Haiti

=Cholera In Haiti =

﻿Written by Jacquelyn Pearlmutter
**What is Cholera?** Cholera is a serious disease that is infectious and is caused by Vibrio Cholera bacteria. It affects the intestinal system of the body. Someone who is infected with this disease experiences severe vomiting, diarrhea, and severe dehydration.
 * Background on Cholera: **

**Result of Cholera:** Without medical treatment, people infected with Cholera can result in death within four to twelve hours after the symptoms begin.

**How is it spread?** Cholera is contagious and is spread through human contact. Some people are infected by Cholera by eating undercooked meat and shellfish.

**Treatment:** Cholera can be treated with fluids and antibiotics. In some poorer areas, where antibiotics are not available for everyone, a mixture of water and glucose for dehydration is helpful. Cholera can sometimes resolve itself after a period of time.

**Dangers of Cholera?** The dangers of Cholera are that it spreads easily among a group of people. This is because people experience human contact on a day to day basis. Another danger is that Cholera causes extreme dehydration and in areas where water is not a surplus liquid, many people can not get enough water and die.

**Where is this disease common?** Cholera is common in unsanitary living conditions because of the poverty and lack of resources, like water. Cholera is not common in developed countries because of the medical treatment that is available, regulated health standards, clean/sanitary water, and the fact that developed countries have effective sewage systems. [|facts on cholera]

This is a diagram of what Cholera does when it enters a body and it also says what affects Cholera brings.


 * Cholera in Haiti: ** Cholera has recently spread to Haiti harming the majority of the population there. With the heartbreaking 2010 earthquake in Haiti, many Haitians still do not have homes and are living on the streets. These people are exposed to bad health conditions because of the unsanitary conditions they live in. The reason why the spreading of Cholera has been hard to stop is because of the vast number of people in Haiti who don't receive clean water and are not able to take care of their hygiene and health. This disease has now spread to Port-au-prince, the Capital of Haiti.

This first photo shows Haitians crowded in a room. Some of them are receiving treatment and others are waiting for treatment. By looking at this photo it is clear that the people look dehydrated and very sick.

In the next photo, a girl is lying on a bench hooked up to an iv. She is receiving treatment. From both of these photos, it is clear that the hospitals in Haiti are unable to treat the number of people with Cholera, so many people have to crowd in rooms or receive treatment outside of hospitals. This third photograph shows two younger girls who are hooked up to IV's. It is sad to see so many pictures with younger kids who have this disease.

As of November 19, 2010, the Cholera Epidemic has killed more then 1,100 people and hospitalized and sickened thousands of other Haitians. This disease was first found in Haiti in October and it has already threatened and hurt many people. Haiti is struggling to help everyone with this disease. [|Cholera] seventy-five thousand and eight hundred eighty-eight people have been affected with this fatal disease. Of this seventy-five thousand and eight hundred eighty-eight people, three-thousand four-hundred eighty-five people were hospitalized. Thirty- two thousand and two hundred eighty-three recovered from this disease because of treatments and were sent home. In the Northern province of Artibonite seven-hundred and sixty people were killed. This was the hardest hit because more people were killed in the Northern Province then in other areas. Following that province is Nord who had two-hundred and ninety deaths. Then in Ouest two-hundred and eighty-five people died and in the Haitian Capital one-hundred sixty-two have died. Lastly Plateau Central had one-hundred seventy-seven deaths. The one place that has not had a single Cholera death is Nippes. This is as of November 29. [|fox news]
 * Affects of Cholera in Haiti: ﻿ **

Port-Au-Prince has camps that have been set up to help these people who have been infected with this disease. Some of these camps are holding hundreds of thousands of people. The reason why these camps have to hold so many people is because after the 2010 drastic Earthquake in Haiti, many families are still homeless. Hospitals in Haiti have also experienced over crowing, so this one of the reasons why tents are being set up. In addition aid workers are traveling to Haiti to help control this situation and help those who are sick. Hospital manager, Francoise Gyron,e told The Associated Press, "In this hospital, because of space constraints, we have to make sure that people can be sent to another place where we can provide better care very fast, so that we can still receive patients." The Haitian President Rene Preval, in order to help this situation, has brought a number of speakers in a sunday meeting on November 28 to strive for citizens to practice good hygiene and proper cooking methods. This could be helpful because one of the reasons why this disease has been hard to stop is because of the number of people who do not clean themselves and have little to eat. But this teaching may also not be helpful because many people are still homeless and unable to access clean water and reliable sanitation. In addition when people went around trying to teach hygiene, many of the Haitians said, "Let me have some soap, I cant afford it." [|fox news]
 * Help in Haiti: **

