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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

Camille Lacourt in Haiti believes donations can help.

Here in Haiti, more than 4.8 million people do not have access to a source of drinking water. 4.8 million people, that’s 36% of the population, a statistic that Camille Lacourt wants to change by its humanitarian implication. Landed on the island of Hispaniola on February 19 for a five-day stay, the five-time World Swimming Champion was able to see with his own eyes the tremendous work done on the ground by UNICEF and its various partners.

“We see that there is a lot of work and that it works quickly” says the French celebrity, sponsor of the Nuit de l’Eau. This presence in Haiti of Camille Lacourt was aimed at seeing and witnessing UNICEF’s action on the ground and seeing how the funds collected by the Nuit de l’Eau are used.

Camille Lacourt, parrain de la nuit de l’eau, visite l’école de Trianon à Mirebalais. Cette école est “Hygiene friendly school” soutenue par l’UNICEF.
Des enfants se lavent les mains et peuvent accéder à des toilettes séparées grâce au soutien de l’UNICEF.

“All donations are useful. There has been a lot of work done but there is still a lot left. Haiti is not just earthquakes and hurricanes. Do not help only at these times but a little bit all the time, ” explains Camille.

In the department of the Center, Camille was able to see everything that was done and all the difficulties encountered to bring the drinking water from the sources to the populations. At La Chapelle he visited a water system damaged by Hurricane Irma. Thanks to the many donations, this supply system has been rehabilitated and many water points are now cleaned up. In total, 910,000 people now have access to a drinking water point.

Also in the Center, he was able to meet the students of the National School of Trianon in Mirebalais, one of the 152 “friendly schools of hygiene”. There, with UNICEF support, children can wash their hands and can access separate toilets. These programs were partly funded by public generosity at the 2017 Nuit de l’Eau.

“For us when we are lucky to come on the field, we see that the work has really been done and is being done. That’s the message I’m trying to convey: donations, it’s useful, it’s really helpful” says Camille Lecours

Accompagné du médecin Karine Sévère, responsable du CTC de Port au Prince, Camille Lacourt, parrain de la nuit de l’eau, visite les installations et les malades atteints de cholera ou de diarrhée aïgues.

Finally in Port-au-Prince in the West Department, accompanied by the doctor Karine Sévère, doctor in charge, he visited the “Centre de Traitement du Choléra et de Diarrhée Aigüe Gheskio” and a water chlorination point in the Bristou district in Petionville.

“It’s very far from what we know but yes I relativize a lot saying that I was very lucky to be able to do my sport in pools filled with water and that here there is not enough, so that gives me even more desire to talk about that “added Camille Lacourt.

A CHANCE TO LIVE FOR HAITIAN CHILDREN.

Together, we can give each child more than a day, more than a month, more than survival.

Did you know that every year in Haiti, 9600 children die at birth? Although impressive and unacceptable, this figure is still marginal on a global scale. Indeed, according to a new report on neonatal mortality published today by UNICEF and available here, there are 7,000 newborns in the world who die every day.

“We know that the vast majority of these babies can be saved by providing affordable, quality health care for every mother and newborn. Small gestures from each of us would help ensure the first steps of these newborns in life. Says Henrietta H. Fore Executive Director of UNICEF.

In Haiti, at the maternity Isaie Jeanty near Cité-Soleil, a rather difficult area of the capital Port-au-Prince, this little miracle occurs every day. For Liliane Jean-Charles, a young mother living in the area of Canapé Vert, this second universal experience of childbirth went very well for her.

Children

Liliane Jean-Charles, a young mother living in the area of Canapé Vert, this second universal experience of childbirth went very well for her. She loves children.

“There was pain, but the doctors took very good care of me during the delivery says Liliane. Despite the rather limited technical resources of this maternity, Liliane really felt that there was a pair of safe hands to accommodate her baby at birth and in the minutes that followed. “They showed a lot of patients waiting for the baby to show up,” says Liliale, already standing next to her bed, just minutes after giving birth.

His baby named Christopher is his second: “I love children because it’s a gift from God. It’s a gift that embellishes the house. Because without children, there are no flowers in the house.”

Thanks to the care of MIJ medical staff, Liliane Jean-Charles and her little Christopher will be able to return home quickly.

For the year 2017, 3340 childbirths were performed at the Maternity Isaie Jeanty of Port-au-Prince. UNICEF is contributing in his way to this challenge by strengthening the technical and logistical capacities of the maternity ward by distributing various equipment, accessories and materials such as gynecological tables, medical instruments and products.

Together, we can give each child more than a day, more than a month, more than survival.

#EveryChildALIVE

For more informations https://www.unicef.org/french/every-child-alive/

152 schools received hygiene certification.

On November 21st, the hygiene certification ceremony of 152  schools took place at the Montana Hotel in Port-au-Prince.

Certification Ceremony of 152 Schools at the Montana Hotel in Port-au-Prince on 21 November 2017.

