Cholera, Water, and Recovery in Haiti

By Bryan Schaaf on Friday, October 29, 2010.

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

 

The United Nations Children’s Fund (UNICEF), an authority on water, sanitation, and hygiene (WASH), reports that before the earthquake, only four out of ten Haitian children had access to sanitation—one in ten in rural areas.  Only one in five drank from safe water piping systems within their homes—one in twenty-five in rural areas.  Sanitation coverage stood at an alarmingly low 17%, a decrease from 1990.  Few schools had proper water and sanitation facilities, half of the rural population practiced open defecation, and household sanitation (where it existed) was largely limited to rudimentary latrines.  Clearly, this is a context in which a water-borne disease can spread like wildfire.  In post earthquake Haiti, UNICEF acknowledges improved access to safe drinking water and sanitation for 1.2 million people, but without investing in infrastructure and improving local capacity, these gains are not sustainable – particularly when results stem from water-trucking, portable latrines and daily latrine desludging.

 

So what is cholera?  Cholera is an acute diarrheal infection caused mainly by ingestion of food of water contaminated by a bacterium called “Vibrio cholera 0:1”.  Each year, there are an estimated 3–5 million cholera cases and 100,000–120,000 deaths due to cholera.  Far more people (mostly children) die from other forms of diarrhea each year, but cholera is especially dramatic given the speed with which it can spread and through which people can die without treatment.  Something important to keep in mind is that approximately 75% of individuals infected with the bacterium will be asymptomatic but can still transmit.  Of those with symptoms, approximately two percent will be severely affected.  After a short incubation period of from one to five days, severe symtpoms could include watery diarrhea and/or vomiting that causes severe dehydration.  With prompt and proper treatment, the case fatality rate (the number of people who have it and die) should be less than one percent.  According to the World Health Organization (WHO) the death rate from the cholera outbreak in Haiti has been much higher, although it is getting better, decreasing from 10% at the beginning of the outbreak to about 7.7% now.  This may be due to increased awareness of the importance of seeking care as early as possible.  For 80% of cases, oral rehydration salts (ORS) to replace lost fluids is enough.  For severe cases, intravenous administration of fluids and other forms of treatment are necessary. 

 

A county can’t treat its way out of a cholera epidemic.  Prevention is key. What is most important is to ensure, as soon as possible, that people have access to clean water, adequate sanitation, and are able to practice good hygiene.  Vulnerable populations should also be advised to not eat raw food, eat only cooked food, and to avoid washing cooking utensils in and/or bathing in potentially contaminated water.  Bathing in rivers and streams is very common in Haiti.  Community mobilization is critical, especially in a context like this where there has not been a cholera outbreak for decades.  Health care providers were unaccustomed to seeing and treating cholera, and families may have mistaken it for run of the mill diarrhea, which if you’ve spent any amount of time in Haiti, you probably have a personal understanding of how common it is.  While it is true there are cholera vaccines, they are not very practical for responding to outbreaks.  Multiple doses are required 7-14 days apart, and effectiveness is only 70% after the second dose.  Whether vaccination will be part of a long term control strategy is up to the Haitian government. 

 

Acute diarrhea and vomiting were first reported on October 19 in Saint Marc, a medium sized city in the  Artibonite Valley.  As of October 27, almost 5,000 cholera cases and over 300 deaths had been reported.  Other cases were later confirmed on the Central Plateau, in the North, the Northeast and in the West.  Why are the majority of cases occurring in the Artibonite?  Given poor WASH conditions around the country, this could have started anywhere.  But the fact that the Artibonite received the highest number of returns after the earthquake, without comparable investments in the water and sanitation infrastructure, could have been a contributing factor.  The fact that people bathe and wash clothes in the Artibonite River is not unusual.  What may have been different here is the extent to which people were drinking out of it for lack of other options.  To any extent, cholera will be in Haiti for year to come.

 

No cases have been confirmed in the Dominican Republic yet.  The Dominican Ministry of Health has been on high alert and activated a response plan that includes limiting border crossings to individuals with official documentation and a health exam.  The Dominican military has significantly increased its presence along the border.  The concern of the Dominican Ministry of Health is understandable but it is unfortunate that border restrictions will negatively impact trade between the two countries and limit access to medical clinics just on the other side of the Dominican Republic – at least at far as the three formal border crossings go.  The rest of the border remains highly porous.  The Dominican Government is assisting the Haitian Government with water purification and is bolstering medical facilities along the border.

 

The Haitian Government is ultimately responsible for addressing the health needs, emergency and otherwise, of its people.  In this case, the Haitian Ministry of Health (Ministère de la Santé Publique et de la Population or MSPP) and the National Direction for Potable Water and Sanitation (Direction Nationale de l'Eau Potable et de l'Assainissement or DINEPA) are particularly important.  Both Ministries lack resources and have limited capacity but are doing what they are supposed to be doing – taking the outbreak seriously, developing plans, and attempting to coordinate many different responders. President Preval, Prime Minister Bellerive, and Minister of Health Alex Larsen have made public statements acknowledging the extent of the outbreak and providing information on prevention.  For his part, President Préval has agreed to lead a national emergency task force to coordinate the response.  Mario Andresol, the Director General of the Haitian National Police (HNP) has offered up his staff to assist the Haitian Ministry of Health.  Many Presidential candidates have spoken out about cholera while on the campaign trail.

 

MSPP has set in place a National Response Strategy which prioritizes protecting families at the community level, strengthening primary health care centers across the nation, and establishing a network of special Cholera Treatment Centers (CTCs) and designated hospitals for treating severe cases.   According to WHO, the MSPP is sending community health agents into poor and densely populated areas, including temporary settlement areas created after the earthquake, to actively seek out and refer the sickest people to the CTCs, while at the same time giving them a first dose of oral rehydration salts. MSPP also will be establishing a network of community health posts to treat diarrhea.  DINEPA has a National Action Plan in place that emphasizes: (1) Distribution of water purification tablets to local water distribution points and kiosks; and (2) chlorination of as many water sources around the country as possible.

 

Given that the Cluster Approach is active in Haiti, three clusters are playing leading roles in the response: (1) Health; (2) WASH; and (3) Logistics.  These clusters include government officials, international organizations, non governmental organizations, and local groups.  The WASH Cluster members are working with Logistics Cluster members to distribute chlorine throughout the country.  DINEPA is also working with the WASH cluster to distribute soap and to carry out awareness campaigns. MINUSTAH is providing security and logistical support.

 

The WHO/Pan American Health Organization (PAHO) has been working closely with the Ministries of Health from both Haiti and the Dominican Republic. PAHO’s Caribbean Epidemiology Center (CAREC), located in Trinidad, is also working with other countries in the Caribbean to prepare for and response to any suspected cases.  At the request of each government, the U.S. Centers for Disease Control and Prevention (CDC) has deployed experts to assist with the response and are now on both sides of the border.  The United States Agency for International Development (USAID), also present in both countries, is playing a very active role in the response and is funding the efforts of international and non governmental partners.  France has deployed medical staff to Haiti while the Brazilian Ministry of Health has sent medicines and supplies.  

 

UNICEF is distributing medical supplies in the most heavily affected areas of the Artibonite. Radio is the most trusted media in Haiti and the prevention message has been reinforced by IOM nationwide radio programming on commercial and community radio stations. In addition, the International Organization for Migration (IOM) and the Red Cross Movement are using SMS text and voice messages to reach people in the with SMS information on cholera prevention, treatment and hygiene.  Over 80 specialized IOM staff with hygiene training have been deployed for direct outreach to displaced persons in camps across Port-au-Prince. They are broken into teams of 10, each one with 2 Haitian Red Cross health and hygiene specialists, targeting over 60 camps identified by IOM’s WASH team as the most vulnerable. The International Committee of the Red Cross (ICRC) is currently focused on supporting prisons and will dispatch supplies.  The Canadian Red Cross has been sending convoys of trucks up to Artibonite. The Haitian Red Cross is actively involved in information and awareness campaigns. The American Red Cross has deployed emergency response teams and provided supplies such as cots.

 

Many different NGOs throughout the county implement WASH programs and many are now responding to emergency health needs.   Population Services International (PSI) has donated all of its regional stock of water purification tables to Haiti.  ACTED has distributed water purification tablets as well.  Save the Children (STC) is carrying out a health information campaign.  Medecins Sans Frontieres (MSF) has deployed medical teams to cholera affected areas.  The International Medical Corps (IMC) is working closely with the Albert Schwetizer Hospital in Deschapelles, the largest in the Artibonite Valley.  The International Rescue Committee (IRC) is carrying out prevention activities in 37 settlements in Port au Prince.   Food for the Hungry is training staff and communities on cholera prevention and response in 30 settlement sites.  The Center for International Studies and Cooperation (CECI) is distributing soap, ORS and other supplies.

 

The present emergency highlights the importance water plays in Haiti’s long term recovery.  When I think about water from my time in Haiti, I first recall all the rusted out water pumps throughout the country which worked at one point, but no longer do.  Inevitably, they broke down and the community lacked either the means to buy new parts or the expertise to fix the equipment.  I think of rural communities where people collect water from streams and rivers, often in the same places where they water livestock.  I think of communities on the Central Plateau where generations had lived on the same piece of property without realizing water was only ten feet below them.  With cement, tools, some technical assistance, and a lot of sweat, they were able to construct a reasonably good well.  Finally, I can’t help but think of all the times I contracted a water-borne disease myself, of which giardia was the most frequent culprit.

 

The Haitian government does not have a long tradition of investing in the basic needs of its people.  There have been administrations that could have but chose not to do so and those that wanted to but did not have the means to do so.  Investments in water yield rich dividends as it is necessary for health, agriculture, and security.  These dividends are maximized by complementary investments in sanitation and hygiene.  It is up to the Haitian government to plan, to coordinate, and to build WASH partnerships – not just for Port au Prince but for every department in Haiti.  Building the capacity of both DINEPA and MSPP are a long term, indispensable part of the solution. For its part, UNICEF plans to continuously build the capacity of DINEPA to extend its presence throughout Haiti’s ten departments.  DINEPA has no shortage of partnerships it can build on including the United Nations Development Program (UNDP), Inter American Development Bank (IDB), USAID, the French Development Agency (AFD), The Spanish Development Agency (AECID), the European Union (EU) and many others.  Donors should assist DINEPA and MSPP to bolster its human and financial resources.  They should also hold each accountable for demonstrating leadership and results.

 

One size won’t fit all in each of Haiti’s departments.  Boreholes may be drilled in some areas, while wells might be dug manually in others.  Piped water may be expanded into some areas but not others.  Chlorination may be possible in some places while point of use methods better in others.  A long term commitment to WASH is needed by both the Haitian government and the international community.  Expanding water networks will require tackling Haiti’s ever thorny land tenure issues. Concerning sanitation, UNICEF notes that communities need to be empowered to take ownership, eliminate open defecation, and to manage their own sanitation facilities.  National plans and strategies should be just that, including rural as well as urban areas.   At the highest levels, the Haitian government has expressed a desire to decentralize – this will take both a legislative framework to do so and a lasting commitment to improve access to basic services.

 

One of the main coordination mechanisms in Haiti right now is the Interim Haiti Reconstruction Commission (IHRC) which is co-led by Haitian Prime Minister Bellerive and former U.S. President Bill Clinton.  To date, the IHRC has approved only one WASH project, designed to expand public water supply in Port au Prince.  The cost is 200 million over five years, but is reportedly only 57% funded.   Were the IHRC to articulate WASH as a priority and to secure support for the implementation of nationwide programs, it would be a step in the right direction.

 

The current cholera emergency is unfortunate as the poorest of the poor are most at risk.  My hope is that the present situation will encourage a lasting committment to promote WASH - not just to respond to cholera, but as an integral part of Haiti's recovery and long term development.  Please feel free to post your thoughts on WASH related issues in Haiti below.

 

Thanks!
Bryan

 

  

 

Nutrition in a Time of Cholera for Mothers and Babies

12/6/2010
United Nations Children's Fund (UNICEF)
By Tania McBride
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In the cramped and squalid conditions of the tented city in Mais Gate, a camp for Haitians displaced by the January earthquake, baby Sebastian brings a sparkle to his mother Lucienne's eyes. At eight months, dribbling from cutting teeth and tipping the scales at a whopping 11 kg, Sebastian is alert, sitting up, clambering over his mother and almost standing on his own. He is the Brutus in the baby tent, an example to the young mothers of a well-nourished, breastfed baby. Lucienne gives credit for Sebastian's good health and growth to the nurses at the tent – which is run by the non-governmental organization Concern and supported by UNICEF. "Before the earthquake, I had no idea about how to handle a baby, how to even hold a baby, and certainly I knew nothing about breastfeeding," she recalls. "In some ways, it was due to the tremblement that I have this healthy boy."
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On the day of the quake, Lucienne was in her house with three other family members. Spared injury but unable to live in the damaged house afterwards, she has been camped in Mais Gate, surviving as best she can and going to the baby tent every day with Sebastian. "I came to the tents when I was heavily pregnant with Sebastian," she says. "With the information I received from Mauvette, I was able to prepare ahead of time what I would need to ensure Sebastian's survival." Head nurse Mauvette, who lectured at a Port-au-Prince nursing school prior to the earthquake, has seen over 450 women through the baby-tent programme in Mais Gate since it was established in early February. She says education about the importance of exclusive breastfeeding and infant care in these difficult conditions is critical – not only for mothers but for fathers and other caregivers. "Many of the mothers who came to the tent had fed their babies some form of liquids after they were born and solid foods before they reached six months," notes Mauvette. "With a lot of education, we were able to convert them exclusively to breastfeeding, and their children are thriving."
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The baby tent staff also has worked to dispel myths associated with the earthquake. Many women feared that their breast milk had been affected by the quake and would harm their babies, for example. Mauvette and her team, including two nurses and a psychologist, reassured the mothers through education sessions. Now they report that approximately 80 per cent of the mothers in their caseload practice exclusive breastfeeding. "This is extremely encouraging in a country like Haiti, as there is conclusive global evidence that exclusive breastfeeding is one the most effective child-survival interventions," says UNICEF Haiti Chief of Nutrition Dr. Mohamed A. Ayoya. "What we are seeing being practiced in this baby tent is being replicated in other UNICEF-supported baby tents, in community-based therapeutic programmes and also in stabilization centres for children with severe acute malnutrition." Beyond the current emergency, adds Dr. Ayoya, a long-term, sustainable strategy will be needed to promote proper feeding for infants and young children throughout Haiti. "It's essential that a range of people are involved – women, men health professionals and traditional leaders," he says.
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Meanwhile, at Mais Gate camp, stagnant pools of water line the makeshift roads and people live on top of each other, with little or no privacy, in makeshift tarpaulins or tents supplied by aid agencies. Men, women and children constantly traipse to the camp's water points to fill containers of water for drinking, washing and cooking. The Concern baby tent is an oasis in a time of cholera, which broke out in Haiti in October. Anyone who enters the tent has to wash his or her hands thoroughly with chlorine-treated water and soap. Mauvette vigilantly polices the visitors; those who don't wash thoroughly enough are given a demonstration of how to do so and a lecture on the importance of preventing cholera. "Each of these mothers is receiving soap, oral rehydration salts and Aquatabs to help them through this time when cholera is rife in Haiti," the head nurse explains, referring to supplies intended to prevent and treat the diarrhoeal dehydration associated with the waterborne disease. "The baby tents are not just a place to learn about how to exclusively breastfeed," she says. "In many ways they are a vital lifeline to information that mothers and fathers need in order to keep their families healthy and safe from the spread of disease." Lucienne agrees. She is thankful for the camaraderie and support of the doctor, nurses and other mothers in the baby tents. However, she shakes her head when she is asked if she would like to have more children. "These are the worst conditions to bring up a child," she says. "Until my family's situation changes, I am not going to subject another child to this sort of life."

Canadian Health-Care Workers Warn Cholera Will Skyrocket

12/6/2010
The Canadian Press
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There's a permanent smell of bleach at the cholera treatment centre in Bercy, Haiti, where doctors and nurses, many of them Canadian, attempt to provide medical aid for those who are still paying the price from January's devastating earthquake. The tents at the 180-patient centre, run by Samaritan's Purse, are crammed with rows of Haitians lying quietly on makeshift cots, suffering from a cholera epidemic that experts predict is only going to get worse. The alternative to the smell of bleach could be much worse considering the dirt floors are often covered with the vomit and diarrhea from patients who flock to the centre and others like it run by aid organizations in the island nation. "I'm wearing my rubber boots and you are constantly in vomit and diarrhea," said Dr. Jeff Way of Calgary, who returned from a one-week tour at the centre last month along with his wife Mary Ann, who is a registered nurse.
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"They hired local people to come around with big insecticide spray tanks filled with Clorox bleach and they are constantly spraying that on the ground," he added. "We're going to smell like bleach for a long time," said Mary Ann. "When they have their diarrhea and vomiting it is like someone has turned on a tap or a fountain," she told The Canadian Press. "I have never seen anything like it before in my life — how much fluid some of these guys could put out — two or three litres of fluid in one episode of diarrhea and vomiting." Way said kneeling on the ground, especially with limited light during the night shift, proved to be an additional challenge when it came to putting in IVs because often the patient's veins have collapsed. "We've had to pray them in." More than 250,000 people died as a result of the Jan. 12, 2010, earthquake. It is not unusual for cholera to follow a major disaster. The cramped and crowded conditions and a lack of clean water and sanitation create a new health emergency.
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Cholera was first recorded in the early 1800s and is still responsible for 100,000 to 130,000 deaths a year around the world. The treatment is simple. Usually rehydration and antibiotics will cure it in short order. "I think the numbers are going to skyrocket because I think it's about to hit City Soleil (the poorest densely populated area in Haiti) and Port-au-Prince and the numbers are so much higher," she said. "The worry is it's going to hit this highly densely populated area and then I don't know how we'll keep up. I hope there isn't people waiting at the gate, you know dying, before they can get in. That's my big fear." Jeff Way, a surgeon at Calgary's Rocky View Hospital who also works in the trauma department at Foothills Hospital, said it makes you realize just how good the medical system is in North America. "The patients arrived all at once, particularly at first light because they are afraid to travel at night and have their own forms of transportation. We were inundated each morning at about 5:30-6 a.m. with people coming in," he said.
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"This is sitting on North America's doorstep and in North America we have excellent health care, but this is most of the world. This is Third World conditions and that's what people in most of the world have." Samaritan's Purse flies in 40 to 45 volunteer doctors and nurses from Canada and the U.S. every week or two to serve in the cholera treatment centres where they work eight-hour or 12-hour shifts to “rehydrate" patients. The United Nations has predicted that as many as 200,000 Haitians will ultimately be affected by the cholera epidemic. "They're very weak. They can hardly walk; they're being carried in by family members. They're not able to hold anything for themselves. It's very sad," said Jane Noble, 50, a licensed practical nurse from Grimsby, Ont. "After the initial earthquake I think we were all paying attention to what was happening here. All the staff that were here in January and February say the situation now is an awful lot worse than it was back then," she said in a recent interview from the centre in Bercy. Rebekah Schreiner, 32, a nurse from Calgary, admits she was expecting more "rubble and devastation" when she arrived in Bercy but said there are tent cities everywhere.
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The treatment provides almost immediate results. "The patients can be really sick if they are dehydrated and kind of listless and lethargic. They perk up amazingly well with the fluids and IV hydration and their families kind of take care of a lot of things," Schreiner added during an interview from Haiti. She and Noble returned to Canada on the weekend. There are three different cholera vaccines available, but the medicine is in short supply and the window of opportunity for administering it effectively is limited. The only real treatment is rest and lots of fluids. "It's been hard. I've never worked in a situation where there is that many sick and dying people," said Mary Ann Way. "I think the memories are really we had a lot of success. I remember pausing one night and looking around at my 40-plus patients and thinking if we weren't here they would all be dead."

Haiti cholera death toll passes 2,000 mark (AFP - 12/6/2010)

More than 2,000 people have died from Haiti's cholera outbreak and almost 90,000 cases have been recorded, the latest health ministry figures showed on Monday. More than six weeks after Haiti's first cholera outbreak in more than a century erupted in late October, data showed deaths continuing to climb at a steady rate and no apparent tailing off in the number of infections. A total of 2,013 people have died from the water-borne bacterial infection and 88,789 cases have been recorded, according to the official figures. UN experts have warned the actual toll could be far higher.

