Story and photos by Nyka Alexander
As the cholera epidemic wanes in cities, rural areas—especially hard-to-reach ones—are where people are now most vulnerable. This story is about the response in one of these communities.
The little town of Oupac in a commune called 4ème Belle Fontaine, is 30 km from Port-au-Prince, a 15-minute helicopter ride but almost inaccessible by roads. The town’s people have to walk six hours to reach the nearest hospital. When cholera began circulating, they were far from help and information.
The head of the Ouest department (or province), Hans Legagnier, heard rumors of several cases and deaths in this community. On January 11, he called the PAHO/WHO Alert and Response team to let them know. Dana van Alphen, coordinator for the team, received the call while attending a Health Cluster meeting, and immediately shared the information with health partners participating in the meeting . After discussing the situation, Aide Medicale Internationale (AMI France) and the French Red Cross decided to send a medical team with sanitary engineers to dig latrines, set up a cholera treatment center (CTC) and provide prevention information to the community.
The Alert and Response system was put in place to identify sudden needs and to rapidly deploy support. It complements a broader network of surveillance that collects data from health centers across the country.
Alerts are investigated to verify all the content from a second source (exact location, numbers of people affected, etc.). For this alert, Patricia Santa Olalla, another member of the Alert and Response team, coordinated with AMI. “They did the field research. They sent someone to the community — I think it was a 4-hour walk – to find a place for the helicopter to land and for the treatment unit to be built.” They also confirmed that the community would welcome the treatment unit and offer support, such as helping to move materials from the helicopter to the site.
Arrangements were made with AMI for a medical team, with UNOPS for helicopter transportation, with the PAHO/WHO-managed PROMESS warehouse for medications, tent and cholera beds, and with the French Red Cross for water and sanitation experts.
On Thursday, January 13, a helicopter departed Port-au-Prince with materials and a crew. But the mission failed. The GPS coordinates were incorrect. The crew landed twice to ask for directions but without success. They flew back to Port-au-Prince disappointed. An areal photo shows how mountainous the area is. The next day, AMI was able to send a local person who went by foot to the community to get precise GPS coordinates.
With the help of the local Scout troop, a 10-bed treatment unit was set up on Saturday night by the team of water and sanitation experts and AMI epidemiologist Dr. Luis Manuel Rosa Sosa. They also built a meeting tent. At 6:30 in the morning, patients began to arrive. By 9:00 a.m., 15 had been seen by Dr. Rosa Sosa before the helicopter with the medical crew had even arrived.
“There were so many. The first thing I did was triage who were the most severe cases. There were many people who were sick, but not all with cholera,” says Dr. Rosa Sosa. Once the medical team arrived, he was able to start his epidemiological work and headed into nearby communities to get a sense of the spread of the epidemic. “There were people ill with many other types of diseases, people with malnutrition. You feel almost impotent facing the scale of the problem,” he says.
The Haitian medical team that AMI assembled, consisting of a doctor and four nurses, will be relieved every five days because of the extreme pressures of the work.
Patients from that first day included a 9-year-old boy whose mother said he had been sick for four days with vomiting and diarrhea.
Responses to other alerts are not always as dramatic. Often the solution is to set up oral rehydration points or to replenish exhausted supplies and materials.
Oupac’s field clinic will stay in place at least through the end of January. On average, the team must care for six admitted patients at a given time. During the week of January 16-23, they had three deaths, one of whom was the older man seen in these photos.
For more information please visit our special page on the Cholera Outbreak on the Island of Hispaniola.