Thursday, October 28, 2010
A Cuban Look at Cholera
Cholera Catastrophe Spreads in Haiti
by Kim Ives
"They are doing exactly the wrong thing," said Dr. Manolo Castro. "When you
bring cholera victims into a hospital, especially one with poor conditions,
you stand a good chance of infecting all the patients in that hospital."
Dr. Castro, 74, is a Cuban doctor working at Haiti's finest pediatric
hospital, St. Damien, in Tabarre. When it comes to cholera, where a virulent
bacterium provokes severe vomiting and diarrhea which can kill in a few
hours, he knows what he is talking about. He has tangled with the deadly
disease before.
In 1990, a cholera epidemic struck the Zambian town where Dr. Castro was a
teacher at a hospital as part of a Cuban medical mission. Soon there were
some 6,000 cholera victims. The hospital's Zambian director packed up his
family and fled. The Cuban Embassy and Zambian government asked Dr. Castro
to step in to help the panicked population. Dr. Castro went to the Public
Health Ministry's office in town and with them identified a local stadium
where they could quarantine hundreds of cholera patients. Within a few
weeks, Dr. Castro's team of six Cuban and six Zambian doctors had brought
the outbreak under control.
"It is essential to isolate cholera victims from other patients, especially
where there is poor sanitation," said Dr. Castro, who helped squelch another
cholera outbreak when stationed in the Cape Verde islands in 1994. "The
government should also stop all traffic and travel between the affected area
and those not affected. Otherwise, the disease is going to spread."
The day after Dr. Castro spoke those prophetic words, it was announced that
Haiti's cholera epidemic had propagated from the Central Plateau and
Artibonite departments (where it emerged) to Port-au-Prince, the capital
through which thousands of people from all corners of the country circulate
every day.
But far from taking aggressive and proactive measures like stopping traffic,
Haitian Public Health authorities have been trying to minimize the crisis,
claiming, as the Health Ministry's general director Gabriel Thimoté did Oct.
25, that the disease's progress has been "stabilized."
At press time on Oct. 26, the only official government figures are that
3,769 people have become sick with the disease in the Artibonite and Central
departments, with 273 fatalities in the Artibonite. Since other areas are
not being tallied, the actual figures are much higher.
For instance, Dr. Ernst Robert Jasmin, the Health Ministry's Northern
Department director, says that there are 17 probable cases in Pilate,
Plaisance and Limbé, with three fatalities. Other authorities report seven
cases in the southern town of Petit Goave and several other cases and deaths
in the town of Arcahaie.
But there is also growing dissension between authorities. Nigel Fisher, the
Canadian assistant head of the UN Stabilization Mission in Haiti (MINUSTAH),
on Oct. 25 put the death count at 284 and said that there were five
confirmed cases of cholera in the capital (as did the Pan American Health
Organization or PAHO). The Haitian government disputes this, saying only one
of the five cases tested positive.
"It is an extremely serious situation and on the basis of the experience we
have had with other epidemics in the world, it would be irresponsible not to
plan for a much larger epidemic," Fisher said. Ironically, he dismissed the
idea of cutting off traffic out of affected areas as impractical.
Dominican health authorities have not been so sanguine. They closed the 130
mile-long border with Haiti on Oct. 25 to everybody except students and
Dominican visa-holders, who have to wash their hands and be checked by
health workers at border crossings. On Oct. 25, MINUSTAH troops fired
teargas to disperse a crowd of Haitians trying to cross over from
Ouanaminthe into the northwestern Dominican town of Dajabon, reports
"Dominican Today."
Meanwhile, Haiti's cholera "will not go away for several years," said Dr.
Jon Andrus, PAHO's deputy director, at a Washington press conference on Oct.
25. "We know that the bacterium is going to spread very rapidly and... we
will see a rapid upswing on the epidemic curve of the number of cases
reported in these early weeks and months."