How Rumors Rule in Cholera-Torn Haiti (12/4/2010)

Truthout
Laura Wagner
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On November 12, 2010, in the bright afternoon sun in front of Ste. Catherine Hospital/CHOSCAL in Cité Soleil, where Médecins Sans Frontières has set up a cholera treatment center, a young woman staggered, keening, tears running down her face, eyes wide with shock. She was in the throes of a kriz, a crisis, a public act of grief and mourning that one displays after losing a loved one. Her child had just died in the hospital, but, she insisted, as a crowd gathered around, it was not cholera. "It was poison! Someone put poison in the water." Cité Soleil may be an extreme example: its recent history has been particularly violent; its reputation sordid. It has been at once a particular target of international intervention and a particular case study of neglect and incompetence. But these characteristics, while more starkly illustrated in Cité Soleil, typify the broader Haitian situation. What happens in Cité Soleil should therefore be of interest not only to people who work there, but to anyone concerned with international intervention and its stigma in Haiti.
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As cholera spreads in Cité Soleil, and throughout Port-au-Prince, so do rumors about its origins and transmission. While waiting to talk to an MSF representative inside CHOSCAL, my friends Damilove Gorguette and Herold Charles, who work for the DINEPA (the government water and sanitation authority) office in Cité Soleil, and I began to talk with the Haitian security guards on duty, who wore MSF or Ministry of Health vests. "It's being spread through the air," the guard in the Ministry of Health vest said. "That's not true," replied Damilove archly, handing him a packet of Aquatabs. "If that were the case, we'd all have cholera." As we talked, a new cholera case arrived, a limp man in a grey T-shirt and jeans, being carried in by three others, each of them supporting him while touching him as little as they could. His head lolled to the side, and it was hard to tell if he was conscious, though a certain tension in his body suggested he was still alive. "It's something they've released in the water," ventured one of the MSF-vested guards. "Who’s 'they'?" I responded. "Those people, moun sa yo! The international community! Why do you think it's the poor who are getting it?" "Because they have a harder time accessing clean water," I replied.
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"What are you talking about? It’s the poor who take more precautions with their water than the upper classes do! No, this is something else. We grew up here, the sun kills the germs and we don"t get sick. Mikwòb pa touye ayisyen. This cholera is something else." This proverb, mikwòb pa touye ayisyen, has been repeated a lot these last weeks. It means germs don’t kill Haitians, and I’ve heard it from residents of Cité Soleil as they gesture toward the stagnant pools of garbage-filled water, teeming with mosquito larvae, tiny fish, and blooms of green algae, that can be found throughout the Cité on the ruined lots where houses once stood. "We were raised here, amid garbage. We grew up in it." Of course the proverb was never true; germs have always killed Haitians - especially those Haitians who don't have access to health care, adequate sanitation, or clean water. But the idea, however wrongheaded, that Haitians are particularly resistant because of their continuous exposure to unsanitary conditions, is now cited as proof that the emergence of cholera is something other than just a "germ," something outside the natural order, and something intentional. At first, the rumors were that cholera itself was merely a rumor, a fundraising ploy. On Tuesday, November 9, as the first reports of cholera in the Cité began to surface, I encountered skepticism. "There's no cholera here," said Mirlande, who runs a small restaurant where she serves up plates of rice, beans, and okra with sauce. She waved her hand dismissively and confidently. "It's in the provinces, in the Artibonite." Even Herold, a Cité Soleil resident who, as a DINEPA employee, is charged with coordinating the distribution of free Aquatabs in the community, told me last Tuesday, "I hear things about cholera, but I can't verify it until I see it with my own eyes." But by that Friday morning, Herold had seen it with his own eyes. "We have people in the hospital now. I know two people have died," he said, while constantly squirting his hands with instant sanitizer. In three days, as the extent of the outbreak became visible and people saw cases in their own neighborhoods and camps, word on the street in Cité Soleil evolved from denial and disbelief to increasing fear and paranoia: cholera is real and was deliberately inflicted.
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The most prevalent accusation is that cholera is a plot by "the NGOs" or "the international community" to profit even more from the misery of Cité Soleil's people. As Herold says, "These NGOs are mafia, they are professional thieves. They're all the same. Except Médecins Sans Frontières, because you actually see them in the community, giving free care. The rest of them are just lining their pockets." Lucienne Estimé, one of the coordinators and residents of the camp at Place Fierté in Cité Soleil, says of the International Organization for Migration, "IOM is a cancer. A cancer is what it is for Camp Fierté! IOM has given us, nothing, nothing, nothing for the last ten months... The man who works for IOM, he doesn't need to know if your house was destroyed in the earthquake, he just says you have to return to your house. What houses can we return to?" According to Estimé, the camp has no showers. Between last Wednesday and Friday, she told me, they had had thirteen cases of cholera in the camp, some of whom have died. And cholera rumors are not limited to Cité Soleil, nor is suspicion about the intentions of international organizations. On November 16, a friend from the Port-au-Prince neighborhood of Christ-Roi told me she'd heard that the UN peacekeeping mission, MINUSTAH, had released a box of dead rats into the water in Cap Haitien with help of "the Americans." "Where did you hear that?" I asked her. "On the radio," she told me. Cholera itself may have first appeared in Cité Soleil, but rumors about its origins are spreading throughout the city. Those rumors feed on Haitians' experiences with NGOs and international aid.
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Cité Soleil - like much of Haiti - is an alphabet soup of NGOs and international organizations; it is no wonder that residents cannot keep them straight. Signs and murals throughout the community advertise projects funded by several acronyms in collaboration. Humanitarian, development and peacekeeping agendas become intertwined and, at least from a ground-up point-of-view, largely indistinguishable. For this reason, and because of several particularly deleterious interventions, "the NGOs" and the "international community" have all become painted with the same brush. From November 2004 to December 2006, MINUSTAH waged an offensive in Cité Soleil in order to root out and apprehend chimères, local gang leaders believed to be supported by ex-President Aristide. This MINUSTAH "war" alienated much of the community. Some Cité residents felt loyalty to particular gang leaders, who at least provided a semblance of local governance in the absence of state-sponsored infrastructure. Moreover, while the community had suffered violence under gang rule, it suffered even more in the years of the MINUSTAH offensive. Building facades remain scarred with bullet holes; houses are still in ruins. Civilians were killed; others still bear injuries such as bullets lodged in their bodies. The young people who grew up in this setting of war and insecurity associate the UN with violence and suffering - an association that now taints MINUSTAH's more recent non-peacekeeping activities (i.e., economic and community development). In 2007, after the most intense violence had ceased, the US Department of State, with support from Department of Defense, launched a Haiti Stabilization Initiative. USAID undertook a project of paving roads in Cité Soleil in an attempt to stimulate jobs and rehabilitate the community. Most of these projects (road and small projects) were executed by IOM. The program encompasses a security component, including re-training of local police and active gang dismantlement groups. The Embassy/USAID produced posters celebrating these roads, showing before-and-after pictures: in muted sepia tones, the photos of old muddy roads are followed by bright and sunny images of clean, paved thoroughfares. However, in several areas these roads were built higher than the homes that surrounded them, slightly convex, without adequate drainage. Cité Soleil, which is built at sea level, has always been prone to flooding; the USAID-built roads worsened this situation, so that now, when it rains, people's homes (and the abandoned lots) flood with run-off and garbage. Trash accrues and mosquitoes breed.
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In 2008, with the funds from USAID/HSI, IOM built a public market in Cité Soleil to replace the main public market that had been destroyed during the years of violence. However, with no community input, IOM sited the market on a vacant tract of land directly between two zones known as "Boston" and "Brooklyn," which were competing gang territories with a history of enmity. At that time, the area was a kind of no man's land, shunned by most people because of its bad memories and the threat of ongoing violence. Also, unlike the old market, the new market was located far from the main road (Route Nationale #1) which runs by Cité Soleil (at the time, there was no Boulevard des Americains, which now cuts through the Cité), so no one from other areas of Port-au-Prince would come to the market. Apart from issues of location, the market was poorly constructed. The roof was so high that the merchants could not hang sheets to protect their wares from the sun and the rain. In the summer of 2008, the first time I visited, the public market was completely empty except for two or three people sleeping inside. A month later, the Haitian National Police ordered the merchants to use the market against their will.
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In light of situations like these, Cité Soleil residents' misgivings about international organizations, and their relationship to the cholera outbreak, begin to look less like unwarranted paranoia and more like reasonable wariness, heightened by poverty and desperation. Add to this the very real possibility that cholera was introduced in Mirebalais by UN peacekeepers from Nepal (which would be the fault, not of the unwitting peacekeepers, who are but outsourced labor from another poor country, but of the MINUSTAH administration and the Haitian firms contracted to construct the sanitation facilities). The notion that cholera is something that "they" have released into the water appears less absurd. People in Cité Soleil know full well the place that they occupy in the agendas of international organizations, as a community especially in need of aid, development, and redemption. They know that a lot of money is supposedly directed toward projects in the Cité, and yet - amid IOM-constructed basketball courts, which are not used by the local youth, a few public plazas now turned into camps, and a sea of tarps and tents from countless organizations - they see little enduring, positive change. This was the case long before the earthquake, and it is thrown into sharper relief now. They know these facts: that international organizations raise money to work in Cité Soleil; little change comes to Cité Soleil; NGO workers boast a quality of life, and a per diem, that they will never enjoy. And then they put those facts together.
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If residents of Cité Soleil distrust and sometimes hate NGOs, the feelings and gossip cut both ways. Rumors and jokes about Cité Soleil’s killers and cannibals routinely surface in casual conversation with NGO workers. Last week, a European NGO employee lightheartedly recommended that I leave some foreign visitors in Cité Soleil overnight, "then come back in the morning and pick up what’s left of them." I made an indelicate retort before I could catch the words escaping my mouth. After an extended - and awkward - silence, he responded sheepishly, "It's a red zone. I'm not even allowed to go there." In the eyes of the international community – and many Haitians – the whole of Cité Soleil is considered violent and criminal because of the presence and dominance of a few violent criminals. In turn, this delegitimizes Cité Soleil's residents, so that their opinions and perspectives can be discredited or ignored. Interventions are designed based on the idea that Cité Soleil residents are criminals to be feared or victims to be pitied – but rarely agents, partners or legitimate speakers about their own situation or community. Most residents of Cité Soleil are, of course, decent and normal people trying to carve out a life for themselves amid considerable hardship - and often unable to do so. And when we look at the criminal elements in the Cité - the young men who turn to guns, who turn to stealing, who turn to those who offer them a bit of power and a sense of belonging - we should remember this proverb, which people from Cité Soleil told me the first time I went there: Chen grangou pa jwe. The hungry dog doesn’t play. If you are desperate enough, poor enough, you may do anything.
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The way NGOs are perceived by a community that they are supposed to serve can be an effective - and real - obstacle to communication, both in the time of cholera and in general. Seemingly "irrational" or "ignorant" beliefs about cholera and its origins, and about the intentions of the international community, are rooted in distrust and skepticism based on experience. One may argue that while "relativism" has its place, in this life-or-death situation, ignorance is not to be tolerated. I would argue the opposite: that the persistence and prevalence of rumor at this fatal and decisive moment illustrates the acute need to understand it. Subjective truths matter, because the supposed relationship between cholera and the international community is true to those who believe it, and therefore has a very real and powerful impact.
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Laura Wagner is a PhD candidate in anthropology at UNC Chapel Hill.

Cuban medics a big force on Haiti cholera frontline (12/3/2010)

Reuters
By Pascal Fletcher
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They don't send out press releases, don't have public information officers and their contacts are not widely publicized by the huge international humanitarian operation helping cholera-hit Haiti. But when the United Nations appeals for more doctors and nurses to combat the deadly disease that is killing dozens by the day, it is to Cuba's medical brigade that U.N. officials are likely to turn to first. With a tradition of service in the world's poorest and most forgotten states, the Cubans are a major frontline force in the multinational response to the raging epidemic, which has killed at least 2,000 people and probably more, since mid-October in the impoverished country.
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While many Western aid workers crowd Haiti's capital, where more than 1.3 million vulnerable homeless survivors of the January 12 earthquake are crammed into tent camps, Cuba's medics are seeking out cholera victims in hard-to-reach rural hamlets. A Cuban-led team trekked this week to one such settlement -- the dirt-poor mountain village of Plateau in Haiti's cholera-ravaged Artibonite department, where they set up an emergency makeshift cholera treatment centre on the benches of a Protestant church. We don't look for publicity but we do look for the people," Dr. Lorenzo Somarriba, coordinator of the Cuban Medical Brigade in Haiti, told Reuters at the brigade's headquarters in a Port-au-Prince suburb. "The Cuban doctors are working in the most difficult places. It's our policy to concentrate on areas outside the national capital," he said, a fact acknowledged by both Haitian and foreign health authorities. A small Cuban flag sits on the table in front of Somarriba, while pictures of former President Fidel Castro and guerrilla icon Ernesto "Che" Guevara, himself a doctor, adorn the walls. Plateau represents the 39th cholera treatment location set up and run by the Cubans across much of Haiti's daunting geography, from the coast to the denuded mountains of the interior where poor, illiterate peasants are helpless victims of a deadly diarrheal disease they have never known before. These locations are carefully marked on a map of Haiti in the Cuban brigade's headquarters and Somarriba, a Cuban vice minister of health, reels off figures and statistics like a general marshalling his forces in a military campaign.
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The Cuban-led medical brigade in Haiti is 908 people strong, Somarriba said. It includes Cuban-trained professionals from 19 other countries -- mostly Latin American, Caribbean and African nationals who serve under the Cuban flag. It is the largest medical contingent in Haiti from any one nation, treating 30 percent to 40 percent of the cholera patients. The Cuban contingent consists mostly of doctors and nurses but also includes technicians and logistics experts. They have warehouses, a fleet of trucks, and planes that fly in supplies and personnel from the communist-ruled island to the west. The scale, organisation and experience of this presence make Cuba the country that Haiti's government and its relief partners seek out when they need to ramp up the struggling response to the unchecked epidemic.
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"They (the Cubans) are available, they are trained up, they have resources in place," said Nyka Alexander, spokeswoman in Haiti for the World Health Organisation. "We know the terrain. We have people who speak Creole and the people know us," says Somarriba, citing the 12-year presence of a Cuban medical brigade in Haiti. Cuban medics first came to help after Hurricane George in 1998. The United Nations' top humanitarian official, Briton Valerie Amos, said during a visit to Haiti last month that the country needed an urgent surge of foreign medics -- at least 1,000 nurses and 100 more doctors -- if it was to have any hope of curbing the death rate of the raging epidemic. Britain's government said days later it would fund 115 doctors, 920 nurses and 740 support staff from the region to set up 12 treatment centres and 60 subsidiary units in Haiti.
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U.N. officials said Cuba was the first to offer more personnel. "There is a call for everybody but the response came first from the Cubans. They are going to send 300 additional doctors," Edmond Mulet, head of the U.N. peacekeeping mission in Haiti, told Reuters. Somarriba said the Cuban medical reinforcements were ready in Havana and would be flown in. He said that besides its own resources, the Cuban brigade was receiving significant contributions for its work from the Panamerican Health Organisation/World Health Organisation, the U.N. children's agency UNICEF and the World Food Programme. Cuba also had been working since 2007 with socialist ally and oil producer Venezuela to create a health service network across Haiti. Havana already had helped Haiti after the devastating January earthquake, with a medical response reaching a peak of more than 1,700 personnel in March.
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Somarriba said Cuban doctors and nurses already in Haiti had treated the first cases of the cholera outbreak on October 15 in Mirebalais in the Centre Department, raising the alarm about severe diarrhoea later confirmed to be cholera. In centres run by the Cuban brigade, less people were dying from cholera, Somarriba said. The mortality rate there was under 1 percent, below the national average of 3.5 percent. He quickly added: "We should avoid competition, comparison. We should all just be helping ... we'll be helping Haiti and all of the Americas because of the risk of this spreading." They may not have the public relations punch of many international charities but the Cubans have a powerful cheerleader in former President Fidel Castro, who has recounted their exploits in statements on Cuban government websites "Haiti needs to be rebuilt from its foundations, with the help and cooperation of everyone," Castro said. (Editing by Bill Trott)

Cholera Cases Climb, but Fewer Patients Dying (PAHO - 12/2/2010)

The number of cholera cases continues to grow in Haiti, but a smaller proportion of people who become ill are now dying from the disease, according to data released this week. In the first weeks of the cholera epidemic, which began in late October, the proportion of hospitalized patients dying of cholera was as high as 9 percent. In the latest reports from Haiti's Ministry of Health, that figure is down to 3.5 percent. "This is progress," said Dr. Jon K. Andrus, Deputy Director of the Pan American Health Organization/World Health Organization (PAHO/WHO). "There are still too many deaths, and we face many challenges. But the hard work of Haitian doctors, nurses, and community workers and their partners in the international community is, in fact, saving many lives." The data released this week show that, since late October, cholera has killed more than 1,800 people and has sickened at least 80,000 in all 10 of Haiti's departments. Andrus and other public health experts believe, however, that these numbers significantly underestimate the true toll of the epidemic because of gaps in case reporting.
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Epidemiological modeling carried out by PAHO/WHO and the U.S. Centers for Disease Control and Prevention (CDC) for planning purposes projects an estimated 400,000 cases over the first 12 months, with as many as half those cases occurring in the first three months of the epidemic. Andrus said this means efforts need to be scaled up, since "cholera is now entrenched in Haiti, and conditions on the ground are such that we should expect many more cases." "The main challenge we face in Haiti today is scaling up the response over the next few weeks, particularly as we approach the holiday season when it will become more difficult to mobilize outside support, supplies, and other resources," he said. Scale-up plans developed by Haiti's Ministry of Health with support from PAHO/WHO and other U.N. agencies propose an increase in the number of cholera treatment centers and expanded efforts to promote prevention and treatment at the family and community levels through public education and by providing chlorination tablets and oral rehydration salts. This work alone will require an additional 350 doctors, 2,000 nurses, and 2,200 support staff over the next three months, training for some 30,000 community health workers and volunteers, and additional supplies of oral rehydration salts and water purification tablets. Andrus noted that these requirements could change as the situation continues to evolve. Other pressing needs include more intravenous rehydration solution, antibiotics, chlorine, body bags, personal protective equipment, water bladders and cisterns, cholera beds, and materials for constructing latrines.
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The impact of cholera in Haiti has been particularly severe, Andrus and other experts say, because large sectors of the population have poor access to clean water and sanitation, because Haitians had not been previously exposed to the disease and therefore lacked natural immunity to it, and because of difficulties in getting patients to health facilities in time for effective treatment. "We know that many patients were arriving too late at hospitals and health clinics. Expanding the number of treatment facilities and educating people about the need for early treatment have helped reduce the proportion of deaths," Andrus said. "In the midst of this outbreak, people need to know that with the very first loose stool they need to start taking oral rehydration salts. If they do that, we can save more lives." PAHO/WHO and other international partners have been supporting the Haitian Ministry of Health in efforts to educate the public on preventing and coping with cholera and in efforts to improve hygiene in resettlement camps, homes and public places such as markets, schools, healthcare facilities, and prisons. To scale up these efforts, PAHO/WHO has proposed the immediate recruitment of 1,000 community environmental workers. Andrus also noted the critical importance of scaling up access to clean drinking water and improved waste disposal. "PAHO/WHO continues to work with its partners to monitor water quality and increase access, but it is essential that Haiti get funding for and begin to build large-scale systems for water supply and sewerage treatment," he said.
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Sonia M. Mey, Media/Press Knowledge Management and Communication Pan American Health Organization World Health Organization, PAHO/WHO 525 23rd Street, NW Washington, DC 20037, USA Telephone +1 202 974 3036 Mobile +1 202 439 9691 Fax: +1 202 974 3143 email: maysonia@paho.org www.paho.org

Volunteer workforce key to the fight against poverty and disease

12/3/2010
International Federation of Red Cross And Red Crescent Societies (IFRC)
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Ambitions to tackle critical challenges such as poverty or the spread of disease cannot be realised without a well supported volunteer workforce, according to a global partnership of volunteer based organisations. On December 5, International Volunteer Day, The International Federation of Red Cross and Red Crescent Societies (IFRC) will join with other voluntary based organisations in a year long effort to highlight the role of volunteering in today's world. ' Volunteers are vital to finding solutions to our greatest humanitarian challenges' says IFRC Under Secretary General for National Society and Knowledge Development, Dr Mukesh Kapila. 'Volunteering is the common link that binds humanitarian action and lasting development at the community level.' According to Dr Kapila, the role of Haitian Red Cross volunteers in responding to the current cholera outbreak illustrates the value of a well-equipped and, well-organised local network of volunteers. 'Over 1,000 trained Haitian Red Cross volunteers are visiting camps and other areas at risk to deliver potentially lifesaving information. They know how to relate to the people in the camps because they are part of the same community. They have an unprecedented level of access and ability to relate to, and communicate with, people who are vulnerable to the spread of cholera in Haiti' says Dr Kapila. Around the world, Red Cross Red Crescent volunteers are in a unique position as community members to play a significant role in development efforts.
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Throughout 2011, the International Year of the Volunteer, IFRC will measure and recognize the economic and social value of volunteering in tackling humanitarian and development issues. It will also work towards better protection for volunteers and promote volunteerism to grow and strengthen the global volunteer workforce. It will ask individuals and corporate organisations around the world to "find the volunteer inside you" by supporting Red Cross and Red Crescent Societies; through volunteering as an individual; by encouraging corporate volunteering initiatives as employers or employees or by becoming a regular financial donor to support the work carried out by volunteers.
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For further information, or to set up interviews, please contact:
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Sadia Kaenzig, IFRC senior communications consultant for health, +41 22 730 4455, +41 79 217 33 86,
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Susie Chippendale, senior communications officer, +41 22 730 4942, +41 799 592 536
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The International Federation promotes the humanitarian activities of 186 National Red Cross and Red Crescent Societies. By coordinating international disaster relief and encouraging development support, it seeks to prevent and alleviate human suffering. The International Federation, its 186 National Societies and the International Committee of the Red Cross together constitute the International Red Cross and Red Crescent Movement.

