder.   The Interaction Haiti Aid Map is another good resource you can use to search for organizations active in the health sector.  More information also avaliable at Relief Web and the One Response Haiti page.  Take a look at the websites of NGOs active in the health sectors such as the International Medical Corps, the International Rescue Committee, Partners in Health, Mercy Corps, and Interaction (an advocacy organization that represents U.S. based NGOs working on development and humanitarian assistance.)

 

Haitians deserve a better health care system.  The earthquake has provided an opportunity to think critically about how best this can be accomplished over the long term.  Please feel free to post your thoughts in the comments section below.

 

Bryan 

Examining Mental Health in Haiti (2/10/2014)

10/14/2014
Al Jazeera
By Cath Turner
.
Religion and culture seem to be the most persistent obstacle to better mental health services [AP]
The numbers associated with the Haiti earthquake in January 2010 are still hard to comprehend: more than two-million affected; 222,750 killed; 80,000 bodies missing; 188,383 houses destroyed or damaged; 1.5 million displaced. In the aftermath of that devastating event, the International Organisation for Migration (IOM) recognised the enormous emotional and psychological damage inflicted on millions of Haitians, and carried out an assessment of psychosocial needs. The staff interviewed 950 families in displacement camps over a four month period, from May to August of 2010.
.
Before the earthquake, there was no mental health system in the country. There was a great deal of social stigma surrounding mental health. "Psychologist" was a dirty word. Alwrich Pierre Louis from IOM explains: "When we discuss mental health with them, the person says, 'No, I don't have any kind of problem, maybe it's another thing. You think that I'm crazy but you're wrong." In the days and weeks and months after the earthquake, millions of Haitians were confronted with death, trauma, loss, grief, survivor guilt and fear. And for many, those still haven't gone away.
.
Hundreds of thousands of people are still living in tent cities, four years after the quake. The IOM study revealed anxiety and depression are compounded by concerns about overcrowding, lack of clean water and facilities, fear of sexual assault, gangs and a lack of police. IOM found thirty-two percent of those surveyed said they had experienced at least one of the three major distress indicators: panic attacks, serious withdrawal or suicide attempts.
.
On a scale of 1 to 5, with 5 being the maximum, 60 percent of those interviewed said their pain level was 5. When participants were asked to list their three main needs, more than 70 percent said housing, health was second, followed by work and security. So where can Haitians go for help? What mental health services are available? The short answer is, not many. IOM told Al Jazeera that mental health has never been a priority for the Haitian government and it still isn't. 15 percent of its budget is allocated to health; less than 5 percent of that is spent on mental health. This was painfully obvious when our crew visited a state-run mental health hospital in Port-au-Prince. According to Dr Louis Marc Jeanny Girard, the facility can only take in 112 patients, and more Haitian psychiatrists are needed across the board.
.
He says the most common conditions associated with the earthquake are agitation, delusional and bipolar disorders, epilepsy, schizophrenia and drug-related mental disorders. One of the most persistent obstacles to better mental health services is deeply entrenched in Haitian culture: religion. Alwrich from IOM explains "Maybe they don't have the capacity or inclination to go see a psychologist. So instead, they go to see a person of voodoo." But mental health professionals say they're committed to working with religious people because they have such large connections and influence in their communities. They are making inroads. IOM staff say it took a devastating earthquake to push mental health out into the open and now there's less stigma and more mental health support. But hundreds of thousands of people still aren't getting the help they need. There are growing pleas to the Haitian government to increase its investment in the mental health system and make it a priority. But no-one is sure if anyone is listening.

A New Dawn for One of Haiti's Notorious Slums

Miami Herald
BY JACQUELINE CHARLES
JCHARLES@MIAMIHERALD.COM
.
PORT-AU-PRINCE -- For years, the low-lying slum along the bay and the AIDS clinic across the street lived in separate worlds, a one-way relationship where the sick shuffled out but healthcare providers didn’t dare go in. Then Haiti’s massive Jan. 12, 2010 earthquake and subsequent cholera outbreak crumbled the barriers. “We didn’t ask for any of it,” Dr. Jean William Pape, founder of GHESKIO, Haiti’s leading HIV/AIDS clinic and research center, said about the disasters. “But now we got them. What are we going to do with them?” For all the devastation and death both catastrophes unleashed, they also stirred hope of a healthcare turnaround for the most destitute of Haiti’s poor. For the past year, a small army of community healthcare workers has quietly ventured beyond the clinic’s front gate to confront some of the stumbling blocks that have long made providing quality healthcare in the developing world challenging. On any given day inside Port-au-Prince’s slum-by-the-bay, T-shirt clad health workers and physicians can be seen handing out buckets of chlorinated water and other cholera treatment, supervising community clean-ups and stepping into humble homes to deliver primary care. The intense focus on Haiti’s slums come as an increasing number of Haitians leave tent cities for crowded ghettos, triggering fears of a deepening public health catastrophe in a country where people already contract tuberculosis at a higher rate than anywhere in the hemisphere — except for Peru — and many children never make it to their third birthday because of any number of illnesses, including 21 waterborne diseases. It also comes in a country with one of the hemisphere’s highest rates of HIV, the genesis for the founding of GHESKIO, the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections.
.
But the current mission has little to do with AIDS treatment. Rather, the focus is on improving the lives of the poor in a nation where clean water and sanitation are luxuries, and where the government is struggling to raise $2.2 billion to eradicate a cholera epidemic that has claimed 8,048 lives and sickened 650,218, according to Haiti’s Health Ministry. “When I look at old Paris, old Rome, those were all slums that they improved. So why can’t we improve these slums?” Pape said. “If you provide them with the tools, they’ll get there.” Twenty years ago, Pape could look out across a busy Harry Truman Boulevard and see the pristine blue ocean hugging Port-au-Prince’s bay. Today, the ocean is murky, its shallow bay waters filled with trash to create the Village of God and various communities of ramshackle concrete block shanties that make up the City of the Eternal. It’s a place where gangs and disease run rampant, where the rain brings down topsoil and human waste, and where residents are more likely to go to the bathroom in plastic bags than outhouses. But treating disease inside the slums, a refuge of warring gangs and kidnappers, has long been a challenge — even for the clinic. “My staff was very reluctant,’’ Pape said. “This is a very dangerous area where people are killed all of the time.’’
.
The first opportunity came with the quake, which forced fleeing residents to set up a tent city in the clinic’s parking lot. Then cholera hit. “We used to have 14 to 15 cholera victims a day,” Dr. Mireille Peck, a GHESKIO physician and head of its community program, said on a stroll through the Village of God. A year ago February, the clinic, with government support, started a door-to-door cholera vaccination campaign using smart phones. It went even further, teaming with residents to enter homes to conduct a health survey and treat victims. That relationship made the clinic’s staff realize the residents were their neighbors, Pape said. “My staff is happy they did it. They realized these are real people who have needs like everybody else, which is to send their kids to school and hope for a better life,” he said. Paul Farmer, chair of Harvard Medical School’s Department of Global Health and Social Medicine said, “Haiti’s progress depends on inclusion and inclusion depends on some basic services.” “You can’t do good medicine for poor people without having some strategies to address their poverty,” said Farmer, whose Boston-based Partners In Health/Zanmi Lasante nonprofit medical organization provided the cholera vaccination to Haitians living in the Central Plateau, where the disease started. “Anyone who exposes him or herself as a nurse or physician to a lot of patients living in poverty gets an earful about social conditions,” Farmer said.
.
As a result, addressing transportation, food, electricity and housing issues become important in struggling communities such as Village of God. On a recent morning, as workers from GHESKIO toured the Village, some of its 10,000 residents chatted about the transformation. The tension that normally welcomed visitors has been replaced with pride, and an overwhelming sense of accomplishment. “This is a zone that used to be very dirty. They have motivated us,” said Gabriel Mizo, 46, a block leader inside the community. “GHESKIO’s doctors have brought a lot of hope.” Then someone shouts: “There is no more cholera here.” Crime persists, however. Earlier this month, Haiti National Police launched a surprise raid, arresting 17 gang members including a top leader. But much of the activities in the village these days center around the work of clinic staff. Throughout the community, there are several oral re-hydration points for those who contract cholera. Specialized buckets of portable water, created in the clinic’s lab, are also provided to families. Even the water provided by private providers has improved, thanks to negotiations by the clinic’s doctors. On a tour of the village, Peck notes the visuals that are also feeding the sense of pride. Lots once strewn with garbage are clean, and canals normally infested with mosquitoes have been reduced to puddles. “You don’t see how it is clean?” she said, stopping in front of a group of women who were employed in a clinic-run community clean-up program that closed in November after funds dried up. “They are still sweeping because they have taken ownership of the project.” A few yards away, giggling school children pour out of one of the few multi-story structures. Almost all of the students have been vaccinated against cholera by GHESKIO’s teams — as well as against several common childhood diseases through an unrelated Ministry of Health campaign. “If today we have these children sitting here and they are healthy, after God, we have to thank Dr. Peck and the people at GHESKIO,” said Pastor Jean Samson Charles, the school’s director. “They have stood alongside us and fought for us to allow us to be here today.”

Lack of Doctors Plagues Haiti's Health System in the Grande Anse

3/22/2013
Global Press Insitutue
By Ganyelar Laurent, GPI
.
JEREMI, HAITI – Natache Mizene, 29, lies in a bed at Hôpital Saint-Antoine de Jérémie, the only state hospital for the Grandans department. She is wearing a green, floral gown, and her whole body is swollen. Her doctor has diagnosed her with kidney failure. “Despite all my efforts to attract doctors, there really is no doctor who wants to come to St. Antoine.” Dr. Jean Marie Duvilaire, 65, director of St. Antoine Hospital “I am diabetic, I have difficulty breathing, and I have hypertension,” says Mizene, an accounting student. “My doctor says I suffer from renal insufficiency.” But she can’t get the treatment she needs at St. Antoine Hospital, located in Jeremi, the capital of the Grandans department in southwestern Haiti. “I was in the hospital for three months already when they sent me to another place because they could not do anything for me,” she says. Frantz Alexis, 25, an intern at St. Antoine Hospital, confirms that the hospital can’t provide Mizene with the treatment she needs. “Mizene should have an ionogram, a special type of blood test,” Alexis says. “But unfortunately, we do not have the equipment for that here at the hospital.” Alexis is a third-year student at École d’Infirmières Notre Dame du Perpétuel Secours, a local nursing school. “What makes her body swollen like that is that she has difficulty urinating, so all the salt stays in her body,” he says. They have prescribed medication for Mizene that makes patients urinate, but it is not working, he says. “She should see a nephrologist to look at her kidney, but unfortunately, we do not have a nephrologist here,” he says. “She needs to go to Port-au-Prince for that. In her case, there is nothing we can do for her here.” Mizene says the hospital staff sent her to Port-au-Prince, the capital, to obtain care. But patients are responsible for paying for all their own costs, and she couldn’t afford to continue treatment away from home. “After two weeks, I was forced to return here because I do not have the money to go to another place,” Mizene says.
.
Patients of St. Antoine Hospital say they suffer physically and economically because they can’t obtain the care they need locally. Staff members attribute this to a lack of specialists and resources. The directors of the hospital and the Grandans delegation of the Ministère de la Santé Publique et de la Population, Haiti’s public health and population ministry, cite some progress but acknowledge that significant change is still needed. There are 45 public medical institutions, including small clinics and dispensaries, that serve the nearly 433,000 inhabitants in the Grandans, says Dr. Jean Lionel Gerôme, director of the ministry’s Grandans delegation in Jeremi. But St. Antoine Hospital is the only state hospital in the department. Dr. Jean Marie Duvilaire, 65, a surgical physician, serves as the director of St. Antoine Hospital. He says the hospital, which was built in 1923, has grown along with the population. But patients and staff say not all medical services are available at the hospital. This hurts patients’ health. It also affects them financially if they have to travel to obtain care at a different hospital or stay in the hospital until they can afford treatment elsewhere. When patients need services that are not available at St. Antoine, the staff refers them to hospitals in other towns or departments. But transportation is another barrier, as roads are in bad shape. Agnus Teodore Fils, a former St. Antoine patient, sits on a small bed in his home in beige shorts and no shirt. A belt hangs around his neck.
.
“I was shot in the right shoulder,” he says, visibly in pain. “They rushed me to the emergency room, where they removed the bullet. But there were additional small fractures.” He says the hospital couldn’t provide the treatment he needed. “They told me there was nothing they could do for me because they did not have an orthopedic doctor,” he says. So they sent him to Okay, a town in the Sid department. But the ambulance was out of commission. “What was most difficult at my moment of suffering was that the hospital ambulance did not have tires or gas,” he says. “My family had to resolve these problems very quickly.” His family paid for gas and tires in order to transport him to Okay.
.
But not all families can afford to obtain treatment elsewhere. Norman Benoit, who was born in December 2012, was in the hospital with his parents. Dr. Nadege Nassice, 33, a pediatrician at the hospital, says that Norman has myelomeningocele, a birth defect in which the backbone and spinal canal fail to close before birth. “There is nothing we can do for him here except put him on antibiotics so that the opening does not become infected,” she says. “We have to wait until the parents find the money to take him to a neonatal surgical specialist in Port-au-Prince.” This shortage extends nationwide. “There are only three or four neonatal surgical specialists in Haiti,” Nassice says. Patients cannot obtain the care they need at St. Antoine Hospital because of a lack of doctors and resources. Duvilaire took charge of the hospital in May 2010 after the former director died in 2009. ervices are available at the hospital, says Duvilaire, who is wearing black pants and a white T-shirt that reads “Jinekolog san Frontyè,” or Gynecologists Without Borders in Haitian Creole. But the problem is the lack of professionalism among the staff. “The biggest problem we have at the hospital is that both doctors and nurses give the impression they do not care,” he says. “It is this unprofessional attitude that the patients criticize.” He says he reprimands staff for unprofessional behavior, such as tardiness. “For example, some morning, a patient comes in bleeding and is not being treated because the gynecologist has not come in yet,” he says. “When that happened, I needed to give him a reprimand.” The staff is also too small to handle the volume of patients. “We are lacking physicians at the hospital,” Duvilaire says. “We had one gynecologist for the whole hospital. Now, we have a second one.” The hospital added a second gynecologist in 2012, but he has to leave every four or five months to see his family, who does not live in Jeremi. “The hospital needs three other gynecologists because we need staffing stability,” Duvilaire says. The hospital does not even have certain types of doctors “We do not have a single orthopedist,” Duvilaire says. “There was a time when I was the only doctor in the hospital. Can you imagine that? Now, we have two doctors on our permanent staff. Many of our patients have prostate problems, but we cannot do a lot for them because we do not have a pathologist.”
.
Sabin Saintil, 44, chief of nursing at St. Antoine Hospital, wears a blue shirt, beige pants and white tennis shoes. He attributes the staffing shortage to low salaries. “I have worked at St. Antoine Hospital for 15 years,” he says, carrying a large, black bag. “In my opinion, the reason we have such a difficult time attracting doctors is the monthly salary they get.” Orthopedists, for example, earn 25,000 gourdes ($600) per month at public health institutions, Duvilaire says. They are also few in numbers in Haiti. “While the doctors in Port-au-Prince get the same low salary,” Saintil says, “they usually have private clinics on the side, which are profitable, and there are other side jobs they are able to do. Because there are no doctors here, I often take on the role of a doctor.” There are not many doctors from Jeremi, and those from other areas generally like to stay in their own communities. “They have to live in a city, which is not their city,” Saintil says. “It’s not easy.” Duvilaire, who is from Abriko, another town in the district of Jeremi, says that the public health ministry asked him several times to take the director role before he finally accepted nine months later. He had wanted to stay and work to help his native community, where he had been directing a health center and serving as deputy mayor. He has had equal trouble attracting other doctors to St. Antoine. “Despite all my efforts to attract doctors, there really is no doctor who wants to come to St. Antoine,” he says. Gerôme attributes this to the isolation of the Grandans department. “Due to the poor accessibility of the department of Grandans, it is not easy to find specialists to work,” he says during a telephone interview while in Port-au-Prince. Another issue is funding from the ministry, Duvilaire says. “Since 2009, St. Antoine Hospital has not received a single gourde from MSPP,” he says, apart from employee salaries. “They only take responsibility for the salary of the employees. For the functioning of the hospital, we receive nothing.” This hampers operations. “We only have one generator at the hospital,” Duvilaire says, “and when that generator breaks down, we cannot do operations, do blood analysis and other things.”
.
Gerôme says the national budget allocates funding for public hospitals. The largest portion comes from the state and funds the salaries of staff, the purchase and maintenance of equipment,transportation and training. International partners also provide additional financial support, he says, such as the U.S. President’s Emergency Plan for AIDS Relief, the Université de Nantes in France, Médecins du Monde in France and the International Training and Education Center for Health in the United States. Duvilaire says he has tried to resolve the lack of supplies at the hospital by engaging with these partners. “Where I feel I was successful was in getting material and equipment to the hospital,” he says. “The University of Nantes sent two containers of supplies for the hospital.” Duvilaire says that when Dr. Florence Guillaume took over of ministry of public health in 2011, St. Antoine received some additional aid. The hospital used a portion of the aid to pay additional staff. “We were able to attract a dozen general practitioners and five extra nurses,” Duvilaire says. “It has helped us some.” But Duvilaire says that before he leaves his position as director of the hospital, he would like to see significant change. Gerôme says the state plans to reorganize the health care system to involve the community and other private sectors in health management and education. The state also plans to improve salaries and training of health care personnel, supervision of health care facilities, and the allocation and relocation of staff. “A supervisory body was established at the departmental bureau level, with the intention of evaluating clients’ degree of satisfaction,” Gerôme says. “All elements were analyzed, including the reception, the length of the waiting period before meeting with care personnel, record-keeping, the confidentiality of personal records, the quality of diagnostics and treatment.” It also analyzed physical and financial accessibility to services, the cost of medication, and the system of referrals and counterreferrals for patients requiring care unavailable in the department. Gerôme says the ministry is also investigating allegations of past negligence within the ministry to identify those involved. It has organized training sessions and has formalized disciplinary action to avoid future negligence. All interviews were translated from Haitian Creole, except the interview with Gerôme, which was translated from French.

Maternity Ward at Haiti's State University Inaugarated

3/8/2013
.
The maternity ward at the State University Hospital of Haiti (HUEH) was inaugurated this Friday, March 8, 2013, to coincide with International Women’s Day. Two hundred hygiene kits were distributed, and HUEH provided information addressing women’s health issues, such as family planning, sexually transmitted diseases, prevention of mother to child transmission of HIV and free urogenital lesion screenings. The maternity ward is one of the rare buildings of the hospital that survived the January 12, 2010 earthquake. Despite its ruined condition, 6,000 deliveries were performed each year; along with 15,000 gynecological and 12,000 pre-natal consultations. The renovations cost a total of USD $150,000. The renovations included rebuilding the roof, the installation of a new water distribution network, the rehabilitation of a new electrical power system as well as the installation of fans. Exterior and interior painting was also completed. The U.S and French governments, Haiti’s international partners, contributed equipment to complete the renovation work. In addition to such efforts, USAID provided a generator, a battery-operated inverter that provides electricity in three operating rooms, including the labor room, as well as computers to computerize patients’ records. Some of the equipment at the maternity ward was donated by the Association Martiniquaise Urgence Caraibes. The French Government will finance a professional training program from 2013 to 2015 for maternity ward personnel, including obstetrical doctors, nursing staff, and support staff. The renovations and new equipment at the maternity ward provides the staff with better working conditions, and reduces maternal and newborn mortality rates. HUEH is Haiti’s largest hospital, serving patients from every region of the country. Every year, about 70,000 people benefit from its reasonably priced healthcare services.

USG Helps Build Two New Public Health Facilities (2/28/2013)

In Monday, February 25, U.S. Ambassador to Haiti Pamela A. White, CDC Director Tom Frieden, Haitian Minister of Public Health and Population, Dr. Florence D. Guillaume, representatives from donor partners as well as other U.S. and Haitian officials attended the inauguration of two new public health buildings in Port-au-Prince. These buildings were supported through a partnership between CDC, CDC Foundation, Kaiser Permanente, Robert Wood Johnson Foundation, Proteus On-Demand and the medical technology company BD (Becton, Dickinson and Company). The ribbon cutting ceremonies for two new public health buildings in Haiti’s capital city mark another milestone in the country’s recovery and rebuilding since the 2010 earthquake. The buildings will be used by Haiti’s Ministry of Public Health and Population (MSPP or Ministère de la Santé Publique et de la Population), MSPP’s Division of Epidemiology, Laboratory and Research (Direction d’Epidémiologie, de Laboratoire et de Recherches or DELR) and the Haiti office of the U.S. Centers for Disease Control and Prevention (CDC) as they work to strengthen the country’s public health systems.
.
“‘Building back better’ isn’t just a slogan, it’s a reality in public health. These buildings represent an important step forward to save lives in Haiti. We are grateful to the CDC Foundation and their generous partners for their support and collaboration.” said Dr. Tom Frieden, CDC Director. “These new buildings have an importance far beyond their physical presence—they will serve as a basis and catalyst for programs that will save literally tens of thousands of lives.” The two new buildings help in the transition of Haiti’s MSPP from temporary to permanent facilities following the earthquake. One building serves as a central office from which public health activities will be managed in Haiti by Dr. Florence Guillaume, Minister of Public Health and Population, and her staff. The second building for MSPP’s DELR houses a portion of MSPP’s surveillance, epidemiology and laboratory staff and CDC’s staff in Haiti, who are now working side-by-side in the country.
.
CDC Foundation partners financed the buildings through donations and in-kind support. The building for Haitian DELR and CDC staff was funded by a $2 million contribution from the GE Foundation and a $500,000 contribution from The Robert Wood Johnson Foundation. Kaiser Permanente donated $587,000 for the MSPP central office. Partner funding for both buildings also provided furnishings, fixtures, electronics, computers, printers, and internet connectivity. In-kind contributions were provided by Proteus On-Demand to increase the size of the MSPP building and make enhancements within the facility. Also recognized at the ceremony was medical technology company BD (Becton, Dickinson and Company), which last year donated more than 1.7 million syringes and 15,000 BD™ sharps collectors for a national measles and rubella immunization campaign in Haiti.
.
“We are grateful that our partners recognized the need for a comprehensive response to the earthquake in Haiti and for their generous contributions to build these new facilities,” said Charles Stokes, president and CEO of the CDC Foundation. “the CDC Foundation is positioned to help CDC and its public health partners secure crucial resources.” MSPP’s Dr. Guillaume said, “These investments are another positive action helping to move Haiti’s public health system from the disaster and recovery phase into a longer-term solution. Haiti’s MSPP demonstrated foresight in working to address emergency response needs while initiating long-term strategic plans that are improving health in Haiti. The U.S. Government reiterates its continued support and commitment to help strengthen Haiti’s public health infrastructure and national health programs for the Haitians.

New Health Center Inaugarated in Ounaminthe (1/18/2013)

On Friday, January 18, 2013, Haitian Minister for Public Health and Population Florence Guillaume and U.S. Ambassador Pamela White inaugurated the newly rehabilitated Health Center in Ouanaminthe, a border town in Northeast Haiti. The ceremony, which was also attended by Ministry of Health Northeast Department Director Jean Denis Pierre and Ouanaminthe Medical Center Director Pierre Sadate, highlighted the U.S. Government’s efforts to support the Government of Haiti in improving basic health services in Haiti and enhancing the living conditions of the Haitian people. The U.S. Government, through USAID’s Office of Transition Initiatives (OTI), helped repair the facility, including fixing the roof, painting hospital walls and ceilings, tiling the floors of the maternity unit, as well as rehabilitating the sterilization room, to create a more sanitary and modern healthcare environment. “This medical center, providing health services to more than 100,000 people from the areas surrounding Ouanaminthe, is a testament to the Haitian government’s commitment to extending basic services to its citizens,” said U.S. Ambassador White. In addition, USAID, through its health project Santé pour le Développement et la Stabilité d’Haïti (SDSH), is providing the Ouanaminthe Health Center with a package of integrated priority health services, including child and maternal care, family planning, and treatment of HIV/ AIDS and tuberculosis. The project is also enhancing the facility’s information systems, waste management, and financial and human resource management. SDSH also targets Ouanaminthe as one of eight new Maternal Health Centers of Excellence in Haiti.

