H5N1

DR: Public Health confirms ninth case of cholera

Via DiarioLibre.com in the Dominican Republic: Public Health confirms ninth case of cholera. Excerpt:

An eleven month old baby girl and a 25 year old man, both Haitian, became yesterday the two new victims of cholera in the country, raising the total to 9 victims. 

This was the report from the Minister of Public Health, Bautista Rojas Gomez, who said that the persons are neighbors of the little Haitian girl that last Saturday proved positive for cholera in the Doctor Arturo Grullon Children's Hospital in Santiago. 

The victims live in the area of La Olla, in the town of Navarrete, where about 80 Haitian families live in crowded conditions. 

The little girl was attended to at the public hospital in Navarrete and the young man at the hospital in Esperanza. Both are out of danger. 

As of yesterday, the authorities had analyzed 101 suspect cases, of which nine have been positive for the virus and five have been treated as out-patients.

Philippines: DOH activates task force against bird flu

Via Philstar.com, a Xinhua report: DOH activates task force against bird flu. Excerpt:

In a bid to prevent bird flu, the Department of Health has activated an inter-agency task force to strengthen its preparedness and reduce the opportunities for the virus to enter the country, Philippine health secretary said Tuesday. 

The inter-agency task force against bird flu is composed of experts from the Bureau of Quarantine, Department of Agriculture, airport authorities and Department of Environment and Natural Resources, said Health Secretary Enrique Ona, adding the Bureau of Quarantine, Departmenf of Health and airport authorities are in charge of screening passengers coming from overseas: the Department of Environment and Natural Resources' task is to monitor migratory birds, while the Department of Agriculture monitors poultry. 

Health authorities explained that the bird flu, or avian influenza, is a disease in birds which can be transmitted in humans through droplets or secretions where it causes flu-like symptoms such as fever, body weakness and muscle pain, cough, sore throat, sore eyes, diarrhea, and difficulty in breathing in a week 's time from the onset of the cough. 

The progression of the disease is quick and the virus is virulent. The case fatality ratio of the disease is 60-70 percent. 

Thermal scanners were again installed at the Ninoy International Airport in Manila, while the Department of Environment and Natural Resources has kept a tight watch over pet and cage birds being transported at entry points, such as airports and seaports.

Haiti: "The drums of vomiting and diarrhea are full"

Via HaitiLibre.com: Haiti - Cholera Epidemic : Les Cayes, dramatic situation. Excerpt:

The situation in the front of the Cholera epidemic in the department of South and particularly in the town of Les Cayes, is extremely worrying. Health services are totally overwhelmed while the number of cases continues to increase and no major medical aid agency is present in the area. 

The fourth largest city does not currently of treatment centers to the extent of the humanitarian crisis will intensify. NGO "Terre des Hommes" (TDH) is launching an urgent appeal to all stakeholders with expertise in the care and treatment of cholera so that they are mobilized as soon as possible in order set up a cholera treatment center (CTC). 

The agglomeration of Les Cayes has a combined population of over 320,000 inhabitants. The city is approximately the size of Cap Haitien. Urban areas are densely populated, the poorest populations living near river mouths, no sanitation system. With its canals and open drains much of the city center located in flood zones, Les Cayes presents high risks of contamination. 

The number of people infected in the Southern Department, although it is less than the number of cases recorded in Port au Prince (note that the government refuses to reveal the true assessment of PAP and Metropolitan area since November 24, 2010), continues to increase. 

Until now, throughout the department, 12 zone of infection, including 5 located in the city have been identified. Official figures show 160 cases treated, but they are largely underestimated. 

Health authorities already sorely lacking resources, human and material to cope with a situation that continues to worsen. The only treatment center, a small structure built in emergency hospital in Les Cayes by Doctors Without Borders (MSF) Switzerland with the assistance of TDH, finds itself without the continued support of medical organizations. 

Located within the walls of the hospital, the CTU transitional, has a capacity of only 25 beds. women, men and children do not have separate spaces. Managed by inadequately trained personnel and overworked, lacking supervision, it recorded 10 to 15 daily admissions in recent days. It is completely saturated. Central Prison inmates are also referred. 

There is no system of management of contaminated waste, the drums of vomiting and diarrhea are full, others are full of medical supplies clothes mixed with the sick and other household waste. 

TDH trying stopgap, while providing support WASH, but without appointed loading area, storage and processing of waste remains a major problem. No location was identified by the authorities despite repeated requests for a month. 

MSF, which handles 80% of cases of cholera in the country, had to withdraw due to lack of available staff. Given the gravity of the situation, Medecins du Monde (MDM - Switzerland) sent two members of its medical staff for a few days.

