Institute for Justice and Democracy in Haiti

Reaching Haiti’s Cholera Victims As Hard As Curing The Disease (Miami Herald)

By: Jacqueline Charles, Miami Herald
September 5, 2011

The SUV slowly churns up the green mountainside, rocking from side-to-side as it struggles for traction on rocky terrain.

Any wrong turn and the packed vehicle could easily fall 300 feet. But to save lives in deeply remote rural areas, Fabienne Lorcerie and her team of cholera response experts must risk theirs.

“All the other medical missions I’ve been on, I could plan a little bit better,’’ says Lorcerie, a nurse, whose voice barely hid her frustration. “Everything is so far away here, and that makes it hard to anticipate.’’

The cholera epidemic that has claimed thousands of lives in Haiti has fallen from its peak. But the disease, which has infected more than 400,000 Haitians since its initial outbreak a year ago, is continuing to have a major impact on far flung villages surrounding communities like this one in the lower Aribonite Valley. It’s main water supply, the 199-mile Artibonite River, was the initial source for spreading the epidemic.

“It’s a big headache,’’ Romain Gitenet, head of mission for the French humanitarian aid group Doctors Without Borders who supervises the mobile cholera response team, which registered 10,000 new cholera cases in the valley over 10 weeks earlier this summer. “Cholera has no limits.’’

More than half of Haiti’s 10 million citizens live in remote rural communities, many of them accessible only by foot and mules. And at least 40 percent have no access to a doctor or nurse, much less sanitation or potable water. With even cell service lacking, alerts aren’t often heard until too late.

The trip to Bois Carre, a mountaintop village in the lower Artibonite Valley, was sparked by an alert from a frightened farmer. After showing up at the Doctors Without Borders office in Gonaives, he told an alarming story: some 25 people were dead from cholera and another 58 had the waterborne disease in the nearby town of Ossé.

Panic ensued. The mobile reactive team had just returned from a cholera outbreak in the villages of Chenot and Perodin. In Chenot, the team took eight days to set up a 30-bed treatment unit and train medical staff after the community logged 15 cases a day. In Perodin, the mortality rate from the disease was at 11 percent.

With no way to confirm the farmer’s information by telephone, the team took to the road. Bois Carre was the furthest point they could go by car before having to make the rest of the journey on foot.

“I am asking myself about the amount of time it will take to get there,’’ Lorcerie said, standing in a dirt yard in Bois Carre, worried that the forming storm clouds could produce rain and make crossing the river at the foot of the mountain impossible. “The hardest part is knowing there is an emergency and not being able to do anything today, and you have to come back another day.’’

Bois Carre has had its own bout with cholera, say villagers. Located hundreds of feet in the mountain, the village is desolate and rugged. The nearest hospital and cholera treatment facility are five hours by foot.

“The situation is very difficult for us,’’ said Fredo, 49, a villager. “There are times the river is impassable and you are carrying a victim to get help. You have to put the person down and wait for the river to go down. By the time you reach, the person has already died in your hands.’’

When cholera first broke in Haiti nine months after the devastating earthquake, the international community responded, raising tens of millions of dollars for specialized beds, water purification tablets and soap. While groups like Doctors Without Borders opened cholera treatment units and trained medical staff, others like Mercy Corps, working in the Central Plateau, turned motorcycle taxi drivers into community health aides.

Armed with hygiene information to help prevent the spread of the epidemic, the taxi drivers traveled into remote villages to sensitize the community. Sometimes, the taxis even served as ambulances, ferrying vomiting patients on the back of their bikes to treatment.

Earlier this year, the program was cut because of lack of funds, Mercy Corps spokeswoman Lindsay Murphy said.

“Funding is not enough to fight against cholera in the upcoming months,’’ said Dr Gabriel Thimothé, executive director of Haiti’s Health Ministry, which lacks money to provide even basics, such as water at treatment centers.

Recently, the Center for Economic and Policy Research, a Washington-based think tank, issued a report showing aid groups withdrawing from cholera treatment efforts right before the rainy season, and those left were stretched to capacity to deal with the “predictable” spike and high rate of mortality in rural communities.

“This should be a top priority,’’ said co-director Mark Weisbrot.

Health experts anticipate that Haiti might experience one more deadly peak before the end of this hurricane season. After that, there are chances that the disease might become endemic in Haiti with frequent peaks over the years.

Even as the health problem is far from resolution, there is another issue brewing on the political front: blame and compensation. The outbreak has triggered protests against the U.N. and its Nepalese peacekeepers who have been blamed by some for importing cholera. The peacekeepers have a base near the Artibonite River.

Earlier this year, Haitian lawmakers formed a cholera commission in parliament. The commission’s objectives are unclear, but with recently erected billboards around Port-au-Prince saying cholera and the peacekeeping mission are “one and the same,” calls are increasing for U.N. compensation.

Adding to the outcry: a recent gene study indicating the cholera strain in Haiti is similar to the one in Nepal. Earlier this year, an independent panel convened by the U.N. stopped short of blaming the Nepalese peacekeepers.

“They have a moral responsibility to find money so these people can get help,’’ said Sen. Simon Desras of the Central Plateau.

This summer as Haiti experienced another cholera peak with the return of the rainy season, Desras’ region was hard-hit with hundreds of deaths and thousands of new infections.

“The people have no access to healthcare, no hospitals, no medicine. In many of these areas when someone becomes sick, the population has to put them on a plank of wood and four men have to carry them. In the time it takes them to reach help, they are dead.’’

As Lorcerie and her team trekked from Gonaives to Bois Carre, brothers Robert Roland and Edner Charles were making their way from the tiny village of Ossé to meet them.

People were sick; some had died, the brothers said, anxious to get the foreign doctors back to Ossé to help. Visibly worried about the menacing clouds, Lorcerie wondered whether there was enough time to make it in and out of the town on foot without getting stranded.

“The situation seems very serious,’’ said Lorcerie, unable to get a clear answer from the farmers on the length of the walk. As she mulled over her decision, she tried to gather more information from the farmers. But instead of clarity, there was confusion as the men gave contradictory information, ranging from the number of people infected to the time to walk to the village.

There was another problem: No donkeys to carry the tents and cholera-treatment beds.

“Treating cholera is easy, but it’s the logistics that are difficult,’’ Lorcerie said.

The team abandoned the trek for the night and finally made it to Ossé the following day, crisscrossing several rivers during the two-and-a-half hour trip. They found frightened villagers.

“We aren’t sure at all if it was cholera cases, it could be Typhoid or malaria,’’ Lorcerie said. “We have no idea because the people do not know the definition of cholera.’’

The team installed a small cholera station offering rehydration salts — and made a note to begin basic cholera and hygiene education.

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