Emergency Appeal: Cholera outbreak in Pestel region (South Haiti) worsens

By Dr. Michael D. McDonald
Published on http://haiti.mphise.net/, Friday, January 13, 2012
(Read also the reports of Dr. John Carroll of his current, cholera mission to the Pestel region, link here.)

Current indications are that the cholera outbreak in mountainous Section 3 and 4 of the Pestel commune of Grand'Anse, Haiti (along the gulf coast from Jeremie to Miragoane) are worsening. Given our last phone conversations with the assessment teams on the ground, it appears that there are over 65 dead and over 300 cases. One report from the middle of the night last night indicated that people from the village areas surrounding Perla, Marcohon, Pavion, Tozia, and Desriveaux may be fleeing the area, potentially spreading the outbreak to new areas. We are awaiting verification and validation by other independent sources of these reports of potential challenges to outbreak containment.

A team of local Community Health Workers organized primarily by two missionary groups, closely tied to the Pestel clinics are doing door-to-door surveys of cases and deaths, and providing ORS. The Pestel clinics appear to have reached out to MSPP in December, when the first cases of cholera started to have an impact on the delivery of medical care, following the first case on December 4, 2011. No MSPP-led response was forthcoming at that time, when there were fewer cases.

Apparently, there may have been an assessment by PAHO in December, with a conclusion that there wasn't an outbreak in Pestel requiring a response. In early January, when the cases started to overwhelm the clinics, and it appeared that MSPP and PAHO would not assist a response, further efforts were made to reach out to CDC. Today, Haiti MPHISE team member conversations with CDC have begun to advance discussions regarding cases and deaths, and to rectify varying reports from different teams on the ground.

It is our hopes at this point that the constructive discussions with CDC today, January 13, 2012 will lead toward a potential integrative management and governance effort to engage and scale up a more robust Phase II Cholera Epidemic Management Initiative during the Pestel outbreak. This Phase II initiative will link the community-centric cholera management efforts on the ground with sustainable systems and resources more effectively linking to MSPP, PAHO, CDC, CARE, and other NGOs under the emerging One Team Against Haiti. The Phase II Initiative in Pestel will then be expanded to four additional pilot sites in four other Departments in preparation for the fourth wave of the epidemic in the March through June 2012 timeframe.

We are now getting reports of over 300 cases and 65 deaths in the mountains of Pestel since January 1, 2012. However, we are still working on validation and verification of the cases and deaths, because it appears that most of the sick and dead never made it to the clinics. There is a significant concern regarding the health worker findings of many bodies of dead and dying cholera victims on the streets and in homes, which must be validated. Appropriate body removal remains a problem that health workers are educating the Pestel villagers about, but more must be done to ensure that the normal practices of body washing in water sources, dangerous contact with cholera-infected corpses, or inadequate burials do not take place.

Endemic chronic diarrhea in the Pestel area is confounding the assessment of the milder cases of cholera without sufficient cholera rapid tests in hand. However, we expect that there are still far more cholera infections than we will be able to verify until cholera rapid tests are performed. The perimeter of the outbreak is not yet determined, and the outbreak still seems to be expanding, although this could be an artifact of better surveys and reporting this week versus in previous weeks leading to a false impression that the outbreak is still expanding, when it may have already reached a plateau.

Cholera tests have now been performed on five springs that are strongly suspected of sourcing contaminated water to the main four village areas and outlying areas in Section 3 and 4. Confirmation of the contamination is pending from the National Lab. Additional rapid test reports should be shared tomorrow.

Three CTCs have been set up in three of the hardest hit areas in Section 3 and 4 of the Pestel commune, but are in need of additional supplies and medications. DRI has provided most of the basic pharmaceutical supplies for opening a CTC, but teams are still canvassing the Haiti Medical and Public Health Information Sharing Environment (Haiti MPHISE) and the Phase II Cholera Epidemic Management Initiative teams for further supplies and personnel, as the scope of the outbreaks may continue to grow, as we get further up into the mountains.

Much of the coordination this week has been done by Miriam Frederick and her staff in Pestel. There, actions have been triggered by the alerts from Dr. Philip Senigue (who manages medical interventions in clinics across a large area in the South) to engage other public health and medical teams through the Haiti MPHISE. Dr. Philip Senigue's identification of a new set of cholera cases associated with the current outbreak stem from December 2011 in the village areas surrounding Perla, Marcohon, Pavion, Tozia, and Desriveaux. From the reports we have received from Dr. Senigue and Community Health Workers in the area, the cholera cases and deaths have worsened rapidly in the early January 2012 timeframe.

Miriam's teams know the areas of the current outbreak well. They have been working on water and nutrition issues in this area for some time. Dr. Philip Senigue has had extensive recent experience with cholera. It is my understanding that he saw 2000 cases last year about this time in the Pestel area.

Michael D. McDonald, Dr.P.H. <michael.d.mcdonald@mac.com>
President, Global Health Initiatives, Inc.
Coordinator, Haiti MPHISE http://haiti.mphise.net/
Haiti Resilience System http://www.haitiresiliencesystem.org/

Supplementary news from Pestel:
On Jan 15, 2012, Shelly Chvotzkin <babydocdo@gmail.com> wrote:

Hello, everyone!

As some of you know, we have been working very hard since January 3rd on this cholera outbreak in Pestel. The Pestel commune is approx 7-10 hour drive depending on the road and rain conditions. We have 4 CTCs set up and they are staffed.

Global DIRT is there now to help, but need to get back to PAP as they LITERALLY picked up and left to go to Pestel on moment's notice to help us. We really could use more assistance in helping to get supplies up to these villages and CTCs as well as help at them so that the current nurses could get a little break. I will make all the arrangements for the anyone from the La Gonave trip to go to Pestel. We can go on the same dates...January 26-31. I can arrange transportation directly from New Life to Pestel. If people are willing to pay for air transport, I can speak with my friend Jon from Global DIRT as he has a helicopter available to drop off supplies...maybe he can drop us off too...but I'm sure he will need money to pay for gas! and use of the chopper.
I need to know how many people are interested in going ASAP. I will arrange with my contact in Pestel the lodging and food. You all ROCK!!!! Thank you for helping us in Pestel!!!