Cholera Outbreak

As most of you know, there has been a cholera outbreak here in Haiti with 4,700 cases and 330 fatalities thus far. The number of infected individuals is actually much higher because 90% of cases do not show symptoms, but still carry the disease. Cholera is a potentially fatal bacterial infection that causes severe diarrhea and dehydration. The spread of the disease is caused by ingesting contaminated food or drinking water which was contaminated by the feces of an infected person. Most cases can be treated by oral rehydration salts, but some people become severely dehydrated and require IV fluids. The problem is that after an incubation period of 5-7 days, it can become severe quickly with rapid loss of bodily fluids causing people to die from dehydration if they don’t get the proper treatment.

The source of the outbreak in Haiti is the Artibonite river, but it is unknown how the river was contaminated. This is a very unusual event for Haiti since cholera is not endemic here. Some reports have indicated that the source of the outbreak was a sewage pipe from the Nepalese MINUSTAH base which could make sense because cholera is endemic in Nepal, but nothing has been confirmed yet (although CDC confirmed the strain matches one found in Southeast Asia). Whatever the source may be, many have feared an outbreak such as this because after the earthquake, so many people have been forced to live in extremely close proximity without access to proper water and sanitation facilities which makes the spread of disease very easy.

While the earthquake has affected the potential spread of cholera, it did originate in an area that was not highly affected by the earthquake, but it did experience an increase in population size after the earthquake and could be a huge problem should it spread to the tent camps in Port-au-Prince. On the other hand, following the earthquake, many other organizations have come to Haiti and are here with supplies, the ability to map and coordinate. However, let’s be honest, the coordination is all relative.

For example, here in Leogane, I attended the health cluster meeting and a representative from MSPP (the Ministry of Health) was there. He sat in the front of the room off to the side. When asked to stand, he said maybe next time. Instead of taking charge, he sat as the various organizations fought over who was going to do what. Finally, they decided to split all the NGOs working in the area into two groups, one for treatment and one for prevention. However, several days later, we learned the treatment group was planning prevention education. Clearly the coordination was effective! In my opinion, a lot of it boils down to the inability to coordinate without leadership. For example, if MSPP can’t step up and lead, it becomes impossible for the NGOs to coordinate.

However, there are some good things about the cluster meetings. I have been attending the Water, Sanitation & Hygiene (WASH) meetings. We have been able to map out the sections of the commune where each of the different organizations work, what each is doing and what supplies we have. This will be extremely helpful if the outbreak spreads to Leogane. Right now, the emphasis is really on education and prevention. One of the biggest concerns is how to properly dispose of the dead bodies. People need to be educated on this and how to clean up after a family member has been infected. For example, people in Artibonite were washing the clothes of the sick and dead in the river, which can lead to further contamination of the river. The bottom line is that people need to receive prevention education and understand what is going on. Here in Leogane, MSF has taken the lead in being the treatment center for potential cases. Additionally, the field hospital that has been sitting vacant since it closed in August, was offered as a place of isolation for patients. Volunteers went into the field hospital to clean it out in case it needed to be used and the people living close by starting protesting and burning tires. They thought sick patients from Artibonite were going to be brought to Leogane and they didn’t want people bringing cholera here to Leogane.

I realize for me, there couldn’t be a better time to be working for an organization that deals with providing safe water to families. Treating water, washing hands, and other basic hygiene practices are some of the biggest needs at a time like this in order to prevent transmission. Gadyen Dlo was able to quickly mobilize training and get the messages out to our health workers. We trained all 152 community health workers on details about cholera, how it is transmitted, how to prevent it and how to make oral rehydration salts at home. The health workers will share the information in their communities. In addition, we equipped them with more chlorine to sell at the users homes in order to treat their water. CNP also held a training session with their new community nutrition workers and distributed systems (a 5-gallon bucket with a lid and spigot and a bottle of chlorine) to each of their employees.

Below is one of the monitrices (CNP's community nutrition workers) at the cholera training.