Kangaroo Care Helps Stabilize Premature Babies in Haiti

11/19/2012
Webwire
By Suzanne Suh
.
On the occasion of World Prematurity Day, governments around the globe are organizing events to raise awareness on the serious issue of premature births. Every year, 15 million babies are born prematurely. And with more than 1 million premature deaths each year, prematurity is the second leading cause of death of children under 5 years old. Many of those who do survive may face a lifetime of challenges – from learning disabilities to visual and hearing problems. A global movement called A Promise Renewed aims to reduce the death rate of children under 5 to 20 or fewer deaths per 1,000 live births by 2035. UNICEF is supporting specific actions geared to achieving a dramatic reduction in neonatal mortality. One of the key priority interventions that has shown promise is ‘kangaroo mother care’, a programme that encourages mothers to wrap their premature babies to their chests using a pouch. Close body contact with the mother has proven to help stabilize babies’ body temperatures, steady their heart rates and help with breathing.
.
Marie Michelle François lies on a bed in the neonatal unit. Her newborn baby is strapped to her stomach in a stretchy wrap. His head is covered with a thick knit hat, despite the sweltering heat. Born at 32 weeks, he is one week old and weighs less than three pounds. His eyes flutter, but he does not awaken. He isn’t her first premature baby. Ms. François has had another preterm baby, who died. This is, however, the first time she has used kangaroo mother care. In Haiti, where, in 2008, nearly half the population did not have access to healthcare, and where only a quarter of women give birth with a skilled attendant present, a baby born before term is very vulnerable. Yet, thanks to kangaroo mother care, more and more preterm babies born in the neonatal unit of the Hospital of the State University in Port-au-Prince are surviving. The method, named for the similarity to how certain marsupials carry their young, was initially developed to care for preterm infants in areas where incubators are unavailable or unreliable. In kangaroo care, the baby wears only a diaper and a hat and is placed in foetal position with maximal skin-to-skin contact on the parent’s chest. “Kangaroo care arguably offers the most benefits for preterm and low-birth-weight infants, who experience more normalized temperature, heart rate and respiratory rate, increased weight gain and reduced incidence of respiratory tract disease,” explains Health Specialist at UNICEF Haiti Mireille Tribié. Kangaroo care also helps to improve sleep patterns of infants, and helps to promote frequent breastfeeding.
.
Chief of the neonatal unit at the hospital Dr. Severe says, “What is great about kangaroo care is the simplicity of the method. After 10 days, we already see a much rapider turnover – babies gain weight much more quickly because the baby learns how to position itself to feed. Being close to the maternal heartbeat facilitates the baby’s development.” After the earthquake of 12 January 2010 demolished the maternity ward along with the hospital, Dr. Severe and his colleagues found themselves in the direst of conditions – fighting to save the lives of women and babies in makeshift tents with no electricity or running water. “[O]ut of 12 patients, 11 would die – we had no electrical current. We finally created a neonatal ward in the obstetrics department, but we had no furniture. Mothers were on the floor, on chairs,” he recalls. The turning point, in his opinion, was when UNICEF provided beds, incubators, cribs and other technical and financial support to the neonatal unit. UNICEF also sponsored sending four health professionals to Cameroon last year to receive training on kangaroo care. UNICEF then helped them to pass on the knowledge in training sessions for teams of health personnel throughout Haiti.
.
Naika Desrameux has worked in the neonatal unit since October 2011. “Before, there was a very high mortality rate among preterm newborns. We didn’t have enough incubators for them all. But with kangaroo care, the mothers are like human incubators. They keep the baby warm, and we don’t have to worry about infections.” Ms. Desrameux is one of the professionals trained in Cameroon. “The reality in Cameroon is very similar to the reality here in Haiti, so I was very excited about coming back and teaching women this approach here. With kangaroo care, we can really have an impact here in Haiti. It is really magical to see,” she says. For Ms. François, it is making the difference between life and death. “I wish I could have done this with my other babies,” she says, gazing down at her baby boy lying prone on her stomach. “I like having my baby near me all day.”

All about the University Hospital of Mirebalais (PIH)

10/30/2012
.
The construction of the new University Hospital of Mirebalais (Hôpital Universitaire de Mirebalais - HUM), of 205,000 square feet with a capacity of 300 beds and equipment at the cutting edge of technology is almost completed. In addition, this hospital is among the most ambitious health sector solar projects ever undertaken in a developing country. With 1,800 solar panels, Mirebalais Hospital is the largest hospital in the world to be completely powered by solar energy.Drs. Maxi Raymonville and David Walton, physicians for PIH/Zanmi Lasante and members of the executive leadership team of Mirebalais National Teaching Hospital, give us an update on its progress, and what’s to come.Q: Now that construction is nearly complete, what is your team focused on?"At this point we are currently focused almost exclusively on operational planning—we’re setting up structures for governance and staffing, developing plans for hiring, and creating standard operating procedures for how everything will run when the hospital opens. We’re also working on curricula, developed with our main educational partners at the Université d’État d’Haiti to train Haitian nurses, doctors, community health workers, and other health professionals, which will strengthen the next generation of health providers.
.
We're also looking forward to Nov. 6, when Dr. Jim Yong Kim, a PIH co-founder, makes his first official visit to Haiti in his role as president of the World Bank. In honor of his visit, ZL and the Ministry of Health will host a ribbon-cutting ceremony that will mark the completion of our hospital construction efforts. This event celebrates PIH/ZL’s partnership with Haiti’s public sector, and we’re especially excited that President of the Republic Michel Martelly will attend. We’re continuing to work with the Ministry of Health to open the hospital as soon as possible and will have a dedication ceremony in early 2013 to celebrate the culmination of this work and the partnerships that have made it possible."Q: How many people do you expect will use the hospital?"The hospital will provide primary care services to approximately 185,000 people in Mirebalais and two nearby communities. But patients from a much wider area—all of central Haiti and areas in and around Port-au-Prince—also will be able to receive secondary and tertiary care at this facility. We could see as many as 500 patients every day in our ambulatory clinics when we are fully operational."Q: What are some of those primary care services?"They include everything from community health services to HIV/AIDS and TB care, care for non-communicable diseases, and prenatal care. Patients will receive vaccinations and treatment for malnutrition, for example, as well as basic primary care and dental services. We will also offer secondary level services including mental health, emergency medicine, and general and orthopedic surgery. Our women’s health services include family planning, reproductive health, and comprehensive emergency obstetric care. We aim to provide the same services you would find at any U.S.-based hospital.
.
Once the hospital is running at full capacity, we’ll have more than 30 outpatient consulting rooms, six operating rooms, and space to host trainings for 200-plus participants."
.
Q: How many people will the hospital employ ?"We’ll eventually employ more than 1,000 people—including 175 community health workers—drawn primarily from the Mirebalais area."
.
Q: How much did it cost to build the hospital? And how much will it cost to run each year ?"Thanks to incredibly generous supporters, we have raised $17 million to design, build, and outfit the hospital and residences, and we have received another $5-6 million in in-kind donations. When it opens, the hospital’s operational budget is estimated to be about $12.5 million for each of the first two fiscal years. PIH/ZL and the Ministry of Health are still finalizing the budget and both entities will share the cost of running HUM, providing high-quality health care to poor people through Haiti’s public sector. We will continue to rely on our friends and supporters who believe we can—and should—provide health care to people everywhere, and especially to people living on the margin of extreme poverty. We are also working out a mechanism for long-term financing with the Ministry of Health and other sources."
.
Q: How will the hospital be governed ?"ZL and PIH will operate the hospital under a Memorandum of Understanding with the Ministry of Health for several years. We hope, with the Ministry’s consent, to form an HUM Advisory Board shortly after opening the hospital. The board would ideally be comprised of executives from the Ministry of Health, Zanmi Lasante, PIH, and private citizens who would be advocates and supporters of the hospital. We would hope that within two years, the Advisory Board could become a governing board. Composition of the board(s), timing of their formation, authority, and other related issues will be agreed with the Ministry of Health after the hospital opens.
.
Eventually the Ministry of Health will manage the hospital, but in the meantime we’ll use an accompaniment and mentorship approach to pair Haitian leaders with international experts from the United States and elsewhere who will help launch the hospital and then steward this transition. This will enable HUM to demonstrate best practices in hospital management, and establish a strong Haitian leadership team that can make the hospital a success and a model for public hospitals throughout the country."Q: Explain more about the hospital’s role in improving nursing and medical education in Haiti."Haiti’s public health sector lacks resources to provide attractive career options for young health professionals—many decide to work in private facilities and a vast majority leave the country altogether. We want to help retain health professionals for the public sector here by creating an environment that offers the tools, resources, supervision, and mentoring and academic environment they need to be satisfied in their jobs and advance in their careers.
.
To that end, PIH/ZL is working with l’Université d’Etat d’HaÏti, l’Ecole Nationale des Infirmières [the national medical and nursing schools, respectively], and other international partners to develop academic programs to train future generations of nurses, doctors, and other health professionals. We will offer medical residencies at HUM in several areas, including internal medicine, obstetrics and gynecology, and surgery. The hospital also will serve as a site for clinical rotations for Haiti’s national nursing schools, and offer nurses advanced training in several specialty areas, including emergency care, neonatal intensive care, and surgery."
.
Q: How will HUM impact the economic life of Mirebalais ?"Based on PIH’s experience opening a full-service hospital in the rural settlement of Cange, the town of Mirebalais can expect to see remarkable growth and opportunity with the opening of the hospital. We anticipate seeing larger economic growth in the form of new hotels, restaurants, and other small businesses to cater to the increased flow of goods and people in and out of Mirebalais. Ultimately, we expect HUM will affect the community’s economy on three levels. First, direct employment of more than 1,000 staff in Mirebalais; second, the benefit of those salaries on their families (the ability to keep their kids in school, for example); and third, business growth that will stem from fulfilling the needs of these new professionals."
.
Q: Talk about some of the building’s “green” aspects—how did the hospital incorporate sustainable building practices and green technology ?"Our green technology plan incorporates electricity conservation measures, natural ventilation and lighting, water-efficient plumbing, and a solar energy system that’s among the most ambitious health sector solar projects ever undertaken in a developing country. In fact, according to publicly available data, HUM will be the largest hospital in the world that can be powered entirely by solar energy. Working with the Ministry of Health, we chose to use solar power as a cost-effective, reliable, and environmentally responsible way to help power the facility and avoid the burden of Haiti’s frequent blackouts. On most sunny days, the system’s 1,800 solar panels will generate more electricity than the hospital consumes, allowing the surplus energy to feed back into the electrical utility.
.
In addition to solar power, the hospital minimizes energy needs through high-efficiency fluorescent light fixtures, motion sensors for lights that will save up to 60 percent in energy usage, and natural ventilation that reduces both the spread of infection and the need for air conditioning. On the roof, reflective white coating keeps the building cooler and makes the solar panels up to 15 percent more efficient. All this new technology is being introduced with an eye toward sustainability—all the equipment will be regularly serviced by professionally trained Haitian staff."
.
Q: What does this hospital symbolize for you ?"HUM offers an incredible opportunity to raise the standard of health care for our patients in Haiti. In partnership with the government, we have the capacity to provide high-quality services drawing on international best practices for healthcare delivery, administration, and education. We hope that our work will improve care both throughout our PIH/ZL network and across Haiti."

Putting the Patient First in Haitian Health Care System

10/1/2012
World Bank
.
SUBMITTED BY MARYANNE SHARP, CO-AUTHORS: ERIK JOSEPHSON ON FRI, 2012-09-28 12:41
.
The tree provides shade but scant respite from the heat. Chantal, four months pregnant, has just returned from washing her family’s clothes in the nearby river. Her small village, just twenty houses and a single dirt road located about 60 kilometers north of the capital Port-au-Prince, has no health facilities of any kind. The nearest health post (staffed for two hours a day by a high school graduate) is an hour’s walk away while the nearest health center is two. In Haiti, only about a third of births take place in a health facility, so encouraging women to attend prenatal visits and to give birth in facilities requires a special focus from government and donors. Two decades earlier Chantal’s mother gave birth to five children, including Chantal, on the dirt floor of her hut alone. Her husband sat in the next room waiting for her to be finished. Two died due to preventable complications during delivery.
.
Despite this, Chantal sees no reason to deviate from this well-worn tradition, but has been convinced by a matrone –a midwife and village health advisor of sorts- to allow her to assist with the delivery. She will collect between US$ 1-2 for her services. Conversely, all deliveries in health facilities are free, a national policy in Haiti to encourage women to make use of them. Health systems in any setting are replete with perverse incentives, encouraging inappropriate or undesirable behaviors. For example, matrones justifiably fear losing their minimal compensation if women were to heed the advice and attend free consultations at these health facilities. Other barriers include tradition, transportation and poor quality of care. Any one is powerful in itself, but when combined they pose a significant challenge to governments pondering how to reduce preventable deaths and improve the health of their population.
.
With the highest maternal mortality in the Western Hemisphere a Haitian woman has a 1 in 37 chance of dying from maternal causes during her childbearing years. Child mortality in Haiti is three times the Latin American average, with children under five at high risk from contracting preventable illnesses such as diarrhea and pneumonia. So how to attract Chantal, her newborn and her family to use the facilities’ free maternal and child health services? Improving the quality is one answer. Changing the behavior of service providers is another. But for once, the answer is not necessarily to inject more money. By North American, European or South-East Asian standards the funds financing the Haitian health system are minuscule. For Haiti, the available funding is, at this moment in time and at this level of organization of the system, acceptable. The real focus therefore must be on vastly improving governance and management to build a system that is accountable for results.
.
The patient must be the starting point, relentlessly managing the system for results –- i.e. providing better health outcomes for people. Patients should be encouraged to make use of health services, facility staff must benefit from increased compensation and suitable working conditions, demands on their time for non-clinical purposes should be kept to a minimum and, perhaps most importantly, the link between the population and the system regulator (i.e. the government) must be restored. There are multiple issues with Haiti’s health system, ranging from financial and physical barriers to quality healthcare, to the broken social contract and other intractable problems. Services also suffer from overburdened, undertrained, undercompensated and therefore underperforming health staff. Addressing these all these matters requires a new approach.
.
Improving the coverage and quality of maternal and child services can begin to be addressed with results-based financing. This should incentivize widening the provision of essential services and improving quality of care to create lasting behavior change among service providers and repair the health staff-patient relationship. But before this can happen both the Haitian government and its donor partners must uphold their respective responsibilities, be bold and take calculated risks. For the former this means reforming the civil service, fully assuming its leadership role and tackling graft. For the latter, it’s taking the long view: making resources available to strengthen governance systems, and taking a firm line against intransigence and obfuscation. It also means providing direct funding to allow the government to play its regulatory and stewardship role.
.
In Haiti, the Ministry of Health is looking to introduce a new approach to results-based management through the delivery of evidence-based, high-impact and cost-effective health and nutrition services, provided in part at facility level and in part in the community. To do this, vendors – both public and private-- would be contracted to provide services, receiving a bonus once the target number of patients treated at an acceptable level of quality has been reached. This approach will be supported jointly by USAID and the World Bank. The success of this approach, however, depends on governance and management of the system. And ultimately building a health system that is leaner and much better performing.

Biggest Health Problem Facing Haiti is TB (Reuters - 9/6/2012)

By Anastasia Moloney
.
A Haitian doctor who runs one of the world’s leading AIDS treatment and research centres believes the biggest single health threat in Haiti today is infectious tuberculosis (TB). TB rates among adults are still higher than they were before the devastating January 2010 earthquake, which flattened much of the Caribbean nation, according to Jean William Pape, the doctor who heads the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) in Port-au-Prince. “Tuberculosis is the major problem in Haiti, more so than HIV,” Pape said. “Cholera remains a problem but I think we have a way to deal with cholera.” he said, referring to a recent nationwide oral vaccination campaign against the disease. TB is a worldwide pandemic that in 2010 infected 8.8 million people worldwide and killed 1.4 million, according to the World Health Organization (WHO). The bacterial infection destroys patients' lung tissue, causing them to cough up the bacteria, which then spreads through the air and can be inhaled by others. GHESKIO, founded by Pape in 1982, provides around 500 TB patients free treatment every year, making it the largest provider of TB care in Haiti.
.
So far this year, GHESKIO has registered 781 cases of TB in adults, compared with 760 cases of the airborne disease in 2009 before the quake. Haiti had the highest rate of TB in the Americas before the quake, and the disaster has made things worse, Pape said. In the aftermath of the 2010 earthquake, 1.5 million people made homeless by the disaster lived in makeshift tent cities, many sprawled in and around the capital Port-au-Prince. The number of Haitians living in the camps, where crowded, unsanitary conditions create a fertile breading ground for TB transmission, has dropped to 390,000, but the lingering effects of the disaster on Haiti’s TB prevalence rates are still being felt. “Tuberculosis is a residual of the earthquake,” Pape said during an interview with AlertNet in his office at GHESKIO’s main site in downtown Port-au-Prince. “If you want to spread tuberculosis there’s no better way to do it than to put an infected person under a tent with other people – It’s spread by coughing and by having people in such a small environment not exposed to ventilation,” said Pape, who is also a professor at Cornell University’s Weill Medical College in New York.
.
Children infected with TB usually develop the full-blown disease within months, but in adults it can take months, or sometimes years, to develop, he added. “We are almost at pre-quake rates for incidence of tuberculosis in infants,” Pape said. “But since many adults were exposed, I expect that we will continue to see a spike in the adult population, particularly because adults who are HIV infected are at 10 to 20 times more at risk to develop tuberculosis disease.” Because the human immunodeficiency virus (HIV) that causes AIDS weakens the immune system, people with it are much more likely to be infected with TB. The number of TB cases has fallen across the world since 2006, according to the WHO, but the disease still remains one of the leading causes of death worldwide.

Personal coaches help Haitian families try to get out of poverty

8/30/2012
Washington Post
By David Brown
.
BOUCAN CARRE, Haiti — The people who live in this part of Haiti’s Central Plateau need more of pretty much everything that makes life safe, comfortable and predictable. Three-quarters of families do not have enough food and two-thirds do not have access to clean water. Thirty percent of households are headed by women, and 40 percent of children are not in school. One in four children is unvaccinated, and half are underweight. About 80 percent of houses do not have latrines, and 60 percent of farmers do not own the land they cultivate, according to a survey of 5,200 families in the commune, or county, of Boucan Carre. Is it realistic for people to make headway against so many problems on their own? Several centuries of poverty would suggest the answer is no. Would a personal assistant help? An experiment here may answer that. Half of the commune’s 10,000 households are being assigned a “household development agent” — a neighbor who will work as a health educator, vaccinator, epidemiologist, financial analyst, social worker, scheduler and advocate all at the same time. With the agent’s help, a family will assess its needs and come up with a plan to make things better. “The idea is to forge a relationship from the get-go,” said Maryanne Sharp, an official at the World Bank, which is overseeing the $4 million project. “We want the family to say, ‘Yes, we own the plan, and we will work on these objectives on this timetable.’ ” The commune’s other 5,000 households will function as a control group, continuing as they have, scrounging out a living in one of Haiti’s poorest and most isolated places. In two years, the families will be resurveyed and their children and houses reexamined. If those with agents are doing better, then the strategy of coaching people out of poverty may be expanded throughout the country.
.
The experiment, aided by Haiti’s health ministry and run by two charities, Zanmi Lasante and World Vision, acknowledges several realities of life here. One is that fixing just one of a poor family’s many problems — say, access to medical care or substandard housing — may not make much difference. The second is that house calls are the most efficient way to reach people in rural areas. The third is that finding help in a place where more than 900 nongovernmental organizations operate — and provide 70 percent of the health care — can be daunting and confusing. The all-encompassing nature of the job is not the only unusual feature of the project, which is called Kore Fanmi — “family support” in Creole. The agents will also be eligible for pay-for-performance (P4P) bonuses. “If their families perform better, they will receive more salary,” said Francesca Lamanna, a World Bank economist who oversees the project. “This will help them do their jobs better.” P4P is rapidly becoming a feature of American medicine, including with Medicare. But it is “kind of a new fad in global health,” said Amanda Glassman, an economist at the Center for Global Development in Washington. Evidence suggests it improves outcomes, at least for a while. Critics worry that it may lead to people gaming the system and undermine professionalism. These World Bank experiments are going to be very useful to generate knowledge, not just for Haiti but for other countries that are interested in doing this,” Glassman said.
.
Three communes are getting agents. Boucan Carre has a population of 50,000. About 3,200 people live in town; the rest live in smaller settlements down numberless tracks and footpaths. Zanmi Lasante, the organization co-founded by physician Paul Farmer, has worked in the area for more than two decades and is running the development-agent experiment. On a recent day, commune leaders were invited to come hear about it. The town is 45 minutes up an unpaved road from the highway. The trip in is a glimpse of life in a Haitian valley. A man in a black suit and a woman in a white dress saddled horses to go to a funeral. Three men stopped at a stream the road crosses to wash their motorbikes. Girls in school uniforms and matching hair ribbons walked past tethered goats grazing, farmers hoeing and people sitting. Some of the houses are detailed in pastel colors; others are covered with cracked stucco tinted merely by dust. On a hillside above town, the 21 community leaders sat in a gazebo with a roof held up by concrete pillars. All were men. They included several pastors and at least one voodoo priest. Leading the discussion was Adrienne Noel, a 40-year-old nurse with Zanmi Lasante. Her T-shirt had a slogan in Creole saying approximately, “The great national effort for the health of children.” She told them that the agents were already collecting information about each household — the data included measurements of each child’s arm circumference to gauge nutritional status — that would be used to calculate a “vulnerability score.” The score would determine the priorities of the development plan and the frequency of visits, up to twice a month. Twice monthly, Noel said, the agents would hold gatherings called “rally posts” at which they would immunize children or hold educational sessions for targeted groups, such as teenagers and young mothers. Each agent would have an up-to-date “opportunity map” — essentially a Yellow Pages to government offices and charities, the services they offer and how to apply for them. She emphasized, however, that Kore Fanmi is not a giveaway program. There have been many of those in Haiti, especially since the earthquake of January 2010.
.
“It is important to have the family contribute. If they get help building a latrine, the family can at least dig the hole or carry the materials,” Noel said. “It is important not to promise things, because people would then expect you to do things for them.” After three hours, the meeting wound down. Lunch — beans and rice, chicken and vegetables — was brought in from town in urns and dished into plastic bowls. Most of the men had met the agents in their communities. The meeting nevertheless was a revelation to many. “I now realize the program isn’t about getting a free house, or sacks of rice and containers of oil,” said Francois Charles, a 37-year-old wearing a red Carlsberg beer shirt. “It is about working with people.” “And working with people with respect,” said a man a few seats away.
The group stood, and a man prayed and wished everyone a safe trip home. A few who lived close by stayed around and helped clean up, tossing chicken bones to dogs scavenging beneath the gazebo.
.
The agents, about 50 of them, arrived the next day and gathered in the same gazebo. The meeting began with the singing of a hymn. Hired in January, they have on average a ninth-grade education. Even with that level, which was lower than planned, few women qualified. They spent multiple week-long stays in the nearby town of Hinche learning what a vaccine does, how to calculate a dosage and how to give an injection. They learned about ways to purify water and get a micro-finance loan. They learned how to raise consciousness, even as theirs was being raised. “The human rights framework is a very new view for a lot of them,” said Kate Thanel, a 28-year-old American employee of Zanmi Lasante who helped write the illustrated booklets the agents use. “Things like domestic violence and the rights of women and children are things we’re just starting to talk about in these rural areas.” Each agent is assigned about 100 families. The salary is $177 a month. (One woman quit a $125-per-month job as a teacher to become an agent.) They are eligible for a 20 percent bonus based on their performance, as judged by records and audits, and on the improvements in their families’ status, as judged by things such as children being in school and fully vaccinated. One of the agents is 22-year-old Mirlande Renelien. She and her husband live on rented land in a 20-house settlement called Trenka. They grow corn, wheat and millet, and hope her salary will allow them to also buy some animals. Renelien, in a bright green top, stood out not only because she was one of the few women but also because she was seven months pregnant. She had walked five hours to the meeting. The meeting did not get finished until midafternoon — too late for starting the trek back to Trenka. Renelien would spend the night with a cousin in Boucan Carre. Carrying her Kore Fanmi backpack, she headed down the hill into the village. At dawn, she would trudge back home, one weary soldier in a battle to make life in Haiti a little bit easier.

