Archive for the “Medical” Category

Article 40 of the 1987 Haitian Constitution stipulates that “The State has the obligation to publicize in the oral, written and televised press in the Creole and French languages all laws, orders, decrees, international agreements, treaties, and conventions on everything affecting the national life, except for information concerning national security.” Too often, the State does not reach out to the public in Kreyòl. The Ministry of Health and the video of cholera prevention guidelines by Jocelyne Pierre-Louis are a refreshing, and potentially life-saving, exception.

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(Non-) Histoire du choléra en Haïti

Deborah Jenson, co-directrice, Duke FHI Haiti Lab

Dans les annales du dix-neuvième siècle en Haïti, on retrouve des traces de cordons sanitaires et d’autres mesures prises contre le choléra. Les autorités haïtiennes se montraient vigilantes contre la possibilité de son introduction maritime. Le Président Boyer s’inquiétait en août 1832 de l’introduction potentielle en Haïti du choléra venu de l’Europe et des États-Unis:

“La prudence commandant de prendre des moyens convenables pour s’opposer, autant que possible, à l’invasion en Haïti du choléra-morbus, qui a déjà franchi l’Europe, et pénétré aux États-Unis, je vous invite à vous réunir au commissaire du gouvernement, au commandant de la place, au juge de paix et au conseil des notables, afin de prendre les mesures les plus appropriées aux localités, à l’égard des bâtiments qui arriveront des ports des États-Unis dont la proximité rend la communication de cette épidémie plus facile.[1]

A plusieurs moments du dix-neuvième siècle, le gouvernement haïtien s’est avéré prudent. Le Moniteur de 1892 a annoncé l’initiative du Président Hyppolite à interdire des navires “infectés par le choléra”[2] dans les ports ouverts de la République.

Et on ne trouve pas de témoignage direct de l’arrivée du choléra en Haïti (ni en “Hayti,” St. Domingo, ou Saint-Domingue).  L’historien Thomas Madiou s’est même posé la question d’une possible résistance environnementale de l’Haïti à ce fléau mondial:

“Il est à observer que cette maladie n’est jamais parvenue en Haïti, même quand elle s’est trouvée en même temps tout autour de notre île, à St. Thomas, à Porto-Rico, à la Jamaïque et à Cuba, au Vent comme sous le Vent. Cela tiendrait-il aux émanations de notre sol qui ne permettraient pas d’exister aux animalcules cholériques ou à un état particulier de notre atmosphère?[3]

Madiou n’était pas le seul à se poser cette question; un consul du gouvernement britannique en Haïti citait l’exemple haïtien pour mettre en question la nature contagieuse de la maladie.[4]

J’ai trouvé, durant la première moitié des années 1850, le seul moment où la communauté internationale note au moins une rumeur de choléra en Haïti, lorsqu’une pandémie sévissait dans l’aire antillaise comme ailleurs. David Watts indique que de 1850 à 1851, la Jamaïque aurait perdu 25,000 à 30,000 individus, soit 8% de sa population.[5] Le choléra faisait des ravages également à St. Thomas, à Trinidad, en Guadeloupe, et ailleurs.  Les Medical Times de 1852, à la fin d’un compte rendu du choléra autour du monde, constatait que à « Port-au-Prince, Hayti, the epidemic is greatly diminished in severity. »[6] Mais des témoins directs ont démenti la nouvelle du choléra en Haïti pendant cette période. Le Massachusetts Daily Atlas du 14 janvier 1851 citait un capitaine Moyer, rentré du Cap en Haïti: « Captain Moyer […] reports that port as healthy, and has been so for a long time. The reports that cholera was raging there proved to be false. »  Est-ce parce que le gouvernement autoritaire de Faustin Soulouque ne permettait pas la circulation de nouvelles du choléra? Possiblement; mais dans une époque où les commerçants voulaient surtout éviter de ravitailler dans des ports contaminés, ce serait remarquable qu’un empereur haïtien parvienne à faire taire la presse internationale.

