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'An extraordinary few days in Haiti'

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Nursing Times’ Haiti-based nurse blogger Fi Stephenson reflects on an extraordinary few days in Haiti

Having moved back to Port au Prince to start a new Haitian chapter of my career, I was asked to go back to Cap Haitien, in the north, to help get the ball rolling on a potential cholera treatment centre. Cholera is spreading its fingers across from the west coast up into the northern district of Haiti - and the number of cholera cases there is rising quickly. The official number of deaths in Haiti due to cholera has now risen to 1,000. Unofficially this number will be higher as some patients will not have been able to reach a clinic or hospital in time for treatment.

It was wonderful to visit my lovely patients and their families and catch up on their news before I got down to work on the cholera project.

So, where does one start?

The number of cholera cases has been escalating in the north over the past few days. I have been told by a volunteer doctor that patients have been presenting at her rural clinic trying to disguise their symptoms, afraid that they would not be treated but cast out by frightened locals.

There is so much fear and ignorance here. There is now also anger. Cholera has not officially been in Haiti for many, many years – the consensus is that it has not been here since before independence day, over 200 years ago. Now, it is said that the strain of cholera comes from Asia. Wherever it came from, we must deal with it quickly, professionally and productively to try and reduce the dire effects of such a virulent organism.

Our main message: prevention is better than cure. It is also important to get the message across that cholera can be treated. People are working very hard to get the message out to the local people, increase their knowledge and reduce fear.

It really is down to basic hygiene - the safe use of water, preparation of food and the use of disinfectant.

The World Health Organisation has very good written advice, in many languages, which has been a fantastic resource.

At the clinic we have posted information everywhere, given impromptu educational sessions and handed out information leaflets in Creole to the nurses and patients, asking everyone in turn to spread the knowledge to their friends and families.

The biggest danger cholera presents is loss of water from the body; our education includes advising people not to panic, but  to act quickly, drink oral rehydration salts mixed with safe water (boiled or chlorinated) and go immediately to a health centre, continuing to drink as they go. We tell people precisely where they can get rehydration salts from and how to mix the solution.

The WHO has produced substantial information on cholera and on how it can be prevented:

WHO information

During the past three decades, intensive research has contributed substantially to our understanding of the epidemiology and clinical management of cholera.

It is now known that:

  • in more than 90% of cases, cholera is mild and therefore may be difficult to distinguish from other types of acute diarrhoeal disease;
  • asymptomatic carriers of the disease are common;
  • improved treatment - in most cases by oral rehydration therapy - can reduce case fatality rates for cholera to less than 1%;
  • where cholera is present, but not epidemic, it causes fewer than 5% of all cases of acute diarrhoea;
  • vaccination, mass chemoprophylaxis, and cordon sanitaire are ineffective in preventing or controlling outbreaks;
  • care in drinking and eating habits, safe disposal of excreta and personal cleanliness are the most effective ways for individuals to reduce the risk of cholera.

Common sources of infection

  • Drinking water that has been contaminated at its source (e.g. by faecally contaminated surface water entering an incompletely sealed well) or during storage (e.g. by contact with hands soiled by faeces), and ice made from contaminated water.
  • Food contaminated during or after preparation e.g. milk, cooked rice, lentils, potatoes, beans, eggs, and chicken.
  • Seafood particularly shellfish, taken from contaminated water and eaten raw or insufficiently cooked.
  • Fruit and vegetables grown at or near ground level and fertilised with night−soil, irrigated with water containing human waste, or “freshened” with contaminated water, and then eaten raw.
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