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Eliminating Cholera from Haiti – The last mile is the most difficult

Michel Ange supervising the a rapid response team at Carrefour

Port-au-Prince, April 2018: “It could be one of the most important activities happening in Haiti now,” states Michel Ange, team leader of one of the 58 rapid response teams working relentlessly to eliminate cholera in Haiti. “We are saving lives, educating the local population around hygiene practices, and helping to eradicate a killer bacterium.”

In 2017, for the first time since cholera was introduced to Haiti in 2010, the epidemic was under control and the highest suspected cases were concentrated in three out of the ten Departments: West (31%), Artibonite (29%) and Centre (19%). 2018 began with the lowest numbers recorded, 995 cases between January 1st and March 31st  compared to 4,248 cases for the same period last year (source: DELR/MSPP).  This evolution is largely due to a strategy that combines reinforced local coordination, surveillance, solid rapid response, and enhanced prevention through water chlorination and intensified hygiene awareness. With the support of UNICEF, the Ministry of Health launched this “alert-response” strategy in 2014, resulting in the activation of rapid response teams that are staffed with agents of the Ministry of Health response teams and Non-Governmental Organizations (NGO). It required three years of close monitoring and technical support to reach a satisfactory level of performance, and now the results speak for themselves. Due to the availability of funding, all rapid response teams were activated in 2017, resulting in an unprecedented response rate of 95 percent to all suspected cases.

“We are good at what we do. You can see that in how the number of cases has dropped in the last year,” states Michel Ange. She is not showing off but simply stating a fact. Never has the chance to eliminate cholera been so close, yet the way there was hard. “It was an uphill battle but organizations like Solidarity International and UNICEF didn’t give up at all.”

UNICEF and the Ministry of Health continue to support a network of response teams nationwide. Four NGOs, are working hand in hand with the 13 teams from the Ministry of Health, called EMIRA (in French, Equipe Mobile d’Intervention Rapide), to deliver a complete package of activities: visiting affected households and an average of 12 houses living in a 50m perimeter around the patient’s house and establishing a “cordon sanitaire” to avoid the disease from spreading in the community. The teams provide oral prophylaxis to the patients and their families, disinfect homes, and distribute oral rehydration salt, soap and water chlorination tablets. They also secure water sources by establishing emergency water chlorination points or support DINEPA (National Directorate for Drinking Water and Sanitation) to chlorinate the water systems in affected areas when needed.

A rapid response team is distributing supplies to fight against cholera

These NGO teams are composed 100 percent with skilled Haitian professionals who have been trained to investigate and respond to suspected cases of cholera and other types of acute diarrhea, which directly benefit children as diarrhea remains one the main causes of child morbidity in Haiti.

Fund predictability also allowed for the improvement of complementary health and hygiene promotion activities and community mobilization, activities, crucial to ensure quick outbreak control. In addition to the work of response teams, UNICEF’s NGO partners deployed community engagement teams which reinforced the rapid response by conducting hygiene awareness interventions in schools, churches, places or events gathering people in affected areas, and food hygiene sensitization in public market places.

In the metropolitan region of Port-au-Prince, rapid response agents like Michel Ange have contributed to respond to approximately 5,000 suspected cholera cases in 2017, and to sensitize over 360,000 people in affected neighborhoods. It is a labor of passion and love. “Haiti is my home, my country, and I love it with all my heart. Of course, it is a difficult place, but with the help of organizations like Solidarités International and UNICEF, we are learning techniques to address our problems, to take over,” says Michel Ange with a smile. “My children will grow up in a stronger Haiti, a better Haiti than the one I had…we will all help each other to learn and grow together.”

Today, the situation invokes optimism but the fight is not over. To avoid a resurgence of the epidemic, an effective set-up must be maintained to ensure surveillance, prevention and response until the last case is gone; this requires steady and predictable funding.

Haiti: Institutional death due to Cholera, Epidemiological Week 7 (February 2018):

Eliminate cholera in Haiti by the rapid response teams

UNICEF Haiti works with its partners such Solidarités International to support the rapid response strategy of the Ministry of Public Health and Population in order to eliminate cholera with its rapid response teams. This is the story of Michel-Ange

Rapid response teams: a real rampart against cholera

A rapid response team in the Department of Centre

The numbers of cholera cases have significantly reduced in 2017. They have never been so low. The new Cholera strategy has paid off. At the center of attention are the rapid response teams, who are true warriors. The members will fight cholera in the targeted departments, in good weather or rainy weather. Mainly in the department of Centre (Plateau Central), where the distances to be covered are sometimes immense. UNICEF is one of the key players in the fight against cholera in the country.

Mirebalais, November 23, 2017-The all-terrain car is rolling on the rocks, the road is not good. It is necessary to zigzag between the crevasses, to avoid the mud. It rained last night, but conditions are acceptable to reach Menaj, a locality close to the town of Laschaobas (Centre).

ACTED’s rapid response team, UNICEF’s partner, with their recognizable green T-shirts from several meters, is on the warpath. They come to conduct an awareness session. But the community is quiet because today is market day. However, there are still people who will be able to listen to messages and receive hygiene kits if it’s needed.

A member of the team with a loudspeaker has already broken off to bring together the people who are present. In the empty valley, his voice is echoed. He managed to gather about twenty women and a few children. Men are in the fields.

Important to continue awareness

A sensitization session

The team begins to raise awareness about hygiene. Today, the team is there for a reinforcement of awareness. It usually takes place after the distribution of hygiene kits. These kits contain soap, oral rehydration serum, and aquatabs (chlorine tablets) and a pail with a robinet.

“You have to wash your hands in crucial moments, before eating and after getting out of the toilet. Use treated water for your health and that of your children’’. After these messages, the team asks the residents who do not live too far to bring the water they use to test the chlorine residual, to check if they have followed the instructions.

The activities of rapid response teams consist of three parts: investigation, response, awareness. “Regarding the situation for the Lower Plateau, it’s pretty quiet because we went from 38 cases per week to 14 cases and for the moment it’s only 7 cases,” says Jennyfer Joseph, cholera project manager for the Lower – Central tray.

To travel long distances

One of the biggest challenges for rapid response teams is returning to the long distances they must travel to reach remote locations. Sometimes it can take hours or even days. Because they must sleep on the way, to continue their activities and to make sure that everyone is sensitized to the principles of hygiene.

“In some mountainous places, even mules cannot pass, but we have to go if there are cases of cholera. It’s part of our mission. Sometimes we do missions of several days in these localities to reach everyone, “recalls Nadia Delmond, emergency team leader for Acted, recalling that the reception of people is always positive.