Help PIH Respond to Cholera Outbreak in Haiti

by Partners In Health (PIH)
Help PIH Respond to Cholera Outbreak in Haiti
Help PIH Respond to Cholera Outbreak in Haiti
Help PIH Respond to Cholera Outbreak in Haiti
Help PIH Respond to Cholera Outbreak in Haiti
Help PIH Respond to Cholera Outbreak in Haiti
Help PIH Respond to Cholera Outbreak in Haiti
Help PIH Respond to Cholera Outbreak in Haiti
Help PIH Respond to Cholera Outbreak in Haiti
Photo by Cecille - Partners In Health
Photo by Cecille - Partners In Health

Cholera is unfortunately still a part of daily life in Haiti. Years after one of the world’s deadliest outbreaks of Cholera, government and international agencies are still working to stop the spread of the disease. Partners In Health is one of these, thanks to supporters like you.

First introduced by UN peacekeeping forces, Cholera has had a devastating effect on Haiti. 10,000 people have been killed and countless more have fallen ill. That included mothers, fathers, daughters, and sons as well as infants. What makes Cholera a tough illness to combat is the manner in which it spreads and the conditions in which it thrives. Haiti’s environment provides both.

Being a waterborne illness, Cholera is spread by contaminated drinking water. In the absence of latrines or public sewage systems, the world’s poor often drink from the same river or stream used for defecation — infecting water supplies. This means that developing nations and areas affected by natural disasters are often at risk of Cholera outbreaks. In the case of Haiti, this small country has the unfortunate luck of being both a developing nation and a nation routinely affected by natural disasters.

However, there is still hope for Haiti. The number of cases and deaths per year has dramatically decreased. A part of that is due to donors like you.

Relief came to the people of Haiti in 2012 when large scale vaccination programs were launched to protect the people from the harmful bacteria. PIH was among one of the outbreak’s first responders in Haiti. Within several months, PIH had set up 11 Cholera treatment facilities throughout the country and began treating the sick. These vaccination programs were highly successful in reducing the total number of Cholera cases and defying expectations by successfully protecting 90% of adults and 94% of children.

That was until October 4, 2016, when Hurricane Matthew struck the small island nation. As expected with this water-borne disease, after the hurricane hit there was again an increase in the number of Cholera case and deaths. Thankfully, PIH and other relief agencies were there and ready to help the survivors. PIH directly treated 1,682 patients following the hurricane and worked with the Haitian Ministry of Health to help vaccinate an additional 800,000 Haitians.

In Haiti, PIH remains the largest non-profit health care provider, and as such we will continue to work there to protect the citizens in reducing (and maybe eliminating) deaths and illness due to Cholera. Your support has contributed to the countless lives that were saved from Cholera. We thank you!

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  In the aftermath of Haiti’s devastating earthquake, UN peacekeepers stationed in central Haiti’s Artibonite Valley introduced cholera to the country, triggering the second largest epidemic of the disease in history.

 Cholera, which is a new disease to Haiti, has sickened more than 770,000 people and killed more than 9,200 people since its outbreak. So far this year, it has sickened some 6,000 individuals and is killing an average of 37 people every month. Haiti’s persistent cholera issues are due to its continued bombardment of tropical storms such as Hurricane Matthew in 2016, and lack of access to clean water and improved sanitation, making it easier for the disease to spread. The world health organization has termed Haiti’s cholera outbreak as endemic, as the bacterium could very well be established in Haiti’s rivers. This is a far cry from pre-2010, when cholera was not a known disease in Haiti.

 Partners In Health has been actively working to combat the spread of the disease and treat those effected, by organizing more than 3,300 community health workers, bringing together stakeholders and government organizations. In partnership with Haiti’s Ministry of Health, Partners In Health has administered more than 80,000 oral vaccinations and consistently runs public hygiene education campaigns.

 While we’ve made strides in combating cholera in Haiti, there is still much work to be done. “We need to raise our expectations of what’s possible to do in Haiti and other countries in terms of these diseases that we’ve completely eliminated from our own societies,” said Dr. Ivers, a senior policy adviser with Boston-based Partners In Health. There are still many others who need cholera oral vaccinations. Your continued support of Partners In Health helps support our program to vaccinate Haiti and stop the threat of cholera for good.

