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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  1. Tweets that mention Haiti Cholera Update #19 « Those Emergency Blues -- Topsy.com

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