Combatting cholera in Haiti: home straight

His name: Vibrio cholerae. Its victims: Haiti and its inhabitants. Since October 2010, the epidemic is rife. Nearly 10,000 people died, and 820,300 people affected by cholera-like diarrhea. Today, in most parts of the country, cholera is being defeated. There are still some suspect cases of cholera in the hard-to-reach areas of the Center and Artibonite departments. But even there, the diarrheal disease is about to be eliminated. No cholera case has been confirmed since February 4, 2019.

In a breathtaking landscape, the rapid response team is moving forward. Still and always. Ready to cross on foot the Artibonite and its tributaries which were carriers of the vibrio at the peaks of the epidemic. Nine years after its outbreak, UNICEF and its partners remain mobilized to defeat the last cholera hotspots, such as that of Lascahobas. In this mountainous area - the Mornes - bordering Dominican Republic, suspected cases are often reported in the villages at altitude and therefore, remote.

“Every day, we intervene with our teams and the EMIRA,” says Jennyfer Joseph, Cholera project manager at NGO Acted, a UNICEF partner. EMIRA is the Rapid Response Mobile Teams of the Ministry of Public Health and Population (MSPP). “Sometimes, it takes 4 to 5 hours to reach suspicious areas and we spend the night there because we do not have time to return to our base.”

30-year old Joseph with 10 years already on the ground, never gives up. That day, they must go back to an isolated house where who suffered diarrhea was taken on a motorcycle to the Lascahobas Acute Diarrhea Treatment Center (CTDA). “We always follow up after a suspect case," she explains. “During the first visit, we organize a “cordon sanitaire”. In other words, we decontaminate with the chlorinated product every 15 to 20 surrounding houses located 50 meters around the house-strain.”

The house of little Jean Widler, the baby declared "suspect case", is simple, made of wood. The arrival of the rapid response team causes the influx of neighbors. A lucky chance for Jennyfer Joseph, who organized a new awareness session, decontamination and distribution of chlorinated product. “When you have diarrhea, or you are vomiting, the first thing you need to do is take oral serum,” she explains. “And especially for children and the elderly because they are less resistant.” On the spot, the crowd seems to be receptive. “From the first liquid stool of my son, we decided to make him to the hospital,” says Yolette, the mother of little Jean Widler. “I did not hesitate at all as many of my relatives died of cholera in the past."

After decontamination, the rapid response team distributes cholera kits containing water chlorine products, soap, and oral hydration serum to all houses, and informs families about preventive hygiene practices and water chlorination steps.

The EMIRA nurse distributes antibiotics as a preventive measure. From 1 January 2018 to 15 September 2019, 17,135 cholera prevention and response interventions were conducted by 55 rapid response teams supported by UNICEF, with 92% cases in less than 48 hours. A total of 126,809 houses were disinfected with chlorine and 143,685 homes received water treatment products. About 2 million people have been informed of good hygiene practices to prevent the disease.

In the beginning, cholera was an absolute taboo. Haitians, who have lived for more than a century without cholera, suddenly witnessed the onslaught of the epidemic that decimates them in no time. From October 2010 to 31 December 2018, 820,300 suspected cases and 9,792 deaths were reported by MSPP. After falling by 67% between 2016 and 2017, the number of suspected cases decreased by 72% in 2018, compared to 2017. January 1 to 8 October 2019, 636 suspect cholera cases of were recorded, a decrease of 81% compared to the same period last year. “We have a drastic decline in cases, and we are happy to say that we have had no confirmed cholera case since February 4, 2019," declares Maria Luisa Fornara, UNICEF Representative in Haiti. “That said, we must not stop. We must keep up the efforts, to continue mobilizing, strengthening community surveillance and capacity of laboratories. We must also work with communities on better water supply conditions and better hygiene and sanitation measures.”

According to WHO, three years without any laboratory-confirmed cholera case are necessary to declare the end of the epidemic in Haiti. With 3,794 suspected cases as of December 31, 2018, the medium-term plan objective of less than 0.1% annual incidence was already widely achieved. The elimination of cholera by 2022 is now possible in Haiti.