Haiti cholera death toll starts to rise again
December 17, 2010
Sick ... a patient at a cholera treatment centre run by Medecins Sans Frontieres. Photo: AP/Guillermo Arias
PORT-AU-PRINCE: Haiti's cholera death toll has jumped by about 210, with more than 2400 now dead, health officials in the capital say. The deaths shook hopes that the outbreak had begun to taper off.
However, there are signs of potential progress in the earthquake-ravaged country. A study by the International Office of Migration shows the number of homeless people living in tent cities has dropped to 1 million, from a peak of 1.5 million in July.
The study found that 130,000 families still live in tents in Port-au-Prince and Delmas - the congested urban centre - underscoring the challenge of finding suitable land to relocate people and their homes. The largest decrease took place in Leogane, a city 32 kilometres west of Port-au-Prince that had 185 camps in September and 125 last month.
Advertisement: Story continues belowThe Health Ministry in its latest cholera figures listed 2405 deaths since the infections began in mid-October. More than 54,500 people have been treated in hospital, out of 109,196 cases.
Last Friday the toll had reached 2193, after a series of daily tolls of 27 and 26 deaths suggested that the waterborne epidemic could be easing its grip.
Those numbers represented the first time for a month that authorities had recorded fewer than 30 people dying from cholera on two consecutive days.
The outbreak, Haiti's first in more than a century, spawned deadly anti-United Nations riots last month as people turned their anger on international peacekeepers accused of bringing the disease into the country. The Nepalese army denies the cholera emanated from septic tanks at its base in the Artibonite valley.
The UN is set to name a panel to investigate the epidemic's origin.
Agence France-Presse, The Miami Herald
Cholera in Haiti: MSF Extends Activities into Northern, Southern Parts of the Country
DECEMBER 15, 2010
Haiti 2010 © Aurelie Baumel / MSF
A young cholera patient is brought into an MSF facility in Port-au-Prince to receive treatment.
Since October 22, 2010, Doctors Without Borders/Médecins Sans Frontières (MSF) has treated 62,000 people with cholera symptoms in Haiti. This week, MSF's 4,000 Haitian staff and 315 international employees treated close to 2,000 patients each day in the 47 centers and cholera treatment units it has established across the country.
MSF has treated more than 15,000 people in the capital with cholera symptoms since the epidemic began. The number of patients admitted into MSF facilities in Port-au-Prince has stabilized at a daily average of 385 patients this week. The situation is also stabilizing in the Artibonite department, which has thus far been hardest hit by the epidemic and where more than 23,000 people have been treated. This week, slightly more than 1,000 people were admitted into MSF facilities there.
However, the epidemic continues to spread in Haiti's northern cities and rural areas. During the past week, more than 4,000 patients were treated in the Department du Nord, as its known locally, and 1,100 patients were treated in the Department du Nord Ouest. Despite the significant logistical challenges involved in reaching isolated parts of both departments, MSF teams are expanding the number of units, treatment centers, and rehydration points in both areas.
Meanwhile, the epidemic has increased sharply in the South. Of the 475 people treated in the South for cholera since the start of the outbreak, 439 presented in the past seven days. In Jacmel, in the Departement du Sud Est, approximately 100 patients are arriving at MSF's 50-bed cholera treatment unit every day. "Our team had to handle an inflow of 260 in a single day," says Dr. Loreto Barcelo, MSF's coordinator in Jacmel. "There were people everywhere… Patients, their families… There were several hundred people at the treatment site. We had to put up to four patients in a single bed and try to save as many as possible while waiting for extra help to arrive. We now have an additional 20 nurses helping us and opened a new 100-bed treatment center, which is helping us manage the situation."
This week, new cholera treatment facilities were set up in Pignon, St Raphaël, Ranquitte (Nord), Gaspard (Nord Ouest), and Jérémie (Grande Anse). However, as the epidemic continues to spread, the response by local and international organizations remains inadequate.
