Cholera care fails to reach rural Haitians

Cholera care fails to reach rural Haitians

Nature.com – David Cyranoski – January 19, 2011


Last week, three months into Haiti’s cholera epidemic, local and

international health agencies noted with cheer the news that the number of

cholera cases in all ten of Haiti’s departments seems to have either reached

a plateau or started to fall. But there are signs that this trend should be

viewed with caution, and that a more nuanced analysis is needed that takes

into account differences in the rural and urban incidence of the disease.


For now, the undeniable success is that overall mortality rates have

continued to drop from highs of around 6% as the epidemic took hold to about

1% ‹ numbers that are more in line with mortality for outbreaks elsewhere.


And, as health agencies debate how to control a disease from which, since 21

October, 189,000 have fallen ill and roughly 3,800 have died (see ‘Cholera

vaccine plan splits experts’, many are saying that it could have been much

worse. Haiti’s slums and tent camps are squalid and overcrowded. Although it

is impossible to measure the individual effects of component medical and

infrastructure-related efforts, it looks as though the various campaigns to

battle the disease have staved off a much bigger calamity.


But the numbers hide a disturbing fact: rural areas are still experiencing

high infection and mortality rates. As of 11 January, the fatality rate in

the Southeast department bordering the Dominican Republic was 10.1%. In

Nippes, in the south of the country, it was 8.4%. By contrast, the capital

Port-au-Prince’s 0.9% rate was much lower than any of the departments.


Big divide

Port-au-Prince’s success has been the countryside’s failure. How did this

divide emerge?


The urban edge is most visible at cholera treatment centres in

Port-au-Prince. The medical charity Doctors Without Borders (MSF) runs a

centre in Martissant, one of the most dangerous slums in one of the world’s

most dangerous cities. The gangs, guns and persistent threat of violence led

the United Nations to label Martissant a “red zone”, meaning staff require

security clearance and usually an escort of peacekeeping soldiers.


On the gate outside the camp, scrawled images of a handgun, a machine gun

and a knife have been crossed out with a large red X and a roughly painted

“Weapons Forbidden”. Armed guards who, according to MSF staff, accompanied a

US Fox News crew this morning had to check in their guns at the door.


Inside, however, this is one of the calmest spots in Port-au-Prince. In

part, the tranquillity comes from the lethargy of the ill. But the facility

also has the air of a situation under control.


A steady stream of 40 to 50 people a day enter the centre. Heike

Haunstetter, an MSF doctor, shows us the two emergency tents ‹ one for

children, the other for adults ‹ along with another tent for milder or

recovering cases, and a fourth for patients about to be discharged.


Humour and hydration

In the emergency tent, nurses inject both arms of an elderly woman.

Haunstetter pinches the skin of the patient’s abdomen to show how severe

dehydration causes skin to lose its springiness.


The mortality rate here has dropped to 0.5%. “We feel things are

stabilizing, though there’s no comprehensive statistical evidence for that,”

says Haunstetter.


With a system in place, MSF now has the luxury of hiring two clowns wearing

weird glasses and quirky costumes to help make their point. The clowns sing

of hygiene and hydration, fetching glasses of water that, through humorous

exhortation, they force patients to drink.


The urban success has also been a result of efforts to improve water

quality, sanitation and hygiene. The International Organization for

Migration (IOM), for example, based in Geneva, Switzerland, has set up

oral-rehydration centres, built latrines and is sending over 170,000 litres

of water per day to the 250 most vulnerable of the country’s 1,150 camps.


“There’s even access with text messaging to people in the camps. The camps

are easy to target,” says Patrick Duigan, head of the IOM’s health division

in Haiti. The rates at which people become ill are difficult to calculate

because they are usually scored at hospitals, but there has been no dramatic

5 7% that has been seen in other countries, he says, adding that in terms of

a health threat from cholera, “there’s been no real difference between the

camps and non-camps”.


Such attention has not been possible in rural areas, says Jean-Claude

Mubalama, chief of health of the United Nations Children’s Fund (UNICEF) in

Haiti. The Congolese epidemiologist and doctor explains that some rural

areas have only one nurse for 10,000 people and that access is blocked by

mountains and rivers. Some would have to walk for four hours, crossing the

rivers, to get to the closest cholera treatment centre.


It’s not much easier for aid workers. Mubalama indicates on a map a

25-kilometre distance in the southwest. “It took me a full day just to drive

from here to here.” He points to several areas in the northwest and south.

“Nobody’s there to take care of those people,” he says.


MSF, the IOM and other organizations have made some headway, especially in

the north. But some say the situation could have been better handled. MSF,

in a report to mark the anniversary of the earthquake, censured the Pan

American Health Organization, the World Health Organization’s regional arm,

for misdirecting resources by making projections of larger caseloads

occurring in metropolitan areas.


The report reads: “Huge amounts of aid were concentrated in Port-au-Prince

while insufficient support was provided to the inexperienced health workers

battling the disease’s aggressive spread in rural areas. MSF teams found

some health centres facing shortages of life-saving oral rehydration

solution and others that had simply been shuttered.”


