Archive for category Humanitarian Crisis or Crisis in Humanitarianism?

Three Strikes and You’re Out, and By Out, I Mean Dead

This story was plastered above the fold in yesterday’s print edition of the Toronto Star:

Gleb Alfyorov thought he was going to a hospital for help.

So did the judge who ordered a 30-day psychiatric evaluation of the Pickering teen.

“I want you to be with a team of specialists — nurses and doctors who can meet with you and talk with you about things,” Judge Susan MacLean told the troubled 16-year-old who had been convicted of breaking his older sister’s nose.

That night, a police cruiser dropped Gleb at Syl Apps Youth Centre in Oakville, a jail which was not set up to assess or treat him.

Gleb was strip-searched, interviewed and directed to cell 12. A stunning series of miscommunications kept him from receiving help.

Twenty-nine days later, he hanged himself from a ceiling grate in his cell with his black shoelaces. It was five days after his 17th birthday.

[But go read the the whole thing.]

Essentially, the story tells of a sixteen-year-old boy who had some serious (and undiagnosed) mental health issues and a history of substance abuse. Instead of being properly diagnosed and treated, various experts and professionals handled Gleb Alfyorov like an animal until he finally committed suicide in despair. It is ugly and depressing reading, especially if you’re a health care professional, because it appears, first, that no one bothered to look at Gleb Alfyorov’s chart, and second, no one could be bothered to act as his advocate. It’s pretty clear no one had actual responsibility for Gleb in any meaningful way.

In truth, he had three strikes against him anyway.

He had a  mental illness, and we all know how people with mental illness are valued, even by health care professionals.

He was a drug abuser, and we all know about the perception — and some of us believe it — that drug abusers are  scum and get what they deserve.

He had a criminal record, and criminals are no better than animals. Right?

In short, he didn’t have a chance. To health care professionals, people like Gleb Alfyorov don’t matter much. We might officially protest it ain’t so, but we know it’s true. They aren’t important, and they are a dime a dozen. They’re difficult, hard-ass cases. They don’t have the appeal of breast cancer patients or sick babies. Who really gives a shit, right?

The testimony at the coroner’s inquest will no doubt involve a lot of hand-wringing and complacency at the same time; some will and blame the victim and others will blame circumstance and everyone will avoid anything that looks like the acceptance of responsibility. Witnesses will say “the system” killed him, when in fact “the system” is actually composed of individuals whose action or inaction contributed to Gleb’s death.

When completed, the inquest will recommend some systemic changes which will hopefully improve a deeply awful system. But in the end, I think none of that will matter, until we get it through our thick skulls that young men like Gleb aren’t disposable, but human beings intrinsically worthy of being treated with respect and dignity. And no coroner’s inquest can change that attitude.

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How to Eat in the Most Obese County in the United States

Let’s start with an appetizer:

One thing you need to know before going to the Mississippi Delta is what a Kool-Aid pickle is — and how to make it.

1. Pour pickle juice from a jar of pickles into a bowl.
2. Add Kool-Aid to pickle juice.
3. Pour pickle juice back over pickles.
4. Enjoy?

Where can you find Kool-Aid pickles? All over the region, including at the Double Quick, a chain of convenience stores, many of which also sell a smorgasbord of fried foods.

The video, produced by the NPR and Oxford Magazine, documents the difficulties eating well in (putatively) one of the richest agricultural regions on earth, where fresh, unprocessed food is the exception. Not surprisingly, there is a close relationship between poverty and poor diet; the devastating sequellae of diabetes, hypertension, heart disease and stroke, it hardly needs to to be said, ends up afflicting those least able to afford the health care, drugs and lifestyle changes necessary for effective management. Note the interview in the grocery store, and the dearth of fresh vegetables, apart from a few over-processed tomatoes and cucumbers.

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Haiti Cholera Update #19

The latest MSPP (Ministère de la Santé Publique et de la Population) report as of 29 November 2010 showed 80,860 cases of cholera accounting for 1,817 deaths since the outbreak began. There have been  36207 hospitalizations. The hospital mortality rate is 3.5%. Cholera promptly treated has a mortality rate of 1-2%. On the mortality rates, Jim Wilson at Haiti: Operational Biosurveillance offers the following comment:

Case fatality rates such as the most recent Health Cluster report of 2.3% is representative of gross national level aggregation of information available to officials, which represents a substantial bias towards CTC/CTUs staffed by experienced teams such as MSF. What is not reflected is the continually documented “first contact” pattern of daily clinical mortality seen by rural communities and urban environments such as Gonaives several weeks ago reported by officials do not reflect the true impact of cholera at the community level.  The daily mortality we have documented on multiple occasions may range from 10 to 100%. We often see sudden overwhelming of local capacity to the point of backloading corpses for burial, having run out of body bags.

