A medical team from Maine got home early Thursday after a grueling – and harrowing – trip to Haiti.

The five-member team from the Maine-Dartmouth Family Medicine Residency in Augusta spent three long days trying to save cholera victims in Cap Haitien, then had to get out of the city through violent street demonstrations and roadblocks.

“every roadblock we passed, there were crowds of people with Maine-Dartmouth Family Medicine Residency machetes and sticks running at us,” said Dr. Chiedza Jokonya of Cape Elizabeth, a pediatrician and faculty member who led the medical mission.

Jokonya’s team included Nina Miller, another faculty member, and three primary care residents – Suhas Pinnaka, Prativa Basnet and Lalaine Llanto.

Twice a year, Jokonya leads a weeklong medical mission to Haiti’s capital city, Port-Au-Prince. this time, the United Nations asked the team to go north to Cap Haitien, where the cholera epidemic was overwhelming medical personnel. the team agreed.

“they desperately needed help up north,” said Jokonya.

As of early this week, the cholera outbreak had killed 1,034 people in Haiti and hospitalized 16,799, according to the United Nations Office for the Coordination of Humanitarian Affairs.

When they arrived in Cap Haitien, Jokonya said, the situation was chaotic. everyone was getting IVs, whether they needed them or not, and supplies were limited.

“We spent a day just organizing triage,” Jokonya said.

Then she and the residents worked day and night, sometimes using flashlights, to treat cholera patients, some of whom arrived so dehydrated from vomiting and diarrhea that they could not be saved.

“the residents worked 72 hours straight with maybe a couple hours of sleep. all of them had patients dying on them,” she said. “We couldn’t stop. if we stopped, there was nobody to see the patients.”

The people at the hospital were grateful for the help, she said. But anger in the city’s streets made it difficult to leave.

“On the third day, when the U.N. was supposed to pick us up, that’s when the violence erupted,” she said.

Street demonstrations began in Cap Haitien on Monday over suspicions that the cholera was brought to Haiti by U.N. peacekeepers from Nepal. Protesters threw rocks, blocked roads and set fires, forcing the airport to be closed.

The protests spread to Haiti’s capital Thursday as protesters blocked roads and attacked foreigners’ cars.

Jokonya’s team left the city Tuesday by truck after recruiting local men to provide security. they passed seven roadblocks, where they had to stop and move logs and, in one case, move a parked truck.

“We were stuck between groups of people,” she said. “There were fires along the way.”

When demonstrators threw stones or approached the truck, the local men got out and “talked them down,” she said.

The team drove three hours to Gonaives, where the U.S. Embassy arranged to take them to Port-Au-Prince, she said. they arrived in Boston late Wednesday and got home early Thursday.

“I don’t know what they are going to do if the (cholera) numbers increase,” Jokonya said. “I sent out appeals to groups of doctors to come and take our place, but because of the violence, I don’t think it will happen. this is the most frightening situation I have ever been in in my life.”

Jim Schneid, Maine-Dartmouth’s chairman, said the medical residency was glad to get the team home.

“We were all concerned for their safety when they were involved in the unrest,” he said. “they all knew there was a cholera risk when they went down last week, and they all had the option when asked by the United Nations to not participate. I’m very proud of the group.”

While the Maine-Dartmouth team was getting home, Nathan Nickerson of Portland was trying to find a way to get back to Cap Haitien.

The executive director of the Portland-based nonprofit Konbit Sante Cap Haitien Health Partnership was in Florida on Thursday, monitoring the security situation and hoping to fly to Cap Haitien as soon as today.

Nickerson, who was in Haiti just two weeks ago, hopes to help distribute medical supplies and water disinfection kits. But he said from Florida late Thursday that it wasn’t clear whether security had been restored enough to reopen Cap Haitien’s airport.

McClatchy-Tribune Information Services

UNITED NATIONS, Dec. 17 (UPI) — the United Nations announced Friday the creation of an independent panel of scientific experts to explore the source of the cholera epidemic in Haiti.

