[Gasfghj]

http://www.nytimes.com/2010/10/23/wo...23cholera.html

Cholera Reported in Several Areas in Haiti
The New York Times, By DONALD G. McNEIL Jr, October 22, 2010

A cholera outbreak in a rural area of northwestern Haiti has killed more
than 150 people and overwhelmed local hospitals with thousands of the sick,
the World Health Organization said Friday, increasing long-held fears of an
epidemic that could spread to the encampments that shelter more than a
million of Haitians displaced by the January earthquake.


Even as relief organizations rushed doctors and clean-water equipment toward
the epicenter ‹ the Artibonite, a riverine rice-producing area about three
hours north of the capital, Port-au-Prince ‹ Haitian radio reported that
cholera cases had surfaced in two other areas: the island of La Gonâve, and
the town of Arcahaie, which lies closer to the capital. In addition, a
California-based aid group, International Medical Corps, said they had
confirmed cases in Croix-des-Bouquet.

Relief agencies had long feared a major outbreak of diarrheal diseases,
particularly among people living in crowded, unsanitary tent cities, and, as
in the case in Artibonite, drinking from rivers.

But the appearance of cholera ‹ which dehydrates and kills victims more
rapidly than most other diarrheas ‹ was a surprise. Haiti and the rest of
the Caribbean has not seen the vibrio cholerae bacteria, which lives in
human intestines, for at least 50 years.

Like most population centers in Haiti, Artibonite has absorbed thousands of
those displaced by the earthquake, which killed an estimated 200,000.

Television images showed hospital corridors, hallways and even parking lots
there filled with victims lying down, getting intravenous fluids as crowds
of screaming relatives were kept outside.

³People are all over on the floor,² Charles Henry Baker, a Haitian
presidential candidate, who appeared on Reuters TV after touring a hospital.
³We need help and we need quick help.²

Dr. Michel Thieren, senior program officer in Haiti for the Pan-American
Health Organization, a W.H.O. affiliate, said the best hope for minimizing
casualties was a public education campaign to tell people to drink only
clean water, and a bigger effort to get clean water to everyone.

Cholera has circled the globe in waves since it first appeared in India in
1816. It killed tens of millions of people during the 19th century, and the
globe is now in the grip of what is considered the seventh pandemic; a
strain presumed similar to the one in Haiti appeared in South America in
1991.

Victims can lose as much as 10 quarts of water a day through diarrhea and
die because their electrolytes get out of balance, causing a heart attack,
or their blood gets so thick that their organs shut down. It can be fought
by rehydrating victims with intravenous fluids and water with salts and
sugars. It can be headed off by trucking in clean water or huge filters that
can clean local water.

[Gasfghj]

Friday, 22 October 2010, 13:00h (Haiti time)
Situation Update Nr 01

• Government Officials confirmed a Cholera outbreak in the Département
Artibonite.
• The Ministry of Health reported the worst-affected areas were Douin,
Marchand Dessalines and areas around Saint-Marc, approximately 100km (60
miles) north of Port-au-Prince.
• More than 1,500 people are reported to be sick. The diseased suffer from
sever diarrhea, which leads to extreme and rapid dehydration, which led to
death in at least 141 cases so far.
• The Artibonite River is likely to be the source for the outbreak, after
recent heavy rains spurred its banks to overflow and flooded the area.
• The Ministry of Health will initiate a public campaign to notify the
public how to employ good hygiene to prevent the spread and to protect
lives.

