Dr. Ivers reported that access to clean water and health care facilities remain major concerns, particularly in isolated rural areas. There are still many communities in the outbreak region whose only water source is the contaminated Artibonite river or rain water. Although water purification tablets and oral rehydration salts have been widely distributed throughout the region, rehydrating cholera patients requires such a high volume of fluids—about 20 liters of fluid daily per patient—that PIH is urging all suspected cases (anyone with diarrhea) to seek treatment at a hospital, Dr. Ivers said. But access to medical facilities is also a challenge: communities in the Artibonite are widely spread out, and even the nearest hospital can be hours away by foot, horse, or car. 

Highlights from PIH’s team on the ground:

·         Community outreach remains a major priority. PIH is sponsoring radio messages that are being played throughout the region and thousands of PIH community health workers and social workers have been mobilized to educate their communities and to distribute water purification tablets and oral rehydration salts. Training materials for community health workers are also being finalized. Topics include preventing transmission and disinfecting the homes of cholera patients.

·         PIH is working with partners on the ground to set up special triage facilities and Cholera Treatment Centers (CTCs)—located away from the hospitals to prevent cholera patients from infecting non-cholera patients.

·         In Mirebalais, 25-30 inmates at the prison are very sick and are being treated at PIH’s health center in Lacolline. Five deaths have been reported among prisoners. As the prison facility is woefully overcrowded—300 prisoners in a space built for 80—PIH is working to set up a space to evacuate the remaining prisoners.

·         Several cases of cholera were reported in Port-au-Prince over the weekend, increasing concern that the epidemic could spread rapidly through the crowded spontaneous settlements where more than 1.2 million displaced people have been living since the January 12 earthquake. At the four settlement camps served by PIH clinics, teams are carrying out intensive education and prevention campaigns with residents and are making preparations to manage and control any outbreaks that might occur. So far all the cases in the Port-au-Prince area appear to be people who had travelled there from the rural areas to the north where the epidemic remains concentrated.

·         Patients are continuing to stream into PIH’s facility in St Marc, but the situation is growing more manageable each day, thanks to clinical reinforcements and improved infection control and triage mechanisms.

·         The situation is “under control” at PIH’s hospital in Petite Rivière, where PIH has instituted an effective means of infection control with technical assistance from partners.

·         There have been no cases reported at other health facilities operated by PIH in the Central Plateau region north of Lacolline.

·         PIH was able to get 14 water trucks to some of the communities most in need, thanks to a partnership with the non-profit organization Yele Haiti. However, there is still a high demand for potable water. PIH is working with Yele Haiti and other organizations, including Operation Blessing International and charity: water, and the Haitian government to meet this need.

About PIH: PIH works in 12 countries around the world to provide quality health care to people and communities devastated by joint burdens of poverty and disease. PIH has been providing vital health care services in Haiti for more than 20 years and is the largest health care provider in the country, working with the Haitian Ministry of Health to deliver comprehensive health care services to a catchment area of 1.2 million across the Central Plateau and the Lower Artibonite Valley. PIH had nearly 5,000 staff in Haiti before the January 12 earthquake.