H5N1

Cholera in Haiti: A serious humanitarian crisis

Via ACTED, the Agency for Technical Cooperation and Development: Cholera in Haiti: A serious humanitarian crisis. Excerpt:

The Haitian cholera epidemic which first appeared in October 2010 has affected over 645,000 people, or more than 6% of the population, causing 8028 deaths, according to the World Health Organization (WHO).   

In 2013, a total of 120,000 cases are projected, equal to the number of cases in 2012. More than half of all cholera cases worldwide were in Haiti in 2012 and roughly one third of all deaths, according to a new study by Renaud Piarroux and Stanislas Rebaudet from the University of Aix-Marseille. 

While international organizations with expertise in health and water-sanitation-hygiene face funding cuts and are withdrawing from the fight against cholera, the epidemic continues to kill. The number of cases in Haiti at the beginning of 2013 is comparable to the same period last year, raising fears of a new upsurge in cases during the current rainy season. The case fatality rate is above the "acceptable" level of 1%, and in fact is much higher in some departments. 

At the same time, a significant number of CTCs / CTUs have been closed or abandoned.  In Port au Prince, the number of CTCs decreased from 84 to less than 20 within five months. At the community level, capacity to respond to a cholera outbreak with emergency water treatment and sanitation has scaled back dramatically, This problem is even more critical in the context of limited capacity (and resources) of the MSPP and DINEPA in the short and medium term. As a result, response capacity is near zero in several “high-risk” departments. 

Emergency response capacity—necessary to eliminate the cholera epidemic-- is further weakened by an information and early warning system characterized by gaps in surveillance and whose reliability is not assured. 

Finally, it is regrettable that no NGOs contributed to the development of the national plan to eliminate cholera, even though they played a key role in the response to recent outbreaks.

Haiti is famously the "Republic of NGOs," foreign agencies with more power than the Haitian government itself. Their influence has not always been constructive, but the government's public health policy for decades has been simply to abdicate to any outsider willing to pour money into a bottomless pit. 

The only factor that counts in Haiti is not its government, nor the NGOs, nor the Pan American Health Organization; it's the United States. For two centuries, successive American governments have treated Haiti as either a threat or an annoyance: The presence of a free black country in the western hemisphere was a threat to the slaveholding US, and it becomes an annoyance when its governments default on their debts or act as if they were independent of foreign influence.

Ideally, from the American point of view, Haiti would shut up and stop drawing attention to itself. The Americans have no interest in a Haiti that goes its own way; if it can't provide a cheap workforce for American investors, a poor black nation has no reason to exist.

When military occupation became politically awkward, the US resorted to the "our son of a bitch" policy that has served it so well around the world, tolerating the Duvaliers.

But an American son of a bitch inevitably becomes an American enemy. Remember Saddam Hussein and Manuel Noriega? Or Ho Chi Minh working with the Americans at the end of World War II?

So the Americans ousted Baby Doc Duvalier and put up with Aristide, and then with his ouster, and his restoration, and his ouster again. The 2010 earthquake must have been really annoying, because the world cared even if Washington didn't.

So the Americans effectively parked Haiti with the UN, which at least spread the cost of babysitting over more countries. And so things have remained for years, despite the embarrassing importation of cholera by the Nepalis. At least it was the UN that was embarrassed, not Washington.

Until and unless the Americans experience more direct political embarrassment, Haitians can contract 10 million cholera cases for all that Washington cares. A few NGOs will beg for money to deal with some of the cases, but that will be as far it goes: politics will always trump public health, not to mention simple decency.

Dr. Carroll: Cholera alive and well in Cité Soleil

Cholera patient, May 24, 2013 (Photo by John Carroll)

Via the Peoria Journal Star, Dr. Carroll writes: Cholera Alive and Well in Cite Soleil–May 24, 2013.

I just wanted to let you know that cholera is not gone in Soleil. 

At the Cholera Treatment Center-Saint Mary on the Soleil Wharf this afternoon there are six inpatient pediatric cases being treated with IV fluids and one toddler being treated with oral rehydration solution. All of these kids are from Soleil except one who is from Drouillard (a zone just outside of Soleil). 

There are six adult inpatient cholera patients in the adjoining room. 

Like clockwork, six to twelve hours after the rain comes in the late afternoon, patients present to this CTC with vomiting and diarrhea. And it is clouding up right now and raining almost every day here during Haiti’s rainy season.

