Update April 2 2010: Disease Threatens Haitian Children

New York donor conference:

As needs remain, Haiti must be given capacity to ensure access to medical care for its population
International aid must consider a direct financial support to the health system in Haïti. Decisions at the New York conference need to allow the Haitian health system to continue to address the population’s immediate medical needs.
Port-au-Prince/New York
While the majority of the Haitian population is still extremely vulnerable, the UN donor conference to be held in New York on 31 March must not take measures that would limit the access to health care of the population, says international medical organisation Médecins Sans Frontières (MSF).

Since the earthquake of 12 January nearly all public and many private medical structures have offered free of charge health care. Meanwhile plans have been disclosed to progressively reinstate hospital fees as early as mid-April.

“Making access to health care contingent upon someone’s financial means would totally ignore the reality that we see in the streets and makeshift camps in Haiti,” said MSF emergency coordinator Karline Kleijer. “Hundreds of thousands of people have been displaced and live in rickety huts made of plastic sheeting, tents or ruined houses, with one latrine for a few hundred people on average. Shelter, hygiene, water and medical care remain a priority need.

“Short term humanitarian needs remain huge and unmet, and the arrival of the rainy and hurricane seasons threatens to cause further deterioration of the present living conditions. We have already seen large parts of camps collapsing during the recent rains. The collapse or flooding of shelters and tents could force many of the displaced to move again.”

Respiratory infections and diarrheal diseases are today the two main diseases that MSF treats. Earthquake victims continue to need post-operative and rehabilitative care, physiotherapy as well as psychological counseling. In addition, the population at large needs obstetric, pediatric, and trauma care.

“Haitians must have access to an efficient health system,” declared Dr. Christophe Fournier, MSF international president. “Necessary financial resources for the health structures to function can not be drawn from the extremely precarious population.”

International aid must consider a direct financial support to the health system in Haïti. Decisions at the New York conference need to allow the Haitian health system to continue to address the population’s immediate medical needs.

MSF has been assisting Haitian communities since 19 years. Today, some 3,300 Haitian and international MSF staff are supporting government hospitals and run facilities on its own. Since the earthquake, MSF teams have performed more than 4,000 surgeries, provided psychological counseling to over 20,000 people, and treated 53,000 patients. MSF has distributed 14,000 tents and close to 20,000 non-food item kits (including kitchen and hygiene kits, jerry cans, blankets and plastic sheeting). MSF is funding its activities in Haiti exclusively with private donations and is therefore no stakeholder in the donor conference in New York.

Source

Medical needs in Haiti remain high as MSF moves into next crucial phase

In response to the dire situation confronting people living in makeshift camps or on the street ten weeks after the quake, MSF is stepping up the distribution of tents and plastic sheeting, as well as blankets and hygiene and cooking kits.

HIGHLIGHTS

Ten weeks after the January 12 earthquake that left up to 300,000 people injured, medical needs remain immense in Haiti, and they continue to grow. A crucial phase has begun with thousands of injured people requiring long term medical care just as some of the health providers who responded to the initial emergency phase have begun to discharge patients and leave the country . ?MSF is expanding its capacity to care for the many wounded requiring extensive postoperative care – including secondary surgeries, physical therapy, rehabilitation, and mental healthcare – for at least the next year. In recent weeks, more than 200 patients have been referred to MSF medical facilities by other medical teams leaving the country. ? MSF is also focusing on primary health care, with the opening of new out-patient departments and the creation of additional capacity for secondary health services, including emergency obstetrics, intensive care for malnourished children, and inpatient care for paediatrics and adults.

In response to the dire situation confronting people living in makeshift camps or on the street ten weeks after the quake, MSF is stepping up the distribution of tents and plastic sheeting, as well as blankets and hygiene and cooking kits.

