Following its response to the catastrophic earthquake in Haiti in 2010, International Medical Corps’ teams responded to the equally devastating outbreak of cholera in late October 2010. International Medical Corps was one of the very first organizations to respond and had medical staff on the ground in one of the worst areas – Artibonite – days before the outbreak was confirmed to be cholera. International Medical Corps aggressively rolled out a network of cholera treatment centers (CTCs) and mobile medical units in Haiti’s most remote and affected areas to care for more than 39,700 cholera patients. International Medical Corps also trained and mentored more than 1,200 doctors, nurses, and community health workers so that our network of CTCs were established and staffed largely by local health professionals and could eventually be handed over to the MoH and be a part of the country’s long-term infrastructure to prevent and treat cholera.
Since that time, International Medical Corps’ work has focused on cholera preparedness and response to outbreaks, particularly in rural areas where access to health services and knowledge of cholera and how to prevent it is very low. During 2013, International Medical Corps’ work focused on cholera education and prevention activities in the Grand North, considered one of the country’s most under-served areas in terms of infrastructure and economy. The Grand North (including the North, Northeast and Northwest Departments) has demonstrated its vulnerability to cholera outbreaks, and since the initial outbreak in 2010, there have been over 135,374 suspected cholera cases within the three departments, with this region also seeing a higher case fatality rate than that of Haiti nationally, at 1.6%.
In response, International Medical Corps assessed the needs of several remote communities in the North and North-East Districts and focused its support on re-supply of the area’s health centers with general use and cholera medicines while also delivering education campaigns to help local residents prevent the spread of cholera. International Medical Corps, in partnership with the Council of Haitian Non-State Players (CONHANE) and the MSPP, worked with four community based organizations in the selected communities to conduct cholera prevention awareness activities through house-to-house visits and hygiene awareness sessions in churches and schools. By the end of 2013, International Medical Corps’ cholera prevention efforts in the north of Haiti indirectly benefitted more than 125,000 people.
Now, in 2014, International Medical Corps has continued its work responding to cholera outbreaks in Haiti in the Grand North through mobile medical units. International Medical Corps currently operates six mobile medical units staffed by trained Haitian health personnel who investigate suspected cases of cholera, provide treatment or referral, and sensitize and educate at-risk communities. Once a suspected case is identified through the surveillance system, International Medical Corps’ mobile medical unit team quickly deploys to the area to investigate the suspected case and provide treatment or support referral to the nearest health facility. The team educates the household and provide supplies to disinfect the home. The teams teach proper hand washing techniques; the importance of water treatment in order to avoid contracting cholera; and the proper use of latrines and waste management techniques.
After the household work is complete, the mobile medical team then focuses its prevention efforts with the surrounding community. The team trains and mobilizes community volunteers in the surrounding community to assist in awareness campaigns to remind the population that cholera is still present in their community and that they need to apply good hygiene practice to avoid the spread of cholera. As needed, the mobile medical teams also directly teach local residents how to identify all types of diarrheal related water diseases and cholera in particular, and how to properly prepare and use oral rehydration salts – critical tools in the fight against cholera.
Thanks to the generosity of Global Giving and other generous donors, International Medical Corps’ six mobile medical team (two in each targeted Department - the North, Northeast and Northwest) have achieved the following results from 2014 to-date: 19,576 individuals have been reached to-date with cholera prevention and health promotion messages, 19,127 Oral Rehydration Salt (ORS) sachets and 88,450 aqua tabs were distributed, and 771 cases of acute diarrhea have been treated by International Medical Corps’ teams. While this work has helped to save lives and has laid an important foundation of knowledge in vulnerable communities in the Grand North, each hurricane season now brings with it the potential for a large scale outbreak, which combined with difficult terrain and low access to health care, could result in a rapid increase in cases and deaths. Looking forward, International Medical Corps plans to continue these mobile medical units in the Grand North through the fall and then transition to broader Disaster Risk Reduction activities to help to further build resilience at the individual, household, and community level to dangerous threats such as cholera as well as other hazards in the region.
During 2013, International Medical Corps’ efforts in Haiti focused on cholera prevention for vulnerable populations in the north of Haiti, indirectly benefitting more than 125,000 people. According to the Haitian Ministry of Health (MSPP), reports related to new cholera infections started to increase in those communities during the month of June. In response, International Medical Corps conducted weekly visits in Haiti’s Grand North District to confirm and evaluate the situation within targeted health facilities and to assess the condition of the cholera patients. During the visits, several problems were identified by International Medical Corps health professionals, including, among others, a (lack of medical supplies to treat patients infected by cholera and a low awareness of cholera among the at-risk population, to which may be attributed to shortages in available trained health staff and volunteers in the community to conduct Cholera awareness and prevention activities.
