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Table of Contents
Introduction (1 Feb 23)....................................................................................................................... 2
Is the crisis about over? (1 May 10).......................................................................................... 3
Ways to catch (or not get) Cholera (1 Feb 22) ............................................................................ 4
Vaccination against Cholera (1 Feb 22) ................................................................................... 6
Why not Vaccinate? (1 Feb 23) ............................................................................................ 7
Q: How bad is this going to get? (1 Mar 20)........................................................................... 8
Death Rate cannot be computed due to unknown data (1 Mar 01) ............................... 9
Haiti Population Volume likely to get infected with Cholera ........................................10
What is Cholera? (1 Feb 22) ....................................................................................................11
Medical Professionals (1 Feb 26) ................................................................................................ 13
Cholera arrival in Haiti (1 May 11).............................................................................................. 16
UN independent investigation (1 May 05) ............................................................................18
Other nations beyond Haiti (1 May 16).................................................................................23
1
http://haiti.mphise.net/cholera-faq-development
A: The crisis continues. Medical personnel are over-whelmed. They need more personnel,
funding,2 expertise. Mountain rural communities represent approximately 2/3 of Haiti by
land area and are extremely difficult to access. People in those communities, often die at
rate of 100% of getting the disease, before rest of Haiti learns they need help. The risk of
catching cholera is seasonal, due to lack of good sanitation, combined with rainy seasons. 3
1. Official data from Gov of Haiti, WHO, PAHO, international community, etc. is a
gross under-reporting … check out story from doctors on-the-ground such as:
http://biosurveillance.typepad.com/haiti_operational_biosurv/2010/12/heas-sitrep-
12810.html
2. Government offices are not open 24x7. There can be lags in data flow, reporting,
the data they choose to include in the official reports.
3. People die, and the official data does not know how come they died, unless there is
lab testing, whose facilities capacity lacking. There is more interest in getting medical
aid where needed, than figuring out statistics.
4. Cholera epidemics are usually multi-year phenomenon. In tropical zones like Haiti,
they have two wet season peaks per year. In colder and dryer periods, cholera cases
go down. Haiti will tend to have fall and spring peaks per year for the next three
years and then cholera will become an endemic disease in Haiti.
5. Immunity from the cholera vaccine tends to last about 2 years. The cholera vaccine
is expensive and sufficient units are not available. WHO has approved a vaccine that
is not particularly appropriate for Haiti.
6. Water and sanitation systems still need to be addressed, and cannot be solved rapidly.
7. Even though astronomical funds have been pledged for Haiti, there is a huge
mismatch between promised and needs, resulting in many NGOs running out of
money, and leaving the country.
8. OCHA is the UN agency with mandate for overall coordination of humanitarian aid
to Haiti. OCHA is an unwieldy monster bureaucracy, without the agility needed for
rapidly coping with disasters.4
2 http://reliefweb.int/rw/rwb.nsf/db900sid/KKAA-8EB93P?OpenDocument&rc=2&cc=hti
(Sources: OCHA/Relief Net and Voice of America)
3 http://www.haiti.mphise.net/seasonal-rains-bring-rise-cholera-cases-haiti
http://www.haiti.mphise.net/haitians-rainy-season-looms-bringing-another-wave-cholera
http://www.haiti.mphise.net/fresh-outbreak-cholera-haiti-after-heavy-rains-0
http://haiti.mphise.net/node/1083
4 See my 1 year mini-reviews of how various efforts fared in their efforts to deliver what Haiti needed, for the
Cholera – There are many ways for it to spread. There are a variety of good sanitation
practices to protect against all of these ways.5 The important thing is to be aware of the
different ways it can spread, or a person can catch it, then take preventative actions for all of
them.
You don’t catch it by breathing air of an infected person, or touching them while they are
alive, or touching same objects they touched, you catch it by the bacteria going into your
mouth, then down into your digestive system. However, the way you touch infected people,
and the risk that the objects can be moist for a while, can then mean the bacteria is on your
hands, which you can handle stuff which will later go in your mouth.
Human Carrier: Typically only 25% of the people, who carry the bacteria in their gut,
even show the symptoms, so someone in a region of the world, which has the epidemic,
might travel to a region of the world which does not yet have it. If there is poor sanitation
there, the human waste products (toilet # 2) can get into the food chain to other humans.
Contaminated Water: Food prepared, or washed, using water which has the cholera
bacteria, will deliver the bacteria to whoever eats that food. That water could have been
contaminated by a carrier or marine life. The water needs to be boiled, which may be
impractical in tent cities.
