Patients affected by cholera receive treatment at an MSF cholera treatment center in Port-au-Prince

PORT-AU-PRINCE, MAY 9, 2012—Cholera cases are on the rise in Haiti following the onset of the rainy season, and the country is not adequately prepared to combat the deadly disease, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

While Haiti’s Ministry of Health and Populations claims to be in control of the situation, health facilities in many regions of the country remain incapable of responding to the seasonal fluctuations of the cholera epidemic. The surveillance system, which is supposed to monitor the situation and raise the alarm, is still dysfunctional, MSF said. The number of people treated by MSF alone in the capital, Port-au-Prince, has quadrupled in less than a month, reaching 1,600 cases in April. The organization has increased treatment capacity in the city and in the town of Léogâne, and is preparing to open additional treatment sites in the country. Nearly 200,000 cholera cases were reported during the rainy season last year, between May and October.

“Too little has been done in terms of prevention to think that cholera would not surge again in 2012,” said Gaëtan Drossart, MSF head of mission in Haiti. “It is concerning that the health authorities are not better prepared and that they cling to reassuring messages that bear no resemblance to reality. There are many meetings going on between the government, the United Nations and their humanitarian partners, but there are few concrete solutions,” he said.

An MSF study in the Artibonite region, where approximately 20 percent of cholera cases have been reported, has revealed a clear reduction of cholera prevention measures since 2011. More than half of the organizations working in the region last year are now gone. Additionally, health centers are short of drugs and some staff have not been paid since January.

“Rain is just one of the risk factors for contamination. But as soon as the rains end, cholera subsides, and funding stops until the next rainy season, instead of money being channeled towards cholera prevention activities. As a consequence, people are still highly vulnerable when cholera comes back,” said Maya Allan, MSF epidemiologist.

The majority of Haitians do not have access to latrines, and obtaining clean water is a daily challenge. Of the half-million survivors of the January, 2010 earthquake who continue to live in camps, less than one third are provided with clean drinking water and only one percent recently received soap, according to a April 2012 investigation by Haiti’s National Directorate of Water Supply and Sanitation.

“Hygiene advice is of little use if people are unable to put it into practice,” said Drossart. ”People urgently need the means to protect themselves against cholera.”

While the cholera vaccination being used in some parts of Haiti can help control the disease, it is not a foolproof solution. The vaccine provides immunity for approximately three years and is estimated to be only 70 percent effective. Only major improvements of Haiti’s water and sanitation systems will provide durable solutions to the epidemic, but that will take time.

“The priority today is to save lives,” said Drossart. “All health actors in Haiti need to start working towards this goal immediately.”

http://www.doctorswithoutborders.org/press/release.cfm?id=5990&cat=press-release

Since early Feburary, an apparatus for treating water by ultra filtration (UF) has been in operation at the Jacmel prison in the Southeast Department. Its installation was funded by the Community Violence Reduction (CVR) Section of MINUSTAH, and implemented by the NGO Life Giving Force (LGF Haiti). The project is part of the program to mitigate against the cholera epidemic in South-East department, and includes the installation of such devices in Multipurpose Centres in seven communities in the South East and in some detention centers in the country.

The Jacmel prison is equipped with a new water filtration system
Photo: UN / MINUSTAH

With a capacity of 20,000 lit ers per day supplying safe clean drinking water for upwards of 5,000 persons, the recently installed UF water treatment system can provide continuous drinking water for both the administrative staff and inmates over the long term, and thus significantly reduce the risk of contamination by waterborne diseases, especially cholera.

All of the beneficiaries are overjoyed. Gesny Jean the Director of the Jacmel prison offered this comment: “It is a useful and important project. To have a water purification station in the prison is a good way to combat the cholera outbreak, some cases had been reported in this prison, causing casualties among the prisoners.” Another source of satisfaction for Mr. Jean is that fact that the project was carried out “in record time.” Indeed, it took only two weeks between the “site evaluation by the technical team of LGF, design configuration, the filter installation and technical training of prison staff.”

As for the prisoners, their relief is evident as they use this precious resource. “The installation of this unit has brought us great relief because up until now we have only received an erratic supply of tablets” – Aquatabs -  “to treat tap water,” said one young prisoner.

