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Haiti Health Cluster Bulletin Update

April 18, 2011 in Disaster Relief, Haiti, Helping Children, Providing Medical Support by Jonathan White | Comments closed

Haiti Health Cluster Bulletin:

Cholera and Post-Earthquake Response in Haiti: April 15th, 2011

The following report was compiled by the The Ministère de la Santé Publique et de la Population (MSPP) and PAHO, the Regional Office of the World Health Organization (WHO) for the Americas,coordinate the Health Cluster. MSPP Cluster Contacts: Dr. Claude Surena; Dr. Jean Hugues Henrys; PAHO/WHO Contacts: Dr. Juan Carlos Gustavo Alonso and Dr. Josep Vargas.

Highlights

  • The number of cholera cases nationwide continues to decrease. The number of cases in Northeast, Centre, Port-au-Prince, North, Northwest, Artibonite, West (except Leogane-Gressier), South, Grande Anse and Southeast departments are stable or decreasing. However, cases in Nippes and West (Leogane-Gressier) are increasing (although only slightly in the West).
  • The continued decrease of cholera cases together with the phasing out of health actors from cholera treatment facilities has raised concerns about the capacity to cope with a potential increase in cases during the upcoming rainy season. The impact on the health sector is important given that the management of the cholera outbreak has been highly dependent on the support of foreign health organizations. A gap analysis is underway to identify potential risk areas and to sensitize donors to maintain their support to the cholera response.
  • An independent evaluation mission has arrived in Haiti to assess the efficiency and effectiveness of the coordinated national and international response to cholera, both in terms of immediate and medium term impact. The results will assist the MSPP and its international and national partners to draw lessons from successes and shortcomings, and improve the joint response in case of a possible recurrence of the epidemic especially due to the upcoming rainy season.

Situation Overview

  • 4 April 2011, the cumulative number of reported cholera cases was 274,418, including 4,787 deaths. The observed cumulative incidence of cholera cases since the beginning of the outbreak was of 26.2 per 1,000 inhabitants, ranging from 4.9 per 1,000 in the Department of South-East to 40.3 per 1,000 in the Department of Artibonite.
  • Overall, the number of medical staff from health partners has been reduced in most CTCs and CTUs. Medical staff has been trained and is currently employed in the CTUs established in health centers. NGOs are mostly phasing out due to the decrease in cholera cases or due to the lack of funding. However, health partners continue to provide support to maintain regular training and refreshment courses for local medical staff, and maintain a surveillance system to monitor the evolution and assessment of the potential need to reactivate their response.
  • Apart from the essential work of the NGOs, it is important to mention the role of the Cuban Medical Brigade (CMB) as well. The CMB treated a high percentage of cholera and diarrhea cases during the epidemics through a network of CTCs and CTUs. They built up belts of community workers around each CTC and CTU, thus ensuring prevention and health promotion activities that accompanied the efforts to save lives at the treatment centers. The CMB also deployed active research brigades, who go to the difficult to reach sub-communes to investigate and treat cholera cases, thereby diminishing the “silent zones”.
  • The criteria for closing down cholera facilities and for phasing out NGOs from cholera facilities are well established, and there is an effort to maintain sufficient supplies and medical materials at the cholera centers. Nevertheless, lack of sufficient supervision and irregular payment of salaries to local health staff represent major risks that can jeopardize the response capacity at local and departmental level in case of sudden increase in the number of cholera cases, or any other major outbreak.
  • The WASH sector remains of paramount importance. The chlorination of water systems and water trucks delivering water to the metropolitan areas has been a huge progress, despite the challenges that this method still faces. Attention needs to be paid to the private companies and the alternative treatment systems being used so as not to have resurgence within the urban areas. In rural areas, the treatment of water remains a difficult challenge

Wash (Environmental Health)

PAHO/WHO continues to support the MSPP in identifying needs and priorities for the improvement of sanitary conditions of the health centers in several departments through water sanitation networks and

waste management. Environmental health is an essential part of the long term fight against the spread of cholera and other diseases related to water and sanitation management. The financial resources of numerous NGOs that ensured drinking water distribution and removal of excrement from latrines and septic tanks in Port-au-Prince are running out or have been exhausted.  Transition strategies offer only a limited solution, and serious concerns exist with regard to access to drinking water and adequate public health conditions.