Recreating the Standard of Nursing Education in Haiti

7/8/2012
By Sheila Davis
PIH Director of Global Nursing
.
The second summer session of the Regis College Haiti Project recently came to a close. This unique program is recreating the standard of nursing education in Haiti. It has been a personal honor to work with such an incredible group of global nursing leaders, and I am incredibly pleased that—thanks to a generous $462,800 grant from the Clinton Bush Haiti Fund—we will have the opportunity to continue this partnership for years to come. The Regis College Haiti Project is a collaboration among the Regis College School of Nursing, Science, and Health Professions, Haiti’s Ministry of Health, and the University of Haiti to train nursing leaders in Haiti. At the completion of the three-year program, the 12 nursing faculty members will graduate from the University of Haiti as nurse practitioners with advanced educational and research skills and continue to teach the next generation of Haitian nurses. Next summer, Regis will host two cohorts simultaneously—the first cohort will return as teachers for the second group who will be at Regis for their first summer session of classes.
.
The 12 Haitian nursing professors enrolled in the project’s first cohort spent six weeks continuing their program by taking two masters-level courses at the Regis College campus in Weston, MA. The nurses also spent time shadowing nurses at local Boston hospitals. It was another summer of hard work and perseverance, and the 12 nurses will return to Haiti having gained critical experience in advanced nursing research, problem solving, and community health. My colleague Nadia Raymond—a Haitian nurse herself and PIH’s liaison to the Haiti Project—summed up well our gratitude to Regis College and all those involved. “I would like to thank the President of Regis College, Antoinette Hayes, RN, PhD, for her perseverance and patience making the Regis College Haiti Project a reality. Along with the team at Regis College, Partners In Health, Haiti's Ministry of Health, and other supporters, President Hayes has worked tirelessly to make this dream come true.
.
This is my second year assisting with the program, and I have enjoyed every second of it. In the process I have learned so much from the struggles and triumph of these 12 nurse leaders. I had the privilege of attending classes alongside them and providing English to French interpretation. I remain impressed with their eagerness to learn and their commitment to this program.” The Clinton Bush Haiti Fund grant is a watershed moment for this joint project. I look forward to updating you further on the progress of these nurses and their tireless efforts to improve medical education in Haiti.

Long Time Heath Solutions a Priority in Haiti (7/16/2012)

As earthquake recovery efforts show continued progress throughout the capital of Port-au-Prince and surrounding areas, American Red Cross activities in the Northern region of Haiti are showcasing new strides toward a broad approach to comprehensive health outreach. The American Red Cross was helping to establish long-term health and community improvements here before a massive earthquake rocked Haiti on January 12, 2010. Now, working with the Haitian Red Cross, the American Red Cross is working to evaluate and build community capacity to respond to threats like the 2010 cholera outbreak. “We need a more responsible strategy – beyond just showing up, implementing programs and leaving,” said Borry Jatta, technical advisor for health programs for the American Red Cross in Haiti. “We need to ensure that local communities are able to continue our work on their own, and we need to determine what are the skills and competencies the community needs to do so.” A child receives a dose of Shanchol, an oral cholera vaccination. The American Red Cross contributed $1 million to the vaccination campaign, implemented by Partners in Health in the Artibonite region of Haiti. Photo courtesy of Partners in Health.
.
Jatta will spend the next week assessing program activity in Cap-Haitien, a northern coastal city where the American Red Cross is targeting its expanded cholera outreach. “We’re working with the Haitian Red Cross to train these communities to respond right away and know how to minimize risk,” Jatta said. “They are now running the cholera oral rehydration points, for example, so if someone gets sick within the community, that would be the first point of response.” Additionally, more than 50,000 Haitians have already benefitted from the country’s first cholera vaccination campaign, implemented by Partners in Health, with support from the American Red Cross. The American Red Cross has dedicated more than $17 million to fight cholera in Haiti, including funding for vaccination, treatment centers, and prevention education, and more than $32 million to other health programs, including hospital and clinic support.

Haiti, US Sign Health Framework Agreement (6/26/2012)

By the Caribbean Journal staff
.
Haiti Prime Minister Laurent Lamothe and United States Ambassador to Haiti Kenneth Merten have signed into effect a partnership framework aimed at supporting Haiti’s health strategy. The agreement looks to advance Haiti’s ownership and oversight of an “adaptable and self-correcting public health system in Haiti,” and to reduce dependence on donor support over time, according to a release from the US Embassy. Its ultimate purpose is to “refocus” the cooperation between the two countries’ governments and their partners on supporting Haiti’s efforts to improve its health system. “By signing this partnership agreement, we want to meet the expectation of the Haitian people by offering a new way of working together that puts the government in the ‘driver’s seat,’” Merten said. “We want to reaffirm our commitment to provide resources to support the reconstruction of the Haitian health system.”
.
Lamothe thanked the US government for its involvement in a number of projects “that benefit the Haitian nation,” particularly in the field of health. “My government will play its part to ensure that the objectives of this partnership framework are met and respected,” the Prime Minister said. “This partnership is an agreement in principle of collaboration between the two governments to improve the Haitian health system.” The framework covers a five-year period, after which health care in a number of areas, from reproductive health to HIV/AIDS, is expected to have improved. The agreement was signed in a ceremony at the Plaza Hotel in Port-au-Prince.

IBM SmartCloud Helps Empower Medical Workers in Haiti

EWeek.com
By: Darryl K. Taft
.
IBM announced a collaboration with Colleagues In Care to empower medical workers in Haiti through use of the IBM SmartCloud cloud computing platform. IBM (NYSE: IBM) announced that its cloud technology is being used as part of an effort to improve healthcare delivery in Haiti through a collaboration with ‘Colleagues In Care’ Global Health Network. The organization is using IBM cloud-based social analytics and collaboration services to provide the global network of healthcare volunteers with immediate access to critical data and information for the current healthcare needs of the Haitian citizens. The network consists of about 200 doctors, nurses, and business professionals coming together virtually from all around the globe including Canada, China, Haiti, France, Ireland, Italy, the United Kingdom, and the United States. In a press release on the collaboration, IBM said prior to the 2010 earthquake in Haiti, the country’s healthcare programs were already poorly staffed with limited resources. According to the 2009 World Health Organization statistics, Haiti had one nurse and three doctors for every 10,000 people. Infant and maternal mortality, hypertension and stroke, and life threatening illnesses were among the highest in the world.
.
Today, Colleagues In Care is using the IBM SmartCloud for Social Business to virtually connect medical workers and volunteers from around the globe. Using the IBM SmartCloud, the volunteers and those on the front lines taking care of patients are armed with an online medical knowledge system that includes treatment options, clinical pathways, and best practices specific to the situation in Haiti. For example, doctors on the ground in Haiti now have immediate access to information. Previously, a healthcare worker typically had no access to a specialist to consult about a specific medical condition. Via the IBM SmartCloud, they can now immediately determine how to best care for a patient directly in front of them, at the same time collaborating with colleagues to determine more population-based strategies of effective care.
.
Medical workers can then develop, post, and share their stories about their experiences, providing this critical background to incoming medical workers. The volunteers are also participating in approximately 70 online communities on topics including “Mother and Baby,” “Hypertension,” “Heart Failure,” “Stroke,” and "Eye Care" to track initiatives from start to finish. “At Colleagues In Care, we share a deep level of purpose to stand with and support our medical colleagues in Haiti,” said John Kenerson, M.D. and co-founder of Colleagues In Care with his wife Lisbet Hanson, M.D., in a statement. “Working with IBM, we are helping the citizens of Haiti find relief from the devastations they continue to face daily. Many of our medical volunteers come from highly respected medical institutions, and we’re humbled by the opportunity to share our knowledge with those that need it most.”
.
Through social networking, file sharing, Web-based meetings, activities, and forums, the volunteers are sharing ideas and information as if they were in the same room. A video of Colleagues In Care using IBM cloud technology can be found here. IBM said the medical knowledge system has been so effective that Colleagues In Care is looking to replicate the system in other under-served regions and countries facing low and limited resources. IBM's partnership with CIC began as the result of an IBM Services Grant, but has evolved to include dozens of IBM employees from around the world who volunteer their expertise to help connect medical colleagues. The long-standing commitment to working with charitable organizations around the world is part of IBM’s On Demand Community, a global program reflecting IBM's strategy to help the world work better, making a wide range of knowledge and expertise available to volunteers.
.
CIC has connected many of the world's leading healthcare organizations and associations' medical specialists focused on a similar cause, mission and passion. The CIC best possible practices technology-based volunteer model can be replicated anywhere. There is no limitation to the potential reach of the Colleagues In Care healthcare collaboration model, IBM said. IBM has helped with several other hospital and healthcare organizations and embarked on a similar project with Children’s Hospital Boston. Indeed, IBM Interactive is working to help bring pediatric critical care expertise from Children's Hospital Boston to those who need it most, regardless of location, politics or lack of understanding, the company said. The project is known as OPENPediatrics. According to IBM, “This solution will transfer the knowledge clinicians need to treat critically ill children with clarity, ease and efficiency. The interactive prototype focuses on respiration-related diagnosis and treatment through simulation, video and social collaboration. This approach will help transform the apprenticeship model to an interconnected learning model through imagining new ways to apply interactive solutions to help deliver Smarter Healthcare.”
.
The Children’s Hospital Boston website describes the organization’s collaboration with IBM: "Under the leadership of Dr. Jeffrey Burns, Chief of the Division of Critical Care Medicine, and Dr. Traci Wolbrink, Assistant in Critical Care Medicine at Children’s Hospital Boston, OPENPediatrics is soon to launch a web-based educational resource for clinicians around the world. By harnessing the unparalleled reach of the Internet, and in close collaboration with IBM Interactive, access to the latest knowledge about effective health care will no longer be bottlenecked within the walls of institutions, but shared instantly so that clinicians across the globe can gain access to life-saving information at any time. The early 2012 beta launch of this comprehensive, continuously updated, and peer-reviewed knowledge exchange platform will be dedicated to providing multimedia and interactive educational resources to physicians and nurses on optimal care of the critically ill child. More specifically, the overall objectives include providing information on demand, curricular learning maps for training clinicians, and a platform for knowledge exchange and collaboration between care providers around the world."

Keeping Detainees Healthy - A Public Health Challenge (4/19/12)

The ICRC, which has visited detainees in Haiti continually since 1994, is engaged in a huge effort to help the Haitian authorities address the problems stemming from prison overcrowding and poor conditions of detention. The health of detainees is one of the major challenges that the authorities are striving to meet with the help of the ICRC, among others, in order to contain the spread of infectious diseases such as tuberculosis and HIV/AIDS. Sandra Martin is a general practitioner at the ICRC. She works closely with the authorities and prison doctors to improve access to health care in Haitian places of detention.
.
Why tackle the issue of health in detention?
.
A prison is a place that’s both closed and open. Detainees not only share that space, they also come in contact with the outside world, because they are monitored and assisted by prison officers and support staff and visited by their families. In prison, infections can spread very quickly if no system is in place to prevent diseases and treat them whenever and wherever they occur. For example, when detainees are admitted to prison, they may be carrying an infectious disease. When prison staff and families come in contact with these detainees, they risk contracting the disease and transmitting it to people on the outside, or vice versa. This clearly indicates that prison health is a real challenge to public health.
.
What are the issues affecting health in Haitian prisons?
.
Access to health care remains the major issue, mainly because of overcrowding and the shortage of prison health-care workers. Take, for example, the civilian prison in Port-au-Prince, the largest penal institution in Haiti. Most of the time, the detainees are locked in overcrowded cells, with no toilets. Many of them fall ill. The close quarters foster the spread of diseases such as cholera, scabies and flu, as well as tuberculosis, which is endemic in Haiti. Unfortunately, there are not enough medical workers in the prison to detect and care for the detainees effectively. Overall, prisons are overpopulated and understaffed. It’s essential to increase the workforce in order to remedy the existing problems to the extent possible. This will ensure greater attention to the needs of detainees, particularly in terms of health care. For example, the shortage of staff has direct repercussions on security management, which in turn affects access to care.
.
What solutions have been implemented or proposed by the ICRC?
.
Since 1994, the ICRC has worked closely with the Haitian authorities, and has offered them its expertise in improving conditions of detention. The ICRC trains prison medical workers in controlling the diseases that are most common in detention and in the management and use of medicines. It also supervises these workers. In emergencies, the ICRC facilitates the recruitment of additional medical staff and distributes medicines and other medical supplies. That’s what happened during the cholera epidemic: the ICRC helped the Prison Administration Directorate to step up medical care in the affected prisons by hiring 10 additional nurses. In addition, the prison dispensaries were regularly supplied with medicines, oral rehydration salts and intravenous fluids.
.
In April 2011, a hygiene-promotion team, composed of a nurse and an ICRC water and habitat engineer, was set up to train and raise the awareness of detainees and prison officers about the impact of hygiene on health in prisons. This team is also prepared to take action in places of detention in case of emergency. With ICRC support, a health project on preventing and treating infectious diseases in the prison environment was signed in 2009 between the GHESKIO centre (a Haitian private institution working on HIV/AIDS research and treatment), the US non-governmental organization Health Through Walls, and the Ministry of Justice. The implementation of this project led to a significant drop in deaths from tuberculosis in the civilian prison in Port-au-Prince. This positive outcome is very encouraging. Our goal is to get the Haitian authorities to extend the project to other prisons around the country.
.
You mentioned the good cooperation with the authorities. What does the ICRC expect from the authorities and other parties in the future? We would like to see a comprehensive health-promotion plan for detainees drawn up and implemented by the relevant authorities, possibly within the framework of a round-table meeting that brings all interested parties together. We must continue to press for greater synergy and coordination between the Haitian authorities and organizations working in the field of prison health. In addition, stronger working relationships between the justice and health ministries can only boost efforts to address the health of detainees. The ICRC, meanwhile, will continue to offer its expertise and to play the role of facilitator and mobilizer for other parties wishing to link up with a plan of action implemented by the Haitian authorities in the field of prison health.

Sebelius Encouraged by Vaccine Efforts in Haiti (4/23/2012)

Associated Press
BY JENNIFER KAY
ASSOCIATED PRESS
.
MIAMI -- Following a two-day trip to Haiti, U.S. Secretary of Health and Human Services Kathleen Sebelius said Wednesday that she was encouraged by the Haitian government's efforts to boost health in the Caribbean country still battling a cholera outbreak that began after the 2010 earthquake. Haiti, the United States and international partners announced this week a nationwide vaccination campaign to immunize Haitian children against diseases such as diphtheria, tetanus, whooping cough, measles rubella, polio and other diseases.
.
That program and efforts to curb the cholera epidemic bode well for the health of vulnerable Haiti, said Sebelius, who praised Haitian Health Minister Dr. Florence Duperval Guillaume for focusing on projects that could show results to international donors investing in long-term improvements to sanitation and access to clean water. "We're eager to work with her," Sebelius said. Plans to use some donor funding for earthquake recovery efforts are still waiting for approval as Haiti's government awaits confirmation of a new prime minister. Until then, Guillaume is "very focused on measurable, deliverable results, understanding that in order to have continued interest from the donor community, in order to make sure that their budget resources are spent wisely, they needed to focus on areas that really made a difference in people's health and could show people that there were results," Sebelius said.
.
Cholera has killed more than 7,000 people and sickened 530,000 more, according to Haitian health officials. Last week, Haiti's Health Ministry approved a separate campaign by Boston-based Partners in Health and the Haitian-run Gheskio Center to distribute a two-dose, oral vaccine to roughly 100,000 people. The cholera vaccination program was supposed to begin in January, but an ethics committee in the Health Ministry delayed the distribution out of concern that the two groups were using the vaccine as a research project.
.
The nationwide vaccination program to prevent infectious diseases includes support from the U.S. Centers for Disease Control and Prevention and from the GAVI Alliance, a group of international health organizations, the Bill & Melinda Gates Foundation and others. On her way back to Washington, Sebelius toured women's health, pediatric and dental services at a Borinquen Medical Centers of Miami-Dade clinic on the edge of Miami's Little Haiti. Roughly 40 percent of Borniquen's patients at its seven clinics are Haitian, a number that has swelled since 2010 with Haitians displaced by the earthquake and their South Florida family members seeking care, said president and CEO Robert Linder.

MSF Opens Surgical Referral Center in Port au Prince (4/11/12)

Médecins Sans Frontières/Doctors Without Borders (MSF) has officially opened a new emergency trauma, orthopaedic and visceral surgery referral centre in the Tabarre neighbourhood, in the east of Haiti’s capital, Port-au-Prince. Named ‘Nap Kenbe’ – Creole for staying well – the surgical referral centre is the third facility providing emergency treatment to be opened by MSF in the capital, Port-au-Prince, since the earthquake of 12 January 2010, and its fourth in this region (Ouest) of Haiti. Work on the 107-bed Nap Kenbe centre began in 2011 and was completed in February 2012. The centre treats victims of accidental trauma, such as falls and road accidents, and victims of violence, such as beatings, assaults and bullet wounds. “MSF is now supporting the Ministry of Public Health and Population with 600 hospital beds in Haiti for emergency care. This is still far from adequate, but is nevertheless an advance,” says Gaëtan Drossart, MSF’s head of mission in Haiti.
.
In a country where 75 percent of the population live below the poverty line, and where referral facilities are vastly inadequate, MSF’s new centre will improve access to surgical care for the population of the Port-au-Prince metropolitan area. “By bringing together Haitian health professionals and high tech equipment, the Nap Kenbe centre makes it possible to deliver high quality care in a city where many Haitians have had no access to emergency trauma treatment,” says Drossart. “At a time when the Haitian government and donors are working to rebuild the country, it is essential to deal with the shortcomings in high quality and accessible medical care for a very impoverished population.”

Haitian Women Diagnoses with Rabies Dies (7/20/2011)

NJ Today
.
A 73-year-old woman who tested positive for rabies after being bitten by a dog in her native Haiti in April died today at Overlook Medical Center in Summit. The New Jersey Department of Health and Senior Services and the U.S. Centers for Disease Control (CDC) are working with Overlook Medical Center and the Westfield Regional Health Department to assess the level of exposure among the patient’s family, health care workers at the hospital and other possible contacts. The woman developed neurological symptoms on June 25 while visiting family in Union County. She had been hospitalized at Overlook since July 2 and could have been infectious as of June 11. Rabies is a deadly virus found in the saliva of a rabid animal and is transmitted by a bite, scratch or contact with infected saliva via exposure to an open cut or wound. Initial symptoms can include fever, pain at the site of the bite, lethargy, lack of appetite, nausea and vomiting. The incubation period is usually one to three months, but may be longer. After the illness progresses to the point of encephalitis—or infection in the brain—the disease is almost always fatal. Rabies can be prevented with a dose of immune globulin and a series of vaccinations.
.
The CDC notified the state and the hospital’s Infection Prevention Department Monday, July 18 that the woman was positive for rabies. Additional CDC testing confirmed today that the patient was infected with a rabies strain related to a strain in an individual infected in Haiti several years ago. An assessment is being made of health care workers who may have come in contact with the patients, as well as to assess their level of exposure and the need for post-exposure treatment. “The risk of infection to health care workers and others who may have been in contact with the patient is extremely low. Given the infection control precautions used in hospitals, exposures should be very minimal,” said Acting Health and Senior Services Commissioner Dr. Tina Tan. Dr. Tan noted that transmission would have to occur through contact with an infected patient’s saliva into an open cut or wound on a health care worker or other contact. Transmission of rabies from a patient to health care workers has never been documented in the U.S., according to State Public Health Veterinarian Dr. Faye Sorhage, who is at Overlook working with the hospital staff and a CDC representative. “We are conducting thorough interviews and assessments of all health care personnel who may have had contact with the patient,” said Mary Pat Sullivan, RN, chief nursing officer at Overlook Medical Center. “With standard infection control policy and procedures in place in the hospital setting, exposure risk is minimal.”
.
Rabies cases in humans are rare in the U.S. Most are caused by contact with bats or bites from dogs and other animals received in other countries. In New Jersey, raccoons and bats carry the virus and cats account for the vast majority of domestic animal rabies cases. Dogs and other domestic pets animals can also become infected but can be vaccinated to protect against the disease. To protect yourself and your pets from rabies:
.
Vaccinate your pets against rabies
.
Do not feed or touch wild animals
.
Avoid contact with strays or pets other than your own
.
Report unusual behavior in stray or wild animals to municipal animal control
.
Report all bites immediately to your local health department
.
Individuals who have been bitten or attacked by an animal should take the following precautions:
.
Wash the wound immediately with plenty of water and soap
.
Learn as much as you can about the animal. If the animal is with an owner, get the owner’s name and address. If it is a wild or stray animal, look to see if there are any features that will allow you to identify it later on. If possible, safely capture the animal and confine it and call your local animal control officer
.
Contact your physician or local emergency room for wound care and consultation about the need for preventative treatment

Report the incident to your local health department
.
The last case of rabies infection in New Jersey was in 1997 when a Warren County man died after removing several bats from his home. The man did not seek medical attention or notify public health officials that he had been either bitten or scratched. Prompt medical attention may have saved his life. Prior to that, the most recent human rabies case in New Jersey was in 1971. In 2010, there was one human rabies case in Louisiana and it was attributed to exposure in Mexico. In 2009, there were four human cases diagnosed in the US; one diagnosed in Virginia was attributed to a dog bite that occurred in India. The other three were bat exposures in Texas, Indiana, and Michigan.

Yele Donates Ambulance to Saint March (Haiti Libre-7/21/2011)

On Tuesday, the world star, Wyclef Jean presented on behalf of Yéle Haiti, an ambulance to the hospital Saint-Nicolas, to Saint-Marc. The singer said that "the ambulance was donated by the Chicago Fire Department..." and that it "will help save lives," adding "I was here in October with the Senator Youri Latortue when the epidemic cholera began, and the medical staff told me about the problem of ambulance." For Youri Latortue, Senator of the Artibonite "is a promise kept !"Yfto Mayette, the hospital director declared, for her part "this is a dream which today becomes a reality" adding that "This ambulance will allow us to help the patients [...] if a patient is beyond our level, the ambulance will allow us to transport it to another hospital..." Now the hospital Saint-Nicolas has two ambulances.