If you bathe in contaminated water, such as a polluted river, and some of it gets into your
mouth, you just caught cholera.
Many Haitians use sources of water which is contaminated, not because of any educational
deficiencies, but because fresh clean water is generally not available in Haiti, except for
people with lots of money.
Marine Life: Cholera bacteria is carried in a variety of plankton and sea food. It can
remain dormant for decades, then “bloom” in the appropriate climate conditions, like those
recently for Haiti. If you use that plankton in salad, and wash it, the washing process only
cleans the outside of the plankton, not the bacteria which is inside.
Animal Carrier: Farm Animals do not get this disease, but they carry the bacteria in their
gut, so if meat is not properly cooked, all sorts of problems can be communicated.
5 http://www.associatedcontent.com/article/6021120/how_to_prevent_and_control_an_outbreak.html?cat=5
Dead Bodies which died of cholera: Someone who has died of cholera is covered
with the vibrio, and anyone touching the body without adequate knowledge about self
protection and good hygiene is at risk of infection!!!!!
During the last moments of life people in the advanced stages of this illness are losing bodily
fluids from intestinal reflux and diarrhea. These bodily fluids contain the vibrio and these
fluids, as well as any other moist surface upon which they are found including the body, are
infectious until that body is properly disinfected and all external orfices to the
gastrointestinal system 'plugged' with chlorine saturated rags/sponges. Any one touching or
otherwise handling that body is subject to contamination and infection.
The clothes, bedding, floors, and all surfaces upon which these bodily fluids are found are
sources of infection!!!
Investigation of several cases during this outbreak including the very first clinical cases in
Lafito, revealed that the victims had not traveled to or within an area where cholera was
being reported, their only connection was that they had attended a funeral ceremony for a
cholera victim, shortly before becoming infected, and had laid hands on the body.
A pandemic is when a disease is in multiple nations. The problem which exploded in Haiti
in middle of October 2010 is now also in patients in Dominican Republic, Venezuela, USA,
and other nations, so by definition it is a pandemic. It is not yet proven what relation the
Haiti problem has to cholera disasters in Nigeria, Zimbabwe, and other nations, but the fact
remains that several nations already have a problem with cholera, and there is high risk of it
spreading to more nations.
However, the authorities are still labeling this as an epidemic or outbreak, which means the
volume of people catching the thing is way in excess of what would normally be considered
reasonable.
Q: The patients in Dominican Republic and USA are under the care of doctors, so it is not
yet a problem there, right?
A: For every one person with the symptoms, there are three other people on average who
are carrying it, but show no symptoms.
A: If a person has recently handled moist bedding of a person who died of cholera, and not
disinfected self afterwards, then their hands carry the cholera bacteria, so shaking hands can
then have both persons have it, then if either puts their hand to their mouth, they got it.
Q: If a person has cholera bacteria on their hands, and they use a door knob, is the bacteria
still on the door knob ready to be transferred to another person?
A: Many bacteria can be communicated that way, such as SARS, but when the moisture goes
away, which is needed as a carrier for cholera bacteria, it also dies. As a general rule, all
surfaces which are often touched by multiple people, such as telephone handsets, door
knobs, cooking utensils, they all should be regularly either cleaned or disinfected or both.
Q: If a person visits toilet of a commercial airliner, who has cholera, then someone else uses
same toilet, can they catch cholera by sitting on the infected toilet seat?
A: Cholera is transmitted to a body through the mouth. With proper sanitation, hand
washing etc. you should be safe from this kind of threat.
A: All travelers to areas where cholera has occurred should observe the following
recommendations:
Drink only water that you have boiled or treated with chlorine or iodine. Other safe
beverages include tea and coffee made with boiled water and carbonated, bottled
beverages with no ice.
Eat only foods that have been thoroughly cooked and are still hot, or fruit that you
have peeled yourself.
Avoid undercooked or raw fish or shellfish, including ceviche.
Make sure all vegetables are cooked, avoid salads.
Avoid foods and beverages from street vendors.
Do not bring perishable seafood back to the United States.
A simple rule of thumb is "Boil it, cook it, peel it, or forget it."
There is stuff which can be put in the water supply to kill the bacteria, which has been used
successfully in other nations, if I am to believe everything I read. But this suffers from the
“not invented here” syndrome of the oligarchy of international interests in charge in Haiti.
There are people who want to test the “put in water” solutions, but they have been unable to
get funding or approval to do this in Haiti.
