Reports on Haiti’s Cholera Outbreak

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Reports on Haiti’s Cholera Outbreak. Below a series of recent articles on the recent cholera outbreak in Haiti (in chronological order from top to bottom)

Haiti’s first cholera epidemic in a century kills scores

The Guardian, Rory Carroll, 22 October 2010

Haiti’s first cholera epidemic in a century has swept a region north of the capital Port-au-Prince, killing dozens and overwhelming health services.

At least 142 people have died and more than 1,500 were stricken by diarrhoea, fever and vomiting in the worst public health crisis since the January earthquake. Authorities and aid agencies scrambled to contain the outbreak in the largely rural Artibonite region before it reached tent cities housing vulnerable quake survivors.

President René Préval said the virulent diarrhoeal disease that spread through the area this week  was what many had feared. “I can confirm it is cholera,” he told Reuters. Michel Thieren, a Pan American Health

Organisation doctor, said it was unclear whether the epidemic had peaked but that it was definitely not over.

Clinics in the most badly affected areas about 60 miles north of the capital were swamped by hundreds of people. “It’s very chaotic,” Terry Snow, of the Youth With a Mission, told CNN. “People are trying to figure out what to do. People are lost.”

At one hospital, Belismene Jean Baptist, 70, told reporters he fell sick after drinking public canal water. “I ran to the bathroom four times last night vomiting,” he said.

Hundreds of people were laid out in St Nicholas hospital in the town of Saint-Marc town, many with intravenous drips in their arms, until rain forced them inside.

Haiti’s health minister, Alex Larsen, announced emergency prevention measures. “This disease is very dangerous. It can kill in three hours because once the diarrhoea starts it doesn’t stop.”

Authorities worried the disease would spread to camps which house many of the estimated 1.5 million people left homeless by the 12 January quake. “The

concern is that it could go from one place to another place and affect more people,” Claude Surena, the head of Haiti’s Medical Association, told AP. No cases had been reported in Port-au-Prince.

Cholera is an intestinal infection caused by bacteria transmitted mainly through contaminated food or water. It causes rapid and severe dehydration which can kill within hours, especially if the person is very young, old or weak.

Artibonite largely escaped the quake, which killed about 300,000 people, but extreme poverty and an influx of survivors bred unsanitary conditions which contaminated rivers and other water sources with human faeces.

Haiti has not had cholera in over 100 years, Claire-Lise Chaignat, head of the World Health Organisation’s global task Force on cholera control, told reporters in Geneva. “The population is in a weakened state and the situation is serious.”

Until now the absence of such an outbreak was one of the few brights spots in an otherwise grim post-quake story of stalled aid and reconstruction.

Authorities urged people wash their hands, not to eat raw vegetables, to boil all food and drinking water, and to avoid bathing in and drinking from rivers. Cholera can be treated by drinking clean water mixed with salt and sugar.

Aid agencies dispatched medicine and clean water supplies to affected zones. “Teams are involved in treating patients and implementing necessary measures to prevent the outbreak from spreading,” said Médecins Sans Frontières.

— — —

Haiti cholera hospital is a horror scene

Source: AlertNet

Date: 22 Oct 2010

22 Oct 2010 10:54:00 GMT

Written by: David Darg

Reuters and AlertNet are not responsible for the content of this article or for any external internet sites. The views expressed are the author’s alone.

We woke to disturbing news on Thursday. Our friends at Partners in Health told us droves of people were arriving at St Marc, sick with diarrhea, and that they were dying from dehydration at an alarming rate. The question was clear, could we mobilize to provide clean water to an area suspected of having Haiti’s first major cholera outbreak in decades?

Our staff immediately began loading our trucks with equipment. As we drove the two hours to St Marc emails on my phone showed the death toll was climbing steadily. Everyone was nervous.

