Cholera battle continues in rural Haiti
By Jennifer Browning
Marie Maude Pierre arrived at the Cholera Treatment Center (CTC) in Mirebalias at 2 a.m. on a Thursday with her 19 month old daugher, Daphta.
Pierre said Daphta’s diarrhea started Wednesday morning, but seemed to get better during the day after she coerced her daughter to drink the Oral Rehydration Solution (ORS) she had for emergencies just like this.
“At first I wasn’t really worried because I had ORS at home, so I mixed it with treated water,” Pierre said. “She wouldn’t drink it at first, but I finally got her to drink it.”
But during the evening, Daphta refused to drink the ORS and her symptoms worsened so Pierre, who lives in Grand Boucon, began the long walk to the CTC in Mirebalais so Daphta could receive treatment.
Pierre learned about cholera back in October. While shopping at the market, she received a text message on her phone from Digicel telling her there was a cholera outbreak along the Artibonite nearby. The text also explained what cholera was and what needed to be done to prevent and treat it.
“When I came home from the market, everyone was talking about cholera and how it was spreading very quickly and that a lot of people were infected already.”
After talking to people in the community, Pierre’s husband heard health agents were distributing aqua tabs and ORS nearby in Saut d’Eau.
After receiving treatment for over ten hours Daphta is already showing signs of progress.
“When we got here, they gave her the IV and now she is already looking better,” Pierre said. “Now she is willing to sit up and she is even smiling.”
When Aciane Devoinsin returned from the market, her older daughter told her that 2-year old Yusmie had diarrhea, by the middle of the night the vomiting began.
“I could tell that she was very tired and I worried that she wasn’t able to keep any fluids down,” Devoinsin said. “So I found a ride to come here.”
Even though Mirebalais is the closest CTC, it took Devoinsin two hours to get her daughter to the CTC from her village of Sarazin, near Las Cahobas.
“When we arrived the doctors put the IV in immediately. Yusmie was so weak when we got here, but now I can tell she is feeling better,” she said. “She wanted to play this morning. I am happy that at least my daughter is starting to feel better, and I am so thankful that there are people here who can help her.”
Both women said that they are taking precautions at home to treat all of the water before they use it for drinking or cooking, but it is difficult when a toddler is involved.
“I try to watch her and keep her hands clean,” Devoinsin said. “But she plays on the dirt floor, on the ground and I can’t carry her all day. I still continue to use the aqua tabs that were given to our family and everyone else has stayed healthy.”
Looking inside the acute care tent at the CTC operated in partnership by Project Medishare and Partners in Health, one might think that cholera is no longer an issue in Haiti. Mirebalais CTC administrator Almeus Techelet said until December the CTC was completely full.
“We had to double our capacity in order to treat everyone who came through the door,” Techelet said. “In January the flow of patients has lowered, and while we have less patients, we still have several people arrive each day with cholera.”
Techelet says the decrease in patients is due to education and prevention campaigns that were launched when cholera was discovered in October.
“People are more cautious now and they have learned to how to prevent getting cholera,” Techelet said. “This is why the patient flow has gone down. People now are taking more precautions about the water they use and drink, what they eat. They are more careful about preparing their food and also washing their hands.”
Dr. David Walton, the deputy chief of missions for Partners in Health, said the decreasing number of patients seen at the Mirebalais CTC is deceiving.
“It’s tricky because if you look right here at this cholera treatment center you would be deceived to think that cholera is getting better, but if you take a look at the places in the south there are reports of hundreds of people dying in the mountain sides and even in other cholera treatment centers and cholera treatment units,” Dr. Walton said. “This being one of the places where the epidemic started, we have sort of stabilized, but in many parts of the country they are just hitting that peak of cholera ravaging the countryside.”
In addition to more people following precautions, Dr. Walton said today more people are catching the disease earlier, which makes it easier for doctors to treat.
“Another thing we are seeing is a lot of people are coming earlier in the disease, so they get a little diarrhea and upset stomach and they get here well before they have the chance to develop severe cholera and severe dehydration,” he said. “So we are seeing people not necessarily in shock but a little bit earlier, which is good because it helps us resuscitate them. “
Dr. Walton explained that cholera hit St. Marc and Mirebalais the hardest first, so now these two places are stabilizing. And while the results at Mirebalais are positive, he said that doesn’t mean cholera is over in Haiti.
“It has been positive. You look at places like here…people live up there in the tops of those mountains. People live all over in there. You can’t see their houses from here but they are up there. How do you get the message to people up there? You have to get out, get to them and get the message to the people,” he said. “I think it has been really positive, but it’s only as effective as our ability to get those tools to the people.”
Together Project Medishare and PIH have been pushing a community-based initiative to educate the population about cholera and how to prevent it by washing hands, drinking treated water and disposing waste correctly. However, the reality of the sanitation situation in Haiti makes it difficult to meet what may seem simple criteria.
“If they don’t have latrines and they don’t have chlorination tabs and they don’t have access to clean water, then telling them all of these things falls on receptive ears but deaf ears none-the-less because they can’t implement the changes,” he said. “So it is really a question of education plus implementation of getting those things to the people so they can effectuate the change we are asking them to make.”
“Cholera is here to stay. Right now we are in the epidemic phase right now but it goes from an epidemic phase to an endemic phase much like TB is endemic, HIV is endemic and again because 70 percent don’t have access to clean water and 60-70 percent don’t even have a pit latrine to use the bathroom and unless you address that cholera is going to be here for a long, long time.”
Techelet said that the partnership with Project Medishare and PIH is essential for the CTC’s success.
“I thank Project Medishare because Medishare is paying the doctors and staff here and gave us the tents, material and other support,” Techelet said. “Their contribution is really important for the success of what we are doing here.”
Dr. Walton agreed that the partnership between the two organizations is important also because both are working with Haiti’s Ministry of Health.
“If you look at Haiti and the number of NGOs that work in Haiti, most of those NGOs are working independent of each other and working independent of the Ministry of Health,” he said. “One of the things about Partners in Health and Project Medishare is that we are working together, and there needs to be much more of that.”
He said such coordination helps not only accomplish the goals regarding healthcare in Haiti, but also accomplishes the goals of the Ministry of Health.
“There needs to be coordination, both with each other to have a synergistic effect in this case on healthcare and cholera, but also just the approach in how we accomplish our goals and those goals of the ministry,” he said. “We are not here to accomplish our own agenda, we are here to do essentially what the Ministry would have us do. Our goals are the same, but we are not operating in a vaccum. This is not our country and we are not elected by the people of Haiti to come here and work. So Medishare and PIH working to operate this CTC is a perfect example of how I think these collaborations should take place.”
He said such collaborations have helped the CTC in Mirebalais be a success.
“It’s about coming together, sitting down, and figuring out how we can pull our resources…how we can be implementers of a strategy that is both formed by us but is influenced by the Ministry to fight cholera. And I think the results are clear. It is one of the best CTCs in the country.”