India has an oral vaccine, which Bangladesh is using in the largest cholera fighting
experiment in history, so far.7 The study includes 240,000 people from one of Dhaka’s
poorest suburbs, Mirpur, two-thirds of whom will receive two doses of the cheap, Indian-
made vaccine. The remaining 80,000 people will not be given the vaccine as the control
group. Both groups will be monitored for the next four years.
Russia has a vaccine which they have offered to Haiti, but apparently the offer is being
ignored.
Bio-surveillance checked rumors regarding some medicines being less effective than others.
Thanks to Haitian officials' rapid response to their inquiry, the National Laboratory
(LNSP) has officially confirmed the Haiti strain is not resistant to doxycycline. It
is sensitive to doxycycline, cipro, and cotrimoxizole but resistant to ampicillian
and bactrim.
1) The effectiveness of the cholera vaccine has been debated. It is less effective with the
chronically malnourished. If those inoculated with the vaccine are not able to only drink
6 http://www.haiti.mphise.net/dennis-chao-model-cholera-vaccination-haiti
7 http://vaccinenewsdaily.com/news/233583-bangladesh-begins-worlds-largest-cholera-vaccine-trial
A: No one knows.
Many people speculate. A study by the University of California, San Francisco (UCSF) and
the Harvard Medical School,8 released 2011 March 16, estimates the number of cases could
reach up to 779,000 between March and November of 2011..
Sanitation in Haiti has been a disaster area, since long before the 2010 January earthquake.
That is one of the primary causes, in Haiti, for the spread of this disease. Solving that could
take years.
There is a public relations problem with many people seeking to nail down death rate and
other statistics, which detracts from the need to emphasize what is missing from support for
medical professionals, and other people, trying to mitigate this disaster. If that support was
superior, then the spread of the disease would not be as catastrophic as it has been. 9
Unfortunately a large number of medical researchers, outside of Haiti reality, are doing their
analysis based only on the official incomplete reports. 10
8 http://www.topnews.in/usa/cholera-epidemic-haiti-may-exceed-un-projections-study-28373
9 http://www.associatedcontent.com/article/6122776/cholera_epidemic_in_haiti_what_did.html?cat=5
10 Here is an example of a wonderful effort, using seriously incomplete data sets.
http://www.annals.org/content/early/2011/03/07/0003-4819-154-9-201105030-00334?aimhp
Several people have asked me to fact check some of my shared info, but Haiti does not do a
good job of keeping track how many people have died, what they died of, and this disease is
one where many people are carriers without showing the symptoms.
No one knows how many people have caught the disease, or how many have died, so there
can only be projections based on what is known.
Although the death rate is around 2% with what is in the official figures, it is largely known
that official figures are hugely under-reported.11 It is just not known how many people have
died from this, who never got into the official figures.
In the early stages of this epidemic, up to one in ten people with symptoms dies, in areas
with poor access to good medical care which is informed about cholera treatment and has
the appropriate medical supplies. More than half, who die, do so before they can get to a
hospital. This is one of the reasons that the death rate is much higher in rural and mountain
areas, than where it is more practical to get to medical facilities.12 There could be people
dead who no one knows they were trying to get to a hospital.
In Haiti villages where the disease first strikes, usually 100% of the initial victims die, until
quality medical care finds out they have the problem, and gets there. Then the death rate
drops to 20-40%, then drops more.
The historic case fatality for cholera case around the world (showing up mostly in
developing countries) has been around 2%. Good medical care systems can reduce the
case fatality rate to near 0. However, this current epidemic in Haiti is showing far worse
outcomes than most.
Officially, there have been over 4,000 deaths in the first three months of the epidemic in
Haiti. Unofficially, the numbers are probably over 7,000. Compare this to 1,500 deaths
in Ecuador over three years. This may be partly from the greater virulence of the 01
Ogawa strain. But that does not explain everything.
Poor nutrition. Poor water systems. Co-morbidities. High burden of illness and high
social burden are also factors.
11http://biosurveillance.typepad.com/haiti_operational_biosurv/2010/12/heas-sitrep-12810.html
12National mortality rates from cholera are down to 2 percent, from as high as 9 percent earlier, but in some
rural areas, more than one-in-ten people who contract the disease die.
In Haiti's Sud Est region, the mortality rate hit 10.7 percent as of 2011 Feb. 9, while in Nippes it was 6.7
percent and in the Grande Anse region, 5.9 percent.
http://www.google.com/hostednews/ap/article/ALeqM5iZdt_XRYLIGJXA-
nf0QEryGs40ew?docId=d5e68b358385450c8de8e6b2a67f623a
In other nations with cholera epidemics, maybe 2% of the population got the disease. How
many people in Haiti? 9 million … 2% of that is 180 thousand.
