Volunteers Continue Cholera Education As New Clinic Building Nears Completion

Cholera: A Disease of Contrasts

When the combined ICDDR,B and Project HOPE team received word late Saturday evening that the airport in Cap Haitien, one of Haiti’s Northern coastal towns hardest hit by cholera, had reopened after it had been closed due to riots, they drove through the night back to Port Au Prince to catch the first morning flight to Cap Haitian. At 6:00 am Sunday morning, the team departed for Cap Haitien.

Upon arrival they moved due south to Hôpital Sacre Coeur (HSC) in Milot where many cholera patients have sought treatment. Here, in addition to training and assessment, one of the ICDDR,B’s two microbiologists, Dr. Zahid Hayat Mahmud, will collect samples from patients to test for culture and sensitivity to see which antibiotic the cholera bacteria in this region is sensitive to. The cholera bacteria can have different sensitivities to different antibiotics regionally in the same outbreak, necessitating the need to take several samples in all regions where outbreaks of cholera have occurred. These samples will be sent back to the National Lab in Port Au Prince where ICDDR,B team member and microbiologist Dr. Sirajul Islam is standing by to test the samples. Dr. Mahmud and other team members have reported that in their home country of Bangladesh they see more than 30,000 cholera patients a month and can treat as many as 1,000 per day. They have two cholera epidemics per year, pre monsoon and post monsoon, giving them the hands-on practical experience and knowledge base it requires to help Haiti learn about cholera.

HSC in Milot has seen more than 220 cholera patients and 12 cholera related deaths. On the first day of training a comprehensive plan was put in place to reach staff at all levels of the hospital from cleaning staff and security personnel to sanitation workers and clinical staff. Three classes took place at the hospital training over 150 personnel and an additional class took place at a church to more than 130 members of a local Haitian youth group and congregants.

HSC and their treatment of cholera patients is in stark contrast to the hospital the team had visited two days prior in Les Cayes. In Les Cayes fear of contracting cholera kept some local staff from touching or even come near cholera patients. In addition, lack of staffing and resources left their system poorly organized to be able to appropriately manage the numbers of cholera patients they were being asked to treat.

Although HSC is also burdened by supply issues they are much better staffed and have the resources to organize a system wide plan. The fear of cholera here has taken on a different form. Staff is digging in, treating and touching their patients, but they have adopted habits that will use valuable fiscal resources such as donning masks, full gowns, rubber boots and surgical hats. These habits are some of the things that the team hopes they can change with the education and training they have to offer. Cholera is a disease that can only be contracted through contaminated water or food. Trying to dispel the myths about contracting cholera from all sorts of other means is proving harder than the team had thought. This being Haiti’s first ever cholera outbreak, it is no wonder there is so much fear and misunderstanding and for this reason the team is hoping a little education goes a long way.

Photos and story submitted by HOPE volunteer, Carrie Alexander, a Pediatric Nurse Practitioner and Johns Hopkins MPH student.