The Map of Haiti and others countries in the Caribbean
Haiti
Acknowledgement
This Cholera Proposal would not be having been possible without the support of “the Hinckley Institute at the University of Utah who gives me opportunity to serve the world and to see the good in the world. I am grateful to those who provided guidance and support during my internship at Medical Care Development International from ministry of health in Haiti (MSPP) I’m thankful my best Dr. Benavente Louis for his valuable contributions to this proposal. I’m thankful to Dr. Pablo Paolo and for Dr Jeff Wendell their leadership support of my research for this assignment and to Dr Jean-Louis Pierre Paul for helping me find cholera surveillance data in Haiti. From CDC of Washington DC I am thankful for the guidance and support I received from my instructor James Curry. I’m thankful for Gina Shipley who is always seeing the better side of angel from everyone and for choosing me to be intern in Washington DC this fall also by representing Hinckley instate of Politic. From USID (the United States Agency for International Development is the United States) in Washington DC I’am thankful to Dr Robinson Richard for his guidance and suggestions as the idea for this project research was being formed. I am grateful to all of the individuals who were interviewed in our office in DC and in Haiti this study for taking time out of their busy schedules to share their insights on cholera in Port au prince Haiti. From the university of Utah (U of U) I am thankful to the Hinckley institute faculty, my classmates, and my fellow Hinckley Interns in Washington DC. I would not have been so fun at Park place apartment and successful without the support that I receive from them.
Budget for the Project
This amount of money is for four years’ budget.
Contact Details of Foundation Member:
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Abbreviations and Acronyms
ACF : Action contre la Faim
AWD: Acute Watery Diarrhoea
CP: Care Practices
CDC: Center for Disease Control
DRR Disaster risk reduction
FRC Free residual chlorine
CC Community committees
CFR Case fatality rate
CTC Cholera treatment centre
FDA: US Food and Drug Administration
MSF: Medicines Sans Frontiers
Wash: Water, Sanitation and Hygiene
WHO: World Health Organisation
MoH: Ministry of Health
FAE: Economic and Social Assistance Funds (Fonds d’Assistance Economique et Sociale)
IDA: International Development Association
IDB: Inter-American Development Bank
LNSP: National Laboratory of Public Health (Laboratoire National de Santé Publique)
M&E: Monitoring and Evaluation
MSPP : Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population)
NGOs: Non-Governmental Organizations
ORS:Oral Rehydration Salt
PAHO: Pan-American Health Organization
PDO: Project Development Objectives
PRUC
PHE Public health engineer
PHP Public health promoters
Cholera Emergency Réponse Project (Project de Réponse D’Urgence Au Choléra)
TEPAC: Technicians on water and sanitation
UNICEF: United Nations Children's Fund
WHO: World Health Organization
SSS Salt-sugar solution
SWM Solid waste management
WASH Water, sanitation, and hygiene
Policy Proposal
Office:
Issue: How to eliminate cholera in Haiti
Introduction
Haiti is an island located in Hispaniola at the western part as they share the island with the Dominican Republic. It is also the largest country in the Caribbean right behind Cuba and the Dominican Republic. It is situated between Puerto Rico and Cuba and also on the south of Caicos and Turks.
Haiti has been pushed to the bottom of World Bank rankings in terms of health because of various factors. These factors include: poor sanitation systems, insufficient health services and poor nutrition. Another pertinent has the lack of access to health care services because of constraints such as poverty. According to World Bank, about 80% of the population in Haiti lives below the poverty line. Also in terms of healthcare spending, it comes last amongst the western hemisphere rankings.
The cholera outbreak in Haiti is so far, the worst cholera epidemic in recent history. After the 2010 earthquake, in a little over two years about 7000 lives were lost and this number rose further in August 2015 as about 9000 were lost again with infections grossing about 700, 000.
Artibonite River was the main suspect source for the whole epidemic since it is where most of the affected people came from. As such the water, they drunk from the river was suspected to have been the cause. Also, suspicions were abounding among the Haitians on some United Nations peace keeping military base that was stationed at one of the tributaries of the river (Jonathan, 2010). This was however refuted by the officials as they insisted the camp followed strict sanitation procedures. However, in the year 2016 a report from the United Nations special reporter Aston Philip indicated that the UN had accepted responsibility for the initial outbreak (Jonathan, 2016). This thus necessitated a new set of action by the United Nations that was geared towards solving the problem.
Background
In the 19th and the 20th century, there has been about six cholera outbreaks and the one in Haiti was termed as the seventh. It was caused by a new strain of Vibrio Cholera known as El Tor. Outbreaks caused by this strain started in the year 1961 and the outbreak in Haiti was the first recorded of the bacterium (Chin et al, 2011).