Clinton/Bush Haiti Fund Announces $1.8 Million for Health

7/20/2011
Business Wire
.
The Clinton Bush Haiti Fund today announced a $1.8 million grant to the Boston-based nonprofit Partners In Health to support its Haitian sister organization Zanmi Lasante in a program that will make long-term, sustainable improvements in the scope and quality of Haiti’s healthcare and medical education sectors. The grant will be used to launch a residency program for family practice physicians and a certification program for auxiliary nurses at the public hospital in St. Marc supported by Partners In Health and Zanmi Lasante. “The earthquake and cholera outbreak have only heightened the healthcare sector’s challenges,” Clinton Bush Haiti Fund CEO Gary Edson explains. “The Clinton Bush Haiti Fund’s three-year grant for Zanmi Lasante’s work is an investment in Haiti’s human capital. It will provide training for critically needed family practice physicians and auxiliary nurses at l’Hôpital Saint Nicolas, the chronically understaffed public hospital serving 220,000 St. Marc residents and, ultimately, the 1.5 million people of the surrounding Artibonite region.” Additionally, Zanmi Lasante will leave a lasting legacy for the nation’s public health system by upgrading and standardizing auxiliary nurse education, creating a first-ever certification program to be replicated by other medical training centers throughout Haiti.
.
Amplifying the impact of the Clinton Bush Haiti Fund’s grant, Partners In Health will match the funds more than one to one, and will work closely with the National Faculty of Medicine and Haiti’s Ministry of Public Health and Population. Today’s announcement is an example of the Clinton Bush Haiti Fund’s support for projects that provide both humanitarian assistance and economic opportunity, helping Haiti “build back better.” “This grant represents an invaluable investment in the decentralization and long-term, sustainable reconstruction of Haiti’s health system,” said Dr. Paul Farmer, co-founder of Partners In Health and chair of the Department of Global Health and Social Medicine at Harvard Medical School. “It will enable Zanmi Lasante and Partners In Health – working in partnership with Haiti’s Ministry of Health and national medical school – both to improve the quality of care for the people of St. Marc and to train a new generation of healthcare providers to deliver comprehensive, community-based care in even the poorest and most remote places.”
.
The Clinton Bush Haiti Fund is a 501(c)(3) nonprofit organization founded after Haiti’s January 12, 2010 earthquake, when President Barack Obama asked former Presidents Bill Clinton and George W. Bush to head a fund aimed at easing the suffering of the Haitian people while laying the groundwork for “building back better.” The Clinton Bush Haiti Fund initially responded to the catastrophe with millions in humanitarian relief. By the time the Fund began independent operations in May 2010, it transitioned to primarily serving its longer-term mission of sustainable reconstruction efforts designed to promote jobs and create economic opportunity, enabling Haiti to chart its own successful future. To date, the American people have entrusted the Fund with more than $53 million from 200,000 individuals, supporting innovative programs that help Haitians to help themselves.
.
Partners In Health (PIH) works in 12 countries around the world to provide quality healthcare to people and communities devastated by joint burdens of poverty and disease. PIH has been providing vital healthcare services in Haiti for more than 20 years, working with the Haitian Ministry of Health to deliver comprehensive health care services across the Central Plateau and Lower Artibonite Valley. For more information please visit www.pih.org.
.
Zanmi Lasante (Haitian Creole for “Partners In Health”) was founded in 1983 to provide health care and social support to a destitute squatter community of peasants displaced by a hydroelectric project in central Haiti. Today, Zanmi Lasante is the largest healthcare provider in Central Haiti, serving an area across the Central Plateau and Lower Artibonite regions. Since the 2010 earthquake, Zanmi Lasante has been working with Haiti’s Ministry of Public Health and Population and the National Medical School of Haiti on plans to sustain medical education in the short-term and to improve it over the long-term. Among its efforts, Zanmi Lasante has taken on 15 medical residents whose training was disrupted by the earthquake, allowing them to continue their training at various PIH facilities. The organization has also completed more than half of the construction of a 320-bed teaching hospital in Mirebalais that will open its doors in January 2012.

MSF Reorganizes Post-Earthquake Medical Services (6/22/2011)

Following the January 2010 earthquake MSF launched the largest emergency operation in its history. A year and a half later, MSF’s projects are adjusting to changing situations. Thirty-five seconds. That’s all it took for an earthquake to shatter the lives of millions of Haitians on January 12, 2010. Medical needs were immediate and massive. More than 300,000 people were injured and 1.5 million left homeless. Then in October, a cholera epidemic struck, with 250,000 cases in the first five months. MSF treated almost half of these patients. Today, the epidemic is resurgent and hurricane season is approaching. In response to the situation on the ground, Doctors Without Borders/Médecins Sans Frontières (MSF) is reorganizing its services in Haiti. The needs remain high. In many places where MSF works, medical care was insufficient even before disaster struck.
.
“MSF’s Trinité trauma hospital collapsed in the quake, killing seven patients and two of our colleagues,” said MSF Emergency Director Dr. Pierre Wagner. “The others immediately set to work to help victims that were arriving from everywhere. “We quickly resumed work in inflatable tents set up on a school sports field. There we performed more than 16,000 consultations and 9,000 surgeries. But it’s time to leave this provisional facility. The school wants its field back.” Dr. Wagner and his team are transferring the emergency services that were based at the inflatable hospital to a new MSF hospital—a 170-bed facility that will improve access to free medical services for people living in neighborhoods like Cité Soleil, the largest slum in the city. MSF has been supporting the Choscal public hospital in Cité Soleil since 2004, but “we’re going to withdraw from Choscal so that the Ministry of Health can take over again,” said MSF Head of Mission Gaëtan Drossart. “We’re also building a new 114-bed hospital to the east of town.” In an industrial park in the neighborhood of Tabarre, 100 workers began excavation in November and will assemble the 268 modules that make up the facility before it opens in the fall.
.
MSF has offered emergency obstetric care for pregnant women in Port-au-Prince since 2006. Even before the earthquake, Haiti had the highest level of maternal mortality in the western hemisphere. “Our maternity hospital sustained terrible damage on January 12,” said MSF Medical Director Dr. Hans Boucher. “Our teams went to reinforce the Ministry of Health maternity hospital for almost a year. Meanwhile, we built a new 100-bed emergency obstetrics center that opened in March. “We don’t handle normal births because there are already enough places for that,” said Dr. Boucher. “We take complicated cases like eclampsia and hypertension; cases where the life of the mother or the child is in danger.”When the earthquake struck, MSF teams already in the country immediately started giving aid, and reinforcements soon arrived. Staff began work in the densely populated southern suburbs of Port-au-Prince, turning a dental clinic into a 80-bed emergency facility with a focus on surgery and pediatric care. That clinic is set to close in late July with the opening of MSF’s new, larger hospitals.
.
“In Léogane, the epicenter of the earthquake, we found an enormous need for medical services,” said Gérard Bedock, an MSF coordinator. “Eighty percent of the buildings had been destroyed and not one health center was functioning.” MSF set up a hospital beneath some basic tents in Léogane a few days after the earthquake; it later grew to 150 beds, specializing in obstetrics, pediatrics, and emergency trauma cases. The cases that staff are now seeing are no longer linked to the earthquake; the facility has become a community referral hospital and MSF aims to hand it over to the Ministry of Health. All of MSF’s new facilities were built in coordination with the Haitian health authorities, and their design has taken earthquakes and hurricanes into account. MSF spent $150 million (€100 million) in Haiti in 2010 and plans to spend $70 million (€50 million) in 2011. About 3,000 Haitian staff and 250 international staff work for MSF in the country.

Limb Salvage Team Helps Victims Of Haitian Earthquake

5/31/2011
.
A team of plastic and orthopedic surgeons achieved a high success rate in limb salvage-minimizing the need for amputations-among patients injured in last year's devastating earthquake in Haiti, reports a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). Mobilized in the acute phase of disaster response, this "ortho-plastic limb salvage team" approach provides expert surgical care to severely injured patients under the most difficult conditions. "This study gives valuable information on the range and frequency of procedures over time, which can be used to help in the preparation for any future emergencies and demonstrates a low amputation rate for the patients treated," according to the new report by Dr. Anthony James Clover of Cork University Hospital, Ireland, and colleagues. Dr. Clover and colleagues detail their experience on a surgical team that traveled to Haiti in the aftermath of the devastating earthquake on January 12, 2010. The trip was organized by the British Association of Plastic Reconstructive and Aesthetic Surgeons, in partnership with Medical Emergency Response International. A preliminary team was on the ground in Haiti by January 15. By January 20, surgical procedures were being performed in a tent hospital set up on a tennis court in a suburb of Port-au-Prince. The team followed a combined orthopedic/plastic surgery approach to managing severe limb injuries. The focus was on avoiding amputation whenever possible. A rotating staff of five plastic surgeons, five orthopedic surgeons, and five anesthetists, supported by traveling and local nurses, performed the operations. During the 10 week trip, 348 operations were performed on 148 patients-an average of 47 surgeries per week. Most of the patients had severe crush injuries, and were sent to the hospital for surgery after initial evaluation elsewhere. The orthopedic surgeons used bone manipulation and fixation techniques to repair and reconstruct fractures and other bony injuries. The plastic surgeons used skin grafts and other techniques to reconstruct the skin cover and blood supply to the injured limbs.
.
Most of the orthopedic operations were carried out in the first few weeks. The need for general anesthesia also decreased, reflecting the decline in more complex operations as time went on. Overall, about three-fourths of the procedures were soft tissue procedures requiring the expertise of plastic surgeons. Dr. Clover and colleagues believe their combined orthopedic/plastic surgery approach was highly successful in salvaging the severely injured limbs. Just four percent of patients eventually required amputation. Complications were infrequent and generally related to delays in medical care before arrival at the surgical hospital. The experience highlights the ability of surgical specialists to execute a prompt and effective response to mass-casualty disasters like the Haitian earthquake. The high priority on preserving the injured limbs was due to the high disability associated with amputation in poor countries like Haiti where rehabilitation and prosthetic services aren't widely available. By focusing on limb salvage, their goal was to mitigate the long-term human and economic consequences of limb loss. "This experience shows that a favorable amputation rate can be achieved, and the changes in work load over time demonstrate the benefit that an ortho- plastic limb salvage team can provide in the early stage of disaster relief," Dr. Clover and coauthors conclude. They also emphasize the need for the quickest possible response, in order to have appropriate surgical expertise manage the initial influx of acute injuries. The organizers are creating lists of needed equipment and supplies, as well as surgeons and other medical professionals available to respond to future disasters. Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

How Structural Violence Impacts Maternal Mortality in Haiti

5/19/2011
Partners in Health
.
“Structural violence is one way of describing social arrangements that put individuals and populations in harm’s way… The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people.” - PIH co-founder Paul Farmer, Pathologies of Power
.
“When unjust systems or structures prevent people from achieving good health, and from achieving good lives, this is structural violence in action,” says Donna Barry, Director of Policy and Advocacy for Partners In Health (PIH). In an article entitled “Structural Violence: A Barrier to Achieving the MDGs for Women,” published recently in the Journal of Women’s Health (JWH), PIH Medical Director Joia Mukherjee, Barry, and several other co-authors argue that maternal mortality continues to plague poor women in poor communities because public health interventions have not addressed the impact of structural violence. Drawing on examples from PIH’s work in Haiti and Lesotho, the authors also clearly demonstrate how women’s lives can be saved and transformed by programs that combine quality health care with determined efforts to uproot structural violence and the social determinants of disease, especially poverty, sexism, and gender-based violence. In the late 1980s, 99 percent of the half million maternal deaths occurring each year took place in poor countries. Nearly a quarter century later, 350,000 women still die every year from pregnancy-related causes, the vast majority in the poor world. In a 2010 report on maternal mortality, the United Nations Population Fund (UNFPA) found that complications from pregnancy and childbirth are the leading causes of death for 15-19 year old women and adolescent girls in developing countries. ”Structural Violence” assesses the status of the United Nations Millennium Development Goals (MDGs), unanimously set by 191 UN member states in 2000. Three of the eight MDGs deal directly with women’s health: to promote gender equality and empower women (MDG-3); to reduce child mortality (MDG-4); and to improve maternal health (MDG-5). “[But] while elevating the status of women is intimately connected to achieving these goals…structural violence – in terms of gender inequality and the feminization of poverty – serves as a barrier to achieving the MDGs,” write Mukherjee and her co-authors.
.
“When we focus only on providing new facilities and services, and we don’t remove the real barriers to utilization, we fail,” says co-author Sarah Marsh, former Director of Women’s Health Programs for Partners In Health in Haiti, in an interview about this article. “We have to understand that women may have other reasons for being intimidated from the formal health care system.” Undoubtedly, the most substantial barriers to health care for poor women have been the costs – including user fees charged by health facilities, the high costs of transportation, and lost work time traveling to the nearest clinic. Women are also frequently inhibited from accessing health care by social and cultural factors, including stigma, reticence to expose highly personal matters to medical attention, and intimidation by their husbands and families. PIH has found that one way to overcome the structural violence in this system is by changing how facility-based health care is delivered. For example, in most developing countries, family planning services are “vertical” within the health system: a woman sees a family planning nurse in a separate room from routine care, with separate registration and waiting lines. Not only can this eat away at precious time the woman could be using to care for her family or earn income, the separate waiting line may carry stigma within her community. PIH works to combat this trend. Nurses at our rural clinics in Lesotho offer to discuss family planning at each visit a woman makes to the facility, regardless of the focus of her visit. This is one example of how PIH has systematically used lessons learned in Haiti, where Zanmi Lasante overcame the stigma and additional wait associated with HIV testing by offering it routinely with each health system contact – from check-ups to malaria treatments.
.
Additionally, pregnant women are offered transportation money and logistical assistance to reach clinics for prenatal care. Delivery plans are coordinated with the woman and her relatives, and women who live too far from the clinic are provided beds and meals at a lying-in center for the two weeks before their due date. Pregnant women outside a lying-in center in Lesotho. These centers allow women to make the long journey from their homes to the health center before they go into labor. “Meeting women’s family planning needs by reducing waiting times in clinics, increasing the number of providers delivering family planning methods, and improving access by delivering services in the communities helps overcome structural barriers to family planning and improves a country’s overall ability to provide universal access to reproductive health services,” write Mukherjee and her colleagues. Another approach that directly addresses structural violence is the recruitment, training, and employment of local women as health agents. The majority of community health workers (CHWs) employed by PIH are women; in the countries profiled in the article, Lesotho and Haiti, more than 90 percent and 80 percent of CHWs, respectively, are women. Providing village women with paying jobs that are valued in the community improves the status of women in several ways.
.
“First, this values their knowledge of the local population and conditions,” write Mukherjee and her co-authors. “Second, it puts cash in the hands of women, which is known to improve the health of women and children. In addition, some of these CHWs were traditional birth attendants, but have now been trained and compensated to be more general community health workers and to accompany pregnant women.” In Lesotho, for example, hundreds of traditional birth attendants (TBAs) who had previously delivered babies in women’s homes have been trained and employed to reach out to all women of childbearing age in their villages. These maternal health workers provide community education, and help pregnant women and their families secure access to health services before delivery. As part of the program, both the maternal health workers and the pregnant women they work with are offered incentives to attend prenatal visits, deliver at the clinic or hospital.

Haiti Prepares Plan to Vaccinate 90% of Infants (5/16/2011)

Associated Press
By DONALD G. McNEIL Jr.
.
Haiti, which did a poor job of vaccinating its children even before the 2010 earthquake, has come up with a plan to immunize 90 percent of its newborns by 2015, the Pan American Health Organization announced last week. The country now needs over $100 million to carry it out. Assuming that GAVI — the former Global Alliance for Vaccines and Immunization — approves the plan, Haiti will be the last country in this hemisphere to adopt a pentavalent vaccine that protects against Haemophilus influenzae type B, or Hib, and hepatitis B, as well as diphtheria, whooping cough and tetanus. The plan will also include the relatively new rotavirus and pneumococcal vaccines. Even before cholera reached Haiti in 2010, 2,000 children each year died of rotavirus, which also causes diarrhea. Haiti has been free of polio, measles and rubella since 2002. The ambitious plan depends on international support, which poured in after the earthquake and cholera epidemic. Major improvements will be needed, said Dr. Jon Andrus, deputy director of the Pan American Health Organization, liked building a solar-powered “cold chain” to keep vaccines refrigerated as they are distributed to rural clinics. And even assuming GAVI approval, donations are still $21 million short. Whether the plan works will depend on Haiti’s ability to reverse decades of incompetent government and bad coordination among aid groups. “In Haiti, you can never tell,” Dr. Andrus said. “There may be a coup, there may be a hurricane, there may be an earthquake. Things are unpredictable.” A version of this article appeared in print on May 17, 2011, on page D6 of the New York edition with the headline: With World Support, an Ambitious Plan Would Vaccinate 90 Percent of Infants.

PAHO Thanks American Red Cross for Blood Support (5/11/2011)

The Director of the Pan American Health Organization/World Health Organization (PAHO/WHO), Dr. Mirta Roses, thanked the American Red Cross for its support in maintaining supplies of blood for transfusions in Haiti after the earthquake that devastated the country in January 2010. In a letter to the President of the American Red Cross, Gail McGovern, Dr. Roses highlighted the coordination of efforts to ensure an adequate blood supply in Haiti between January 2010 and March 2011. She noted that the Red Cross continued to supply blood to Haiti not only during the emergency period but also for a number of months during the recovery phase. On behalf of the Haitian Ministry of Health and the Haitian people, I want to express my endless appreciation to the American Red Cross for its invaluable contribution,said Dr. Roses.
.
Haiti has the lowest blood collection rate in the Americas, but it managed to nearly double the number of units it collected each year between 2005 and 2009. Then the January 2010 earthquake destroyed the National Blood Transfusion Center in Port-au-Prince, leaving the country with only 25 percent of its normal capacity to collect, process and store blood for transfusions. In her letter, Dr. Roses cites the Red Cross's William Fitzgerald, Senior Advisor, and Debbie Perkins, National Inventory Manager, for coordinating the first delivery of 249 units of red blood cells from the United States to Haiti on 21 January 21 2010 and 350 additional units on 28 January. Overall, 5,130 units were shipped to Haiti between January 2010 and March 2011. Coordinating these blood supplies required continuous communication between participating organizations in the United States (American Red Cross, America's Blood Centers, Blood Centers of America, the National Blood Exchange, PAHO/WHO headquarters) and in Haiti (Ministry of Public Health, PAHO/WHO country office, and the Program for Essential Medicines and Supplies (PROMESS) in Port-au-Prince, managed by PAHO/WHO) to assess local blood needs and the country's limited capacity for storage and distribution.

Haitian Red Cross Launches SMS Malaria Campaign (5/1/2011)

The Haitian Red Cross has launched a prevention campaign against malaria in throughout the country, with the sending of SMS to more than 3.5 million people. The messages include information such as how the malaria is transmitted, how to recognize symptoms, treatment options and the simple steps for prevention. The SMS campaign is only a part of the strategy of the Red Cross in Haiti, which focuses on the engagement and the participation of the community. "Mobile technology is a fast, easy and economical way to make available information that can save lives directly in the hands of the people" The SMS campaign has also encouraged the Haitians to listen the weekly program of Radyo Wouj Kwa, which is broadcast live nationwide on the network of Radio 1. A special program dedicated to malaria with invited experts, including Dr. Clergé Junior Agénor, Coordinator of Program of Health Emergency of the Haitian Red Cross and Jean-Philippe Strayford, promoter of hygiene. Listeners had the opportunity to appeal directly to ask questions and get appropriate answers. The appellants were anxious to know among other things: how to manage insecticide-treated mosquito nets, if nets are dangerous to humans, what specific measures could be taken to protect children against malaria.
.
"Hundreds of volunteers of the Red Cross visit the camps and communities every day," has declared Dr. Clergé Junior Agenor. These young reinforce the messages of awareness and simple preventive measures with community members, such as information on cleansing, the destruction of places, where mosquitoes can breed easily and the promotion of the use of insecticide treated bednets. Pregnant women and young children especially are the groups most at risk. Besides this awareness activity, the Haitian Red Cross also provides a distribution targeted of insecticide-treated bed nets to families in selected communities at risk of Carrefour, Mirebalais, Arcahaie, Sainte Marie, Léogâne and Petit Goâve. A total of 500 families will benefit from these nets.

McMaster School Of Nursing Leads The Way In Haiti (4/29/2011)

Anita Fisher, an associate professor with McMaster University's School of Nursing (SON), is leading the way for Canada in efforts to rebuild nursing education in Haiti since last year's devastating earthquake. Fisher presented at the Partnerships to Enhance Nursing Education in Haiti conference in April in New York City. She represented the only Canadian university in attendance and gave an overview of its near 20-year involvement with Haiti. This two-day meeting of representatives from several universities, along with 14 Haitian nursing officials, was to coordinate efforts of North American nursing schools to plan and support nursing education in Haiti. A grant in October from the Canadian government allowed the SON, in partnership with University Hospital School of Nursing in Haiti, the Haitian Nurses' Association (ANIHL) and the Hopital Universitaire de La Paix (HUP) in Port-au-Prince, to support joint Canada-Haiti academic projects to build capacity of academic institutions, provide opportunities for Haitians to resume studying and enhance their skill sets.
.
To that end, Fisher visited Haiti last fall to better understand nurses' concerns and determine how the SON could aid nursing development at the three organizations. She said Haitian nurse leaders want a four-year bachelor of science in nursing (BScN) required for entry to practice and that McMaster could provide support for this given its role in developing the program in Canada. In January, two Haitian nursing students visited McMaster to describe their fellow students' needs and learn about health care in Canada. A visit to Hamilton, Ont. by four Haitian nurses and one senior administrative official is planned for June. "We need to look at the standards for nursing education across Haiti," said Fisher. "Bringing Haitian nurses from each level promotes understanding of their needs and where we can help. Working hand-in-hand with these nurses to develop their BScN curriculum, we can help them develop as a teaching institution and improve the level of patient care at the hospital level."

Putting around the clock care in a place at Haitian hospital

3/30/2011
The Record
By Greg Mercer
.
PORT-AU-PRINCE, HAITI — Juslene Wisler, a 54-year-old street vendor sitting outside the gates of the La Paix Hospital, knows health care in her country follows a strict clock. “If you get a sickness at night, you can die,” she said matter-of-factly, as trucks and crammed taxis careen past her. “There are no doctors at night.” Less than a hundred metres away inside the hospital walls, Dr. Bob Wickett and nurse Kelly Freeman, volunteers from St. Mary’s General Hospital in Kitchener, are trying to change that. They’re trying to do something that’s never been done before at a public hospital in Haiti — build a 24-hour emergency room in a country where only the rich can afford that kind of urgent care. In Haiti, that’s almost an audacious idea: that anyone, whether they live in a nice house on the hill or a tent slum, can be rushed into an ER any time of day and get immediate attention. Here, doctors usually quit work in the afternoon and patients are used to waiting until the next morning.
.
Last May, Wickett and Freeman, both veterans of the St. Mary’s ER, agreed to lend their expertise to a project that has been the dream of many, but unrealistic until the Hamilton-based St. Joseph International Outreach Program got involved. “This is a new concept for them … and it’s requiring an entirely new specialty,” Wickett said. “We didn’t really know what we were getting into until we got here.” The pair soon learned they were basically starting from scratch. When they first arrived, La Paix’s ER was being used as a storage room. And the would-be emergency department was horribly undersupplied. There wasn’t a single person on staff at La Paix who had worked in emergency care, either.
.
And this is still the poorest country in the western hemisphere, so Wickett and Freeman know the La Paix ER will be very different from what they are used to working with in Canada. They know it will treat a different kind of trauma — with high levels of motorcycle crashes, stabbings and gunshot wounds — than what they see in Kitchener, too. But they’re thrilled to help Haitians create something that’s really a first of its kind. And they say the Haitians’ enthusiasm for the new department is infectious. “They’re writing the book on emergency care in Haiti. They’re pioneers,” said Freeman. “How can you not want to try to help with something like this?” The goal is to have the ER working around the clock by July. There is still a lot of work to be done first, said Myriam Grouse, La Paix’s ER department chief. They need to train nurses and doctors and order a long list of equipment.
.
“We don’t have everything we need yet, but we are getting ready,” she said. Among the hospitals’ medical staff, the project is a source of pride, although some are grumbling about the prospect of working overnight shifts. “When we have a patient that has a problem but we can’t accept them, we suffer, too,” said Myrtha Eugene, the head ER nurse at La Paix. “I’m very happy about this. This is progress.” Before the ER opens, both women will travel to St. Mary’s for more training, and ER staff from the Kitchener hospital will travel to La Paix, too. For Haitians who long ago accepted that 24-hour urgent care is only for those who can afford it, the project is welcome news. “Right now, you can’t go to the hospital at midnight, unless you have money. We just wait until the morning,” said Meritane Mathurin, waiting to get picked up outside La Paix’s main entrance. “If we could come at any time and find doctors, that would be very good. This will be a great saviour.”

Cuba and Brazil develop health cooperation in Haiti (2/24/2011)

A Brazil-Cuba-Haiti Tripartite Commission was created to restore the Public Health System of Haiti after an earthquake devastated its capital, Port-au-Prince, in January 2010. Granma newspaper reported last June 8 that this alliance would contribute to the training of professionals and the building of health facilities. This same newspaper published on Thursday statements in Port-au-Prince by Carlos Felipe Almeida D’Oliveira, Project Coordinator of the Brazilian Health Ministry, who affirmed that health cooperation in Haiti runs satisfactorily. Almeida explained that the Brazilian Congress assigned an amount of 80 million dollars to be used this year and the following in different projects like the construction of these hospitals, with the assistance of Cuban experts. He pointed out that the hospitals will be located in Carrefour, Bon Repos, Tabarre and Croix des Bouquets, in the West department, very near to the capital. The project also includes the purchase of 30 ambulances, vaccines and other supplies to support the national immunization program, and the training, in two years, of 2,000 health community activists, an experience already implemented successfully in Brazil. Almeida extolled the work of the Cuban Medical Brigade, which, until last Friday, had saved the life of 69,639 Haitians infected with cholera, registering a very low lethality rate (0,39 per cent) and reporting no deaths for 34 days in a row due to that disease.

