HAITI Stories about the cholera outbreak and one year on

Stories and blogs about the cholera outbreak in Haiti and recovery one year after the earthquake
By Sabine Wilke, CARE Haiti

December 27th, 2010 - A caravan of knowledge
December 27th, 2010 - A year of Guerda
December 14, 2010 - Gaining weight, gaining hope
21 November 2010 - Off the map, on high alert
21 November 2010 - A Well-timed Voice, a DJ’s Right Choice

December 27th, 2010 - A caravan of knowledge

If a writer was looking to name the protagonist of a story set in post-quake Haiti, he or she could not have chosen better. Max Charitable is part of CARE’s health team in Léogâne, a town west of Haiti’s capital Port-au-Prince that suffered major damage from the January 12 earthquake. And the 46 year-old community worker wears his last name quite well.

Today, Max’s mission is all about making noise - a strange job for a man who despite his height speaks with a soft voice and does not look like someone who enjoys the spotlight. But Max’s business is serious, and the noise planned for a reason. On this sunny day, a group of four CARE cars will cruise around Léogâne to spread the word about GBV. In the humanitarian world, this type of acronym is omnipresent and often difficult for outsiders to understand. GBV stands for Gender-Based Violence, an all too frequent occurrence in regions that have suffered from a major disaster. Ever since the earthquake, women and girls in Haiti are even more vulnerable to assaults and attacks. Many camps are pitch-black at night and instead of their neighbors, people live in crowded conditions among strangers. CARE is working with the communities to address these issues and find hands-on solutions. One of these is knowledge: Knowing that abuse is not just collateral damage but a crime, knowing where to report a case of rape, knowing how to protect one’s daughters.

Open mic in La Ferronay

Around noon, the caravan finds a shady spot at the camp La Ferronay. One of the trucks is blasting with music: Max and his team have set up a sound system on the back, the speaker boxes thoroughly attached to avoid them from falling down on the bumpy roads. A cable connects to a microphone. Quickly, a crowd gathers around the truck, many of them wearing the same blue t-shirt with Creole slogans against violence that the CARE staff has distributed.

Among the many women in the audience is 29-year-old Marie Michelle Chéry, who holds her little daughter in her lap. She listens carefully to the short presentation by the CARE team, but seems too timid to get involved in the discussion. Up front, a woman and a man are now leading a heated discussion about money, seduction and how to treat your partner with respect. The crowd cheers, and then Marie Michelle gets up, walks to the truck and takes a stand. “It is not okay to force your partner to have sex”, she says.

After her speech, Marie Michelle sits down on a creaking plastic chair with her one-year-old daughter Abigaelle. „I am most scared at night, when I walk past the gardens next to our camp. There is no light and I have heard that women have been attacked there.“ And what are her hopes for little Abigaelle? „I wish that she grows into a smart young girl who knows when to follow my advice. I want her to become a lady.“

As for her other lady, 12-year-old daughter Kimberley, Marie Michelle is very aware of the risks the young girl is already exposed to: „I am trying hard to explain to her how to protect herself. If a man talks to her on the street, she should come and see me right away. I need to know about it to be able to protect her“, explains the mother. Kimberley is standing beside the chair, listening to her mother speak. Hopefully she will know how to follow her mother’s advice, even if her father does not always agree. „Sometimes my husband does not understand my fears and then he mocks me”, tells Marie Michelle. “But other times he is understanding and supportive. Not every man will understand these issues, but these debates are still very important.“

“We need to talk”

After a long day of noise, CARE’s Max Charitable quietly reflects on the work accomplished and the road ahead. „We encourage the people to reflect about the issues and find solutions. The next step is to take action“, he says. The communities in the areas where the earthquake wreaked havoc are fragile; there is a lot of trauma underneath the surface. Much too often, violence, whether against women, children or even men, is a means of coping. “This is why we need to get the community members to talk to each other and understand the dynamics”, insists Max. “We address these issues using a multimedia approach: messages for radio stations, theatre pieces and sketches in the camps, flyers and T-shirts with slogans in Creole.” One of these slogans reads almost like a poem: „Fanm se manman lavi an pa fe vyolans sou yo“ – Women are the mothers of life and you should not use violence against them.