Equally, LGF Haiti’s ultra filtration water treatment systems were welcomed by those using the community centers in the seven regions in which they were deployed. In operation in these multi purpose centers since November 22, 2011, the LGF 20k UF systems, capable of producing 20,000 lpd of clean drinking water, are powered by solar making them completely autonomous. The construction and fit out of the community centers located in Grand-Gosier, Belle-Anse, Marigot, Cayes-Jacmel, La Vallée, Bainet et Côte- de-Fer were funded by the UN MINUSTAH Section CVR section for a total of US $1,367,000.

This place is crazy. And it was just Carnaval. So multiply by that x 100. It’s loud, dusty, dirty, unorganized, under resourced, over priced, confusing, dangerous, beautiful, luring and despite it’s chequered history, completely full of life. The kind of zest that is difficult to find in most developed nations yet beyond the smiles and laughter, the need for clean, disease free water is so imperative that without it it will be difficult to get this nation back on it’s feet.

Fresh off a couple of weeks on the ground here in Port au Prince makes one’s head swim. In some ways I realize that I’m not doing it too hard as I’m not living cheek by jowl with other unfortunate IDPs in a tent camp but instead I have a roof over my head, clean sheets on my bed and access to good food when I need. Oh, and, not to mention the internet.  But I have been out in the field, learning and helping as much as I can with the installations of various LGF Haiti clean water projects all of which are located in struggling neighborhoods where people often walk great distances just to get dirty water out of a dirty truck. It’s amazing that these projects get completed because everything is so much more difficult than you would ever imagine. I have traveled quite a bit globally and had some inkling of what I was getting into here but the traffic here was the first aspect that I had completely underestimated. What should normally take 20 minutes could easily be a couple hours often stuck in bumper to bumper amongst a loose interpretation of lanes. Cars and trucks are so twisted they appear to be driving sideways on things that resemble tires. Potholes here are more like sinkholes. It’s like an ad for “4 Wheeler Magazine” and when you’re stuck in it, the street kids approach your car often rubbing their bellies with one hand while the other is open and empty. “I’m hungry.” It kills you. But they’re working it and getting things done in their own little orb. We have some Haitian friends who talk about  what Port au Prince was like in the 70′s with a population of around 300,000. Now some estimate it to be over 3 million and the proper planning for such an expansion never happened. But the earthquake did and there’s still more than enough evidence of it’s destruction as you make your way around the quagmire.

Left? Right?

When I look around, I can’t imagine where to begin. Should I pick up that piece of rubbish? Where to put it? But reliable sources say that the city is so much cleaner than even 6 months ago with various recycling and waste removal programs in tact and the tent cities are shrinking. It’s a good reminder of the fact that the last person was moved out of their tent 10 years after the Kobe, Japan earthquake. And that’s an industrialized nation. People talk about ‘reconstruction’ here in Haiti. When it comes to water and sanitation infrastructure, it should really be referred to as ‘construction’. There was little to no infrastructure prior to the earthquake so we’re all starting from scratch here. So to focus on the smaller picture sometimes is best and building out these clean water kiosks as businesses seems to make good sense. A few of the recent kiosks are now being powered by solar arrays which is an exciting piece of the puzzle. Off grid is pretty good when the existing grid is unreliable at best.

The in-country LGF Haiti team is wonderful and very hard working. It has been a pleasure to finally place the faces with the names and they are doing a fantastic job with all of the training that goes along with setting up these kiosks. Eager locals lap up all the information behind the technology and how to sell the water to profit their community, clinic or school as well as build their own business. We have been working with the World Bank and Sean Penn’s organization J/P HRO on some recent projects with schools and clinics. They have been fantastic partners as well which in this challenging environment is the only way to achieve anything.

Then there’s Chicken Alley. Chicken stand after chicken stand lining the street with vendors fanning the flames with paper plates, yelling and vying for business. Jim loves it there and in the darkness of the night, it looks like a gnarly film set but I will tell you this…..the chicken was very, very tasty indeed. And the next day?…… all was well.

The LGF Haiti team working on the install.

Ian securing the tank.

Drum roll…

…purified water turned on!

Pleased pupils and smiling staff

Johnson imparting just a fraction of his vast knowledge.