On retrouve aussi relativement peu de traces du choléra dans la partie orientale de l’île d’Hispaniola, sauf dans la période 1866-1868. Dans l’année1868, le Boston Daily Advertiser estimait à 20 par jour le chiffre des morts du choléra à Santo Domingo. (Le Philadelphia Inquirer du 17 mars 1868 notait en qu’en Haïti, “Intelligence having been received of the existence of cholera in Santo Domingo and Saint Thomas, the government had ordered all vessels arriving at Port-au-Prince or any of the out ports from those places, to be put in quarantine.”)

Spenser St. John, grand raciste de l’historiographie d’Haïti, a noté en 1886 que “Bien que Port-au-Prince soit la ville la plus dégoûtante que j’aie jamais vue, elle n’a jamais été visitée par le choléra.”[7]

Kenneth F. Kiple, dans son étude experte du choléra à la Caraïbe, de l’arrivée de cette maladie au Cuba en 1833 jusqu’à ses effets meurtriers à la Jamaïque, ne mentionne pas une seule fois Haïti, ni la République dominicaine.[8]

Presque deux cent ans après son arrivée aux Antilles, le choléra a enfin franchi la barrière invisible d’Haïti, comme si quelque lwa des mers ou des barrières eut échoué. Rappelons qu’Haïti est loin d’être le seul pays vulnérable; des États-Unis au dix-neuvième siècle à l’Amérique latine aux années 1990,[9] notre hémisphère connaît bien le choléra.  Malgré la date de la première pandémie documentée du choléra en 1817, des records de maladies qui ressemblent fort au choléra remontent plus de deux mille ans dans la culture grecque et sanskrite.

Les microbes vibrio cholorae existent dans l’environnement aquatique dans un état inactif, comme la belle au bois dormant; l’infection de par des agents humains n’est pas strictement nécessaire, alors, pour son introduction. Les microbes vibro cholorae entrent dans un état viable plutôt que dormant à l’aide de facteurs déclenchant que les chercheurs associent de plus en plus avec le changement climatique et ses effets sur les planctons aquatiques.[10] En effet, il est possible que Madiou ait eu raison en quelque sorte; que les conditions ne favorisaient pas le réveil du choléra en Haïti. Cela a changé; Haïti se réveille à un nouveau cauchemar; on peut culpabiliser le changement climatique, et puis pour son intégration, bien sûr, les conditions désastreuses de l’après tremblement de terre de janvier 2010, avec des camps de tentes qui s’étendent de la banlieue nord de Port-au-Prince presqu’à Jacmel.

Depuis longtemps, les activistes humanitaires “tremblent” à l’idée d’une possible introduction du choléra en Haïti, selon Francine Tardif dans son Regard sur l’humanitaire: une analyse de l’expérience haïtienne en 1997: “Pour les pays environnants, la possibilité d’une pénétration du choléra en Haïti fait également trembler puisque, de l’avis générale, il deviendrait alors difficile de contrôler la maladie.”[11] Le fait que 75% des gens infectés n’auront jamais de symptôme – une bonne nouvelle en apparence – assure en même temps sa transmission prolongée.  Face à ce nouveau crève-cœur insupportable, rappelons l’histoire digne de la résistance d’Haïti à cette maladie omniprésente dans l’histoire occidentale, et les conditions globales à la fois “naturelles” et façonnées par la civilisation industrielle humaine qui ont ouvert cette boîte d’une Pandore sans cœur.


[1] S. Linstant de Pradine, ed. Recueil général des lois et des actes du gouvernement d’Haïti: 1827-1833 (Paris: Auguste Durand, 1866) 5:437.

[2] Recueil des lois et des actes de la République d’Haïti de 1887 à 1904, ed. Claudius Ganthier (Port-au-Prince: Chez l’auteur, 1912) 671-72.

[3] Thomas Madiou, Histoire d’Haïti : 1827-1843 (Port-au-Prince: Editions Henri Deschamps, 1987-1991) 7:122.

[4] “Her Majesty’s Consul at Port au Prince:–‘It is a remarkable fact that, in 1833, when the cholera was raging in the neighboring islands, not a single case occurred in Hayti, neither were there any quarantine restrictions to prevent its introduction.’” Measures Adopted for the Execution of the Nuisances Removal and Diseases Prevention Act, and the Public Health Act, up to July 1849, in Sessional Papers printed by order of the House of Lords, or presented by Royal Command, in the Session 1849 (London: William Clowes and Sons, 1849)16: 161.