Response
• The response is being coordinated by the Ministry of Health, the
Direction Nationale de l'Eau Potable et Assainissement (DINEPA), the Health
Cluster and the Wash Cluster.
• A crisis cell has been established at WHO/Promess in Port-au-Prince, in
order to coordinate the response in Artibonite. Representatives from the
Health and the WASH Cluster,
including their Government counterparts (Ministry of Health and
DINEPA), as well as the Logistics Cluster and OCHA are part of the
coordination cell.
• The Haitian Red Cross has sent a truck loaded with medical supplies to
the main hospital in St Marc. Another convoy of trucks is scheduled to leave
from Port-au-Prince today,
carrying 31,000 litres of clean water and chlorine as well as large
tents and sleeping mats to increase the hospital's capacity.
• One Logistics Cluster staff is supporting WHO to conduct a Health
Structure assessment in St Marc today.
• The Logistics Cluster received the following cargo movement requests for
today so far:
o French Red Cross: 6,000 hygiene kits and 6 tents, from
Port-au-Prince to St Marc;
o International Relief and Development - IRD: 40 boxes of rehydration
salt, from Port-au-Prince to St Marc
o Médecins du Monde - MdM, France: 5,000 pocket Ringer’s lactate,
from Jeremie to Port-au-Prince;

End.
-----------------------------------------

Best regards,
Logistics Cluster Haiti
Haiti — Humanitarian Logistics Information

[Gasfghj]

Changing Perspectives: Report from St Marc

first hand report... warning --gruesome and difficult to read

[katespepach]

"The only way to halt a disease like cholera is to stop
people from getting infected."

This seems crucial.
How are they doing I wonder?

Does anybody know?

[Gasfghj]

"The only way to halt a disease like cholera is to stop
people from getting infected."

This seems crucial.
How are they doing I wonder?

Does anybody know?

Pedro--- there are now multiple cases reported in Petionville

from WHO
There are vaccinations available to help protect against exposure to cholera:
#
# The CVD 103-HgR (Mutacol®) vaccine was approved for use in Canada in 2002 for use in adults and children older than 2-years-old.
# DukoralTM was approved for use in 2003 for adults and children aged 2 years and older.

The WHO does not recommend vaccination as it may lend a false sense of security to those vaccinated. Instead, the WHO recommends following these measures to avoid infection:
#
# Drink only water that has been boiled or disinfected with chlorine, iodine or other suitable products.
# Avoid ice, especially when travelling to parts of the Caribbean, Africa, India, Asia and South America.
# Avoid raw seafood and only eat thoroughly cooked food. Remember: cook it, peel it, or leave it.

I would not eat ANYTHING that I had not prepared myself in my own kitchen...

better yet, why not just come back here to the DR for a while?

[JulieSmithXIV]

Pedro, I agree - you should bring the family over at least until the situation is clear.

This time if there IS a rush on DR hospitals like there was post-earthquake the international community needs to step in and relieve the DR of the burden. Ideally by opening emergency treatment centres on the Haitian side to prevent people from crossing in the first place.

For uninfected people trying to cross just to escape the outbreak, I guess the unofficial "entrance fees" will increase.

[katespepach]

Wife and kid in D.R. so no worries.

Little bit busy with work to come back.

Ho Hum,

Well at least life is never dull.


I hope they do not close the borders completely.
But I guess if they have to.......

[Gasfghj]

By JACOB KUSHNER, Associated Press Writer Jacob Kushner, Associated Press Writer – 1 hr 9 mins ago

PORT-AU-PRINCE, Haiti – A spreading cholera outbreak in rural Haiti threatened to outpace aid groups as they stepped up efforts Saturday hoping to keep the disease from reaching the squalid camps of earthquake survivors in Port-au-Prince.

Health officials said at least 208 people had died and 2,674 others were infected in an outbreak mostly centered in the Artibonite region north of the capital.

But the number of cases in towns near Port-au-Prince were rising, and officials worried the next target will be hundreds of thousands of Haitians left homeless by January's devastating quake and now living in camps across the capital.

"If the epidemic makes its way to Port-au-Prince, where children and families are living in unsanitary, overcrowded camps, the results could be disastrous," said Dr. Estrella Serrano, World Vision's emergency response health and nutrition manager.

Officials confirmed at least five cholera cases in Arcahaie, a town close to Port-au-Prince, and four cases in Limbe, a small northern municipality. Ten cases were reported in Gonaives, the largest city in the Artibonite, according to Partners in Health, a U.S.-based humanitarian group.