media type="youtube" key="40GEQqWMKIs?fs=1" height="385" width="640" This is a video showing and talking about the over crowding that these Hospitals and tents are receiving. This video also shows the dire conditions that these Haitians are surround by. It talks the help that they are receiving and what they need to do to help the over crowding situation. It is scary that so many Haitians don't know if they have the disease and it is also scary that some Haitians are unable to receive help.

[|news]

This photo depicts a woman who is dying from Cholera. Her skin is really dry and she looks hungry and thirsty. It is very sad to see this photo because it is only one person out of all the Haitians who are affected with this disease. This woman is receiving treatment for this disease, but not everyone is being immediately treated. Because not everyone is being immediately treated this disease is being further spread among the Haitians and is causing more and more fear.


 * I interviewed a Tufts Medical Student about the issue in Haiti because she has recently traveled to Haiti and first hand experienced and treated patients affected by the Cholera Epidemic. This is our interview-**

** Do you think that this Cholera outbreak will end anytime soon, or do you think it is going to keep spreading? **  Unfortunately I don't think that Cholera will end anytime soon. I think that we will continue to see a residual amount of Cholera in Haiti for at least the next 10-20 years. There will be times when morbidity and mortality (illness and death) are high due to the natural disease which is associated with fluctuating outbreaks. There will also be times when the disease is relatively silent, hiding out in the more rural communities that lack basic medical care and the capability of diagnosing the condition as cholera. Additionally, I think that the Domincan Republic will soon see their first case of Cholera and will similarly be affected by the disease. Hispaniola is a relatively small island with limited isolation between the two countries, both of whom suffer from a similar breakdown of public health infrastructure that allows for the spread of cholera in the first place.

** Why is this disease so hard to stop? Why do you think it spread to Haiti in the first place? **  Cholera is transmitted via fecal oral route, meaning ingesting stool particles from a person who is sick with cholera. The disease is relatively easy to treat in resource rich health care settings. The most important treatment is rehydration of the patient who is sick and can be losing up to 15 liters of fluid a day. I attached a photo of a cholera patient surrounded by bottles of waters showing how much hydration is needed to keep the patients alive. You can imagine how tough it is to provide this much fluid in resource poor settings like Haiti. (this is the picture that is being talked about above)

 Cholera is easily controlled in countries that regulate sewage disposal and provide access to clean water. Sick individuals who use rivers and streams to go to the bathroom contaminate the water that is often used by others in the village for drinking, cooking, and washing. This is one way cholera is transmitted from one host to many others. Vibrio cholerae, or the cholera bacteria making people sick, is killed by chlorinating water sources. Therefore the solution to eradicating the spread of this disease- clean water sources- is not a novel one specific to cholera. Establishing public health infrastructure to provide sanitation efforts would significantly decrease the spread of cholera, as well as many other <span class="yshortcuts" style="line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">infectious diseases endemic to Haiti.

<span style="font-family: arial,helvetica,clean,sans-serif; line-height: 15px;"> I attached two photos.... one with a few cots leaning up against the tree. You can talk about how these are the typical cholera cots with a hole cut out of them where a bucket is placed underneath to collect stool and measure fluid loss. The second photo is one of myself with some Haitian nurses and doctors working in the cholera isolation unit. As I mentioned cholera is fecal oral transmission route, however you see these workers covered head to toe with bacteria as though it were an airborne <span class="yshortcuts" style="line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">infectious disease. This highlights the great deal of fear in the Haitian community, even amongst educated healthcare workers, about contracting the disease.

<span style="font-family: arial,helvetica,clean,sans-serif; line-height: 15px;"> (This is sally Greenwald who i interviewed) <span style="font-family: arial,helvetica,clean,sans-serif; line-height: 15px;"> (This is a picture of the cots leaning aga inst the tree.)

