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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.

Aerial viewThe 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.

 

Last Updated on Friday, 28 January 2011 07:23


2014

PAHO year in review: 2014 public health highlights in the Americas (12/24/2014)

years end-150The year 2014 was marked by progress as well as significant challenges for public health in the Americas. The region's countries advanced toward goals including universal health coverage, expanded access to vaccination, and ensuring that fewer babies are born with HIV. They also confronted major new challenges, including the arrival and spread of the chikungunya virus and the need to prepare for the possible imported cases of Ebola.

PAHO/WHO provides training in risk communication for possible Ebola introduction (12/09/2014)

Mesa directiva

Professionals from 11 countries of the Americas are in Quito, Ecuador, this week for a training workshop on risk communication organized by the Pan American Health Organization/World Health Organization (PAHO/WHO). The two-day workshop (December 9 and 10) is part of efforts to ensure that countries in Latin America and the Caribbean are prepared to respond effectively to potential imported cases of Ebola and other public health emergencies.

Avoiding local transmission of Ebola is the goal in Latin America and the Caribbean (11/10/2014)

Dr. Espinal, Director of the Department of Communicable Diseases and Health Analysis

The Director of the Department of Communicable Diseases and Health Analysis of the Pan American Health Organization/World Health Organization (PAHO/WHO), Dr. Marcos Espinal, said that preventing local transmission of Ebola is the main goal in preparing for the eventual arrival of cases of the disease in Latin America and the Caribbean.

Ebola: PAHO/WHO briefs health authorities on support for preparedness in the Americas (11/06/2014)

PAHO/WHO mobilizes Ebola preparedness teams in Latin America and the Caribbean (11/03/2014)

Countries of the Americas plan for possible Ebola introduction (10/31/2014)

PAHO Director Urges Countries of the Americas to Prepare for Early Identification of Possible Ebola Cases (10/27/2014)

Health officials briefed on Ebola and chikungunya during 53rd PAHO Directing Council (10/02/2014)

First imported Ebola case is reported in the Americas (10/01/2014)

PAHO Director briefs OAS envoys on Ebola in Africa and chikungunya in the Americas (09/25/2014)

WHO statement on the second meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola Outbreak in West Africa (09/22/2014)

WHO welcomes the extensive Ebola support from the United States of America (09/17/2014)

WHO welcomes Cuban doctors for Ebola response in West Africa (09/12/2014)

PAHO urges countries to eliminate mosquito breeding sites to prevent the spread of dengue and chikungunya (09/10/2014)

Statement on the WHO Consultation on potential Ebola therapies and vaccines (09/05/2014)

Ebola Virus Disease: Occupational Safety and Health (08/29/2014)

WHO issues "roadmap" to scale up international response to the Ebola outbreak in West Africa (08/28/2014)

PAHO Calls on the Countries of the Americas to Remain on Guard against the Ebola Virus despite a Climate of Calm (08/28/2014)

Unprecedented number of medical staff infected with Ebola (08/27/2014)

WHO-deployed health worker receiving care after testing positive for Ebola (08/26/2014)

Anecdotal evidence about experimental therapies (08/25/2014)

Why the Ebola outbreak has been underestimated (08/25/2014)

Travel and Transport in Relation to Ebola Virus Disease (EVD) Outbreak (08/18/2014)

Ethical considerations for use of unregistered interventions for Ebola virus disease (EVD) (08/11/2014)

PAHO/WHO urges the countries of the Americas to be vigilant and prepared for potential introduction of Ebola virus (08/10/2014)

“The Ebola epidemic is a serious public health problem, but it can still be controlled” (08/05/2014)

Número especial en periódico internacional sobre leptospirosis en la interface animal-humano-ecosistema (07/25/2014)

Dominican Republic is first country in the Americas to publish guidelines for clinical management of chikungunya (07/17/2014)

El Instituto Nacional para Síntesis Matemática y Biológica (NIMBioS) organizó taller para modelaje matemática de leptospirosis (06/10/2014)

Polio declared public health emergency of international concern under International Health Regulations (05/05/2014)

Countries of the Americas share risk of antibiotic resistance, must act now to protect health (04/29/2014)

Países de América debaten en Buenos Aires sobre la implementación del Reglamento Sanitario Internacional (04/29/2014)

Water and sanitation improvements remain key to defeating cholera in Haiti and the Dominican Republic (03/21/2014)

Haiti partners see progress, challenges in cholera control (02/05/2014)

2013

Representatives from the Ministries of Health met to discuss coordination and operational aspects of cholera prevention and control in the Subregion (12/09/2013)

Poster sobre leptospirosis gana premio en el Fórum de “Una Salud” en Davos, Suiza (11/22/2013)

