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Dernières nouvelles du
choléra, (2 nov) sans compter le cyclone Thomas qui arrive
vendredi. 5nov).. Source d'information : Journal Haïti
Liberté P. Jean-Yves Urfié Paroisse Saint
Paul de Furcy 509-37-98-39-69 (Haïti)
Cholera
Catastrophe Spreads in Haiti
By
Kim Ives
"They are doing exactly the wrong
thing," said Dr. Manolo Castro. "When you bring
cholera victims into a hospital, especially one with poor
conditions, you stand a good chance of infecting all the
patients in that hospital."
Dr. Castro, 74, is a
Cuban doctor working at Haiti's finest pediatric hospital, St.
Damien, in Tabarre. When it comes to cholera, where a
virulent bacterium provokes severe vomiting and diarrhea which
can kill in a few hours, he knows what he is talking about. He
has tangled with the deadly disease before.
In 1990, a
cholera epidemic struck the Zambian town where Dr. Castro was
a teacher at a hospital as part of a Cuban medical mission.
Soon there were some 6,000 cholera victims. The hospital's
Zambian director packed up his family and fled. The Cuban
Embassy and Zambian government asked Dr. Castro to step in to
help the panicked population. Dr. Castro went to the
Public Health Ministry's office in town and with them
identified a local stadium where they could quarantine
hundreds of cholera patients. Within a few weeks, Dr. Castro's
team of six Cuban and six Zambian doctors had brought the
outbreak under control.
"It is essential to isolate
cholera victims from other patients, especially where there is
poor sanitation," said Dr. Castro, who helped squelch
another cholera outbreak when stationed in the Cape Verde
islands in 1994. "The government should also stop all
traffic and travel between the affected area and those not
affected. Otherwise, the disease is going to spread."
The
day after Dr. Castro spoke those prophetic words, it was
announced that Haiti's cholera epidemic had propagated from
the Central Plateau and Artibonite departments (where it
emerged) to Port-au-Prince, the capital through which
thousands of people from all corners of the country
circulate every day.
But far from taking aggressive and
proactive measures like stopping traffic, Haitian Public
Health authorities have been trying to minimize the
crisis, claiming, as the Health Ministry's general director
Gabriel Thimoté did Oct. 25, that the disease's
progress has been "stabilized."
At press time on
Oct. 26, the only official government figures are that 3,769
people have become sick with the disease in the Artibonite and
Central departments, with 273 fatalities in the Artibonite.
Since other areas are not being tallied, the actual figures
are much higher.
For instance, Dr. Ernst Robert Jasmin,
the Health Ministry's Northern Department director, says that
there are 17 probable cases in Pilate, Plaisance and Limbé,
with three fatalities. Other authorities report seven cases in
the southern town of Petit Goave and several other cases and
deaths in the town of Arcahaie.
But there is also
growing dissension between authorities. Nigel Fisher,
the Canadian assistant head of the UN Stabilization Mission in
Haiti (MINUSTAH), on Oct. 25 put the death count at 284 and
said that there were five confirmed cases of cholera in the
capital (as did the Pan American Health Organization or PAHO).
The Haitian government disputes this, saying only one of the
five cases tested positive.
"It is an extremely
serious situation and on the basis of the experience we have
had with other epidemics in the world, it would be irresponsible
not to plan for a much larger epidemic," Fisher said.
Ironically, he dismissed the idea of cutting off traffic out
of affected areas as impractical.
Dominican health
authorities have not been so sanguine. They closed the
130 mile-long border with Haiti on Oct. 25 to everybody except
students and Dominican visa-holders, who have to wash their
hands and be checked by health workers at border crossings. On
Oct. 25, MINUSTAH troops fired teargas to disperse a crowd of
Haitians trying to cross over from Ouanaminthe into the
northwestern Dominican town of Dajabon, reports "Dominican
Today."
Meanwhile, Haiti's cholera "will not go
away for several years," said Dr. Jon Andrus, PAHO's
deputy director, at a Washington press conference on Oct. 25.
"We know that the bacterium is going to spread very rapidly
and... we will see a rapid upswing on the epidemic curve of
the number of cases reported in these early weeks and
months."
"The official numbers almost surely
under-represent the true number of cases largely because, in
general, approximately 75% of the cases have no symptoms, they
are asymptomatic, yet they can carry the bacterium and transmit
it to others," Andrus said. "And these same
asymptomatic cases may carry the bacterium for up to two weeks
and shed that bacterium back into the environment."
The
epidemic is really expected to explode when it reaches the 1.5
million people living in some 1500 tent cities sprinkled from
the capital to Léogane. Just like the sprawling slums
of Cité Soleil and Carrefour, the tent camps lack
sanitation and are regularly flooded by torrential rain storms.
Water used for cooking and washing often contains sewage,
cholera's principal vector.
Doctors and medicine have
been pouring in from Haiti's neighbors. Cuban Ambassador to
Haiti Ricardo Garcia Napoles has traveled to Mirebalais, St. Marc
and other towns to help organize the response of Cuba's hundreds
of in-country doctors to the crisis. The South American
alliance UNASUR is dispatching a planeload of medicine and
equipment to fight the epidemic on Oct. 27, with medical teams
to follow soon. Brazil said it was making an additional grant
of $2 million for medicine.
Despite the incoming aid, Dr.
Castro is very concerned that Haiti lacks enough doctors to
respond to this nightmare scenario. "There is a
cholera stool sample kit, which gives immediate reliable
results, but many Haitian doctors are not trained in how to
use it," he said. For the past 13 years, Dr. Castro has
worked at different hospitals in Haiti and taught at the Aristide
Foundation's medical school until it was militarily closed
and occupied by U.S. soldiers immediately following the 2004
coup d'état against and kidnapping of President
Jean-Bertrand Aristide. When closed, the school was producing
about 125 Haitian doctors per year, twice the number of the state
university.
"If you multiply 125 doctors per year,
and it could have been more, by the last six years, you will
see that the 2004 coup d'état has deprived Haiti of close
to 800 doctors," noted Hilaire Toussaint, who runs the
Aristide Foundation. He is now looking for funding to reopen
the medical school next year.
The last cholera epidemic
in the hemisphere was in Peru in 1991, which had about 500
cases over the course of two years, with a fatality rate of
less than 1%.
In 2008, "56 countries reported
190,130 cases [of cholera], 5,143 of them fatal," Dr.
William Pape, Haiti's leading doctor in the fight against the HIV
virus, told Le Nouvelliste. "But many cases were not
recorded due to the limitations of the surveillance systems
and the fear of sanctions limiting travel and commercial
exchange. It is estimated that the disease's true figure is
about 3-5 million cases with 100,000-120,000 deaths per
year."
"It is going to be a long battle,"
Dr. Pape said. "I fear for the slums of Port-au-Prince."
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