But early in 2011, we are already above 200,000 known victims in the official statistics.
If you figure the 1 million plus people in the tent cities, and wooden shack towns, have very
bad sanitation, and the ¾ million who escaped Port au Prince early on to rural areas, but got
malnutritioned, the aftermath of earthquake made Haiti more vulnerable to this kind of
thing.
while Haiti has about 12, 000 cases and 796 deaths in less than a month (1/12 of a year).
1. There is a lag in data getting to official records, such that the actual rate of sickness
and death is approx four times the official records. Thus, if official story says 1,000
people dead, the truth is closer to 4,000 people dead.
2. For every one person who shows symptoms, another three have the disease but are
not sick, so multiply by four again how many are infected. Thus if official story says
10,000 people got the disease, the truth is closer to 160,000.
A: Yes, first of all children and elderly are more vulnerable than middle aged.
Second, people who have been malnutritioned due to aftermath of prior disasters, are in a
weakened state, vs. any diseases.
Third the mean population with type O blood, the most susceptible to cholera, is about 4%.
With 1 and 1/2 one million people living in squalid conditions, that puts maybe 60,000
A. Check out what Senator Bill Frist, an MD has to say, based on the information he has
received so far.
Remember that the aftermath of the earthquake was made worse thanks to serious damage
to Haiti civil service killed in collapsed government buildings. What do you suppose will
happen to the quality of service to the people of Haiti when government officials start dying
of cholera?
Q: What is cholera?
A: Lots of Internet sites answer this question. Check out some of the following:
http://renewal4haiti.org/Cholera
Wikipedia http://en.wikipedia.org/wiki/Cholera
Officials say transmission between people is rare. However, some deaths in Haiti have been
traced to the scenario of cholera infected persons being touched by persons who were
otherwise healthy before they did so. There have also been cases of a person, who died of
cholera, being touched at a funeral by people who were infected in the process. The issue is
a lack of education how to be around a sick person, without getting contaminated with their
disease.
A: Lots of Internet sites answer this question. Check out some of the following:
http://www.cdc.gov/nczved/divisions/dfbmd/diseases/cholera/
http://haiti.mphise.net/meet-dr-kesler-dalmacy-and-dr-marie-ange-d-tardieu
Q: If I refrain from getting close to anyone who has the cholera symptoms, will I be
safe?
A: Short answer ... No, because many people carry the bacteria without showing the
symptoms.
At the present time, most people who are “passing” the bacteria look just like anyone else.
Haiti sanitation is a disaster area. You can catch it many ways thanks to people who have
the bacteria but are not currently sick, and thanks to environmental issues.
Human victims do not show the symptoms for 1-4 days, after the bacteria in person’s food
or water consumed, but they are passing the disease on to other people. After symptoms
first appear, the victim could be dead in 1 hour to 2 days, so getting more liquids into
someone with the symptoms is absolutely critical to save them.
It has been reported that once a person is infected by this vibrio that they may shed it back
into their environment for four to six weeks. So the hospital makes the symptoms go away,
and once again they are infecting their community.
A: All suspected cases of cholera anywhere in Haiti must be immediately reported to the
following surveillance numbers:
37019136, 37019135.
For urgent cases which do not have transport, partners should call
34827636 / 38515331.
If deaths occur in camps, partners should call 38799177.
If you are a medical worker in Haiti, and you treat a suspected case of Cholera, many medical
authorities want to be informed PDQ by you. You can report it to HEAS using this form.
If you are working to help victims of cholera, with medical services or water sanitation,
your organization is URGENTLY requested to contact the relevant GoH
ministry and UN cluster, so that your efforts can be coordinated with other NGOs working
this crisis. Your failure, to make contact with them, to help them coordinate NGOs into a
team effort, could cost lives. Their failure to make use of your services is also a risk.
Q: When we have a developing crisis with more patients needs for medical personnel or
medical supplies than our clinic has available, where do we go for help?
A: Your people should already have a liason with HEAS. If not, join HEAS immediately,
and communicate your needs to Jim Wilson, MD iceaxe5@gmail.com
If you are in USA, also contact IMAT which sends medical teams to Haiti on a regular basis.
If you are in CANADA, contact CMAT which regularly sends medical teams to Haiti.
Q: How or where can medical professionals (and other people) learn latest health and
sanitation needs with Haiti cholera epidemic?
http://haiti.mphise.net/guide-navigating-haiti-aid-un-clusters
This document is also available on Scribd under account of AlMac99, and other places.
