Haiti is not often cited as a global health role model,
although perhaps that will change. There was a point less than four years
ago when a cholera epidemic was raging out
of control. That moment passed faster than many anticipated, however, and
we are now far more experienced in dealing with health emergencies.
As the international community attempts to halt the spread
of Ebola in Africa, it may be instructive to examine what Haiti learned in
fighting cholera. You see, even the poorest developing country can take steps
to protect its citizens. No disease should be out of control for very long.
The Ebola epidemic in West Africa has seen more than 6,500
people contract the disease across the region, making this current outbreak the
biggest on record with more than 3,000 deaths according to the World Health
Haiti suffered its own unexpected epidemic in 2010, when
cholera made its first appearance in our country, brought in by U.N.
peacekeepers from Nepal. Initially, cholera was a disaster, as our health
system is as overburdened and underfunded as any in West Africa. From the onset
in 2010 until January 2014 the government of Haiti has reported 698,304
suspected cases of cholera and 8,562 deaths due to this diarrheal disease.
Cholera hit Haiti at a bad moment. Most of the country’s
health centers had been destroyed by the devastating earthquake in 2010, and
people had little access to medical care. Since cholera was new to Haiti,
health care professionals were not ready to handle it, the population had never
heard of it and did not understand how it was transmitted or how to prevent
it. Many people attributed cholera to supernatural forces; the taboos and
myths made it very difficult to take practical steps.
Ebola is a far greater threat, killing between 50 to 80
percent of those infected and outpacing efforts to develop a vaccine or
specific treatments. But cholera, if left untreated, can also spread and
kill quickly. For an unprepared country such as Haiti, cholera represents
a real danger.
Thankfully, the international community and NGO partners
supported Haiti’s Ministry of Health as it swiftly developed a response
strategy. Hundreds of cholera treatment centers were created nationwide, mass
communication campaigns were launched alongside door-to-door education
programs. Four years later, we have the cholera situation under
The number of diagnosed cases of cholera has dropped from
more than 100,000 suspected cases in 2012 to fewer than 60,000 cases in 2013
according to the United Nations, which estimates that the number will drop to
45,000 suspected cases in 2014.
We are now much more prepared to manage an epidemic.
With the support of the international community working with the Haitian
government, in the last three years Haiti has brought online a total 222 health
care sites, including 111 health centers and dispensaries, 24 community
hospitals and 43 specific treatment centers for acute diarrhea.
Our speedy, targeted and united response to the cholera
epidemic is the underlying model that we would use in the unlikely event that
Ebola comes to Haiti.
Dr Florence Guillaume, the current health minister, has
already launched an Ebola education prevention program using the media to talk
about the disease and begin to create awareness. Our experience shows that
specific treatment centers are essential so that you can keep infected patients
separate from the general population who still need to be able to access
general health services.
As a public health specialist working in Haiti for the past
16 years, I recognize the importance of preparing our health system and our
health professionals to help prevent an epidemic. But probably the most
important component is addressing the behavior of every person that could be
One of the crucial lessons we learned from cholera is that
volunteers and community health workers must go to door to door to talk to
people, to address their concerns, to build trust and break down the rumors and
myths that can spread with a new illness .
Some organizations held teach-ins in tent cities created
after the earthquake to spread the word about hygiene, sanitation and early
oral rehydration. Other used locally made TV documentaries to explain how
diarrhea can affect kids and adults, and what to do to treat it. Some
people were skeptical. But as they saw how those who followed the advice
were able to survive cholera, the practices took hold.
Changing the way people think and behave is at the root of
every major improvement in public health and the communication messages have to
be appropriate to the population’s level of education. In Haiti, despite
attempts to increase access to education, 1 in 4 women and 1 in 5 men over the
age of 6 have no education whatsoever. Nevertheless we were able to change the
mindsets of people around cholera and to teach both how to prevent and treat
Haiti still faces challenges in the provision of health care
and access to basic health services but the Ministry of Health with its
partners have never been so well coordinated. The optimist in me
believes that may be this time the world will come to Haiti to learn.
Anick Supplice Dupuy is the Executive Director of
PSI/Haiti, an NGO that focuses on promoting HIV/AIDS prevention, Malaria,
Family planning and maternal and child health and child survival.
She is an Aspen New Voices
Fellow. Follower her on Twitter at @asdupuy