Guilbert speaking in gauges.

The cutting of the ribbon.

Members of the LGF Haiti in-country team (left) with members of the local water committee (right)

Clean water.    Happy kids!

]]> http://www.lifegivingforce.com/2012/02/07/lgf-haiti-installs-more-clean-water-kiosks-in-port-au-prince/feed/ 0 http://www.lifegivingforce.com/2012/01/12/haiti-un-urges-investing-in-water-and-sanitation-services-to-combat-cholera/ http://www.lifegivingforce.com/2012/01/12/haiti-un-urges-investing-in-water-and-sanitation-services-to-combat-cholera/#comments Thu, 12 Jan 2012 03:04:29 +0000 admin http://www.lifegivingforce.com/?p=1974 11 January 2012 –
Dramatic improvements in water and sanitation services are needed to eliminate cholera in Haiti and the Dominican Republic, health experts who took part in a United Nations-organized briefing to outline concrete steps to stem the spread of the disease in the region said today.

The event, organized by the UN World Health Organization’s (WHO) regional arm, the Pan-American Health Organization (PAHO), urged governments and international organizations to boost investment in the infrastructure and institutional capacity required to provide water and sanitation in areas affected by the disease.

Cholera is an acute intestinal infection caused by eating food or drinking water contaminated with the bacterium known as vibrio cholerae. The disease has a short incubation period and produces a toxin that causes continuous watery diarrhoea, a condition that can quickly lead to severe dehydration and death if treatment is not administered promptly. Vomiting also occurs in most patients.

Women carry jerry cans of chlorinated water which is being used to help eliminate cholera

On the eve of the second anniversary of the terrible earthquake that devastated our country, marked progress has been made toward reconstruction, but much remains to be done.

While cholera no longer poses a threat to countries with high standards of hygiene, it remains a challenge in countries with limited access to safe drinking water and adequate sanitation.

PAHO Director Mirta Roses discussed the misconceptions surrounding the provision of water and sanitation, mainly that it is seen as expensive, and emphasized that the costs of not investing in these services is much higher as evidenced by the thousands of people who have died in Haiti since the cholera outbreak in October 2010, ten months after it was hit by a devastating earthquake.

Ms. Roses stressed that the right to water and sanitation is an essential human right, making it crucial for governments to strive to provide these services in every sector of society.

Ms. Roses also underscored the importance of water and sanitation as a pre-requisite for sustainable development and economic growth in any country, and warned that ignoring this would leave countries “extremely vulnerable.”

“As we fight with climate change and the scarcity of water, it is even more important to be responsible but also to be equitable in the distribution of this precious resource,” Ms. Roses said, adding that partnerships are also essential to fight the disease as countries shift from cholera control to cholera elimination.

Kevin De Cock, Director of the United States Centers for Disease Control and Prevention’s (CDC) Center for Global Health, echoed Ms. Roses remarks, stressing the role of the infrastructure in preventing the spread of cholera.

He warned that even though fatality rates have decreased because of effective treatment, “there are still 100 to 200 cholera cases daily in Haiti, and we expect surges with the onset of the rainy season.”

Mr. De Cock said that for Haiti to meet the Millennium Development Goals (MDGs), the global development targets with a 2015 deadline, some 250,000 households will need improved water sources, and another 938,000 will require access to improved sanitation.

The Chief of Water Sanitation for the UN Children’s Fund (UNICEF), Sanjay Wijesekera, argued that in addition to investing in infrastructure, an effective strategy that takes into account the various forms of transmissions is needed, as well as education to encourage behavioural change in communities.

Haitian President Michel Joseph Martelly joined the event via video link and reiterated his Government’s commitment to tackle the disease. “On the eve of the second anniversary of the terrible earthquake that devastated our country, marked progress has been made toward reconstruction, but much remains to be done,” he said.

“Safe drinking water and adequate sanitary facilities are the right of every Haitian. Only a joint, comprehensive strategic approach can help us eliminate cholera, which has stricken half a million Haitians and killed thousands.”

The President of the Dominican Republic Leonel Fernández stressed his Government’s willingness to collaborate with Haiti through vaccination programmes and control strategies.