[5] David Watts, The West Indies: Patterns of Development, Culture, and Change since 1492 (Cambridge: Cambridge University Press, 1990) 462.

[6] Medical Times and Gazette: Journal of Medical Science, vol. 26, July-Dec. 1852 (London: John Curchill, 1852) 299.

[7] Sir Spenser St. John, Haïti, ou, la république noire (Paris: Plon, 1886) 21.

[8] Kenneth F. Kiple, “Cholera and Race in the Caribbean,” Journal of Latin American Studies, Vol. 17, No. 1 (May, 1985) 157-177.

[9] Voir Marta-Louise Ackers et al, “Are There National Risk Factos for Cholera? The Correlation Between Socioeconomic and Demographic Indices and Cholera Incidence in Latin America,” International Journal of Epidemiology (1998) 27: 330-334.

[10] Rita R. Colwell, “Global Climate and Infectious Disease: The Cholera Paradigm,” Science 274.5295 (1996): 2025-2027.

[11] Francine Tardif, Regard sur l’humanitaire: une analyse de l’expérience haïtienne dans le secteur de santé entre 1991 et 1994 (Paris: L’Harmattan, 1997) 133.

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“Haiti: Operational Biosurveillance” has confirmed multiple cases of cholera in Petionville.

Prevansyon:

Pa manje manje ki pa kwit; pa bwè dlo ki pa bwiye ou pirifye; lave men anvan nou manje, apre n itilize twalet yo, e anvan nou touche visaj nou.

Anpil moun ki enfekte ak kolera pa gen sentom; kolera pa toujou grav. Maladi a ka trete fasil. Pran prekosyon sanitè, rete kalm. Se yon bakteri ki bay kolera.

Tretman:

Si w gen yon gwo boutey dlo pirifye o bwiyi, twa kiyè sik ak yon kiyè sel, ou ka trete yon moun ki malad ak kolera. Ede l bwe–se lè moun ap vini desidrate yo an danje. Kò nou yo bezwen likid, sik, ak sel.

Nou ka itilize klorox (javel) dilwye nan dlo pou netwaye yon kay kote yon moun te malad.

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Unfortunately, limited cases of cholera have been confirmed on the Ile de Lagonav and in the Port-au-Prince suburb of Kwadèboukè, according to the New York Times.

Voice of America Kreyòl reports on the mobilization of aid.

A VOANEWS article cites a health expert’s explanation of the illness:

«Se yon bakteri ki bay kolera. Li pwopaje sitou nan dlo oubyen manje ki kontamine. Moun ki trape maladi ka gen fyèv, gwo dyare, ak vomisman. Maladi a ka trete byen fasil. Men san tretman li ka touye moun nan kèk èd-tan sèlman.»

According to the World Health Organization, only 5-10% of infected individuals develop severe symptoms, and 75% have no marked symptoms at all. But among those with severe symptoms, immediate fluid replenishment with purified or boiled water, sugar, and salt, is essential.

All food should be washed with purified or boiled water, cooked, and eaten at the time of cooking. Bleach diluted with water can be used to clean the ground.

The epidemic is currently thought to have begun around the Artibonite, where Peligre Lake, shown below, overflowed in last weekend’s flooding.

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Although it has not been internationally confirmed, cholera has been confirmed in the Artibonite by Claude Surena and Alex Larsen.

Instructions for avoiding contamination:

Prevansyon

Yon sèl bagay ki kab fè ou pa gen kolera: VEYE TOUT SA OU METE NAN BOUCH OU.

Bwè SÈLMAN dlo potab. Sa vle di fòk dlo a oswa pirifye, bouyi, filtre, ou byen ak kloròks ladann. An Ayiti, meyè chwa ke ou genyen se bouyi dlo a jiskaske ou touye mikwòb ki ka ladann.

Mouch, ravèt ak lòt insèkt ka ba ou kolera tou. PA SERE manje pou demen. Manje tout manje’w CHO, lè’l fèk sòti sou dife.

Evite bay moun lanmen. Si’w fè sa pa erè, lave men’w BYEN lave.