According to staff at the Martissant camp, doctors comment on how they have

“never saved so many lives before”. Those working in rural areas could never

make such claims. The epidemic makes for tough choices for aid workers, keen

to make the most of their resources. “People want to be where they can show

rapid results, where they can get visibility,” says Mubalama. “That is why

there are so many in the city.”

Haiti Once Had Tourists, Now it has Ghosts


“A tourist got off a plane in Port-au-Prince, told immigration officials he was Miles Graham, 35, a dentist from Omaha. The Haitians looked right past his white cap, tight woolen shirt, dark glasses and absurd phony mustache and said: ‘Welcome, Marlon Brando.’”

The Time magazine People item that ran Sept. 28, 1959, was light on intimate details. Brando was in the company of ingénue actress France Nguyen — “lush” was Time’s description of the just-turned-20 Nguyen — who was starring on Broadway in The World of Suzie Wong. A Volkswagen Beetle was rented for getting around. (That will be an eyebrow raiser for those familiar with travelling throughout Haiti.) And the couple danced to the voodoo drums at the Bacoulou nightclub.

Perhaps the tumescent atmosphere didn’t need underscoring then, back in the day when Haiti was a tourist hot spot, a rum-soaked island getaway for romantics and sun-seekers, when lovers swam naked at Kyona Beach and dined at La Picardie in Port-au-Prince, as Brando and Nguyen did.

The journalist and author Bernard Diederich added those details in his book 1959: The Year that Inflamed the Caribbean. The arrival of Cuba’s Castro had caused the U.S. administration to look more favourably upon the murderous little man leading Haiti who conjured the voodoo gods sitting in his bath wearing a black top hat: Papa Doc Duvalier, that bulwark against Communism, as the rationalizing Americans saw it. Thus began a time, Diederich wrote, “of collective denial and frozen expressions . . . as if Medusa had magically turned us all, foreigners and Haitians alike, into stone.”

Still we stare.

Is it too obvious to state, all these years later, that this curiosity of a country is unnervingly destabilizing? What you see in Haiti, an observer told me, depends on where you’re standing. As incongruous as it sounds, a main plank of the country’s economic rehabilitation platform is tourism, which thrives next door in the Dominican Republic and is all but dead in Haiti, and that was before the earthquake, and before the cholera. Where can one possibly stand to get a clear-eyed view of that?

The Royal Caribbean ocean liner is sounding the retreat from its berth at Labadie on Haiti’s north coast.

I cannot determine whether the ship is Freedom of the Seas or Liberty of the Seas or Independence of the Seas, but it sure is big, a multi-storied floating city that can accommodate more than 3,500 passengers. The Oasis of the Seas holds 6,000. Could that be she?

Some of the passengers are waving from their state-room balconies, which is nice.

Abandoned in their wake is the zip line for the adventurers, the aqua park for kids and the beach chairs from which the indolent can order the Labaduzee, the Royal Caribbean’s signature frozen rum punch.

No, I can’t tell you what the Labaduzee tastes like. The beach is off limits to regular folk, cordoned off by sky-high wire fences. When the cruise line states in its tourism literature “Only Royal Caribbean can take you there,” they mean it quite literally. The promotional materials persist in locating Labadie “on the north coast of Hispaniola” — the land mass shared with the Dominican Republic — as if the word “Haiti” would give foreigners the jim-jams.

On this side of the fence, beguilingly decrepit tin-topped water taxis are humped up on the beach. They are painted in reds and blues and yellows, a welcoming sight for wanderers open more to adventure and less to private enclaves.

We are headed to Norm’s Place, one of those guest house names that gets tipped from traveler to traveler as a place you would rather be.

There is no road to Norm’s Place.

To get to Norm’s Place you have to walk up the two-step gangplank of one of these twee boats and putt-putt into the Atlantic Ocean, heading westward, momentarily dwarfed by the Royal Caribbean behemoth and those waving stick figures. As with the city tap-taps — the converted pickups that serve as private buses — the water taxis are emblazoned with comforting affirmations. In our case, La Main du Sauver.

Norm’s Place comes into view as an ancient, low stone guest house tucked in a cove. The grounds are flowered and treed. The bedrooms are scattered in outbuildings behind the main house. Four-poster beds are dressed in mosquito netting. The doors from the main house stand open to the ocean. The sunset is blushing in shades of apricot and goes exceptionally well with a Prestige beer in its stubby brown bottle with its cheery red label.

So this is Haiti. A pretty narrative at last, thank God.

Snap out of it.

“I used to sleep here the whole night when I was 18 years old. We would go swimming at four o’clock in the morning.”

Franck Madiou is rather mournfully tipping his head toward the western reaches of the beach. One doesn’t have to look far to note that what was a stretch of virgin sand — Madiou is holding up an ’80s-era photograph against the horizon — is defiled now by concrete buildings mere steps from the water’s edge. “For me this is a paradise,” he says, staring at the snapshot. He raises his eyes to the newer reality: “That is very ugly.”

There’s the usual tale of corruption and short-term thinking and serial local politicians with pocket-fattening agendas that don’t include, say, shoreline preservation.