“We are calling for an international panel and we are in discussions with WHO (the U.N. World Health Organization) to find the best experts to be in a panel, completely independent… (and) have the best investigation on the source of the outbreak,” the Under-Secretary-General for Peacekeeping Operations, Alain Le Roy, said at a U.N. press conference.

There has been speculation that U.N. peacekeepers from Nepal serving in Haiti may have been the source of the epidemic.

“There is no consensus among scientists on this issue,” Le Roy said.

None of the Nepalese peacekeepers had either tested positive for, or shown any symptoms of, cholera and repeated testing of water from their camp has not turned up any detectable strain of the disease, the U.N. says.

“We want to make the best effort to get to the bottom of this and find answers that the people of Haiti deserve,” U.N. Secretary-General Ban Ki-moon said.

Haiti was in an ongoing recovery operation from a January earthquake that killed more than 200,000 people when cholera broke out in October.

CHOLERA EMERGENCY IN HAITI FAR FROM OVER
(msf.org) – by Aurelie Baumel

Cases still increasing in north and south of the country .

The cholera epidemic in Haiti has stabilized in the Artibonite region but continues to spread in the northern and southern parts of the country. The emergency is not over and every department in the country is now affected. This past week, more than 1,850 patients with cholera and cholera-like symptoms were treated every day in MSF and MSF supported structures.

Médecins Sans Frontières (MSF) continues to operate 47 cholera treatment centers (CTCs) throughout Haiti and is planning on opening more in the near future to serve areas that are newly confronting the disease. CTCs should open soon in the southern towns of Les Cayes and Jeremie, while additional exploratory missions and communications programs – in order to educate populations about the nature of and treatment for cholera – are being conducted elsewhere in the same region.

Overall, MSF has more than 4,000 staff members working on cholera in Haiti, and they have treated more than 75,000 patients since the start of the epidemic. Some 13,000 new patients presented in the past week across the country.

In Port-au-Prince, there was a big spike in the case load at the beginning of last week, when traffic in the capital was snarled and mobility limited during the days of unrest that followed the announcement of the preliminary results for the presidential elections. overall, the numbers at MSF CTCs in the city jumped from 2,000 new cases two weeks ago to 4,100 cases last week, though the rate of progression slowed this past weekend when the situation in the capital stabilized. overall, MSF’s cholera teams have treated more than 21,000 people in the capital in the past two months.

In the Nord department, there were more than 3,500 new cases last week, but there was not the same kind of rapid increase as there was in Port-au-Prince, and, overall, the situation in the department seems to be stabilizing as the numbers of new cases plateau.

In the Nord Ouest department, MSF treated more than 1,100 new cases last week. That brings the overall number in the area to approximately 7,000, but the caseload seems to be stabilizing there as well. The same goes for the northern parts of the Artibonite region, where the epidemic began. in the southern part of Artibonite, the numbers actually began to drop last week. overall, there were 1,200 new cases in the whole of Artibonite, pushing the totals there above 26,000.

There were also 250 new cases in the Ouest department, not including Port-au-Prince, and in southern Haiti, there were more than 100 new cases in the Sud Est department, 130 in the Sud department, as well as 200 in Nippes, where there had not been any cases previously.

The overall case fatality rate remains below two percent, but MSF continue to press efforts to educate communities – particularly those where the disease is just now appearing – about cholera, its causes and treatment with the hope of assuaging fears and helping people understand why new CTCs are crucial to treat patients and arrest the spread of the disease.

“in places where we’ve been able to effectively communicate with communities, we have seen some stabilization and even some decrease in the numbers of new cases,” said Delphine Chedorge, MSF’s head of mission in Haiti. “This is a crucial aspect of the cholera response, because people need to know what they are dealing with, what they can do to help people who have contracted the disease, and how they can avoid contracting it in the first place.