"The official numbers almost surely under-represent the true number of cases
largely because, in general, approximately 75% of the cases have no
symptoms, they are asymptomatic, yet they can carry the bacterium and
transmit it to others," Andrus said. "And these same asymptomatic cases may
carry the bacterium for up to two weeks and shed that bacterium back into
the environment."
The epidemic is really expected to explode when it reaches the 1.5 million
people living in some 1500 tent cities sprinkled from the capital to
Léogane. Just like the sprawling slums of Cité Soleil and Carrefour, the
tent camps lack sanitation and are regularly flooded by torrential rain
storms. Water used for cooking and washing often contains sewage, cholera's
principal vector.
Doctors and medicine have been pouring in from Haiti's neighbors. Cuban
Ambassador to Haiti Ricardo Garcia Napoles has traveled to Mirebalais, St.
Marc and other towns to help organize the response of Cuba's hundreds of
in-country doctors to the crisis. The South American alliance UNASUR is
dispatching a planeload of medicine and equipment to fight the epidemic on
Oct. 27, with medical teams to follow soon. Brazil said it was making an
additional grant of $2 million for medicine.
Despite the incoming aid, Dr. Castro is very concerned that Haiti lacks
enough doctors to respond to this nightmare scenario. "There is a cholera
stool sample kit, which gives immediate reliable results, but many Haitian
doctors are not trained in how to use it," he said. For the past 13 years,
Dr. Castro has worked at different hospitals in Haiti and taught at the
Aristide Foundation's medical school until it was militarily closed and
occupied by U.S. soldiers immediately following the 2004 coup d'état against
and kidnapping of President Jean-Bertrand Aristide. When closed, the school
was producing about 125 Haitian doctors per year, twice the number of the
state university.
"If you multiply 125 doctors per year, and it could have been more, by the
last six years, you will see that the 2004 coup d'état has deprived Haiti of
close to 800 doctors," noted Hilaire Toussaint, who runs the Aristide
Foundation. He is now looking for funding to reopen the medical school next
year.
The last cholera epidemic in the hemisphere was in Peru in 1991, which had
about 500 cases over the course of two years, with a fatality rate of less
than 1%.
In 2008, "56 countries reported 190,130 cases [of cholera], 5,143 of them
fatal," Dr. William Pape, Haiti's leading doctor in the fight against the
HIV virus, told Le Nouvelliste. "But many cases were not recorded due to the
limitations of the surveillance systems and the fear of sanctions limiting
travel and commercial exchange. It is estimated that the disease's true
figure is about 3-5 million cases with 100,000-120,000 deaths per year."
"It is going to be a long battle," Dr. Pape said. "I fear for the slums of
Port-au-Prince."
by Kim Ives
"They are doing exactly the wrong thing," said Dr. Manolo Castro. "When you
bring cholera victims into a hospital, especially one with poor conditions,
you stand a good chance of infecting all the patients in that hospital."
Dr. Castro, 74, is a Cuban doctor working at Haiti's finest pediatric
hospital, St. Damien, in Tabarre. When it comes to cholera, where a virulent
bacterium provokes severe vomiting and diarrhea which can kill in a few
hours, he knows what he is talking about. He has tangled with the deadly
disease before.
In 1990, a cholera epidemic struck the Zambian town where Dr. Castro was a
teacher at a hospital as part of a Cuban medical mission. Soon there were
some 6,000 cholera victims. The hospital's Zambian director packed up his
family and fled. The Cuban Embassy and Zambian government asked Dr. Castro
to step in to help the panicked population. Dr. Castro went to the Public
Health Ministry's office in town and with them identified a local stadium
where they could quarantine hundreds of cholera patients. Within a few
weeks, Dr. Castro's team of six Cuban and six Zambian doctors had brought
the outbreak under control.
"It is essential to isolate cholera victims from other patients, especially
where there is poor sanitation," said Dr. Castro, who helped squelch another
cholera outbreak when stationed in the Cape Verde islands in 1994. "The
government should also stop all traffic and travel between the affected area
and those not affected. Otherwise, the disease is going to spread."
