Cholera Response and Prevention in Fond-des-Blancs, Haiti

Lessons Learned in a Low-Resource Setting

Dr. Miliane ClermontLisa P. Ward

St. Boniface Haiti FoundationFond-des-Blancs, Haiti

SBHF at a Glance

100,000patient visits

in 2016

350 staff

98% Haitian

200+ surgeries per month

25,000+ people

vaccinated in 2016

Care for the most

vulnerable

6,500+ prenatal visits per

year

Training & Professional Development

St. Boniface Hospital

Largest Referral

Hospital in S. Haiti

Only functioning NICU for 2.3

million peopleOnly accessible surgical care in

S. Haiti

National Center for

Spinal Cord Injury

National Training Center

for MNCH

… and much more

Haiti & Water/Sanitation AccessPopulation: 10,413,211

24% under poverty level

25% do not have any contact with media

Safe water drinking coverage 64 %

Sanitation coverage : 26% (UNICEF 2013)

23 % do not have access to any toilets

Cholera in Haiti2010: Earthquake

Cholera brought later that year by UN Peacekeepers

Over 9,000 deaths and approx. 800,000 sickened across the country over the past 7 years.

St. Boniface Hospital received first cholera cases in 2011 and constructed Cholera Treatment Center (CTC) Tent on hospital campus

Cholera Outbreak in Fond des Blancs

Over two days, 6 suspected Cholera patients arrive at St. Boniface Hospital. Staff becomes concerned about a new outbreak in the area.

Over the next 5 days, an additional 28 suspected Cholera patients arrive. More patients are expected over the next days and weeks.

All staff are alerted via WhatsApp message.

What do you do next?

Cholera Response Simulation What are your IMMEDIATE priorities as your role within the organization?

Each group will have 10 minutes to discuss and then briefly present the priorities for their role at the hospital

Groups◦ Chief Medical Officer/Medical◦ Facilities Director/Operations◦ WaSH Coordinator/Community Health◦ Supply Chain Manager◦ Monitoring & Evaluation

Chief Medical DirectorResponse priorities

◦ Acute diarrhea protocol + antibiotics

◦ Communication with the community, hospital staff and our office in Newton, MA

◦ Staffing the CTC

◦ Communication with MSPP + other health facilities

◦ Working with MSPP to send samples to verify cholera

Facilities DirectorResponse Priorities◦ Cholera Treatment Center (CTC)◦ Triage tent and larger CTC◦ Water, electricity, barriers, toilets and showers ◦ Separation between CTC and Spinal Cord Injury Center

WaSH Coordinator & Community HealthResponse Priorities◦ CTC: Handwashing stations, chlorine availability, infection

control◦ Community: Utilizing Community Health Workers,

Education sessions on prevention, distribution of Aquatabs

Supply Chain ManagerResponse Priorities◦ Verifying what is “in stock” at the hospital: Medicines, IV

fluids, Aquatabs, etc◦ CTC: Locating cholera beds and other equipment needs◦ Contacting partners for donations

Monitoring & EvaluationEstablish use of Registry and consistent data entry practices

Verify data collected in Registry with patients/families

Interview each patient/family regarding patient history

Work with WaSH/Community Health to determine source of outbreak

Collate data for mapping

Map of InitialOutbreak

November 2015

Post-OutbreakOngoing monitoring and community health education activities

Average number of monthly cases from within Community Health catchment area dropped to zero in the spring of 2016

Hurricane MatthewOctober 4, 2016

140 mph winds, up to 40 inches of rain

Fond des Blancs saw tropical storm force winds and major flooding

Crops destroyed, roads and other infrastructure severely damaged

Major fears of new wave of cholera due to lack of access to clean water after the storm

Cholera Vaccine CampaignSt. Boniface Hospital distributed 23,271 doses of the Cholera Vaccine.

The Community Health staff, led by Dr. Miliane and Miss Yanick RN, delivered these doses over the span of 8 days.

The focus was on schools, markets and rally posts within our catchment area.

The 2nd dose was given at the same locations 4 months laterin 4 days.

Lessons Learned: Control & Prevention

In order to control and prevent cholera, a multi-pronged approach is needed :

◦ Well-established team and system with pre-determined leaders

◦ Team made up of variety staff

◦ Network of Community Health Workers

◦ Education

◦ Access to medicine and water treatment tablets

◦ Cholera Vaccine Campaign

Thank You Mèsi Anpil