The CARE team also organizes roundtables with representatives of each camp, inviting five young people, five mothers, five men et cetera to talk about the issues and to come up with solutions. The results of these discussions are then put to paper and handed over to the local authorities. Mostly, the communities require simple actions such as lights in the camps at night, or whistles to make noise in case of an attack. But these measures can only be a first step. “You know, men have a very possessive mentality here, they are very macho”, explains Max. “So they think it is their right to ‘own’ a woman and treat her as they like.” There has been some progress, he says, but it is not enough. “Ultimately, women need to be empowered to emancipate themselves economically from men, otherwise they will always be dependent and susceptible to abuse.”

There is still a long way to go for this caravan in Léogâne and elsewhere in Haiti.

December 27th, 2010 - A year of Guerda

When I first met Guerda, she was seven months pregnant and living in a miserable makeshift shelter in Carrefour, one of the hardest-hit areas of the January 12 earthquake. It was February, a month after the earth had shook. Flimsy cotton sheets served as a shelter for Guerda’s family, wooden sticks held up the structure. Inside, some blankets were put on a pile of gravel to make a mattress. One of Guerda’s little boys showed me inside, he was wearing nothing more than a rag.

I still have the notes of that day: Guerda Griffon, 29 years old. Husband fisherman, already 4 kids. Hurt her back when escaping from a building that crumbled down. Scared about the birth. Message to the world: We need help.

Afterwards, I wrote a blog entry and called it „The end of questions“. It was one of these occasions where even someone whose job is communications simply runs out of words. Here she was, this young woman, barely two years older than me. But our lives could not be any more different, and this difference was outrageously unfair. There was no pre-natal bliss about Guerda’s situation, no happy expectations. Instead: Worries, fears and plain misery. But at least CARE’s health team was here to talk to expecting mothers and help out with advice and some relief goods. We handed out so-called „clean delivery kits“, containing gloves, plastic sheets, razor blades and some other items to ensure a somewhat sterile birthing environment. Guerda also received a „newborn kit“ with tiny clothes and a blanket.

Eleven months later, sitting in my office, I recognize Guerda on a photo taken during another CARE distribution. She is holding a baby in her arms. This time, the emergency was cholera and the CARE team handed out soap and hygiene items for the camp population. I was about to return to Haiti and happy to see that Guerda had made it. Haiti’s maternal mortality rates are among the worst worldwide. Out of 100,000 births, 670 women do not survive. But Guerda did, and she even made it to the hospital, which is not a given in post-quake Haiti. „After the earthquake, there was no maternal health service available. Hospitals evacuated pregnant women because they were full of heavily traumatized people and lacked space. The risk of infection was too high for women in labor”, explains Dr. Franck Geneus, CARE’s health coordinator.

During the immediate emergency response, clean delivery and newborn kits were a first measure to protect mothers’ health. But there is still a long road ahead. With millions of people still living in camps, pregnant women need to know where to turn to for a safe delivery and maternal health care. CARE is now working with traditional midwifes and local hospitals to set up a referral system for prenatal care and birth services. But with many institutions destroyed and staff lost, this is no easy task.

When I meet Guerda again in Carrefour, she seems to have aged even more in these last months. Luckily, the birth went well, considering the circumstances: “I delivered in a hospital. First, I was able to take a tap-tap, a public transport, because the driver did not make me pay for this. Then, at the hospital, there were complications and an ambulance took me to another hospital. I spent four days there.”