Earthquake in Haiti — One Year Later (WHO/PAHO - 1/31/2011)

Situation Overview: One year after the 12 January earthquake struck Haiti, PAHO/WHO continues to support the response through initiatives aimed at rebuilding a devastated health system and improving the health of the Haitian population. The human impact of the 7.0 magnitude earthquake had an unimaginable impact in a country marked by a high incidence of poverty. Prior to the earthquake, around 67% of the population was living on less than US$ 2 a day. An estimated 220,000 people lost their lives and over 300,000 were injured. Roughly 2.8 million people were affected and nearly 1.5 million found themselves without a home. A year later, one million people remain in temporary settlement sites throughout Port-au-Prince and other affected areas.
.
In the immediate aftermath of the earthquake, a complex humanitarian response was launched to save lives and assist the affected population. Four days after the disaster, PAHO/WHO began holding daily coordinating meetings as Health Cluster lead. Hundreds of NGOs and bi-lateral agencies offered support to the Government of Haiti – pouring human and material resources into the country. Ensuring the intentions of partners were appropriately aligned with the priorities of Haiti's Ministry of Health and Population (MSPP) was a key function of the Health Cluster in the initial weeks following the earthquake. The Cluster was the sole mechanism by which priorities could be outlined with MSPP and synchronized among implementing partners. In the months that followed the earthquake, far reaching interventions saved lives and reduced the health consequences of the disaster. Key accomplishments include:
.
• Rapid establishment of 17 field hospitals in the most devastated areas which provided emergency medical care to thousands of patients
.
• Uninterrupted management of the cold chain • Distribution of 345,000 boxes of emergency medical supplies between January and March through PROMESS, the medical warehouse managed by PAHO/WHO
.
• Coordination by the PAHO/WHO Health Cluster of over 400 health partners in the four months following the earthquake
.
• Implementation of the first phase of the PAHO/ WHO, UNICEF and MSPP's post-disaster vaccination program, resulting in the delivery of over 900,000 vaccine doses to the most vulnerable children and adults
.
• Establishment of three distinct disease surveillance systems to track illness, share information, and alert personnel to emergency situations
.
• Comprehensive mapping of all health facilities in Haiti, providing the foundation for a referral system
.
• Coordination of the response to the cholera outbreak, and support to CTCs (Cholera Treatment Centers) and CTUs (Cholera Treatment Units)
.
• Provision of essential medicines and medical equipment for the treatment of cholera patients
.
• Organization and management of teams to investigate and control cholera outbreaks in all 10 Departments
.
Relief and early recovery actions have been complicated by severe weather, a cholera epidemic, and civil unrest. As efforts continue in 2011, PAHO/WHO remains committed to ensuring greater access to health care for the Haitian population and building a decentralized system for health service delivery.

CDC Update on Health Assistance to Haiti (1/31/2011)

WELCOME to the first quarter 2011 Global Health E–Brief, designed to inform readers about key global health activities at the Centers for Disease Control and Prevention (CDC). One year after a 7.0 magnitude earthquake struck the island nation of Haiti; upwards of 1.5 million people continue to live in displaced persons camps while the country faces the added burden of a cholera crisis. CDC and a wide range of partners are helping Haiti reorganize, reconstruct, and restore systems to meet these enormous challenges. Haiti′s Ministry of Health requested CDC assistance in responding to control disease outbreaks. CDC has sent more than 277 technical staff to support public health in Haiti since the earthquake. Additionally, CDC and partners continue to work toward restoring the entire public health system that enables disease monitoring and response. Dr. Jordan Tappero, CDC medical epidemiologist and leader of the CDC cholera response team in Haiti states, “Our primary focus here is to save lives and control the spread of disease.” This quarter′s E—brief highlights the health impact of this work in Haiti.
.
On January 12, 2010, Haiti was hit by a magnitude—7.0 earthquake. More than half a million people died or were injured, and approximately 2 million people were displaced from their homes. Overcrowded and poor living conditions increased Haitians’ risk for communicable diseases. The earthquake destroyed most government buildings, schools, homes, hospitals, and transportation and communication infrastructure in the Western part of the country, including the capital Port-au-Prince and much of the Southeastern part of the country. Immediately after the earthquake, the Ministry of Public Health and Population (MSPP) turned to the Centers for Disease Control and Prevention’s (CDC’s) Haiti Office in Port—au—Prince for help in strengthening the country’s public health workforce. Within 2 weeks, the ministry, the Pan—American Health Organization (PAHO), CDC, and other national and international agencies had launched the National Sentinel Site Surveillance (NSSS) System. The NSSS has since enabled Haiti to monitor injury and disease trends and to detect outbreaks such as the cholera epidemic. It also has provided vital information about disaster-affected populations throughout Haiti so that relief efforts could be better targeted. The ministry is now maintaining the NSSS, with collaboration and support from CDC and other partners. The goal is for the system to be a long-term national surveillance system for Haiti, generating data that will help decision makers allocate resources and identify effective public health interventions.
.
“The NSSS could not have been launched so quickly if it weren’t for the surveillance sites that had already been established by hospitals and clinics affiliated with PEPFAR, the US President's Emergency Plan for AIDS Relief,” noted Daphne B. Moffett, PhD, Captain in the US Public Health Service and Deputy Director for CDC′s Health Systems Reconstruction Office. In the months immediately following the earthquake, 51 PEPFAR sites provided the ministry and its public health partners with daily information via e—mail and phone, so they could target disaster relief resources where they were most needed. Over the past year, the ministry, PAHO, CDC, and partners have collaborated to establish two additional surveillance systems that complement the NSSS. The Internally Displaced Persons Surveillance System (IDPSS) allows non-governmental organizations to share and track illness data. Clinics voluntarily report diagnoses that pose the greatest public health risk to internally displaced persons who face overcrowded living conditions, poor hygiene and sanitation, malnutrition, exposure to mosquitoes, and incomplete vaccination coverage. In addition, Haiti’s nationwide cholera surveillance system allows hospitals and clinics to send daily cholera case counts to local ministry officials. Aggregate data are sent on to department-level officials and then to central government officials.
.
Strengthening Epidemiology and Laboratory Capacity: Over the past year, CDC also has worked closely with the ministry and other partners to expand the capacity of Haiti’s National Public Health Laboratory. One of the goals is to improve the quality of diagnostic testing for TB, HIV/AIDS, malaria, and rabies, which are major public health problems in Haiti. In addition, CDC is launching a Field Epidemiology and Laboratory Training Program (FELTP) in Haiti. Working with the country′s Ministry of Health, FELTPs have a proven track record of strengthening a country′s capacity to respond to public health priorities and emergencies through mentoring and training of epidemiologists. Developing partnerships is an important element of establishing, supporting, and sustaining FELTPs, and CDC regularly collaborates with national and international organizations and other federal agencies, including the US Agency for International Development (USAID).
.
Strong Capacity Means Fast Response: Because surveillance and laboratory system investments for outbreak-prone disease were established by the Haitian MSPP in collaboration with CDC last fall following the earthquake, health officials were able to rapidly identify cholera. Jordan W. Tappero, MD, MPH, recalls how quickly the events unfolded after an Epidemic Intelligence Service (EIS) officer called him one evening in October 2010 to give him a heads up about reports received by the MSPP of watery diarrhea among patients in the Artibonite Department of Haiti. “Within 30 minutes, two EIS officers were in a car with laboratory media (collected from the National Public Health Laboratory) needed to identify cholera. The two EIS offers went immediately to the facility that had reported patients with rice water diarrhea,” said Tappero, Director for CDC’s Health Systems Reconstruction Office. Rapid tests of the first 11 specimens were positive for Vibrio cholerae. “They brought the specimens to Haiti’s National Public Health Laboratory. Within 36 hours, colonies were growing in culture media, confirming cholera,” he said. Forty-eight hours after that phone call from the EIS officer, CDC’s resident laboratory advisor Georges Dahourou, PharmD, MSc, working side by side with ministry laboratorians at Haiti’s National Public Health Laboratory, was able to confirm the cholera outbreak for public health officials. CDC Director Tom Frieden advised the Haitian MSPP to report the findings to the World Health Organization. It was the first cholera outbreak in Haiti in at least a century. “Having a public health infrastructure and partnerships in place was critical after the earthquake hit the Port—au—Prince area,” said Brian Wheeler, MPH, Deputy Director for the CDC Haiti Office in Port—au—Prince. Partnerships and infrastructure will be critical to Haiti’s long-term reconstruction efforts and success in managing many longstanding health problems — such as HIV/AIDS, malaria, TB, and malnutrition — as well as new challenges such as cholera.
.
When the January 2010 earthquake struck Haiti, the first priorities of Haitian public health officials and their partners, including CDC and USAID, were improving access to clean water and sanitation and promoting basic hygiene. They knew these basic public health actions could protect Haitians from threats they faced as a result of living in crowded, temporary camps. Even before the January 2010 earthquake devastated much of Port-au-Prince, many Haitians lived without access to basic water and sanitation services. According to the WHO/UNICEF Joint Monitoring Program, only 71% of Haitians living in urban settings had access to an improved drinking water source—household connection, public standpipe, borehole, protected dug well, protected spring, or rainwater collection. Access for rural Haitians was even lower –only 55%. In addition, Haitians had limited access to resources that could turn any of these water sources into safe drinking water. Haitians’ access to improved sanitation—connection to a public sewer or septic system, pour-flush latrine, simple pit latrine or ventilated improved pit latrine—was even more limited. Only 24% of urban Haitians had access to improved sanitation. Of Haitians living in rural Haiti (53% of the total population), only 51% had any type of sanitation coverage; an estimated 49% of rural Haitians rely on open defecation. Dr. Eric Mintz, CDC epidemiologist and cholera expert, remarked, “Poor water and sanitation conditions are the reasons why cholera is such a big problem in Haiti. “Fortunately, we are helping the government of Haiti take the steps needed to improve access to safe water and educate the public about basic hygiene that can prevent cholera and other diarrheal diseases.” Despite the challenging circumstances, the Haitian Ministry of Health and Population (MSPP) and the National Directorate for Water and Sanitation (DINEPA) immediately set in place procedures to improve water quality through disinfection at the source and household level. CDC supported the Ministry’s efforts to test drinking water supplies in the Port-au-Prince camps established for Haitians displaced by the earthquake and helped to establish a portable lab to identify the organisms that affect water quality and cause disease, including cholera. CDC also trained people to monitor drinking water outside of Port-au-Prince. When the first cases of cholera were confirmed by the Haitian National Public Health Laboratory in October 2010, the Government of Haiti, CDC, USAID, and other partners quickly developed educational materials for clinicians. Within a month, more than 400 clinicians were trained and spread across the country to share their new skills with other health workers. In addition, USAID rapidly mobilized to distribute soap, chlorine-based disinfectants, and other supplies to ensure Haitians could protect themselves through hand washing, cleaning, and purifying and safely storing water. Although some cholera cases have occurred in the camps that still serve as home for over 1 million persons displaced by the earthquake, major outbreaks in those camps have thus far been avoided and case fatality rates have been relatively low. Mintz notes that much has been accomplished, but additional short- and long-term efforts are needed to address the cholera outbreak, which is expected to continue for a period of years unless the poor water and sanitation conditions are resolved. CDC and USAID are working together on hygiene promotion and cholera prevention campaigns. The short- and long-term cholera response in Haiti requires the Haitian government and the international community to expand the focus to water, sanitation, and hygiene efforts. USAID and CDC are currently assessing how to support the Haitian government and leverage efforts of other international partners to ensure the short- term effectiveness and continued sustainability of water, sanitation, and hygiene activities. Activities being considered include expanding household water treatment and safe water storage throughout Haiti, expanding the number of latrines and sanitation at heath facilities, chlorination of piped water supplies, wider distribution of soap for hand washing, and promotion of safe food-handling practices. Other long-term efforts, in partnership with the Haitian government, could include construction of physical infrastructure, training the Haitian workforce to operate and maintain the infrastructure and ongoing health education to improve hygiene behaviors. The Haitian government and its partners are well aware that the country has a long way to go to reduce the burden of cholera and improve water, sanitation, and hygiene. However past responses to cholera outbreaks in Mexico and Chile show that improvements in water, sanitation, and hygiene are achievable. In Mexico, the government dramatically increased access to safe drinking water and sanitation, reducing deaths from diarrhea by 18% with only rare cases of cholera. In Chile, a similar response led to a similar reduction in cholera and decreases of 87% in typhoid fever and 61% in hepatitis A. “The good news is that we have seen other countries affected by cholera outbreaks successfully, over time, reduce deaths from cholera and eventually the impact of future outbreaks,” Mintz said.
.
In late October 2010, the public health laboratory of Haiti′s Ministry of Public Health and Population (or MSPP) identified the presence of the bacteria that causes cholera in samples from people with acute watery diarrhea in the Artibonite Department. When a cholera outbreak occurs in resource-limited countries like Haiti, where sanitary conditions are poor and safe water systems do not exist, public health officials must act quickly to save lives. One of MSPP′s first requests of CDC and partners was for help to educate health care workers to manage cholera clinically and to teach Haitians how to prevent the illness. “Education is the key here,” says Dr. Robert Tauxe, a CDC expert in waterborne diseases. “Cholera is a fairly simple disease requiring a fairly simple response. But without an understanding of how to mount an effective response, cholera can be quite devastating. It is not only that the general population is unfamiliar with the disease but also that the health care system in Haiti—from staff to facilities—is unprepared to deal with an outbreak. And because cholera can spread fast and kill fast, fluids need to be replaced in the body quickly. If untreated, mortality can reach 20 percent or more. But with treatment, primarily oral or intravenous rehydration, mortality can be less than 1 percent.”
.
In November 2010, Tauxe was deployed to Haiti to lead a training campaign for Haitian health care workers. He was joined by Dr. Azharul Islam Khan, head of the Short Stay Unit, Clinical Sciences Division, Dhaka Hospital, Dhaka, Bangladesh, and representative of the respected International Centre for Diarrhoeal Disease Research, Bangladesh, and WHO′s Global Outbreak Alert and Response Network. Khan was invited to participate because of his expertise in cholera treatment and management. He arrived at CDC one week prior to deployment to Haiti with Tauxe to assist in the development of the training materials. Bangladesh is well known for the development of oral rehydration solution (ORS), an intervention credited with saving the lives of more than 20 million children struck with diarrheal diseases. CDC also reached out to Haitian experts, including Dr. Yves Lambert, infectious disease specialist at Haiti′s State University Hospital.
.
CDC’s training complemented the Government of Haiti’s public awareness campaigns and messages emphasizing safe water, sanitation, hand-washing and proper food preparation. CDC coordinated message development and clinical guidelines among experts in Atlanta, WHO/PAHO, MSPP, and many partners. Within days, Five Basic Prevention Messages were shared, immediately followed by Diagnosis and Testing guidelines, and Clinical Presentation & Management. Materials were translated into French, Haitian Creole, and Spanish. The training, which emphasizes that “no one need die from diarrheal disease,” is being rolled out in three phases. First, CDC and partners trained 33 “master trainers” selected by MSPP. Topics include:
.
The microbe and how it causes cholera
Clinical presentation and treatment
Transmission and prevention
Laboratory diagnosis
Surveillance
Clinical management of a single case
Operation of a Cholera Treatment Center
The master trainers then taught public health officials and clinical staff in Haiti′s ten departments.
.
The final phase involves the training of community health workers (CHW) across the country by department—level health officials. CHWs staff local health institutions that are either part of MSPP’s network, or sites funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) (see related story for more on how this network of sites across Haiti assisted with the cholera response). Because a large percentage of Haiti′s population speaks Haitian Creole rather than French, CHW training materials, including laminated cards, were translated into Haitian Creole. This final stage of training covers a range of instructions, from hand—washing and proper water treatment to effective sanitation and preparation of a body for burial.
.
As participants share knowledge gained from the trainings, awareness of how to prevent and treat cholera will increase throughout Haiti. Similarly, feedback provided by master trainers, department-level health officials, and CHWs is being evaluated by CDC to strengthen the training for the ongoing and future responses. Already, improved understanding of cholera and its treatment is believed to be a factor in the decreasing case fatality rate documented for cholera since the beginning of the outbreak. According to a partner from the International Rescue Committee who attended training in Port-au-Prince on November 22, “this training has been very useful; the presenters are great and very animated.” Of Khan, in particular, she said, “after listening to him, I feel like going out and saving the world.” “Every person at every level has been so cooperative and supportive here,” Khan said of his experience at CDC′s headquarters and in Haiti."Particularly useful were the daily calls between the team in Haiti and staff at headquarters." "The two-way discussion has led to a valuable flow of information, which is the grounding for a successful intervention." “CDC′s unique combination of evidence-based approaches, surveillance, clinical training, and applied training in the field should serve as an example for the world.”
.
Earthquake Can′t Stop Progress to Eliminate Lymphatic Filariasis in Haiti: Not even an earthquake can stop an outstanding public health program. With strong support from local Haitian leaders and CDC and other U.S. partners, the program to eliminate lymphatic filariasis (LF) in Haiti has managed to stay on track, treating nearly three million persons since the earthquake struck in January 2010. LF is a mosquito-borne parasitic infection sometimes called elephantiasis. The disease causes hugely swollen limbs and fluid accumulation in the scrotal sac. It is disabling and stigmatizing. According to the World Health Organization (WHO), more than 8.6 million Haitians are at risk for LF, with a national prevalence of approximately 10%. Infection levels in some communities are among the highest in the world: 30% of children are infected by age 4. Haiti is one of only four countries in the Americas where transmission of LF still occurs. Stopping transmission of the disease is a first step toward elimination. Transmission can be interrupted by treating the entire population in endemic communities once a year for 5 to 8 years with a two drugs: DEC and albendazole. Albendazole has the added benefit of eliminating intestinal worms that cause anemia and malnutrition in children. The genesis of the LF program in Haiti was a research effort carried out by CDC scientists beginning in the 1980s. These studies contributed to understanding of the diagnosis and treatment of infection and informed the global strategy to eliminate LF. From its beginning as a CDC-led research activity, the LF elimination program in Haiti gradually added partners and expanded to reach more communities. Key partners included the Haitian Ministry of Public Health and Population (MSPP); University of Notre Dame (funded by the Bill & Melinda Gates Foundation); IMA World Health (funded by RTI/USAID); PAHO and CDC. Despite the unprecedented devastation of the earthquake, the partners re-doubled their efforts, and with new donors, the program is now poised to reach all of Haiti for the first time, making elimination of LF an achievable goal. Patrick Lammie, a CDC scientist involved with the program since its inception notes: “That the program in Haiti continues today is a testimony to the commitment and dedication of a small group of Haitian colleagues who continued to keep the focus on the program at considerable personal risk during periods of political instability.” In particular, Dr. Lammie cites Dr. Beau de Rochars, a Haitian physician who was instrumental in the success of the Haitian program. (Now Dr. Beau de Rochars is a CDC Epidemic Intelligence Officer.) Results from Haiti have documented a dramatic decline in levels of LF infection. In parallel, hookworm infection -- a major cause of anemia in Haiti – has virtually disappeared. Infection with other intestinal worms has also declined. Dr. Beau DeRochars says the LF program has given Haitians good results. “Patients with LF complications are treated with respect and dignity; prevention is emphasized, especially for children; and by protecting kids from intestinal parasites, the LF program is offering children a better future.” Despite overwhelming odds, the LF program is now poised to offer Haiti a future free of this disabling and stigmatizing disease.
.
With CDC Assistance, Haiti Successfully Tests and Adopts Rapid Diagnostic Tests for Malaria:
Already a major public health problem in Haiti, malaria became a bigger challenge after much of Haiti′s public health infrastructure was destroyed after the January 12, 2010 earthquake. With CDC′s help, Haitian officials investigated whether rapid diagnostic tests (RDTs) could be used as one part of a national strategy to quickly and accurately diagnose and treat malaria. Plasmodium falciparum malaria, the most lethal of malaria parasites, is endemic to Haiti and remains a major concern for residents, displaced persons, and emergency responders one year after the January 12, 2010, earthquake. Rapid, accurate diagnosis of malaria has historically been difficult. Until recently, the only way to diagnose the disease was for a skilled laboratory worker to use a microscope to look for malaria parasites in a blood sample. In addition, this was the only approved method for diagnosing malaria, according to Haiti′s national policy for the diagnosis and management of malaria. Unfortunately, many facilities in Haiti have neither functioning microscopes nor staff with the skills to use this diagnostic method. Recognizing that the millions of people displaced by the earthquake were at increased risk of malaria because they were sleeping in the open or in tents that mosquitoes could easily enter, CDC helped Haiti′s Ministry of Public Health and Population (MSPP) test RDTs to see if they could help meet the country′s acute need for quick malaria diagnostics. Dr. Michelle Chang, MD, medical epidemiologist, coordinated the technical assistance CDC′s Malaria Branch provided to Haiti′s MSPP. During 2 weeks in April, MSPP and CDC worked to gather in country, local data and experience that would lay the groundwork for a policy change. In Port-au-Prince and several towns affected by the earthquake, an assessment was conducted to compare expert microscopy with two brands of RDTs in four health facilities where local health workers were trained in RDT use. In two of the sites, one brand of RDTs showed acceptable sensitivity and specificity, indicating that it performed well. In a third site, the other brand of RDT showed poor sensitivity, and in the fourth site there were not enough data. The findings convinced the MSPP that at least some RDTs could perform adequately in Haiti′s setting. Given these results, which correlated with previously published, lab-based evaluations of RDTs, MSPP favored the use of RDTs as part of the national strategy at health centers and clinics where microscopy is not available. Considering the in-country experience along with the known evaluations of RDTS and WHO recommendations, the MSPP approved three RDTs for diagnosis of P. falciparum malaria as part of their national policy.
.
“This policy change using in-country data and published reports greatly expands the opportunities for accurate malaria diagnosis across the country. This means that Haiti′s health system can more easily discern if a person with fever has malaria versus another disease, and can then treat that person accurately and appropriately. The ability to easily test people will also help the country maintain accurate surveillance on the burden of malaria in Haiti and mobilize resources accordingly.” said Dr. Chang.
.
Review of Earthquake Injuries Data Informs Future Responses to Disasters: The 7.0 magnitude earthquake that struck Haiti on January 12, 2010, caused an estimated 222,570 deaths and 300,000 injuries. In impoverished countries like Haiti, analyzing the causes of deaths and injuries post-disaster can help countries better prepare for disasters in the future. Analysis of the injuries and surgical procedures common after the earthquake in Haiti was possible thanks to establishment of the first field hospital by the University of Miami Global Institute/Project Medishare (UMGI/PM). The facility, which had 280 beds, three operating rooms, and 220 volunteer, rotating staff from the United States and Canada, eventually handled many of the complex medical and surgical cases. In June 2010, UMGI/PM approached CDC for assistance in conducting a retrospective review of available inpatient records between January 12 and May 28, 2010. Data collected from paper-based medical records were entered into an electronic database to characterize injuries and surgical procedures, and ultimately to guide future earthquake planning in resource-limited settings. Of the 1,369 admissions, injury-related diagnoses were recorded for 581 (42.4%) patients, of which 346 (59.6%) required a surgical procedure. The most common injury-related diagnoses were fracture/dislocation; post-traumatic wound infection; and head, face, and brain injuries. The most common injury-related surgical procedures were skin surgeries, orthopedic, and surgical amputation. The exact number of amputees resulting from the earthquake is unknown, but aid agencies say Haiti ranks among the highest-ever for the number of limbs lost in a single natural disaster. Of the patient records that documented injuries, approximately 28% were earthquake related. Most patients with injuries related to the earthquake came to the hospital during the first four weeks of the response. In following weeks, other injuries (e.g., motor vehicle-related, violence-related) were seen. Of all injured patients, more than three-fourths were discharged to a residential setting. Nearly three percent died.
.
Some important lessons emerged from the data reported through UMGI/PM. First, injuries following earthquakes (limb fractures and significant skin injuries) in resource-limited areas often require urgent orthopedic and plastic surgery performed by highly skilled medical staff. While a surge of injuries and surgical procedures were noted immediately after the earthquake in Haiti, an important lesson for disaster preparedness and response is that sustained numbers of injuries caused by the disaster and injuries from violence and damaged infrastructure can be expected for several months. In areas like Haiti, with high levels of poverty, poor social and economic infrastructure, and history of social upheaval and high levels of interpersonal violence, the need for medical response to injuries can be prolonged and substantial. Therefore, field hospitals preparing for a long-term response to resource-limited settings following an earthquake should be prepared to mobilize, deploy and utilize resources for many months following the disaster.

