Cholera and violence leave Haiti in a precarious position
washingtonpost.com

Wednesday, November 17, 2010; 6:39 PM

UTTERLY UNFORESEEN as recently as four weeks ago, cholera is now on a pace to kill as many as 5,000 to 20,000 Haitians in the coming year, and conceivably many more - a tragic follow-on to the devastation of January's catastrophic earthquake. There are growing fears that the widening epidemic, which follows despair at the slow pace of reconstruction, may provide the trigger to a wave of violence that has been feared in Haiti since the quake. International donors and agencies, which have already done so much to ease suffering in Haiti this year, must now once again respond urgently.

The disease is spreading rapidly from the central plains, where it was first detected last month, to the capital of Port-au-Prince and the country's northern and southern peninsulas. In just four weeks, at least 14,000 people are reported to have been infected and nearly 1,000 to have died from the disease. There's little doubt the actual tally is much higher, given the disease's foothold in Haiti's river system, the state of the country's public health system and the portion of the population living in remote areas.

Rumors that U.N. peacekeepers in Haiti were the original source of the cholera bacterium have sparked two days of rioting this week. The violence reflects the desperation of people traumatized by disaster, disappointed by failed promises of a Herculean rebuilding effort, and left rudderless by an ineffective, depleted and often invisible government.

With national elections for president and parliament scheduled for Nov. 28, this is an exceptionally volatile juncture in Haiti. In Port-au-Prince, international aid agencies are warning that already jam-packed hospitals may be forced to treat patients in the streets. Health experts expect the illness to spread across the border to the Dominican Republic. If ever there were a moment for the United States and other donor countries to show their concern, this is it.
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The United Nations has appealed for $164 million in emergency aid; as The Post's William Booth has reported, the country is short of soap, bleach, intravenous fluids, powdered rehydration solutions and health specialists trained to deal with the disease. In some cases, warehouses in the capital have plenty of supplies, but there is no efficient distribution system to get the life-saving goods to far-flung hamlets where the disease is now appearing.

An equal but longer-term priority is to improve Haiti's severely inadequate water systems, so that drinking water is not contaminated by sewage - a common method of cholera transmission. Fewer than half of Haitians are thought to have access to safe drinking water, and supplies were further degraded when Hurricane Tomas caused widespread flooding in the country earlier this month.

Medical trainers and public health specialists are scrambling to do what they can to prevent cholera deaths, and Haitian authorities backed by the United Nations are trying to maintain order. But without urgent help, those efforts on the ground will be swamped, and a bad situation in Haiti may easily become much worse.

UTTERLY UNFORESEEN Please, this is more like "Crónica de Una Muerte Anunciada" or A Death Foretold. Everyone worth their salt knew that unless relief efforts were geared up and put into fast operation, Haiti stood a significant chance of secondary crises. The rainy season and the Hurricane months were the first major hurdles. And they lack of movement on many fronts in the re-development effort compounded everything.

Anti-U.N. protests erupt in Haitian capital

From Ivan Watson, CNN

November 19, 2010 -- Updated 0010 GMT (0810 HKT)
STORY HIGHLIGHTS

* Demonstrators blame U.N. peacekeepers for the cholera outbreak
* Protests have been ongoing in the northern city of Cap-Haitien
* Aid agencies say the protests are hampering treatment

Port-Au-Prince, Haiti (CNN) -- Like cholera itself, Haiti's protests against the United Nations spread Thursday to the capital, Port-au-Prince, as angry people took to the streets demanding the global body get out of their country.

Similar demonstrations erupted earlier this week in the northern coastal city of Cap-Haitien after assertions that U.N. peacekeepers from Nepal were responsible for starting the cholera outbreak that has claimed more than 1,100 lives and spread to eight of the nation's 10 departments.

The United Nations has denied that its forces were responsible for the outbreak.

In Port-au-Prince on Thursday, a planned protest began peacefully in the center of the city but turned violent as it moved toward the presidential palace, with one woman overcome by tear gas, witnesses said.
Chart: Cholera in Haiti
Cholera 101: Disease facts
Cholera, violence spread across Haiti
Riots in Haiti over cholera source
RELATED TOPICS

* Haiti
* Cholera
* United Nations

At the central square, Champs de Mars Plaza, several hundred young men moving in a pack blocked traffic by setting fire to tires in the street and turning over Dumpsters.