Mental Health

The working group that formulates the Mental Health Policy and the National Plan continues to be dynamic. This group consists of the MSPP, PAHO/WHO, national and international mental health actors and several experts from universities (Toronto, and Montreal). The drafting of the national policy document is currently being finalized.

The list of essential psychotropic drugs for the country is in its final stages of development and the proposal will be submitted to the MSPP by mid-April. The WHO-AIMS is in its final phase, consisting of the compilation of data and development of the evaluation report.

Health Promotion

The final version of The Ways of Working (WOW) document on hygiene promotion will be circulated starting 6 April. It systemizes the lessons learned formulated during the Hygiene and Sanitation Promotion Workshop (Haiti 2010) held at Moulin Sur Mer on 11-12 March.

Nutrition

To continue to reinforce MSPP capacity, PAHO/WHO has provided support for the development and reproduction of 500 copies of the Global Acute Malnutrition (GAM) management protocols that were provided to the MSPP in September 2010. With the cholera outbreak, PAHO/WHO has provided support to the MSPP to update the Protocol, taking into account the care of malnourished children suffering from

cholera.

New growth standards: In May 2010, PAHO/WHO took the lead in MSPP adopting new growth standards, and later by professional associations and partners. Based on these new standards, PAHO/WHO has supported the MSPP in the review of the “chemen lasante” map, thereby creating the opportunity to dispose of a draft of a child nutrition and health booklet since February 2011.

Revision of the IMCI: In order to make the necessary adjustments based on new WHO

recommendations and on the new national protocol for GAM management, PAHO/WHO is offering support for the review of current IMCI standards. The review of the national nutrition policy is underway.

Fortification: In order to prevent micronutrient deficiencies, the technical nutrition committee that support to the MSPP is currently conducting discussions on fortification of wheat flour with micronutrients.

Post Earthquake Health Surveillance

World TB Day, which took place on March 24th 2011, is designed to build public awareness that tuberculosis remains an epidemic, causing several million deaths each year, mostly in developing countries.

This year, Haiti’s National TB Program of the Ministry of Health commemorated the World TB Day by organizing a Ceremony to launch the Reconstruction of the TB Hospital of Leogane, which was totally destroyed by the 2010 Earthquake. The Leogane center received the most significant number of TB cases in the country, and its loss resulted in an enormous challenge for TB services.

The meeting was aired on Haitian National Television and was attended by all national and international TB partners. The reconstruction will be done by Italian NGO INTERSOS, with technical support by PAHO/WHO and additional support by the Japanese Embassy.

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“UN condemned over ‘appalling’ Haiti earthquake camps” (BBC news)

October 7, 2010 in Disaster Relief, Haiti, Helping Children, Rebuilding Communities by Jonathan White | Comments closed

Just in case people have forgotten that very little has actually been done to resolve enormous tent city/homeless situation in Port au Prince, or the fact that the  $1 Billion the US promised has yet to materialize due to political games being played in the US Senate….the BBC has checked back in on the situation in Haiti and reviewed a recent report published by Refugees International and is not impressed, here is their not so uplifting update:

http://www.bbc.co.uk/news/world-latin-america-11491537

In addition to RMF supporting a team of nurses in one of the few remaining small hospitals in Port au Prince, we are continuing to push for a much larger scale health care capacity building project, but as with most initiatives down there dealing with immense funding challenges with very little promised money actually being delivered.

To contribute to our Haiti Earthquake Relief Efforts, please click the Donate button below or through our website at realmedicinefoundation.org.

