Partners In Health Hosts Comprehensive Discussion on Cholera Epidemic in Haiti

Cholera clinic PIH in Mireblais, Aug 2011.jpg

PIH cholera treament center in Mireblais, Haiti

A one hour press conference by Partners In Health on October 19, 2011 featured a comprehensive discussion on the cholera epidemic in Haiti. Hosts reminded participants that Haiti's is the largest cholera outbreak in the world in recent history. You can listen to the one-hour conference call via the link enclosed below. See also a related news story below.
As discussed on the call, organizations that have been providing cholera treatment services in Haiti are closing down their work in large numbers. From 128 in January 2011, the number of organizations providing cholera treatment and prevention has declined to 40. The world has delivered only 43% of the app. $4.6 billion promised for relief and recovery in Haiti for 2010 and 2011.
According to a just-released report by the Office for the Coordination of Humanitarian Affairs (OCHA) of the United Nations, access to potable water in the camps of displaced persons has declined to just seven percent of residents, and toilet facilties to 38 percent. Across Haiti, only 54 percent of Haitians have access to potable water and 30% to latrines. (The five-page report is attached here and is available at this link:
The conference call discussed in detail the efficacy of introducing available cholera vaccines to Haiti. PIH is launching a project to vaccinate 200,000 people in a region close to the city of St. Marc. "I hope people on this call will be shocked by the low cost of what it would take to introduce a vaccination program," Paul Farmer told the call. Director of Policy and Advocacy for PIH, Donna Barry, says it would cost $20 million for a comprehensive program across the country. The organization has been spending $500,000 per month on cholera treatment.
A particularly piercing question was asked by one journalist on the conference call: "How is it possible that in the midst of the world's largest humanitarian operation, a cholera epidemic continues out of control?"

Dr. Paul Farmer, Dr. Louise Ivers and Ms. Donna Barry Call for Integrated Approach to Slow Haiti’s Year-Long Cholera Epidemic, Including Introduction of Cholera Vaccine

**MEDIA RELEASE** October 19, 2011
Contact: Kria Sakakeeny, 617-998-6541(
Meredith Eves, 617-998-8945, (
BOSTON – Dr. Paul Farmer, a co-founder of Partners In Health (PIH) and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, Dr. Louise Ivers, Senior Health and Policy Advisor to PIH, Assistant Professor of Medicine, Harvard Medical School and Associate Physician, Brigham and Women’s Hospital, and Donna Barry, NP, MPH, PIH Director of Policy and Advocacy hosted a press conference call today to discuss the cholera epidemic in Haiti one year after the outbreak. Dr. Farmer, Dr. Ivers and Ms. Barry discussed the urgent need for an integrated response which includes: 1) scaling-up efforts to aggressively identify and treat all those with cholera 2) improving access to clean drinking water and strengthening Haiti’s sanitation infrastructure, and 3) rolling out the safe, affordable and effective oral cholera vaccine, Shanchol.
In one year, cholera has killed over 6,500 Haitians and nearly half a million have been treated for the disease (roughly 5% of the country’s population). Cholera has killed more people in Haiti in one year than it did in all the other countries in the world combined in 2010. Since the start of the outbreak, PIH has mobilized its extensive network of community health workers, nurses and physicians to treat more than 75,000 patients. PIH now operates 12 cholera treatment facilities, and has hired and trained 3,378 community health workers to identify and treat cases of cholera and conduct aggressive public hygiene education campaigns. PIH psychosocial and mental health teams have also counseled and conducted memorial services for more than 4,000 families affected by cholera-related illness or death.
Cholera is well on its way to becoming endemic in Haiti, and, in the absence of a comprehensive and integrated response, cases will continue to rise and fall according to seasonal patterns. A link to the full audio of the call: Please see below for key quotes:
Dr. Paul Farmer on need for integrated approach to controlling the cholera epidemic:
“What we're calling for, a year into the epidemic, is a prompt integration of these prevention and care and treatment measures, including: chlorinated water at the household or village level, hand washing and hygiene measures, building up systems that haven't previously had them, improved case-finding, treating with oral rehydration salts and finally integration of oral cholera vaccine.”
Dr. Paul Farmer on Haiti’s water insecurity:
“Some years ago, PIH and many sister organizations began talking about the right to water. We did so because those of us who are clinicians, we can sit in our clinics and work in our hospitals and wait for people to come in sick with complications of water-borne diseases, or we can work with public authorities and appropriate NGO partners and others to build real water security in Haiti. We've been sounding that drum for some years now.”
Dr. Paul Farmer on aid agencies leaving Haiti:
“There's been this steady erosion of support, people coming in and leaving, it's been ADD of humanitarian work, it's just so short term. But we're not there for the short term, our partners are Haitian, we work with the Ministry of Health, our organization is really fundamentally a Haitian organization. And we, unable to retreat to some other activity or some other place in the world, are now probably putting in a half million dollars a month into cholera”
Dr. Paul Farmer on need to increase production of cholera vaccine:
“This entire debate should sound familiar... [because there were] the same discussions around HIV. The failure of imagination regarding price and this fetishized cost -- that it had to cost $10,000 per patient per year [for HIV], which was absurd at the time, because it’s not as if these drugs or the vaccines were made out of platinum... they could easily be manufactured, and the same plunge in prices with the increased demand, we expect to see that with cholera vaccine, and that of course will help us to have a global vaccine stock pile”
Dr. Louise Ivers on PIH cholera cases and aid agencies leaving Haiti:
“We've seen over 75,000 cases of cholera [in PIH-supported facilities] alone, that doesn't include cases that been seen in the communities. Between October 2010 and early January 2011, we had a lot of support from other collaborating organizations that were responding to the epidemic; however, since late winter/early spring of this year, we've seen most of those organizations either move to other parts of the country or stop their cholera treatment activities.“
Dr. Louise Ivers on introducing a safe, effective proven cholera vaccine:
“We are planning to vaccinate about 100,000 Haitians with a vaccine called Shanchol. We're planning on that number because 200,000 doses is the currently available number of vaccine doses, and we'll be working on this project in collaboration with GHESKIO, as well as with the Haitian Ministry of Health. The campaign planning is already underway, including stakeholder meetings and meetings w/ local communities involved in the vaccination campaign to ensure that we can have a communications campaign that really makes sense to explain to everybody involved what the vaccine is, how effective it is, what it means form them, and also for people who don't receive the vaccine, to understand why that might be so at this time. And our intention is that this would just be the beginning of a larger national campaign to include cholera vaccination as part of national protocols to control the epidemic.”
Donna Barry on aid agencies leaving Haiti:
“128 organizations working with cholera in Jan 2011, and that number has now decreased to around 40, so there are far less partners that are working, not just with us, but w/ the Haitian Ministry of Health and others to help treat the cases and also working on prevention methods.”
Donna Barry on failure to disburse relief funding:
“In 2010 and 2011, about $4.6 billion was pledged for relief efforts and of that, 43% has been dispersed, which means that there's 57% that's yet to be disbursed. We're in October, with only two and a half months left in 2011, and 57% of that money is still left to be dispersed.”
About PIH: PIH works in 12 countries around the world to provide quality health care to people and communities devastated by joint burdens of poverty and disease. PIH has been providing vital health care services in Haiti for more than 20 years and is the largest health care provider in the country, working with the Haitian Ministry of Health to deliver comprehensive health care services to a catchment area of 1.2 million across the Central Plateau and the Lower Artibonite Valley. PIH had 5,000 staff in Haiti before the January 12 earthquake.