Several threw rocks at a campaign poster for presidential candidate Jude Celestin, whose candidacy has been endorsed by outgoing president Rene Preval.

Others threw Molotov cocktails at the poster.

Some Haitians have said Celestin is a symbol of what is not working in the country, and that Preval's endorsement of him means the election -- set for November 28 -- will not be fair.

Near the presidential palace, which was destroyed in the January 12 earthquake that killed more than 200,000 people and left more than 1 million homeless, stores were closed and few cars were in the streets, though pedestrians were moving about freely.

A sprawling makeshift tent city that is home to thousands of people who lost their homes in the quake is located in the area.

"The Haitian government is never do nothing for us," said Pierre Aliodor, a protester who lives in the camp. "And we know the international government is still spending a lot of money for the Haitian people. But Preval, with his government, he still keeps their money to take back to the United States to buy some house."

Since the earthquake struck, neither he nor his wife had received any help from the government or from any of the many non-governmental organizations that are in Haiti, Aliodor said.

Aliodor called for elections to be delayed. "This is not election time," he said, adding that both Preval and the U.N. forces should depart, "because they are not good for the Haitian people."

In another part of town, dozens of Haitians -- most of them young and male -- attacked a government tractor that was being used to clear barricades blocking the streets.

In addition to the 1,110 reported deaths, another 18,382 people have been hospitalized with the disease, the health ministry reported. The hospital death rate was 4.0 percent, far above the none to 1.0 percent that infectious disease experts said they expect in developed countries.

In Washington, Mark Ward, the acting director of the Office of U.S. Foreign Disaster Assistance at the U.S. Agency for International Development, said U.S. authorities have "a lot of confidence" in the Haitian government's response to the outbreak.

The U.S. government strategy for aid in Haiti is to focus on prevention, he said, citing the need for clean drinking water, the addition of chlorine to the water supply, the ready availability of oral rehydration salts, education of the populace about how to protect themselves from getting the disease, and money to expand treatment centers.

"We're going to invest a lot of money in their health system in the next five years," said Thomas C. Adams, special coordinator for Haiti.

"Every hour that the efforts of medical and relief workers are obstructed means more deaths of Haitians from cholera," said Dr. Mirta Roses, director of the Pan American Health Organization (PAHO). "We understand the frustration of many Haitians with the tragic situation that has developed as a result of systemic poverty, the January earthquake and now the cholera epidemic. But relief and medical workers are as critical to saving lives as rescue teams were after the earthquake."

In Cap-Haitien, a cholera treatment center at the main stadium is being operated by Medecins Sans Frontieres, also known as Doctors without Borders. Before the recent unrest, the organization was planning to open another center in a different part of town, said Dr. Lea Guido, PAHO representative in Port-au-Prince. On Wednesday alone, the center took in 100 patients.

PAHO said the unrest had led it and other United Nations agencies to discontinue much of their work supporting cholera treatment centers, training health personnel, and delivering supplies to affected communities.

"The last shipment of medical supplies was delivered over the weekend, and we had to postpone distribution planned for Monday," said Guido. "The airport was closed, and many roads remain blocked. We have not been able to ship new supplies to the area at all this week."

Beginning Monday, residents of Cap-Haitien, which has been hard hit by the outbreak, began demonstrations against U.N. peacekeepers. The northern port city is in the North Department, the Haitian province that has the highest fatality rate from cholera, 7.5 percent.

"Experience shows that without access to health care, the rate could rise to as much as five times that figure," PAHO said in a statement.

Health workers at Hopital Universitaire, the city's main hospital, treated at least six patients with gunshot wounds. "MINUSTAH shot them," said a man pushing a wheelbarrow holding one of the wounded. He was referring to the U.N. forces in Haiti by their acronym.

At Cap-Haitien's Justinien Hospital, Dr. Wilton Cheruben told CNN that 37 people with bullet wounds had been treated between Monday and Wednesday night. The victims included a 9-year-old and a 14-year-old who were shot in the mouth; a 6-year-old was shot in the back and an 11-year-old was shot in the arm, he said.

