Wednesday, 17 November 2010

Lead role by Cuban doctors in containing Haiti Cholera

What's Happening in Haiti?
by Emiliano Mariscal, 4 November 2010
(Argentine doctor, Graduate of [ELAM] the Latin American School of Medicine (Cuba) and member of the Cuban medical brigade in Haiti.)

Sources: Ezili Danto, Spanish original on ALBA-TCP website.
Translation: by Norman Girvan.

To my friends and family,

These lines are meant to provide information on the health situation in Haiti, as a result of the concern of many friends who have written asking about conditions here.

The first thing I can say is that we have a disease--cholera-- which has not been reported in this country for over 100 years. Secondly, that it is one of the most dreaded diseases here, given the ideal conditions that exist for its persistence and spread.

Briefly, my first experience of the disease was this: two days before its presence in Haiti was confirmed; we accompanied an epidemiologist, a microbiologist and an entomologist to Mirebalais, a community in the Centre Department; where the Cuban medical brigade stationed at a hospital had reported an outbreak of diarrhea of such unusual severity that it had already killed three people.

During the tour of the community we frequently had occasion to recall the work of Dr. John Snow, the forerunner of modern epidemiology, because when we visited the locations from which the deceased originated they all had a common element: proximity to the River.

People have no piped water supply, so they obtain water from the river; whether for drinking, washing utensils, personal hygiene, etc. Another common element is the absence of latrines, so it is usual for them to relieve themselves outdoors.

We also observed overcrowding, extremely poor housing conditions, small garbage dumps scattered throughout, malnutrition, a low educational level, helplessness and resignation. Patients admitted to hospital had watery diarrhea, whitish, accompanied by profuse vomiting, the most severe cases arrived with dehydration with three deaths.

Water samples were taken, feces, and vomit by the authorities of the Ministry of Health of Haiti. Our conclusion: the source of infection is contaminated water; by reason of clinical characteristics indicating an extremely aggressive bacteria that is spread by water, the existence of environmental conditions for its persistence and spread, an incubation period of around 24 hours, and the fact that in the space of a few hours it can result in complications, which, if untreated, can cause premature death.

Cholera having been absent for one hundred years, we could not be sure that this was what we were dealing with until there was laboratory confirmation. The report was turned over to Haitian authorities and the next day, the outbreak occurred in Saint Marc. Soon after came the confirmation that this is indeed a Vibrio cholerae.

16 days have elapsed from the beginning of the epidemic to date Haitian authorities have reported 330 deaths and approximately 4,600 inpatients.

There are several international institutions such as PAHO and the CDC, who are advising the Haitian Ministry of Health, but the lead role, although you don’t hear about it in the mass media, is played by Cuba in close coordination with the health institution in Haiti [1]. The reality is that the action of the Cuban Medical Brigade has contained the epidemic and delayed its spread of the epidemic to Port au Prince (which is the most feared, as there are 1 500 000 people living in settlements there in extremely precarious conditions).

The town of Arcahaie (part of the Department West) leads directly to Artibonite (and especially to Saint Marc), where our brigade provides medical care in two institutions (as part of the strategy for reconstruction and strengthening of the health care system developed together with Ministry of Health of Haiti) which have been turned into Cholera Care Centers. Up to October 30 the two institutions had treated 1,182 patients, confirming at the same time, the presence of transmission in the sub-communities of Arcahaie, finding in them the conditions described in the first focus control area in Mirebalais.

You don’t need to be a health specialist to work out that if the 1,182 patients had not been referred to these centers, they would have sought assistance in Port au Prince; and that's exactly the way the epidemic spreads (described extensively in the literature), when sick people come in search of health institutions and others who are not yet sick, but are in the incubation period, move away from the place for fear of contracting the disease. As a result many people would have moved to Port au Prince where there are no conditions to contain the influx of sick people.

The fundamental tasks are to carry out health education and to provide safe sources of water supply for the population. Both elements are difficult to achieve, the first because it is difficult to change long ingrained habits in the population; the second, because although there are resources (grants), establishing the organizational capacities needed to bring it about is a complex matter.

The work is going forward. The Cuban Medical Brigade is ready to continue contributing to the fight against this terrible epidemic together with the Haitian authorities. Their presence in the community through health education activities linked with community leaders and Cholera care centres are high expressions of the principles of solidarity and internationalism.

Fifty-one young graduates of the Latin American School of Medicine are now in the forefront of this hard battle, working arm in arm as one with their Cuban brothers and teachers. The others continue working in positions throughout the country, many of them ready to go to the front line as necessary.

The prospect is that the disease will remain in the country for several years, with outbreaks happening as water sources are polluted.

A hurricane is now approaching, which is forecast to reach Haiti today. No doubt this will aggravate the situation, providing conditions for the further spread of the disease to places where it had not reached. There are also areas of high flood risk.

Cuba has been here for 12 years; since the earthquake the commitment is to rebuild and strengthen the health care system, Cuba will be here during the cholera epidemic and in the wake of the Hurricane. Just ask any citizen of this country about the Cuban doctors and you will see their faces blossom.

Proud to be part of another page of the many pages of Cuban internationalism; proud to be a member of the Cuban Medical Brigade; proud to be a child of the Americas, committed above all to my homeland that is Latin America and to my compatriots who are the children of this soil.

[1] Translator’s note: it is not clear if this refers to the Haitian Ministry of Health. The Spanish reads “la institución sanitaria de Haiti”