Certification Ceremony of 152 Schools at the Montana Hotel in Port-au-Prince on 21 November 2017.

This activity was organized by the Ministry of National Education in collaboration with the Ministry of Public Health and Population, DINEPA, UNICEF and several other partners including the Inter-American Development Bank.

The project/program officially launched in November 2014, aims at the constitution of a number of model schools, in hygiene, in each of the ten departments of the country. In order to receive their certification, the 152 schools had to comply with a number of standards and criteria related to hygiene, water and sanitation.

Deserving schools represented at the ceremony all demonstrated during the inspections that they had available toilets and latrines, handwashing points near the toilets, the availability of water for everyday use and that technical supervision was provided by school inspectors and engineers. School principals also presented their commitment and participation in hygiene education and the establishment of a functioning health club in their respective institutions.

New hygiene behaviors

Mrs. Emeline Rafael, director of the Lycée des Jeunes Filles of Jérémie.

Mrs. Emeline Rafael, director of the Lycée des Jeunes Filles of Jérémie.

“I find that there are a lot of differences because now we are trying to create new hygiene behaviors among students. Says Emeline Rafael, director of the Jérémie Young Women’s High School, just after receiving her plaque confirming the certification of her institution.

“They are given guidelines but it is up to them to manage their own health conditions, they are young teenagers from 11 to 12 years, they understand very well what we expect from them. They are asked to set up committees and give them instructions on hygiene. They are taught to have positive behaviors, to wash their hands after going to the bathroom if not, they do get sick and go out of school. If we are not in good health, we will not stay in school either, says the director.

“The certification of the schools is an absolute necessity. The analysis of the situation carried out in 2012 gives the following figures: 25% of Haitian schools have drinking water installation, 50% have functional toilets, 69% have handwashing station. 52% of them teach hygiene or promote it.” Said Mr. Marc Vincent, UNICEF Representative during his remarks.

13 schools supported by UNICEF

During this first evaluation in 2017, of the 17 certified schools in the departments of the Center and Artibonite, 13 are supported by UNICEF (9 in the Center and 4 in the Artibonite). 8 other schools in Artibonite are ready and awaiting evaluation for their certification.

The schools that UNICEF helped rebuild across the country, after the January 12 earthquake are all equipped with toilet blocks with possibility of collecting rainwater because the issue of water can be a challenge in some parts of the country. UNICEF also conducted hygiene awareness sessions for school staff and schoolchildren.

“This certification will help to make schools safer. Because of the insalubrity of some schools, they can become a threat to the health of children. School should be a protective environment. We know they are particularly vulnerable to microbes and the health of our children is a top priority, “said UNICEF Representative Marc Vincent.

Still a lot of effort

Despite the success of this program, there is still much work to be done. According to the latest available statistics, the pupil/toilet ratio in Haiti is currently 128, whereas the standards provide for 25 to 50 students per cabin. 72% of the Haitian population does not have access to adequate sanitation and 42% do not have adequate access to drinking water while access to health services is limited. Even though 20% of drinking water control in schools is provided by DINEPA, 73% of schools in the country still have no control over the quality of this water.

In this sense, through the representative of the Director General, Mr. Guito Edouard, DINEPA is committed to strengthening its collaboration in the project to enable the achievement of common objectives for the well-being of Haiti’s children.

All children have the same rights

Mr. Marc Vincent, UNICEF Representative during his address.

Mr. Marc Vincent, UNICEF Representative during his address.

“UNICEF places a lot of emphasis on equity that advocates for access to care and service for all children without distinction. All children have the same rights. These certified schools are in line with Sustainable Development Goals 3, 4 and 6, which refer to “good health and well-being, quality education, clean water and sanitation, respectively. We need to do a lot more, so that the SDGs, more than accounting goals, become a reality, “said UNICEF Representative Marc Vincent.

The project carried out by the School Health Department aimed to certify over 2 years, a minimum of 100 schools, (10 on average per department), from the point of view ” water, sanitation and hygiene “, so as to propose them as models at national level. With already 152 schools that have been awarded the certification, the country is on the right track.

Hygiene, keys to development

Mr. Charles Ernest Chatelier, Director General of the FAES, declared in front of the room: “Let’s all be friends of the hygiene because it is one of the keys of the development of the country.”

Establishments certified received a plaque of honor. This status will be reviewed every two or three years, after evaluation. A new sticker will then be affixed to the plate in case of maintenance of good hygiene practices. Other institutions will gradually be added to the list, at the level of each geographical department.

“We have to go beyond a simple project. We need to build better citizens, “said Pierre Josué Agénor Cadet, Minister of National Education.

Through this program, the Ministry of National Education intends to: make known and propose as models, at the national level, the certified schools; encourage principals, school staff, students, parents and the community to maintain schools, with the support of the School Health Department; to encourage the regular inspection of these schools from the physical, health and educational points of view; Encourage the establishment in these institutions of a health club made up of pupils and operating under the aegis of the Direction and / or the School Council; to show decision-makers and the general public that, as things stand, health is the best gateway to excellence and the quality of education.