Toujou mache avèk dezenfektan. Dezenfekte TOUT bagay ou manyen. Dezenfekte twalèt ak latrinn.

TOUJOU kenben men’w pwòp.

Instructions for treatment:

Depi premye dyare nou ta genyen, komanse pran serom oral tou swit. 1 lit dlo trete ki egal 3 boutey kola – 3 gwo kiye sik – 1 gwo kiye sel – yon ti gras bikarbonat – ji yon ti sitron.

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The traumatic origins of the Haitian nation are incontestable, as portrayed in our blog banner image, Edouard Duval-Carrié’s “Little Crippled Haiti.” Despite the victory over colonial rule and slavery represented by the Independence of 1804, the founding fathers who signed the Acte d’indépendance all had ancestral ties to the Middle Passage and slavery. This genesis of a new nation presents fundamental differences to that of Haiti’s neighbor and contemporary in the crafting of Independence, the U.S.. Scholars including Colin Dayan and Robert Fatton have made convincing cases for the instrumentality of traumatic origins in Haiti, without necessarily pinpointing strategies for remedial action; the discourse of mental health, or global health, remains uneasily aligned with discourses of history and politics.

In the wake of the sekous or quake of 2010, mental health and disaster paradigms align much more directly for proactive health initiatives–but tragically, the infrastructure for ongoing trauma healing is as shaken as the rest of the institutional structures of Haiti. The New York Times notes also that “mental health has never been a priority in Haiti,” as psychiatrists involved in the recovery are discovering. Part of the problem is that in a landscape of NGOs and short bursts of international interventions in humanitarian medical aid, the intensive communicative interface necessary to psychological or psychiatric consultations, and the sustained assessment necessary to successful pharmacological treatment, have often remained just out of reach.

Haitian psychologist Marie Geolnarol-Archer has been walking the streets and alleyways of the disaster zone, patting backs and rubbing shoulders as a prelude to discussion of passer-bys’ trauma symptoms. Her work indicates a new and singular openness to recognition of traumatic symptoms and the need for mental health assistance.

Global health needs around trauma arguably epitomize the inseparability of medical initiatives and linguistic and cultural education–plus staying power–for successful intervention.

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http://www.globalhealth.duke.edu/news-events/general-announcements/duke-global-health-case-competition

2010 Global Health Case Competition

What is the Duke Global Health Case Competition?
Do you want to find a way to contribute to the discussion about the earthquake aftermath in Haiti?  Use your experience to generate innovative ideas that can translate into action on the ground through participating in the first annual Duke Global Health Case Competition.

This competition is a unique opportunity for Duke graduate and undergraduate students from multiple schools and disciplines to come together to promote awareness of and develop innovative solutions for 21st century global health issues. Common across U.S. business schools, a case competition features teams of four to six students working through a real-life case scenario with the goal of providing helpful strategic recommendations to move the case subject forward efficiently and effectively. The competition is centered on team presentations to judges, who then score student recommendations and award prizes.

Developed and driven by it the Duke Global Health Institute Student Council, the global health case competition focuses on a global health-related case that will require an interdisciplinary approach to formulate recommendations regarding the case that may involve issues such as health care policy, public health implementation and planning, business partnership/investment, medical research, logistics management, faith/cultural understanding, and international law.

Who can participate?
Students (graduate and undergraduate) from across Duke University are encouraged to participate in multidisciplinary, multi-school teams to ensure that interdisciplinary skills are represented on each team. Teams will be comprised of three to five studentsfrom three or more Duke schools. Students can sign up as individuals or in a team.  Students who register as individuals will be grouped together to form interdisciplinary teams.

Space is limited so sign up now!  Team RegistrationIndividual Registration

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Many relief workers may be using smart phones in Haiti with little inkling of the size of the bills that can ensue. If you have had this experience and are an ATT customer, call ATT, as they are currently accepting petitions for credit on international charges for voice, text, and data roaming in or with Haiti.