MSF: Treating cholera patients in northern Niger

Via MSF: Treating Cholera Patients in Northern Niger. Excerpt:

Cholera has broken out in northern Niger, in an area now inhabited by large numbers of Malian refugees who fled conflict in their homeland. 

Doctors Without Borders/Médecins Sans Frontières (MSF) has treated all of the nearly 250 people affected by the cholera outbreak in northern Niger that was declared by the country’s health authorities on May 11. MSF has also opened two cholera treatment centers in the regions of Mangaïzé and Ayorou, north of the capital, Niamey. Six people have died in the outbreak thus far, however. 

“As soon as the first cases appeared, MSF rushed to open a cholera treatment center,” says Dr. Benoit Kayembé, MSF’s head of mission in Niger. “We currently have 100 beds in Ayorou and another 50 in Mangaïzé. As well as treating people with the disease, which mainly involves rehydrating them, our teams are leading health awareness campaigns in the affected villages. The teams are also treating water points in these communities and actively looking for further cases of cholera.” 

Fear That Disease May Spread Southwards 

“Some of the patients come from the camps of Malian refugees, but the majority are from local communities,” adds Kayembé. 

MSF is currently the only medical organization treating people infected by cholera in the region. Its teams are worried about the proximity of the affected area to the Niger River, which flows from northern Niger towards the capital, and could well carry the disease along with it. 

“We can expect to see cases spreading towards Niamey,” says Kayembé. “The region already suffered from cholera last year. Having so many people displaced within the region makes it easy for cholera to spread to other parts of the country.”

In many regions of the world, and notably in sub-Saharan Africa, fighting over the scraps in poor countries is so violent and vicious that the poor flee into more poverty—made more ingrained by starvation and disease. 

Just 4 germs cause most of severe infants' diarrhea

Via The New York Times, a May 20 report: 4 Germs Cause Most of Infants’ Severe Diarrhea. Excerpt:

Just four germs are responsible for most of the severe and fatal diarrhea among the world’s infants, according to a large new study. 

Diarrhea is a major killer of children, with an estimated 800,000 deaths each year; it has many causes, and doctors want to focus on the most common ones to bring death rates down. 

The study, financed by the Bill and Melinda Gates Foundation and published by The Lancet, found that the most common causes were rotavirus; a protozoan called Cryptosporidium; and two bacteria, Shigella and a toxin-producing strain of E. coli. In some areas, other pathogens, including the bacteria that causes cholera, were also important. 

The study followed more than 9,000 children with diarrhea seen at clinics in Bangladesh, Gambia, India, Kenya, Mali, Mozambique and Pakistan, and, for comparison, more than 13,000 children without the disease. The children with diarrhea were more likely to have stunted growth and eight times as likely to die during a two-month follow-up period. 

Diarrhea seemed to be linked to chronic malnutrition, which causes gut inflammation that can make it harder to digest food.

Haiti Medical Association puts cholera on congress agenda

Via Prensa Latina: Cholera, Priority in the 61 Congress of Haitian Medical Association. Excerpt:

Cholera appears among the main topics on the agenda of the 61 Congress of the Haitian Medical Association, which will be held from May 27 to 29. 

Infectious diseases and the environment in relation to medicine is the theme of the meeting, according to organizers. 

Medical sources consider the aforementioned conditions are still a challenge for the Caribbean country, the poorest in the Western Hemisphere. 

They also coincide in the idea that the conference will provide an analysis opportunity for professionals in order to find solutions to several problems. 

Two days ago, health authorities urged Haitians to be alert to avoid possible contagion of cholera, when the number of deaths for that disease, which emerged in October 2010, surpasses 8 000.

Well, it may surpass 8,000, or 9,000, or 10,000. MSPP has posted another 8 days' worth of cholera statistics, covering May 6-13. It reports 656,321 cases since the outbreak began, an increase of 1,021 cases since May 5—the last time statistics were made public. But as usual several departments have failed to report any cases at all, and the number of deaths—8,105 on May 5–has fallen to 8,090.

Haitian government warns public of cholera risk

Via Global Times, a Chinese news website: Haitian government warns public of cholera risk. Excerpt:

Haiti's government Monday called on the public to act against cholera infections especially in the capital Port-au-Prince where one fourth of all cholera cases have occurred, local media said. 

"Even though we do not have new reports of deaths, cholera is always latent," said Brignol Boulin, head of the Health Ministry's Preventive Attention Department in West Department, where the capital is located. 

Boulin urged practicing good hygiene and following the sanitary measures established when a cholera epidemic first gripped Haiti almost three years ago. 

