In rural Nippes, access to medical care is crucial in the fight against cholera  

The sweet smell of sickness lingers in the air, mixed with that of moist furniture, disinfectant and human pain. Visiting a hospital in Haiti is never a pleasant experience. With a quasi non-existing public health system, clinics and health centers are gravely mal-equipped and struggle to care for their patients. Since cholera broke out in late October and quickly spread all over the country, facilities are even more overwhelmed. Many of them lack staff, supplies and space to adequately treat patients with cholera symptoms who need to be quickly rehydrated and separated from other patients to avoid infection.

Erna St. Louis is the head nurse of the medical centre in Arnaud. A large river, aptly called Grande Rivière (Great River) separates this community from the rest of the department Nippes. If the water level rises, there is no passing through. On good days, cars, donkeys and people on foot manage to cross the river with some difficulties. Here as elsewhere in rural areas, access is one of the major obstacles for people seeking treatment against cholera. CARE has provided medical supplies to the local health authority of Nippes which has called for support when the number of cases increased tremendously. The authorities then passed on the material to four communities which are particularly hard to reach, Arnaud being one of them. The cholera kit donated by CARE contains oral rehydration salts, lactate ringer solution, IV-sets, antibiotics, water disinfectant tabs and other supplies such as sterile gloves.

 “Many people do not accept that they have cholera”, explains Nurse Erna and points at a patient lying in the only examination room. “Most of them blame bad digestion, sometimes people even talk about so-called ‘zombies of diarrhea’, meaning that bad spirits have come to haunt them and give them these symptoms”, she says. The first case of cholera in the community of Arnaud was registered on November 16, a month after cholera first broke out in Haiti. In two months, the medical centre of Arnaud has documented 118 hospitalizations and 6 deaths. This death rate of 5 percent is far above the national average of 2 percent.

Jean-Robert Emil is only 43 years old, but his skinny body seems to vanish beneath the white sheets of the hospital bed. Too weak to raise his voice, he whispers while staring in the void. His sister and niece brought him here, they organized a chair and asked their neighbors to carry him for almost two hours to reach the health centre. Now he is safe, getting life-saving lactate ringer solution to hydrate his weakened body. But his mind still does not want to accept the fact that this is cholera. “We wanted to put him in the tent with the other cholera patients, but he refused”, says Erna. Her colleague Elma Féguière replaces the bottle of solution which has run out. Jean-Robert will need some more time to recover and hopefully come to terms with his state.

The tent for cholera patients sits at the rear end of a field behind the clinic, far away from the public eye. At first, the community was adamant in its refusal to allow the clinic to set up a tent - fear and disinformation about cholera are still reigning in many parts of Haiti. The muddy path leading to the tent is used by the village population, donkeys and school children. At night, the nurses have trouble finding their way without a flashlight, but the clinic’s budget does not allow for the 2,50 USD investment. Inside the tent, five patients lie on simple hospital beds, again covered with white bed sheets, and they look equally weak and exhausted as Jean-Robert. Everyone is hooked to an IV-set.

The young girl on the far left seems to have regained some of her strength. Hérlande St. Louis is 21 years old and started to feel symptoms three days earlier. The next day, she walked 45 minutes to find a motorbike to take her to the clinic. “I always treat my water”, she insists. “But one day, I washed my face with untreated water and I think some of it must have entered my mouth.” Her mother has not left her side since Hérlande has been admitted to the centre, and while she is waiting for her daughter to get better, she receives information on how to prevent cholera in her daily chores. And Hérlande will do her part: “Once I am back home, I will explain to everyone how I got infected and how important it is to wash your hands and treat your water.”

CARE teams are ramping up their efforts in remote areas across Haiti to reach as many people as possible with prevention messages and hygiene promotion. CARE has also started setting up so-called ORS distribution points in remote areas where access to medical care is difficult. The points are maintained by the community and stocked with oral rehydration salts (ORS). These allow patients with symptoms of cholera to regain fluids as quickly as possible until they can reach a health clinic. Jean-Robert and Hérlande were lucky to receive the treatment they needed to survive. For thousands of other rural Haitians, knowing how to prevent contraction remains their best bet for now while medical care remains scarce.

21. November 2010
Sabine Wilke
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