Unless your professional work depends on internet access from your phone, consider acquiring a local pay-as-you go phone with text messaging in Haiti. You can find one of the ubiquitous Digicel stores through the site below. If you need more minutes, you can do so online, or you can purchase supplementary sim cards with minutes from street vendors (–tell anyone on the street “Mwen vlè achte minit Digicel,” and a vendor will likely materialize):

http://www.digicelhaiti.com/en/

For people communicating by phone with Haitian contacts, you can “top up” their phone minutes by registering at the Digicel site and choosing “topping up” under “Quick links.” Cell phones are lifelines; preservation of your contacts’ communicative access to a larger world can be an important first step.

Health care workers using smart phones can download an app with English-Haitian medical Creole from Educa Vision.

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Kr: Sa vle di nou kab genyen kèk pasyans nan lopital nou an. M konnen Chapel se sèl lopital k ap resevwa pasyans deyò eta Florid.

En: This means we can have some patients in our hospital. I know that Chapel Hill is the only hospital which is receiving patients outside of Florida.

Fr: Cela veut dire que nous pouvons avoir quelques patients dans notre hôpital. Je sais que Chapel Hill est le seule hôpital qui reçois des patients dehors de l’état de Floride.

FOR IMMEDIATE RELEASE
Monday, February 1, 2010
CONTACT: (202) 690-6343

HHS Activates Additional Components of National Disaster Medical System to Help U.S. Hospitals Treat Survivors of Earthquake in Haiti

As part of the ongoing medical response to the Haiti earthquake, USAID, the agency coordinating the US Government response, announced  today that the U.S. Department of Health and Human Services (HHS) has activated additional components of the National Disaster Medical System (NDMS)  to help U.S. hospitals provide care to critically ill survivors.

"Medical evacuations have only been used in limited instances where patients had medical needs that could not be met in Haiti," said USAID Administrator Rajiv Shah.  "We are committed to working with Haitian people and the Government of Haiti to create long-term care facilities in-country. Continued medical assistance is critical to these efforts. We will continue to work across the whole of the U.S. Government and with  international partners, and NGO partners to ensure the well-being of the Haitian people is the foremost priority.

This activation will allow U.S. hospitals that treat Haitian patients evacuated with life-threatening injuries due to the earthquake, to receive federal reimbursement for the costs they incur. The first NDMS flight could leave Haiti as early as tomorrow.

"States have been tremendous partners in the response effort to the devastating earthquake in Haiti," said HHS Secretary Kathleen Sebelius. "This is part of our larger strategy, working with the government of Haiti and our international partners, to help increase the capacity both inside Haiti, as well as in the U.S. and other countries, to help Haitians who need critical medical assistance."

Haitian and American patients will be referred by Haitian hospitals, NGOs, the USNS Comfort, or other facilities if they meet criteria for evacuation.  These evacuations are being reserved for the rare patients with life-threatening conditions that cannot be handled within Haiti or by evacuation to another country.  There must also be a reasonable chance that the patient can survive the flight and the treatment in the U.S.

Accredited hospitals, usually over 100 beds in size and located in large U.S. metropolitan areas, are encouraged to enter into a voluntary agreement with NDMS.  Hospitals agree to commit a number of their acute care beds, subject to availability, for NDMS patients.  Because this is a completely voluntary program, hospitals may, upon activation of the system, provide more or fewer beds than the number committed in the agreement.  Hospitals that admit NDMS patients are guaranteed reimbursement at 110% of Medicare rates by the federal government.

HHS has been working with the government of Haiti and international partners to provide life-saving care to survivors of the earthquake.  HHS previously activated the field medical care component of NDMS which has enabled approximately 270 health and medical personnel to deploy to Haiti as part of Disaster Medical Assistance Teams.  These teams have seen more than 23,000 patients, performed 98 surgeries, and delivered 28 babies since they began providing care in Haiti on January 17 and continue to provide life-saving medical care on the ground.

In addition, public health experts from HHS Centers for Disease Control and Prevention (CDC) are participating on teams conducting rapid assessments of ongoing surveillance of health conditions in Haiti to help prevent and contain additional health threats to the people of Haiti following the earthquake.

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The Haitian government now has its situation reports, official communiqués, reference documents, and a list of functioning medical centers under the “Documents” page of this site, as well as a wealth of other materials. Crucial for linkage of relief efforts to the recovery of the Haitian state apparatus. www.aidg.org is helping to launch the site.

http://haitiseisme2010.gouv.ht/

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