Archive for November, 2010
I’m starting what I hope will be an annual tradition here at Those Emergency Blues: giving out an award for the Best Writing from a Nurse Blogger in the preceding year.
My aim is simple: I want to encourage and recognize all the exceptional writing by nurse bloggers. I want us to tell our stories in a clear and forceful way.
Apart from the prestige (dubious), and a fancy-pants button for your website (yet to be designed), there are fabulous prizes:
1ST — $50 gift certificate from Amazon
2ND— a gift basket of smelly stuff from the artisans at Cree
3RD — the nurses’ friend: a travel mug.
Rules are simple:
- Submissions must be written by a nurse. They may be on any topic or any length.
- Submissions may be made by the author (strongly encouraged) or by anyone who sees a great blog post deserving recognition.
- Deadline for submission is 2359 ET, 31 December 2010.
- Winners will be announced in January 2011.
How to Submit a Blog Post: Submissions — I prefer a link to the original post — can be made to me at torontoemergencyrn (at) gmail (dot) com or left in the comments of this post.
This being a one horse operation, submissions will be evaluated by myself, and another judge.
I will occasionally post entries here — with the author’s permission, of course.
Please feel free to reTweet this post or copy it to your own blogs: I really want this disseminated as widely as possible through the Nursosphere!
A short update: the elections in Haiti have nearly bumped cholera off the radar.
The latest MSPP (Ministère de la Santé Publique et de la Population) report as of 24 November 2010 showed 75,888 cases of cholera accounting for 1,721 deaths since the outbreak began. There have been 31,210 hospitalizations. The hospital mortality rate is 3.6%. Cholera promptly treated has a mortality rate of 1-2%. As mentioned in my last update, political interference may be tainting the figures: note the sharp drop in hospitalizations on the bar graph to the right just prior to yesterday’s elections.
Everyone is sensitive about it. Rumors abound about how it can/cannot be transmitted. (And fyi–Rumors in Haiti might as well be fact with the way people heed them.) I’ve read article after article about how people are dying trying to get to treatment centers because public transport won’t pick them up. I read a quote from an article on CNN yesterday that said the two biggest needs right now in Haiti are doctors/nurses who know how to treat cholera and trucks to carry dead bodies.
I had a good friend of mine (a fellow ex-pat) whose (Haitian) boyfriend’s father recently died suddenly in Port Au Prince with cholera-like symptoms. They did a bunch of labs. Turned out he did NOT have cholera. Still, the morgue initially wouldn’t take his body. They brought the labs proving it was not cholera from which he died. They finally agreed to take the body, but had to pay double the price because of the “risk” they were assuming.
- HaitiLibre is also reporting the border with the Dominican Republic is now closed:
The cholera epidemic in Haiti continues to spread. Insufficient medical resources in the field are not able to control the disease. Faced with this alarming situation, the Dominican Republic, which decided to deploy significant military resources at its borders. “With cholera we can not play, or ignore the risks despite all measures of disease control, we are not fully shielded face of this threat” said a government official.
While only 4 cases of cholera were confirmed and treated in recent days, Dominican Republic (no deaths), the authorities decided to close the border with Haiti where the disease has already made more than 2,000 dead.
Major General Carlos Alberto Rivera Gates, the head of the Dominican army, said the reinforcement and the closure of the border for an indefinite period, met the dispositions adopted at a meeting held last Wednesday at National Palace, under the direction of the President of the Dominican Republic Leonel Fernández and attended, among others, Ministers: Public Health, Armed Forces and the directors of Cesfront, migration and other institutions.
I will post the next update Wednesday (more likely) Thursday, or sooner if events warrant. For more immediate updates, I highly recommend Crawford Killian at his blog H1N1.
Praecipio International (HEAS)
On the ground, good sources of information and of course needing donations:
Posted by torontoemerg in Before I Start Throwing Things, I'd Better Write This Down, Teddy Bears, Ribbons and Wristbands Make It All Better, Warm Fuzzies, What Passes for Humour Around Here on Monday 29 November 2010
A well-deserved shot at corporate pink ribbon campaigns.