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Haiti update- Hurricane season complicates relief efforts

September 27, 2010 in Disaster Relief, Haiti, South America by Jonathan White | Comments closed

By Dr. Martina Fuchs

Information by OCHA (United Nations Office for the Coordination of Humanitarian Affairs)

At approximately 3pm local time on September 24th a storm with high winds and rain struck the Port-au-Prince metropolitan area for about 30 minutes. The storm was not predicted and no warnings were therefore issued. Thus far, five people were confirmed dead and there are several reports of injuries and people being trapped under fallen trees and collapsed shelters. The camp management and camp coordination cluster (CCCM) currently estimates 2,000 tents damaged or destroyed in camps across Port-au-Prince. Assessments of damage are ongoing and these numbers may well rise. The Direction de la Protection Civile (DPC) has requested the distribution of shelter materials (100 tarpaulins) to affected populations in three camps. Planning for this is under way. UNICEF has also mobilized 1,000 blankets for camps at Caradeux where 931 children were affected.

While four hospitals have reported flood and other damage, most are functioning and have increased staff to deal with the incoming injuries. The MSF Holland hospital is damaged but functioning; the MSF Belgium facility is fully functional and reports an influx of patients. One hospital (L’Hôpital de la Paix) has reported to be unable to function due to flooding. Clinic tents at Pétion-Ville Golf Club camp were blown down. The IFRC Hospital (L’Hôpital de la Fédération Internationale de la Croix-Rouge) in Carrefour reports no structural damage and has put extra staff on standby. Minor damage is being reported in Léogâne and Petit-Goâve where the bridge at the entrance to the city was affected, but the main area of concern is Port-au-Prince.

The UN and humanitarian partners has convened an emergency response taskforce at OCHA, with the main clusters represented to ensure full coordination of assessments and response. DPC has activated the Centre d’Opération d’Urgence Départemental to coordinate the response, and has activated their representatives at camp level. Priority areas for the response have been identified as shelter and mitigation work in camps where water is not draining away. All camp leaders are being called across the affected area to gather information about the damage and needs and to determine appropriate response. MINUSTAH (United Nations Stabilization Mission in Haiti) has deployed five battalions across town to assess camps and damage to the area. They have also responded to some reports of people trapped or medical emergencies. Multi-sectoral assessment teams are being assembled by CCCM/IOM and will begin assessments at first light including teams from WFP among other agencies. A minimum additional five IFRC teams will also deploy, in coordination with CCCM. These are rapid assessment teams and will trigger rapid distributions of assistance. An aerial assessment of the affected area will also be conducted on September 26th.

Update as of September 25th, 2010:

Information by OCHA (United Nations Office for the Coordination of Humanitarian Affairs)

Six deaths and 67 injuries have been reported by Direction de la Protection Civile (DPC). To date 172 camps have been assessed and 21 priority sites have been identified. The priority need is shelter, with no major food or medical needs reported as a result of this storm.  Shelter cluster partners are distributing 5,240 tarpaulins, 150 tents and 785 shelter kits to those affected by the storm. Shelter cluster reports that these distributions will meet half of shelter needs and rest will be met tomorrow with further mobilization of stockpiled resources. The Government of Haiti has 15,000 tents available for distribution from Monday, September 27th, and 600 mattresses.

The DPC has reported 8,432 shelters damaged or destroyed. Approximately half of shelter needs have been met through the distribution of 5,240 tarpaulins, 150 tents and 785 shelter kits to those affected. In Corail camp, IOM relocated 111 families to transitional shelters constructed ahead of schedule. Assessment teams in Cité de Soleil reported that some houses had sustained damage and required tarpaulins as a form of emergency repair to reduce exposure to rain.

20 MINUSTAH soldiers are currently providing escorts for tarpaulin distributions in some affected camps. Security issues may remain a challenge for further distributions. The security situation remains calm. MINUSTAH UNPOL and Formed Police Unit (FPU) officers have been assigned to secure IDP camps are continuing their patrols to assess and report on the situation while ensuring security. This includes 559 UNPOL and FPU officers that have a permanent presence in six main IDP camps as well as 312 UNPOL and FPU officers patrolling other camps.

