Cholera Response and Prevention in Fond-des-Blancs, Haiti Lessons Learned in a Low-Resource Setting Dr. Miliane Clermont Lisa P. Ward St. Boniface Haiti Foundation Fond-des-Blancs, Haiti
SBHF at a Glance Care for the most vulnerable 100,000 patient visits in 2016 Training & Professional Development 350 staff 98% Haitian 200+ surgeries per month 6,500+ prenatal visits per year 25,000+ people vaccinated in 2016
St. Boniface Hospital Largest Referral Hospital in S. Haiti Only functioning NICU for 2.3 million people Only accessible surgical care in S. Haiti National Training Center for MNCH National Center for Spinal Cord Injury and much more
Haiti & Water/Sanitation Access Population: 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 Haiti 2010: 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 Director Response 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 Director Response 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 Health Response Priorities CTC: Handwashing stations, chlorine availability, infection control Community: Utilizing Community Health Workers, Education sessions on prevention, distribution of Aquatabs
Supply Chain Manager Response 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 & Evaluation Establish 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 Initial Outbreak November 2015
Post-Outbreak Ongoing 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 Matthew October 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 Campaign St. 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 later in 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