PORT-AU-PRINCE, Haiti—The number of cholera cases seen in the Haitian capital has jumped about threefold in recent weeks, an official with a foreign aid group said Monday.

Pascale Zintzen, deputy head of mission for Doctors Without Borders, said the group’s four treatment centers in the Port-au-Prince metropolitan area have handled as many as 850 cases in a single week lately. That compares with about 250 cases a week more than a month ago.

The rise is largely attributed to the second rainy season of the year, when showers and floods cause the waterborne disease to spread freely in the crowded and unsanitary capital, Zintzen said.

One cholera treatment center in the densely packed Port-au-Prince area of Martissaint has 90 beds for patients but is almost out of space, she said.

“We are not far from it,” Zintzen said by telephone. “We are worried about what we see at the moment.”

Despite the jump in cases, the weekly number is still far below what foreign aid groups saw in the initial peak last November after the disease surfaced a year ago.

Health care workers for Doctors Without Borders treated as many 4,600 patients in one week at its treatment centers in the Port-au-Prince area and about half that number in late May, when the year’s first rainy season kicked in.

There had never been any documented cases of cholera in Haiti until a year ago, when a U.N. peacekeeping battalion from Nepal likely introduced the disease.

Cholera is caused by a bacteria that produces severe diarrhea and is contracted by eating or drinking contaminated food or water. The disease is relatively easy to treat if people can get help in time, but Haiti’s poverty sometimes makes it difficult to find immediate help.

The epidemic has killed more than 6,200 people and sickened nearly 440,000 others, according to Haitian health officials.

Source: http://www.boston.com/news/world/latinamerica/articles/2011/10/10/haiti_group_sees_jump_in_cholera_cases_in_capital/

La Difference Family that lives directly in front of water kiosk

On Sunday the 12th of June, 2011, LGF Haiti joined partners IOM and Green Venues to celebrate the official launch of Haiti’s first joint clean water and recycling initiative in Cite Soleil’s breathtaking community, La Difference.

Self-motivated to create a clean and engaged neighborhood in one of Haiti’s most challenging slums, La Difference celebrated by hosting an afternoon series of spectacular theatrical, musical and dance performances.

Celebratory performance by local dancers

These inspiring young artists channeled a message to promote recycling, cleanliness and water education, and encouraged neighboring communities to do the same.

The ceremony closed with the ribbon cutting of La Difference’s privately-owned potable water kiosk, installed by LGF Haiti.

La Difference Private Potable Water Kiosk, owned and managed by Francois.

And, as members of the community, supporters and friends raised a glass of cold water together, LGF Haiti could not have been more proud to a part of this beautiful initiative.

Haiti Iron Market - Before reconstruction

Designed in Paris in the 1880s, the Iron Market was originally erected in 1890 during a highpoint in Haiti’s economic history by President Florvil Hyppolite and stood as a symbol of Haitian progress until 2008 when it was partially damaged by fire. During the earthquake of 2010, the remaining structure suffered massive damage, dealing a death blow to 120 years of Haitian history.

Over the last eleven months, the Digicel Group, a Caribbean-based mobile phone company operating in Haiti, has been working to restore the Marché en Fer to its original grandeur. The rebuilding project has been funded and spearheaded by Digicel’s Chairman, Denis O’Brien in a personal capacity and is valued at US$12 million. While the project has remained true to the style of the original edifice, pains have been taken to ensure that the structure is built to international safety standards and equipped with all the needs of a 21st century market. This includes numerous ceiling fans to cool down vendors and patrons, electricity for appliances, and concrete stalls with latticed partitions to hang wares.

Haiti Iron Market - After reconstruction

Perhaps most importantly, LifeGivingForce has teamed with Digicel to provide potable water of the highest standard for the entire market. The system installed can produce up to 20,000 liters of water per day and will be delivered to 14 different access points making clean drinking water accessible to all. Power for the pumps, and for all electricity needs of the market place, will come from a solar array of 533 solar panels producing 108KW of electricity, making it the largest solar array in the Caribbean.

