Haiti struggles to deal with major cholera outbreak

Haiti’s capital Port-au-Prince is bracing itself for an outbreak of cholera as the disease which has killed 200 in the countryside makes itself known in the city. The five confirmed cases in the capital are among more than 2,000 people who were infected in an outbreak mostly centred in the Artibonite region north of Port-au-Prince. At least 208 people have died with that figure likely to rise in the country’s first outbreak of cholera since 1960. The outbreak is the latest disaster to hit the poverty-stricken country still struggling to recover from the devastating 7.0 earthquake which left much of the country in ruins last January. (photo: David Darg)

Medecins San Frontieres sent assessment teams to the Artibonite region including the coastal town of St Marc, 70km north of Port-au-Prince. MSF said St Marc’s hospital was becoming overcrowded and does not have the capacity to handle a cholera epidemic. MSF staff are giving patients an oral rehydration solution to replace fluids lost from diarrhoea and vomiting symptoms of a cholera infection. Patients too sick to drink the ORS are given infusions intravenously. “The most important thing is to isolate the cholera patients there from the rest of the patients, in order to best treat those people who are infected and to prevent further spread of the disease,” the local MSF coordinator said. “This will also enable the hospital to run as normally as possible. We are setting up a separate, isolated cholera treatment centre now."

David Darg, of the US-based Operation Blessing International, drove the two hours from Port-au-Prince to find a “horror scene” at St Marc hospital. Darg said he had to fight his way through the gate through crowds of distressed relatives while others carried dying relatives into the compound. “Some children were screaming and writhing in agony, others were motionless with their eyes rolled back into their heads as doctors and nursing staff searched desperately for a vein to give them an IV,” he said. “The hospital was overwhelmed, apparently caught out suddenly by one of the fastest killers there is.”

Cholera is an acute intestinal infection caused by bacteria carried in human faeces and can be transmitted by water, some foodstuffs and, more rarely, from person to person. The main symptoms are watery diarrhoea and vomiting, which lead to severe dehydration and rapid death if not treated promptly. According to the World Health Organisation, there are an estimated three to five million cholera cases every year causing between 100,000 to 120,000 deaths. The WHO is worried about the emergence of a new and more virulent strain of cholera that now predominates in parts of Africa and Asia, as well as the unpredictable emergence and spread of antibiotic-resistant strains. And because brackish water and estuaries are natural reservoirs of this strain, cholera could increase where there are rising sea levels and increases in water temperatures.

While it is too early to tell what is causing the Haitian outbreak, conditions in the IDP camps remain primitive and conditions were ripe for disease to strike in areas with limited access to clean water. 230,000 people died in the quake. 1.2 million people were displaced as of August 2010 and a further 1.8 million are affected. According to a post-earthquake fact sheet produced by USAID, the majority of IDPs in Artibonite are “residing with host families, straining resources and creating housing space issues for both groups.” It noted deficiencies in disease reporting processes. As well there has been a mass migration of 120,000 people from Artibonite to Port-au-Prince in search of a better life.

So far there has been no reports of cholera in the camps, but if it does a public health crisis could be imminent. "It will be very, very dangerous," Claude Surena, president of the Haitian Medical Association, said. "Port-au-Prince already has more than 2.4 million people, and the way they are living is dangerous enough already. Clearly a lot more needs to be done."

Cameroon struggles to cope with cholera outbreak

A raft of international aid agencies is rushing urgent supplies to Cameroon as the country deals with its worst outbreak of cholera in six years. The outbreak started in May in the country’s Far North region and subsequently spread to the neighbouring North region causing over 2,199 confirmed cases of cholera resulting in 163 deaths. UNICEF and other agencies are rapidly distributing supplies for medical workers and water treatment kits for families, along with medication. The waterborne infection is highly contagious yet is easily preventable with clean water and sanitation.

Over five million people live in the Far North and North regions of Cameroon and the regions share borders with Nigeria, Chad and the Central African Republic. Parts of the Far North region have suffered extensive flooding over the past month, leaving many communities increasingly vulnerable to disease. UNICEF said it was concerned that any further spread of the outbreak could have serious consequences for women and children across the sub-region. Al Jazeera has reported outbreaks in Chad and Nigeria with 400 deaths in these two countries in the past few months.

The latest outbreak was triggered by unusually heavy rains which caused severe flooding and landslides. The landslides submerged houses and made traditional pit toilets unusable. Safe drinking water is rare in the Far North region due to drought and the poor are turning to untreated water from hand-dug wells, increasing the region's vulnerability to cholera and other water-linked diseases. Authorities have begun disinfecting wells and other water points and are urging communities to practice proper hygiene. “We are urging people to be careful with the food and water they consume, and with how they handle the remains of people who died of cholera,” one official said.

All 13 regional hospitals in the Far North are full with little or no room to treat any more cases. Cameroon minister of public health Andre Mama Fouda said the risk of cholera spreading further south was very high with Cameroon still in the middle of its rainy season. "We are calling on the population to adopt strict personal hygiene and follow food and water consumption guidelines,” he said. “They should avoid drinking unchlorinated water and eating at makeshift street markets where food is not well preserved.”

Superstition is hampering relief efforts. Some communities have stopped attributing the increasing number of deaths to cholera. A volunteer leading said the hardest thing was stopping people from being sceptical. “For example, they believe that if you're not a sorcerer, cholera can't get you, and so it only affects sorcerers,” he said. Another volunteer said local religious leaders told everyone to stay away from the fields because of the risk of getting cholera. The volunteers’ message to people is simple: stop defecating in the open, use latrines, wash hands with soap and boil all water before use.

According to the World Health Organisation, cholera is an acute diarrhoeal disease that can kill within hours if left untreated. The infection is caused by ingestion of food or water contaminated with the bacterium vibrio cholerae. The short incubation period of between two hours to five days can make an outbreak explosive in its impact. There are up to five million cases every year with 120,000 fatalities. Control measures rely on prevention, preparedness and response.

80 percent of cases can be successfully treated with oral rehydration salts. But oral rehydration treatments remain scarce in the world's poorest countries. Some have blamed Big Pharma for making drug treatments too expensive but writing in The Wall Street Journal Alec Van Gelder of the International Policy Network does not agree. He puts the blame on lack of investment in domestic health care infrastructure. He said that in July's AU summit, leaders were confronted with WHO figures showing that only six member countries have met their 2001 pledge to invest 15 percent of their national output on health care. “The real global public health problem is that for every aid dollar African governments receive for health care they divert up to $1.14 of their own resources to other areas,” Van Gelder said.