When he was a young lad Madiou remembers holiday trips to Port-au-Prince. It was a 2 ½-hour drive from nearby Cap-Haïtien to the capital. Today the trip takes at least six, possibly seven, hours. We flew Salsa Air, an experience that involved extended delays on the way up and, eventually, the absence of our names on the return flight manifest. Photographer Lucas Oleniuk proposed a spirited branding line for the airline: “Why fly when you can dance?”

Back to Norm. “Norm” was Norman Zarchin, an American businessman who travelled through Haiti in the ’70s. Stayed. Started dealing in mahogany masks and sculptures. Fell in love, married Franck’s mother, Angelique.

Norm’s Place is Norm and Angelique’s joint labour of love. Norm died last year. Angelique is temporarily in the U.S., so Madiou is managing the joint.

Madiou’s story-telling takes a sharp corner and goes to what anywhere else would seem an inconceivably dark place. “I was born in Cap-Haïtien . . . 1965,” he says. The time of Papa Doc. His father’s name was Captain Serge Madiou. In the spring of 1967, Captain Madiou was found by the Haitian military’s Grand Tribunal in Port-au-Prince to have conspired with 18 other officers “with the intention of creating a climate of disorder and anarchy with the ultimate goal of a criminal attempt against the life of the Constitutional Chief-for-Life.” Each in the group was found guilty on two counts, mutiny and high treason, and ordered executed at Fort-Dimanche, the dungeon of death where more than 3,000 Haitians were disappeared in the Duvalier years.

The mind snaps and zaps as Madiou recounts the stories he has heard. The prisoners were given food too hot to eat with only 30 seconds to get the gruel down. So they threw their plates against the jail cell walls — “plat,” he says, trying to verbalize what that might sound like — and ate their dinner as it ran in rivers to the stone floor.

He believes his father spent no more than two weeks in Fort-Dimanche. He was told his father instructed his fellow officers: “Do not bend your knee before Duvalier.” He believes his father spat in the face of the bespectacled Chief-for-Life. He believes — and there is some documented support for this — that his father was executed by Duvalier personally.

Madiou was 2. His father’s photo is on his cellphone.

This was meant to be a story about tourism. One gets used to the curlicues of the Haitian reality. Just as I’m expecting a buildup to a thunderous indictment of the Duvalier years, Madiou weaves. “I can tell you the dictatorship of Duvalier was very hard. But under Duvalier’s system we live better. . . . The only thing you have to do is, don’t interfere with political affairs. That way you can send your children to school. You can eat. You have a house or a home. It was better.”

What you see depends on where you’re standing.

I see young laughing, naked boys splish-splashing in the warm ocean waters, hanging off the bows of the water taxis. I go swimming too, with an American backpacker we have picked up on our travels. A fisherman poles slowly alongside and asks if we would like him to bring us conch for dinner. Tip: if you come here and would like to have lobster for dinner, you need to order it early in the day.

Visiting Cap Haïtien in October, 2009, Bill Clinton, then the newly appointed UN special envoy to Haiti, enthused about the prospects for tourism. “I love this place,” he said. “It’s wonderful. I see the potential.”

There is potential. There’s Jacmel with its cultural vibrancy, even if it isn’t the St.-Tropez of the Caribbean as once hoped. More promising is the area further west on the south coast: Les Cayes, Ile-a-Vache. Port-Salut with its beaches. Port-a-Piment with its caves.

But if a tourism plan is to work, it has to work in Cap-Haitien.

Come.

The cicadas are singing so loudly in unison, one can barely hear the clopping of the horses as they head up the stone path to the Citadelle La Ferrière.

Wusses ride horses. Better to walk up the steep incline and pledge not to stop for little rests. It’s harder than it looks.

Situated just south of the Cap, the Citadelle is a UN world heritage site, the landscape is green and glorious, and the experience is as historically gratifying as a trip to any of those French chateaux.

The French. Henri Christophe, who fought in the revolutionary battle under Toussaint L’Ouverture, built the fort so he could put down the French, should they ever return. He declared himself King Henri I, ruler of Haiti’s northern region, and he had bronze and iron cannon hauled up here by human chain to help reinforce the point.

The French never came. Cannonballs remain stacked on site, the breeze drifts languorously across the grounds, and toilets installed prior to completion of the fort in 1813 still do the job: lift the wooden lid and observe the 40-metre open-air descent to the ground. Children would love it.

There are no children. A half-dozen visitors drift about the great stony stairs sucking in the vistas that never end. The grounds of Christophe’s Sans Souci Palace are similarly barren. There are no buyers for the straw hats that blanket the little market area just outside the palace grounds. There’s no one to listen to the tale of an ailing and embattled Christophe killing himself by means of a silver bullet to the heart.

Wait. A tiny gathering of horse-backed tourists approaches. A boozy-looking fellow is teetering side to side, managing to hold a cigarette and a beer in one hand, a sandwich in the other. The little pageant quickly passes.

Twenty years ago, visitors would come by the carload from the DR, says Eduardo Almeida, country manager for the Inter-American Development Bank. For the IADB, tourism is a small, but fundamental, part of its plan for development in the country’s north. “If we focus here we will be able to make a tremendous difference,” he says. “Every week Royal Caribbean stops at Labadie with 6,000 people. . . . So let’s say that 10 per cent of these people would be willing to spend $100. $60,000 a week, $3 million a year. Three million dollars in a region that is totally poor. That’s a lot.”