The day after Dr. Castro spoke those prophetic words, it was announced that
Haiti's cholera epidemic had propagated from the Central Plateau and
Artibonite departments (where it emerged) to Port-au-Prince, the capital
through which thousands of people from all corners of the country circulate
every day.
But far from taking aggressive and proactive measures like stopping traffic,
Haitian Public Health authorities have been trying to minimize the crisis,
claiming, as the Health Ministry's general director Gabriel Thimoté did Oct.
25, that the disease's progress has been "stabilized."
At press time on Oct. 26, the only official government figures are that
3,769 people have become sick with the disease in the Artibonite and Central
departments, with 273 fatalities in the Artibonite. Since other areas are
not being tallied, the actual figures are much higher.
For instance, Dr. Ernst Robert Jasmin, the Health Ministry's Northern
Department director, says that there are 17 probable cases in Pilate,
Plaisance and Limbé, with three fatalities. Other authorities report seven
cases in the southern town of Petit Goave and several other cases and deaths
in the town of Arcahaie.
But there is also growing dissension between authorities. Nigel Fisher, the
Canadian assistant head of the UN Stabilization Mission in Haiti (MINUSTAH),
on Oct. 25 put the death count at 284 and said that there were five
confirmed cases of cholera in the capital (as did the Pan American Health
Organization or PAHO). The Haitian government disputes this, saying only one
of the five cases tested positive.
"It is an extremely serious situation and on the basis of the experience we
have had with other epidemics in the world, it would be irresponsible not to
plan for a much larger epidemic," Fisher said. Ironically, he dismissed the
idea of cutting off traffic out of affected areas as impractical.
Dominican health authorities have not been so sanguine. They closed the 130
mile-long border with Haiti on Oct. 25 to everybody except students and
Dominican visa-holders, who have to wash their hands and be checked by
health workers at border crossings. On Oct. 25, MINUSTAH troops fired
teargas to disperse a crowd of Haitians trying to cross over from
Ouanaminthe into the northwestern Dominican town of Dajabon, reports
"Dominican Today."
Meanwhile, Haiti's cholera "will not go away for several years," said Dr.
Jon Andrus, PAHO's deputy director, at a Washington press conference on Oct.
25. "We know that the bacterium is going to spread very rapidly and... we
will see a rapid upswing on the epidemic curve of the number of cases
reported in these early weeks and months."
"The official numbers almost surely under-represent the true number of cases
largely because, in general, approximately 75% of the cases have no
symptoms, they are asymptomatic, yet they can carry the bacterium and
transmit it to others," Andrus said. "And these same asymptomatic cases may
carry the bacterium for up to two weeks and shed that bacterium back into
the environment."
The epidemic is really expected to explode when it reaches the 1.5 million
people living in some 1500 tent cities sprinkled from the capital to
Léogane. Just like the sprawling slums of Cité Soleil and Carrefour, the
tent camps lack sanitation and are regularly flooded by torrential rain
storms. Water used for cooking and washing often contains sewage, cholera's
principal vector.
Doctors and medicine have been pouring in from Haiti's neighbors. Cuban
Ambassador to Haiti Ricardo Garcia Napoles has traveled to Mirebalais, St.
Marc and other towns to help organize the response of Cuba's hundreds of
in-country doctors to the crisis. The South American alliance UNASUR is
dispatching a planeload of medicine and equipment to fight the epidemic on
Oct. 27, with medical teams to follow soon. Brazil said it was making an
additional grant of $2 million for medicine.
Despite the incoming aid, Dr. Castro is very concerned that Haiti lacks
enough doctors to respond to this nightmare scenario. "There is a cholera
stool sample kit, which gives immediate reliable results, but many Haitian
doctors are not trained in how to use it," he said. For the past 13 years,
Dr. Castro has worked at different hospitals in Haiti and taught at the
Aristide Foundation's medical school until it was militarily closed and
occupied by U.S. soldiers immediately following the 2004 coup d'état against
and kidnapping of President Jean-Bertrand Aristide. When closed, the school
was producing about 125 Haitian doctors per year, twice the number of the
state university.
