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.”

since October 22, 2010, Doctors without Borders/Médecins Sans Frontières (MSF) has treated 62,000 people with cholera symptoms in Haiti. This week, MSF's 4,000 Haitian staff and 315 international employees treated close to 2,000 patients each day in the 47 centers and cholera treatment units it has established across the country.

MSF has treated more than 15,000 people in the capital with cholera symptoms since the epidemic began. The number of patients admitted into MSF facilities in Port-au-Prince has stabilized at a daily average of 385 patients this week. The situation is also stabilizing in the Artibonite department, which has thus far been hardest hit by the epidemic and where more than 23,000 people have been treated. This week, slightly more than 1,000 people were admitted into MSF facilities there.

however, the epidemic continues to spread in Haiti's northern cities and rural areas. during the past week, more than 4,000 patients were treated in the Department du Nord, as its known locally, and 1,100 patients were treated in the Department du Nord Ouest. despite the significant logistical challenges involved in reaching isolated parts of both departments, MSF teams are expanding the number of units, treatment centers, and rehydration points in both areas.

MSF is treating victims of post-election violence

MSF treated 96 victims of the violence that erupted in Port-au-Prince and several other cities between December 7 and 12. Of that number, 38 had gunshot wounds. four people died of their wounds. MSF has surgical supplies and medical teams at six facilities in Port-au-Prince and two in other regions of the country. The organization remains prepared to treat any additional wounded patients. despite the insecurity, MSF teams have managed to ensure continuity of medical care, including responding to the cholera epidemic and treating persons wounded in the violence.

meanwhile, the epidemic has increased sharply in the South. Of the 475 people treated in the South for cholera since the start of the outbreak, 439 presented in the past seven days. in Jacmel, in the Departement du Sud Est, approximately 100 patients are arriving at MSF's 50-bed cholera treatment unit every day. "our team had to handle an inflow of 260 in a single day," says Dr. Loreto Barcelo, MSF's coordinator in Jacmel. "there were people everywhere… Patients, their families… there were several hundred people at the treatment site. We had to put up to four patients in a single bed and try to save as many as possible while waiting for extra help to arrive. We now have an additional 20 nurses helping us and opened a new 100-bed treatment center, which is helping us manage the situation."

This week, new cholera treatment facilities were set up in Pignon, St Raphaël, Ranquitte (Nord), Gaspard (Nord Ouest), and Jérémie (Grande Anse). however, as the epidemic continues to spread, the response by local and international organizations remains inadequate.

Some have raised the possibility of launching a vaccination campaign. Under the circumstances, epidemiologist Kate Alberti wonders if this is appropriate. "The epidemic affects the entire country today, including the most remote areas. This isn't the time to carry out a vaccination campaign. The priority is to treat patients, provide access to chlorinated water and improve hygiene measures to prevent others from becoming ill." however, Alberti adds, "in the future, we will consider vaccination as a viable option to immunize the population and limit the appearance of a new epidemic."