We arrived at St Marc hospital to a horror scene. I had to fight my way through the gate as a huge crowd of worried relatives stood outside, while others screamed for access as they carried dying relatives into the compound. The courtyard was lined with patients hooked up to intravenous (IV) drips. It had just rained and there were people lying on the ground on soggy sheets, half-soaked with feces.

Some children were screaming and writhing in agony, others were motionless with their eyes rolled back into their heads as doctors and nursing staff searched desperately for a vein to give them an IV. The hospital was overwhelmed, apparently caught out suddenly by one of the fastest killers there is.

Our friend, Cate Oswald, from Partners In Health came out from a triage tent clutching a hand-drawn map. It showed the local river and the names of a few communities where the patients had been coming from.

Cate and some of her colleagues led us into the countryside to find the source of the epidemic.

Soon we were heading down narrow dirt roads with rice paddies and canals on either side. The crisis had started the day before. Doctors realized it was getting serious during the night. By then the villagers had heard of the deaths and word spread quickly not to drink water from the river.

Most people had gone thirsty for hours. The roads were lined with villagers holding buckets, begging for water. Some larger groups had set up road blocks and our convoy was forced to stop and explain that we didn’t have water, only equipment to purify water, and that we were heading to the source of the problem. The villagers reluctantly let us pass.

People were constantly trying to flag us down and pointing to sick friends and relatives. One group forced us to stop – they had a girl close to death. PIH staff started her on an IV and placed her in their vehicle. Her mother, clutching another baby, explained that her husband had died yesterday and asked us to save her daughter.


We arrived at the place where many of the patients had originated from, a small dusty community called Babou La Port. Our team set up a water purification system, which filters and chlorinates, ensuring that any bacteria or diseases are killed.

As we worked, sick villagers of all ages congregated under the shade of some large trees. The medical staff placed IVs in some. One, a boy named Frantz, was brought to us by his grandmother. He was weak and vomiting. His grandmother was frail and could only point to the river when we asked her how long Frantz had been ill.

Diarrhea is unfortunately a common problem in this part of the world. A villager with cholera might lie down on feeling ill, expecting to get better, and be dead within hours.

Convoys of trucks plastered with the posters of various presidential candidates drove up and down the dirt roads. Many candidates saw this as an opportunity to campaign. They were tossing out small plastic bags of water to the desperate crowds. There were fights for the water and one man was crushed under a truck in the scuffle.

Our filtration unit fired up and word spread quickly. Soon a sea of multi-colored buckets surrounded us. There were no cheers and little laughter; most of the villagers were stunned, afraid and weak. They were just relieved to have water.

Some of our Haitian staff agreed to stay with the system overnight and keep it operating. It was a daunting challenge, to stay awake surrounded by deadly disease and desperate villagers.

Back at St Marc hospital not much had changed, other than the death toll. As I write, the confirmed toll is 135 and rising with thousands more infected. There are still patients being carried into the hospital close to death

Now however the cries of the mothers are louder and there are even more people at the gates desperate to hear news of their loved ones. The hospital is struggling to cope with such a sudden influx of patients, especially since it is still trying to recover from the January earthquake.

The scenes at St Marc reminded me of Haiti’s capital Port-au-Prince after the quake: patients lying in the streets, doctors struggling to cope, mass hysteria and fatigue.

On Thursday morning, as the scale of the problem began to emerge, my friend Dr Koji from Partners in Health shook my hand and said “Let’s stop this”. The only way to halt a disease like cholera is to stop people from getting infected. The hardest hit areas now have access to safe water, and thanks to people like Dr Koji the sick are receiving treatment.

— — —

Cholera outbreak spreads to Haiti capital

By Maura R. O’Connor

October 24, 2010 13:13

PORT-AU-PRINCE, Haiti (globalpost)— Once health officials detected the first cases of cholera in Haiti’s capital on Saturday, the Haitian government, the United Nations and humanitarian agencies began a race to thwart a potential pandemic from spreading within the city’s many tent camps and across the nation.