Pictured below is Nancy and Madam Jacque, two of our supervisors with Gadyen Dlo.

Amidst all of the cholera and emphasis on safe water, there is a shortage of aquatabs in country, which are an affordable, easy way to treat one’s water by dropping the tablet in and waiting for 30 minutes. Therefore, DINEPA (The Ministry for Water & Sanitation) has been promoting the use of other products such as chlorine. As it turns out, Gadyen Dlo is the only organization in Haiti that produces the sodium hypochlorite solution in country. Therefore, we were contacted by UNICEF to help out in Artibonite and have already delivered 710 5-gallon buckets with a lid and spigot, 710 240mL bottles with the dosing cap, 710 1-gallon jugs, and 235 gallons of chlorine to St. Marc. Tomorrow, we have another 470 gallons of chlorine being shipped to St. Marc. They are putting the systems in 353 schools in St. Marc.

It was totally crazy getting all of this together and we had to do it in less than a 24 hour turnaround time. Needless to say, we were running around like crazy trying to figure out all of the logistics and where we could make all of the chlorine, etc. We ended up rigging up something here at the house using the generator here It was quite a hectic few days, but totally worth it. All of our staff here at Gadyen Dlo have been working incredibly hard and I am very proud at what we have been able to accomplish.

Pictured below is Yvens and Jean Marcel, two of our amazingly dedicated Gadyen Dlo staff members.


Here is the production site for our chlorine in the back of our house. Notice the nice covering our security guards put up for us.

Is your help helpful?

Learning to ask this question was one of the most valuable lessons I learned in public health school. While it seems like a simple question, it is something that many organizations fail to do. So many organizations have good intentions and think that they know what communities need, but they fail to listen to the community and understand if what they want to do for the community is really helpful and needed. I have experienced this to a whole new level here in Haiti. Prior to the earthquake, there was never a problem with not having enough people wanting to help or a lack of organizations working in Haiti. Now, there are even more organizations that are here trying to help, but is what they are doing helpful?

This is something that I struggle with and is a common issue in development work. So much time, energy, and money is put into organizations believing they are doing good work and helping people, but sometimes that isn’t the reality. There are some fairly recent news articles that I have read that highlight many of the problems facing Haiti, the role of NGOs and how helpful they truly are. This news article describes how the cost of rent has skyrocketed in parts of Port-au-Prince because there are now fewer standing structures, but now there are NGOs present who are willing to pay exorbitant prices to house their expat staff in what buildings are left standing (http://news.yahoo.com/s/ap/cb_haiti_earthquake_housing). This article describes the bleak outlook with no end in sight for the many Haitians still living in tents (http://www.huffingtonpost.com/jane-regan/haitis-13-million-displac_b_765620.html). Why do an estimated 40% of tent camps not have access to clean water? Despite many NGOs supposedly empowering local people through the formation of camp committees that select recipients and distribute aid, less than a third of people living in camps are aware of the strategy or even the name of the committees. (http://www.huffingtonpost.com/mark-schuller/unstable-foundations-huma_b_749924.html). These are just a few of the many issues with organizations working in Haiti.

Here in Leogane, you see organizations everywhere and many of them are doing positive work, but at the same time, many of them have barely begun to implement programs on the ground. An enormous amount of money was donated following the earthquake, but the people are not seeing the changes on the ground. The majority of the donated money seems to have gone into setting up structures, getting an expat staff here and arranging for their accommodations. Every day, I see nice, new cars driving around with expats inside with a different NGO sticker placed on the outside, but I have no idea what they are doing. For example, on the left is what was supposed to be the World Food Program base, with what looks like materials to build houses that have been sitting there for months, with nothing being constructed. Apparently, they were for hurricane relief, but then they decided not to do that, so another organization is going to take them. For now, they sit. I find the disparity in the picture on the right ironic: materials to build houses on one side of the wall with no one organizing their use and then the tent camp behind the walls, where people live who have no home. Furthermore, there are many organizations here that live in these amazingly beautiful houses throughout town. Save the Children’s residence comes with satellite television and everything, but yet they don’t have enough money to fund all of their programs. I know that every organization is trying to do great work, but it is hard when you see a lack of progress and the lives of people are not improving here. I know that some Haitians appreciate our willingness to come to their country and help, but others get angry because where is their help? They don’t see it. What makes us think we know what is best for them?