There are no visitors poised on the underwater sapphire blue bar stools at the Karibe Hotel. It is too cool at this time of year for in-pool drinking.

But the hotel is full. “We mostly have reconstruction wheelers and dealers coming in,” says Richard Buteau, whose family owns the Karibe and the Kinam and the Ritz apartment hotel, all in Port-au-Prince.

The Buteaus have been in the hotel business in Haiti for 80 years, starting with Aux Cosaques, an auberge that Buteau’s grandfather built above the capital in Kenscoff as a cooling getaway. As a young boy Buteau’s father was given the task of priming the oil lamps every Sunday.

That boy would go on to create Le Rond Point, a restaurant near the port, where tourism in the capital really started. “It was the place to be,” says Buteau.

On Tuesday, the Interim Haiti Recovery Commission will once again descend on the Karibe to outline more go-forward plans for the country.

Tourism isn’t the kind of story that draws much press. Buteau, not surprisingly, sees it as a linchpin. “But you need to have people with a vision who believe tourism is an alternative to poverty,” he says. “Even Fidel Castro, one of the biggest leaders in the Caribbean, who threw away capitalism and the tourism industry with his revolution, has realized that if he wants his people to get out of poverty he has to consider tourism as an option.”

Tourism is complicated. “It’s easier to have a textile industry,” Buteau continues. Tourism demands non-stop electricity, water, roads, hospitals, security. But rather than seeing those gaping inadequacies as impediments, Buteau sees tourism as a driver to help force change. Environmental protectionism is in there, too. “Once you bring an economic value to something the people start protecting it rather than destroying it.” Unquestionably, a strong tourism sector is a cultural boost, something that Haiti deserves to benefit from.

Funny, but as we sit behind the hotel on the enormous grounds I realize how quiet it is. Where’s the music? “You put Haitian music next to them, they get annoyed.” He’s talking about the wheeler dealers.

He champions developing the industry in hubs, like the north. “You cannot solve all the problems of Haiti but you can decide, well, we’re going to take that region and we’re going to do a success story there and we’re going to make it happen.” Other hubs would ignite, he believes, if just one success could be proved.

At the end of our conversation we walk through the Karibe lobby. There are photos of Aux Cosaques and Le Rond Point hanging on a wall by the bar. “The good old days,” he says, breezing away to his next appointment.

http://www.thestar.com/haiti/economic/article/908715–haiti-once-had-tourist

Who Cares About Haiti?

Who Cares About Haiti ? The Wall Street Journal, By MARY ANASTASIA O’GRADY,
November 21, 2010

Ten months after a magnitude 8.0 earthquake killed more than 200,000
Haitians and destroyed an already decrepit infrastructure, some 1.3 million
impoverished souls are still barely surviving in tent cities around the
country. Living conditions are deplorable and after nearly a year, optimism
about a way out of what were once dubbed “temporary” camps has dimmed.

Now more than 1,100 people have died in a cholera epidemic, and riots that
began in the northern city of Cap-Haitien spread to the capital of Port au
Prince last week. Protestors allege that the United Nations peace-keeping
mission brought the disease to Haiti. The jury is still out on the source of
the cholera, but the unrest has taken a further toll.

And so it goes. Just when you think things can’t get any worse, more
poverty, violence and sorrow conspire to increase the sense of helplessness
in what is the ultimate economic basket case in the Western Hemisphere.
Millions of people the world over watch from afar and wonder why something
can’t be done.

Here’s the $64 million question: Is Haiti’s seemingly intractable misery the
result of a society and culture that is incapable of organizing itself to
create civil order and a viable economy? Or is it the consequence of ruling
kleptocrats—abetted or at least tolerated by influential foreigners—treating
every economic transaction in the country as an opportunity for personal
enrichment?

Evidence abounds that it is the latter. So why have the U.S. and the U.N.
refused to take even small steps toward shutting down an official corruption
racket that pushes millions of helpless people into lives of desperation?
Instead they’ve put Bill Clinton—whose political family famously went into
business with the notoriously corrupt former President Jean Bertrand
Aristide—in charge of rebuilding the country with billions in foreign aid.

Development takes generations, and nation building by outsiders is a fool’s
game. But often there is a simple change that can yield fast returns. One
no-brainer target in Haiti is the port at Port-au-Prince, where the bulk of
imports must enter the country, but where Haiti’s legendary mafia will only
release containers after sizable bribes are collected.

A report this year by the Rand Corporation describes the port’s importance
this way: “The costs of shipping through Haiti’s ports have imposed a major
burden on Haitian consumers and businesses. Because imports play such an
important role in consumption, investment, and business operations, the cost
of imports is a key determinant of living standards and economic growth.”
And yet, Rand says, “importing a container of goods is 35 percent more
expensive in Haiti than the average for developed OECD countries.”

Haitian officials like to blame inefficiency at the capital’s port on a lack
of modern infrastructure. But Haitians know that’s only part of the story.
Writing for the online magazine The Root in October, Haitian-born business
consultant Yves Savain explained that pulling a container out of the port in
the capital “takes walking the documents from office to office to secure an
unspecified number of signatures.” The full cost, which he said includes
“legitimate and illicit duties,” constitutes “a substantial and arbitrary
financial drain on all sectors of the national economy.”