On Monday, the government presented a new plan to prevent the spread of cholera, mobilizing some 50 healthcare workers in a campaign to raise the public's awareness of the disease. 

Since cholera first broke out in October 2010, some 8,053 Haitians have died of the disease and 651,250 have been infected despite great government efforts to control its spread. 

Clean water is not easily available throughout Haiti, a poor country with little infrastructure that was further weakened by a devastating earthquake in 2010. 

Up to May 5, 166,460 cholera patients were registered in Port-au-Prince, of which 1,705 died, according to Helman Ceneus, coordinator of the government's new prevention plan. 

Ceneus said the warning should be taken seriously because cholera tends to spread more quickly during the rainy season, which begins in May.

Uganda: 216 cholera cases, 7 deaths

Via ReliefWeb, an IFRC report: Uganda: Cholera Outbreak - May 2013.

On the 18th April 2013, the Ministry of Health (MoH) reported an outbreak of cholera in the districts of Hoima, Nebbi and Buliisa. 

The reports from the ministry of health epidemiology and surveillance department indicate that since the beginning of 2013 the cumulative number of cases reported from the cholera affected districts has reached 216 cases and 7 deaths. 

The overall case fatality rate nationally from these districts stands at 3.2%. (IFRC, 10 May 2012)

Haiti: 8,105 (or more) cholera deaths as of May 5

MSPP has published another week's worth of cholera statistics on its Documentation. I confess I've been thinking of just giving up on this front, because the numbers are so obviously bogus, and no one seems to give a damn—not PAHO, not the Haitian and foreign media, not the NGOs, and certainly not the Haitian government itself.

Consider the most recent date covered in this batch, May 5. It lists total of 655,300 cholera cases seen, 326,636 cases hospitalized, and 8,105 deaths—all in the two and a half years since the outbreak began in October 2010.

But the May 5 numbers do not include any reports from Grande Anse, Nippes, Nord Est, Ouest, Port-au-Prince, or Sud Est—6 out of Haiti's 11 reporting departments. Some departments like Grande Anse seem not to have reported in weeks or months.

When MSPP releases a batch of "daily" reports, often two weeks late, the first day's numbers usually include a sharp increase in cumulative cases over the previous day's cases. This increase is unexplained; I would like to think it includes the delayed reports from laggard departments, but who knows?

Haiti has become the madwoman in the humanitarian attic, kept out of sight and never mentioned in polite company. When the screams do reach downstairs, everyone clatters their teacups and makes louder small talk...about anything but the source of the screams.

So I guess I'll keep posting those phony numbers, if only to remind myself of how the rest of the world has failed a small black nation.

Haiti cholera victims threaten to sue the UN

Via BBC News: Haiti cholera victims threaten to sue the UN. Excerpt:

Victims of Haiti's cholera epidemic have given the United Nations a 60-day deadline to start talks about billions of dollars worth of compensation or face legal action. 

The UN is accused of negligently allowing peacekeeping soldiers to pollute Haiti's water with cholera. 

A UN cholera expert agrees that this is "most likely" to be true. 

The UN rejected an earlier call for compensation and continues to insist it is immune from legal proceedings. 

The cholera epidemic began in Haiti near a camp for UN soldiers, where there were leaking sewage pipes. Some human waste was also dumped near a river outside the camp. 

>The camp housed UN soldiers from Nepal, where cholera is endemic. The UN's own cholera expert, Danielle Lantagne, has said that Haiti's outbreak is likely to have come from UN soldiers. 

The victims include relatives of the 8,000 people who have died and hundreds of thousands of people who have fallen sick. 

Lawyers for the victims say the UN is breaking international law. 

They say they will open legal proceedings in New York with claims totalling many billions of dollars if the UN does not start talks within 60 days. 

The lawyers say they will file claims for $100,000 (£64,000) for the families of those who have died and $50,000 (£32,000) for every one of the hundreds of thousands who have fallen sick.

Haiti: 8,102 cholera deaths as of April 28

Just after posting my rant about Haiti, I checked MSPP's Documentation and found another week's worth of cholera numbers. This brings us from April 21 to April 28. As usual, several departments failed to report for all or part of this week—not just Grande Anse, but also Port-au-Prince and various others. The totals are therefore not very reliable.

According to MSPP, 654,736 persons have now contracted cholera since the outbreak began in October 2010. While 399 persons fell ill in that week, only 3 died and the total is now 8,102.