MSF activity specific to locations across Haiti

HOSPITALS – SURGERY – POST OPERATIVE CARE

Port au Prince – Saint-Louis Hospital: Surgical activities are ongoing in a 200-bed capacity inflatable hospital, which includes two operating theaters. An additional operating room is planned for treating treat patients suffering from burns. At the moment, around 200 patients are hospitalized and 770 surgical operations have been performed since setup. The hospital provides complete post-operative care: medical and surgical follow up, physiotherapy, psychological and social care. The hospital aims to treat the same cases that were treated at the now destroyed facility of La Trinité: major traumas (road accident, gunshots, burn victims, etc.) and health care for victims of sexual violence.

Port au Prince – Choscal Hospital in Cité Soleil: MSF intervened in this Ministry of Health hospital initially focusing on earthquake-related trauma. There are two operating theaters for major surgery, one for minor surgery. MSF also works in the emergency room and the maternity ward. The hospital has a 100 bed capacity, all under tents as the building has been slightly damaged by the earthquake and patients are still afraid to get in. The team has rearranged the hospital into a general hospital serving an extremely precarious population. Psychological care continues for all patients and caretakers.

Since the earthquake, 2705 (1852 new cases and 853 dressing) emergency cases treated in the emergency room, 874 trauma (trauma, wounds and burns), 201 trauma due to violence (57 gun shot, other aggressions by knife, machete, stone, bottle,…), 718 surgical interventions, 91 major orthopedic interventions including 37 amputations and 222 wounds operations; 363 deliveries including 39 cesarean section. Still a daily average of about 2/3 violence-related injuries, including gunshot and machete wounds.

Port au Prince- Site Office du Tourisme: Site functional since February 22. At present, 40 patients are hospitalized and receiving post operative and medical care, mental health care, and physiotherapy.

Port au Prince- Site « Mickey », Crèche angle rue Christ Roi et Bourdon Site opened on January 19. Currently, 61 patients are hospitalized and receiving post operative and medical care, mental health care and physiotherapy. For the immediate term: maintaining the maximum post operative care capacity, following up minor surgery cases, reinforcement of mental health rehabilitation

Port au Prince – site Lycée with its 80 beds of post operative care, was closed. Patients were transferred to the OCB facilities.

Port-au-Prince – Bicentenaire: Post-op, emergency and surgical facility with two operating theaters and pediatric and obstetric services. Presently 41 patients hospitalized in the 77-bed structure. A total of 90 beds foreseen. Mental health services are also provided.

Carrefour Arts et Metiers orthopedic hospital: Around 40 surgical interventions are performed every day in this 135-bed trauma and post-op hospital, which houses two operating theaters, and one of the few x-ray machines in the city. Orthopedic surgery, skin grafts, and muscle flaps are being performed and post-op care and rehabilitation are provided. Currently, 80 patients are hospitalized. Rehabilitation care is offered to patients in collaboration with Handicap International. Psychological care is offered to patients and families.

Léogâne: 90-bed hospital. Maternity activities are increasing; 50 deliveries and three C-sections performed in the past week. .

Jacmel: Full outpatient and inpatient services are available under tents (81 beds) as the main hospital was badly damaged. Surgery is ongoing in the hospital’s operating theater (services offered; internal medicine, surgery, maternity, pediatrics, emergency). Mental health services are also provided.

POST-OPERATIVE CARE

Although a full range of post-operative care is offered in all MSF supported structures where surgery is performed, some sites are specifically dedicated to welcome patients after surgery.

Promesse: Post-op structure with an initial capacity of 50 beds. Handicap International physiotherapists are working in collaboration with MSF. 46 patients are currently hospitalised. Mental health care provided.