Lest you think the satire is a little harsh, or if you get warm fuzzies donating to pink ribbon campaigns, consider that corporations jumped all over pink ribbon campaigns not just because of their intrinsic worth, but more importantly, because it’s a “safe”, non-controversial issue, and more to generate profits. Think Before You Pink, an advocacy website, makes a necessary corrective:
She and the Times agree on the source of the disease’s peculiar popularity in corporate America. It is a quality that the breast cancer awareness ribbon both captures and enables. “Companies want to support breast cancer,” Cone says simply. “Breast cancer is safe.”
Unlike AIDS, breast cancer is free of what companies euphemistically call “lifestyle issues.” And, perhaps as importantly, breast cancer provides charitable credentials for what can be a very small investment. With the ribbon’s message of ”awareness” translating most often into a familiarity with early detection techniques, all a company has to do, to do good, is put a ribbon on its merchandise.
New Balance, for example, donates money from the sale of its Race for the Cure caps, socks and T-shirts to the Komen Foundation, but its pink ribbon sneakers, a Foundation spokesperson says, are ”just for awareness.” The sneakers have the tiny pale-pink outline of a ribbon sewn onto the corner of their tongues—difficult if not impossible for anyone except the owner to see. The possibility that those two wan loops might remind woman to get the mammogram that saves her life, however, provides the sneakers with their raison d’étre.
It is this dynamic that drives the pink ribbon’s detractors to distraction. “There is a value to awareness, but awareness of what, and to what end?” asks Barbara Brenner, activist and executive director of Breast Cancer Action (BCA) in San Francisco. “We need changes in the direction the research is going, we need access to care—beyond mammograms—we need to know what is causing the disease, and we need a cure. The pink ribbon is not indicative of any of that.”
Check out the website’s list of questions to consider before buying pink.
The latest MSPP (Ministère de la Santé Publique et de la Population) report as of 24 November 2010 showed 72,017 cases of cholera accounting for1,648 deaths since the outbreak began. There have been 31,210 hospitalizations. The hospital mortality rate is 3.6%. Cholera promptly treated has a mortality rate of 1-2%. There are reasons to believe, as noted below, that these numbers are suspect.
- According to HaitiLibre, the release of data related to the epidemic is politically motivated:
At less than 48 hours of the elections, the last official assessment of the Ministry of Public Health and Population (MSPP) for the Wednesday 24 and published on Friday 26 indicates that for the area of Port-au-Prince region Metropolitan (Port-au-Prince, Carrefour, Cité Soleil, Delmas, Kenscoff, Petion-Ville, Port-au-Prince, Croix des Bouquets and Tabarre) there was 0 death and 0 hospitalization between November 23 and 24… Already yesterday, we had questioned the validity of the mortality figures published by the Ministry , which indicated an increase in deaths abnormally low +0.4%, whereas in the previous 48 hours (November 21 and 22) the death rate average was +23.68% per day.
Knowing that health personnel in the ground, informs us that the area of Port-au-Prince represents nearly 50% of cholera cases, the only explanation to this brutal and instantaneous stop of the epidemic, must find its answer in political reasons and not in treatment efficacy (unfortunately).
- Commenting on the above, Crawford Killian thinks he might have misread the tables. (I don’t think he has.)
This article obliged me to go back and look at earlier reports. From November 17 to 23, the cumulative number of hospitalizations in Port-au-Prince increased from 1,457 to 3,097. The cumulative number of deaths rose from 64 to 146.
We see a sharp jump in hospitalizations and deaths on November 20, then a drop in hospitalizations and deaths the next day. That makes no sense.
Then hospitalizations and deaths both jump on the 22nd, rise a bit more on the 23rd, and then stop on the 24th. Apart from these updated numbers, the Ministry has offered no interpretation or analysis.
- Jon Kim Andrus, Deputy Director Pan American Health Organization (PAHO), presser, 23 November 2010. (Transcript ~ YouTube) The situation, he says, is bad, and there are no resources, either human or material:
We believe certain critical issues need to be addressed if our efforts to treat patients and save lives are to be successful. Safe water and sanitation are lacking. 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.
