Posts Tagged ‘oral rehydration solution’

Marie Maude Pierre provides a cup of water for her 19-month-old daughter Daphta at the Cholera Treatment Center (CTC) in Mirebalias. Pierre said after just a few hours of receiving IV fluids Daphta already seemed to feel better. Project Medishare, in partnership with Partners in Health, is operating the CTC which has already treated over 10,000 patients since November. Photo by Jennifer Browning.

By Jennifer Browning

Marie Maude Pierre arrived at the Cholera Treatment Center (CTC) in Mirebalias at 2 a.m. on a Thursday with her 19 month old daugher, Daphta.

Pierre said Daphta’s diarrhea started Wednesday morning, but seemed to get better during the day after she coerced her daughter to drink the Oral Rehydration Solution (ORS) she had for emergencies just like this.

“At first I wasn’t really worried because I had ORS at home, so I mixed it with treated water,” Pierre said. “She wouldn’t drink it at first, but I finally got her to drink it.”

But during the evening, Daphta refused to drink the ORS and her symptoms worsened so Pierre, who lives in Grand Boucon, began the long walk to the CTC in Mirebalais so Daphta could receive treatment.

Aciane Devoinsin tries to comfort 2-year-old Yusmie. Devoinsin took a two hour journey in the middle of the night to get her daughter to the CTC from her village of Sarazin, near Las Cahobas. Photo by Jennifer Browning.

Aciane Devoinsin tries to comfort 2-year-old Yusmie. Devoinsin took a two hour journey in the middle of the night to get her daughter to the CTC from her village of Sarazin, near Las Cahobas. Photo by Jennifer Browning.

Pierre learned about cholera back in October. While shopping at the market, she received a text message on her phone from Digicel telling her there was a cholera outbreak along the Artibonite nearby. The text also explained what cholera was and what needed to be done to prevent and treat it.

“When I came home from the market, everyone was talking about cholera and how it was spreading very quickly and that a lot of people were infected already.”

After talking to people in the community, Pierre’s husband heard health agents were distributing aqua tabs and ORS nearby in Saut d’Eau.

After receiving treatment for over ten hours Daphta is already showing signs of progress.

“When we got here, they gave her the IV and now she is already looking better,” Pierre said. “Now she is willing to sit up and she is even smiling.”

When Aciane Devoinsin returned from the market, her older daughter told her that 2-year old Yusmie had diarrhea, by the middle of the night the vomiting began.

CTC staff spray their shoes with a high concentrated bleach solution to help avoid further spread of cholera. Photo by Jennifer Browning.

“I could tell that she was very tired and I worried that she wasn’t able to keep any fluids down,” Devoinsin said. “So I found a ride to come here.”

Even though Mirebalais is the closest CTC, it took Devoinsin two hours to get her daughter to the CTC from her village of Sarazin, near Las Cahobas.

“When we arrived the doctors put the IV in immediately. Yusmie was so weak when we got here, but now I can tell she is feeling better,” she said. “She wanted to play this morning. I am happy that at least my daughter is starting to feel better, and I am so thankful that there are people here who can help her.”

Both women said that they are taking precautions at home to treat all of the water before they use it for drinking or cooking, but it is difficult when a toddler is involved.

“I try to watch her and keep her hands clean,” Devoinsin said. “But she plays on the dirt floor, on the ground and I can’t carry her all day. I still continue to use the aqua tabs that were given to our family and everyone else has stayed healthy.”

Looking inside the acute care tent at the CTC operated in partnership by Project Medishare and Partners in Health, one might think that cholera is no longer an issue in Haiti. Mirebalais CTC administrator Almeus Techelet said until December the CTC was completely full.

“We had to double our capacity in order to treat everyone who came through the door,” Techelet said. “In January the flow of patients has lowered, and while we have less patients, we still have several people arrive each day with cholera.”

Techelet says the decrease in patients is due to education and prevention campaigns that were launched when cholera was discovered in October.

“People are more cautious now and they have learned to how to prevent getting cholera,” Techelet said. “This is why the patient flow has gone down. People now are taking more precautions about the water they use and drink, what they eat. They are more careful about preparing their food and also washing their hands.”

Dr. David Walton, the deputy chief of missions for Partners in Health, said the decreasing number of patients seen at the Mirebalais CTC is deceiving.

“It’s tricky because if you look right here at this cholera treatment center you would be deceived to think that cholera is getting better, but if you take a look at the places in the south there are reports of hundreds of people dying in the mountain sides and even in other cholera treatment centers and cholera treatment units,” Dr. Walton said. “This being one of the places where the epidemic started, we have sort of stabilized, but in many parts of the country they are just hitting that peak of cholera ravaging the countryside.”

In addition to more people following precautions, Dr. Walton said today more people are catching the disease earlier, which makes it easier for doctors to treat.

“Another thing we are seeing is a lot of people are coming earlier in the disease, so they get a little diarrhea and upset stomach and they get here well before they have the chance to develop severe cholera and severe dehydration,” he said. “So we are seeing people not necessarily in shock but a little bit earlier, which is good because it helps us resuscitate them. “

Dr. Walton explained that cholera hit St. Marc and Mirebalais the hardest first, so now these two places are stabilizing. And while the results at Mirebalais are positive, he said that doesn’t mean cholera is over in Haiti.