UN Secretary General Appeals for Aid to Fight Cholera

Caribbean 360
12/3/2010
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United Nations Secretary-General Ban Ki-moon today called on the international community to provide immediate massive aid to Haiti to fight a deadly cholera epidemic raging through the impoverished country, warning that hundreds of thousands of lives are at risk. “Clearly, it will continue to spread, unfortunately,” he told an informal meeting of the General Assembly, noting that the epidemic could affect as many as 650,000 people in the next six months, and that the current toll may already be twice as high as the over 1,800 deaths and nearly 81,000 cases reported so far. A UN appeal launched three weeks ago for UD$164 million is only 20 percent funded as the Haitian Government, UN agencies and the humanitarian community seek to provide treatment and put preventive measures in place, supplying water-purification materials, carrying out large-scale public information campaigns, and helping to build treatment centres. “One thing is clear,” Ban said. “Admirable as they may be, these collective efforts are simply not sufficient. Without a massive and immediate international response, we will be overwhelmed. The lives of hundreds of thousands of people are at risk. And it is up to us to act, with maximum speed and full resources.”
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The appeal was repeated by Assembly President Joseph Deiss, who told the 192-member body that efforts to prevent the spread of the epidemic cannot wait. “In the current circumstances, the international community must do everything within its power to help the Haitian authorities and people,” he said. “Urgent action must be taken to meet the humanitarian challenges and ease the suffering of the Haitian population.” Ban cited the urgent need for more cholera treatment centres, both large and small, and more trained medical and non-medical personnel to run them to minimize the fatality rate, which he noted had decreased over the past six weeks from 7.6 percent to 3.6 percent in a country that is still reeling from an earthquake in January that killed 200,000 people and rendered some 1.3 million others homeless. The UN World Health Organization (WHO) and its regional arm, the Pan-American Health Organization (PAHO), estimate that an additional 350 doctors, 2,000 nurses and 2,200 support staff will be required over the next three months, in addition to the 300 medical personnel that Cuba has already committed. Some 30,000 community health workers and volunteers also need to be trained to help staff an estimated 15,000 oral re-hydration points, while still others are required to promote better hygiene in camps and communities. Cholera is spread through contaminated food and water – due to poor access to safe water, inadequate sanitation and high population density in the camps.

WHO/PAHO: Controlling the cholera outbreak (12/1/2010)

As of 1 December Haiti’s Ministry of Public Health and Population (MSPP) reported 80 860 cholera cases and 1817 related deaths nationwide. All ten departments are affected. The actual number of cases and deaths remain underestimated due to the weak surveillance system. One-third of all reported deaths occur in the community. Up to 400 000 people could become ill over the next six to 12 months, half of which during the first three months. Despite support from the international community, the health care system is under stress because of the structural damage and loss of personnel caused by the January earthquake. The response seems adequate in most IDP camps but there is much concern in slums around Port-au-Prince, where the proportion of people that could be affected could be as high as 5%. Outbreaks in remote rural areas are also of concern, because there are fewer resources to treat cases and a lack of infrastructure to implement prevention.
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Violence has compromised the delivery of supplies and access, mostly in the north. Insecurity has also severely limited activities in Port-au-Prince. As of 30 November, 40 cholera treatment centres (CTCs) were operational (100 to 200 beds each) and 61 cholera treatment units (CTUs) were functional. Few oral rehydration centres (ORCs) have been established so far due to difficulties in implementing the response. More than 70 health partners are supporting the response and at least 24 NGOs are providing health care in the CTCs and CTUs. As Health Cluster lead, WHO/PAHO is liaising with the humanitarian clusters for advancing an inter-sectoral response to the epidemic and supporting the Government to coordinate the overall response based on the National Cholera Response Plan. The plan aims to protect families at community level, strengthen primary health care facilities already operating across the nation, establish a network of special cholera treatment centres and strengthen designated hospitals for treatment of severe cases.
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WHO/PAHO has mobilized human and material resources to support the MSPP for disease surveillance, case management, essential medicines and supplies, water and sanitation, logistics and communications.
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Between 19 and 22 November, WHO/PAHO, in coordination with the MSPP and WFP, distributed 87 tons of medicines and supplies, covering one-third of the expected patient caseload over the coming months;
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WHO/PAHO has set up training programmes for health providers and community workers on the prevention and treatment of cholera;
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From headquarters, WHO has deployed 11 staff members to support the Health Cluster for risk assessment coordination, logistics and environmental health.
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WHO is coordinating with external partners, including Global Health Cluster partners, the Global Outbreak Alert and Response Network (GOARN) and other networks, to identify additional experts;
WHO participated in the development of the inter-sectoral strategy for the epidemic in collaboration with the Clusters for Water and Sanitation, Education, Food, Logistics, and Camp Coordination and Camp Management, United Nations agencies, NGOs and the UN Stabilization Mission in Haiti (MINUSTAH). The strategy was launched in Geneva on 16 November, seeking US$ 164 million of which US$ 42.5 million are for strengthening the health sector. It is part of the Consolidated Appeal Process 2011.

Further activities to reinforce the response are planned. They include:
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expanding the number of CTCs and CTUs to 50 and 200 respectively;
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establishing ORCs at each of the 1200 primary health care facilities across the country with trained health staff to identify, manage and refer cholera cases;
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identifying, training and deploying 350 doctors, 2000 nurses and 2200 support staff to allow the expansion of the CTC/CTU network, as well as 30 000 community health workers for the ORCs;
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ensuring appropriate management of dead bodies;
delivering chlorine for both household and large-scale water treatment;
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conducting health education campaigns to reinforce cholera-prevention behaviours, increase early detection and treatment of cases and improve household water treatment and storage.
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As of 29 November, only 16% of the US$ 42.5 million needed to strengthen the health sector had been received. Brazil, Canada, Finland and the USA have already donated funds to support WHO’s activities and Italy, Andorra and Spain have made pledges.
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The Assistant Director-General for HAC visited Haiti from 22 to 26 November to review status of operations and he met with the Emergency Relief Coordinator.

American Red Cross commits additional $2 million to Cholera

The American Red Cross announced today it is committing an additional $2 million to combat an escalating cholera epidemic in Haiti that has killed more than 1,700 people and sickened more than 75,000. The funds will be used to purchase much-needed supplies, including 40 million chlorine tabs, 3 million pieces of soap, and 140,000 oral rehydration solution sachets, as well as tens of thousands of buckets, jerry cans and water purification sachets. These items will be distributed in coming weeks. The new contribution increases the total American Red Cross support for the cholera response to date to more than $3.3 million. The American Red Cross contribution is part of a broad response to the cholera outbreak by the global Red Cross network, which includes hygiene promotion, water and sanitation services and provision of medical supplies. “This multi-faceted response is urgently needed to save lives,” said David Meltzer, senior vice president of International Services at the American Red Cross. “The Red Cross is engaged on multiple levels from leading cholera prevention activities in camps such as hygiene promotion to educate thousands of Haitian earthquake survivors, to funding treatment facilities and bringing desperately needed supplies into Haiti. And we are prepared to do much more in the days and weeks to come.” Since the cholera outbreak began last month, the American Red Cross has provided 5,000 cots for use in health centers operated by Partners in Health, Project Medishare and the Haitian Ministry of Health. At the request of the Haitian Ministry of Health, the American Red Cross has also purchased 250,000 sachets of oral rehydration solution, an essential supplement to combat the rapid dehydration from cholera which can lead to a patient’s death. As the number of cholera cases grows, the Red Cross is trying to prevent the crisis from crossing borders.
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“We are deeply concerned about the possible spread of cholera beyond Haiti and are also contributing tens of thousands of dollars to help prevent the spread of cholera in the neighboring Dominican Republic,” Meltzer said. The Red Cross has been a leader in prevention activities. For weeks, teams of Haitian health promoters managed by the American Red Cross have been going tent to tent in the camps of Port-au-Prince to personally teach vulnerable Haitians about basic hygiene practices as well as prevention and response tips for cholera. These face-to-face interactions have been reinforced by 2.7 million text messages sent to hundreds of thousands of cell phone users in Haiti by the global Red Cross network, as well as weekly Red Cross radio broadcasts, special advertisements and sound trucks that drive through Haitian communities in order to share cholera prevention messages quickly and to as wide an audience as possible. During the response, the Red Cross has also been providing safe, chlorinated water each day to an estimated 280,000 displaced survivors throughout Port-au-Prince. Thanks to the generosity of the American people following the January earthquake, the American Red Cross anticipates having the funds necessary to respond to these unexpected emergencies in Haiti. .

Cholera Panic Sparks Witch Hunt 12 Killed (12/2/2010)

Associated Press
By JONATHAN M. KATZ
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Terror over a fast-spreading cholera epidemic has triggered a violent witch hunt in rural Haiti in which locals have murdered at least 12 neighbors on accusations they used "black magic" to infect people, police said Thursday. The fast-killing infection is new to Haiti and there is widespread confusion and fear about the disease. In less than six weeks since the first-ever case was confirmed in the country's rural center, nearly 1,900 people have died and more than 84,000 been infected. Rumors began to spread last week in the remote southwestern Grand Anse region, where the first cases of cholera are only now being seen, that Vodou practitioners had fashioned a magic powder to spread the infection. Vodou is a widely held faith in Haiti that combines elements of African religion with Roman Catholic Christianity. It includes deeply held tenets of magic, both good and evil, and its priests are especially influential in rural populations.
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In response to the killings, the government in Port-au-Prince issued a statement Thursday imploring: "Cholera is a microbe ... The only way to protect one's self against cholera is to observe the principles of hygiene." "There is no cholera powder, nor cholera zombie, nor cholera spirit" and Vodou priests "can neither treat cholera, nor make a powder that gives cholera," it said. Confusion over how the disease spreads has also prompted attacks on cholera-treatment centers. The origins of Haiti's cholera epidemic have not been proven. Public health experts believe the bacteria, which matches a South Asian strain, was imported from a cholera-endemic country. Much speculation has centered on a base of U.N. peacekeepers from Nepal with documented sanitation problems which was located on the river where the outbreak began. Riots against the U.N. peacekeepers broke out last month in the country's north, and chants linking politicians with the epidemic have become standard at anti-government protests around Sunday's disputed presidential election.

Haiti simmers amid vote limbo, anti-cholera attacks (12/2/2010)

AFP
By Clarens Renois
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Tensions simmered in Haiti with its political future hanging in the balance, as protesters renewed charges of vote-rigging and cholera fears led to deadly mob violence. As vote-counting continued ahead of the expected release of preliminary results on Tuesday, candidates in last weekend's presidential and legislative elections remained split over whether to endorse the outcome. With the impoverished Caribbean nation in limbo, several hundred opposition demonstrators peacefully took to the streets of Port-au-Prince seeking annulment of the vote to determine the successor to Rene Preval. "Arrest Preval!... Cancel the election!" the protesters shouted as they made their way to the headquarters of the election commission, which was guarded by blue-helmeted UN peacekeepers and Haitian anti-riot police. "Our message is clear: We want Preval to go and we do not want elections with him in power," said candidate Jacques Edouard Alexis.
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But chief UN peacekeeper Edmond Mulet asked protesters to stop their calls for Preval's ouster "The UN and the international community will never accept that a legitimate Haitian president leaves under pressure from the street. It would be a coup," he warned. Twelve of the 18 contenders rejected Sunday's election shortly after polls closed, but longtime opposition leader and pre-election favorite Mirlande Manigat and another leading candidate, popular musician Michel Martelly, later reversed their calls for the polls to be scrapped. An unexpected admission from the ruling INITE (UNITY) party that its candidate Jude Celestin may have lost has fueled a sense that Haiti could experience a political watershed if the dysfunctional, failing nation is able to manage a relatively peaceful transition of power. International monitors -- while acknowledging widespread problems including violence and claims of fraud -- declared the elections valid. Final results are expected on December 20.
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Mulet urged Preval's government to recognize results, saying "the international community will pull out of Haiti and the country will not benefit from international support and resources if the people's decision is not respected." But the stubborn cholera epidemic, which has claimed more than 1,800 lives since mid-October, cast a shadow over the first election since a massive earthquake tore the country apart in January, killing some 250,000 people. The epidemic took a ghastly turn as officials revealed that at least 12 people had been stoned or hacked to death in the last week by angry mobs accusing them of trying to spread cholera through witchcraft. "Their corpses were burned in the streets" in the far southwest area of Grand Anse, the region in Haiti least affected by the disease, local prosecutor Kesner Numa told AFP.
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"These people were accused (by the mobs) of witchcraft related to cholera," said Numa, adding that the attackers believed their victims were trying to "plant a substance that spreads the disease in the region." Local communities were refusing to cooperate with investigations of the killings there, officials said. Suspicion about the outbreak has swept through Haiti, where many accuse UN peacekeepers of having imported the disease. According to the latest official cholera tally, 1,817 people have died and a total of 80,860 cases have been recorded, with 36,207 hospitalizations. But while the epidemic is still spreading throughout the country, it is less lethal, according to the Pan American Health Organization (PAHO). PAHO spokeswoman Donna Eberwine-Villagran acknowledged, however, that the official toll was underestimated, and that Haiti could see up to 400,000 infections over the next 12 months. Amid the epidemic and the election tensions, the president's already tarnished image suffered further with the release of a leaked US diplomatic cable portraying him as seeking to "orchestrate" the vote. "Close friends speculate that many of Preval's actions during the past year... stem from his very real fear that politics will prohibit him from returning to private life in Haiti after his presidency," a June 2009 cable by Washington's then-ambassador said. Haiti has been plagued by dictatorships and political upheaval, and several past leaders have fled or been forced into exile, including Jean-Bertrand Aristide, Haiti's first democratically elected president.

Cholera rages in rural Haiti, overwhelming clinics

Associated Press
12/3/2010
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A gray-haired woman, her eyes sunken and unfocused from dehydration, stumbles up a dirt path slumped on the shoulder of a young man, heading to a rural clinic so overcrowded that plastic tarps have been strung up outside to shade dozens who can't fit inside. On the path to the clinic, another cholera victim lies dazed, her head bleeding because she couldn't stay atop the motorcycle taxi that carried her along the twisting country roads to the treatment center on the front line of Haiti's sudden battle with cholera. Nearby, a 16-month-old girl wails as a nurse prods her with a needle, trying to find a vein for the intravenous fluids she needs to save her life. Many feared Haiti's growing epidemic would overwhelm a capital teeming with more than 1 million people left homeless by January's earthquake. But, so far, it is the countryside seeing the worst of an epidemic that has killed nearly 1,900 people since erupting less than two months ago.
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Rural clinics are overrun by a spectral parade of the sick, straining staff and supplies at medical outposts that could barely handle their needs before the epidemic. At the three-room clinic near Limbe, in northern Haiti, a handful of doctors and nurses are treating 120 people packed into three rooms. "It's really attacking us," Guy Valcoure, grandfather of the 16-month-old, says of the cholera. He piled on the back of a motorcycle with the baby and her mother to make a 40-minute ride in pre-dawn gloom to reach the clinic. Holding a plastic cup in case his granddaughter gains enough strength to drink some water, Valcoure watches anxiously as a nurse tries without success to find a vein to give her intravenous fluids. Eventually, a doctor manages to get an IV into the baby's foot. "She's going to be OK," the nurse tells Valcoure. Not everyone is so fortunate. It was too late to save an old woman carried to the clinic on a door over the weekend, says Dr. Benson Sergiles, a doctor from Cap-Haitien on loan to the clinic. "It's getting worse by the day," he says, his eyes bleary from being up all night. And experts say the disease has not yet reached its peak.
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The Health Ministry says there have been more than 80,000 cases since cholera was first detected in late October and the Pan-American Health Organization projects it could sicken 400,000 people within a year. A makeshift clinic run by the aid group Doctors Without Borders in Cap-Haitien is seeing 250 patients a day and expects two or three times as many in coming weeks, said Dr. Esther Sterk, a physician from the Netherlands in charge of the treatment center in a crowded gymnasium. The cases are also rising further into the countryside, as at the little clinic near Limbe. "I don't think we're anywhere near the end of this," said Dr. John Jensen, a Canadian doctor volunteering with his wife, a nurse, for nearly a month at the clinic about 12 miles (20 kilometers) west of Cap-Haitien. Fear over the spread of cholera even triggered a violent witch-hunt in the remote southwestern Grand Anse region, where locals have killed at least 12 neighbors on suspicions they used "black magic" to infect people, national police spokesman Frantz Lerebours said Thursday.
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Cholera made its first appearance on record in Haiti near the central town of Mirebalais. From there it spread north through the Artibonite region. It has sickened thousands in the capital, but it is the vast rural population that is most vulnerable because cholera is spread by bacteria in contaminated water, and poor rural people often have no access to clean water and no clinics nearby. "Most Haitians live in rural areas and most don't have latrines," said Dr. Louise Ivers of the medical aid group Partners in Health. "Most people have to do their business in a hole in the back garden and drink water from an unprotected source." It is these people who have the fewest options when they get sick. "Why do you die from cholera? Because you don't have access to health care," Ivers said.
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A hospital in the central Haitian city of Maissade has just two physicians to care for a population of 60,000. That center along had treated 350 cholera patients as of last week, said Dr. Tim Rindlisbacher of Toronto, Canada, who recently worked there as a volunteer with the Canadian aid group Humanity First. He said he believes many more never got treatment. "It is easy to miss it in the rural areas," Rindlisbacher said. "There's a lot of people who never make it to a hospital, never make it to a doctor and there's no way of tracking those people." In much of the countryside, public transportation is rare. The nearest doctor or nurse could be a trek of many hours through the mountains. Even in the cities, ambulances don't exist and cholera patients usually travel by taxi or collective transport.
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Associated Press journalists this week came upon four men carrying a 14-year-old boy on a stretcher along a dirt road, his mother trudging alongside. They had been walking four hours from their village to the town of Grand Riu Du Nord, in mountains about 16 miles (25 kilometers) south of Cap-Haitien to reach a clinic staffed by Cuban doctors, who treated the boy. A maddening fact about cholera, which rapidly drains the bodily fluids from its victims, is that it is easy to treat and most people survive if they get medical attention. Doctors Without Borders says the disease has a mortality rate of less than 1.5 percent among people who reach the more than two dozen treatment centers it operates around Haiti. Yet no one knows how many are dying uncounted and alone out in the countryside. One small village visited by Guytho Alphonse, a public health promoter for the aid group Oxfam, is a three-hour walk from the nearest medical clinic. He said villagers told him that an entire family of six had died of the disease. His visit was meant to prevent such tragedies: he was distributing oral rehydration mixture and chlorine for treating wells.
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Dr. Thony Michlet Voltaire, who runs a hospital in the town of Sante Borgne, about 40 miles (65 kilometers) from Cap-Haitien, said he was getting 40 patients a day. He said seven people had arrived in such bad shape over the past week that they could not be saved. "A lot of people are dying at home because they can't make it to us," said Voltaire, who said his clinic, the Alliance Sante Borgne, was in dire need of medicine, volunteers and such basic supplies as clean bed sheets. Aid groups and international organizations such as the United Nations are working on campaigns to confront the outbreak, but Ivers and others said it will take an army of health workers to stop cholera's spread. "Let me put it this way: We have 3,000 community health workers and we are hiring more ... as many as we can," she said.

Open Sewers Challenge Cholera Treatment Efforts in Haiti

12/1/2010
By Emily Schmall
Freelance journalist
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At night the roads in the capital of Haiti, the poorest country in the Western Hemisphere, are dark except for the moon, the stars and the spontaneous methane fires of burning trash. The acrid scent of raw sewage is the pungent threat of disease. The escalating cholera epidemic has killed more than 1,700 people and made 75,000 sick, according to the Red Cross. There is no sewage treatment plant in all of Haiti, and until this changes, the threat of cholera and other infectious diseases shows no signs of abating, experts say. "The biggest challenge to battling the cholera epidemic is sanitation," said Henry Gray, a water and sanitation emergency coordinator for the Paris-based nonprofit Medecins Sans Frontiere. While the Haitian government mulls plans to build a sewage treatment plant, "that would be drop in the ocean for the amount of sewage that's being produced," Gray said. The open sewers are the likely reason Alex Daristide, 5, arrived to the Sartre cholera treatment center -- among 32 treatment centers throughout Haiti -- Monday after a day of unceasing vomiting and diarrhea. His family learned about the epidemic on the radio two weeks ago, his brother, Jean-Pierre Auguste, 20, said, and began to add chlorine tablets to their drinking water. But Port-au-Prince's open sewers present contamination threats even to the most cautious.
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Since January, humanitarian organizations have installed 13,000 latrines, most of which are traditional portable bathrooms, concentrated mostly in the tent camps that average 50 people to every toilet, Gray said. "It's not the camps where we are seeing a disproportionate number of cases. It's the slums. The number of toilets in the slums is a worry. There are very few," he said. MSF has appealed to the United Nations and the Haitian government to free up redevelopment funds to address the problem of the sewage, said Dr. Michel Janssens, an MSF press officer based at the southern treatment center." Critical decisions have to be taken now, open new sites special for cholera waste and treat waste disposal correctly to avoid a new epidemic coming from all that waste," Janssens said. MSF trucks dispose of human waste and used medical supplies 20 kilometers away from the center, in a mountain heap of trash managed by the Haiti Recovery Group, the joint venture of for-profit Florida-based AshBritt, Inc. and the GB Group of Haiti. A community of homeless scavengers have used corrugated tin and plywood recovered from the pile to build makeshift homes.
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During a recent trip to the site a reporter was not allowed to enter because employees of the U.S.-based Christian non-profit World Vision were on strike. The 60 workers say they were hired to direct incoming trucks full of waste to the appropriate dumping spot but they had not been paid since they began working Sept. 4. In nearby Canaan, an estimated 12,000-family camp city spread over three miles of dusty plain, residents share 50 latrines -- holes surrounded by walls made of plywood. Residents burn trash to keep mosquitoes away. "There is not enough water or food, and we have no place to put the waste. It's not healthy to breathe in the fumes of the fires but we have no other way to get rid of trash. We are living out here like animals," said Elie Elifort, 43, the president of an eight-member committee elected by residents to take charge of building roads and providing security. The committee dug a 20-foot-deep well, but because of overdrawing, the ocean water mixes with groundwater, so residents boil it twice, in vain hope of improving the taste and ridding it of contamination.

