Help PIH Respond to Cholera Outbreak in Haiti

(Eusuze Murat (center), a WASH hygiene promotion supervisor, and Joseph Rolles (right), a WASH engineer intern, walk with health workers to the town of Larang in Cerca-La-Source.)

Thank you for supporting Partners In Health and our efforts to treat and prevent cholera in Haiti, which has enabled us to continue working in partnership to make measurable progress fighting this disease and saving lives.

Cholera is a centuries-old disease, but it’s a relatively young scourge in Haiti. It entered the country in October 2010 when contaminated sewage from a United Nations peacekeepers’ camp leaked into one of the largest water sources, the 200-mile Artibonite. There have since been more than 745,500 cases of cholera and nearly 9,000 deaths, according to Haiti’s Ministry of Public Health and Population.

The disease is a day-to-day battle for health care professionals working with Zanmi Lasante (ZL), Partners In Health’s sister organization in Haiti.

There’s an immediate side to eliminating cholera, which requires identifying and treating patients for a potent diarrheal disease that could kill within 24 hours. And then there’s the long-term side, which requires infrastructural and behavioral change.

In 2012, Haiti government officials crafted a 10-year national plan to eliminate cholera by responding to both sides of the epidemic—curing those who are ill and preventing further infections by improving water, sanitation, and hygiene (WASH) in rural and urban areas. To support those efforts, ZL formally began a WASH program in January 2014, applying its nearly three decades of expertise in programs related to health; water, sanitation, and hygiene; and disease control. The WASH team promotes behavioral change and supports the construction and rehabilitation of water and sanitation infrastructure at ZL- and government-supported clinics, hospitals, and schools.

“At the end of the day, if people are dying from preventable water-borne diseases, no amount of medicine or health care access will make a difference,” says Elizabeth Campa, ZL’s senior health advisor and advisor to the WASH program. “Without WASH, we do not have health.”

WASH staff face an uphill climb. Haiti is the most underserved country in the Western Hemisphere in terms of water and sanitation infrastructure, according to a 2012 report by the World Health Organization and UNICEF. Only 69 percent of the population has access to a clean water source and 17 percent had access to improved sanitation facilities in 2010.  The latter is comparable to some countries in sub-Saharan Africa and far below the regional average of 80 percent for Latin America and the Caribbean.

The work of the WASH team was critical during the most recent waves of the cholera epidemic, and for the past two years, its rapid response team helped chlorinate water, disinfect homes, provide hand soap, and offer referrals to mobile cholera treatment centers.

WASH is also focused on long-term, community-based programs, such asCommunautes Assainies (Healthy Communities). Its goal is to reduce the prevalence of diarrheal diseases by 25 percent in 20 communities in and around Mirebalais and Cerca-La-Source within a 16-month period.

Since October 2014, the WASH team has supervised and provided technical support for community members who have built nearly 700 household toilets. The goal is to expand that number to 2,000 by January 2016. The team will also oversee the construction of water and sanitation facilities in 20 schools and five health centers over that same period.

A major, yet less visible, part of WASH's work involves improving social norms regarding hygiene and sanitation. The WASH team meets regularly with local leaders to understand common practices. Together they decide when to gather the larger community to inform residents on cholera’s reach in Haiti, its transmission through contaminated water, and its broader economic and social impacts. During those meetings, a volunteer committee is selected and asked to develop a plan for the community’s eventual certification as “open defecation free” (ODF). A local resident is chosen as the WASH community agent, tasked with smoothing neighbors’ transition to a new way of life.

Once activities are in full swing, WASH staff provide advice to community members on the proper location and maintenance of household toilets. Government officials and local representatives assess the community after several months' work and award ODF status once that goal is reached. They also continue to monitor the community to ensure residents remain faithful to their plan.

WASH can already point to success stories. Jeremy, a town in Cerca-La-Source, was certified this month an ODF community, and other towns have built dozens of household toilets and are working to change behavior regarding sanitation and hygiene—arguably the more difficult of the two steps.

Other WASH community projects under way in the Central Plateau include improving water, sanitation, and hygiene facilities in the Belladere hospital and Lacolline School in Lascahobas. And next year, WASH will begin improving facilities at 25 ZL- and government-supported schools.

“All our kids in the ZL network of schools will have a safe place to relieve themselves and access to water points for drinking and washing their hands,” Campa says. “My hope is that this project will plant a seed in our kids’ lives on the importance of sanitation, clean water, and good hygiene behavior.

“Adolescent girls will likely not miss so much school because they'll have a safe place to wash during their menstruation,” she adds. “And our team is striving to target the parents of these kids too in constructing their own household sanitation. The possibilities are endless.”

Thank you for supporting Partners In Health and our efforts to fight Cholera in Haiti.  We’re thrilled to share excerpts from an article recently published on our website about the success of the Cholera vaccination campaign—made possible with the support of generous people like yourself.

When a cholera epidemic exploded in Haiti less than a year after the devastating earthquake in January of 2010, the staff at Partners In Health/Zanmi Lasante responded immediately and aggressively. We mobilized thousands of community health workers, opened cholera treatment wards, ran sanitation and hygiene initiatives, and more. A proposal to administer the new, World Health Organization-approved vaccine Shanchol was also floated.

The idea was doubted and criticized by many, but the community wanted the vaccine, and PIH/ZL was determined to provide the best care available. With the blessing of the Haitian Ministry of Health, PIH/ZL pushed ahead, and after overcoming all sorts of obstacles in distributing the tiny vials—training legions of staff, fighting the axle-gripping mud of rainy season, working around a simultaneous polio vaccination campaign, ensuring 45,417 patients swallowed two doses of the drug two weeks apart—the campaign finished in June 2012.

This past February, Dr. Louise C. Ivers and colleagues published a paper showing exactly how much the vaccine Shanchol slowed the spread of cholera in villages north of St. Marc, Haiti, in 2012. Writing in The Lancet Global Health online, the senior health and policy adviser at Partners In Health finds that Shanchol was widely effective when administered to thousands of adults and children in the region. “We found that there were about 65 percent fewer cholera cases among people that were vaccinated than there were in those that were unvaccinated,” she says.

It’s fantastic news, and not just for the obvious reason that fewer cholera cases means fewer cholera fatalities. ”Effectiveness of reactive oral cholera vaccination in rural Haiti: a case-control study and bias-indicator analysis” also reminds us of the importance of a vaccination campaign that almost never happened. And it paves the way for even stronger efforts to end the epidemic that has killed 8,800 Haitians and infected 20,000 last year alone. “It’s a huge victory,” says Dr. Ralph Ternier, director of community care and support at Partners In Health's (PIH) sister organization Zanmi Lasante (ZL).

“Our study contributes to mounting evidence that oral cholera vaccines have an important role to play as a component of comprehensive, integrated cholera control efforts in Haiti,” the study concludes.

As Dr. Ivers hints, the results of the study aren’t as earth-shattering as might be expected, but rather put a fine point on a cholera-fighting strategy that has become, well, standard. Since the vaccination campaign, the Haitian Ministry of Health, with the support of their partners, administered the vaccine to 300,000 citizens, and the World Health Organization has begun stockpiling the drug for use in future outbreaks.