Health Studies/Public Policy
The devastating natural disasters that hit Haiti in 2010, poverty was at an ultimate high in the nation. The high poverty rate in the country essentially made it very vulnerable to the retraction of the infectious disease, Cholera. Many Haitians had little to no access to clean drinking water when the natural disasters took place, because homes and valuable possessions were lost. Contaminated water that was picked up from streams and rivers by civilians, were unable to be drinkable because many families, in loss of their homes, were now lacking stoves to boil their water in. This ultimately made the disease much more susceptible, and soon enough, it was rapidly killing a vast amount of the population. Before the earthquakes even hit Haiti, 63percent of the population had access to an improved drinking water source and only 17 percent had access to a latrine. The increase in poverty rates did not make these numbers go up any, in fact they dropped to a significant low. As aforementioned, with the inability to find clean water to drink, came vulnerability to retract the disease. With the increase of poverty in Haiti, came the increase of Cholera.
The relationship between increased poverty and increased cholera.
Periago, Director of PAHO/WHO in Washington, DC has pointed out that as GDP increases in a country at the same time cholera decreases. In a 2000 report the highest incidence for cholera per 100,000 people (in Bolivia) was between 325 and 350 and the Per capita Gross National Product (GDP) for these people was approximately 1000. Whereas people with a GDP of 5000 (in Chile) showed a zero amount of cholera reported. A 1991-1993 report from Peru showed that the fatality rate due to cholera was very high in the rural population. Over 70 percent of the population showed a fatality rate over 3.0. The Pan American Health Organization (PAHO) concluded that “Cholera spreads in poverty.” (Periago, 2002, p. 6)
Contaminated streams and rivers.
Tappero and Tauxi (2011) reported that on October 19, 2010 an outbreak of cholera in Haiti was confirmed by the Laboratorie National de Sante Publique. Twenty seven patients in five hospitals were interviewed in order to determine the path of the cholera into the body. The patients interviewed all lived or worked next to the Artibonite River. (Tappero & Tauxi, 2011) The cause of cholera in many of the patients was because they had drunk untreated water directly from the river.
The lack of access to sanitary facilities (latrines).
In Haiti in October 201another problem identified in patient interviews was that “few had defecated in a latrine.” (Tappero & Tauxi, 2011) One way cholera is caused is when feces enters the drinking water source.
The Haitian government needs to prioritize fixing the infrastructure for water treatment and sanitation facilities. Tappero and Tauxi (2011) point out that this strategy has been successful in other countries. The return on investment of $1 is $8 in avoiding lost time at work and school, not having to haul water, productivity increases; not only would there be direct health benefits but the financial savings in health costs could be up to $8 per person. (Tappero &Tauxi, 2011) The international community can assist Haiti by sending the funding that was pledged after the earthquake.
The five priorities for Haitian decrease in cholera formulated by the Ministère de la Santé Publique et de la Population (MSPP) and the Centers for Disease Control and Prevention (CDC) must be initiated. (Tappero &Tauxi, 2011) Public education is necessary to increase hygiene especially hand washing. Other topics needed are learning to drink boiled or appropriately treated water (chlorinated) and to bury feces when defecating in nature. Schools can continue to teach hygienic behaviors annually or every semester. Posters can be displayed where many people pass each day and in other appropriate spots. People need to know exactly how to use ORS sachets and they must learn the habit of calling for help as soon as possible so the cholera will not become worse for the patient and a cholera outbreak will not result. People need to ensure good habits in the home of washing their hands well. Only safe water must be used for drinking water so water from outside sources should be boiled.
More Haitian doctors, nurses, health clinicians and Cholera Health Workers (CHWs) need cholera training so enough personnel is available to help on a daily basis and in case of another outbreak . (Tappero &Tauxi, 2011) Oral rehydration solution (ORS) sachets have been shown to reduce the need for hospitalization and for intravenous rehydration for patients in the hospital so supplies need to be constantly replenished. The antimicrobial medicines that are used for cholera patients need to be held in good supply.
Cities, provinces and the national government have a responsibility to make sure everyone in Haiti has easy access to fresh water or to properly treated water. Water treatment plants need to be improved and more should be built. Good sewage facilities need to be instituted in cities. In rural areas the government can support poor people with grants to enable a good, modern latrine for every family.
Cholera is dangerous and painful illness that can quickly turn into an epidemic so the best plan is to avoid cholera. The best is to ensure jobs for a least one member of every family because high income results in less cholera. Since that will take time to accomplish given the situation in Haiti the people must be educated. All levels of the Haitian government need to be involved in cholera prevention. The international community can play an important role in meeting the goal.
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Periago, M. R. (2002). Cholera in Latin America: Lessons from History, Pan American Health Organization, Regional Office of the World Health Organization. Available from http://new.paho.org/hq/
Tappero, J. W., and Tauxe, R. V.(2011). Lessons learned during public health response to cholera epidemic in Haiti and the Dominican Republic. Emerg Infect Dis [serial on the Internet]. Available from http://dx.doi.org/10.3201/eid1711.110827 and http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3310587/