Official reports confirm 8 of 10 departments with cases of cholera. We know that in the other 2 departments, clusters of cases are now being investigated. So, for all intents and purposes, as we fully expected before, cholera is virtually everywhere in the country. Given the extremely poor sanitary conditions that existed well before the earthquake, the recent hurricane, and now the epidemic, we expect the number of cases to continue to grow. We have not yet reached a peak and we don’t know when that peak will occur.
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.
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.
We are working with other UN agencies and many NGOS to respond to the outbreak, but a lot more is needed, especially in providing safe water and adequate sanitation to Haitians particularly in Port-au-Prince and the provinces. About 58% of the population before this crisis lacked access to potable water. About 76% of Haitians earn less than $2 a day. We now know that about 1.6 million Haitians are living in precarious conditions, particularly those in the 1,300 displacement camps.
We must work together to manage the impact of this outbreak, particularly to minimize loss of life. This requires an integrated approach bringing together those who provide clean water, improve sanitary conditions, and those who provide treatment to the ill. We need more of everything: more training for staff in Haiti, more doctors, more nurses, more treatment centers, more medications, more toilets, more clean water.
We have asked for $164 million for this emergency, and so far have received about 10 percent of this amount. 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. Our aim is to help Haiti overcome these obstacles and build self-sufficiency in these vital areas. [Emphasis mine]
The head of the UN mission in Haiti (Minustah), Edmond Mulet, gave us last Saturday, one of his statements that he has the secret, to make us share his idyllic reading of the situation has 1 week of the elections. He says that presidential and parliamentary elections next Sunday will take place in a “Haitian climate calm, tranquil, serene, and without violence” (!!), adding “in the circumstances of Haiti”.
Should we understand if his words, that there are “Haitian circumstances” where the climate of violence may be considered “as serene or acceptable” according to its criteria? Of course, Mulet, skilful desinformator with the service of UN, was quick to qualify his remarks by stating “If we compare the current electoral process, the election campaign last year, or the 2006 presidential or even presidential before”. Compare with worse, does not justify the current situation of violence. Know Mulet one death is one death too many, and no level of violence in our country is unacceptable, violence does not trivialize.
The kind of movement and congregating you see with people going to vote is not the kind of movement that creates an increased risk of cholera transmission,” Andrus said. “Close contact does not put people at greater risk of cholera the way it would, for example, for flu.
- James Wilson has written a truly damning post on bureaucratic obfuscation and obstruction related to the epidemic on his blog Haiti: Operational Biosurveillance. in the context of Nigel Fisher’s remarks at the U.N.:
As with any crisis or disaster of any etiology, blame is a common feature. The same is true in infectious disease disasters, particularly when there is a strong suspicion of accidental (and potentially culpable) virgin soil introduction of an exotic agent. Nigel Fisher’s recent comments on behalf of the United Nations are typical of a bureaucracy facing intense scrutiny that has not engaged in effective management of risk communication and public accountability. The scrutiny is warranted.
If you want some understanding on how a disease which is easily treated is rapidy becoming a disaster, it’s a must-read.
- “Haiti needs a surge of foreign nurses and doctors to stem deaths from a raging cholera epidemic that an international aid operation is struggling to control, the United Nations’ top humanitarian official said.”
About 1,000 trained nurses and at least 100 more doctors were urgently needed to control the epidemic, which has struck the impoverished Caribbean nation months after a destructive earthquake.
The outbreak has killed more than 1,400 Haitians in five weeks and the death toll is climbing by dozens each day.
“We clearly need to do more,” Valerie Amos, the U.N.’s Undersecretary-General for Humanitarian Affairs, told Reuters in Port-au-Prince during a visit seeking to increase the scale and urgency of the cholera response.
“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 in an interview late on Tuesday at the U.N. logistics base in Port-au-Prince.
The real death toll may be closer to 2,000, U.N. officials say. Hundreds of thousands of Haitians are likely to catch the disease, they say, and the epidemic could last a year, complicating an arduous recovery from the Jan. 12 earthquake.
I will post the next update Monday, or sooner if events warrant. (I apologize for the delay of a day with this one.) For more immediate updates, I highly recommend Crawford Killian at his blog H1N1.