International Medical Corps assessed the situation and designed an intervention that would reinforce the capacity of the selected health facilities to response to cholera outbreaks and increase the awareness of the community to avoid the spread of cholera to the remote and underserved areas during the rainy/hurricane season. During the rainy season, flooding from strong tropical storms and hurricanes can contaminate water sources in remote areas and cause waterborne diseases to spread. These storms also damage the already poor road infrastructure, which can lead to medicine shortages and prevent patients with severe cases of cholera from being able to reach major health centers for treatment.
International Medical Corps assessed the needs of several remote communities in the North and North-East Districts and focused its support on re-supply of the area’s health centers with general use and cholera medicines while also delivering education campaigns to help local residents prevent the spread of cholera. Based on the distance and needs of each community and considering the generally poor road infrastructure of the region, four underserved communities and their respective health facilities were selected for this effort. These health centers were serviced in the following order: (1) Hôpital de l’Espérance de Pilate, (2) Centre de Santé de Dondon, (3) Centre de Santé de Ferrier and (4) Centre de santé de Sainte Suzanne. These four health centers serve a combined population of 125,326 people.
International Medical Corps provided a several month supply of medicines to the health centers and deployed community volunteers through local community based organizations for one month. Awareness training needed to be conducted to help the vulnerable communities recognize the ever present existence of cholera and that they needed to continue using good hygiene practice in order to avoid further cholera contamination. International Medical Corps, in partnership with the Council of Haitian Non-State Players (CONHANE) and the MSPP, worked with four community based organizations in the selected communities to conduct cholera prevention awareness activities through house-to-house visits and hygiene awareness sessions in churches and schools. During the awareness campaigns, the volunteers reminded the population that cholera is still present in their community and that they need to apply good hygiene practice to avoid the spread of cholera.
Thanks to the generosity of Global Giving and other generous donors, the intervention has completed all the planned activities and all result has been positive. International Medical Corps, along with CONHANE, was able to deploy 40 volunteers and two zones coordinators, reaching two communities in the North and two communities in North-East. Over 34,000 people in 4,839 households have been sensitized to the importance of proper hygiene practices to prevent the spread of cholera, and also received Aquatabs and oral rehydration salts (ORS) to treat the disease. Further, all 40 volunteers are available to continue the campaign which will ensure that an even larger number of people can be reached with critical hygiene education in the near future. Additionally, 100,000 water purification tablets (Aquatabs) and 5,000 ORS sachets have been distributed to prevent cholera in the community. While the project has been successful, it is important to remember that cholera is still present in Haiti. Prevention efforts must continue to stop the spread of cholera, particularly in vulnerable communities.
International Medical Corps, in partnership with the Haitian Ministry of Public Health and Population (MSPP), supports a Multi-Purpose Health Worker training program at the Higher Institute of Health Leadership Training of Cayes. This program puts into place a standardized education system that is supported by the MSPP. The current program is located in Les Cayes which is located in the South Department region of Haiti. International Medical Corps’ program officer in the area interviewed six students about their future after participating in this training program that was launched last year. Below are the responses from the interviewed students:
While looking for work after graduating high school, Pierre found an announcement for a health officer training program in the newspaper. Pierre wanted to learn more about being a health officer before he joined the program, so he consulted his uncle who currently works as a health officer and could explain the duties of the job. After his conversation with his uncle, Pierre decided to enroll in the program. After he passed the training program’s entrance exam, he was confident that being a health officer could lead to a successful career. Pierre, whose personal motto was “health for all”, wished to help the people in his community who are suffering from behavioral issues.
Pierre did very well in school, and said that the key to achieving good grades was to study very hard every day. Ultimately, his goal is to attain a master’s degree in community health and health education pending completion of his training as a health officer. For Pierre, the health officer training program provides an excellent opportunity to develop a meaningful career directly out of high school, because approximately 90% of the trainees from this program find work in their local communities. Given current economic conditions, Pierre is a little concerned about the ability of the Ministry of Public Health and Population (MSPP) to continue to place such a high proportion of graduating students in the health system. However, he remains confident in his decision to pursue this training because the program will endow him with the skills necessary to be compliant with national health standards. Pierre is determined to achieve success in his career by the age of 30 and says, “A health officer career will provide for the needs of my family in the future.” He continues by stating that “Decentralization of the program is also good idea for the welfare of students.”
