Posts Tagged Cholera

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 #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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    Haiti’s Cholera Epidemic: One Nurse’s Account

    [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.

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    Haiti Cholera Update #15

    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%.

    James Wilson reports on conditons in the epicenter:

    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.

    The Columbia Journalism Review on Haiti as disaster porn:

    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.

    MSF criticizes the current response to the  epidemic:

    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.

    Pictures of the cholera protests.

    HaitiLibre on the anti-Haitian protests in the Dominican Republic, ten cases of cholera have been reported.

    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.

    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 #13

    The last report of the MSPP (Ministère de la Santé Publique et de la Population) on 12 November 2010 reports 14,642 cases of cholera and 917 deaths. The hospital mortality rate is 3.8%. Cholera promptly treated has a mortality rate of 1-2%. It is probably worthwhile to bear in mind that in the view of James Wilson at Haiti: Operational Biosurveillance, the number of cases is likely enormously under-reported. He currently estimates approximately 100,000 people have been infected. If 75% of these cases are subclinical, and we accept a (conservative) 3.8% mortality rate, the estimated number of deaths would be 950 — a figure strikingly close to official reports. The United Nations is estimating 200,000 persons will be infected during the epidemic. According to Nigel Fisher, Deputy Special Representative and Resident and Humanitarian Coordinator, MINUSTAH,

    The Cholera continues to, the number of cases continue to expand quite rapidly as foreseen. We do have cases now in every ‘Department’ as well as in Port Au Prince. The numbers of cases that we’ve had so far have been Ministry of  Health cases of hospitalized patients, we’re now trying to ramp up the collection of data from communities so that we can get a more realistic figure. We expect to have, once that data comes in, a significant increase in recorded cases so people should not be surprised at that.

    The U.N. has launched a US$164 million appeal to combat the epidemic in Haiti.

    The World Health Organization meanwhile has declared that finding a definitivre source of the epidemic is not a priority:

    A WHO spokeswoman says controlling the outbreak and helping those infected is more important.

    Fadela Chaib told reporters in Geneva on Tuesday that “at some time we will do further investigation but it’s not a priority right now.”

    One protester was killed late Mondays as anti-U.N. riots spread to several Haitian cities in what WHO described as politically motivated unrest.

    The U.N.’s spokeswoman in Geneva, Corinne Momal-Vanian, described the suspicion that Nepalese troops were to blame for the outbreak as “misinformation.”

    Rioting has been reported in were reported in Cap-Haïtien, and The Guardian is reporting UN soldiers shot and killed one protester. Mediahacker is reporting two deaths, and other civil disturbances in Hinche and Gonaives. In Hinche, says Mediahacker, “protesters tried to leave the coffin of a man who died of cholera in front of the city’s UN peacekeeping base.” The violence has been variously attributed to the presence of MINUSTAH (United Nations Stabilization Mission in Haiti), who are widely suspected by the Haitian people and politicians of bringing cholera in to the country, the upcoming national elections on the 28th, or the establishment of cholera treatment centres in the community, which has been a point of contention in other places. One account:

    The earthquake, the hurricane, and now the cholera. The manifestasyon which began this morning around 6:30 a.m. is strictly about Cholera and the UN, and people are serious about wanting them out. I asked a man on the street if he thinks this will go on into tomorrow: “Wi, demen sidyevle,” yes, God-willing, he says, “we won’t stop until Minustah quits the country. They brought cholera here and many many people died.” One woman told me that there are riots like this in Port-de-Paix and Hinche, but this is so far unconfirmed.

    Spanish Minustah soldiers are coming from Ft. Liberte, but groups of protesters went out to Limonade to set up road blocks earlier today. Rt 1 leading into Cap from the south and out to the east are blocked. The picked-apart skeletons of trucks make quick barricades across the roads, sometimes within 100 yards of another. Groups have also set burning tires up to block paths. You have to identify yourself as NOT Minustah or else people will throw rocks. One man told me “Ameriken se Ameriken, Minustah se Minustah.”

    We heard helicopters around 2:00 p.m., but haven’t seen them since. The airport is closed and the US Embassy has sent out a new warning on their site. Earlier this afternoon, protesters burned the police stations at Pont Neuf and Barriere Bouteille before heading to the one at l’Arsenal in downtown Cap. As of 3:00 p.m., one person has died and 26 others are hospitalized from the altercations. The man who died was shot by a Minustah soldier.

    Médecins sans frontières on the present course of the outbreak:

    The situation in the north of Haiti remains extremely serious. MSF teams working in the region are overwhelmed by the needs of the many new patients arriving at facilities in Cap Haitien, Port de Paix, Gonaives, and Gros Morne every day. Fears persist in the communities, including in Port-au-Prince, over the presence of cholera treatment centers (CTCs), in spite of their importance to immediate lifesaving measures against the epidemic.