He also has posted a map (above) showing areas of concern for HEAS (Haiti Epidemic Advisory system), which in of itself suggests actual numbers of cases are much higher than official estimates — and bound to get worse:

  • Red- where we continuously receive emergency requests for assistance due to “first contact” high mortality and have facilitated several mobile emergency responses.
  • Orange- where we occasionally receive notification of “first contact” high mortality but confirmation is difficult; we suspect there is far greater mortality in these mountains but it goes unreported because of very low NGO presence and difficulty of access.
  • Yellow- where we have confirmed cholera activity at multiple sites throughout the southern peninsula, however the majority of international response is focused on PaP, Artibonite, and recently the north… the south is left relatively untouched in terms of response.  As with the orange areas, we suspect far more activity that is what reported because of very low NGO presence.  We also note very large time lags in official reporting from this area.  The southern peninsula is the next battle front, where we expect the ‘war’ to go very badly given the low availability of response assets.

However PAHO (Pan-American Health Organization) thinks things are getting better:

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.

Given what is known about underreporting of cases, a mortality rate of 2.3% might be somewhat optimistic.

See, for example, James Wilson above, or HaitiLibre on conditions in the country’s south, particularly in Les Cayes:

The number of people infected in the Southern Department, although it is less than the number of cases recorded in Port au Prince (note that the government refuses to reveal the true assessment of PAP and Metropolitan area since November 24, 2010), continues to increase. Until now, throughout the department, 12 zone of infection, including 5 located in the city have been identified. Official figures show 160 cases treated, but they are largely underestimated.

Health authorities already sorely lacking resources, human and material to cope with a situation that continues to worsen. The only treatment center, a small structure built in emergency hospital in Les Cayes by Doctors Without Borders (MSF) Switzerland with the assistance of TDH, finds itself without the continued support of medical organizations. Located within the walls of the hospital, the CTU transitional, has a capacity of only 25 beds. women, men and children do not have separate spaces. Managed by inadequately trained personnel and overworked, lacking supervision, it recorded 10 to 15 daily admissions in recent days. It is completely saturated. Central Prison inmates are also referred.

There is no system of management of contaminated waste, the drums of vomiting and diarrhea are full, others are full of medical supplies clothes mixed with the sick and other household waste. TDH trying stopgap, while providing support WASH, but without appointed loading area, storage and processing of waste remains a major problem. No location was identified by the authorities despite repeated requests for a month.

Also:

  • If you click on nothing else, you must read this post from On the Goat Path. There is nothing pretty or romantic about the epidemic. It’s horrendous and gut-wrenching:

From our perspective, it wasn’t clear that cholera had hit the city, even though news reports were claiming otherwise.  You just don’t see it.  Living in our house in a relatively nice part of town, the presence of cholera was not obvious, which stresses that this is not a disease that people who have the proper resources get.  It’s a disease that affects the poor, but with the vast majority of people in this country living on less than $2 a day, almost everyone is vulnerable.  All we needed to do was travel downtown last Thursday and the toll of this cholera epidemic slapped us in the face.

Ben and I were driving around PAP Thursday looking for protests when we drove by a man who looked like he was dead on the side of the road.  We pulled over and looked down, “Yeah, he’s dead,” I said just as the man moved his head back and forth lethargically.  We were shocked, so we asked people who were standing close-by how long he had been laying there.  They explained that the man had cholera and that he had been there for a couple hours.  Soon after his mother came and began to wail, saying that he was her only child and asking “Why is this happening?” in Kreyol.

Special “cholera beds” have been created to help overtaxed nurses. These beds have a hole that allows the streaming diarrhea (like rice water) to drop into a plastic bucket. The hole is diamond shaped, and the beds are covered with a silvery foil. Diamonds and silver. The irony was piercing for a physician from wealthy Canada.

Secretary-General Ban Ki-moon today called for a speedy solution to the political crisis in Haiti after yesterday’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.”

  • Meanwhile, demonstrations in St-Marc against MINUSTAH (Mission des Nations Unies pour la stabilisation en Haïti) leave 6 dead and  injure 15. MINUSTAH has been implicated in introducing cholera into Haiti, which the United Nations has repeatedly denied.

I will post the next update Sunday, 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)

ReliefWeb Latest Updates on the Epidemic. Key Documents.

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

Partners in Health (Twitter).

Médecins sans frontières

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Haiti Cholera Update #18

MSPP. Click to enlarge.

