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