“it is hardly surprising that people would be anxious about cholera when it appears in their communities for the first time. but as we tend to the new cases that present at our programs and that our assessment teams find in areas that haven’t had medical services until now, we also need to make people understand that opening new CTCs in or near their towns and villages can help stop the spread of the disease, protecting their communities, rather than endangering them.”

Haiti’s electoral authorities announced Thursday they would review the results in an effort the defuse the protests. At least four people died in the week’s unrest.

The announcement of the election results had come late on Tuesday evening and the sound of sporadic gunfire filled the air through the night. As the sun came up a pall of black smoke obscured the view of the port below, and the chants of demonstrators rose on the breeze. the streets below were devoid of traffic, which brought its own problems to a city in the initial stages of a cholera epidemic.

With hundreds of thousands of people still living in camps after the January earthquake, many citizens of Port-au-Prince depend on the fresh chlorinated water that is trucked into their camps on an almost daily basis. if traffic can’t move, water can’t be delivered, and hospital staff can’t get to work.

A spokeswoman at the American relief organization Samaritan’s Purse said the organization was working with a skeletal crew. she said one member of the hospital staff had hitched a ride to work on the back of a motorbike. A group of men stopped the bike, beat the driver, and threatened to do the same to the nurse, stopping only when they saw her uniform.

Cholera patients also need a functioning public transport system. This is a disease that is easily treated, but it can kill within hours of the first symptoms. Aid workers say people are now waiting much longer before seeking medical help because they fear being on the streets.

As Thursday morning wore on, the tension grew. We drove around the city to survey the situation. Our fuel was running low and no gas stations were open. Martelly supporters thrust posters through the car window. By then our increasingly nervous driver wanted to turn back as he’d spotted a large group of youths moving down a side street at an ominous jog trot.

And then our translator took a call from his girlfriend. Armed men were firing shots outside their home — a small shanty among the thousands that now fill the public space outside the Presidential Palace, itself lopsided and leaning precariously as a result of the earthquake. Time to head back.

As darkness fell the occasional gunshot rang out once more.

PORT-AU-PRINCE, Haiti — a contingent of U.N. peacekeepers is the likely source of a cholera outbreak in Haiti that has killed at least 2,000 people, a French scientist said in a report obtained Tuesday by the associated Press.

Epidemiologist Renaud Piarroux concluded that the cholera originated in a tributary of Haiti’s Artibonite river, next to a U.N. base outside the town of Mirebalais. He was sent by the French government to assist Haitian health officials in determining the source of the outbreak, a French Foreign Ministry official said Tuesday.

“No other hypothesis could be found to explain the outbreak of a cholera epidemic in this village … not affected by the earthquake earlier this year and located dozens of kilometers from the coast and (tent) camps,” he wrote in a report that has not been publicly released.

The report also calls for a further investigation of the outbreak, improved medical surveillance and sanitation procedures for U.N. peacekeeping troops and better support for Haitian health authorities.

The AP obtained a copy of the report from an official who released it on condition of anonymity. Piarroux confirmed he had authored the report but declined in an e-mail interview to discuss his findings. Copies were sent to U.N. and Haitian officials, the foreign ministry confirmed.

U.N. spokesman Martin Nesirky told reporters in new York that there is still no conclusive evidence that its base was the source of the outbreak. He said the organization “remains very receptive to any scientific debate or investigation on this.”

The report’s revelation comes on a day of high tensions in Haiti, as people anxiously await the results of the disputed Nov. 28 presidential election and potential resulting violence.

Piarroux could not prove there was cholera inside the base or among the soldiers, a point the U.N. has repeatedly used to deny its soldiers brought the disease to Haiti or that its sanitation procedures were responsible for releasing it into the environment. He writes that military doctors said there were no instances of cholera within the unit.

But he also hinted strongly at a cover-up.