Haiti Nearly a Year Later (NYT - 12/2/2010)

By NICHOLAS D. KRISTOF
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MIREBALAIS, Haiti: An emergency cholera hospital is the grimmest kind of medical center, and it’s a symbol of the succession of horrors that have battered Haiti over the last year. Here in Haiti’s central plateau, I visited a cholera treatment center run by an excellent aid group, Partners in Health, in collaboration with the Ministry of Health. Nobody goes in or out without being thoroughly disinfected; to try to control the epidemic, bodies are buried rather than released to families. In one tent, 40 seriously ill patients were lying next to each other on cholera beds — boards with holes in the middle and waste buckets underneath to catch the constant diarrhea. Staff members put a sheet over Tiphay Merilus, 66, just as I arrived. Patients a few feet away in other beds averted their eyes as a sanitation crew carried out Mr. Merilus’s corpse and disinfected his cot.
Already, more than 1,700 people have died of cholera in less than a month, and the Pan American Health Organization estimates that 400,000 Haitians may get cholera over the next year.
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The earthquake in January caused some 250,000 deaths. The death toll was a result not only of seismic activity but also of poverty: shoddy construction and slow rescue efforts meant many more deaths than if the same quake had occurred in, say, California. Then came cholera, which is a disease of poverty — abysmal sanitation and lack of potable water can create an epidemic. One cholera patient, Dieulimere Renatu, 21, told me that she gets drinking water from a river. If she were to seek water from a safer source, she would have to spend three or four hours a day fetching water for her family — and then would have less time to work and earn money. Those are the trade-offs that Haitians face. After the earthquake, Bill O’Reilly suggested that humanitarians were romanticizing aid as a solution for Haiti: “One year from today, Haiti will be just as bad as it is right now.” I criticized him at the time, but he wasn’t far off. Haiti has certainly improved since the immediate aftermath of the quake, and aid kept alive many who would otherwise have died. But reconstruction has barely started. Most of the rubble is still waiting to be cleared off, and more than one million people are still living in tents.
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Part of the problem is that the government, crippled by the quake, has done little. Another is that aid groups created a parallel state that further diminishes the government — and a country needs a central authority to make decisions. The limitations of aid are very much on display in Haiti. After the quake, aid groups rushed in porta-potties to provide sanitation, but they cost $13 a day to clean and empty the wastes. So many thousands of dollars each day go to companies with the specialized trucks that clean porta-potties and then dump the wastes untreated at the city dump. There are solutions. One sanitation aid group, SOIL, has provided 300 dry composting toilets that turn human waste into fertilizer. The composting kills the cholera bacteria and other pathogens within a few days, according to Sasha Kramer, the executive director of SOIL. The compost then provides desperately needed topsoil and fertilizer to boost agricultural production. Ultimately what Haiti most needs isn’t so much aid, but trade. Aid accounts for half of Haiti’s economy, and remittances for another quarter — and that’s a path to nowhere. The United States has approved trade preferences that have already created 6,000 jobs in the garment sector in Haiti, and several big South Korean companies are now planning to open their own factories, creating perhaps another 130,000 jobs. “Sweatshops,” Americans may be thinking. “Jobs,” Haitians are thinking, and nothing would be more transformative for the country. Let’s send in doctors to save people from cholera. Let’s send in aid workers to build sustainable sanitation and water systems to help people help themselves. Let’s help educate Haitian children and improve the port so that it can become an exporter. But, above all, let’s send in business investors to create jobs. Otherwise, there will always be more needs, more crises, more tragedies, more victims. Back in the cholera treatment center here in Mirebalais, health workers were still disinfecting the bed on which Mr.Merilus had died when, in the tent next door for milder cases, a middle-aged woman suddenly collapsed. Nurses splashed water on her face but could not revive her. So they rushed her to the main cholera hospital tent to take the newly vacant bed there. And that is the brutal cycle of poverty in Haiti that only jobs and trade can break.

Cholera Spread Becoming Less Lethal (12/1/2010)

Agence France-Presse (AFP)
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The cholera epidemic gripping Haiti in the wake of national elections continues to spread throughout the country but is less lethal, the Pan American Health Organization said Wednesday. "We went from nine percent of cases dying in the early days to 2.3 percent now," said Donna Eberwine-Villagran, a spokeswoman for PAHO, a local branch of the World Health Organization. "It's improving," she told AFP, adding however that the number of cases would continue to rise. According to the latest official tally, 1,817 people have died from the disease in Haiti, which is still reeling from a devastating earthquake in January that killed over 250,000 people and left over a million homeless. A total of 80,860 cases have been recorded for this highly contagious disease, with 36,207 hospitalizations. Eberwine-Villagran warned that the official toll was an underestimation. "There is no way to estimate the toll," she added. "Cholera can kill people within hours if it is not treated... The Haitians were never exposed to cholera before, so they didn't know what to do." The PAHO has estimated cholera could see up to 400,000 cases over the next 12 months, half of them within three months alone.
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Haiti's Health Ministry, the PAHO and the International Organization for Migration have evaluated 80 care centers in the country and found that 38 of them were suitable for cholera treatment centers or oral rehydration posts (ORPs). "The plan is create 250 ORPs to provide first-line cholera treatment in camps, which were prioritized according to environmental risks and poor coverage by sanitation and health services," PAHO said. Amid the epidemic, Haitians were also awaiting results of Sunday's national elections. An unexpected admission from the ruling INITE (UNITY) party that it may have lost has fueled a sense that a real political shift was imminent. Election officials and MINUSTAH, the UN stabilization mission in Haiti, said preliminary results of the presidential and legislative elections will be announced on December 7. Final results are expected on December 20. If none of the 18 presidential candidates garner more than 50 percent of the vote, a second round will take place on January 16. Mirlande Manigat, the longtime opposition leader and former first lady who was ahead in polls, proclaimed "I will be president of Haiti." "I am telling my voters, supporters of other parties and all Haitians that we are the children of a single country that is sick and needs help from us all. I am counting on you and you can count on me," she told reporters. MINUSTAH, meanwhile, called for patience so that the process of verifying results can go forward smoothly. It also urged Haitians to be skeptical of non-official results. Widespread fraud allegations following the polls have added to the climate of intimidation and fear that persists in Haiti, a Caribbean nation whose recent past is plagued by dictatorships and violent political upheaval.

Electoral Unrest Could Hurt Cholera Reponse (11/30/2010)

Caribbean 360
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Secretary-General Ban Ki-moon today called for a speedy solution to the political crisis in Haiti after Sunday’s first round of elections, warning that worsening security would hamper efforts to fight the cholera epidemic in a country already devastated by January’s earthquake. “The Secretary-General is concerned following the incidents that marked the first round of the presidential and legislative elections in Haiti on Sunday,” a statement issued by Mr. Ban’s spokesman said. “The Secretary-General looks forward to a solution to the political crisis in the country and calls on the Haitian people and all political actors to remain calm, since any deterioration in the security situation will have an immediate impact on the efforts to contain the ongoing cholera epidemic.” Some of the 18 presidential candidates have repudiated the vote and their supporters have mounted protests.
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Meanwhile, the number of cholera cases and deaths continues to rise with no significant shift in the overall situation, the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported yesterday, noting that the north of the country remains the area with the highest caseload. As of the end of last week, more than 1,600 people have died and some 50,000 have been infected since the epidemic began in October. In the capital 50 deprived neighbourhoods, home to around 1 million people, are especially vulnerable to cholera – which is spread through contaminated food and water – due to poor access to safe water, inadequate sanitation and high population density. Preparations are in place across the country to respond more forcefully as the epidemic spreads, OCHA said. The Pan-American Health Organization (PAHO), the regional arm of the UN World Health Organization (WHO), estimated that as many as 400,000 people could become ill, with half of those cases in the coming three months. Calculations reflect a worst case scenario that is avoidable if all sectors of society and health partners are able to step up their actions.
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Working closely with PAHO/WHO, OCHA has put together a list of the infrastructure, institutional and personnel needs to respond to the epidemic. There are currently 40 Cholera Treatment Centres (CTCs) and 61 Cholera Treatment Units (CTUs). More are needed, with humanitarian partners working to increase the numbers and bed capacity. To respond to needs for water chlorination in households, the UN Children’s Fund (UNICEF) has 190 million Aquatabs and 1.5 million bars of soap in the pipeline, and nutritional efforts are focused on mitigating the impact of cholera on children under five, pregnant and/or lactating women, and other vulnerable groups by maximizing prevention efforts. Haiti is still struggling to recover from the January quake, which killed some 200,000 people and displaced more than one million others, many of whom are still living in crowded camps.

IOM Carries out Cholera Prevention/Response in Border Region

IOM Carries Out Cholera Prevention and Response, Conflict Mitigation Activities in Dominican-Haitian Border Areas – IOM teams are targeting vulnerable communities throughout the central Dominican-Haitian border area in the provinces of Elias Piña and Dajabón to raise awareness about prevention and response to Cholera and provide urgently needed emergency supplies. Four teams of Spanish and Creole speaking IOM staff and employees of the partner NGO Colectiva Mujer y Salud, trained by the Dominican Ministry of Public Health in Cholera prevention and response tactics, mounted a prevention operation reaching from Hondo Valle, Elias Piña to Restauración, Dajabón. IOM selected this mountainous section of the border for its initial intervention due to its remoteness and the frequency of cross-border movements of Haitian migrant agricultural laborers.
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Mobile and fixed information teams distributed materials in Spanish and Creole to migrants, local residents and authorities at official and unofficial markets and border crossing points, as well as in schools, health centers, convenience stores, plazas, parks, water points, and other community gathering locations. Due to high levels of illiteracy in some areas, IOM staff provided open-forum information sessions complete with demonstrations on how to purify water and maintain basic sanitation habits. More than 6,500 direct beneficiaries were reached with preventative information materials and the teams distributed 1,000 sets of oral rehydration salts and 100 water-purification sachets in particularly vulnerable communities. Migrants and local residents have told IOM and its partners that, although information materials are useful, they are in dire need of materials to purify water in order to avoid infection.
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IOM has maintained a presence in Dajabón since the Cholera outbreak in Haiti to provide assistance to the Dominican authorities at this important, and recently inflammatory, border crossing point. The Creole and Spanish speaking IOM Community Liaison Officer stationed at the Dajabón border crossing maintains daily communication with the authorities (including the Ministry of Health, General Directorate of Migration, Border Patrol, and Customs) and provides the authorities with simultaneous translation and operational assistance in bi-national exchanges in order to reduce tensions and mitigate conflicts that continue to arise in the wake of the spreading epidemic. IOM has recently received formal requests from the Ministry of Health and the General Directorate of Migration to expand this activity and to provide support for community interventions towards the reduction of migration-related tensions and conflicts throughout the Dominican territory.
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To date the Dominican Republic has reported seven confirmed cases of cholera and zero fatalities. Based on IOM observations, health posts on the Dominican side of the border are well equipped and prepared, general awareness of cholera is on the rise throughout the communities thanks to interventions from the Dominican Ministry of Health, IOM, Colectiva Mujer y Salud, and World Vision. Chlorine for water purification is readily available allowing for a substantial increase in water quality at the numerous supply points. Haitian migrants from border areas continue to cross into the Dominican Republic to buy basic items such as chlorine, food, and clothing which are not readily available on the Haitian side. The IOM intervention is funded by the United States Department of State, Bureau of Population, Refugees, and Migration (PRM). For more information please contact Jean-Philippe Antolin, Tel: + 829 340 8911, Email: jantolin@iom.int, or Zoe Stopak-Behr, Tel: +809 481 2671, Email: zstopak-behr@iom.int

Reported cholera cases in Haiti rise to 72,000 (11/30/2010)

United Nations News Service
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The number of reported cases of cholera in Haiti has risen to just over 72,000, including 1,648 deaths, the United Nations health agency said today, noting that fewer deaths are now being recorded than earlier in the epidemic, which erupted in late October. The case mortality rate now stands at 2.3 per cent, Fadela Chaib, spokesperson for the UN World Health Organization (WHO), told reporters in Geneva. There are now 40 cholera treatment centres in the country with a an average capacity of 100 to 200 beds each, Ms. Chaib said, adding that the 61 cholera treatments units – small units established in hospitals and health centres – had an average capacity of 20 beds each. Ten additional cholera treatment centres and 39 cholera treatments units are required, as well as 350 more doctors, 2,000 nurses, 2,200 support staff and 30,000 community health workers, Ms. Chaib said. The community health workers would mostly work in rural villages, where needs are greatest, she added. Meanwhile, a survey carried out among 37 aid groups providing health care by Haiti's Ministry of Public Health and Population has identified key challenges to the cholera response, Elisabeth Byrs, spokesperson for the UN Office for the Coordination of Humanitarian Affairs (OCHA), said. These include the removal of the bodies of the dead, the disposal of medical waste, the identification of sites on which to set up health centres, and a lack of trained personnel. On funding, Ms. Byrs said some $32.9 million of the $164 million humanitarian agencies are seeking for the cholera emergency has been received as of today.

Cuba to send 300 more health staff to Haiti (11/27/2010)

Xinhua
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Cuban former President Fidel Castro said here on Saturday that his country will "reinforce" the medical brigade in Haiti with 300 more doctors, nurses and health technicians to fight the cholera epidemic in that Caribbean nation. The current Cuban health brigade in Haiti is comprised of 965 specialists. "It was decided by the Cuban Communist Party(CCP) and the Government to reinforce the medical brigade in Haiti with a contingent of Brigada Henry Reeve, consisting of 300 doctors, nurses and health technicians, to reach the figure of over 1,200 people," Castro said in a an article published on Saturday. In the article "Haiti: underdevelopment and genocide," the Cuban leader considered "extremely important to prevent the epidemic from spreading throughtout Latin America and the Caribbean." Castro said that nearly 40 percent of Haiti cholera patients have been treated by the 965 Cuban health staff there and stressed that they managed to "reduce the dead number to less than 1 for every 100 patients." Fidel Castro, 84, began writing articles on important world issues in 2006 after handing over power to his brother Raul due to a serious illness. After a long convalescence, he returned to public life in July holding meetings with intellectuals, journalists, scientists, economists. He has given interviews to several overseas media and published two memoires books about his guerrilla life in the Sierra Maestra.

PAHO Urges Other Countries to Ramp Up Cholera Preparedness

11/29/2010
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Countries throughout the Caribbean and the rest of the Americas should be taking steps now to protect their populations from cholera, before the epidemic spreads further, a top Pan American Health Organization (PAHO) official says. In addition to Haiti, the Dominican Republic and the United States have reported confirmed cases of cholera, and the risk that it may spread to other countries cannot be discounted, said Dr Jon K. Andrus, Deputy Director of PAHO. “For many of us here, this brings up memories of the cholera epidemic that began in Peru in 1991 and spread to more than 16 countries in the Americas within two years,” Andrus said. “Considering the intensity of travel and trade in the Americas, we know it’s difficult to prevent importations of isolated cases of cholera in other countries, but there are important steps that can be taken to prevent cholera from spreading and causing epidemics.” PAHO recently sent an alert to health officials in its Member States in Latin America and the Caribbean urging them to take steps to prepare for the possible arrival of cholera. Among the recommended measures were:
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-Stepped-up surveillance to ensure that any potential cholera cases are detected rapidly.

-Strengthening preparedness and response plans to ensure that countries’ health systems are able to deal with any sudden surges or emergence of cholera.
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-Improving water and sanitation services to prevent the spread.
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-Increased public education about the importance of hand washing, proper disposal of feces, and prompt treatment with oral rehydration salts or, for severe cases, specialized medical care.
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PAHO has already been helping health officials in Caribbean plan for the possible arrival of cholera on their shores. In the message to other member countries, PAHO offered support for planning and preparation in such areas as surveillance, water and sanitation, and social communication. Modeling exercises done for planning purposes in Haiti project an estimated 400,000 cases of cholera over the next 12 months, Andrus said, with as many as half those cases possibly occurring within the next three months. But the projections, he cautioned, “represent work in progress that takes into account many assumptions, for example, differences in attack rates between urban and rural areas, and no change in environmental conditions. We are working to refine these preliminary estimates with key partners in order to improve and sustain supply management for the epidemic response.” A central challenge and essential goal for responding to the epidemic in Haiti is ensuring safe water and sanitation, and prompt treatment of cases, Andrus said.
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“In the short term, efforts must focus on distributing chlorine tablets as well as oral rehydration salts to everyone. In the long term, we must create the systems and infrastructure to ensure equitable access to these basic services,” he noted. To support Haiti’s response to the cholera epidemic, PAHO, other U.N. agencies, and other partners have appealed for US$164 million in international aid. Andrus said that so far about 10 percent of this request had been received. “It is clear the country will need more funding. Our response, along with all the partners, has not been as rapid as we would like. The reason is that, even before the crisis, the country lacked the building blocks of health, which are water, sanitation, safe food, and adequate health services.”
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He said that making Haiti self-sufficient in all these areas is an essential long-term goal. Meanwhile, PAHO is encouraging partners to do everything possible to hire and train the Haitian people using cash-for-work programmes. “This is consistent with our primary objective of helping the Haitian people and the Haitian government in the response and in taking the prime ownership of the response to this crisis,” Dr Andrus said. The cholera epidemic that has claimed more than 1,600 lives in Haiti.

Cholera: The unnecessary killer in Haiti (11/28/2010)

Miami Herald
BY FRANCES ROBLES
frobles@MiamiHerald.com
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The cholera outbreak ravaging Haiti’s countryside is part of a worldwide pandemic that began 50 years ago and should be easy to stop — with technology developed in the 1800s. Haiti’s poor sanitation system makes it vulnerable to a disease that first swept the United States and other parts of the world more than 150 years ago. The current global wave of cholera — the seventh in recorded history — made its way from Asia to Africa then Latin America, and is now back for its second strike at this hemisphere. But as other countries in the region slowed the disease in its tracks by developing better sanitation and medical response systems, Haiti was blindsided by an organism not seen in the Caribbean since 1850. If history is a guide, the outbreak that has already killed at least 1,250 people in Haiti could take thousands more lives there over the next several years before it is contained, experts said. “There shouldn’t be those numbers of deaths in Haiti,” said Chris Hamlin, a University of Notre Dame historian who wrote Cholera: A Biography. “This outbreak is surprisingly big to me. Most outbreaks are more immediately confronted. This is not rocket science.” The word cholera was coined by the ancient Greeks, although they used it to describe a different illness, Hamlin said. For years, the acute intestinal bacterial infection ravaged entire cities, killing 25 percent of its victims, many of them within hours. “Cholera is still a regular feature of life in many parts of the developing world,” said Robert Tauxe, deputy director of the U.S. Centers for Disease Control and Prevention’s Division of Foodborne, Waterborne, and Environmental Diseases. “In the 19th Century, it was a regular feature of life everywhere.”
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First spotted in the Americas in 1832, it went up the Mississippi, down the Erie Canal and eventually swept New York City tenements. By the 1850s, huge epidemics were sweeping the Caribbean, Latin America, Africa, Asia and Europe. In 1850, thousands died in London and in Hamburg, Germany. “Back then, nobody knew how to treat it,” Tauxe said by telephone from Haiti, where he is helping healthcare providers battle the illness. “A quarter the patients would die.” Today, cholera sickens three million to five million people a year, killing up to 130,000 of them, said Peter Hotez, president of the American Society of Tropical Medicine and Hygiene, who wrote the book Forgotten People, Forgotten Diseases. “It’s one of the fastest killers around,” Hotez said. “It produces toxins that damage the intestines and takes all the water out of a person’s body. A healthy individual can be practically at death’s door in a very short amount of time. It’s every bit as important as HIV, but has become one of those forgotten diseases.” The chief symptom, Hotez said: “diarrhea from hell.” In most countries, about 1 percent of the sick die. In Haiti, the death rate is 4 percent, suggesting that either patients are waiting too long to seek help or authorities have not managed to get adequate treatment and hydration supplies where they are most needed, experts said.
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The current pandemic was first detected in 1961, Tauxe said. It languished in Asia for 10 years, and then spent a decade wreaking havoc in Africa. “It affected almost all the inhabited world, except for maybe Australia,” said Tauxe, who began working on the disease in 1984. “We started waiting, thinking: When is it going to arrive in the West?” The answer: January 1991, when cholera came to Chancay, a small village near Lima, Peru. It spread through Latin America and took a decade to contain. Sometimes dozens of passengers from South American flights would arrive in the United States sick. “It was severe. It came to every country in Latin America except Paraguay and Uruguay,” said University of California anthropologist Charles Briggs, author of the book Stories in the Time of Cholera, which chronicled the epidemic’s toll among the indigenous people of Venezuela. Experts agree that cholera is wildly unpredictable. When the disease swept Latin America, sickening a million people in the first five years, the Caribbean was left unscathed. “The Caribbean braced for it — and it didn’t come even though people were dying in Venezuela, just seven miles from Trinidad.” That’s one of the reasons Haiti was so unprepared for the current outbreak. While Peruvian doctors, like those in Bangladesh, became world masters at treatment, Haiti’s health corps had virtually no training in the disease, experts said. “Cholera in this millennium should kill no one,” Briggs said. “It is easily prevented with clean water and easily treated with IVs. Cholera is still one of the clearest, most persistent and most repugnant ways to demonstrate the gaps between the haves and the have-nots.”
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Epidemics in the United States waned in the late 1800s, when sewage treatment and clean drinking water systems were widely installed. It took Latin America most of the 1990s to develop the infrastructure to the point that, although cases of cholera pop up from time to time, “it just does not find fertile ground to explode in,” Tauxe said. Now, cases in the United States are rare, and usually related to a less severe strain from undercooked Gulf Coast seafood. In Haiti, conditions are ripe for cholera to linger for years, and to make a significant comeback in other places in the hemisphere with extreme poverty and a lack of clean water, public health experts say. History shows that a key element to containing epidemics is having lots of clean water at hand — not just to prevent the illness in healthy people, but to treat the sick. “Haiti,” Briggs said, “is a powder keg for cholera.”

