For the past several days, new cases of cholera come in, and an equal number of patients are discharged, and we are seeing a regular daily census of about 25 adults and 15 children. The public information program by the Ministry of Health, the local Rotary clubs, and by the HAS field staff appear to have been effective, as patients come to the hospital early in the course of the disease.
In a dramatic technical innovation, yesterday morning all of us with Haiti cell phones – despite the poverty in Haiti, there are over 3 million cell phone users – received a text message which said “to get more information about cholera, send a free SMS to “maladi” (illness). Shortly thereafter, we all received a voice message from the director of our local health district, Dr. Willy Staco, with brief instructions on how to avoid cholera, and the need to come to a health center immediately if symptoms occur. We had been in discussions in the summer with local telephone carriers about the whole concept of MHealth (Mobile Health), but now we have a clear example of how effective such an approach can be.
Later today, a team from the US Centers for Disease Control will arrive at HAS to spend a week or more researching the sources of the disease, visiting the homes and courtyards of patients, and taking samples from water sources, wells, rivers and canals. The Mellon house has been converted to a research center, with map tables, a wi fi internet line, and a sample storage facility.
HAS field staff have visited many of the households from which our cases have come in the past several days, and have found concentrations of cases in courtyards where the water table is quite high (it is possible to dip water out of the well with a cup), and the wells are very near to latrines and canals. The wells are treated with chlorine powder, but it is apparent that continued exposure to the pathogen will continue in the absence of a dependable potable water source.
Our nursing staff, which has been working long hours in the past ten days, has been supported by a group of nurses from Jacmel and Les Cayes (far from the current cases), and today a group of five nurses from Project Hope have arrived to provide more support for what is essentially a nursing disease. Most of the Hope nurses had been in Haiti previously during the earthquake.
The hospital (more appropriately “the hospitals” because of the separate facilities for the cholera patients) is quiet and orderly, the patterns of care have become systematized, and the work flow is becoming second nature. After a flurry of visits from various news agencies, their attention span appears to have waned, and we are able to return to our work undisturbed.
The forecast for the progress of the disease is at the moment unclear; we hope that the pattern of admissions will decline, but are afraid that it will remain steady, or even increase in the days ahead.
We send to you all our thanks for your concern and support…