“It can not be ruled out that steps have been taken to remove the suspected fecal matter and to erase the traces of an epidemic of cholera among the soldiers,” he wrote.

The report also notes that septic tanks and pipes that would have helped to confirm sanitation problems and the presence of the bacteria were no longer at the base when he visited.

Nepalese troops earlier confirmed they had replaced a leaking pipe, which contained a foul-smelling runoff that the U.N. denies was human waste, between two visits by an AP reporter in October. the AP also found the local contractor dumped waste into overflowing pools dangerously close to a hillside that drains into the river.

Piarroux’s is the first scientific report linking the base to the epidemic, though many other epidemiologists and public health experts have said for weeks that the soldiers are the most likely source of the infection.

Other scientists and experts say it is possible that ocean currents or other climate-related events carried the bacteria to Haiti. Further studies on bacterial samples that could address those questions are ongoing.

The U.S. Centers for Disease Control and Prevention confirmed in October that the strain of cholera bacteria in Haiti matched one from South Asia, a region that includes Nepal, but said it had no further information about the cause of the outbreak at the time.

Many Haitians have long suspected the Nepalese base was the source of the disease, and anger at the troops sparked a week of riots in which U.N. soldiers were injured and several Haitians were killed.

The report says that the first cases of the disease were from the village of Meille, where the base is located. the first confirmed case, a 20-year-old man from the village, developed symptoms on Oct. 14 and was found by Cuban doctors at a hospital in nearby Mirebalais.

Haitian investigators “indicated that the first patients were obtaining drinking water from a tributary of the Artibonite River flowing just below the (U.N.) base,” he said.

It notes that the rotation of soldiers began arriving days before those first cases from Nepal, where there were cholera outbreaks over the summer.

It goes on to describe how the disease flowed into the Aribonite River before “exploding” in the delta where the river meets the sea. Hundreds of cases were reported within days, before the outbreak spiraled out of control to infect the entire county.

Until this outbreak there had not been a diagnosed case of cholera in Haiti as far back as records go in the mid-20th Century, Claire-Lise Chaignat, head of the global task force on cholera control at the World Health Organization, said in October. There were suspected cases a century before, but experts say it would have likely been a different strain than the ongoing El Tor pandemic.

The disease was totally unknown to today’s Haitians, who had developed no immunity against it and had no information on how to fight it until aid workers mobilized after the outbreak. Terror over its fast-killing power has triggered attacks on cholera treatment centers and a witch-hunt in rural Haiti. At least 12 people were killed on accusations they used magic to spread the disease.

For the first critical month of the outbreak, the United Nations, U.S. Centers for Disease Control and Prevention, World Health Organization and others said that an investigation into how the disease arrived in Haiti was not necessary and could in fact be harmful. Those who asked questions about it were accused of playing “the blame game.”

It was not until AP reports of sanitation problems at the base and calls by experts including Paul Farmer, a physician and U.N. official, for a thorough investigation that the matter was seriously discussed in public.

Farmer said there were compelling public health reasons to find the source of the infection, including finding information to help prevent its further spread, and that avoiding the questions was a matter of politics.

The U.N. mission confirmed to AP last month that a French epidemiologist had met with met with U.N. peacekeeping mission chief Edmond Mulet in Port-au-Prince to discuss his findings. At the time the mission denied that he had implicated the peacekeepers, but acknowledged that it was now taking the allegations about its base more seriously than when rumors first arose.

On Tuesday the mission said the report was still not definitive.

“We have neither accepted nor dismissed his findings, as it’s one report among others,” U.N. mission spokesman Vincenzo Pugliese said. “The Nepalese contingent in Mirebalais is just one piece of the cholera puzzle, since there is no conclusive evidence at this point that the Nepalese camp was or was not the source of the epidemic.”

In roughly six weeks the disease has spread to every region of the country and sickened nearly 100,000 people. the U.N. says the death toll could be twice the official count and that up to 650,000 people in Haiti could get cholera over the next six months.

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