Sesión sobre leptospirosis advoca por el enfoque de “Una Salud” para la reducción del impacto de los brotes (11/22/2013)

Simulacro de Leptospirosis en Choluteca, Honduras (10/31/2013)

Experts urge more WATSAN investments to halt cholera in Haiti, prevent its spread to more countries (10/25/2013)

USAID and World Vision join coalition to eliminate cholera from Haiti and the Dominican Republic (06/28/2013)

Experts in leptospirosis meet in Brasilia (04/15/2013)

2012

International Health Leaders Pledge to Work Together to Eliminate Cholera in Haiti and the Dominican Republic (10/16/2012)

2011

Llamado a la acción: La Hispaniola libre del cólera (12/28/2011)

Técnicos evaluaron respuesta y desafíos a un año de la epidemia de cólera en República Dominicana (12/07/2011)

Puerto Rico Presents Pilot Project for the Prevention and Control of Dengue (11/23/2011)

Journalism Award Winners Focus on Drug Resistance in Latin America (08/17/2011)

Haití condecora a la OPS/OMS por labor durante brote de cólera (04/20/2011)

Experts Warn of “Untreatable Infections” (04/05/2011)

Response to Cholera in Belle Fontaine, Haiti (01/28/2011)

Water, Sanitation and Hygiene Key to Control Cholera Epidemic in Haiti (01/10/2011)

2010

Experts to Discuss Cholera Vaccination in the Americas (12/15/2010)

Se prepara Plan de Contingencia ante la amenaza de un posible brote de Cólera en Guatemala (12/03/2010)

Cases Continue to Climb, But Fewer Patients are Dying from Cholera (12/02/2010)

National Day of Education and Prevention of Cholera in the Dominican Republic (12/01/2010)

Elections Not Expected to Increase Cholera Spread in Haiti (11/25/2010)

Cholera Outbreak in Haiti - Press Briefing by Dr. Jon Andrus, PAHO Deputy Director, 23 November 2010 (11/23/2010)

International Agencies Propose Joint Strategy to Fight Cholera in Haiti (11/16/2010)

PAHO Press Briefing on the Cholera Outbreak in Haiti, Tuesday, 16 November 2010 (11/15/2010)

PAHO Briefs NGO Partners on Cholera Outbreak in Haiti (11/15/2010)

Press Briefing on Cholera Outbreak in Haiti by Dr. Jon Andrus November 9 (11/09/2010)

Haiti’s Cholera Epidemic Likely to Grow Much Larger (11/09/2010)

Number of Cholera Cases and Deaths Still Rising in Haiti (11/02/2010)

CDC: Cholera Outbreak Strain Identified (11/01/2010)

PAHO’s Deputy Director Updates OAS’ Group of Friends of Haiti on Outbreak Situation (10/28/2010)

PAHO Position on Cholera Vaccination in Haiti (10/28/2010)

PAHO: Haiti’s Cholera Epidemic Still Trending Upward (10/27/2010)

PAHO: Haiti’s Cholera Epidemic Still Trending Upward (10/27/2010)

Press briefing on the cholera outbreak in Haiti by Dr. Jon Andrus, 27 October 2010 (10/27/2010)

PAHO: Cholera cases likely to increase in Haiti (10/25/2010)

PAHO Responds to Cholera Outbreak in Haiti (10/22/2010)

Taller analizó el impacto de la vacuna contra la influenza pandémica (09/15/2010)

WHO Declares H1N1 Pandemic Over, Urges Continued Influenza Vigilance (08/10/2010)

Facts and Myths about the Safety of the Pandemic Influenza (H1N1) 2009 Vaccine (05/26/2010)

Spain Donates Four Million Doses of Influenza A Vaccines to Latin American Countries (03/04/2010)

Nicaragua: Lista para recibir y aplicar la vacuna contra la Influenza AH1N1 en grupos priorizados (02/24/2010)

2009

Jóvenes de los Ecoclubes difunden mensajes de prevención frente a la pandemia de influenza H1N1 (12/14/2009)

WHO Says Prompt Treatment Can Prevent Serious Cases, Deaths from H1N1 (11/12/2009)

Preparing Communities to Respond to Pandemic Influenza (11/03/2009)

Autoridades de Salud alertan sobre brote severo de dengue en Nicaragua (10/02/2009)

PAHO Unveils Two Communities of Practice on Pandemic (H1N1) 2009 (09/21/2009)

Countries of the Americas Examine Response to Pandemic H1N1 2009 and Challenges Ahead (09/11/2009)

Países de las Américas se organizan para adquirir la vacuna de la gripe pandémica (09/10/2009)

Pandemic (H1N1) 2009 in the Americas: What's Next? (09/02/2009)

Chile's President Urges a Collective Response to A (H1N1) Pandemic (06/24/2009)

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