Some have raised the possibility of launching a vaccination campaign. Under the circumstances, epidemiologist Kate Alberti wonders if this is appropriate. "The epidemic affects the entire country today, including the most remote areas. This isn't the time to carry out a vaccination campaign. The priority is to treat patients, provide access to chlorinated water and improve hygiene measures to prevent others from becoming ill." However, Alberti adds, "In the future, we will consider vaccination as a viable option to immunize the population and limit the appearance of a new epidemic."
>via: http://www.doctorswithoutborders.org/news/article.cfm?id=4917&cat=field-news
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TUESDAY, DECEMBER 14, 2010
WNU #1060: Specialist Confirms UN Caused Haiti’s Cholera
Issue #1060, December 12, 2010 1. Haiti: Specialist Confirms UN Caused the Cholera
2. Haiti: Protests Greet Dubious Election Results
3. Puerto Rico: Police Occupy Campuses
4. Latin America: Argentina, Brazil Recognize Palestine
5. Links to alternative sources on: Paraguay, Bolivia, Ecuador, Colombia, Venezuela, Guatemala, Mexico, Haiti
ISSN#: 1084 922X. Weekly News Update on the Americas covers news from Latin America and the Caribbean, compiled and written from a progressive perspective. It has been published weekly by the Nicaragua Solidarity Network of Greater New York since 1990. For a subscription, write to weeklynewsupdate@gmail.com . It is archived at http://weeklynewsupdate.blogspot.com/ *1. Haiti: Specialist Confirms UN Caused the Cholera
A report by a leading French cholera expert, Dr. Renaud Piarroux, concludes that the outbreak of the disease in Haiti in mid-October originated at a base maintained by the United Nations Stabilization Mission in Haiti (MINUSTAH) near Mirebalais in the Central Plateau. “No other hypothesis could be found,” Piarroux wrote, even though he and his team had looked for “another explanation, even an improbable one, [that] could be advanced to explain the sudden occurrence of this cholera epidemic.”MINUSTAH is a 13,000-member military and police force that has occupied Haiti since June 2004; it was the target of repeated protests even before the cholera outbreak [see “Haiti: Anti-Occupation Protests Boil Over,” WNU supplement 11/18/10].In interviews with Haitian, Cuban and World Health Organization (WHO) medical personnel and with local residents in the most severely affected areas, Piarroux, who heads the mycology and parasitology department at the La Timone hospital in Marseilles, found that the first reported case was in the village of Meillé, near Mirebalais, on Oct. 14. MINUSTAH troops from Nepal, which had been experiencing a cholera epidemic, arrived in the area on Oct. 8 and Oct. 12; their base is located upstream from Meillé on a small tributary of the Artibonite River, a major waterway which traverses central Haiti.The epidemic spread downstream to Mirebalais by Oct. 16, and then it appeared in a more explosive form on Oct. 19 in the Artibonite delta region near the western coast. From there it has spread to other departments and to the Dominican Republic. The official death toll from the disease in Haiti had reached 2,120 as of Dec. 10.Cholera is generally transmitted through human excrement, and Meillé residents reported that a “nauseating” black liquid had been flowing into their river from pipes at the base in mid-October. Although there were no problems at the base when he inspected in early November, Piarroux noted that “nothing can exclude the possibility that measures were taken to eliminate the suspect fecal matter and to erase the traces of a cholera epidemic among the soldiers.” He recommended the opening of “a judicial inquiry into the origins and development of the epidemic, for even if the epidemiological inquiry leaves no doubt about what happened, it wasn’t intended to establish the responsibilities of specific parties.”The French and Haitian governments had asked Piarroux to carry out the investigation, but as of Dec. 10 the report had not been officially released. UN spokesperson Martin Nesirky said in New York on Dec. 7 that the evidence wasn’t conclusive. According to the French daily Le Monde, the UN is concerned about protecting its troops, while “the Haitian government has preferred to suppress the matter so not to embarrass MINUSTAH during an electoral period”--presidential and legislative elections were held on Nov. 28—“which is delicate for the authorities.” (Washington Post 12/8/10 from AP; Le Monde (France) 12/11/10, 12/12/10)In a Dec. 7 newspaper column, former Cuban president Fidel Castro wrote that reports from Cuban doctors in Haiti support Piarroux’s conclusions. Cuban medical brigades have been a major force in treating patients since the epidemic started [see Update #1058]. But Castro cautioned against blaming Nepal, a former colony of the United Kingdom, for the situation. Nepalese men “were utilized in [Britain’s] colonial wars, and now they seek employment as soldiers,” he noted. (La Jornada (Mexico) 12/8/10)A group of researchers wrote in a Dec. 9 article in the New England Journal of Medicine that genome sequences from Vibrio cholerae bacteria pointed to South Asia—which includes Nepal--as the most likely source of the epidemic. They dismissed claims that the current epidemic was caused by the effect of climate changes on dormant local bacteria. “Our data distinguish the Haitian strains from those circulating in Latin America and the US Gulf Coast and thus do not support the hypothesis that the Haitian strain arose from the local aquatic environment…. It is therefore unlikely that climatic events led to the Haitian epidemic, as has been suggested in the case of other cholera epidemics.” (NEJM 12/9/10)
Sunday, December 05, 2010
Vengeance on Dark Souls
These are a few anecdotes and statistics that I have jotted down during the last few days. They are all related to each other in some obtuse fashion.