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.

  • Pictures from the blog The Life and Times of the Mangine Many illustrating the realities of water in Haiti. Comment from the blog:

    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.

    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.

    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)

    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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    Haiti Cholera Update #17

    MSPP graph. Click to embiggen.

    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.

    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).

    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.

    But something’s wrong with the cumulative totals:
    11/19: 1,618 hospitalizations; 77 deaths
    11/20: 2,140 (h); 95 (d)
    11/21: 2,066 (h); 85 (d)
    11/22: 2,866 (h); 140 (d)
    11/23: 3,097 (h); 146 (d)
    11/24: 3,097 (h); 146 (d)

    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.

    [snip]

    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.

    [snip]

    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.

    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.

    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.

    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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    Haiti Cholera Update #9

    As of writing there have been no further reports of cases or deaths from cholera from MSPP (Ministère de la Santé Publique et de la Population). The MSPP’s last release three days ago noted 6,742 hospitalized cases of cholera and 442 deaths since the outbreak began. This represents a crude mortality rate of 6.6%. Cholera promptly treated has a crude mortality rate of 1-2%. Cholera is now found in five départements: Artibonite, where the outbreak began, and Centre, Nord, Nord-Ouest, and Ouest. It is important to note that even this information was stale at the time of its release, and represented data three days old, from 31 October 2010, meaning effectively, there has been no official release of information for nearly a week. James Wilson at Haiti: Operational Biosurveillance (HOB) believes this number represents significant underreporting:

    Current official stats are 6,742 cases and 442 fatalities. This is definite under-reporting. If we assume the case counts are 1/4 the true community load, then we now have nearly 27k cases shedding pathogen into the environment. We believe the true statistic to be closer to 50k based on the degree of under-reporting.

    Tropical Storm Thomas has passed Haiti, though rainfall associated with the storm continues; 2.5-5 cm of additional rain is expected to fall over the country. HaitiLibre reports significant flooding, and authorities have evacuated hospitals in Leogane, Les Cayes and Saint Louis Hospital in Delmas (Port-au-Prince). HaitiLibre is providing updates on the flooding on their website. According to PAHO (Pan American Health Organziation) the storm produced:

    rain accumulations of 5 to 10 inches over much of Haiti and the Dominican Republic, with possible isolated maximum amounts of 15 inches. This brings additional challenges to the current health situation, with reduced availability of drinking water, difficult hygienic conditions, and limited access to health services and to waste management.

    HaitiLibre continues to report violence on the Border with Dominican Republic, associated with the outbreak-induced closure of the transnational markets on the Dominican side of the border.

    Medical supplies obtained by PAHO seem to suggest the health organization is digging in for the long haul:

    Immediate distribution [of medical supplies] covered over 3,500 liters of IV fluids, more than 64,000 sachets of oral rehydration salts, and 180,000 antibiotic tablets. Additional distribution to hospitals and health facilities in Haiti can cover at least 600,000 ORS doses, 50,000 liters of Ringer’s Lactate, and more than 3,500,000 antibiotic tablets. In addition, 10 complete WHO Diarrheal Disease Kits, each able to treat 400 to 500 people, have been purchased and are arriving Nov. 4

    Crawford Kilian writes on the cognitive gap between the hype of humanitarian relief  and the reality on the ground, sentiments I tend to agree with:

    The NGOs, UN agencies, and individuals who are blogging this disaster on the ground are remarkable people, doing wonderful things. Many of them are putting themselves in harm’s way. Haiti would be far worse off without them.

    But a lot of them are using Haiti as a sales pitch for donations or political support. They describe the frightful conditions the Haitians are dealing with, and then they describe their own heroic efforts to improve those conditions. Much as I admire them, I’m beginning to gag a little when I read their self-congratulating posts.

    (But read the whole post.)

    Also via Crawford’s blog, H1N1, American earthquake relief to Haiti is still held up in the U. S. Congress:

    The US Congress put up another obstacle today to delivering the $1.15 billion (£600 million) in reconstruction money that it promised to Haiti in March but has so far failed to deliver.

    The State Department will have to prove to Congress’s satisfaction that the money will not be stolen or misused, which may be a difficult target before the cash even reaches the country.

    Without the reconstruction money, temporary shelters have gone unbuilt, rubble has not been removed and 1.3 million people remain homeless because they are unable to afford safe places to live.

    More resources:

    Haiti: Operational Biosurveillance (Twitter)

    H5N1

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

    Mediahacker: Independent multimedia reporting from Haiti (Twitter)

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

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

    Partners in Health (Twitter).

    Médecins sans frontières

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