Guerda’s husband is doing better, he can go fishing again. And their shelter is now made up of plastic sheets that offer a little more protection from the rain. There is a real mattress and a table. But now, cholera is a major scare and the whole family is trying hard to respect the hygiene rules. CARE has set up latrines and hand-washing stations in this camp and initiated a waste-removal program. I am glad to see these improvements. And at the end of the visit, I also see something else: Guerda’s first smile. She proudly presents the latest addition to her family, her son Josué Lalané. He is not very interested in the situation and keeps sleeping in his mother’s arms. May he soon wake up to find a home that is worthy of its name in a country on the firm road to recovery.

December 14, 2010 - Gaining weight, gaining hope

Situated just west of Port-au-Prince, Carrefour has suffered severe damage when the earthquake struck on January 12, 2010. Life has never been easy for the people living here, but since the disaster, things have become almost unbearable.

In just 35 seconds, the earthquake transformed 90 percent of Carrefour into a heap of ruins. Astek was one of the hardest-hit areas. Nestled in the hills overlooking the Bay of Port-au-Prince, this community offers amazing panoramic views. It’s the type of setting where one would expect to see villas and mansions. Instead, tiny concrete houses and huts are scattered across the hillside, separated by patches of cleared land and piles of debris. Narrow, rubble-strewn roads lead uphill. Our CARE vehicle is panting and scrambling over the stony ground, each bump telling the story of how difficult it is to get people and goods to this neighborhood.

63-year old Gellia Voltaire sits on a mattress in her newly built shelter in Astek. She is wearing a doctor’s coat she bought at a local market. It still bears the name of a Miami hospital and the employee who once wore it.

Gellia’s tiny frame looks almost lost in the spotless white garment. “I used to be quite chubby”, she says with a grin. “But ever since the earthquake, I just grew skinnier and skinnier. Life was very hard.“ “But now I have a house and I am gaining weight again“, she laughs and rubs her belly.

So what exactly helped Gellia put on the much needed pounds?

“I subscribed to CARE’s list of people in need for a shelter”, she explains. “My house was completely destroyed. All I had left was one mattress.” CARE prioritizes the most vulnerable: widows, chronically ill, female-headed households. When Gellia was selected to receive a shelter, she needed to organize five volunteers to help her set it up. CARE provides the materials and two trained carpenters to support the construction. “The carpenters did not ask for anything, they just came and helped me.” Gellia still seems amazed that this service was offered free of charge. She insists: “They did not even ask for a glass of water!”

Speaking of water, Gellia did not simply sit around and watch the others work for her. While CARE provided the cement, she had to find water, sand and grit to mix it up. “I did not have money, so I just went around the neighborhood and asked for support.” This sense of community is strong in Carrefour and elsewhere in Haiti. And CARE makes sure to engage the people who receive a shelter in every step of the process. They are informed about its design and purpose, they have to provide some material and also get suggestions on how to extend it. This helps people embrace their new home and feel responsible for its maintenance.

Morning sadness under a new roof

A few blocks up the sandy road from Gellia, Masseleine Dorwilus sits in front of her house and soaks up the last sunbeams of the day. She holds her youngest son in her lap. Baby boy Dave Raphal was born just after the earthquake and spent the first months of his life on the street between rubble and dust. “Before the earthquake, we lived in a blockhouse with two rooms. We even had a tin roof”, the 34 year-old mother explains. But like millions of other Haitians, Masseleine’s life was cruelly interrupted that January afternoon. “It was a terrible day. Our house collapsed, muggers took our belongings. But no one died.”

Masseleine has four more children, aged 12 to 4. She used to sell vegetables, but now she can hardly afford to buy anything. And there is no money to send the children to school anymore. “In the mornings, they see the other kids leaving for class. It makes them cry. I try to keep them distracted, but it’s hard.”

Another daily struggle is water. Masseleine has to walk for an hour to get to the nearest water point, and she can hardly carry enough for the whole family, even if the older children help out. So she goes there three times a day. Ever since the first cases of cholera were reported in Carrefour, it is even more important to maintain a minimum level of hygiene.