An increase of 250 MINUSTAH soldiers has been made to the 550 already permanently stationed in IDP camps: there are now 800 soldiers securing camps. Since the storm MINUSTAH provided immediate first aid, facilitated the transfer of the most critically injured to hospitals – a task shared with UNPOL officers – and assisted NGOs to move IDPs to safer grounds during the first hours.

No further increase in health issues as a result of this emergency has been reported. L’Hôpital de la Paix is operational. At the Pétion-Ville Golf Camp their field hospital was destroyed but the tent has been replaced by UNICEF and the facility is now functioning.

Map: Priority camps for assistance due to September 24th Storm

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Haiti Video Interviews: Living in a Tent Camp

July 19, 2010 in Disaster Relief, Haiti, In the news, Initiatives, Rebuilding Communities, Videos by Jonathan White | Comments closed

By Kevin Connell and Jonathan White

This series of video clips was shot by RMF’s Kevin Connell in the St. Pierre Square tent camp in Petionville, an upper-class neighborhood of Port-au-Prince.  This is a small tent camp set up in a public square but one of the largest tent camps in the city is located on a nearby golf course with an estimated 50,000 people occupying.  Voluntary settlements like these were setup in virtually every square or open space in the city after the disaster.  These clips gives you a little more insight into the living conditions that most of the Haitians displaced by the earthquake are still dealing with.  Little has been done to create any longer term housing solutions, but as you can see from these video clips the Haitian’s are still making the best of a very tough situation.

http://www.realmedicinefoundation.org/video/interview-with-evens

http://www.realmedicinefoundation.org/video/can-i-see-your-place

http://www.realmedicinefoundation.org/video/on-the-way-to-evens-home

http://vimeo.com/12389131

The man being interviewed is Edwin, he’s in his early 20’s, originally from Carrefour, which is a poorer neighborhood nearer to the coast, but had moved to Petionville when he was younger.  Edwin has finished high school where he learned English (spoke fluently) and had done apprenticeship training to be a mechanic.  He said he wasn’t working because there were no jobs available if you don’t know someone or aren’t connected to someone in a position to hire you – kind of the extreme of our unemployment situation here in the US.

Edwin said his time is now focused on taking care of his family, with 6 brothers and sisters.  They all live in the tent shown in the final clip, which is small to say the least.  He didn’t mention how many family members had died in the disaster, but did say that his entire extended family was living in the tents and therefore homeless: aunts, uncles, cousins, etc.  As you can hear in the clips, he references the government as the source of most of the problems, and does not hold out much hope for their ability to lead in the reconstruction.  One surprising thing was that he didn’t seem to hold any complaints for the international community, which was found to be pretty common.  When Kevin asked him what he would say to America, he simply thanked the US for our support.

Life in the community

All the people were very welcoming and friendly, which was a little surprising, given their predicament.  The community had truly carved out a life in that square and things appeared “normal” for them, which really highlighted their adversity/resourcefulness, but also their general acceptance of the dire situation around them.  They were mostly busy doing laundry or taking care of their kids.  Many of the kids were studying out of textbooks.  They all lit up when Kevin said he was from America – they apparently have high hopes for our role in the reconstruction.