Revised editions will also get periodically uploaded.
From there, add to your bookmarks: (As you visit each site, note many have links to other
relevant places which you may wish to bookmark also.)
Join Haiti Epidemic Advisory System. (HEAS) This group is getting traffic from
medical personnel on the ground all over Haiti … where specific help is needed –
personnel, answers, supplies … and progress delivering it.
Setup your RSS news reader to subscribe to new posts as they arrive on the Haiti
Operational Bio-Surveillance site.
Humanitarian Haiti has this tab just for Cholera Response. When you get to
Humanitarian Haiti, also check the other tabs, particularly the list of clusters. You
want to visit, and bookmark the ones on Health-Medical, and WASH (Water
Sanitation Hygiene).
Pan American Health Organization (PAHO) multiple pages on situations in Haiti, such
as http://new.paho.org/disasters/?lang=en
Check Government of Haiti relevant sites like Cholera statistics by section communal
available on the medical ministry MSPP websites http://www.mspp.gouv.ht and
http://www.mspp.gouv.ht/site/index.php French
Also review the text (if any) surrounding my mention of those sites, and what you see when
you visit, to determine which of them will be most critical for you to follow.
November 23, USAID reported that WHO and PAHO massively disseminated their oral
rehydration posters, throughout November HEAS
noted that the 1:3 ratio was incorrect and also that the make-up volume should be a liter, not
a gallon. Experts advised that administering a too-dilute solution could cause hyponatremia.
hyponatremia has been suggested as a possible cause of some recent cases of paralysis in
Haitian receiving treatment for cholera.
January 19, CCCM's [Cluster for Camp Coordination Management] situation Report at
http://www.cccmhaiti.info/page.php?id=41 stated "CCCM partners are raising their
concern regarding the coming "carnival" season [March 6-8], due to the expected movement
of population, which could cause a major spread of the disease," and recommended for
Leogane and Gressier, "...Provide some sensitization flyers (poster and flyers from
WHO/PAHO)...."
Q: What do the medical professionals working the Haiti cholera crisis most need which they
do not already have access to?
A: Multiple areas.
Welcome at Haiti ports of entry, to make sure new additions to the overall work force are
aware of HEAS and related resources, officialdom registration requirements.
Gov of Haiti to relax border crossing taxation and other hold-ups for products intended to
save Haitian lives.
Different organizations which have collected medical data base info on NGOs working the
crisis, to share their info.
Q: How on earth did Cholera get into Haiti in the first place, and what can be done
about that?
A: In the absence of credible scientific evidence, there is only speculation and inference how
it got there.14 For example, here is the Estuary Theory:15
Cholera in Florida in 2011 was traced to Apalachicola Bay oysters, where tropical storms can
help distribute the problem over a wider area.16
14Is cholera caused just as much by environment, hydrology and weather patterns as by poor sanitation?
http://www.circleofblue.org/waternews/2011/the-stream/the-stream-february-22-cholera-and-climate/
15
http://haiti.mphise.net/estuary-theory
from the Gulf of Mexico due to tectonic shifts resulting from the earthquake;
evolved into disease-causing strains from non-pathogenic strains naturally present in
Haiti;
or originated from a human host who inadvertently introduced the strain into the
Haitian environment.
Q: But didn’t the Nepal peacekeepers bring cholera with them from Nepal, then conduct
their sanitation in a criminally reckless manner?
A: That is an accusation theory which may not yet been proven in either a scientifically
credible manner,18 or in a way which would stand up in a court of law, assuming there is any
court which has relevant jurisdiction. The circumstantial evidence published in the news
media so far, could just as easily be interpreted to say that the Nepal peacekeepers who went
home from Haiti, caught it in Haiti, then returned it to their native land. If I was on the jury
of a trial of either accusation, I would have to rule that the investigators have so far failed to
prove their theories. For example, I see a news photo of a truck driver doing inappropriate
dumping. Nowhere in that media is there any proof that this was ordered by UN, by Nepal,
by Gov of Haiti, by anyone else. The truck and the driver are effectively anonymous
individuals.
Various officials, who ought to know what they are talking about, have made various
statements on various sides of these allegations. According to Monsters and Critics,
Sweden's ambassador to Haiti, Claes Hammar, was reported Wednesday Nov-17 to have
confirmed that the cholera came from Nepal.
