Bill & Melinda Gates Foundation

On Ebola: Haiti Has Lessons in Slowing the Spread of Infectious Disease

October 10, 2014

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 Organization.


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 control.


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 affected.


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 it.


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

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