"If you multiply 125 doctors per year, and it could have been more, by the
last six years, you will see that the 2004 coup d'état has deprived Haiti of
close to 800 doctors," noted Hilaire Toussaint, who runs the Aristide
Foundation. He is now looking for funding to reopen the medical school next
year.
The last cholera epidemic in the hemisphere was in Peru in 1991, which had
about 500 cases over the course of two years, with a fatality rate of less
than 1%.
In 2008, "56 countries reported 190,130 cases [of cholera], 5,143 of them
fatal," Dr. William Pape, Haiti's leading doctor in the fight against the
HIV virus, told Le Nouvelliste. "But many cases were not recorded due to the
limitations of the surveillance systems and the fear of sanctions limiting
travel and commercial exchange. It is estimated that the disease's true
figure is about 3-5 million cases with 100,000-120,000 deaths per year."
"It is going to be a long battle," Dr. Pape said. "I fear for the slums of
Port-au-Prince."
Where Did Cholera Come From in Haiti?
UN probes base as source of Haiti cholera outbreak
Photo by John Carroll
Cite Soleil
October 25, 2010
Posted: Oct 27, 2010 9:17 PM
Updated: Oct 28, 2010 8:58 AM
By JONATHAN M. KATZ
Associated Press
MIREBALAIS, Haiti (AP) - U.N. investigators took samples of foul-smelling waste trickling behind a Nepalese peacekeeping base toward an infected river system on Wednesday, following persistent accusations that excrement from the newly arrived unit caused the cholera epidemic that has sickened more than 4,000 people in the earthquake-ravaged nation.
Associated Press journalists who were visiting the base unannounced happened upon the investigators. Mission spokesman Vincenzo Pugliese confirmed after the visit that the military team was testing for cholera - the first public acknowledgment that the 12,000-member force is directly investigating allegations its base played a role in the outbreak.
Meanwhile the epidemic continued to spread, with cases confirmed in two new departments in Haiti's north and northeast, said U.N. Office for the Coordination of Humanitarian Affairs spokeswoman Imogen Wall. At least 303 people have died and 4,722 been hospitalized.
International aid workers and the United Nations are focusing their efforts on stemming the spread of the outbreak, which was first noted on Oct. 20. But Haitians are increasingly turning their attention to its origins: How did a disease which has not been seen in Haiti since the early 20th century suddenly erupt in the countryside?
The mission strongly denies its base was a cause of the infection. Pugliese said civilian engineers collected samples from the base on Friday which tested negative for cholera and the mission's military force commander ordered the additional tests to confirm. He said no members of the Nepalese battalion, whose current members arrived in early October for a six-month rotation, have the disease.
The unit's commander declined to comment.
Local politicians including a powerful senator and the mayor of Mirebalais are pointing the finger at the Nepalese peacekeeping base, which is perched above a source of the Meille River, a tributary to the Artibonite River on Haiti's central plateau. The Artibonite River has been the source of most infections, which remain concentrated in the rural area surrounding it - mostly down river from the mouth of the Meille.
"They are located exactly where the sickness started," Mirebalais Mayor Laguerre Lochard, who is also running for Senate, told the AP. Area residents are also blaming the base; a young man walked by its gate laughing and chanting, "Co-co-cholera. Cholera MINUSTAH" - referring to the peacekeeping mission by its French initials.
Cholera is pandemic in much of the world but almost unheard of in the Western Hemisphere. It is endemic to Nepal, which suffered outbreaks this summer. A recent article in the Japanese Journal of Infectious Diseases about outbreaks in 2008-09 said the strain found by researchers was "Vibrio cholerae O1 Ogawa biotype El Tor."
That is the same strain that has been identified in Haiti, epidemiologist Eric Mintz of the U.S. Centers for Disease Control and Prevention told the AP. But he cautioned that strain is common and description too general to be a "smoking gun" that would identify the strain's country of origin.
The CDC is not directly investigating the base, spokesman David Daigle said.