ICRC steps up work to fight cholera (11/26/2010)

The cholera epidemic continues to spread to an alarming extent in 10 departments of Haiti. According to the latest estimates by the Ministry of Public Health and Population, 25,000 persons have come down with the disease and 1,115 have died. Numerous humanitarian organizations are involved in the struggle to combat it. Some areas are more prone to cholera than others: poor neighbourhoods in Port-au-Prince, for example, where overcrowding and poor hygiene facilitate its spread. Another example is prisons. Out of a total of 18 prisons (holding 5,500 persons), six facilities (3,500 detainees) are affected. They are Cap Haïtien, Mirebalais, Saint Marc and Hinche (both north of the capital), Les Cayes (south of the capital) and the civilian prison in Port-au-Prince. In all, 174 detainees have so far been treated for cholera; 22 of them have died.
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The ICRC delegation in Haiti has just been reinforced by the arrival of four nurses, a doctor and two water-and-sanitation engineers. In Cité Soleil, Martissant and other impoverished neighbourhoods of Port-au-Prince, the ICRC is working together with the Haitian National Red Cross Society to facilitate access to clean water and to take sick people to hospital. It is also taking part in hygiene-awareness campaigns. But the ICRC is concentrating particularly on places of detention, in which it remains one of the few humanitarian organizations present. The organization is coordinating its activities with the rest of the International Red Cross and Red Crescent Movement and all others involved. Confronting cholera in places of detention Since the epidemic erupted, the ICRC has been striving to enable the authorities to take preventive measures in all prisons. To this end it is working closely with the national prison service, the Ministry of Justice and Public Security, the national police, the United Nations Stabilization Mission in Haiti, and various UN agencies and non-governmental organizations.
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Hygiene measures have been taken in 11 places of detention. These consist among other things in cleaning and disinfecting cells and latrines, chlorinating water, and holding awareness-raising sessions for staff and detainees about hygiene and cholera. The ICRC has also distributed hygiene items such as soap and cleaning materials. On the advice of the medical department of the prison service, over 3,500 detainees in the facilities affected are receiving a preventive dose of doxicycline, an antibiotic used to treat cholera. In addition, prison dispensaries are being regularly supplied with medicines, oral rehydration salts and IV drips. In conjunction with medical staff at Port-au-Prince central prison, the ICRC has set up a cholera-treatment centre within the facility. It consists of four observation and treatment stations. Staff from the ICRC and the Japanese Red Cross Society are present daily.
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In impoverished neighbourhoods, the ICRC is cooperating with the national agency for water supply and treatment, its partners from the International Red Cross and Red Crescent Movement, and a number of NGOs. To expedite the process of taking sick people to hospital, the ICRC is actively supporting the Haitian Red Cross by providing Red Cross staff with vehicles, protective equipment and first-aid material. Since the epidemic started, the Red Cross has taken over 300 sick people to hospital. Assisted by the ICRC, Haitian Red Cross volunteers give residents information about cholera and impress on them the importance of being extra-strict about hygiene. So far they have held information sessions for over 3,000 people. In the neighbourhood of Cité Soleil, the ICRC is stepping up the process of disinfecting the water-supply network. In addition, water-purification tablets are being distributed to people using tapstands repaired by the ICRC.

Election in Haiti beset by cholera, confusion (11/28/2010)

Associated Press
By JONATHAN M. KATZ
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The ballot is as crowded as the earthquake-ravaged capital itself, and a collapsed presidential palace is the prize. The voter rolls are filled with the dead, and living citizens are still struggling to figure out if and where they can vote while worrying about political violence and a spreading cholera epidemic. It's Election Sunday in post-quake Haiti. Most polls opened an hour or more after their 6 a.m. (1100 GMT) start time and confusion reigned at many. Observers from dozens of parties crowded voting areas and furious voters were turned away from stations where poll workers could not find their names on lists. "I don't know if I'm going to come back later. If I come back later it might not be safe. That's why people vote early." said Ricardo Magloire, a Cap Haitien radio journalist whose polling station at a Catholic school was still not taking ballots after people had waited more than an hour.
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At another voting place in the St. Philomene neighborhood, a woman complained that young men were taking advantage of the chaos to vote multiple times. The allegation could not be confirmed because a crowd of one candidate's supporters swarmed around two AP journalists and forced them to leave the area, threatening a photographer. One man was shot to death at a polling place in rural Artibonite, Radio Vision 2000 reported, though no details were available. Ninety-six contenders are competing for 11 Senate seats and more than 800 more are seeking to fill the 99-seat lower house. But the focus is on the presidential contest. Nineteen candidates are on the ballot, though many Haitians believe the race comes down to a man who is not: outgoing President Rene Preval, who was barred by law from running again.
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The laconic leader twice sailed into office bolstered by supporters of his former ally, ousted former President Jean-Bertrand Aristide. But in Preval's second term, those voters branded him a traitor for not returning Aristide from exile. Frustrations also grew among the jobless masses as Haiti's economy continued to be one of the world's worst. When the earthquake struck last Jan. 12 and a stunned Preval hid from sight, impatience turned to anger that has fueled anti-government protests. The candidate of Preval's recently formed Unity party is Jude Celestin, the little-known head of the state-run construction company whose dump trucks carted many of the quake's estimated 300,000 dead to mass graves. His well-funded campaign included airplanes trailing banners with his name and dropping leaflets that flutter like yellow-and-green birds over tent camps for people made homeless by the quake. A text message sent to Haitian cell phones Saturday summed up the primary message of Celestin's campaign: "Let's assure stability." His campaign workers already refer to him as "The President." Some opinion polls put Mirlande Manigat, 70-year-old former first lady whose husband was helped to power and then deposed by a military junta, as a more popular contender.
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Popular musician Michel "Sweet Micky" Martelly, known for jazzy, sarcastic dance music, had thousands of urban youths toting his pink signs and shouting to "Vote for the bald head!" Some Aristide supporters are expected to back lawyer Jean-Henry Ceant, running on the "Love Haiti" ticket. Aristide's Fanmi Lavalas party was disqualified on an unexplained technicality, sparking threats of a boycott by supporters. Ousted former prime ministers Jacques Edouard Alexis and Yvone Neptune are seeking political rehabilitation, as is Charles-Henri Baker, a garment factory owner who lost to Preval five years ago. Wyclef Jean, whose own bid for president ended with an August disqualification, was in Haiti on Sunday. Jean supporters said on Twitter that the Haitian-American singer would not be publicly endorsing anyone — a blow to any candidate hoping for a last-minute boost from his legions of young fans.
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Clashes among rival political camps caused several deaths in recent weeks. At least one person was killed in a clash between Celestin and Baker's supporters in the far western town of Jeremie. On Friday night, Martelly aides said a hail of bullets ended his campaign-closing rally in the southwestern peninsula town of Les Cayes, with one supporter reported killed. His campaign blamed the unconfirmed attack on "Mr. Preval and his heir apparent, Mr. Jude Celestin, (and) the Unity (party) hierarchy." Unity officials did not respond to requests for comment. The victor gets a five-year term at the helm of a disastrous economy and leadership of an increasingly angry and suffering population worn down by decades of poverty, the earthquake, a recent hurricane and now a cholera epidemic that has killed more than 1,600 people. And the election's winner will assume an office has had only one occupant survive and complete a full, constitutional term in more than 200 years: Rene Preval. Yet there is an unprecedented opportunity in store for the new president: overseeing the largest capital spending spree in Haiti's history, the $10 billion pledged in foreign reconstruction aid after the quake. Very little of the money has been delivered so far, as many donor nations wait to see who will take over the government.
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Donors also want to see if the election goes off as planned — and the results are deemed fair. More than 4.7 million voters are registered on electoral lists. Overseeers with the United Nations and Organization of American States acknowledge that hundreds of thousands are people who died in the earthquake, while many living voters who want to participate have not received their voter cards or are unsure where their polling places are. "We're looking at the best elections possible under the circumstances," OAS Assistant Secretary-General Albert Ramdin, who is in Haiti to monitor the elections, told The Associated Press. "We know that the (voter) list is not complete. We know that the list is inflated. We know that much more needed to be done to be on time in terms of training of polling station workers." Ramdin said the OAS helped deliver 800,000 voter cards in recent days. Its 120 observers planned to visit about 40 percent of the 1,500 voting centers Sunday. Other observers include a small European Union team, a much larger group of national observers and visitors including a delegation of 12 U.S. Congress members Preliminary results are not expected until Dec. 7, and all but the most confident supporters of individual candidates expect to see a run-off for races at all levels. Political passions often translate into violence during Haitian ballots. But election fervor was muted Saturday in the northern town of Limbe, where hundreds lay stricken with cholera. AP journalists had to ask nearly a dozen people before finding one who knew the location of a polling station. The town was festooned with Celestin posters, but resident Jean Gil Fresnel predicted Manigat will win. "Preval sent him and Preval's no good," Fresnel, 37, said as he leaned against a bicycle. "Preval hasn't done anything. He hasn't built any schools, he hasn't brought any jobs and now he wants us to support this guy?" Others said they were skipping it completely. "I'm not going to vote because the politicians never do anything for this country," said Frantz Varvit, a 29-year-old bracelet-maker. "You go vote and nothing changes."

Election in Haiti beset by cholera, confusion (11/28/2010)

Associated Press
By JONATHAN M. KATZ
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The ballot is as crowded as the earthquake-ravaged capital itself, and a collapsed presidential palace is the prize. The voter rolls are filled with the dead, and living citizens are still struggling to figure out if and where they can vote while worrying about political violence and a spreading cholera epidemic. It's Election Sunday in post-quake Haiti. Most polls opened an hour or more after their 6 a.m. (1100 GMT) start time and confusion reigned at many. Observers from dozens of parties crowded voting areas and furious voters were turned away from stations where poll workers could not find their names on lists. "I don't know if I'm going to come back later. If I come back later it might not be safe. That's why people vote early." said Ricardo Magloire, a Cap Haitien radio journalist whose polling station at a Catholic school was still not taking ballots after people had waited more than an hour.
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At another voting place in the St. Philomene neighborhood, a woman complained that young men were taking advantage of the chaos to vote multiple times. The allegation could not be confirmed because a crowd of one candidate's supporters swarmed around two AP journalists and forced them to leave the area, threatening a photographer. One man was shot to death at a polling place in rural Artibonite, Radio Vision 2000 reported, though no details were available. Ninety-six contenders are competing for 11 Senate seats and more than 800 more are seeking to fill the 99-seat lower house. But the focus is on the presidential contest. Nineteen candidates are on the ballot, though many Haitians believe the race comes down to a man who is not: outgoing President Rene Preval, who was barred by law from running again.
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The laconic leader twice sailed into office bolstered by supporters of his former ally, ousted former President Jean-Bertrand Aristide. But in Preval's second term, those voters branded him a traitor for not returning Aristide from exile. Frustrations also grew among the jobless masses as Haiti's economy continued to be one of the world's worst. When the earthquake struck last Jan. 12 and a stunned Preval hid from sight, impatience turned to anger that has fueled anti-government protests. The candidate of Preval's recently formed Unity party is Jude Celestin, the little-known head of the state-run construction company whose dump trucks carted many of the quake's estimated 300,000 dead to mass graves. His well-funded campaign included airplanes trailing banners with his name and dropping leaflets that flutter like yellow-and-green birds over tent camps for people made homeless by the quake. A text message sent to Haitian cell phones Saturday summed up the primary message of Celestin's campaign: "Let's assure stability." His campaign workers already refer to him as "The President." Some opinion polls put Mirlande Manigat, 70-year-old former first lady whose husband was helped to power and then deposed by a military junta, as a more popular contender.
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Popular musician Michel "Sweet Micky" Martelly, known for jazzy, sarcastic dance music, had thousands of urban youths toting his pink signs and shouting to "Vote for the bald head!" Some Aristide supporters are expected to back lawyer Jean-Henry Ceant, running on the "Love Haiti" ticket. Aristide's Fanmi Lavalas party was disqualified on an unexplained technicality, sparking threats of a boycott by supporters. Ousted former prime ministers Jacques Edouard Alexis and Yvone Neptune are seeking political rehabilitation, as is Charles-Henri Baker, a garment factory owner who lost to Preval five years ago. Wyclef Jean, whose own bid for president ended with an August disqualification, was in Haiti on Sunday. Jean supporters said on Twitter that the Haitian-American singer would not be publicly endorsing anyone — a blow to any candidate hoping for a last-minute boost from his legions of young fans.
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Clashes among rival political camps caused several deaths in recent weeks. At least one person was killed in a clash between Celestin and Baker's supporters in the far western town of Jeremie. On Friday night, Martelly aides said a hail of bullets ended his campaign-closing rally in the southwestern peninsula town of Les Cayes, with one supporter reported killed. His campaign blamed the unconfirmed attack on "Mr. Preval and his heir apparent, Mr. Jude Celestin, (and) the Unity (party) hierarchy." Unity officials did not respond to requests for comment. The victor gets a five-year term at the helm of a disastrous economy and leadership of an increasingly angry and suffering population worn down by decades of poverty, the earthquake, a recent hurricane and now a cholera epidemic that has killed more than 1,600 people. And the election's winner will assume an office has had only one occupant survive and complete a full, constitutional term in more than 200 years: Rene Preval. Yet there is an unprecedented opportunity in store for the new president: overseeing the largest capital spending spree in Haiti's history, the $10 billion pledged in foreign reconstruction aid after the quake. Very little of the money has been delivered so far, as many donor nations wait to see who will take over the government.
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Donors also want to see if the election goes off as planned — and the results are deemed fair. More than 4.7 million voters are registered on electoral lists. Overseeers with the United Nations and Organization of American States acknowledge that hundreds of thousands are people who died in the earthquake, while many living voters who want to participate have not received their voter cards or are unsure where their polling places are. "We're looking at the best elections possible under the circumstances," OAS Assistant Secretary-General Albert Ramdin, who is in Haiti to monitor the elections, told The Associated Press. "We know that the (voter) list is not complete. We know that the list is inflated. We know that much more needed to be done to be on time in terms of training of polling station workers." Ramdin said the OAS helped deliver 800,000 voter cards in recent days. Its 120 observers planned to visit about 40 percent of the 1,500 voting centers Sunday. Other observers include a small European Union team, a much larger group of national observers and visitors including a delegation of 12 U.S. Congress members Preliminary results are not expected until Dec. 7, and all but the most confident supporters of individual candidates expect to see a run-off for races at all levels. Political passions often translate into violence during Haitian ballots. But election fervor was muted Saturday in the northern town of Limbe, where hundreds lay stricken with cholera. AP journalists had to ask nearly a dozen people before finding one who knew the location of a polling station. The town was festooned with Celestin posters, but resident Jean Gil Fresnel predicted Manigat will win. "Preval sent him and Preval's no good," Fresnel, 37, said as he leaned against a bicycle. "Preval hasn't done anything. He hasn't built any schools, he hasn't brought any jobs and now he wants us to support this guy?" Others said they were skipping it completely. "I'm not going to vote because the politicians never do anything for this country," said Frantz Varvit, a 29-year-old bracelet-maker. "You go vote and nothing changes."

World Bank Emergency Grant for Cholera Fight (11/26/2010)

In response to the first cholera outbreak in Haiti in decades, the World Bank is preparing a US$10 million Cholera Emergency Grant. The outbreak has already caused over 1,200 deaths and could kill up to thousands more in the coming six to 12 months if the outbreak is not contained, according to figures from the Pan American Health Organization (PAHO). “Haiti needs all the help it can get to respond to the deadly cholera epidemic which is ravaging parts of the country,” Ronald Baudin, Haiti’s Minister of Finance. “The support of the World Bank will be key for saving lives and re-establishing the public health service network.” The grant is being prepared with the Government of Haiti and United Nations agencies and is expected to be formally submitted to the Board of Directors of the World Bank for approval in December 2010. It will bolster the surveillance and monitoring capacity of the Ministry of Public Health and Population (MSPP) and the Haitian National Directorate of Water Supply and Sanitation (DINEPA).
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Provisions under World Bank emergency operation procedures allow for up to 40 percent of the grant, once approved, to be used to reimburse eligible expenditures already incurred as part of the emergency response. The grant will also finance the work of nongovernmental organizations (NGOs) to improve access to clean water, provide basic health services for affected populations and vulnerable groups, as well as safe sanitation and waste management in high risk areas. “Implementation of the National Response Strategy to the cholera outbreak requires close donor and partner coordination, including all organizations currently operating on the ground,” said Alexandre Abrantes, the World Bank Special Envoy to Haiti. “The new grant will be used to contract experienced NGOs for immediate cholera response activities and strengthen the capacity of the Government to respond to epidemics.” These activities will complement significant hygiene awareness and prevention efforts already underway, such as the creation of a “Public Health Brigade” to carry out cholera treatment and prevention work throughout the country.
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Through a Global Facility for Disaster Reduction and Recovery grant of US$200,000, the World Bank is identifying national and international actors already involved in these tasks, preparing a standardized training plan and training a core group of 250 trainers. It will also finance an awareness and prevention campaign. The Bank has also provided assistance to the Directorate of Civil Protection since the beginning of the cholera outbreak to coordinate the response of the Government and its partners. This assistance has supported the setup and manning of the National Emergency Operation Center and management of the national campaign "Konbit kont Kolera," which raises awareness on cholera and its prevention.