Mr. Savain was being diplomatic. On a visit to the Journal offices last
week, former Haitian ambassador to the U.S., Raymond Joseph—who resigned in
August—was more direct. “The corruption situation in the ports was one of
the major reasons I decided I could no longer defend this government,” he
says.

In the aftermath of the earthquake, Mr. Joseph says, “I had so many
[nongovernmental organizations] calling me and saying ‘ambassador, could you
help me get our things out of the port?’ They kept telling me [port
officials] want so many thousands of dollars to get the things out.” Mr.
Joseph says that by calling the minister of finance he could sometimes get
the goods out but that he wasn’t always successful.

Another example: A Nov. 14 CBS “60 Minutes” report featured the case of six
containers destined for an NGO housing project that had been “stuck” in the
port for months. No one could figure out why the goods couldn’t be released,
but the NGO was still forced to pay $6,000 to the Haitian government for an
“imposed storage fee.”

Haiti holds elections on Nov. 28 for parliament and president, and enemies
of representative government want to disrupt that process. This partly
explains the recent violence. Yet it would be foolish to write it off as
solely the work of the nefarious underworld.

Haitians are fed up with the squalor that seems to promise an end only in
death. They are angry not only with their own crooked politicians but with
the way in which outsiders turn a blind eye to their tormentors. The fact
that Washington and the U.N. have refused to rein in the extortionists
running the port demonstrates the lack of international political will to
alter the status quo.

Honest update on cholera situation from Dr. Bill Frist

Here is an update, one of the most true I have read about the true situation on the ground in Haiti. Without help this will not be stopped until thousands more have died. Please pray for these people.

As the cholera outbreak continues to ravage through Haiti, killing hundreds and inciting terror and riots throughout the country, I’m afraid I may have more bad news. It has come to my attention today that the cholera outbreak is being vastly underreported and underestimated. My sources on the ground in Haiti have estimated that the current epidemic is up to 400% worse than the official numbers reflect. Considering that the official numbers already state a toll of 1,110 dead and another 18,000 sick, the scope of this savage outbreak is shocking.

Furthermore, it seems that nearly all the organizations on the ground were caught by surprise by this sudden outbreak and are grossly undersupplied. Simply put, eradicating the cholera outbreak requires resources beyond Haiti’s capacity.  Ringers Lactate fluid (required for intravenous rehydration) remains incredibly scarce within the country. The UN also refuses to provide any cholera treatment supplies to any NGO, instead dedicating all its supplies to the Haitian government. Medications from the Haitian Ministry of Health are also currently not forthcoming. Certain organizations are simply waiting for the disease to strike the capital, Port-au-Prince, before acting. A group I frequently work with, Samaritan’s Purse, is receiving reports of high mortality in remote areas with no assistance reaching them. The U.S. government claims that materials are in place to respond to this developing disaster, but this does not seem to be the case and I worry that false confidence may cost lives.

The spread of cholera now seems past controlling, and using Pan American Health Organization calculations (in the MOST optimistic, with an attack rate of 2% scenario) around 200,000 people will require IV fluid. As around 75% of all cases require hospitalization, each patient uses 8 liters per day for three days, the conservative estimate for IV fluid needed stands at 3.6 million units. Unfortunately, some experts believe that the attack rate will rise above 2% due to lingering sanitation and hygiene conditions caused by the devastating earthquake combined with a Haitian population with no exposure to cholera and immature resistance.

With much of the country living in squalid post-earthquake conditions, we should expect an attack rate of up to 5-8%, according to the Refugee Health Manual. At this rate, we can expect as many as 500,000 to 800,000 cases of cholera.  Due to the intense overcrowding, these cases might not be spread out over six months, but rip through the population in six weeks. Roads in Haiti, already devastated by the earthquake and again recently by Hurricane Tomas, continue to keep sick people from seeking and receiving proper aid, meaning that more advanced treatments are needed to halt the disease.

Save the Children, which has been in Haiti for over 30 years and currently operates in 17 large urban camps, is desperately struggling to fight back the disease. They are scrambling to set up new treatment centers around the country as current ones, such as their facility in Port-au-Prince now operates 24 hours a day and still cannot do enough. On the preventive side, Save the Children has distributed 10,000 hygiene kits, 19,000 bars of soap, and chlorinated water to schools and camps. These actions are important and have saved thousands of lives, but in a country of 10 million people, they are simply not enough to hold back the tide.

Similarly my friends at Samaritan’s Purse, who remain a major national player in Haiti, report that even with their huge public awareness WASH program, 400 treatment beds, and over 300 staff dedicated solely to cholera, they were completely unprepared for this outbreak. I find it hard to believe that many organizations were prepared for this and I simply cannot imagine that any hidden capacity exists.