Praecipio International (HEAS)
On the ground, good sources of information and of course needing donations:
Posted by torontoemerg in Battered Nurse Syndrome, Before I Start Throwing Things, I'd Better Write This Down, Public Images of Nurses and Nursing, Uncategorized on Thursday 25 November 2010
So two television shows demean and devalue nurses. Is there any hope things will ever change?
First, by way of Sean Dent at My Strong Medicine, is this charming example of the naughty nurse:
[Mehmet Oz of the Dr. Oz Show] introduces Angel Williams, and she appears wearing a traditional, short-sleeved white nurses’ dress that falls just above the knee. She also wears a red belt, and carries a nurses’ cap. Despite the impressive weight loss, she has not attained a shape that most people would associate with a traditional naughty nurse model. There is no suggestion that Williams, or anyone else who appears in the segment, actually is a nurse.
Oz asks Williams how she managed to dance away that much weight. She explains that she loves dancing and just decided she would do it while cleaning, cooking, and doing a range of other daily activities. Pressed about what inspired her, she says she had reached a point in her life where she was down and out, and she needed to make some changes.
Angel: So I did. I started dancing and moving–and watching your show. You know, you’re the doctor that gets us eating right, thinking right, thinking bright. And I decided to apply all those things to my life.
Williams and Oz thank each other. Oz says he hears she’s going to teach him. She starts quietly laughing–apparently at the very notion that he, a celebrity physician, could learn anything from her! Oz says he’s serious, that he does the show in order to learn from how people answer his questions, and from questions they ask that he would never think of asking. So he asks her again to teach him. She asks the audience to stand up and join them, then prepares to lead them in some dancing.
Angel (as she unbuttons the top of her dress to reveal a red bra): You know, we’re gonna get sexy too, we gotta, you know, be kinda sexy with it. (Now she puts on the nurse’s cap.) Gotta get my hat goin’. So, the first move, Dr. Oz–cause we’re your nurses, we’re gonna keep America moving for you, OK?
Oz: Oh, I love it.
“We’re you’re nurses.” Yes, readers, I physically cringed when I read that. But Dr. Oz is pop culture bubblegum. For real contempt for nurses, you need to go to the respectable media. Paul McLean at Medical Ethics and Me:
Missing from the documentary is what should never be missing from this dialogue — the nurse’s viewpoint. Nurses are the Waldo of “Facing Death.” Where are they? The documentary is full of poignant scenes of doctor-patient and doctor-family dialogue, always difficult and sometimes brutally honest, and shines a brilliant light on a problem that, if society doesn’t sort out, money will forceably and inequitably decide. This is the subject underlying the country’s “death panel” insanity, and kudos to Frontline for looking at it rationally and insightfully. Kudos, too, to the doctors and families who’ve put themselves on display in situations that couldn’t be more difficult. Allowing cameras at such a time took extraordinary courage, but is of such great value.
“Facing Death” is invaluable for any med student, for its view into when “doing no harm” gets particularly tricky. And yet, for all the poignant conversation and close-ups on care, nurses are mostly blurred motion and background noise. The one nurse quoted is the daughter of a dying woman at odds with her sister, who happens to be a doctor. The nurse/sister advocates for acceptance and compassionate care; the doctor/sister wants to do what’s required to maintain the parent’s pulse.
All is revealed through narrator, doctor or patient/family. No clergy is involved. No therapist. And no nurse.
So we’re either boobified by a physician exploiting a pop culture meme to the detriment of the nursing profession, or ignored, probably by the faulty reasoning that our voices don’t count in planning patient care. I’m not sure which is worse.
It’s been obvious to nurses for a very long time that the traditional media controls the narrative about nursing. We complain about inaccurate portrayals and demeaning stereotypes nearly on a daily basis. We heap almost excessive praise when the media gets it right. My own professional organization, the Registered Nurses Association of Ontario, for example, gives out prizes to journalists for the best stories about nursing in the old media. Notice, prizes aren’t given out to nurses telling their own stories, but rather for other people — non-nurses — telling our stories. This last is important, because the whole phenomenon of Web 2.0 is changing how the media and nurses themselves are portray nursing .