"Right now, we don't have any anesthetics, and the people really need some help," he said.

In Cap-Haitien, PAHO staff members have been confined to their living quarters since Monday.

Roses said Thursday it was impossible to identify the origins of the epidemic in Haiti "with currently available data."

U.N. officials said logistical operations, including the supply of clean water and proper sanitation, were disrupted.

The U.N.'s World Food Programme reported that one of its warehouses had been looted and that food supplies were burned. The private charity Oxfam suspended water chlorination projects and other private charities pulled out of the Cap Haitien area.

U.N. staffers have suggested the violence is politically motivated and said it's especially troubling just ahead of Haiti's presidential elections.

Journalists Dmitri Foucard and Osman Jean Junior contributed to this story from Port-au-Prince

« St Michel de L' Atalaye: 25 Fatalities and 125 Overwhelming Clinic With One Nurse | Main

11/20/2010

Borgne: Distress Call to the HEAS

From an HEAS partner:

Just received word from Borgne, Haiti in the north that they are overwhelmed with cholera cases, including fatalities. It is a very remote region in the mountains and there is only a small community hospital backed by a small NGO that I usually work with, but I am presently in Port au Prince. They have no resources. They need cots, IV fluids, and ORS. They claim to have not much support. Can anyone help?

We are attempting to verify need and query for resources. It is likely this coastal town, as with many of the other northern coastal towns, is seeing patients coming in by foot from the mountains seriously ill. Upon arrival, they are often near-death.

11/20/2010

Current Map of Cholera-Affected Areas

We will adjust this map as more information becomes available.

Updates: Official stats, estimates of true case loads, updated map.

While the UN OCHA maps and official MSPP reporting tends to focus on Artibonite and points north, there are other areas routinely not included on the OCHA maps that have reported cholera. We opt on the side of "cholera until proven otherwise" or when political sensitivity is such that full disclosure and transparency allows.

Current official stats are more than 19,646 cases and 1,186 fatalities. This includes more than 1,800 cases in Port au Prince with over 30 fatalities.

* Conservative estimates therefore suggest nearly 80,000 cases of cholera in Haiti to-date, the majority of which were subclinical.

* In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%. In many areas of Haiti, we are documenting outbreaks that are not being accounted for in the official statistics. We therefore estimate the upper bound of estimated case counts to be nearly 300,000.

* Although PAHO projections use an attack rate of 2% of a total estimated Haiti population of 10 million to estimate 200,000 total clinically apparent infections, the true community load will be closer to 800,000 if subclinical infections are counted.

* We err on the side of over-estimating because this is a "virgin soil" epidemic and expected to aggressively spread throughout the country and across the border into the Dominican Republic.

* We are now pursuing answers to the question of uptake by indigenous zooplankton and spread along oceanic currents that pass west of the Gonave Gulf, which is where the Artibonite River discharges, north and west along the northern Cuban coastline and north to the waters east of Florida.

* Nov 18th was Vertieres Day, where we may see some degree of population mixing, particularly in the north. It is unclear at this time to what degree the recent violence will affect observance of the holiday. Holidays are opportunities to spread disease further as populations intermingle.

As noted by HEAS one week ago and yesterday officially acknowledged, cholera is in the Dominican Republic. We expect to see medical clinic inundations inside DR in the near future.

As expected, Florida has reported a case of cholera in a returned traveler. There will be more cases in the United States; we believe it likely more cases are inside the US unreported. Implications for the United States are neglible.

11/19/2010

PAHO Validates the Need for the HEAS

PAHO’s Dr. Sylvain Aldighieri...noted that current priorities are improved surveillance and risk assessment, with timely identification of “hot spots” triggering quick responses, good case management, logistics and supplies, and information and social communication to educate people on care.

Dr. Aldighieri said he was especially concerned about cholera in remote rural areas with difficult access, noting that estimates show one-third of community deaths from cholera are not being reported.

18 November 2010

Dr. Sylvain Aldighieri

Pan American Health Organization

Organization of American States

Washington, D.C.