17 http://www.haiti.mphise.net/node/1055
18 http://www.cidrap.umn.edu/cidrap/content/other/news/may0911cholera-br.html
The strongest conclusion was that the origin was highly-infectious human wastes going into
a tributary of the Artibonite river, near Meille, upstream of Mirebalais, from one or more
Nepalese soldiers at a peacekeeping base there. By deduction, the soldier(s) must have had
full-blown cholera to have excreted enough organisms to have so highly-contaminated the
river that serious and almost immediate infection was transmitted to Haitians who happened
to drink that water just at the time that the slug of microorganisms were passing by in the
river.
Of significance is that the investigators, appearing on the scene within days of the outbreak -
the exact dates and locations were not given in the report - did not find cholera in the river.
Their inference is that there may have been only a single incidence of infectious sewage
overflow or dumping from the peacekeeping base and, from that point, the river flow greatly
diluted the concentration of organisms below Meille, i.e. after a few miles.
Thus, they conclude, the cholera spread first from humans into the river, then into a few
residents who drank the water - in the wrong place, at the wrong time - and got sick, then
from some of them to others, then throughout the country as Haitians fled from the area,
and as their own contaminated diarrhea spread through the environment, to be ingested
from cholera-contaminated food, water and excreta and further spread by subsequently-
infected people.
In one of them, the Secretary-General of the United Nations formed an Independent Panel
of four international experts (the “Independent Panel”), with a mandate to “investigate and
seek to determine the source of the 2010 cholera outbreak in Haiti.” 21
Warning, the UN also has a bad habit of perpetually copying incorrect information. At
the front of the report is a graphic regarding Cholera treatment, which is famous thanks to
the astronomical number of times medical people have brought to authorities attention the
fact that the dosages are incorrect, due to translation errors, the authorities have said thank
you, then continued using the bad information.26 In a few cases, top management of
authorities, treat reports of mistakes by authorities not as reason to fix the mistakes, but to
punish the whistle blowers who tried to help the authorities fix the mistakes.
Much of my grievances are due to the fact that the UN delayed this investigation
until a lot of evidence no longer available. This is like the police waiting until a year
after a bank robbery to investigate it, when all the security tapes are gone, the
fingerprints gone, different employees now working at the bank, memories faded.
In the aftermath of the Cholera epidemic, there was a dramatic shift in Haitian eating
habits. For example, since it was believed the Arbonite river was contaminated, and
since it overflowed its banks during flooding, many Haitians no longer wanted
agricultural products from that area. For UN investigators to determine what
Haitians are eating, six months later, and then say that since they not eating food
from the Arbonite river now, they never did so, that is a misleading conclusion.
MPHISE-HEAS has shared reports from hospitals which treated Cholera cases, with
what info was known about the first patients seen by those hospitals, showing first
cases before dates in this UN report. Maybe the UN investigators did not speak with
the people who developed those reports, or had access to those records.
There is enormous turnover of medical personnel working different places in Haiti,
due to the Republic of NGOs dropping medical support when funds run out, and
having volunteers come and go all the time. It may be impossible to identify all
relevant medical staff, but limiting interviews to whoever is there 7 months after the
incidents is a guarantee of not getting a good picture.
21 http://www.haiti.mphise.net/node/1055
22 http://www.un.org/News/dh/infocus/haiti/UN-cholera-report-final.pdf
23 http://www.haitianinternet.com/articles.php/836
http://www.haitilibre.com/en/news-2875-haiti-cholera-report-of-the-experts-on-the-origin-of-the-
epidemic.html
24 There is also risk that higher up UN authorities could scrap this report, if they do not like some of its
content.
25 I named my copy “Cholera Source 2011 May 04 UN ”
26 http://haiti.mphise.net/leiderman-heas-department-perpetual-errors
http://haiti.mphise.net/feedback-request-creole-ors-poster
What this May-04 UN report has to say for itself: The timeline suggests that the outbreak
spread along the Artibonite River, with first cases in Mirebalais.
After establishing that the cases began in the upper reaches of the Artibonite River, potential
sources of contamination that could have initiated the outbreak were investigated.
MINUSTAH29 contracts with an outside contractor to handle human fecal waste. The
sanitation conditions at the Mirebalais MINUSTAH camp were not sufficient to prevent
fecal contamination of the Meye Tributary System of the Artibonite River. Water in the
Meye Tributary System reaches the Artibonite River junction in less than 8 hours, and flows
downstream in another 1-2 days to a dam and canal system widely used for irrigation
throughout the Artibonite River Delta.
