Haiti

Eliminating cholera

MCC's work helps reduce 291 cases of cholera to 0 in Wopisa-Gabriyèl and Kabay, Haiti

Using cholera prevention education, building household latrines and encouraging other simple hygiene practices, MCC has helped to eliminate cholera in two remote communities in Haiti’s Artibonite Department, the centre of Haiti’s ongoing cholera epidemic.

In the 12 months before these projects started in November 2016, community health workers reported 291 deaths from cholera in the two communities of Wopisa-Gabriyèl and Kabay. In the past 18 months, following the implementation of these projects, there have been zero.

Cholera, a fast-acting bacterial infection that can cause uncontrolled vomiting, diarrhea, and serious dehydration in severe cases, is spread through contaminated food and, especially, water. In the worst cases it can kill in a matter of hours.

The shortest route from Wopisa-Gabriyèl to get medical assistance for cholera or any other illness requires descending this waterfall. By building latrines, community leaders and MCC expect the number of cholera cases to be reduced.  MCC photo/Ted Oswald

Cholera disproportionately affects those without access to affordable medical care or clean drinking water, including those living in rural locations in the mountains of the Artibonite. Without latrines, people are forced to defecate outdoors. Without treated water, people are forced to drink from streams and rivers that are contaminated by feces that contain cholera.

After Hurricane Matthew affected the area in the fall of 2016, increasing the risk of cholera with the flooding, MCC staff approached leaders of Wopisa-Gabriyèl to learn what assistance was needed.

Because of risks from waterborne diseases including cholera, the community identified latrine construction as its most pressing need: “We can’t drink our water safely. We can’t care for our children. We can’t protect our families,” said Pierre Previl, a local leader and community monitor in MCC’s environmental education program.  Community leaders saw better sanitation as a necessary building block for further community development and recovery.

MCC has since partnered with the community to help build simple, but solid latrines. We provide the block, cement, tin, nails and a local expert builder to direct the construction, while community members transport the materials and form work groups to complete the labour. Today Wopisa-Gabriyel has 600 new latrines and Kabay has 181.

These are the tools MCC uses to reduce incidences of cholera in rural communities.MCC photo/Annalee Giesbrecht

In addition, MCC supported hygiene trainings for community health workers, who then train people on hygiene practices. So for example, at school, the community health workers teach students how to use a hand washing station to prevent cholera.

The hand washing stations are basic: just a bucket with a spout and bleach or water treatment tablets to clean the water. MCC provides the supplies to be used at specific locations where cholera can be transmitted easily — schools, churches, fairs and other gathering places.

“Too often in global health, the temptation is to find quick and easy technical solutions,” says Paul Shetler Fast, MCC’s global health coordinator based in Haiti. “However, we’ve found making meaningful sustainable change requires deep on-the-ground knowledge—the geography of watersheds, where each house collects drinking water, and the existing community structures that can be leveraged to create change.”

Haiti’s ongoing cholera epidemic started in 2010, when sewage infected with cholera was released into the Artibonite River by a contingent of United Nation peacekeepers from Nepal. According to the Haitian Ministry of Health, nearly 10,000 people have died of cholera as of the fall of 2018.

That figure is likely to be an underestimate because many people in remote rural areas are too far away to reach medical care in time, said Shetler Fast.

The UN apologized in 2016 for its role in bringing cholera to Haiti, but funding and political will to fully eliminate it have been lacking. While cases of cholera have declined significantly since the peak of the epidemic in 2010 and 2011, it continues to flare up during rainy seasons and after hurricanes.

Following the success of the project in Wopisa-Gabriyèl, MCC implemented a larger follow-up project in the wider Verrettes commune, the Haitian equivalent of a county or municipality, where Wopisa-Gabriyèl is located. Together volunteers from the local hospitals, water authority, public health department, primary schools, disaster response committees and the local government implemented a commune-wide version of this work.

In the last year, the entire commune of Verrettes has seen the same success as Wopisa-Gabriyèl: no transmission of cholera, no cases of cholera originating in the commune and no deaths from cholera.

MCC’s partners were able to extend the project for several additional months because they could re-allocate money previously budgeted for cholera treatment.

MCC’s work in Haiti shows, at least at a small scale, that elimination of cholera really is feasible with relatively small budgets, even in some of the most hard-hit communities in Haiti."

— Paul Shetler Fast

The project was put to the test during a recent Fèt Patwonal, a local feast day, in the capital of Verrettes. Commune community gatherings, especially ones which draw former community members and families from nearby communes where cholera may still be active, are potential flashpoints for the spread of disease.

Three people sick with cholera arrived from outside the commune. However, because of the availability of clean water, accessible hand washing stations, public announcements encouraging regular hand washing, and training on effective hand washing techniques, no attendees contracted cholera and no subsequent cases were contracted in the commune.

“MCC’s work in Haiti shows, at least at a small scale, that elimination of cholera really is feasible with relatively small budgets, even in some of the most hard-hit communities in Haiti,” says Shetler Fast.

“Cholera has been eliminated from every other country in the Americas. It can be eliminated from Haiti too.”