The sick included 50 inmates at a prison in Mirebalais, just north of Port-au-Prince, Health Ministry director Gabriel Thimothe said.

Experts also were investigating possible cases in Croix-des-Bouquet, a suburb of the capital that could act as a transfer point of the disease because it has a widely used bus station, said Paul Namphy with Haiti's national water agency.

[katespepach]

Pedro--- there are now multiple cases reported in Petionville

Wow, where did you hear that?

[Gasfghj]

Wow, where did you hear that?

Jocelyn McCalla.. who is an advisor to Clinton.. just posted it on his Facebook wall

[Gasfghj]

[www.alertnet.com]
Some advice to agencies re reducing Cholera risk - preventive steps.
(culled
from WASH Cluster alert sent out yesterday):

Please share with local Haiti NGOs
serving camps, displaced persons settlements* *

WASH Cluster Mobilization
Suggestions for Preventive Measures

*DINEPA and WASH Cluster recommend all WASH agencies working in
displacement sites and neighbourhoods in the metropolitan area
immediately
follow these priority measures to reduce public health risks. These
measures
should be carried out purely as preventive measure and care should be
taken
not to generate alarm or cause panic:*

*- Ensure that all water supplies, particularly those distributed by
water
truck, are chlorinated to at least 0.5mg/l free chlorine residual.*

*- Clean and disinfected all community latrines and their surroundings
with
chlorine-containing products several times per day.*

*- Ensure access to soap.*

*- Intensify hygiene promotion efforts in particularly hand washing with
soap, the importance of safe drinking water, and the dangers of open
defecation.*

*DINEPA and the WASH Cluster reminds all partners that any case of acute
watery diarrhea must be referred to health structures without delay.*

*Additional information will be communicated on a regular basis to the
WASH
partners.*

*Port - au Prince, 21st October 2010

--
Posted By poxvox to Haiti Vox at 10/23/2010 12:37:00 PM

[Bgfbukpf]

Have not read the entire thread so maybe there is already an answer written here but what is being done atm towards the Haitian population :

1. Assist the area's already infected (access to clean water, waste disposal, moving to new clean sites, etc...)

2. What about the care for those already infected?

3. Any preventive actions already taken to prevent spreading?

[eXC3Kvnn]

The most recent communication from the Dominican Ministry of Public Health (use an automatic translator if you have to)

Dominican authorities are rather swift in stopping 'spillage' of very serious diseases from Haiti into Dominican territory. Almost a decade ago there was a reappearance of polio in a Haitian community in Jarabacoa and it was swiftly taken cared of with not much of anything happening afterward, although polio continued to be an issue in Haiti.

Plus, Dominican authorities have it much easier than the Haitians when it comes to letting the population know of the risk and what to do to prevent being infected since most Dominican households have televisions and radios, which is the most used public announcement medium.

In all likelihood a similar scenario will take place with this cholera ordeal, but take precautions on a just in case basis, especially if you're heading towards the border.

[Gasfghj]

[QUOTE=Acira;910430]Have not read the entire thread so maybe there is already an answer written here but what is being done atm towards the Haitian population :

1. Assist the area's already infected (access to clean water, waste disposal, moving to new clean sites, etc...)

2. What about the care for those already infected?

3. Any preventive actions already taken to prevent spreading?[/QUOTE

I read from your points that you have never been to Haiti.....If thie DR is a third world .. or second world ... country .. then Haiti is fourth.

the existing hospitals are overwhelmed

the Artibonite river has tested positive for Cholera and THAT is the main source of water for the City of St Marc

There is no access to clean water, or sanitation in most of Haiti... there is little chance that such infrastructure can be built in days

Most Haitians had diarrhea for a week a month BEFORE this

This epidemic will have a huge death toll

[Gasfghj]

There is a group working around the clock to crowdsource to a map the number
of cholera cases suspected/confirmed/deaths, as well as clean water
locations and health facilities taking patients. Anyone with this
information, please reply to the email address above. Thank you! Here is the
map link: HealthMap | Global health, local information

[Bgfbukpf]

No I haven't been to Haiti but I follow threads about it constantly to try to understand.