Death and Dancing Coexist on Haiti's Tense Street (11/26/2010)

New York Times
By RANDAL C. ARCHIBOLD
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PORT-AU-PRINCE, Haiti — One body gets a light kick and tumbles into the pit. A Health Ministry worker in Port-au-Prince tried to sanitize a body with a chlorine solution before collecting it off the street. Another — this one the body of a 7-year-old boy — sails briefly in the air before dropping with a sickening thud. He was named Stanley Faustin and fought cholera in the hospital for 11 hours, a government paper shows. Nachena Bien Ame, 18, landed here, too. And so did Roberto Dupitan, 49; Jean Mary Mirat, 30; Pierre Gasnes, 40; heavy sacks colliding with rock over and over. This city’s body collectors work quickly and unceremoniously, dragging the bodies of people who died of cholera from trucks and converted pickups known as tap-taps and sending them into pits freshly dug at the edge of town. Cholera overtook them in hospitals, on the streets, at home — more than 1,500 Haitians dead in the past month and 28,000 more made sick. The government, fighting to control the epidemic, has decreed that their bodies are contaminated, and so Haiti, again, is busy with mass graves, this one a little more than a half-mile from the mounds where tens of thousands of victims of the January earthquake are buried.
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Back in the city, the bustle of life presses on. The place is pregnant with anxiety and sporadic political violence just a few days from the selection of a new president. But here the men focus on nothing but avoiding getting sick themselves as they spray a bleach solution on the bodies, on the plastic in which the bodies are wrapped, on their boots, on the trucks, inside the cabs, on their hands, legs, backs — even a splash on their faces. One of the workers, Andral Jasmin, 33, gingerly holds a small plastic bag by his fingertips and walks to the pit. The bag contains a newborn, but, he said later, he preferred not to think about that. The information was scrawled on a piece of cardboard that he did not read as it dangled from the bag, noting simply that she was a girl, that she was born and died Nov. 24 and that she came from a region called Lily. No name. “I don’t feel anything, because it is not the first baby we have had,” Mr. Jasmin said. “We have had many.” The afternoon sun dropped lower. The shift, 6 in the morning until 6 at night, drew to a close. Soon a bulldozer would come to push the earth over Stanley Faustin and the others, now sinking under the weight of those they never knew.
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As in the United States, negative campaigning is scorned here. But unlike in the United States, here going negative often means deploying provocateurs who disrupt rallies with rocks, bottles and sometimes gunfire. Most campaign stops are lively affairs, taking on a free-wheeling, dance party feel. Candidates typically appear on moving floats similar to those used for carnival celebrations, and no contender can be taken seriously without his own pounding jingle. So it was in the suburb of Carrefour for the last rally on Friday night — all campaigning was to end at midnight before the voting on Sunday — for Mirlande Manigat, a former first lady seeking to become the country’s first elected female president. Just a few days earlier, one of her campaign rallies in Cap Haitien ended when gunfire erupted. One of her chief rivals, Jude Célestin, whom President René Préval supports to succeed him, planned a rally a few miles away around the same time on Friday, setting off jitters. As hundreds of Ms. Manigat’s supporters waited and waited — the city’s epic traffic jams make starting times for anything a mere guess — Mr. Célestin’s motorcade suddenly emerged, bobbing and weaving through the masses on its way to his rally. Catcalls competed with the blaring sirens.
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Then, a large group of his supporters, blowing horns and chanting his jingle, danced and marched through Ms. Manigat’s throng, which responded with jeers and some shoving. But this time the interruption was taken in stride, as somebody cued up her jingle, “Vote, vote, vote for Mirlande!” In at least one neighborhood, for a short while, it was all smiles and charm as United Nations peacekeepers mounted a patrol. A patrol, that is, modified to show the news media the peacekeepers’ workaday tasks and to counteract reports of poor relations with Haitians. Many Haitians have blamed the United Nations troops for the outbreak of cholera here. A strain of the disease that is common to Nepal originated near a camp used by Nepalese soldiers where reporters observed what appeared to be sewage flowing into a river. Even before then, some Haitians viewed the peacekeepers as heavy-handed outsiders. But now the troops, part of a 12,000-member force that since 2004 has maintained order here, form the backbone of a security force seeking to maintain order for the presidential election on Sunday. Nine thousand troops will be deployed that day, delivering ballots and other voting materials and patrolling some polling sites. A contingent of peacekeepers from Brazil says that reports of friction with Haitians are overblown.
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Sure, said patrol Capt. Sergio Demique, “the mood of the population is volatile,” and the troops must help control or even end demonstrations and potential riots. But he insisted that, by and large, the public appreciated their presence. As the troops roamed in their trucks, young men fixed hard stares. One called out, “This is Haiti, we can do what we want!” Other people jeered. But while the peacekeepers walked in the Fort National neighborhood, women greeted them amiably with “bonjour.” Several children gave them thumbs-up signs or called out “Hey, you!” in English, the universal greeting here for anybody thought to be an American. But one little girl was apprehensive. “Give me a high five!” a soldier called to her in English, holding up his hand in anticipation of a friendly slap. “Give me a high five!” he repeated twice more. “I said,” now a little more sternly, “give me a high five.” Sheepishly, she complied.

1,000 British Aid Workers to Haiti to Assist with Cholera

11/26/2010
Cranswick Today
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Britain will supply more than 1,000 medical staff to help fight the worsening cholera epidemic in Haiti, the government has announced. The infection has claimed the lives of more than 1,400 survivors of an earthquake which ravaged the country earlier this year. The UK will provide funding for emergency supplies as well as trained medical personnel to help prevent it from spreading across the region, International Development Secretary Andrew Mitchell said. The announcement follows the latest warning from the UN that up to 400,000 people could be infected by the disease in the next six months - a significant increase on the number predicted two weeks ago. The British government will fund 115 doctors, 920 nurses and 740 support staff from the region to set up 12 major cholera treatment centres and 60 subsidiary cholera treatment units.
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These will be capable of treating several thousand cholera patients over the next two months through £2 million of funding to the Pan American Health Organisation (PAHO). Beyond the capital Port-au-Prince, Haiti is suffering from a chronic lack of decent water, sanitation and medical supplies. Mr Mitchell said: "Despite considerable pledges of support to help Haiti, there are still dangerous gaps in the provision of emergency medical supplies and a desperate shortage of trained medical staff, especially in the northern part of the country. "It is clear much more needs to be done. Analysis from the UN and our own field team reveals that the response needs to be significantly increased if we are to save thousands from the disease." The outbreak of cholera, which causes acute watery diarrhoea and can be fatal if left untreated, came after the seven-magnitude earthquake on January 12 left hundreds of thousands of people injured and homeless. Around 220,000 were killed amid the devastation and more than a million survivors moved into crowded temporary camps in Port-au-Prince.

Elections Looms, Cholera Increases (BBC - 11/25/2010)

Officials say more help is urgently needed in Haiti
Haiti needs at least 1,000 more nurses and 100 doctors to stem deaths from its cholera epidemic, the UN's top humanitarian official has said. Guyana-born Baroness Valerie Amos, said doctors and nurses across Haiti were overwhelmed and their efforts were being hampered by dire shortages of necessary supplies, from soap to body bags. "We clearly need to do more," she told the Reuters news agency during a visit to the Haitian capital Port-au-Prince. "But it's not just money, it's crucially people, in terms of getting more doctors, nurses, more people who can help with the awareness-raising and getting information out there," she said. The UN would reach out to countries and aid organisations with the potential to rapidly supply medical staff, she said - for example Cuba, which already has about 400 doctors and other health workers in Haiti. "We have to control the outbreak and we have to bring down the percentage of people who are dying, and we have to do that as a matter of urgency." UN officials have said that the international response to an appeal for $164m to help combat the cholera epidemic in Haiti has been insufficient. Announcing a grant of $10m in emergency aid to Haiti, the World Bank said the cash was to be used partly to support non-profit organisations. The Haitian government says more than 1,400 people have died. Meanwhile, campaigning is meanwhile in full swing for the elections, scheduled for Sunday, when Haitians will elect a new president and legislative members. Some human rights groups and four of the 19 presidential candidates have called for the elections to be postponed because of the cholera epidemic. There have been outbreaks of violence between rival political factions in the run-up to the vote. But the UN mission in Haiti, Minustah, says the conditions for a successful vote are good. Sunday's elections are seen as a crucial step towards giving Haiti a stable government that can lead recovery efforts after January's massive earthquake, which killed about 230,000 people and shattered the capital, Port-au-Prince. Some 19 candidates are vying to succeed President Rene Preval and it is likely that the election will go to a second round run-off on 16 January. Most candidates have insisted that the elections, which will also choose 99 deputies and 10 senators, should go ahead as planned

BRA to Study Proposal for Cholera Prevention Plan for Border

11/25/2010
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ANSE-A-PITRES, Haiti. – From November 13th through the 21st, a team of seven US-based medical professionals worked at BRA’s adopted medical clinic located in Haiti’s remote border commune of Anse-a-Pitres where they were joined by BRA local providers to deliver life-saving emergency medical attention to the population and to study a comprehensive effort to help contain the spread of the cholera outbreak that is now ravaging the country. Led by BRA’s International Medical Director, Dr. Raymond Thertulien, the group provided free medical care, medicines and pre-natal vitamins to more than 750 people living in Haiti’s communities of Anse-a-Pitres, Thiotte and Grand Gosier, and Dominican’s town of Pedernales in areas of gynecology, pediatrics, general medicine, infectious diseases, and minor surgeries. According to Dr. Thertulien, many cases of bacterial vaginosis, cervicitis, endometritis, malaria, and other bacterial, fungal and parasitic infections, high blood pressure, diabetes, gastrointestinal and musculoskeletal diseases and dehydration were encountered and treated.
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To respond to potential cases of cholera, oral rehydration salts and medications were provided to the clinic. Dr. Thertulien informed that only one case of severe diarrhea was registered and local health authorities were alerted while analysis is pending. But as the disease is quickly spreading with 1,344 deaths and more than 2000,000 potential new cases expected within the next year, BRA is now evaluating closely with its health team to set up a strategic plan of prevention, surveillance and treatment for communities in Southeastern and Southwestern border regions of the two countries, respectively. Dr. Thertulien was accompanied by two members of the Association of Haitian Physicians Abroad (AMHE) - Drs. Paul Nacier and Pierre Leger, Dr. Steve Hill of Asheville Women’s Medical Center, Deanna Ball, RN, Mary Fingeroff, RN, and Mary Leonidas, CRNA, of Ashville, North Carolina.

UN Estimates Cholera Could Affect 400,000 Haitians (11/24/2010)

VOA
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U.N. officials are calling for a much stronger international response to Haiti's cholera outbreak after new estimates show the epidemic could affect as many as 400,000 people. The U.N.'s humanitarian agency says the new estimate is twice what health officials had earlier projected for how far the outbreak could spread. Health officials say the estimate is a worst-case scenario and could be avoided if prevention and treatment responses can reach enough people. U.N. Undersecretary-General for Humanitarian Affairs Valerie Amos called the estimate a wake-up call and said investment is needed in cholera prevention throughout Haiti along with more treatment centers and more health workers.
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Earlier Tuesday, it was announced Amos would be visiting Haiti this week to review the humanitarian response to the cholera outbreak that has killed about 1,300 people. Amos will be in the Caribbean nation for two days, meeting with government and U.N. officials as well as representatives of non-governmental organizations. The visit comes as Haiti prepares for elections Sunday to elect a new president to replace Rene Preval, who cannot run again. Voters will also elect a 99-member lower house and 11 members of the 30-seat Senate. The U.S. ambassador to Haiti, Kenneth Merten, urged Haitians to exercise their right to vote. Speaking to reporters via video conference from Port-au-Prince, Merten said the United Nations Stabilization Mission in Haiti, known as MINUSTAH, will help to provide security along with local police. He said thousands of electoral observers will monitor the polling.
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Also Tuesday, the U.N. special envoy for Haiti, Edmond Mulet, told reporters via video conference that preliminary results of the vote would be available December 7 and that final official results would be announced December 20. Any runoff elections would be held January 16. Besides the cholera epidemic, Haiti is still recovering from a January 12 earthquake which killed more than 200,000 people and left about one million others homeless. Haiti is the Western Hemisphere's poorest country.

Haiti cholera deaths still rising as election nears (11/23/2010)

Aid agencies are trying to step up their work in Haiti, where a cholera outbreak is now known to have killed 1,344 people since last month. Aid efforts, especially in the worst-hit areas in the north, were disrupted last week by protesters who blame UN peacekeepers for spreading the disease. Officials said the security situation there had stabilised. Campaigning is meanwhile in full swing for Sunday's elections despite some calls for a postponement. Voters are due to elect a new president and members of the legislature. Late on Friday, four candidates appealed for the election to be delayed so authorities could focus on tackling the cholera outbreak. The four, none of whom is a front-runner in the 28 November poll, also called for an independent inquiry to establish the origin of the cholera. Some Haitians have blamed UN peacekeepers from Nepal, where cholera is endemic, for bringing the disease to their country. Violence erupted last week, with people setting up barricades and throwing rocks at UN vehicles.
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UN agencies and other aid groups said the protests were preventing them from carrying out relief work in the Cap-Haitien area, which has the highest fatality rate in the country. The challenges of rebuilding Haiti are immense However, at the weekend, supplies were once again being sent to the area, humanitarian groups said. "The security situation there has now stabilised," Imogen Wall of the UN humanitarian agency, Ocha, told Reuters. "We're going to have to scramble to get back to where we were." Oxfam said they planned to resume their work in the north on Monday. In the capital, Port-au-Prince, one of the main challenges is to prevent cholera from spreading in the slums and tent camps housing more than one million people left homeless by January's devastating earthquake. So far the squalid encampments appear to have been spared. "In all the camps where we have been working since the earthquake, we have not had one single confirmed case of cholera," Raphael Mutiku from Oxfam told the French news agency AFP on Sunday.
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Cholera is an Intestinal infection caused by bacteria transmitted through contaminated water or food Source of contamination usually faeces of infected people Causes diarrhoea, vomiting, severe dehydration; can kill quickly.
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"Most of the cases of cholera in Port-au-Prince are in slums that did not receive post-earthquake relief." However, there are concerns that the peak of the disease has not yet been reached and that people's urgent needs are not being met. Over the weekend, international medical charity MSF said the response so far had been "inadequate". It said swift action was needed to build latrines, provide safe water supplies, remove bodies and reassure frightened people that the disease is treatable. But the UN agencies have said that their work has been hindered by the recent riots. UN officials have also said that the violence is being encouraged by forces that want to disrupt the presidential election. Some 19 candidates are vying to succeed current president, Rene Preval and it is likely that the election will go to a second round run-off on 16 January. Most candidates have insisted that the elections, which will also choose 99 deputies and 10 senators, should go ahead as planned.

Postponing Haiti polls could threaten stability (11/22/2010)

Reuters
By Allyn Gaestel
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A raging cholera epidemic in Haiti may deter some voters from participating in Sunday's national elections, but postponing or canceling the polls could threaten stability in the Caribbean country, the European Union's envoy said on Monday. The month-old epidemic has killed 1,344 people in the earthquake-ravaged nation as of Friday. With the death toll still climbing, some Haitian presidential candidates have openly called for the elections to be postponed. The outbreak of the deadly diarrheal disease, affecting 8 out of 10 provinces, has heaped misery on Haiti's population of 10 million which is still struggling to recover from a Jan. 12 earthquake that killed more than 250,000 people.
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Lut Fabert, head of the EU diplomatic mission in Haiti, told reporters that while fear of cholera could keep some away from polling stations, this should not be a deterrent to the presidential and legislative elections. "At the moment, the EU sees no obstacle blocking these elections from happening," she told a news conference along with EU experts who are supporting the Haitian polls. "The most important thing is that the process advances according to the rules and that there is a good participation of the population," Fabert added. Cholera is basically spread by contaminated water and food, rather than person-to-person contact, and Fabert said voters needed to be assured that just gathering in one place to cast their ballots would not infect them with the disease.
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Hand sanitizers would be in place at polling stations to protect hygiene, she added. Fabert said she was confident the more than 12,000-strong United Nations peacekeeping contingent in Haiti could guarantee security for the elections, despite several days of anti-U.N. riots last week in the northern city of Cap-Haitien. At least two people were killed and dozens were injured in the clashes between U.N. troops and protesters, who blame Nepalese U.N. peacekeepers for bringing the cholera to Haiti. The U.N. mission in Haiti (MINUSTAH) says there is no conclusive evidence to support this charge. Despite the big health, security and logistical challenges facing the Nov. 28 elections the international community fears their postponement or cancellation could create a dangerous political vacuum that could be exploited by criminal or destabilizing forces in Haiti.
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"To not have elections now could jeopardize political stability in Haiti," Fabert said. The European Union is providing 5 million euros ($7 million) to finance the organization of the elections and a team of seven European electoral experts were supporting the polls, said team leader Marie Violette Cesar. But the EU team would not act as a formal observer mission because they could not cover the entire country, she added. A joint observation mission from the Organization of American States and the Caribbean Community said in a report on Friday that preparations for the polls were "on track". But it said challenges remained, acknowledging the cholera epidemic could impact voter participation. Sunday's vote will choose a successor to President Rene Preval -- who cannot stand for re-election -- appoint a 99-member parliament and 11 members of the 30-seat Senate. The presidential contest has 19 candidates including several frontrunners, but no clear favorite, meaning the vote could go to a second round in January.
(Writing by Pascal Fletcher; Editing by Jackie Frank)

Relief work resumes in Cap Haitian after riots (11/22/2010)

The Haitian city of Cap Haïtien is now calm after several days of riots linked to the cholera outbreak in the Caribbean country, and two United Nations agencies have resumed relief operations in the city, the world body’s humanitarian arm reported today. Unrest erupted in Cap Haïtien and other areas last week disrupting efforts to respond to the cholera outbreak that has made nearly 20,000 people ill and claimed the lives of more than 1,000 people over the past month. UN agencies had called for an end to the violent protests saying they were undermining the response to the outbreak. The UN World Health Organization (WHO) and the UN World Food Programme (WFP) have since the weekend been able to resumes flights to Cap Haïtien and distribute relief supplies, the UN Office for the Coordination of Humanitarian Affairs (OCHA) said. Meanwhile, the Under-Secretary-General for Humanitarian Affairs, Valerie Amos, will tomorrow travel to Haiti to review the humanitarian response to the cholera outbreak. Ms. Amos, who is also the UN Emergency Relief Coordinator, will meet with government and UN officials, as well as representatives of non-governmental organizations, during her two-day visit. On Saturday, the top UN humanitarian official in Haiti voiced concern over the slow response to an appeal launched 10 days ago seeking $164 million to curb the spread of the cholera outbreak. “While we are very grateful for the contributions received so far, both cash and in-kind, so far we only have received less than 10 per cent of what we need,” said UN Humanitarian Coordinator Nigel Fisher. “Critical supplies and skills are urgently needed. We need doctors, nurses, water purification systems, chlorine tablets, soap, oral rehydration salts, tents for cholera treatment centres and a range of other supplies,” he added.

Strategy For Cholera In Haiti (VOA - 11/22/2010)

The cholera outbreak in Haiti poses many challenges, said U.S. State Department Special Coordinator for Haiti, Tom Adams. Poor sanitation is a major cause of the outbreak. "Also the fact that for at least 50 years, and perhaps as long as 100 years, Haiti has not had any cholera so there are no immunities amongst the population," Mr. Adams noted. In addition, the current strain of cholera appears to be more virulent than normal strains. Mark Ward, Acting Director of the Office of Foreign Disaster Assistance at the United States Agency for International Development [USAID] expressed confidence in efforts by the Haitian government to treat the disease and check its spread. Mr. Ward praised the work of Haiti's medical professionals who are working around the clock to fight the deadly disease. USAID's Office of Disaster Assistance has provided about $9 million dollars to meet the crisis.
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"Our strategy right now is focused very much on prevention," said Mr. Ward. The U.S., said Mr. Ward, will work closely with Haitian authorities and non-governmental organizations to provide facilities, especially to those in remote areas. "We're not doing this alone," Mr. Ward noted. "There are a number of other countries around the world that are also really stepping up and helping out." These include Brazil, the European Union, Spain and Japan. International organizations and NGO's also play a significant role in the cholera response.
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Dr. Manoj Menon, of the U.S. Government's Center for Disease Control and Prevention said CDC’s top priority in Haiti is to save lives and control the spread of disease. CDC’s assistance in the response is focusing on the following areas: first to focus on hospitalized patients to reduce the case fatality rate; second, to assist patients in the community and ensure that they have access to oral rehydration salt and are aware of its proper use and have access to cholera treatment centers if needed; third, to prevent illness, via improved access to safe drinking water and education on improved hygiene, sanitation, and food preparation practices; fourth, working on surveillance, both laboratory surveillance and epidemiological surveillance, to monitor the spread of disease and inform the rational use of public health resources; and fifth, continue to work on the science to adjust interventions as necessary. Cholera is a deadly disease. But it is preventable and treatable. The U.S. is committed to working with Haiti and its international partners to meet this challenge.

Was Cholera Outbreak Brought on By the Weather? (11/21/2010)

SciDev
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Weather conditions — not UN soldiers — may have triggered Haiti's cholera epidemic, which has killed more than 1,000 people in less than a month, three leading researchers have told SciDevNet. A coincidence of several catastrophic events — from climatic changes caused by the ocean-atmosphere phenomenon La Niña, to the plunge in water and sanitation quality following Haiti's disastrous January earthquake — provide the most likely explanation for the outbreak, which has hospitalised 17,000 people. The outbreak suddenly appeared in small communities along the Artibonite River, 60 miles north of the capital Port-au-Prince, on 21 October. Its origin has not been determined with certainty but the popular belief is that the disease arrived with infected UN soldiers from Nepal. They were stationed in a rural base near the river where the outbreak first started. Cholera is endemic in Nepal whereas Haiti has not had a recorded cholera case in the last 50 years. The US Centers for Disease Control and Prevention said in a press release earlier this month that genetic analysis of the cholera strain that hit Haiti reveals that it most closely matches South Asian strains, which further fuelled the suspicion. But scientists SciDev.Net talked to all rejected the idea that cholera was imported from Nepal. "Vibrio cholerae, the bacterium responsible for cholera, may have been dormant in water until weather-related conditions caused it to multiply enough to constitute an infective dose if ingested by humans," said David Sack, a cholera specialist at Johns Hopkins University Bloomberg School of Public Health in the US.
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Rita Colwell, a professor at the University of Maryland, also in the US, agreed that the aquatic environment conditions produced by a strong La Niña this year may have made cholera flare up in Haiti for the first time in 50 years. Colwell's research aims to predict cholera outbreaks by correlating disease occurrence with weather patterns, water surface temperatures and algal blooms (on which plankton that house the bacteria feed). She has found that the annual patterns of higher sea temperatures along the coast correlate with patterns of cholera cases in both Bangladesh and Peru, based on data from 1992–1995 and 1997-2000, respectively. Weather conditions do not have to be present together with poor sanitation and lack of clean water for an epidemic to occur, she said, but the latter increase chances of an outbreak. Cholera spreads when faeces from infected humans, who may not present any cholera symptoms, get into drinking water that other people consume. "Diarrhoeal diseases exist in Haiti. The difference now is that several catastrophic events have occurred practically at the same time, exacerbating conditions of poverty."
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Afsar Ali, an associate professor of environmental and global health at the University of Florida, US, agrees that climatic factors promoted the bacteria's multiplication in the Artibonite area. He told SciDev.Net that when he visited Haiti in August, refugees from the earthquake were using water directly from the river and ocean. Since V. cholerae favour estuarine water, where the tide meets the stream, he warned at that time of the risk of a cholera epidemic. "Interestingly, the refugees got cholera first. If, as it is likely, cholera was already present in the Haitian coastal region, permanent residents exposed to low levels of the cholera bacterium for prolonged periods of time would logically have more immunity than refugees." The climate-cholera link in Haiti may be confirmed if, as Colwell believes, the epidemic weakens in winter as the waters in the Caribbean cool down.

