Cholera raging again where it initially began – in Gonaives’ Artibonite Province

From: Sandra Mignot sandramignot

Cholera surges in Haiti’s Central Plateau
Associated Press – By TRENTON DANIEL July 9, 2011

MIREBALAIS, Haiti An old man with sunken cheeks is so dehydrated he must
be carried down the dirt lane to a clinic where the air is thick with the
odor of bleach. Minutes later, a worried father enters, carrying a
two-year-old girl in a frilly white dress, her eyes sunken and unfocused.

Such scenes are once again common in Haiti where a deadly cholera epidemic
that swept the country last fall has returned, fueled by weeks of heavy
rains that have helped spread the waterborne bacteria that flourishes in the
country’s rivers and rice fields.

The treatment center in Mirebalais, a dusty crossroads town a one-hour drive
north from the capital, Port-au-Prince, is again seeing dozens of new
patients a day, many arriving at the edge of death from dehydration.

The center saw a fivefold jump from April to May and it hasn’t let up since,
said Louise Ivers, senior health and policy adviser to the U.S.-based
Partners in Health, which runs the clinic in association with the Health

“When people come here, they’re in critical condition, ready to die,” said
Francole Adonis, who registers the new arrivals at the center. “They’re
collapsing in the yard. The situation is horrible.”

The number of new cases each day spiked to 1,700 day in mid-June, three
times as many as sought treatment in March, according to the Health
Ministry. The daily average dropped back down to about 1,000 a day by the
end of June but could surge again as the rainy season develops.

The epidemic began in rural Haiti last fall, likely brought by U.N.
peacekeepers from Nepal. It swept through the countryside of an impoverished
nation already overwhelmed by a January 2010 earthquake that left hundreds
of thousands homeless and by political instability following disputed

Cholera has sickened at least 370,000 people and killed more than 5,500
since the outbreak started in October, according to the Health Ministry. The
precise total is unknowable since many Haitians live in remote areas with no
access to health care. The disease is relatively easy to treat if people can
get help in time.

When the outbreak began, foreign volunteers descended on Haiti to staff
rural clinics and help provide access to clean drinking water. Many feared
it would devastate Port-au-Prince, where hundreds of thousands of people
were living in densely packed refugee camps. But people in the capital had
access to latrines and potable water, thanks to the huge international aid
effort, and it was spared the worst of the disease.

The disease faded in winter and spring, when rain is less frequent, and many
aid workers moved on. U.N. troops in Haiti turned their attention to the
country’s many other pressing problems.

Now there is a fear among aid workers who remain that there won’t be enough
resources if the latest surge gets much worse.

“If the cases continue on the same path we could see a lot of health-worker
fatigue,” said Cate Oswald, a Partners in Health coordinator. “The health
care force is already stretched thin.”

Oswald recalled how volunteers were everywhere during the first response to
the outbreak, providing supplies such as bleach, which is sprayed on shoes
and throughout the centers to prevent the spread of cholera.

“At one point we were worrying about too much duplication of efforts,”
Oswald said.

“Then the rains started coming.” Oswald paused. “And cholera was still

The rains have deluged the Caribbean, including Haiti, in recent weeks. The
rivers of the Artibonite, where rural Haitians drink, bathe and wash their
clothes, are flowing through a valley ringed by chocolate-brown mountains,
and cholera is again raging in the region.

“Sometimes, it’s 50 patients a day. Sometimes it’s 200 patients a day,”
Pierre-Marie Cherenfant, a Mirebalais doctor who oversees the clinic, said
of the flow of cases coming to the facility.

Smaller treatment centers throughout Haiti’s Central Plateau are also
reporting sharp increases in recent weeks, though the most recent breakdown
for Mirebalais is not yet available, Ivers said.

There are signs of a growing problem in Carrefour, a large and crowded city
on the right at the western edge of the capital. Treatment centers there
were reporting more than 300 new cases a day in early June, more than twice
what they were seeing back in November, according to the aid group Oxfam.

An emergency latrine built in Carrefour collapsed as heavy rains fell and
the waste spilled into a camp, according to a June report by the U.N.’s
shelter cluster.

UNICEF’s Mark Henderson, head of the U.N.’s water and sanitation response,
said many non-governmental organizations tapped into earthquake-related
funds in the fall in a desperate effort for treatment and prevention. That
money is no longer available.

“The initial funding that everybody received has come to an end,” Henderson

Though the number of new cases is again rising, Health Ministry statistics
show the number of deaths is far less than what it was during the initial
surge. On a single day in mid-December, about 110 people died, compared to
almost 20 in a single day in mid-June, according to the Health Ministry. The
mortality rate is now under 2 percent, half what it was when the outbreak

The reason for the lower percentage of deaths is that people aren’t waiting
to get better, as many did when the disease first emerged, and instead are
rushing for help. A public health campaign has featured radio jingles and
text messages to educate people about the disease.

Haiti had never had a reported cholera outbreak until October but the
initial cause of the outbreak is now no longer so mysterious.

This month, an article in the U.S. Centers for Disease Control and
Prevention journal said evidence “strongly suggests” that a Nepalese
peacekeeping mission, based in Mirebalais, inadvertently imported the
disease. The article points to “an exact correlation” in time and place
between the arrival of a Nepalese battalion from an area of its South Asian
homeland that was experiencing a cholera outbreak and the appearance of the
first cases in a river a few days later.

The treatment center in Mirebalais started as a single one-story building.
It quickly grew to include several large tents and temporary shelters, and
now they are expanding again.

As Associated Press journalists toured the site recently, construction
workers prepared the foundation for new buildings.

Thunder boomed in the background as health worker Rosette Jean-Philippe
darted among beds and cots, adjusting IVs hooked to thin wrists and
replacing bags of rehydration fluid.

“When you’re here, that’s what you have to do to save lives,” Jean-Philippe

Jim Smith, MD

“Bondye bay tout pou nonm yo pataje”

(Haitian Creole saying: “God provides all for man to share”)


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