I’m beginning to think nurses should worry less about how the old media depicts us and focus more on how we describe ourselves through social media. Let me put it this way: I was alerted to both the PBS Frontline show and the dancing nurses by Ellen Richter and Vern Dutton respectively via Twitter, who pointed me to Paul McLean’s and Sean Dents’s post and the original link at The Truth About Nursing. Before I wrote this post, I posted on Mehmet Oz’s Facebook wall — as did Vern Dutton — about the inappropriateness of the show (and I encourage you to do the same). And now, I’m writing my own blog post, which I will Tweet and post on my Facebook page. The point is that it’s within the power of nurses ourselves to seize the narrative and tell our stories unfiltered either by cultural biases or media expectations — or even the likes of Mehmet Oz. I know my blog, in its own small way, has influenced and educated a number of people about what nurses know and about our pivotal, essential place in health care. Multiply that by growing number of nurse-bloggers and tweeters — and suddenly the traditional media looks a little less hegemonic. Mehmet Oz and PBS (as do any number of medical dramas) still need to be called out. Their antiquated attitudes aren’t quite irrelevant. But I’m hopeful. Because we increasingly own the narrative, it’s only a matter of time until we can say to all of ‘em, “To hell with you. We don’t need you.”
The latest MSPP (Ministère de la Santé Publique et de la Population) report as of 20 November 201 0 showed 60,240 cases of cholera and 1,415 deaths since the outbreak began. There have been 25,248 hospitalizations. The hospital mortality rate is 3.8%. Cholera promptly treated has a mortality rate of 1-2%.
The United Nations’ Nigel Fisher on the epidemic:
But U.N. humanitarian coordinator in Haiti Nigel Fisher said the real death toll might be “closer to two thousand than one” because of lack of data from remote areas, and the number of cases 60,000-70,000 instead of the official figure of around 50,000.
Addressing a U.N. news conference by video link from Haiti, Fisher said experts from the World Health Organization were now revising their estimate that the diarrheal disease, spread by poor sanitation, would cause 200,000 cases within six months.
“They are now revising that to 200,000 in closer to a three-month period. So this epidemic is moving faster,” he said, adding that it was now present in all 10 of Haiti’s provinces. “It’s going to spread.”
“The medical specialists all say that this cholera epidemic will continue through months and maybe a year at least, that we will see literally hundreds of thousands of cases,” Fisher said.
It was “almost impossible to stop the spread of these cases because it is so contagious, and those who carry the cholera bacterium often take days to show it, and in that (time) they may move anywhere,” he added.
Fisher said U.N. and other aid workers needed to “significantly ratchet up” their response, including going through faith groups to distribute chlorine tablets to purify water, and increasing the number of treatment centers.
Deaths from the cholera epidemic in Haiti could rise above 10,000 if help doesn’t quicken, but bureaucracy is slowing aid down, says a Canadian who heads the United Nations humanitarian efforts in the Caribbean country.
“All the conditions for a massive cholera epidemic are present in Haiti,” Nigel Fisher told CBC News. “It is exploding.”
The United Nations puts the reported cholera death toll at 1,344, but says experts believe the tally could be as high as 2,000. Though official numbers state about 50,000 Haitians have been stricken by the disease, Fisher believes the true number could be closer to 70,000.
“If we don’t move — we, the whole community and national counterparts — don’t accelerate the process, we could see deaths going above 10,000 or so.”
He cited a previous price of $2,000 to clear a container at customs recently jumping up to $5,000 or more.
It’s a complicated situation, he said. Buildings where customs officers used to work were levelled by the earthquake, and the workers are often not being paid by the government, which is broke, he said. “The only way of getting money for them is by ripping people off,” Chauvin said. “It’s complete corruption down there. I don’t know what the answer is. If you think of something, let me know.”
An article in the Guardian is sharply critical of the UN’s presence in Haiti:
Rather than examine its role in the epidemic, however, the UN mission has opted for disavowal and obfuscation. UN officials have refused to test Nepalese soldiers for the disease or to conduct a public investigation into the origins of the outbreak. Rather than address the concerns of an outraged population, the agency has preferred to characterise the fresh wave of protests as a “politically motivated” attempt to destabilise the country in the runup to presidential elections on 28 November. Protesters have been met with tear gas and bullets; so far at least three have been killed.