Cholera 500m from the US Embassy: St Damien's

500 meters from the United States Embassy in Tabarre / Port au Prince is St Damien, a private Catholic hospital.

So far they've seen 200 cholera patients and 10 fatalities, most of whom were dead upon arrival.

They are prepared for more patients with 1000 total beds available.

They have asked for more body bags.

This, in addition to over 2000 patients seen in MSF's Port au Prince facilities, is further indication of the dire situation Port au Prince is in.

Haiti's cholera epidemic is no surprise, experts say
By JACQUELINE CHARLES

McClatchy Newspapers


CARL JUSTE
In Grande Saline, Haiti, Minerva Joseph, 14, knows the danger of cholera and the need to stay out of the Artibonite River. But “we don’t have any other water here,” she said.



GRAND SALINE, Haiti | Residents of this desolate fishing hamlet use the sea as a toilet and water from the filthy river for drinking. The sea and river merge at a stagnant crossing at the edge of the village, where many now worry about the deadly cholera epidemic sweeping the country.

But fear of the disease came too late for Feconne D’Ayiti, 7. He died hours after drinking untreated river water, said his father, Fecky D’Ayiti.

“He began vomiting. He had diarrhea,” said D’Ayiti, 26, a fisherman.

D’Ayiti is certain that cholera killed his son.

In a matter of weeks, the disease has killed more than 1,000 people, hospitalized about 17,000 with cholera-like symptoms, and prompted violent protests against international peacekeepers — whom residents accuse of importing the illness from South Asia.

The arrival of cholera in Haiti was not a surprise, observers said. The Jan. 12 earthquake that left a government-estimated 300,000 dead and at least 1.5 million living in precarious tents and tarps — mostly in the shattered capital Port-au-Prince — merely shed the spotlight on long-known issues exacerbated by decades of bad governance and international Band-Aid solutions.

“It has always been a mystery for everyone who always wondered, ‘How is it that cholera never entered Haiti?’ We have all of the conditions here for it to have existed,” Evelyn Ancion Degraff of the World Health Organization said this week during a nationwide cholera broadcast. “It’s all a question about sanitary and personal hygiene.”

Not entirely, said humanitarian aid workers, who argued that what Haiti needed was a “global water policy.”

“Even before the earthquake, areas of the country lacked access to clean, drinkable water,” said Stefano Zannini, Doctors Without Borders head of mission in Haiti. “Now the problem is worse because of the epidemic. Clean water is key to preventing cholera.”

Water.org, a Kansas City-based organization working to provide safe drinking water in developing countries, has a project under way in Pignon. It is close to Artibonite, the area where cholera first appeared.

April Davies of Water.org, who has visited Haiti, said drinking water sources there varied greatly from place to place. Some areas had wells. In other places, people relied on rainwater collected in cisterns.

Even in cities, many people lack access to public water systems. People buy water at kiosks or from trucks.

“In Port-au-Prince it’s a big business. People pay a lot for small quantities,” Davies said.

Haiti also lacks adequate sewage treatment facilities.

“The large majority of people, their waste goes untreated,” Davies said.

In some parts of Port-au-Prince, sewage runs through open ditches and canals into the ocean. At some tent cities, waste is hauled out by trucks that take it to the city dump.

In other countries with conditions similar to those in Haiti, cholera never completely goes away, Davies said. To contain the outbreak, education is important, she said.

Some residents in Grand Saline, where the Artibonite River empties into the Gulf of Gonave, feel anger and abandonment. Cholera first hit hardest here, contributing to 595 deaths and an additional 9,694 hospitalizations in the Artibonite area.

“We’ve never had an honest person here do anything for us,” said Ybsen Dastino, 28.

Cholera arrived here after breaking out in the Central Plateau.

Residents drink the water from the brackish river. They bathe, wash, fish in it — and until recently drank from it.

“Of course I am afraid. People are dying,” Sherline Bayard, a mother of three teenagers, said as she washed in the Artibonite River, which epidemiologists say is spreading the waterborne-infection.

“We don’t have anything else,” she said. “The river is all we have.”

