A Day in the Haiti Cholera Zone's Health Facilities (I)

A Day in the Haiti Cholera Zone's Health Facilities (I)

A volunteer nun tending to a chld at the Drouin health centerOn Tuesday and Wednesday, Dr. Serge Conille, the HIV/AIDS technical Advisor of the USAID-funded SDSH project led by Management Sciences for Health, and designated lead of the project's emergency cholera task force, and I visited project-supported health facilities in the epicenter of the epidemic in the lower Artibonite Department (Province).

We drove into the cholera zone over a dirt track through a flat plain of fields, green, but neglected. The road ran parallel to what appeared to be a wide canal, the dikes on either side uneven and crumbling. Later, I found out that this was the Artibonite river, source of the epidemic. It was constrained and channeled some 25 years ago as part of a “whole valley development plan” which included promotion of rice cultivation. The rice is largely gone and the dikes are frequently overrun by the river which floods the surrounding countryside isolating some villages, sometimes for long periods of time. A local aid worker later told me that during the floods after the hurricanes of 2008 people in some of these villages starved to death as their crops were ruined and they could neither leave nor could relief workers reach them.

When we arrived at the small health facility in Grand Saline there were men burying plastic tubing which crossed the road from the river to a large plastic water filter and storage tank from which people were filling buckets. A generator growled in the background to operate the water pump. The tank had been newly installed by an American NGO. Now they were also ferrying cholera victims from isolated communities to the hospital.

The reports we had received over the last few days led us to expect chaos: patients on the floor, hospital staff exhausted by days and nights of constant work in horrifying conditions, dead bodies in the courtyard…as that had been the situation for the first three or four days of the epidemic. What we found today at the Drouin Health Center and the three health facilities we visited over the next two days was, thankfully, nothing like that. We entered the building and stepped carefully on the foam pad at the door to disinfect our shoes. Dr. Nathan, the head of the facility, greeted us and showed us the clean ward where some fifteen patients were being cared for on clean beds. Volunteers from two international NGOs were assisting the hospital staff. They had just arrived the day before. The number of new cases, Dr. Nathan told us, had been declining over the past few days from hundreds on Saturday to less than 15 today. So had the death rate---since patients were arriving earlier in the course of their illness. We found the same pattern in the other health facilities we visited later: clean wards, few patients, all on beds and well cared for. Newly arrived international organizations were bearing supplies and bringing medical and other personnel to assist in patient care, and therefore rapidly declining case and mortality rates.

We asked whether there were sufficient supplies to care for the patients. Dr. Nathan thanked us for the oral rehydration salts, sheets, towels, water purification tablets and other basic supplies sent by MSH the previous Saturday. These were the first to arrive, but other organizations had provided additional supplies over the coming days. "What did he need now?" "Fuel to run the generator," he said. It was going day and night and their budget was insufficient to pay for it. We found the same thing at the other health facilities. For now there were sufficient medical supplies to meet the current needs. What were needed were items that did not appear on any of the lists of urgent requirements that we had all put together. Instead it was practical items that would improve the conditions in which the patients were cared for and in which the health staff worked: biscuits to feed patients as their condition improved (since many patients came from far away and neither the health facilities not patient families had the money to purchase any), hand sanitizer for the staff (so that they would be protected from infection and could eat and drink without fear), paper aprons rather than cloth since there was neither time nor personnel for doing laundry, disinfectant to clean the wards, disinfecting pads to place at the doors, bags to contain the deceased, since families were abandoning them at the health facility.

Agma Prins is Chief of Party of the Santé pour le Développement et la Stabilité d’Haíïti (SDSH) project, led by Management Sciences for Health and funded by USAID.

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