The U.N. issued a statement on Tuesday defending the base. It said the Nepalese unit there uses seven sealed septic tanks built to U.S. Environmental Protection Agency standards, emptied every week by a private company to a landfill site a safe 820 feet (250 meters) from the river.
But those are not the conditions AP found on Wednesday.
A buried septic tank inside the fence was overflowing and the stench of excrement wafted in the air. Broken pipes jutting out from the back spewed liquid. One, positioned directly behind latrines, poured out a reeking black flow from frayed plastic pipe which dribbled down to the river where people were bathing.
The landfill sites, across the street, are a series of open pits uphill from family homes. Ducks swim and pigs wallow in pools of runoff. The pits abut a steep slope which heads straight down to the river, with visible signs where water has flowed during recent heavy rains.
The people who live nearby said both the on-base septic tank and the pits constantly overflow into the babbling stream where they bathe, drink and wash clothes.
"The water is no good at all. You shouldn't wash in it," said Jean-Paul Chery, a sand miner who lives near the human-waste pits with his wife and five children.
Lochard, the mayor, said he had told Nepalese officers not to place the landfill sites in that location but never received feedback from peacekeeping headquarters in Port-au-Prince.
Pugliese denied that the reeking black flows from the base were human waste, saying that the only liquid investigators was testing came from kitchens and showers. He said the pipes had only been exposed for the tests, though he could not explain why the liquid inside them was allowed to flow toward the river.
The samples were collected in mid-morning by uniformed military personnel, who scooped black liquid into clear jars with U.N. sky-blue lids. About a half hour later, as AP and Al Jazeera journalists stood by, the Nepalese troops began hacking around the septic tank with pickaxes and covered the exposed pipe jutting from behind the fence, but did not plug it.
Then tanker trucks from the contractor, Sanco Enterprises S.A., arrived to drain the septic tank and dump their contents across the street in the waste pits. As the septic tank drained, the flows behind the base stopped.
The waste company's CEO, Marguerite Jean-Louis, declined to comment, citing her contract with the U.N.
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Albert Schweitzer Hospital
Pittsburgh-area groups help Haitians to battle outbreak of cholera
By Bill Zlatos
PITTSBURGH TRIBUNE-REVIEW
Thursday, October 28, 2010
U.S. health officials are using Hôpital Albert Schweitzer Haiti, founded by heirs to a Pittsburgh fortune, as a base for investigating a cholera outbreak that killed hundreds in Haiti.
"Right now, I'm meeting with eight representatives of the Centers for Disease Control and Prevention," Ian Rawson, managing director of Hôpital Albert Schweitzer, said Wednesday from Haiti. "They'll use our facility as a base. We're right in the middle of where this outbreak has occurred."
The hospital is one of several groups with Pittsburgh-area ties addressing the latest crisis in Haiti. In January, an earthquake devastated the capital of Port-au-Prince, killing 220,000 people and leaving 1.5 million people homeless, according to the BBC.
Hôpital Albert Schweitzer was founded by the late William Larrimer Mellon Jr., a physician and heir to the family's banking and oil fortune, and his wife, the late Gwen Grant Mellon. She was Rawson's mother and Mellon, his stepfather.
The hospital is in Deschapelles in the middle region of the Artibonite River, where most of the cholera cases were reported.
Cholera is associated with contaminated water, poor sanitation and hygiene facilities used by massive numbers of people. It can cause acute diarrhea and severe dehydration, which can be easily treated. If left untreated, the disease can kill quickly. As of yesterday, 284 cholera deaths and 3,769 cases were reported in Haiti, according to the World Health Organization.
Last week, Hôpital Albert Schweitzer treated 90 patients with cholera — so many that it set up a separate cholera hospital.
"We admit 20 and discharge 20 a day," Rawson said.
In the first wave of the disease, he said, the patients were men who worked in rice fields and drank from the river. Now the patients are women, children and families. The CDC is trying to determine how the river became contaminated, Rawson said.