In October 2010, HNPHL went on to confirm diarrheal illness cases that had been widely reported in many hospitals in the Artibonite area were actually caused by cholera. This was the first time there had ever been a cholera outbreak in Haiti and so there was widespread panic and this further led to complications when it came to relief efforts. Poor distribution of health services was also another factor to blame for the spread of the virus. This was all due to logistical problems (“Epidemiological Update: Cholera”, 2014).
As opposed to rumors that the spread was caused by lack of access to clean drinking water, it was actually discovered that the main reason behind the outbreak was improper treatment sewage. Haiti was an example of how untreated sewage could actually be the cause as the main suspect turned to be raw sewage from the United Nations camp. The camp was comprised of United Nations peacekeepers from Nepal who were under the MINUSTAH. Despite the numerous efforts by the officials to deny the responsibility of the camp in causing the epidemic, neighbors to the camp actually confirmed that waste was indeed being spilled into the river. Furthermore, samples from the military police confirmed these allegations.
The graveness of the issue was to the point that there were suggestions that the elections should be cancelled. This was however turned down by the MINUSTAH head as he stressed that this would lead to a vacuum in the political scene and it would bring about problems. The outbreak moved from being just but a simple emergency and it was classified as a matter that was deemed to be a threat to national security. As such, presidential candidates had to address the issue in their manifestos as it was getting out of hand.
Statistics
Ever since the first outbreak there has been about 754,735 cases that have been reported in Haiti and they have further spread to other countries such as Cuba and Mexico where infections have been recorded as 678 and 190 respectively. In Haiti about 434,029 have been hospitalized because of the illness. In terms of deaths, Haiti has also been the main contributor with deaths in Haiti totaling over 9,200 out of the 9,700 deaths reported in all countries (Moni, 2010).
Since it was first reported in the year 2010, about six percent of the total Haitian population has contracted the disease (Robert, 2013). There was a slight decrease in the cases of those affected in the year 2014 but in the middle of the following year, the number of cases shot up because of the rains. This pushed the death toll from the initial 7000 to about 9000. In just a year after it first hit, the disease claimed over four thousand and five hundred lives (CDC, 2011). The event took place because the country got effected in a high speed and the full country got effected by the disease. There didn’t had enough resources to prevent it at initial stage and it wasn’t possible to provide proper medical care on time due to lack of resources.
Initial reactions to the epidemic
At around November of 2010 the United Nations went forward to issue an appeal to fight the disease spreading. They wanted to raise about one hundred and sixty million US dollars for the cause. It said that all its efforts were at risk of being jeopardized by the disaster and the issue of lack of space in hospitals for the afflicted patients ("UN probes base as source of Haiti cholera outbreak", 2010). One year later the United Nations received about 5000 petitions from victims who had been affected by the disaster where they were asking for millions of dollars in compensation for what they assumed had been caused by United Nations members.
In response, the UN went ahead to invoke the immunity it had where it would not be issued with any lawsuits. In 2013 a law firm by the name KKWT sued the United Nations but the case was dismissed. An appeal has however been filed by the same firm (Pilkington, 2013).
Possible reasons as to why Haiti has failed to curd cholera outbreaks
There are a few reasons as to why a solution was not found earlier in regard to the cholera crisis that afflicts Haiti even as of today. These hindrances may have a lot to do with the relevant authorities taking the wrong approach to solve the whole issue or lack thereof of an authority with the capacity to handle such issues. This authority would be mandated with the responsibility of coordinating any relevant efforts of stopping the occurrence and spread of the disease. It would also be required to come up with viable solutions that would be used to combat cholera in the poverty-stricken nation.
For one, Haiti’s efforts towards combating the cholera menace have been more of reactive where the country only starts making efforts once disaster has stricken and is hitting fever pitch. As such not only are these efforts myopic and short term but in most cases they end up failing as it is hard to control the spread of the disease. Also there are usually high numbers of casualties because of the fact that there are not enough health facilities to handle all the patients. What is worse is that is are minimal efforts by the Haitian government in terms of increasing the number of hospitals.
Poor sanitation is also another pertinent issue and also the main reason as to why cholera spreads so easily in the island. Not only are the locals poorly educated on hygiene issues but also the available sanitation facilities are in poor state. They range from poor drainage systems, poor piping systems and also lack of proper sewage treatment facilities. This has led to the waste mixing with the drinking water from the rivers. Most of the population happens to depend on water from the rivers as they do not have access to piped water. This is largely attributable to the fact that more than eighty percent of the population in Haiti is currently living far below the poverty line. As such they cannot afford piped water and other sanitation amenities. As well as, almost half of the people in rural areas have access to water and majority of people in Haiti depends on unsafe sources of water (WorldBank, 2015).