So far, in fact, so normal. The truth is that the whole UN mission in Haiti is based on a violent, bald-faced lie. It says it is in Haiti to support democracy and the rule of law, but its only real achievement has been to help transfer power from a sovereign people to an unaccountable army. (But read the whole thing.)
In its most recent Cholera Haiti Health Cluster Bulletin 4 (Nov 23 2010), the Pan-American Health Organization (PAHO) reports on structural and organizational difficulties:
The situation in Haiti is urgent and will only become worse over the coming weeks. One month after the initial cases of cholera, 24 Non-Governmental Organizations (NGOs) are now providing cholera response health services in Cholera Treatment Centers (CTCs) and Cholera Treatment Units (CTUs). Throughout Haiti, 36 CTCs are operational with a total bed capacity of roughly 2,830. These centers atheir current capacity will not be sufficient to meet the population’s needs as the outbreak grows.
A serious concern has become ever increasing pressure on CTCs to treat patients. Renewed emphasis must be placed on implementing the first two components of the National Cholera Response Plan, which aims to protect families at the community level and strengthen primary health centers already operating across the nation .CTUs,which are smaller than CTCs and are attached or near an existing health center, have not scaled-up their capacity quick enough. Increasing the number of CTUs throughout the country is essential for triaging patients and relieving the burden of care on CTCs. The operational role of the CTU also prevents primary health centers from becoming overwhelmed with cholera patients, which results in neglect of those with non-cholera conditions.
Taking into account stockpiles at the PAHO/WHO warehouse PROMESS, as well as other agency warehouses, there appears to be sufficient supplies for treatment today. However, in many health facilities throughout the country, medical professionals are only using IV fluids when patients present with cholera symptom. In most cases, simple rehydration salts are enough for treatment and the over use of IV fluids is depleting supplies more rapidly than is necessary. Extensive and regular training activities need to be undertaken to address this issue.
The official line: the Haitian ambassador to the U.S. speaks at a news conference:
QUESTION: Hi, (inaudible). You might have said that one of the protestors (inaudible), that there have been some forces deliberately trying to destabilize the country, taking advantage of the situation. (Inaudible) and can you stand on (inaudible) and A, whether – who these forces might be and what are their names? And then I (inaudible).
AMBASSADOR MERTEN: Right. Quite perfectly frankly, I don’t think we have a really completely clear picture of who those people were who were fomenting unrest up in the North. There are – there is no shortage of people with suggestions as to who may be behind it, there – and that those suggestions go across the political spectrum and the social spectrum here in Haiti.
I think the important thing to remember is that things have calmed down and the United Nations has been able to respond and is doing its job, again, with coordination of the Haitian police, with the Haitian police. I think as we move forward towards Election Day, we’re – I believe that they will be able to fulfill their mandate as outlined.
QUESTION: Oh, okay. I’m wondering what the U.S. has done to deal with the public health challenge of containing the cholera epidemic while still getting people out to the polls.
AMBASSADOR MERTEN: Well, the U.S. has done a great deal in partnership with many NGOs here on the ground, the Haitian Government, UN organizations, and other donors to combat this cholera outbreak. We have been transporting and importing rehydration solution, making sure it gets out to people. Our colleagues from CDC, which there are quite a few here right now, have been training Haitian and other trainers so that people can go out to the countryside and talk to people and help people learn how to get the treatment they need and get the care they need, because cholera is, in effect, a very treatable malady if you catch it in time and give it the proper treatment. We’ve been very active in that regard, as have many of our donor partners.
QUESTION: One other thing, actually, for this election is going to have any impact on what happened or what is happening there, and if anything U.S. can do more or the international community?
AMBASSADOR MERTEN: We meet and discuss on this subject every day and meet with our colleagues to try and determine what more we can usefully do to help the Haitian people confront this issue. This is not a static process. This is not something where we’ve decided we are going to do X and X is all we’re going to do. We continue to evaluate and see what we can bring to bear to be most helpful.