<span style="font-family: arial,helvetica,clean,sans-serif; line-height: 15px;">** Do you think it would be too chaotic and dangerous to travel there? ** <span style="font-family: arial,helvetica,clean,sans-serif; line-height: 15px;"> I think that care needs to be taken whenever you travel to a developing country in which you have less government regulations on criminal behavior. I have been to Haiti 7 times over the last three years and have always felt safe and respected by the Haitian people.

<span style="display: block; line-height: 1.2em; margin: 0px; outline-color: initial; outline-style: none; outline-width: initial; padding: 0px;">**Once someone has <span class="yshortcuts" style="background-attachment: initial; background-color: transparent; background-image: initial; background-position: initial initial; background-repeat: initial; border-bottom-color: initial; border-bottom-style: none; border-bottom-width: initial; cursor: pointer; line-height: 1.2em; outline-color: initial; outline-style: none; outline-width: initial;">symptoms of Cholera, how can they be treated?** Basically a rehydration- IV serum if the patient can't keep up with oral rehydration. For very sick patients antibiotics such as Doxycycline can be used, but again the focus is on rehydrating the patient.

As i mentioned before all of these questions above were answered by Sally Greenwald.

** A magazine featured in the Boston Globe on December 6, 2010 about Cholera has some heartbreaking and sad pieces of an article featured below: **

 * What are some of the signs that death is coming and what happens when someone is affected by Cholera?**

"DEATH BY cholera is obscene on so many levels. Massive watery diarrhea overtakes the person. Dehydration occurs within hours. Vomiting prevents drinking. The patient lies on the floor listless, stooling continuously, eyes staring and skin sunken. Soon, the patient goes into shock. Death is not far behind."

<span style="border-collapse: separate; font-family: Arial,Helvetica,sans-serif; line-height: normal;">**What is the current death rate in Haiti with this Cholera outbreak?**

"The Haitian minister of health reports 34,248 hospitalized cholera cases with 1,751 deaths since the outbreak began in October. The numbers are likely larger. This death rate of 2.3 percent is double the international standard... The World Health Organization has suggested that cholera, sadly, will affect up to 400,000 Haitians."

<span style="border-collapse: separate; font-family: Arial,Helvetica,sans-serif; line-height: normal;">**What is necessary to end this outbreak (supplies, medicine, etc..)?**

"With special intravenous fluid and a rehydration solution given properly and in time, patients can live. With clean water and adequate sanitation, cholera will not spread to others. But Haiti and the international community were not adequately prepared for this horrific outbreak. Preventing the spread of the disease and death depends on the Haitian government's ability to get clean water and medical supplies to the affected areas and deliver proper care in time. This is no small feat for a country still struggling from the life-changing effects of last January's catastrophic earthquake. Today, more than 1.5 million people continue to live in tents. There are reports that badly needed supplies are stockpiled in customs warehouses."

"Much of the care in Haiti is provided by international relief groups - Project HOPE, Catholic Relief Services, American Refugee Committee, and Partners in Health among others. Getting supplies is difficult. The role of the United Nations has been compromised by recent reports that the cholera may have been brought to Haiti by the Nepalese soldiers serving in January's earthquake relief. Subsequent riots against the United Nations have paralyzed relief efforts."
 * What relief programs are there and are they helpful?**

**How will a new elected president help Haiti's Cholera epidemic and what is the United States doing to help Haiti?** "Haiti is also in the midst of national elections, the results of which may lead to more civil unrest and governmental inaction. Neither Haiti nor the international community is up to the cholera challenge. The crisis is of such magnitude that the US government should immediately offer Haiti a military airlift of supplies and medics. The focus of such military relief should be to ensure adequate medical supplies, provide safe water and sanitation, and train Haitian health workers in appropriate treatment protocols.  For this relief effort to happen, the Haitian government must ask for our help. The Haitian government would direct the military efforts in coordination with its own public health campaign and the international relief groups already on the ground... We should not stand by and watch as another humanitarian disaster unfolds in Haiti. Our neighbors are suffering and dying needlessly. As Mass. General's founders proclaimed 200 years ago." [|Boston Globe article]

**These answerers to these questions were featured in the Boston Globe and answered by Larry Ronan, MD, is co-director of the Office of Disaster Response/MGH Center for Global Health. He has recently returned from Haiti where he brought a Mass. General cholera team of doctors and nurses.** **ronan.ART** **Credit: Larry Ronan**