Cholera Outbreak in Haiti
Jon Kim Andrus, MD
Pan American Health Organization
23 November 2010
Good afternoon. Thanks for coming. In this briefing we want to give you an update on the situation in Haiti.
Haiti’s Ministry of Health, PAHO, and other key partners in Haiti have established a new alert and response unit to strengthen the existing surveillance system. The alert and response unit will identify and investigate hot spots of increasing cases or deaths and then help mobilize teams to respond.
We believe certain critical issues need to be addressed if our efforts to treat patients and save lives are to be successful. Safe water and sanitation are lacking. In the short term, efforts must focus on distributing chlorine tablets as well as oral rehydration salts to everyone. In the long term, we must create the systems and infrastructure to ensure equitable access to these basic services.
Official reports confirm 8 of 10 departments with cases of cholera. We know that in the other 2 departments, clusters of cases are now being investigated. So, for all intents and purposes, as we fully expected before, cholera is virtually everywhere in the country.
Given the extremely poor sanitary conditions that existed well before the earthquake, the recent hurricane, and now the epidemic, we expect the number of cases to continue to grow. We have not yet reached a peak and we don’t know when that peak will occur.
Cases have been reported in the Dominican Republic as well as here in the United States.
The Pan American Health Organization has sent a message urging health ministries in all our member countries throughout the Americas to strengthen their contingency planning in view of the fact that cholera could spread to other countries in the hemisphere.
For many of us here, this brings up memories of the cholera epidemic that began in Peru in 1991 and spread to more than 16 countries in the Americas within two years.
Considering the intensity of travel and trade in the Americas, we know it’s difficult to prevent importations of isolated cases of cholera in other countries, but there are important steps that can be taken to prevent cholera from spreading and causing epidemics.
Our message to health authorities is that they should begin preparing now, before the appearance of cases. PAHO is recommending a series of measures that include:
- Stepped-up surveillance to ensure that any potential cholera cases are detected rapidly.
- Strengthening preparedness and response plans to ensure that countries’ health systems are able to deal with any sudden surges or emergence of cholera.
- Improving water and sanitation services to prevent the spread.
- And finally, increased public education about the importance of hand washing and proper disposal of feces, as well as prompt treatment with oral rehydration salts or, for severe cases, specialized medical care.
We have also offered support to countries to update and implement preparedness and response plans in surveillance, water and sanitation, and social communication. PAHO has already been working with ministries of health in Caribbean countries to strengthen their planning for the possible arrival of cholera cases on their shores.
In the capital, Port-au-Prince, workers at the Logistics Cluster and at PAHO’s PROMESS warehouse loaded some 40 metric tons of essential medicines and supplies onto trucks and helicopters as part of a three-day operation to supply the areas most heavily affected by cholera and to preposition supplies in remote areas where cholera has not yet arrived. And we just learned minutes ago that an additional 42 metric tons of supplies were included in these efforts.
In Haiti’s North Department, international staff and medical workers--including some PAHO staff--remain confined to their living quarters, following civil unrest earlier this week. We hope PAHO staff may soon be able to resume their work supporting the response to the cholera epidemic.
Since the beginning of the crisis, PAHO has distributed enough supplies to treat about 80,000 cases of cholera, including supplies like oral rehydration salts and intravenous fluids for severe cases. We have more on hand, but in the near future we will need even more supplies, cholera beds, and doctors, nurses, and people to train local doctors how to treat cholera patients. We also need more experts on social mobilization to communicate about cholera prevention.
We need to plan for enough supplies to treat as many as 400,000 cholera cases occurring over the next 12 months. We need to plan for up to half of those cases occurring over the next 3 months because of the explosive nature of this epidemic. This represents work in progress that takes into account many assumptions, for example, differences in attack rates between urban and rural areas, and no change in environmental conditions. We are working to refine these preliminary estimates with key partners in order to improve and sustain supply management for the epidemic response.
To support health promotion activities, WHO/PAHO has printed and begun to distribute 97,000 posters and 150,000 laminated pages in Creole with guidance on cholera prevention and treatment. A course was developed for community and religious leaders explaining how to manage cholera in their community. The government will deliver this training.
Another major challenge is staff. On the part of PAHO, we already had about 50 people working in Haiti and have recently deployed 50 more, including epidemiologists, sanitary engineers, logisticians, clinicians, communications experts, and others. But we will need more, and we will need more funds to pay for people and supplies. Despite substantial international support, the Haitian health system is over-stretched, especially after the major losses in the January earthquake. We hear reports from our partners like MSF and CDC, that the staffing issue is also a challenge to them.
To that end, we are encouraging partners to do everything possible to hire and train the Haitian people using cash-for-work programs. This is consistent with our primary objective of helping the Haitian people and the Haitian government in the response and in taking the prime ownership to this crisis. Since cholera has a foothold and will not go away in the near future, the priority of hiring and training Haitians also aligns with our long-term vision of capacity development.
We are working with other UN agencies and many NGOS to respond to the outbreak, but a lot more is needed, especially in providing safe water and adequate sanitation to Haitians particularly in Port-au-Prince and the provinces. About 58% of the population before this crisis lacked access to potable water. About 76% of Haitians earn less than $2 a day. We now know that about 1.6 million Haitians are living in precarious conditions, particularly those in the 1,300 displacement camps.
We must work together to manage the impact of this outbreak, particularly to minimize loss of life. This requires an integrated approach bringing together those who provide clean water, improve sanitary conditions, and those who provide treatment to the ill. We need more of everything: more training for staff in Haiti, more doctors, more nurses, more treatment centers, more medications, more toilets, more clean water.
We have asked for $164 million for this emergency, and so far have received about 10 percent of this amount. It is clear the country will need more funding. Our response, along with all the partners, has not been as rapid as we would like. The reason is that, even before the crisis, the country lacked the building blocks of health, which are water, sanitation, safe food, and adequate health services. Our aim is to help Haiti overcome these obstacles and build self-sufficiency in these vital areas.