Bonjou! We have now been here for nearly two months and what a two months it has been. After a brief one and half weeks of orientation courtesy of Emily and Fidel, we took over as this year's Global Health Fellows on July 1.
Much of our time here has been dominated by the ongoing cholera epidemic. Hearing the wailing of grieving family members of recently deceased patients during the night is something we will not soon forget. Following several appeals for assistance, the Director of the Departmental Ministry of Health asked MSF-Belgium to visit St. Joseph's Clinic to assess the cholera situation in this area. After a brief site survey on July 2, MSF arrived on July 12 (they left on August 6 after Tropical Storm Emily fizzled out) to begin their work in earnest to revamp and revitalize the cholera treatment infrastructure at the clinic.
Building a cholera treatment center (CTC) is no small endeavor as we soon learned. We expected the construction to take no more than a few days and involve the setting up of a few tents similar to the one that was originally being used to handle large patient volumes. How wrong we were.
After 11 days of work, MSF built quite a sight to see: 5 tents (one for triage, one for observation, and three to handle patients based on severity of illness), 4 toilets, 4 showers, 2 footbaths, water treatment setup with 2 bladder reservoirs, stations for disinfecting hands and feet of staff and visitors as well as to wash clothes of patients, a morgue (thankfully we have not had to use this as no patients have died since the construction of the CTC), incinerator to burn accumulated waste, a site to dump patient vomit and diarrhea, and a kitchen to prepare 2 meals daily for patients. Take a look at the slideshow below for a more comprehensive perspective. Words alone do not do the CTC justice.
One of the members of the MSF team included a Health Promoter named Mackenton. Mackenton enlisted two of our community health workers (CHWs) along with a cadre of citizens from Thomassique to help sensitize family members of cholera patients while he helped to provide two of our CHWs with valuable information in countering misconceptions of how cholera is spread.
Part of the difficulty in preventing cholera stems from the aforementioned misconceptions. Back at the end of June during one of our meetings with our health committee in Bouloum, we heard the frustrations of community members over cholera's sudden appearance in fall 2010. Some compared cholera to the arrival of HIV in Haiti in the 1980s and others claimed that cholera was in the air and that drinking chlorinated water would not prevent cholera (subsequently we heard that limes were a better method of treating water). Many of these notions stem from the seeming randomness in who falls ill. That randomness however is apparent primarily because we do not readily realize all of the ways in which we use water each day - to bathe and wash our hands, to drink, to clean clothes and our living space, to wash dishes, to cook (there are certainly other ways). In Haiti, often the same source of water - perhaps a puddle, a stream, a river, or a spigot tapped into a pipe - is used to accomplish all of these tasks. With little water sanitation infrastructure, these water sources can be rapidly contaminated and were in the days and weeks following the introduction of cholera into the Artibonite River. Mackenton accompanied us to our July meeting with the Bouloum committee and was able to dispel many of these misconceptions with simple messages - the only way that one can contract cholera is via the mouth and while there may be rumors over how to prevent cholera, the one guaranteed way to avoid falling sick is by drinking chlorinated water. After hearing Mackenton's simple yet effective presentation, the committee members expressed their appreciation to him and to us. We provided the committee members with additional handouts in the hope that they will help to disseminate correct information about cholera in the committee.
Despite this one success story, the fight against cholera continues here and throughout Haiti as the rainy season is in full swing. We continue to meet with representatives from Partners in Health and World Vision (who are incidentally continuing the invaluable help that MSF began) to learn more about ways in which to sensitize community members against cholera and to coordinate our initiatives (beyond just cholera) with these organizations.
