Update 29 October: 4649 dead and sick 33o
I stitched this title to Nelly, who presents a show on national television.
This article is the first version of an article that I will submit the house journal of PROTOS. You have the scoop and I update the data as possible.
course, we rarely take the pen (or keyboard) or the floor to say that all is well. However, I wanted to write to express signs of hope, nine months after the quake, but once again, this is not the case.
Facts
A cholera epidemic has hit the Lower Artibonite and Lower Central Plateau (see map) to October 18. In four days there were 138 deaths and more than 1500 patients. From October 22, cases were identified in Arcahaie then were Hinche, Port-au-Prince and Limbe who were affected. On October 27 the official toll is 292 dead and 4,147 ill.
It had long feared an outbreak in the metropolitan area after the earthquake of January 12 while the lives of survivors were precarious and that the authorities had of finding a solution to the management of hundreds of thousands of bodies.
Yet in rural areas as the epidemic struck, as a reminder to all that commendable efforts developed in the area of direct impact of the earthquake should not obscure the reality of life for Haitians in rural areas, Haitians' country apart. "
disease
The evocation of this disease evokes for most people in developed countries, a medieval disease, yet the WHO Each year 3-5 million cases and 120,000 deaths . Cholera is an acute diarrheal illness caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae . 80% of cases are treatable with oral rehydration salts but the most serious cases require infusions (photo David Darg).
In general, about 75% of those infected have no symptoms, although the bacterium is present in their faeces for 7-14 days after infection and was eliminated in the environment where it can potentially infect other people. But the present form in this area of Haiti seems highly virulent: very short incubation time (hours), diarrhea and severe vomiting (but without abdominal pain) that cause death within hours. The Health Minister, Alex Larsen confirmed Oct. 22 it was a strain of type O1, the most dangerous type. " The last case Cholera in Haiti in the last century.
The situation in hospitals
The general weakness of individuals linked to malnutrition, or people infected with HIV creates a breeding ground the rapid development of such epidemics. There is also the problem of access health services, limited in rural areas. The hospital of San Marco is overwhelmed and patients are treated on the floor (the photo-story). Health centers need to be refueled quickly in saline for rehydration and must manage the body of the deceased. At the hospital of St. Mark the bodies are placed in bags, disinfected but in other municipalities such as Grande Saline, the victims' bodies are unburied individual and placed in a common grave. More pain for families in a country where the funeral-related beliefs are important. In more remote areas, flooding of rivers restricts the movement and prevent some people from reaching the few existing health centers. The race to drinking water, ways to treat water or saline rehydration began and has even been exploited by political candidates for president or legislative (senator or deputy). Ironically, this same 22 October, water treatment stations to be inaugurated in Bocozelles (a section of Saint Marc).
What source of contamination?
At the time these lines appear, the source of contamination was identified at the Artibonite River. The hypothesis raised and on which the government works contamination is a tributary of the river by emptying latrines MINUSTAH base. If this happens, it does not go up the esteem of Haitians as regards the United Nations presence in the country. MINUSTAH has obviously denied any involvement.
The state environmental and hygiene conditions and sanitation habitats would have allowed such an epidemic from spreading. Low coverage and poor performance of drinking water in rural areas still forcing most people to drink water from rivers and springs. Also, according to many, the river water would have "little more taste," ... It also has very little infrastructure for sanitation and public remains poorly informed preventive behaviors to prevent the spread of these diseases.
What evolution?
After ten deaths from the early days, the progression of the epidemic appears to have marked a step and the government declared that the epidemic was contained. However, at the same time, NGOs and United Nations, will still want alarmist, saying fear spreading mass opinion more widely publicized by the media that the position of encouraging the Haitian government. This fear is based among others on the fact that in places quite remote and little affected by the distribution of water treatment, people continue to drink water from the Artibonite. As mentioned above, 75% of people do not show symptoms but can contaminate the environment and ensure the spread of bacilli in their faeces, and until two weeks after infection. Thus it is likely that cholera is present in the country for several years. This implies a change of habits and policy of access to water by some physicians.
If the daily number of deaths is decreasing, we can not say that the epidemic is contained in the sense that it progresses geographically. This increase (see map) is related to the movement of persons but cases of deaths are those people who have contracted cholera in the Artibonite. Thus, it is not present, for now, the creation of new foci of infection. The metropolitan area is particularly monitored because the spread within camps for the homeless could be catastrophic as had been the case in Rwanda in 1994 with 23,800 people dead.
Fearing a spread, the Dominican Republic has decided to control the border and to prohibit entry into its territory to any person without a passport, a measure deemed unnecessary by WHO, however. This paralyzes all trade, big business for cities on both sides of the border (the market of both countries are allowed some days to get from one side and one without identity checks). Incidents had also occurred in Ouanaminthe, leading the MINUSTAH soldiers to disperse the crowd with tear gas. Two days later, the neighbors have agreed to reopen but markets will meet bi hygiene measures and controls implemented by the Dominican Ministry of Health.
psychosis settles and people have attacked the MSF staff at St. Mark protesting against the installation of a treatment center with 400 beds fearing that the entire area is contaminated.
Responses
The presence of health NGOs in Port-au-Prince has enabled a rapid response with the onset of the cholera treatment center in St. Marc and Port au Prince
President Préval has indicated that the National Directorate of Water Supply and Sanitation (DINEPA) will launch a water purification in the region. DINEPA is responsible for distributing © Aquatabs, HTH, rehydration serum and soap through OREPAs existing town halls, CASEC (kinds of rural mayors) and NGOs, even if there are still snags in coordination.
PROTOS works with CPH Belladère (see map) which is also in the vast area of the Lower Plateau. For now, no cases were identified but prevention is still required. Construction activities of a drinking water system, awareness and empowering people to improve their hygiene and sanitation, remain far more crucial to avoid such cases. Grassroots organizations with whom PROTOS works, the Cusic (association of irrigators) and UDECOBEL (CBO) working on public awareness. PROTOS has also applied for a requisition for Aquatabs © , HTH, rehydration serum and soap from DINEPA for distribution on the Iron Cross and Belladère in collaboration with the municipality and the Provincial Directorate of Agriculture. Belladère area being considered for prevention and not as a priority area, only the soap is made available to us so far. On 28 October, we issued 8.000 bar soap (1 bar / person / week) in the dispensary of the Iron Cross and the DDA Belladère (possiilité storage). City Hall and grassroots organizations are responsible for distributing to the people.
Through local media, people are informed about the manufacture of a rehydration serum using treated water, sugar and salt.
The USA, Canada, Spain, Belgium and France among others sent medical missions, equipment processing water or rehydration as well as monetary donations.
More humorous, it was even heard on the radio that Haitians are generally very warm, we had to stop to kiss all the time!
It is difficult to disentangle reality and misinformation, but this is not direct result of the earthquake as some French media have been announced. It is interesting to note in passing no international media is talking about the track as foreign source of the problem, although this is unlikely given the absence of cholera over the past century. Haitian authorities, they really wrong when they ask questions about the management of excreta MINUSTAH camps around the country?
In conclusion, we could say that we definitely did not need that while the hurricanes were spared the country (the season has been exceptionally strong yet) so far . But, I think even the concept of resilience so often praised Haitians for decades and especially after the earthquake, has no real meaning ...
0 comments:
Post a Comment