Haiti: 34,248 hospitalizations, 1,751 deaths as of November 27

It may be crooked, but it's the only game in town. The Ministry of Public Health and Population has published cholera statistics for Saturday, November 27 on its Documentation page.

 On that day, 740 people were hospitalized and 30 died. The totals are now 34,248 hospitalizations and 1,751 deaths in about seven weeks.

DR military wound Haitians trying to enter by force

Via DiarioLibre.com, a report datelined Dajabon: DR military wound Haitians trying to enter by force. Excerpt:

Several Haitians were wounded during a firefight that happened on the frontier bridge across the Masacre River when a group of citizens from the neighboring country of Haiti tried to violently cross into the bi-national market that is held on Mondays and Fridays in Dajabon. 

One of the wounded was crossed over to the Dominican side and received urgent care at the Ramon Matias Mella Hospital in Dajabon. 

The other gunshot victims were taken to the public hospital in Juana Mendez, Haiti where they are in serious condition according to reports. 

On the Haitian side of the frontier there were several tractor trailers loaded with construction materials and other merchandise set afire. 

From Dominican territory it was possible to observe the vehicles in flames, burned in reprisal of the incidents and the wounding of the Haitians. 

The flurry of gunshots began when in the middle of the bi-national market that moves hundreds of millions of pesos, dozens of Haitians burst through the bridge in a violent manner, throwing stones at the Dominican soldiers who responded to the aggression by shooting their weapons. 

After the shooting, the Haitians that were in the market quickly returned to their country and the Dominicans also cleared out of the area.

A powerful account of cholera in Port-au-Prince

Thanks to MMRC for tweeting the link to a blog called On the Goat Path, which has the single best report I've read so far: Cholera Reaches Port-au-Prince as Victims Are Left In Mass Graves. This is a long post, with grim photographs. Excerpt:

I normally wouldn’t write such a gruesome post but this seemed like something that needed to be put out there.  The situation in PAP is bad, and the fact that it has resulted in this is terrifying.  

There is a ton of anger amongst the people regarding the source of the epidemic, and all signs are pointing towards Nepalese UN troops who have a base by the Artibonite River, where the epidemic began.  The CDC has confirmed the strain came from southeast Asia, and there is video of latrines at the Nepalese base that leak their sewage directly into the river.  

The UN’s response to these accusations is that “the source of the epidemic doesn’t change our response to it medically,” but it is irresponsible to not take responsibility for being responsible for the deaths of thousands of Haitians when you are supposed to be here to protect them. 

The numbers are grossly under-reported, as the number of deaths that the Ministry of Health announces every day is only including those who died in a hospital, or were brought there after they died.  Hundreds, if not thousands of people are dying in their homes, or out in the countryside, because they didn’t get a chance to make it to the hospital. 

While it’s just an estimate, I would say that that number is probably only a 10th of the real number of deaths.  Even the team that was collecting bodies admitted that they didn’t provide their data to anyone. 

But the saddest part of all of this is that this epidemic is not going anywhere.  Health officials here admit that cholera will be in Haiti for at least 20-30 years, and in the end will affect over 200,000 people.  Until the infrastructure here changes into something that can sustain a proper sanitation system and deliver clean water, the disease will continue making people sick, and killing others. 

It’s scary because for the people who have lived with absolutely nothing, and could survive before the epidemic because they had learned to live with so little, this is uncharted territory. But now this disease has come and taken everyone by surprise, killing those who have been fighting for their lives for decades, in just a matter of hours.

Fighting fear and tears in Haiti

Via The Ottawa Citizen: Fighting fear and tears in Haiti. Excerpt:

When Louise Noel closes her eyes, she sees eight-year-old Angeline Sérat lying in a hospital bed, sick with cholera and asking if she’s going to die. 

“I told her no, I didn’t think it was serious. But when I went back to the hospital, she had passed away,” Louise said in French by telephone from Gonaïves, a city on the west coast of Haiti’s northern peninsula. “It’s very hard. I can’t sleep, because every time I try, I see that little girl.” 

Six years ago, Louise and her husband, Ismorin Noel, gave up a comfortable life in Ottawa to return to Haiti and found La Judée Centre for Orphaned Children. Today, the couple cares for 28 orphans, ranging in age from toddlers to teenagers. 

The orphanage was spared damage from January’s earthquake that left hundreds of thousands dead and more than a million homeless. But the cholera epidemic that spread with the help of extreme poverty and unsanitary conditions left by the quake made its way to Gonaïves about two weeks after it was first confirmed on Oct. 21. 

Louise noticed some children were coming down with diarrhea. Ismorin shuttled them to a nearby clinic run by Médicins Sans Frontières while Louise stayed at the orphanage to look after the rest, with six children falling ill in total.

After Angeline died, the kids got scared. 