More than 200 people have died since the first known case was detected one week ago outside the Haitian capital, while 2,646 people have so far been infected, according to U.N. figures.

The outbreak comes less than one year after a massive earthquake struck the country, killing about 300,000 people.

Despite some reports Monday that the outbreak may be “stabilizing” residents in Port-au-Prince are preparing for the worst. The mood is tense, as rumors swirl that airports will be closed and borders shut down.

“People aren’t in a panic just yet,” said one resident. “But conversations in the street are more and more about cholera instead of soccer or politics, as they usually are.”

To make matters worse, the U.N.’s Office for the Coordination of Humanitarian Affairs confirmed today that they are investigating the first suspected cases of cholera in Haiti’s North and South regions.

Until Saturday, the epidemic appeared to be limited to the Central and Artibonite regions, where the Haitian government has declared a state of emergency.

“There’s a lot of rumors about suspected cases … The situation is changing by the hour,” said Imogen Wall, head of communications for the U.N. humanitarian agency. “We are planning for the worst-case scenario — a nationwide outbreak.”

The five people found to be infected with cholera in Port-au-Prince Saturday had traveled from the country’s Artibonite and Central regions.

It is the first cholera epidemic here in at least a century, which means there is a relatively low level of immunity to the bacterium among Haiti’s population. Many of the infected, in fact, are arriving at hospitals too late, some dying within a few hours of showing symptoms.

“People’s immunity to this disease is nonexistent,” Wall said. “The medical profession here has no experience with cholera, and it moves incredibly fast. It’s not a good combination of factors.”

St. Nicolas hospital in the town of St. Marc has been overwhelmed by more than a thousand cholera patients since Thursday. The hospital has been quarantined and 20 doctors, nurses, and logistical specialists from Médecins Sans Frontières have arrived to help.

Staff at St. Nicolas have been working around the clock and are exhausted,said Yolaine Surana, coordinator for the government’s Civil Protection Department. Other medical staff members were sent to the border of the Artibonite region on Thursday to try and grasp the spread of the disease in the region. Many are worried that the number of deaths is being underreported.

“We sent them to the top of the mountain, there is no road there,” said Surana, highlighting the difficulty of containing and treating an epidemic in the Haitian countryside which lacks even basic infrastructure. “We are crossing our fingers.”

In Port-au-Prince, five cholera treatment centers are being constructed in the event of a mass outbreak, and nongovernmental organizations are launching public information campaigns in the camps as well as distributing soap and chlorine.

Despite these efforts, there are no guarantees that the disease can be prevented from spreading into the crowded tent cities, where more than a million Haitian have been living in since a massive earthquake struck on Jan. 12, many without adequate sanitation or clean water.

“The level of sanitation in Haiti and in Port-au-Prince was not good even before [the quake],” said Melody Munz, environmental health coordinator with the International Rescue Committee. “The public messaging is absolutely critical. But people here are very frightened so they’re paying close attention.”

In recent weeks, human rights groups such as Refugees International have decried the condition of the camps, claiming that 70 percent of them are unmanaged because of a lack of coordination between the United Nations and other international humanitarian agencies.

Government officials now believe that the source of the outbreak is the Artibonite River, which runs across the middle of Haiti from the Dominican Republic into the Gulf of Gonave. Heavy rains in past weeks may have flooded the river with sewage, but it is not known why the bacterium has affected the country now after being nonexistent for so many decades.

“The awful thing about the outbreak is that it’s a total coincidence,” Wall said about the outbreak following so closely after the earthquake. “Cholera is not present across the Caribbean … But because of the earthquake response we have the supplies we need in country and the medical staff.”

Even as suspected cases appear to be spreading nationally, there is a faint sign of hope that the fatality rate in Artibonite may be dropping.

“The first couple of days was very high, about 9 percent,” said Munz. “Now it seems to be about 5 percent. The goal is to get it down to one and then have no new cases. It’s a question of time and our vigilance.”

