The peak of the week-long cholera epidemic in Haiti has still not been attained, but there are signs that efforts to contain the outbreak are working.
Switzerland is sending water specialists to the Caribbean island state as part of international efforts to help control the disease and stop it penetrating the overcrowded quake-affected capital, Port-au-Prince.
According to Claire Lise Chaignat, head of cholera control at the World Health Organization (WHO), it is too early to say the cholera epidemic that has killed 284 Haitians and infected 3,769 others has been contained.
“We have not yet reached the peak,” she told reporters in Geneva on Wednesday.
But Chaignat said everything was in place to contain and avoid a “worst-case scenario” – the disease spreading to Port-au-Prince, which is still crowded with 1.3 million homeless survivors of the January 12 earthquake.
“There are still 500 camps with people living in very cramped conditions and using emergency sanitation, so if cholera came to the capital it would be a big issue,” Sharon Reader, communication delegate for the International Federation of Red Cross and Red Crescent Societies (IFRC) told swissinfo.ch.
On Sunday Haitian Foreign Minister Marie Michele Rey expressed confidence about tackling the disease and said it appeared to be under control for the time being.
Chaignat said the number of deaths and cases had slowed slightly in the main outbreak area of Artibonite, north of the capital, which is a “good sign” showing that the aggressive medical response taken since October 21 was starting to have an impact.
The death rate is currently 7.7 per cent, which is well above the one per cent or below that the WHO considers normal, but below the ten per cent when the outbreak appeared last week.
This “very high” rate is due to the “surprise effect” and the fact that many of those infected were not treated immediately, said Chaignat.
If left untreated, cholera can kill in 24 to 48 hours by dehydrating victims with severe diarrhoea. People in Haiti, which had not had an outbreak for at least half a century, may not have recognised the disease until it was too late, she said.
The United Nations, the Haitian government and aid partners are expecting the disease to spread further in its epidemic phase. The UN has said a nationwide outbreak with tens of thousands of cases remains a “real possibility”. Suspected cases have been reported in Nord and Sud provinces, and five cases have been confirmed in the capital.
To avoid a catastrophe they have launched a combined treatment, containment and prevention strategy for the entire country.
"The surveillance system is in place, the early warning is in fact functioning quite well," said Chaignat.
Swiss water specialists
The international aid operation has rushed doctors, nurses and medicines to the rural central zone straddling the Artibonite river, the suspected source of the disease, which is spread by bacteria in contaminated water and food.
Switzerland is sending two water specialists to Haiti to help the response. The experts from the disaster relief unit will assist the local authorities to test and produce clean drinking water in rural areas during a three-week mission.
The team is equipped with a mobile water-testing laboratory and materials to produce chlorine for disinfecting water.
Twelve special cholera treatment centres are being set up in the main outbreak zone, in Port-au-Prince and elsewhere, to isolate patients. A public education campaign is urging the country's ten million people to wash their hands regularly with soap, avoid eating raw vegetables, and boil food and drinking water.
Health Minister Alex Larsen said the government would train 30,000 health workers to join the national campaign in the coming months.
Medicines and messages
The Swiss branch of the church charity Caritas, which has been active in the region for over 30 years, has pledged SFr100,000 ($101,184) to support a hospital and eight health centres in the Artibonite region.
This will allow them to build up stocks of medicines, water purification tablets, oral rehydration salts and other materials, Karin Mathis, Caritas’s Haiti desk officer, told swissinfo.ch.
“But one of the main activities is a radio prevention campaign, working with local communities to broadcast messages on hygiene and safe drinking water,” she explained, adding that much needed to be done to “de-stigmatize” the disease.
On Tuesday protesters attacked a cholera treatment centre as it was preparing to open in the seaside town of St Marc, highlighting fears surrounding the almost-unknown disease.
Following the earthquake that hit Haiti on January 12, 2010, Switzerland carried out its largest emergency response operation, deploying 110 experts focusing on health, water and temporary shelter.
The government’s humanitarian aid unit also sent three freight aircraft from Switzerland, with more than 170 tons of aid items that were distributed in the quake-affected zone.
Swiss Solidarity, a fundraising charity led by the Swiss Broadcasting Corporation, swissinfo.ch’s parent company, collected more than SFr65.5 million ($61.6 million) donated by the Swiss public. So far SFr10 million has been invested in projects in Haiti.
In addition to the SFr12 million spent by Switzerland for the emergency operation, the Swiss government announced on March 24 that it would allocate SFr36 million for reconstruction for the 2010-2012 period.
Swiss aid will be used for reconstruction efforts and rebuilding basic infrastructure. The Swiss Agency for Development and Cooperation plans to continue to provide temporary shelter while working on more permanent housing with other organisations. It has also signed an agreement to rebuild a hospital as well as three schools in 2010.
Cholera is an acute diarrheal infection caused by contact with or ingestion of food or water contaminated with the bacterium Vibrio cholerae 0:1.
Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases. Up to 80% of cases can be successfully treated with oral rehydration salts.
There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera every year around the world.
Health officials expect the Haiti cholera epidemic will now become endemic, joining illnesses like malaria, tuberculosis and HIV/Aids.
It is the first case reported in Haiti since WHO started collecting data in 1948. Cholera appeared for the first time in Latin America in Peru in 1991 as part of the seventh cholera pandemic which has slowly spread from Bangladesh via the Middle East and Africa since 1961.
Experts say the source of the Haiti outbreak remains a mystery. It may have been imported or present in the environment; the climate or salinity of the water may also play roles.
swissinfo.ch and agencies