Delmas 30: The first 70 patients and their caretakers have been transferred to this new post-op tented center, from the inflatable hospital structure in Saint Louis. The center will have more than 100 beds for people needing physiotherapy and mental health support. They will be transferred in the middle of March to the MSF facility in the Port-au-Prince neighbourhood of Tabarre (capacity: 140 beds)

Sarthe: On February 23 MSF opened a new, a 203-bed post-operative center in a converted soft drink factory in the Sarthe area of Port-au-Prince (potential capacity of 300 beds). All patients from Chancerelle and Choscal who need further post-operative care (wound care, more specialised orthopaedic surgery, reconstruction surgery) were referred to this new structure. Up to now 150 patients were admitted. Handicap International physiotherapists are working in collaboration with MSF to optimize reeducation (including prosthesis for the amputee) and mental health support is provided as well.

SPECIALISED CARE : NEPHRO + NUTRITION + EMERGENCY OBSTETRICS

Port au Prince – General Hospital The nephrology team did an initial handover to the Ministry of Health, with donations of materials and three dialysis machines to the nephrology unit in the general hospital. Currently, 30 chronic patients are receiving dialysis. Another five dialysis machines has been installed recently to increase capacity of the unit. A nephrologist came for one week to give specific trainings.

Carrefour stabilisation center for malnutrition: Stabilization center and ambulatory feeding center for severely malnourished children. There are currently 22 children hospitalized.

Carrefour Maternity Hospital: MSF supports this Ministry of Health structure with staff, fuel and supplies to run 24hr maternity/emergency obstetrics services.

Isaie Jeanty, Emergency Obstetrics Hospital: MSF is working in collaboration with the Ministry of health for the maternity and emergency obstetric care in this 85-bed Ministry of Health hospital. This is the main referral hospital for Port-au-Prince for complicated and eclampsia cases.

PRIMARY CARE

Port au Prince – Martissant: This MSF structure provides an emergency and stabilization center through an outpatient department and a 30-bed inpatient department. There is also a 15-bed maternity service. The center has seen more than 3892 consultations since the earthquake and 1967 dressings. More than 1000 trauma had been treated including 100 by violence.The team is preparing to move some patients back into the undamaged structure.

Port au Prince – Delmas 24: A new health center opened on February 15 in the Delmas area of Port-au-Prince. About 150 consultations are offered every day. MSF plans to open five out patient departments in total in the Delmas area (including in Saint Louis Hospital and Delmas 24).

Saint-Louis OPD and ambulatory: Opened February 27; 120 consultations/day. Follow up of post op in ambulatory ( dressing, physio, mental health…)

Les Collines: OPD will open March 10.

Fort National/poste Marchand: OPD will open March 15.

Port-au-Prince – Site “Mickey”, Crèche angle rue Christ Roi et Bourdon: Outpatient structure performing between 120 and 170 consultations per day.

Port-au-Prince – “Tourism”, in front of the Champ de Mars: Outpatient activities began February 15; average of 160 consultations per day.

Leogane, Dufort and region: OPD is operational in the city of Leogane on the site of Hopital Sainte Croix. At the Dufort fixed clinic site, approximately 250 consultations are carried out each day, with referrals to Leogane when required. In addition, MSF teams are operating mobile clinic activities in 20 locations, between Gressier and Petit Goave. In total, 2,130 consultations were carried out last week.

Carrefour Feuille: A team of one nurse, three doctors and one midwife is running a tent clinic in a camp for 9,000 homeless people in the area. Main pathologies are now diarrhea, skin diseases, upper respiratory infections, fever, gyneco cases, traumas and increasing requests for psychological counseling. An average of 130 consultations are carried out per day. The team is performing dressing changes and providing vaccinations. Mental health services are also provided.

Carrefour, Village Grace IDP camp: The basic health care unit includes an outpatient department, antenatal and post natal care and a mental health component in a site that is home to 15,000 displaced persons. 150 patients are seen daily.  250 dressings are done per week. Vaccination campaign for DTP and measles was carried out last week. Psychological care is offered to patients and families.

Carrefour, International Grace Hospital: A new hospital, located next to Grace camp, will offer out-patient services by the end of this month. Other planned activities include pediatric care and emergency services.