I examined a 60 year old lady in the Cholera Treatment Center (CTC) a couple of mornings ago. She had no pulse that I could feel at her right radial or brachial areas. I could feel a slight pulse at her right femoral artery which meant that she had a blood pressure of at least 40 mm Hg. I was not able to take her blood pressure in her arm at all. After my exam I was staring down at her on her cart and she looked at me and thanked me even though her brain was not getting a "full head of steam" with her low blood pressure. I had no idea how she could even talk let alone thank someone. Two lines were started in her left wrist and her right saphenous vein by the ankle and she perked up in an hour. However, she was febrile with her new circulatory status and had a tender abdomen, so I transferred her out of the CTC. I had bad feelings about her...like more was going on than "just cholera".
-------------We had an 18 month old boy with pretty severe cholera. He also had an hour of seizures off and on, which is called status epilepticus. The CTC where I work has no medication at all except Ringer's Lactate IV fluid. People with cholera, especially children, can become hypoglycemic with cholera. Their sugar can become so low that they seize. So we started some Dextrose solution along with the Ringer's Lactate and his seizures stopped, he woke up, and started eating. Hypoglycemia is a poor prognostic indicator but he sure looked good the next day.
-------------One of the Haitian nurses I work with lives in a tent. She has lived there with her family every since their house collapsed in the earthquake. She comes to work everday to the CTC in immaculate condition. Her clothes are pristine and she has a smile on her face. What about that?
---------------The definition of cholera that we use here is greater than or equal to three liquid stools within 24 hours with or without vomiting. We use no lab tests to diagnose it and draw no other labs. We treat as fast as we can, especially the severe cases with IV fluids running wide open.
----------------I had a middle age man a couple of days ago who was completely out of it with tenting of skin and he had a heart rate of 144. He had been sick for about 18 hours. Fluids were run in quickly through two lines and he woke up and waved both arms in the air as Haitians do thanking God.
----------------Some rough statistics re cholera: About 80% of people with cholera are asymptomatic. That leaves 20% symptomatic. Of the symptomatic 20%, approximately 80% of them can be treated with oral rehydration solution (ORS). Only the remaining 20% need IV fluids.----------------
For a CTC of 200 beds, about 160 employees are needed.
-------------One should never run out of supplies in a CTC. Ringer's Lactate is life saving and so are good nurses. I worry about Haiti and lack of IV solution.
-------------Each bad cholera patient needs about 60 liters of potable water per day.
Start cholera patients drinking with IV still in. And a severe cholera patient can lose his entire body weight in fluids in several days!!
-------------I saw this on the back of a guy's tee shirt outside the CTC the other day: "Vengeance on Dark Souls".
---------------"Je we, bouch pe." (What the eyes see, the mouth is afraid to say.)
-----------Reporting systems are poorest in countries like Haiti, where cholera is highest.
-------------"Lajan vire loloj." (Money twists the mind.)
-------------I have noticed that my patients with cholera breathe fast. I think this is due to the fact that they have a metabolic acidosis and are "blowing off their carbon dioxide" to compensate for their acidosis.