Deep Springs International, a nonprofit group based in Grove City, is ramping up to provide clean water. The group provides a $10 household system with three months' worth of water purifier and a five-gallon bucket and lid and teaches people proper sanitation.
"The fear is that the outbreak will spread into the earthquake zone where people are already vulnerable," said David McGinty, a board member of Deep Springs.
PPG Industries is helping Deep Springs by supplying a month's worth of chlorine tablets for community water tanks.
Global Links, a nonprofit group in Point Breeze, today will load a 40-foot sea container with mattresses, linens, intravenous poles and soap for shipment to Haiti. The group will send another container next month.
"When you have so many people living in a confined area with a lack of proper sanitation and potable water, it leads to conditions such as the cholera outbreak," said Kathleen Hower, CEO of Global Links. She visited Haiti last summer.
"Once it enters the camp, it's going to spread quickly," she continued. "People are very afraid."
The North Side-based Brother's Brother Foundation provided earthquake relief but has supplied nothing specific to cholera treatment, said President Luke Hingson.
Bill Zlatos can be reached at bzlatos@tribweb.com or 412-320-7828.
By Bill Zlatos
PITTSBURGH TRIBUNE-REVIEW
Thursday, October 28, 2010
U.S. health officials are using Hôpital Albert Schweitzer Haiti, founded by heirs to a Pittsburgh fortune, as a base for investigating a cholera outbreak that killed hundreds in Haiti.
"Right now, I'm meeting with eight representatives of the Centers for Disease Control and Prevention," Ian Rawson, managing director of Hôpital Albert Schweitzer, said Wednesday from Haiti. "They'll use our facility as a base. We're right in the middle of where this outbreak has occurred."
The hospital is one of several groups with Pittsburgh-area ties addressing the latest crisis in Haiti. In January, an earthquake devastated the capital of Port-au-Prince, killing 220,000 people and leaving 1.5 million people homeless, according to the BBC.
Hôpital Albert Schweitzer was founded by the late William Larrimer Mellon Jr., a physician and heir to the family's banking and oil fortune, and his wife, the late Gwen Grant Mellon. She was Rawson's mother and Mellon, his stepfather.
The hospital is in Deschapelles in the middle region of the Artibonite River, where most of the cholera cases were reported.
Cholera is associated with contaminated water, poor sanitation and hygiene facilities used by massive numbers of people. It can cause acute diarrhea and severe dehydration, which can be easily treated. If left untreated, the disease can kill quickly. As of yesterday, 284 cholera deaths and 3,769 cases were reported in Haiti, according to the World Health Organization.
Last week, Hôpital Albert Schweitzer treated 90 patients with cholera — so many that it set up a separate cholera hospital.
"We admit 20 and discharge 20 a day," Rawson said.
In the first wave of the disease, he said, the patients were men who worked in rice fields and drank from the river. Now the patients are women, children and families. The CDC is trying to determine how the river became contaminated, Rawson said.
Deep Springs International, a nonprofit group based in Grove City, is ramping up to provide clean water. The group provides a $10 household system with three months' worth of water purifier and a five-gallon bucket and lid and teaches people proper sanitation.
"The fear is that the outbreak will spread into the earthquake zone where people are already vulnerable," said David McGinty, a board member of Deep Springs.
PPG Industries is helping Deep Springs by supplying a month's worth of chlorine tablets for community water tanks.
Global Links, a nonprofit group in Point Breeze, today will load a 40-foot sea container with mattresses, linens, intravenous poles and soap for shipment to Haiti. The group will send another container next month.
"When you have so many people living in a confined area with a lack of proper sanitation and potable water, it leads to conditions such as the cholera outbreak," said Kathleen Hower, CEO of Global Links. She visited Haiti last summer.
"Once it enters the camp, it's going to spread quickly," she continued. "People are very afraid."
The North Side-based Brother's Brother Foundation provided earthquake relief but has supplied nothing specific to cholera treatment, said President Luke Hingson.
Bill Zlatos can be reached at bzlatos@tribweb.com or 412-320-7828.
Wednesday, October 27, 2010
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