Is this outbreak of Cholera a direct consequence of the earthquake or is it something that happens on a regular basis in Haiti?

I do not understand, but again, forgive my ignorance, that if this has to do with the earthquake, that no preventive measures are already have been taken to avoid such outbreak since it can be expected as people are homeless, more concentrated in some area's and essential lifelines (if available before) were destroyed.

[katespepach]

This is the first Cholera in Haiti for a hundred years according to the BBC.

According to my health NGO buddy around 150 people die from regular intestinal infections, especially bacterial infections each week normally in Haiti.

The river in St Marc flooded mixing with sewage (turds) and this is the main source of water for cooking, washing and for some, drinking.

Again, according to the BBC, the situation although not a direct result of the earthquake is being exacerbated by lots of extra people living in the St Marc / Artibonite region having left Port au Prince because of the earth quake. So the earthquake could be seen as a proximate cause, if you like.

If you wash your hands and eat only canned food, well cooked food and boiled and disinfected water and remember not to eat any turds then you should be OK.

Nobody has to die of Cholera as it is easily treatable.
Allegedly there are 100,000 IV treatments available - not enough obviously.
And 30,000 vaccination doses available - I will give you three guesses who gets those

Most Haitian country folk see upset stomachs and mild diarrhea as a way of life - not a nice thing to say but it is true - so these people did not think anything out of the ordinary was happening until it was too late. That is what caused the initial spike in the death toll.

The cases in Port au Prince apparently were people who got infected further north and traveled to Port au Prince - thus Port au Prince is not a new infection center - according to the BBC.


As a precaution, I personally am restricting myself to certain distilled spirits, fine imported tonic water, ice that I make myself and lemon (yes the yellow ones) that I bought before the outbreak - oh, and cigarettes for my vitamins.

[Plaumpholavup]

As I understand things related to cholera, it is generally a water-borne disease. Since feces can easily contaminate water sources through evacuation or run-off,stopping it is a massive undertaking, especially given the already disastrous situation in Haiti.

Prevention in the DR is basically related to proper sanitation measures and personal hygiene.

The government will over-react, of course, they don't know any way else to react! But probably for the better.

Hopefully the 8,000 NGOs in Haiti will do something other than ride around in their 4x4s. (Yeah, I know, I am being judgmental..but so many commentaries!)

Anyway, one issue will certainly be Haitian cholera patients in Dominican health facilities and the possible consequences. A little poop can infect a lot of people..

HB

I just noted Pedro's comment about the river in Saint Marc...that would do it for a start. Controlling will be huge effort...

[katespepach]

Hopefully the 8,000 NGOs in Haiti will do something other than ride around in their 4x4s. (Yeah, I know, I am being judgmental..but so many commentaries!)

I agree 100%.

This is where they could justify their existence finally.

And as I said before, if they fail in this then I will lose what little remaining faith I ever had in these people.

We will know in a week.

So for now let's give them a chance.

[Gasfghj]

No I haven't been to Haiti but I follow threads about it constantly to try to understand.

Is this outbreak of Cholera a direct consequence of the earthquake or is it something that happens on a regular basis in Haiti?

I do not understand, but again, forgive my ignorance, that if this has to do with the earthquake, that no preventive measures are already have been taken to avoid such outbreak since it can be expected as people are homeless, more concentrated in some area's and essential lifelines (if available before) were destroyed.

Well -- you probably have seen, even here in the DR, how the rivers and streams are used for bathing, washing clothes, washing motos, and for slop entrails of animals from abbatoirs. Now just add to that picture that this is also the DRINKING water supply. While there is Culligan water in bottles available in Haiti... this costs money that many simply do not have.

I think that people in the camps.. even though they are just in tents.. DO have monitored latrine areas and clean water. But I have not been over since the quake so I do not know for sure... only assuming since the camps are under direction of NGOs.