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MIREBALAIS, HAITI - NOVEMBER 17, 2017: Juliel, 26 years old and working as a town crier for PIH's vaccination campaign in downtown Mirebalais, walks through the neighborhood not far from HUM calling residents to get their cholera vaccination. Part of her path took her past the Aba Kolera house that morning.

Photo by Cecille, Partners In Health

 

In late 2017, when hurricanes and tropical storms soaked Haiti and increased the likelihood of a deadly uptick of cholera, Partners In Health responded by launching an ambitious cholera vaccination campaign in partnership with the Haitian Ministry of Health.  Our goal, to reach all 100,000 residents of Mirebalais District, was propelled by supporters like you.

Vaccination teams visited schools, churches, health centers, and homes to administer two oral doses per person, over the span of several weeks. In all, PIH and the Haitian government’s efforts protected more than 80,000 people against the deadly disease.

Community health workers are trained to recognize the signs and symptoms of cholera and teach them to community members; prepare oral rehydration solution (ORS), use ORS to treat cholera symptoms, and teach community members how to prepare and use ORS; refer cholera cases to the health center immediately; and teach community members correct hand washing, water treatment, latrine use, food hygiene, household sanitation,  and waste disposal techniques and procedures approved by Haiti’s Ministry of Public Health and Population.

While we’ve made progress, there is still plenty to be done. There are still malnourished children, patients stricken with cancer, friends and neighbors are still living with HIV/AIDS, and a looming threat of cholera, heightened each year during hurricane season. Partners In Health is unwavering in our efforts to not just end cholera in Haiti, but to continue to tackle other infectious diseases ten countries around the world.  All of this good work wouldn’t be possible without the help of donors like you! We were glad to have you as partners in health this year, and hope that you’ll continue to accompany us into the future,and as we work to build comprehensive public health systems and delivers care in remote, impoverished communities around the world.

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Thank you so much for supporting Partners In Health and our efforts to combat cholera in Haiti and around the world.   We are excited to share an update with you about the progress that we have made, together with partners, to advance the effectiveness and accessibility of a preventative vaccine.

On September 12, 2018, Precision Vaccinations published the following article, written by Don Ward Hackett on their website, which details much of the success of this project.

 2 Doses of Cholera Vaccine 76% Protective For 4 Years

September 12th, 2018 – There is some timely good news regarding cholera Vaccine Effectiveness, given the ongoing emergency in Zimbabwe

According to a new case-controlled Harvard study, people who received 2-doses of a killed, bivalent, whole-cell oral cholera vaccine during the height of the 2010-2017 cholera outbreak in Haiti were reported to be 76 percent less likely to become sick from the bacterial infection.

Additionally, this protection appeared to last for 4 years.

In contrast, single-dose effectiveness decreased over time in a log-linear fashion, with a predicted Vaccine Effectiveness (VE) of 79 percent at the end of 1 year, which then declined to 0 VE before the end of the 2nd year.

This study’s findings are consistent with the 2-dose long-term vaccine protection of killed, bivalent, whole-cell oral cholera vaccines (OCV) reported in previous studies done in India (65% and 69%) and Vietnam (50%).

Left untreated, cholera can swiftly turn devastating, even deadly, said these researchers. 

Since cholera was introduced to Haiti by infected Nepalese UN peacekeepers in the wake of the catastrophic 2010 earthquake, more than 800,000 cases of cholera have been recorded and 10,000 people have died of the disease, reported the NY Times

In most industrialized countries, such as the USA, cholera is generally not a significant health issue.

The bacterium Vibrio cholerae kills by causing an infection that produces acute diarrhea, which in turn causes massive dehydration and the rapid loss of vital electrolytes such as potassium, calcium, and chloride.

The study was led by researchers at the Harvard Medical School (HMS) Department of Global Health and Social Medicine and Massachusetts General Hospital, with colleagues at Zanmi Lasante (Partners In Health) in Haiti.

“Our findings yield crucial insight for understanding the optimal use of oral vaccines in the context of comprehensive cholera control and prevention,” said lead author Molly Franke, assistant professor of global health and social medicine at HMS. 

“In the challenging conditions present in Haiti in the wake of the earthquake and in the midst of an active cholera outbreak, the consistent, long-term protection provided by the vaccine makes these vaccines well worth the investment,” she said.

The current study lends support for the long-term effectiveness of vaccination as part of a comprehensive anti-cholera program that also includes treatment centers and efforts to improve access to clean water.  