    [snip]

    In the lower Artibonite region, where the outbreak started, MSF teams in Petite Rivière and St. Marc are still very busy. While there are some indications of the epidemic possibly stabilising, the CTCs in both places are at capacity. The caseload in Dessaline, however, is still increasing; 177 people were admitted on Friday and a 280-bed capacity facility is being built. In general, as in the north, it is still difficult to reach remote areas to offer treatment where it is needed. MSF has resorted, in some cases, to dropping materials from helicopters to support some local health centres.

    In Port-au-Prince, the picture remains chaotic and troubling. The Cite Soleil neighbourhood, a sprawling slum, is essentially the frontline of the outbreak in the capital. Efforts are underway to increase admissions to 250 per day at the MSF-supported, Ministry of Health, Choscal Hospital. People presenting with severe symptoms are transferred to CTCs in MSF facilities in the nearby Sarthe and Tabarre neighborhoods. Teams are also looking for another place to construct a cholera treatment unit (CTU) in the neighbourhood.

    I missed this quote in the last update, but it’s worth going back to. From James Wilson, somewhat facetiously:

    Direct quote from senior US government official:

    …we think [the cholera epidemic] can be managed effectively, as the response has been good in Haiti, and the GOH with our help has gotten out ahead of the curve, and are working hard to stay there…This is not to say that 1,500-2,000 or so deaths from cholera a year in Haiti for the next several years is acceptable, and we hope to get the mortality rates down well below that. But this is not in the same league as the earthquake either, so I think you can turn off the alarm bells.

    Cholera has spread to inside Haiti’s prison system:

    After the death, last month, of 5 prisoners to the Civil prison of Hinche (of the cholera), it is the turn of the National Penitentiary to be affected by the cholera epidemic. In recent days, four prisoners died, reported a spokesperson for the Haitian National Police (PNH), indicating that more than ten others presented all the symptoms of the cholera.

    The National Penitentiary, principal prison of the capital, houses 1.469 inmates (figure of October 2010) with sub human living conditions, compared to that, the life is good in the IDP camps. Danielle Boisvert, who heads the correctional unit of MINUSTAH since June 1st, 2010 was declared in September “On average, each prisoner has access to less than 1 m2 and in certain prisons such as the National Penitentiary, they have less than 0.5 m2. In less than one half-m2 a person cannot sleep wide nor even squatted” ideal conditions for the spread of cholera.

    I will post thew next update Thursday or Friday, or sooner if events warrant. For more immediate updates, I highly recommend Crawford Killian at his blog H1N1.

    More resources:

    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 #12

    As of 9 Novemeber 2011, MSPP (Ministère de la Santé Publique et de la Population) reports 11,125 cases of cholera and 724 deaths.  The hospital mortality rate is 3,9%. Cholera promptly treated has a mortality rate of 1-2%. HaitiLibre reports that there are now 278 confirmed cases of cholera in Port-au-Prince, and 10 deaths. In the outlying regions as well as in the Artibonite, the website reports, the situation is becoming dire:

    The epidemic is spreading each day a little more in Gonaives, agglomeration of more than 300,000 inhabitants : for the single day of November 8, 460 people presented themselves for consultation at the hospital in Raboteau when they were 360 the day before and 104 the day before. The epidemic is becoming out of control in these areas. The ACF [Action Contre la Faim] said that the focus of the international community in Port-au-Prince and the lower Artibonite, although it is important, is detrimental to other affected areas.

    In the Artibonite, the center of the epidemic, OCHA, MINUSTAH, the government and humanitarian partners report that with the increasing workload, more medical staff with more experience is needed urgently as well as medical supplies supplementary, including at least 1,200 body bags according to an official report.

    The Haiti Epidemic Advisory System (HEAS) gives this analysis in its layest sitution report:

    Cholera has now seeded the Haitian environment in more sites than can be properly assessed. Evidence of community transmission is present in multiple sites such as the northwest, greater Port au Prince area, and strongly suspected in the southern peninsula. Transmission modes include waterborne, food contamination, and human-to-human contact.

    Transmission in the original epicenter of the epidemic along the Artibonite River has decreased substantially and shifted to surrounding rural areas, extending to the northern coast. As feared, cholera transmission in communities along the coastal highway between St Marc and Cite Soleil likely resulted in dozens of indigenous cases now identified in Cite Soleil, with dire implications for Port au Prince. Multiple confirmed cases without travel history to Artibonite have been documented in both Cite Soleil and Port au Prince, and hundreds more suspect cases have been declared inside Port au Prince. Significant political interference prevents full clarity of the situation inside the city. As of this report, [9/11/10 --- ed.]  HUEH and other major medical centers inside Port au Prince are stable and able to handle the patient flow.

