Washington, D.C., November 18, 2010 (PAHO) — As violence and insecurity obstruct medical care for cholera patients and the delivery of critical training and supplies, the Pan American Health Organization/World Health Organization (PAHO/WHO) today called on the Haitian population to support medical and relief workers in the same way they supported search-and-rescue teams following the January earthquake.
"Every hour that the efforts of medical and relief workers are obstructed means more deaths of Haitians from cholera," said Dr. Mirta Roses, PAHO's Director. "We understand the frustration of many Haitians with the tragic situation that has developed as a result of systemic poverty, the January earthquake and now the cholera epidemic. But relief and medical workers are as critical to saving lives as rescue teams were after the earthquake."
Sporadic violence has occurred this week in and around Cap Haïtien, in Haiti's North Department. PAHO's country office has received reports of cholera victims dying in the streets because they were unable to reach health facilities in time. Cholera is easily treatable with prompt administration of oral rehydration salts or, in more severe cases, with intravenous fluids. Delayed treatment, however, can result in death within hours.
Haiti's Ministry of Health has reported 18,382 hospitalized cholera cases and 1,110 deaths nationwide. This includes 1,515 hospitalized cases in the Nord Department. The official mortality rate for hospitalized cases in this area is close to 7.5 percent. Experience shows that without access to health care, the rate could rise to as much as five times that figure.
Given poor sanitary conditions in Haiti, PAHO experts expect the cholera epidemic to continue to spread. A joint strategy presented last week by the Haitian government and its international partners projects some 200,000 cases of cholera over the next six to 12 months in the country.
Efforts to fight the epidemic are focused on preventing cases through improved water and sanitation services and education of families and communities about hygiene and home care for cholera patients, as well as reducing deaths by ensuring prompt, appropriate care for people who become infected.
WHO/PAHO and partners in the Health Cluster are providing a range of support to the government and population. Training programs have been set up for health providers and community workers to explain how to prevent and treat cholera. Medical and educational supplies have been distributed, and treatment centers have been set up.
In Cap Haïtien, a cholera treatment center at the main stadium is being operated by Doctors without Borders, and before the recent unrest, the organization was planning to open another center in a different part of town, said Dr. Lea Guido, PAHO Representative in Port-au-Prince. On Wednesday alone, the center took in 100 patients.
"These efforts are critical to saving lives," said Dr. Roses. "We already faced enormous challenges in trying to get ahead of this epidemic. But a situation of violence and insecurity is now threatening to seriously limit our success."
Unrest in and around Cap Haïtien has forced staff from PAHO/WHO and other United Nations agencies to discontinue much of their work supporting cholera treatment centers, training health personnel, and delivering supplies to affected communities.
"The last shipment of medical supplies was delivered over the weekend, and we had to postpone distribution planned for Monday," said Dr. Guido. "The airport was closed, and many roads remain blocked. We have not been able to ship new supplies to the area at all this week."
PAHO staff members in Cap Haïtien have been confined to their living quarters since violence erupted on Monday. They had been helping with the distribution of supplies, providing training and coordinating with other health actors in the region. Similarly affected agencies include the World Food Program (WFP), the International Organization for Migration (IOM), the United Nations Children's Fund (UNICEF). At present, PAHO/WHO has no plans to evacuate staff from the area.
"We must ensure that this important work is able to resume unfettered," said Dr. Guido. "Cholera treatment is simple, but access is key."
PAHO Director Dr. Mirta Roses noted today that it was impossible to identify the origins of the epidemic in Haiti with currently available data. Additional analyses are being carried out on the cholera strain circulating there, but even these are unlikely to resolve the question of how the strain arrived in Haiti, she said.
"You have cases of cholera showing up in countries around the world every year, including here in the United States," said Dr. Roses, speaking from Washington. "Some are acquired, some are imported. What is important is that the disease does not spread if there are adequate public health conditions."