With poverty comes illiteracy and as such, the majority of the locals do not have the relevant knowhow on how to handle some of the basic sanitation needs that are a prerequisite for the prevention of cholera. As such, they suffer because of their ignorance. This is mainly because they tend to overlook some of the red flags that act as warning signs that there is an outbreak. This includes signs such as symptoms of cholera as well as disease patterns. Also the government does very little in offering the basic civic education when it comes to ways on how the country’s population can be able to deal with the disease. Not only are the people left vulnerable to attacks but they are also left without knowledge on what to do in case they are infected by the bacterium.
Shortage of funding to undertake all these activities could have also possibly been another reason. The country is one of the poorest in the world and maybe this had a lot to contribute when it came to the shorthanded and ineffective methods that the country was taking. The national budget was not sufficient to support large scale projects aimed towards curbing the menace. Also international donor funding was probably insufficient or as well nonexistent. For the country to find a long term solution, it had to have a good capital base to support its drives.
Thesis statement
The purpose is to eliminate the cholera epidemic in the Haiti.
The proper disposal of waste and properly treat of raw sewage by improving the system.
Proposal
After the onslaught of the epidemic, the need for better health policies, that will aid to curb the current health issues, has arisen. The main problem as to why the incidence turned out to a disaster was the lack of contingency measures and preparedness to handle crises. As such, whenever there is an adverse occurrence, there is no way for them to control the situation. The health sector is in poor condition and thus there is the need for reforms in the form of expansion of facilities and setting up of contingencies. All these processes require resources and the resources are in the form of financial funding. This funding has to either come from the government, the general public or the international community.
The best way for this to take place is the development of a policy that facilitates for a larger share of the country’s resources to be redistributed to cater for health and disasters. The finances will be equitably allocated to cater for the building of more hospitals and also emergency response centers to cater for emergencies. The hospitals will also serve the purpose of research facilities in regard to finding solutions for the epidemics. They will be tasked with finding preventive measures to try and avert adverse occurrences and also advancing warnings concerning impending disasters. This will be more of a general effort as it will also aid in the control of all other diseases as well.
The finances will be raised by increasing government allocations through increasing tax margins on all non-basic products. This will ensure that the cost of living doesn’t sky rocket in the already poverty stricken nation. Also there will be funds drives both on the national as well as the international levels to donate towards the disaster prevention and control efforts. The funds drives will be delegated to a special body whose only mandate will be drumming enough support towards the country’s disaster preparedness efforts. On the local scene raffle tickets, will be sold where there will be prizes for the winners. On the international sphere, the nation’s representatives will be given the responsibility of convincing the international community to support the country’s initiatives of striving to avert the spread of cholera as well as well as the occurrence of other natural disasters that further aggravate the severity of cholera. With these measures in place, the country would be in a very good position to fight the cholera menace and find a lasting solution as with funding it can practically achieve anything.
Specific attention will be paid to cholera and means to completely alleviate it in the country will be considered. Disease control and prevention centers will be opened in the various major hospitals in the country. The main purpose will be to come with a lasting solution to the cholera pandemic. This will be through finding a cure or a vaccine for the bacterium. This would serve to help the already ailing as well as helping prevent more infections. These findings would also be used to aid other countries that have been affected by the same in combating cholera.
However, the best way to deal with the problem would be to deal with the root because of it. In this case, it is improper sanitation and also poor methods of treating sewage. As such the sewage gets into the water supply and this causes widespread cases of cholera. Keeping in mind that most of the population is living below the poverty line; it means that very few have access to piped water. The majority depends on water from streams and maybe busted pipes that act as a time bomb which is always waiting to blow up. The public works sector therefore will be become another sector that will be on the spotlight to effect changes that will help in the eradication of cholera in the country. The sector will also have to liaise with the health sector so as to find a suitable way to build waste disposal infrastructure as well as proper piping systems for clean water to be availed to all the citizens of the country.
The partnering of the two sectors will require an oversight body to oversee all the activities that take place and also ensure that no body oversteps its mandate. Also it will responsible for defining the responsibilities of the two sectors and it will also gauge the effectiveness of the measures that are being put into implementation. This will therefore act as a benchmark and a point to denote the amount of progress by the efforts between the two sectors. This body will be required to provide a monthly report about the state of affairs to the public. The operations of this body will also be temporary and it will serve up to the point where cholera stops posing as a direct threat to the nations well-being. It will then be merged with the health sector where it will act as the point of connection to the public works sector in case there is need for collaboration between the health sector and any other sector.