    The issue of “suspected” versus “confirmed” reporting and decision points for action have been hotly debated inside the HEAS community. As was observed in the United States during the 2009 H1N1 influenza pandemic, the number of samples collected is disproportionate to the ability of LNSP to process them in a timely fashion and publicly declare confirmation status. The entire nation is now sensitized to report cholera, however many have never seen cholera before. This implies means the false positive rate is likely increased. Diarrheal disease not due to cholera is caused by a wide variety of other endemic pathogens and is seen this time of year during the major rainy season.  All of this acknowledged, hesitation to verify or assume “cholera until proven otherwise” may mean the difference between 1 and 10 fatalities for a given community. This is a tremendous challenge to the HEAS community.

    [snip]

    Conclusion

    The cholera epidemic in Haiti proceeds in an uncontrolled, uncontained fashion and will likely encompass all of Haiti within a matter of weeks.  Ecological establishment will be pervasive regardless of ongoing response efforts.

    Efforts to improve access to safe drinking water and sanitation are as challenging as they were post-quake, and now additional vast areas of Haiti will require similar attention.  It is unlikely effort will be mobilized quickly enough to forestall the spread of cholera. Public health intervention in the areas of education, hygiene, and training of medical responders will continue to be important. However, the default operational position now is not to prioritize effort to prevent spread but to prevent or mitigate unnecessary fatalities. The HEAS is narrowly focused on early, actionable warning coupled to “swarm” medical response.  We have observed time deltas [i.e. change --- ed.] between warning and imminent healthcare facility collapse can be as short as 24 hrs. The HEAS has encouraged high false positive rate reporting to ensure communications with involved medical facilities and staff can be established and resources mobilized quickly enough should they be required. This process has already assisted several overwhelmed facilities and likely prevented unnecessary loss of life. [Emphasis mine]

    Médecins san frontières reports on conditions in PAP:

    It’s a really worrying situation for us at the moment. All of the hospitals in Port-au-Prince are overflowing with patients and we’re seeing seven times the total amount of cases we had three days ago.In the slum of Cite Soleil, located in the north of the city, yesterday we recorded 216 separate cases of cholera arriving at the hospital, while the total number recorded just 5 days ago was 30. Patients are coming from everywhere, throughout the city, slums and wealthier areas. At the moment we have 400 beds set aside for the stabilization and rehabilitation of patients and we’re hoping to get that up to 1,000 by the end of the week.

    But we are really worried about space. If the number of cases continues to increase at the same rate, then we’re going to have to adopt some drastic measures to be able to treat people. We’re going to have to use public spaces and even streets. I can easily see this situation deteriorating to the point where patients are lying in the street, waiting for treatment. At the moment, we just don’t have that many options.

    We’re looking for alternative spaces, but you have to remember what the situation in Port-au-Prince is like. Since the earthquake, every available space that wasn’t damaged has been filled by camps where people are living in extremely precarious conditions. Just to find an empty area in this city is a major logistical challenge, so for us to find room to treat people is very complicated.

    James Wilson at Haiti: Operation Biosurveillance has produced a useful timeline of the epidemic, from Case 0 to the report from MSF: “All the hospitals in Port-au-Prince are overflowing.”

    Dominican authorities prepare to reopen the trans-national markets closed by the epidemic.

    PAHO (Pan American Health Organization) Director, Jon Andrus stated during his briefing (PDF) of 9 November 2010 that “there is no reason to expect the elections to have a negative impact on the cholera epidemic . . . and in fact, the Ministry of Health is planning to use the occasion to disseminate prevention>
    messages to the population. It will help prevent the spread of infection”.

    More resources:

    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 #11

    MSPP (Ministère de la Santé Publique et de la Population) has no updated figures on cholera deaths or hospitalizations as of writing (c. 1500 ET). However Al Jezeera quotes an MSPP official saying the death toll has risen to 587. Al Jezeera also states there have been 120 suspected reported in Port-au-Prince. Five confirmed deaths have been reported at Wharf Jeremie, on the outskirts of Cité Soleil. James Wilson at Haiti: Operational Biosurveillance reports this number has increased to over 200 patients, and Haiti Epidemic Advisory System (HEAS) is urgently appealing for funding. He also notes further outbreaks have been reported in multiple places throughout Haiti, significantly without history of travel to known outbreak areas, indicating endemic or in situ environmental transmission through contaminated water, including places in the southwest affected by Hurricane Tomas. One gets the sense reading through his posts of a bad situation rapidly deteriorating. Wilson also remarks hospitals have been underreporting cases by as much as 400%. If this is true, it represents a serious breakdown in reporting of deaths and hospitalizations by MSPP.