Life-saving peanut paste for children, made in Haiti

Haiti's first and only plumy'nut factory in Cap haitian

Haiti’s first and only plumy’nut factory in Cap Haitian. (c)UNICEF Haiti/2015/Walther

After two days in Cap Haitian (and 12 hours on the road) I am back in Port-au-Prince. During the visit I got the chance to meet Patricia Wolff, Director of Meds & Foods for Kids (MFK), a Haiti-based company that produces therapeutic foods to cure malnutrition in children, including Plumpy’nut. Plumpy’nut is a peanut based high calorie paste for therapeutic feeding, which was a revolution when it entered the humanitarian practice over a decade ago, due to its quick impact on the nutritional status of children and its long shelf-life. A large part of the Plumpy’nut supply that UNICEF Haiti uses to support nutrition centres across the country is produced by Patricia’s team, which is in many ways a pioneer of social business in Haiti.

While the company continues to struggle to ensure sustainable profit, they appreciate the headway made, placing the value of social enterprising at the centre. “We declare victory early, once we break even in terms of income/expenses. Profit is what is to the social benefit of all.” Starting a business in Haiti is a challenge. Costs related to electricity, water, roads and security are significantly higher than elsewhere, which increases the costs of locally produced products. “When UNICEF buys from us it is for philosophical reasons. They believe in the principle of local purchases and the need to strengthen local capacities. Seen from a purely commercial aspect they could get it cheaper from Nutriset in France.” explains Patricia.

A proud mom and her daughter, who can smile again after the successful treatment.

A proud mom and her daughter, who can smile again after the successful treatment. (c)UNICEF Haiti/2015/Walther

She came to Haiti 26 years ago as a volunteer, and never left. “Many people here got sick, because they were malnourished. I saw children and women die needlessly.” Together with the inventors of the original Plumpy’nut recipe she started to work for the establishment of a therapeutic food factory in Haiti. In 2003 MFK set-up shop close to Cap Haitian, in the North of Haiti. At the beginning they produced Plumpy’nut for ten children a month, saving 100 children per year.” In 2010 the company became a partner of Nutriset, the French based company which owns the patent of Plumpy’nut. Today about 1/3 of the 450 metric tons that MFK produces every years is distributed in Haiti.

To ensure access for the most vulnerable children Patricia’s products are bought by humanitarian and development actors such as UNICEF which then supply community health centres in cooperation with the Haitian Government. Yet available funds are insufficient to cover the needs.

A boy's upper arm is measured by a nurse. It is a measure that gives quick and reliable information about a child's nutritional status.

A boy’s upper arm is measured by a nurse. It is a measure that gives quick and reliable information about a child’s nutritional status. (c)UNICEF Haiti/2015/Walther

As I write these lines, among children under 5 years living in Haiti, 11 % are underweight (moderate and severe), 22% suffer from chronic malnutrition (moderate and severe) and 5% from acute malnutrition (moderate and severe). This may be due to the poverty of their family, to disease or unfavorable feeding practices. If a child does not get sufficient nutrients during the first 1000 days of life (1), his brain and body will never fully develop, which will have consequences on school performance and later on income. There is no second chance to catch up! Plumpy’nut is part of the solution, if it goes hand in hand with overall development that enhances food security for families.

To conclude in Patricia’s words “We are part of those who have won the lottery. It’s only fair if we give a lifting hand to those who haven’t.” So true. This philosophy of reaching those who are the most vulnerable is at the heart of UNICEF’s mission in Haiti, and everywhere across the world.

A mother and her son share a moment of joy. Before the treatment at a UNICEF-supported nutrition center the little boy was too weak to even open his eyes.

A mother and her son share a moment of joy. Before the treatment at a UNICEF-supported nutrition center the little boy was too weak to even open his eyes. (c)UNICEF Haiti/2015/Walther

 

(1)              For more information on the first 1000 days, please check https://www.youtube.com/watch?v=NymebwpbL4c.

 

CORRECTION

An error was found in this article, we have made ​​the necessary corrections on the 18/05/2015. Please find below the adjusted numbers for the prevalence of malnutrition for children under 5 years:

  1. Prevalence of underweight (moderate and severe) 11%
  2. Prevalence of Chronic malnutrition (moderate and severe) 22%
  3. Prevalence of acute malnutrition (moderate and severe) by 5%

* Percentage of children of less than five years considered as malnourished according to three anthropometric indices measuring the nutritional status: (1) weight depending on age ; (2) the size according to age ; and (3 ) the weight depending on the size .

Source: EMMUS 2012 Survey Mortality, Morbidity, and use of services

 

By Cornelia Walther, Chief of Communication at UNICEF Haiti