But again, I’m not really sure that discussing this in terms of the election is really all that germane. I see them as two separate issues. We have a cholera problem here, which is something that the Haitians and we are all grappling with, which is a major public health challenge here. And we have the elections which should take place, need to take place, and we are here to support that effort.
I will post the next update Friday, or sooner if events warrant. For more immediate updates, I highly recommend Crawford Killian at his blog H1N1.
Praecipio International (HEAS)
On the ground, good sources of information and of course needing donations:
[An eye-opening, first-hand account of the epidemic from Connie Ghiglieri RN, who left it here as a comment on my last cholera update. Posted here with permission, for which I am grateful: it is very difficult to get first-hand,on-the-ground information from Haiti unfiltered by media or aid agencies. Very slightly edited.]
I just spent two weeks at the cholera treatment center in Hinche. I am a RN from Arizona. Here is what I wrote to a friend to describe my experience:
I am in Hinche. . .working at a cholera treatment center. . .Cholera is a very dark hell, plain and simple. Not like anything I have ever seen or could have imagined. . . and thus far we have been able to keep things under control and have not lost many, which is a small victory but an unrelenting battle. . .there is not a moment to breathe. . .it is just work and sleep and sometimes eat.
Never have been in a situation where the urgency to perform is so damn constant. Keeping people hydrated is the key, they come in often close to death and look like they are dead except that they are puking and shitting volumes. IVs are such a challenge to keep going and patent. Their clotting factors must be way off, have to constantly restart them. Then keeping them drinking when even tho they often end up vomiting what they have just taken in, and keeping them clean. . .oh the inhumanity. . .there is no dignity involved in this disease other than the compassion that we feel, and them saying an occasional quiet merci, or just making eye contact. . . but for the most part they are too sick to really care.
Most of our patients are on cots that are soaked with liquid cholera (looks like rice water. . . sort of. . .that’s being generous ) and bleach, with a bucket alongside to use if they can. . .We try to keep a plastic barrier between them and the cot. . .yeah not entirely successful, the rest are on the wooden MSF cholera beds. . .wooden benches covered with plastic with holes cut in them with a bucket underneath. Pretty much everyone is naked and then covered with whatever we have, mostly plastic surgical gowns. . .and at night they are freezing. We used to diaper most patients when they first came in because they are too weak to use the buckets, yes adults. . . but we have run out of those, so you guessed it. . .naked. . .what I would give for a pamper. . .We too wear plastic surgical gowns as barriers. . . and gloves. . . at all times, I probably change my gloves at least 50-60 times in a shift. . .not kidding. . .I wear rubber boots and I wash my hands several times a night with a clorox solution…and do not get my hands near my face. . .for any reason.
Hard not to touch people skin to skin, but I just don’t do it. The best I can do is give the patients back rubs with lotion…but rarely have time for that. We try to clean people with baby wipes, but I’m not sure there are enough of those in the world for this disease. . .we run out every day. The smell is. . .well, it is distinct and now I am used to it and am sure I will recognize it anywhere. . .right now it is just what it is and I don’t think about it. I actually don’t think about much except checking IVs, keeping them going, keeping people drinking, keeping them clean, keeping the tents as clean as possible and then hydrate. . .checking IVs, drinking, clean. . .hydrate. . .IVs, drinking, clean….simple, simple, simple yet exhausting. . .BUT when you see someone go from death to life in a matter, sometimes, of hours. . .it is all good and for a moment you remember life really is beautiful. . .and then you take a breath and . . .hydrate. . .IVs, drinking, clean. . .
The news of it spreaking rapidly in Haiti is the worst possible. I don’t want to leave.
As of writing, there are no updated figures from MSPP (Ministère de la Santé Publique et de la Population). The latest figures released on 16/11/10 showed 49,418 cases of cholera and 1186 deaths since the outbreak began. The hospital mortality rate is 3.9% Cholera promptly treated has a mortality rate of 1-2%.
