Many residents still living in “atrocious” conditions Cholera is still rife in Haiti and far from under control. Having ravaged other parts of the island in June of this year, it is now returning to the Haitian capital with a vengeance. According to figures from the Ministry of Public Health and Population, at the end of August more than 446,000 people had been infected by the disease and approximately 6,300 people had died from it. Since the first cases of cholera were confirmed in October 2010, MSF has treated almost 160,000 patients. Its teams have worked in nine out of the 10 departments in Haiti. At present, the MSF teams are treating patients with cholera in Port-au-Prince as well as in the departments of Artibonite, Nord and Ouest. In its four cholera treatment centres currently open in Port-au-Prince, the MSF teams have observed a significant increase in the number of patients admitted. “In the space of a month, we have gone from fewer than 300 admissions a week to more than 850, which unfortunately suggests that the situation will worsen in the weeks to come,” says Gaétan Drossart, MSF head of mission in Haiti.

Haiti © Yann Libessart/MSF
A patient at the MSF cholera treatment centre in May in the Delmas 33 area of Port-au-Prince. One of the cholera treatment centres in which MSF is working is in Martissant, one of the most deprived areas in the capital. Driving along the main road that leads to the treatment centre, it is impossible not to notice how vulnerable people living here are. Between the piles of debris, water from the leaking sewers is seeping into and flooding several roads. This creates an environment in which infectious diseases can spread very easily. “The hygiene conditions in the area are atrocious,” says Nicolas Charret, the on-site project coordinator. “It is extremely densely populated with very little in the way of functional sanitary infrastructure, which facilitates the spread of cholera, especially when people drink contaminated water and food.” The cholera treatment centre, attached to the emergency centre permanently managed by MSF, is where MSF treats people infected by vibrio cholerae, the bacterium that has been spreading throughout Haiti for the last year. The centre has 90 beds and at present is treating more than 250 patients a week (its maximum capacity). Mathias Kennes, a nurse at the treatment centre, explains that, with cholera cases, it is essential to quickly determine the degree of dehydration suffered by the people admitted because this is the cause of most deaths. The treatment is then adapted according to the observed severity of the case. “If the person is severely dehydrated, they need to be treated straight away, either intravenously or through a nasogastric tube. With the correct treatment and intensive monitoring, patients, even those severely ill, usually recover in three or four days,” he says.
Haiti © Yann Libessart/MSF
The MSF cholera treatment centre in Delmas 33, Port-au-Prince. In the tent housing the convalescent patients Amonly Jaquette, a 19-year-old local man, talks to the MSF staff. He says that initially he felt bloating in his stomach, which was quickly followed by diarrhea. “I knew right away that I was ill because it was really intense,” he says. “I’d heard on the radio that if this happened, you had to do something. I knew that MSF were in Martissant. So I turned up and they took care of me immediately.” After three days of treatment, Jaquette is hoping to go home soon. However, before he leaves, he explains that he is going to try and take more appropriate hygiene measures, including getting chlorinated water. But he also says that it will not be easy to maintain these standards, given the lack of sanitary facilities in the area, which are shared by most of the residents. In Haiti, almost a year after the start of the cholera outbreak, resources for adequately preventing the disease remain rudimentary and at the mercy of the uncertainties of life in the country.