Arming hundreds of community health workers to fight cholera

By Kate Thanel, PIH Haiti Curriculum and Training Specialist

Mikwob pa ka touye ayisyen. Sak pou ta touye ayisyen fok li ta  gwose yon kay.  Se yon kamyon ki pou ta pote l’.
Germs can’t kill a Hatian. To kill a Haitian, a germ would have to be as big as a house. You would need a semi-truck to transport such a germ.
          -Haitian Proverb

	Community health workers at a special training on treating and preventing cholera in their villages.
	Training participants practice using readily available materials to measure ingredients for Oral Rehydration Solution.

“Can germs kill a Haitian?” asks a facilitator at a recent training for community health workers in Haiti. A wavering “No” comes from the participants. “But haven’t we seen cholera killing Haitians?” the facilitator persists. “Yes,” comes the answer. “Cholera is color blind,” he continues. “Epidemics across the world have affected people regardless of their nationality or strong stomachs. That is why it is so important for us to learn about prevention.”
 
The session is one of many trainings that are being carried out by PIH’s Haitian sister organization, Zanmi Lasante (ZL) at sites across the Artibonite and Central Plateau regions of Haiti. The trainings are part of ZL’s efforts to slow the spread of the cholera epidemic through widespread community education on basic sanitation measures. The trainings are providing hundreds of community health workers (CHWs) with techniques for health promotion and community education, specifically focusing on sharing vital cholera prevention messages with their communities. Following the training, CHWS will have the tools they need to organize educational demonstrations in their neighborhoods on topics such as hand washing.
 
In addition to community outreach, the training participants learn to identify cases and to refer them to the Cholera Treatment Centers (CTCs), which are being set up near ZL facilities at many of our sites.  The training also lets CHWs practice preparing Oral Rehydration Solution (ORS). Because many cholera victims live in remote areas, receiving ORS from their local CHWs will help keep them hydrated as they seek medical care, which may mean traveling hours to reach a health center by foot, or by boat where the roads have been washed out. Without this support, many of these patients would not make it to a CTC.  In addition to ORS, the CHWs will also distribute water purification materials to those most in need. The training also stresses preventive measures such as hand washing and water purification, and provides techniques for sharing these at a community level.  Participants also learn basic guidelines for managing human waste and disposing of contaminated materials in areas that lack basic resources such as latrines.
 
ZL teams have been working diligently to respond to the sudden crisis, and to ensure that CHWs are well equipped to address outbreaks in their communities. Working through the night on Monday a week ago, the psychosocial team compiled relevant information on the epidemic into a comprehensive presentation, as the training team worked on a trainers guide to address specific health promotion needs.  ZL’s history of investing in a comprehensive training program facilitated these teams’ ability to hit the ground running in the rapid development and implementation of trainings that commenced the very next day.  ZL staff is working double time coordinating efforts and providing training support for our partners, doing whatever it takes to ensure that the needs of the most vulnerable communities are met.