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Real Medicine in Haiti: 6 months later and beyond

July 12, 2010 in Disaster Relief, Donate, Haiti, In the news, Initiatives, Providing Medical Support, Rebuilding Communities, Whole Health by Jonathan White | Comments closed

July 12, 2010

By Alex Areces and Jonathan White

As we pause to mark the somber six month anniversary of the earthquake in Haiti and the 230,000 lives lost, it is worth noting not only the significant achievements of the international aid community but also how dire the situation remains and the immense challenges that lie ahead.  Most of the 1.5 million Haitians that were left homeless are still living in the immense tent cities due to sheer scale of the logistical and legal challenges of rebuilding literally hundreds of buildings on mostly private property. The health care system is still in tatters, and struggling to keep up with the contstant flow of new patients from these tent cities.  Much of the money raised in the initial weeks for rebuilding is still sitting on the sidelines with no clear way to spend it.   With no easy solutions on the horizon to re-house this immense displaced population the repairing and re-growth of the health and education systems are more important than ever.  Knowing that it will take many more months for any kind of progress on the resettlement of these people living in tent cities, RMF is committed more than ever to concentrating on the rebuilding of a sustainable health care system to care for this immense displaced population.

The living conditions in many of these tent cities with rubble everywhere, limited sanitation options, and very little protection from the heavy rains common this time of year presents a variety of hazards for these people every day, resulting in multiple injuries and deaths.  Little Chon Oxius, 11 months old, is one of them, and a few weeks ago he came to see Dr. Margaret Degand, RMF’s partner doctor at the Lambert Santé Hospital’s free clinic, with severe burn trauma complications.

Dr. Degand or “Maggie”, as she is fondly referred to is Lambert’s Santé’s Medical Director and founder and one of nation’s top clinicians and plastic surgeon.  Dr. Degand spontaneously opened her private surgical clinic in Pétion-Ville to all the victims of the quake at no cost working tirelessly around the clock for days and weeks to hundreds that came to her clinic desperate for emergency care.   With continued financial support and volunteer assistance, she has been managing to keep her public clinic open. She shares RMF’s vision to increase the overall quality and accessibility of patient care to the public during this crisis. In May 2010, Maggie entered into official partnership with RMF to continue offering Public Care.

Little Chon’s Story

RMF’s Operations Director for Haiti, Alex Areces, has been very busy directing our initiatives in Haiti and had come across Chon part of our work with Lambert’s Santé’ Hospital.  Chon lives in one of the tent cities for Internally Displaced Persons (IDP). His mother was preparing a meal on a “Chien Jambe”, a makeshift stove on the ground, which roughly translates to ‘food cooked so low a dog could cross over it’.  It’s basically a pot sitting atop three stones, with a fire lit below.

As mom prepared the evening meal little Chon found his way to the Chien Jambe and toppled the pot burning both his hands nearly to the bone! Having been treated at other facilities, he was eventually referred to one of the finest (once private) facilities in Haiti that in the past he could never have afforded.  When first seen at Lambert Santé, Chon had severe retraction of all fingers of both hands forming a permanent fist of scar tissue, commonly found in this type of burn.  Grasping objects becomes all but impossible.

On June 15th, Chon underwent a contracture scarring removal and skin grafting of all his fingers in both hands. This lengthy procedure is known for a high degree of failure during the post operative period. Delicate skin grafting has to be protected from retracting again, so each of little Chon’s fingers are fixed in an extended fixation with specialized pins. Frequent follow-up care is critical with meticulous attention given to his wound dressings. Each session lasts more than 30 minutes to each hand! Now just 4weeks following his surgery, the grafted skin on Chon’s hands have almost completely healed with no retraction and a very satisfactory extension. He will shortly start a regimen of applied physical therapy to restore the maximum of mobility to his little fingers.

With a comprehensive rehabilitation program, Chon will recuperate much of his hand function, ensuring that he will be able to thrive and pursue a life without the limitations of the scarred hands from his horrendous burn trauma.

Moving forward

Thanks to the loving and dedicated care of the medical personnel at Lambert Santé and generous support of our donors, Chon and countless others can have fruitful and productive lives.  While much of the donor money raised by the international community during the initial weeks of the crisis is still sitting on the sidelines, RMF continues to assure that any funds raised are spent in a timely and highly effective manner and accountable manner where they are needed most.