Setting up transitional shelters is no easy task. Land has to be cleared, material procured, and land ownership defined. It’s also difficult for families to move back to neighborhoods where everything has been destroyed. Many people are reluctant to leave the camps, even if they are offered a transitional shelter. But most neighborhoods lacked water wells and latrines. After the first round of shelters had been built, CARE will look into ways to set up latrines and water facilities in Astek.

Even faced with so many daily hardships, the transitional shelter still lifts a major burden off Masseleine’s shoulders. “It only took two days to construct it. And I am very happy. Before, we were living on the street.” The shelter’s surface measures 18 square meters and Masseleine and her husband have added some features. They set up a covered front porch with the help of plastic tarps and put up a lace curtain to make it more inviting. Inside, everything is neatly organized. With seven people in one room, everyone needs a lot of discipline.

Haitians have a distinct way of answering to the cordial question of “how are you”. They say “pas pi mal”, which literally means “not bad”. This is a means of neither bragging nor complaining, in case things are going really great or very bad. For Gellia and Masseleine, life is “pas pi mal” right now. These two women come from two different generations. But they share one chapter of their life story. It starts with the end of their world in January, and leads to a wooden frame, plastic tarps and a tin roof by autumn. The next pages will have to be written carefully to lead to a happy ending.

21 November 2010 - Off the map, on high alert

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.

Photo: Sabine WilkeJean-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 - A Well-timed Voice, a DJ’s Right Choice

Sometimes in life, two people’s paths cross in the most unexpected way. And sometimes, these encounters can even save a life.

Gonaives, a small coastal town in Northern Haiti, has been one of the most affected areas of the ongoing cholera crisis. Blondine has been working 24/7 ever since the epidemic started. She is a nurse for CARE’s health programme and is responsible for an HIV/AIDS support network. But now her days are filled with cholera. CARE sends out prevention messages through radio stations and local volunteers, delivers medical items to hospitals and coordinates with the other aid organisations involved in the response. Last week, Blondine and her team have trained 80 more volunteers to inform their communities about how to best protect themselves against the microscopic but lethal bacterium.

Meanwhile, the health centres in and around Gonaives are overflowing with cholera cases and most of them do not take other cases anymore. This is why it is so crucial to establish so called CTCs – cholera treatment centers, which can be set up next to a hospital but ensure that the cholera cases are isolated from the other patients. This is already underway in the Centre de Diagnostique Integré de Raboteau, a hospital in Gonaives. CARE will organize the disinfection of the main building once all the cholera patients have been moved. Blondine is here to check on the progress and talk to the nurses and doctors. Depending on the needs, CARE will also provide IV-Sets, lactate ringer solution and liquid antibiotics to the health centre.

Maxime Eliano is only 22 years old, but at the moment he looks like an old man. His skinny body is cramped on an old makeshift hospital bed in the hallway of the building. His eyes are hollow and his body weakened by the dehydration. Turns out, Maxime is a disc jockey for a local radio station. And for the town festival “Fête de la Patrimoine de Gonaives” at the beginning of November, he was on a special mission. The CARE team led by Blondine had put in extra hours to prepare a CD with cholera prevention messages and gave it to several DJs in town. During the celebrations, these messages would be spread via intercom from music trucks to reach as many people as possible. There was no time to hire a professional speaker to record the messages, so Blondine grabbed the microphone herself.

And this is where their paths crossed. Maxime was one of the DJs putting CARE’s prevention record on spin during the festival. And when he himself developed symptoms of cholera about two weeks later, he knew exactly what was going on: Abdominal pains, diarrhoea, vomiting – the DJ did not have to think twice and made the right choice. He went straight to the hospital and got life-saving treatment. He might still look very weak, but his chances for full recovery are very good. And now here is Blondine standing beside his bed. The woman whose voice might just have saved this DJ’s life…