Haiti Cholera Update #16

From MSPP Rapport du Cas. Click to enlarge.

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.

Furthermore:

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.”

Via H1N1, one obstacle stalling relief efforts:

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.

[snip]

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.

[snip]

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.

[snip]

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.

Via H1N1, Ansel Herz’s Flikr Photostream. Very worthwhile.

More pictures from the ground.

PAHO’s updated interactive map  on the cholera outbreak on Hispaniola.

Enormously unhelpful.

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.

More resources:

#Haiti Daily (Twitter newspaper)

Haiti Information Project.

Haiti: Operational Biosurveillance (Twitter)

H5N1

HaitiLibre (English) (français) (Twitter — English and French)

Mediahacker: Independent multimedia reporting from Haiti (Twitter) (Flikr)

Ministère de la Santé Publique et de la Population (Homepage) (Cholera Updates) (in French)

PAHO’s Haiti Cholera page. (PAHO Situation Reports and other documentation.) (Blog.)

Praecipio International (HEAS)

On the ground, good sources of information and of course needing donations:

Partners in Health (Twitter).

Médecins sans frontières


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