This issue needs immediate global attention. Many organizations on the ground do not have the resources to quickly buy, deliver, and administer necessary cholera medications, like Ringers Lactate.  Even if they can afford these costs, it is only the beginning of the current logistical nightmare. The airport in Cap-Haitien has been shut down and there are roadblocks between Cap-Haitien and Port-au-Prince, effectively isolating the entire North of the country. If supplies do make it to Haiti, customs holds these shipments 3 to 10 days and the backlog of supplies, not just at Port-au-Prince but around the country is staggering and costing lives every day. NGO’s are unable to receive and distribute supplies and are resorting to covert and illegal means in some cases to secure these life-saving medicines. Civil unrest around the country, caused by the belief that the UN Peacekeepers are connected to the outbreak, are further hampering the delivery of supplies that eventually do get through the ports.

These hindrances to saving lives must be eliminated. Haiti needs IV fluids sent in massive quantities. Life-saving supplies must be allowed to enter immediately into the country, not sit on pallets for 3 to 10 days out of bureaucratic formality. Organizations on the ground have sophisticated software that allows all the various partners to work together to comprehensively treat the population; we simply do not have enough supplies. The immense backlog of supplies at the ports has strained the entire response grid to the point of collapse and the internal rioting makes it difficult and dangerous to move supplies inside Haiti. The world must help, and must help now.

In addition, the United States needs to seriously and objectively consider a military airlift of supplies into Haiti. While this may appear a drastic measure to some, we cannot sit idle while our neighbor to the south suffers through this nightmare. Our military provided crucial support to those suffering after the Indian Ocean tsunami, Hurricane Katrina, and the earthquake that ravaged Haiti in January, and can do so again in this dire time of need.

Cholera is a disease we can defeat if we work together. Up to 80% of cases can be successfully treated with relatively simple medicines, such as rehydration salts. So join me in telling your friends, writing your congressman, volunteering, or writing a check to one of the many worthy organizations on the ground. We need to spread the alarm, and quickly. This epidemic is larger than previously thought or reported, we are drastically underequipped to deal with it, and it’s moving fast.

Very best,
Senator Bill Frist, M.D.

[from http://billfrist.com/index.php?q=taxonomy/term/8]

Cholera in Remote Haiti

Cholera is hitting the remote regions of Haiti too. Currently Aid for Haiti has a remote medical team of doctors in the mountains of central Haiti. They report widespread cholera death and disease in this region. Working out of Potino, a small village, they have seen and treated multiple serious cases of cholera. One case in particular sticks out. “She was the sickest person I have ever seen” Dr. Caleb, who worked throughout the earthquake aftermath, said about one woman who staggered into the clinic yesterday”. Four of her close family have died in these mountains in the last week without being able to find medical treatment. The hospitals of Cange and Mirabalis, only 30 miles away are much to far to reach on foot when suffering from a disease that can take life in a matter of hours. “We gave her 4 liters of IV fluid in an hour”, “She showed up with no radial pulses and seemingly dying until she was able to walk out days later” said Dr. Caleb. This underscores a chronic problem that Aid for Haiti has been trying to address in these remote regions.

Please join us in prayer for the people effected by this terrible disease. Please also consider financially supporting us during this time of need.

Haiti cholera clashes reach capital Port-au-Prince

Demonstrators run past burning tyres in Port-au-Prince, Haiti, Thursday, 18 November.

Protests linked to the outbreak of cholera in Haiti have spread to parts of the capital, Port-au-Prince.

Police fired tear gas as demonstrators set up barricades and threw rocks at United Nations vehicles. On Monday, clashes between residents and UN troops in the north had left two people dead.

Some Haitians blame UN peacekeepers from Nepal for bringing cholera to the country – a claim denied by the UN.

US health experts say Haiti is vulnerable to further outbreaks.

Sporadic gunfire could be heard on Thursday as protesters took to the streets of Port-au-Prince, which was devastated by a massive earthquake in January.

Hundreds of youths erected barricades of burning tyres and attacked vehicles belonging to the UN mission (Minustah).

The protesters shouted slogans like: “Cholera: It’s Minustah who gave it to us!” and “Minustah go home!”

Cholera is present in all 10 of Haiti’s regions. About 1,100 people have died from the disease since it emerged in the country last month.

Most of the 38 deaths recorded in the capital have been in the slum district of Cite Soleil.

The unrest comes less than two weeks before a presidential election, due on 28 November.

Officials from both the UN and the Haitian government have said described the protests as politically motivated, accusing unnamed groups of taking advantage of the situation to try to disrupt the election.


In its latest update, the Atlanta-based Centers for Disease Control (CDC) said the course of the disease was “difficult to predict” as it was the first cholera outbreak in Haiti for more than a century.

Oxfam’s Julie Schindall: “The implications are very serious…we have to move as fast as we can… and now we’ve been stopped”

“The Haitian population has no pre-existing immunity to cholera, and environmental conditions in Haiti are favourable for its continued spread,” it said.

The CDC said about 1.3m Haitians remained in camps following the earthquake and the camps’ “ability to provide centrally treated drinking water, adequate sanitation, handwashing facilities, and health care varies”.

Just 17% of Haitians had access to adequate sanitation before the quake, the CDC said, adding that the situation had considerably worsened since then.

The first cases of cholera – a water-borne disease – were reported near the Artibonite River north of Port-au-Prince. However future outbreaks could result from tainted food, the CDC warned.