----------------Patients may present after only a few hours of illness with massive volume loss of between 500 and 1000 mL per hour, and rapidly can lose more than 10 percent of their body weight. In patients treated with proper rehydration, diarrhea is most severe during the first two days and then ends after four to six days.
-------------The mortality of cholera in untreated patients may reach 50 to 70 percent. In areas endemic for cholera, the mortality risk is increased in children (ten times greater than that in adults) and in pregnant women, who also have a 50 percent risk of fetal death during the third trimester. Patients can die within two to three hours of the first signs of illness, although death in untreated patients usually occurs after 18 hours to several days.
On November 2, Americans will have the opportunity to vote for their representatives in Congress, an election likely to affect whether the "normal" retirement age is raised for Social Security and how decisively President Obama moves to end the war in Afghanistan. There are many legitimate criticisms to be made of the electoral system in the United States as we know it. But it could be much worse. We could be confronted with the electoral system that Haitians are currently facing in elections scheduled for November 28.
In Haiti, as things are currently run, political parties are completely excluded from participation if the people currently in power don't like them, including Haiti's largest political party, the Fanmi Lavalas party of deposed and exiled former President Jean-Bertrand Aristide.
It is a telling fact of our political-media culture that while American newspapers regularly carry articles, op-eds and editorials raising the alarm about democracy and human rights in countries where the U.S. has little influence, the major U.S. media are virtually silent about extreme violations of democratic rights in Haiti, a country where the U.S. has tremendous influence. (Two rare, praiseworthy exceptions have been the Miami Herald, which last month published this op-ed by Ira Kurzban, and the reporting of the AP's Jonathan Katz.)
In particular, the unfair elections that Haitians are expected to endure are expected to be paid for by foreign donors, including the U.S. There is no serious question whether the U.S. has influence it can use. Indeed, in Afghanistan, the U.S. and other Western donors, who pay for Afghan elections, told the Afghan government, unless you implement certain reforms, we're not paying for the election.
But, although both Republican and Democratic Members of Congress have called for the U.S. to use its influence in Haiti to ensure a fair electoral process, there has been so far no visible change in U.S. policy. Despite all the blather following the earthquake about how "this time it's going to be different, this time Haitians will have a say," it's not different this time. Not yet.
In June, the Senate Foreign Relations Committee published a report prepared under the direction of Republican Senator Richard Lugar, the ranking Member. Senator Lugar's report called on the State Department to press the Haitian government to reform Haiti's Provisional Electoral Council so that political parties, including Fanmi Lavalas, would not be arbitrarily excluded from participating in the election. But, as far as anyone can tell, the State Department never said boo about it.
Now Representative Maxine Waters is circulating to her colleagues a letter to Secretary of State Clinton, urging Secretary Clinton to make a clear statement that elections must include "all eligible political parties" and "access to voting for all Haitians, including those displaced by the earthquake." Rep. Waters' letter urges that the US not provide funding for elections that do not meet these minimum, basic democratic requirements.
Shouldn't it be a no-brainer to say that the U.S. shouldn't pay for elections in Haiti from which the largest political party is excluded? If you agree, ask your Representative to sign the Waters letter for fair elections in Haiti. You can reach the Capitol Switchboard at 202-224-3121; ask to be transferred to your Representative's office.
Follow Robert Naiman on Twitter: www.twitter.com/naiman
Haiti, through our eyes
December 16, 2010 by Linda Raftree
When people tell their own stories and take photos of themselves, the results are quite different from when outsiders bring in their stereotypes and their agendas.
I love love love this photo series by youth in Croix des Bouquets and Jacmel.
In October, 2010, Plan commissioned photojournalist Natasha Fillion, a Canadian photojournalist based in Port-au-Prince, to train and work with 22 teenagers to document their own lives in their own home, neighborhoods and schools. The youth, ages 14-19, got a crash course in photography and were given a digital camera and sent out ‘on assignment’ in their communities. Their brief was to cover topics such as home life, education, leisure, friends, everyday Haiti, and anything about which they were passionate. The photos were taken over a period of 2 weeks.