Louise and Ismorin hired three staff members to comfort the children who cry through the night. Angeline’s six-year-old sister, Tika, cried so much, Louise started letting her sleep in her room. 

“It’s exhausting,” Louise says. “Every time one child gets better, another one gets sick.”

Japan to cull 20,000 chickens

Via BusinessWeek.com: Japan to Cull 20,000 Chickens as Bird-Flu Outbreak Discovered. Excerpt:

Japan will cull about 20,000 chickens at a farm in the western prefecture of Shimane after the country’s first case of avian influenza since 2009 was discovered by the government today. 

The government has asked the farm operator, which also raises about 3,300 chicks, not to move the birds out of the area to contain the disease, Yuji Kawakami at Shimane Prefecture’s livestock office said today by phone. The owner of the egg- laying chicken farm in Yasugi city found five dead birds yesterday, he said. 

The government has asked farms within a radius of 10 kilometers from the Yasugi farm not to move birds, according to the Ministry of Agriculture, Forestry and Fisheries. 

“Preventing the spread of bird flu is important from the standpoint of crisis management,” Chief Cabinet Secretary Yoshito Sengoku told reporters in Tokyo today.

Arkanoid Legent has more on this, as well as reports on H1N1 in Malaysia, a diarrhea outbreak in the Philippines, and malaria in Tamil Nadu. 

Haiti Cholera Update #18 from Emergency Blues

Another excellent summary from TorontoEmerg: Haiti Cholera Update #18 « Those Emergency Blues. Excerpt:

A short update: the elections in Haiti have nearly bumped cholera off the radar. 

The latest MSPP (Ministère de la Santé Publique et de la Population) report as of 24 November 2010 showed 75,888 cases of cholera accounting for 1,721 deaths since the outbreak began. There have been 31,210 hospitalizations. The hospital mortality rate is 3.6%. Cholera promptly treated has a mortality rate of 1-2%. 

As mentioned in my last update, political interference may be tainting the figures: note the sharp drop in hospitalizations on the bar graph to the right just prior to yesterday’s elections.

The absence of cholera news today has been a classic example of Sherlock Holmes's dog that didn't bark in the night. It's been all politics, with almost no attention paid since Saturday to the people actually sick and dying from cholera. If the election fiasco leads to still more social disruption, some of those people will be killed as much by politics as by Vibrio cholerae.

Wikileaks and President Preval

Ansel Herz has a new post on Mediahacker: Wikileaks, Cablegate and Haiti. It's a translation from an article in Le Monde, based on materials evidently not yet publicly released. Excerpt from a must-read article:

Rene Preval, a “stubborn” president and with the “character of a chameleon” 

For the U.S. Embassy in Port-au-Prince, the outgoing president of Haiti, Rene Preval, is an ally, but his “personality” poses a problem. After being elected in 2006, Preval had been able to count on the support of the United States, Brazil, and France – all very involved in Haiti. “His commitment to building democratic institutions, promoting political stability and economic development is in line with our own interests,” said a diplomatic message from March 2007 obtained by Wikileaks and reviewed by Le Monde. 

"Preval is still the indispensable man of Haiti,” insists a lengthy memo from June 2009, entitled “Deconstructing Preval”. However “the relationship with him is a challenge that can be frustrating and sometimes rewarding,” say the text. 

The difficulty stems from his “world view, his personality, and his withdrawn leadership style,” as well as his “chameleon-like character.” With a “discrete and complex personality, the president shares little. His inner circle has narrowed considerably over the past two years.” Moreover, “Preval’s isolation in the palace in the course of the last year is notable.” 

“He rarely leaves the palace, except to go to his home every night or to the place that he bought for his fiancee in the hills above Port-au-Prince.” 

Cynical vision of Haitian politics 

A businesswoman trained in the United States, “Elizabeth Delatour is the only advisor with whom he has meaningful discussions,” stated the memo from 2007, two years before she married Rene Preval. The memo admitted nonetheless that it was difficult to gauge her influence. 

In fact, “Preval doesn’t have confidence in his advisors or his ministers to make decisions or even to apply them.” As a result, “Preval is very little inclined to delegate power and thus the most insignificant details arrive on his desk,” explains the 2009 memo. 

The Haitian president rarely accepts “diverging opinions”. This “unilateral” decision-making and his “tendency to micromanage,” accompanied with a “cynical” vision of Haitian politics (“often justfied”, adds the author of the note). 

“Stubborn and suspicious”, the Haitian president remains “skeptical about the commitment of the international community.” “Preval is essentially a nationalist,” “suspicious with respect to foreign intentions and convinced that no one understands Haiti as well as he does.” Preval “admits that he does not read or listen to the news, local or international.”