“It has been positive. You look at places like here…people live up there in the tops of those mountains. People live all over in there. You can’t see their houses from here but they are up there. How do you get the message to people up there? You have to get out, get to them and get the message to the people,” he said. “I think it has been really positive, but it’s only as effective as our ability to get those tools to the people.”


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RADIO TALK: Community health nurse Wiseline Celestine and staff member Ronel Marcellus go live on the airvaves at a Thomonde radio station talking about cholera and how to prevent the disease. The Project Medishare staff created a skit which discusses the importance of hand washing, boiling drinking water, cooking food thoroughly, avoiding fish from the Artibonite River along with raw fruit, and using regular and pit latrines appropriately as to limit exposure of disease. Photo by Jennifer Browning.

By Jennifer Browning

As part of Project Medishare’s Cholera Prevention and Education campaign, community health nurse Wiseline Celestine and Ronel Marcellus, Project Medishare’s bookkeeper, in Thomonde created a skit, which is airing on three radio stations that have far reach in the upper region of the Central Plateau. The radio skit discusses the importance of hand washing, boiling drinking water, cooking food thoroughly, avoiding fish from the Artibonite River along with raw fruit, and using regular and pit latrines appropriately as to limit exposure of disease.

Project Medishare and its community health agents hope that this education campaign will prevent the spread of cholera in the communities we serve, however should the outbreak reach our area, we have a treatment plan to activate immediately.

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Project Medishare community health nurse Wiseline Celestine hands a box of oral rehydration packets to a community health agent. Project Medishare's health agents are working feverishly to educate the people in order to prevent cholera in their communities. Photo by Jennifer Browning.

By Jennifer Browning

Forty community health agents gathered at the Project Medishare office in Thomonde today to meet with Country Director Marie Chery, Dr. Serge Pintro, Zanmi Lasante doctors and Project Medishare medical staff. After the meeting the staff handed out water purification tablets and oral rehydration solution to community health agents. The health agents will distribute these items to those in their community reminding them how important it is they follow specific prevention guidelines.

Project Medishare  medical staff reinforced the prevention guidelines.

Federick Fanel, a health agent with Partners In Health’s sister organization, Zanmi Lasante, was also invited to attend to help spread the word in the community. Fanel, who is also a teacher in Thomonde, said he learned much at the meeting.

“They not only reinforced the importance of boiling and treating water, but also how important it is to disinfect the latrines. In rural Haiti, there are many people without latrines, so it is important that we instruct them how to properly build a pit latrine by digging a deep hole, and more importantly covering it properly after use.”

Each community health agent received a large box full of bottles of water purification tablets to distribute in their communities. They also received oral rehydration packets to have on hand in case they encountered anyone with cholera symptoms. Photo by Jennifer Browning.

Fanel said that he also learned how to instruct others on how to make their own oral rehydration solution, if they did not have any of the ready-made packets on hand.

During the meeting Dr. Malou Phanord also stressed to the health agents how important home visits were at this time.

“Home visits are even more important today, because there may be some who have symptoms and stay at home,” she said.

Should a health agent notice a person with cholera symptoms, Project Medishare community health nurse Wiseline Celestine also gave specific instructions on what the health agent should do. Because cholera severely dehydrates its victim, it can kill within hours.

“If someone has diarrhea as a symptom, before you take them to the hospital, it is important to immediately start giving them the rehydration solution,” Celestine told the health agents. “This will help them stay hydrated on their way to the hospital. Many of the deaths in Artibonite were on the way to the hospital, because they were not able to hydrate before leaving for the hospital.”

She then talked about how it was necessary for all the water people used to be purified.

“It is important to tell them to use these purification tablets to not only purify the water they drink, but all water,” she said. “They must treat the water they bathe in, the water where they wash their dishes and their clothes. It is a lot of effort, but it is very necessary!”

Benet Joacime, a supervisor for health agents stationed in very rural Baille Touribe said he appreciates meetings like the one today because it allows for good communication between the Project Medishare medical staff and the health agents.

“When we learned that cholera had started in the Artibonite, we immediately went out to our sections and started educating about preventing cholera,” Joacime said.

For Joacime, he said it was important to make sure all of the community health agents in his area were organized and understood how to educate each area about prevention.

“It is a big responsibility because I have to make sure my community is safe,” he said, “so I have to put more leadership out to my agents, and be really organized to make sure everyone understand how important this is.”

He continued to explain how the health agents are using all of Project Medishare’s resources to spread the word. Health agents who oversee hard to reach areas are given motorcycles and all agents are given megaphones to speak to large groups and community education rallies.

At these community cholera prevention meetings, Benet said people listen closely.

“From what we see, people are very afraid of this disease,” he said. “They listen on the radio and they hear how bad things are in the Artibonite, so they really know how important it is to follow our instructions.”

When we were notified of the outbreak, the purification tablets and disinfectants weren’t available for us to distribute to the communities,” Joacime said. “People were worried. We continually heard ‘how can I protect my family?’ ‘How do we purify the water?’”

Without the purification tablets to distribute, Joacime said that health agents stressed the importance of boiling water, cooking food thoroughly and steering clear of raw fruits and vegetables. However, now they can help the people in their community go one step further in making sure the water they use is clean.

“Now that we have these important items to hand out to the people. We can go back to our communities and as we distribute the purification tablets and rehydration solution, we can reinforce the message,” he said. “We are so grateful that we have these to give to the people in our community to keep them safe.”

*Laurene Leger contributed to this story.

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