Clean drinking water at Marche en Fer - supplied by LGF

The opening ceremony for the Marché en Fer was held on January 11, 2011. Team LGF were lucky enough to be amongst the attendees at the inauguration where Digicel Chairman, Denis O’Brien, the former US President Bill Clinton and the Mayor of Port-au-Prince, Muscadin Jean-Yves Jason, jointly cut the ceremonial ribbon. It is estimated that over 900 vendors will operate from the new building selling arts and crafts, fruit and vegetables, dry produce and beauty products – many of these had stands in the Iron Market for years prior to last year’s earthquake which claimed hundreds of thousands of lives in Port-Au-Prince. LifeGivingForce is proud to be a part of this project as it represents a firm commitment to the rebuilding of Haiti and an opportunity for the citizens of downtown Port-au-Prince to gain access to safe, clean drinking water in a place where they live and work. It’s the first major project to come to completion since the earthquake, so many see it as a symbol of the start of reconstruction in Haiti and a beacon of hope. For us, and for all Haitians, we hope this is a harbinger of things to come.

Digicel Marche en Fer inauguration - Team LGF

The recent cholera outbreak, however, has highlighted the need for long-term potable infrastructure and that emergency water, what aid groups are delivering today, is not sustainable or scalable. Despite the decades of aid and billions now pouring into Haiti, most Haitians do not have access to clean, affordable water. The aid and donor communities need to step up.

But it needs to be done the right way. The right way is NOT to have NGOs provide free water to everyone indefinitely; it’s not sustainable or affordable and does nothing to develop capacity in Haiti. It’s also NOT waiting for the Haitian government to take on a country-wide feasibility study for an infrastructure program.

LifeGivingForce is working with local business people and local leadership (mayors, comité) to setup and run infrastructure for clean, affordable water The infrastructure is run by local businesses and comités in a commercially viable way that makes it sustainable. Donors/NGOs can provide the funding and oversight for the upfront costs of the infrastructure, but Haitians run operations with enough “profit” to make it in everyone’s interest to maintain and grow a system providing clean, affordable water to a much larger proportion of the population that has it now.

For example, in rural areas where there is no clean, affordable water, donors and NGOs can partner with local businesses and local mayors and comités to help finance water purification systems that will last for the next 10-20 years and have the businesses profitably distribute and sell the water at less than 1 gourdes/gallon (currently 1 gourde buys you a small water sachet on the open market). Proceeds from the sale ensure that there is an incentive and the resources to maintain the systems and run manage operations efficiently so that not only is it sustainable, but it will encourage other businesses and local governments to do the same. A mobile phone call costs 1 gourde. Any of you who have been in countryside will see even the poorest owning mobile phones and making calls. 15 goudes/day will allow a family to provide safe, clean water for drinking and cooking (using SPHERE guidelines of 10 liters/person/day for drinking and cooking). This is exactly the model we are deploying now with MINUSTAH-CVR in the SudEst.

In urban slums of Port-au-Prince, 1 gallon of water of dubious quality trucked in from La Plaine sells for 5 gourdes. We can get this down to less than 1 gourde for high quality water, provided through a system operated by local businesses and that requires no trucking. This makes the building and long-term provisioning of water sustainable with an incentive to expand. We are putting a proposal together to do this in the slums of PaP. Eventually, I can see a scalable public-private partnership where equipment is funded by donors, operations are run by businesses based in the slums, and the government regulates the price of water to make it affordable to a population that doesn’t get it now.

There will still be a segment of the population that may not be able to afford even 1 gourde. They can be given vouchers or credits by the NGOs to purchase the quality water from existing vendors once there is enough capacity to provide it. It’s far more efficient that NGOs staffing distribution of free emergency water at high cost forever.

This ground up, market-driven approach to building water infrastructure for everyone may seem slower than a top-down, government-funded approach, but how long have Haitians been waiting for that to happen?

The role of NGOs should be to fund infrastructure setup and oversee programs like the examples above to make it sustainable, scalable, and self-propagating.

The other day I listened to a representative from a NGO on CNN responding to a question about why 9 months after the crisis we’re facing a cholera outbreak. The response was that the group was focused on hygiene and sanitation education. I don’t dispute the importance of that, but telling people that they need to wash their hands and drink clean water when there isn’t anything affordable seems a little disconnected. The response was also indicative of the fact that the majority has been focused on providing temporary aid to those directly affected by the earthquake, not on infrastructure development. That needs to change.