More information about our initiatives in Haiti: http://www.realmedicinefoundation.org/initiative/haiti-earthquake-relief-projects

If you’d like to donate to this or any of Real Medicine’s causes, you can click the donate button on this page or through our website at realmedicinefoundation.org


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Sleeping Giant – Port-au-Prince, April 18, 2010

April 18, 2010 in Disaster Relief, Donate, Haiti by Kevin Connell | Comments closed

After a three-week hiatus from Haiti to help present Real Medicine’s strategy for the country to key contacts in Washington, including a Director on Obama’s executive committee at the White House, it’s been very strange being back on the ground in Port-au-Prince.

I’m not sure what has specifically changed.  The crush of relief workers, military personnel and patients is less pronounced but still ever-present.  There is still unbearably bad traffic in the mornings and afternoons on the major arteries, UN peacekeepers / Haitian police continue to prowl the streets and setting periodic roadblocks, and the massive tent communities continue to loom, sweeping through the city’s interior up into the suburbs.  But overall, things seem to have settled down into an eerie sort of aftermath calm—a grudging acceptance of the new baseline—where the original problems persist, but have been allowed to recede just below the surface.

One of the topics of discussion you hear everywhere is the concern over where and how the money donated for the reconstruction is being spent.  A recent article mentioned close to $10 billion in aid that has been pledged so far for the long term rebuilding and development of Haiti.  But if you are here on the ground, that money is hard to see.  The tent communities are now getting drenched each night in the inevitable nightly monsoon that happens at about 7pm.  These rains are expected to get much worse as the season progresses.

One tangible thing I have noticed is that much of the rubble that once clogged the streets downtown has been removed or neatly pushed into corners.  However, I do not see many trucks carrying wood or hear the sound of hammers, drills or saws in the distance.  Most people have yet to see the temporary housing structures being built that were so central to the reconstruction plan.  The UN had put together an elaborate strategy to carve out zones in each neighborhood to move the original residents of those neighborhoods back into while the surrounding buildings are rebuilt.  It seemed like a very sensible plan—preserve the social and familial networks while making room for the reconstruction.  However, like many of the plans for this country post-earthquake, we are still waiting to see them actualized.

As a somewhat-related side note, I just read a security brief from a friend in the business here that left me very concerned about the stability of Haiti in the near future.  The 4,000 criminals that escaped from jail when the national prison collapsed have reportedly been rebuilding their criminal organizations alongside the reconstruction efforts, and it’s feared that there may be a rise in rioting/crime on the horizon, particularly if the aid/reconstruction funding continues to go unseen.  One piece of news that was particularly startling was that some of these gangs actually have training camps in certain areas of the city where the work to prepare for kidnappings, robberies, etc.  With the 2 MSF employees kidnapped in March, it seems the stage may be set for more clashes between the relief efforts and the inner-city’s criminal element.

Despite these challenges, Real Medicine has continued to push forward with its plans to continue to build sustainable primary healthcare in the communities that need it the most.  We are currently discussing project plans with key partners in Haiti.  One of which involves being the implementing partner for a new primary health clinic in a neighborhood to the north end of the capital that has very little access to basic healthcare.  Our team has been performing due diligence on these partnerships, the proposed communities involved and the project itself to ensure that all three meet with our standard of expectation.   Funding remains a key concern for this and other projects, as we work to access the unprecedented amount of funding that was raised in the initial weeks after the disaster.

Part of me is happy with the delays, recalling that the ~$9B was given to this country’s development over the last decade had yielded a corresponding drop in GDP of 25%.  Clearly, we need to be careful with our aid and development budgets.  But then I think about those people living under sheets amidst the monsoon-like rain we had tonight—so bad that it was difficult to drive through the runoff on the road.  And I wonder what all this time is really adding to the decision-making—shouldn’t the risk/reward of a development project be clear enough after 8 weeks of review and analysis?  It leaves me wondering if that money will make it to the efforts on the ground after all.  Until then, the development community (Real Medicine included) will continue to hurry-up and wait for continued progress in Haiti.  I only hope that the locals living out in the mud can do the same.


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