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Jamaica, Cuba, the UK sending medical teams

The big news of the week is FINALLY the world appears to be taking notice that cholera is rampaging through Haiti, and direct, hands-on, medical help is needed. While significant money has been pledged to Haiti, the direct funding and deployment of organized medical teams into Haiti to respond to the cholera outbreak has been lacking. This is beginning to change. On Monday, Jamaica announced they are standing up and deploying a medical team and support into Haiti. On Saturday Fidel Castro announced Cuba will be sending another 300 to increase their medical brigade to nearly1300 in Haiti. Also on Saturday, the UK has pledged support for 1775 people (115 doctors, 920 nurses and 740 support staff), and supplies, funded by UK taxpayers, to combat cholera in Haiti.

On November 25th, The Wall Street Journal online published an article bringing the situation into focus:  Cholera Spreading in Haiti Faster Than Thought

Officially, the disease had sickened 66,593 people and killed 1,523 as of Monday, according to the Ministry of Health. But the real number of cases is likely much higher, health officials acknowledge, partly because the systems used to count the ill aren't capturing every nonhospitalized case. Cholera is spread through contaminated water and food, and officials had predicted it would move around the country quickly because sanitation is poor and clean water is lacking.”
Quoting Nigel Fisher, UN Humanitarian Coordinator in Haiti, saying more resources are needed to combat the epidemic,"Funds are an element but not the only element," he said. "We have to be able to support a massive communication response. We've asked other international agencies, 'if you have resources for next year, reallocate them to cholera now and to take their capacities outside of Port-au-Prince,'" where most of the resources are concentrated.

Early in the month, the UN sent out an appeal by the world body for $164 million to fund a scaled-up cholera response. Aljazeera reported on Nov 21
 the UN Office for Co-ordination of Humanitarian Affairs (OCHA) said that as of mid Novembers it had received only $5m of the total amount the UN had appealed to governments for, in order to fight the outbreak.

Nigel Fisher, the UN's humanitarian co-ordinator in the country, said: "While we are very grateful for the contributions received so far, both cash and in-kind, so far we only have received less than 10 per cent of what we need. Critical supplies and skills are urgently needed. We need doctors, nurses, water purification systems, chlorine tablets, soap, oral rehydration salts, tents for cholera treatment centres and a range of other supplies."

Speaking to Al Jazeera, Imogen Wall, a spokeswoman for the OCHA in Port-au-Prince, the capital, said  that the response to date had been “completely inadequate”, and went on to say,"I think we still need to make people understand how serious this is. We're looking at potentially up to 200,000 cases in a country that cannot cope, a population with no resistance, a health profession that doesn't know how to deal with this. I think it's just very hard to make people understand just how serious it is and vulnerable these people are to a terrible but very, very treatable disease."

On Monday, November 22, Jamaica’s Prime Minister Bruce Golding gave instructions for a team of medical and support personnel to be mobilized to deploy to Haiti in response to the cholera epidemic. In addition to the medical team, medical supplies and water treatment applications, the contingent will include Jamaica Defence Force (JDF) personnel and security. As reported in the online news source, a statement from the Office of the Prime Minister said

“Jamaican government will be working closely with other CARICOM (Caribbean Community) governments and international agencies to contain and defeat the cholera epidemic which is not only a cause for alarm in Haiti but a threat to the entire region and, in particular, Jamaica because of its close proximity”. 

The 360 article also notes that Jamaica is on alert to prevent cholera from coming in. Surveillance and response procedures are already in place at the island’s airports to keep a watch out for those who have recently been in Haiti or who display cholera-related symptoms. Additionally, The Prime Minister has instructed the JDF and the Maritime Police to intensify their surveillance to intercept boat traffic between Haiti and Jamaica, to ensure that the necessary test and quarantine procedures are fully enforced in relation to persons arriving in Jamaica from Haiti.

On Tuesday November 23, Valerie Amos, the U.N.’s Undersecretary-General for Humanitarian Affairs spoke in PaP, reportedly saying “We clearly need to do more.” An article in Guyanas Stabroek News  quotes Amos as saying: “it’s not just money, it’s crucially people, in terms of getting more doctors, nurses, more people who can help with the awareness-raising and getting information out there. We have to control the outbreak and we have to bring down  the percentage of people who are dying and we have to do that  as a matter of urgency. I’m being told it hasn’t reached its peak yet, that it will get worse before it gets better.” Intent on keeping the world aware of what is going on in Haiti now, "I will go back with a set of very clear action points …  talking to member states, talking to partner organizations and  saying very clearly to them we’re not doing enough, we have to  do more,” she said.

On November 24th, two press releases came out. One from UN OCHA, the other from the World Bank. 