AP Interview: UN envoy Farmer says Haiti cholera outbreak is now world’s worst

PORT-AU-PRINCE, Haiti — Haiti has the highest rate of cholera in the world a mere year after the disease first arrived in the Caribbean nation, a leading health expert said Tuesday. Dr. Paul Farmer, one of the founders of the medical group Partners in Health and U.N. deputy special envoy to Haiti, said cholera has sickened more than 450,000 people in a nation of 10 million, or nearly 5 percent of the population, and killed more than 6,000.
Farmer told The Associated Press on the anniversary of cholera’s arrival in Haiti that it’s also on the verge of becoming the leading cause of death by infectious disease in the Caribbean nation.
“It’s freakin’ incredible,” Farmer said by telephone. “In 365 days, you go from no cases to the largest number in the world.” That’s significantly more than the 100,000 to 300,000 cases documented annually in Bangladesh, Farmer said. The Democratic Republic of Congo sees 13,000 to 30,000 cases a year. He also said that cholera is likely to become endemic in Haiti, meaning it will become “native” to the country. “It’s going to be with us for a long time,” he said.
Farmer attributes the spread of the disease to what he describes as Haiti’s status as the “most water insecure” country in the world, which means many people have insufficient access to clean water.
Cholera is caused by a bacteria found in contaminated water or food. It spreads quickly in unhygienic environments and can quickly kill people through complete dehydration, but is easily treatable if caught in time. Haiti has long suffered from improper sanitation because of its poverty but sanitation conditions in the capital and other urban areas became much worse after last year’s earthquake forced thousands of people to set up makeshift shelters in public plazas, soccer fields and other open areas.
Evidence suggests that the disease inadvertently arrived in Haiti by U.N. peacekeeping troops from Nepal. Cholera then spread through Haiti’s biggest river because a Haitian contractor failed to ensure proper sanitation at the U.N. base. There were no documented cholera cases in Haiti prior to the start of the outbreak a year ago this month. The epidemic threatens to worsen before it abates as the year’s second rainy season causes the disease to spread.
The foreign aid group Doctors Without Borders said in a statement Tuesday that it continues to see “dangerous and unpredictable fluctuations” in the number of cholera cases. For example, the group said it treated 281 patients for cholera in the Haitian capital in the last week of August. That number jumped to 840 per week a month later.
Aggravating the situation will be the withdrawal of humanitarian workers who leave because of a lack of funding, the United Nations’ Office for the Coordination of Humanitarian Affairs said Tuesday. That means fewer drainage services and less maintenance on the latrines aid workers set up in the settlement camps.
Out of 12,000 latrines needed, only about a third were reported to be working in August, down from more than 5,800 the month before, OCHA said. Meanwhile, the number of nonfunctional latrines more than doubled, from about 1,300 in July to about 2,600 in August. Also, more than 1,000 latrines have been abandoned, leading to outdoor defecation, which heightens the risk of contamination for people living in the camps.
The United Nations Office for Project Services and the government’s water and sanitation agency halted the cleaning of latrines at the end of August because of lack of funding, OCHA said.
Despite the spread of cholera, Farmer said it was possible to wipe out the disease by improving Haiti’s water system and sanitation. The use of education and oral vaccines is also important, he added. “To eradicate cholera we’re going to have to vaccinate huge numbers of people,” Farmer said. “It’s going to require a massive campaign like polio.”AP Interview: UN envoy Farmer says Haiti cholera outbreak is now world’s worst