27 My research notes “Haiti Cholera 2010 Oct” has raw info as it came out, about the epidemic which
apparently started Oct 2010 in Haiti, rather repetitive as each day bits of new info added to a repository of
known so far.
28 I might not have a copy of that precise report, but I have downloaded multiple reports right around that date
from PAHO ECO, OCHA, WASH, and many of them repeat same info with latest day’s updates. See “Al
docs” directory in the Sitrep section, dated around then.
29 MINUSTAH = UN peacekeepers in Haiti.
1) the outbreak strains in Haiti are genetically identical, indicating a single source for the
Haiti outbreak; and,
2) the bacteria is very similar, but not identical, to the South Asian strains of cholera
currently circulating in Asia, confirming that the Haitian cholera bacteria did not originate
from the native environs of Haiti.
These research findings indicate that the 2010 Haiti cholera outbreak was caused by bacteria
introduced into Haiti as a result of human activity; more specifically by the contamination of
the Meye Tributary System of the Artibonite River with a pathogenic strain of the current
South Asian type Vibrio cholerae.
the widespread use of river water for washing, bathing, drinking, and recreation;
regular exposure of agricultural workers to irrigation water from the Artibonite
River;
the salinity gradient in the Artibonite River Delta, which provided optimal
environmental conditions for rapid proliferation of Vibrio cholerae;
the lack of immunity of the Haitian population to cholera;
the poor water and sanitation conditions in Haiti;
the migration of infected individuals to home communities and treatment centers;
the fact that the South Asian type Vibrio cholerae strain that caused the outbreak
causes a more severe diarrhea due to the larger production of the more potent
classical type of cholera toxin;
and, the conditions in which cholera patients were initially treated in medical
facilities did not prevent the spread of the disease to other patients or to the health
workers.
The Independent Panel concludes that the Haiti cholera outbreak was caused by the
confluence of circumstances as described above, and was not the fault of, or deliberate
1) The Haiti cholera outbreak highlights the risk of transmitting cholera during mobilization
of population for emergency response. To prevent introduction of cholera into non-endemic
countries, United Nations personnel and emergency responders traveling from cholera
endemic areas should either receive a prophylactic dose of appropriate antibiotics before
departure or be screened with a sensitive method to confirm absence of asymptomatic
carriage of Vibrio cholerae, or both.
4) To improve case management and decrease the cholera case fatality rate, United Nations
agencies should take stewardship in:
a) Training health workers, especially at the treatment center level;
b) Scaling-up the availability and use of oral rehydration salts at the household and
community level in order to prevent deaths before arrival at treatment centers; and,
c) Implementing appropriate measures (including the use of cholera cots) to reduce the risk
of intra-facility transmission of cholera to health staff, relatives, and other patients.
5) To prevent the spread of cholera, the United Nations and the Government of Haiti
should prioritize investment in piped, treated drinking water supplies and improved
sanitation throughout Haiti. Until such time as water supply and sanitation infrastructure is
established:
a) Programs to treat water at the household or community level with chlorine or other
effective systems, handwashing with soap, and safe disposal of fecal waste should be
developed and/or expanded; and,
b) Safe drinking water supplies should continue to be delivered and fecal waste should be
collected and safely disposed of in areas of high population density, such as the spontaneous
settlement camps.
6) The international community should investigate the potential for using vaccines reactively
after the onset of an outbreak to reduce cholera caseload and spread of the disease.
(click on the link below for the full 32 page report - PDF file)
http://www.un.org/News/dh/infocus/haiti/UN-cholera-report-final.pdf
Q: What is significance of whether Haiti had cholera 50 years ago or 100 years ago?
1. Because cholera has not been in Haiti for several generations, there are no local
immunities to the disease. Vulnerabilities are maximized.
2. It feeds into conspiracy theories how the disease just appeared in Haiti seemingly
out of no-where. Many people believe there must be a patient zero, someone who
knowingly, or unknowingly, delivered the deadly disease to Haiti. But the science of
investigations with other nations cholera outbreaks is such that we usually cannot
figure out definitively how it happened. There are suspects, there is evidence, but no
absolute proof.
Haiti Libre reports suspected cases in Dominican Republic Nov-9, then a week later
officialdom reports confirmed case.
