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OPINION

Cholera in Haiti - a nurse's view

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Nursing Times’ resident Haiti-based nurse Fi Stephenson on the recent cholera outbreak that has hit the country.

The main outbreak is about 60 miles north of Port au Prince in a place called St Marc. St Marc is one of the two main towns between PaP and Cap Haiten on the west coast of Haiti.

The official ‘count’ is 253 deaths to date and over 3,015 people treated for diarrhoea and dehydration.

People were being treated in a car park there until the rain came, and then those that needed to stay were taken to nearby shelter. NGO’s have been driving up with intravenous fluids and IV sets to help.

I have no idea of the ‘real’ count as I am sure that some people affected will not have managed to get to any medical facility.

Now the question is what to do with the bodies? It is hot and humid here. The local hospital has an incinerator but disposing of so many bodies will take time. Some people are apparently being told to burn their relatives body – but this will depend on their religious beliefs.

This outbreak is being taken seriously, although I have not heard of any road blocks in and out of the area occurring. There is concern that people will come down from the area into Port au Prince to get away from the infected area – only to bring the disease with them. There are radio braodcasts but not everyone has a radio. But, news is getting out there.

Some friends of mine, who were in the area yesterday, told me that local people were still swimming in the water up there.

To be honest I am just surprised this has not happened sooner, or here in PaP, given the terrible conditions that people are living in. Many people cannot afford to buy ‘safe’ water and so use the water from dirty polluted rivers and rain ‘run offs’.

If you can imagine streets with filthy puddles, pigs walking through them to feed on rubbish mounds, food stalls situated beside piles of rotting food and litter. Tents closely packed along side the slow flowing water filled gutters – that is normal life in Port au Prince. Waste is piled high everywhere.

We were alerted yesterday that there was an outbreak of severe diarrhoea. 90% of samples have come pack as positive to cholera according to a Government Health Official. Everyone is being warned about sanitation, not eating from street stalls and only drinking safe bottled water for example. We have cascaded the information to all our staff and told them to cascade the news further to their friends and family (especially children, the elderly and ill).

The key stipulations being basic common sense – but difficult over here given the living conditions for many people;

  1. Strict hand washing with soap before and after each patient
  2. Strict hand washing with soap before eating and /or preparing food
  3. Washing salad with safe water only (I have seen a lot of people who have just arrived in Haiti, over the months, get sick after going to a restaurant having eaten salad – you have to be really careful until your gut gets used to the ‘local bugs’….)
  4. Cooking food properly
  5. Not eating from street stalls
  6. Drink only safe bottled water
  7. Washing hands with soap after using hand gel 3 times
  8. Ensuring the toilet seat is clean before use
  9. Strict hand washing with soap after visiting the toilet
  10. Seeking medical attention if symptomatic to reduce the risk of severe dehydration, which has been the main cause of death.

It seems that the preventative medication for cholera is not available to local people here. Treatment is correction of dehydration and antibiotics.

Some people here are wondering whether flights will be prevented from arriving or departing – but nothing official has been said yet.

The main thing is strict hygiene and no scare mongering. Most people are being sensible – we were heading north to a place near St Marc tomorrow but that is now out of the question as we need to stay well in order to do our own jobs of looking after people.

UPDATE

There are now confirmed cases in Port au Prince itself.

There was panic buying of bottled water in a number of supermarkets, leaving the shelves bare. We are all being vigilent. Hand washing and hygiene being the key. I heard that dehydration powder was coming via Panama but that was an unconfirmed source. Basically the numbers of deaths and confirmed cases go up by the day. Some Clinics here are hesitating to open their doors tomorrow in PaP due to the risk of many people in one place. There are NGO meetings all over the place to explore the risks involved.

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