More treatment infrastructure, burial sites, and facilities to dispose of human waste are
needed. There is a lack of understanding and awareness of this disease by many Haitians,
despite a nationwide information campaign. A massive scale-up of prevention and
awareness raising activities is needed. At least 30,000 community health workers and
volunteers need to be given the messages and materials to reach people.
There is also a desperate lack of trained health workers and supplies for this response.
The Pan-American Health Organization (PAHO) estimates over 350 doctors, over 2,000
nurses and over 2,200 additional support staff are needed for the next three months. The
ongoing national and international responses need to spread much further outside the
capital Port-au-Prince. Currently only around 10% of households outside the capital are
estimated to be getting access to soap and clean water.
There are also supply gaps which need to be filled. Oral rehydration salts, water
purification tablets, chlorine, body bags, medical supplies, soap, latrines and other
supplies are in short supply. Some 4 million water purification tablets and 11,000 bars of
soap are needed just in Port-au-Prince and just for the next two weeks.

The World Bank press release announced a US $10 million Cholera Emergency Grant,  as part of their $479 million reconstruction support.

The US$10 million grant will bolster the surveillance and monitoring capacity of the Ministry of Public Health and Population (MSPP) and the Haitian National Directorate of Water Supply and Sanitation (DINEPA). The initiative is aligned with the Cholera Inter-Sector Response Strategic Plan for Haiti, under the leadership of MSPP and DINEPA.
The grant will also finance the work of nongovernmental organizations (NGOs) to improve access to clean water, provide basic health services for affected populations and vulnerable groups, as well as safe sanitation and waste management in high risk areas.

Alexandre Abrantes, the World Bank Special Envoy to Haiti offers  “The new grant will be used to contract experienced NGOs for immediate cholera response activities and strengthen the capacity of the Government to respond to epidemics.”

These activities will complement significant hygiene awareness and prevention efforts already underway, such as the creation of a “Public Health Brigade” to carry out cholera treatment and prevention work throughout the country.

Through a Global Facility for Disaster Reduction and Recovery grant of US$200,000, the World Bank is identifying national and international actors already involved in these tasks, preparing a standardized training plan and training a core group of 250 trainers. It will also finance an awareness and prevention campaign.

…. psssst… World Bank people… could you fund the good folks on this website participating in the HEAS, including the brilliant duo of Dr. Jim Wilson and the Haiti MPHISE, Dr. Michael D. McDonald, who are working with little or no funding, to do precisely what you are saying, and doing it with out layers of bureaucratic constraints to respond rapidly … because this cholera moves quickly in Haiti!

On Friday, November 26th, as reported by Xinhua,  UN Secretary-General Ban Ki- moon on Friday met at the UN Headquarters in New York with a large number of ambassadors from the Americas, Europe and Asia to press them to send trained medical professionals to Haiti to help deal with the cholera outbreak.

The Xinhua article states
The UN Office added that oral rehydration salts, water purification tablets, chlorine, body bags, medical supplies, soap, latrines and other supplies are in short supply. Some 4 million water purification tablets and 11,000 bars of soap are needed just in the capital, Port-au-Prince, and just for the next two weeks.

On Saturday November 27th, Fidel Castro announced via the website Cuba Debate, that Cuba will send an additional 300 doctors, nurses and health specialists to Haiti, bringing the total Cuban Medical Brigade of doctors, nurses and technicians up to nearly 1300. From the website:

Es de suma importancia evitar que la epidemia se extienda a otros países de América Latina y el Caribe, porque en las actuales circunstancias causaría un daño extraordinario a las naciones de este hemisferio.

Se impone la necesidad de buscar soluciones eficientes y rápidas a la lucha contra esa epidemia.

Roughly translating Castro’s words:
“It is extremely important to prevent the epidemic from spreading to other countries in Latin America and the Caribbean, because under actual circumstances [like this in Haiti] it would cause extraordinary damage to the nations of this hemisphere.

There is a need for efficient and quick solutions to combat this epidemic. The need to find efficient and fast solutions in the fight against the epidemic is upon us.”

Also on Saturday, November 27, 2010, the UK pledged to fund 115 doctors, 920 nurses and 740 support staff, and emergency supplies to combat cholera in Haiti. A BBC article UK pledges aid to fight Haiti cholera  reports the medical staff will set up 12 major cholera treatment centres and 60 subsidiary treatment units, capable of treating several thousand patients over the next two months.

Says Secretary Andrew Mitchell, "It is clear much more needs to be done. Analysis from the UN and our own field team reveals that the response needs to be significantly increased if we are to save thousands from the disease.

"We must stop the disease spreading further and trained medical teams and equipment funded by the British taxpayer will bring crucial relief to the devastated country."

Cholera is an old enemy of mankind. Evidence from the battle elsewhere in the world, indicates we will not win this easily. The direct funding of trained cholera treatement and education teams must be supported. In addition, we will need to use the established tools as well as consider what new approaches might be effective in Haiti.