Polio ruled out in Haitian patients' paralysis (1/28/2011)

Miami Herald
By JACQUELINE CHARLES
jcharles@MiamiHerald.com
.
Four Haitian cholera patients who were mysteriously paralyzed after treatment for the waterborne-disease do not have polio, said a Haitian epidemiologist. ``They are negative,'' Dr. Roc Magloire, of Haiti's Ministry of Health, said as test results came back from a lab. The four patients -- three of whom died -- were all treated at the same cholera treatment center in northwest Haiti when they developed paralysis 24 to 72 hours afterward. The cases were first reported by local health authorities on Jan. 10. Magloire said the cause of the paralysis may be environmental, but more tests are needed. Haitian health officials are being joined in their efforts by toxicologists and other medical experts from the Pan American Health Organization/World Health Organization and the Centers for Disease Control and Prevention. They are investigating possible sources, including contamination at the treatment center, or at the patients' home from medication or food. The cholera-related mystery comes as Haiti reports ``tremendous progress'' with fighting the illness that has killed 4,030 people since first being diagnosed in Haiti. ``People are not quite as frightened as they were originally. They know what it is,'' said Carleene Dei, mission director for the U.S. Agency for International Development in Haiti. ``They know what it can do to you; they have a good idea how to prevent it. . . . They know you don't have to die. The fear and the trauma of the first outbreak has diminished significantly.''
.
Still, challenges remain as Dei and other USAID officials learned first-hand when they visited several cholera-related projects in the Central Haiti town of Mirebalais this week. The projects are operated by Partners In Health and Mercy Corps., two nongovernmental organizations that provide medical assistance and cholera prevention activities with U.S. funding. The United States has contributed nearly $42.5 million for Haitian cholera programs. During the hours-long trip, the group spoke with patients and doctors at a cholera treatment center and observed a community meeting on hygiene and sanitation. Medical professionals and community health workers said their biggest challenge today is reaching people in remote communities, where bad or nonexistent roads make it difficult for people to get treatment in time. ``The best strategy is don't get cholera, push the prevention out there and get the [oral rehydration salts] out there which can take care of so many of the cases before they get bad,'' said Mark Ward, former acting director of the Office of U.S. Foreign Disaster Assistance. ``We can't treat everybody but we should be able to prevent it across the country and get the prevention message out there.''

Health Officials Looking Into Potential Cholera Cases

1/26/2011
Associated Press
.
Health officials are looking into the cases of four people who became paralyzed in northwestern Haiti while recovering from cholera. The experts are trying to determine if the patients in Port-de-Paix were sickened by polio. Local health authorities reported suspected cases on Jan. 10. Of four showing paralysis three died and one is hospitalized in the capital. Officials from the Pan American Health Organization, Haiti's Ministry of Health and U.S. Centers for Disease Control and Prevention say they doubt polio is the cause. PAHO spokeswoman Nyka Alexander says the surviving patient has tested negative for that disease. But PAHO says polio vaccine was added to an upcoming vaccination campaign against diphtheria and measles in the area as a "prudent measure."

Haiti's Health Workers Were "Heroes" in 2010 (PAHO - 1/12/2011)

In the face of unprecedented health challenges during 2010, Haiti's health workers were "heroes" whose untiring efforts saved lives and reduced the suffering of thousands of injured and ill, said Dr. Mirta Roses, Director of the Pan American Health Organization/World Health Organization (PAHO/WHO), in remarks today, one year after the Jan. 12, 2010, earthquake. "Health workers, including the authorities at all levels, were personally affected by the disaster, including some 300 who died during the quake," Dr. Roses recalled. "Other health workers lost family members and friends and saw their homes and workplaces destroyed or damaged. In spite of these challenges, Haiti's doctors, nurses, laboratory technicians and other health workers, including staff of the Pan American Health Organization, were in the forefront of rescue efforts. In the aftermath of the earthquake they carried on, often working for days on end without sleep, and for weeks on end without a break." These health workers "are an inspiration," said Dr. Roses, and "the source of hope for the future strengthening of a public health system in Haiti that will make 'health for all' a reality for the Haitian people." Haiti's 2010 earthquake claimed more than 200,000 lives, injured many thousands more, and devastated the country's transportation, housing, water, and sanitation infrastructure.
.
In the health sector, casualties of the quake included the headquarters building of the Ministry of Health, over 200 ministry staff working there, and 30 hospitals that were destroyed or seriously damaged in the three regions most affected by the quake. Ten months later, an outbreak of cholera in the country's north spread quickly to all 10 departments of Haiti. The most recent reports indicate a cumulative 181,829 cholera cases nationwide and 3,759 deaths since October 2010. International agencies and nongovernmental organizations have provided invaluable support for Haiti's response to both the earthquake and the cholera epidemic. But it is Haiti's own health workers, said Dr. Roses, who have been in the forefront providing medical care for earthquake and cholera victims as well as educating the public about prevention and the need for early treatment of cholera symptoms. "They have led the fight against cholera as well as efforts to reduce maternal and infant mortality, prevent HIV, and address other ordinary daily health needs," Dr. Roses noted. Officials of Haiti's Ministry of Health have provided crucial leadership, despite the destruction of their headquarters and the loss of key personnel. After the earthquake, health officials developed and began implementing a strategy to rebuild the country's health system, including rebuilding 30 hospitals in the three departments most heavily affected by the earthquake as well as guaranteeing free health care to the country's most vulnerable groups.
.
Since the start of the cholera epidemic, and despite a lack of experience with the disease, Haiti's health officials, healthcare providers, and community health workers-with support from U.N. agencies and international nongovernmental organizations-have gradually improved case management and reduced the case fatality rate from a high of 9 percent to an average 2.1 percent nationwide. In both the aftermath of the earthquake and the ongoing cholera epidemic, a key challenge has been coordinating the more than 400 organizations and agencies participating in the health response to both emergencies. PAHO/WHO has worked closely with the Ministry of Health to coordinate these partners and to ensure the effective and efficient deployment of staff and supplies. In addition to addressing the acute healthcare needs created by earthquake and the cholera epidemic, the Ministry of Health and its partners in the Health Cluster have managed to restart programs for outbreak control and environmental health, immunization, maternal and neonatal health, nutrition, gender-based violence, HIV, tuberculosis, malaria, dengue, mental health, and rehabilitation services for disabled people. In addition to Dr. Roses' remarks, PAHO also marked the first year after the 2010 Haiti earthquake with a candlelight remembrance and a minute of silence. In Haiti, commemorative events have included a mass at the ground of the Port-au-Prince cathedral and other memorial services, an opening of the National Archives' Register of Deceased and Missing Persons from Jan. 12, 2010, special radio and TV programs, and a soccer game between two teams of amputees. In addition, the United Nations' mission in Haiti is unveiling a monument in honor of the 96 U.N. staff who perished in the quake.
.
For more information please contact Donna Eberwine-VillagránThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it , Public Information Officer, Knowledge Management and Communication, tel (202) 974-3122, fax (202) 974-3143.

Health Lags in Haiti One Year After the Earthquake (1/12/2011)

By Katherine Harmon
.
As many of Haiti's earthquake-damaged buildings remain in ruins, its public health infrastructure continues to face major roadblocks to rebuilding
Much of Haiti's population of 10 million already lacked reliable access to ambulance services, clean water and good sanitation before a magnitude 7 earthquake struck there in January 2010. Now, after receiving billions of dollars in aid and a small army of volunteer health workers, has the country climbed onto more stable ground for health? The short answer is, no. But the significant challenges facing Haiti in ensuring the health of its citizens involve factors more complex than temporary housing camps or damaged hospitals, public health experts say. "The central public health concerns are in many ways the central reconstruction concerns," says Sandro Galea, chair of the epidemiology department at Columbia University's Mailman School of Public Health. Without foundational social, political and economic infrastructure, such as plentiful jobs and rebuilt neighborhoods, he notes, "you end up being exposed to many more risks to your health," such as violence, depression and poor diet.
.
But building new sewers and reforming government agencies are hardly the issues that play easily on international sentiment. In the immediate wake of the quake aid and volunteer offerings poured into the country, much of it targeted to addressing very immediate—and very real—needs, such as providing first aid, food and water. "There has been a massive influx of international volunteers and organizations," says Richard Garfield, a professor of clinical international nursing at Columbia University's School of Public Health. "But those actions are largely short-term, and what will make a real difference is jobs and governance." Transitioning international goodwill to long-term improvement looks itself like many roads in Haiti: rough and unclear. Just as the earthquake was little surprise to some seismologists, Haiti's intense vulnerability was familiar to the international aid community. "There was a big problem in quality of care, particularly in health services that poor people had access to," Galea says. "I think the earthquake has exacerbated this, and it will be slow rebuilding.
.
In large part because of its persistent poverty Haiti had long been host to a cadre of nongovernmental organizations (NGOs) that provided health and other services that the government was unable to supply. Infrastructure in place for international government and NGO programs such as the U.S. President's Emergency Plan for AIDS Relief and Partners In Health, respectively, were transitioned to help with response needs after the earthquake. "Haiti was and remains the republic of NGOs," Garfield says. He acknowledges that "the large influx of international voluntary health workers was remarkably successful in providing primary care." Because access to fundamental services had been relatively spotty before, many Haitians received basic health services after the earthquake that they had not had access to before the disaster. Some specialized services, however, proved to be mixed blessings. With so many surgeons entering the country, Garfield says, after the earthquake the country had "a rate of amputations that is about double of what it should have been"—in part because "cutting is what they do."
.
After the initial rush of action following a major disaster or conflict, there is what Galea refers to as the "then what?" period. "Relief agencies can be quite good at providing for [infectious] diseases in the short term, but the challenge is transferring from these relief agencies to a more permanent infrastructure," he says. And for organizations that have been meeting in-demand needs, dialing back their work can be tricky. "It's not always clear when humanitarians should exit," Doctors Without Borders (Médecins Sans Frontières, MSF) president Unni Karunakara said in a briefing on Monday. He pointed out that as a medical agency, the needs they serve never really go away. But before the NGO begins to pull out of Haiti (which, he noted could be two to five years away), "we want to see that a certain level of services are being provided by other actors," such as Haiti's Ministry of Health or even other agencies, he said. This hurdle is not unique to Haiti, Galea notes. In many countries when a humanitarian crisis hits—whether it is from a natural disaster, political unrest or another cause—NGOs and other agencies "parachute in" and create excellent services. But many groups end up having to leave eventually, and if the services are not integrated with local systems, they can leave large coverage gaps. "I think there has been progress made [in determining] what needs to occur to get Haiti to a healthier place," says Daphne Moffett, deputy director for the Health Systems Reconstruction Office at the U.S. Centers for Disease Control and Prevention's Center for Global Health. "The idea is to work with the Ministry of Health, so that they are able to define what it is they need." Many independent organizations have been hesitant to get involved too deeply with the nation's Ministry of Health. "Almost nobody has provided personnel to work along with the very small and very poorly trained staff" at the health ministry, Garfield notes. "And nobody wants to get involved because it's dirty and messy."

Foreign Teams 'Took Over Haiti Health Aid' (UKPA - 1/10/2011)

International medical response teams staged a "takeover" after the devastating earthquake in Haiti, undermining the country's own ability to provide healthcare, according to a report by a British charity. While "welcome and vital", few of the foreign aid agencies made use of local doctors and nurses and extensive health facilities in Port-au-Prince, Haiti's capital, after the disaster, international health charity Merlin said. Having been at the forefront of saving lives in the initial aftermath, local health workers found themselves sidelined and undermined, Merlin said. The charity said there had been a "brain drain" of Haitian healthcare workers into better paid jobs with international non-governmental organisations (INGOs), worsening the chronic shortage of healthcare workers in the country. Free healthcare from INGOs has also "severely affected" the viability of many existing facilities which all relied to some extent on fees paid by patients, according to the report - entitled Is Haiti's health system any better? The charity, which provides training, equipment and medical experts to help in global emergencies, said there should be a more co-ordinated and "collaborative" approach to emergency responses. There should also be long-term investment in health workers in "high-risk" countries such as Haiti to help them prepare for health crises, it said.Paula Sansom, Merlin response team co-ordinator, said: "The international response to Haiti was incredible and saved thousands of lives. "We have to build on this momentum and work together to ensure emergency responses not only save lives but help to leave behind a stronger health system. "There is a collective responsibility for Haiti and the collective will is there to do things better." The Haiti earthquake, which struck one year ago, has been described as the "biggest urban disaster" in modern history. An estimated 230,000 people were killed in the magnitude-7.0 earthquake and more than 1.5 million were left homeless.

Fast Facts on USG Support to Haiti: Health (1/8/2011)

Office of the Haiti Special Coordinator
.
The U.S. government is working to help prevent and treat disease in Haiti by providing sustainable health care solutions to help Haitians build a system that will improve their quality of life and lay the foundation for long-term, sustainable development.
.
Prior to the earthquake, Haiti’s health statistics were grim: 25 percent of children were malnourished;
An estimated 40 percent of the population had no access to basic health services; Haiti had the highest rates of child mortality in the Americas, the highest rate of tuberculosis in the Western Hemisphere, and HIV/AIDS prevalence was at a 2.2 percent infection rate. The earthquake exacerbated a difficult situation, and presented the Government of Haiti, the U.S. government, and the international community with new health challenges to overcome.
.
Once the earthquake struck, the U.S. government moved quickly to help the Government of Haiti take the steps necessary to mitigate the spread of disease and improve the general health of Haitians. Over one million people have been immunized against highly communicable diseases, including polio and diphtheria.
.
PEPFAR utilized its 109 sites across the country to provide both emergency and ongoing care in the aftermath of the earthquake.
.
Targeted food aid is being distributed to approximately 1.9 million of Haiti’s most food-insecure, including children under five, pregnant and lactating women, school children, orphans and vulnerable people in institutions.
.
To prevent malaria and other insect-borne diseases, USAID partners distributed 800,000 insecticide-treated mosquito nets to earthquake-affected Haitians.
.
Sanitation and hygiene are also essential elements to improving the long-term health situation in Haiti.
.
The U.S. government’s post-earthquake initiatives included installing latrines and water, sanitation and hygiene stations, as well as pre-positioning non-food relief commodities throughout Haiti. We are working to educate Haitians on proper hygiene practices to limit the spread of disease, particularly now that cholera is present and presents a grave threat to the health of the country.

Combating TB in Port-au-Prince's tent cities (IRIN - 11/17/2010)

Health workers in Haiti are concerned about the spread of tuberculosis (TB) in the tent cities that have housed more than one million people since the massive earthquake in January. "With the quake this became an emergency," said Macarthur Charles, a doctor with Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), one of the largest HIV- and TB-focused NGOs in Haiti. "The main TB hospital, the sanatorium here in Port-au-Prince, collapsed and [the GHESKIO] hospital in Leogane [about 29km west of Port-au-Prince] for treating multi-drug resistant TB [MDR-TB] also collapsed." GHESKIO suffered losses to its health infrastructure worth an estimated US$10 million, and the two government TB sanatoriums were also destroyed by the quake. "TB is an extremely important situation because transmission is facilitated by the situation of people living under tents," said Jean William Pape, director and founder of GHESKIO.
.
Across the capital, people are crammed into tiny tents, with 6-10 people sharing a single tent made for two people. "There is a delay in care. There is the issue of malnutrition or of having untreated HIV that allows you to have more TB, and then there's the question of you being in small areas with other people," said Megan Coffee, a US infectious diseases specialist who has been running an expanded TB ward at Port-au-Prince's General Hospital since January. The spread of MDR-TB is also a concern. The condition often develops as a result of patients on first-line TB drugs not completing the initial course of treatment. Treating MDR-TB can cost 50-200 times more than first-line treatment. An estimated 2 percent of newly diagnosed TB patients and 12 percent of previously treated TB patients in Haiti have MDR-TB, according to the UN World Health Organization (WHO).
.
After the earthquake, GHESKIO was able to trace all its MDR-TB patients and continue their medication; some are being treated as outpatients while others are being housed in isolation tents in the capital. GHESKIO is building a new 30-bed centre for patients with MDR-TB, and is strengthening its laboratory capacity to improve TB surveillance. Shortly after the quake, health workers saw a spike in TB cases, but some think this could have been as a result of increased screening by volunteer organizations. "A lot of the foreigners who came to Haiti to help, they had TB on their mind, they were screening for it... I think that drove the referrals we saw early on, and now I think we've gone down because there is less active screening," said Anany Gretchko Prosper, head of medical operations for Partners in Health, another long-standing health NGO.
.
While the earthquake has destroyed TB infrastructure, stretched limited health resources and worsened living conditions, the disease is not new to Haiti. According to a new WHO report on TB, the current prevalence in Haiti is 312 cases per 100,000 people, by far the highest in the western hemisphere. Like much of the developing world, it is closely linked to HIV; Haiti's HIV rate is 2.2 percent. With 30 percent of the global HIV positive population likely to contract TB in their lifetime, the joint TB and HIV burden in Haiti is heavy. ''The patients I've been seeing in the aftermath of the earthquake had nothing to do with the earthquake - there's no way that TB developed in two weeks.'Living conditions for those in tents are visible now, but they existed long before the earthquake. I would say 60 percent of people now living in tents lived in the same conditions before," Prosper said.
.
"The patients I've been seeing in the aftermath of the earthquake had nothing to do with the earthquake - there's no way that TB developed in two weeks," said Coffee. Ahead of Hurricane Tomas in October, the expanded TB ward Coffee runs was transferred from tents to a room in the hospital, with 27 beds for in-patient care; hundreds of outpatients also frequent the clinic. About 25 percent of Coffee's patients are HIV-positive and some 40 percent of in-patients are HIV-positive. However, GHESKIO's Charles acknowledged that these new centres could quickly reach capacity, and providing adequate treatment and care would remain "a challenge". Following the quake, UNAIDS released a situation assessment which named some of the priority areas for action in Haiti as: rebuilding the health system, restoring networks for people living with HIV, and protecting internally displaced people from HIV. It noted that a new national strategic plan for HIV would be needed, taking into account the country's new realities.

Haiti: Where Building a Hospital Can Be Illegal (11/12/2010)

Time
By Tim Padgett and Jessica Desvarieux
.
Rodrigue Jean and his neighbors are building a desperately needed medical facility in Haiti, but in doing so they're also violating a new government decree. The cinderblock clinic is going up in a sprawling squatter camp called Canaan, one of many that have sprung up in a mountain valley north of Port-au-Prince since January's massive earthquake. Some 30,000 families have settled in Canaan, lured by the Haitian government's announcement that it acquired the land for them via eminent domain. The problem is that Haiti's threadbare treasury apparently can't pony up to compensate the owner, and now the government is backtracking — and banning the construction of social infrastructure such as hospitals, schools and streets in the camp. (See photos of Haiti's cholera crisis.) Jean laughs at the restriction. From the entrance of the clinic, where doctors have agreed to work for nominal fees, he gestures toward Canaan's four schools, its convenience stores and its rough new streets being carved out of the dusty valley. "Only death can pull us out of here now," says Jean, 33, a Port-au-Prince electronics salesman who lost a child in the quake that killed more than 200,000 people, but whose wife is expecting a baby any day now. "I mean, what government is going to tear down a clinic?" (Watch the video "A Breach of Faith in Haiti.")
.
It's a good question. And his defiance is also a sign of how impatient Haitians have become with the slow pace of recovery — and with a weak government that's only beginning to find its reconstruction groove. Canaan isn't one of the squalid tent camps that still house most of the 1.5 million Haitians left homeless by the quake. Its residents live in sturdier, 190-sq.-ft. (18 sq m) "t-shelters," or temporary housing, with plywood walls and tin roofs, built largely by foreign NGOs like the Chile-based Un Techo para Mi Pais (A Roof for My Country). With $2 million funding from the Inter-American Development Bank (IDB), Techo has erected almost 700 t-shelters in Canaan, and is urging the government to drop its infrastructure ban. "If you don't allow formal urban planning in these communities," warns local Techo director Sebastián Smart, "you're just going to end up with gigantic rural versions of Port-au-Prince slums."
.
The cholera epidemic that this week reached Port-au-Prince has given the postquake housing crisis a new urgency. So have the looming Nov. 28 presidential election (in which the handpicked successor of President René Préval is running second in polls) and the increase in often violent evictions of tent-camp dwellers from privately owned properties. Perhaps as a result, the transfer of displaced Haitians to t-shelter communities, a critical first benchmark for recovery, finally appears to be quickening. Since August, the number of t-shelters built in Haiti has jumped from fewer than 10,000 to more than 19,000 — close to half the target of 45,000 set for the quake's Jan. 12 first anniversary by the Shelter Cluster, an umbrella body of aid groups including the U.N. Although quake rubble remains a daunting obstacle to finding available land for t-shelter communities (even now, less than a tenth of quake debris has been removed), housing advocates say Préval's government has begun to tackle Haiti's medieval land-title system and is presenting guidelines for identifying who owns what property and how to obtain it for the displaced. "That's a crucial link that was missing before," says Lilianne Fan, a Shelter Cluster coordinator. "We've got a more impressive reconstruction framework now."
.
Priscilla Phelps, a senior housing advisor to the Interim Haiti Recovery Commission headed by former U.S. President Bill Clinton and Haitian Prime Minister Jean-Max Bellerive — which is managing most of the $10 billion reconstruction aid pledged by international donors — agrees. "I've gotten great cooperation from the government," she insists, especially regarding a new property-mapping system modeled after one used in Southeast Asia after the catastrophic 2004 tsunami. "We're seeing a lot more housing being built in rural areas." And the provinces are exactly where Haiti's future may lie. The government wants many if not most tent-camp dwellers to rebuild their urban neighborhoods. But many development experts advocate relocation: establishing viable communities in the underpopulated heartland for the thousands who lost their homes in the overpopulated capital. Tapping its economic potential, they say, is key to making the western hemisphere's poorest country something more than a basket case so dependent on international aid that even before the earthquake, foreign NGOs had effectively become a substitute for government. (Officials blame the bloated NGO presence — even Homeopaths Without Borders has a delegation in Haiti — in large part for Port-au-Prince's current traffic paralysis.)
.
Creating provincial "poles of development" by promoting local agriculture, tourism and garment manufacturing, says IDB Haiti representative Eduardo Almeida, "is really the best, if not the only, way to develop [Haiti] from here on out." Almeida, whose organization is heading an aggressive t-shelter construction effort in areas outside Port-au-Prince, also agrees that Haiti can't afford to "just construct new slums" in the process. But Canaan and places like it are a reminder of the difficulty Haiti faces in reconciling the need for well-planned communities with the claims of well-heeled property owners — like the Haitian real estate development firm Nabatec, which owns the land that 30,000 Canaan families have made their home. Nabatec's president, Gerard-Emile "Aby" Brun, says the Préval government's blunder may now cost him both the 600 acres (245 hectares) where Canaan sits and the $19 million he was supposed to receive for it under eminent domain.
.
Nabatec, Brun claims, had also planned an industrial park for the valley — a source of jobs that he feels may well have benefited the very families now squatting on the land. Equally important to Haiti's development, he insists, are "clear signals that private investment is supported." And he rails at groups like Techo for continuing to build t-shelters in Canaan and arranging the delivery of potable water and other services. "They are violating the [government decree]." But Nabatec's critics say the land had been idle for too long for the government not to consider it a logical refuge for quake victims. And Techo's Smart insists the NGOs can't turn away families "who have no other place to go," since land for t-shelters is still so scarce. "In the face of the emergency in Haiti," says Smart, "we feel we're doing the only thing we can do." At one of Canaan's schools, principal Joseph Laurent, dressed in suit and tie, herds children wearing uniforms into a sprawling UNICEF tent for classes. "I don't think the government is going to send these children back to Port-au-Prince," says Laurent, whose academy back in the capital collapsed in the earthquake. As its biblical name implies, they see Canaan as their promised land.