A woman returning to Florida from Haiti has been diagnosed with Cholera, according to
multiple US news media - Al Mac first saw these stories Nov 18. There have been scattered
reports of other returnees from Haiti, bringing back infections.30
There has been a lot of news media coverage of a wedding party in the Dominican Republic
which served poorly cooked lobster from Haiti, which sickened dozens of people, and then
they carried cholera to Venezuela, USA, and other nations, whose good sanitation mitigated
risk of much more spread, but did not stop it entirely.31
30 http://www.associatedcontent.com/article/7749440/haitian_cholera_epidemic_slows_spreads.html
31 http://online.wsj.com/article/BT-CO-20110209-720304.html
14 dead
16 currently hospitalized
750 cases so far
Q: Let’s suppose for the sake of argument that humanitarian workers go to one nation that
has some horrible disease, they catch it but do not show the symptoms, travel to another
nation, and now both nations have the disease. How do we prevent this?
Q: Fighting cholera is very serious business, so why are some people apparently
behaving irrationally?
A: In history, we know that certain diseases have caused humongous deaths, and high death
rates among victims, so certain words like "Cholera, Ebola, Plague, Typhoid" tend to incite
extreme fear and panic, irrespective of advances in medical and other sciences.
In Haiti, there are some other words, and actors, which incite similar emotions.
For whatever reasons, many poor people in Haiti have come to distrust the UN military, and
international community, so many believe the conspiracy theory that cholera was deliberately
introduced into their nation as a form of biowar.
32 http://www.defend.ht/world/articles/caribbean/996-dominican-government-declares-cholera-state-of-alert
http://www.google.com/hostednews/canadianpress/article/ALeqM5jDM0jPI-
CYEnvIe8E8QX8Uc039Yg?docId=6867566
http://www.bbc.co.uk/news/world-latin-america-13424941
33 http://www.youtube.com/watch?v=SsjsMFx_4NU&sns=tw
A. The one in St Marc went in open air tents in a soccer field across the street from a school,
without first consulting or educating the local community, because time was of the essence
to save lives of patients. Parents in panic, think their children could catch it. Community
loss of recreational facilities. UN military provides security. Many obvious reasons when
you realize lots of general public do not have good understanding of how people catch
cholera.
Elsewhere in Haiti, people who do not know how cholera is communicated to other people,
they fear infection from these treatment facilities getting into local communities, so they do
not want one in their community.
No one wants a prison in their back yard – the criminals might escape.
No one wants a serious disease facility in their community – the disease might get out.
No one wants a heavily polluting industry near where they live – the pollution could hurt
them.
Q: Could the hydro-electric oil leak into Arbonite river be the source of the cholera?
Q: Various government officials around the world have been stating where the Cholera came
from to Haiti, at the same time as people involved with relevant labs have been asking for
relevant samples so they can figure this out. Where do the government officials
get their info, if the labs do not yet have the evidence?
A: The government has a responsibility to reassure the people, even if they do not yet have
credible info to provide good facts. This is one reason why, when they do have credible
info, some people do not believe what they have to say.
Even though SOME labs ask for cooperation through HEAS, that does not mean that ALL
labs have failed to get what they need. Some conduct their info with confidentiality. It is
possible that the government gets its info from secret labs.
Q: What people ought to be panicking over is not solving the mystery of where the Cholera
came from, but how to protect the mass of poor people in the tent city camps from a variety
of threats, including hurricanes. UN leadership has said that most of these people must
A: We do not know. We are stuck with the builders saying “Trust us, we know what we are
doing, you do not need any certification whatsoever from experts in building safety.”
The alert system was introduced in November in support of the MSPP in the
collection, verification and response to urgent warnings of cholera in Haiti. The
alert system has provided additional data from national epidemiological
surveillance system by providing qualitative information allowing a better analysis
of data and thus better guide the required response.
The system has demonstrated its ability to detect not only early warning of
cholera but also for other situations of risk to public health requiring rapid
response. For example, the system detected in various Departments of
aggregates of suspected cases of acute flaccid paralysis, and poisoning by
methanol.
It is important and a priority to strengthen the system and integrate it into the
surveillance system at both national and departmental levels. Developing a
warning system with the involvement of all partners on the ground allow early
detection of situations that pose a potential risk to public health. The
mechanisms for transmitting information at municipal level and county will be
defined in terms of existing resources in each department (health workers,
community brigades, CASEC, etc.).
2.1. The warning system and immediate response from PAHO / WHO should
be maintained, while adjusting to changing circumstances.
2.2. Cuban brigades active research should continue their work by integrating, as
expected, health personnel Haitien.
2.3. Staff and Community brigades CASEC ASEC should continue to play a role
in the alert of cases and deaths in their demographic and geographic areas.
6. Proceed with the implementation of the program of social protection and access
to basic health services, including the management of cholera with a system of
resource allocation based on the activities demonstrated