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.