Carrefour, Shikina clinic, Waney 87. An out-patient health center offering basic health care, antenatal and post natal care, as well as mental health services. This is an urban area with many displaced are living in small groups.

Carrefour, outreach activities: A MSF team is working in a number of sites in the Carrefour area, including in displaced persons camps, homes for the elderly, clinics and orphanages.

Petionville Golf Club Camp (Golf course): A health care clinic offering basic health care and ante-natal care to pregnant women, referral services and psycho social counseling in this camp where 40,000 people are estimated to live. About 150 consultations have been provided every day (ANC, PNC as well as mental health).

MENTAL HEALTH

Psychological care is routinely offered to patients who have been through major surgery in MSF supported structures. But there are other mental health activities targetting specific groups.

Sarthe + Choscal + Martissant : A team of psychologists is still focusing on the patients and the caretakers inside the three hospitals, but as also shifted towards providing counseling to  displaced people living in makeshift camps around the structures.

Carrefour, Grace Village IDP camp: Psychological care (individual and group sessions) is offered in the camp, through the clinic and through outreach workers who work in the camp as well as in the surrounding neigborhoods.

Carrefour, MSF Field hospital: A team of psychologists is supporting the patients.

Delmas, Petion Ville Club IDP camp: Psychological care is offered in the camp through individual sessions and group councelling.

Bicentenaire, Promess, Jacmel and Carrefour Feuille: Mental health activites taking place in MSF facilities in all these locations. A team of Payasos sin Fronteras (Clowns Without Borders) worked in collaboration with MSF – their project has now finished.

NON FOOD ITEM DISTRIBUTIONS

Port au Prince – Ecole Saint Louis: 1,800 tents distributed in the camp near the inflatable hospital to an estimated 8,500 people. NFI (hygiene and cooking sets) will be distributed in the coming days to the same population.

Grand Goàve: 2,638 complete family kits distributed.

Petit Goave: complete family kits and tents for 364 families

Grace Village IDP camp: NFI kits distributed to 3,000 families (kit = 2 jerrycans, bucket, hygiene kit, plastic sheeting or tent, 6 pieces of soap and a hygiene kit)

Carrefour: 1,800 NFI kits to IDPs at different sites.

Port au Prince – Delmas 33: 200 NFI kits to IDPs at Solidarity site and 200 NFI kits to Delmas 33 “future hospital” site.

Leogane: Distribution of 1,550 NFI kits in rural areas in the periphery of Leogane. 5,000 additional NFI distributions planned for next week (plastic sheeting instead of tents), accompanying mobile clinics.

Jacmel:Distribution of kits to more than 1,800 families.

Cité Soleil: 2954 tents were distributed in several camps spread within Cité Soleil slums. Still ongoing with additional NFI kits distribution to come.

WATER AND SANITATION

Marrtissant, Cite Soleil, Chancerelle: Water distribution is continuing via 15 bladders, including one in Martissant, 11 around Cité Soleil, one in Chancerelles, and three in Sarthe,  focusing on IDPS close to the medical facilities. MSF has also undertaken the cleaning and emptying of community latrines inside the slum of Cité Soleil, which had been backed up for a prolonged period.

Carrefour, Grace Village Camp: MSF is providing 76m3/day water for 15,000 IDPs and constructing 45 latrines.  Additionally, 45 showers will be constructed and 15 Portocabs have been installed..

Chancerelle, Aviation camp: 50 latrines, 50 showers and 20 washing places under construction. Water provided by MSF to part of camp. Installing 30,000 liter tank.

Carrefour, Child detention center: Ten latrines and showers under construction; eight portocabs installed in the meantime.

Carrefour, Joseph Janvier camp: maintenance of 20 existing latrines for 1,500 IDPs.

Carrefour, various sites: chlorination treatment of tanks/wells and small interventions in other areas. Chancerelle, Aviation camp: 50 latrines, 50 showers and 20 washing places under construction. Water provided by MSF to part of camp. Installing 30,000 liter tank.