Thousands to Benefit from Rebuilt Clinic (ICRC - 11/15/2010)

Over the next twelve months, the ICRC Special Fund for the Disabled (SFD), with financial support from the American Red Cross and the Norwegian Red Cross, will rebuild and re-equip – and later help to maintain – one of the most important physical rehabilitation facilities in Haiti, which is managed by Healing Hands for Haiti International (HHHI). This will benefit thousands of disabled people in the country. The clinic is due to re-open by the end of 2011. It will include facilities for consultations and physiotherapy, a workshop for manufacturing artificial limbs and other mobility devices and training rooms for HHHI staff. "Even before the earthquake it was a challenge to help the huge number of disabled people living in Haiti. The disaster added thousands of newly handicapped patients, while our medical facilities, prosthetic clinic and workshop were completely devastated," said Eric Doubt, executive director of HHHI, shortly before the signing of a project agreement between HHHI and the SFD. "Currently there are between 8,000 and 10,000 amputees in need of professional care. We urgently need to rebuild facilities for them."
.
Since the earthquake in 2010, HHHI staff and volunteers have been working in makeshift facilities and, in rotation, in various hospitals and health centres. "We do a lot of work, but the therapy requires specific equipment and long-term commitment," Mr Doubt said. "For instance, two-year-old Blaurha lost one of her legs during the earthquake. For as long as she continues to grow, she's going to need a new artificial leg every few months, and each one will have to be manufactured individually." "The humanitarian needs are enormous, so the redeveloped facility is going to be bigger and better than the previous one. Not only will it have more capacity, but we will also be helping to raise the level of service and improve the functioning of the clinic long-term," said Andreas Lendorff, a member of the Board of the SFD. "The re-opened clinic will help amputees and other disabled people, pre- and post-earthquake, to become more autonomous and to resume active lives." The American Red Cross will finance the reconstruction, which is expected to cost 1.8 million US dollars, while the Norwegian Red Cross will fund the material, technical and educational support that the SFD will provide to HHHI for the next five years.
.
"The American Red Cross is pleased to be funding the reconstruction of this important facility," said Ricardo Caivano, Country Director in Haiti for the American Red Cross. "We hope that this prosthetics centre, through our collaboration with a group of outstanding partners, will meet the needs of an important and often forgotten part of the Haitian population." "Life in Haiti is a challenge, and especially if you have a physical handicap," said Sven Mollekleiv, president of the Norwegian Red Cross and vice-chairman of the SFD. "This centre will do more than provide people with arms and legs; it will help them live with dignity. Its work is vital and life-saving. Helping people to manage their daily lives is crucial. We are glad to provide support for this important effort to give people's lives worth," he added.
.
HHHI was founded in 1999 and is dedicated to bringing physical medicine and rehabilitation services and programmes to Haiti, which will eventually be run by Haitians for Haitians. Founded by the ICRC in 1983, the SFD provides support for physical rehabilitation services in more than 30 low-income countries: mainly materials and training for local experts to manufacture artificial limbs and other mobility devices, and frequently using its own, low-cost technology. The SFD has been working with HHHI since 2005.
.
For further information, please contact:
.
Olga Miltcheva, ICRC Haiti, tel: +870 772 381 258 or +509 37 02 31 52
.
Marçal Izard, ICRC Geneva, tel: +41 22 730 2458 or +41 79 217 3224
.
Eric Doubt, Healing Hands for Haiti International, tel: +1 801 349 2865
.
Julie Cell, American Red Cross Haiti, tel. +509 3488-5864
.
Norwegian Red Cross, media office in Oslo, tel. +47 948 72 999

Aid Spawns Backlash in Haiti for Health and Other Sectors

11/13/2010
Wall Street Journal
By JOSé DE CóRDOBA
.
PORT-AU-PRINCE, Haiti—The Hopital de l'Universite d'Etat d'Haiti, the country's largest public hospital, is so chronically underfunded and decrepit that it has the reputation as a place where people come to die, not get better. After January's devastating earthquake, there was hope the hospital could turn things around. Scores of foreign doctors from international medical charities flew in to treat the injured. Charities donated new equipment, and the hospital set up its first intensive care unit. There was talk of ongoing cooperation with foreign medical schools. Ten months later, the foreign doctors and charities are gone. The intensive care unit is closed. An unused defibrillator and a cardiac monitor lie askew atop a cart. Nobody at the hospital is trained on how to use either piece of equipment. "Now the hospital is the way it was before the earthquake," says Alix Lassegue, the facility's director. The tale of the general hospital casts a stark light on why Haiti has struggled to capitalize on the kindness of strangers. Donor countries like the U.S. have pledged nearly $10 billion to rebuild. Because donors have long been concerned about corruption in Haiti's government, an estimated 70% of this year's money will be channeled through charities, otherwise known as nongovernmental organizations, or NGOs.
.
Haiti's third-largest city of Gonaives combats the cholera outbreak spreading across the country, which has already killed at least 800. Video courtesy of Reuters. But as the past few months have made clear, there is little coordination among the NGOs or between the NGOs and Haitian officials. Some NGO plans don't fit or clash outright with the plans of the government. Some are geared toward short-term relief—a classic case of giving a man a fish instead of teaching him to fish. More than a million people are still living in tent cities across Haiti, fueling a cholera epidemic that has killed 796 people even as NGOs have rushed to contain it. The United Nations has asked for $164 million to help combat the disease. There is now a growing debate over the role of NGOs in Haiti. Defenders of NGOs say there is no choice but to work through charities given the inefficiency and alleged corruption of Haiti's government. Transparency International ranks Haiti 146 out of 178 countries in its Corruption Perception Index.
.
Critics say the NGOs have put Haiti in a Catch-22: By building a parallel state that is more powerful than Haiti's own government, aid groups are ensuring Haiti never develops and remains dependent on charities. "The system as it is guarantees its failure," says Laura Zenotti, a political scientist at Virginia Tech University who has studied NGOs in Haiti. "A word for the NGOs," warned former President Bill Clinton, the U.N.'s special envoy to Haiti, at a ceremony here marking the six-month anniversary of the earthquake, "tell us what you are doing, and where." Even NGOs with a long history in Haiti sometimes show a cavalier attitude toward the authorities, Haitian officials say. For two months, the government refused to allow a new obstetrics hospital built by Médecins Sans Frontièrs to open, saying the group ignored its request to locate the hospital elsewhere to better cover the country's health needs. "They didn't even ask permission to build, and when we asked them to stop, they didn't stop," says Dr. Claude Surena, the coordinator of Haiti's national commission to reconstruct the health system.
.
Paul McPhun, who oversees MSF in Haiti, says the group did inform the government about its new hospital, which replaced one destroyed in the quake, and only as the hospital neared completion did the location become an issue. Mr. McPhun says MSF could have done a better job of "giving updates" to the ministry of health, but the urgency of saving lives after the quake was too acute. "To continue in Haiti, we need to be partners and have to be a part of the reconstruction plan, but I don't think anybody knows what those plans are," he says. A cholera outbreak in Haiti that has killed 796 people and hospitalized more than 12,000 is worsening despite the efforts of well-funded aid groups that manage most of the country's social services. Above, a child at a Port-au-Prince hospital is treated for symptoms of the disease.
.
It is a bind other countries have faced as NGOs have expanded in strength and numbers since the 1980s. Haiti is one of the world's most extreme examples of a country that both needs NGOs and has also, say critics, been held back by them. Called "the Republic of NGOs," Haiti is believed to have more aid groups per capita than any nation, perhaps as many as 10,000, according to the World Bank. The NGOs range from international giants such as Save the Children, Catholic Relief Services and Médecins Sans Frontièrs (known in English as Doctors Without Borders) to a plethora of U.S. evangelical churches that help one school or one Haitian church at a time. Aid groups provide four-fifths of social services here, according to a 2006 analysis by Washington's National Academy of Public Administration, a congressionally chartered, nonpartisan group of management experts. Jean Palerme Mathurin, economic adviser to Prime Minister Jean-Max Bellerive, says NGOs may account for as much as a quarter of Haiti's gross domestic product. He says the NGO presence has permanently "infantilized" the country, creating a vicious cycle: The government lacks the money—and historically, the inclination—to provide social services. Those services, therefore, are provided by NGOs, which means the government, in turn, has no incentive to improve.
.
Paul Farmer, founder of Partners in Health, an NGO which, in conjunction with the ministry of health, is the country's largest health provider, believes that NGOs and foreign governments should channel some of their funds directly to the Haitian state. "NGOs have flourished in number and size as the public sector has withered in Haiti," says Dr. Farmer. Many of the NGOs are a world apart from the rest of Haiti, based in rented mansions in the affluent mountaintop Port-au-Prince suburb of Pétionville. Here, fleets of SUVs with stenciled initials of the organizations are constantly on the move. "There must be hundreds," said Hans van Dillen, the former representative for the Holland division of MSF, earlier this year. "Cars, cars, cars, clogging up the streets of Port-au-Prince."
.
Sitting at a table in the leafy home where MSF Holland is based, Mr. van Dillen recalled a mad scramble after the earthquake as different NGOs fought each other to control sites to put up field hospitals and medical tents, as he said, "putting their logo over your logo." At night, most aid workers disappear. Fearing kidnappings and other crimes, NGOs typically have strict curfews for their staff beginning as early as 6:30 p.m. There is no doubt the aid money has saved thousands of lives here and provided relief to millions, especially in the aftermath of the earthquake. But whether the efforts of well-funded aid groups—some of which have been in Haiti for 50 years—can improve Haiti's long-term outlook is another matter. Life for millions of Haitians has barely improved over the decades. In terms of economic development, Haiti ranks 149th—just ahead of Sudan—out of 182 countries tracked by the U.N. The challenges to remaking Haiti's public health-care system are on display at the Hopital de l'Universite. Its annual budget is just $5 million, 95% of which goes to pay salaries. As a comparison, MSF raised $100 million for its Haiti program after the quake. The Red Cross raised $816 million.
.
Hours after the quake hit, the hospital became a bloody triage center. Hundreds of injured Haitians lay on the ground in front of the complex, screaming in pain or lying in shocked, stunned silence. The nursing school collapsed, killing some 30 student nurses. The badly cracked pediatric wing was evacuated, forcing patients into makeshift army tents. Within days, scores of foreign doctors arrived, working around the clock in horrific conditions, sometimes performing amputations without anesthetic. Claire-Marie Cyprien, a Haitian-American anesthesiologist from Florida, says the other foreign doctors she worked with "were very dedicated" and quickly turned things around. She helped amputate the hands of her sister, who lived in Haiti. The Haitian doctors, just emerging from an almost indescribable disaster, appeared lost, she says. "In retrospect, I think they were a bit dazed, and we shunted them aside." The hospital director, Dr. Lassegue, stayed at his post, as did Marlaine Thompson, the chief nurse. Many of their colleagues, dealing with family tragedies, didn't return for months. "Many were traumatized," said Dr. Lassegue.
.
To manage relations with the foreign doctors, Dr. Lassegue asked two prominent NGOs, California-based International Medical Corps, known as IMC, and Partners in Health to act as the liaison with all other medical groups working in the hospital. At the height of the emergency, there were 19 NGOs at the hospital. Dr. Lassegue says these included Médecins Sans Frontièrs, the Norwegian and Canadian Red Cross, Scientology Volunteers Ministry, Operation Blessing, Mission of Love, the Duke University Team, the Mount Sinai University Team, and the Bomberos Unidos Sin Fronteras, a Spanish firefighters' group.
.
Haitian doctors acknowledge the contributions of the foreign doctors. Nevertheless, there was friction. "They came, they helped, it was good, but they didn't work with Haitian doctors," says Max Harry Kernisant, a surgeon at the hospital. He says that while there is no doubt that the foreign doctors did excellent work, he sometimes felt their attitude betrayed condescension and arrogance, and that they were partly driven to build up their numbers on medical operations to drum up contributions. Things would be worse if it weren't for NGOs, says Samuel Worthington, president of InterAction, an umbrella group that represents major U.S. aid groups, including IMC. "What NGOs can say is that there are a lot more kids in school, a lot less mothers dying, thanks to their efforts," says Mr. Worthington, who expects his members to be in Haiti for 50 years. "As long are there are social problems, there will be NGOs working here."
.
Between them, IMC and Partners in Health managed the emergency room and staffed the hospital's first intensive-care unit. There was talk about making the ICU a permanent fixture, through ongoing cooperation with foreign medical schools. But by March, the only NGOs with doctors on hand were IMC and Partners in Health. Most doctors worked in two-week rotations, and the staff was stretched thin as it tried to man the emergency room and the ICU at the same time. By the end of July, both groups had pulled their doctors out. Partners in Health says it decided to return to its focus on health in rural areas. In conjunction with Haiti's ministry of health, it has broken ground on a new teaching hospital. Jason Erb, IMC's Haiti director, says the group left after six months as part of an agreement with the hospital's administration. He says it was a strain for IMC to keep a volunteer program at the hospital, but IMC would have found a way had the organization been asked to. IMC is still in Haiti, where it maintains a network of 15 primary care clinics, and runs nutrition and mental-health programs.
.
Since the charities left, the hospital is back to business as usual. The occasional rat scrambles across the grounds, and sewage seeps from broken pipes by the emergency room, where dozens of half-naked patients lie in narrow cots. "And what happens now? We are in the same situation as before," says Dr. Kernisant. Some help may be on the way. U.S. Secretary of State Hillary Clinton and French Foreign Minister Bernard Kouchner recently signed a joint memorandum to provide $50 million to rebuild the hospital. The agreement doesn't specify when the money will start flowing in. In July, the American Red Cross agreed to make a $3.8 million grant to the hospital to pay staff bonuses.
.
In the meantime, 20 miles from Port-au-Prince in the devastated town of Leogane, Médecins Sans Frontièrs has opened a new hospital in place of the impromptu field hospital it set up in the days immediately following the quake of Jan. 12. Shipped in containers from Europe, the "hospital-in-a-box" comes complete with an operating room. While doctors in Haiti's public hospitals often go unpaid, sometimes juggling two or three jobs and using outdated equipment, MSF doctors are earning top dollar, in local terms, plus bonuses. The aim, says MSF, is to hand over the facility to Haiti's ministry of health once the earthquake emergency is over.
.
MSF's Mr. van Dillen was unapologetic about scooping up Haitian staff, many of whom worked at hospitals destroyed by the quake. But worried about the long-term impact that hiring away doctors could have on the country, he lowered the bonus to 50% of salary, rather than the original 100%. He also said MSF is exploring ways to work with the ministry of health, including combining some of its facilities in Carrefour, a heavily damaged area on the edges of Port-au-Prince, with facilities at a next-door Haitian hospital that suffered earthquake damage. "It would help get us away from the parallel system we have built," he said, "which is good for Haiti's poor now, but not good for Haiti in the future."

A Healthcare Crisis in Haiti (Melody Munz, IRC - 10/5/2010)

The storms have been relentless here, and another powerful one is expected to bear down Friday. The entrance to Cité de la Joie in Port-au-Prince looks like the mouth of a murky and muddy river. This joyless shantytown is built on a landfill on the edge of a drainage canal that's filled with sewage, discarded bottles, plastic bags, Styrofoam food containers, fruit peels and other refuse. Every time it rains, the canal overflows, creating a foul mucky mess that seeps under plastic sheeting and into the fraying tents and makeshift shelters of some 2,000 earthquake survivors who live there. It covers their belongings, their food, their cooking pots, their clothes, their children and their hair.
.
Here, rain is rarely associated with growth or renewal or any sort of washing away. It is more often destructive -- damaging tents, ripping through plastic sheeting, washing away meager belongings. It causes sheer misery for too many people without a proper roof over their head. And in crowded settlements and destitute neighborhoods with open sewers, trash-filled drains and piles of rotting waste, it can be a carrier of lethal bacteria.
.
Cholera may be a new and frightening disease for Haitians, but the conditions under which it thrives and spreads have existed here for decades. Most at risk is the destitute and forsaken countryside, where public health infrastructure is virtually nonexistent. The Haitian government, with support from international institutions, must focus resources on developing this public health infrastructure to ensure that all Haitians have access to clean, potable water and basic health and sanitation services, especially in Haiti's chronically neglected rural areas, where residents rely on a polluted river for drinking water.
.
The rallying cry, "Build back a better Haiti," is meaningless unless it prioritizes the health of the population. Even before January's earthquake, the lack of sanitation and safe drinking water left Haitians across the country wide open for such a cholera outbreak. According to the Human Development Index, fewer than 20 percent of Haitian households in rural areas and less than 30 percent of residents in urban areas have access to latrines. As a result, a large portion of the population resorts to open defecation while others create makeshift toilets by putting flimsy plastic bags over buckets. Since there is little if any garbage collection, these bags get tossed anywhere and everywhere. Congestion only makes matters worse. Haiti's capital is overflowing with more than 2 million residents, but it was designed to accommodate a 10th of that.
.
The decline of the agricultural sector, combined with a government-led push to centralize services in Port-au-Prince, has pulled too many people into a dangerously tight urban squeeze. And nearly 10 months after the quake destroyed large swaths of the city, more than 1 million of these people remain displaced -- living in crowded, filthy, flooded and disease-prone places. The cholera epidemic that we in the humanitarian aid community had all feared finally arrived with a vengeance in late October in Haiti's rural Artibonite region, where there is a dearth of clean water, sanitation and health care. Haitian health officials and aid groups scrambled to respond as thousands became infected and hundreds rapidly succumbed to the disease. Cholera spreads like wildfire when people ingest food or water contaminated with feces that contains the bacteria. The disease that causes severe diarrhea and vomiting can lead to dehydration and death within hours.
.
While efforts intensified to contain the outbreak in Artibonite, aid groups, together with the Haitian government, launched a massive effort to prevent what would be a far worse disaster -- the spread of cholera to the squalid and sprawling camps of Port-au-Prince. My organization, the International Rescue Committee, was able to respond quickly since we already had an extensive water and sanitation program in place. Our teams of mostly Haitian staff and camp volunteers had built latrines, showers and washing stations for nearly 100,000 quake survivors, and our network of 156 hygiene promoters who live in the camps were regularly delivering health messages.
.
Preparing for the worst case scenario, we swiftly ramped up cholera prevention efforts in the 30 camps where we operate -- chlorinating water at its sources, sanitizing latrines and building oral rehydration kiosks. We've also stepped up our hygiene promotion -- urging vigilance when it comes to washing hands with soap, eating only cooked foods and drinking only treated water. Kits are being readied for distribution that contain water purification tablets, plastic containers, soap and hand-washing basins, and our clinics and mobile medical units are on standby. Haitian and U.N. officials say the rate of infections and deaths appear to be slowing, yet suspected cases continue to be identified in new areas. Sad to say, it's unlikely that we've seen the end of the epidemic, and we may not have seen the worst. Containment and prevention activities must not only continue, it's critical that they be scaled up as the Haitian people brace for more storms, rain, mud and muck.
.
Whether or not the epidemic has peaked, what's clear is that Haiti is suffering a dire public health crisis that long precedes the January 12 earthquake. The cholera outbreak put a spotlight on systemic problems that need to be tackled if sustainable and meaningful recovery can ever take hold. The opinions expressed in this commentary are solely those of Melody Munz.

Mobile field hospitals in the Haiti earthquake response

October 2010
Overseas Development Institute
By Hossam Elsharkawi, Toerris Jaeger, Lene Christensen, Eleanor Rose, Karine Giroux and Brynjulf Ystgaard
.
In the wake of the January 2010 earthquake in Haiti, the International Federation of Red Cross and Red Crescent Societies (IFRC) mobilised the biggest single-country emergency response operation it had ever mounted. Deployments included field hospitals, one of which was a specially designed rapid response mobile and light hospital with 30 expatriate staff. This was initially set up in Port-au-Prince at the main university hospital, and later relocated to Petit Goave in the south-west of Haiti. This article describes the lessons learned during the hospital deployment.
.
The RDEH ERU: The Rapid Deployment Emergency Hospital is a health Emergency Response Unit (RDEH ERU) and one of the IFRC’s global emergency response standby tools. The unit is positioned in Oslo and owned and managed by the Norwegian Red Cross. The standard configuration is a tented 20-bed medical/surgical facility, with medical supplies and its own facilities for power generation, lighting, water purification, sanitation and telecommunications, along with vehicles and a base camp for staff. The standard set-up requires 12–14 specially trained personnel. In the case of Haiti, additional medical supplies, tents, beds, relief items and two ambulances were provided to support local hospitals.
.
The RDEH is designed to be loaded into one Ilyushin 76 cargo plane, but due to lack of availability the unit was divided between two smaller Antonov cargo planes and a Boeing 747. The Antonovs landed in Port-au-Prince and the Boeing in Santa Domingo, from where items were trucked into Haiti. Self-offloading aircraft like Ilyushins and Atonovs are preferred as off-loading equipment is often not available in emergency contexts. The expanded multinational team of 30 (from Norway, Canada, Israel and Denmark) included two surgical teams, one outpatient team, a midwife, nurses, technicians, administrators, community health specialists, psychosocial support specialists and paramedics. They arrived between 15 and 19 January.
.
The ERU was set up in the grounds of the University Hospital in Port-au-Prince. An advance team of two arrived from Norway 24 hours ahead of the unit, and identified the site along with the IFRC Field Assessment and Coordination Team (FACT). The first patients were treated in the out-patient department on 16 January, and surgery commenced on 18 January. The outpatient department treated an average of 70–80 people per day, dealing with major dressing changes and wound care and management. A total of 300 surgical procedures were performed. The ERU team set up its base camp in the hospital compound and remained there for the duration of the four-week mission, providing surgery, an outpatient clinic, psychosocial support to patients and local staff, epidemic prevention measures and material help and technical advice to the hospital management. The hospital was provided with over 800m2 of tenting, 100 quick-set-up beds, blankets, plastic sheeting, a portable X-ray machine, a generator, a laboratory module and medical supplies.
.
The hospital compound comprised over 25 buildings, with 700 beds and approximately 2,000 staff. Some structures, such as the nursing school, had totally collapsed, while others were partially damaged and not usable (including paediatrics, maternity and some operating rooms). Post-quake, the compound contained over 1,400 people, including patients, their families and staff. Repeated after-shocks forced patients and staff out of the remaining buildings and further complicated patient care and hospital management. Many patients and their families were exposed to the elements for many days as tents and shelters were being set up. Many international aid agencies had teams in place working during daylight hours, using salvageable hospital spaces and tented facilities. Daily coordination meetings were held involving aid agencies and the hospital management team.
.
The RDEH ERU Operating Theatre was the best and most equipped facility on the hospital campus. It enabled the team to handle a large proportion of procedures requiring a proper clean (semi-sterile) environment, such as caesarean sections and emergency laparotomies.[1] The surgical team operated in close collaboration with other agencies working at the hospital, selecting patients from a common pool and returning them to wards on the hospital grounds after surgery. The RDEH had to run its own recovery services. A full complement of ward nursing staff was neither locally available nor provided for in the RDEH set-up. An experienced nurse originally designated to work with children had to take charge of this facility, which functioned efficiently, and expatriate paramedics provided post-operative care. Future deployments require better staffing for post-operative nursing care.
.
Psychosocial support: The ERU’s psychosocial support component comprised two trained delegates and a supporting kit. The first task upon arrival was to provide psychological first aid (PFA) and emotional support for patients and relatives. Applying a community-based approach, delegates recruited and trained a team of 20 Haiti Red Cross volunteers to provide PFA and other basic psychosocial services to patients and others in need. The volunteers learned to listen to patients and observe behaviour so as to identify people showing signs of mental health distress or symptoms of disorder. When identified, patients were evaluated by the psychosocial delegate, to decide whether follow-up was needed. Additional activities included visiting and interacting with patients on wards, following up on specific requests by hospital colleagues and awareness-raising on normal reactions to abnormal events.
.
The psychosocial delegates and their volunteer teams established a protocol to ensure the protection and care of unaccompanied minors and isolated children. A child-friendly space was set up, with structured playing and activities that allowed the children to regain a sense of normality. A social space was also set up in the hospital grounds, with games and recreational equipment to enable socialising and an opportunity to talk. This was used by hospital staff, patients, visitors and relatives. In the paediatric unit, particular attention was given to parents and children, to reinforce parenting skills and re-establish daily routines through games that stimulated psychomotor development. Creative activities such as the establishment of a children’s choir and an exhibition of drawings helped raise spirits in the hospital and bolstered mechanisms of social support. Ensuring the wellbeing of volunteers and local hospital staff was another psychosocial activity. Delegates ensured supervision and support for volunteers as they were as affected by the earthquake as those they were assisting.
.
After three weeks, the situation within and outside the hospital had stabilised, and the psychosocial team established contact with communities surrounding the facility. Delegates trained three groups of community workers from the NGO Médecins du Monde and hospital staff, to enable them to continue providing services in the longer term.
.
Epidemic prevention and community health: The Community Health Module (CHM) comprised two trained delegates and a supporting kit with Information, Education and Communications (IEC) material for epidemic hazard mapping and priority activities focused on disease prevention. The urgency of medical needs following the earthquake dictated that, for the first few days, all medical staff (CHM delegates included) provided care for injured patients. CHM delegates also worked with the sanitation committee at the University Hospital to address poor hygiene and sanitation conditions.
.
CHM delegates focused on three basic health messages: hand washing, safe disposal of waste (including use of latrines) and drinking safe (potable) water. Haitian Red Cross Volunteers were trained in hygiene promotion, targeting the population living in informal IDP camps. Activities were initially carried out with the 1,400 patients and family members within the hospital compound. In early February, the Haitian government asked the IFRC to vaccinate a population of 150,000 IDPs, as part of a mass vaccination campaign. CHM delegates trained 110 Haitian Red Cross vaccinators, and assisted in the planning and implementation of the campaign.
.
After approximately four weeks, the RDEH was moved to a rural hospital in Petit Goave. This area had also been severely affected by the earthquake, but had not received as much attention as the capital. CHM delegates carried out assessments of health and hygiene conditions in IDP camps. Training of new Haitian Red Cross Volunteers in hygiene promotion activities continued, and hygiene promotion activities were carried out with over 2,000 families in 13 IDP camps. Training was coordinated with Oxfam.
.
The success of epidemic prevention activities was due largely to very close cooperation with the Haitian Red Cross, whose Volunteers proved to be a tremendous asset. Many were already trained and their local knowledge and acceptance by the population greatly facilitated their work. The Volunteers were able to communicate effectively with the target population, particularly since they were enduring the same losses and hardships. Training both Red Cross and community members (community mobilisers, health committees) improves the prospects for sustainability.
.
Most of the IDP camps assessed in Petit Goave had neither potable water nor sufficient, if any, latrines. This made it difficult to convey hygiene messages when hygiene promoters could offer only good advice and soap. Ideally, there should be closer coordination with actors providing water, sanitation and shelter. The provision of hygiene kits would also improve matters.
.
Conclusion: The hardware of the RDEH ERU was ideally suited for this type of disaster response, as it was configured for rapid deployment and quick set-up, with lighter, smaller medical and non-medical components than traditional mobile hospitals. The ability to rapidly set up and perform safe surgery within hours was critical to saving many lives at the University Hospital. The ability to move once the situation had stabilised was likewise critical to providing continued care at another location.
.
Working 16 to 18 hours a day in very difficult circumstances meant that the flexibility and hardiness of the specially trained medical and non-medical ERU members, drawn from four nations and with a mix of skills and backgrounds, were crucial to the mission’s success. Most had undergone specialised ERU and Field School training.[2] At the beginning, all delegates were required to participate in all set-up tasks, including off-loading and erecting tents in addition to providing safe and good-quality medical care. Explicitly pairing experienced delegates with less experienced ones in mentoring roles has proved to be successful as a training methodology. The need for post-operative care and ward nursing was critical, and future deployments need to ensure sufficient personnel providing such care utilising both nurses and paramedics. The many surgical teams working at the University Hospital overloaded the post-operative end, with minimal or no care due to the lack of nurses. Additionally, and perhaps most critically, the ability of the team to work in close collaboration and coordination with local hospital management, the Haitian Red Cross leadership and Volunteers and other international providers increased the efficiency and effectiveness of the entire relief effort. Such interventions need to operate in support of local medical teams, no matter how basic, as an explicit objective.
.
After-shocks limited the extent to which existing structures could be used, both due to potential collapse and the psychological trauma and fear experienced by staff and patients, and hospital managers were not able to order patients or staff into these structures for several weeks. First-phase responders need to bring sufficient supplies and shelter for themselves and their patients, as well for the services they wish to provide, or they risk becoming a burden and further depleting local resources. The RDEH was the only unit deployed to the University Hospital that was entirely self-sufficient and thus did not put further strain on already weakened infrastructure and staff. Surgery and outpatient care provide a platform for epidemic control measures and psychosocial support activities. Thus, the RDEH ERU maximised its impact by going beyond clinical care. Providing expert advice in running field hospitals, and supporting but not substituting for hospital managers, proved vital and enabled the RDEH to move to another location.
.
Hossam Elsharkawi, PhD Hossam.Elsharkawi@redcross.ca), is Director, Emergencies and Recovery, Canadian Red Cross. Toerris Jaeger is Head of Disaster Management at the Norwegian Red Cross. Lene Christensen, MA, is Knowledge Management Adviser, Danish Red Cross. Eleanor Rose, RN, BScN, is Canadian Red Cross Community Health Delegate and Travel Health Advisor. Karine Giroux Delegate for the Psychosocial Support Programme in the ERU, Canadian Red Cross. Brynjulf Ystgaard is a surgeon and Norwegian Red Cross Delegate.

