Access to hospitals and clean water are major challenges to controlling cholera outbreak

	Treating patients in the courtyard of the hospital in St. Marc. Photo courtesy of David Darg, Operation Blessing International.

With thousands of suspected cases and hundreds of reported deaths, the Lower Artibonite region of Haiti is facing a full-blown cholera epidemic. Beginning last week, a daily high volume of patients has been arriving at PIH health facilities in the outbreak areas, reported Partners In Health Chief of Mission in Haiti Louise Ivers from Port-au-Prince on Monday morning.

In partnership with Haiti’s Ministry of Public Health and Population (MHPP), PIH operates three hospitals in the area hit hardest by the outbreak. These hospitals, which serve the communities of St. Marc, Verrettes, and Petite Riviere, report improving situations due to more effective infection control and efficient triage, with technical assistance from MSF-Spain and MSF-Belgium. The hospital at St. Marc has been triaging an average of 600 new patients each day, and has a regular load of about 250-300 hospitalized cholera patients.

Access to medical facilities and clean water remain major concerns, particularly in isolated rural areas, said Dr. Ivers. Over the weekend, PIH was able to get 14 water trucks to some of the communities most in need, thanks to a partnership with the non-profit organization Yele Haiti. In addition, water purification tablets and oral rehydration salts have been widely distributed throughout the region. However, there are still many communities in the outbreak region whose only water source is the contaminated Artibonite river or rain water.

Complicating matters, on top of a need for clean water for general consumption, cholera patients need a particularly high volume of fluids—about 20 liters daily for each patient, said Dr. Ivers. As having access to this volume is virtually impossible in many areas, PIH is urging all suspected cases (anyone with diarrhea) to seek immediate treatment at a hospital.

But access to medical facilities is also a challenge: communities in the Artibonite are widely spread out, and even the nearest hospital can be hours away by foot, horse, or car. 

To reach out to remote villages, PIH is sponsoring regular radio announcements at stations throughout the region. In addition, thousands of PIH community health workers and social workers have been mobilized and deployed to find suspected cholera cases and educate their communities about the importance of washing their hands regularly and drinking only clean or purified water. They have also been supplied with soap, water purification tablets and oral rehydration salts to distribute. Additional training materials for community health workers are being finalized. Topics include preventing transmission and disinfecting the homes of cholera patients.

	One of the settlement camps in Port-au-Prince served by a PIH clinic.

Although the outbreak remains concentrated in the Lower Artibonite region of Haiti, the fluid nature of Haitian society – regular travel from capital city to the country side to visit markets, etc. – makes it inevitable that there will be some cases of cholera in Port-au-Prince, said PIH Chief Medical Officer Dr. Joia Mukherjee. Five cases have already been reported in the city, and all five appear to be people who had traveled there from the infected rural areas. Conditions of overcrowding and extreme poverty could facilitate a widespread epidemic unless urgent and effective action is taken to provide access to clean water and sanitation, added Dr. Mukherjee.  The 1.2 million displaced people who have been living in settlement camps in and around Port-au-Prince since the January 12 earthquake are particularly vulnerable. PIH clinics in the capital city, which serve four of the camps, are carrying out intensive education and prevention campaigns with residents and are making preparations to manage and control any outbreaks that might occur.

Cases of cholera have been reported as far east as PIH’s health center in Lacolline, which is currently treating 25-30 sick prison inmates. As the prison facility is woefully overcrowded—300 prisoners in a space built for 80—PIH is working to set up a space to evacuate the remaining prisoners. Five deaths have been reported among the prisoners.

There have been no cases reported at other health facilities operated by PIH in the Central Plateau region north of Lacolline.