Monday, November 22, 2010

Desperate Needs

Soon after I arrived in Haiti to coordinate Direct Relief International’s cholera response efforts, I had a conversation with some doctors, nurses, and a pharmacist who had been working in country when the outbreak started. They told me that when they heard there was cholera in the country, they all felt a tinge of excitement. At first I chalked this up to some kind of strange humor that medical professionals have been known to have. I’ve worked with enough doctors and have enough paramedic friends to know that they can get strangely excited about seeing a new kind of illness or a particularly gruesome injury. So I assumed they were excited because they would now get to treat cholera patients; something they wouldn’t likely get do in the States. But when I began to question them, I found out that wasn’t the case at all.

As I have traveled throughout Haiti over the past ten months visiting hospitals and clinics, I’ve realized that resources in the country are extremely limited. Many medical facilities lack fundamental items such as latex gloves, generic antibiotics, and soap--not to mention surgical equipment, x-ray machines, and basic lab supplies.

On Tuesday I met with an aid organization called Management Sciences for Health (MSH) to discuss developing a maternal-child health program in the rural areas in Haiti. They asked Direct Relief to help raise the standard level of care in these rural clinics by donating supplies and equipment so that when there is a complication during childbirth, the mother and baby might have a chance for survival. (Currently Haiti has the highest maternal and infant mortality rates in the western hemisphere). I told them that we might not have the resources to donate high tech obstetric equipment to the 150 facilities they were talking about. However, they reminded me it’s not high tech obstetric equipment they need. In many of these clinics, there are no surgical instruments for the doctor to use to perform a cesarean section. Many don’t have birthing beds so mothers are required to lay on a piece of wood set on top of concrete blocks or tires during labor. What they were asking for was not high tech at all. To raise the standard of care in these places, all you need to do is provide an exam table, some basic instruments, a sterilizer, a bit of soap, and some gloves. These items would save lives.

After the earthquake in January, there were some very serious injuries that would have been difficult to deal with even in the most advanced medical facilities. Thousands of people needed amputations. Many were paralyzed. People were trapped under the rubble for days and required advanced care for long periods of time. Medical staff did amazing work but there were patients who had sustained such extreme injuries that they could not be saved.

But cholera is easy to treat. That’s why the medical staff was excited. They felt like they would really be able to save the lives of the people who contracted it and could easily stop the spread to other people. All that’s needed to contain the illness is access to clean water and soap. And if a person does get cholera, it can be treated in the early stages with a simple oral rehydration solution made with water, sugar, and salt. If it’s progressed to the later stages, all that’s required is a simple IV drip that a nurse can administer and possibly a few doses of a generic antibiotic—things you would find in any small clinic in the US.

Cholera is no longer a serious concern for most areas of the world. In fact, just this week officials announced that cholera has been confirmed in the Dominican Republic and in Florida—both were found in people who had traveled to Haiti. However, health officials aren’t concerned about it in these areas because when the population has access to soap and clean drinking water cholera does not become an issue.

In Haiti though, where there is not enough soap, water, IV solutions, or antibiotics to go around, there are now over 15,000 confirmed cholera cases, over 1,100 deaths, and it has spread from one department (equivalent to a county in the US) to all ten. And bio surveillance teams in Haiti say these numbers are probably 400% under reported due to the fact that the Center for Disease Control only counts cases that have been confirmed by lab tests. As I’ve mentioned, lab equipment in Haiti is largely non-existent outside of the private hospitals and those treatment centers that have sent their samples off for testing often receive inconclusive results due to problems with the sample.

Haiti has endured through years of terrible hurricanes, an HIV epidemic, and most recently of course the January 12th earthquake that’s been called the worst natural disaster in the western hemisphere. But cholera is different. Cholera should be easy. The medical staff I talked to made the same mistake I did when talking about upgrading the rural medical facilities to help save pregnant mothers. We assumed that the most basic things that we take for granted like having enough soap and water and being able to give birth on an exam table are available in Haiti. But often they are not. And they need all the help they can get.

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