The global cholera vaccine stockpile is managed by the Global Task Force on Cholera Control (GTFCC), which decides on OCV use in non-emergency settings, and the International Coordinating Group (ICG), which decides on outbreak response and features representatives from WHO, UNICEF, the International Federation of the Red Cross and Red Crescent Societies (IFRC) and Medecins Sans Frontières (MSF).

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Please enjoy the following interview with one of our nurses to see behind the scenes of the work being done in Haiti. 

 

"Magda is a woman on a mission. She may not be big in stature, and her voice might carry more squeak than roar, but there is no doubt that she commands attention when she enters a room.  

Louis Juste is among a tight-knit, highly competent group of oncology nurses at University Hospital in Mirebalais, Haiti. She has been a nurse for eight years, more than half of which have been with Zanmi Lasante, as Partners In Health is known in Haiti. 

An extrovert by nature, Louis Juste says she loves her job providing care for the dozens of cancer patients who circulate through the ward every week. But that’s just one outlet for her energy. She is currently studying to become a lawyer, advocates for prisoners’ rights in the capital of Port-au-Prince, and volunteers with a nonprofit called PUSH, which helps young Haitians hone their professional skills and improve their employability. 

In honor of International Nurses Day, Louis Juste reflected on her role in Haiti, the importance of advocating for patients, and what the next generation of nurses needs to know.

What do you like most about your job?*

People usually think nurses only give to patients; they don’t realize how much patients give to nurses. When you work with patients, especially those with cancer, they are struggling. They have socioeconomic problems that impact their lives and family, but they’re still strong and happy. That makes you strong. The patients are super heroes to me. They give me strength.

What is the relationship like between doctors and nurses?

A doctor doesn’t collaborate with nurses. They give orders, and you have to execute them.

Usually the doctor writes in a chart and says what they want you to do for each patient. Sometimes they write, ‘Give nursing care.’ I used to say to them that they should not write, ‘Give nursing care.’ I know what I have to do. That’s my job. You can write, ‘Give 20 mg Benadryl for a day.’ But tell me that I should give nursing care? It’s not acceptable. They treat nurses like maids.

But the problem is not just the doctor; it’s the system. In Haiti, there are a lot of nursing schools. A lot of them are not certified. So doctors have seen a lot of nurses who don’t really know what they are doing, and that’s why they think that nurses only give pills or injections. 

In what ways do you advocate for your patients?

When a patient comes to the hospital, and the patient is sad, you should notice that as a nurse. You’re not a psychologist, but you should have some notion of psychology to understand patients, talk to them, and refer them to a psychologist. If they are having economic or family problems, you can refer them to a social worker. 

Patients sometimes come from very far, and if they are palliative patients who have to come every week, it’s very difficult because they don’t have money for transportation. So they don’t come. Nurses then call to ask why, and patients say they don’t have money. That’s when, as a nurse, you can talk to the doctor, tell them that a particular patient lives far away, and ask them to maybe consider giving chemo to the patient every three weeks. You advocate for the patient, and the patient knows that. 

Sometimes doctors give patients medications, and the patients don’t understand what they are supposed to do. They don’t want to talk to the doctors, because they see they are in a hurry. But they know you’re more patient, you have more time for them, and they ask you to help. 

I understand nurses sometimes have too many patients. Sometimes the nurse can’t really remember a patient’s name. I think it’s very important to remember. When you do, patients feel safe and that someone cares for them. You have to call patients by their name, not Bed 1.

What advice would you give students interested in nursing in Haiti?

If they want to become a nurse, they have to work hard at school. Sometimes students think that if they’re going to nursing school, they don’t need to know anything about math, that they just need to know biology or chemistry. It’s not true. You have to learn everything. Whatever they offer at school, you take it. 

When you are searching for a nursing school, check to see that it’s certified.  Then when you are at school, you have to learn to become a very competent nurse. If you’re competent and do your job, people will respect you. 

I want nurses to be aware of their position, of their worth. They shouldn’t just give pills or execute orders. We need to have more professional development opportunities for nurses in Haiti so that they can take advantage of the broad scope of specialization within the field. We need to start to change the image of nursing here. If you are a nurse, you are competent, and you should have autonomy to do your job. 

*This interview has been edited and condensed."

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Partners In Health (PIH)

Location: Boston, MA - USA
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Laura Soucy
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Boston, MA United States
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