Leogane (periphery): Water distribution: target of 200,000 litres per day. Will install two latrine blocks in gathering spots, and, if used, will increase numbers. Again, water and sanitation activities will be in support of mobile clinics and around MSF hospital structures.

Port au Prince – Mickey: Water distribution of 80,000L/day

Port au Prince – Ecole Saint Louis: Water and sanitation work (latrines) for estimated 7,000 IDPs.

Jacmel: MSF installed a water bladder, drinking points, and ten latrines in St. Michel Hospital.

Grand Goave: Sanitation facilities established in four camps: Lifeline, Park Ferrus, Servants et Tit Paradise: 4-6 latrines per block, showers, bladders, and seven water distribution sites for a total of 7,000 beneficiaries.

Port au Prince – In Petionville and Carrefour Feuille: portable or fixed latrines, portable showers, waste areas and water bladders were installed for a total population of 31,800 people. MSF has carried out out water storage and distribution, constructed washing areas, showers, latrines, waste areas and hygiene promotion in the following camps :

Place Boyer, Place St. Pierre, Marie Therese, Hospital Sanatorium, Campeche, Tapis Rouge, Pinchinat (Jacmel).

Source

MSF/Doctors
Without Borders needs all the help they can get, to help those in Haiti.

The road to recovery for Haiti is a long way off.

There is and  estimated 300,000 that may have died.  I do not think they have an actual total number as some may still be buried in rubble.

For more information  MSF in Haiti

Haiti: Public Health Crisis Looming and Where is Media?

By Georgianne Nienaber

March 29 2010

The rainy season is about to hit earthquake-ravaged Haiti. The meteorological forecast for next week calls for thunderstorms beginning this Wednesday, lasting at least through the following Tuesday, and Dr. Jim Wilson is worried. Wilson is the Executive Director of Praecipio International, which is the Haiti Epidemic Advisory System (HEAS), based in Petionville-Port au Prince, Haiti. Wilson is also internationally known as the person who identified the H1N1 outbreak in Mexico and was a key player and founder of ARGUS, a global detection and tracking system for the early detection of biological events. He identified SARS outbreaks, H1NI, Marburg hemorrhagic fever, and issued the first warning of H1N1 resurgence in the United States in the summer of 2009. Wilson has been warning about the increase in diarreal disease in Haitian infants, and his warning is falling on deaf ears in the mainstream media.

For anyone who has been to Haiti and observed ground conditions there, the reasons are obvious. During the week of March 12 we were in some of the IDP camps. After a minor rainstorm floodwaters caused the overflow of pit latrines, bringing raw sewage into the camps and contaminating local water sources. This was in the camps that had pit latrines. A camp of 5,500 people near the slums of Cite Soleil had no latrines or sanitation of any sort. Feces, vomit and urine were everywhere in the surrounding bush. Obviously, contact with raw sewage greatly increases the chance of exposure to waterborne pathogens that cause diarrheal disease. Prior to the January 12th earthquake, diarrheal disease was already a leading cause of illness and death for children in Haiti. Now, children and adults are living in “shelters” that in the best conditions amount to salvaged pieces of tin providing makeshift “roofs,” to tattered pieces of plastic held together with sticks. The USAID “fact sheet” about tent material would be laughable if the consequences were not so tragic.
On March 11, a USAID/OFDA flight delivered 750 rolls of plastic sheeting to Haiti. To date, USAID/OFDA has provided 15,480 rolls of plastic sheeting to meet post-earthquake shelter needs, benefiting approximately 774,000 people. The ongoing distribution of USAID/OFDA-funded plastic sheeting supports Shelter Cluster efforts to provide shelter materials to approximately 240,000 households before the likely June onset of the hurricane season.

Here is a video of what it is like to live under plastic sheeting. Imagine this scenario in the hurricane season.

This video was taken on March 12, 2010.