Humanitarian workers recently installed a water-filtration system next to the shore, not far from the fishing boats that before cholera provided for a measly living. They also handed out water-purification tablets. A government campaign on cholera prevention is being heard, with children able to recite the message by heart.

But aid workers said they were a temporary fix to a much deeper problem that plagued not just rural communities, such as this one on northwest Haiti’s coastline, but scores of others, including urban slums.

Water in Haiti has become a luxury. Only 40 percent of the population, according to official government estimates, have access to safe drinking water through homes or distribution points.

“We can treat water. But we need strong municipal water systems,” said Paul Farmer, founder of Partners in Health, the aid group that helped get the filtration system to Grande Saline. “What Haiti needs is water security, just like every country.”

Two years ago, Farmer’s humanitarian group and others issued a report accusing the U.S. government of blocking millions of dollars in loans by the Inter-American Development Bank to provide access to safe drinking water in communities.

In Haiti, where a large number of children younger than 5 die of diarrhea from drinking dirty water, the report showed the devastating consequences that the lack of clean and safe water had on the population.

President Rene Preval has called for a coordinated and organized response to fighting the epidemic. Observers said the symptoms — not the cause of the problem — were being treated.

In Grande Saline, the cases of infection were diminishing, health officials said, but the danger remained.

Minerva Joseph, 14, knows the danger all too well — at least three of her friends have been lost to the disease.

“You have to bathe in the river,” she said. “We don’t have any other water here.”

The Star’s Alan Bavley and The New York Times contributed to this report.


Read more: http://www.kansascity.com/2010/11/19/2454164/haitis-cholera-hit-is-no-surprise.html#ixzz15qr6AhuZ

Analysis: Whodunnit? Officials have sticky problem in Haiti


By Maggie Fox, Health and Science Editor

WASHINGTON | Thu Nov 18, 2010 6:09pm EST

WASHINGTON (Reuters) - DNA fingerprinting has confirmed what health experts have suspected -- the cholera epidemic that has killed more than 1,100 people in Haiti came from one single source. But little immediate good can come from tracking down that source.

Rumors had been circulating for weeks that Nepalese troops with the United Nations mission brought the cholera to Haiti, which, despite having many other health problems, did not have cholera.

Health officials deny this and say checks show no evidence that one of the Nepalese soldiers carried the infection.

But it has to have come from somewhere and at the height of the humanitarian effort after January's devastating earthquake, an estimated 10,000 different non-governmental organizations were sending people and supplies into the Caribbean island nation.

Cholera broke out in Haiti's breadbasket Artibonite Department a month ago and despite efforts to control it, has spread to infect more than 18,000 people.

It perfectly illustrates the classic public health warning -- any disease can be carried anywhere in the world in just hours, and without good sanitation or a good public health infrastructure, can spread like wildfire.

And in the case of cholera in Haiti, it is likely to become a longtime, if not permanent, resident.

The U.S. Centers for Disease Control and Prevention and the Pan-American Health Organization have analyzed samples of Vibrio cholerae from several patients and they are all identical.

SINGLE SOURCE SUSPECTED

This suggests it entered Haiti in a single "event" -- not necessarily an infected person, but possibly. People often can carry cholera with no symptoms and in a country with chlorinated water and good sewage, the bacteria in their waste quickly get destroyed.

Other potential sources include imported food, especially seafood, or a boat or ship's bilge water. With tons of aid pouring into Haiti for months, it may be impossible to track down who or what carried it in.

Public health officials will try. They want to prevent such outbreaks in the future and finding the culprit will help experts come up with ways to prevent it from happening.

But what if it does turn out that a U.N. trooper carried it in? Riots already going on in Cap-Haitien and protests in Port-au-Prince [ID:nN18144494] could worsen and other countries may be reluctant to accept U.N. aid when they need it the most.

And what if health experts are unable to find the source? Will anyone believe them, or will suspicious residents call it a cover-up -- and resist public health advice that could help stem the epidemic?

If some other aid organization turns out to be the source, again, not only could Haitians resist more help, but other countries may become warier of letting these non-governmental organizations help in the case of disasters.

Ricardolito......where are you.....