On October 2, 2022, two cases of Vibrio cholerae O1 infection were confirmed in the greater Port-au-Prince area. As of January 3, 2023, >20,000 suspected cholera cases had been reported throughout the country.
What are the implications for public health practice? Multiple factors, including social unrest, have affected public health infrastructure and facilitated cholera resurgence. Although cases have declined, a multipronged approach, including sufficient and timely case management, strengthened surveillance, emergency water treatment, and targeted oral cholera vaccination campaigns are urgently needed.
the infrastructure has never quite recovered from the 2010 earthquake.
And more recently a 2021 earthquake that destroyed much of what was rebuilt. From UNICEF:
Early in the morning of 14 August 2021, a 7.2 magnitude earthquake rocked Haiti, causing hospitals, schools and homes to collapse, claiming hundreds of lives, and leaving communities in crisis. By mid-September, around 650,000 people, including about 260,000 children, were estimated to be in need of humanitarian assistance.
Two reports on the background of the epidemic:
From PBS Newshour:
from WION, an Indian news site.
The prevention of Cholera is fairly straightforward: when we were in Africa, we were instructed about what to do if it hit our area (luckily it did not):
doctors or healthworkers should place patients in local schools etc that had running water since local clinics had few beds, And with IVs and WHO Rehydration fluid, the death rate is much lower than in the past. Stress on washing hands and boiling water, and giving cholera vaccine was done.
One reason our area might not have had the problem: We had village health workers in many small villages to encourage little things like washing hands and boiling drinking water, and we had a well digging project funded by Oxfam to dig wells to provide cleaner water near the villages (that still had to be boiled, but was less contaminated than using river water, and with more water available nearby, washing hands etc. was easier to do).
But if you want health care workers to work in these areas, you need to guarantee them physical safety.
So what is going on in Haiti?
So who was rebuilding the infrastructure? Why aren't locals, especially those with an education, taking jobs helping to rebuild their country?
Answer: Lots of chaos political instablity earthquakes and hurricanes don't help.
To make things worse, many who could rebuild the country, i.e. those with energy and education will flee the country to make a life elsewhere:
from the MiamiHerald July 2022:
The university-educated Philippeson, who is fluent in five languages, is part of a generation of Haitians who have migrated to Brazil, Chile and other South American nations following their country’s devastating 2010 earthquake. After years of living in South America, they decided to make their way north in a treacherous 7,000-mile trek through the road-less jungles of Central America to Mexico in the hopes of living in the U.S...
These educated Haitians could easily find jobs in other countries, but are the tip of the iceburg for what is now a world wide migrant crisis. For exmple:
A recent national survey by the country’s Citizen Observatory for Institutionalization of Democracy found that 82% of Haiti’s nearly 12 million people would migrate if they had the chance.
The deep disenchantment with the country and democracy has been shaped by the volatile nation’s downward spiral over the past six years..
So what is the answer? Send in the marines? The US and UN has done this in the past, and it didn't work.
And often those trying to help become scapegoats for the problems.
For example: Some blamed the failure of rebuilding the infrastucture after the 2010 earthquake many years ago on the Clinton fund scandal, including many in the US Hatian community, but that aid has to be put into the context of the problem of foreign aid in general.
BBC report on the Clinton fund problems gives insight into the problems of foreign aid in general.
A US Government Accountability Office report discovered no hint of wrongdoing, but concluded the IHRC's decisions were "not necessarily aligned with Haitian priorities". Mr Clinton's own office at the UN found 9% of the foreign aid cash went to the Haitian government and 0.6% to local organisations.
The bulk of it went to UN agencies, international aid groups, private contractors and donor countries' own civilian and military agencies. ...
part of the problem:
Jake Johnston, an analyst with the Center for Economic and Policy Research, a nonpartisan group that has studied the quake reconstruction, told the BBC "it's hard to say it's been anything other than a failure".
But he believes the State Department and IHRC simply replicated the mistakes of the whole foreign aid industry by chasing short-term gains instead of building longer-term capacity on the ground.
"They relied too much on outside actors," Mr Johnston says, "and supplanted the role of the Haitian government and domestic producers."
Sigh.
Summary: Do you let efficient, trained, and honest outsiders handle the aid, or encourage and help locals do it, knowing that they are often untrained and alas too often corrupt and so much of the money will be stolen by them or by local gangs?
and now the UKGuardian reports famine is coming.
Read it and weep.
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