Two of the young ladies in the health officer training program talked about how they felt about the program and their desired outcome of their participation:
Gracieuse learned about the health officer training program from a friend. She was most interested in the aspects of the program regarding housing, nutrition, transportation and the formation and delivery of training materials. Gracieuse believes the program will ultimately benefit the entire country of Haiti. She hopes to apply the skills learned in this program to benefit the general population, with support from the government. When asked about what she sees in the future for the program, Gracieuse replied: “Given the economic situation, I am concerned for the future of the program, however, I intend to perform the job of health officer as necessary to improve our community and our lives.”
Medina also learned about the health officer training program through a friend that attended the first run of classes. When she first enrolled in the program, Medina was worried that the training program would teach her some basic skills and then leave her without support. After spending more time in the program, she now believes that it will allow her to teach people in her community to take control of their health while keeping her supported as she becomes acustomed to her new profession. When asked what she will do after classes end, Melinda said “I will continue to use the concepts to preserve my health, the health of my family and my community as a whole. If the program is delivered as intended, we can improve the health of ourselves and our community. I plan to use my education to provide effective services to the community for health promotion and disease prevention.”
Mackenson first heard about the health officer training program through radio commercials. Wanting to hear more about the program, he contacted a recent graduate to ask them about the training and the careers it can lead to. At first, Mackenson thought that he would only receive enough financial and material support to meet the training requirements for the position of health officer. Now he believes that the health officer program and its focus on improving the entire Haitian healthcare system is good initiative that will not only benefit him as an individual, but the community as a whole.
When asked what he will do after classes have ended, Mackenson replied that he wants to be hired quickly so he can apply the concepts he learned in the program. He believes that educating people about essential health topics will be beneficial to the population, because they will be able to protect themselves against diseases related to the environment (e.g. diarrhea, cholera, etc.) and act to remedy factors that may affect their health negatively. Mackenson stated, “In my opinion, this program will allow me to have the means to meet my needs, support my family and help others who are vulnerable. I will use my skills, knowledge and expertise to serve the community to which I am assigned.”
Jean first heard of the health officer training program through a poster from the Ministry of Public Health. For Jean, this program seemed to offer skill training that is critical to the health of individuals and ultimately the community in general. He said “At the end of this program, I will enter the labor market and demonstrate the knowledge I have acquired by serving the community.” Jean hopes that the Ministry of Health will achieve the objectives of this program. “People in the community need our presence so that they can learn basic concepts of hygiene and safeguard their health,” Jean explained. “Health is a right that must be preserved. I will work with the community to promote health education and teach the basic principles of hygiene. Eventually, I hope to become an expert in that subject.”
Genel learned about the health officer program through a friend. He first thought that this program would be identical to many other training programs, but he now believes that this program has the ability to address most of the existing problems facing the country in regards to environmentally spread communicable diseases. He hopes that all the students currently in the program are able to find work in the public health sector. When asked how he saw this program’s future, he replied: “The program will change the point of view of many in regards to health, and the community will be less affected by epidemics. After I graduate from the program, I will be ready to serve the entire Haitian population; my knowledge and skills will help people take charge of their health by taking into account their environment.”
Three and a half years after the earthquake that devastated Port-au-Prince and the surrounding region, International Medical Corps continues its work to support health system strengthening in Haiti.
With International Medical Corps, the Haitian Ministry of Public Health and Population (MSPP) is piloting the “Agents de Santé Polyvalent,” or Multi-Purpose Health Worker, Program. This program replaces the previous mix of community-health worker initiatives from the government and various NGOs, putting in place a standardized education system supported by MSPP.
The current pilot program is located Les Cayes, a small city in the South Department. The program provides an intense and rigorous education program for the 29 participants from the region over the course of two years.
The first thirteen weeks of the program consist of lectures and presentations covering mathematics, physics, chemistry, communication, precautions, infection control, personal hygiene, community hygiene, environmental health, ethics and conduct, and community diagnosis. Following the lecture component, students then go to the field to practice what they have learned under supervision of MSPP staff.
As a part of this field visit, students must assess the community to determine what health issues exist. Following this assessment, they return to the community to provide information on the issues they encountered, including education on hygiene promotion and environmental hygiene.