It is unclear how cholera reached Haiti. There are claims that it originated from septic tanks at a base for UN peacekeepers from Nepal, but the UN says there is no evidence for this.

Cholera causes diarrhoea and vomiting, leading to severe dehydration. It can kill quickly, but is treated easily through rehydration and antibiotics.

At least 17,000 cases have been reported across Haiti.

The CDC and other agencies are trying to distribute oral rehydration solutions to combat the spread of the disease.

http://www.bbc.co.uk/news/world-latin-america-11791172

Earthquake Effects Linger On

During the morning hours of a recent clinic day in Port au Prince, a young man limped up. “Im 15 years old now” he told us with a shy smile. As he conveyed his story, he told us of the day of the earthquake when the roof of the house he was staying in came down on top of him. “It landed on my leg” he said. He told the story of the terror and pain of being without treatment for many days. “One day we found an American team, who told me I had a broken leg” he conveyed. “It was a blessing from God, I think.” In a mobile clinic on the streets of the city they inserted an external fixator, a device that consists of two long screws inserted into the bone and connected by a metal rod outside of the skin. The only trouble was, no one had a plan for its removal.

Amidst the chaos after the earthquake, many people came to help and almost all soon left. This left the people of Haiti in the same condition that they were before, only now caring for major injuries.  “From clinic to clinic, all around the city” this young man and his mother had traveled for months looking for help. Afraid to touch something that had been in so long, time and time again everyone told him the same thing: “tell whoever put it in to take it out, not me”. Now nine months later, still having a device inserted into his bones that should have been removed after only a few weeks, his leg muscles were stiff to the touch and contracted. It was apparent that he would need surgery soon.

Seeing the need of this young man we took him to one of the largest facilities in Port au Prince, the Medishare/University of Miami Hospital to locate a orthopedic surgeon. Here, was one of only three places in a city of two million people effected by the earthquake which had orthopedic surgeons left in the country. Unfortunately, we also discovered another reason that this family was unable to have this metal tool removed from his bone. In Haiti today the average wage stands at 300 US dollars per year, making it difficult to keep a family fed. To have this procedure done, this aid hospital required over 200 US dollars, an amount that was impossible for this poor family to raise. Due to generosity of people just like yourself, we were able to cover the entire hospital fees for this young man. At the time the clinic was over, he was scheduled for surgery and was grateful most of all to God who made a way for him to get care.

Please continue to pray for this young man, as surgery will only be the beginning of the long struggle of rehab that will need to take place to allow him full use of a leg that had remained immobile for 9 months. Please also pray for the hundreds left in Haiti like this young boy who need orthopedic care now that all of the major aid has left the country. The needs are still as great as ever in Haiti.

Flooding increases cholera risk in Haiti

ST. DENIS, Haiti — Three medical workers arrived at a clinic near here over the weekend on a mission to deliver supplies and spread the word about preventing a deadly cholera outbreak from getting worse after the torrential rains brought by Hurricane Tomas.
Multimedia

Several of them said, yes, they drank water from a river known to be contaminated with the cholera-causing bacteria. And, no, they don’t always have money to buy bottled water.

“We know there may be cholera in there, but sometimes it is all we have to drink,” said Alienne Cilencrieux, 24. “If we have Clorox, we pour some in and drink it. It tastes bad. Or we dig in the ground until we find water and drink that.”

The cholera outbreak, which has killed more than 500 people and sickened more than 7,000 in the past two and a half weeks, is largely confined to this region of rice paddies and small settlements, where the water has long provided life and livelihood.

But after several inches of rain fell as Hurricane Tomas passed on Friday, health authorities are racing to keep people from drinking unsanitary water, particularly here, where the Artibonite River is known to be contaminated with the disease.

At the public hospital in nearby Petite Rivière, the number of cholera cases has risen since Friday, after trailing off during the week. But doctors said it was too soon to say whether the increase was an anomaly or a sign that the epidemic may worsen with the flooding.

There were also several reports that new cases were suspected in far-flung areas of Haiti, including several cases under investigation on Monday in the capital, Port-au-Prince, raising concern that the disease may have spread there.

The city’s overcrowded earthquake survivor camps and unsanitary conditions could promote the disease. But previously, the only cases confirmed in the capital were among people who had traveled from areas already affected.

Surges in suspected cases are common, as people confuse common diarrhea with cholera, which is much worse and can quickly dehydrate and kill its victims if untreated.

Even spikes in confirmed cases have “happened from time to time, and it may not be directly related to Hurricane Tomas,” said Crystal Wells, a spokeswoman for the International Medical Corps, a group working here in the Artibonite River region. It is now building a cholera clinic at a hospital in Gonaïves to handle the surge in suspected cases there.

Singer Ronald, a spokesman for the Health Ministry, said Monday that the ministry was testing the new cases to confirm the disease and determine where it might be spreading.

In the countryside, medical workers from Doctors Without Borders have quickly found that they have to battle not only the water, which is everywhere, but also the fact that generations of Haitians use the river and its tributaries for almost everything.

Rice farming requires heavy water use, and irrigation ditches and branches from the Artibonite lace through here. The people cook with the water and wash clothes in it. And most alarmingly for those trying to check the spread of cholera, which is found in feces and spread through water, the people sometimes defecate in it.