It will however have to be clearly stated that all emergency response units, research centers and hospitals will be under the health sector and the oversight body will only be able to have access to them through the health sector. This will allow for clear separation of powers and jurisdiction and also control of the centers by qualified and well informed individuals in regard to the activities that take place there. The body will also not be granted any powers to dictate policies and activities for the sectors. The body will instead suggest possibly viable options that the two sectors can exploit and once they are in agreement, the body will guide the processes up to the point of completion and it will review all the activities and propose changes where they are deemed necessary. Therefore, the policy suggestion is that there is need for control and prevention units that will aid in the aversion of cholera another disaster through quick response services, proper sanitation services, mass education and also research. All these methods will be geared towards total eradication of cholera as well as other possible natural disasters that might rock the country. As such, the move will be wholesome as it will not only serve to address issues to do with cholera but also other natural disasters. This effort will be a joint move between the public works sector and the health sector. They will also have an oversight body guiding their activities.
Conclusion
The cholera epidemic has been hitting Haiti year in year out without the country finding a permanent solution to curb its influx. As such more people have been dying every year. The reason behind this is the fact that instead of the country focusing on proactive solutions, it waits for disaster to strike and then a string of reactive processes takes place. The scale of cholera outbreaks and spread at times overwhelms these efforts and this brings about unwanted results. Even when effective, they only serve to slow down and impede its spread and magnitude. The best way to deal with this issue is the introduction of solutions that will serve to stop the outbreak first of all or at least minimize it. From then on, measures to respond to its occurrence and treatment of the same would then be suggested. In this case, the best way to handle and curtail its outbreak would be through the improvement of sanitation facilities ("UN probes base as source of Haiti cholera outbreak", 2010). This would be through proper sewage disposal as well as treatment so that raw sewage would not contaminate clean drinking water for the masses. Also mass education on how prevent oneself from cholera outbreaks would be vital as it would assist people to avoid unhygienic activities and practices.
For all these activities to actually be successful there would also need to be a body that would act as an oversight committee to make sure that all the efforts between the two collaborating sectors are viable. It would also play and advisory as well as a regulatory role in the affairs of the two sectors. Passing of information to the public in respect to the activities of alleviating cholera in Haiti would also be the duty of the body. All these activities combined would be more than beneficial in not only combating the cholera menace as well as the frequent occurrence of natural disasters in the region. It would also be responsible for the improvement of amenities on the country. This is mainly because of the fact that there would be the construction of proper drainage systems, better sewage treatment facilities and also piped water for almost all of the country’s population. As such, this simple drive has multiple benefits that scope far beyond the intended purpose and the gains are also long term.
References
Jonathan M. K. (2016). "U.N. Admits Role in Cholera Epidemic in Haiti". New York Times.
Epidemiological Update: Cholera". (2014) Pan American Health Organization/World Health Organization. November 6, 2014.
Government of Haiti, health ministry http://www.mspp.gouv.ht/site/downloads/Rapport%20%20Web%2012.08_Avec_Courbes_Departementales.pdf
Robert R. (2013). "Cholera has struck more than 6% of Haitians". CIDRAP.
Moni B. (2010). "Cholera death toll in Haiti rises to more than 3,000". CNN. Retrieved 7th January 2017.
CDC,. (2011). Cholera in Haiti: One Year Later| Cholera in Haiti | Cholera | CDC. Cdc.gov. Retrieved 13 January 2017, from https://www.cdc.gov/cholera/haiti/haiti-one-year-later.html
"UN probes base as source of Haiti cholera outbreak". (2010). Retrieved 11 March 2013.
Jonathan M. K (2010). "Experts ask: Did U.N. troops infect Haiti? Associated press.
Chin, C. S.; Sorenson, J.; Harris, J. B.; Robins, W. P.; Charles, R. C.; Jean-Charles, R. R.; Bullard, J.; Webster, D. R.; Kasarskis, A.; Peluso, P.; Paxinos, E. E.; Yamaichi, Y.; Calderwood, S. B.; Mekalanos, J. J.; Schadt, E. E.; Waldor, M. K. (2011). "The Origin of the Haitian Cholera Outbreak Strain". New England Journal of Medicine. 364 (1): 33–42
Pilkington, E. (2013). "UN will not compensate Haiti cholera victims, Ban Ki-moon tells president". The Guardian. Retrieved 22 February 2013.
WorldBank,. (2015). 5 Things You Need to Know About Water in Haiti. World Bank. Retrieved 13 January 2017, from http://www.worldbank.org/en/news/feature/2015/05/27/five-things-you-need-to-know-about-water-in-haiti