International Medical Corps is proud to support MSPP and the future “Agents de Santé Polyvalent.” The Haitian government aims to eventually roll this program out countrywide, providing one health officer for every 1,000 Haitian people.
“It’s like your heart is about to explode. Even now, three years later, you still feel the pain.”
In 2010, Dr. Virginia Chevalier was a young medical resident doing her hospital rounds in southern Haiti when, around 5pm on January 12, the earth started shaking. She remembers everything sliding beneath her feet and feeling like there was nothing to support her. She still feels the shaking, even today.
Virginia knew from an early age that she would be a doctor; she says it was written in the stars. Raised in Port-au-Prince, the second child of four, Virginia “saw everything”—Haiti’s extreme poverty, lack of health care and stark inequalities. It was “like hell,” so Virginia decided to do something to help. She earned her medical degree in Port-au-Prince and went south for her residency. Then the earthquake hit.
Within about six hours, the hospital where Virginia worked started receiving patients “without hands and legs; with broken eyes.” She still had two hands but wished she had more to carry everyone at the same time as they called out to her, “I need this. I am dying. Miss, please, nurse...” All the while, she couldn’t stop thinking about her family in Port-au-Prince. But there was no way to get in touch.
Words fail to describe what Virginia felt when she returned to the capital three days later, so she keeps repeating “very, very stressful.” Even being a doctor couldn’t prepare her for what she saw. Virginia walked for an hour on broken streets that “smelled dead” to reach her family home. At last, she found her parents, alive but too afraid to go inside their house. It was then that Virginia finally broke down and wept. Relief mixed with grief.
Life became entirely about staying alive. With no food, no water, no money, “You just try to survive.” Virginia willed herself to focus on the patients who came to her begging for help, but her mind was “without energy.” After two weeks, Virginia went back to work in the south. She and the other hospital staff treated patients outside under the hot sun as aftershocks went on for week. They were always on high alert; always ready to run. Everything felt like shaking—“You just keep wondering when something will happen again.”
Then life goes on, or it has to. But everyone in Haiti who experienced the earthquake that day, Virginia insists, still has a psychological impact. Even the survivors are “lost mentally because people cannot support the shock.” They think, “Why am I still alive? Why me? When I lost my family and my country is in ruins?” So, says Virginia, “You have to fight—with everything you have. Otherwise, you will lose your mind.”
When she finished her residency, Virginia tried to return to Port-au-Prince to be with her family. She applied to countless jobs in the city to no avail. Finally, one day, she had a talk with God: “Ok I’m ready to go where you want me to go.” She expanded her job search to outside Port-au-Prince and immediately received calls from several different non-governmental organizations, including International Medical Corps. After meeting with us, Virginia cancelled her other interviews. It just felt right.
According to Virginia, International Medical Corps saw more in her than she saw in herself. After one month, she became the supervisor of one of our sites, then another, and finally her work took her back to Port-au-Prince. Step by step, she became a manager: “I grew up with International Medical Corps. I learned so much.” Today, she does more capacity-building than clinical work, and although she sometimes misses contact with patients, she knows she’s “helping lay the groundwork for more.”
For instance, says Virginia, “If you work in a clinic, you may deliver a beautiful baby girl. But I get to fight for something else: to have more health facilities where women can give birth safely and hygienically; more trained OBGYNs; places where a mother can take her child if it has disabilities.”
Virginia also likes that “International Medical Corps does not come and try to decide what you need for you. They put national staff in the middle of the process and ask ‘What do you need? ‘How can we help the situation?’” She is proud to represent International Medical Corps at meeting with agencies like the United Nations and World Health Organization, but says her presence is “unusual” because “I’m female and a Haitian national.”
It shouldn’t be. Ultimately, the expertise of an ex-pat will come and go, but it’s Haitians who will stay. Says Virginia, “We will always be part of our country. It’s our country. And we have something to say.”
Today, Virginia believes that it was all “not for nothing.” She thinks that Haiti was “slipping” before the earthquake and then was “shaken to move forward”—to better understand “the lack” that existed and how to rebuild in a more equal and sustainable way. In the end, says Virginia:
“I think the earthquake brought something to us. We started to realize that the way we used to live was not correct, and that we have to integrate into the world. If every Haitian can think like this, I think that everything that happened to us will serve to progress us; to bring something different for the next generation. There is a lesson. We have to push to enter into life; to not be separate.”
And so, Virginia — and Haiti — bravely pushes on.
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