UNICEF assists in disseminating cholera prevention information

10/28/2010
United Nations Children's Fund (UNICEF)
.
In addition to providing medical supplies, UNICEF is assisting government and humanitarian aid partners in carrying out cholera information and training sessions with health care workers and hygiene promoters so they are better prepared to raise public awareness in the capital of Port-au-Prince. UNICEF is also supporting cholera awareness and hygiene promotion activities in schools and IDP camps and through mass media in Port-au-Prince and areas surrounding the Artibonite River, where the majority of cholera cases have originated. The messages will help familiarize the public with the precautions they can take to protect themselves from contracting the disease. The messages encourage sanitation measures, such as washing hands with soap before handling food and after using the latrine, drinking only clean, chlorinated or boiled water and keeping away from those affected by the cholera outbreak. Additional messages address the need for proper disposal of human excrement and garbage and eating only cooked or peeled food.
.
The Haitian Ministry of Health yesterday reported that hospitalizations due to cholera totalled 4,649. The departments with confirmed cases are: Artibonite (76.5 per cent), Central (22.9 per cent). The ministry lists the total number of deaths due to cholera now as 305. "We are increasing our response activities in affected areas using several approaches," says Jean-Claude Mubalama, Health Section Head for UNICEF Haiti. "We are working with the Government of Haiti and UN and NGO partners to address current medical and community needs, bringing in more medical and non-medical supplies, and assisting in increasing public awareness about precautions they can take to protect themselves from the disease." UNICEF has distributed medical supplies to three towns (Drouin, Dessalines, and St Michel de l'Attalaye) in Artibonite. Approximately 10,000 sachets of oral rehydration salts are being brought to each affected area. A basic health kit for the town's health centre in Drouin, and a diarrhoea kit capable of treating 100 patients in St Michel de l'Attalaye have been distributed. "In close collaboration with our UN and NGO partners, we are actively supporting the Ministry of Health in preventing the disease from spreading further," said Mubalama. "If the disease spreads to Port-au-Prince we will have a big problem, especially considering the living conditions in the IDP camps."
.
UNICEF is working with the Ministry of Health in developing a plan of action in case the disease surfaces in IDP camps in Port-au-Prince. The plan would address the need to isolate cholera cases from other medical cases. As part of preparations in Port-au-Prince, UNICEF is assisting in setting up three cholera treatment centres. These are in addition to three cholera treatment centres being established in Artibonite. Cholera is a highly infectious abdominal disease that spreads through contact with contaminated water or food. Symptoms include severe and profuse watery diarrhoea, vomiting and abdominal pains. If not treated, patients can die from severe dehydration. The disease can be prevented by proper hygiene and sanitation practices, including regular hand washing and the provision and use of safe drinking water.
.
About UNICEF: UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world's largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments. For more information about UNICEF and its work visit: www.unicef.org
.
For further information, please contact:
.
UNICEF Country Office, Haiti, Jean Jacques Simon, Chief Communications
Cell: + 509 370 23698
jsimon@unicef.org
.
Douglas Armour, Communication Specialist
UNICEF Country Office, Haiti
Cell: + 509 3765 7872
darmour@unicef.org
.
Patrick McCormick, UNICEF New York;
Tel + 1 212 326 7426 / Cell + 1 917 582 7546
pmccormick@unicef.org

UNICEF distributes thousands of mosquito nets (10/27/2010)

United Nations Children's Fund (UNICEF)
By M.P. Nunan
.
LEOGANE, Haiti, 27 October 2010 – Richemond Casseus is walking through a small village – typical of the hundreds that line Haiti's coastal areas. And he does not like what he sees. VIDEO: UNICEF'S M.P. Nunan reports on the distribution of mosquito nets to Haitian families in fight against malaria. Watch in RealPlayer "Usually, a small house like this is lined with palm fronds – but they didn't stay," he says, pointing out the gaps in between every slat in the wall of the thatched home. "It's important for the family living here to have mosquito nets."
.
Casseus is a Senior Liaison Officer with Malteser International, the UNICEF partner that is distributing some of the 400,000 mosquito nets UNICEF is giving out to over 200,000 Haitian families. Up the path, he points to a mango tree. When fruit is left to rot on the ground, it's a breeding ground for mosquitoes, says Casseus. And then there's the mud, a sign that livestock are living too close to the village. "It's easy for mosquitoes to lay their eggs here, and they would attack people who sleep in the nearby house. The animals should be put much further from the house," he explains.
.
Casseus has just come from distributing mosquito nets to roughly 650 people from a handful of villages outside Leogane. The people spent hours lined up in the sun for the nets – which were distributed in empty water buckets, along with water purification tablets. At 250 Haitian gourdes – or US$7 – mosquito nets are financially out of reach for most of these villagers. Malaria is under-reported in Haiti, with an official prevalence rate of just 5-7 percent. That figure does not mesh, however, with the UNICEF estimate of 70-80 per cent of people living in low-lying coastal areas who are at risk of contracting the disease. What's more, UNICEF believes that only five per cent of children under-five who contract the disease receive treatment for it.
.
For that reason, the UNICEF distribution campaign targets households with children under-five and pregnant women. The nets are also sprayed with insecticide to ensure protection. Still, it's not just malaria that goes under-reported. There are no credible statistics for incidents of dengue fever, says UNICEF Country Director Francoise Gruloos-Ackerman. Referring to the Dominican Republic, Gruloos-Ackerman said, "We are on an island and in the neighboring country - they have dengue. So supposing the mosquitoes are not stopping at the border and the immigration office, we have dengue here in this country too - but we have no figures." Prior to the UNICEF distribution, just six per cent of Haitian households in affected areas were reported to use mosquito nets.

Cholera fears spark anti-clinic protest in Haiti (10/26/2010)

Associated Press
By JONATHAN M. KATZ
.
Protesters threw rocks at a cholera treatment center as it was preparing to open in the city of St. Marc on Tuesday, highlighting the fear surrounding a disease that was almost unknown in Haiti before it began spreading through the countryside, aid workers said. Some of the roughly 300 students and other protesters said they feared the Doctors Without Borders-Spain clinic would bring more of the disease to their seaside town, which is one of the hardest hit in the week-old epidemic that has killed 284 people and infected 3,769, according to United Nations figures. U.N. peacekeepers from Argentina arrived with riot shields to reinforce police. Warning shots were heard; the U.N. said its soldiers fired blanks. There were no reports of injuries.
.
Haitian health officials assured the crowd the clinic would not open in that neighborhood. Doctors Without Borders-Spain country chief Francisco Otero said the medical aid group would try to reopen it in another part of St. Marc. The clinic is intended to rehydrate and treat people with the severe diarrheal disease. "In the coming days we are going to start to work with this community, to explain that there is no risk for them to have such a facility," Otero told The Associated Press. More than 420 new cholera cases were confirmed Tuesday, according to the U.N. Office for the Coordination of Humanitarian Affairs. Twenty-five new deaths were confirmed, bringing the total to 284. OCHA spokeswoman Imogen Wall says the majority of cases occurred along the central Artibonite River with many new instances in Haiti's central plateau. St. Marc's main hospital was the first to widely alert the epidemic as it overflowed with the sick and dying.
.
U.N. staff have been told to avoid areas of heavy infection unless they are given special permission to go there. Guatemalan police manned a checkpoint Tuesday on the highway from Port-au-Prince to Mirebalais, a hard-hit city in central Haiti, to make sure unauthorized U.N. vehicles did not pass. Aid workers, meanwhile, scrambled to contain the spread of the disease, which has not occurred in Haiti for generations. Speaker trucks passed through neighborhoods in the capital, where a handful of cases have been confirmed in people who apparently contracted it in the countryside, advising the city's millions of residents to wash their hands. The Dominican Republic, which borders the central plateau where many new cases are being found, announced that all people crossing the border must wash hands and complete a medical form. They also stepped up military surveillance and closed a twice-weekly binational market on Monday, sparking protests on the Haitian side of the border.

Interanational Action Update (10/26/2010)

On Saturday, International Action met with DINEPA water department officials and UN WASH Cluster partners to strategize a coordinated response to the spreading cholera epidemic. To combat this fatal waterborne disease, International Action plans to supply and install 50 chlorinators and 8 water tanks throughout Artibonite Department, the epicenter of the outbreak. Nine hundred chlorine tablets have also been released by the organization to the Haitian water agency and other NGOs addressing the public health crisis. As of Saturday morning, the casualty toll stands at 194 deaths and 2,364 Haitians hospitalized. If left untreated, cholera can kill within hours. The Ministry of Health has confirmed that the outbreak has reached the Haitian capital, and leading health officials fear that up to 800,000 Haitians in Port-au-Prince will contract cholera over the next 6 months. Chlorinators and chlorine tablets are readily available in Haiti to any organization operating in cholera-affected areas. Interested parties should email info@haitiwater.org or call +1 202.488.0735 in the US. Our Haiti Director Dalebrun Esther can be reached at +509 3712.6918. If you would like to donate to our efforts, please visit our website.
.
Sincerely,
.
Lindsay, Youngmin, Jeffery, Jeremy, and the rest of the International Action Team
.
info@haitiwater.org
T: (202) 488-0735
F: (202) 488-0736

At Cholera Epicenter in Haiti, Fear and Misery (10/25/2010)

AFP
By DEBORAH SONTAG
.
ST. MARC, Haiti — Here at the epicenter of the cholera epidemic, about 60 miles north of the capital, scores of children and adults are doubled over in a hospital courtyard, stretched out on benches or cots, racked by convulsive stomach disorder or limp with dehydration. They have buckets by their sides and intravenous solutions dripping On Monday, Martila Joseph sat on one of the benches, tears cascading down her face as she held her all-too-still 4-year-old daughter in her arms. “I don’t know if my kid will survive,” she moaned. The cholera outbreak, with 259 deaths and more than 3,300 confirmed cases counted as of Monday morning, has so far been contained to the region around the epicenter — the central rural areas around the Artibonite River. But the capital, Port-au-Prince, is tensely preparing for its arrival in the densely populated slums and tent camps of earthquake survivors. Treatment centers are being established, soap and water purification tablets being distributed and public safety announcements stressing hygiene.
.
“It travels with the speed of lightning, I’ve heard, and it can kill a person in four hours,” said Jean Michel Maximilien, a camp leader, on Sunday. “So of course we are all on edge.” The Haitian government reported optimistically on Monday that the epidemic might be leveling off. "The situation is beginning to stabilize,” Gabriel Thimothee, director-general of the Health Ministry, said at a news conference. “Since yesterday we have registered only six new deaths." Officials emphasized that no new cases have originated in the capital, according to Associated Press. But health experts cautioned that the danger remained high. Daniel Epstein, a spokesman for the Pan American Health Organization, said Monday that in 75 percent of cholera cases, the carriers are asymptomatic. That would mean that the number of people who have the microbe — and could spread it — may be closer to 12,000.
.
Since the January earthquake, this devastated country has been bracing for a secondary disaster — a hurricane, an eruption of violence, an outbreak of disease. But nobody anticipated that cholera would make its first appearance in 50 years. It was “the one thing we thought we were relatively safe on,” said Imogen Wall, spokeswoman for the United Nations humanitarian coordination office. The catalyst for the outbreak is still unknown. “That’s the who-dunnit, the mystery,” Petra Becker, a social worker for Doctors Without Borders, said Sunday after washing her hands with a chlorinated solution at the entrance to a fenced-off treatment area for suspected cholera cases at her organization’s field hospital here.
.
As of Sunday, five cases of cholera had been confirmed in Port-au-Prince, but all were individuals who traveled from the Artibonite valley, according to Dr. Michel Thieren of the Pan American Health Organization. Still, five other patients at the Doctors Without Borders hospital were exhibiting symptoms — intense, precipitous diarrhea and vomiting — and are being isolated, tested and treated for the disease. In a cordoned area with space for 20 patients, the five lay inside tents on beds with triangular holes cut in the heart of the mattress, and a bucket beneath the hole. There were two adults and three children, a few of them hooked up to intravenous drips. One chubby little girl, Neftali Firmin, 5, lay listlessly beside her very nervous mother.
.
The mother said they lived in the capital city and had not visited the Artibonite valley. Wringing her hands, she said that her daughter grew violently sick to her stomach without warning. Neftali had been given rehydration fluids, but her mother wanted the hospital to give her medicine. “When are they going to give her the cure for cholera?” the mother asked visitors. Cholera is an acute bacterial infection that rapidly and dangerously dehydrates the body. If left untreated, it can kill some victims within hours. But the treatment itself is straightforward. Some patients rally after getting a simple solution of clean water mixed with sugar and salt, like what Neftali received. Others require intravenous hydration, and are administered antibiotics.
.
In a sign of the anxiety in this city, residents of the tent camp that surrounds the Doctors Without Borders hospital displayed their discomfort on Sunday with the creation of the new clinic in their midst. For several hours, they blocked access by placing rocks and ropes on an entry road. “We’re really concerned,” Bernard Alcinor, a camp resident, said. “The disease is marching through the country, and we don’t want it here.” But after negotiations, camp leaders relented for now and traffic began flowing again to what is still essentially a treatment center in waiting. Although all are concerned about the crowded, unhygienic living conditions in the tent and tarp camps sheltering some 1.3 million displaced people, the slums are a potentially bigger problem as they do not have even the portable, cleanable latrines that many camps do. Haitian authorities and international groups have been working to assure a more ample supply of chlorinated water, to clean and disinfect community latrines and to caution the public about hand washing, proper use of water and “defecation in open air.”

Death toll rises from Haitian cholera outbreak (CNN-10/24/2010)

Five cases of cholera have been confirmed in Port-au-Prince, Haiti, a U.N. spokeswoman told CNN Saturday, as public health officials worked to keep the country's cholera outbreak from spreading to the capital. A fast-moving cholera outbreak has claimed at least 208 lives in Haiti, the spokeswoman, Imogen Wall, said earlier in the day. The country's health ministry is reporting another 2,364 cases from the recent outbreak, said Wall, spokeswoman for the U.N. Office for the Coordination of Humanitarian Affairs. Wall said the discovery of five infected individuals in Port-au-Prince does not mean cholera is spreading to the main city. The five patients in Port-au-Prince were infected in Artibonite, north of the capital, Wall said. They traveled to the nation's main city, where health officials discovered them to be infected within the incubation period, she said. The five have been isolated and are receiving treatment, she said.
.
The cholera outbreak comes after recent heavy rains caused the banks of the Artibonite River to overflow and flood the area. Dammed in 1956 to create Lac de Peligre, the Artibonite River is Haiti's dominant drainage system. On Friday, officials with the U.S. Centers for Disease Control and Prevention and the U.S. Agency for International Development discussed the outbreak and efforts to work out a containment strategy. The CDC will send an 11-member team to Haiti over the next few days to find out which antibiotics will be most effective in treating the cholera outbreak. USAID will provide supplies needed to set up treatment centers. The group has already prepositioned 300,000 oral re-hydration kits and are distributing water purification kits in affected areas. Other than the five cases in Port-au-Prince, officials said that all the reported cases were in the Artibonite and Central Plateau regions, north of the capital. They said they're working to contain the outbreak there and prevent its spread.
.
Chaos reigned across the Artibonite and Central Plateau regions Friday, as hospitals overflowed with people rushing to get help from the fast-moving cholera outbreak. Eric Lotz, Haiti's national director for the nonprofit Operation Blessing, described a "horrific" scene outside St. Nicolas hospital, the main medical facility in the city of St. Marc, as patients and their family members fought to get care. "There was bedlam outside the gate," said Lotz. "Inside (the hospital), every square inch is covered with people." Some people waited 24 hours or more to get help outside the hospital, many of them on stretchers, said Terry Snow, Haiti director for the nonprofit Youth With a Mission. Snow said he tried to take one man with cholera to various clinics, only to end up at St. Nicolas hospital and be told that it was full. The man died soon thereafter in the back of his truck, he said.
.
"It's very chaotic," Snow said of the scene in St. Marc and more rural agricultural areas nearby. "People are trying to figure out what to do. People are lost." Sandrellie Seraphin, who works for Partners in Health and the Clinton Foundation, visited the hospital Wednesday. "It's terrible," she told CNN by phone, describing the crowds of people trying to get help. "There's a great fear among the people" about the disease. Snow said that "constant miscommunication and confusion" have hindered aid efforts, though he expressed hope things may improve, as more help comes in. Haitian Prime Minister Jean-Max Bellerive called the cholera outbreak "unprecedented" and said authorities were working with the Centers for Disease Control and Prevention to understand what happened. "We have to determine ... where (the cholera) came from," he said.
.
Cholera is caused by a bacterial infection of the intestine and, in severe cases, is characterized by diarrhea, vomiting and leg cramps, according to the U.S.-based Centers for Disease Control and Prevention. In such cases, rapid loss of body fluids can lead to dehydration and shock. "Without treatment, death can occur within hours," the agency says. A person can get cholera by drinking water or eating food contaminated with the bacteria. During epidemics, the source of the contamination is often the feces of an infected person, and infections can spread rapidly in areas where there is poor sewage treatment and a lack of clean drinking water, according to the CDC. "If the environmental conditions are not right, anybody who ingests that food or water can get ill," said Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University in Nashville, Tennessee. "This is the disease that can cause more severe dehydration than any other." All the reported cases in the Lower Artibonite involve severe diarrhea and vomiting, Wall said.
.
Ian Rawson, director of Hopital Albert Schweitzer Haiti near Verrettes, said patients began showing cholera-like symptoms October 16. The pace picked up significantly Tuesday and beyond, though he said the situation was under control Friday at his 80-bed facility about 16 miles east of Saint Marc. "So far, we've been able to manage it," Rawson said, noting that new patients were now coming in via pick-up trucks about every 10 minutes. Temperatures in the mid-90s exacerbated the dual concerns about dehydration and people contracting cholera by drinking tainted water. People lined roadsides in and around villages with buckets, according to Lotz, hoping that passerby might have clean water.
.
He said that his organization on Thursday helped install one water filtration unit, capable of providing 10,000 gallons of clean drinking water and planned to install another two Friday. But some parts of the impoverished nation remained out of reach, he said. One village had been totally cut off by floodwaters. Operation Blessing was among many nonprofit organizations, nations and international bodies in the region offering help. In a State Department briefing Friday, spokesman P.J. Crowley said members of several U.S. agencies were "on the ground" to facilitate and provide clean water and ensure sound sanitation. U.N. staff, too, have sent tents and rehydration supplies to the region, Wall said. Haiti is still trying to bounce back from a catastrophic 7.0-magnitude earthquake on January 12 that destroyed much of the capital city. The U.N. mission in Haiti credited access to clean water and free medical facilities for preventing feared outbreaks of cholera and tuberculosis.
.
But Snow said he has noticed a rise in new illnesses -- from skin infections to flu-like viruses -- in the region since tens of thousands of people moved to the area after the earthquake and the opening of a new canal off the Artibonite River. Whatever the cause, Lotz said the scene this week at hospitals in and around St. Marc eerily resembled what happened in Port-au-Prince after the colossal quake. "It's the same scene, without the wounds, just the same numbers of people inundating the hospital," said Lotz, who was in the Haitian capital last January.

Post new comment