Against a backdrop of violence, war between gangs, scarcity of gasoline and political unrest, since October 2022, a new cholera epidemic has been added to the daily worries of the most vulnerable in Haiti. In just a few months, more than 26,000 suspected cases of cholera have been recorded across the country.
The inhabitants of Borneau, a locality of Croix des Bouquets, live in a very precarious situation. For several months now, they have been at the center of a civil war between armed groups fighting over the territories at the northern entrance of the country as well as the Central Plateau. Taken hostage in the midst of this conflict and above all terrified, the people of Borneau have great difficulty to access health care. They only have one route via Seau d'Eau to reach the University Hospital of Mirebalais (HUM), the only surrounding hospital that can provide them with adequate care.
Several people presented themselves in January with symptoms indicative of cholera, such as profuse diarrhea and vomiting. A few days later, 5 deaths followed. Initially, HUM received 24 seriously ill with severe dehydration, all from Borneau. The following day, 27 new seriously ill patients, still from this locality, were hospitalized.
In less than a week, HUM received and treated more than 100 Borneau patients suffering from cholera. “In Borneau there is no medical structure. There only is a community network which includes a few health workers who do not have the materials to treat the population. They only have their knowledge,” says Dr. Jean Joel Manassé, head of clinical cholera response at Zanmi Lasante (ZL).
ZL's response strategy since the resurgence of cholera has been based on the following pillars: the clinical management of patients, the implementation of a series of community actions and the urgent response to infrastructural and health needs. Thus, in partnership with other local actors such as the MSPP and DINEPA / OREPA, ZL has been able, thanks to its ability to anticipate quickly by setting up equipment and personnel, to reduce the burden of cholera in its various sites. According to Dr. Manassé, Chief Internal Medicine Physician at HUM, an important aspect of ZL's response has been to work with organized communities to raise awareness about hygiene and thus promote behavior change.
In Borneau, ZL’s medical staff and community agents have initiated activities to raise awareness among community members and especially community leaders on key issues such as hygiene and sanitation but also on the need to accompany people presenting symptoms to the hospital. “We quickly understood that we had to bring the care closer to the population,” says Dr. Manassé. “So, we operated a treatment point on their route to start treating the sick before they arrive at HUM. This has allowed us to reduce the time taken for treatment and also to alleviate transport costs in order to relieve the victims and their families. Thus, they do not wait for a state of total despair in order to seek care.”
"We quickly understood that we had to bring the care closer to the population," says Dr. Manassé
There is still ground to be conquered to defeat the scourge of cholera. For 17 weeks already, ZL has set up 13 sites, spread over 2 departments and 11 cities of the country in order to take care of those affected. Thus, 5,581 patients were treated and 73,348 vaccines were administered.
However, ZL still needs to strengthen community response with personnel, products, medicines and materials. It is therefore necessary to constantly maintain the institutional structures with the personnel, the spaces, the medicines, the sanitation equipment and the healthcare system. “Today the problem is in Borneau; tomorrow, it could be a completely different locality. I believe that with the strategies we have put in place, we will relieve those who really need it,” asserts Dr Manassé.