The same “fact sheet” indicates that the United States has provided $769,948,358 in aid to Haiti. Where it has gone is anyone’s guess. By the time Freedom of Information Act requests have been filed and freelance investigative journalists have done their homework, it will be too late to assist the 1.3 million estimated homeless. Infants will start dying by the thousands before the media takes note, and an outbreak of even more serious waterborne disease will likely occur.

The lies are almost frightening in the Machiavellian planning and presentation. Drive along the main roads and you will see “camps” of moderate white tents, set in orderly rows with the banners of NGOs prominently displayed. This is what you will likely see on CNN.


Take a little time to venture off the beaten path–you will not have to go far–and the reality hits you right between the eyes.



Wilson suggests that there is another area of concern that has not been examined by health officials here in the States and in Haiti.

The reason for this high level of concern is obvious to all of us who are working on the ground. An extension of that concern may be seen when considering the fragile nature of the current ad hoc medical infrastructure in the quake-affected areas. It is our assessment this infrastructure comprised mainly of volunteers is easily overwhelmed by a sudden influx of patients, particularly pediatric patients. The higher the clinical acuity, the more easily it is to overwhelm.

Dr. Wilson is being mild in his public comments. Having seen this
Amputate a leg and send someone home. To what? Fix a broken arm and send a child, homeless, to an IDP camp where there is seldom a doctor or food to be found.


We found this stash of “medical supplies” at an ad hoc camp of 2500 outside of Leogane.

This ad hoc infrastructure is both limited and easily overwhelmed. Because of these conditions, rapid identification of diarrheal disease hot spots when they emerge is critical, so that aid can be moved quickly to prevent further spread of disease and exhaustion of medical resources.

Is Haiti prepared? Probably not.

There are 800,000 doses of the oral rehydration agent, Pedialyte, stored, but it will not be enough if a large outbreak occurs. Infants can die within 24 hours if not given the proper palliative care. There are not enough oral and IV antibiotics in-country. Even if drugs and rehydration kits were freely available, there is not an adequate distribution system in place to deliver supplies and no one to coordinate at many of the camps, except those located with the guarded compounds of the NGOs. Haitian mothers have not been told how to make simple rehydration solutions of salts and sugars.

The current Haitian public health surveillance consists of forms submitted to the Haiti Ministry of Health once a week and an under-developed network of sites to support laboratory testing.

Dr. Wilson suggests that along with the forms, health workers share information about the types of health events they are witnessing.

This is referred to as “informal surveillance,” and we offer the following Google group, the “Haiti Epidemic Advisory System” and the InSTEDD-supported SMS/text messaging alert system called Geochat to facilitate communication among us. In this Google group we will be sharing insights into what to look for and examples of informal surveillance in action. Please note this group is only for ground-based Haiti responders. The link to the Google group may be found here, and instructions for how to sign up for the SMS/text messaging Geochat service is found on the group website.

Our team encountered the Haitian Minister of Health, Dr. Alex Larsen, in Petionville one evening. It was a chance encounter, since all of the government offices were destroyed during the quake and officials who are still alive are hard to find.

We asked the purple-shirted chain-smoking minister if we might have a conversation with him after he finished his conversation and dinner. He said “yes,” but left without even a goodbye or “we will talk later.” Maybe Anderson Cooper can get him to open up. If he can find him.

A journalist friend in Rwanda, Patrick Bigabo, sent me a message on FACEBOOK that pretty much sums up the state of media affairs with regard to Haiti.

“The problem with public affairs reporting in poor nations is that for the western media there is no news unless horror is ongoing. Real media has vanished.”

Source

The links below have other information and links to other stories about Haiti.

War Crimes and Oil has the most.

Haiti: The Miracle and the Nightmare

Haiti: War Crimes and Oil

Help Haiti Everybody Hurts Video

Published in: on April 2, 2010 at 7:39 am  Comments Off on Update April 2 2010: Disease Threatens Haitian Children  
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