Beating cholera in Haiti, one home at a time

With no new cases confirmed since February, the country is getting closer to eliminating the disease.

By Mehdi Meddeb
Haiti. A woman walks with her child.
UNICEF Haiti/2019/Meddeb
06 December 2019

LASCAHOBAS, Haiti – In its most severe form, it’s one of the swiftest acting lethal infectious diseases. If the sufferer isn’t treated properly, they can die within hours, and in places where drinking water is unprotected from faecal contamination, the disease can spread with stunning speed through entire populations. It’s not surprising that the words “cholera outbreak” spark fear.

But even as the global number of cases of cholera – a form of acute, watery diarrhoea – has remained high in recent years, dedicated response teams across Haiti have shown that patience, commitment and the right resources can overcome this fast-moving and often deadly disease.

Yolette knows only too well the devastation the disease has wrought in a country that has seen almost 10,000 people die among the more than 800,000 suspected cases reported since October 2010.

“As soon as my son experienced a watery stool we decided to take him to the hospital,” Yolette Berdovil says of baby Jean Widler. “I didn’t hesitate because many of my relatives have died from cholera.”

Most of those infected with vibrio cholerae – the name of the bacteria that causes cholera – don’t develop symptoms, and for the majority of people who do, these symptoms are mild to moderate. But for the minority who develop acute watery diarrhea, and who experience the extreme loss of fluid and electrolytes, the disease can be deadly.

Speed is of the essence

A rapid response team is dispatched to Yolette’s home after learning of the suspected cholera case, sparking curiosity among the neighbours.

Team member Jennyfer Joseph, cholera project manager at ACTED, a UNICEF NGO partner, is quick to take advantage of the opportunity to share potentially life-saving information about the disease with the crowd that has gathered around the house.

Haiti. I crowd gathers after the arrival of a cholera rapid response team.
UNICEF Haiti/2019/Meddeb
Jennyfer Joseph, cholera project leader with the NGO ACTED, shares information about the disease in Lascahobas, Haiti.

“When you have diarrhea or vomiting, the first thing you need to do is take an oral hydration solution,” Jennyfer explains, adding that this is especially true for children and the elderly, who are less resistant to cholera.

Rapid response teams distribute cholera kits containing water chlorination products, soap, and oral hydration solutions to other homes in the area too, in addition to talking about hygiene best practices.

No cases of cholera have been confirmed in Haiti since 4 February 2019

“We always follow up after a suspected case is reported,” Jennyfer explains. “During our first visit [to an area with a suspected case] we cordon off the area and decontaminate surrounding houses with chlorine products.”

A nurse from one of the response teams, which are supported by the Ministry of Public Health and Population, also distributes antibiotics after homes have been disinfected, as a preventive measure.

Anytime, anywhere

More than 17,000 cholera prevention and response interventions were conducted by 55 rapid response teams supported by UNICEF from 1 January 2018 through 15 September 2019, with more than 125,000 houses disinfected with chlorine.

 “Sometimes, it takes four to five hours to reach areas with suspected cases. We spend the night because we don’t have time to return to our home base,” Jennyfer says.

Haiti. A rapid response team walk through Lascahobas.
UNICEF Haiti/2019/Meddeb
A cholera rapid response team is deployed in Lascahobas, Haiti.

The dedication of teams like Jennyfer’s has contributed to a dramatic turnaround, with the number of suspected cases tumbling by 72 per cent in 2018, compared with a year earlier.

More importantly, no cases of cholera have been confirmed in Haiti since 4 February 2019.

But Maria Luisa Fornara, UNICEF Representative in Haiti, recognizes that there’s more to be done.

“We’ve seen a dramatic decline in the number of cases, but we must not stop” she says. “We need to continue mobilizing, strengthening community surveillance and building the capacity of laboratories.”

Although no cases have been confirmed in Haiti since February, suspected cases have been reported in more remote mountainous areas, including the Mornes, near the border with the Dominican Republic.

“Our teams are intervening every day,” Jennyfer says.

Under World Health Organization guidelines, it will take three years of no laboratory-confirmed cholera cases before the epidemic in Haiti can be fully declared as over. Jennyfer and other rapid responders have February 2022 firmly in their sights.