HIV-positive people especially vulnerable to cholera

11/22/2010
Plusnews
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As the death toll from the cholera epidemic sweeping through Haiti surpasses 1,000, with more than 19,000 confirmed cases, health officials say people living with HIV are especially vulnerable. Only about 25 percent of people infected with cholera develop symptoms - mainly watery diarrhoea and vomiting - but people already weakened by illness, malnutrition or pregnancy are particularly at risk. "[People living with HIV] are very much at risk because they already have a weakened immune system," explained Hanz Legagneur, director of the Ministry of Public Health in the country's West Department. Cholera can be easily treated with oral rehydration salts that replenish the body's water and electrolytes, but can be deadly for people who fall ill quickly and lose too much water before obtaining assistance.
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People living with HIV are often too poor to pay for transport to health facilities, which can prove deadly when time is short. "Anyone can die within four hours without treatment or oral rehydration salts; [for] someone infected with HIV it will be even less - it can be two or three hours," said Reginald Dupont of SeroVIE, an NGO for lesbian, gay, bisexual and transgendered Haitians living with HIV. Haiti - with an HIV prevalence of 2.2 percent - has approximately 120,000 HIV-positive people. Like much of the population, many are living in tents following January's earthquake, with little access to potable water or clean toilets. Health workers have been overwhelmed by the cholera epidemic and have not yet released numbers of HIV-positive people who have contracted the water-borne disease. But according to Dupont, people infected with HIV often lack adequate access to healthcare and due to stigma, may not receive appropriate medical attention.
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The UN Population Fund (UNFPA) has distributed nearly 7,000 hygiene-cholera kits since 1 November to pregnant women and people living with HIV. The kits contain soap, a toothbrush and a bucket, as well as chlorine to prevent infection. National and international organizations are also working to raise awareness about cholera prevention measures. According to Marie Jose Salomon, the HIV focal point for the UNFPA in Haiti, radio spots explaining the risks of cholera to people with HIV are set to be released soon. Although cholera treatment centres have been set up nationwide, the UN Office for the Coordination of Humanitarian Affairs has estimated that only 10 percent of the money, supplies and skills needed to adequately address the epidemic have so far been made available.

Cholera fighting efforts restart in Haiti's north (11/21/2010)

Reuters
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Aid supplies to combat Haiti's deadly cholera epidemic are flowing again into the country's northern regions after protests by Haitians blaming U.N. troops for the outbreak, humanitarian groups said on Sunday. Vehicles carrying equipment from some aid groups have begun to reach the northern city of Cap-Haitien, where aid efforts were disrupted last week by several days of protests that saw Haitians throw up road barricades and hurl stones at U.N. peacekeepers, said Imogen Wall of the U.N. humanitarian agency, OCHA. "The security situation there has now stabilized," Wall said. "We're going to have to scramble to get back to where we were." The cholera epidemic, which has so far killed 1,250 people, has hit Haiti's northern area the hardest and added another challenge for the impoverished country as it prepares to hold national elections on Nov. 28. The government and its aid partners are fighting to prevent the disease from spreading in crowded city slums and tent camps housing some 1.5 million people left homeless by a Jan. 12 earthquake. Julie Schindall, a spokeswoman for the international charity Oxfam, said her group planned to resume aid activities in the northern region on Monday as workers scramble to contain the epidemic that has swept through Haiti, the poorest country in the Western Hemisphere. In over a month, the epidemic has spread to eight of the country's 10 provinces and some 20,000 people have been treated in hospitals for the diarrheal disease, which can kill in hours through dehydration if not treated quickly. The anti-cholera campaign has been complicated by reports -- denied by the U.N. mission in Haiti -- that U.N. peacekeepers from Nepal brought the disease to Haiti, where it had been absent for 100 years. At least two people were killed and dozens wounded in clashes blamed by the United Nations on political agitators looking to inflame political tensions before next week's vote to choose a successor to President Rene Preval, a 99-member parliament and 11 members of the 30-seat Senate. (Reporting by Kevin Gray in Miami; Editing by Peter Cooney)

Job Takes Hazardous Turn for Body Collectors (11/21/2010)

Miami Herald
BY JACQUELINE CHARLES
jcharles@MiamiHerald.com
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Residents afraid of catching cholera turned on a group of body collectors -- and the photojournalists following them -- Saturday, snatching the lead supervisor and beating him up before calling police. ``It was a bad moment. I really thought they were going to kill me,'' Rochefort Saint-Louis, the supervisor of a Ministry of Health body collection team told The Miami Herald, after he was eventually released. Saint-Louis, 30, is among a group of scrappy young men recently hired by Haiti's Minstry of Health to travel through the country to pick up victims of cholera who have died in institutions, in homes or in many cases, who were abandoned on the streets. He continued working after the incident, transporting 13 dead-by-cholera victims to a far flung burial site near the city of Cabaret, not far from a mass grave for vicitims of the January earthquake that killed an estimated 300,000. ``I was afraid to lose the job,'' he said. ``This is my first job.'' Still, Saint-Louis and his team are learning that the job is both hazardous and sad. They had already picked up one dead cholera victim when they turned into a neighborhood in the city of Carrefour to collect another at the request of government officials. Three foreign photojournalists and their Haitian driver were following to document the work on film. As they pulled up, they were greeted by an angry crowd. ``Residents confronted the truck with the body and said we don't want your cholera here,'' said Lee Celano, a freelance photographer. He was injured by shattered glass after rocks, thrown by the crowd, broke three of the car's windows.
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`I don't really understand why they turned on us. It just shows how there is a strong amount of paranoia over cholera here and how they are completely irrational about it,'' Celano said. ``People are really scared and doing irrational things.'' Cholera is a waterborne infection that is transmitted by drinking or eating food that is contaminated. It is not likely spread by casual contact. Celano said the crowd soon began setting up barricades with rocks to prevent everyone from leaving. At some point, someone grabbed Saint-Louis. They stole his cellphone and money and beat him, he said. His abductors eventually called the police to say someone had come to dump a dead-by-cholera victim in their community.
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The police came and arrested him, Saint-Louis said. He was eventually released after police realized he was a government employee. ``The government really needs to give us the means to do our job,'' said Saint-Louis, who began work on Monday and seriously contemplated quiting even before Saturday's incident. ``They have to educate the population. Sensitize them. We are trying to protect the public health, but the people could end up killing us. They almost did today.'' Instead of an ambulance, the team drives a truck where the body bags are exposed, adding to the population's fears. They also do not have police escorts as they go through neighborhoods retrieving bodies off streets where they've been abandoned by family and friends, or at private homes. On Sunday, Haitian officials are supposed to tape a public service campaign to inform the public on the post-mortem procedure. Meanwhile on Saturday, the U.N. Office for the Coordination of Humanitarian Affairs announced that their response to its $164 million appeal to fight the waterborne infection in Haiti has so far been ``insufficient,'' with less than 10 percent of what's needed pledged. Nearly 50,000 people have sought medical attention of whom 19,646 cases have been confirmed as having cholera, the United Nations said in a statement. ``Without medical help, the mortality rate will increase dramatically. Oral rehydration salts or home made sugar-salt solutions are enough to treat 80 percent of cases. If we can provide timely treatment to patients we can save lives,'' said Nigel Fisher, humanitarian chief in Haiti.

Haitian cholera hospital counts its dead on the lawn

AFP
11/21/2010
By Stephane Jourdain
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The woman stricken by cholera lay in bed in a hospital tent. Fluids were delivered to her body through an IV drip while nurses made sure she drank water all the time. But all the efforts to save her life proved to be in vain. She passed out, and feverish attempts by a hospital crew to jump-start her failing heart came to naught. After about 20 minutes of fruitless efforts to revive the patient, the doctors gave up, and another dead body was taken to a lawn that serves as a hospital morgue. "It’s the fourth death today," sighed an American doctor who took care of the patient. "She was young, 30 years. There’s something wrong with this emergency service. We have to do something." Theresa Hospital is located in the town of Hinche in central Haiti. Here, on the banks of the Artibonite River, the first cases of what would become a massive cholera epidemic were discovered a month ago. To accommodate all the patients, large khaki tents have been pitched in front of the hospital. The chaotic surroundings include two men carrying a coffin, chickens dashing in and out of hospital tents and nurses in blue uniforms trying to make their way between parked cars and beds. The dead bodied were placed on a lawn, a few meters (yards) away from the tents. The hospital’s death toll from the cholera epidemic now stands at 22. "It is not going well," said hospital director Doctor Prince-Pierre Soncon. "When the epidemic was just beginning, we reported only three new cases every day. Then their number jumped to 15 and then to 35. This morning we have already had 60."
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Because the hospital has no access to the Internet, it has trouble reporting data to Port-au-Prince, the capital. However, it was visited Saturday by a group of French and Haitians doctors and epidemiologists, who were able to collect some information. "We need chlorine, hydrating liquids, IV drips, antibiotics," added Soncon. "We have some reserves, but the demand is so great that they will not last long." New patients arrive one after another. A couple brings a small boy who is visibly exhausted. A young mad clad in jeans and a polo shirt stumbles in by himself. But he is obviously in pain and vomits on the bench where he sits even before nurses can attend him. "It’s difficult. People come here very sick," explained Atalante Saint-Preux, a young Haitian nurse. "They are our friends, brothers and sisters, and we need to help them." Marie-Lourde Denise, 37, has been hospitalized since Wednesday. She has been suffering from dizziness and stomach pains since she went to wash clothes in the Guayamouco River.
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"I think when I was washing the clothes, I also washed my face with the river water," she explained. "I think that was the cause. Three days later, I was hit by diarrhea, nausea and stomach pains. I immediately went to the hospital because I thought it was cholera." Denise has won her battle with the disease and was scheduled to leave the hospital soon. Hinche is patrolled by UN troops from Nepal, but some local residents have accused the UN soldiers of spreading the disease. As a result, six peacekeepers were injured last Monday when about 400 angry demonstrators pelted them with rocks. Since that incident, the situation has calmed down, but foreigners are still worried for their safety. "I try to limit by trips," said Antonin Danalet, a young mathematics professor from Switzerland, who works at a local university. "Since Monday, I have been insulted twice in the streets," he added. "People treat me as a stranger, as someone who could bring them cholera."

Politics in the Time of Cholera (Economist - 11/18/2010)

Rebuilding Haiti
By Pooja Bhatia
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SO OFTEN in Haiti urgent problems—mudslides that bury towns, storms that wash houses out to sea or spikes in food prices—and chronic political instability have conspired to subvert efforts to lay the basis for sustained development. The earthquake last January that devastated the capital, Port-au-Prince, was supposed to have changed that. It inspired promises by world leaders to put Haiti on a more solid footing, backed by pledges of billions of dollars, and an ambitious, if vague, reconstruction plan from the government. But the earthquake has made Haiti even more vulnerable: witness the escalating cholera epidemic that in the past few weeks has claimed more than 1,100 lives. Haiti is trapped in an especially vicious circle. More than 1m people still live in squalid tent camps in or around the capital and their continued exposure to the elements and disease precipitates emergencies that distract policymakers from reconstruction and resettlement. A general election due on November 28th adds another layer of complication. Understandably, Haitians are more scared of cholera than enamoured of their politicians. A lacklustre campaign may culminate in an unusually low turnout.
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The electoral authority insists that the vote will go ahead. But it cannot without security and logistical help from Minustah, the United Nations mission in Haiti. And the UN has itself come under fire over the cholera outbreak. After a sudden surge in cholera cases in the north of the country, two people died this week in violent demonstrations against the UN in Cap-Haïtien, Haiti’s second city. Six UN personnel were injured in a similar protest in Hinche. Many Haitians reckon that Nepalese peacekeepers introduced the cholera virus (it is a South Asian strain). The UN denies this, and claims that the protests were election-related. In any event, they halted aid flights and a water-chlorination campaign. Doctors say that cholera has not yet peaked and is likely to last months, if not years. Postponing the election would merely prolong a political limbo that is causing delay or inaction among donors, investors and even government officials. Candidates have continued to hold rallies and broadcast radio ads.
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For the first time in Haiti’s two decades of patchy democracy, there is no clear front-runner for president among the 19 candidates, and the contest is likely to go to a run-off, due on January 16th. That may be between Jude Célestin, who runs the state construction agency and is the protégé of René Préval, the current president, and Mirlande Manigat, whose husband, Leslie, was president for four months between two military governments in 1988. Ms Manigat, who describes herself as of the moderate left and wants to rein in Haiti’s thousands of NGOs, is ahead in some polling. Mr Célestin may be hurt by Mr Préval’s low-key response to the quake, which has made him unpopular. Whoever wins will inherit a country overwhelmed. Cholera’s effects go beyond the death toll. They are compounding Haiti’s other woes. Farmers and fishermen in Grand’Anse, a verdant department that was hit badly by a recent hurricane, have seen sales plummet as customers spurn local foodstuffs. Potential investors are also being scared off by cholera, even though it can be easily prevented with good sanitation and clean drinking water (or treated by oral rehydration). Textile buyers called off a forum scheduled for this week, according to Gregor Avril of the manufacturers’ association. The International Finance Corporation, part of the World Bank, postponed a meeting to discuss special economic zones. Hoping to quell fears among its well-heeled clientele, the capital’s fanciest restaurant has emblazoned its menu with “Everything is Imported”. All this has prompted government economists to reduce their estimates for economic growth.
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The immediate priority remains taming an epidemic that in the past fortnight has got out of control. Health workers have struggled to find sites for treatment centres where cholera patients can be segregated, because of neighbours’ fears of contagion. The mayor of St Marc, where cholera first appeared, authorised a centre last month. But when Médecins Sans Frontières, a medical charity, prepared to open it, protesters attacked with rocks. The mayor withdrew his support. As a result, St Marc’s hospital has been inundated with cholera cases, obliging other patients to go elsewhere. In Carrefour, a suburb of the capital, the mayor has refused to allow outsiders to seek help at its treatment centre, despite cajoling by national officials. Aid workers hope that local leaders will start to see treatment centres as an asset. The government has at last begun a concerted campaign to educate Haitians about cholera and its treatment. This has included Mr Préval’s appearance on a four-hour television programme—the most his people have seen of their reclusive president in years. Fighting cholera, like reconstruction, needs a legitimate and effective government. Irrelevant though it may at first seem, the election matters too.

Haiti in dire need of soap to help combat cholera epidemic

11/21/2010
Boston Globe
By William Booth
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The difference between life and death in Haiti is now an ordinary bar of soap. Soap could slow the terrifying cholera outbreak that is quickly spreading and has entered the ravaged capital, according to health care specialists and international aid groups. But in the squalid slums of Port-au-Prince and the river towns where the cholera outbreak began three weeks ago, many Haitians held up their hands and shook their heads, saying they had no soap to stop an infection that is spread by contaminated food and water and where a vigorous hand-washing, especially after using the toilet, is the number one way to save lives. A cake of yellow Haitian soap costs about 50 cents. But many Haitians do not have soap because they cannot afford it. More than half the population lives on less than $1.25 a day. “They buy food instead,’’ said Gaelle Fohr, a coordinator for hygiene programs in Haiti for the UN Children’s Fund. “We borrow, we buy, but right now, we don’t have any soap in the house, I am sorry to say,’’ said Joceline Jeune, living with three children in a hillside shanty at the edge of a displaced persons camp, as a gutter filled with greasy, gray water flowed inches from her front door. When confronted by dubious toilets or fly-specked markets, people here daily use the expression, “Mikwob pa touye ayisyen,’’ which translates, “Germs don’t kill Haitians.’’
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“As hard as it is to believe, Haiti still needs soap. They have many needs, but soap — and access to clean water — is absolutely essential to fight cholera,’’ Nigel Fisher, the top UN humanitarian aid coordinator, said in an interview. There are plans for more water trucks, and more chlorine in water tanks, wells, and distribution points. But building a modern water and sanitation system will take years. By contrast, experts say, soap is fast and doable, allowing people to clean their hands. Foreign governments, international aid groups, and individuals have sent more than $3.4 billion in humanitarian aid here in the 10 months since a tremendous 7.0 magnitude earthquake struck the capital, killing about 300,000 people and displacing more than 1.5 million, according to the Haitian government. But poverty is so deep, needs can seem bottomless.
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“Haiti has crowded slums, poor hygiene, incredible poverty — before and after the earthquake. This is an extremely contagious, extremely virulent strain,’’ Fisher said. “It can kill in a few hours — unless you get help. We have well over a million people in camps; we have a disease that spreads by hand, mouth, touch, water. It can lie dormant for five days. You cannot tell who is infected. The country is now facing a tremendous challenge with limited resources.’’Experts at the Pan American Health Organization forecast that 200,000 Haitians will show signs of the disease, while it is possible that 1 million will be infected but remain asymptomatic carriers still capable of spreading the potentially deadly bacteria. The United Nations has appealed for $164 million in emergency funds to fight cholera in Haiti. The organization plans to spend more than half the money on clean water, basic sanitation, and improved hygiene, and far less on treating the sick, because of the relative cost and importance of prevention. Epidemiologists anticipate that the epidemic will continue to spread, and cases will appear in bursts of sudden outbreaks over the next six months. “For the people who live in the hills, it is a two-hour walk to the road, where they can catch a tap-tap [a bus], and some of them have already been sick for two or three days, and they have to be carried to that road,’’ said Heather Lorenzen of the International Medical Corps as she was erecting tents to serve as a cholera treatment center in Gonaives in the Artibonite valley.
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Across the street, workers in yellow gloves and protective masks were scouring the floors and walls of the main hospital that had been overwhelmed by cholera patients. The illness can produce diarrhea and vomiting, and patients die not of the toxin that the cholera bacteria produces but of dehydration. In the past two weeks, international aid groups have been scrambling to deliver soap and hygiene kits to some of the millions still living in tarp and tent camps in the capital and to the most vulnerable populations in the countryside. UNICEF brought 100,000 pieces of soap to 500 of the country’s orphanages. Along the Artibonite River valley, the group distributed 82,000 bars. It will be heading to 5,000 schools in coming weeks. Another group, Clean the World, has distributed 100,000 bars of used soap it collected from 550 North American hotels that recycle the bars instead of throwing them away after one use by a guest. They promise 200,000 more bars of soap by the end of the month. But shortages abound — not only of soap, but also of bleach, intravenous fluids, powdered rehydration solutions, and doctors and nurses trained in treating cholera. Haiti had not had an outbreak in more than 50 years..

Haiti Cholera Response Less than 10% Funded (OCHA - 11/20/2010)

The response to last week's UN-led appeal for 164 million USD to fight cholera has so far been insufficient for an adequate response to the epidemic, the Humanitarian Coordinator in Haiti said today. "While we are very grateful for the contributions received so far, both cash and in-kind, so far we only have received less than 10% of what we need," said Humanitarian Coordinator Nigel Fisher. "Critical supplies and skills are urgently needed. We need doctors, nurses, water purification systems, chlorine tablets, soap, oral rehydration salts, tents for cholera treatment centres and a range of other supplies." At the national launch of the cholera response plan last week, which details plans for a 14 month response, the UN and the Government of Haiti stressed the importance of responding, quickly given how fast the disease is spreading. The epidemic was accelerated by flooding caused by Hurricane Tomas on November 5th. The response has also been impeded by recent violence in Cap Haitien, one of the most serious of the current hotspots, where most cholera response has been suspended for the past four days. So far, nearly 50,000 people have sought medical attention, of whom 19,646 cases have been confirmed as having cholera – and these numbers, which only represent those who have reached medical facilities, are expected to rise. "Cholera is an extremely simple disease to cure, and the case mortality rate of 2.4% in medical facilities shows that almost all patients receiving help are surviving" said Mr Fisher. "Without medical help, the mortality rate will increase dramatically. Oral rehydration salts or home made sugar-salt solutions are enough to treat 80% of cases. If we can provide timely treatment to patients we can save lives."
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The Cholera Response Plan focuses on the need to improve water and sanitation and on public information to help prevent the spread of the disease, as well as scaling up medical capacity by building specialized cholera treatment centres (CTCs), smaller treatment units and oral rehydration centres. The plan includes activities to be undertaken by nearly 50 NGOs. So far 36 CTCs have already been set up nationwide along with 61 smaller cholera treatment units, and more are being built. More are planned, as CTUs need to be provided for every hospital in Haiti. Yesterday alone humanitarians distributed 40 tonnes of medical supplies. The response strategy also provides for 650 oral rehydration centres which can administer basic lifesaving rehydration salts. Distribution of water purification tablets, oral rehydration salts and soap is ongoing across the country, as is a large scale public information campaign.
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The mission of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is to mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors. "We would like to thank those donors and partners who have responded so far," added Mr Fisher. "We also need to recognize that this appeal relates to emergency response needs now. In the longer term, effective management of cholera– and other communicable diseases that Haitians suffer from every day – must mean proper investment in Haitian capabilities, in protected water supplies and environmental sanitation systems across the country, and in proper waste disposal methods. The reality we must all face is that cholera is here to stay in Haiti. We must minimize unsanitary conditions that foster epidemics."
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For further information, please call:
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Stephanie Bunker, OCHA-New York, +1 917 367 5126, mobile +1917 892 1679, bunker@un.org;
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Emmanuelle Schneider +1 646 241 4651, mobile +1 646 752 3117, schneider1@un.org; Imogen Wall +509 3491 2244, wall@un.org;
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Elisabeth Byrs OCHA-Geneva, +41 22 917 2653, mobile, +41 79 4734570, byrs@un.org.
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OCHA press releases are available at http://ochaonline.un.org or www.reliefweb.int.

