Cholera in Haiti

From Dr. Jean William Pape, Director of GHESKIO  As of October 27, 2010 there have been 4,000 cases of cholera in Haiti and over 300 deaths. The epidemic started in the Center Department in the city of Mirebalais, and has spread to the Artibonite valley on both sides of the river, with most cases diagnosed and treated in the St Marc area. Two days ago, cases were reported in Arcahaie, and Cabaret indicating that the epidemic is moving towards the Port-au-Prince area. There are 6-8 cases diagnosed in Carrefour, a heavily populated area close to the downtown GHESKIO site. All the cases diagnosed in Port au Prince come from the Center Department and Artibonite area. There has been no known transmission to date in Port au Prince inhabitants. The greatest fear is that the epidemic will hit the 1.3 million homeless people living in tent cities. At GHESKIO we are more concerned about the people living in slums around Port au Prince. While 90% of tent city populations have access to potable water and latrines, this is not the situation for habitants of slums. Cholera transmission is particularly likely in areas where fecal-oral contamination through non potable water can occur. Thus the slums are a prime concern for new cholera outbreaks, which in turn could spread to tent cities because of the close proximity and exchanges between both populations. In anticipation of these outbreaks, GHESKIO has developed the following interventions: 1.      Cholera Treatment: We have set-up three treatment sites: one at the downtown GHESKIO clinic on Blvd Harry Truman, one at the GHESKIO tent city across the street, and one at the GHESKIO-IMIS site in the north of the city near the airport. a.       Why set-up these treatment sites at these locations?                                                    i.      The  GHESKIO-downtown site is a logical site because it cares for about 1200 hundred patients with HIV, TB, and other STIs daily and is located right across from two major slums with about 200,000 inhabitants (City of God and City of Eternity). This site is very close to Carrefour and Martissant, two heavily populated areas with very little medical infrastructure.                                                  ii.      The GHESKIO tent city has almost 7,000 people, and we are providing the primary care for this population.                                               iii.      The GHESKIO-IMIS site is located north of Port au Prince and is closest to the northern areas affected by cholera. Except for a pediatric hospital, Petit Freres et Soeurs, there are no other clinical care facilities in this area.  b.      Three tents have been set up- one at each of the locations indicated above and the personnel has been identified and are being trained in cholera case management.  2.      Training: Set up two training sites respectively at GHESKIO-INLR and at GHESKIO-IMIS. These sites can train health care personnel from other health care facilities in Port au Prince. 3.      Provisions: Offer potable water to the slums near GHESKIO on a constant basis. 4.      Prevention: Create a 12 member community health team to educate in tent cities and surrounding neighborhoods to: a.       Inform about protective measures : potable water, wash hands b.      Inform people living in the slums about the availability of potable water at GHESKIO c.       Inform about treatment centers at GHESKIO d.      Distribute soaps and chlorox solutions

These efforts are being funded by the Clinton Bush Haiti Fund.