“Patients come to us in critical condition as there is no system in place to provide urgent care, despite the existence of a National Plan for the Elimination of Cholera"
More than 2,000 people with symptoms of cholera have been hospitalized since mid-October in Port-au-Prince, the capital of Haiti. Even though the majority of Haitians remain exposed to cholera due to lack of access to clean drinking water and latrines, capacity to treat those affected by the disease is still inadequate. Médecins Sans Frontières / Doctors Without Borders (MSF) has rapidly reinforced its cholera response with close to 320 beds.
Four years on from the start of a cholera epidemic in Haiti, the country’s health system is still facing shortages of funding, human resources and medicine, and authorities are unprepared for outbreaks that today are known and foreseeable. “Patients come to us in critical condition as there is no system in place to provide urgent care, despite the existence of a National Plan for the Elimination of Cholera,” laments Oliver Schulz, MSF’s head of mission in Haiti.
Despite predictability, health system unprepared for cholera
Almost 100 patients are arriving each day in the emergency centre in Martissant, Port-au-Prince, Haiti. “We have tried to refer patients to other cholera treatment centres, but we soon realized there were not enough beds,” explains Olivia Gayraud, MSF’s medical coordinator in Haiti. “The Martissant centre was quickly overwhelmed by the number of patients, as national health structures are poorly prepared to react to cholera outbreaks, despite them being predictable during the rainy season,” she continues
MSF teams rapidly set up two cholera treatment centres in the neighbourhoods of Martissant and Delmas 33. The Haitian ministry of health also opened structures, but they were quickly unable to function due to lack of financing. MSF subsequently supported some of those centres, treating a total of approximately 2,000 patients since October 10.
Eradicating cholera requires radical action to prevent and treat the disease. It is necessary to ensure that the chlorination level of water distributed in neighbourhoods is adequate to avoid the spread of the disease
Many of the sick come from areas where access to clean drinking water and proper sanitation is appalling. “The slums provide a favourable environment for vibrio [the bacterium that causes cholera] to develop and infect the population,” explains Olivia Gayraud. Once a person is infected via water or food, the spread of the disease is amplified by inadequate hygiene practices, a lack of latrines and an ineffective water sanitation system. It is, therefore, crucial to improve hygiene measures and sensitise the population to eliminate the disease.
Number of cases increasing as immunity to cholera reduces
In Haiti, the cholera epidemic is particularly severe during the rainy season. In recent years, the population has slowly lost their immunity to the disease. Compared to the same period in 2013, the number of cases handled by MSF has almost doubled.
The lack of sanitary infrastructure and of measures to clean water risk aggravating the epidemic. “Eradicating cholera requires radical action to prevent and treat the disease. It is necessary to ensure that the chlorination level of water distributed in neighbourhoods is adequate to avoid the spread of the disease,” Schulz explains. “The Haitian authorities, in collaboration with their international partners, must activate an emergency response and quickly integrate cholera case management into their health structures.”
Since the first cholera cases appeared in late October 2010, MSF has deployed emergency medical teams across Haiti. Of the 711,558 cases registered by the Haitian ministry of health up to October 28, 2014, MSF has treated more than 204,000, with a mortality rate of less than one per cent. Since 2011, after training personnel and donating material, MSF has gradually handed over responsibility for the cholera treatment centres situated outside the area affected by the earthquake of January 12, 2010.