— — —

Haiti cholera toll near 300, disease seen “settling”

Reuters, By Joseph Guyler Delva, Tue, Oct 26 2010

PORT-AU-PRINCE (Reuters) – Deaths from Haiti’s cholera epidemic approached 300 on Tuesday, and health experts said the illness would “settle” in the poor Caribbean nation, joining other endemic diseases like malaria and tuberculosis.

The week-old epidemic of the deadly diarrheal disease has so far mostly affected the central Artibonite and Central Plateau regions, with an accumulated 295 deaths and 3,612 cases registered to date, Haitian health authorities said.

Although the number of new deaths and cases has slowed slightly from earlier days, a United Nations-led international medical response is fighting to prevent the outbreak from penetrating Haiti’s capital Port-au-Prince, which is crowded with 1.3 million homeless survivors of a January 12 earthquake.

The epidemic has jolted the Western Hemisphere’s poorest nation with another crisis 9-1/2 months after the catastrophic quake that killed more than half a million people.

It also comes a little over a month before the country is due to hold presidential and legislative elections on November 28. Despite the disease outbreak, the polls were still set to go ahead as scheduled, Pierre-Louis Opont, the director general of Haiti’s provisional electoral council, told Reuters.

Announcing updated case figures at a news conference, the Haitian health ministry’s director of epidemiology Roc Magloire said that of five cases previously reported in the capital, only one had been confirmed by laboratory tests to be cholera.

Nevertheless, the U.N., the government, and its foreign aid partners are expecting the disease to spread further in its epidemic phase. They have launched a combined treatment, containment and prevention strategy for the whole country.

“The next news for us and for you is when geographically, new pockets of the epidemic … emerge, in Port-au-Prince or elsewhere,” Dr. Michel Thieren, the Pan American Health Organization’s (PAHO) top official in Haiti, told Reuters.

Suspected cases have been reported in Nord and Sud provinces, but are pending laboratory results.

Thieren said however a slight slowing in the rate of new deaths and cases was being observed in the main outbreak area of Artibonite, which he called encouraging and attributable in part to an aggressive multinational medical response.

With the epidemic reestablishing cholera in Haiti after a long absence, the disease would now become endemic, joining illnesses like malaria, tuberculosis and HIV AIDS which have been afflicting impoverished Haitians for years, Thieren said.

“It’s normal that we should expect a settlement of cholera in Haiti nationwide over the coming months,” he added. But it was hard to predict exactly how the epidemic would spread.


The U.N. has said a nationwide outbreak with tens of thousands of cases is still “a real possibility”.

The international humanitarian operation has rushed doctors, nurses and medicines to the rural central zone straddling the Artibonite River, the suspected source of the disease which is transmitted by contaminated water and food.

Special cholera treatment centers are being set up in the main outbreak zone, in Port-au-Prince and elsewhere, to isolate patients. A public education campaign is urging the country’s 10 million people to wash their hands regularly with soap, avoid eating raw vegetables, and boil food and drinking water.

If left untreated, cholera can kill in hours by dehydrating victims with severe diarrhea, but if caught early it can easily be treated with an oral rehydration solution — or a simple mixture of water, sugar and salt.

Health Minister Alex Larsen announced the government would train 30,000 health workers to join the anti-cholera campaign across the nation in the coming months.

PAHO, the regional office of the World Health Organization, has said there is a “high risk” of the cholera spreading across the border of the island of Hispaniola to Dominican Republic.

The border has not been formally closed but on Monday Dominican Republic authorities canceled the regular farm market normally held in the northern frontier town of Dajabon, and prevented hundreds of Haitians from crossing to attend it.

PAHO has also alerted other states in the Caribbean about the epidemic, the first of cholera in the Americas since a 1991 outbreak in Peru, and was seeking resources to fight it from members like Brazil, Cuba, the United States and Canada.

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