Cholera in the North

Evelyne, me, Solencia, and Mme Grimard (some of my colleagues)

From a note I wrote to my coordinator on Wednesday, November 17 :

Last night I went to the Cap Haitien gymnasium where I was given a tour of the cholera treatment center by the director for Doctors without Borders (MSF) for northern Haiti. MSF has been here for a week and are now seeing only a quarter of the deaths in Cap Haitien compared to the previous week. So much of this has to do with the importance of understanding how easily treatable this disease is, if only patients are hydrated quickly! The MSF director told me that the hospital wasn’t quite where they would like it yet, but they were pleased with the improvements. From my perspective it is so much better than the nightmare I lived through in Hinche.

As soon as the roadblocks clear they will be bringing tents to set up outside the gym to enable them to expand to over 400 cholera beds. They are now coordinating all cholera treatment in Cap Haitien, although they do work with the health ministry. They have also been working in Limbe, the other area where we would like to send volunteers. They only knew about the two hospitals there, not the 60-bed (and rising) center at Seminaire Limbe, five km from Limbe. That is where Dr. Steve has been working tirelessly and with few staff. MSF plans to return to Limbe (again, as soon as the roadblocks clear). They are coming back to the hotel now so I’m going to see how soon they think they can get through. Dr. Steve only has enough IV fluid for the next 24 hours.

Since we don’t usually work with short-term medical volunteers, I’m glad that MSF has accepted to take them under their wing here on the ground – we will just need to coordinate flights, airport pickups, meals, and housing, which will be part of my job the next few weeks.
MSF has also offered to train our community health workers on “bucket chlorine.” This means that a person will be stationed at each community water source (if there are too many some will be closed). The worker will have a concentrated chlorine solution and will put a specified amount in each bucket of water collected. In other countries this has reduced the cholera outbreaks to two or three days. However, due to the already widespread nature of Haiti’s epidemic (now in every region of the country) we will likely need people to do this work for a month or two.

Brief return to Port-au-Prince

Cholera Treatment Center tents in Hinche

Saturday, November 13:
I arrived in Port-au-Prince yesterday after spending the last seven days and nights working in Hinche with patients who had cholera. This morning the J/P HRO group loaned me a computer so I have been able to catch up on some of your responses. Thank you so much for your prayers and notes of encouragement!

It can be so challenging be aware of God's presence when one is physically, emotionally, and mentally exhausted. I thank God for your prayers, and praise God that in the last few days I was really able to gain a better perspective in the midst of the horror. Too tired to focus in prayer, I listened to a song with the following lyrics, "I will lift my eyes to the maker of the mountains I can't climb...'cause you are and you were and you will be forever...you fashioned the earth and you hold it together." How true! God is always moving everywhere to bring life and healing and hope.

Thank you for your prayers for Odlin. He was not on his cot when I arrived to the tent hospital the following day, and everyone assumed that he was dead. What joy to find out the next day that he had been transferred to the neighboring "real" hospital and that they were treating him for typhoid fever. We had already been giving him the antibiotics that treat that terrible disease. I was able to visit him yesterday and he looked somewhat better, although he is very weak and still has diarrhea. There was no family by his side, although I heard that his mother had been around some days earlier. Please continue your prayers that he would not be alone, that he would be assured of God's presence and that he would be completely healed.

Before leaving tonight for my "home" in Cap Haitien I will be visiting the site where we will be holding a Community Health Evangelism (CHE) training in December here in Port-au-Prince and working out logistics.. My computer is still not working due to viruses, but my brother-in-law has sent several CDs and SD cards of material to help it to work again and then to de-bug it and our office computers. Until I get his package and, Lord willing, am able to resurrect my
computer, I may not have much access to the internet.

I will be in Limbe all next week, a town 20 km (one hour and a half) from Cap Haitien. Our team will be training people to be trainers in new villages using the holistic CHE tools. Our volunteer trainers continue to go to village after village teaching cholera prevention. Cholera is spreading quickly in Limbe and in Cap Haitien and many other places in northern Haiti. There are not enough supplies or medical personnel. We have one more shipment of supplies arriving
from the Dominican Republic tomorrow. For the next few weeks I will be facilitating communication between those who want to come short-term (particularly nurses) and the areas of need. I also hope to be able to help get experienced groups such as Doctors without
Borders to the remote areas we work in.

In the name of the one who has defeated death and the grave,
Liz

Cholera Treatment Center, Hinche

Church building in Hinche used for cholera patients

Monday, November 8

Hello! I'm writing from Hinche, a small city a few hours north of Port-au-Prince. (If you click on the map at the top right and zoom in a bit, you'll see it in the center of the country just north of Mirebalais: Arrondissement de Hinche.) Cholera hit this town six days ago, and a cholera treatment area was set up next to the local hospital by using several tents and a small church. Since I am working with the J/P HRO team these two weeks, they sent me here with a group of volunteers on Friday. We plan to stay till Wednesday when another team will replace us.