There are many things I also struggle with in my work here such as living in such a nice house and having the comforts of home – a fan and AC at night, a cook to make my meals, someone to clean my room, but I try to keep myself grounded and truly believe in the work that I am doing and the organizations that I work for. Both organizations I work for employ a large number of Haitians and really follow their lead and rely on them to know how to get resources mobilized and in the hands of the people that need them.

I had a particularly hard weekend a while back when Courtney, Elisa and I decided to go to try out this amazingly beautiful beach that happens to be on the land that a French husband and wife own along with a restaurant. Don’t get me wrong, the beach was beautiful, one of the prettiest and cleanest beaches around, but as the day went on, I became disenchanted by the whole scene. There were so many blans who kept coming to the beach, eating the $30 meals at the restaurant and escaping the reality that is Haiti in order to live their lives the way they do at home. Why is it that we want to live our lives similar to the way we do in the states (or wherever we come from), but just in a developing country and think we are doing the population a wonderful service? Are we truly helping and do we really know what is best if we don’t take the time to understand what life is like here?

The owners of the French restaurant make so much money off of expats, but wouldn’t it be better to train Haitians how to make the food and run the business so that they can profit? The French couple could very easily do the same somewhere else in the world, but most Haitians don’t have that luxury. They cannot get visas to go elsewhere and don’t have the savings to invest in an initial start up business. Beyond all of that, I was enraged when the owner of the restaurant got mad at our Haitian driver for parking in the parking lot (We later found out that this is a common occurrence between the French man and Haitian drivers) and proceeded to yell at him, shove him and tell him he was a disgraceful Haitian and then told us an untrue story of what had happened. We immediately left, and our driver, who is about my age, started crying. I have never been so angry before and we all vowed to never return to that beach again.

However, there are some organizations whose work is actually helpful, especially the ones who have been here for a long time and will continue to stay long after the relief organizations have come and gone. Sadly, many of these organizations, usually smaller ones, are beginning to be run out by larger organizations that have enormous budgets. For example, the Children’s Nutrition Program (CNP) that I work for is having serious financial trouble. They have been working in Haiti since 2000. Prior to the earthquake, the organization was run by only 1 expat in Haiti and a Haitian staff of about 45 employees. Following the earthquake, they expanded rapidly to over 3 times its size pre-quake and could do so with subgrant money coming in from large organizations like Save the Children and some private donations. Initially, it made sense for these large organizations to partner with smaller organizations already at work in Haiti. CNP made sense because they already had the link to the community and ability to get supplies and medical care out through their existing systems, connections and employees. At the same time, CNP, who had never had a long term grant and relied on private donations, had to fight to compete with organizations that came to Haiti after the quake who paid employees more and even tried to take CNP’s employees. CNP grew and grew very quickly and stuck to what they knew how to do – nutrition work. However, the subgrant funding from Save the Children is now ending and so CNP has to drastically scale back because alone, they can’t maintain the growth. Therefore, the valuable services offered by CNP will be cut back and people like me, have had their positions eliminated. During this time, CNP has done a good job at trying to keep Haitian employees, but it is difficult to at a time like this. I am not worried for myself, but sad for the many children our programs served because where are they going to go now?

While many of this is heartbreaking and disappointing, it is the reality of life here. It is time for us to stop imposing on Haitians what we think should be done and time for us to stop and listen to them and for them to stand up and voice their opinions and be empowered to rebuild their country (http://leoganais.com/2010/10/leoganais-fed-up-with-ngo%E2%80%99-ideas-of-reconstruction/). They do need our help, but they must lead and we have to take the time to listen.