Ensuring a Rapid, Cohesive Cholera Reponse (11/19/2010)

USAID
By Preeti Shah
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About 10 months have passed since a massive earthquake devastated much of the small Caribbean country of Haiti. Since that time, the Haitians, their government, and the international community rolled up their proverbial sleeves and dove into the task of bringing Haiti back to its feet. And then cholera broke out. In response to what was rapidly identified by the Haitian government as an outbreak of potentially significant proportions, a team of nations, international organizations, and NGOs immediately focused on bringing in personnel, and deploying stocks of medical supplies and hygiene kits to begin treating victims of the disease. Cholera flourishes in areas where sanitation systems are poor, where hand washing doesn't happen often enough, and when food and water contamination happens all-too-frequently. Unfortunately, these conditions exist throughout much of Haiti, and they were exacerbated by the January 12, 2010 earthquake. However, it is also easily treated through use of oral rehydration solutions and community-level health clinics, and prevented through changes in hygiene practices and access to clean drinking water. It quickly became clear that a coordinated response was not only important, but also vital to ensuring a rapid and cohesive response to assist the government of Haiti's efforts to slow down the transmission and to treat the victims. We are focusing on four major areas of response that include: providing clean drinking water, either via chlorinating the municipal water supply or providing AquaTabs to rural Haitians; providing oral rehydration salts to those stricken with cholera; providing access to treatment facilities to those in need of them; and conducting a strong public education program about cholera prevention and treatment.
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All U.S. government agencies in Haiti began collaborating on this dual mission of prevention and treatment. The Centers for Disease Control and Prevention and USAID's Office of Foreign Disaster Assistance sent rapid response teams to Haiti. In addition to personnel, we immediately began the important campaign to educate Haitians about how to prevent transmission, and how to identify and treat cholera if infected. Using every means available, this campaign has spanned radio, SMS, sound trucks, pamphlets, as well as the training and mobilization of community health workers carrying the message about clean water, clean hands, and clean homes. Through USAID's Office of Foreign Disaster Assistance, over $9 million (as of November 18) has been contributed for specific efforts to prevent and treat cholera and slow the spread of the disease. This is in addition to the over $1 billion in earthquake assistance the U.S. government has provided to date, which is already working to improve water and sewage systems, as well as long-term public health planning. New cholera treatment facilities, staffed by CDC-trained health workers, have opened and are stocked with oral rehydration salts, IVs, and cholera cots donated by the United States, as well as international partners and NGOs. CDC experts predict that cholera will remain a public health concern in Haiti for several years, though the initial and early phases are usually the most challenging in terms of new cases. We will continue to work alongside the government of Haiti, our international partners, and the NGO community to combat this outbreak and help Haiti continue its path of recovery.

Bill Clinton Announces $1.5 million for Cholera Response

11/17/2010
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Today, the William J. Clinton Foundation announced it has committed $1.5 million dollars in response to the cholera outbreak in Haiti. In recent weeks, the disease has claimed the lives of more than 1,000 people. As part of its immediate assistance, the Foundation is committing $1 million dollars for the training — in partnership with the Ministry of Health — of 10,000 community public health workers across the country, as well as the purchase of 10,000 portable treatment packs for those in need. The kits will contain oral hydration salts, soap, aqua tabs, chlorine, hand sanitizer, garbage bags, educational material, and stationery. For the longer-term, the Foundation is committing $500,000 to support the implementation of an aggressive national education and awareness campaign. In the coming weeks, the Clinton Foundation and the Ministry of Health will identify a Haitian firm to implement the effort. Both projects will be presented to the IHRC. "The recent outbreak of cholera is a devastating development for the people of Haiti, and serves as an important reminder of all that remains to be done in our work to help Haiti build back better after the earthquake," President Clinton said. "The Clinton Foundation’s commitment of $1.5 million will to help expand treatment, care and education to those who need it and ultimately limit the outbreak’s severity and impact."
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"An effective response to cholera requires a multi-level approach with a strong local mobilization for prevention and early treatment," said Dr. Alex Larson, Minister of Health. "The Clinton Foundation’s partnership with us at the Ministry of Health will give our first line community responders the tools and essential supplies they need to actively reach out to those vulnerable. This contribution supports a core element of our strategy of ensuring widespread education with access to supplies to save lives." The immediate and long-term responses are a result of multiple meetings between President Clinton’s Chief of Staff and the Haitian Government immediately after the outbreak. The programs — which will be presented to the IHRC — will help provide people with adequate treatment and education, and build Haitian capacity in order to avoid future crises. President Clinton has been working in Haiti before the devastating January earthquake and remains a strong partner in the country’s recovery. Through initiatives focused on the economic and social health of the country, the Foundation has supported efforts aimed at improving medical services, education, small business, infrastructure and other keys to Haiti’s future. The total value of assistance to Haiti provided through the Clinton Foundation’s efforts has been nearly $23 million to date. Additionally, the Foundation allocated $1 million for communal hurricane emergency shelter; $1 million for operational support of the IHRC, which President Clinton co-chairs along with Prime Minister Jean-Max Bellerive; and $500,000 in bridge funding for the Petionville Club Camp in Petionville.
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For more information on the Clinton Foundation’s efforts in Haiti, visit http://clintonfoundation.org/haiti_longstanding/haiti_fact_sheet.php
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About the William J. Clinton Foundation: Founded by President Bill Clinton, the William J. Clinton Foundation focuses on worldwide issues that demand urgent action, solutions, and measurable results — global climate change, HIV/AIDS in the developing world, childhood obesity and economic opportunity in the United States, and economic development in Africa and Latin America. For more information, visit www.clintonfoundation.org.

Haitians Plunge Into Rivers of Muck to Stem Cholera

11/19/2010
New York Times
By RANDAL C. ARCHIBOLD
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PORT-AU-PRINCE, Haiti -- Duquesne Fils-Aimé, stripped to the waist, stepped gingerly into the canal, drawing stares of astonishment from the spectators above. When he ducked his head under the water -- if one could call it that -- an audible gasp rose from the crowd. Plastic bottles and bags, shredded underwear, shoes and endless globs of unidentifiable black muck bobbed like a fetid tarp around Mr. Fils-Aimé and his colleagues as they started another shift -- cleaning out the canal by hand. On and on they worked in the drink, making little progress but at least a little cash in a Sisyphean battle against the squalor that chokes the canals and ditches passing as sewers, causes floods of wastewater and helps spread the cholera epidemic now gripping more than half the country. "We do the bad," Mr. Fils-Aimé, 41, said of his work, "and maybe people won't get sick." At least there were no animal carcasses that day; the men have seen plenty of them -- dogs, rats, goats. They swam a few strokes, black water slopping over them in a stench many layers thick. At one point, Mr. Fils-Aimé sat entirely supported on the filth as if shipwrecked, fishing out debris to the lucky crew member on dry land.
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The job pays $112 a month, and the men are thankful for it, even though they say they sometimes go weeks without getting paid. Unemployment is so crushing here that for some, it is the first steady work they have ever had. "I can't tell you how long I was looking for a job, so when I found this I took it," said Dieusov Étienne, 38, who has done the work for three years. Garbage and filth overflow here, spilling from trash bins left unemptied for months and littering tent camps for earthquake refugees. When the rains come, as they did after Hurricane Tomas brushed the island on Nov. 5, the backed-up waterways spread over any vacant patch, creating an ideal home for cholera. Children splash and defecate in the water, people use it to rinse dishes and wash clothes, and some, with few options, even consume it. In a matter of weeks, the disease has killed more than 1,000 people, hospitalized around 17,000 with choleralike symptoms and prompted violent protests against international peacekeepers, whom residents accuse of importing the illness from South Asia. There is no sewage plant in Haiti; some hotels and private homes have their own septic systems, and entrepreneurs scour the city cleaning latrines, often dumping the waste in the most convenient canal or drainage ditch. Even the work of cleaning the canals is a testament to the extreme difficulties of preventing cholera in a country where infrastructure was minimal long before the earthquake and where sanitation crews have to descend into the muck with hardly any tools, much less gloves or suits to protect them. "Sometimes I get a fever and I thank the Lord I am O.K.," Mr. Fils-Aimé said.
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He is well aware that cholera is carried in water, filthy water that, judging by the excrement along the banks around him, is likely to contain the feces that spread the disease. But he needs the money and tries not to think much beyond that. "I am not worried," he said. "Whatever is going to come, is going to come." The workers wash after work, and given the trials of so many here, they carry a sense of resignation about the risks. "I don't care about cholera," said Odvel Étienne, 24, fresh out of the water with bits of debris sticking to his body. "We are all going to die someday." He is the youngest of the crew of four, who are mostly middle-aged and had never worked a regular job before this. His colleague, the elder Mr. Étienne, who is not related to Odvel, tells a typical story -- of moving from farm work in the countryside to the city 15 years ago looking for better opportunities. He moved in with relatives and depended on them. He has a wife, a 12-year-old daughter and three other relatives, and they live in an apartment that suffered little damage in the quake, making him one of Haiti's fortunates.
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He got this job as most people do, through connections. A friend heard of an opening and recommended him. "I knew what it was, but I needed the job," he said. It pays the $62 a month for private school for his daughter and supports the rest of his family. Some, like Désiré Harry, 26, see the men in the muck and wish it were them. "It should be my job, people my age," he complained while watching Mr. Étienne clear a culvert. The people who gathered to watch seemed appreciative -- or awestruck -- over the spectacle of men essentially swimming in a cesspool. "They are the only ones brave enough to do this," said Claude Ambroise, 44, who is also unemployed. Brave, perhaps, does not quite capture it. As the debris picked out of the canal grew, Élines Fedenaud, the lucky dry man, scooped it onto a pile to be picked up by a truck later, if it showed up. Often it does not, the men said, making their work that much more futile. They have been working on the canal for a month but do not seem particularly discouraged that the garbage they have fished out continues piling up, without getting hauled away. What irked them were delays in getting paid; they sometimes went a month or more without a check. As they worked, a passing truck blared campaign jingles to a Caribbean beat, advertisements for Jude Célestin, President René Préval's choice in the Nov. 28 presidential election. The younger Mr. Étienne did a little jig to the music, but he scoffed at all of the 19 candidates in the race. "The money they do for that could be money for what I am doing here," he said. Into the putrid water they went, tossing debris out.

Living fear the dead in cholera-scarred Haiti (11/19/2010)

Miami Herald
BY JACQUELINE CHARLES
jcharles@MiamiHerald.com
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CARREFOUR, Haiti -- Stacked with body bags full of corpses of cholera victims, a converted flatbed truck and a colorful tap-tap taxi swerved into the yard of the mayor's office and their drivers asked where to bury the dead. ``Get out of here. Get out of here before they start throwing stones,'' a city hall employee screamed, her voice panicky, her hands flaring. A crowd started circling. Three poorly armed police officers showed up and announced more were on the way. Then the city hall employee jumped into a car and motioned the corpse vehicles to follow. The angry crowd shouted and began throwing rocks. Frightened by a disease never before known in this nation, Haitians are running scared. Residents are stoning the dead and their handlers, local mayors are refusing their burial, and families are abandoning bodies on the streets. Others have taken to the streets in protests against U.N. peacekeepers because they believe the outbreak may have originated in a U.N. camp. Officials suspect the protests may be politically motivated to prevent the Nov. 28 elections. ``It's a very alarming situation for Haitians,'' said Emilie Clotaire, an administrator at the Adventist Hospital in Carrefour. Earlier this week, the hospital had its first cholera-related death, and after frustrating attempts to get someone from the Ministry of Health to fetch the 31-year-old's body, it ended up hiring someone to do the job, executive director Yolande Simeon said. ``They were stoned when they arrived at the cemetery,'' she said. The dead man's ``family and friends abandoned him.'' The disease carries a stigma. ``Everyone is afraid of cholera,'' Clotaire said. And that creates big problems for those charged with collecting and laying to rest victims. ``Once we collect the bodies, we have no way to dispose of them,'' said Rochefort Saint-Louis, 30, after three days on the job. He is supervisor of two body collection teams the Haitian Ministry of Health recently formed in the wake of the outbreak.
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The young men on these teams will come face-to-face with an epidemic that has Haitians and the world counting: 1,186 dead from cholera, 19,646 hospitalized, and at least two confirmed cases outside of Haiti -- one in the neighboring Dominican Republic and the other in South Florida. The group of 10 scrappy young men said they signed up for the job because it offered employment in a country where jobs are scarce. For Saint-Louis, it was his first job -- ever. Their day began at 6 a.m. Tuesday with meetings at the Ministry of Health. After gassing up their vehicles, it was 11 a.m. when they arrived at traffic-clogged Harry Truman Boulevard, across from the prime minister's office. The air was suffocating with a three-day stench of death, and the bloated body of a naked man, a rope tied around his ankle, was lying in the middle of the road. Nearby residents paid someone to drag him from the water's edge into the street, witnesses said. He died of cholera after going to a local clinic but leaving before he was well. The body collectors -- each clad in a yellow raincoat, gloves, goggles, a face mask and carrying a canister of disinfecting chlorine on their backs -- slammed on the brakes, stepped out and sprayed the body with chlorine before placing it in a body bag. At a stop at the Doctors Without Borders treatment clinic, there were 12 bodies awaiting pickup. They had been piling up for two weeks. As the team brought the bodies out on gurneys, one of the men stopped working. He said he couldn't go on. Another said he couldn't work without a face mask. But the team had no masks, no bottled water to drink and the men hadn't eaten all day. ``People are afraid because of how quickly this illness kills. The people aren't used to that,'' said Jerome Jean-Felix, 32, who is uncertain how long he can keep going on the body collection detail. ``Even we are experiencing the stigmatization. When people hear you are working in cholera, they are afraid.''
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As the final body was loaded in the truck at the Doctors Without Borders office, Roberson Cine and his brothers flagged down the team and demanded their father's body be returned. ``They said he died of cholera; he didn't have cholera,'' the man cried. The government has asked that anyone who dies of cholera be signed over to the state for burial. Just before the vehicles pulled away, Saint-Fort's cellphone rang. ``Where?'' he asked. ``Rue Joseph Janvier, near the General Hospital? How many?'' Two bodies -- in the middle of the street, the caller told him. But there would be no collection on Rue Joseph Janvier that day. Eight hours after their first pickup and with a different police escort each time they entered a new jurisdiction, the team members finally arrived at a mountainside in the middle of nowhere with 14 corpses. Joseph Wills Thomas, the mayor of Cabaret, threatened to arrest them if they disposed of the bodies there. Thomas said he is fed up with everyone sending their dead to him. Sometime, during the night, someone dumped cholera victims in a freshly dug grave, he said, looking at the group accusingly. The deserted hillside is also the site of a mass grave holding many victims of the January earthquake, which left 300,000 people dead. Thomas told the team they needed to wait for the government's National Center of Equipments to come dig the grave -- but he said he would refuse bodies from other jurisdictions. The body collection team dumped the bodies on the ground. When CNE supervisor Serge Baptiste arrived, he told the body collectors, between sips of rum, that the graves weren't ready and they would need to take their cargo away. Saint-Fort's patience was wearing out. The day before, President René Préval had to personally call the mayor of Cité Soleil, he told Baptiste and Thomas, after the mayor refused two bodies that were to be buried in a cemetery there. ``I am my own president,'' Thomas retorted. A loader finally arrived but ran out of gas midway up the hill.

Source of Haiti's cholera outbreak may never be known

11/20/2010
BY FRED TASKER AND FRANCES ROBLES
ftasker@MiamiHerald.com
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As speculation grows that a deadly cholera outbreak came to Haiti through a filthy sewage tank used by United Nations soldiers from Nepal, health experts said Friday that the exact source of the disease may never be known. The outbreak has sparked more violent protests against peacekeepers, ``The bottom line is we don't know exactly where it came from and we likely never will know,'' said Tom Skinner, spokesman for the U.S. Centers for Disease Control and Prevention. Haitians began falling ill and dying in late October and others quickly blamed Nepalese soldiers who had arrived in the country earlier that month from a country where cholera is endemic. Days later, Associated Press reporters spotted U.N. investigators taking samples of foul-smelling waste trickling from the Nepalese base toward the Artibonite River. On Nov. 1, the CDC said a study by it and Haiti's National Public Health Laboratory indicated that the cholera found in Haiti is of a strain commonly found in South Asia.
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On Tuesday, Sweden's ambassador to Haiti, Claes Hammar, was quoted in Stockholm's Svenska Dagbladet newspaper saying ``a diplomatic source'' had told him the cholera came from Nepal. ``It is 100 percent true,'' he told the newspaper. ``We have taken samples and traced the infection to Nepal.'' On Friday Hammar declined further comment. A spokesman for the Swedish ministry of foreign affairs in Stockholm said the ministry ``is waiting for the U.N. to confirm these statements. At this time we have no confirmation from the U.N.'' The U.N. Stabilization Mission in Haiti (MINUSTAH) has consistently disputed that the cholera came from the Nepalese camp. On Oct. 27, Associated Press reporters visited the Nepalese camp near Mirebalais and reported finding overflowing septic tanks and the stench of excrement. Broken pipes spewed black liquid that dribbled toward the river where people were bathing, the wire service report said. U.N. investigators tested sewage and wastewater from the Nepalese camp and found no evidence of cholera, said Nick Birnback, spokesman for the U.N. peacekeeping forces. Under World Health Organization guidelines, they didn't test the Nepalese troops because they showed no signs of illness, he said. But that has not stopped Haiti's rumor mill from accusing Sanco Enterprises, S.A., which has a contract to clean the tanks, from causing the outbreak by illegally dumping waste. Owner Clifford Baron, of Pembroke Pines, said he was unaware of the AP report but vehemently denied illegal dumping. ``Impossible,'' he said. Baron acknowledged he had not personally seen the U.N. site. ``I am the president of the company; I do not go myself,'' he said. ``The drivers do it. I am proud to do what I am doing. I have dreams for my country. As a Haitian, I would never do anything to harm my country.'' Public health experts agree that finding the source is less important than finding ways to prevent more people from getting sick. On Friday, the CDC and other experts said the disease probably can't be traced to a single source. ``The question of how it came here is not central in Haiti,'' said Robert Tauxe, deputy director of the Division of Foodborne, Waterborne and Environmental Diseases for the CDC, speaking by phone from Haiti. ``What's central is making sure people do not die and know how not to get sick.''

UN Facilities, Peacekeepers in Haiti Test Negative for Cholera

11/19/2010
Voice of America (VOA)
By Margaret Besheer
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The United Nations says continued testing of all of its bases and facilities in Haiti for cholera, continues to be negative. The U.N. began the testing after peacekeepers were blamed for causing an outbreak of the disease. More than 1,100 people have died in Haiti since the outbreak began last month, and more than 18,000 others have been hospitalized. The U.N.'s top envoy to the country, Edmond Mulet, has called for calm, asking demonstrators to unblock roads, bridges and airports to allow medical and humanitarian assistance to reach those who need it. Some Haitians have blamed U.N. peacekeepers from Nepal for bringing the water-borne disease to their country. About 1,300 of the 12,000 peacekeepers in Haiti are from Nepal, where there has been an upsurge in cholera. But U.N. Peacekeeping spokesman Nick Birnback tells VOA there is no evidence to support such an accusation. "According to the Nepalese battalions that are there, none of the soldiers have shown any symptoms of cholera. The tests of the premises and the outputs have consistently proven negative - there hasn't been a single positive test. So we think there is no conclusive evidence that shows that this contagion directly comes from this base," he said. He said if a soldier or any other U.N personnel showed symptoms of cholera they would be quarantined and treated. "Were there to be a positive test by any of our blue helmets [ie, peacekeeper], or in fact anyone serving with United Nations in Haiti, that does not prove that they brought it in, it could mean that they got through the fact that they are living in an area that is afflicted by an epidemic," he said. Birnback says the U.N. Mission in Haiti, known by its French acronym MINUSTAH, is now focusing its attention on preventing the spread of the disease and bringing medical and other help to those who need it, while helping secure the country for the presidential elections later this month.

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