The rural camps, hardest hit by cholera are in the worst situation because there is NO relief aid presence and no UN presence. During this last trip it would take almost 5 hours to drive from St. Marc back to Port au Prince to try and secure supplies. We are purchasing ORS, water, and pedialyte (now absent from stores because we are buying so much of it). [REDACTED] gave me 10 cases of pedialyte and some other supplies, which is all they could afford because they feared an outbreak in Port au Prince. Finally, after running out of medications, fluids, etc. and being turned away from most all sources for medical supplies, including the UN, there was no way to help those suffering from cholera. It was simply too difficult to watch another baby die of dehydration and I came home to recover from the worst week I’d experienced in Haiti since the earthquake.
I cannot begin to explain how much worse the situation is in Haiti and how there is very little coordination of any relief aid or the NGO’s. The following is the mission statement of the UN for its mission in Haiti. It is not being carried out now during this cholera outbreak and has not been carried out since the earthquake, which is more than a failure to the Haitian people.
“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.”
I have shared all my findings with the CDC in order to give them as much data as I can gather for their investigators. I have also given our findings to the MOH and OCHA -mainly for informational purposes because I’ve given up the hope of obtaining necessary supplies. I wish the news was better and sadly the deaths will continue because there is little to no support available for those providers in rural areas. There is very little available in the way of supplies even in the larger cities now facing patients with cholera. I am contacting organizations here at home to try and get the ORS, which comes in small packets, donated so I can take it back on my next trip.
CNN’s twenty-four-hour coverage of the aftermath of Haiti’s earthquake, which took an estimated 300,000 lives, doubled the network’s viewership. This coverage undoubtedly played a role in the America public’s response to the tragedy—one out of two Americans donated money to aid organizations. But little reporting has been done since then that asks how exactly that money is being spent, holds aid organizations accountable to their promises, or investigates the American government’s development and economic policies in the country. These policies, argues sociologist Alex Dupuy, have kept Haiti frozen in a destructive cycle of aid-dependence and exploitation for decades, stripping Haiti of its self-determination. “For the level of tragedy, no one’s really being very honest,” said Michael Fairbanks, a development expert, of the American and international community’s rhetoric about Haiti since the earthquake. “[Haitians] are constantly put into the position of adolescence and being infantilized so they can prey on the charity from the rest of the hemisphere.”
The longer American news outlets ignore these critical and complex issues, the easier it will become to view their occasional jaunts to Haiti with cynicism: it’s an convenient place to get B-roll of tragedy and disaster. Their coverage increases viewership, but without a moral component of responsibility towards Haitians themselves over the long-term, such coverage is basically exploitative. And over time, superficial reporting on Haiti’s problems—which plays a role in soliciting charitable donations from Americans-will arguably make the media culpable in the very system of aid-dependence and misguided development policies that help keep Haiti poor.
Despite the huge presence of international organizations in Haiti, the cholera response has to date been inadequate in meeting the needs of the population. According to national authorities, the epidemic has already caused more than 1,100 deaths and made sick at least 20,000 people nationwide.
“MSF is calling on all groups and agencies present in Haiti to step up the size and speed of their efforts to ensure an effective response to the needs of people at risk of cholera infection,” says Stefano Zannini, MSF head of mission in Haiti. “More actors are needed to treat the sick and implement preventative actions, especially as cases increase dramatically across the country. There is no time left for meetings and debate – the time for action is now.”
Crawford Killian at H1N1 has a couple of sharp posts, first on his own learning curve on Haiti and what he’s concluded, and second, an eye-opening read on the results of various charities’ fundraising after the earthquake — ones readers may well have donated to — compared to the actual money disbursed.
The Canadian government, incidentally, has released an additional $4 million to fight cholera in Haiti. Much of this money is directed primarily for long-term projects for the provision of clean water and on education campaigns. Many aid agencies have suggested the need for funding has moved from mitigation and education to more basic needs, such as for supplies like intravenous solutions and antibiotics.
I will post the next update Tuesday or (more likely) Wednesday, or sooner if events warrant. For more immediate updates, I highly recommend Crawford Killian at his blog H1N1.
Praecipio International (HEAS)
On the ground, good sources of information and of course needing donations:
In honour of all that cheesy Movemeber facial hair.
NB: If you have delicate sensibilities, you may not want to watch. Fortunately, I don’t, and suffice to say, it’s very, very funny.