“The two things we do not have enough here are bottled water and latrines,” said Ruben Petit, a local minister helping the workers educate the community.

Anne Khoudiacoff, a Doctors Without Borders nurse, said it was impractical to tell people not to wash or bathe in the waters, even with the risk of incidental consumption, because of the lack of alternatives.

Instead, the focus is on urging people not to consume the water directly and delivering purification tablets and bottled water far and wide.

Still, many residents said they often could not afford to buy the tablets or bottled water. They depend on distribution from aid groups, several of which fanned out over the weekend to deliver supplies.

“We worry about it a lot,” said Solomon Pierre, who lives in a farming hamlet near L’Estère in this region, adding that one of his seven children had cholera but recovered. “Before the cholera we drank from the river and the canals all the time. Now we try not to.”

Away from population centers, rural victims often get sick, try home remedies and travel long distances to crowded public hospitals, arriving in advanced, acute stages of the disease with an increased risk of death.

Our Inspiration, Dr. Van

Dr. Van Middlesworth worked for over 60 years at the University of Tennessee medical school. At the age of 90 he became the inspiration and driving force of AFH’s work in iodine deficiency. He is a inspiration to all of those who meet him. Please take a moment to read these two articles about this man.

#1: Buck Rodgers of the 21st century

#2: A science lab closes, but its muse, 91, carries on.

As he has almost every day since he arrived on campus in 1946, Lester VanMiddlesworth wore a bow tie Thursday. But on this special day, he was wearing a red carnation pinned to his thin blue sweater as well.

VanMiddlesworth, nicknamed “Van,” was the star of a social hour celebrating his achievements as a physiologist at the University of Tennessee Health Science Center, on the occasion of the closing of his lab (he officially retired in 1989). He is 91.

As a child, he spent his days daydreaming about science, inspired by radio broadcasts of “Buck Rogers in the 25th Century,” and buying a nickel’s worth of charcoal, saltpeter and sulfur at the local drugstore for his homemade basement chemistry lab. He idolized Thomas Edison, who died when Van was 12, and adopted Edison’s habit of sleeping just four hours a night.

In college at the University of Virginia, often penniless, he earned money sweeping the gym floor and answering phones for a taxicab company. He’d sneak naps on the floor of Edgar Allan Poe’s old dorm room.

While working on the Manhattan Project as a graduate student at the University of California at Berkeley, he slept on the lowest shelf of his lab.

After moving to Memphis in 1946 — and meeting a beautiful Smoky Mountain nursing student named Rue, his future wife (and lab assistant who worked for free, a “husband’s discount,” she joked) — he began studying radioactive iodine in the thyroids of cows that were ingesting the radiation from nuclear-testing fallout drifting through the atmosphere. His work was so pioneering and so invaluable that it was crucial in the development of the global Nuclear Test Ban Treaty; his findings are now on display in the Smithsonian Institute.

Van was already retired when his department head, Gabor Tigyi, arrived in 1992, but, Tigyi said, “He has been the most passionate man I have ever known. His lab” — he stopped, as if struck by the mental image flashing through his mind — “it’s like, wow, the workshop of a mechanic or an inventor or even a mad scientist. So much beautiful chaos, so many half-finished projects; the kind of lab that is a shrine to the mind and wonderful thinking.”

The author and editor Phyllis Tickle, also in attendance, calls Van “a muse.”

Van’s commitment during his time on campus was extraordinary. “I didn’t come to leave,” he said matter-of-factly at Thursday’s reception.

Van handled the animal cages himself, scrubbed the floors himself, paid out of pocket to attend conferences or speak at far-flung awards ceremonies, often staying at the local YMCA (until the school found out and gave him a travel budget). When academics would visit, he insisted they stay at his home and not at some impersonal hotel — a habit that made for interesting dinner conversations with his wife, their two sons and two daughters.

Spry and cheery with thick, floppy white hair, he can seem bounding with energy even while leaning on a cane. When a neighbor broke her leg three years ago, he surprised her by mowing her lawn for her. Until recently, he rode his bicycle to and from work.

“There are two types of teachers,” said Abbas Kitabchi, an endocrinologist colleague, in an address to the crowd of about 140 people, including Van’s children and grandchildren, “those who can’t be forgiven and those who can’t be forgotten. Van is the latter. His teaching is legendary and he himself is a legend.”

Kitabchi began choking on his words; Van put a hand on his shoulder before grudgingly becoming the center of attention himself.

When the time came for Van’s own speech, 64 years of service were distilled into 8 words: “I can’t say anything, except: thank you, all.”

Later, in the thick of welcoming the receiving line that snaked around the room, he said of leaving that “if you tear off a chunk of yourself — and that’s what you’re doing when you leave everyone you’ve known — it can’t quite be done. It’s artificial. You can’t really be separated.”

Then he grabbed the next handshake with the next grateful student-turned-colleague-turned-friend and joked: “See?” he smiled, his hand squeezing tight, “We’re inseparable.”

http://www.commercialappeal.com/news/2010/oct/15/a-science-lab-closes-but-its-muse-91-carries-on/