Cholera has not been seen in Haiti in at least 50 years, and it can take some time even under the best of circumstances to set up a good system. This site is run by the Ministry of Health in partnership with Partners in Health (PIH). Doctors Without Borders arrived yesterday to provide technical support—they are building special cholera beds and have laid down gravel, which are critical steps. Cholera leads to profuse diarrhea, and it has been incredibly difficult to keep patients, floors, and cots clean. We have also been having heavy rains with the passing of the hurricane, and the tents we work in were very muddy before the gravel.

I'm working with a great group. We're currently sitting around not talking about work for the first time! We've realized that we've been working from late afternoon to mid-morning every night and while not at work have been strategizing. We know this isn't sustainable.

We've established good relationships with the medical director, Ministry of Health, and the Haitian and Cuban physicians who work here. We've had significant challenges working well with the national nurses, and we've been told that this is perhaps due to the government hiring and retention system, although we're also aware that we are from a different culture and are outsiders. Please pray for wisdom and good working relationships. Constant vigilance is needed with IV fluids and oral rehydration since the main cause of death with cholera is dehydration. We have a great team of cleaners who recently received excellent training and are applying it with vigilance. Their efforts have wonderfully changed our work environment.

This is a very challenging environment. We work at night with little light. We do not have all of the supplies we need; the supplies we do have don't stay stocked, and it can be difficult access supplies even when they are here. Patients have died, although thankfully not in our areas on our shifts. Whenever a patient does die the family members wail, which adds to the emotionally-charged atmosphere. There are many patients who are children, and since this site is currently not allowing family members to come in as caregivers, the children are alone.

In addition to praying for the patients, families, and staff, please pray for the efforts of community health workers in prevention of this terrible disease. Our Community Health Evangelism (CHE) volunteers have now gone to 100 villages, teaching prevention methods (hand washing, latrine usage, cleaning drinking water, etc.). However, in the areas in the north where they are starting to see cholera they do not have enough medical personnel. We don't have any CHE programs where I am now, but PIH has been training and sending out their community health workers.

Thank you for your many notes of encouragement and particularly for your prayers. I haven't had access to e-mail since arriving in Hinche, but was able just now to briefly read what you've written. People have asked about donations, and for CHE work they can go to LifeWind International (www.lifewind.org) to the Haiti Disaster Fund (code D921).

In God's mercy,

Liz

Working inside the "church."

P.S. Please pray for Odlin, a little boy I've been caring for since yesterday morning. He arrived malnourished and severely dehydrated, and it was very difficult to get a good access for fluids. We struggled again yesterday afternoon and evening, needing to place another access for fluids (in his shin bone).

Obviously we care for all of our patients, but this little boy has really touched my heart. When he's able, he talks, calls out, "Oh, God!" or "Stop, it hurts!" He also frequently reaches his arms around my neck.

Please pray for this child of God.

Arrival in Port-au-Prince

Breaking down the tents at the J/P HRO refugee camp hospital. (All pictures from J/P.)

I arrived back "home" in Cap Haitien on November 13. It's now been over a month since my computer and all of its drives were disabled due to viruses. That problem combined with inconstant electricity and internet access has interrupted my blogging. I will post here some e-mails that I sent during that time.

Wednesday, November 3
Hello! As many of you have heard, there is a tropical storm/hurricane approaching Haiti. It looks like the rain should start at about 1 pm tomorrow followed by hurricane weather on Thursday evening or else on Friday morning.

I'm still in Port-au-Prince working with the J/P HRO. The plan here is to continue dismantling the tent hospital and store everything by tomorrow noon. We will attend emergencies and deliveries only. As soon as the rain starts, we'll come back to our base which is a large
house. We have stored all the tents we were sleeping in (on the grounds), and we'll start sleeping inside tonight. As soon as the rough weather stops (on the sixth?) we will go back to the refugee
camp and set up to start attending patients as quickly as possible.

In the morning I was the "designated doc at the camp for emergencies." I only saw a few pregnant women, but the title sounds good. In the afternoon I perfected my taping skills at the house we were staying at!

This is a very well-organized group, and I am privileged to be a part of it. Please pray for the people in the refugee camp. Evacuation routes are still being planned, and they are worried about landslides. Please continue to pray for our Community Health Evangelism (CHE)
teams up north. I heard today that the cholera cases continue to increase in Cap Haitien and Limbe. We praise God that yet another shipment of IV solution, chlorine, and oral rehydration salts were able to come in from the Dominican Republic, albeit with some
difficulty crossing the border.

We are anticipating not having power soon, so I will probably not be communicating via e-mail until well after the storm is over. We are anticipating a lot of injuries in the camp due to the weather conditions, and so we wil likely be very busy for days.

After my night shift was over this morning, I attended the meeting of the (mostly Haitian) medical staff. As their portion of the meeting started they sang "Count Your Blessings," then one woman prayed, followed by all reciting Psalm 23. May God truly shepherd this land
and the people He loves so much.