    HaitiLibre on this dysfunction:

    The health authorities said on Monday they were examined at least 120 suspected cases of cholera in the capital of Haiti, Port-au-Prince. At least 114 suspected cases suspected of having the disease in the capital come from Cité Soleil. The samples are being analyzed at the National Laboratory to confirm the presence of bacteria Vibrio cholerae “We are working on the case… We still do not have a confirmation,” said Gabriel Timothée, the Director General of the Ministry of Health.

    If the laboratory confirms the presence of cholera, a population of 2.5 to 3 million people will be threatened with almost half live in camps. Timothée said that many patients are suspected to come from the Artibonite.

    It would be time that the government says the truth to the population, trying to pretend that the cholera outbreak is contained in the Artibonite is pure disinformation, cholera knows no border. Besides the director general does not he know that his Ministry has confirmed that the five regions, the Artibonite, Center, North, Northwest and West of Haiti and the capital was affected by cholera ?

    Why hide to the Haitian population,that many suspected cases are reported almost daily in Port-au-Prince ?

    Thus we have learned from reliable medical sources, a case of cholera had been reported (October 31) at the hospital Bernard Mevs. That the sample taken from the patient and sent to the National Laboratory (Delmas 33) for analysis came back positive. The laboratory report confirmed the presence of Vibrio cholerae type 01. Note that this patient came from a camp near the road Bâtimat, and after investigation of the hospital, this patient had not traveled (for at least a year), in the Artibonite region or Saint-Marc and had not been in contact with people from these regions. It is therefore an infection from a local outbreak.

    [snip]

    While CTC (Cholera Treatment Centre) settled in Port-au-Prince, the actual capacity is of 2,000 “seats”, it will be necessary that the government has political courage to say not only to the population what occurs, but also that it communicates on the real situation of the epidemic in the country and diffuses finally the true figures, which at present is far from true. At 19 days of elections, reveal the magnitude of the situation to the population can only have negative impact on the government and its candidates… Politic for the government of René Préval now seems more important than the health of the population.

    HaitiLibre is also reporting a third case of cholera has been confirmed in Dominican Republic.

    Crawford Killian has some sharp words for the New York Times:

    Blogging cholera in Haiti has taught me that the mainstream media have huge resources and can produce long, informative articles. But they don’t seem to be using the Haitiverse—the blogs and tweets of people on the ground. So they remain hours and even days behind the folks like Ansel Herz and James Wilson.

    I note without irony PAHO has a visit by Fox News to its PAP warehouse featured on its blog.

    More resources:

    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 #10

    According to MSPP (Ministère de la Santé Publique et de la Population — PDF), as of 6 November 2010, there have been 544 deaths and 8138 hospital cases from cholera. Total deaths are divided between 309 hospital deaths and 235 deaths in the community. This represents a hospital mortality rate of 3.8%. Cholera promptly treated has a mortality rate of 1-2 % The total number of cases in the community is unknown. James Wilson at Haiti: Operation Biosurveillance estimates over 50, 000 persons have contracted the disease, either subclinically (75%) or actively (25%).  He writes: “Any claim of containment or control of this epidemic should be treated with skepticism.” People infected with Vibrio cholerae continue to shed pathogens for two weeks after initally contracted the disease.

    Disturbingly, Wilson also reports, via Samaritan’s Purse, a cluster of 47 new cases of cholera in Cité Soleil.  Further outbreaks are noted in Gros Morne, Grand Bois, north and east of St-Marc respectively, and suspected cases in Mole St-Nicholas and St-Louis-du-Nord, both of which are in areas most directly affected by Hurricane Tomas.

    Via HaitiLibre, yet more misery and an increased risk for contamination, a consequence of Tomas:

    The Artibonite River, likely initial vector of cholera, may overflow. Already heavily loaded by the rains brought by the hurricane Tomas, and at the limit of the flood, the river Artibonite could get out of its bed during the day following the opening of the valves of a hydroelectric dam on the River.

    United Nations representative said that the engineers were forced to open the valves of a dam on the river, whose level of the reservoir was too high, to allow water to escape and reduce the pressure on the structure.

    It was asked the people living on the banks of the river infected with cholera to evacuate their families and livestock. The health situation is bad enough, but the overflow of contaminated river could contribute to spread the cholera and to worsen the situation considerably.

    In the course of the day, the area should be flown to locate and assess potential flooding.

    More resources:

    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.)

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

    Partners in Health (Twitter).

    Médecins sans frontières

    [Cross-posted at Sister Sage's Musings]

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